Before initiation of neuraxial anesthesia, evaluation of coagulation status is recommended. Because thrombocytopenia is the most common coagulopathy in preeclampsia, a screening platelet count is recommended. Although an arbitrary platelet count of 100,000 is often suggested, the actual platelet count safe for spinal or epidural placement is unknown.
Spinal anesthesia has been controversial in patients with severe preeclampsia because of the potential risk of sudden hypotension with rapid onset of sympathetic blockade, but there is growing support for its administration for cesarean delivery. It may be preferable to general anesthesia when the patient does not have an existing epidural catheter or there is insufficient time because of nonreassuring fetal heart rate tracing.
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