Kimberly Mendoza, MD, PHD, MPH: No financial relationships to disclose
Vyjeyanthi Periyakoil, MD: No financial relationships to disclose
Key Message : Obstetric anesthesiologists are integral in the care of pregnant patients who experience an intrauterine fetal demise (IUFD) or neonatal demise. Obstetric anesthesia can help balance maternal safety to minimize and reduce maternal risk. Finally, patients with an IUFD or neonatal demise would benefit from perinatal or palliative care support
Abstract: According to the American College of Obstetricians & Gynecologists, perinatal palliative care is a coordinated care strategy to treat the physical, spiritual, and emotional needs of fetuses and newborns with life limiting or life-threatening conditions. Effectively supporting families through these difficult circumstances requires a multidisciplinary approach which can reduce levels of anxiety and uncertainty. The goal of perinatal palliative care is not to aid with neonatal death but to optimize their quality of life and that of their families. In medical centers without a perinatal palliative care program, pregnant patients with intrauterine fetal demise (IUFD) or neonatal demise are missed as patients who would benefit from palliative care support. While multidisciplinary team can include obstetricians, spiritual and religious support, social work, and care management, obstetric anesthesiologists are not included. The role of obstetric anesthesia is important as anesthesiologists have an in depth understanding of the physiologic and pharmacodynamic changes of pregnancy which can significantly affect the bioavailability, distribution, and clearance of drugs. Obstetric anesthesia can help balance maternal safety to minimize and reduce maternal risk. For example, analgesia to alleviate pain during labor may include patient-controlled analgesia (PCA), neuraxial anesthesia through patient controlled epidural analgesia (PCEA) or nitrous oxide. Should patients require a cesarean delivery, general anesthesia, neuraxial anesthesia or both can be considered. The presence of a support person or persons in the operating room is allowed at the permission of the anesthesiologist. Patients may also request anxiolysis or sedation and should be thoroughly counseled on the side effect of anterograde amnesia. Finally postpartum pain can involve multimodal care including, neuraxial, regional anesthesia and medication management. The development and integration of anesthetic guidelines in perinatal palliative care is integral to address and support maternal comfort and offer patients a variety of choices to improve their quality of care.
