Obstetric Analgesia and Anesthesia

Publication Date: February 28, 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

February 28, 2019

Last Updated Month/Year

April 1, 2024

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