This special article presents potentially important trends and issues affecting the field of obstetric anesthesia drawn from publications in 2015. Both maternal mortality and morbidity in the United States have increased in recent years because, in part, of the changing demographics of the childbearing population. Pregnant women are older and have more pre-existing conditions and complex medical histories. Cardiovascular and noncardiovascular medical diseases now account for half of maternal deaths in the United States. Several national and international organizations have developed initiatives promoting optimal obstetric and anesthetic care, including guidelines on the obstetric airway, obstetric cardiac arrest protocols, and obstetric hemorrhage bundles. To deal with the increasing burden of high-risk parturients, the national obstetric organizations have proposed a risk-based classification of delivery centers, termed as Levels of Maternal Care. The goal of this initiative is to funnel more complex obstetric patients toward high-acuity centers where they can receive more effective care. Despite the increasing obstetric complexity, anesthesia-related adverse events and morbidity are decreasing, possibly reflecting an ongoing focus on safe systems of anesthetic care. It is critical that the practice of obstetric anesthesia expand beyond the mere provision of safe analgesia and anesthesia to lead in developing and promoting comprehensive safety systems for obstetrics and team-based coordinated care.
Supplemental Digital Content is available in the text.Published ahead of print November 2, 2016.
From the Department of Anesthesia, Harvard Medical School, Boston, Massachusetts.
Published ahead of print November 2, 2016.
Accepted for publication September 16, 2016.
The author declares no conflicts of interest.
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Address correspondence to Philip E. Hess, MD, Beth Israel Deaconess Medical Center, YA-204B/East Campus, 330 Brookline Ave, Boston, MA 02420. Address e-mail to firstname.lastname@example.org.