الفهرس 
AcknowledgementsOnly 14 pages are availabe for public view
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Abstract
Preeclampsia is a multifactorial syndrome, clinically characterized by hypertension and proteinuria after 20 weeks of pregnancy. It occurs in 3–14% of pregnancies and is responsible for 60,000 maternal deaths worldwide each year. In patients with severe preeclampsia, the risk of pulmonary edema, coagulopathy, hemorrhage, and acute kidney injury (AKI) is higher.
Among patients with severe preeclampsia, spinal anesthesia may cause a greater degree of hypotension than epidural anesthesia; however, this hypotension is typically easily treated and short lived.
Anesthetic procedures are frequent in population, with replacement with crystalloid of the duct during cesarean section under spinal anesthesia for combat hypotension and hypovolemia manifested by oliguria.
In developed countries, the incidence of AKI has increased in the latest decades, especially among women with preeclampsia. In patients with severe preeclampsia undergoing cesarean section, the incidence of AKI has been reported up to 60%, but varying according to the type of patients, definition of AKI, and intraoperative management.
Patients with severe preeclampsia may experience hemorrhagic shock due to several causes, such as placental abruption, operative blood loss, and rupture of subcapsular liver hematoma. These women require immediate resuscitative measures, including intravenous volume replacement and blood typing.
Fluid management in preeclampsia is often difficult because of a leakage of water, electrolytes, and plasma from the intravascular space, due to underlying endolethial damage. This leakage can produce significant fluid shifts into the interstitial space resulting in peripheral and/or central (pulmonary and central nervous system, CNS) edema. As fluid shifts out of the intravascular space, there is also the potential for hypovolemia.
Fluid restriction may precipitate or accentuate ischemic kidney lesions, while fluid overload may increase the hydrostatic pressure in the pulmonary capillaries, leading to PE. Therefore, fluid administration must be assessed in the context of preserving organ perfusion, while limiting or preventing pulmonary edema.
The study is aimed to compare the effect of two different protocol of fluid therapy in sever preeclamptic patients under spinal anesthesia: Hemodynamic and kidney function.
this study isa randomized control double blinded study, was carried out on 60 patients in women health hospital, faculty of medicine,AssiutUniversity, divided into 2 groups:(Group1);30 patients received 15ml/kg/h lactated Ringer (LR) intraoperative,(Group2);30 patients received 30ml/kg/h lactated Ringer (LR) intraoperative.
The main results of the study revealed that:
• both studied groups had insignificant differences as regard age (28.87 ± 5.06 vs. 27.90 ± 4.72 (years); P= 0.99), gestational age (34.40 ± 1.06 vs. 34.43 ± 0.82 (weeks); P= 0.33) and body mass index (35.09 ± 2.87 vs. 35.80 ± 2.77 (kg/m2); P= 0.89).
• both studied groups had insignificant difference as regard time from anesthesia to delivery (9.70 ± 1.08 vs. 9.60 ± 0.89 (minute); P= 0.69), time from operation to delivery (5.83 ± 1.05 vs. 5.67 ± 0.85 (minute); P= 0.42); operative time (41.20 ± 6.34 vs. 41.60 ± 5.60 (minute); P= 0.79) and blood loss (565 ± 84.23 vs. 546.67 ± 75.35 (ml); P= 0.37).