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Anesthetic Management

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  • Inform anesthesia when pt w/ preeclampsia is admitted to delivery suite

  • Early epidural insertion to control labour pain (if no contraindications)

  • For C-section: can use epidural, spinal, CSE, or GA (if no contraindications)

  • No routine fixed IV fluid bolus prior to neuraxial anesthesia

  • Fluids

    • Minimize IV & po fluid intake to avoid pulm edema

    • No routine fluid admin to treat oliguria (<15 ml/hr x 6 hrs)

    • No dopamine or furosemide for persistent oliguria

    • Tx hTN d/t neuraxial anesthesia with phenylephrine or ephedrine

  • Monitoring

    • Art line if BP control is difficult or severe bleeding

    • CVP not routinely recommended

      • If inserted, use to monitor trends, not absolute values

    • PA catheter not recommended unless specific indication

      • Only use in ICU setting

  • Coagulation

    • Platelet (plt) count on admission to L&D

    • Neuraxial technique appropriate if:

      • Preeclampsia (w/o coagulation concerns)

      • Plt count ≥75

      • Low dose ASA & adequate plt count

      • UFH ≤10,000 IU/day subcut 4 hrs after last dose

        • ?ok immediately after last dose w/o delay

      • UFH >10,000 IU/day subcut if normal aPTT 4 hrs after last dose

      • IV heparin if normal aPTT 4 hrs after last dose

      • LMWH 10-12 hrs after prophylactic dose or 24 hrs after therapeutic dose

 

Note that this reference is from the 2014 Guideline: Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P; Canadian Hypertensive Disorders of Pregnancy Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can. 2014;36(5):416-441. doi:10.1016/s1701-2163(15)30588-0

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