الفهرس 
INTRODUCTION
ASSESSMENT OF THE FOETUS AT BIRTHOnly 14 pages are availabe for public view
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Abstract
Pre-eclampsia is a pregnancy specific syndrome, often referred to as toxaemia of pregnancy or pregnancy induced hypertension (PIH). It consists of hypertension, proteinuria and oedema occurring after the 20th week of gestation and resolving within 48 hours after delivery.
Pre-eclampsia is recognized as a leading cause of maternal and perinatal mortality.
The aetiology of pre-eclampsia is unknown. But it is thought to be related to decreased placental perfusion resulting in increased production of renin, angiotensin, aldosterone and tissue thromboplastin and in decreased production of prostaglandin.
The disorder is triggered by a placental pathology followed by a wide spectrum of maternal systemic response. The clinical presentation varies in time and substance with many different organ system affected. Major manifestations of pre-eclampsia include: generalized vasospasm, reduced intravascular volume, hypertension, decreased glomerular filtration rate, and generalized oedema.
During general anaesthesia there is an increased risk of a failed intubation due to sever oedema of the upper airway. The haemodynamic changes associated with direct laryngoscopy, tracheal intubation and extubation may result in marked increase in blood pressure. General anaesthesia in patients with pre-eclampsia undergoing Caesarean section is indicated in emergency Caesarean section or if regional anaesthesia is contraindicated or failed.
The aim of this work was to compare the haemodynamic effects following propofol induction and isoflurane maintenance versus thiopentone sodium and halothane maintenance as regards blood pressure, heart rate, oxygen saturation, ECG changes, urine output and foetal outcome assessed by Apgar score at the first and fifth minutes.
The present study was carried out on forty (40) pre-eclamptic patients scheduled for Caesarean section in El Shatby Maternity University Hospital, divided into two groups, twenty patients each. The first group, patients were anaesthetized with propofol as an induction agent and isoflurane for maintenance and the second group patients were anaesthetized with thiopental sodium as an induction agent and halothane for maintenance.
These patients were thoroughly clinically examined and investigated. Complicated patients were excluded.
In the two groups, H2 receptor antagonist in the form of ranitidine 100 – 150 mg.kg-1 1 – 2 hours prior to induction and atropine 0.5 mg was injected intravenously if bradycardia occurred.
Pre-oxygenation via face mask for 5 minutes prior to induction of anaesthesia was administered.
Anaesthesia was induced with propofol 2 – 2.5 mg.kg-1 intravenously in group I and with thiopental sodium 5 – 7 mg.kg-1 intravenously in group II followed by succinylcholine 1 – 1.5 mg.kg-1 intravenously was given and rapid sequence intubation was done.
Anaesthesia was maintained with atracurium 0.4 mg.kg-1 intravenously in both groups with isoflurane 0.7% in group I and halothane 0.5% ingroup II.
Controlled ventilation was provided to all patients.
Fentanyl 50 g intravenously was given in both groups after delivery of the foetus.
After the end of the operation, the effect of atracurium was reversed by prostigmine 0.04 – 0.08 mg.kg-1 and atropine 1 mg intravenously. Ventilation was assisted till full recovery from anaesthesia then extubation was done when the patients were awake.
The following parameters were recorded; blood pressure (systolic, diastolic and mean arterial pressure), heart rate, oxygen saturation, ECG trace, urine output and foetal outcome assessed by Apgar score in the first and fifth minutes.
These measurements were recorded just before induction, two minutes after induction, every 5 minutes during anaesthesia, during recovery and five minutes after recovery.
Patients who were not easily intubated were excluded from the study.
from the present study the following results were obtained:
Two minutes after induction, there was significant decrease in SBP, DBP and MAP in group I but insignificant in group II. There was significant decrease in group I compared with group II. There was insignificant change in heart rate in group I but there was a significant increase in HR in group II. Oxygen saturation insignificantly changed in both groups with insignificant difference between both groups. Urine output significantly decreased in group I than in group II.
At the different timings of measurements, there was significant decrease in SBP, DBP and MAP in both groups. There was significant decrease in group I compared with group II. HR was insignificantly changed in group I, but was significantly increased in group II at the different timings of measurements. Oxygen saturation insignificantly changed in both groups. Urine output significantly decreased in group I than in group II.
During extubation, there is significant decrease in SBP, DBP and MAP in group I while there is insignificant decrease in SBP, DBP and MAP in group II with significant decrease in SBP, DBP and MAP in group I compared with group II. HR is significantly increased in both groups. There was significant decrease in group I than in group II. Oxygen saturation insignificantly changed in both groups.
Five minutes after extubation, there is significant decrease in SBP, DBP and MAP in both groups. There was significant decrease in SBP, DBP and MAP in group I compared with group II. HR is non-significantly changed in group I but increases significantly in group II. Oxygen saturation insignificantly changed in both groups. Urine output significantly decreased in group I than in group II.
Electrocardiographic monitoring showed five patients in group II of sinus tachycardia during induction, two minutes after induction and during recovery and extubation with no other dysrrhythmias. No any dysrrhythmias seen in group I.
The foetal outcome assessed by Apgar score is non-significantly decreased in both groups in both the first and the fifth minutes.