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Simon Ash Profile picture
@OBsleepmerchant
May 22 • 11 tweets • 11 min read Twitter logo Read on Twitter
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@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
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… ImageImageImage
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… ImageImageImage
Short term outcomes of SMM: LoS >7 days, death, stillbirth, late second trimester loss. #OBAnes #OAA23ASM Image
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 ImageImage
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 ImageImage
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 ImageImageImage
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… ImageImageImageImage
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 ImageImageImageImage

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More from @OBsleepmerchant

Simon Ash Profile picture
May 24
@rr_metabolicmed presents the Bruce Scott Lecture 2023 at #OAA23ASM: Obesity & diabetes in pregnancy - legacy for the child. #OBAnes Image
Study of 1.3 million pregnant women reveals global obesity crisis: 75% pregnant women fail to achieve healthy weight gain during pregnancy, leading to preventable adverse health consequences for both the women and their babies. Obesity has strong evidence for increased risk of… twitter.com/i/web/status/1… ImageImageImage
Maternal obesity and offspring cardiovascular disease: maternal obesity increases offspring cardiovascular death (Hazard ratio [all cause mortality] = 1.35). At current UK maternal obesity rates, this equates to extra 650 deaths before age 50 each year. The Hazard ratio for type… twitter.com/i/web/status/1… ImageImageImage
Read 14 tweets
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
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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