Pre-eclampsia is a multisystem disorder unique to human pregnancy. Over the years, advances in the understanding of the pathophysiology and hemodynamics of the disease have greatly impacted its obstetrical and medical management. Considerable research into the pathophysiology of pre-eclampsia is ongoing and many areas are still debated. Increased heart rate, cardiac output, stroke volume, and left ventricular end-diastolic volume accommodates the growing metabolic needs of the pregnancy. Decreased total peripheral vascular resistance as a consequence of the presence of the low-resistance placental circulation is a physiological characteristic of a normal pregnancy. Current general consensus suggests a combined approach using clinical measurements and serum markers of placental abnormality appropriate for gestational age. Aspirin has been the most widely studied drug therapy in the prevention of pre-eclampsia. Spinal anesthesia is an acceptable option for women with severe pre-eclampsia, especially as an alternative to general anesthesia in emergency cesarean section.