Showing papers in "Obstetric Anesthesia Digest in 2012"

Pregnancy-related Mortality in the United States, 1998 to 2005

Abstract: OBJECTIVE:To estimate the risk of women dying from pregnancy complications in the United States and to examine the risk factors for and changes in the medical causes of these deaths.METHODS:De-identified copies of death certificates for women who died during or within 1 year of pregnancy and matchin

Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood Safer 2006-2008 A Review

Abstract: (Br J Anaesth. 2011;107(2):127–32)

A Randomized Trial of Prenatal Versus Postnatal Repair of Myelomeningocele

Abstract: *Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA; †George Washington University Biostatistics Center, Washington, DC; ‡Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD; §Vanderbilt University Medical Center, Nashville, TN; ||University of California, San Francisco, Benioff Children’s Hospital, and the USCF School of Medicine, San Francisco, CA; and ¶Columbia University College of Physicians and Surgeons, New York, NY. Copyright * 2011 by Lippincott Williams & Wilkins DOI: 10.1097/SA.0b013e318237939e

Novel Biomarkers for the Prediction of the Spontaneous Preterm Birth Phenotype: A Systematic Review and Meta-analysis

Abstract: Please cite this paper as: Conde-Agudelo A, Papageorghiou A, Kennedy S, Villar J. Novel biomarkers for the prediction of the spontaneous preterm birth phenotype: a systematic review and meta-analysis. BJOG 2011;118:1042–1054. Background Being able to predict preterm birth is important, as it may allow a high-risk population to be selected for future interventional studies and help in understanding the pathways that lead to preterm birth. Objective To investigate the accuracy of novel biomarkers to predict spontaneous preterm birth in women with singleton pregnancies and no symptoms of preterm labour. Search strategy Electronic searches in PubMed, Embase, Cinahl, Lilacs, and Medion, references of retrieved articles, and conference proceedings. No language restrictions were applied. Selection criteria Observational studies that evaluated the accuracy of biomarkers proposed in the last decade to predict spontaneous preterm birth in asymptomatic women. We excluded studies in which biomarkers were evaluated in women with preterm labour. Data collection and analysis Two reviewers independently extracted data on study characteristics, quality, and accuracy. Data were arranged in 2 × 2 contingency tables and synthesised separately for spontaneous preterm birth before 32, 34, and 37 weeks of gestation. We used bivariate meta-analysis to estimate pooled sensitivities and specificities, and calculated likelihood ratios (LRs). Main results A total of 72 studies, including 89 786 women and evaluating 30 novel biomarkers, met the inclusion criteria. Only three biomarkers (proteome profile and prolactin in cervicovaginal fluid, and matrix metalloproteinase-8 in amniotic fluid) had positive LRs > 10. However, each of these biomarkers was evaluated in only one small study. Four biomarkers had a moderate predictive accuracy (interleukin-6 and angiogenin, in amniotic fluid; human chorionic gonadotrophin and phosphorylated insulin-like growth factor binding protein-1, in cervicovaginal fluid). The remaining biomarkers had low predictive accuracies. Conclusions None of the biomarkers evaluated in this review meet the criteria to be considered a clinically useful test to predict spontaneous preterm birth. Further large, prospective cohort studies are needed to evaluate promising biomarkers such as a proteome profile in cervicovaginal fluid.

Pelvic Floor Disorders 5–10 Years After Vaginal or Cesarean Childbirth

Abstract: OBJECTIVE:To estimate differences in pelvic floor disorders by mode of delivery.METHODS:We recruited 1,011 women for a longitudinal cohort study 5–10 years after first delivery. Using hospital records, we classified each birth as: cesarean without labor, cesarean during active labor, cesarean after

Shift Work and Pregnancy Outcomes: A Systematic Review With Meta-Analysis of Currently Available Epidemiological Studies

Abstract: Background Varying work schedules are suspected of increasing risks to pregnant women and to fetal wellbeing. In particular, maternal hormonal disturbance arising from sleep deprivation or circadian rhythm disruption might impair fetal growth or lead to complications of pregnancy. Two independent meta-analyses (from 2000 and 2007) reported a small adverse effect of shift work on the risk of preterm delivery (PTD). However, these reviews were based on few high quality studies.

Association Between Thyroid Autoantibodies and Miscarriage and Preterm Birth: Meta-analysis of Evidence

Abstract: Objectives To evaluate the association between thyroid autoantibodies and miscarriage and preterm birth in women with normal thyroid function. To assess the effect of treatment with levothyroxine on pregnancy outcomes in this group of women. Design Systematic review and meta-analysis. Data sources Medline, Embase, Cochrane Library, and SCISEARCH (inception-2011) without any language restrictions. We used a combination of key words to generate two subsets of citations, one indexing thyroid autoantibodies and the other indexing the outcomes of miscarriage and preterm birth. Study selection Studies that evaluated the association between thyroid autoantibodies and pregnancy outcomes were selected in a two stage process. Two reviewers selected studies that met the predefined and explicit criteria regarding population, tests, and outcomes. Data synthesis Odds ratios from individual studies were pooled separately for cohort and case-control studies with the random effects model. Results 30 articles with 31 studies (19 cohort and 12 case-control) involving 12 126 women assessed the association between thyroid autoantibodies and miscarriage. Five studies with 12 566 women evaluated the association with preterm birth. Of the 31 studies evaluating miscarriage, 28 showed a positive association between thyroid autoantibodies and miscarriage. Meta-analysis of the cohort studies showed more than tripling in the odds of miscarriage with the presence of thyroid autoantibodies (odds ratio 3.90, 95% confidence interval 2.48 to 6.12; P Conclusion The presence of maternal thyroid autoantibodies is strongly associated with miscarriage and preterm delivery. There is evidence that treatment with levothyroxine can attenuate the risks.

Management of Asthma in Pregnancy Guided by Measurement of Fraction of Exhaled Nitric Oxide: A Double-blind, Randomized Controlled Trial

Abstract: only when there was no active management of asthma. Maternal asthma was also associated with a significantly increased risk of preterm labor (RR 1.71). Again, this increased risk was found to be significant only for the studies in which active management was not used. Women with asthma did have a significantly increased risk of developing preeclampsia (RR 1.54), which was not affected by whether active management of asthma was provided. In summary, this meta-analysis did find that pregnant women with asthma are at significantly increased risk for adverse perinatal outcomes, including small-for-gestational age infants, low birthweight, preterm labor and delivery, and preeclampsia. Women with asthma should have the condition monitored at least monthly during pregnancy. Active management of asthma is beneficial since it can decrease the risks of preterm labor and delivery. Optimal management strategies for asthma control during pregnancy have not been well defined, however. Future studies are needed to determine the best treatments for parturients to prevent exacerbations and reduce perinatal complications. Clearly, careful monitoring of the asthmatic parturient and her fetus is indicated throughout pregnancy.

Association of Epidural-related Fever and Noninfectious Inflammation in Term Labor

Abstract: OBJECTIVE:To investigate the role of infection and noninfectious inflammation in epidural analgesia-related fever.METHODS:This was an observational analysis of placental cultures and serum admission and postpartum cytokine levels obtained from 200 women at low risk recruited during the prenatal peri

Maternal Insulin Resistance and Preeclampsia

Abstract: Objective The purpose of this study was to determine whether mid-trimester insulin resistance is associated with subsequent preeclampsia. Study Design This was a secondary analysis of 10,154 nulliparous women who received vitamin C and E or placebo daily from 9-16 weeks gestation until delivery. Of these, 1187 women had fasting plasma glucose and insulin tested between 22 and 26 weeks gestation. Insulin resistance was calculated by the homeostasis model assessment of insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index. Results Obese women were twice as likely to have a HOMA-IR result of ≥75th percentile. Hispanic and African American women had a higher percentage at ≥75th percentile for HOMA-IR than white women (42.2%, 27.2%, and 16.9%, respectively; P Conclusion Midtrimester maternal insulin resistance is associated with subsequent preeclampsia.

Perinatal Morbidity Associated With Late Preterm Deliveries Compared With Deliveries Between 37 and 40 Weeks of Gestation

Abstract: In 2006, late preterm births (delivery at 34 to 36wk gestation) accounted for >70% of all preterm births and B10% of all infant deaths in the United States. Since 1990, late preterm delivery has increased by 25% and accounts for a significant portion of the overall rise in the preterm birth rate. Late preterm neonates are at increased risk of morbidity and mortality. This population-based, retrospective cohort study of all low-risk, singleton liveborn deliveries in the United States in 2005 was performed to explore the association between late preterm births and perinatal outcome by gestational age. Based on data from the Vital Statistics Natality birth certificate registry provided by the Center for Disease Control, the gestational age at delivery was grouped into 34, 35, and 36 completed weeks of gestation; infants delivered between 37 and 40 weeks were considered the reference group. Maternal and neonatal outcomes in these groups were compared using the w test and multivariable logistic regression models. Main outcome measures were 5-min Apgar scores, hyaline membrane disease, neonatal sepsis/antibiotic use, and neonatal intensive care unit admission. The study population included 3,167,615 live singleton births delivered between 34 and 40 weeks gestation. Of these, 175,112 neonates were born between 34 and 36 weeks gestation: 23,574 delivered at 34 weeks, 44,705 at 35 weeks, and 106,833 at 36 weeks; 2,992,503 delivered between 37 and 40 weeks gestation. Primary cesarean delivery rates for women at 34, 35, 36, and 37 to 40 weeks gestation were 24.6%, 19.9%, 17.0%, and 14.3%, respectively. The respective operative vaginal delivery rates were 2.16%, 3.01%, 3.55%, and 4.67%. Women were more likely to receive antenatal corticosteroids and tocolysis at 34 weeks than at 37 weeks although the frequency of both therapies was low even at 34 weeks (6.42 % and 5.2%, respectively). A 5-min Apgar score of <7 was recorded in 3.42%, 2.20%, 1.54%, and 0.65% of infants born at 34, 35, 36, and 37 or >37 weeks gestation, respectively; a 5-min Apgar score of <4 was reported in 1.47%, 0.92%, 0.51%, and 0.18% of infants, respectively. Hyaline membrane disease occurred in 3.93%, 2.53%, 1.26%, and 0.17% of infants born at 34, 35, 36, and 37 to 40 weeks, respectively. Mechanical ventilation lasting >6 hours was necessary in 5.76%, 3.14%, 1.49%, and 0.31% of infants at 34, 35, 36, and 37 or >37 weeks, respectively. Surfactant and antibiotics were administered in 1.98% and 10.8%, respectively, of those delivered at 34 weeks, 0.96% and 6.36% at 35 weeks, 0.34% and 3.22% at 36 weeks, and 0.04% and 0.97% at 37 to 40 weeks. Neonatal seizures occurred in 0.09%, 0.08%, 0.06%, and 0.03% of infants born at 34, 35, 36, and 37 or >37 weeks. Neonatal intensive care unit admission rates were, respectively, 47.0%, 24.3%, 11.0%, and 2.49% for infants born at 34, 35, 36, and 37 to 40 weeks gestation. Neonates delivered vaginally had higher risks of low 5-min Apgar scores, hyaline membrane disease, and need for mechanical ventilation when delivered at late preterm gestation compared with term delivery. Similar associations were noted for late preterm infants delivered by cesarean section. Although the risk of perinatal morbidity decreases with increasing gestational age, it is still significant at 34 to 36 weeks gestation. Late preterm neonates are not as physiologically mature as term infants and should not be considered as such. Efforts must continue to prevent preterm deliveries, even those occurring at 34 to 36 weeks gestation. Women should be counseled about the risks associated with late preterm births.

The Effect of Maternal Obesity on the Rate of Failed Induction of Labor

Abstract: Objective The purpose of this study was to quantify the relationship between class of obesity and rate of failed induction of labor. Study Design Using the Ohio Department of Health's birth certificate database from January 1, 2006, through December 31, 2007, we performed a population-based cohort study that compared failed induction of labor rates between obese and normal-weight women. Results The rate of induction is associated with increasing body mass index from 28% in normal-weight women to 34% in class III obese women (body mass index, ≥40 kg/m 2 ). Induction failure rates are also associated with increasing obesity class from 13% in normal-weight women to 29% in class III obese women. Women with class III obesity without a previous vaginal delivery and a macrosomic fetus had the highest rate of failed induction at 80%. Conclusion Obesity is associated with an increased risk of failed labor induction that appears to be related directly to increasing class of obesity.

A Comprehensive Obstetrics Patient Safety Program Improves Safety Climate and Culture

Abstract: Objective The purpose of this study was to determine the effect of an obstetrics patient safety program on staff safety culture. Study Design We implemented (1) obstetrics patient safety nurse, (2) protocol-based standardization of practice, (3) crew resource management training, (4) oversight by a patient safety committee, (5) 24-hour obstetrics hospitalist, and (6) an anonymous event reporting system. We administered the Safety Attitude Questionnaire on 4 occasions over 5 years (2004-2009) to all staff members that assessed teamwork and safety cultures, job satisfaction, working conditions, stress recognition, and perceptions of management. Results We observed significant improvements in the proportion of staff members with favorable perceptions of teamwork culture (39% in 2004 to 63% in 2009), safety culture (33% to 63%), job satisfaction (39% to 53%), and management (10% to 37%). Individual roles (obstetrics providers, residents, and nurses) also experienced improvements in safety and teamwork, with significantly better congruence between doctors and nurses. Conclusion Safety programs can improve workforce perceptions of safety and an improved safety climate.

Fetal Programming of Adult Disease: Implications for Prenatal Care

Abstract: The obesity epidemic, including a marked increase in the prevalence of obesity among pregnant women, represents a critical public health problem in the United States and throughout the world. Over the past two decades, it has been increasingly recognized that the risk of adult health disorders, particularly metabolic syndrome, can be markedly influenced by prenatal and infant environmental exposures (ie, developmental programming). Low birth weight, together with infant catch-up growth, is associated with a significant risk of adult obesity and cardiovascular disease, as well as adverse effects on pulmonary, renal, and cerebral function. Conversely, exposure to maternal obesity or high birth weight also represents an increased risk for childhood and adult obesity. In addition, fetal exposure to select chemicals (eg, phytoestrogens) or environmental pollutants (eg, tobacco smoke) may affect the predisposition to adult disease. Animal models have confirmed human epidemiologic findings and provided insight into putative programming mechanisms, including altered organ development, cellular signaling responses, and epigenetic modifications (ie, control of gene expression without modification of DNA sequence). Prenatal care is transitioning to incorporate goals of optimizing maternal, fetal, and neonatal health to prevent or reduce adult-onset diseases. Guidelines regarding optimal pregnancy nutrition and weight gain, management of low- and high-fetal-weight pregnancies, use of maternal glucocorticoids, and newborn feeding strategies, among others, have yet to fully integrate long-term consequences on adult health.

Incidence, Risk Factors, and Associated Complications of Eclampsia

Abstract: OBJECTIVE:To estimate trends in incidence and identify risk factors and maternal and neonatal consequences of eclampsia in Canada.METHODS:We conducted a population-based cohort study of all women and their newborns (N=1,910,729) delivered in the hospital in Canada (excluding Quebec) from 2003 to 200

Maternal Obesity and Risk of Postpartum Hemorrhage

Abstract: OBJECTIVE: To estimate whether maternal obesity was associated with an increased risk for postpartum hemorrhage more than 1,000 mL and whether there was an association between maternal obesity and ...

A Meta-analysis of Adverse Perinatal Outcomes in Women With Asthma

Abstract: Background Asthma is a common condition during pregnancy and may be associated with adverse perinatal outcomes. Objective This meta-analysis sought to establish if maternal asthma is associated with an increased risk of adverse perinatal outcomes, and to determine the size of these effects. Search strategy Electronic databases were searched for the following terms: (asthma or wheeze) and (pregnan* or perinat* or obstet*). Selection criteria Cohort studies published between 1975 and March 2009 were considered for inclusion. Studies were included if they reported at least one perinatal outcome in pregnant women with and without asthma. Data collection and analysis A total of 103 articles were identified, and of these 40 publications involving 1,637,180 subjects were included. Meta-analysis was conducted with subgroup analyses by study design and active asthma management. Main results Maternal asthma was associated with an increased risk of low birthweight (RR 1.46, 95% CI 1.22-1.75), small for gestational age (RR 1.22, 95% CI 1.14-1.31), preterm delivery (RR 1.41, 95% CI 1.22-1.61) and pre-eclampsia (RR 1.54, 95% CI 1.32-1.81). The relative risk of preterm delivery and preterm labour were reduced to non-significant levels by active asthma management (RR 1.07, 95% CI 0.91-1.26 for preterm delivery; RR 0.96, 95% CI 0.73-1.26 for preterm labour). Author's conclusions Pregnant women with asthma are at increased risk of perinatal complications, including pre-eclampsia and outcomes that affect the baby's size and timing of birth. Active asthma management with a view to reducing the exacerbation rate may be clinically useful in reducing the risk of perinatal complications, particularly preterm delivery.

Postpartum Hemorrhage Resulting From Uterine Atony After Vaginal Delivery: Factors Associated With Severity

Abstract: OBJECTIVE: To identify factors associated with severity of postpartum hemorrhage among characteristics of women and their delivery, the components of initial postpartum hemorrhage management, and the organizational characteristics of maternity units. METHODS: This population-based cohort study included women with postpartum hemorrhage due to uterine atony after vaginal delivery in 106 French hospitals between December 2004 and November 2006 (N=4,550). Severe postpartum hemorrhage was defined by a peripartum change in hemoglobin of 4 g/dL or more. A multivariable logistic model was used to identify factors independently associated with postpartum hemorrhage severity. RESULTS: Severe postpartum hemorrhage occurred in 952 women (20.9%). In women with postpartum hemorrhage, factors independently associated with severity were: primiparity; previous postpartum hemorrhage; previous cesarean delivery; cervical ripening; prolonged labor; and episiotomy; and delay in initial care for postpartum hemorrhage. Also associated with severity was 1) administration of oxytocin more than 10 minutes after postpartum hemorrhage diagnosis: 10-20 minutes after, proportion with severe postpartum hemorrhage 24.6% compared with 20.5%, adjusted OR 1.38, 95% CI 1.03-1.85; more than 20 minutes after, 31.8% compared with 20.5%, adjusted OR 1.86, CI 1.45-2.38; 2) manual examination of the uterine cavity more than 20 minutes after (proportion with severe postpartum hemorrhage 28.2% versus 20.7%, adjusted OR 1.83, 95% CI 1.42-2.35); 3) call for additional assistance more than 10 minutes after (proportion with severe postpartum hemorrhage 29.8% versus 24.8%, adjusted OR 1.61, 95% CI 1.23-2.12 for an obstetrician, and 35.1% compared with 29.9%, adjusted OR 1.51, 95% CI 1.14-2.00 for an anesthesiologist); 4) and delivery in a public non-university hospital. Epidural analgesia was found to be a protective factor against severe blood loss in women with postpartum hemorrhage. CONCLUSION: Aspects of labor, delivery, and their management; delay in initial care; and place of delivery are independent risk factors for severe blood loss in women with postpartum hemorrhage caused by atony.

Gabapentin Improves Postcesarean Delivery Pain Management: A Randomized, Placebo-controlled Trial

Abstract: BACKGROUND:Gabapentin is effective for preventing and treating acute and chronic postoperative pain; however, it has not been described for use in cesarean delivery. We hypothesized that preoperative gabapentin would reduce postcesarean delivery pain.METHODS:Women undergoing scheduled cesarean deliv

Frequency of Fetal Heart Rate Categories and Short-term Neonatal Outcome

Abstract: METHODS: This study reviewed fetal heart rate data and newborn outcomes of women in term labor in 10 hospitals over 28 months. Fetal heart rate characteristics were assessed by labor and delivery nurses, and categories were assigned by computer using definitions from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The duration of time in each category was calculated and correlated with newborn outcome.

Clinical Efficiency in a Simulated Emergency and Relationship to Team Behaviors: A Multisite Cross-sectional Study

Abstract: Effective teamwork during clinical emergencies is required for optimal outcomes for patients. Failure of a medical team in a critical situation can result in permanent patient harm and medical litigation. It is logical, therefore, that proper training in teamwork during emergencies should be a priority in reducing preventable patient harm. However, the specific aspects of teamwork that lead to effective clinical care have not been clearly identified. This cross-sectional, secondary analysis of video recordings of teams performing in a large, randomized, controlled simulation trial in southwest England explored team performance and behaviors (leadership, communication, and task allocation) that affected management of an obstetric emergency. Recruitment for the Simulation & Fire-drill Evaluation study occurred in 2004 to 2005, with 24 staff members randomly selected from each of 6 secondary and tertiary maternity units and allocated to teams of 1 senior and 1 junior doctor and 2 senior and 2 junior midwives. They participated in an obstetric emergency simulation scenario that was video recorded. A list of behaviors, derived from a 2009 literature review of teamwork studies, was used by a steering group of language/communication, psychology, and midwifery researchers; obstetricians; and a statistician to develop a practical assessment tool for teamwork. The assessment grid developed by the steering group was used by 2 independent assessors, a clinician and a language communication specialist, to evaluate specific teamwork behaviors seen in the videos. For this report, a cross-section of 114 healthcare professionals in 19 teams were analyzed from video recordings of the teams managing a simulated case of eclampsia. The “patient” simulated a 1-minute seizure, starting 60 seconds after the handover of the patient to the team, and the drill was concluded after 10 minutes. The main outcome measure was the relationship between teamwork behaviors and the time to magnesium sulfate (MgSO4) administration for seizure control and secondary prevention. A validated clinical efficiency score was used to evaluate the teamwork behaviors. The most efficient teams were more likely to recognize and state the emergency using unambiguous terminology earlier than less-efficient teams. (Two teams never stated the nature of the emergency). They also used closedloop communication (task clearly and loudly delegated, accepted, executed, and completion acknowledged). Twelve teams administered MgSO4 within the allotted 10 minutes period with a median handover-to-administration time of 415 seconds; the least efficient team did not even discuss the need for MgSO4 during the study period. The most effective teams had significantly fewer exits from the labor room compared with the other teams (median exits 3 vs. 6). A correlation was suggested between the clinical efficiency score and whether an SBAR style of communication (situation, background, assessment, and recommendation) was used during handover to the senior doctor, with the most efficient teams more likely to use SBAR. For all groups, there was a lack of explicit declaration of leadership throughout and no clear transfer of command at any point, although the senior doctor seemed to be the leader in most drills. (In 1 team, the senior physician was never called to help). Very few instances of supportive behavior or language were observed in any of the simulations. The authors concluded that there is a relationship between clinical performance and defined teamwork behaviors in a healthcare emergency. In the past, teamwork training has been based largely on opinion, not scientific evidence; however, the results of this study suggested that it is possible to analyze team behaviors using a structured and validated assessment tool. They recommended future studies be performed to determine whether these findings are relevant to real-time emergencies and generalizable to other specialties.

Maternal Morbidity in Cases of Placenta Accreta Managed by a Multidisciplinary Care Team Compared With Standard Obstetric Care

Abstract: OBJECTIVE:To compare maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team with similar cases managed by standard obstetric care.METHODS:This was a retrospective cohort study of all cases of placenta accreta identified in the State of Utah from 1996 to 2008. Cases

Comparison of Transversus Abdominis Plane Block Versus Spinal Morphine for Pain Relief After Cesarean Section

Abstract: trauma. This prospective case series reports on the use of spinal anesthesia in 12 patients with stable eclampsia. A stable eclamptic patient was defined as one who was conscious, cooperative, and responding, had no convulsive episode for the last 12 hours, exhibited no papilledema or other signs suggesting raised intracranial pressure, and was receiving magnesium sulfate and antihypertensive drugs. In addition the patient had to have no other systemic complications present, a platelet count >100 10 cells/L, and urine output >0.5mL/kg/h to be considered a stable eclamptic patient. A standardized spinal anesthesia technique was used using hyperbaric 0.5% bupivacaine 1.7mL with 25mg fentanyl. Hemodynamic parameters were monitored and recorded throughout surgery, and the level of sensory anesthesia was determined by pinprick. Hypotension was treated with intravenous fluids, Trendelenburg positioning, and vasopressors if required. Postoperatively, patients were monitored until the sensory level to pinprick had receded to T12. All patients ambulated at about 12 hours postoperatively, and the usual doses of antihypertensives and magnesium were continued. The 12 patients (mean age 24±2.76 y) had 1 to 3 episodes of seizures (8 patients had 1, 3 patients had 2, and 1 patient had 3 seizures), and the mean time elapsed since the last seizure was 19.33±6.99 hours. Mean baseline systolic and diastolic blood pressures were 151.91±15.25mm Hg and 95.33±13.68mm Hg, respectively. The mean fetal heart rate was 132±7.2bpm. All patients had a sensory level to pinprick of T5-6. Only 1 patient had a single episode of hypotension, treated with 5mg ephedrine as an intravenous bolus. No patients had seizures and none required conversion to general anesthesia. Median Apgar scores at 1 and 5 minutes were 8 and 9, respectively. In the first 48 hours after cesarean delivery, no seizures were recorded in any patient. Spinal anesthesia provides rapid onset of dense block and greater hemodynamic stability than general anesthesia. In addition, regional anesthesia in preeclamptic women has been shown to produce better neonatal outcomes than does general anesthesia. In the present study, spinal anesthesia for these 12 patients avoided the risks of general anesthesia and was not associated with any major complications.