Hypertensive disorders of pregnancy

In this continuing professional development module, we review recent Society of Obstetricians and Gynaecologists of Canada (SOGC) guidelines for the classification and diagnosis of hypertensive disorders of pregnancy (HDP) as well as review the clinical features, laboratory investigations, and outcomes of HDP. We explore the evidence for anesthetic management and prevention of end-organ damage in women with HDP and describe the role and contribution of anesthesiologists as part of a multidisciplinary care team.

Hypertensive disorders of pregnancy can have variable presentations with clinical signs and symptoms that often do not correlate with the underlying severity and progression of the disease. Failure of timely diagnosis and treatment contributes significantly to adverse maternal (neurologic complications, pulmonary edema, and postpartum hemorrhage) and neonatal (respiratory and neurologic complications and stillbirth) outcomes. In the Canadian context, improvements in medical care have led to better maternal and neonatal outcomes. Timing of delivery is crucial in balancing maternal risks and fetal benefits of ongoing pregnancy. Evidence-based SOGC guidelines regarding diagnosis and management of HDP address many aspects of clinical care relevant to anesthesiologists, who have an important role in the multidisciplinary care team.

Hypertensive disorders of pregnancy are on the rise worldwide, and this trend is expected to continue. The major contributors to maternal mortality are failure to recognize HDP promptly or to treat the condition adequately. It is essential that anesthesiologists understand the disease process and acquire knowledge of the guidelines governing current obstetrical care in order to provide evidence-based multidisciplinary quality care to these patients. Anesthetic management helps prevent potentially deleterious maternal and fetal outcomes.

Objectives of this Continuing Professional Development (CPD) module:

After reading this module, the reader should be able to:

  1. Describe the recent practice guidelines of the Society of Obstetricians and Gynaecologists of Canada (SOGC) regarding the diagnosis and classification of hypertensive disorders of pregnancy (HDP), including clinical features and laboratory investigations.
  2. Identify the main maternal and fetal adverse outcomes from pregnancy that are complicated by HDP.
  3. Develop an evidence-based approach to the pharmacologic management of hypertension and prevention of end-organ damage in a woman with preeclampsia.
  4. Describe the role of the anesthesiologist in the multidisciplinary management of HDP.
  5. Review the goals of anesthesia management and the cardiovascular responses to general anesthesia, neuraxial analgesia/anesthesia, vasopressors, and uterotonics in women with HDP.
  6. Describe the assessment and preparation of a parturient for urgent Cesarean delivery under general anesthesia with anesthetic, obstetrical, and fetal considerations.
  7. Describe the postpartum needs of women with preeclampsia.

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