This chapter summarizes the identification, assessment and management of women with established pre-eclampsia. Guidelines for out-patient management and in-patient treatment are given and are based on clinical experience and published reports. Drug treatment options are briefly reviewed and the timing of delivery is discussed. A comprehensive regimen for the intrapartum management of severe pre-eclampsia is provided founded on protocols used in the Royal Victoria Infirmary, Newcastle upon Tyne, over recent years. The chapter emphasizes the importance of medical history, clinical examination and investigations when arriving at what are often difficult clinical decisions. Controversial areas are highlighted with reference to recent published reports.