ASA grade latest Also asa grade in pregnancy
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ASA physical status classification 2025 latest update pregnancy grade
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https://emedicine.medscape.com/article/2172425-overview
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Here is a complete, up-to-date summary of the ASA Physical Status Classification System, including obstetric-specific examples (updated to January 2026).
ASA Physical Status Classification - Latest (2026)
The ASA published an updated statement in January 2026 (published in Anesthesiology Open, Jan 2026). The core 6-grade structure is unchanged, but examples have been refined for adults, pediatrics, and - importantly - obstetrics as a separate category.
The final classification is assigned by the anesthesiologist on the day of the procedure. The suffix "E" is added for emergency surgery (e.g., ASA IIE).
The 6 Grades - Full Table with Obstetric Examples
| ASA Grade | Definition | Adult Examples | Obstetric Examples |
|---|---|---|---|
| ASA I | Normal healthy patient | Healthy, non-smoking, no/minimal alcohol use | Not applicable |
| ASA II | Mild systemic disease - no substantive functional limitation | Current smoker, social alcohol drinker, pregnancy (uncomplicated), obesity (BMI 30-40), well-controlled DM/HTN, mild lung disease | Normal pregnancy, well-controlled gestational HTN, controlled preeclampsia without severe features, diet-controlled gestational DM |
| ASA III | Severe systemic disease - substantive functional limitations | Poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥40), active hepatitis, alcohol dependence, implanted pacemaker, moderate reduction in EF, ESRD on regular dialysis, history of MI/CVA/TIA >3 months ago | Preeclampsia with severe features, gestational DM with end-organ compromise, peripartum cardiomyopathy with mild-moderate EF reduction |
| ASA IV | Severe systemic disease that is a constant threat to life | Recent (<3 months) MI, CVA, TIA, or CAD/stents; ongoing cardiac ischemia; severe valve dysfunction; severe EF reduction; sepsis; DIC; ARDS; ESRD not on regular dialysis | Preeclampsia with severe features + end-organ damage, peripartum cardiomyopathy with severe EF reduction |
| ASA V | Moribund - not expected to survive without the operation | Ruptured aortic/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel with significant cardiac pathology or multi-organ dysfunction | Uterine rupture |
| ASA VI | Brain-dead - organs being removed for donation | - | - |
"E" suffix = Emergency surgery. Defined as any situation where delay would lead to significant increase in threat to life or limb. Example: a healthy patient with acute appendicitis = ASA IE.
ASA Grade in Pregnancy - Summary
Pregnancy alone is classified as ASA II (mild systemic disease with no substantive functional limitation).
The specific obstetric breakdown is:
| Obstetric Condition | ASA Grade |
|---|---|
| Normal (uncomplicated) pregnancy | II |
| Well-controlled gestational HTN | II |
| Controlled preeclampsia without severe features | II |
| Diet-controlled gestational DM | II |
| Preeclampsia with severe features | III |
| Gestational DM with end-organ compromise | III |
| Peripartum cardiomyopathy (mild-moderate EF reduction) | III |
| Peripartum cardiomyopathy (severe EF reduction) | IV |
| Uterine rupture | V |
Key Points
- ASA I is never assigned in pregnancy (the physiological changes of pregnancy alone make it at least ASA II).
- The "E" suffix for emergencies applies in obstetrics too - e.g., a healthy pregnant woman with uterine rupture = ASA VE.
- ASA classification is a subjective clinical judgment - the 2020/2026 updates added specific examples to improve inter-rater reliability, but institutional examples are encouraged to supplement the ASA list.
- Mortality correlation: ASA I-II ~0.1-0.2% perioperative mortality vs. ASA IV-V significantly higher.
Sources: - Mulholland and Greenfield's Surgery, 7e (Table 14.4) | - ASA Statement, Anesthesiology Open Jan 2026 via Medscape | - ASA official classification table with obstetric examples
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