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Simon Ash Profile picture
@OBsleepmerchant
May 16 • 11 tweets • 13 min read Twitter logo Read on Twitter
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@elsmere_g presents on Maternal Medicine at #Anaesthesia2023. Pregnancy is stressful - it will unmask disease. Pick up the phone. Why are we worried? #OBAnes #OAA23ASM ImageImageImageImage
When looking at @mbrrace reports the UK has shown some improvements in maternal mortality, however, there has been an uptick since 2018. While this is partly accounted for by a changing maternal population (older, more obese, more comorbidities, etc), start inequalities related… twitter.com/i/web/status/1… ImageImageImage
Majority are indirect deaths. #OBAnes contributes only a small amount (not to be ignored though). Everyone has a role to play in improving maternity care and reducing mortality & morbidity. Remember majority of deaths occur AFTER delivery - recent pregnancy history shouldn’t be… twitter.com/i/web/status/1… ImageImageImage
Common myths in pregnancy. Imaging is not bad, especially when indicated (delayed diagnosis is deadly). Avoid gadolinium, unless required. Resources. Making a (the) diagnosis is essential. Patients CAN decline imaging, but at least allowed adequate informed consent.… twitter.com/i/web/status/1… ImageImageImage
Drugs are not necessarily bad, context important. Risk-benefit resource = uktis.org. Stopping anti-epileptics can have significant consequences (get expert advice). Coamoxiclav should be avoided in third trimester. Key message: de-prescribing, balancing choices is… twitter.com/i/web/status/1… ImageImageImage
Sick women DO get pregnant. Cancer, renal disease, interstitial lung disease, oh my. Reinforce/ direct contraception and/or pre-pregnancy counselling when you see systemic illness. #Anaesthesia2023 #OBAnes (prelude to #OAA23ASM) ImageImage
Odd symptoms are NOT due to pregnancy, until proven otherwise. Think heart - older patients, more heart disease. Majority do NOT know they have heart disease. Chest pain is NEVER normal. Pain should be explained, when there’s more call for advice/ look deeper. MEWS are important… twitter.com/i/web/status/1… ImageImageImageImage
NOT everything gets better with delivery. Especially important is preeclampsia - often postnatal presentation of eclampsia or HELLP. @mbrrace has recommendations specific to preeclampsia (in bold). #Anaesthesia2023 #OBAnes (prelude to #OAA23ASM) ImageImageImage
Where do we look after the sick parturient (pre/ postnatally)? Depends - pro’s and con’s. May not always be a simple yes/ no answer. Principles of management - MDT MDT MDT. Optimise devastating situations with compassionate care.
#Anaesthesia2023 #OBAnes (prelude to #OAA23ASM) ImageImageImageImage
Networks and MDT’s - knowing WHO to call is important. Important resources with QR codes. #Anaesthesia2023 #OBAnes (prelude to #OAA23ASM) ImageImage
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More from @OBsleepmerchant

Simon Ash Profile picture
May 23
@TasPirani presents of Liver disease in pregnancy. A lot to cover! #OBAnes #OAA23ASM ImageImage
Physiological changes in pregnancy. Normal LFT/ laboratory changes. #OBAnes #OAA23ASM ImageImage
Causes of liver derangement in pregnancy: flare of pre-existing liver disease (known or unknown). Incidence of pregnancy in people with chronic liver disease at King’s College Hospital. Historically, cirrhotic patients have been infertile d/t anovulation. Population based data… twitter.com/i/web/status/1… ImageImageImageImage
Read 18 tweets
Simon Ash Profile picture
May 22
@ICULone presents on Severe Maternal Morbidity (SMM) and its consequences at #OAA23ASM. #OBAnes Image
Definition of acute SMM: severe, life threatening event during pregnancy & within 6 weeks of delivery. @NPEU_UKOSS provides UK wide high quality obstetric surveillance. Deaths, while uncommon, investigated in depth.

Study Aims: operationalise definition of SMM; report incidence… twitter.com/i/web/status/1… ImageImageImage
SMM at a population level. Study population derivation. #OBAnes #OAA23ASM ImageImage
Read 11 tweets
Simon Ash Profile picture
May 22
Prof Donald Peebles on Embedding Maternal Medicine Networks at #OAA23ASM. Knowing who to call is half the solution to any problem? (Touched on by @elsmere_g during #OBAnes session at #Anaesthesia2023) Image
Direct maternal mortality rate per 100,000 maternities had been decreasing over the last 2 decades, but should a remarkable upswing since 2018, not all accounted for by #COVID19. @mbrrace outlined a case for change: most parts of UK have MDT, but make up variable most without… twitter.com/i/web/status/1… ImageImage
The Maternal Medicine Network (MMN) mandate: ensure timely access to specialist advice and care at all stages of pregnancy. Development of Maternal Medicine specialist centres as regional hub & spoke model = urgent national priority (@DOckendenLtd report)

MMN Ambition and… twitter.com/i/web/status/1… ImageImage
Read 5 tweets
Simon Ash Profile picture
May 21
Dr Katy Sheehan and @ArcBroom present the pick of the posters at #OAA23ASM. 4 criteria for selection of #OBAnes abstracts. ImageImage
A positive start, with the power of positive communication on patient satisfaction, morale & culture, and #patientsafety #OBAnes #OAA23ASM ImageImageImageImage
Barriers to care. Ethnicity, Language and Socioeconomic deprivation. @mbrrace, @TheLancet, and most recently @Anaes_Journal (@LateralTilt @noolslucas @SQuashie @Marianfknight) set the stage. #OBAnes #OAA23ASM ImageImageImageImage
Read 18 tweets
Simon Ash Profile picture
May 21
@NoelleHealy (another 🇮🇪 representative - @ISOA_Ireland well represented!) presents on #OBAnes as a team sport - how do we perform better? at #OAA23ASM. Quite an inspiring quote, then setting the stage with @Fionafionakel et al #humanfactors guidelines in @Anaes_Journal… twitter.com/i/web/status/1… ImageImageImage
Why is teamwork important in OB/ #OBAnes? @mbrrace suggests some lessons to be learned. Prompt action is arguably reliant on good communication, within & between teams. Involving consultant/ specialist care early has been a theme for over a decade. #OAA23ASM ImageImageImage
@DOckendenLtd’ final report highlighted “conflicting agendas and poor teamwork” contribute to adverse maternal & neonatal outcomes? So how do we create good teams?

The @JulieAndrews approach may have the hills alive, but for #OBAnes we may need to start at the very beginning,… twitter.com/i/web/status/1… ImageImage
Read 10 tweets
Simon Ash Profile picture
May 21
@emirakur presents an update on @NAPs_RCoA NAP7 Perioperative cardiac arrest & #OBAnes at #OAA23ASM. ImageImage
The history of @NAPs_RCoA projects and key findings for #OBAnes over the years (failed intubation NAP4 1:390, recent US data 1:808 - gotten better or different methodology?) #OAA23ASM ImageImage
Cardiac arrest in pregnancy. CAPS study @BJOGTweets (I see @Marianfknight?) looked at incidence, management & outcomes in UK. #OBAnes have a significant slice of the pie. @SOAPHQ serious complication repository project (incl. @RichSmileyMD @bscottsegal) provide US data: cardiac… twitter.com/i/web/status/1… ImageImageImageImage
Read 11 tweets

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