Obstetric Anesthesia

Obstetric Anesthesia

2 Blocks

Leads

Dr. Jennifer Racine (Civic) & Dr. Marc Stalder (General)

Welcome Message

Throughout most rotations in adult anesthesia, you have the opportunity to gain experience in obstetrical anesthesia at both the Civic and General campuses while on call. We have a busy obstetrical unit, with over 7,000 deliveries per year combined between the two sites. Core I Obstetrical Anesthesia permits a concentrated period of day shifts in the birthing unit with anesthesia staff who have subspecialty training and/or an interest in obstetrical anesthesia. This module is meant to deepen your understanding of what is expected of a consultant in obstetrical anesthesia.

The Obstetrical Anesthesia module members at the General Campus include Drs. Marc Stalder, Rob Jee, Catherine Gallant, and Wesley Edwards, as well as our obstetrical anesthesia fellow. The Obstetrical Anesthesia module members at the Civic Campus include Drs. Jennifer Racine, George Dumistracu, Susan Goheen, Leo Jeyaraj, as well as our obstetrical anesthesia fellow. Our group is also represented by many other staff who have a particular interest in obstetrical anesthesia. Please feel free to ask any of us any questions you may have during your rotation! Our goal is to introduce you to the concepts of perioperative assessment and optimization, as well as introduce you to a variety of medical conditions so that you work on completing the milestones that make up the perioperative EPA.

Core I Obstetrical Anesthesia serves as an introduction to obstetrical anesthesia. During this rotation it is expected that you develop the knowledge and skills to competently provide analgesia and anesthesia to parturients. Given the nature of the subspecialty, you may be exposed to a case that requires Core II level competency. Please see this as a learning opportunity and don’t worry if the objectives of Core I and Core II overlap.

Core II Obstetrical Anesthesia allows you to consolidate your knowledge and apply it to the management of higher risk parturients and peripartum complications.  During this rotation it is expected that you develop more independence in managing cases and demonstrate a leadership role on the Labour & Delivery floor.

EPAs & Milestones

  • Management of analgesia and anesthesia of a parturient
    • Demonstrates ability to select the most appropriate labour analgesia option
    • Demonstrates management and performance of labour epidural analgesia
    • Demonstrates management of epidural analgesia complications
    • Demonstrates anesthetic management for operative delivery of a newborn
    • Demonstrates anesthesia management of peripartum maternal complications including antepartum and postpartum hemorrhage
    • Demonstrates understanding and management of analgesia and anesthesia in the parturient with significant cardiorespiratory and neurological comorbidities.
  • Management of the high risk parturient
    • Demonstrate management plan for anesthesia for the high risk pregnancy consultations
    • Demonstrate management plan for anesthesia for the high risk pregnancy consultations
    • Demonstrate management of high risk parturient, for delivery of the newborn
    • Demonstrate management of the high risk parturient for non-obstetrical surgery
  • Manage the resuscitation of the newborn
    • Demonstrates understanding of NRP protocols and drug choices for neonatal resuscitation

Academic Curriculum

Learning Cases

Core 1

  • Gestational Thrombocytopenia and Immune Thrombocytopenia (ITP)
  • Management of the Morbidly Obese Parturient
  • The Preeclamptic Parturient
  • Postpartum Neurologic Injury
  • Antepartum and Intrapartum Fetal Assessment
  • The Anticoagulated Parturient
  • Consent and Capacity

Core 2

  • Antepartum Hemorrhage
  • Mitral valve stenosis in pregnancy
  • Non-Obstetric Surgery in the Parturient
  • Peripartum Cardiomyopathy and Maternal Cardiac Arrest
  • Abnormal Placentation

Assessment Tools

Core 1

  • Submitted the required number of CCATs (12)
  • Completed a minimum of 8 Obstetrical clinical days
  • Observed Antepartum assessment
  • Compliant with Resident Logbook
  • Submitted a case & staff assignment calendar for the rotation
  • Completed Core 1 Obstetrical Anesthesia learning cases
  • Completed the Neuraxial ultrasound e-modules
  • Successfully completed 5 Neuraxial Ultrasound Assessments
  • Demonstrated evidence of self-learning

Core 2

  • Reoriented self to Obstetrical Anesthesia module and previous requirements/skills
  • Completed a minimum of 8 Obstetrical clinical days
  • Obtained clinical exposure to all required areas
  • Successfully completed 5 Cesearean Sections Assessments and achieved minimal mark required
  • Carried the "OB Anesthesia Staff" pager for 5 days and managed subsequent cases
  • Completed 5 Core 2 Obstetrical Anesthesia learning cases
  • Successfully completed MCQ exam and achieved minimal mark required
  • Submitted the required number of CCATs (12)
  • Submitted a case & staff assignment calendar for the module
  • Compliant with Resident Logbook
  • Demonstrated evidence of self-learning

Resources

  • Chestnut’s Obstetrical Anesthesia Principles and Practice, 5th Ed.
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