Thread by @OBsleepmerchant

@FarberMichaela (@BrighamOBAnes @Harvard @SOAPHQ) presenting the mini-Ostheimer lecture “what’s new in #OBAnes?” at #OAA3dc2022

QR code provided links to the references/ resources much appreciated from @FarberMichaela, she also outlines how slides can be interpreted #OAA3dc2022

The focus of @FarberMichaela’s lecture is recognition of #OBAnes as a peri-delivery speciality in hopes of impacts on #patientsafety and decreasing OB M&M @ruthi_landau @CynthiaAWongMD @JillMhyre
A topical start! Lots to cover, so little time at #OAA3dc2022

Multiple studies looking at Autism and Epidural Labour Analgesia. Controlling for confounders NB. @aljabut
#OAA3dc2022

Take home message: #OBAnes can reassure patients that labour epidurals are NOT associated with a higher risk of Autism @CynthiaAWongMD #OAA3dc2022

Maternal mortality form MBRRACE-UK: key messages and 5 steps for health professionals (including #OBAnes) #OAA3dc2022

Can MBRRACE-UK be replicated in USA - perhaps not nationally but definitely doable at state level, as demonstrated by @cmqcc #OAA3dc2022

@cmqcc demonstrates the importance of cardiac disease in pregnancy/ #OBAnes (@AnaSjaus @AliciaTDennis) A lot of work still to do - call to arms from @arendt_katie #OAA3dc2022

Moving on to next section of @FarberMichaela’s epic talk - can’t imagine having to tweet the #SOAPAM2022 version - up for the challenge of Ostheimer #OBAnes lecture at #SOAPAM2023 in New Orleans. #OAA3dc2022

Thrombocytopenia in #OBAnes - how low will you go? (50 @bhwords) @MelissaEBauer1 @ruthi_landau and many others give us consensus guidelines.#OAA3dc2022

Vast menu of options (starters, mains and sides outlined by @FarberMichaela) for labour analgesia. DPE PIEB potentially faster onset, medication sparing, no increased S/E. Caveats not compared to every option, changing mix changes results? #OAA3dc2022

Next from @FarberMichaela, Chloroprocaine vs Lidocaine for activation of labour epidural for cesareans section - similar results but not non-inferior. #OBAnes #OAA3dc2022

@FarberMichaela asks whether non-inferiority studies are the wave of the future in #OBAnes? Maybe… but with some serious caveats: good article from EHJ. #OAA3dc2022

Cesarean delivery up next with @FarberMichaela’s mini-Ostheimer “what’s new in #OBAnes” at #OAA3dc2022

Degree of uterine tilt vs phenylephrine requirements - 30 degree tilt required less. Now we use phenylephrine infusions all the time in #OBAnes, and surgeons, patients and providers dislike tilt, so why worry? #OAA3dc2022

@FarberMichaela has concerns - it’s more then just the uterus involved and translational studies may give #OBAnes pause #OAA3dc2022

Prophylactic second uterotonics in #OBAnes? More nausea for no real benefit? And it doesn’t matter which agent you use (ergometrine or carboprost) #OAA3dc2022

Using apps for post-cesarean care and #OBAnes follow up? Ping @girardDev this ones for you? Also some good granular quality metrics @AnaSjaus @IWKHealth @DalAnesthesia #OAA3dc2022

Postpartum pain abbreviated for fascial plane blocks still not worth it is IT morphine used in #OBAnes? QLB and TAP equivalent in study from @elboghdadly @CarvalB @PervezSultanMD (@Ropivacaine @amit_pawa @Steve_Coppens @NarouzeMD can comment) #OAA3dc2022

@FarberMichaela continues with PDPH: 22k PDPH a year in USA alone, that’s a significant disease burden, especially if 1/7 to 1/2 of PDPH develop chronic headache. Well powered study: 58.4% of ADP patients have chronic headache at 18months! #OAA3dc2022

Interesting that EBP at time of ADP had less frequent less severe chronic headache - evidence for earlier intervention? No evidence of intracranial hypotension on MRI in 25 patients with chronic headache - what’s the mechanism? Trigeminal sensitization? #OAA3dc2022

Take home message on PDPH from @FarberMichaela - it is NOT always self limiting. We need to follow patients longitudinally. NB we MUST include chronicity as part of informed consent. #OAA3dc2022

What of PPH? TXA is very topical (WOMAN trial- lower mortality if TXA within 3h; TRAAP-1 TXA no difference QBL > 500mL), latest iteration is 2021 TRAAP-2 trial (EBL >1000, transfusion at 48h Decreased PPH, but other parameters not different. #OAA3dc2022

TXA prophylaxis for cesarean has no effect on clinical morbidity from hemorrhage, not warranted as PPx, should not be prioritized over other treatments. Must be carefully stored - drug errors. ?VTE risk. PPH preventable, cycle of too little too late. Enter REACT trial.#OAA3dc2022

We arrive at the REACT study: QBL can be abandoned unless clinical cues concerning. @FarberMichaela respectfully disagrees with the passive “balanced” approach in favour of a more proactive stance. #OAA3dc2022

@FarberMichaela concludes with an invitation to #OBAnes to join her and others in providing excellent peri-delivery care (not just needle jockeys) #OAA3dc2022

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