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Anesthesia for the Parturient with Pre-eclampsia

By August 3, 2018 No Comments

Last December, I rejoiced when my best friend of 20 years informed me that his wife was pregnant. He had come a long way from a rowdy teenager on the school bus to a responsible father- to-be about to grow his family. Although I would be losing a trustworthy wingman, I was excited to be involved as much as possible during the couple’s journey through pregnancy.

At the baby shower, I could sense some concern from my friend and his wife, who had just finished building their crib. She was diagnosed with pre-eclampsia, my friend later told me, and they had been closely watching her blood pressure and staying home as much as possible. We reviewed her pregnancy to date and all signs pointed towards a healthy baby and straightforward course for labor and delivery. Given my background as an anesthesiologist, they naturally wanted to know about their available options for pain control during labor.

In 3-8% of pregnancies, a diagnosis of pre-eclampsia is made after a pregnant patient in the third-trimester presents with elevated blood pressure (systolic blood pressure > 160 mmHg) and significant amounts of protein in the urine. [1] Headaches and edema may cause complaints, although they are nonspecific and frequently associated with normal pregnancy. Patients are closely monitored and treated for hypertension and may receive magnesium to prevent seizures around the time of labor.

Anesthesia for parturient

Your anesthesiologist can provide non-opioid pain relief services (i.e. epidural anesthesia for labor or spinal anesthesia for caesarean sections) for pre-eclamptic patients who are otherwise asymptomatic. The obstetrician will determine the need for more frequent monitoring and your disposition to a center with higher acuity services.

Please make sure to discuss the following items with your anesthesiologist ahead of time.

  1. Hydration – Your anesthesiologist will mention that you will need extra fluids prior to receiving an epidural or spinal. Hydration is decreased in pre-eclamptic patients, and you will need a “bolus” or continuous infusion of fluid through an IV ahead of time.
  2. Blood profile – Most anesthesia services require an evaluation of your blood clotting ability, and a healthcare specialist will check the levels of electrolytes, blood cells, and platelets, which are specialized cells that help to form a clot and stop bleeding. This level is low and can further decrease around the time of labor, thereby increasing the risk of bleeding with epidural procedures and complicating anesthetic management. Levels and function of your clotting system are also measured during this study. Your anesthesiologist may order for extra platelets or other related products if your levels are too low.
  3. Seizure prevention – Your obstetrician may administer magnesium around the time of labor to prevent seizures. This requires a planned hospitalization.
  4. Blood pressure control – Pre-eclamptic patients are given medications to control their blood pressure while maintaining blood flow via the placenta. A beta-blocker (labetalol) and smooth muscle relaxant (hydralazine) have been thoroughly studied. However, your obstetrician and healthcare team monitoring your blood pressure can provide you with individualized treatment and monitoring plans after a diagnosis has been established. Your anesthesiologist will also be prepared to manage changes in your blood pressure during the course of your labor or caesarean section.

 

REFERENCES

  1. Ronsmans C, Graham WJ on behalf of the Lancet Maternal Survival Series steering group, “Maternal mortality; who, when, where and why.” The Lancet, Maternal Survival, September 2006.