Success in the management of pre-eclampsia is partly dependent on a multidisciplinary approach by the midwifery, obstetric, anaesthetic, intensive care and neonatal teams. Fetal complications of pre-eclampsia also result from placental dysfunction, and may be acute or chronic. The presentation of chronic pathology depends on the duration and severity of the changes to the placenta, but may include intra-uterine growth restriction (IUGR), which may ultimately lead to intra-uterine fetal death (IUFD). An accurate clinical assessment of patients with hypertension and/or pre-eclampsia is essential as the clinical course, and subsequent management is different for women with pregnancy-induced hypertension, pre-eclampsia and severe preeclampsia. Maintenance of fluid balance is essential in the management of severe pre-eclampsia, to prevent iatrogenic pulmonary oedema due to fluid overload. Hypotension occurring during Caesarean section or following regional anaesthesia is treated by careful fluid resuscitation. Women with severe pre-eclampsia and eclampsia require close monitoring after delivery.