Pre-eclampsia remains a major cause of maternal and fetal mortality but many complications can be prevented by appropriate intervention. The anaesthetist should play a role in the overall as well as anaesthetic management of these patients. Epidural analgesia remains the method of choice for pain relief in pre-eclamptic patients during labour. Epidural anaesthesia may also be safely used for operative delivery in pre-eclampsia, as can general anaesthesia if precautions against precipitate hypertension are taken.