Hypertensive Disorders of Pregnancy

Hypertensive disorders of pregnancy (HDP) affect 12–22% of pregnancies and are a significant contributor to maternal and neonatal morbidity and mortality. The American College of Obstetricians and Gynecologists categorizes HDP into gestational hypertension; preeclampsia (with and without severe features); hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome; and eclampsia. Chronic hypertension is also acknowledged as a distinct category. Although these classifications define specific conditions, HDP may represent a broader disease spectrum, complicating diagnosis and management. This chapter reviews the various forms of HDP, their fetal effects, and treatment options. The etiology of HDP remains under investigation, but imbalances in angiogenic factors, maternal immune maladaptation, and chronic uteroplacental ischemia are potential mechanisms. The fetal impacts are primarily due to compromised uteroplacental blood flow, leading to complications such as fetal growth restriction and prematurity, as treatment for preeclampsia often necessitates early delivery.