Anesthetic Management of Pregnant Patients with Hypertensive Disorders

Hypertensive disorders of pregnancy are one of the most common medical problems encountered during the management of obstetric patients. Preeclampsia is a type of hypertensive disorder, which is unique to human pregnancy and is a leading cause of maternal and fetal morbidity and mortality. The current widely accepted pathophysiology of preeclampsia is failure of placenta to embed adequately leading to hypoxia due to poor placental perfusion. As a result coagulation cascade is activated with the formation of microthrombi leading to end-organ damage. Preeclampsia therefore involves either one or more than one organ systems including the central nervous, cardiovascular, gastrointestinal, hematological, renal, and uteroplacental systems. Early diagnosis of the disease, accurate monitoring, and timely institution of treatment can prevent complication. In the absence of contraindication, neuraxial anesthesia and analgesia is recommended. Postpartum management includes continuation of monitoring, antihypertensive management, thromboprophylaxis, and analgesia. In the presence of multisystem organ involvement and its related complications, patients need to be managed postoperatively in the intensive care unit. Anesthesiologists being part of the multidisciplinary team are involved in the management of these patients for provision of analgesia/anesthesia and for subsequent management in the postpartum period.