title: Hypertensive disorders of pregnancy.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Women's & Obstetric Anesthesia, IWK Health Centre, Faculty of Medicine, Dalhousie University, 5850/5980 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8, Canada.
authors.forename: Ana
authors.initials: A
authors.lastname: Sjaus
authors.affiliation: Department of Women's & Obstetric Anesthesia, IWK Health Centre, Faculty of Medicine, Dalhousie University, 5850/5980 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8, Canada. d.mckeen@dal.ca.
authors.forename: Dolores M
authors.initials: DM
authors.lastname: McKeen
authors.affiliation: Department of Women's & Obstetric Anesthesia, IWK Health Centre, Faculty of Medicine, Dalhousie University, 5850/5980 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8, Canada.
authors.forename: Ronald B
authors.initials: RB
authors.lastname: George
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000628:therapy*; D007231:Infant, Newborn; D008428:Maternal Mortality; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000628:therapy*; D011256:Pregnancy Outcome