Spinal block caesarean section in parturients with pregnancy-induced hypertension

The objective of this work was to determine whether parturients with pregnancy-induced hypertension (PIH) are at higher risk of post-spinal hypotension at caesarean section. This was an observational study of 24 women with PIH undergoing caesarean section under spinal analgesia with 0.5% hyperbaric bupivacaine, compared with 24 matched normotensive parturients receiving a spinal block for caesarean section. The mean intra-operative systolic arterial pressure (SAP) was similar with and without PIH (p = 0.38). The mean percentage decrease in SAP of baseline was more with PIH (16.2%) than in the controls (0.5%) (p < 0.001). The number of episodes of severe hypotension (SAP decrease to < or = 80% of baseline and < 90 mmHg) (p = 0.80) as well as the magnitude (p = 0.31) of severe hypotension was similar in both groups. There was no difference in the evolution of diastolic arterial pressure and maternal pulse rate between cases and controls. Maximum levels of upper sensory blockade were similar. Foetal and maternal outcome was similar with and without PIH. The decrease in SAP is less on an absolute scale but more on a percentile basis with PIH at caesarean section under spinal analgesia than in normotensive patients. The difference, however, is not clinically sufficient to discourage spinal analgesia for caesarean section with a low dose (1.5 ml, 7.5 mg) of 0.5% hyperbaric bupivacaine in parturients with PIH.