Chapter 33 - Obstetrics

Abstract

Providing obstetric anesthesia care requires an understanding of the 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 is 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 is 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) recent American College of Obstetricians and Gynecologists’ (ACOG) practice bulletins, (3) current Society for Obstetric Anesthesia and Perinatology consensus statements on the anesthetic management of pregnant and postpartum women receiving thromboprophylaxis and a statement on thrombocytopenia, (4) recently updated ASA Committee on Obstetric Anesthesia statements on nitrous oxide and monitoring guidelines for neuraxial anesthesia, and (5) new 2020 advanced cardiac life support (ACLS) guidelines for neonatal resuscitation.