Preeclampsia/Eclampsia: An Insight into the Dilemma of Treatment by the Anesthesiologist

  • Zahid Hussain Khan Mail Department of Anesthesiology and Intensive Care, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Preeclampsia, Eclampsia, Hypertension, Antihypertensive drugs, Monitoring, Anesthesia


A complicated and controversial subject in obstetrics i.e., toxemia of pregnancy is looked upon, both from an anesthesiological and obstetrical point of view. As pre-eclampsia and eclampsia involve immediate treatment and obstetric considerations, the choice between epidural and general anesthesia becomes necessary when cesarean section is contemplated. Apart from the pathophysiology of the vessel spasm as it is induced by preeclampsia, the therapeutic managements of fluid administration, the drugs of choice to treat hypertension as well as the technical aspects of anesthesia are reviewed.


Winer N, Tsasaris V. Latest development: management and treatment of preeclampsia. J Gynecol Obstet Biol Reprod (Paris) 2008;37(1):5-15.

Landau R, Irion O. Recent data on the physiopathology of preeclampsia and recommendations for treatment. Rev Med Suisse 2005;1(4):290, 292-5.

Mushambi MC, Halligan AW, Williamson K. Recent developments in the pathophysiology and management of preeclampsia. Br J Anaesth 1996;76(1):133-48.

Perry IJ, Beevers DG. The definition of preeclampsia. Br J Obstet Gynaecol 1994;101(7):587-91.

Gant NF, Cunningham FG. Management of preeclampsia. Semin Perinatol 1994;18(2):94-102.

Burrow GN, Ferris TF, editors. Medical Complications During Pregnancy. 2nd ed. Philadelphia, PA: WB Saunders Company; 1982. p. 1-36.

Justins DM. Physiological changes in pregnancy and labour. In: Churchill-Davidson HC, editor. Wylie and Churchill-Davidson's a practice of anaesthesia 5th ed. London: Lloyd Luke; 1984. p. 1013-5.

Pritchard JA, Cunningham FG, Pritchard SA. The Parkland Memorial Hospital protocol for treatment of eclampsia: evaluation of 245 cases. Am J Obstet Gynecol 1984;148(7):951-63.

Gutsche BB. Obstetric anesthesia and perinatology. In: Dripps. RD, Eckenhoff JE, Vandam LD, editors. Introduction to Anesthesia: The Principles of Safe Practice. 7th ed. Philadelphia, Pa: WB Saunders Co; 1988. p. 293-314.

Okafor UV, Ezegwui HU. Cesarean delivery in preeclampsia and seasonal variation in a tropical rainforest belt. J Postgrad Med 2010;56(1):21-3.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289(19):2560-72.

Craici I, Wagner S, Garovic VD. Preeclampsia and future cardiovascular risk: formal risk factor or failed stress test? Ther Adv Cardiovasc Dis 2008;2(4):249-59.

Chesley LC. Diagnosis of preeclampsia. Obstet Gynecol 1985;65(3):423-5.

Schwartz ML, Brenner W. Toxemia in a patient with none of the standard signs and symptoms of preeclampsia. Obstet Gynecol 1985;66(3 Suppl):19S-21S.

Thangaratinam S, Coomarasamy A, O'Mahony F, Sharp S, Zamora J, Khan KS, Ismail KM. Estimation of proteinuria as a predictor of complications of pre-eclampsia: a systematic review. BMC Med 2009;7:10.

Dewhurst SJ. Integrated Obstetrics and Gynecology. New York : WB Saunders Co; 1983. p. 259-78.

Dudley DK. Minibolus diazoxide in the management of severe hypertension in pregnancy. Am J Obstet Gynecol 1985;151(2):196-200.

Tondriaux A. Hemodynamic effects of magnesium sulphate in eclampsia. Obstet Gynecol Survey 1985;40:23-4.

Duley L, Meher S, Abalos E. Management of preeclampsia. BMJ 2006;332(7539):463-8.

Iqbal MM, Sobhan T, Ryals T. Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant. Psychiatr Serv 2002;53(1):39-49.

Zuspan FP. Problems encountered in the treatment of pregnancy-induced hypertension. A point of view. Am J Obstet Gynecol 1978;131(6):591-7.

Ekele BA, Muhammed D, Bello LN, Namadina IM. Magnesium sulphate therapy in eclampsia: the Sokoto (ultra short) regimen. BMC Res Notes 2009;2:165.

Belfort MA, Saade GR, Moise KJ Jr, Cruz A, Adam K, Kramer W, Kirshon B. Nimodipine in the management of preeclampsia: maternal and fetal effects. Am J Obstet Gynecol 1994;171(2):417-24.

Kaye AD, Riopelle JM. Intravascular fluid and electrolyte physiology. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young W, editors. Miller's Anesthesia. 7th ed. Philadelphia: Churchill Livingstone; 2010. p. 1726-32.

Belfort M, Akovic K, Anthony J, Saade G, Kirshon B,Moise K Jr. The effect of acute volume expansion and vasodilatation with verapamil on uterine and umbilical artery Doppler indices in severe preeclampsia. J Clin Ultrasound 1994;22(5):317-25.

Duley L, Meher S, Abalos E. Management of preeclampsia. BMJ 2006;332(7539):463-8.

Smith GCS, Fretts RC. Stillbirths-seminar. Lancet2007;370(9600):1715-25.

Dyer RA, Rout CC, Kruger AM, van der Vyver M, Lamacraft G, James MF. Prevention and treatment of cardiovascular instability during spinal anaesthesia for caesarean section. S Afr Med J 2004;94(5):367-72.

Ramanthan J, Sibia BM. Pathophysiology and management of preeclampsia. In: Norris MC, editor. Obstetric Anesthesia. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 1993. p. 109-24.

Okafor UV, Efetie ER, Igwe W, Okezie O. Anaesthetic management of patients with pre-eclampsia/eclampsia and perinatal outcome. J Matern Fetal Neonatal Med 2009;22(8):688-92.

Visalyaputra S, Rodanant O, Somboonviboon W,Tantivitayatan K, Thienthong S, Saengchote W. Spinal versus epidural anesthesia for cesarean delivery in severepreeclampsia: a prospective randomized, multicenter study. Anesth Analg 2005;101(3):862-8, table of contents.

Asbagh FA, Khan ZH. Hypertension in pregnancy. Canclose surveillance curtail perinatal mortality? Int J Gynaecol Obstet 1996;52(2):193-4.

Asbagh FA, Hussain Khan Z. Hypertension in pregnancy. Do these patients require preferential treatment? A studyconducted on 8473 patients in university hospital. ActaMed Iran 1995;33(1-2):39-42.

Dyer RA, Piercy JL, Reed AR, Lombard CJ, SchoemanLK, James MF. Hemodynamic changes associated withspinal anesthesia for cesarean delivery in severepreeclampsia. Anesthesiology 2008;108(5):802-11.

Kamilya G, Bharracharyya SK, Mukherji J. Changing trends in the management of eclampsia from a teaching hospital. J Indian Med Assoc 2005;103(3):132, 134-5.

Hood DD, Curry R. Spinal versus epidural anesthesia for cesarean section in severely preeclamptic patients: a retrospective survey. Anesthesiology 1999;90(5):1276-82.

Aya AG, Mangin R, Vialles N, Ferrer JM, Robert C, Ripart J, de La Coussaye JE. Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: a prospective cohort comparison. Anesth Analg 2003;97(3):867-72.

Dyer RA, Els I, Farbas J, Torr GJ, Schoeman LK, James, MF. Prospective, randomized trial comparing general with spinal anesthesia for cesarean delivery in preeclamptic patients with a nonreassuring fetal heart trace. Anesthesiology 2003;99(3):561-9; discussion 5A-6A.

Abboud T, Artal R, Sarkis F, Henriksen EH, Kammula RK. Sympathoadrenal activity, maternal, fetal, and neonatal responses after epidural anesthesia in the preeclamptic patient. Am J Obstet Gynecol1982;144(8):915-8.

Achola KJ, Jones MJ, Mitchell RW, Smith G. Effects ofbeta-adrenoceptor antagonism on the cardiovascular andcatecholamine responses to tracheal intubation. Anaesthesia 1988;43(6):433-6.

Birnbach DJ, Browen IM. Anesthesia for obstetrics. In: Miller RD, editor. Miller's Anesthesia. Philadelphia, PA: Elsevier Churchill Livingstone; 2002. p. 2211-30.

Kale SC, Mahajan RP, Jayalakshami TS, Raghavan V, Das B. Nifedipine prevents the pressor response tolaryngoscopy and tracheal intubation in patients with coronary artery disease. Anaesthesia 1988;43(6):495-7.

Jouppila P, Kirkinen P, Koivula A, Ylikorkala O. Labetalol does not alter the placental and fetal blood flowor maternal prostanoids in pre-eclampsia. Br J ObstetGynaecol 1986;93(6):543-7.

Rout CC, Rocke DA. Effects of alfentanil and fentanyl on induction of anaesthesia in patients with severepregnancy-induced hypertension. Br J Anaesth1990;65(4):468-74.

Ashton WB, James MF, Janicki P, Uys PC. Attenuation ofthe pressor response to tracheal intubation by magnesiumsulphate with and without alfentanil in hypertensiveproteinuric patients undergoing caesarean section. Br JAnaesth 1991;67(6):741-7.

Gin T, Ngan-Kee WD, Siu YK, Stuart JC, Tan PE, Lam KK. Alfentanil given immediately before the induction of anesthesia for elective cesarean delivery. Anesth Analg 2000;90(5):1167-72.

Frishman WH, Charlap S, Michelson EL. Calcium channelblockers in systemic hypertension. Am J Cardiol1986;58(1):157-60.

Norris MC, Rose JC, Dewan DM. Nifedipine or verapamil counteracts hypertension in gravid ewes. Anesthesiology 1986;65(3):254-8.

Broughton Pipkin F, Rubin PC. Pre-eclampsia: the 'diseaseof theories'. Br Med Bull 1994;50(2):381-96.

Dyer RA, Piercy JL, Reed AR. The role of the anaesthetist in the management of the pre-eclamptic patient. Curr Opin Anaesthesiol 2007;20(3):168-74.

Hussain Khan Z, Tavana NJ. The dilemma ofpreeclampsia and eclampsia: a critical look. J Iran Soc Anesth Int Care 1994;12:37-45. [Persian]

Ramanathan J, Vaddadi AK, Arheart KL. Combined spinal and epidural anesthesia with low doses of intrathecal bupivacaine in women with severe preeclampsia: a preliminary report. Reg Anesth Pain Med 2001;26(1):46-51.

Teoh WH, Sia AT. Ultra-low dose combined spinalepidural anaesthesia for Caesarean section in severe preeclampsia. Anaesthesia 2006;61(5):511-2.

How to Cite
Hussain Khan Z. Preeclampsia/Eclampsia: An Insight into the Dilemma of Treatment by the Anesthesiologist. Acta Med Iran. 49(9):564-574.