Pre-eclampsia: anesthesia, labor and postpartum management
THE CONTEXT
The passage describes anesthetic considerations and care during labor and after delivery in women with pre-eclampsia.
Operative and anesthetic considerations
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The operative discussion includes severe pre-eclampsia with an anticipated prolonged induction–delivery interval and associated factors such as elderly primigravidae or malpresentation. An experienced surgeon should perform the operation.
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Regional anesthesia is preferred. General anesthesia carries risks of aspiration, failed intubation due to laryngeal edema, and stroke.
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The stated platelet count threshold is at least 70 × 10⁹/L to avoid complications due to coagulopathy.
Management during labor
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The objectives are control of hypertension, prevention of convulsions, and safe delivery.
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Continue antihypertensive treatment and monitor blood pressure and urine output every hour.
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Start prophylactic magnesium sulfate when severe features of pre-eclampsia are present. Careful monitoring of fetal wellbeing is mandatory.
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Shorten labor by low rupture of membranes during the first stage and forceps or ventouse during the second stage.
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Give the mother oxytocin 10 IU intramuscularly after delivery of the baby.
Postpartum monitoring and treatment
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Observe closely for at least 48 hours, the period during which convulsions usually occur.
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Continue antihypertensive treatment if systolic blood pressure exceeds 150 mm Hg or diastolic blood pressure exceeds 100 mm Hg.
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The stated nifedipine regimen is 10 mg orally every 6 hours until blood pressure remains below hypertensive levels for at least 48 hours.
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Oral frusemide 20 mg daily for 5 days is described as improving recovery and reducing the need for antihypertensive drugs in severe pre-eclampsia.
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In women with severe hypertension, continue magnesium sulfate for at least 24 hours and continue antihypertensive drugs. These women have increased risks of eclampsia, pulmonary edema, and stroke.
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Keep the patient hospitalized until blood pressure reaches a safe level.
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Labetalol, nifedipine, or enalapril may be used at discharge in breastfeeding women. Avoid methyldopa because of the risk of postpartum depression.