Cardiac Disease and Hypertensive Disorders in Pregnancy

Hypertension during pregnancy has been classified by the American College of Obstetricians and Gynecologists into four distinct categories: (a) pre-eclampsia and eclampsia, (b) chronic hypertension (hypertension that was present before pregnancy), (c) chronic hypertension with superimposed preeclampsia or eclampsia, and (d) latent or transient hypertension of the third trimester (1). Most chronic hypertensive pregnant patients have essential hypertension, which has no appreciable effect during pregnancy unless end-organ damage is present. Chronic hypertension is seen in a critical care unit typically only when a patient has a hypertensive urgency/emergency unrelated to pregnancy, or if the patient has a secondary cause of hypertension that represents a short-term risk to maternal health. Similarly, latent or transient hypertension is also relatively benign, occurring in the last trimester or the immediate postpartum period, with a return of normotension by the first 3 weeks after delivery. It is pre-eclampsia and eclampsia (whether occurring de novo or superimposed upon pre-existing hypertension) that is most likely to require critical care support, and therefore will be the focus of this section.