1. Obstetrical indications

Abnormal fetal heart rhythm

Fetal distress

Severe postpartum hemorrhage (i.e., hemorrhage associated with blood transfusion, hysterectomy, or disseminated intravascular coagulation)

Abruptio placenta, placenta praevia, or placenta accrete

Uterine rupture

Umbilical cord prolapse

Amniotic fluid embolism

2. Maternal indications

Comorbidity index for obstetric patients ≥ 3

Charlson comorbidity index ≥ 2

3. Contraindications to neuraxial techniques

Coagulation factor deficit, Von Willebrand disease, or thrombocytopenia

Sepsis and septic shock

Maternal pyrexia or generalized infection during labor