WILTIMS #368: ♪♫ In the middle of the night... ♫♪

My body is so confused right now. After years of being a solidly night person, I finally converted back to a happily early morning person - getting up at 4am for a couple weeks will do that to you. But now I need to revert back for just one week to ultra-night person. My supposed-to-be-24-hour shift failed miserably at disrupting my schedule, with me falling asleep on the couch at around midnight. Yesterday, I managed to make it to 4am, but only by going out and doing errands at midnight.

Tonight was actually fairly eventful. I helped deliver a baby! ...if by help, you mean stood awkwardly behind the resident. Afterwards, I actually helped deliver the placenta and acted as assistant during the quick repair of some tears that formed during delivery.

When we started the night, we had two women in labor and divided them up between the other night med student and myself. Since I was the OB novice, the other student gallantly ceded the furthest along of the two to me. Of course, the other patient quickly overtook mine and delivered. Then a new admission came, that I took just to increase my chances. By 3am, neither of my patients had delivered. I was losing hope.

Then at 03:30, a woman comes in fully dilated and in active labor. By 04:00 she had already delivered and was mostly sewn back up.

TIL: There's a handy-dandy circular chart in the OB triage area for calculating any obstetrical date from any other known obstetrical date. (see above)

The biophysical profile (BPP) is a test that can be done toward the end of a pregnancy to assess the health of the fetus. Similar to the Apgar score given to newborns, there are five parts of the exam that can each be scaled from 0-2 for totals from 0-10. Unlike Apgar scores, the BPP categories are all or nothing, so you can only have even numbered values. The five categories and criteria are below.

Score	2 (good)	0 (bad)
Reactive fetal heart rate	≥2 accelerations of 15 bpm lasting ≥15 secs in 20 mins	<2
Fetal breathing movements	≥1 episode of  30 secs in 30 mins	No episodes
Gross body movements	≥3 in 30 mins	<3
Muscle tone	≥1 episode of limb/trunk movement	No movements
Amniotic fluid	≥1 vertical pocket of ≥2 cm by ≥1 cm	Largest pocket <2 cm

Total Score	Interpretation
8*-10	Normal
6*	Repeat within 24 hours or deliver if indicated
0-4	Deliver unless otherwise contraindicated

*If the 6 or 8 includes a 0 for amniotic fluid, then shift down one category

I also learned how to build tables in html (see above).