Chapter 33 - Obstetrics

Abstract

Providing peripartum obstetric anesthesia care requires an understanding of the significant changes in organ physiology occurring during pregnancy, labor, and delivery. The clinician must simultaneously consider the care of both mother and fetus. Although the effects of obstetric analgesia and anesthesia on the fetus and neonate are typically benign, knowledge of placental physiology, fetal physiology, and drug transfer are important because there is potential for adverse effects. For many women labor results in significant pain that is dynamic and unpredictable. Neuraxial analgesia and anesthesia are widely used in obstetrics with high efficacy, but an understanding of other techniques appropriate in the peripartum period is also required. General anesthesia for cesarean delivery is typically reserved for situations where neuraxial anesthesia is contraindicated or emergent delivery is needed, but when administered unique maternal and fetal considerations are required. Preparation for effective patient care in emergent obstetric situations such as postpartum hemorrhage and fetal distress are a fundamental portion of the specialty. In addition to a broad summary of obstetric anesthesia, this chapter contains (1) reference to the 2016 American Society of Anesthesiologists obstetric anesthesia guidelines; (2) updated American College of Obstetricians and Gynecologists’ (ACOG) definitions of active labor based on modern obstetric labor curves; (3) updated criteria for preeclampsia from the ACOG Task Force on Hypertension in Pregnancy that removed the requirement of proteinuria when other end organs are affected; (4) reference to a systematic approach for classification and management of fetal heart tracings implemented for improved fetal monitoring in labor; and (5) new 2015 advanced cardiac life support (ACLS) guidelines for resuscitation in pregnancy.