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.
Address reprint requests to: Robert D. Vincent, Jr, MD, Department of Anesthesiology University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216-4505.
© 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.