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Spinal Anesthesia for Postpartum Tubal Ligation After Pregnancy Complicated by Preeclampsia or Gestational Hypertension
  1. Melody D. Suelto, M.D.,
  2. Robert D. Vincent, M.D.,
  3. Elaine J. Larmon, M.D.,
  4. Patricia F. Norman, M.D. and
  5. Carol F. Werhan, M.D.
  1. From the Medical University of South-Carolina (M.D.S.), Charleston, South-Carolina; the University of Alabama at Birmingham (R.D.V.), Birmingham, Alabama; and the University of Mississippi School of Medicine (J.E.L., P.F.N., C.F.W.), Jackson, Mississippi
  1. Reprint requests: Melody D. Suelto, M.D., Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, 165 Ashley Ave, Charleston, SC 29425. E-mail: suelto{at}


Background and Objectives The American College of Obstetricians & Gynecologists has opposed postpartum tubal ligation (PPTL) in patients whose pregnancies have been complicated by a medical condition, including hypertension. A prospective study was conducted to assess the appropriateness of spinal anesthesia for PPTL in patients with hypertensive disorders of pregnancy.

Methods After institutional review board approval and written informed consent, women scheduled for PPTL were enrolled. The hypertensive group (n = 25) consisted of women whose pregnancies were complicated by gestational hypertension, preeclampsia, or chronic hypertension with superimposed preeclampsia. For each hypertensive patient, a matched control was designated by selecting the next consenting normotensive patient scheduled for PPTL. After an intravenous bolus of lactated ringers solution 500 mL, spinal anesthesia was induced with hyperbaric lidocaine. Hemodynamic measurements were recorded every 2 minutes for 20 minutes after spinal injection. Ephedrine IV was administered for systolic blood pressure ≤90 mm Hg.

Results The mean preoperative mean blood pressure (MAP) was 107 ± 17 mm Hg in the hypertensive group and 85 ± 11 mm Hg in the controls, P < .0001. The hypertensive group sustained a more profound percentage decrease in MAP than did their control counterparts during spinal anesthesia (29% ± 12% v 15% ± 8%, P < .0001). However, the lowest intraoperative MAP was similar in both groups. Thirty-five percent of hypertensive patients and 24% of the controls received ephedrine IV.

Conclusions PPTL during spinal anesthesia in patients whose pregnancies have been complicated by hypertension had results comparable with patients with uncomplicated pregnancies; however, further studies are needed to ascertain its safety.

  • Anesthesia: obstetric
  • Anesthetic techniques: spinal
  • Postpartum tubal ligation
  • Preeclampsia
  • Pregnancy-induced hypertension

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