Anesthesia for the patient with preeclampsia
Preeclampsia—a syndrome occurring after week 20 of gestation and characterized by hypertension, proteinuria, and generalized edema—becomes eclampsia if a grand mal seizure occurs (see Chapter 184). Preeclampsia/eclampsia abates within 48 h after delivery of the entire placenta.
Manifestations
Preeclampsia is a multisystem disease, affecting the central nervous system and the cardiovascular, respiratory, renal, hepatic, and hematologic systems, as well as the placenta (Table 185-1) (see Chapter 184).
Table 185-1
Manifestations of Preeclampsia
| Body System | Manifestations |
| Central nervous system | Cerebral edema, cerebral hemorrhage, cortical blindness, headache, hyperirritability, hyperreflexia, seizures, vertigo |
| Cardiovascular | Hypoproteinemia; hypovolemia; hemoconcentration; left ventricular hypertrophy; myocardial dysfunction; pulmonary edema; ↑ sensitivity to catecholamines, sympathomimetics, and oxytocics; ↑ systemic vascular resistance |
| Hematologic | DIC,* platelet dysfunction, prolonged bleeding time,† thrombocytopenia |
| Hepatic | Abnormalities on liver function tests, ↓ hepatic blood flow, ↓ plasma cholinesterase levels, periportal hepatic necrosis, subcapsular hemorrhage |
| Placenta | Chronic fetal hypoxia, fetal malnutrition, intrauterine growth retardation, placental abruption, premature birth, premature labor, uteroplacental insufficiency |
| Renal | ↑ Blood urea nitrogen, ↑ creatinine, ↓ glomerular filtration rate, hyperuricemia, proteinuria, ↓ renal blood flow |
| Respiratory |
