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It is well accepted, at the present time, that regional analgesia and anesthesia (i.e., epidural, caudal, or spinal), if properly administered and maintained and if there is no maternal hypotension, will not affect the uterine blood flow. Joupilla, Hollman, and colleagues have extensively studied, with xenon 112, the effect of regional anesthesia for labor or cesarean section on uteroplacental perfusion. 1 , 2 Healthy parturients in labor showed a 35% increase in intervillous blood flow following the administration of either 10mL of 0.25% bupivacaine or 2% chloroprocaine (Fig. 11-1). 1 In parturients with pre-eclampsia, the epidural injection of 10mL of 0.25% bupivacaine resulted in a much more significant improvement in intervillous blood flow. 2 The increase amounted to 77%.

A cesarean section is defined as the delivery of an infant through incisions in the abdominal and uterine walls.

A parturient is designated as “high risk” because of the various problems that might arise in the antenatal or peripartum periods. Anesthetic management—both in choice and technique—should be based on a thorough understanding of the physiology of pregnancy and also on the pathophysiology of the problems that made the parturients “high risk.” Any high-risk parturient can be a potential candidate for an obstetric emergency. Hence, continuous vigilance and constant communication with the obstetric team is mandatory.

A discussion of physiological adaptations of neonates at the time of delivery is important before concentrating on specific techniques of neonatal resuscitation.

Many obstetricians prefer to perform postpartum tubal ligation immediately after the delivery or before the women are discharged from the hospital. This procedure has a few distinct advantages: 1. Immediately after delivery, the uterine fundus lies between the umbilicus and symphysis pubis, so the fallopian tubes remain easily accessible. 2. Uncomplicated postpartum sterilization does not increase the hospital stay. 3. There is less medical cost.

It has been estimated that every year in the United States about 50,000 pregnant women (0.5% to 2.2%) will receive anesthesia for various surgical indications during their pregnancy. The purpose of this surgery may be (1) to prolong gestation, (2) unrelated to the pregnancy, or (3) to correct fetal anomalies. Hence, an appreciation of the effects of different anesthetic drugs and techniques in such situations is essential in the care of these women. Recently, a question of preoperative pregnancy testing in adolescents has been raised. The authors observed retrospectively 412 adolescent women undergoing surgery. The overall incidence of positive testing was 1.2%. The authors concluded that mandatory pregnancy testing is advisable in all adolescent, surgical candidates aged 15 years and older. 1 However, compulsory pregnancy testing is not practiced in all hospitals; a hospital policy should be established after a discussion with the obstetric as well as anesthesia divisions.

Recent improvement in scientific knowledge and biochemical technology has increased the success rate of in vitro fertilization.

Maternal mortality and morbidity have always been important matters for discussion in obstetric anesthesia. Confidential inquires into maternal mortality in England and Wales have been used for international comparison because of strict record keeping. 1 However, in recent past several important statistics regarding maternal mortality and morbidity have been published in the American literature. 2 – 5