Perioperative management for preeclampsia/eclampsia and severe hypertension?

• A. Manage BP with agents like labetalol or hydralazine, avoid hypotension spells, magnesium sulfate for seizure prophylaxis, monitor.
• B. Aggressively reduce BP to normal by any means causing placental perfusion loss.
• C. Avoid magnesium sulfate entirely.
• D. Rely only on diuretics to manage edema.

Answer: (A)

In perioperative management of preeclampsia/eclampsia with severe hypertension, the priority is to lower blood pressure safely while preserving uteroplacental perfusion and preventing seizures. The best approach uses intravenous antihypertensive agents such as labetalol or hydralazine to achieve a controlled reduction in blood pressure, avoiding rapid or excessive drops that could compromise placental blood flow. Along with blood pressure control, magnesium sulfate is given for seizure prophylaxis in severe preeclampsia and to reduce the risk of progression to eclampsia; this is a standard part of care in the perioperative setting. Throughout, careful monitoring of blood pressure, neurologic status, and respiratory function is essential, and anesthesia should maintain stable hemodynamics to avoid hypotension.

Aggressively driving blood pressure to normal by any means risks placental hypoperfusion and fetal distress. Omitting magnesium sulfate removes critical seizure protection. Relying only on diuretics to manage edema doesn’t treat the underlying pathophysiology and can worsen intravascular volume and placental perfusion.