ABSTRACT
This chapter focuses on anesthetic risk stratification, the physiologic changes of pregnancy, labor and delivery, hemodynamic goals for patients as they present for delivery, and appropriate anesthetic techniques to achieve those goals. Risk stratification is important to the anesthesiologist because anesthesiologists are an integral part of the multidisciplinary team who help identify pregnancies at high risk for maternal harm during childbirth and triage risk-stratifying women with cardiac disease who are pregnant to deliver at appropriate hospitals. Anesthesia for cesarean delivery requires complete insensitivity to the pain of a surgical stimulation. Neuraxial labor analgesia reduces the catecholamine surges from labor pain that can result in tachycardia, arrhythmias, hypertension, increases in cardiac output, and ventricular stress. In women with cardiovascular disease, close monitoring of heart rate and blood pressure during the initiation of neuraxial labor analgesia with rapid treatment of hypotension is paramount. For vaginal delivery in moderate- to high-risk cardiac disease, neuraxial labor analgesia is preferred to reduce the hemodynamic consequences of painful labor.
