Pre-eclampsia anaesthetic plan: magnesium sulphate, blood pressure and neuraxial decisions

Meet the patient

A 31-year-old primigravida at 37 weeks is on the labour ward with a headache that will not shift, flashing lights before her eyes, and a blood pressure of 178 over 114. Her platelets came back at 72, her reflexes are brisk, and she needs a caesarean within the hour. The midwife has already drawn up the magnesium.[4]

The three questions that will decide the next hour are the three that decide every pre-eclampsia case: is she about to seize? (magnesium), will her blood pressure stroke her? (controlled reduction), and can I safely put a needle in her back? (platelets and coagulation). Hold those three and the whole plan slots into place.[1]

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1. [1]Altman D, Carroli G, Duley L, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial Lancet, 2002.PMID 12057549
2. [2]The Eclampsia Trial Collaborative Group Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial Lancet, 1995.PMID 7769899
3. [3]Duley L, Gülmezoglu AM, Henderson-Smart DJ, et al. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia Cochrane Database Syst Rev, 2010.PMID 21069663
4. [4]ACOG Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222 Obstet Gynecol, 2020.PMID 32443079
5. [5]Magee LA, Singer J, von Dadelszen P, et al. Less-tight versus tight control of hypertension in pregnancy N Engl J Med, 2015.PMID 26061848
6. [6]Mushambi MC, Kinsella SM, Popat M, et al. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics Anaesthesia, 2015.PMID 26449292