Type of obstetric anesthesia administered and complications in women with preeclampsia in low- and middle-income countries: A systematic review

ABSTRACT

Background: Delivery is often expedited with cesarean section, necessitating anesthesia, to prevent complications in women with preeclampsia. Anesthesia-associated risks in these women from low- and middle-income countries (LMICs) are not known.

Methods: We searched major databases (until February 2017) for studies on general vs. regional anesthesia in women with preeclampsia. We summarized the association between outcomes and type of anesthesia using a random effects model and reported as odds ratio (OR) with 95% confidence intervals (95% CIs).

Findings: We included 14 studies (10,411 pregnancies). General anesthesia was associated with an increase in the odds of maternal death sevenfold (OR 7.70, 95% CI 1.9 to 31.0, I² = 58%) than regional anesthesia. The odds of pulmonary edema (OR 5.16, 95% CI 2.5 to 10.4, I² = 0%), maternal intensive care unit admissions (OR 16.25, 95% CI 9.0 to 29.5, I² = 65%), and perinatal death (OR 3.01, 95% CI 1.4 to 6.5, I² = 56%) were increased with general vs. regional anesthesia.

Conclusion: General anesthesia is associated with increased complications in women with preeclampsia undergoing cesarean section in LMIC.

KEYWORDS:

• Preeclampsia
• anesthesia
• maternal mortality

Declaration of interest

No potential conflict of interest was reported by the authors. The authors alone are responsible for the content and writing of the paper.

Funding

Ammalife Charity (Registered UK Charity: 1120236) and ELLY Appeal, Bart’s Charity (Registered UK Charity: 212563).

Additional information

Notes on contributors

Soha Sobhy

SS and ST were involved in the conception of the research question and designed the protocol. SS and KD undertook literature search, study selection, and data extraction with the help of ST. JZ and DA helped with statistical analysis. SS designed the tables, figures, and appendices, with input from ST. JN provided expert anesthetic advice. SS prepared the initial drafts of the manuscript, with additional input from ST, JN, and RN. All authors contributed to the drafts and final version of the manuscript.