A Review of the Impact of Obstetric Anesthesia on Maternal and Neonatal Outcomes

Grace Lim, M.D., M.S.; Francesca L. Facco, M.D., M.S.; Naveen Nathan, M.D.; Jonathan H. Waters, M.D.; Cynthia A. Wong, M.D.; Holger K. Eltzschig, M.D., Ph.D.


Anesthesiology. 2018;129(1):192-215. 

In This Article


Advances in obstetric anesthesiology over the last decade have spanned multiple areas. Enhancements in neuraxial labor analgesic techniques, postpartum neuraxial pain management modalities, and prevention of intraoperative hypotension during cesarean delivery have contributed to improvements in care. Still more progress is needed in many areas, including questions about acute postpartum pain and its potential influence on chronic pain, the influence of labor pain on perinatal depression, labor epidural-associated fever, and the impact of labor analgesia on the duration of the second stage of labor and instrumental vaginal delivery. Current and future scientific work on individual physiologic characteristics of pain, labor progress, and other aspects of obstetric care may enhance clinicians' ability to personalize obstetric anesthesia therapies and interventions. Comparative effectiveness studies on diagnostic and treatment modalities for pain during labor and the puerperium, the progress of labor, and obstetric hemorrhage, as well as the effects of these modalities on patient-centered outcomes, are necessary as our discipline advances further into the twenty-first century.