Physiological

Changes In
Pregnancy

DR.FATMA AL-DAMMAS
 Changes In Pregnancy

Pregnancy brings about many physical

changes.
These changes can be divided into 3
area –
Anatomical
Physiological
Biomechanical.
 Changes In Pregnancy

Pregnancy brings about many physical

changes.
These changes can be divided into 3
area –
Anatomical
Physiological
Biomechanical.
Physiological Changes In Pregnancy
1.Pregnancy produces profound physiological changes
that alter the usual responses to Anesthesia
2.Unique challenges - two patients are cared for
simultaneously
3.Failure to take care can be disastrous for one or both of
them
1. What are physiological changes
during labour ?
 Average maximum physiological changes associated with
Pregnancy
Parameter Change

Neurologic
MAC (minimum alveolar concentration)
 Average maximum physiological changes associated with
Pregnancy
Parameter Change

Neurologic
MAC (minimum alveolar concentration) - 40%

1.(MAC) progressively decreases during pregnancy—at

term, by as much as 40%—for all general anesthetic agents

2.MAC returns to normal by The third day after delivery.

Neurologic
 Changes in maternal hormonal and endogenous opiate
levels have been impilcated.
 Progesterone,increases at term
 ↑β-endorphin levels during labor &delivery .
 local anesthesia reduced’ as much as 30%.
 Central Nervous System
• LA requirements for subarachnoid or epidural
anaesthesia are reduced in pregnancy (30%)
• Possible causes include:
a. increased diffusion of LA to the receptor site
b. increased sensitivity of nerve fibres to LA (Lower
connection needed)

c. ? raised CSF progesterone levels

• Spinal ligaments including ligament flavum SOFT
 Central Nervous System
• Valsalva manoeuvres during delivery may increase CSF
and epidural pressures, markedly increasing the spinal
spread of anaesthetia
2. What are Respiratory
physiological changes during
labour ?
 Average maximum physiological changes associated with
Pregnancy

Respiratory
Oxygen consumption
Minute ventilation
Tidal volume
Respiratory rate
PaO2
PaCO2
HCO3
FRC (functional residual capacity)
 Average maximum physiological changes associated with
Pregnancy

Respiratory
Oxygen consumption + 20 to 50%
Minute ventilation
Tidal volume
Respiratory rate
PaO2
PaCO2
HCO3
FRC (functional residual capacity)
 Average maximum physiological changes associated with
Pregnancy

Respiratory
Oxygen consumption + 20 to 50%
Minute ventilation + 50%
Tidal volume
Respiratory rate
PaO2
PaCO2
HCO3
FRC (functional residual capacity)
 Average maximum physiological changes associated with
Pregnancy

Respiratory
Oxygen consumption + 20 to 50%
Minute ventilation + 50%
Tidal volume + 40%
Respiratory rate
PaO2
PaCO2
HCO3
FRC (functional residual capacity)
 Average maximum physiological changes associated with
Pregnancy

Respiratory
Oxygen consumption + 20 to 50%
Minute ventilation + 50%
Tidal volume + 40%
Respiratory rate + 15%
PaO2
PaCO2
HCO3
FRC (functional residual capacity)
 Average maximum physiological changes associated with
Pregnancy

Respiratory
Oxygen consumption + 20 to 50%
Minute ventilation + 50%
Tidal volume + 40%
Respiratory rate + 15%
PaO2 + 10%
PaCO2
HCO3
FRC (functional residual capacity)
 Average maximum physiological changes associated with
Pregnancy

Respiratory
Oxygen consumption + 20 to 50%
Minute ventilation + 50%
Tidal volume + 40%
Respiratory rate + 15%
PaO2 + 10%
PaCO2 - 15%
HCO3
FRC (functional residual capacity)
 Average maximum physiological changes associated with
Pregnancy

Respiratory
Oxygen consumption + 20 to 50%
Minute ventilation + 50%
Tidal volume + 40%
Respiratory rate + 15%
PaO2 + 10%
PaCO2 - 15%
HCO3 - 15%
FRC (functional residual capacity)
 Average maximum physiological changes associated with
Pregnancy

Respiratory
Oxygen consumption + 20 to 50%
Minute ventilation + 50%
Tidal volume + 40%
Respiratory rate + 15%
PaO2 + 10%
PaCO2 - 15%
HCO3 - 15%
FRC (functional residual capacity) - 20%
Respiratory Effects
• Oxygen consumption and minute ventilation
progressively increase during pregnancy.
• Both tidal volume and, respiratory rate increase.
• By term, oxygen consumption has increased about
20—40%, while minute ventilation has increased 40—
50%.
• Paco2 decreases to 28—32 mm Hg; significant
respiratory alkalosis is prevented by a compensatory
↓in pasma bicarbonate concentration.
Respiratory Effects
• Hyperventilation may also increase Pa02
• Elevated levels o 2,3-di phosphoglycerate offset the
effect hyperventilation on hemoglobin affinity for
oxygen.
• The P-50 for hemoglobin increases from 27 to 30 mm
Hg the combination of these factors with increase in
cardiac output enhances oxygen delivery to tissues.
Respiratory Effects
The maternal respiratory pattern changes as the uterus
enlarges.
• In the third trimester, elevation of diaphragm is
compensated by an increase in the AP diameter of the
chest
• Thoracic breathing is favored over abdominal
breathing.
• Both vital capacity and closing capacity are minimally
affected.
• FRC decreases up t 20° at term; FRC returns to normal
within 48 hours of delivery.
• Reduction in expiratory reserve volume .
Respiratory Effects
• Flow-volume loops are unaffected
• Airway resistance decrease.
• Physiologic dead space decreases but intrapulmonary
shunting increases towards term.
• A chest film often shows prominent vascular markings
due to increased pulmonary blood volume and an
elevated diaphragm.
• Pulmonary vasodilataion prevents pulmonary pressures
form rising.
Respiratory: Importance for Anaesthesia
Respiratory: Importance for Anaesthesia
• ++Decreased FRC and increased oxygen consumption
promotes rapid oxygen desaturation during periods of
apnea .
• Preoxygenation prior to induction of general
anesthesia is therefore mandatory to avoid hypoxemia
in pregnant patients.
Following adequate
preoxygenation, the PaO2 in
apnoeic pregnant women falls
~ 80 mmHg/min more than in
the nonpregnant state
Respiratory: Importance for Anaesthesia

• Closing volume exceeds FRC in up to half of all

pregnant women when they are supine at term.
atelectasis
hypoxemia.

• Parturients should not lie flat without supplemental

oxygen.
Respiratory: Importance for Anaesthesia
Rapid gaseous induction
• ↓MAC (as much as 40% decreases at term return to
normal on third day of delivery)
• The decrease in FRC coupled with the increase in
minute ventilation accelerates the uptake of all
inhalational anesthetics.
• ↓FRC ® less dilution
• ↑MV ® rapid d depth
Respiratory: Importance for Anaesthesia
Intubation
- Trauma
- mucosal bleeding
- difficult intubation
• Capillary engorgement of the respiratory mucosa
during pregnancy predisposes the upper airways to
trauma, bleeding, and obstruction.

• Gentle laryngoacopy and the use of small endotracheal

tubes (6—7 mm) during general anesthesia.
 Alteration of Lung Volume in Pregnancy

Functional Residual Capacity FVR

Residual Volume RV ~ 20% decrease
Expiratory Reserve Volume ERV
Vital Capacity VR
Inspiratory Reserve Volume IRV unchanged
Closing Volume CV
Total Lung Capacity TLC ~ 5% decrease
Inspiratory Capacity IC ~ 5% increase
3. What are Cardiovascular changes
during labour ?
Average maximum physiological changes associated with
Pregnancy

Parameter Change

Cardiovascular
Blood volume
Plasma volume
Cardiac output
Stroke volume
Heart rate
Peripheral resistance
Average maximum physiological changes associated with
Pregnancy

Parameter Change

Cardiovascular
Blood volume + 35%
Plasma volume
Cardiac output
Stroke volume
Heart rate
Peripheral resistance
Average maximum physiological changes associated with
Pregnancy

Parameter Change

Cardiovascular
Blood volume + 35%
Plasma volume + 45%
Cardiac output
Stroke volume
Heart rate
Peripheral resistance
Average maximum physiological changes associated with
Pregnancy

Parameter Change

Cardiovascular
Blood volume + 35%
Plasma volume + 45%
Cardiac output + 40%
Stroke volume
Heart rate
Peripheral resistance
Average maximum physiological changes associated with
Pregnancy

Parameter Change

Cardiovascular
Blood volume + 35%
Plasma volume + 45%
Cardiac output + 40%
Stroke volume + 30%
Heart rate
Peripheral resistance
Average maximum physiological changes associated with
Pregnancy

Parameter Change

Cardiovascular
Blood volume + 35%
Plasma volume + 45%
Cardiac output + 40%
Stroke volume + 30%
Heart rate + 15 to 30%
Peripheral resistance
Average maximum physiological changes associated with
Pregnancy

Parameter Change

Cardiovascular
Blood volume + 35%
Plasma volume + 45%
Cardiac output + 40%
Stroke volume + 30%
Heart rate + 15 to 30%
Peripheral resistance - 15%
Cardiovascular Effects
• Cardiac output and blood volume increase to meet
accelerated maternal and fetal metabolic demands.
• An increase in plasma volume in excess of an increase
in red cell mass produces dilutional anemia and reduce
blood viscosity.

• Hemoglobin concentration remains greater

than11.1gIdL.

• ↓in systemic vascular resistance by the second

trimester decreases both diastolic and, to a lesser
degree, systolic blood pressure.

• The response to adrenergic agents and

vasoconstrictors is blunted.
Cardiovascular Effects
• At term, maternal blood volume has increased by
1000—1500 mL in most women, allowing them to
easily tolerate the blood loss associated with delivery.
• total blood volume reaches 90 mL/kg.

• Average blood loss during

vaginal delivery is 400—500 mL
cesarean section 800—1000 mL

• Blood volume does not return to normal until 1—2

weeks after delivery.
Cardiovascular Effects
• ↑cardiac output (40% at term) is due to ↑in HR(15—
30%) + SV (30%).
• Cardiac chambers enlarge and myocardial hypertrophy
is often noted on echocardiography.
• Pulmonary artery, central venous, and pulmonary artery
wedge pressures remain unchanged.

• Most of these effects are observed in the first and, to a

lesser extent, the second trimester.
Cardiovascular Effects
• In the third trimester, cardiac output does not
appreciably rise, except during labor.

• The greatest increases in cardiac output are seen

during labor and immediately after delivery.

• Cardiac output often does not return to normal until 2

weeks after delivery.
 Blood Pressure
a. CO ~ 50%
b. TPR - uterine AV shunt & decreased viscosity
slight decrease in MAP

NB: a high BP in pregnancy, except during

labour, is always abnormal
• CVP and PAOP remain normal during pregnancy
• CVP increases 4-6 cmH2O during contractions
CVS: Importance for Anaesthesia
• Decreases in cardiac output can occur in the supine
position after the 28th week of pregnancy.

decreases of venous return to the heart as the enlarging

uterus compresses the inferior vena cava.

• Up to 20% of women at term develop the supine

hypotension syndrome.
(hypotension associated with pallor, sweating, or nausea
and vomiting).
CVS: Importance for Anaesthesia
• It is due to complete or near-complete occlusion of the
inferior cava by the gravid uterus.

• Turning the patient on her side typically restores

venous return from the lower body and corrects the
hypotension .
CVS: Importance for Anaesthesia

• The gravid uterus also compresses the aorta in

pareurients when they are supine. ↓blood flow to
the lower extremities and, more importantly, to the
uteroplacental circulation.
CVS: Importance for Anaesthesia

• When combined with the hypotensive effects of

regional or general anesthesia, aortocaval compression
can readily produce fetal asphyxia.

• Pareurients with a 28-week or longer gestation should

not be placed supine without left uterine displacement.

• This maneuver is most readily accomplished by placing

a wedge (> 15 degrees) under the right hip.

• Chronic partial caval obstruction in the third trimester

predisposes to venous stasis, phlebitis, and edema in
the lower extremities.
Cardiovascular: Importance for Anaesthesia
• Patients undergoing spinal or epidural anaesthesia must,
a. Be maintained in a lateral tilt position, with left uterine
displacement
b. Be adequately volume preloaded
CVS: Importance for Anaesthesia

• Elevation of the diaphragm shifts the heart’s position in

the chest, resulting in the appearance of an enlarged
heart on a plain chest film
• left axis deviation and T wave changes on the ECG.

• Physical examination often reveals

a systolic ejection flow murmur (grade I or II)
exaggerated splitting of the1ST heart sound (S1)
third heart sound (S3) may be audible.

• A few patients develop small, asymptomaic pericardial

effusions.
What are the criteria to diagnose cardiac
disease during pregnancy ?
• Criteria to diagnose cardiac disease during pregnancy:
1.Presence of diastolic murmurs.
2.Systolic murmurs of severe intensity (grade 3).
3.Unequivocal enlargement of heart (X-ray).
4.Presence of severe arrythmias, atrial fibrillation or flutter
4. What are Renal changes during
labour ?
Average maximum physiological changes associated with
Pregnancy

Parameter Change

Renal
GFR
Average maximum physiological changes associated with
Pregnancy

Parameter Change

Renal
GFR + 50%
Renal Effects

• Renal vasodilatation increases renal blood flow early

during pregnancy
• Autoregulation is preserved.
• The kidneys often enlarge.
• Increased renin and aldosterone levels promote sodium
retention.
• Renal plasma flow and the glomerular filtration rate
increase as much as 50% during the first trirnester
Renal Effects

• glomerular filtration declines toward normal in the third

trimester.
• Serum creatinine and blood urea nitrogen decrease to
0.5—0.6 mg/dL and 8—9 mgldL
• decreased renal tubular threshold for glucose and
amino acids results in : mild glycosuria (1—10 g/d)
prneteinuria (< 300 mg/d).
• Plasma osmolality decreases by 8—10 mOsm/kg.
5. What are Gastrointestinal changes
during labour ?
Gastrointestinal changes
• Gastroesophageal reflux esophagitis are common
during pregnancy.
• Upward and anterior displacemenr of the stomach by
the uterus promotes incompetence of the
gastroesophageal sphincter.
• Elevated progesterone levels reduce the tone of the
gastroesophageal sphincter .
• Placental gastrin secretion causes hypersecretion of
gastric acid.
• Intragastric pressure is unchanged.
Gastrointestinal changes
increased risk of severe aspiration pneumonitis
 Gastric PH ≤ 2.5
 Gastric volumes graeter than 25 ml≤60%.
 Delayed gastric emptying time
 Narcotics and anticholinergics reduce lower
esophageal sphincter pressure
6. What are hepatic changes during
labour ?
Hepatic effeccts
• hepatic function and blood flow are unchanged
• minor elevations in serum trarsaminases and lactic
dehydrogenase levels in the third trimester.
• Elevations in serum alkalin phosphatase are due to its
seccetion by placenta .
• A mild decrease in serum albumin is due to an
expanded plasma volume
• Colloid osmotic pressure progressively decreases,
parallel with the fall in serum albumin
Hepatic effeccts
• A 25—30% decrease in serum pseudocholinescerase
activity is also present at term

• rarely produces significant prolongation of

succinylcholine’s action.

• The breakdown of mivacurium and ester-type local

anaesthesia.
• Pseudocholinesrerase activity may not return to normal
until up to 6 weeks postpartum.
Hepatic effeccts
• High progesterone levels appear to inhibit the release
of cholecystokinin incomplete emptying of the
gallbladder

altered bile acid composition, can predispose to

formation of cholesterol gallstones.
6. What are hematological changes
during labour ?
Average maximum physiological changes associated with
Pregnancy

Parameter Change

Hematologic
Hemoglobin
Platelets
Clotting factors
Average maximum physiological changes associated with
Pregnancy

Parameter Change

Hematologic
Hemoglobin - 20%
Platelets
Clotting factors
Average maximum physiological changes associated with
Pregnancy

Parameter Change

Hematologic
Hemoglobin - 20%
Platelets - 10 to 20%
Clotting factors
Average maximum physiological changes associated with
Pregnancy

Parameter Change

Hematologic
Hemoglobin - 20%
Platelets - 10 to 20%
Clotting factors + 50 to 250%
• Pregnancy leads to a hypercoagulable state, due to,
a. factors VII, VIII, X, XII (? IX)
b. fibrinogen and FDP's
c. fibrinolytic activity - levels of plasminogen activators
d. antithrombin III
 increased risk of thromboembolic disease
e. W.B.C to 21000/cmm
f. Platelets by 10-20 %
7. What are metabolic changes during
labour ?
 Metabolic Changes

• Resemble starvation (blood glucose & aminoacidoses 

(FFA, triglycerides & ketones 
Favour fetal growth
• Diabetogenic state
• Insulin steadily
• Relative insulin resistance( hCPL)
• Pancreatic B-cell hyperplasia
• Increased level of relaxin - softening Cx
- symphysis pubis
- pelvic joints
- ↑in back injury
 Metabolic Changes

• Secretion of human chorionic gonadotropin and elevated

levels of estrogens promote hypertrophy of the thyroid gland

• increase thyroid-binding globulin

• T4 and T3 levels are elevated, free T4, free T3

• thyrotropin (thyroidstimulatiflg hormone) remain normal

• Serum calcium levels decrease

• ionized calcium concentration remains normal.
URETROPLACENTAL BLOOD FLOW
 Uteroplacental Circulation

• 10% CO
• 600-700ml/min pregnancy
(50ml/min non pregnant uterus)
• 80% of (10% or 600ml)normally supply the placenta
• 20% Myometrium

• Dilation of uterious vasculature(no auto regulation)

 Uterine Blood Flow (No auto regulation)

• Abundant a-adrenergic & b-receptors

• Not affected by resp. gas tension
• But extreme hypocapnia Pa CO2< 20mmHg
• Proportional to uterine arterial and venous pressures
• Inversely proportional uterine vascular resistance
 Uterine Blood Flow (No auto regulation)
Factors affecting ↓UBF
• Systemic hypotension
• Uterine vasoconstriction
• Uterine contraction
• Aortocaval compression
• Hypovolemia
 Uterine Blood Flow (No auto regulation)
Factors affecting
• Systemic blockade(local blocks)
• Stress of labour (endogenous catacholamines)
• Phenylphrine (a-agonist)
N.B. Ephidrine mainly b-agonist (used in spinal and epi
hypotension)
• Oxytocin & hypertonic contrations
PLACENTAL FUNCTION
 Foetal functions
Foetus depends on the placenta for
1.Gas exchange – Respiration
2. Nutrition
3. Waste product elimination
 PHYSIOLOGIC ANATOMY

• The placenta is composed of projections of fetal tissue

(villi) that lie in maternal vascular spaces (intervillous
spaces).

• As a result of this arrangement, the fetal capillaries

within villi readily exchange substances with the
maternal blood that bathes them.
 PHYSIOLOGIC ANATOMY
• Maternal blood in the intervillous spaces is derived from
spiral branches of the uterine artery and drains into the
uterine veins.

• Fetal blood within villi is derived from umbilical cord via

two umbilical arteries and returns to the fetus via a
single umbilical vein.
PLACENTAL EXCHANGE

Mechanssms of Placental exchange:

1. DIFFUTION
Respiratory gases and small ions are transported by
diffusion.
Most drugs used in anesthesia have molecular weights
well under 1000 can diffuse across the placenta.

2.BULK FLOW
Water moves across by bulk flow.

3.ACTIVE TRANSPORT
Amino acids, vitamins, and some ions (calcium and
iron) utilize this mechanism.
PLACENTAL EXCHANGE

Mechanssms of Placental exchange:

4.PINOCYTOSIS
large molecules, such as immunoglobulins, are
transported by pinocytosis.
5.Breaks
Breaks in the placental membrane and mixing of
maternal and fetal blood are probably responsible Rh
sensitisation.
Respiratory Gas Exchange

• oxygen has the lowest storage to utilization ratio.

• term, fetal consumption averages about 21 mL/min
• Fetal oxygen stores are normally 42 mL.
• The normal fetus at term can survive 10 minutes or
longer .
Respiratory Gas Exchange

• Transfer of oxygen across the placenta is

dependent on the ratio of maternal uterine
blood flow to fetal umbilical blood flow.

• The reserve for oxygen transfer is small.

• PaO, of only 40 mm Hg.
• The fetal hemoglobin oxygen dissociation curve
is shifted to the left such that fetal hemoglobin
has greater affinity for oxygen than does
maternal hemogloin
Respiratory Gas Exchange

• fetal hemoglobin concentration is usually 15 g/dL

(compared with approximately 12 g/d.L in the mother.
• Carbon dioxide readily diffuses across the placenta.
• Maternal hyperventilation increases the gradient for
the transfer of carbon dioxide from the fetus into the
maternal circulation.
• Fetal hemoglobin also appears to have less affinity for
carbon dioxide than does maternal hemoglobin.
THE PHYSIOLOGY OF NORMAL LABOR
Stages of Labour
Effect of Labor on Maternal Physiology

• During intense painful contraction the minute ventilation

increase up to 300%.
• Oxygen consumption increases 60%
• excessive hyperventilation, PaCO2 ↓ below 20 mm Hg.
• Excessive maternal hyperventilation reduces uterine
blood flow and promotes fetal acidosis.
• analogous to an auto transfusion 300-500ml
• Cardiac output rises 45% over third trimester values.
• The greatest strain on the heart,occurs immediately
after delivery, 80% above prelabor values.
Pain pathways during labor
FETAL PHYSIOLOGY
FETAL PHYSIOLOGY
• (1) Well-oxygenated blood from
the placenta (approximately 80%
oxygen saturation) mixes with
venous blood returning from the
lower body(25% oxygen
saturation) and flows via the
inferior vena cava into the right
atrium.
• 2. Right atrial anatomy
preferentially directs blood flow
from the inferior vena cava (67%
oxygen saturation) through the
foramen ovale into the left atrium.
• 3. Left aerial blood is then
pumped by the left ventricle to
the upper body (mainly the brain
and the heart).
• 4. Poorly oxygenated blood from
the upper body returns via the
superior vena rays to the right
atrium.
FETAL PHYSIOLOGY
5. Right atrial anatomy preferentially
directs flow from the superior
vena cava into the right ventricle.

6. Right ventricular blood is pumped

into the pulmonary artery.

7. Because of high pulmonary

vascular resistance,
95% of the blood ejected from the
right ventricle
(60% oxygen saturation) is shunted
across the ductus arteriosus, into
the destending aorta, and
back to the placenta and lower body.
Obstetric Anaesthesia and its
Challenges for the Anesthetist
 Obstetric Anaesthesia and its
Challenges for the Anaesthetist
• Obstetric anaesthetist must understand maternal adoption to
pregnancy in order to manipulate physiological changes following
general or regional anaesthesia and anaesthesia in such a way that
the condition of the neonate at delivery is optimized
• Understanding Physiology of Pregnancy has enabled many more
women with chronic diseases to achieve pregnancy

• Pharmokokinetics of anesthetic drugs during pregnancy

• Placental transfer of drugs
 Obstetric Anaesthesia and its
Challenges for the Anaesthetist
• Stress of multiple pregnancy, hypertension, PET, ET is well
known now to anaesthetist. Distress of mother or fetus gives no
leave way for anaesthetist but to conduct anaesthesia at VERY short
notice without optimizing the condition
• Mother may be handling full stomach, bleeding, hypotension.
Cannot be deferred otherwise we either loose mother or fetus or
both

• Odd hours, emergency surgery without senior cover or at times

lack of expert help culminates into catastrophic complications
• Maternal resuscitation, antepartum, postpartum hemorrhage etc.
 Obstetric Anaesthesia and its
Challenges for the Anaesthetist
• Neonatal resuscitation – another challenge for both anaesthetist and
neontalogist
• Failure to intubation or ventilate and another night mare for
anesthesia
• Sever bleeding intra-op with little or no help from blood bank in the
form blood, platelets, factors may end into demise also
• Amniotic embolism an other dreaded complication of sudden
collapse,DIC, and ARDS
• HELLP syndrome and associated organ problems in unplanned
unforeseen patient could be too much demanding and stressful
situation for the anesthetist
 Obstetric Anaesthesia and its
Challenges for the Anaesthetist
• Awareness during obstetric anaesthesia incidence is more than any
other type of anaesthesia

• Supine hypotensive syndrome

• Epidural/ spinal failure/ collapse or cardiac arrest after spinal are

some dreaded complications of obstetric anaesthesia

• Post spinal/ epidural headaches, backaches, quade-equina syndrome

 Some Other Challenges in Obstetric Anaesthesia

• Anaesthesia during pregnancy for non-obstetric purpose e.g.

appendectomy, cervical circulate, tocolytic therapy and its
implication may end in abortion and pulmonary edema, ARDS, &
CHF

• Fetal lung maturity in certain diseases - prematurity , diabetes etc

• Drug effects- induction at delivery time and placental transfer, fetal

handling of drugs, implication on well being of the newborn

• Congenital anomalies – resuscitation or needing immediate surgery

e.g. neural defects
 Some Other Challenges in Obstetric Anaesthesia
Trauma in pregnancy - another challenge

• Sudden cardiac arrest and its management is quite different from

other types of cardiac arrest

• Many challenging scenarios may happen

- patient in lathotomy
- head stuck
- cervical tear
- patient demoralized from bad
conduct of labor &
- an anesthetic called to help ???

• Drug abuse in parturient – another havoc

 Obstetric Anaesthesia is a multidisciplinary team
involving

• Obstetrician
• Obstetric Anaesthetist
• Midwife
• Health visitors
• Physicians
• Neonatalogist

Therefore communication is of utmost importance and

good record keeping is vital for obstetric anesthetist
“ A Pregnant Lady Is Like A
Ticking Bomb That Can Burst
Into Fatality Any Moment”
Channa A B