Labor analgesia for the parturient with an uncommon disorder: A common dilemma in the delivery suite

There appears to be an absence of uniform guidelines for management of labor analgesia in pregnant patients with uncommon medical conditions such as Marfan's syndrome, Ehlers-Danlos syndrome, achondroplastic dwarfism, previous back surgery, and kyphoscoliosis. A Medline search for articles highlighting considerations for obstetric anesthesia in parturients with these disorders was performed. Because of the multiorgan involvement and varied presentations of these disorders, no uniform or routine obstetric anesthetic recommendations can be made. In the absence of uniform obstetric anesthesia guidelines for pregnant patients with Marfan's syndrome, Ehlers-Danlos syndrome, achondroplastic dwarfism, previous back surgery, and kyphoscoliosis, the decision whether to administer regional anesthesia (epidural labor analgesia) should be based on an individual risk-to-benefit ratio on a case-by-case basis.