Spinals do not alter uteroplacental haemodynamics [420]. Difficult (or failed) intubation for general anaesthesia in women with HDPs is more common [421] and [422]. Routine preloading with a fixed volume of crystalloid (i.e., 500–1000 mL) will not prevent BP falls in normal women prior to Caesarean delivery [423]; no specific studies exist for HDPs. Preloading may increase the risk of life-threatening pulmonary oedema [2] Hypotension should be treated with vasopressors as an infusion or small boluses
[424]. Oliguria (<15 mL/h) is common in preeclampsia, particularly postpartum. In the absence of pre-existing renal disease or a rising creatinine, oliguria should be tolerated over hours, to avoid volume-dependent pulmonary oedema [2], [425] and [426]. ALK inhibitor Fluid balance should be closely monitored, and furosemide limited to pulmonary oedema treatment, as the benefits of furosemide (and dopamine) for oliguria are uncertain [427] and [428].
Early (<34 weeks) and late (⩾34 weeks) onset preeclampsia may have different haemodynamics (i.e., low cardiac output (CO)/high systemic vascular resistance (SVR) for the former and high CO/low SVR for the latter) [429]. For resistant/labile hypertension, non-invasive or minimally invasive haemodynamic assessment, particularly transthoracic echocardiography, can be used to guide therapy; selleck inhibitor results correlate well with invasive monitoring [430]. Almost all women can be monitored effectively by vital signs and oxygen saturation. Central venous pressure (CVP) monitoring should be limited to haemodynamically unstable women. CVP monitoring Non-specific serine/threonine protein kinase can be used for trends (including response to therapy) rather than for diagnosis. Pulmonary artery catheterization should be limited to the ICU. Most guidance for neuraxial anaesthesia in women with preeclampsia
and coagulation disorders comes from non-obstetric literature and guidelines based mainly on expert opinion. All women with a HDP should have a platelet count, noting the number and trend in the count. Tests of platelet function are not indicated, as results do not correlate with bleeding in the spinal space [431]. Neuraxial haematoma (in the epidural, spinal, or subdural spaces) is rare (<1:150,000 epidurals, <1:220,000 spinals) [432]. However, the potential to cause permanent neurological dysfunction promotes concern in women either with low platelet counts or taking medication affecting coagulation [433]. These women should be assessed soon after the block has worn off to exclude back pain or new/progressive neurological complications [432].