Assessment, surveillance and prognosis in pre-eclampsia

The hypertensive disorders of pregnancy (HDP) remain one of the major causes of maternal mortality and morbidity worldwide. Many international guidelines exist for the classification and assessment of women with hypertension in pregnancy, but definitions and recommendations within these documents are variable. Many recommended investigations do not actually correlate with increased risk of adverse outcomes, making it difficult to determine true prognosis. Although standardised assessment and surveillance has been shown to improve outcomes, the application of these monitoring strategies in many areas of the world is not possible owing to the cost associated with them. Not all of the tests recommended for surveillance of women with pre-eclampsia are independently predictive of adverse outcomes, and many unnecessary tests could be avoided if those tests that are most informative where identified. The Pre-eclampsia Integrated Estimate of RiSk study has identified a group of tests that can be used to predict risk of outcomes accurately up to 7 days after admission to a tertiary hospital with pre-eclampsia. This model needs to be validated in new populations and in different clinical settings before it can be implemented into clinical practice. Until this happens, clinicians should consider the whole clinical picture when assessing women with pre-eclampsia and making decisions around expectant management compared with stabilisation and delivery. Future research in the area of prognosis should focus on women with variable definitions of pre-eclampsia and the other HDP. All studies reviewed were limited to cases of severe pre-eclampsia, and results may not be generalisable across the spectrum of the disorder.