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Simon Ash Profile picture
@OBsleepmerchant
May 18 • 14 tweets • 17 min read Twitter logo Read on Twitter
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@rjharrison79 opens #OAA23ASM with an update on Labour Analgesia for 2023. Sir James Young Simpson remembered. ImageImage
It reads like an #Ostheimer - @rjharrison79 may be a contender to fill @PervezSultanMD’s shoes? Love the QR codes! #OBAnes at #OAA23ASM has gone state of the art! ImageImage
Analgesia efficacy: to puncture or not to puncture, that may be the question. (Puncture and give something or not?) #DPE studies on surgical onset times required, worrying signal regarding PDPH?#OBAnes #OAA23ASM ImageImageImage
What dose do we need - how low would you go? Should you go?
Well, Ultra low as good as low. BUT definitive RCT required. #OBAnes #OAA23ASM ImageImageImage
Which method of delivery is better (Royal Mail as good and cheaper?) All neuraxials superior to opioid PCA - although I think #OBAnes knew that? PIEB + PCEA is optimal - really shouldn’t still be using CEI. However, are there barriers to PIEB? Yes, pharmacy and therapeutics are… twitter.com/i/web/status/1… ImageImageImage
Complications. Optimising management of EBP? EBP optimal >/= 48-72h. So no to early EBP? #OBAnes #OAA23ASM ImageImageImage
What about epidural-related maternal fever? What we know, what we don’t… and probably some things we don’t know we don’t know. New mechanistic studies - likely multifactorial, with sterile inflammation/ thermoregulatory mechanisms likely. We need studies re: neonatal outcomes.… twitter.com/i/web/status/1… ImageImageImageImage
Severe maternal morbidity: 1 per 100 women, associated with >2000x risk mortality. NAP7 - maternal BMI increasing. #OBAnes #OAA23ASM ImageImageImage
Do epidurals protect against SMM? We need more studies - including postnatal period. Labour epidural may be a potentially modifiable risk factor for SMM - @rjharrison79 can you clarify for those #OBanes playing from home, does epidural reduce risk? The last slide got me.… twitter.com/i/web/status/1… ImageImageImage
Equity of care: #OBAnes = 55% of night workload (NAP7). Adequate data required to assess impact on quality & outcomes. @mbrrace data: ethnicity, socioeconomic disadvantage, multiple = more likely to die. SUICIDE 3x more common - maternal mental health matters! #OAA23ASM ImageImageImageImage
Are we providing equity in our care? @SQuashie had same graphic (same source to be fair) - no, there is inequity in #OBAnes care. Underlying causes unclear. Studies required. Multifactorial #OAA23ASM ImageImageImage
Climate crisis: N2O needs cracking (@noolslucas @Rose_Kearsley @Anaes_Journal) - 81% reduction in ambient N2O #OBAnes #OAA23ASM ImageImageImageImage
Returning to the epic Conclusion slide, tweeted and re-tweeted today at #OAA23ASM Well done, @rjharrison79! Great summary of #OBAnes current affairs! Image
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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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