Toward improved management of pre-eclampsia. To prevent or minimize the devastating clinical consequences of pre-eclampsia, a great deal more research and funding must be directed at this important public health problem. Current management of pre-eclampsia continues to be plagued by low rates of timely recognition and referral, inadequate and inappropriately timed therapy, inadequate monitoring and intervention, and failure to apply research advances in new directions. Recognition of pre-eclampsia is a two-step process with initial screening using current standard laboratory tests. All individuals suspected of pre-eclampsia should be referred promptly for further diagnostic evaluation. Treatment should consist of appropriately timed and appropriately provided antihypertensive, anti-inflammatory, and anticonvulsant therapy. All therapies should be given concurrently, rather than sequentially. Further research is necessary to evaluate the need for antiplatelet therapy. All patients with severe pre-eclampsia should be monitored carefully, with frequent laboratory determinations and close assessment for evidence of maternal and fetal deterioration, which may result in rapid delivery. The use of intravenous (i.v.) magnesium sulfate has been shown to reduce maternal morbidity and mortality and should be offered to all women who are found to have severe pre-eclampsia. The use of i.v. antihypertensive therapy, while safe for both mother and fetus, has not been shown to alter the course of pre-eclampsia. The need for routine hospital admission of women with severe pre-eclampsia has been questioned. However, more recent evidence suggests that admission for close fetal surveillance in a setting of ongoing medical assessment is necessary. The most productive avenues for further research are aimed at identification of patients at high risk for developing pre-eclampsia and evaluation of the role of magnesium sulfate therapy in prevention of this syndrome. The effectiveness of newer approaches for treatment and prevention needs to be tested. Future research must focus on evaluating new treatment modalities, such as anti-inflammatory therapy, calcium channel blockers, oxygen and antioxidants, and platelet inhibitors. Research aimed at developing a better understanding of the etiology of pre-eclampsia is required. Additional funding must be made available to support the necessary randomized clinical trials that will establish the effectiveness of a number of these new therapies. With increased awareness of the threat of this serious complication and improved education for both patients and healthcare professionals, better outcomes are likely to be attained in the future.