• Alicia T Dennis, Annie Xin, and Michaela K Farber.
• Division of Obstetric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Critical Care and Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Parkville, Victoria, Australia; School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Department of Anaesthesia, Pain and Perioperative Medicine, Joan Kirner Women's and Children's Sunshine Hospital, Western Health, St. Albans, Victoria, Australia.
• Anesthesiology. 2025 Feb 1; 142 (2): 378402378-402.

AbstractPreeclampsia is a common condition of pregnancy characterized by hypertension complicated by cerebral, cardiac, hepatic, renal, hematologic, and placental dysfunction. Patients with preeclampsia frequently undergo cesarean delivery, the most common major surgical procedure in the world. They represent a high-risk perioperative cohort suffering significant preventable morbidity and mortality. This review focuses on the anesthesiologist's role, through a perioperative lens, in reducing maternal complications through management of hypertension and strategies for preserving the function of the brain, heart, liver, kidney, hematologic and coagulation systems, and placenta in patients with preeclampsia undergoing cesarean delivery. Preeclampsia-specific resuscitation, individualized fluid administration, safe neuraxial and general anesthesia, and management of intraoperative bleeding are discussed along with strategies for postoperative analgesia, thromboprophylaxis, and antihypertensive agents in patients who breastfeed. This review discusses recently recognized postoperative deterioration in maternal mental health, the possibility of myocardial injury after cesarean delivery, and the need for long-term cardiometabolic follow-up.Copyright © 2025 American Society of Anesthesiologists. All Rights Reserved.

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