Obstetric Analgesia and Anesthesia
Publication Date: March 1, 2019
Last Updated: March 14, 2022
Recommendations
Neuraxial analgesia does not appear to increase the cesarean delivery rate and, therefore, should not be withheld for that concern. (A)
574
Opioids are associated with adverse effects for the woman and the fetus or newborn, most significantly respiratory depression, so attention should be paid to respiratory status. (A)
574
Spinal anesthesia, combined spinal–epidural, or general anesthesia are suitable for emergent cesarean delivery when no epidural is in place. (B)
574
Thrombocytopenia is a relative contraindication to neuraxial blockade, but a safe lower limit for platelet count has not been established. (B)
574
In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor. (C)
574
Epidural and spinal analgesia or anesthesia generally are considered acceptable in a patient with a platelet count greater than or equal to 70 x 109/L provided that the platelet level is stable, there is no other acquired or congenital coagulopathy, the platelet function is normal, and the patient is not receiving any antiplatelet or anticoagulant therapy. In some circumstances, epidural or spinal analgesia and anesthesia may be acceptable for patients with platelet counts below 70 x 109/L. (C)
574
Recommendation Grading
Overview
Title
Obstetric Analgesia and Anesthesia
Authoring Organization
American College of Obstetricians and Gynecologists
Publication Month/Year
March 1, 2019
Last Updated Month/Year
January 9, 2023
Document Type
Consensus
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Adolescent, Adult
Health Care Settings
Hospital
Intended Users
Nurse midwife, nurse, nurse practitioner, physician, physician assistant
Scope
Prevention, Management
Diseases/Conditions (MeSH)
D000760 - Anesthesia and Analgesia, D000773 - Anesthesia, Obstetrical, D016362 - Analgesia, Obstetrical, D015360 - Analgesia, Epidural, D000758 - Anesthesia, D000698 - Analgesia, D000700 - Analgesics
Keywords
anesthesia, analgesia, anesthesia and analgesia