Anesthesia for Obstetrical Emergencies
Pp. 149-167 (19)
Anesthesia for obstetrical emergencies presents some of the most difficult
decision making quandaries in anesthesiology due to the double considerations of both
mother and fetus. Concerns for the mother often compete with concerns for the fetus.
In the following chapter, several topics will be discussed including emergency cesarean
section in patients with comorbidities such as asthma, morbid obesity and eclampsia. A
cesarean section may have to be done without a spinal, epidural, or general anesthetic;
that is a cesarean section done using only local anesthesia. Non-hemorrhagic
emergencies during labor such as umbilical cord prolapse, breach presentation and
shoulder dystocia are elaborated. Recommendations for hemorrhage- antepartum due to
placenta previa, placental abruption, trial of labor after cesarean section, and uterine
rupture; as well as those for postpartum- hemorrhage due to placenta accreta, increta,
percreta, as well as uterine atony and uterine inversion are discussed. The pregnant
patient undergoing nonobstetrical surgery presents with other challenges that are also
addressed in the chapter.
Asthma, Breach presentation, Eclampsia, Emergency cesarean
section, Morbid obesity, Obstetrical emergencies, Placenta abruption, Placenta
accreta, Placenta increta, Placenta percreta, Placenta previa, Shoulder dystocia,
TOLAC (trial after trial of labor after cesarean section), Umbilical cord prolapse,
Uterine atony, Uterine rupture.
Johns Hopkins Medical Institution, Baltimore, MD, USA.