Overview

The labor and delivery unit is one of the few places in medicine where the patient can be completely well when she walks through the door and in cardiac arrest before she leaves. The obstetric anesthesiologist lives in that gap, and this book was written to fill it. Obstetric Anesthesia in Clinical Practice is organized across six parts. It treats the obstetric anesthesiologist not as a subspecialist who administers epidurals but as a peripartum physician responsible for the maternal-fetal unit across the entire continuum from the first contraction to the postpartum ICU bed. Part One builds the physiological and pharmacological foundation in a way that most obstetric anesthesia references skip entirely. A full chapter is dedicated to uteroplacental physiology and placental drug transfer, illustrated in atlas format. A second complete chapter addresses fetal physiology, antepartum surveillance, and intrapartum monitoring with decision algorithms built into the text. Neonatal resuscitation receives its own dedicated chapter with an illustrated step-by-step NRP sequence, meconium aspiration management, and therapeutic hypothermia for hypoxic-ischemic encephalopathy. Part Two covers neuraxial analgesia and anesthesia with a depth and visual richness not found in any competing reference. A complete ultrasound atlas of the lumbar spine accompanies the anatomy chapter. The labor analgesia chapter covers epidural technique, CSE, dural puncture epidural, PIEB, and PCEA with troubleshooting algorithms embedded at each decision point. The cesarean anesthesia chapter integrates the 2025 ERAS Society ERAC guidelines structurally within the technique discussion rather than appending them as an afterthought. A unified POCUS framework chapter covers gastric volume assessment, lung ultrasound, focused cardiac assessment, ultrasound-guided vascular access, and POCUS in obstetric emergencies as a single integrated clinical system. Part Three addresses airway management with obstetric-specific algorithms drawn from current DAS and ASA guidelines, paired with ultrasound assessment of the pregnant airway at the tongue base, epiglottis, and cricoid membrane. A dedicated chapter on aspiration covers gastric POCUS with a clinical decision integration algorithm. Artificial intelligence and closed-loop anesthetic delivery receive a full standalone chapter, the only such treatment in any obstetric anesthesia reference currently available. Part Four manages labour, delivery, surgical, and postpartum care including preterm delivery as a standalone chapter with gestational age-stratified anesthetic approaches, non-obstetric surgery in pregnancy, trauma management, chronic pain after childbirth, and maternal mental health including postpartum depression and birth trauma PTSD. Part Five covers obstetric emergencies and critical care through chapters on hemorrhage with TEG and ROTEM-guided resuscitation, hypertensive disorders including HELLP and eclampsia with POCUS-guided hemodynamic assessment, amniotic fluid embolism, maternal cardiac arrest with perimortem cesarean delivery algorithm, sepsis, and a dedicated maternal mortality chapter built around the anesthesiologist's preventive role. Part Six covers the parturient with systemic disease across six chapters spanning cardiac disease with lesion-by-lesion anesthetic planning, obesity with dedicated POCUS-guided neuraxial placement and video laryngoscopy algorithms, respiratory and hematologic disease, neurologic and psychiatric disorders including the opioid-dependent parturient, and a chapter on malignant hyperthermia, LAST, anaphylaxis, and awareness under general anesthesia in pregnancy. Back matter includes a fifteen-algorithm visual library, obstetric anesthesia drug formulary, ASA and SOAP practice guidelines, laboratory reference values in pregnancy.

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