Contributors <br>About the editors <br>Preface <br><br>1. Physiological maternal adaptive changes during pregnancy, e.g., alterations of endometrium and decidua, menstruation, placenta, fetal membranes, placental hormones, morphological and functional fetal development<br>Amber N. Edinoff, Brooke Williams, Layne Landry, Elyse M. Cornett and Alan David Kaye<br><br>1. Introduction <br>2. Estrogen and progesterone in pregnancy <br>2.1 Progesterone <br>2.2 Estrogen <br>2.3 Decidualization <br>3. Physical changes in pregnancy <br>3.1 Cardiovascular system <br>3.2 GI system <br>3.3 Respiratory system <br>3.4 Skin <br>3.5 Sensory <br>3.6 Hematology <br>4. Pharmacologic changes in pregnancy <br>4.1 Absorption <br>4.2 Distribution <br>4.3 Metabolism <br>4.4 Elimination <br>5. Issues arising from the physiologic changes of pregnancy <br>5.1 Hypertensive disorders of pregnancy <br>5.2 Peripartum cardiomyopathy <br>5.3 Pulmonary changes in pregnancy <br>5.4 Postpartum depression <br>6. Conclusion<br>References<br><br>2. Anatomy of the reproductive tract: The placenta, uteroplacental circulation, anatomy, transfer of drugs, and respiratory gas exchange<br>Jessica Galey, Amy Zheng and Shobana Bharadwaj<br><br>1. Anatomy of the female reproductive tract<br>1.1 Organs<br>1.2 Innervation <br>1.3 Blood flow<br>1.4 Uterine blood flow changes during pregnancy <br>2. Anatomy of the placenta<br>2.1 Embryology<br>2.2 Macroscopic anatomy<br>2.3 Maternal vasculature<br>2.4 Fetoplacental vasculature<br>3. Placental physiology<br>3.1 Oxygen transfer<br>3.2 Carbon dioxide transfer <br>3.3 Acid base<br>3.4 Placental drug transfer<br>3.5 Common drugs used during pregnancy<br>3.6 Anesthetic drugs and placental transfer<br>4. Conclusion<br><br>3. Uterine blood flow and the effects of obstetric anesthesia<br>John Pallan, Amy Zheng, Jessica Galey and Shobana Bharadwaj<br><br>1. Introduction<br>2. Anatomy<br>3. Uteroplacental blood flow<br>4. Response to vasoactive agents<br>5. Mechanisms of changes<br>6. Determinants of uterine blood flow<br>7. Measuring uterine blood flow<br>8. Regional anesthesia and uterine blood flow<br>9. Doppler ultrasonography and uterine blood flow<br>10. General anesthesia and uterine blood flow<br>11. Effects of obstetric drugs<br>12. Conclusion<br><br>4. Perinatal pharmacology<br>Rucha Kelkar, Alina Smoleva, Therese Larson, Sahar Shekoohi and Alan David Kaye<br><br>1. Definition, background<br>2. Maternal factors<br>3. Placental factors<br>4. Basic fetal pathophysiology and risk factors<br>5. Fetal drug uptake, distribution, metabolism, and excretion<br>6. Related issues, historical trends<br>References<br><br>5. Parturient anesthesia assessment and evaluation<br>Hrayr Ghazaryan, Artush Grigoryan and Lincoln Frederick Arbogast<br><br>1. Introduction<br>2. History of anesthesia in obstetrics<br>3. Physiological changes in pregnancy<br>3.1 Cardiovascular<br>3.2 Respiratory<br>3.3 Gastrointestinal<br>3.4 Urinary<br>3.5 Endocrine<br>3.6 Hematologic <br>3.7 Coagulation<br>4. Preanesthesia evaluation of parturients<br>4.1 Past surgical history and anesthetic history<br>4.2 Past obstetric history<br>4.3 Past medical history<br>4.4 Physical examination<br>5. Evaluation of parturient with systemic disease<br>5.1 Cardiovascular diseases <br>5.2 Respiratory diseases <br>5.3 Anemias <br>5.4 Coagulation disorders <br>6. Endocrine diseases <br>6.1 Diabetes mellitus <br>6.2 Hyperthyroidism <br>6.3 Musculoskeletal disorders <br>6.4 Renal diseases<br>6.5 Liver diseases<br>7. Conclusion <br>References<br><br>6. How to create and maintain a safe and an efficient obstetric anesthesia practice<br>Anjum Anwar, Huma Wali and Hina Shamim<br><br>1. Introduction<br>2. Maternal care framework in the United States<br>3. Preanesthesia evaluation for obstetric patients <br>3.1 Background <br>4. Current state of affairs and challenges <br>4.1 Recommendations <br>5. Telemedicine <br>6. Patient education <br>7. Intrapartum care for parturient <br>7.1 Introduction <br>8. Challenges and recommendations <br>8.1 Medication shortages <br>8.2 Staffing and training/anesthesia workforce <br>8.3 Recommendations <br>8.4 Anesthesia management of high-risk pregnancies <br>8.5 Peripartum obstetric hemorrhage <br>8.6 Concept of the pregnancy heart team and cardiac obstetrics <br>8.7 Critical care in obstetrics <br>9. Enhanced recovery after CD <br>10. Process improvement to enhance patient safety in obstetric anesthesia <br>11. Handoffs and checklists <br>12. Simulation and team working in obstetric anesthesia <br>13. Racial disparities <br>14. Strategies to improve global inequities in obstetric anesthesia <br>15. Trauma informed care in obstetrics <br>References <br><br>7. Obstetric anesthesia consultation<br>Courtney Hood, Kristen L. Fardelmann and Benjamin Cobb<br><br>1. Indications for consultation <br>2. Components of consultation <br>3. Common indications for anesthesiology consultation <br>3.1 Anticoagulation <br>4. Thrombocytopenia <br>5. Placenta accreta spectrum (PAS) <br>6. Maternal cardiovascular disease <br>6.1 Interventions/ECMO <br>7. Spinal column/cord pathology, neurologic disease <br>8. Obesity <br>9. Opioid use disorder (OUD) <br>10. History of anesthetic complications <br>11. Consultation clinics <br>12. Conclusion <br>References <br><br>8. Obstetric management of labor and delivery, including preoperative assessment and basic standards for preanesthesia care<br>Huma Wali, Haneen Alnazzawi and Anjum Anwar<br><br>1. Introduction <br>2. CVD in the pregnant patient <br>3. Pregnancy counseling risk stratification <br>4. Mode and timing of delivery <br>5. Type of hospital and location within the hospital <br>6. Peripartum plan <br>7. The difficult airway in obstetrical anesthesia assessment <br>8. Preparation for difficult airway management <br>9. Difficult airway trolley <br>10. Difficult airway management <br>11. Simulation and training <br>12. Mental health and pregnancy <br>13. Management of psychiatric patients during pregnancy <br>14. Racial disparities in maternity care <br>15. Strategies for reducing disparities <br>15.1 Implementing protocols and safety bundles <br>16. Health care professionals’ education and communication <br>17. Outcome measurement, reviews, and community partnerships <br>18. Neuroobstetrics <br>19. Antenatal period/preconception <br>20. Intrapartum <br>21. Postpartum <br>22. Multiple sclerosis <br>23. Cerebrovascular diseases in pregnancy <br>24. Role of anesthesiologist in the management of stroke <br>25. Headache during pregnancy and postpartum <br>26. Evaluation of pregnant patients with headaches <br>27. Pregnancy and hematology <br>28. Iron-deficient anemia <br>29. Coagulation disorders <br>30. Hereditary coagulation disorders <br>31. Acquired coagulation disorders <br>32. Venous thromboembolism <br>32.1 Antepartum recommendations <br>32.2 Intrapartum recommendations <br>33. Respiratory diseases in pregnancy <br>34. Asthma <br>35. Respiratory failure <br>36. Obstructive sleep apnea <br>References <br><br>9. Fetal assessment and physiology<br>Mariana Montes, Chad T. Dean and Thomas James<br><br>1. Antenatal fetal assessment <br>2. Estimating gestational age <br>3. Routine ultrasonography <br>4. Evaluating the well-being of the fetus <br>4.1 Clinical assessment <br>5. Antepartum fetal testing <br>6. Fetal development and physiology <br>7. Fetal environment <br>8. Fetal cardiovascular system <br>9. Fetal respiratory system <br>10. Fetal hematologic system <br>11. Fetal neurologic system <br>12. Transition to the extrauterine environment <br>13. Physiologic changes in postnatal life <br>13.1 Cardiovascular and respiratory changes <br>14. Thermal regulation <br>15. Postnatal fetal assessment <br>16. APGAR score and umbilical cord gas and pH <br>References <br><br>10. Opioid analgesics in labor<br>Peter Louis Kovacs, Jayanth Dasika and Venkata Satya Lakshmi Damalanka<br><br>1. Introduction<br>2. Opioids<br>2.1 Mechanism of action<br>3. Pharmacokinetics<br>3.1 Absorption<br>3.2 Distribution<br>3.3 Biotransformation<br>3.4 Excretion<br>4. Effect on organ systems<br>4.1 Cardiovascular<br>4.2 Respiratory<br>4.3 Cerebral<br>4.4 Gastrointestinal<br>5. Plan for labor analgesia<br>6. Pharmacologic options for labor analgesia<br>7. Systemic analgesics<br>7.1 Opioid analgesia<br>8. Patient-controlled analgesia<br>8.1 Remifentanil PCA<br>8.2 Fentanyl PCA<br>8.3 Intermittent bolus opioid<br>8.4 Choice of opioid<br>8.5 Butorphanol<br>8.6 Fentanyl<br>8.7 Morphine<br>8.8 Meperidine<br>9. Regional analgesia<br>9.1 Neuraxial analgesia<br>9.2 Mechanism and site of action<br>9.3 Epidural opioids<br>9.4 Intrathecal opioids<br>10. Summary and conclusion<br>References<br><br>11. Mechanisms of labor pain and anesthesia in healthy parturients<br>Justin Swengel and Patrick McConville<br><br>1. Mechanisms of labor pain and its management<br>2. Nonpharmacologic treatment of pain<br>3. Pharmacologic techniques for labor pain control<br>3.1 Inhaled agents<br>3.2 Opioids <br>3.3 Neuraxial techniques<br>References <br><br>12. Nonopioid analgesia<br>Jayanth Dasika, Peter Louis Kovacs and Venkata Satya Lakshmi Damalanka<br><br>1. Nitrous oxide<br>2. Acetaminophen and nonsteroidal antiinflammatory drugs<br>3. Sedatives and analgesic adjuncts<br>References<br><br>13. Nonpharmacologic and alternative management of labor and delivery analgesia<br>David Gutman and Michael Marotta<br><br>1. Introduction<br>2. Water immersion<br>3. Biofeedback<br>4. Hypnosis<br>5. Acupuncture<br>6. Subcutaneous of intracutaneous sterile water injection<br>7. Manual/massage/reflexology<br>8. Conclusion <br>Reference <br><br>14. Local anesthetics and adjuvants in healthy obstetric patients<br>Jeffery Cao, Munfarid Zaidi, Lee Chang, Melissa Nikolaidis and Yi Deng<br><br>1. Introduction<br>2. Lidocaine<br>2.1 Mechanism of action<br>2.2 Clinical application<br>2.3 Side-effect profile<br>3. Ropivacaine<br>3.1 Mechanism of action<br>3.2 Clinical application<br>3.3 Side-effect profile<br>4. Bupivacaine<br>4.1 Mechanism of action<br>4.2 Clinical application<br>4.3 Side-effect profile<br>5. Chloroprocaine<br>5.1 Clinical application<br>5.2 Side-effect profile<br>6. Mepivacaine<br>6.1 Clinical application<br>6.2 Side-effect profile<br>7. Local anesthetic systemic toxicity<br>8. Adjuncts in neuraxial anesthesia<br>9. Epinephrine<br>10. Bicarbonate<br>11. Clonidine<br>12. Dexmedetomidine<br>13. Neostigmine<br>14. Magnesium<br>15. Experimental adjuncts<br>16. Opioids<br>17. Conclusion<br>References<br><br>15. Epidural anatomy and epidural anesthesia for labor and cesarean delivery<br>Fatoumata Kromah and Nicholas Malki<br><br>1. Introduction <br>2. Background <br>2.1 Epidural analgesia for labor and vaginal delivery <br>2.2 Epidurals for CD <br>3. Definition of topic <br>4. Issues related to this topic <br>5. Historical evolution/trends <br>6. Pathophysiology <br>6.1 Anatomy of the epidural space <br>7. Risk factors <br>8. Patient evaluation <br>9. Diagnosis <br>9.1 Medical History <br>9.2 Coagulation Status <br>9.3 Infection Control <br>9.4 Anatomical Considerations <br>9.5 Patient Preference and Informed Consent <br>9.6 Multidisciplinary Collaboration <br>10. Treatment <br>11. Anesthetic management <br>12. Pharmacology <br>13. Clinical issues or considerations <br>14. Prevention and self-care <br>15. Global impact and challenges <br>16. Future directions, novel treatments, and research studies <br>17. Summary/conclusion <br>18. Relevant images and tables <br>Abbreviations <br>References <br>Suggested readings <br><br><br>16. Neuraxial anesthesia for vaginal delivery<br>Kristin N. Bembenick, Angela Nguyen, Corrie Jackson, Sahar Shekoohi, Aaron J. Kaye, Alan D. Kaye and Harish Siddaiah<br><br>1. Introduction <br>2. Background <br>2.1 Epidural analgesia for labor and vaginal delivery <br>2.2 Epidurals for CD <br>3. Definition of topic <br>4. Issues related to this topic <br>5. Historical evolution/trends <br>6. Pathophysiology <br>6.1 Anatomy of the epidural space <br>7. Risk factors <br>8. Patient evaluation <br>9. Diagnosis <br>9.1 Medical History <br>9.2 Coagulation Status <br>9.3 Infection Control <br>9.4 Anatomical Considerations <br>9.5 Patient Preference and Informed Consent <br>9.6 Multidisciplinary Collaboration <br>10. Treatment <br>11. Anesthetic management <br>12. Pharmacology <br>13. Clinical issues or considerations <br>14. Prevention and self-care <br>15. Global impact and challenges <br>16. Future directions, novel treatments, and research studies <br>17. Summary/conclusion <br>18. Relevant images and tables <br>Abbreviations <br>References <br>Suggested readings <br><br>17. Neuraxial analgesia for cesarean delivery<br>Andrew Jensen, Kevin Chen, Melissa Nikolaidis and Yi Deng<br><br>1. Background <br>1.1 Cesarean delivery <br>1.2 Anesthesia with cesarean delivery <br>1.3 Trends in cesarean sections <br>2. The cesarean delivery <br>2.1 Indications <br>2.2 Contraindications <br>2.3 Degree of urgency <br>2.4 Risks <br>3. Anesthetic considerations for cesarean delivery: General anesthesia <br>3.1 Airway <br>3.2 Volatile anesthetics <br>3.3 Anterograde amnesia <br>4. Anesthetic considerations for the cesarean delivery: Neuraxial approach <br>4.1 Spinal <br>4.2 Epidural <br>4.3 Combined spinal and epidural <br>5. Acquiring the neuraxial blockade <br>5.1 Anatomic landmarks <br>5.2 Epidural placement <br>5.3 Procedural steps <br>5.4 Spinal placement <br>5.5 Procedural steps <br>5.6 Combine spinal-epidural placement <br>5.7 Procedural steps <br>5.8 Settings of placement <br>6. Diagnosing the coverage of neuraxial anesthesia <br>6.1 Appropriate coverage <br>6.2 Assessment using pinprick or temperature sensation <br>7. Troubleshooting inadequate coverage of neuraxial analgesia <br>7.1 Epidural management <br>7.2 Spinal management <br>8. Side effects of effective neuraxial block <br>8.1 Hypotension <br>8.2 Nausea <br>8.3 Shivering <br>9. The awake patient <br>9.1 Communication with parturient <br>9.2 Communication with other members of the medical team <br>9.3 Patient positioning <br>10. Global impact and challenges <br>11. Future directions, novel treatments, or research studies <br>References <br>Further reading <br><br>18. General anesthesia for normal, uncomplicated cesarean delivery: Indications and strategies<br>Fatoumata Kromah<br><br>1. Introduction <br>2. Background <br>3. Definition of the topic <br>3.1 General anesthesia <br>3.2 Cesarean delivery <br>4. Issues related to GA for the CD <br>4.1 Potential risks and side effects <br>4.2 Choice of anesthetic agents <br>4.3 RA versus GA <br>5. Historical evolution/trends <br>5.1 Early developments <br>5.2 Advent of RA <br>5.3 Shift from GA to RA <br>5.4 Current practices <br>6. Pathophysiology <br>6.1 Nervous system <br>6.2 Maternal physiology <br>6.3 Fetal physiology <br>6.4 Postoperative recovery <br>7. Risk factors <br>7.1 Maternal health conditions <br>7.2 Obstetric complications <br>7.3 Fetal health concerns <br>7.4 Specific perioperative risks <br>8. Patient evaluation <br>8.1 History taking <br>8.2 Physical examination <br>8.3 Relevant investigations <br>9. Diagnosis <br>10. Treatment <br>10.1 Preoperative preparation <br>10.2 Preoxygenation and preinduction <br>10.3 Induction and intubation <br>10.4 Maintenance and emergence <br>10.5 Postoperative care <br>11. Anesthetic management <br>11.1 Preoperative preparation <br>11.2 Intraoperative management <br>11.3 Postoperative management <br>12. Pharmacology <br>13. Clinical issues or considerations <br>13.1 Urgent versus elective CD <br>13.2 Patient preference <br>13.3 General health status <br>14. Prevention and self-care <br>15. Global impact and challenges <br>16. Future directions, novel treatments, and research studies <br>16.1 Improved monitoring techniques <br>16.2 Novel anesthetic agents <br>16.3 Enhanced recovery after surgery protocols <br>16.4 Telemedicine and digital health <br>16.5 Research on long-term impacts <br>17. Summary and conclusion <br>Abbreviations <br>References <br>Additional suggested readings<br> <br>19. Airway management of the pregnant patient for labor and cesarean delivery<br>Moataz Maher Emara, Mohamed Maher Elwaraky, Laila Alhafez and Sally Hamdy Abdelaziz Ahmed<br><br>1. Incidence of GA and difficult airways in the obstetric population <br>2. Physiological changes during pregnancy: Implications on airway management <br>2.1 Respiratory parameters and gas exchange alterations <br>2.2 Airway obstruction and difficulty in intubation <br>2.3 Gastric emptying and aspiration risk <br>2.4 Pharmacological considerations <br>3. Evaluation and prediction of difficult airway <br>4. Maternal complications related to airway management <br>4.1 Aspiration pneumonitis <br>4.2 Bronchospasm <br>4.3 Post-extubation hypoventilation <br>4.4 Accidental awareness <br>5. Suggested protocol for airway management in pregnant women <br>5.1 Preparation of the parturient <br>5.2 Preparation of equipment and personnel <br>5.3 Positioning <br>5.4 Preoxygenation/apneic oxygenation <br>5.5 Rapid sequence induction <br>5.6 Induction and neuromuscular drugs <br>5.7 Cricoid pressure <br>5.8 Laryngoscopes <br>5.9 Tracheal extubation <br>6. Guidelines for difficult airway in pregnant women (UK-OAA/DAS) <br>6.1 Anticipated difficult intubation <br>6.2 Unanticipated difficult or failed intubation <br>6.3 Direct and indirect (video) laryngoscopy direct laryngoscopy <br>6.4 Obstetric Anesthetists’ Association and Difficult Airway Society guidelines <br>6.5 Other relative guidelines <br>References <br><br>20. Postoperative pain management for cesarean delivery<br>Antonio Gonzalez Fiol, P.J. McGuire, Kristen L. Fardelmann and Aymen Awad Alian<br><br>1. Acute pain after cesarean delivery <br>2. Neuraxial anesthesia and adjuvant drugs <br>2.1 Multimodal analgesia <br>2.2 Shared decision-making for pain management in the postpartum period <br>2.3 Opioid-sparing multimodal analgesia (OSMMA) <br>3. Opioid analgesics <br>4. Enhanced Recovery After Cesarean (ERAC) <br>4.1 Racial and ethnic disparities <br>5. General anesthesia <br>6. Local and regional analgesia techniques <br>7. Acute pain management for the patient with substance use disorder (SUD) <br>References <br> <br>21. Postoperative sterilization surgery and anesthesia considerations<br>Melissa Nikolaidis, Jacy Gressen, Tommy Li and Yi Deng<br><br>1. Introduction: Postpartum birth control <br>1.1 The advantages of postpartum birth control preplanning <br>2. Methods for immediate postpartum contraception <br>2.1 Reversible contraception <br>2.2 Irreversible contraception <br>3. Current policies affecting postpartum sterilization <br>4. Postpartum sterilization procedure <br>4.1 Surgical considerations <br>4.2 Anesthetic considerations <br>5. Postsurgical sterilization pain management <br>6. Chapter summary <br>References <br><br>22. Anesthesia for assisted reproductive techniques<br>Fouzia Khalid and Amber Naz<br><br>1. Introduction <br>1.1 What is assisted fertilization <br>1.2 Ovum retrieval done through <br>1.3 Sperm collection <br>1.4 Patient preparation <br>1.5 Does ART procedure need anesthesia? <br>1.6 Conscious sedation <br>2. General anesthesia <br>2.1 Propofol <br>2.2 Thiopental <br>2.3 Ketamine <br>2.4 Etomidate <br>2.5 Inhalational anesthesia <br>2.6 Benzodiazepine <br>2.7 Dexmedetomidine <br>2.8 Opioids <br>2.9 Non-opioid analgesic <br>2.10 Antiemetics <br>2.11 Neuraxial anesthesia <br>2.12 Paracervical block <br>2.13 Patient controlled analgesia <br>2.14 Newer techniques <br>2.15 Complications associated with assisted fertilization <br>2.16 Ovarian hyperstimulation syndrome <br>2.17 Ectopic pregnancy <br>2.18 Multiple gestation <br>References <br><br>23. Anesthesia considerations for pregnant patients with cardiovascular disease<br>Islam Mohammad Shehata Elsayed, Yasmeen Ahmed Mohamed Taha, Hala Mostafa Goma and Nesrine Abdel Rahman Elrefai<br><br>1. Cardiac diseases in pregnancy <br>2. Common risk factors of cardiac disease in pregnancy <br>3. Types of cardiac diseases in pregnancy <br>4. Risk classification of the patient with cardiac diseases <br>5. General considerations of cardiac parturients <br>6. Preoperative evaluation of cardiac pregnant patient <br>7. History <br>8. Preoperative clinical assessment <br>8.1 Cardiac tests during pregnancy <br>9. Preoperative considerations for specific cardiac lesions <br>9.1 Congenital heart diseases <br>9.2 Arrhythmia <br>9.3 Prosthetic heart valves <br>10. Rheumatic valvular disease <br>10.1 Mitral stenosis (MS) <br>10.2 Mitral or aortic regurgitation <br>10.3 Myocardial infarction <br>11. Peripartum cardiomyopathy <br>11.1 Cardiac tests for diagnosis of peripartum cardiomyopathy <br>12. Preoperative preparation of cesarean section <br>12.1 Monitoring for cesarean delivery <br>13. Anesthesia techniques <br>13.1 Regional anesthesia <br>14. Anticoagulant therapy considerations <br>14.1 The cardiovascular effects of regional anesthesia <br>14.2 The type and severity of cardiac illness <br>14.3 How to conduct safe neuraxial anesthesia <br>15. Postpartum care <br>16. Conclusion <br>References <br><br>24. Anesthesia considerations for pregnant patients with lung disease<br>Adam Lin Wendling and Clinton Pillow<br><br>1. Introduction <br>2. Background <br>3. Issues related to this topic <br>4. Historical evolution/trends <br>5. Pathophysiology <br>6. Risk factors <br>6.1 Preexistent pulmonary disease <br>6.2 Acquired pulmonary disease <br>7. Patient evaluation <br>7.1 History <br>7.2 Physical <br>7.3 Confirmatory tests <br>8. Diagnosis <br>8.1 Obstructive lung disease <br>8.2 Restrictive lung disease <br>8.3 Respiratory tract infections <br>8.4 ARDS <br>9. Treatment <br>9.1 Asthma <br>9.2 Cystic fibrosis <br>10. Anesthetic management <br>10.1 General principles <br>11. Global impact and challenges <br>12. Future directions, novel treatments, or research studies <br>13. Summary and conclusion <br>References <br><br>25. Anesthesia considerations for patients with renal, hematologic, connective tissue, and immunologic diseases<br>Rucha A. Kelkar, Alexandra D. Dautel, Lillian V. Lauck, Michael J. Quintana, Sahar Shekoohi and Alan David Kaye<br><br>1. Introduction <br>2. Renal considerations <br>2.1 Definition, background, related issues, historical trends <br>2.2 Pathophysiology <br>2.3 Risk factors <br>2.4 Patient evaluation, diagnosis, treatment <br>2.5 Anesthetic management, pharmacology <br>3. Hematologic considerations <br>3.1 Definition, background, related issues, historical trends <br>3.2 Pathophysiology <br>3.3 Risk factors <br>3.4 Patient evaluation, diagnosis, treatment <br>3.5 Anesthetic management, pharmacology <br>3.6 Clinical issues/considerations, prevention, self-care <br>3.7 Global impact and challenges <br>4. Connective tissue considerations <br>4.1 Definition, background, related issues, historical trends <br>4.2 Pathophysiology <br>4.3 Anesthetic management and risk management <br>4.4 Patient evaluation, clinical issues/considerations, prevention <br>5. Immunologic considerations <br>5.1 Definition, background, related issues, historical trends <br>5.2 Pathophysiology <br>5.3 Risk factors <br>5.4 Patient evaluation, diagnosis, treatment <br>5.5 Anesthetic management, pharmacology <br>5.6 Clinical issues/considerations, prevention, self-care <br>5.7 Global impact and challenges <br>6. Future directions, novel treatments, or research studies <br>7. Summary and conclusion <br>References <br><br>26. Anesthesia considerations for parturients with endocrine disorders<br>Evan Nicholas Lian, Asher Le and Aladino De Ranieri<br><br>1. Introduction <br>2. Diabetes mellitus <br>2.1 Anesthetic implications <br>3. Thyroid disease <br>3.1 Hyperthyroidism <br>3.2 Hypothyroidism <br>3.3 Temperature regulation <br>4. Pituitary disease <br>4.1 Acromegaly <br>5. Adrenal disease <br>5.1 Cushing syndrome <br>5.2 Adrenocortical insufficiency <br>5.3 Pheochromocytoma <br>References <br><br>27. Anesthetic considerations for patients with neurologic disorders in pregnancy<br>Philip Rubin and Lisa Leffert<br><br>1. Introduction <br>2. Background <br>3. Case #1 <br>3.1 Historical evolution/trends <br>3.2 Pathophysiology <br>3.3 Risk factors <br>3.4 Patient evaluation/diagnosis <br>3.5 Treatment/surgical correction <br>3.6 Impact on pregnancy <br>4. Case #2 <br>4.1 Historical evolution/trends <br>4.2 Pathophysiology <br>4.3 Risk factors <br>4.4 Treatment <br>4.5 Impact of pregnancy <br>5. Case #3 <br>5.1 Pathophysiology <br>5.2 Risk factors <br>5.3 Patient evaluation/diagnosis <br>5.4 Treatment <br>5.5 Impact on pregnancy <br>6. Case #4 <br>6.1 Historical evolution/trends <br>6.2 Pathophysiology <br>6.3 Impact on pregnancy <br>7. Conclusion <br>References <br><br>28. Anesthesia considerations for fetal growth restriction and macrosomia in pregnancy<br>Kylie Dufrene, James Ilochi, Caleigh Foto, Julia Hebert, Carlos Narvaez, Sahar Shekoohi and Alan David Kaye<br><br>1. Fetal macrosomia <br>2. Obstetric anesthesia considerations complicated by macrosomia and fetal growth restriction <br>2.1 Anesthesia considerations for a cesarean birth <br>2.2 Anesthesia considerations for conversion from vaginal to cesarean birth <br>2.3 Pregnancy complications related to fetal growth outcomes and anesthesia considerations <br>2.4 Intraoperative complications <br>2.5 Intraoperative complications associated with FGR <br>2.6 Intraoperative complications associated with macrosomia <br>3. Common intraoperative complications in both conditions <br>3.1 Blood loss and hemorrhage <br>3.2 Amniotic fluid embolism <br>3.3 Monitoring and management strategies <br>3.4 Fetal growth restriction: Definition, diagnosis, and anesthetic implications <br>3.5 Anesthetic considerations for FGR <br>3.6 Optimal timing for induction in FGR <br>3.7 Minimizing risks and enhancing safety <br>3.8 Anesthetic agent teratogenicity <br>References <br><br>29. Anesthesia considerations for pregnant patients with morbid obesity and neoplasm<br>Erica Johnson, Teshi Kaushik and Christina Faya<br><br>1. Introduction and background <br>1.1 Definition <br>2. Issues related to maternal obesity <br>3. Pathophysiology <br>3.1 Effect of obesity on the respiratory system <br>3.2 Effect of obesity on the cardiovascular system <br>3.3 Effect of obesity on the gastrointestinal system <br>4. Anesthetic management <br>4.1 Preoperative assessment <br>4.2 Preoperative counseling <br>4.3 Monitors and access <br>5. Labor analgesia <br>5.1 Equipment set up <br>5.2 Patient positioning <br>5.3 Epidural versus DPE versus CSE for labor analgesia <br>5.4 Epidural catheter dislodgement <br>5.5 Initiation of epidural analgesia-Local anesthetic pharmacology <br>6. Anesthesia for cesarean delivery <br>6.1 General considerations for anesthesia for cesarean delivery <br>7. Neuraxial anesthesia for cesarean delivery <br>7.1 Spinal anesthesia <br>7.2 Combined spinal epidural anesthesia <br>7.3 Continuous spinal anesthesia <br>7.4 Local anesthetic dosage <br>7.5 Phenylephrine dosage <br>7.6 Postdural puncture headache <br>8. General anesthesia for cesarean delivery <br>8.1 Unique challenges for general anesthesia for C-sections <br>9. Postoperative pain management <br>10. Summary and conclusion <br>10.1 Neoplasm in pregnancy <br>References <br>Further reading <br> <br>30. Anesthesia considerations for parturients with substance abuse or psychiatric disorders<br>Justin Swengel and Patrick McConville<br><br>1. Psychiatric disease and substance abuse in the parturient 313<br>2. Psychiatric diseases 313<br>3. Depression 313<br>4. Anxiety 315<br>5. Bipolar disorder 316<br>6. Schizophrenia 317<br>7. Substance use and abuse 318<br>8. Licit drugs 318<br>8.1 Tobacco 318<br>8.2 Alcohol 319<br>8.3 Caffeine 320<br>9. Illicit drugs 320<br>9.1 Marijuana 320<br>9.2 Cocaine 321<br>9.3 Amphetamines 321<br>9.4 Opioids 322<br>9.5 Hallucinogens 324<br>References 325<br>Further reading 326<br><br>31. Opioid use disorder in pregnancy<br>Sonal Zambare, Lauren Brown-Berchtold and Amy I. Lee<br><br>1. Introduction <br>2. Historical evolution and trends <br>3. Pregnancy and opioid use <br>4. Treatment of opioid use disorder <br>5. Pharmacology <br>5.1 Buprenorphine <br>5.2 Methadone <br>5.3 Naltrexone <br>6. Challenges in managing patients with an opioid use disorder <br>7. Barriers to effective analgesia <br>7.1 Antenatal considerations <br>7.2 Labor analgesia <br>7.3 Anesthesia and analgesia for cesarean delivery <br>8. Teams involved in managing patients with OUD <br>9. Neonatal effects <br>10. Breastfeeding <br>11. Conclusion <br>References <br><br>32. Anesthesia considerations for patients with renal, hematologic, connective tissue, and immunologic diseases<br>Adam Lin Wendling and Seth Garrett<br><br>1. Introduction <br>2. Issues related to this topic <br>2.1 Renal disease <br>2.2 Selected pathophysiologic conditions leading to AKI and CKD <br>2.3 Treatment for renal disorders <br>3. Immunologic disease <br>3.1 Background <br>3.2 Historical evolution/trends <br>3.3 Multiple sclerosis and the related condition neuromyelitis optica <br>3.4 Myasthenia gravis (MG) <br>3.5 Rheumatoid arthritis (RA) <br>3.6 Systemic lupus erythematosus <br>3.7 Sjogren’s syndrome <br>3.8 Systemic sclerosis/scleroderma <br>3.9 Inflammatory bowel disease (IBD) <br>3.10 Autoimmune hepatitis (AIH) <br>4. Connective tissue diseases <br>4.1 Background <br>4.2 Historical evolution/trends <br>4.3 Selected connective tissue disorders with significant impact on obstetric and perioperative management <br>5. Hematologic complications of pregnancy <br>5.1 Background <br>5.2 Historical evolution/trends <br>5.3 Selected hematologic disorders with significant impact on obstetric and perioperative management <br>5.4 Thrombocytopenia <br>5.5 Immune thrombocytopenia (ITP) <br>5.6 Hypertensive disease of pregnancy <br>6. Coagulation disorders <br>6.1 VWD <br>6.2 Acquired hemophilia <br>6.3 Procoagulant disorders <br>7. Future directions, novel treatments, or research studies <br>8. Summary and conclusion <br>References <br><br>33. Anesthesia considerations for patients with COVID-19<br>Nesrine Refai, Hala Mostafa Goma, Islam Mohammad Shehata Elsayed and Ahmed Hashim<br><br>1. Introduction <br>2. Pathophysiology <br>3. Risk factors <br>4. Diagnosis <br>5. Treatment <br>5.1 Preoperative assessment of COVID pregnant patient <br>5.2 Exclusion of acute phase of COVID infection <br>6. A respiratory complication of COVID-19 which indicates pre- or postoperative ventilation <br>7. Early diagnosis of pulmonary embolism <br>7.1 Preoperative medications <br>8. Preoperative assessment of intrauterine fetus <br>9. How to improve oxygenation in COVID-19 pregnant patient <br>9.1 Methods of improving oxygenation <br>9.2 High-flow nasal cannula <br>10. Noninvasive positive pressure ventilation <br>11. Extracorporeal membrane oxygenation <br>11.1 Preparation of the operating room for COVID patients <br>11.2 Equipments <br>11.3 Personal protection <br>References <br><br>34. Anesthesia considerations for patients with preeclampsia<br>Alexandra Waits, Kennedy Kirkpatrick, Melissa Nikolaidis and Yi Deng<br><br>1. History of preeclampsia <br>2. Epidemiology <br>3. Pathophysiology <br>4. Histologic findings <br>5. Risk factors for preeclampsia development <br>6. Diagnostic criteria and clinical presentation <br>7. Morbidity and mortality <br>8. Risk stratification <br>9. Healthcare economic burden <br>10. Treatment of hypertensive disorders of pregnancy <br>11. Anesthetic considerations in preeclampsia <br>11.1 Cardiovascular <br>11.2 Fluid management <br>11.3 Neuraxial anesthesia <br>11.4 General anesthesia <br>11.5 Regional techniques <br>11.6 Uterotonic agents <br>11.7 Eclampsia management <br>References <br><br>35. Anesthesia considerations for patients with infections, HIV, and sexually transmitted diseases<br>Claudia Wei and Amy I. Lee<br><br>1. Introduction <br>2. Bacterial infections <br>2.1 General considerations <br>2.2 Anesthetic management of the septic parturient <br>3. Viral infections <br>3.1 Human immunodeficiency virus <br>3.2 Coronavirus disease 2019 <br>3.3 Herpes simplex virus <br>3.4 Human papilloma virus <br>3.5 Hepatitis <br>3.6 Varicella <br>3.7 Others-cytomegalovirus, rubella, measles <br>4. Conclusion <br>References <br><br>36. Anesthesia considerations with multiple births and fetal malpresentation<br>Joseph Bavaro, Candice Cuppini and Andrew Hallmark<br><br>1. Anesthesia considerations for multiple births <br>1.1 Introduction <br>1.2 Definitions/epidemiology <br>1.3 Maternal physiologic changes <br>1.4 Fetal morbidity in multiple gestation <br>1.5 Anesthetic management <br>2. Anesthesia for fetal malpresentation <br>2.1 Definitions and epidemiology <br>2.2 Obstetric considerations <br>2.3 Anesthetic considerations <br>References <br><br>37. Anesthesia considerations for vaginal birth after C-section, and for abnormalities of the reproductive tract<br>Emily Dinges<br><br>1. Trial of labor after cesarean <br>1.1 Introduction <br>1.2 Background <br>1.3 Historical evolution and trends <br>1.4 Issues related to this topic <br>1.5 Anesthetic management <br>1.6 Other causes of uterine rupture <br>2. Abnormalities of the reproductive tract <br>2.1 Hymen malformations <br>2.2 Mullerian anomalies <br>2.3 Mullerian anomalies and effects on reproduction <br>2.4 Anesthetic considerations <br>References <br><br>38. Anesthetic considerations for nonobstetric surgery during pregnancy<br>Kristin Horton and Mary Lynne Roberts<br><br>1. Introduction <br>2. Brief review of physiologic changes in pregnancy <br>2.1 Cardiovascular <br>2.2 Hematology <br>2.3 Pulmonary <br>2.4 Airway <br>2.5 Gastrointestinal <br>2.6 Neurologic and neuromuscular <br>2.7 Endocrine <br>2.8 Pharmacologic <br>2.9 Uteroplacental blood flow <br>2.10 Summary of physiologic changes <br>3. Preoperative assessment and management <br>3.1 Risks of surgery and general anesthesia during pregnancy <br>3.2 Timing of surgery <br>3.3 Choosing anesthetic type <br>3.4 Monitoring <br>3.5 Patient assessment <br>3.6 Premedications <br>3.7 Pain control and multimodal analgesia <br>3.8 Aspiration prophylaxis <br>3.9 Other medications <br>4. Intraoperative management <br>4.1 Positioning <br>4.2 Induction/airway <br>4.3 Hemodynamic and respiratory goals <br>4.4 Anesthetic medications and the fetus <br>4.5 Maternal code blue <br>4.6 Considerations for surgical subspecialty procedures <br>5. Postoperative management <br>5.1 Postoperative monitoring <br>5.2 Imaging <br>5.3 Pain management <br>6. Summary <br>References <br><br>39. Anesthesia considerations for rare obstetric procedures: Cerclage placement, external cephalic version, and fetal intrauterine procedures<br>Hani El-Omrani, Thanh-Giang Vu and Emily Dinges<br><br>1. Cerclage <br>1.1 Background <br>1.2 Types of cerclage <br>1.3 Methods of cerclage placement <br>1.4 Anesthesia for cerclage placement <br>1.5 Cerclage removal <br>2. External cephalic version <br>2.1 Introduction <br>2.2 The impact of regional anesthesia or analgesia on ECV outcomes <br>2.3 Recommendations for regional anesthetic or analgesic techniques for ECV <br>2.4 Summary <br>3. Fetal intrauterine procedures <br>3.1 Operative techniques <br>3.2 Common indications <br>3.3 Anesthesia considerations <br>References <br><br>40. Anesthesia considerations for patients with spine surgery<br>Alan David Kaye, Rucha A. Kelkar, Alexandra D. Dautel, Lillian V. Lauck, Michael J. Quintana, Shahab Ahmadzadeh and Sahar Shekoohi<br><br>1. Introduction <br>2. Pathophysiology, diagnosis, and treatment <br>2.1 Scoliosis <br>2.2 Discectomy and laminectomy <br>2.3 Chronic spinal cord injury <br>2.4 Spinal dysraphism <br>2.5 Implantable devices <br>3. Patient evaluation <br>4. Anesthetic management <br>4.1 The use of neuraxial ultrasound <br>4.2 Considerations for scoliosis <br>4.3 Considerations for chronic spinal cord injury <br>4.4 Considerations for spinal dysraphism <br>4.5 Considerations for the presence of implantable devices <br>4.6 Considerations for failed neuraxial and operative delivery <br>5. Future directions <br>6. Conclusion <br>References <br><br>41. Anesthesia considerations for patients with special spine considerations including chronic spinal cord injury, spinal dysraphism, and implantable devices<br>Mikayla Troughton, Helen Pappas and Carmen Lopez<br><br>1. Introduction <br>2. Pathophysiology, diagnosis, and treatment <br>2.1 Scoliosis <br>2.2 Discectomy and laminectomy <br>2.3 Chronic spinal cord injury <br>2.4 Spinal dysraphism <br>2.5 Implantable devices <br>3. Patient evaluation <br>4. Anesthetic management <br>4.1 The use of neuraxial ultrasound <br>4.2 Considerations for scoliosis <br>4.3 Considerations for chronic spinal cord injury <br>4.4 Considerations for spinal dysraphism <br>4.5 Considerations for the presence of implantable devices <br>4.6 Considerations for failed neuraxial and operative delivery <br>5. Future directions <br>6. Conclusion <br>References <br><br>42. Peripartum hemorrhage and management<br>Dana Darwish, Christopher Choi and Faiza A. Khan<br><br>1. Overview <br>2. Causes <br>3. Management of PPH <br>3.1 Stages of hemorrhagic shock <br>3.2 Transfusion protocols and use of TXA <br>3.3 Medical management <br>3.4 Surgical management <br>3.5 Anesthetic evaluation and management <br>4. Anesthetic management <br>4.1 Preoperative checklist <br>4.2 Anesthetic induction and maintenance <br>4.3 Anesthetic risks and complications <br>4.4 Complications of postpartum hemorrhage <br>5. Special considerations: Placenta accrete spectrum <br>5.1 Anesthetic management <br>6. Conclusion <br>References <br><br>43. Point-of-care coagulation testing for obstetric hemorrhage<br>Elvera L. Baron and Daniel Katz<br><br>1. Postpartum hemorrhage (PPH) and need for point-of-care (POC) coagulation testing <br>2. Hemostasis: Normal pregnancy as compared to patients with PPH <br>3. Viscoelastic testing: ROTEM, TEG, others <br>3.1 Identification of hemostatic changes in pregnancy <br>3.2 Identification of clinical coagulopathy <br>4. Advantages of VTs <br>5. Disadvantages and limitations of viscoelastic tests <br>6. Other viscoelastic tests and new machines <br>7. Conclusion <br>References <br><br>44. Trauma during pregnancy<br>Joseph Abro, Grayce Davis, Rishi Patel and Travis Pecha<br><br>1. Epidemiology <br>2. Maternal complications and outcomes <br>3. Fetal complications and outcomes <br>4. Assessment and resuscitation in pregnancy <br>4.1 Primary survey <br>4.2 Secondary survey <br>4.3 Cardiopulmonary resuscitation <br>5. Critical care during pregnancy <br>5.1 Preeclampsia/eclampsia <br>5.2 Amniotic fluid embolism <br>5.3 Cardiomyopathy in pregnancy <br>5.4 Hemorrhagic shock in pregnancy <br>5.5 Sepsis <br>5.6 PRES <br>References<br> <br>45. Postdural puncture headaches<br>Peter Arrabal, John Crowe, Andrea Girnius and Michael Hawryschuk<br><br>1. Introduction <br>2. Pathophysiology <br>3. Incidence and risk factors <br>4. Prevention of PDPH after unintentional dural puncture <br>5. Clinical features and diagnosis of PDPH <br>6. Treatment options <br>6.1 Epidural blood patch <br>6.2 Other treatments for PDPH <br>7. Long-term outcomes <br>8. Summary <br>References <br><br>46. Fetal and neonatal assessment of complications and injuries (including abnormal labor, dystocia abnormalities of expulsive forces, abnormal presentation, position and development, and pelvic contraction)<br>Anusha Kallurkar, Jackie Hanners, Kristina Gambino and Dani Zoorob<br><br>1. Abnormal fetal presentation <br>1.1 Occiput-posterior (OP) presentation <br>2. Abnormal fetal testing <br>2.1 Tachysystole <br>2.2 Maternal hypotension <br>3. Labor complications <br>3.1 Cord prolapse <br>3.2 Chorioamnionitis <br>3.3 Uterine rupture <br>3.4 Uterine inversion <br>4. Delivery complications <br>4.1 Operative vaginal deliveries <br>4.2 Shoulder dystocia <br>5. Conclusion <br>References <br><br>47. Hypotension and hypertension in pregnancy<br>Daniel Hernandez-Barajas, Brooke Ingram Tsao and Jose Humanez<br><br>1. Hypotensive disease of pregnancy <br>1.1 Introduction <br>2. Background <br>2.1 Definition of hypotension in obstetric patients <br>2.2 Issues related to this topic <br>2.3 Pathophysiology of hypotension in obstetrics <br>3. Risk factors <br>4. Patient evaluation <br>5. Diagnosis <br>6. Treatment <br>6.1 Left uterine displacement <br>7. Anesthetic management <br>8. Prevention <br>9. Global impact and challenges <br>10. Gestation hypertension and preeclampsia <br>11. Preeclampsia <br>12. Diagnostic criteria of preeclampsia <br>12.1 Hypertension <br>12.2 Proteinuria <br>12.3 Thrombocytopenia <br>12.4 Renal insufficiency <br>12.5 Impaired liver function <br>12.6 Abdominal pain <br>12.7 Pulmonary edema <br>12.8 Headache <br>13. Hemolysis, elevated liver enzymes, and low platelet count syndrome <br>14. Eclampsia <br>15. Gestational hypertension <br>16. Pathophysiology <br>17. Clinical recommendations and treatment <br>18. Anesthetic management <br>References <br><br>48. Pulmonary aspiration and interventions to reduce the risk of aspiration<br>Jason Gabriel Hirsch<br><br>1. Background <br>2. History <br>3. Incidence <br>4. Physiology of pregnancy <br>5. Risk factors <br>6. Pathophysiology <br>7. Management <br>8. Prevention <br>References <br><br>49. Amniotic fluid embolism<br>Brooke Ingram Tsao and Grace Cruz<br><br>1. Introduction <br>2. Incidence <br>3. Diagnosis <br>3.1 Disseminated intravascular coagulation <br>3.2 Differential diagnosis <br>4. Risk factors <br>5. Pathophysiology <br>6. Pharmacology and treatment <br>7. Anesthesia considerations <br>References <br><br>50. Intraamniotic infection<br>Lauren Brown-Berchtold and Sterling Adams<br><br>1. Introduction <br>2. Historical evolution <br>3. Pathophysiology <br>3.1 Microbiology <br>3.2 Risk factors <br>4. Patient evaluation <br>4.1 Initial evaluation <br>4.2 Clinical history <br>4.3 Physical examination <br>4.4 Laboratory testing <br>4.5 Imaging <br>5. Diagnosis <br>5.1 Steroids and leukocytosis <br>6. Treatment <br>6.1 Intrapartum <br>6.2 Length of antibiotic therapy <br>6.3 Isolated maternal fever considerations <br>7. Prevention <br>8. Clinical considerations <br>8.1 Dysfunctional labor <br>8.2 Maternal outcomes <br>8.3 Neonatal outcomes <br>9. Anesthetic management <br>10. Conclusion <br>References <br><br>51. Preterm birth<br>Edward Springel, Arunthevaraja Karuppiah, Miheret Yitayew, Nayef Chahin, Jenny R. Fox and Joseph A. Khoury<br><br>1. Epidemiology of preterm birth <br>2. Risk factors for preterm birth <br>3. Pathophysiology of preterm birth <br>4. Prediction of preterm birth <br>5. Obstetric strategies to reduce risk of preterm birth and improve outcomes of premature neonates <br>5.1 Primary prevention of preterm birth <br>5.2 Secondary prevention of preterm birth <br>5.3 Tertiary prevention of preterm birth <br>6. Measures to improve neonatal outcome <br>6.1 Betamethasone <br>6.2 Magnesium sulfate for neuroprotection <br>6.3 Antibiotics <br>7. Anesthesia impact on fetal heart rate monitoring <br>7.1 Fetal heart rate monitoring in preterm fetus <br>7.2 Impact of perinatal anesthesia on the newborn <br>7.3 Analgesia for preterm labor and vaginal delivery <br>7.4 Anesthesia for cesarean delivery <br>7.5 Interactions between tocolytic therapy and anesthesia <br>References <br> <br>52. Neurologic complications from regional anesthesia and general anesthesia in obstetric practice<br>Carmen Lopez, Mikayla Troughton and Emery McCrory<br><br>1. Introduction <br>2. Peripheral nerve injury <br>2.1 Mechanism <br>2.2 Risk factors <br>2.3 Lateral femoral cutaneous nerve <br>2.4 Femoral nerve <br>2.5 Obturator nerve <br>2.6 Lumbosacral plexus <br>2.7 Common peroneal nerve <br>2.8 Treatment and prevention <br>3. Central nervous injury <br>3.1 Unintentional dural puncture and postdural puncture headache <br>3.2 Cerebral vein thrombosis <br>3.3 Spinal cord trauma <br>3.4 Anterior spinal artery syndrome <br>3.5 Spinal epidural hematoma <br>3.6 Epidural abscess <br>3.7 Chemical injury and arachnoiditis <br>3.8 Transient neurological symptoms <br>4. Neurological complications from general anesthesia <br>4.1 Ulnar nerve <br>4.2 Brachial plexus <br>4.3 Common peroneal nerve <br>References <br><br>53. Intraoperative and postoperative anesthesia-related morbidity and mortality, extremes of reproductive life, and abortion<br>Alexander M. Aldanese, Fadi M. Huzien, Denver Stutler, Nikole K. Nikolov, Kylie Dufrene, Aaron J. Kaye, Harish Siddaiah, Sahar Shekoohi and Alan David Kaye<br><br>1. Introduction <br>2. Anesthetic causes of maternal mortality <br>2.1 Management of the difficult airway in obstetrics <br>2.2 Aspiration of gastric acid <br>2.3 Maternal mortality and the complex landscape of local anesthetic toxicity <br>2.4 Obstetric anesthesiologic mortality due to high spinal or epidural block: a comprehensive analysis <br>3. Anesthetic causes of maternal morbidity <br>3.1 Postdural puncture headache <br>3.2 Postpartum neurologic deficits and related pathophysiology <br>3.3 Postpartum back pain <br>3.4 Common complications of extreme maternal ages and anesthesia management <br>3.5 Anesthetic complications during a cesarean section <br>3.6 Intrapartum and postpartum hemorrhage <br>3.7 Effect of anesthesia on preeclampsia and eclampsia <br>3.8 Anesthesia in preterm labor <br>3.9 Common complications of anesthesia use during abortive procedures <br>4. Conclusion <br>References <br><br>54. Anesthesia for fetal surgery<br>Kylie Dufrene, Alexandra Dicke, Van Smith III, James Ilochi, John David Sawyer, Sahar Shekoohi and Alan David Kaye<br><br>1. Indications for fetal surgery <br>2. Anesthesia considerations in fetal surgery <br>2.1 Minimally invasive surgery <br>2.2 Open fetal surgery <br>2.3 Exit procedure <br>3. Anesthetic considerations for fetal surgery <br>3.1 Epidural <br>3.2 Regional anesthesia <br>3.3 General anesthesia <br>3.4 Gestational age considerations <br>3.5 Intraoperative fetal monitoring during fetal surgery <br>3.6 Rationale for fetal monitoring <br>3.7 Monitoring parameters and interpretation <br>3.8 Challenges and considerations <br>References <br><br>55. Obstetric anesthesia and medicolegal/ethical issues<br>Alan David Kaye, Angela Nguyen, Emily Dantes, Cameron Robicheaux, Julia Trettin, Kylie Dufrene, Aaron J. Kaye, Sahar Shekoohi and Harish Siddaiah<br><br>1. Introduction <br>2. Physiological changes in pregnancy relevant to anesthesia <br>3. Standard obstetric anesthesia techniques <br>4. Anesthetic management of obstetric complications <br>5. Medicolegal and ethical considerations in obstetric anesthesia <br>6. Informed consent in obstetric anesthesia <br>7. Liability issues in obstetric anesthesia <br>8. Ethical dilemmas in obstetric anesthesia <br>9. Cultural and religious considerations <br>10. Patient advocacy and rights <br>11. Future direction and innovations in obstetric anesthesia <br>12. Summary and conclusion <br>References <br><br>56. Fetal evaluation, including the premature fetus and the compromised fetus<br>Hamdy Bakry Alqenawy, Mohamed Elmezaien, Rania Gamal El-Skaan and Mohamad Ismail<br><br>1. Antenatal surveillance <br>1.1 Fetal movement count <br>1.2 Fetal heart rate-based tests <br>1.3 Imaging-based tests <br>2. Intrapartum fetal heart rate monitoring <br>2.1 NICHD classification, interpretation, and management of FHR patterns <br>3. Anesthesia in special situations <br>3.1 Twin to twin transfusion syndrome <br>3.2 External cephalic version <br>3.3 Shoulder dystocia <br>3.4 Intrauterine transfusion <br>References <br><br>57. Fetal and neonatal complications and treatment, including resuscitation<br>Jenny R. Fox, Kelly Stanley, Edward Springel, Fatoumata Kromah and Joseph A. Khoury<br><br>1. Introduction <br>2. Antepartum management <br>2.1 Fetal heart rate monitoring <br>2.2 Rapid clinical assessment of suspected fetal hypoxemia and acidosis <br>2.3 Maternal positioning <br>2.4 Cessation of uterine stimulation <br>2.5 Intravenous fluid resuscitation <br>2.6 Tocolytics <br>2.7 Correction of maternal hypotension <br>2.8 Maternal oxygen supplementation <br>2.9 Amnioinfusion <br>2.10 Altering pushing efforts in labor <br>2.11 Cord prolapse <br>3. Newborn management <br>3.1 Role of obstetrical anesthesiologist in neonatal resuscitation <br>3.2 Transition from fetal circulation to newborn circulation <br>3.3 Team communication: Maternal team to neonatal team <br>3.4 Thermoregulation <br>3.5 Delayed cord clamping <br>3.6 Initial assessment of the newborn <br>3.7 Neonatal resuscitation <br>3.8 Assessing heart rate <br>3.9 Positive pressure ventilation <br>3.10 Newborn endotracheal intubation equipment <br>3.11 Target oxygenation saturation <br>3.12 Chest compressions <br>3.13 Epinephrine and volume resuscitation <br>3.14 Post resuscitation care <br>4. Neonatal complications <br>4.1 Pneumothorax and airway obstruction <br>5. Special considerations <br>6. Summary <br>References <br><br>58. Diagnosis and treatment of fetal/newborn asphyxia and respiratory failure<br>Miheret Yitayew, Grace Mueller, Whitney Bender, Joseph A. Khoury, Fatoumata Kromah and Nayef Chahin<br><br>1. Anesthetic management in the context of asphyxia and respiratory failure <br>2. Defining birth asphyxia <br>3. Historical evolution of birth asphyxia <br>4. Global impact and challenges <br>5. The fetus’ cardiovascular response to asphyxia <br>6. Antenatal fetal surveillance for signs of chronic asphyxia <br>7. Intrapartum fetal heart rate assessment <br>8. Ancillary intrapartum fetal well-being assessments <br>9. Physiology of a neonatal hypoxic-ischemic brain injury <br>10. Evaluating for hypoxic ischemic encephalopathy <br>11. Therapeutic hypothermia and prognostication <br>12. Neonatal respiratory failure <br>12.1 Respiratory distress syndrome <br>13. Meconium-stained amniotic fluid and meconium aspiration syndrome <br>14. Congenital diaphragmatic hernia <br>15. Transient tachypnea of the newborn <br>16. Congenital pulmonary airway malformation <br>References <br>Further reading <br><br>59. Retrolental fibroplasia and anesthesia<br>Alan David Kaye, Evan Sinnathamby, Claire Fisher, Hannah Matejowsky, Kristin N. Bembenick, Thomas J. Tran, Shahab Ahmadzadeh and Sahar Shekoohi<br><br>1. Introduction <br>2. Epidemiology <br>3. Risk factors <br>4. Clinical considerations and anesthetic management <br>5. Patient evaluation <br>6. Prevention <br>7. Global impact and challenges <br>8. Diagnostic steps <br>9. Diagnostic modalities <br>10. Treatment <br>11. Advances in treatment <br>12. Clinical studies <br>13. Conclusion <br>References <br><br>60. Long-term effects of anesthetics on the fetal and neonate<br>Farzad Ebrahimi<br><br>1. Introduction <br>2. Is there any empirical evidence demonstrating the teratogenic effects of anesthetic agents administered during the first trimester of pregnancy? <br>2.1 Nitrous oxide <br>2.2 Benzodiazepines <br>2.3 Opioids <br>2.4 Nonsteroidal anti-inflammatory drugs <br>3. Fetal nervous systems development <br>4. Long-term effects of anesthetics administered during the second trimester on the fetus <br>5. Is it safe to administer anesthetics during the third trimester? <br>5.1 Is dexmedetomidine capable of providing brain protection against neuroapoptosis caused by inhalation of gases? <br>6. What are the drawbacks of the prior research? <br>7. Conclusion <br>References <br><br>61. Illustrated ultrasound evaluation of the stomach fasting/nonfasting status<br>Sydney T. Gennaro-Dennis, Emily Johnson, Karlee Mott, Alex Wandler, Shahab Ahmadzadeh, Sahar Shekoohi and Alan David Kaye<br><br>1. Introduction <br>2. Background <br>3. Gastric ultrasound as an effective clinical tool <br>4. Evolving concepts in clinical use of point-of care ultrasounds <br>5. Historical evolution and trends in gastric ultrasound <br>6. Pathophysiology <br>7. Risk factors <br>8. Patient evaluation <br>9. Diagnosis <br>10. Treatment <br>11. Anesthetic management <br>12. Pharmacology <br>13. Clinical issues or considerations <br>14. Prevention and self-care <br>15. Global impact and challenges <br>16. Future directions, novel treatments, or research studies <br>17. Summary and conclusion <br>References <br><br>62. Ultrasound evaluation of the spinal vertebrae<br>Emile Legendre, Grace Wester, Kristen Adams, Alison Hawkins, Varsha Allampalli, Sahar Shekoohi and Alan David Kaye<br><br>1. Key summary points <br>2. Introduction <br>2.1 History <br>2.2 Benefits of neuraxial anesthesia <br>2.3 Traditional landmark approach <br>2.4 History of ultrasound-guided neuraxial anesthesia <br>3. Why use ultrasound? <br>4. Physics and anatomy <br>4.1 Physics of sonography <br>4.2 Gross anatomy of the lumbar spine <br>5. Technical procedure <br>5.1 Sonography of the lumbar spine <br>6. Conclusion <br>Acknowledgment <br>References <br><br>63. Neurological injury after neuraxial anesthesia<br>Ruba Elmaoued and Amy I. Lee<br><br>1. Introduction/background <br>2. Incidence of nerve injuries <br>3. Intrinsic obstetric palsies <br>3.1 Lateral femoral cutaneous nerve <br>3.2 Femoral nerve <br>3.3 Obturator nerve <br>3.4 Lumbosacral plexus <br>3.5 Peroneal nerve <br>3.6 Sciatic nerve <br>3.7 Pudendal nerve <br>4. Anesthesia-related neurologic deficits <br>4.1 Postdural puncture headache <br>4.2 Spinal/epidural hematoma <br>4.3 Infection: epidural abscess and meningitis <br>4.4 Direct trauma <br>4.5 Chemical injury <br>4.6 Arachnoiditis <br>4.7 Transient neurologic syndrome <br>5. Medicolegal implications <br>6. Conclusion <br>References <br><br>Index