ASPIRE Obstetric Anesthesia Subcommittee Meeting
November 8, 2023
Agenda
Announcements
May 2023 Meeting Recap
Measure Review: BP-04
BMI Stratification
Uterotonic Agents
Welcome New Members!
• Jonathan Paul, MD- Columbia University
• Laurance Ring, MD- Columbia University
• Muhammed Athar, MD- University of Arkansas
• Jack Peace, MD –Temple Health
Seeking OB Subcommittee Vice-Chair
• Follow up to initial basecamp post late summer
• 3-year term
• Help shape direction of OB Subcommittee
• Measure performance review, new measure development, measure revision
• Identify and participate in research opportunities
• Work with Nicole and the MPOG team
• OB Subcommittee Vice-Chair Description: here
Announcements
• OB Subcommittee Teams Meeting Dates 2024:
• Feb 7, 2024 @1pm EST (Brendan Carvalho, MD -SOAP Stanford)
• May 22, 2024 @1pm EST
• Oct 2, 2024 @1pm EST
• PCRC proposals updates at future meetings:
– PCRC 193
– PCRC 150
May Meeting Recap
• Measure review: ABX 01-Percentage of cesarean deliveries with documentation of antibiotic
administration initiated within one hour before surgery start.
• At the May subcommittee meeting, members voted to add Placenta Accreta as an exclusion
for the GA measures.
– Score change minimal < 0-3% for sites
– GA-01- Percentage of cesarean delivery cases where general anesthesia was used.
– GA-02- Percentage of cesarean delivery cases where general anesthesia was administered after neuraxial
anesthesia.
– GA-03- Percentage of cesarean delivery cases where general anesthesia was used after epidural.
• Azithromycin measure – Percentage of unscheduled cesarean deliveries in which
azithromycin was administered within 60 minutes before incision or procedure start and
anesthesia end.
In the News: Summer/Fall 2023
Events:
•Healthy 27 y/o G2P1 laboring:
•Epidural
•Abnormal presentation: Arm above head
•Cord prolapse-> taken to OR to delivery: 10 minutes
•Mom emergently intubated d/t pain. Fluid suctioned from lungs.
•Extubated without issue, lab work normal postoperatively
•Day 10: Patient is weak, requiring increased respiratory support ->
Intubated, Hypotensive, WBC count: 40
•Patient codes but is resuscitated. Codes again: resuscitation not
successful.
Discussion
:
• Anything we can learn?
Doctor's Wife Dies Days After Giving Birth to
Their Baby (Exclusive) (people.com)
BP-04 Measure Review
Dan Biggs, MD – University of Oklahoma
Preet Singh, MD- Washington University
Measure review
• The measure review schedule is posted on Basecamp. Please also check your
emails for the measure review schedule.
• Template form
Measure
Published
date
Present at OB
subcommittee
Assigned to
ABX-01
July 2020
May 2023
Monica Servin and Brandon Togioka
BP-04
Feb 2021
Nov 2023
Preet Singh and Dan Biggs
GA-01
Feb 2021
Feb
2024
Melinda Mitchell and Sharon Abramovitz
GA-02
Aug 2021
Feb 2024
Melinda and Sharon
TEMP-05
Aug 2021
Feb or May 2024
Wandana Joshi and Christine Warrick
BMI Stratification
BMI and Cesarean deliveries
According to the CDC, in 2020 31.8% of
live births were cesarean deliveries
Uterotonic Agents
Uterotonic Agents Included:
- Oxytocin
- Misoprostol
- Carboprost
- Methergonovine
4891
1287
428
114
1579
615
588
62
787
417
300
124
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
50000
0
1000
2000
3000
4000
5000
6000
7000
8000
Oxytocin Only Oxytocin + 1 Additional
Agent
Oxytocin + 2 Additional
Agents
Oxytocin + 3 Additional
Agents
CESAREAN CASES WITH UTEROTONIC
AGENTS
CESAREAN CASES WITH EBL (#)
Uterotonic Agents and EBL
April 2022 -March 2023
EBL>1L EBL>1.5L EBL>2L Total Cases
THANK YOU!
Nicole Barrios MHA, BSN-RN
Obstetric Anesthesia Subcommittee Lead
nicbarri@med.umich.edu
Monica Servin, MD
MPOG Obstetric Anesthesia
Subcommittee Chair
monicar@med.umich.edu