Preeclampsia is a multisystem, highly variable disorder unique to pregnancy that typically occurs after 20 weeks of gestation and associated with significant maternal and neonatal morbidity and mortality worldwide (1–3). Maternal and neonatal mortality related to Preeclampsia is due to problems with cardiovascular, acute liver injury, hypoplacental perfusion, thrombocytopenia, and neurologic sequelae (4–10).
Several risk factors are mentioned in different works of literature including but not limited to chronic hypertension, diabetes mellitus, obesity, history of preeclampsia, primi-gravida, renal disease, autoimmune disease, older maternal age, multiple pregnancy, infection, genetic factors, and high altitude. However, studies revealed that smoking showed a protective effect in preeclampsia(5, 11).
Evidence showed that preeclampsia is associated with several maternal catastrophic problems in later life which include, ischemic heart disease, type 2 diabetes mellitus hypertension, and thromboembolism events. Besides, preeclampsia caused intrauterine retardation and preterm delivery which is associated with higher rates of infant respiratory distress syndrome, sepsis, broncho-pulmonary dysplasia, and neurodevelopmental disability in childhood (2, 5, 12, 13).
Despite a tremendous effort made by World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), World Bank Group, the United Nations Population Division (UNPD) and other stakeholders strived to achieve the Millennium Development goals(14); the maternal and neonatal mortality is still very high(4, 15–23).
It is estimated that the global maternal mortality by the year 2015 was more than 303,000, and low and middle-income countries accounted for approximately 99% of the global maternal deaths. The sub-Saharan Africa countries alone accounting for 66% (201 0000 while the Southern Asia region accounted for 66 000 maternal mortality in 2015(14).
More than 300, 000 mothers lost their lives worldwide due to pregnancy and pregnancy-related problems every year, and 99% (302,000) of them are from low and middle-income countries(24). Preeclampsia is the second leading cause of maternal mortality which accounted for 10%-15% of maternal and neonatal death and 15% of preterm deliveries worldwide, and the majority of deaths were from low and middle-income countries (4, 7, 17, 25–27).
A systematic review and meta-analysis showed that the global incidence of preeclampsia was 4.6%, and European, American, and African regions accounted for 17%, 9%, and 4% respectively(17).
A World Health Organization systematic analysis revealed that preeclampsia is the second cause of maternal death following hemorrhage accounted for 14% (343, 000) of global maternal death. It is the major cause of maternal death in developed regions counted for 12.9%( 19000) maternal death while Sub-Saharan Africa, Asia, and Latin America accounted for more than fifty percent of maternal mortality associated with hypertensive disorder of pregnancy(23).
A systematic review by Sobhy et al including 44 studies from low and middle-income countries showed that the risk of death from anesthesia in women undergoing obstetric procedures was
1.2 Per 1000 women who are responsible for 2·8% of all maternal deaths(4).
Management of preeclampsia is very challenging for anesthetists due to the heterogeneous clinical spectrum of the disease characterized by hypertension, intravascular dehydration, risk of hypotension, thrombocytopenia, acute liver injury, high risk of aspiration and difficult airway (17, 28–30).
Recent evidence showed that spinal anesthesia is associated with better maternal and neonatal outcomes as compared to general anesthesia (31–38). However, spinal anesthesia is associated with hypotension, nausea and vomiting, and cardiac arrest (39–43).
Observational studies showed that the hemodynamic impacts of spinal anesthesia are well tolerated in preeclamptic parturient as compared to none preeclamptic parturient (32, 35–38, 44). However, the body of evidence is still in demand on maternal and neonatal effects of spinal anesthesia in the preeclamptic parturient. Therefore, this systematic review and Meta-Analysis is intended to provide evidence on maternal and neonatal outcomes of preeclamptic parturient that underwent cesarean section under spinal anesthesia.