Sjaus Ana, McKeen Dolores M, George Ronald B
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.
Can J Anaesth. 2016 Sep;63(9):1075-97. doi: 10.1007/s12630-016-0689-8. Epub 2016 Jul 21.
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.
在本继续职业发展模块中，我们回顾加拿大妇产科医师协会（SOGC）近期关于妊娠高血压疾病（HDP）分类与诊断的指南，并审视HDP的临床特征、实验室检查及结局。我们探究HDP女性麻醉管理及预防靶器官损害的证据，并描述麻醉医师作为多学科护理团队一员的作用与贡献。
妊娠高血压疾病的临床表现多样，其临床体征和症状往往与疾病的潜在严重程度及进展不相关。未能及时诊断和治疗会显著导致不良的孕产妇（神经系统并发症、肺水肿和产后出血）和新生儿（呼吸及神经系统并发症和死产）结局。在加拿大，医疗护理的改善已带来更好的孕产妇和新生儿结局。分娩时机对于平衡孕产妇风险和持续妊娠对胎儿的益处至关重要。基于证据的SOGC关于HDP诊断和管理的指南涉及了与麻醉医师相关的许多临床护理方面，麻醉医师在多学科护理团队中发挥着重要作用。
妊娠高血压疾病在全球范围内呈上升趋势，且预计这一趋势将持续。孕产妇死亡的主要原因是未能及时识别HDP或对该疾病进行充分治疗。麻醉医师必须了解疾病过程并掌握当前产科护理指南的知识，以便为这些患者提供基于证据得多学科优质护理。麻醉管理有助于预防潜在有害的孕产妇和胎儿结局。
