• Maternal Mortality
  • Most often related to arterial hypoxemia during airway management difficulties
  • Pregnancy-induced anatomic changes: Decreased functional residual capacity, increased oxygen consumption, or oropharyngeal edema may expose the parturient to an increased risk of arterial oxygen desaturation during periods of apnea and hypoventilation
• Pulmonary Aspiration
• Hypotension
  • Regional anesthesia: Related to the degree and rapidity of local anesthetic-induced sympatholysis
  • Prehydration: 1,000–1,500 mL of crystalloid solution before initiation of regional anesthesia and avoidance of aortocaval compression may decrease the incidence of hypotension
  • Treatment is left uterine displacement, rapid IV fluid infusion, and vasopressor administration (phenylephrine 100–150 µg results in less fetal acidosis than ephedrine)
• Total Spinal Anesthesia
• Local Anesthetic Systemic Toxicity
  • Maintain hemodynamics, ventilation and oxygenation
  • Consideration of early administration of 20% lipid emulsion (1.5 mg/kg over 1 minute followed by 0.25 mL/kg for at least 10 minutes after attainment of hemodynamic stability)
  • Treatment is with IV administration of thiopental (50–100 mg) or diazepam (5–10 mg)
• Postdural Puncture Headache
  • The incidence is lower with pencil-point needles (Whitacre or Sprotte) compared with diamond-shaped (Quincke) cutting needles
  • Treatment of a severe headache is with a blood patch (10–15 mL of the patient's blood is injected into the epidural space close to the site of dural puncture)
• Nerve Injury
  • The possible role of compression of the maternal lumbosacral trunk by the fetus should be considered

IV = intravenous.