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KEY POINTS
Unlike other operations wherein the patient is primarily concerned with him- or herself, the pregnant woman usually is concerned for her baby’s welfare.
The anesthesia provider must be aware of the various physiologic changes of pregnancy and incorporate them into the anesthetic plan.
These physiologic changes have implications for various diseases and must be considered.
While minimum alveolar concentration (MAC) may be decreased during pregnancy, the amount required to prevent awareness is not. The dose of inhalation agent should not be decreased in pregnant patients.
There is extremely weak evidence that surgery during the first trimester is linked to central nervous system defects Also, there is the concern that anesthesia for surgery during the third trimester may lead to learning difficulties later in life for the infant.
Preterm labor and delivery remain the leading cause of perinatal morbidity and mortality in the United States. Preterm labor is difficult to control with medication, with the most promising being the calcium channel–blocking drugs. Magnesium sulfate is frequently used for neuroprotection in the preterm neonate.
The etiology of preeclampsia remains to be elucidated, with the disease process resulting from an imbalance of angiogenic and antiangiogenic proteins.
Magnesium sulfate is the most effective medication for the prevention of seizures in those with preeclampsia.
Labetalol is the preferred drug for the control of blood pressure in mothers with preeclampsia. Antihypertensive medication does not treat the disease process; rather, it is used to prevent intracerebral hemorrhage.
The two causes of antepartum hemorrhage are placenta previa and placental abruption. With the increase in cesarean deliveries, there is a high risk of placenta accreta in patients with previous cesarean delivery and placenta previa.
The perinatal transmission of human immunodeficiency virus (HIV) is low if the viral load is less than 1000 copies/mL, and these patients do not require cesarean delivery. This level may be achieved if the mother takes a combination of antiretroviral therapy.
Aggressive treatment of gestational diabetes mellitus, even mild gestational diabetes, with diet modification, exercise, and insulin if required is associated with improved maternal and neonatal outcome.
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Most assume that evaluation of the pregnant patient involves preparing the patient for the impending delivery. This thought is not far from reality as cesarean section is the most common surgical procedure performed in the United States.1 Furthermore, with approximately 80% of parturients receiving epidural analgesia, the evaluation of pregnant patients represents a significant component to the work of an anesthesia provider. However, providers will encounter pregnant patients in the operating rooms as pregnant patients frequently require surgical procedures, both related to the pregnancy and unrelated to the pregnancy. In the pregnant patient, coexisting medical conditions are worsened by the physiologic changes of pregnancy. The proper evaluation of these patients must consider the effect of the physiologic changes of pregnancy in addition to an understanding of obstetrics and other surgical interventions if they are required.