Patient selection

Protocols of care for women with pre-eclampsia should stipulate criteria for selecting patients whose severity of disease warrants high-dependency care ( Table,!). Screening for maternal and fetal complications

Blood pressure should be monitored by sphygmomanometry. Renal function should be assessed by measuring hourly urine output, serum creatinine, and potassium. Elevated serum alanine transaminase levels indicate hepatic dysfunction, while sustained ankle clonus suggests cerebral involvement. Fundoscopy should be undertaken to exclude retinal hemorrhages, and hemostatic function should be screened by measurement of thrombin time and serum D-dimer levels. Hemoglobin estimation and a peripheral blood film may show evidence of hemolysis. Lung auscultation and pulse oximetry may indicate pulmonary edema. Placental dysfunction and fetal growth retardation should be excluded by cardiotocography and ultrasonography with Doppler assessment of the uteroplacental and fetal circulations.

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