|Pre-eclampsia is one of the most widely investigated conditions relating to human reproduction. To date no firm cure has been found, and a clear, well-defined mechanism has not been ascribed to the pathogenesis of the disorder. Some researchers seem to focus on single pathways in isolation of others. The disease rather represents a multitude of possible underlying pathologies involving genetics, immune dysregulation, vascular maladaptation and sociobiological factors; complicating clinical management. However, a central theme is the presence of reduced placental perfusion resulting in a hypoxic and/or ischaemic placenta, delivery of which results in a resolution of clinical symptoms. It is within this context that we examine how an intervention such as increasing placental perfusion may represent a promising treatment strategy for reducing maternal and neonatal mortality and morbidity related to the the syndrome in low resource environments. Treatment using sildenafil citrate, should specifically target mothers that exhibit increasing levels of sFlt1 and sEng even before 20 weeks of gestation; with continuous monitoring of blood pressure, urinary protein excretion and platelet count. Given the complex multifactorial nature of this disease and the elusive nature of its eitiology, our recommendation represents a viable option to decrease perinatal and maternal morbidity and mortality from pre-eclampsia.