Pre-eclampsia – anaesthetic considerations

Pre-eclampsia is a multisystem disorder associated with end-organ damage that forms part of the spectrum of hypertensive disorders of pregnancy. It occurs after 20 weeks’ gestation and contributes to significant maternal and fetal morbidity. In the UK, it was responsible for nearly 2.5% of maternal deaths in the recent maternal confidential death report. Placental growth factor-based testing and estimation of soluble fms-like tyrosine kinase 1 to placental growth factor (sFlt-1/PIGF) ratio can improve diagnostic accuracy and predict the risk of maternal complications. Aspirin in the dose of 75–150 mg for antenatal prophylaxis, targeted blood pressure control using anti-hypertensive medications, fluid restriction, magnesium sulphate for seizure prophylaxis and timely delivery remain the key strategies to decrease maternal morbidity. Anaesthetists may be involved as part of multidisciplinary team in managing hypertensive and obstetric emergencies in severe pre-eclampsia, facilitate resuscitation, monitoring and stabilization, and provision of appropriate labour analgesia and anaesthesia. Neuraxial anaesthesia provided the coagulation status is normal is preferred for operative interventions. If a general anaesthesia is administered, anaesthetists should be cognisant of the precipitant nature of pre-eclampsia. This should include preparation for a potential difficult intubation, plans to obtund the pressor response to laryngoscopy and avoidance of hypertension on emergence from anaesthesia. Critical care input may be useful in women with cardio-respiratory, neurological, and hepato-renal morbidity.