title: Epidural-associated hypotension is more common among severely preeclamptic patients in labor.
abstract: OBJECTIVE
  To determine whether severe preeclampsia is associated with increased maternal hypotension or fetal heart rate abnormalities after epidural anesthesia placement during labor.
  
  
  METHODS
  Retrospective cohort study of 100 women with severe preeclampsia and 100 normotensive controls who underwent epidural anesthesia during labor from May 2008 to July 2011. Blood pressures during 2-minute time intervals for 20 minutes postepidural were compared with baseline measurements. Fetal heart rate abnormalities and related interventions were evaluated according to study group.
  
  
  RESULTS
  Severe preeclampsia was associated with a greater percent decrease in blood pressure across all intervals and more episodes of systolic and diastolic hypotension after dosing. Severely preeclamptic women received more intravenous pressor support and developed more Category II fetal heart rate tracings, minimal variability, and late decelerations after dosing.
  
  
  CONCLUSIONS
  Severe preeclampsia is associated with more frequent hypotension, need for pressor support, and fetal heart rate abnormalities after epidural anesthesia placement during labor.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Vricella
authors.forename: Judette M
authors.initials: JM
authors.lastname: Louis
authors.forename: Brian M
authors.initials: BM
authors.lastname: Mercer
authors.forename: Norman
authors.initials: N
authors.lastname: Bolden
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000503:physiopathology; D007743:Labor, Obstetric; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy; D012189:Retrospective Studies; D012720:Severity of Illness Index