Anesthesia and maternal hypertensive disorders - analysis of a tertiary maternity center

Background and Goal of Study: Hypertension is the most common medical problem complicating 2-3% of pregnancies (1). Maternal hypertensive disorders and their implications, are a growing reality faced by the obstetric anesthetist. 
The aim of this study is to characterize the obstetric patients with hypertensive disorders admitted in a tertiary maternity from June 2015 to June 2016, and analyse their anesthetic/analgesic management.

Materials and Methods: A retrospective analysis was carried out by reviewing clinical data of consecutive patients diagnosed with chronic hypertension, gestational hypertension, preeclampsia, and severe preeclampsia and HELLP syndrome, in our maternity in the considered time frame. A descriptive analysis was performed. Continuous variables were reported as mean (standard deviation).

Results and Discussion: In this period there were 2670 deliveries and the incidence of hypertensive pathology was 3,9% (n=104), which is in agreement with the literature. 
The average age was 34±4,7 years, 44% were nulliparous and 6,7% had multiple pregnancies. Sixty one percent were obese.
The most common maternal hypertensive disorder was preeclampsia (31,7%), followed by chronic hypertension (29,8%), gestational hypertension (29,8%) and severe preeclampsia/HELLP syndrome (8,7%).  
The overall incidence of preterm deliveries was 41% (n= 43), and in 17 of these (39,5%), the gestational age was under 34 weeks. 
The percentage of neuroaxial techniques for labor analgesia was very high (94%).
The caesarean section rate in the hypertensive pathology group was 52,9% (n=55). Severe preeclampsia and HELLP syndrome had the highest rate, 80% and 100% respectively. General anesthesia was performed in 27,3% (n=15) of caesarean sections. 

Conclusions: Maternal hypertensive disorders demand an interdisciplinary approach with an early involvement of the anesthetic team. We found a very high c-section rate in the studied group contrasting with the overall c-section rate (29,3%) of the maternity. Similarly, there was a high general anesthesia rate. The high neuroaxial analgesia percentage can be explained by the fact that, in our institution, epidural catheters are placed very early during labor. 

References: 1- Alessia M, Sabina C, Alessandro C, et al. J Prenat Med. 2009 Jan-Mar; 3(1): 1–5.