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Anesthesia for the patient with preeclampsia

Authors
Joy Hawkins, MD
Emily McQuaid-Hanson, MD
Section Editor
David L Hepner, MD
Deputy Editor
Marianna Crowley, MD

INTRODUCTION

Preeclampsia is a multisystem disorder with unique concerns for the anesthesiologist in the peripartum period. This topic will discuss the anesthetic management of labor and delivery for preeclamptic patients, including labor analgesia, cesarean delivery, fluid management, and invasive monitoring. The pathogenesis, clinical features and diagnosis, and obstetric management of patients with preeclampsia are discussed separately. (See "Preeclampsia: Clinical features and diagnosis" and "Preeclampsia: Management and prognosis" and "Preeclampsia: Pathogenesis".)

PREANESTHESIA EVALUATION

Preeclamptic patients should be evaluated by an anesthesia clinician early in labor, with the expectation that an emergency delivery may be required at any time. Women with preeclampsia are at an increased risk for life-threatening events, including placental abruption, cerebral hemorrhage, pulmonary edema, acute kidney injury, hepatic failure or rupture, disseminated intravascular coagulation, and progression to eclampsia. (See "Preeclampsia: Clinical features and diagnosis".)

The preanesthesia evaluation of these patients should focus on severity of disease, the airway examination, hemodynamic status, and coagulation parameters, all of which may change over time.

Severity of preeclampsia — Preeclampsia may be classified as severe (also called preeclampsia with severe features) or preeclampsia without severe features (table 1). (See "Preeclampsia: Management and prognosis".)

In general, peripartum anesthesia for patients with preeclampsia without severe features is managed as it would be for patients without preeclampsia, recognizing that severity may increase at any time. Patients with preeclampsia without severe features may or may not receive magnesium for seizure prophylaxis. (See "Preeclampsia: Management and prognosis", section on 'Seizure prophylaxis' and 'Intraoperative magnesium' below.)

                                

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Literature review current through: Nov 2016. | This topic last updated: Tue Nov 22 00:00:00 GMT+00:00 2016.
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