Ultrasonography is a safe, relatively inexpensive, and portable imaging modality. With the increasing availability of mobile, portable, and pocket-sized ultrasound machines, point-of-care transthoracic echocardiography has become a bedside tool to serve in medical emergencies and in peri-operative settings to assess the hemodynamically unstable obstetric patient in a timely fashion. In managing obstetric critical illness, some characteristics of pregnant women facilitate a focused cardiac examination, including anterior and left lateral displacement of the heart, spontaneous ventilation, and familiarity with ultrasound use. It supplements the physical examination, basic investigations, and aids in the diagnosis of significant cardiac pathology. While many acronyms exist, such as bedside echocardiography, point-of-care echocardiography, hand-held echocardiography, or goal-directed echocardiography, national and international scientific bodies have agreed on the terminology “focused cardiac ultrasound” or FoCUS. This chapter provides an overview of the definition, techniques, and diagnostic aims of a FoCUS examination and its clinical applications in obstetric cardiac disease. The chapter concludes by summarizing certification standards and training requirements.

Genetic disorders commonly present or show severe manifestations early in life and in reproductive-age women. The impacts of such disorders in pregnancy are complex, often involving both mother and fetus. This chapter provides an overview of key concepts in genetics, focusing on the patterns of inheritance of monogenic disorders. The features and management of several common disorders are discussed, including alpha-1 antitrypsin deficiency, autosomal dominant polycystic kidney disease, Charcot Marie Tooth disease, Ehlers Danlos syndrome, Loeys-Dietz syndrome, glucose-6-phosphate dehydrogenase deficiency, Down syndrome, Turner syndrome, and mitochondrial disorders with a focus on management considerations, relevant for the practice of the obstetric anesthesiologist.

Hematological disorders are a heterogeneous group that may be inherited or acquired. During pregnancy the condition may improve, stabilize, or deteriorate due to normal physiological changes. Major risks in women are hemorrhage or thrombosis; inherited conditions may affect fetus as well. A multidisciplinary team is required to manage the pregnancy, delivery, and postpartum. This chapter reviews and summarizes the literature on maternal and fetal outcomes with a focus on anesthetic considerations and publications.

Airway management and failed intubation in the pregnant woman present unique challenges which differ from the non-pregnant patient. The provision of general anaesthesia in the obstetric population requires additional considerations of the physiological changes in pregnancy, environmental factors and the safe outcome of mother and baby. Appropriate team planning, preparation and performance of rapid sequence induction should be carried out in order to help to reduce adverse airway events. The OAA/DAS guidelines are designed to help to standardise teaching, reduce the incidence of failed intubation and give guidance on further management should failed intubation occur.

Males and females are affected differently by natural disasters due to biologic, social, cultural, and reproductive health differences. Out of the female population, 25% are in the reproductive stage of their lives (age 15–45) and 20% of them are pregnant. While as many as 10% of natural disaster victims seeking medical assistance may need an obstetrician or gynecologist, these needs are not usually given high selection priority, whereupon rescue teams are likely to lack those essential specialists. The chapter gives clinical guidelines for managing labor in field hospital settings and dealing with ethical issues arising from treating pregnant women in disaster areas. Based on the literature and the authors’ experience, this chapter covers the effects of a disaster on women’s health in general and especially on pregnant women. The recommendation for the obstetric/gynecologic team composition, the medications and medical equipment needs, and how to arrange an Ob/Gyn department in a field hospital are given. The chapter gives clinical guidelines for managing labor in field hospital settings and dealing with ethical issues arising from treating pregnant women in disaster areas.

The chapter lists the recommendations on prevention and management of the consequences of sexual violence, reduction of HIV transmission, prevention of excess maternal and neonatal mortality and morbidity, and planning of comprehensive reproductive health services in the early days and weeks of an emergency.

The world’s most fragile states contain 38% of the world’s population and are among the world’s poorest. In these states up to 10% of all deaths and 20% of deaths among young adults may be attributed to untreated surgical disease, and over 500 000 women die each year during childbirth. International aid organizations have a presence in fragile states notably the International Committee of the Red Cross (ICRC). The potential for long-term field missions to address disparities in access to acute trauma, surgical, and obstetric care is not to be underestimated. Every opportunity for training and support of local health care staff is to be valued. The success of long-term deployments rests on sound planning before the implementation of programs and honest appraisal of ongoing programs.