Management of pre-eclampsia: issues for anaesthetists

Area of Science:

• Obstetrics and Anesthesiology
• Maternal Medicine
• Critical Care in Pregnancy

Background:

• Pre-eclampsia is a significant contributor to maternal morbidity and mortality globally.
• Substandard care contributes to preventable deaths, emphasizing the need for improved management strategies.
• Anesthetists play a critical role in managing pregnant patients with pre-eclampsia and its complications.

Purpose of the Study:

• To review and summarize essential anesthetic management considerations for pre-eclampsia based on current literature.
• To highlight key issues for anesthesiologists caring for patients with pre-eclampsia and related hypertensive disorders.
• To provide guidance on optimizing care to reduce maternal mortality associated with pre-eclampsia.

Main Methods:

• Systematic literature search of electronic databases (MEDLINE, EMBASE, Cochrane Library).
• Inclusion of keywords related to obstetrics, pregnancy complications, pre-eclampsia, HELLP syndrome, eclampsia, and anesthesia.
• Examination of guidelines from relevant Colleges and Societies.

Main Results:

• Early recognition and multidisciplinary expert team management are vital for pre-eclampsia.
• Accurate monitoring, including transthoracic echocardiography, is essential.
• Management includes controlling severe hypertension (systolic BP >180 mmHg) with IV antihypertensives and using magnesium sulfate for eclampsia prevention/treatment.
• Restricted IV fluid therapy, avoidance of ergometrine, and specific considerations for neuraxial/general anesthesia and postpartum care are discussed.

Conclusions:

• Effective anesthetic management of pre-eclampsia requires a comprehensive approach, integrating early diagnosis with vigilant monitoring and evidence-based interventions.
• Optimizing anesthetic care, including fluid management and medication choices, can mitigate risks associated with pre-eclampsia and eclampsia.
• Postpartum care, addressing analgesia, thromboprophylaxis, and potential complications like pulmonary edema, is a critical component of overall management.