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]

Three questions. Is she about to seize (magnesium)? Will her blood pressure stroke her (controlled reduction)? Can I safely put a needle in her back (platelets and coagulation)?^[1][4][6]

References7ShowHide

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, von Dadelszen P, Rey E, et al. Less-tight versus tight control of hypertension in pregnancy N Engl J Med, 2015.PMID 25629739
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
7. [7]Kwan WF, Lee C, Chen BJ A noninvasive method in the differential diagnosis of vecuronium-induced and magnesium-induced protracted neuromuscular block in a severely preeclamptic patient J Clin Anesth, 1996.PMID 8832451