Labour analgesia in pre-eclampsia: the current perspectives

ABSTRACT

Pre-eclampsia is a disease of pregnancy involving various systems with associated high blood pressure and other changes. The pathophysiology of this disease is not well known but the main pathological change is vasoconstriction in the vascular bed of the parturient with abnormalities in the uteroplacental circulation. A multi-disciplinary approach is essential for proper management of this disease. The provision of analgesia during labor significantly reduces the stress response and thus is helpful in reducing the elevated blood pressure and also exerts beneficial effects on uteroplacental perfusion. The neuraxial analgesia technique is considered to be the gold standard and has been found to be effective and safe in pre-eclamptic parturients. The use of lower concentrations of local anesthetic drugs in combination with opioids results in less motor blockade, lesser dose of drugs and lesser incidence of significant side-effects. The patient-controlled epidural analgesia technique is very beneficial with excellent maternal satisfaction. The concern of coagulation abnormalities associated with pre-eclampsia should be kept in mind with the institution of neuraxial techniques with careful monitoring of neurological status. The reduction in stress response with consequent reduction in blood pressure in pre-eclamptic parturient is highly desirable irrespective of the technique of analgesia used