Key messages

• Pre-eclampsia, a multisystem disorder characterized by systemic hypertension and proteinuria, is a major cause of maternal death.

• Abnormal placentation is central to the pathogenesis of pre-eclampsia; there is failure of endovascular trophoblast invasion of the myometrial segments of spiral arteries.

• Endothelial dysfunction precedes clinical hypertension and accounts for the pathological changes seen in various organs.

• Uncontrolled lipid peroxidation and deportation of syncytiotrophoblast basement membrane elements from the placenta may mediate endothelial dysfunction.

• Neutrophil and platelet activation occurs, although this is probably secondary to endothelial dysfunction.

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