Pre-eclampsia: One name, two conditions - The case for early and late disease being different

The identification of a patient simply as "preeclamptic" on the basis of elevated blood pressure and proteinuria is not sufficient to express the real haemodynamic adaptation of that mother. The importance of measuring cardiac output, stroke volume and total vascular resistance (TVR) is increasingly consistent with bedside observations from these patints. Clinicians should understand that to differentiate between the types of pre-eclampsia they should try to obtain as much information from the heart and cardiovascular system of the mother. The presence of elevated TVR characterizes more frequently the early "placental" PE. The presence of reduced TVR characterizes more frequently the late "metabolic" PE. These data, and not only the blood pressure alone, will help in the choice of the best treatment to be utilized in the effort of gaining days or weeks to induce foetal lung maturation and prepare the best possible maternal and neonatal conditions at birth. © 2013 Cambridge University Press.