Subarachnoid Block Without Vasopressor Requirement in a Preterm Teenage Primigravida with Impending Eclampsia: A Longitudinal Observational Analytic Case Study

Abstract

Background. Neuraxial anesthesia in patients with suspected impending eclampsia requires careful hemodynamic monitoring.

Objective. To describe the perioperative course of subarachnoid block without vasopressor administration in one late-preterm teenage primigravida.

Methods. A 19-year-old primigravida at 35 weeks and 6 days presented with headache, visual symptoms, nausea, blood pressure 131/81 mmHg, and dipstick proteinuria +2. Magnesium sulfate (4 g loading dose, then 1 g/h), oral antihypertensives, and supplemental oxygen were administered. Emergency cesarean delivery was performed under subarachnoid block with 0.5% hyperbaric bupivacaine 15 mg and fentanyl 25 μg. Hemodynamic measurements were recorded at 13 perioperative milestones, with follow-up at 6 weeks.

Results. Bilateral T4 sensory block and Bromage score 3 were achieved. Intraoperative systolic blood pressure decreased from 131 to 118 mmHg (-9.92%) and MAP from 97.67 to 86.00 mmHg (-11.95%). RPP decreased from 9,956 to 8,496 bpm·mmHg (-14.66%). No vasopressors were administered. A male neonate weighing 1825 g had Apgar scores of 7, 8, and 9. Blood pressure rose to 160/89 mmHg at 4 hours postoperatively and was treated with antihypertensives. No seizures were reported. Maternal blood pressure and proteinuria had normalized at 6 weeks.

Conclusion. This case documents intraoperative hemodynamic stability without vasopressor administration. A single case cannot establish comparative safety or causality.