Advanced (CA3) OB Rotation Learning Objectives
(Chapter Notations are from Chestnut: Obstetric Anesthesia unless otherwise noted)
Anesthesia for the Pregnant Cardiac Patient; Shnider, Ch 26
-Describe the normal cardiovascular changes associated with pregnancy.
-For the following list of cardiac diseases, describe the clinical manifestations,
pathophysiology, interaction with the normal cardiovascular changes of
pregnancy and the anesthetic considerations for vaginal and Caesarean delivery.
-Valvular heart diseases
-Congenital heart diseases - focus on ASD, VSD, PDA, Tetralogy of
Fallot, and Eisenmenger’s Syndrome
-Primary Pulmonary Hypertension
-Hypertensive disorders
- Peripartum cardiomyopathy
-Marfan’s syndrome and dissecting aortic aneurysm
- Hypertrophic cardiomyopathy
-Coronary artery disease
-Atrial fibrillation
-Briefly describe the anesthetic considerations for cardiac surgery during
pregnancy – focus on mortality and morbidity for mother and fetus, indications
for less invasive procedures, fetal monitoring and the management of fetal distress
during cardiopulmonary bypass.
-Briefly describe the fetal effects of commonly administered cardiac drugs.
Neonatal Resuscitation; Chestnut, Ch 9
-Describe the initial evaluation of the newborn - to include Apgar score and
umbilical cord blood gas analysis.
-Describe the management of the newly born healthy, term baby.
-Describe the management of neonatal resuscitation (Fig 9-4) - include discussion
of appropriate pharmacologic interventions.
-Describe IV and intraosseous access in the newborn and the use of volume
expanders.
-Describe the management of the neonate with meconium aspiration syndrome –
prevention, diagnosis and treatment.
-Describe the management of the newborn with congenital diaphragmatic hernia,
esophageal atresia and tracheoesophageal fistula.
-Describe the ethical considerations in the resuscitation of the extremely
premature newborn and of those with severe congenital anomalies.
Advanced
OB Curriculum
Non-Obstetrical Surgery in the Pregnant Patient; Chestnut, Ch 16
Maternal Considerations:
-Describe the frequency of non-OB surgery in pregnant women and the
common procedures performed.
Risk of Teratogenicity:
-Describe the relationship between the dose and timing of a teratogen and
the risk of teratogenicity.
-List commonly used non-anesthetic drugs known to be teratogenic in
humans.
-Describe the relative frequencies and etiologies of human developmental
abnormalities (genetic, drugs, environmental chemicals, etc.).
-Describe the association between drugs commonly used in anesthesia and
fetal abnormalities, e.g. benzodiazepines, volatile anesthetics, nitrous
oxide, etc.
Fetal Effects of Anesthesia
-Describe the fetal effects of drugs commonly administered during
anesthesia including volatile anesthetics, opiods, muscle relaxants,
reversal agents, atropine, glycopyrrolate, nitroprusside and esmolol.
-Describe the incidence and timing of preterm labor after non-OB surgery
as well as the techniques and monitoring used to prevent it.
Management
-Describe the ideal timing for emergent, urgent and elective surgery in the
pregnant patient.
-Describe the anesthetic management of common non-OB surgeries in
pregnant women – include monitoring, choice of anesthetics and patient
positioning.
Aspiration Risk; Chestnut, Ch 30
-Describe the effects of pregnancy on gastric function.
-Describe the risk factors for aspiration pneumonitis (particulates, volume and
pH).
-Describe the pathophysiology of aspiration pneumonitis.
-Describe the clinical course of aspiration (diagnosis, treatment, appropriateness
of lung lavage, steroids and prophylactic antibiotics).
-Describe methods to prevent aspiration – include pharmacological agents,
anesthetic choice and cricoid pressure.
-Describe appropriate NPO policies for parturients who are to be delivered.
Substance Abuse; Chestnut, Ch 22
-Describe the pathophysiology of cocaine abuse, effects on the pregnant mother
and fetus and the anesthetic management of a pregnant patient with a history of
acute or chronic cocaine abuse.
-Describe the pathophysiology substance abuse in the pregnant mother and fetus,
and the anesthetic management of patients with exposure to these substances:
MDMA, opiods, alcohol and tobacco.
Advanced
OB Curriculum
Trauma; Chestnut, Ch 53
-Describe the incidence and common etiologies of trauma during pregnancy.
-Describe how pregnancy complicates a trauma assessment and treatment – focus
on the cardiovascular, hematological, coagulation and acid-base changes
associated with pregnancy.
-List obstetric complications associated with trauma.
-Describe the 4-minute rule for perimortem Cesarean delivery.
Electronic Fetal Monitoring and Diagnosis of Fetal Asphyxia; Shnider,
Ch 36
-List the common causes of fetal asphyxia.
-Describe the fetal response to asphyxia.
-List the 2 major components of commercial FHR monitors.
-Describe the characteristics of normal FHR patterns.
-Describe the characteristics of abnormal FHR patterns, causes and the
appropriate therapeutic maneuvers (focus on Table 36.5).
Obesity; Chestnut, Ch 49
-Describe the physiologic changes associated with obesity and the interaction with
pregnancy – include a discussion on perinatal outcome.
-Describe the anesthetic management of obese pregnant patients - include
preoperative and postoperative considerations.
Anesthesia for Fetal Surgery and Other Intrauterine Procedures;
Chestnut, Ch 7
-List fetal conditions that may be amenable to peripartum correction.
-Describe how anesthetic considerations for fetal surgery vary from those for nonOB surgery in pregnant patients.
Endocrine; Chestnut, Ch 41
-Describe the clinical manifestations, interactions with pregnancy and obstetric
and anesthetic management of parturients with diabetes mellitus, thyroid disorders
and pheochromocytoma.
Consensus Guidelines for Obstetric Anesthesia; Chestnut, Appendices
A, B and C
-Review the ASA Guidelines for Regional Anesthesia in Obstetrics, Practice
Guidelines for Obstetrical Anesthesia and the ASA’s Optimal Goals for
Anesthetic Care in Obstetrics.
Medico-legal Issues: Chestnut, Chapter 29
-Describe the legal requirements for negligence on the part of a physician.
-Describe the process through which a malpractice claim proceeds.
-Summarize the important findings of the ASA Closed Claims Project analysis of
closed Obstetrical claims.