Updates In Anaesthetic Management Of Pre-eclampsia & eclampsia

Pre-eclampsia and eclampsia are recently refered as pregnancy induced hypertension. A diagnosis of pre-eclampsia requires onset of high blood pressure after 20 week gestation with a systolic blood pressure of 140 mmHg or diastolic blood pressure 90 mmHg and protein in the urine. Eclampsia is the occurance of seizures in presence of pre-eclampsia. The seizures are unrelated to brain conditions and usually happen after the 20th week of pregnancyA 2-stage model has been proposed as useful conceptually to address its pathophysiology. Stage 1 of pre-eclampsia, reduced placental perfusion, is considered the ”root cause.” This then somehow translates, in some but not all women, into stage 2: the multisystemic maternal syndrome of pre-eclampsia.The lesions in eclampsia are caused by loss of cerebrovascular autoregulation. At increased arterial pressures, normal cerebral vasoconstriction initially occurs. However, when the upper limit of autoregulation is reached, cerebral vasodilation starts to occur, allowing local hyperperfusion with subsequent interstitial or vasogenic edema.General management of antepartum women with preeclampsia consists of frequent laboratory monitoring (platelet count, liver and renal function tests), assessment of maternal blood pressure and symptoms, and frequent evaluation of fetal growth and well-being.Treatment of moderate hypertension in the antenatal period may reduce the need for later acute management of sever blood pressure.