Curriculum

Our fellowship includes a didactic component as well as extensive clinical experience. We offer didactic lectures, journal clubs, and conferences to help you master the subspecialty of obstetric anesthesia. There are also opportunities for interdisciplinary educational initiatives with our obstetric colleagues, residents, and nurses. We cover a broad area of obstetric anesthesiology topics, including:

  • Maternal physiology
  • Embryology and teratogenicity
  • Fetal and placental physiology and pathophysiology
  • Neonatal physiology and neonatal resuscitation
  • Obstetric management of labor, including normal labor and abnormal labor and indications for urgent and emergent delivery
  • Tocolytic therapy
  • Pain of labor, pain pathways
  • Local anesthetic use in obstetrics, including recognition and treatment of complications
  • Neuraxial opioid use in obstetrics plus recognition and treatment of complications
  • Regional anesthetic techniques as well as recognition and treatment of complications
  • General anesthesia use in obstetrics and recognition and treatment of complications
  • Anesthetic and obstetric management of obstetric complications and emergencies, including preeclampsia, eclampsia, placental abruption, placenta previa, placenta accreta, vasa previa, uterine rupture, uterine atony, amniotic fluid embolism, and umbilical cord prolapse
  • Medical disease and pregnancy:, especially hypertensive disorders, morbid obesity, respiratory disorders, cardiac disorders, endocrine disorders, autoimmune disorders, hematologic and coagulation disorders, neurologic disorders, substance abuse, HIV infection, and AIDS
  • Cardiopulmonary resuscitation and advanced cardiac life support of the pregnant women
  • Postpartum tubal ligation
  • Post-operative pain management in the parturient
  • Non-obstetric surgery during pregnancy
  • Effects of maternal medications on breastfeeding
  • Ethical issues during pregnancy
  • Principles and ethics of research in pregnant women, fetuses, and neonates
  • Organization and management of an obstetric anesthesia service
  • Transport and monitoring of critically ill parturients within the hospital and between hospitals
  • Maternal mortality
  • Medical economics and public health of women during reproductive years as it applies to obstetric anesthesiology, such as availability of obstetric analgesia and reducing cesarean section rates

Clinical Training

The fellow will be expected, under the supervision of one of the obstetric anesthesia attendings, to manage the labor and delivery suite.  This will include direct patient care; along with supervision and teaching of the junior residents.  During the fellowship year the fellows will also rotate in the Neonatal Intensive Care Unit (NICU), the Maternal Fetal Medicine (MFM) service, and the Blood Bank. The strong relationship we share with the MFM team and all the obstetricians fosters a collaborative care effort and provides for a busy consultation service where we become involved with our most challenging patients’ from early on in their pregnancies. 

 

Consult Service

In addition to the clinical training there is an active consult service where patients are evaluated antepartum who have an array of medical conditions that may impact on the ability to receive neuraxial anesthesia. These conditions include thrombocytopenia, factor XI deficiency, prior back surgery with instrumentation, cardiac disease, and intracranial lesions to name a few.  The fellow will evaluate the patient along with the attending to develop a delivery plan.

Educational Responsibilities

In addition to clinical training of the junior residents, the obstetric anesthesia fellow will be involved in the monthly lecture series to the junior residents and journal clubs.  Opportunities also exist for interdisciplinary educational initiatives with our obstetric colleagues, residents and nurses. 

Performance Improvement (PI)

The fellow will become involved in quality initiatives on the labor and delivery suite. This includes participation in PI meetings, peer review of medical records, and developing obstetric anesthesia policy, as needed.  Further, the fellows will develop or participate in a quality related project.

Academic Responsbilities

The fellow will have 25% non-clinical time dedicated to academic pursuits. The obstetric anesthesia fellow will participate in the ongoing research projects on the labor and delivery suite. In addition, fellows are encouraged to develop their own projects, write review articles, and submit case reports.  Participation in research projects should lead to presentation at a national anesthesia meeting.  We meet Bi-Monthly to review and discuss recent publication as part of journal club.

Anesthesia Meetings

Each Fellow is allowed up to 5 days of conference time to attend one national meeting per year in the area of obstetric anesthesiology preferably the SOAP meeting.  The fellow may receive up to $2,500 to cover expenses.  This meeting is in addition to any meeting where an abstract is presented by the fellow.

Ongoing Research Studies

  1. Platelet patterns in women with preeclampsia
  2. Utility and characterization of platelet mapping and function in preeclampsia
  3. Assessment of P6 pressure bands in the prevention of shivering during cesarean delivery.
  4. Thromboelastometry:
    1. in Cesarean Delivery at Quantified Levels of Blood Loss
    2. in Obstetric Hemorrhage: An Observational Trial
    3. in the Parturient on Anti-Coagulants: An Observational Trial
    4. in the Parturient with a Coagulation Disorder: An Observational Trial
    5. in the Parturient with an IUFD: An Observational Trial
  5. Assessment of coagulation profile in women with recent fetal demise

Future Studies

  1. Trends in transfusion medicine on the labor floor
  2. Utility of transthoracic echocardiography in the post partum patient
  3. Use of epidural Duramorph to treat post vaginal delivery pain
  4. Intrathecal vs. Intravenous Dexamethasone for post cesarean analgesia
  5. Utilization of 360 video and augmented reality for training in post partum hemorrhage management
  6. Assessment of glycemic control in women receiving dexamethasone for cesarean delivery

 

Recent Obstetric Publications

1. Katz D, Beilin Y, Review of the Alternatives to Epidural Blood Patch for Treatment of Postdural Puncture Headeache. Anesthesia & Analgesia. 2017

2. Katz D, Beilin Y. A Review of the Alternatives to Epidural Blood Patch for Treatment of Post-Dural Puncture Headache in the Parturient. Anesth Analg 2017; 124:1219-28.

3. Katz D, Hamburger J, Gutman D, Wang R, Lin HM, Marotta M, Zahn J, Beilin Y. The Effect of Adding Subarachnoid Epinephrine to Hyperbaric Bupivacaine and Morphine for Repeat Cesarean Delivery: A Double Blind Prospective Randomized Control Trial. Anesth Analg 2018;127:171-8.

4. Beilin Y. Maternal hemorrhage – regional versus general anesthesia: does it really matte? Anesth Analg 2018; 127:805-7

5. Beilin Y, Katz D.  Factor XI Deficiency: The Key is Individualization. Anesthesia and Analgesia. 2019; 128:e10-e9.

6. Hamburger J, Beilin Y. Systemic adjunct analgesics for cesarean delivery: a narrative review. Int J Obstet Anesth. 2019 Nov;40:101-118

7. Katz D, Beilin Y. Management of post-partum hemorrhage and the role of the obstetric anesthesiologist. The Journal of Maternal-Fetal & Neonatal Medicine 2019, in press.

8. Katz D, Hamburger J, Batt D, Zahn J, Beilin Y. Point-of-Care Fibrinogen Testing in Pregnancy. Anesth Analg 2019;129: :e86-e88.

9. Romano D, Hyman J, Katz D., Knibbs N, Einav S, Reznick O, Beilin Y. A Retrospective Analysis of Obstetric ICU Admissions Reveals Differences in Etiology for Admission Based on Mode of Conception. Anesthesia and Analgesia. 2019 Epub ahead of print]

10. Katz D., Riley K, Kim E, Beilin Y. Comparison of Nitroglycerin and Terbutaline for External Cephalic Version in Women Who Received Neuraxial Anesthesia: A Retrospective Analysis. Anesthesia and Analgesia. 2019 Epub ahead of print] 

11. Katz D, Wang R, O'Neil L, Gerber C, Lankford A, Rogers T, Gal J, Sandler R, Beilin Y. The association between the introduction of quantitative assessment of postpartum blood loss and institutional changes in clinical practice: an observational study. IJOA 2019, in press.

Books

Chestnut DH, Wong CA, Tsen LC, Ngan Kee WD, Beilin Y, Mhyre JM, Bateman BB, eds. Chestnut’s Obstetric Anesthesia: Principles and Practice, 6th edn.  Philadelphia: Elsevier Saunders, 2018.      

Book chapters

1. Spitzer Y, Beilin Y. Hypertensive Disorders of pregnancy. In: Baysinger C, Bucklin BA, Gambling DR, eds. A Practical Approach to Obstetric Anesthesia, 2nd ed.  Philadelphia: Wolters Kluwer Health, 2016, 435-50.

2. Weiner MM, Hamburger J, Beilin Y. The Pregnant patient with cardiac disease. In: Kaplan’s essentials of cardiac anesthesia for noncardiac surgery. Philadelphia: Elsevier, 2018, 446-492.

3.Hamburger JZ, Beilin Y. Thrombocytopenia: An Introduction. In: Mankowitz SKW, Ed., Consults in Obstetric Anesthesiology. New York: Springer International publishing. 2018, 593-596.

4. Hamburger JZ, Beilin Y. Thrombocytopenia: Gestational, Idiopathic, and Preeclampsia. In: Mankowitz SKW, Ed., Consults in Obstetric Anesthesiology. New York: Springer International publishing. 2018, 597-600.

5. Hamburger JZ, Beilin Y. Thrombotic Thrombocytopenic Purpura. In: Mankowitz SKW, Ed., Consults in Obstetric Anesthesiology. New York: Springer International publishing. 2018, 605-608.

6. Knibbs N, Beilin Y. Breakthrough pain after labor epidural analgesia. In: Husain T, Fernando R, Segal S, eds, Obstetric Anesthesiology. Cambridge: Cambridge University Press, 2019, 10-14.

7. Katz D, Beilin Y. Renal Disease. In: Chestnut D, Wong C, Tsen L, Kee W, Beilin Y, Mhyre J, e. Chestnut’s Obstetric Anesthesia: Principles and Practice, 6th edn.  Philadelphia: Elsevier Saunders, 2018.  [In Press]

8. Wax D, Beilin Y. Liver disease In: Chestnut D, Wong C, Tsen L, Kee W, Beilin Y, Mhyre J, e. Chestnut’s Obstetric Anesthesia: Principles and Practice, 6th edn.  Philadelphia: Elsevier Saunders, 2018. [In Press]

 

Abstracts presented at recent meetings

1. Katz D, Beilin Y. The Effect of Adding Intrathecal Epinephrine to Hyperbaric Bupivacaine and Preservative Free Morphine for Repeat Cesarean Delivery: A Double Blind Prospective Randomized Control Trial. Poster presentation at the 49th Annual Meeting of the Society for Obstetric Anesthesia and Perinatology, Bellevue, Seattle, May 12, 2017.

2.  Katz D, Beilin Y. Functional Fibrinogen in Pregnancy.  Poster presentation at the 49th Annual Meeting of the Society for Obstetric Anesthesia and Perinatology, Bellevue, Seattle, May 12, 2017.

3. Katz D, Beilin Y. Implementation of  Triton, an FDA-Approved Technology for Quantification of Blood Loss (QBL): A Performance Improvement Study. Poster presentation at the 28th Health Care Risk Management Conference: Using Data to Reduce Malpractice Risk. February 28, 2018, New York NY.

4. Romano D, Hyman J, Katz D, Knibbs N, Einav S, Beilin Y. Etiology of ICU Admission in Obstetric Patients Differs by Mode of Conception. Poster presentation at the 50th Annual Meeting of the Society for Obstetric Anesthesia and Perinatology, Miami, FL, May 11, 2018.

5. Riley K, Kim E, Katz D, Beilin Y. Terbutaline Versus Nitroglycerin for External cephalic Version. Poster presentation at the 50th Annual Meeting of the Society for Obstetric Anesthesia and Perinatology, Miami, FL, May 11, 2018.

6. Kulkarni A, Knibbs, N, Beilin Y.  CSF Cutaneous Fistula in the Parturient with Coagulopathy. Poster presentation at the 50th Annual Meeting of the Society for Obstetric Anesthesia and Perinatology, Miami, FL, May 11, 2018.

7. Romano D, Hyman J, Katz D, Knibbs N, Einav S, Beilin Y. A Retrospective Analysis of Obstetric ICU Admissions Reveals Differences in Morbidity by Mode of Conception. Poster presentation the 72nd annual postgraduate assembly in Anesthesiology of the New York State Society of Anesthesiologists, New York, NY, December 8, 2018.