BoardsBridgePreeclampsia with Severe Features — Anesthetic Management of Cesarean Delivery
BP control, magnesium loading, neuraxial vs GA decision, airway rescue in a vasoconstricted, edematous parturient
Pregnant patient with preeclampsia with severe features (BP ≥160/110 or end-organ damage) presenting for cesarean — control BP acutely, load with magnesium sulfate, prefer neuraxial unless airway/fetal emergency, prepare for difficult intubation and Mg-potentiated atony.
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Severe-features preeclampsia cesarean is a 4-bundle: BP, Mg, airway, hemorrhage
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Key numbers
- Severe-range BP: SBP ≥160 or DBP ≥110 sustained, treat within 30-60 min
- Magnesium sulfate: 4-6 g IV load over 15-20 min, then 1-2 g/hr maintenance
- Labetalol IV: 20 mg → 40/80/80 mg q10min, max 300 mg
- Hydralazine IV: 5-10 mg q15-20min, max 30 mg
- Therapeutic Mg level: 4-7 mEq/L; loss of DTRs heralds toxicity
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ACOG Pb222 Hypertension Pregnancy 2020 · ASA Obstetric Anesthesia 2016
Re-review cadence: 12 months from reviewed date.
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Card ID: severe-features-cesarean · Path: aba.ob.preeclampsia-hypertensive.severe-features-cesarean