Moaveni, Daria M. MD*; Birnbach, David J. MD, MPH*†‡; Ranasinghe, J. Sudharma MD*; Yasin, Salih Y. MD†
From the Departments of *Anesthesiology, Perioperative Medicine and Pain Management, † Obstetrics and Gynecology, and ‡Epidemiology and Public Health, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida.
Accepted for publication January 16, 2013.
Published ahead of print April 4, 2013
Funding: No funding was provided for this review article.
The authors declare no conflicts of interest.
Reprints will not be available from the authors.
Address correspondence to David J. Birnbach, MD, MPH, University of Miami Miller School of Medicine, University of Miami-Jackson Memorial Hospital Center for Patient Safety, 1611 NW 12th Ave. Miami, FL 33136. Address e-mail to .
Anesthesia & Analgesia 116[6]:p 1278-1292, June 2013. | DOI: 10.1213/ANE.0b013e31828d33c5
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AbstractIn Brief
Suboptimal communication between anesthesiologists and obstetricians can be associated with unintended poor maternal and neonatal outcomes, especially for emergency cesarean deliveries. Obstetricians use the results of antepartum and intrapartum fetal assessments to assess fetal well-being and to make decisions about the timing and method of delivery. Because abnormal results may lead to the need for urgent or emergency cesarean deliveries, these decisions may directly impact anesthetic care. Lack of familiarity with fetal assessments and the significance of the results may thus hinder the communication necessary for optimal patient care. In this review article, we discuss the current antepartum and intrapartum fetal assessment modalities, including the nonstress test, biophysical profile, Doppler velocimetry, electronic fetal heart rate monitoring, fetal electrocardiogram [STAN-ST waveform analysis], and fetal pulse oximetry. The physiologic basis behind these modalities and the available evidence regarding their utility in clinical practice are also reviewed. The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring categories, which are incorporated into the American College of Obstetricians and Gynecologists guidelines for intrapartum care, is examined. The implications of test interpretation to the practice of obstetric anesthesiology is also discussed. Anesthesia provider understanding of fetal assessment modalities is essential in improving communication with obstetricians and improving the planning of cesarean deliveries for high-risk obstetric patients.
Published ahead of print April 4, 2013
A 32-year-old G4P2 at 35 weeks’ gestation presents for induction of labor for a biophysical profile of 4 of 10 and decreased umbilical artery Doppler flow. At a cervical examination of 4 cm dilation/80% effacement/−2 cm station, recurrent late decelerations occur and an emergency cesarean delivery is requested. The anesthesiologist meets the patient and learns that her weight is 100 kg, and she has a Mallampati class 4 airway with a thyromental distance of FETAL ASSESSMENT FOR ANESTHESIOLOGISTS: ARE YOU EVALUATING THE OTHER PATIENT?