Clinicians should be aware of the potential involvement of other organs when assessing maternal risk, including placental disease with fetal manifestations.

Senior obstetric and anaesthetic staff and experienced midwives should be involved in the assessment and management of women with severe pre-eclampsia and eclampsia. Some women will present with convulsions, abdominal pain or general malaise. In these cases, pre-eclampsia should always be considered and the blood pressure taken and the urine analysed. Clinical symptoms are important components of worsening disease, particularly headache and abdominalpain.⁰⁵⁰¹ However, increasing oedema is not in itself a sign that should determine management. Maternal tendon reflexes, although useful to assess magnesium toxicity, are not of value in assessing the risk of convulsion, although the presence of clonus may be. Continuous oxygen saturation monitoring with a pulse oximeter is valuable, as it will often give early signs of pulmonary oedema.