Anesthetic Management

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

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