Pre-eclampsia (PE) is a pregnancy-specific syndrome that is a principal cause of maternal morbidity and mortality, accounting for almost 15% of pregnancy-associated deaths. It is also one of the major causes of iatrogenic prematurity among new born babies, placing a heavy burden on both prospective parents and on the health service. The mild form of PE most commonly presents with the features of maternal hypertension and proteinuria but can swiftly and unpredictably become severe with many extensive complications, which can involve the maternal liver, kidneys, lungs, blood and platelet coagulation and nervous systems. These clinical problems normally only become apparent in the second half of pregnancy but are believed to start during the first trimester. The diverse symptoms of PE have made it a difficult disease not only to define but also to identify a causative agent for the symptoms. It has therefore proved difficult to develop specific drugs that can be used to manage the condition in the clinic. Therapeutic intervention so far has been primarily aimed at combating the two main complications of PE - the hypertension and seizures. Current therapies are widely recognised as inadequate. This review examines the complex pathological mechanisms believed to be responsible for the multi-system complications of PE. It highlights current findings that exhibit the potential to target these effects with the aim of either preventing or altering the course of this life-threatening disease of pregnancy.