Summary

In study session IV you have learnt

• Pregnancy- induced hypertension or pre-eclampsia is a multisystem disease occurring after the 20th week of pregnancy. It is characterised by hypertension, oedema and proteinuria.
• Eclampsia is severe form of toxaemia complicated by tonic/clonic convulsions which may lead to coma.
• Pre-eclampsia is more common in women with first pregnancies, diabetics, patients with polyhydramnios and multiple pregnancies. Several maternal physiological changes such as cardiovascular, renal, haematological, and neurological that could impact anesthesia could occur during eclampsia.
• The aim of treatment in pre-eclampsia is to control blood pressure, prevent eclampsia and plan delivery of the foetus at the appropriate time.
• Hypertension is managed by drugs such as hydralazine. Magnesium sulphate is the drug of choice for seizure prophylaxis.
• In the management of convulsions; protection of the airway and provision of oxygenation is essential. Convulsion is treated by drugs such as diazepam. If the seizure is prolonged and unresponsive to IV treatment, endotracheal intubation using a rapid sequence induction may be necessary.
• Patients with pre-eclampsia have a relative hypovolemia and require careful fluid management.
• Anaesthetic problems could arise including; uncontrolled hypertension, imminent convulsions, hypovolemia, electrolyte imbalance and pulmonary oedema causing hypoxia.
• Regional techniques are superior to general anaesthesia in pre-eclamptic patients without cerebral symptoms.
• General anaesthesia is the anaesthetic of choice in all patients with diminished level of consciousness, such as those who have had eclamptic convulsions or are showing signs of increased cerebral irritability. General anaesthesia may also be necessary in pre-eclamptic patients because of coagulation problems, maternal haemorrhage, or severe foetal distress.