Update on Pre-eclampsia

Evaluating hemostatic thresholds for neuraxial anesthesia in adults with hemorrhagic disorders and tendencies: A scoping review

Neuraxial anesthesia can be complicated by spinal or epidural hematoma and may result in permanent neurologic injury. There is a paucity of literature characterizing this serious complication in patients with congenital and acquired hemorrhagic disorders or tendencies. The objective of this scoping review was to describe the hemostatic laboratory parameters where neuraxial anesthesia has been administered with and without spinal and epidural hematoma in patients with preexisting hemorrhagic disorders and tendencies, including immune thrombocytopenia, gestational thrombocytopenia, thrombocytopenia associated with hypertensive disorders of pregnancy, platelet function disorders, von Willebrand disease, coagulation factor deficiencies, and fibrinogen disorders. A systematic search of Ovid MEDLINE, CINAHL, Embase, Scopus, and Web of Science was performed. Two authors independently reviewed all titles, abstracts, and full texts to determine study eligibility and extract data. Qualitative synthesis of 91 studies revealed significant gaps in our understanding of the risk of spinal and epidural hematoma in patients with hemorrhagic disorders and tendencies, including few studies of males and in nonobstetric settings. Most reviewed articles were small, retrospective studies at high risk for potential bias. With such low-quality data, we were unable to provide any true estimates of the risk of spinal or epidural hematoma for these patients, nor could we attribute any specific hemostatic or laboratory values to increased risk of hematoma. There is a need both for larger and more rigorously designed and reported studies on this subject and for structured, comprehensive recommendations for safe administration and removal of neuraxial anesthesia in patients with hemorrhagic disorders and tendencies.

Lack of Association Between Periodontal Parameters and Preeclampsia

BACKGROUND

It was hypothesized that periodontal diseases may increase the risk of preeclampsia. To test this hypothesis, this study was conducted to determine the association between periodontal parameters and preeclampsia among women in the north of Jordan.

METHODS

A case-control study was conducted among women who gave birth at Princes Badea Teaching Hospital between September 2004 and May 2005. A total of 115 preeclamptic women and 230 randomly selected controls were analyzed. The number of teeth, restorations, decayed tooth surfaces, and clinical periodontal parameters were determined within 24 hours after delivery. Information regarding participants' demographics, antenatal history, and family history were collected through personal interviews.

RESULTS

After adjustment for potential confounding factors, there were no statistical differences between preeclamptic cases and normotensive controls with regard to mean periodontal probing depth, mean clinical attachment loss, mean gingival recession, mean plaque index, and mean gingival index. In addition, there were no significant differences in the percentages of sites with periodontal probing depth >/=3 or >/=4 mm, percentages of sites with clinical attachment loss >/=3 mm, number of filled surfaces, and number of missing teeth. Only the number of decayed surfaces was found to be associated with increased odds of preeclampsia (adjusted odds ratio of 1.13; 95% confidence interval of 1.02 and 1.25).

CONCLUSION

This study did not support the hypothesis of an association between periodontal parameters and preeclampsia.

Regional Anaesthesia in Pre-eclampsia

Pre-eclampsia is a multisystemic disorder that is characterised by endothelial cell dysfunction as a consequence of abnormal genetic and immunological mechanisms. Despite active research for years, the exact aetiology of this potentially fatal disorder remains unknown. Although understanding of the pathophysiology of pre-eclampsia has improved, management has not changed significantly over the years. Anaesthetic management of these patients remains a challenge. Although general anaesthesia can be used safely in pre-eclamptic women, it is fraught with greater maternal morbidity and mortality. Currently, the safety of regional anaesthesia techniques is well established and they can provide better obstetrical outcome when chosen properly. Thus, regional anaesthesia is extensively used for the management of pain and labour in women with pre-eclampsia. This article highlights the advantages and disadvantages of regional anaesthetic techniques including epidural, spinal and combined spinal-epidural analgesia, used as a part of the management of pre-eclampsia. The problems associated with general anaesthesia and controversies in relation to obstetric regional anaesthesia are discussed.