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  • Print publication year: 2011
  • Online publication date: December 2011

Chapter 8 - Coagulation and regional anesthesia

Summary

Pre-eclampsia is a multisystem disorder unique to human pregnancy. Over the years, advances in the understanding of the pathophysiology and hemodynamics of the disease have greatly impacted its obstetrical and medical management. Considerable research into the pathophysiology of pre-eclampsia is ongoing and many areas are still debated. Increased heart rate, cardiac output, stroke volume, and left ventricular end-diastolic volume accommodates the growing metabolic needs of the pregnancy. Decreased total peripheral vascular resistance as a consequence of the presence of the low-resistance placental circulation is a physiological characteristic of a normal pregnancy. Current general consensus suggests a combined approach using clinical measurements and serum markers of placental abnormality appropriate for gestational age. Aspirin has been the most widely studied drug therapy in the prevention of pre-eclampsia. Spinal anesthesia is an acceptable option for women with severe pre-eclampsia, especially as an alternative to general anesthesia in emergency cesarean section.

Further reading

Bolton-MaggsP H B, PerryD J, ChalmersE Aet al. The rare coagulation disorders – review with guidelines for management from the United Kingdom Haemophilia Centre Doctors’ Organisation. Haemophilia 2004; 10: 593–628.
BreivikH, BangU, JalonenJet al. Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine. Acta Anesthesiol Scand 2010; 54: 16–41.
HorlockerT T, WedelD J, RowlingsonJ Cet al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med 2010; 35: 64–101.

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