Airway management in the obstetric patient: management strategy

Objective: To integrate the available evidence into a conceptual framework that supports decision-making on airway management in pregnant patients. Materials and methods: Using a hypothetical case to illustrate the problem, we developed an explanatory document based on a structured narrative review. It describes key aspects and a step-by-step approach to achieving airway control, culminating with three challenging theoretical scenarios. Results: Pregnancy induces anatomical and physiological changes that complicate airway management, including edema, laryngeal distortion, and increased bleeding risk. Diaphragmatic elevation, together with reduced functional residual capacity, favors atelectasis, rapid hypoxemia during apnea, and an increased risk of aspiration particularly after 30 weeks’ gestation. We propose a practical framework for evaluation, preparation, planning, and execution of obstetric airway management, integrating these principles across three theoretical scenarios. Conclusions: Airway management in obstetrics is challenging due to pregnancy-related changes that increase difficulty and complications, especially hypoxemia. Continuous training and a comprehensive, protocol-driven approach are essential to optimize maternal and neonatal outcomes.