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Obstetric Analgesia and Anesthesia Guidelines

Obstet Gynecol; ePub 2017 Apr; Plante, Gaiser, et al

The American College of Obstetricians and Gynecologists (ACOG) has issued clinical management guidelines which review medical options for analgesia during labor and anesthesia for surgical procedures that are common at the time of delivery. The guidelines offer recommendations that include:

  • Neuraxial analgesia does not appear to increase the cesarean delivery rate and, therefore, should not be withheld for that concern. (Level A)
  • 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. (Level A)
  • Spinal anesthesia, combined spinal–epidural, or general anesthesia are suitable for emergent cesarean delivery when no epidural is in place. (Level B)
  • Thrombocytopenia is a relative contraindication to neuraxial blockade, but a safe lower limit for platelet count has not been established. (Level B)
  • In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor. (Level C)
  • Epidural and spinal analgesia or anesthesia generally are considered acceptable in a patient with a platelet count ≥80,000/microliter 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. (Level C)


Obstetric analgesia and anesthesia. Practice Bulletin No. 177. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;129:e73–89.