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Obstetrical Anesthesiology Service Busy at Ronald Reagan UCLA Medical Center

May 31st, 2011

Obstetrical Anesthesiology Service Busy at Ronald Reagan UCLA Medical Center
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Richard Hong, MD, Chief of Obstetric Anesthesiology

"The labor and delivery unit at UCLA Medical Center has long been regarded as a great place to have a baby. The nurses, doctors, midwives, and support staff all work to help families have a safe and satisfying birth.  ...with the opening of the new building, Ronald Reagan UCLA Medical Center, we now look as good as we truly are."- Susan Huser, CNM

Since the opening of the new Ronald Reagan UCLA Medical Center (RRUMC), expectant mothers have been coming to UCLA in increasing numbers with deliveries up approximately 10% since RRUMC opened its doors in July of 2008.  In the Labor and Delivery Unit, the private patient rooms have picturesque views of Westwood Village, the UCLA campus, and Bel Air, for a vastly upgraded experience from what patients had in the old UCLA hospital.  The business of babies is booming in Westwood!

This of course means more requests for Obstetrical Anesthesiology services, as the majority of laboring women coming to RRUMC opt for epidural labor analgesia or require anesthesia for ceserean delivery.  The UCLA Department of Anesthesiology remains committed to providing timely around-the-clock, in-house anesthesiology coverage for all possible delivery scenarios, often administering spinal, epidural, or general anesthesia as dictated by the clinical situation.

The immediate availability of anesthesiology services is not only convenient for women who wish relief from labor pain, but it is critical for the safety of mothers and neonates involved in potentially complicated or emergent deliveries.  One example where 24/7 anesthesiology services may help is for patients planning on either a trial-of-labor-after-cesarean (TOLAC) or vaginal birth after cesarean (VBAC).  These pregnant women carry a small but serious risk of complications including uterine rupture.  The American College of Obstetricians and Gynecologists has somewhat relaxed their stance on having staff "immediately available" but still recommends in their latest practice bulletin on the matter, that TOLAC/VBAC births are "most safely undertaken where staff can immediately provide an emergency cesarean." (1)

The Department of Anesthesiology has been working closely with nursing and obstetrics to further improve the birth experience beyond the improved aesthetics of the new hospital.  A multidisciplinary involvement with the California Maternal Quality Care Collaborative has yielded streamlined procedures for management of obstetrical hemorrhage, a growing cause of maternal morbidty and mortality nationwide.  Team-based simulations of obstetrical emergencies are played out on the unit to improve preparedness.  Patients with various medical conditions are often asked by their obstetricians to consult with the anesthesiologists far in advance of their expected delivery date.  Patients with serious heart conditions are often discussed by a multidisciplinary team to put a careful birth plan into motion.

Occasionally, after thorough advanced planning based on intrauterine ultrasound diagnosis, an infant in the process of being born may require an ex-utero intrapartum treatment (EXIT) procedure.  An “EXIT” procedure is a surgical procedure on the infant to allow him/her independent survival, carried out as part of a cesarian birth, albeit while the infant is still dependent upon the mother’s blood circulation through the placenta.  An EXIT procedure necessitates a large multidiscipinary team of subspecialty physicians and nurses, which UCLA is capable of providing.

The primary goal of the UCLA Obstetric Anesthesiology Service is a safe birth environment for every expectant mother and her infant in any situation.

1. ACOG Practice Bulletin No. 115.  Obstetrics & Gynecology: August 2010 - Volume 116 - Issue 2, Part 1 - ppg 450-463.

 

Lorraine Belmont, RN, and Debbie Tsuyuki, RN, monitoring contraction patterns and fetal heart tones for patients in labor.
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Lorraine Belmont, RN, and Debbie Tsuyuki, RN, monitoring contraction patterns and fetal heart tones for patients in labor.
Nitin Dhamija, MD, CA-2 resident, and Richard Hong, MD, Chief of Obstetrical Anesthesiology.
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Nitin Dhamija, MD, CA-2 resident, and Richard Hong, MD, Chief of Obstetrical Anesthesiology.
 
Nitin Dhamija, MD, CA-2 resident removing epidural catheter from new mother in private post-partum room, after successful pain relief during labor and delivery.
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Nitin Dhamija, MD, CA-2 resident removing epidural catheter from new mother in private post-partum room, after successful pain relief during labor and delivery.
Left to right:  Obstetricians and team performing Cesarean section delivery, with Colin Bauer, MD, CA-2 Anesthesiology Resident providing anesthesiology care.
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Left to right: Obstetricians and team performing Cesarean section delivery, with Colin Bauer, MD, CA-2 Anesthesiology Resident providing anesthesiology care.
 
L&D staff devoted to excellent patient care, left to right:  Melissa Pascual, ACP; Lourdes Padilla, ACP; Nancy Escobido, RN, AN I, and Kelly Bruce, RN.
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L&D staff devoted to excellent patient care, left to right: Melissa Pascual, ACP; Lourdes Padilla, ACP; Nancy Escobido, RN, AN I, and Kelly Bruce, RN.
Infant warmer ready in “in room” delivery suite.
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Infant warmer ready in “in room” delivery suite.




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