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The problems in the pregnant woman are universal: physiological changes during pregnancy lead to a reduction in time from onset of apnea to oxygen desaturation and to an increased likelihood of regurgitation from a full stomach. An antenatal visit allows the airway to be evaluated and discussion to be held with the parturient about the use of invasive monitors, such as invasive arterial blood pressure monitoring and the use of continuous positive airway pressure devices during and after labor and delivery. A recent development in the management of the airway in the obese patient is the use of the so-called ramped position. Perhaps the main factor responsible for a higher incidence of difficulties in airway management is that general anesthesia is generally reserved for extreme obstetric emergencies. The use of supraglottic airways in the management of the obstetric airway is undergoing evaluation.
Hypoxia in pregnancy is rare, however the anatomical and physiological changes associated with pregnancy may exacerbate hypoxia and hypoxaemia arising from pathological processes.
In this review we seek to briefly outline the well recognised changes to the maternal airway and respiratory anatomy and physiology. We will discuss a hierarchical approach to the tests used in differential diagnoses, summarise the physical principles behind commonly used tests and identify pitfalls and considerations in their use in the obstetric population. Some of the more commonly seen pathological states that may cause hypoxia in pregnancy will be discussed.