Obstetric Anesthesia

Conduct a focused history and physical examination before providing anesthesia care.

• This should include, but is not limited to, a maternal health and anesthetic history, a relevant obstetric history, a baseline blood pressure measurement, and an airway, heart, and lung examination, consistent with the American Society of Anesthesiologists (ASA) “Practice Advisory for Preanesthesia Evaluation.”
• When a neuraxial anesthetic is planned or placed, examine the patient’s back.
• Recognition of significant anesthetic or obstetric risk factors should encourage consultation between the obstetrician and the anesthesiologist.

A communication system should be in place to encourage the early and ongoing contact between obstetric providers, anesthesiologists, and other members of the multidisciplinary team.

The anesthesiologist’s decision to order or require a platelet count should be individualized and based on a patient’s history (e.g., preeclampsia with severe features), physical examination, and clinical signs.

• A routine platelet count is not necessary in the healthy parturient.

A routine blood cross-match is not necessary for healthy and uncomplicated parturients for vaginal or operative delivery. The decision whether to order or require a blood type and screen or cross-match should be based on maternal history, anticipated hemorrhagic complications (e.g., placenta accreta in a patient with placenta previa and previous uterine surgery), and local institutional policies.

Fetal heart rate patterns should be monitored by a qualified individual before and after administration of neuraxial analgesia for labor.

• Continuous electronic recording of fetal heart rate patterns may not be necessary in every clinical setting and may not be possible during placement of a neuraxial catheter.