Pre-eclampsia and the anaesthetist

Pre-eclampsia remains a significant problem in modern obstetrics, contributing to 1 in 4 very low birth weight babies. Between 2-4% of women will develop pre-eclampsia. Maternal and fetal morbidity and mortality remain a significant problem. Increasing understanding of the underlying pathophysiology has resulted in a more scientific approach to prophylaxis and prevention. Larger data sets are now being analysed, and the evidence concerning the role of aspirin and calcium in preventing pre-eclampsia is clearer. The role of anti-oxidants is also currently being elucidated. Oxidative stress is thought to be fundamental to the clinical disease. The ability to predict pre-eclampsia has significantly advanced with this improved knowledge, and it is likely that good predictive algorithms will soon be available in clinical practice. The role of combining good prediction with prevention has yet to be established, but has the potential to target health resources far more efficiently. Good prediction may also impact on tailoring antenatal care appropriately. Management of pre-eclampsia is empirical, preventing end-organ damage through timely delivery and control of fits and blood pressure, facilitated by appropriate surveillance. Risks of pulmonary complications can be limited through careful monitoring of fluid balance. Magnesium sulphate should be considered in pre-eclamptic women if there is a concern of seizures. Women given magnesium sulphate have a 58% lower risk of an eclamptic seizure (95% CI 0.4-0.71). Magnesium sulphate should be used in the context of severe pre-eclampsia and under the direction of a senior obstetrician.