Observational study of choice of anaesthesia and outcome in patients with severe pre-eclampsia who present for emergency Caesarean section

Objectives: Recent evidence in the literature suggests that regional anaesthesia may be the preferred choice over general anaesthesia for patients with severe pre-eclampsia who present for a Caesarean section. This study was conducted to determine if this applied to our population and to assess outcomes. Design: A retrospective comparative observational study was conducted. Setting and subjects: The study was carried out at the King Edward VIII Hospital and included patients with severe preeclampsia who presented for emergency Caesarean section. Eighty-four charts were analysed. Outcome measures: The type of anaesthetic that was administered was determined and compared for maternal intraoperative haemodynamic changes and maternal and neonatal outcomes. Results: Sixty-nine per cent of patients received spinal anaesthesia and 25% general anaesthesia (GA). Intraoperative systolic blood pressures of < 100 mmHg were recorded in 19% of GA and in 27.6% of spinal anaesthesia cases. A > 20% fall in mean arterial pressure from baseline was noted in 66.7% of GA and in 75.9% of spinal anaesthesia cases. There was no maternal mortality and one case of morbidity (a spinal anaesthesia case). An Apgar score of < 7 was recorded in 66.7% of GA cases and in 19% of spinal anaesthesia cases. Neonatal morbidity and mortality occurred in 33.3% of GA and in 10.3% of spinal anaesthesia cases. Conclusion: Maternal morbidity and mortality were not significantly different between the two groups. Neonatal outcomes were poorer in the GA group, but neonates in the GA group had significantly lower birthweights and gestational ages. Their mothers also had more severe disease. This study supports spinal anaesthesia as an appropriate anaesthetic choice in patients with severe pre-eclampsia.