title: [New aspects of obstetric anesthesia].
abstract: BACKGROUND
  The risk profile of patients in obstetric anesthesia has substantially changed. Even more so than other disciplines, obstetric anesthesia is therefore in the true sense of the word dependent on the close coordination of all concerned and a good interdisciplinary cooperation.
  
  
  OBJECTIVE
  This article explains the important anesthesiological risks connected with parturition and presents the corresponding concepts for prevention, diagnosis and management of peripartum complications.
  
  
  METHODS
  The increase in the number of high risk pregnancies, which are mostly due to an increase in obesity, require clearly defined guidelines and interdisciplinary concepts which are described and discussed in this article. The neuraxial block is still the most effective procedure for treatment of birth pain and offers a promising new method with the programmed intermittent epidural boluses presented in this article. Finally, the German speaking countries Germany, Austria and Switzerland have developed a treatment algorithm for the management of postpartum hemorrhage which is presented here.
  
  
  RESULTS
  The anesthesiological components of a risk pregnancy must be recognized early and include obesity, preeclampsia and drug-induced coagulopathy. Epidural analgesia is the most effective analgesic procedure in obstetrics. Patient-controlled remifentanil analgesia currently represents the best alternative in cases of contraindications for a neuraxial procedure.
  
  
  CONCLUSIONS
  In risk situations, such as pre(eclempsia), emergency cesarean section, massive blood loss or other peripartum emergency situations, optimal interdisciplinary cooperation between midwives, obstetricians and anesthetists is required. However, not only emergency situations require a good interdisciplinary cooperation. Just as important is the cooperation to recognize risk pregnancies and a timely joint planning of the approaching birth.
authors.affiliation: Anästhesiologie, Universitätssital Basel, Spitalstr. 21, 4031, Basel, Schweiz, thierry.girard@unibas.ch.
authors.forename: T
authors.initials: T
authors.lastname: Girard
authors.forename: S
authors.initials: S
authors.lastname: Brugger
authors.forename: I
authors.initials: I
authors.lastname: Hösli
mesh_terms: D000328:Adult; D000465:Algorithms; D016362:Analgesia, Obstetrical; D016058:Analgesia, Patient-Controlled; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000639:trends*; D000775:Anesthesia, Spinal; D002585:Cesarean Section; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D009407:Nerve Block; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D010348:Patient Care Team; D058725:Peripartum Period; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D018566:Pregnancy, High-Risk; D012306:Risk; D055815:Young Adult