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.
SMM at a population level. Study population derivation. #OBAnes#OAA23ASM
Coding SMM in Scotland: diagnoses & procedures. Sepsis and esclampsia most frequent diagnoses; ICU admission & wound re-closure most common procedures. Peuperal sepsis leading cause of admission to any critical care facility. SMM incidence 50 per 1000 pregnancies. #OBAnes… twitter.com/i/web/status/1…
Risk factors for SMM: previous cesarean section, multiple gestation, African/ Middle East/ Asian descent, increased BMI, and pre-existing comorbidities have increased OR; parity protective? Increased SMM in recent years, more readily diagnosed or admitted to critical care? Or… twitter.com/i/web/status/1…
Short term outcomes of SMM: LoS >7 days, death, stillbirth, late second trimester loss. #OBAnes#OAA23ASM
Is coding accurate? Peuperal sepsis ICD-10 code. Definition closer to SMM: infection + organ dysfunction or peuperal sepsis + critical care admission. PPH excluded. #OBAnes#OAA23ASM
Media coverage - balanced? Key points: SMM as defined occurs in 1% of pregnancies. Definition requires refinement & validation. Risk factors for SMM increasing. SMM strongly linked to maternal death, stillbirth/ fetal loss, increase LoS. #OBAnes#OAA23ASM
Longer term outcomes. Consequences: PTSD, distrust of system. Surviving critical illness - post intensive care syndrome. Affects families and patients: mental health, cognitive and physical fall out —> quality of life impacts. #OBAnes#OAA23ASM
Study design. One-year mortality: 200 per 100,000 if admitted to ICU (2.5 per 100,000 if not). 42day readmission 26.7%, 42day to one-year readmission 14.1% (if admitted to ICU). Longer term outcomes: mortality, hospital readmission and NB psychiatric hospital admission.… twitter.com/i/web/status/1…
Implications. High emergency readmissions. Post ICU follow-up services ideal, but still patchy. Psychological support probably lacking. Maternity specific adaptations to existing services required? #OBAnes#OAA23ASM
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@SQuashie presents an update on anesthesia for operative delivery. Declarations. Methodology and themes. #OAA24ASM #OBAnes
Gastric USS. Oral rehydration has benefits over NPO wrt vasopressor use. #siptilsend safe, noting some patients have increased gastric volumes irrespective of starvation status. #OAA24ASM #OBAnes
@SQuashie continues at a rapid pace. To DPE or not to DPE remains a question - 16min vs 19 min, is that 3 min clinically relevant? Esketamine for supplemental analgesia - >95% had psych effects, read @rjharrison79 editorial. #OAA24ASM #OBAnes
@Jamesocarroll presents an Update on Labour and Delivery. Disclosures #OAA24ASM #OBAnes
How the lecture was put together. Screening. Themes. How to interpret the slides. Very Ostheimer-esque @Jamesocarroll #OAA24ASM #OBAnes
@Jamesocarroll Clinical practice theme: intrathecal catheters & ADP. Intrathecal catheters: No decrease in PDPH, but reduction in EBP. 10mL intrathecal saline decreased PDPH & need for EBP. Of note, the percentage of epidurals requiring multiple attempts. #OAA24ASM #OBAnes
8am-ish in Denver and time for a much anticipated session: PDPH beyond the guidelines. Moderated by Dr Lisa Leffert, featuring @Ropivacaine, @euklaas, @sharonOzynger and @WouterSchievink at #SOAPAM2024 #OBAnes
(HT: @Ropivacaine, bless his heart, he knows I hate missing out)
Hot off the Press? August 2023! @JAMANetworkOpen with quite an illustrious team including @Ropivacaine @robin_russell1 @KalagaraHari @LimGrapes @claralexlobo @noolslucas @NarouzeMD (please tag others if you have their handles?) #SOAPAM2024 #OBAnes
Introduction, Methods and the 10 questions. #SOAPAM2024 #OBAnes
Next up at #CASAM2023 - fittingly keeping the most important academic session to last: #OBAnes @ValZaph moderating the Maternal Experience and Outcomes: Improving the care we provide. @DrWesleyEdwards
Dr Christina Lamontagne kicks off the session with: Use of Dexmedetomidine in improving maternal experience and outcomes. Nothing to disclose. Then an important disclosure: All indications discussed are OFF LABEL in Canada. Objectives. #OBAnes#CASAM2023
Why does Dr Lamontagne use a lot of dexmedetomidine (not only in #OBAnes mind)? Clinical pharmacology of dexmedetomidine (1): highly selective alpha-2 agonist; sedation WITHOUT amnesia at locus coeruleus. #CASAM2023
Dr Ning Nan Wang introduces @harshamd5 to open the chronic pain session: Perioperative use of opioid in the context of Opioid Epidemic. #CASAM2023
The opioid crisis isn’t new - China probably remembers the Opium wars that helped establish a British foothold on the continent. Opioids and OUR crisis. Is what we fear the real crisis? Are opioid-related deaths due to surgical prescriptions? No, mostly due to street fentanyl.… twitter.com/i/web/status/1…
Opioid use around the time of surgery. Understanding nociception vs pain. Does eliminating opioids during surgery make a difference - no definitive conclusions. #CASAM2023