For labour induction, cervical ripening (even with an unfavourable cervix), increases the chance of vaginal delivery [384] and [385]. With severe preeclampsia, this will take more time and be less successful compared with normotensive pregnancy [386] and [387]. Neither IUGR nor oligohydramnios are contraindications

to induction [388]. Rates of vaginal delivery after induction are 6.7–10% at 24–28 weeks (suggesting advisability of Caesarean with viable fetuses), 47.5% at 28–32 weeks, 68.8% at 32–34 weeks, and 30% with birthweights <1500 g [385], [388], [389], [390] and [391]. Vaginal delivery likelihood is reduced (but still exceeds 50%) when there is increased umbilical artery resistance [392] and [393]. The following predict Caesarean delivery: absent or reversed

umbilical artery Panobinostat datasheet end-diastolic flow, abnormal BPP, and abnormal sequential changes in Doppler studies of the fetal circulation [394], [395], [396] and [397]. Preeclampsia is associated with thrombocytopoenia and coagulopathy, and active management of the third stage [398], avoiding ergometrine (ergonovine maleate), should be performed to avoid postpartum haemorrhage [399], [400], [401], [402], [403] and [404]. 1. The anaesthesiologist should be informed when a woman with preeclampsia is admitted to the delivery suite (II-3B; Low/Strong). 5. Intravenous and oral fluid intake learn more should be minimized in women with preeclampsia, to avoid pulmonary oedema (II-2B; Low/Strong). 9. Arterial line insertion may be used for continuous arterial BP monitoring when BP control is difficult or there is severe bleeding (II-3B; Very low/Strong). 12. Upon admission to delivery suite, women with preeclampsia should have a platelet count done (II-1A; ADAMTS5 Low/Strong).

Communication between caregivers is essential [2]. Early consultation (by telephone if necessary) with anaesthesia should occur, at the latest with delivery suite admission of a woman with preeclampsia. Anaesthesiologists may co-manage hypertension, maternal end-organ dysfunction, and use of medications with anaesthesia/analgesia implications. Early placement of an epidural catheter is advantageous to: (i) attenuate labour pain-induced increases in cardiac output and BP [405], [406] and [407], and in the event that either (ii) thrombocytopoenia develops or (iii) Caesarean delivery is required. Neither epidural nor combined spinal-epidural, analgesia harms the fetus [405], [408] and [409] or increases Caesarean delivery in severe preeclampsia [410] and [411]. If neuraxial analgesia and/or anaesthesia is contraindicated, intravenous opioid analgesia is a reasonable alternative; but neonatal depression may result and require naloxone [412]. For Caesarean delivery, spinal is preferred over epidural anaesthesia (unless already placed) because of its more rapid onset and smaller calibre needle [413].