A 13-Year Review of Eclampsia and Anesthetic Techniques at a Single Tertiary Care Center

Abstract

Objective: To assess recent perinatal outcomes of women with eclampsia in relation with the choices of anesthesia. Materials and Methods: The electronic medical records of women with eclampsia that delivered at a single tertiary care center between January 2005 and December 2017 were retrospectively reviewed. Anesthesiologists had the discretion to decide the choice of anesthesia for cesarean delivery. Results: The authors identified 45 eclampsia cases from 113,914 deliveries during the study period. The mean ± standard deviation (SD) of maternal age and gestational age at delivery of the cases was 24.4±8.5 years and 35.4±3.0 weeks, respectively, and 32 (71.1%) were primigravids. There were 29 (64.4%), eight (17.8%), and eight (17.8%) eclampsia cases that occurred antepartum, intrapartum, and postpartum, respectively. Out of the cohort, 35 (77.8%) underwent Cesarean delivery, of which 18 (51.4%) and 17 (48.6%) received general anesthesia or combined, and regional anesthesia, respectively. There was one (2.2%) maternal and three (6.67%) neonatal deaths. The general anesthesia group had a higher incidence of platelets of less than 100,000/mL and higher admission to the intensive care unit (p<0.05). Conclusion: Eclampsia remains a cause of serious perinatal morbidity. Most eclampsia occurred without prior risks, warning signs, or a critically high blood pressure. With proper patient selection and individualization, general or regional anesthesia is safe. The higher intensive care unit admissions were likely attributable to severe sequelae of eclampsia in those that underwent a general anesthesia. Keywords: Eclampsia, General anesthesia, Spinal anesthesia, Epidural anesthesia, Perinatal outcomes