Pain management in the critically ill obstetric patient.

Safe and successful pain management in pregnant women requires an understanding of the normal physiologic changes of pregnancy. Some hemodynamic changes of labor and delivery are attenuated by effective epidural analgesia. The ideal analgesic agent for laboring parturients should produce a rapid onset of analgesia that lasts throughout labor without any adverse effect on the mother or fetus. There is no ideal analgesic for pain relief in labor. The physiologic changes of labor and delivery are reviewed, together with commonly used analgesic techniques. Special emphasis is placed on critically ill obstetric patients with concomitant cardiac disease.