1. Maternal physiologic changes, their time course, and clinical implications, including:
a. Central nervous system (MAC requirement)
b. Respiratory system (anatomy, lung volumes, minute ventilation, FRC, respiratory rate, blood gas)
c. Cardiovascular system (cardiac output, stroke volume, PVR, heart rate, aorto-caval compression, regulation of uterine blood flow)
d. Gastrointestinal system (gastric acid, motility, anatomic position, gastroesophageal function)
e. Hepatic system (enzyme levels, uptake and distribution of drugs)
f. Hematologic system (blood volume, plasma volume, Hct, coagulation)
g. Renal system (GFR)
2. Fetal and placental development and physiology including placental gas exchange and uterine blood flow determinants. Mechanisms of placental drug transfer, fetal disposition of drugs, and anesthesia/drug effects on fetus and newborn.
3. Fetal monitoring including heart rate patterns and their significance, and fetal lung maturity measurements using amniotic fluid (L/S ratio).
4. Physiology of labor including the different stages, normal and abnormal progress of labor, and potential effects of anesthesia and analgesia on labor and its outcome.
5. Pain pathways of parturition and available methods of analgesia during labor.
6. Regional analgesic techniques including epidural, spinal, combined spinal-epidural, and caudal, pudendal, and paracervical analgesia, their management and complications.
7. Local anesthetic choice including properties, placental transfer, and optimal dosages.
8. Rational choice, advantages, and disadvantages of general versus regional anesthesia for elective operative vaginal and Cesarean delivery, including management of inadequate or failed regional block.
9. Anesthetic considerations in an emergency Cesarean section including choice of anesthesia and airway management strategies, including management of inadequate or failed regional block.
10. Management of parturient with difficult airway or failed intubation.
11. Knowledge of, and management strategies for, major complications of regional anesthesia including hypotension, PDPH, total or high spinal, neuropathy, and local anesthetic toxicity.
12. Pharmacology of oxytocics and tocolytics.
13. Understand the problems during pregnancy and their implications in anesthetic management:
a. Respiratory conditions (asthma)
b. Cardiac conditions (rheumatic or congenital heart disease, hypertension)
c. Neurological conditions (seizures, headaches, myasthenia, paraplegia)
d. Endocrine conditions (thyroid disease and diabetes)
e. Renal conditions
f. Hematological conditions (Rh and ABO incompatibilities)
14. Anesthetic considerations and management of specific obstetric issues:
a. Dystocia and malpresentations (various types of breech)
b. Multiple gestations
c. Pre-eclampsia and eclampsia
d. Placenta previa
e. Placenta abruptia
f. Retained placenta
g. Supine hypotensive syndrome
h. Aspiration
i. Amniotic fluid or other embolism
j. Uterine atony, hyperstimulation, and rupture.
k. Cord prolapse
l. Postpartum bleeding
m. Massive hemorrhage
15. Current practice of CPR in the parturient and the rationales for early delivery.
16. Management of newborn including evaluation, APGAR scoring, neurobehavioral testing, and neonatal resuscitation.
17. Anesthetic considerations and management of parturient for non-obstetric surgeries.
18. Controversial issues in obstetric anesthesia:
a. Regional anesthesia in febrile patients
b. Regional anesthesia and its relationship to the incidence of neonatal sepsis workup
c. Regional anesthesia and its relationship to the progress of labor and the incidence of operative delivery