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Part 4. Managing Anesthesia Care
Section E. Specialty Areas of Anesthetic Practice
Chapter 61. Anesthesia for Obstetric Care and Gynecologic Surgery
Lawrence C. Tsen, MD
1. The use of epidural, spinal, and combined spinalepidural techniques for obstetric care has increased dramatically because of the quality and safety of the analgesia and anesthesia produced, the ability to titrate the degree and duration of pain relief, and the expanding number of situations for which their use is appropriate. Labor analgesia and obstetric anesthesia can have beneficial effects on the outcomes of external cephalic version, in utero fetal and placental surgery, and parturients with significant comorbid conditions.
2. Teratogenicity, defined as any significant postnatal change in function or form in an offspring after prenatal treatment, is difficult to evaluate in prospective clinical trials given the low incidence of occurrence and the number of confounding factors. The list of agents or factors proven to be human teratogens does not include anesthetic agents used routinely in clinical practice.
3. Clinically used estimates of gestational age originate from the first day of the last menstrual period. However, fertilization does not occur until 2 weeks after this time, so 14 days are added to actual fetal development in order to fit within the clinical schemas. Thus, although the period of major fetal organogenesis is considered to occur between 5 and 55 days, within the clinically used schemas this period occurs in weeks 310 of gestation.
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