General Principles
What is the primary goal of obstetric analgesia?
Adequate pain relief while maintaining maternal and fetal safety
Give a drug class that is most commonly used for systemic labor analgesia.
Opioids
What nerve block is used for episiotomy and perineal repair?
Pudendal nerve block
What is the gold standard for labor analgesia?
Epidural analgesia
When is general anesthesia MOST commonly indicated in obstetrics?
Emergency cesarean section
Why is left uterine displacement important during labor analgesia?
To prevent aortocaval compression and maternal hypotension
Opioid that is preferred in labor due to rapid onset and less neonatal depression.
Fentanyl
Spinal nerve roots that are blocked in pudendal nerve block.
S2-S4
What neuraxial technique has the fastest onset?
Spinal (subarachnoid) block
What is the greatest risk of general anesthesia in pregnant patients?
Difficult airway / aspiration
Name ONE physiologic change in pregnancy that increases anesthesia risk.
↓ FRC / ↑ O₂ consumption / delayed gastric emptying / airway edema
What is the most common maternal side effect of systemic opioid analgesia?
Sedation/Nausea and vomiting
What nerve block relieves cervical dilation pain?
Paracervical block
What is the most common complication of neuraxial analgesia?
Hypotension
Why does pregnancy increase aspiration risk?
Delayed gastric emptying and ↓ LES tone
What principle explains why most anesthetic drugs affect the fetus?
Placental transfer via passive diffusion
Why is meperidine discouraged in labor analgesia?
Produces normeperidine → neonatal respiratory depression
What major fetal complication is associated with paracervical block?
Fetal bradycardia
Why are lower doses of local anesthetics used in labor epidurals?
To preserve motor function and allow pushing
What induction technique is used to reduce aspiration risk?
Rapid sequence induction
Why must hypotension be rapidly corrected in laboring patients?
To maintain uteroplacental perfusion and prevent fetal hypoxia
Why is systemic analgesia NOT ideal in advanced labor?
Incomplete pain relief and increased fetal drug exposure
Why can a pudendal nerve block NOT replace epidural analgesia?
It does not relieve uterine contraction pain
Give ONE absolute contraindication to neuraxial analgesia.
Patient refusal / coagulopathy / infection at site / severe hypovolemia
Why should GA be avoided if neuraxial anesthesia is possible?
Increased maternal and neonatal risks