Pitfalls in diagnosis and management of preeclampsia

Hundreds of reports deal with the subject of preeclampsia. A review of the world literature highlights the confusion and controversy regarding terminology, blood pressure measurements, diagnosis, and populations studied. More than 100 clinical, biophysical, and biochemical tests have been recommended to predict the future development of the disease. Results of the pooled data and the wide scatter therein suggest that none of these tests is sufficiently sensitive or specific for use as a screening test in clinical practice. There is some evidence that nutritional supplementation or antithrombotic agents might reduce the incidence of preeclampsia, but the data are not conclusive. In addition, the data do not suggest any benefit in perinatal outcome from the use of antihypertensive therapy in such pregnancies. The findings suggest that there is a definite need for standardization regarding definition, terminology, and diagnosis and for large multicenter clinical trials. Finally, there is an urgent need to identify a marker of preeclampsia.