OB Hx

Question 1

What date did James Young Simpson use diethyl ether to anesthetize a woman with a deformed pelvis for delivery?

Answer 1

January 19, 1847

Question 2

What else happened on the same day James Young Simpson used diethyl ether?

Answer 2

He was named the Queen of Scotland’s physician

Question 3

What other notable things did James Young Simpson accomplish?

Answer 3

Designed obstetric forceps, designed anesthetic properties of chloroform, made innovations in hospital architecture, and wrote a textbook on the practice of witchcraft in Scotland

Question 4

What did Simpson think about pain?

Answer 4

All pain, labor pain included, is without physiologic value. Pain only degrades and destroys those who experience it”.

Question 5

Who is Simpson’s US equal?

Answer 5

Charles D. Meigs

Question 6

What did Meigs argue?

Answer 6

Labor pain has a purpose, and uterine pain is inseparable from contractions

Meigs argued that abolishing the pain would alter contractions. In the 1850s, the majority of OB physicians supported Meigs stance.

Question 7

Who performed anesthesia for the birth of Queen Victoria’s 8th child-Prince Leopold?

Answer 7

John Snow provided Chloroform

Question 8

What was the response to Queen Victoria receiving chloroform?

Answer 8

The public was critical and the court’s physicians denied it

Question 9

What was the response when chloroform was given for princess’s Beatrice birth 4 years later?

Answer 9

Chloroform was given and it was accepted.

Question 10

What was used for “twilight sleep”/amnesic and more comfortable during labor?

Answer 10

Opioids + scopolamine

Question 11

What did Paul Zweifel demonstrate in 1874?

Answer 11

He demonstrated with a chemical reaction that chloroform was present in the umbilical blood of neonates.

He used a light-absorption technique to demonstrate a difference in oxygen content between umbilical arterial and venous blood. He established the placental transfer of oxygen.

Question 12

What was seem when Morphine/opioids were given during pregnancy and birth?

Answer 12

Withdrawal symptoms in newborns (violent fetal movements and sudden fetal death)

Question 13

What did Gillette describe in 1877?

Answer 13

15 instances of neonatal depression that he attributed to morphine given during labor.

Question 14

What did the studies from 1880-1950 show?

Answer 14

-Few studies showed the effects of anesthesia on the newborn
-The studies that did show apnea, oligopnea, or asphyxia rarely ever defined what that meant and the significance
-Few studies used controls or compared one mode of treatment to another.
-few writers used their data to evaluate the safety of the practice they described. (Essentially, although there was reporting it was lacking substance).

Question 15

Who was Virginia Apgar?

Answer 15

A physician/Surgeon turned anesthesiologist

Question 16

Where did Virginia Apgar get the inspiration to pursue anesthesiology?

Answer 16

The chairman of the Department of Surgery at Columbia

Question 17

Where did Virginia Apgar do her anesthesia training?

Answer 17

She trained with Ralph Walters at the University of Wisconsin and with E.A. Rovenstien at Bellevue Hospital

Question 18

What were Virginia Apgar’s accomplishments once she returned to Columbia Presbyterian Hospital?

Answer 18

She was the director of the division of anesthesia and was the first woman to be appointed a professor at Columbia University (1949)

Question 19

What year was the Apgar score described?

Answer 19

1953

Question 20

What did the Apgar score describe?

Answer 20

reliable system for evaluating newborns. It was sufficiently sensitive to detect differences among neonates. The Apgar score called attention to the child and made its condition the new standard for evaluating obstetric management.

Question 21

Who was John Snow?

Answer 21

Surgeon turned anesthesiologist

Question 22

What substances did John Snow experiment with?

Answer 22

ether and chloroform

Question 23

In what stage of Labor did John Snow ultimately begin administering anesthesia

Answer 23

2nd stage of labor and limited administration to brief periods during contractions and attempted to keep the patients comfortable but responsive

Question 24

What did John Snow develop?

Answer 24

He recommended using a vaporizing apparatus he developed for surgical cases to maintain better anesthesia control

Question 25

When did research start coming out about regional anesthesia for spinal, lumbar, epidural, caudal, paravertebral, parasacral and pudendal blocks?

Answer 25

1900s-1930s

Question 26

When did information about the positive effects of regional anesthesia begin to come out?

Answer 26

After 1944

Question 27

What did Dick-Read promote?

Answer 27

“natural childbirth”

Question 28

What did Dick-Read believe?

Answer 28

He argued that fear made the uterus contract and become ischemic and, therefore, painful. He believed and presented that women could avoid pain if they learned to abolish their fear of labor.

Question 29

What did Curtis Mendelson describe in 1946?

Answer 29

Aspiration

Question 30

What two issues have dominated the debate of OB anesthesia?

Answer 30

Two issues have dominated the debate:

-the effects of anesthesia on labor
- the effects of anesthesia on the newborn.

Question 31

Important milestones in OB anesthesia:

Answer 31

-The introduction of inhalation agents in 1847
-The expanded use of opioids in the early decades of the twentieth century
-The refinement of regional anesthesia

Question 32

Outstanding conceptual developments:

Answer 32

Zweifel’s idea that drugs given to the mother cross the placenta and affect the fetus

Apgar’s idea that the condition of the newborn is the most sensitive assay of the quality of anesthetic care of the mother

Question 33

The history of OB anesthesia suggests that:

Answer 33

The major improvements in patient care have followed the application of principles of basic science