From the Guidelines
Lower extremity compartment syndrome in preeclampsia requires immediate surgical consultation for potential fasciotomy, as it can lead to severe complications including permanent neurovascular damage and exacerbation of multi-organ dysfunction. Preeclampsia, characterized by hypertension and often proteinuria after 20 weeks gestation, can lead to significant fluid shifts and edema, increasing the risk of compartment syndrome 1. If compartment syndrome is suspected in a preeclamptic patient, immediate blood pressure control is essential using medications like labetalol (20-80 mg IV every 10-30 minutes) or hydralazine (5-10 mg IV every 20-30 minutes) to maintain BP below 160/110 mmHg, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APHA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. Magnesium sulfate (4-6g IV loading dose followed by 1-2g/hour maintenance) should be administered to prevent seizures, as suggested by the executive summary of the workshop on preeclampsia 1. The affected limb should be elevated, and all constrictive bandages removed while awaiting surgical evaluation. Compartment pressures exceeding 30 mmHg or within 30 mmHg of diastolic pressure typically require fasciotomy. Delay in treatment can lead to permanent neurovascular damage within 6-8 hours. Definitive management of preeclampsia involves delivery of the fetus and placenta, though compartment syndrome may require immediate intervention regardless of gestational age. Close monitoring of renal function, coagulation parameters, and liver enzymes is necessary as compartment syndrome may exacerbate the multi-organ dysfunction already present in severe preeclampsia.
Some key points to consider in the management of preeclampsia and compartment syndrome include:
- The importance of immediate surgical consultation for potential fasciotomy in cases of suspected compartment syndrome
- The need for careful blood pressure control using medications like labetalol or hydralazine
- The administration of magnesium sulfate to prevent seizures
- The elevation of the affected limb and removal of constrictive bandages
- The potential for compartment syndrome to exacerbate multi-organ dysfunction in severe preeclampsia
- The importance of close monitoring of renal function, coagulation parameters, and liver enzymes.
It is also important to note that preeclampsia is a significant risk factor for future hypertension and cardiovascular disease, and that women with a history of preeclampsia should be closely monitored and managed to reduce their risk of these complications, as suggested by the peripartum management of hypertension position paper of the ESC Council on Hypertension and the European Society of Hypertension 1.
From the Research
Relationship Between Lower Extremity Compartment Syndrome and Preeclampsia
There is limited research directly linking lower extremity compartment syndrome and preeclampsia. However, some studies provide insight into the individual conditions:
- Preeclampsia is characterized by high blood pressure during pregnancy, with no cure, and is managed with medications like hydralazine, labetalol, and magnesium sulfate to slow disease progression 2, 3, 4.
- Lower extremity compartment syndrome is a condition that can arise from various etiologies, including traumatic injuries, and is difficult to diagnose due to subjective clinical signs and symptoms 5, 6.
Key Findings
- The current clinical management of preeclampsia involves medications to lower blood pressure and prevent maternal seizure, but there is no direct link to lower extremity compartment syndrome 2, 3.
- Lower extremity compartment syndrome requires immediate fasciotomy as treatment, but diagnosis can be challenging due to subjective clinical signs and symptoms 5, 6.
- There is no direct research linking the two conditions, but both can have severe consequences if not managed properly 2, 5, 3, 4, 6.