Pre-eclampsia and the anaesthetist

Pre-eclampsia is a multisystem disorder of pregnancy that forms an integral part of the spectrum known as hypertensive diseases of pregnancy, occurring after 20 weeks of gestation. Its incidence seems to be increasing globally and it remains the fourth most common cause of direct maternal deaths in the UK. Intra-cerebral haemorrhage, pulmonary, liver and renal dysfunctions are recognized complications of pre-eclampsia that contribute to maternal morbidity and mortality. Measurement of specific maternal angiogenic factors such as placental growth factor (PGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) may aid in the diagnosis and management of this condition. Strict blood pressure control using anti-hypertensive medications, fluid restriction, magnesium sulphate for seizure prophylaxis and timely delivery remain the key strategies to decrease maternal morbidity. Neuraxial anaesthesia, provided the coagulation status is normal, is the preferred technique for delivery. If general anaesthesia is used, emphasis should be on preparing for a difficult airway and ablation of the pressor response of laryngoscopy and intubation.