Vaginal delivery

Epidural analgesia can be offered if available in pre-eclampsia and can be beneficial in BP control.

Platelet count should be >100 before epidural is considered.

Extreme caution should be exercised in the use of ergometrine for the 3rd stage.

Operative delivery is indicated if BP remains high to minimize length of second stage.

Caesarean section - spinal anaesthetic

Regional blockade is preferred and related severe hypotension is uncommon.

Careful BP measurement is required.

Platelets should be >75 with normal coagulation studies.

Careful use of vasopressors due to exaggerated hypertensive response.

Avoid ergometrine to minimize increase in BP.

Caesarean section - general anaesthetic

If GA is unavoidable, intubation can be obtunded with:

• Intravenous labetolol
• Short-acting opioids
• Bolus of MgS04 (if not already on infusion)

Airway may be more difficult due to laryngeal oedema (small ETT).

Ketamine anaesthesia may worsen hypertension.

MgS04 and antihypertensive infusions need to be continued.

Fluid restriction (85 ml/hr)