Thread by @OBsleepmerchant

The PREMIER #OBAnes event of the year: The Gerard W Ostheimer Lecture - What’s New in #OBAnes?

@FarberMichaela hands the reigns to @PervezSultanMD

Large audience beyond #SOAPAM2023 @CarolynWeiniger @DrNickB_ObAnaes @LoughreyJPR @GongGasGirl (#OBSIG23SYD & #ASM23SYD)… twitter.com/i/web/status/1…

Disclosures quite impressive - including the editorial reduction of a years work to 50 minutes. Methods: includes #OBAnes on Twitter! 108 articles. 32 in lecture. AND there’s an app @CarolynWeiniger! #SOAPAM2023

The format of the lecture! 5 #OBAnes sections to cover! Global, North America, Antenatal, Analgesia and Postnatal. #SOAPAM2023

Next 1000 babies will be born in 1 minute. Most maternal mortality occurs in LMICs, most is preventable. #OBAnes #SOAPAM2023

A study from Kenya. Barriers to implementation of @WHO #PPH recommendations: drug availability (esp temperature stable carbetocin), unskilled personnel. #OBAnes #SOAPAM2023

A success story from India: decreased MMR. Targeted national and international efforts required. Note the geographic distribution (maternity care deserts aren’t only a US thing) #OBAnes #SOAPAM2023

@mbrrace reports are so important for #OBAnes to read. 2.5x higher MMR in more deprived areas. Socioeconomic and racial disparities #SOAPAM2023

@DOckendenLtd’s report. Actionable recommendations: abandon targeting numbers as quality metrics (Goodhart’s Law - < 5% GA rate comes to mind), ensure adequate staffing. Good leadership required for a culture of safety (psychological and safety) #OBAnes #SOAPAM2023

On to North America section: 84% of pregnancy-related deaths in 36 US states are preventable. Most are postpartum. Psychiatric disorders are leading cause. #OBAnes #SOAPAM2023

Anesthesia-related adverse events in #OBAnes. Quality metrics are important and needed. #OBAnes role as Perioperative physicians is vital to impacting this. #SOAPAM2023

@ASALifeline statement on #OBAnes metrics. Caution with Goodhart’s Law - but maybe using two metrics that reflect each other may overcome?Labour ward dashboards may be beneficial. #SOAPAM2023

HOT TOPIC: safe staffing. Quality metrics are required. Week day staffing is understandably better. Cannot use UK staffing model, nor is the situation uniform across US. #OBAnes #SOAPAM2023

Dobbs vs Jackson. Repealing Roe V Wade resulted in most US states no longer protecting abortion (irrespective of indication). Impactful @SOAPHQ statement. #OBAnes #SOAPAM2023

States have become laboratories for experimentation. Need to ensure we follow impact of law change on MMR and SMM. Hesitancy to treat, decreased training and skills. #OBAnes #SOAPAM2023

Moving along to antenatal care. Buprenorphine associated with lower risk of adverse neonatal outcomes compared with methadone. Maternal outcomes similar. NB do NOT change medications without expert advice. #OBAnes #SOAPAM2023

Antenatal penicillin allergy testing is safe, feasible and impacts clinical care. De-labeling is important (@LouiseSavic @LondonAllergy) #OBAnes #SOAPAM2023

On to analgesia section. IT Chloroprocaine and bupivacaine are effective for cerclage. Former has a favourable recovery profile, however, safety data required. #OBAnes #SOAPAM2023

DPE does not improve labour analgesia in obese patients compared to standard epidural. There may be a benefit to block onset time - watch the press! #OBAnes #SOAPAM2023

Comparison of Ultra-low, Low and High concentrations of LA for LEA: concentrations > 0.1% unfavourable but </= 0.1 and </= 0.08% similar. #OBAnes #SOAPAM2023

Carbetocin and Oxytocin at elective cesarean. Low doses preferable to high for both.low dose oxytocin bolus & infusion is non-inferior to high dose carbetocin. NO DIFFERENCE in secondary outcomes. #OBAnes #SOAPAM2023

@PervezSultanMD’s own VERY NB paper on inadequate neuraxial anesthesia in patients undergoing ELECTIVE cesarean. We need better definitions for what is inadequate, how do we manage this, and what are long term outcomes? It is clear that the problem is bigger than expected!… twitter.com/i/web/status/1…

@Anaes_Journal article already covered extensively and homework from @hnixon147’s #SolShnider track lecture this morning. @noolslucas @SusannaStanford @BogodDavid @DavidGray37 @robin_russell1 READ IT! #OBAnes #SOAPAM2023

@YavorRM @Chronotrope this one may interest you. The use of TIVA for GA is an #OBAnes research priority. Many questions - answer them? #SOAPAM2023

IV dexamethasone has analgesia benefits post-cesarean section. However, effects of maternal, fetal and neonatal glucose homeostasis is still unclear. #OBAnes #SOAPAM2023

But here’s a study looking at neonatal hypoglycaemia related to peri-cesarean dexamethasone use. It is associated with altered glucose metabolism in pregnancies complicated by DM. #OBAnes #SOAPAM2023

Expert consensus regarding core outcomes for ERAC - sorely needed research on the same now required. #OBAnes #SOAPAM2023

Factors associated with failed EBP. Success depends on definition (seems to be a lot of that theme) - complete success ONLY 33% with 1st EBP. Timing of EBP after ADP makes a difference to success. #OBAnes #SOAPAM2023

SUMMARY: awesome work @PervezSultanMD #OBAnes #SOAPAM2023

Thank you’s for @PervezSultanMD. Standing ovation all round. How many people will now not be able to shake the similarity between @CarvalB and Stanley Tucci (@MarkHamill if you know his twitter handle?!?) #OBAnes #SOAPAM2023