Pre-eclampsia cannot be defined precisely by clinical signs which are just readily detectable secondary features of the primary abnormality within the uterus. The multisystem sequelae could be thought of as a secondary maternal adaptation, with the large variation in clinical presentation reflecting variable susceptibility of maternal target organs. The changes may be characteristic of pre-eclampsia but are not specific and therefore reflect a process rather than a discrete disease entity. Because the pathogenesis is so controversial it is not surprising that views on management differ so much.