Anaes · Obstetric anaesthesia
Obstetric anaesthesia
Also known as Obstetric anaesthesia · Caesarean section anaesthesia · Labour epidural · Pre-eclampsia anaesthesia · Obstetric GA · SS_OB specialised study unit
Exam-pass obstetric anaesthesia hub (SS_OB): maternal physiology, labour epidural/CSE, caesarean decision matrix, OAA/DAS failed intubation and wake-versus-proceed, pre-eclampsia/magnesium, PPH with WOMAN TXA, AFE, and leaf links for crises.
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- Obstetric failed intubation is several-fold more common than non-pregnant — engorged friable airway, rapid desaturation, full stomach. Always have an OAA/DAS plan and a wake-versus-proceed decision before induction.
- Aortocaval compression from about 20 weeks: left lateral tilt or manual uterine displacement whenever supine.
- Phenylephrine is first-line for spinal hypotension at caesarean (better fetal acid-base than ephedrine).
- PPH: TXA 1 g IV within 3 hours (WOMAN); activate MTP early; fibrinogen is the key clotting factor to watch.
- Maternal cardiac arrest: timely perimortem caesarean without delay to improve maternal (and fetal) outcome.
Meet the patient
A 32-year-old, 38 weeks pregnant, is rushed to theatre for a category-1 caesarean for fetal bradycardia. She has a Mallampati 3 airway, a BMI of 34, and ate two hours ago. The epidural from labour is not working. You have ninety seconds to decide: spinal, or crash GA?[1]
Three physiological facts frame every obstetric decision: the parturient desaturates rapidly (FRC down, oxygen consumption up), she bleeds fast (high uterine blood flow at term), and her airway is oedematous, friable, and several-fold more likely to fail intubation. MBRRACE-UK puts airway, haemorrhage, and cardiac disease at the centre of preventable maternal death — every plan accounts for all three.[5][6][7]
References10ShowHide
- [1]Mushambi MC, Kinsella SM Obstetric Anaesthetists' Association/Difficult Airway Society difficult and failed tracheal intubation guidelines--the way forward for the obstetric airway Br J Anaesth, 2015.PMID 26511060
- [2]WOMAN Trial Collaborators Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial Lancet, 2017.PMID 28456509
- [3]Ngan Kee WD, Khaw KS, Ng FF Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for Caesarean section Br J Anaesth, 2004.PMID 14977792
- [4]Delgado C, Ring L, Mushambi MC General anaesthesia in obstetrics BJA Educ, 2020.PMID 33456951
- [5]Freedman RL, Lucas DN MBRRACE-UK: saving lives, improving mothers' care - implications for anaesthetists Int J Obstet Anesth, 2015.PMID 25841640
- [6]Bamber JH, Plaat F Beyond the numbers: obstetric anaesthesia and maternal deaths Br J Anaesth, 2025.PMID 40089396
- [7]Mushambi MC, Kinsella SM, Popat M, et al. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics Anaesthesia, 2015.PMID 26449292
- [8]Dyer RA, Butwick AJ, Carvalho B Oxytocin for labour and caesarean delivery: implications for the anaesthetist Curr Opin Anaesthesiol, 2011.PMID 21415725
- [9]Günaydın B Management of Postpartum Haemorrhage Turk J Anaesthesiol Reanim, 2022.PMID 36511487
- [10]ACOG Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222 Obstet Gynecol, 2020.PMID 32443079