title: Spinal anesthesia-induced hypotension: a risk comparison between patients with severe preeclampsia and healthy women undergoing preterm cesarean delivery.
abstract: We previously showed that, in comparison with term healthy parturients, patients with severe preeclampsia had a less frequent incidence of spinal hypotension, which was less severe and required less ephedrine. In the present study, we hypothesized that these findings were attributable to preeclampsia-associated factors rather than to a smaller uterine mass. The incidence and severity of hypotension were compared between severe preeclamptics (n = 65) and parturients with preterm pregnancies (n = 71), undergoing spinal anesthesia for cesarean delivery (0.5% bupivacaine, sufentanil, morphine). Hypotension was defined as the need for ephedrine (systolic blood pressure <100 mm Hg in parturients with preterm fetuses or 30% decrease in mean blood pressure in both groups). Apgar scores and umbilical arterial blood pH were also studied. Neonatal and placental weights were similar between the groups. Hypotension was less frequent in preeclamptic patients than in women with preterm pregnancies (24.6% versus 40.8%, respectively, P = 0.044). Although the magnitude of the decrease in systolic, diastolic, and mean arterial blood pressure was similar between groups, preeclamptic patients required less ephedrine than women in the preterm group to restore blood pressure to baseline levels (9.8 +/- 4.6 mg versus 15.8 +/- 6.2 mg, respectively, P = 0.031). The risk of hypotension in the preeclamptic group was almost 2 times less than that in the preterm group (relative risk = 0.603; 95% confidence interval, 0.362-1.003; P = 0.044). The impact of Apgar scores was minor, and umbilical arterial blood pH was not affected. We conclude that preeclampsia-associated factors, rather than a smaller uterine mass, account for the infrequent incidence of spinal hypotension in preeclamptic patients.
authors.affiliation: Division of Anesthesiology, Pain Management, Emergency and Critical Care Medicine, University Hospital, Nîmes, France.
authors.forename: Antoine G M
authors.initials: AGM
authors.lastname: Aya
authors.forename: Nathalie
authors.initials: N
authors.lastname: Vialles
authors.forename: Issam
authors.initials: I
authors.lastname: Tanoubi
authors.forename: Roseline
authors.initials: R
authors.lastname: Mangin
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Ferrer
authors.forename: Colette
authors.initials: C
authors.lastname: Robert
authors.forename: Jacques
authors.initials: J
authors.lastname: Ripart
authors.forename: Jean-Emmanuel
authors.initials: JE
authors.lastname: de La Coussaye
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001034:Apgar Score; D001724:Birth Weight; D001794:Blood Pressure / Q000187:drug effects; D002585:Cesarean Section; D004809:Ephedrine / Q000627:therapeutic use; D005260:Female; D005312:Fetal Blood / Q000378:metabolism / Q000502:physiology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007022:Hypotension / Q000139:chemically induced* / Q000188:drug therapy; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature / Q000150:complications / Q000503:physiopathology*; D011225:Pre-Eclampsia / Q000150:complications / Q000503:physiopathology*; D011247:Pregnancy; D018570:Risk Assessment; D015145:Tocolysis; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D004809:Ephedrine