Pre-eclampsia and the anaesthetist

Pre-eclampsia is a multi-systemic hypertensive disorder occurring after 20 weeks of pregnancy with an incidence of 2–8% in the UK. It has been one of the leading causes of maternal mortality throughout the world. Intra-cerebral haemorrhage, pulmonary and liver dysfunction are the key complications of severe pre-eclampsia leading to a fatal outcome. Serial surveillance of both mother and the fetus antenatally, aggressive monitoring and management of the blood pressure, appropriate fluid balance, magnesium sulphate to prevent seizures and timely delivery of the baby remain the mainstays of its management. 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.