الفهرس 
physiological changes ofOnly 14 pages are availabe for public view
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Abstract
Summary
Pregnancy produces profound physiological changes that
alter the usual response to anesthesia, many of these changes are
useful to the mother in tolerating the stresses of pregnancy and
delivery.
Preeclampsia has been defined as hypertension developing
after 20 weeks’ gestation or in the early postpartum period and
returning to normal within 3 months after delivery. The classic
triad of preeclampsia includes hypertension, proteinuria, and
edema.
The exact etiology of preeclampsia is unknown and
probably complex, However, Many theories center on problems of
placental implantation and the level of trophoblastic invasion.
The anesthesiologist must perform a thorough preanesthetic
evaluation, including a history and physical examination, with
careful attention to the airway examination due to the increased
risk of pharyngolaryngeal edema, and assessment of the patient’s
cardiopulmonary, fluid, and coagulation status.
The rate of eclamptic seizures in women with mild
preeclampsia is less than 1%. Use of magnesium sulfate to prevent
eclamptic seizures in women with mild preeclampsia is
controversial.
Medications commonly used by obstetricians to treat
hypertension associated with severe preeclampsia include
hydralazine, labetalol, and nifedipine (or other calcium channel
blockers) with a goal diastolic BP of 90–105 mmHg and systolic
BP of 140–155 mmHg or a mean arterial pressure of 105–125
mmHg.
Magnesium sulfate is the drug of choice for prevention of
seizures in the preeclamptic woman, or prevention of recurrence
of seizures in the eclamptic woman
Laboratory tests include: a complete blood count with
platelets; bilirubin, aspartate transaminase, and alanine
transaminase in order to identify potential HELLP syndrome;
electrolyte, urea, and creatinine assessment to check for acute
renal failure or uremia; 24-hour proteinuria; prothrombin,
activated thrombin time, and fibrinogen (microangiopathic
hemolytic anemia); blood group
Women with HELLP should be delivered regardless of
gestational age, but if expectant management is planned, it should
only occur at a tertiary care hospital with close maternal and fetal
monitoring due to the severe nature of the disease
The choice of a safe anesthetic and maintenance of
intraoperative stability to ensure the delivery of a healthy neonate,
and to minimize maternal morbidity and mortality, is of particular
concern.
Studies that compared regional and general anesthesia in
patients with preeclampsia have also shown varying results. Some
reported poorer maternal and neonatal outcomes in the general
anesthetic group, while others indicated similar maternal and
neonatal outcomes when a comparison was made between the two
groups
In preeclampsia, spinal anesthesia is generally considered
for cesarean delivery when there is no indwelling epidural catheter
or there is a contraindication to neuraxial anesthesia (e.g.,
coagulopathy, eclampsia with persistent neurologic deficits).
Spinal anesthesia affords quicker onset of anesthesia than epidural
or Combined Spinal Epidural anesthesia.
General anesthesia is indicated in severe preeclampsia with
HELLP syndrome, eclampsia, coagulopathy, cerebral edema and
in patients who refuse regional anesthesia.
In postpartum, close monitoring is done of vital signs, fluid intake
and output, and symptoms for at least 48 hours. Management
should be done in high dependency unit or transferred to intensive
care unit (ICU) if required. The patients with severe preeclampsia
are prone to convulse or develop pulmonary edema within 24 h of
delivery.