Pre-eclampsia: Understanding clinical complexity.

Worldwide 2–8% of pregnancies are complicated by pre-eclampsia (PE), with an estimated maternal mortality of 50 000 cases annually [1]. PE is a part of the hypertensive syndrome of pregnancy and is defined as hypertension (4 140/ 90 mmHg) with proteinuria (4 300 mg/ 24 h). Symptoms of PE commence in the second half of pregnancy. These might encompass general symptoms of hypertension and/or proteinuria such as headache, exhaustion, nausea, vomiting, visual disorders and edema. Multiple organs can be affected causing severe complications such as eclampsia or progress to HELLPsyndrome. Delivery is the only definitive treatment. In preterm stages of pregnancy treatment of the disease occurs mainly symptomatically, aiming for analgesia and control of hypertension. In high-risk groups, a slight risk reduction of developing PE is achieved by administration of acetylsalycic acid in early pregnancy [2]. A century of research has not yet given physicians more powerful tools to protect both maternal and fetal conditions (Fig. 1). PATHOPHYSIOLOGY