Pre-eclampsia and anaesthesia

  • A. Bhuvanagiri
  • R. Alexander
Conference paper


Pre-eclampsia (PE) and eclampsia are the most common pregnancy-related conditions leading to admission to critical care unit [1]. Although the death rate has fallen over the last four decades, there is still a small but significant mortality rate [2]. Epidemiological studies suggest the true incidences of PE and eclampsia are approximately 3% and 0.05% of all deliveries, respectively [3]. Hypertensive disease of the pregnancy is also the second leading cause of direct deaths according to the statistics of the Confidential Enquiry of Maternal Deaths, 1977 – 1999 [4]. The rates, however, have fallen from 9.1 to 7.1 cases per million maternities compared with the previous report. Recommendations for treatment have been published in the CEMD 1997–1999 report, Appendix 1.


Obstet Gynecol Epidural Analgesia Maternal Death Magnesium Sulphate HELLP Syndrome 
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  1. 1.
    Department of Health (1999) Report on confidential enquiries into maternal deaths in the United Kingdom,1994–1996. HMSO, LondonGoogle Scholar
  2. 2.
    Leitch CR, Cameron AD, Walker JJ (1997) The changing pattern of eclampsia over 60 year period. Br J Obstet Gynecol 104: 917–922CrossRefGoogle Scholar
  3. 3.
    Saftlas AF, Olson DR, Franks AL et al (1990) Epidemiology of pre-eclampsia and eclampsia in the United States 1979–1986. Am J Obstet Gynecol 163: 460–465PubMedGoogle Scholar
  4. 4.
    Department of Health (2001) Report on confidential enquiries into maternal deaths in the United Kingdom, 1997–1999. HMSO, LondonGoogle Scholar
  5. 5.
    Higgins JR, de Swiet M (2001) Blood pressure measurement and classification in pregnancy. Lancet 357: 131–135PubMedCrossRefGoogle Scholar
  6. 6.
    Brown MA, Buddle ML (1996) Hypertension in pregnancy. Maternal and fetal outcomes according to laboratory and clinical features. Med J Aust 165: 360–365PubMedGoogle Scholar
  7. 7.
    Fadigan AB, Sealy DP, Schneider EF (1994) Preeclampsia: progress and puzzle. Am Fam Physician 49: 849–856PubMedGoogle Scholar
  8. 8.
    Lie RT, Rasmussen S, Brunborg H et al (1998) Fetal and Maternal contributions to risk of pre-eclampsia: population based study. BMJ 316: 1343–1347PubMedCrossRefGoogle Scholar
  9. 9.
    Magee LA, Ornstein MP, vonDadelszen P (1999) Fortnightly review: management of hypertension in pregnancy. BMJ 318: 1332–1336PubMedCrossRefGoogle Scholar
  10. 10.
    Redman CW, Sacks GP, Sargent IL (1999) Preeclampsia: an excessive maternal inflammatory response to pregnancy. Am J Obstet Gynecol 180: 499–506PubMedCrossRefGoogle Scholar
  11. 11.
    Myatt L (2002) Role of placenta in Preeclampsia. Endocrine19: 103–111Google Scholar
  12. 12.
    Roberts JM, Lain KY (2002) Recent insights into the pathogenesis of pre-eclampsia. Placenta 23: 359–372PubMedCrossRefGoogle Scholar
  13. 13.
    Winker K, Wetza B, Hoffmann MM et al (2003) Triglyceride rich lipo proteins are associated with hypertension in preeclampsia: Clin Endocrinol.Metab 88: 1162–1166Google Scholar
  14. 14.
    Lowe DT (2000) Nitric oxide dysfunction in the pathophysiology of preeclampsia. Nitric Oxide 4: 441–458PubMedCrossRefGoogle Scholar
  15. 15.
    Saphier CJ, Repke JT (1998) Hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. A review of diagnosis and management. Semin Perinatol 22: 118–133PubMedCrossRefGoogle Scholar
  16. 16.
    Sibai BM,Taslimi MM, el-Nazer A et al (1986) Maternal perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes and low platelet in severe preeclampsia-eclampsia. Am J Obstet Gynecol 155: 501–509Google Scholar
  17. 17.
    Sibai B, Ramanathan J (1992) The case for magnesium sulphate in preeclampsia-eclampsia. Int J Obstet Anaesth 1: 167–171CrossRefGoogle Scholar
  18. 18.
    Harnett MJ, Data S, Bhavani-Shankar K (2001) The effect of magnesium on coagulation in parturients with preeclampsia. Anaesth Analg 92: 1257–1260CrossRefGoogle Scholar
  19. 19.
    Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomized placebo controlled trial. Lancet 2002:359:1877–1890Google Scholar
  20. 20.
    Mushambi MC, Halligan AW, Williamson K (1996) Recent developments in the pathophysiology and management of preeclampsia.Br J Anaesth 76: 133–148Google Scholar
  21. 21.
    Bosio PM, McKenna PJ, Conroy R (1999) Maternal central hemodynamics in hypertensive disorders of pregnancy. Obstet Gynecol 94: 978–984PubMedCrossRefGoogle Scholar
  22. 22.
    Belfort MA, Anthony J, Saade GR et al (1993) The oxygen consumption/oxygen delivery curve in severe preeclampsia: evidence for a fixed oxygen extraction state. Am J Obstet Gynecol 169: 1448–1455PubMedGoogle Scholar
  23. 23.
    Jouppila P, Jouppila R, Holeman A et al (1982) Lumbar epidural analgesia to improve intervillous blood flow during labour in severe preeclampsia. Obstet Gynecol 59: 158–161PubMedGoogle Scholar
  24. 24.
    Ramanathan J, Coleman P, Sibai B. (1991) Anaesthetic modification of haemodynamic and neuroendocrine stress responses to caesarean delivery in women with severe preeclampsia: Anaesth Analg 73: 772–779Google Scholar
  25. 25.
    Kanayama N, Belayet HM, Khatun S et al (1999) A new treatment of preeclampsia by long-term epidural anaesthesia. J. Hum Hypertens 13: 167–171PubMedCrossRefGoogle Scholar
  26. 26.
    Hood DD, Curry R (1999) Spinal versus epidural anaesthesia for caesarean section in severely preeclamptic patients: a retrospective survey. Anaesthesiology 90: 1276–1282CrossRefGoogle Scholar
  27. 27.
    Ramanathan J, Vaddadi AK, Arheart KL (2001) Combined spinal and epidural with low doses of intrathecal bupivacaine in women with severe pre eclampsia: preliminary report. Reg Anaesth Pain Med 26: 46–51Google Scholar
  28. 28.
    Hodgkinson R, Hussain FJ, Hayashi RH (1980) Systemic and pulmonary blood pressure during caesarean section in parturients with gestational hypertension Can Anaesth Soc J 27: 389–394Google Scholar
  29. 29.
    Beilin Y, Bernstein HH, Zuncker-Pinchoff B (1995) The optimal distance that a multi orifice epidural catheter should be threaded into epidural space. Anaesth Analg 81: 301–304Google Scholar
  30. 30.
    Overdyk KF, Harvery SC (1998) Continuous spinal anaesthesia for caesarean section in a parturient with severe pre eclampsia. J Clin Anaesth 10: 510–513CrossRefGoogle Scholar
  31. 31.
    Young P, Johanson R (2001) Hemodynamic, invasive and echocardiographic monitoring in the hypertensive parturient. Best Pract Res Clin Obstet and Gynaecol 15: 605–622CrossRefGoogle Scholar
  32. 32.
    Cotton DB, Gonik B, Dorman KF (1985) Cardiovascular alterations in severe pregnancy-induced hypertension seen with intravenously given hydralazine bolus. Surg Gynecol Obstet 161: 240–244PubMedGoogle Scholar
  33. 33.
    Ellis SC, Wheeler AS, James FM et al (1982) Fetal and maternal effects of sodium nitroprusside used to counteract hypertension in gravis ewes. AM J Obstet Gynecol 143: 766–770PubMedGoogle Scholar
  34. 34.
    Mabie W, Gonzales A, Sibai B et al (1987) Comparative trial of labetolol and hydrallazine in the acute management of severe hypertension complicating pregnancy. Obstet Gynecol 70 328–333PubMedGoogle Scholar
  35. 35.
    Stratta P, Besso L, Canavse C et al (1996) Is pregnancy-related acute renal failure disappearing clinical entity? Ren Fail 18: 575–584PubMedCrossRefGoogle Scholar

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© Springer-Verlag Italia, Milano 2004

Authors and Affiliations

  • A. Bhuvanagiri
  • R. Alexander

There are no affiliations available

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