Pre-eclampsia-eclampsia 1996: preventable? Have disputes on its treatment been resolved?

The fetal and maternal morbidity and mortality associated with hypertension complicating pregnancy primarily results from pre-eclampsia. This review focuses on recent developments in the areas of prevention and management. It specifically analyses studies designed to determine whether low-dose aspirin or calcium supplements, taken throughout pregnancy, reduce the incidence of pre-eclampsia, a debate on whether we have been too aggressive in terminating pregnancies in patients with severe pre-eclampsia remote from term, and the efficacy of parenteral magnesium sulfate in the prevention or treatment, or both, of the eclamptic convulsion. We conclude that neither aspirin nor calcium appears to improve the gestational outcome, although large trials currently under way may alter this view. The debate on 'conservative' versus aggressive management of early-onset severe pre-eclampsia seems to be more apparent than real. After years of acrimonious debate there are data to support the superiority of magnesium over phenytoin to prevent pre-eclampsia and the efficacy of the drug in reducing recurrent convulsions in eclampsia. However, whether 'prophylactic' therapy is indeed necessary or whether blood pressure control alone will prevent eclampsia remains to be determined.