Pre-eclampsia before 20-week gestation: diagnosis, investigation and management

Pre-eclampsia (PET) is a hypertensive disorder of pregnancy predominantly occurring after 20-week gestation. Proteinuria, which is of variable magnitude, is required to make the diagnosis. Maternal clinical manifestations are variable and may result in renal impairment, liver dysfunction and haematological abnormalities. The foetus may be growth restricted with oligohydramnious. Risk factors include a history of hypertension, previous history of PET, primiparity and advanced maternal age. We report the case of very early-onset PET and advise that it should always be considered in the differential diagnosis of proteinuria and hypertension prior to 20-week gestation. We also discuss the role of kidney biopsy in such situations, the dilemmas faced in patient management and the need for long-term follow-up for these patients.