Hypertensive disorders of pregnancy are unique to pregnancy and occur after 20 weeks of gestation, with a prevalence of about 10.32%. Because the cause is unknown and there is no effective prevention method, especially severe hypertension is extremely harmful to mother and child and is one of the main causes of maternal and perinatal mortality. Causes of maternal death due to pre-eclampsia include cerebrovascular accidents, pulmonary edema and liver necrosis. The basic pathophysiological alteration of pre-eclampsia is the systemic spasm of small arteries, especially those below 200 μm in diameter, which are prone to spasm. Vascular endothelin and angiotensin can act directly on blood vessels to constrict them, resulting in the deposition of intravascular substances such as platelets and fibrin through the damaged endothelium, further narrowing the lumen of small arteries and increasing peripheral vascular resistance. In addition, sodium ions can promote the infiltration of calcium ions into the vascular smooth muscle cells, so the increase in calcium ions is also an important factor in the increase in vascular resistance. Small artery spasm will lead to corresponding changes in the heart, brain, kidney, liver and other important organs and changes in coagulation activity. Haemoconcentration, hypovolemia, increased whole blood and plasma viscosity, and hyperlipidemia are common in hyperemesis, which can significantly affect microcirculatory perfusion and contribute to the development of intravascular coagulation. Hyperemesis can lead to placental abruption, intrauterine death, cerebral hemorrhage, liver damage and HELLP syndrome, etc., which should be fully understood by anesthesiologists and used as a basis for treatment. 1.Anesthesia for hyperemesis combined with heart failure Severe hyperemesis is mostly accompanied by anemia, and the heart is in a state of low discharge and high resistance, and when there is severe hypertension or upper respiratory tract infection, heart failure is very likely to occur. Prior to anesthesia, acute left heart failure and pulmonary edema should be treated actively, rapid digitalization, dehydration and diuresis, morphine and antihypertensive as appropriate, so that heart failure can be controlled for 24-48h and cesarean delivery can be selected on a standby basis. (1) Anesthesia selection Epidural block is preferred because it reduces peripheral vascular resistance and cardiac afterload and improves cardiac function. General anesthesia should be selected with drugs that have no obvious inhibitory effect on the heart, and anesthesia should be induced smoothly to prevent strong stress reactions, while drugs should be selected to avoid inhibitory effects on the fetus. (2) Anesthesia management Before anesthesia, according to the degree of heart failure control, a maintenance dose of 0.2-0.4 mg of furazolidin propyl and 20-40 mg of furosemide should be given by sedation to reduce the cardiac load. At the same time, routine oxygen was administered to maintain smooth respiratory and circulatory function. Pay attention to check renal function, prevent infection and promote improvement of the condition. 2.Anesthesia for severe hyperemesis Once severe hyperemesis is diagnosed, all patients are hospitalized and given comprehensive treatment such as antispasmodic, sedative, antihypertensive, and moderate volume expansion and diuretic. Caesarean section should be considered for termination of pregnancy only if pre-eclampsia does not improve after 48-72 hours of active treatment or if the pregnancy has reached 36 weeks and has improved after treatment; if eclampsia has been controlled for 12 hours. (1) Pre-anesthesia preparation Detailed understanding of the drugs used for treatment: including the type and dose of drugs, the time of the last application of analgesics and antihypertensive drugs, in order to grasp the role of drugs on the mother and fetus and adverse reactions, to facilitate the choice of anesthesia methods and the treatment of possible adverse reactions. Magnesium sulfate treatment: magnesium sulfate is the drug of choice for severe hyperemesis, should routinely observe the amount of urine after the drug, the presence of respiratory depression, check the knee reflex, heart rate and electrocardiogram, the presence of atrioventricular block, if there are abnormalities should check the blood magnesium ion concentration. Once there are signs of toxicity should be given calcium antagonist treatment. Preoperative discontinuation of antihypertensive drugs: application of alpha and beta receptor antagonists; angiotensin converting enzyme inhibitors, should be discontinued 24-48h before anesthesia. This class of drugs has mostly synergistic effects with anesthetic drugs, which can easily lead to intraoperative hypotension. Know the bleeding volume of the patient 24h before anesthesia: facilitate the regulation of fluid balance during anesthesia surgery. (2) Choice of anesthesia Termination of pregnancy is an extremely important measure in the treatment of severe hyperemesis gravidarum. Any serious condition, especially MAP higher than 18.7kPa (140mmHg); short-term inability to deliver vaginally, or failed induction of labor, significantly low placental function, severe fetal hypoxia, eclampsia convulsions controlled by treatment for 2-4h or uncontrollable are indications for termination of pregnancy. When the treatment of heart failure and pulmonary edema of hyperemesis improves, anesthesiologists should actively prepare and try their best to cooperate with termination of pregnancy by seizing the opportunity of anesthesia surgery. Clinical anesthesia often encounters severe hyperemesis complicated by heart failure, cerebral hemorrhage, placental abruption, coagulation abnormalities, as well as hemolysis, elevated liver enzymes, thrombocytopenia, called HELLP syndrome and acute renal failure. The principle of anesthesia selection should be based on the relevant organ damage. According to the pathophysiological changes of hyperemesis and the safety of mother and child, continuous epidural block should be preferred for mothers without coagulation abnormalities, DIC, shock and coma. For those who are contraindicated to epidural block, general anesthesia should be considered under the condition that maternal safety is the main concern and fetal safety is secondary, which is conducive to the protection of damaged organ functions, active treatment of the primary disease, and removal of the cause as soon as possible to turn the patient into a safe one. (3) Anesthesia management Strive for smooth anesthesia: reduce stress reactions, apply small doses of fentanyl before general anesthesia intubation to reduce intubation-induced blood pressure fluctuations, while avoiding the use of ketamine, and use inhaled anesthetics for hypertension that occurs during anesthesia. The respiratory and circulatory functions should be regulated in a physiologically safe range. Blood pressure should not be reduced to too low, but controlled at 18.6-20.0/12.0 kPa (140-150/90 mmHg) for the best benefit of mother and baby. Prevent the occurrence of supine hypotension syndrome, if monitored with hypertension, also apply ganglion blocking drugs (camphor Ottifine) and nitroglycerin to lower blood pressure. Maintain cardiac, renal and pulmonary functions: moderate volume expansion, adjust blood volume and maintain electrolyte and acid-base balance based on hemoglobin, hematocrit, central venous pressure, urine volume, blood gas analysis and electrolyte examination. Active management of complications: Any complication of heart failure, pulmonary edema, cerebral hemorrhage, DIC, renal failure, HELLP syndrome should be actively managed according to the treatment principles of related diseases. Basic monitoring of anesthesia: including ECG, SpO2, NIBP, CVP, urine volume, blood gas analysis, to ensure timely detection of problems and timely treatment. Prepare for resuscitation of neonatal asphyxia. After anesthesia surgery, the patient should be admitted to the ICU and continue to be monitored and treated until the patient is out of the danger period. Postoperative analgesia should be given when the condition permits.