A comparison of haemodynamic changes under subarachnoid blockade in pre-eclampsia and normal parturients during caesarean section

Background: Preeclampsia poses significant maternal and fetal risks during cesarean delivery due to hypertension and hemodynamic instability. Due to rapid and minimal airway complications, Subarachnoid blockade (SAB) is preferred over general anesthesia. Interestingly, preeclamptic parturients often demonstrate more stable blood pressure and require fewer vasopressors compared to normotensive women under SAB. Understanding these hemodynamic differences is crucial for optimizing anesthetic management and improving maternal and neonatal outcomes. Therefore, this study aimed to compare the hemodynamic changes under subarachnoid blockade in preeclamptic and normotensive parturients undergoing cesarean section. Methodology: In this study, Sixty parturients scheduled for elective cesarean section were randomly allocated into normal (n=30) and preeclamptic (n=30) groups. All received spinal anaesthesia with 10 mg 0.5% hyperbaric bupivacaine at L3-L4, preloaded with 10 ml/kg normal saline. Hemodynamics were monitored intraoperatively, hypotension treated with mephentermine, and neonatal outcomes assessed using APGAR scores at 1 and 5 minutes. Results: “Preeclamptic parturients were older (31.8±2.1 vs 25.4±3.3 years) and had higher baseline SBP (149.2±4.9 vs 117.2±10.4 mmHg). They experienced less hypotension following spinal anesthesia (lowest MAP 88.6±5.8 vs 73.6±5.8 mmHg) and required no vasopressors, while neonatal APGAR scores were slightly lower but remained within clinically acceptable limits (1 min 7.0±0.37 vs 8.17±0.38; 5 min 8.87±0.35 vs 9.17±0.38).” Conclusion: Subarachnoid block in preeclamptic parturients provides better perioperative hemodynamic stability with less hypotension and reduced vasopressor requirement compared to normotensive parturients. With appropriate monitoring and fluid management, spinal anesthesia is a safe and effective technique for cesarean section in preeclampsia.