Key messages

• Women with severe pre-eclampsia should be managed by a multidisciplinary team including experienced anesthetists, obstetricians, and, when appropriate, intensive care specialists.

• Treatment of severe hypertension is vital in order to avoid cerebral sequelae. The aim should be to keep mean arterial pressure below 125 mmHg or diastolic blood pressure below 110 mmHg.

• Optimal fluid management requires selective use of hemodynamic monitoring and plasma volume expansion. The use of diuretics should be limited to women with pulmonary edema.

• The value of routine seizure prophylaxis in all women with severe pre-eclampsia is unproven. If prophylaxis is deemed necessary, magnesium sulfate is the drug of choice.

• Epidural blockade is the optimal method for intrapartum analgesia and operative anesthesia. In order to avoid difficult or failed intubation, and the hypertensive response to intubation and extubation, general anesthesia should be avoided unless there is a coagulopathy.

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