Anaesthesia and pre-eclampsia.

Pre-eclampsia continues to be one of the major causes of maternal mortality. ~ Anaesthetic considerations in preeclampsia are important and may contribute to the overall management. 2 Pre-eclampsia is characterized by the triad of (1) hypertension, (2) proteinuria and (3) oedema. 3 Hypertension in pregnancy is usually associated with pre-eetampsia but can also be due to other hypertensive disorders. Hypertension occurs in 5-10 per cent of all pregnancies and is usually seen in primigravidas after the 20th week of pregnancy. Third trimester hypertension is defined as a diastolic blood pressure of more than 85 mmHg or a mean pressure exceeding 95 mmHg. 3 Pre-eclampsia becomes eclampsia if convulsions occur. Convulsions can occur with only minimal blood pressure elevations and thus it can be misleading to categorize pre-eclampsia as mild or severe solely on the basis of the degree of blood pressure elevation. Severe pre-eclampsia is diagnosed when one or more of the following are present: (1) blood pressure of at least 160 mmHg systolic or 110 mmHg diastolic on two readings six hours apart, (2) proteinuria ~5 g-24 hri, (3) oliguriaJ<400 ml-24 hr -I, (4) cerebral or visual disturbances, and (5) pulmonary oedema or cyanosis. The HELLP Syndrome, a particularly severe type of preeclampsia, is diagnosed in the presence of haemolysis, elevated liver function tests and low platelet counts. 4 Eclampsia, though, is usually preceded by warning signs such as headache, hyperreflexia and epigastric pare.