Background Blood pressure is considered to be the most predictive of complications in women with pre-eclampsia compared to the other tests.

Methods We performed systematic quantitative review of test accuracy studies. We conducted an electronic search in MEDLINE (1951–2010), EMBASE (1980–2010), the Cochrane Library (2009) to identify relevant articles. A hand-search of selected specialist journals and reference lists of articles obtained was then carried out. There were no language restrictions for any of these searches. Studies were selected independently by two reviewers if blood pressure profile was evaluated to predict maternal and fetal complications of pre eclampsia. Data was extracted on study characteristics, quality and accuracy to construct 2×2 tables with maternal and fetal complications as reference standard.

Results There were eight primary articles in the review including a total of 2304 women. For the prediction of eclampsia, abruption, renal, neurological and liver impairment, mean arterial pressure ≥140 mm Hg or blood pressure ≥170/110 had high specificity (more than 80%) and low sensitivity (<50%). The area under the curve for any adverse maternal outcome was 0.68 (95% CI 0.29 to 0.92). The specificity for adverse fetal outcomes was more than 70% in 11/15 (73.3%) studies and sensitivity was more than 70% in 6/15 (40%) studies.

Conclusion Blood pressure is a moderate predictor of adverse maternal and fetal outcomes, with severe hypertension more predictive of fetal complications than maternal complications.