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Chestnut’sObstetric Anesthesia:
Principles and Practice
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Chestnut’sObstetric Anesthesia:
Principles and PracticeFourth Edition
David H. Chestnut, MDDirector of Medical Education
Gundersen Lutheran Health SystemProfessor of Anesthesiology
Associate Dean for the Western Academic CampusUniversity of Wisconsin School of Medicine and
Public HealthLa Crosse, Wisconsin
Linda S. Polley, MDAssociate Professor of Anesthesiology
University of Michigan Medical SchoolDirector, Obstetric Anesthesiology
University of Michigan Health SystemAnn Arbor, Michigan
Lawrence C. Tsen, MDAssociate Professor of Anaesthesia
Harvard Medical SchoolDirector of Anesthesia, Center for Reproductive Medicine
Department of Anesthesiology, Perioperative andPain Medicine
Brigham and Women’s HospitalBoston, Massachusetts
Cynthia A. Wong, MDAssociate Professor of Anesthesiology
Northwestern University Feinberg School of MedicineMedical Director, Obstetric Anesthesia
Northwestern Memorial HospitalChicago, Illinois
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CHESTNUT’S OBSTETRIC ANESTHESIA: ISBN: 978-0-323-05541-3PRINCIPLES AND PRACTICE
Copyright ! 2009, 2004, 1999, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by anymeans, electronic or mechanical, including photocopying, recording, or any information storage and retrievalsystem, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’sRights Department: phone: (+1) 215 239 3804 (US) or (+44) 1865 843830 (UK); fax: (+44) 1865 853333;e-mail: [email protected]. You may also complete your request on-line via the Elsevier websiteat http://www.elsevier.com/permissions.
Notice
Knowledge and best practice in this field are constantly changing. As new research and experiencebroaden our knowledge, changes in practice, treatment, and drug therapy may become necessary orappropriate. Readers are advised to check the most current information provided (i) on proceduresfeatured or (ii) by the manufacturer of each product to be administered, to verify the recommendeddose or formula, the method and duration of administration, and contraindications. It is theresponsibility of the practitioner, relying on his or her own experience and knowledge of the patient,to make diagnoses, to determine dosages and the best treatment for each individual patient, and totake all appropriate safety precautions. To the fullest extent of the law, neither the publisher nor theeditors assume any liability for any injury and/or damage to persons or property arising out of orrelated to any use of the material contained in this book.
The Publisher
Library of Congress Cataloging-in-Publication Data
Chestnut’s obstetric anesthesia : principles and practice / [edited by] David H. Chestnut ... [et al.].– 4th ed.
p. ; cm.Rev. ed. of: Obstetric anesthesia. 3rd ed. 2004.Includes bibliographical references and indexISBN 978-0-323-05541-3
1. Anesthesia in obstetrics. I. Chestnut, David H. II. Title: Obstetric anesthesia.[DNLM: 1. Anesthesia, Obstetrical–methods. 2. Anesthetics. 3. Obstetric Labor
Complications. WO 450 C525 2009].RG732.C44 2009617.9’682–dc22 2008050031
Acquisitions Editor: Natasha AndjelkovicDevelopmental Editor: Anne SnyderPublishing Services Manager: Tina RebaneProject Manager: Norm StellanderDesign Direction: Louis Forgione
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
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To my wife, Janet, and our children, Stephen, Annie, Mary Beth, Michael,and John Mark and Catherine
DHC
To my sons, Tad and John
LSP
To my wife, Paulita, our children, London and Hamilton,and my parents-in-law, Deirdre and Oscar
LCT
To my husband, Lawrence, and our children, Anna, Molly, Leah, and Sofie
CAW
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Contributors
Susan W. Aucott, M.D.Assistant Professor of PediatricsJohns Hopkins University School of MedicineDirector, Neonatal Intensive Care UnitJohns Hopkins HospitalBaltimore, Maryland
Angela M. Bader, M.D., M.P.H.Associate Professor of AnaesthesiaHarvard Medical SchoolVice Chair for Perioperative MedicineDirector, Weiner Center for Perioperative EvaluationDepartment of Anesthesiology, Perioperative and Pain
MedicineBrigham and Women’s HospitalBoston, Massachusetts
Yaakov Beilin, M.D.Professor of Anesthesiology and Obstetrics,
Gynecology, and Reproductive SciencesVice Chair for QualityCo-Director of Obstetric AnesthesiaMount Sinai School of MedicineNew York, New York
David J. Birnbach, M.D., M.P.H.Professor and Executive Vice Chair of AnesthesiologyDirector, UM-JMH Center for Patient SafetyUniversity of Miami Miller School of MedicineMiami, Florida
David L. Brown, M.D.Chair, Institute of AnesthesiologyCleveland ClinicCleveland, Ohio
Brenda A. Bucklin, M.D.Professor of AnesthesiologyUniversity of Colorado School of MedicineDenver, Colorado
Alexander Butwick, M.B.B.S., FRCAInstructor in AnesthesiaStanford University School of MedicineStanford, California
William Camann, M.D.Associate Professor of AnaesthesiaHarvard Medical SchoolDirector, Obstetric AnesthesiaBrigham and Women’s HospitalBoston, Massachusetts
Katherine Campbell, M.D.Department of Obstetrics, Gynecology, and Reproductive
SciencesYale University School of MedicineNew Haven, Connecticut
Brendan Carvalho, M.B., B.Ch., FRCA,MDCHAssistant Professor of AnesthesiaStanford University School of MedicineStanford, California
Donald Caton, M.D.Professor Emeritus of AnesthesiologyUniversity of Florida College of MedicineGainesville, Florida
Paula D. M. Chantigian, M.D., FACOGObstetrician and GynecologistByron, Minnesota
Robert C. Chantigian, M.D.Associate Professor of AnesthesiologyMayo ClinicRochester, Minnesota
Contributors vii
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David H. Chestnut, M.D.Director of Medical EducationGundersen Lutheran Health SystemProfessor of AnesthesiologyAssociate Dean for the Western Academic CampusUniversity of Wisconsin School of Medicine and Public
HealthLa Crosse, Wisconsin
Edward T. Crosby, B.Sc., M.D., FRCPCProfessor of AnesthesiologyFaculty of MedicineUniversity of OttawaOttawa HospitalOttawa, Ontario, Canada
Robert D’Angelo, M.D.Professor and Vice Chair of AnesthesiologySection Head, Obstetric AnesthesiaWake Forest University School of MedicineWinston-Salem, North Carolina
Joanna M. Davies, M.B.B.S., FRCAAssistant Professor of AnesthesiologyUniversity of Washington School of MedicineSeattle, Washington
Kathleen M. Davis, M.D.Assistant Professor of AnesthesiologyUniversity of Maryland School of MedicineBaltimore, Maryland
David D. Dewan, M.D.Professor of Anesthesiology (retirement status)Wake Forest University School of MedicineWinston-Salem, North Carolina
M. Joanne Douglas, M.D., FRCPCClinical Professor of Anesthesiology, Pharmacology and
TherapeuticsFaculty of MedicineUniversity of British ColumbiaBritish Columbia Women’s Hospital and Health CentreVancouver, British Columbia, Canada
Sunil Eappen, M.D.Assistant Professor of AnaesthesiaHarvard Medical SchoolVice-Chair for Clinical AffairsDepartment of Anesthesiology, Perioperative and Pain
MedicineBrigham and Women’s HospitalBoston, Massachusetts
James C. Eisenach, M.D.Professor and Vice Chair for ResearchSection of Obstetric AnesthesiaWake Forest University School of MedicineWinston-Salem, North Carolina
Roshan Fernando, M.D., FRCAConsultant Anaesthetist and Honorary Senior LecturerDepartment of AnaesthesiaUniversity College HospitalsLondon, United Kingdom
Michael Froelich, M.D., M.S.Associate Professor of AnesthesiologyUniversity of Alabama at Birmingham School of MedicineBirmingham, Alabama
Robert Gaiser, M.D.Professor of Anesthesiology and Critical CareUniversity of Pennsylvania School of MedicinePhiladelphia, Pennsylvania
Carin A. Hagberg, M.D.Professor and Chair of AnesthesiologyUniversity of Texas Medical School at HoustonHouston, Texas
M. Shankar Hari, M.D., FRCAConsultant in Intensive Care MedicineGuy’s and St. Thomas’ NHS TrustLondon, United Kingdom
Miriam Harnett, M.B., FFARCSIConsultant AnaesthetistCork University Maternal HospitalCork, Ireland
Andrew P. Harris, M.D., M.H.S.Professor of Anesthesiology and Critical Care MedicineJohns Hopkins University School of MedicineBaltimore, Maryland
Joy L. Hawkins, M.D.Professor of AnesthesiologyAssociate Chair for Academic AffairsUniversity of Colorado School of MedicineDirector of Obstetric AnesthesiaUniversity of Colorado HospitalAurora, Colorado
David Hepner, M.D.Assistant Professor of AnaesthesiaHarvard Medical SchoolAssociate Director, Weiner Center for Perioperative
EvaluationDepartment of Anesthesiology, Perioperative and Pain
MedicineBrigham and Women’s HospitalBoston, Massachusetts
Norman L. Herman, M.D., Ph.D.Assistant Professor of Anesthesiology (retirement status)Cornell University Medical CollegeNew York, New York
viii Contributors
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Paul Howell, B.Sc., M.B., Ch.B., FRCAConsultant AnaesthetistSt. Bartholomew’s HospitalsWest SmithfieldLondon, United Kingdom
Tanya Jones, M.B., Ch.B., MRCP,FRCA
Smiths Medical Research Fellow in Obstetric AnaesthesiaDepartment of AnaesthesiaRoyal Free HospitalLondon, United Kingdom
BettyLou Koffel, M.D.Chief of StaffInterstate Ambulatory SurgicenterPortland, Oregon
Lisa R. Leffert, M.D.Assistant Professor of AnaesthesiaHarvard Medical SchoolCo-Chief, Obstetric AnesthesiaDepartment of Anesthesia and Critical CareMassachusetts General HospitalBoston, Massachusetts
Karen S. Lindeman, M.D.Associate Professor of Anesthesiology and Critical
Care MedicineJohns Hopkins University School of MedicineBaltimore, Maryland
Elizabeth G. Livingston, M.D.Associate Professor of Obstetrics and GynecologyDuke University School of MedicineDurham, North Carolina
Alison Macarthur, B.M.Sc., M.D., M.Sc.,FRCPC
Associate Professor, Faculty of MedicineUniversity of TorontoDepartment of AnesthesiaMount Sinai HospitalToronto, Ontario, Canada
Andrew M. Malinow, M.D.Professor of AnesthesiologyUniversity of Maryland School of MedicineDirector, Obstetric AnesthesiologyUniversity of Maryland Medical SystemBaltimore, Maryland
David C. Mayer, M.D.Professor of Anesthesiology and Obstetrics
and GynecologyUniversity of North Carolina School of MedicineCo-Director of Obstetric AnesthesiologyUniversity of North Carolina HospitalsChapel Hill, North Carolina
Jill M. Mhyre, M.D.Assistant Professor of AnesthesiologyUniversity of Michigan Medical SchoolWomen’s HospitalUniversity of Michigan Health SystemAnn Arbor, Michigan
Marie E. Minnich, M.D., M.M.M.,M.B.A., C.P.E.
Division of AnesthesiologyGeisinger Health SystemDanville, Pennsylvania
Holly A. Muir, M.D., FRCPCChief, Division of Women’s AnesthesiaVice Chair for Clinical OperationsDepartment of AnesthesiologyDuke University Medical CenterDurham, North Carolina
Naveen Nathan, M.D.Instructor of AnesthesiologyNorthwestern University Feinberg School of MedicineChicago, Illinois
Kenneth E. Nelson, M.D.Associate Professor of AnesthesiologySection of Obstetric AnesthesiaWake Forest University School of MedicineWinston-Salem, North Carolina
Warwick D. Ngan Kee, B.H.B., M.B.,Ch.B., M.D., FANZCA, FHKCA,FHKAM
Department of Anaesthesia and Intensive CareThe Chinese University of Hong KongPrince of Wales HospitalShatin, Hong Kong, China
Errol R. Norwitz, M.D., Ph.D.Associate Professor of Obstetrics, Gynecology and
Reproductive SciencesYale University School of MedicineNew Haven, Connecticut
Contributors ix
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Geraldine O’Sullivan, M.D., FRCAConsultant AnaesthetistObstetric AnaesthesiaGuy’s and St. Thomas’ NHS TrustLondon, United Kingdom
Peter H. Pan, M.D.Professor of AnesthesiologyDirector of Clinical ResearchSection of Obstetric AnesthesiaWake Forest University School of MedicineWinston-Salem, North Carolina
Joong Shin Park, M.D., Ph.D.Department of Obstetrics and GynecologySeoul National University HospitalSeoul, Korea
Donald H. Penning, M.D., M.Sc., FRCPProfessor of Clinical AnesthesiologyUniversity of Miami Miller School of MedicineMiami, Florida
Linda S. Polley, M.D.Associate Professor of AnesthesiologyUniversity of Michigan Medical SchoolDirector, Obstetric AnesthesiologyUniversity of Michigan Health SystemAnn Arbor, Michigan
Roanne Preston, M.D., FRCPCClinical Associate Professor of AnesthesiologyFaculty of MedicineUniversity of British ColumbiaBritish Columbia Women’s Hospital and Health CentreVancouver, British Columbia, Canada
Robert W. Reid, M.D.Consultant in Critical Care MedicineSaint Luke’s Health SystemKansas City, Missouri
Felicity Reynolds, M.B., B.S., M.D.,FRCA, FRCOG ad eundem
Emeritus Professor of Obstetric AnaesthesiaSt. Thomas’ HospitalLondon, United Kingdom
Mark A. Rosen, M.D.Professor and Vice Chair of Anesthesia and Perioperative
CareProfessor of Obstetrics, Gynecology, and Reproductive
SciencesDirector of Obstetric AnesthesiaUniversity of California San FranciscoSan Francisco, California
Brian K. Ross, M.D., Ph.D.Professor of AnesthesiologyUniversity of Washington School of MedicineSeattle, Washington
Dwight J. Rouse, M.D., M.S.P.H.Professor of Obstetrics and GynecologyUniversity of Alabama at Birmingham School of MedicineBirmingham, Alabama
Eduardo Salas, Ph.D.Professor of PsychologyProgram Director, Human Systems Integration Research
DepartmentInstitute for Simulation and TrainingUniversity of Central FloridaOrlando, Florida
Alan C. Santos, M.D., M.P.H.Professor and Chair of AnesthesiologyOchsner Clinic FoundationNew Orleans, Louisiana
Scott Segal, M.D.Associate Professor of AnaesthesiaHarvard Medical SchoolVice Chair for EducationDepartment of Anesthesiology, Perioperative and Pain
MedicineBrigham and Women’s HospitalBoston, Massachusetts
Shiv K. Sharma, M.D., FRCAProfessor of Anesthesiology and Pain ManagementUniversity of Texas Southwestern Medical SchoolDallas, Texas
Kathleen A. Smith, M.D.Assistant Professor of Anesthesiology and Obstetrics and
GynecologyUniversity of North Carolina School of MedicineCo-Director of Obstetric AnesthesiologyUniversity of North Carolina HospitalsChapel Hill, North Carolina
John A. Thomas, M.D.Assistant Professor of AnesthesiologySection of Obstetric AnesthesiaWake Forest University School of MedicineWinston Salem, North Carolina
Alan T. N. Tita, M.D., M.P.H., Ph.D.Department of Obstetrics and GynecologyUniversity of Alabama at Birmingham School of MedicineBirmingham, Alabama
x Contributors
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Lawrence C. Tsen, M.D.Associate Professor of AnaesthesiaHarvard Medical SchoolDirector of Anesthesia, Center for Reproductive MedicineDepartment of Anesthesiology, Perioperative and Pain
MedicineBrigham and Women’s HospitalBoston, Massachusetts
Marc Van de Velde, M.D., Ph.D.Professor of AnesthesiaDirector, Obstetric AnesthesiaCatholic University LeuvenLeuven, Belgium
Robert D. Vincent, Jr., M.D.Staff AnesthesiologistUniversity of South Alabama Medical CenterMobile, Alabama
Mark S. Williams, M.D., M.B.A., J.D.Clinical Associate Professor of AnesthesiologyUniversity of Alabama at Birmingham School of MedicineSenior Vice-President and Chief Medical OfficerSt. Vincent’s Health SystemBirmingham, Alabama
Richard N. Wissler, M.D., Ph.D.Associate Professor of Anesthesiology and Obstetrics and
GynecologyDirector of Obstetric AnesthesiologyUniversity of Rochester School of Medicine and DentistryRochester, New York
David J. Wlody, M.D.Professor of Clinical AnesthesiologyState University of New York – Downstate Medical
CenterChair of AnesthesiologyLong Island College HospitalBrooklyn, New York
Cynthia A. Wong, M.D.Associate Professor of AnesthesiologyNorthwestern University Feinberg School of MedicineMedical Director, Obstetric AnesthesiaNorthwestern Memorial HospitalChicago, Illinois
Jerome Yankowitz, M.D.Professor of Obstetrics and GynecologyUniversity of Iowa Roy L. and Lucille A. Carver College
of MedicineIowa City, Iowa
Mark I. Zakowski, M.D.Obstetric AnesthesiologyCedars-Sinai Medical CenterLos Angeles, Callifornia
Rhonda L. Zuckerman, M.D.Assistant Professor of Anesthesiology and Critical CareAssistant Professor of Gynecology and ObstetricsJohns Hopkins University School of MedicineBaltimore, Maryland
Contributors xi
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Preface
Three decades ago, I could not decide whether I wanted to pursue a career in anesthesiology or obstetrics. So ð I decided todo both. I obtained training in both specialties largely because of my love of perinatal medicine. This text is the result of mydesire to prepare a comprehensive resource for all anesthesia providers (and obstetricians) who provide care for pregnantwomen.
In the preface to the first edition, I identified two goals: (1) to collate the most important information that anesthesiaproviders should know about obstetrics, and (2) to prepare a thorough and user-friendly review of anesthesia care forobstetric patients. I asked each contributor to prepare a comprehensive, scholarly discussion of the subject and also toprovide clear, practical recommendations for clinical practice. As we unveil the fourth edition, those goals remain intact.Further, the fourth edition has undergone a more extensive revision than either the second or the third edition.
First, consider the cover. The maternal-fetal image draws attention to the fact that the anesthesia provider and theobstetrician provide simultaneous care for two (or more) patients – both the mother and her unborn child. As I look at thatimage, I am awestruck by the miraculous beauty of conception, pregnancy, and childbirth.
Second, consider the content. At least 10 chapters – including the chapters on neuraxial labor analgesia, cesareandelivery, the difficult airway, and hypertensive disorders – have been rewritten from start to finish. The three previouslypublished chapters on neuraxial labor analgesia have been consolidated into a single chapter, as have the two previouslypublished chapters on anesthesia for cesarean delivery. All chapters have been updated, and most chapters have undergoneextensive revision. Two new chapters address the important subjects of patient safety and maternal mortality. And thefourth edition – for the first time – features a dedicated website that includes the whole content of the book and is fullysearchable. The book’s interior has been enhanced by the addition of a second color, which allows a better and moreattractive visual presentation.
Third, consider the contributors. The fourth edition includes an astounding number of 32 new contributors! Of specialsignificance is the addition of three outstanding new editors. I hand-picked these new editors as a result of my personalinteraction with them in the preparation of previous editions of this textbook, as well as my familiarity with – and respectfor – the depth and breadth of their knowledge and judgment, and the quality of their scholarship. The title page lists theiracademic affiliations and hospital leadership positions. In addition, Linda S. Polley, M.D., is the current President of theSociety for Obstetric Anesthesiology and Perinatology (SOAP). Lawrence C. Tsen, M.D., is the President-elect of SOAP,and he also serves as Editor-in-Chief of International Journal of Obstetric Anesthesia. And Cynthia A. Wong, M.D., is theobstetric anesthesia section editor for Anesthesia and Analgesia. The addition of these extraordinary obstetric anesthesiol-ogists to the editorial team has resulted not only in the preparation of a better product, but it also reflects the publisher’s(and my own) long-term commitment to this text.
My fellow editors and I should like to acknowledge the important roles of four groups of special people. First, we shouldlike to thank the 72 other talented and distinguished contributors to the fourth edition, as well as the contributors toprevious editions of this text. Without their commitment to this project, the fourth edition would not have seen the light ofday. Second, we should like to gratefully acknowledge the invaluable contributions made by our competent, loyal, and attimes long-suffering assistants: Jennifer Lee and Donna Stortz (DHC); Mary Lou Greenfield (LSP); Judy Johnson (LCT); andAllison Ernt and Sean Jones (CAW). Third, we should like to acknowledge the encouragement, expertise, and attention todetail provided by the professional production team at Elsevier Mosby. And finally, we should like to thank you, the readers,not only for your support of this text through the years, but also for your ongoing commitment to the provision of safe andcompassionate care for pregnant women and their unborn children.
David H. Chestnut, M.D.
Micah 6:8
Preface xiii
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Contents
PART IIntroduction
Chapter 1
The History of Obstetric Anesthesia 3Donald Caton
PART IIMaternal and Fetal Physiology
Chapter 2
Physiologic Changes of Pregnancy 15Robert Gaiser
Chapter 3
Uteroplacental Blood Flow 37Warwick D. Ngan Kee
Chapter 4
The Placenta: Anatomy, Physiology, andTransfer of Drugs 55Mark I. Zakowski and Norman L. Herman
Chapter 5
Fetal Physiology 73Kenneth E. Nelson and Andrew P. Harris
PART IIIFetal and Neonatal Assessment and Therapy
Chapter 6
Antepartum Fetal Assessment and Therapy 89Katherine Campbell, Joong Shin Park, and Errol R. Norwitz
Chapter 7
Anesthesia for Fetal Surgery and OtherIntrauterine Procedures 123Mark A. Rosen
Chapter 8
Intrapartum Fetal Assessment and Therapy 141Elizabeth G. Livingston
Chapter 9
Neonatal Assessment and Resuscitation 155Susan W. Aucott and Rhonda L. Zuckerman
Chapter 10
Fetal and Neonatal Neurologic Injury 185Donald H. Penning
PART IVFoundations in Obstetric Anesthesia
Chapter 11
Patient Safety and Team Training 211David J. Birnbach and Eduardo Salas
Chapter 12
Spinal, Epidural, and Caudal Anesthesia:Anatomy, Physiology, and Technique 223Cynthia A. Wong, Naveen Nathan, and David L. Brown
Chapter 13
Local Anesthetics and Opioids 247Alan C. Santos and Brenda A. Bucklin
PART VAnesthesia Before and During Delivery
Chapter 14
Nonanesthetic Drugs during Pregnancy andLactation 285Jerome Yankowitz
Chapter 15
In Vitro Fertilization and Other AssistedReproductive Technology 305Lawrence C. Tsen and Robert D. Vincent, Jr.
Chapter 16
Problems of Early Pregnancy 319Robert C. Chantigian and Paula D. M. Chantigian
Contents xv
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Chapter 17
Nonobstetric Surgery during Pregnancy 337Marc Van de Velde
PART VILabor and Vaginal Delivery
Chapter 18
Obstetric Management of Labor andVaginal Delivery 361Alan T. N. Tita and Dwight J. Rouse
Chapter 19
Vaginal Birth after Cesarean Delivery 375David H. Chestnut
Chapter 20
The Pain of Childbirth and Its Effects on theMother and the Fetus 387Peter H. Pan and James C. Eisenach
Chapter 21
Childbirth Preparation and NonpharmacologicAnalgesia 405Marie E. Minnich
Chapter 22
Systemic Analgesia: Parenteral andInhalational Agents 415Roshan Fernando and Tanya Jones
Chapter 23
Epidural and Spinal Analgesia/Anesthesia forLabor and Vaginal Delivery 429Cynthia A. Wong
Chapter 24
Alternative Regional Anesthetic Techniques:Paracervical Block, Lumbar SympatheticBlock, Pudendal Nerve Block, and PerinealInfiltration 493David H. Chestnut
Chapter 25
Postpartum Tubal Sterilization 505Joy L. Hawkins
PART VIICesarean Delivery
Chapter 26
Anesthesia for Cesarean Delivery 521Lawrence C. Tsen
Chapter 27
Postoperative Analgesia: Systemic and LocalTechniques 575David Hepner and Sunil Eappen
Chapter 28
Postoperative Analgesia: Epidural and SpinalTechniques 593Brendan Carvalho and Alexander Butwick
PART VIIIAnesthetic Complications
Chapter 29
Aspiration: Risk, Prophylaxis, andTreatment 633Geraldine O’Sullivan and M. Shankar Hari
Chapter 30
The Difficult Airway: Risks, Prophylaxis, andManagement 651John A. Thomas and Carin A. Hagberg
Chapter 31
Postpartum Headache 677Alison Macarthur
Chapter 32
Neurologic Complications of Pregnancy andNeuraxial Anesthesia 701Felicity Reynolds
Chapter 33
Medicolegal Issues in Obstetric Anesthesia 727Mark S. Williams, Joanna M. Davies, and Brian K. Ross
PART IXObstetric Complications
Chapter 34
Preterm Labor and Delivery 749Holly A. Muir and Cynthia A. Wong
Chapter 35
Abnormal Presentation and MultipleGestation 779BettyLou Koffel
Chapter 36
Fever and Infection 795Scott Segal
Chapter 37
Antepartum and Postpartum Hemorrhage 811David C. Mayer and Kathleen A. Smith
Chapter 38
Embolic Disorders 837Kathleen M. Davis and Andrew M. Malinow
Chapter 39
Maternal Mortality 853Jill M. Mhyre
xvi Contents
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PART XThe Parturient with Systemic Disease
Chapter 40
Autoimmune Disorders 869Robert W. Reid
Chapter 41
Cardiovascular Disease 881Miriam Harnett and Lawrence C. Tsen
Chapter 42
Endocrine Disorders 913Richard N. Wissler
Chapter 43
Hematologic and Coagulation Disorders 943Shiv K. Sharma
Chapter 44
Human Immunodeficiency Virus 961David J. Wlody
Chapter 45
Hypertensive Disorders 975Linda S. Polley
Chapter 46
Liver Disease 1009Michael Froelich and Robert W. Reid
Chapter 47
Malignant Hyperthermia 1023M. Joanne Douglas
Chapter 48
Musculoskeletal Disorders 1035Roanne Preston and Edward T. Crosby
Chapter 49
Neurologic and Neuromuscular Disease 1053Angela M. Bader
Chapter 50
Obesity 1079Robert D’Angelo and David D. Dewan
Chapter 51
Renal Disease 1095Yaakov Beilin and Robert W. Reid
Chapter 52
Respiratory Disease in Pregnancy 1109Karen S. Lindeman
Chapter 53
Substance Abuse 1125Lisa R. Leffert
Chapter 54
Trauma 1149Paul Howell
Appendix A
American Society of AnesthesiologistsGuidelines for Regional Anesthesiain Obstetrics 1165
Appendix B
Practice Guidelines for ObstetricAnesthesia: An Updated Report by the AmericanSociety of Anesthesiologists Task Forceon Obstetric Anesthesia 1167
Appendix C
Optimal Goals for Anesthesia Care inObstetrics 1179
Appendix D
Online Resources for Obstetric AnesthesiaProviders 1181William Camann
Index 1185
Contents xvii
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