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Anesthetic Management
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Inform anesthesia when pt w/ preeclampsia is admitted to delivery suite
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Early epidural insertion to control labour pain (if no contraindications)
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For C-section: can use epidural, spinal, CSE, or GA (if no contraindications)
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No routine fixed IV fluid bolus prior to neuraxial anesthesia
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Fluids
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Minimize IV & po fluid intake to avoid pulm edema
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No routine fluid admin to treat oliguria (<15 ml/hr x 6 hrs)
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No dopamine or furosemide for persistent oliguria
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Tx hTN d/t neuraxial anesthesia with phenylephrine or ephedrine
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Monitoring
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Art line if BP control is difficult or severe bleeding
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CVP not routinely recommended
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If inserted, use to monitor trends, not absolute values
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PA catheter not recommended unless specific indication
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Only use in ICU setting
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Coagulation
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Platelet (plt) count on admission to L&D
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Neuraxial technique appropriate if:
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Preeclampsia (w/o coagulation concerns)
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Plt count ≥75
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Low dose ASA & adequate plt count
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UFH ≤10,000 IU/day subcut 4 hrs after last dose
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?ok immediately after last dose w/o delay
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UFH >10,000 IU/day subcut if normal aPTT 4 hrs after last dose
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IV heparin if normal aPTT 4 hrs after last dose
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LMWH 10-12 hrs after prophylactic dose or 24 hrs after therapeutic dose
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Adapted from SOGC Clinical Practice Guideline. Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy: Executive Summary. J Obstet Gynaecol Can 2014;36(5):416–438
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