• BP > 140/90 before pregnancy or ≥ 20 week of gestation 

Gestational hypertension

• Isolated hypertension after 20 week of gestation with no sings of preeclampsia

Preeclapmsia

• Gestational hypertension at ≥20 week of gestation + organ dysfuction

Eclampsia

• Tonic-clonic seizure (or unconcious state) in women with pre-eclampia

HELLP

• Hemolysis, elevated liver enzymes, low platelets syndrom

• Thrombocytopenia (<70-80 000 mm3) and coagulopathy (↑INR, aPTT)
• HELLP with coagulopathy and severe liver lesion 
• Placentar abruption
• Fetal hypoxia
• Aortic valve stenosis
• Decreased level of conciousness (eclampsia)

General anesthesia for CS and hypertension

• Ideally control blood pressure below 140/90 mmHg
• In emergency situation, give Labetalol 10 mg i.v. as a bolus
• Alternatively give Remifentanil 1 μg/kg i.v. 30 sec before induction of GA or Lidocain 1,0-1,5 mg/kg i.v. before induction of GA 

Fluid management

• Restrictive strategy
• Infusion rate max. 80mL/h
• During regional anesthesia
•  max. 500mL of crystaloids and 250mL of coloids 
• Lung edema! 

• 4 - 6g MgSO4 / 100 mL NaCl i.v. in 10 - 20 minutes
• follow 1 - 3 g/h continuously (therapeutic serum level 2-3 mmol/L)
• continue with magnesium 24 - 48 hrs after delivery
• Maximum daily dose 30 - 40 g

Toxicity: every 4hrs control: blood pressure, respiratory rate, patellary reflex, SpO2, diuresis and   serum levels of Mg 

Antidote: Calcium chloride 1 g i.v. in 5 - 10 minutes

Renal impairment: 

• serum kreatinin > 100 μmol/L bolus 4 - 6g MgSO4, follow 1 g/h continuously 
• serum kreatinin > 200 μmol/L bolus 4 - 6g MgSO4 with no following Mg infusion

• Brain edema
• Intracranial haemorrhage
• Placentar abruption
• Heart failure
• Hepatorenal failure
• Disseminated intravascular coagulation
• ARDS
• Lung edema
• Difficult airway management

Eclampsia (and seizures) – differential diagnosis


Epilepsy – mydriasis and hyperreflexia (eclampsia – miosis and hyporeflexia)

• Hypoglycemic coma
• Intoxication, drug abuse (cocain)
• Convulsions in high intracranial pressure (trauma?)
• Acute pancreatitis

• Preference of general anesthesia due to complicated neurological status 
• Regional anesthesia only with full conciousness of patient and after cardiovascular stabilization
• Prevention of aortocaval compression
• + the same management as by patient with severe preeclampsia

• Same management as by patient with severe preeclampsia
• Preference of regional anesthesia if possible
• we prefer spinal anesthesia (difficult epidural catheter extraction during progressive thrombocytopenia)
• Thrombocyte substitution for tracheal intubation and caesarean section < 40 000/mm3
• If possible, use bedside monitoring of coagulopathy (Hemocue, trombin test, ROTEM,TEG)

• BP > 140/90 before pregnancy or ≥ 20 week of gestation 

Gestational hypertension

• Isolated hypertension after 20 week of gestation with no sings of preeclampsia

Preeclapmsia

• Gestational hypertension at ≥20 week of gestation + organ dysfuction

Eclampsia

• Tonic-clonic seizure (or unconcious state) in women with pre-eclampia

HELLP

• Hemolysis, elevated liver enzymes, low platelets syndrom