What's in a test?
Comprised of fetal breathing, movement, muscle tone, heart rate, and amniotic fluid, this test assess overall wellbeing of the fetus
Biophysical Profile (BPP)
24 y/o G1P0 at 40w2d with no significant PMH and uncomplicated pregnancy who presented in labor. The L&D nurse calls requesting an epidural on behalf of the patient at which point the anesthesia resident does…
H&P, anesthetic history, physical exam, rhythm strip
FHR between 110-160bpm (average during a 10min span, lasting at least 2 min)
True
Commonly used for blood pressure augmentation on L&D, be careful as this indirect alpha and Beta agonist can alter the fetal baseline heart rate
Ephedrine
Known for his creative anesthetic’s, this OB attending started his training in Neurosurgery
Dr. McCutchen
In the presence of decelerations or absence of accelerations, this test can be followed up with a BPP for better assessment of fetal wellbeing.
NST (non stress test)
24 y/o G1P0 at 40w2d with no significant PMH and uncomplicated pregnancy who presented in labor. Patient recently received a combined-spinal epidural. The L&D nurse calls concerning patients BP of 82/54 at which point the anesthesia resident does…
focus exam, assess vitals, assess rhythm strip, determine if medication or fluid administration is needed
Variable Decelerations is indicative of fetal head compression
False
(VEAL/CHOP)
A transient sinusoidal pattern can be seen on the FHR monitor after administration of this partial agonist-antagonist of the mu receptor & partial agonist of kappa receptor
Butorphanol
This OB attending is a Fulbright Scholar who spent time teaching anesthesia in Rwanda
Dr. Cassidy
This scoring system provides and accepted convenient method for assessing the status of an infant immediately after delivery and its response to resuscitation if needed.
APGAR
The L&D nurse (who is recently out of school) calls regarding late decels in the previously mentioned patient. On arrival to the room you assess the patient and realize that these interventions (remembered by the pneumonic POISON) have not been tried.
Position, Oxygen, IV fluids, Sterile exam, Oxytocin off/decreased/tocolysis, Notify OB
Acceleration is an abrupt increase in FHR>15bpm for 15 seconds after 32 weeks gestation or >10bpm for 10 seconds before 32 weeks gestation
True
Some causes of fetal baseline bradycardia are congenital heart block, late fetal hypoxia or acidosis, and propranolol which works on these receptors
Beta 1 & Beta 2
Known for her work in Ghana, this OB attending started her Global Health career in Turkey
Dr. Owen
BPP score between 0-2 is an indicator for immediate...
Delivery
Mom & baby are doing well but the L&D nurse calls regarding 5/10 pain with contractions. The anesthesia resident does…
Maternal fever and chronic fetal distress are two factors that can lead to fetal baseline bradycardia
False (Fetal Tachycardia)
Used in patients with overactive thyroid, propythiouracil can cause a fetal baseline bradycardia. This medication works by
inhibiting thyroid peroxidase which converts T4 to T3
She’s probably not on your list of favorite attendings to work with, but it’s only because you haven’t done OB yet!
Dr. Dean
This test is indicated in IUGR, cord malformation, unexplained oligohydramnios, and suspected pre-eclampsia
Umbilical artery doppler velocimetry
Category III FHR is called which comprises absent baseline variability with recurrent late decels or bradycardia, or recurrent variable decels. Anesthesia resident is called and brings along…
Contraction Stress Test (CST) is the gold standard for antepartum fetal assessment
False
(Rarely utilized, False positive rate of >50%)
Often times avoided (or tried to avoid) in L&D, this common anesthetic works on these receptors
Volatile, works on every receptor (seemingly)
Arguably the most nocturnal OB attending, this anesthesiologist isn’t the only person “pumping GAS” in his family
Dr. Peter Pan