Clinical evaluation of anesthesia for cesarean section of the patients with hypertensive disorders in pregnancy: retrospective study for 10 years

Bang, Eun Chi; Lee, Hyun Sook; Kang, Yong In; Cho, Kyung Sook; Kim, Su Yeon; Kim, Jun Young

Clinical Research

Obstetric Anesthesia

Anesthesia and Pain Medicine 2009;4(4):341-347.
Published online October 31, 2009.

Clinical evaluation of anesthesia for cesarean section of the patients with hypertensive disorders in pregnancy: retrospective study for 10 years

Eun Chi Bang, Hyun Sook Lee, Yong In Kang, Kyung Sook Cho, Su Yeon Kim, Jun Young Kim

Department of Anesthesiology and Pain Medicine, College of Medicine, CHA University, Seoul, Korea. ecbang63@hanmail.net

Abstract

BACKGROUND
There are many difficulties in anesthetic management for cesarean section of the patients with hypertension.The anesthetic management of hypertensive disorders in pregnancy has been controversial. METHODS: We reviewed the medical records of the patients with hypertensive disorders in pregnancy from Jan., 1998 to Dec., 2007, and made clinical analysis of the anesthesia for cesarean section. RESULTS: Of the total 775 parturients with hypertensive disorders, 638 (82.3%) was delivered by cesarean section.Indications for cesarean section were, in order of frequency, hypertensive disorders in pregnancy (36.9%), multiple pregnancy (13.8%), previous cesarean section (11.6%), etc.Of the total cesarean section, 468 (73.4%) were emergency cases.The majority of preoperative systolic blood pressures were 141-160 mmHg (36.2%) and 161-180 mmHg (35.2%). The majority of preoperative diastolic blood pressures were 91-100 mmHg (28.6%) and 101-110 mmHg (25.0%). 350 (54.9%) had epidural anesthesia, 195 (30.5%) had general anesthesia, and 93 (14.6%) had spinal anesthesia.Estimated blood loss was significantly lower after regional anesthesia than after general anesthesia.In patients received magnesium sulfate (MgSO4), (40.0% of total) 83.5% had regional anesthesia and 16.5% had general anesthesia.In the cases with MgSO4 1 min Apgar score was lower and neonatal birth weight was smaller than in cases without MgSO4. CONCLUSIONS: Anesthesiologist must have much attention on the prevention, treatment and anesthetic management for cesarean section of patients with hypertensive disorders in pregnancy.

Key Words: Cesarean section, Epidural anesthesia, General anesthesia, Hypertensive disorders in pregnancy, Spinal anesthesia