The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community -- Milne et al. 330 (7491): 576 -

The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community -- Milne et al. 330 (7491): 576 -- BMJ
This paper in the BMJ along with a leader in the same issue challenged my understanding of antenatal care arrangements.
The advice on screening at initial appointment, along with early referral for specialist assessment in at risk groups should be easy to follow. One of previous pre-eclampsia, multiple pregnancy, underlying medical conditions (pre-existing hypertension, booking diastolic >90mmHg, pre-existing renal disease, booking proteinuria (>/= to + protein on more than one occasion), pre-existing diabetes or the presence of antiphospholipid antibodies should all trigger referral. More than one of first pregnancy, >/= to 10 yrs since last baby, age >/=40 years, BMI >/=35, or family history of pre-eclampsia should also trigger referral.
After 20 weeks, at every assessment I should be looking for new hypertension (hypertension at or after 20 weeks' gestation in women with a diastolic blood pressure < 90 mm Hg before 20 weeks), new proteinuria, headache, visual disturbance, epigastric pain, vomiting, reduced fetal movements or a small for dates baby. The guidance gives various thresholds for referral. In my practice if any of the criteria are present then the expectant mother requires hospital assessment - exceptwhere there is 1+ of proteinuria in the absence of other features I would review them within the week.