This prospective observational study compared the effects of general and spinal anesthesia in 173 severe preeclamptic women undergoing emergency cesarean section. 146 (84.5%) patients underwent spinal anesthesia (SA) and 27 (15.5%) patients had general anesthesia (GA). Most of the patients were primigravid and nulliparous. Intraoperatively SA group required more intravenous fluid and vasopressor support, while GA group required more preoperative labetalol injection for blood pressure control. Overall 13.3% of patients required critical care, particularly GA group (44.4% versus 7.5%; ). Patients receiving GA had a higher mortality (25.9% versus 1.4%; ). The length of hospital stay was comparable. Significantly more neonates of patients receiving GA were found to be preterm (77.8% versus 44.5%; ) and required advanced resuscitation. GA group also had higher neonatal mortality (29.6% versus 11%; ). To conclude, severe preeclamptic mothers receiving general anesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was significantly higher with general anesthesia. 1. Introduction Severe preeclampsia is the development of hypertension characterised by systolic blood pressure exceeding 160？mm？Hg and/or diastolic blood pressure exceeding 110？mm？Hg, together with proteinuria (>5？gm/24？hr) after 20 weeks of gestation. It can be accompanied by symptoms or signs of imminent eclampsia, pulmonary edema, or HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome [1]. Fetal complications include placental abruption, intrauterine growth restriction, premature delivery, and intrauterine fetal death. The incidence of stillbirths and neonatal deaths in mothers who suffered severe preeclampsia was 22.2/1000 and 34.1/1000, respectively, in the UK with a higher incidence in developing countries [2]. The impact of the disease is felt more severely in developing countries where, unlike other more prevalent causes of maternal mortality (such as hemorrhage and sepsis), medical interventions may be ineffective due to late presentation of cases [3]. The problem is confounded by the continued mystery of the etiology and the unpredictable nature of the disease [3]. Preeclampsia is a principal cause of fetal morbidity and mortality, also the leading reason of maternal ICU admissions, and responsible for 15–20% of maternal deaths worldwide [4]. In India the incidence of preeclampsia is 7.6% during pregnancy of which 3.3% is severe preeclampsia [5]. Delivery of the infant and placenta is the only effective treatment.
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