Overview

This textbook covers the clinical practice of obstetric anesthesia across 28 chapters, four appendices, and a clinical glossary. It is organized into seven parts addressing foundational science, neuraxial techniques, cesarean delivery anesthesia, high-risk maternal conditions, peripartum crisis protocols, fetal and neonatal considerations, and quality improvement. Part I covers the obstetric anesthesia environment, maternal physiological changes in pregnancy and labor, placental pharmacology and fetal drug transfer, and ethics in obstetric anesthesia practice. Part II addresses neuraxial anatomy, ultrasound-guided patient assessment, epidural analgesia techniques including programmed intermittent epidural bolus, combined spinal-epidural, dural puncture epidural, intrathecal opioid techniques, and the recognition and management of neuraxial complications. Part III covers spinal anesthesia for cesarean delivery, epidural and CSE anesthesia for cesarean delivery, general anesthesia and airway management in the parturient, and postoperative analgesia after cesarean delivery. Part IV addresses high-risk maternal conditions including preeclampsia and HELLP syndrome, obstetric hemorrhage, cardiac disease in pregnancy, obesity and metabolic disorders, neurological and pulmonary disorders, coagulation disorders and thrombophilia, multiple gestation, preterm labor, and fetal intervention anesthesia. Part V presents structured crisis protocols for failed airway management, massive obstetric hemorrhage and damage control resuscitation, amniotic fluid embolism, anaphylaxis, peripartum cardiac arrest, and simulation-based crisis team training. Obstetric critical care and ICU management are also covered. Part VI addresses fetal monitoring, fetal distress, intrauterine resuscitation, neonatal resuscitation, and transitional neonatal physiology. Part VII covers non-obstetric surgery in pregnancy, chronic pain in pregnancy, and quality improvement, patient safety, documentation standards, informed consent, closed claims analysis, and departmental credentialing and peer review. The appendices include an obstetric dosing reference, a neuraxial block quick-reference and troubleshooting guide, ASRA anticoagulation timing tables, fetal heart rate classification reference, standardized clinical scales and scoring systems, and a glossary of 60 clinical terms.

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