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Postpartum Tubal Ligation After Pregnancy Complicated by Preeclampsia or Gestational Hypertension.

Obstetrics & Gynecology: July 1996
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Objective: To determine the anesthetic and surgical morbidity associated with postpartum tubal ligation after pregnancy complicated by pregnancy-induced hypertension.

Methods: Preoperative hemodynamic measurements, laboratory results, choice of anesthetic technique, intraoperative hemodynamic changes, and postoperative morbidity were compared in 53 women with pregnancy-induced hypertension (hypertensive group) and 53 controls who underwent postpartum tubal ligation between October 1992 and November 1995. We used a retrospective case-control design.

Results: Preoperative mean blood pressure (BP) measurements (+/- standard deviation) were greater in hypertensive women than in controls (158 +/- 22/91 +/- 12 versus 126 +/- 13/71 +/- 10 mmHg; P < .001). Among women given spinal anesthetics for tubal ligation, the minimum intraoperative systolic BP was significantly lower in controls than in hypertensive women (P < .05). However, the maximum percentage decrease in systolic BP was greater in hypertensive women than in controls (33 +/- 14 versus 22 +/- 10%; P < .05). Only one patient in each group developed intraoperative hypertension. The percentage of patients discharged later than the first postoperative day was greater in hypertensive women than in controls (23 versus 8%; P < .05).

Conclusion: The lack of profound hemodynamic responses during spinal or general anesthesia for postpartum tubal ligation supports the continued use of this procedure in selected women with pregnancy-induced hypertension.

(C) 1996 The American College of Obstetricians and Gynecologists

Postpartum tubal ligation may be considered after vaginal delivery of women with pregnancy-induced hypertension who do not have pulmonary edema, thrombocytopenia, or persistent oliguria.