Regional anesthesia in patients with pregnancy induced hypertension

Abstract

Pregnancy induced hypertension is a hypertensive disorder, which occurs in 5% to 7% of all pregnancies. These parturients present to the labour and delivery unit ranging from gestational hypertension to HELLP syndrome. It is essential to understand the various clinical conditions that may mimic preeclampsia and the urgency of cesarean delivery, which may improve perinatal outcome. The administration of general anesthesia (GA) increases morbidity and mortality in both mother and baby. The provision of regional anesthesia when possible maintains uteroplacental blood flow, avoids the complications with GA, improves maternal and neonatal outcome. The use of ultrasound may increase the success rate. This review emphasizes on the regional anesthetic considerations when such parturients present to the labor and delivery unit.

Anesthetic practices for patients with preeclampsia or HELLP syndrome: A survey

“…However, authors in the field generalize safety in the range of a platelet count somewhere between 50,000 and 100,000/ µL. In addition, the most cited cut-off is 70,000 to 80,000/µL (5,12,14). The real dilemma, therefore, lies with the management of patients with preeclampsia whose platelet counts range between 50,000 and 100,000/µL.…”

“…Platelet counts of less than 100,000/µL in women with preeclampsia may be associated with an impaired coagulation function and should prompt additional investigations of the coagulation status (12). Instead of stratifying patients according to platelet count as a trigger to order coagulation tests, some recommend that it is practical and cost-effective to screen for both platelet count and coagulation studies at the same time (14,15). As reflected from the current survey findings, a significant proportion of anesthesiologists in Turkey still prefer general anesthesia regardless of a normal coagulation profile and a platelet count exceeding 100,000/µL.…”

Anesthetic considerations in HELLP syndrome

“…Administration of regional anesthesia not only prevents the complications of general anesthesia, such as difficult intubations, a vasopressor response to tracheal intubation but also improves uteroplacental blood flow and neonatal results . It has been proven that the sympathetic blockade that produces neuroaxial anesthesia improves intervillous blood flow in hypertensive delivering women by lowering uteroplacental resistance …”

“…Administration of neuraxial anesthesia minimizes the potential risk of fetal exposure to depressant anesthetic drugs, reduces the risk of maternal pulmonary aspiration, promotes rapid wandering and lowers the incidence of maternal thromboembolism . Nevertheless, it is advisable to closely monitor the neurological status of these patients …”

Intraoperative requirement of Phenylephrine for spinal anaesthesia, with comparison of hemodynamic parameters between severe pre-eclamptic and normotensive parturients for elective caesarean section: A prospective study

“…If SBP maintains >80% of baseline then the Apgar scores and umbilical artery pH are undeterred in preeclampsia. 6 A number of studies have been conducted to find the hemodynamic effects of regional anaesthesia in patients with preeclampsia. Present study is planned to study the intraoperative hypotension and Phenylephrine requirement in patients undergoing elective caesarean section under spinal anaesthesia with severe preeclampsia when compared with normotensive patients.…”