Evaluation of the use of continuous lumbar epidural anesthesia for hypertensive pregnant women in labor

The use of continuous lumbar epidural anesthesia in women with pregnancy-induced hypertension remains controversial. We retrospectively reviewed the charts of 285 women with pregnancy-induced hypertension who were delivered in a 2-year period. Among 185 vaginally delivered patients who received continuous lumbar epidural or local anesthesia, there were no significant differences in the incidence of maternal hypotension, abnormal fetal heart rate tracings, low Apgar scores, or neonatal intensive care unit admissions. Of 100 patients delivered by cesarean section, the incidence of low Apgar scores, depressed umbilical cord pH values, and neonatal intensive care unit admission was increased among those who received general anesthesia (p < 0.05).. However, general anesthesia patients were more likely to have abnormal fetal heart rate tracings (27% versus 4%) requiring urgent delivery. Thus differences in outcome probably reflect poorer fetal condition prior to anesthesia induction rather than a specific anesthetic effect. These results demonstrate that continuous lumbar epidural anesthesia is safe and effective for both the fetus and the mother with pregnancy-induced hypertension.