Spinal anesthesia for postpartum tubal ligation after pregnancy complicated by preeclampsia or gestational hypertension

Background and Objectives: The American College of Obstetricians & Gynecolo gists has opposed postpartum tubal Ligation (PPTL) in patients whose pregna ncies have been complicated by a medical. condition, including hypertension . A prospective study was conducted to assess the appropriateness of spinal anesthesia for PPTL in patients with hypertensive disorders of pregnancy. Methods: After institutional review board approval and written informed con sent, women scheduled fur PPTL were enrolled. The hypertensive group (n = 2 5) consisted of women whose pregnancies were complicated by gestational hyp ertension, preeclampsia, or chronic hypertension with superimposed preeclam psia. For: each hypertensive patient, a matched control was designated by s electing the next consenting normotensive patient scheduled for PPTL. After an intravenous bolus of lactated ringers solution 500 mL, spinal anesthesi a was induced with hyperbaric lidocaine. Hemodynamic measurements were reco rded every 2 minutes for 20 minutes after spinal injection. Ephedrine IV wa s administered far systolic blood pressure less than or equal to 90 mm T-fg . Results: The mean preoperative mean blood pressure (MAP) was 107 +/- 17 mm Hg in the hypertensive group and 85 +/- 11 mm Hg in the controls, p < .0001 . The hypertensive group sustained a more profound percentage decrease in M AP than did their control counterparts during spinal anesthesia (29% +/- 12 % v 15% +/- 8%, P < .0001). However, the lowest intraoperative MAP was simi lar in both groups. Thirty-five percent of hypertensive patients and 24% of the controls received ephedrine IV. Conclusions: PPTL during spinal anesthesia in patients whose pregnancies ha ve been complicated by hypertension had results comparable with patients wi th uncomplicated pregnancies; however, further studies are needed to ascert ain its safety.