SPINAL-BLOCK CESAREAN-SECTION IN PARTURIENTS WITH PREGNANCY-INDUCED HYPERTENSION

The objective of this work was to determine whether parturients with p regnancy-induced hypertension (PIH) are at higher risk of post-spinal hypotension at caesarean section. This was an observational study of 2 4 women with PIH undergoing caesarean section under spinal analgesia w ith 0.5% hyperbaric bupivaeaine, compared with 24 matched normotensive parturients receiving a spinal block for caesarean section. The mean intraoperative systolic arterial pressure (SAP) was similar with and w ithout PIH (p=0.38), The mean percentage decrease in SAP of baseline w as more with PIH (16.2%) than in the controls (0.5%)(p<0.001). The num ber of episodes of severe hypotension (SAP decrease to less than or eq ual to 80% of baseline and < 90 mmHg)(p=0.80) as well as the magnitude (p=0.31) of severe hypotension was similar in both groups. There was no difference in the evolution of diastolic arterial pressure and mate rnal pulse rate between cases and controls. Maximum levels of upper se nsory blockade were similar. Foetal and maternal outcome was similar w ith and without PIH. The decrease in SAP is less on an absolute scale but more on a percentile basis with PIH at caesarean section under spi nal analgesia than in normotensive patients. The difference, however, is not clinically sufficient to discourage spinal analgesia for caesar ean section with a low dose ( 1.5 mi, 7.5 mg) of 0.5% hyperbaric bupiv acaine in parturients with PIH.