Obstetric anaesthesia and analgesia

This chapter discusses the anaesthetic management of the pregnant patient, for labour analgesia as well as surgical intervention. It begins with a description of the physiological and pharmacological changes of pregnancy. It describes methods of labour analgesia, including remifentanil, and epidural analgesia and its complications, such as post dural puncture headache (PDPH). It describes anaesthesia for Caesarean section (both regional and general); failed intubation; antacid prophylaxis; postoperative analgesia; retained placenta; in utero fetal death; hypertensive disease of pregnancy (pre-eclampsia, eclampsia and the hypertension, elevated liver enzymes and low platelets (HELLP) syndrome); massive obstetric haemorrhage; placenta praevia and morbidly adherent placenta (placenta accreta, increta and percreta); amniotic fluid embolism (AFE); maternal sepsis, and maternal resuscitation. It discusses comorbidity in pregnancy such as obesity and cardiac disease, and the patient who requires non-obstetric surgery while pregnant. It provides information on safe prescribing in pregnancy and breast-feeding.