Aarvold ABR, Wiggins J, Sebbag I, Kintu A, Mung'ayi V, Douglas J.
This chapter is not designed to be an anaesthetic text but focuses on anaesthetic issues specifically related to parturients with hypertensive disorders of pregnancy. Early consultation and involvement of anaesthesia will result in the best possible outcome for women with a hypertensive disorder of pregnancy and their babies. Provision of effective analgesia for labour will not only decrease pain, but also attenuate its effects on blood pressure and cardiac output. In addition, epidural analgesia benefits the fetus by decreasing maternal respiratory alkalosis, compensatory metabolic acidosis, and release of catecholamines. An effective labour epidural can be used should a Caesarean delivery be required, avoiding the need for general anaesthesia. Both neuraxial (epidural, spinal, continuous spinal and combined spinal epidural) and general anaesthesia are appropriate for Caesarean delivery. The choice of technique will depend on the overall condition of the parturient, the urgency of the situation and whether there are contraindications to any particular technique. Challenges associated with anaesthesia include maintaining haemodynamic stability during laryngoscopy and intubation with general anaesthesia, or after sympathetic block secondary to neuraxial anaesthesia. Although neuraxial anaesthesia is preferred to general anaesthesia, owing to potential problems with the airway in the woman with pre-eclampsia, neuraxial anaesthesia may not be possible in the presence of a low platelet count or other coagulation abnormality. The interaction of non-depolarising muscle relaxants (as part of general anaesthesia) and magnesium sulphate will limit their use in the woman with pre-eclampsia. Adequate analgesia and ongoing monitoring are important components of overall postpartum management.
Chapter 10: Anaesthesia [p.185-213]. In: Magee LA, von Dadelszen P, Stones W, Mathai M, editors. The FIGO Textbook of Pregnancy Hypertension: An evidence-based guide to monitoring, prevention and management. London; The Global Library of Women's Medicine, 2016.