Obstetric Anesthesia Subcommiee Minutes
May 14th, 2025
1:00-2:00 pm EST - Zoom
Aendees:
John Kowalczyk, Brigham & Women's
Jeremy Juang, UCSF
Lawrence Tsen, Brigham & Women's
Laura Cohen, UMass Memorial
Sharon Reale, Brigham & Women's
Chrisne McKenzie, UNC
Arthur Calimaran, Cleveland Clinic
Jackie Goatley, University of Michigan
Pam Tyler, Corewell Health
Tom Klumpner, University of Michigan
Johanna Cobb, Dartmouth
Allison Lee, UPENN
Wandana Joshi, Dartmouth
Henriea Addo, MPOG
Ashraf Habib, Duke
Kate Buehler, MPOG
Josh Goldbla, Henry Ford Health
Meilou Calabio, MPOG
Melinda Mitchell, Henry Ford Health
Leanna Delhey, MPOG
Kae O'Conor, Johns Hopkins
Frances Guida-Smiatacz, MPOG
Mellany Stanislaus, Johns Hopkins
Tory Lacca, MPOG
Wendy Owens, MyMichigan
Tiany Malenfant, MPOG
Joshua Younger, Northwell Health
Kam Mirizzi, MPOG
Brandon Togioka, OHSU
Diana O'Dell, MPOG
Alexander Taylor, Trinity Health
Nirav Shah, MPOG
Heather LaLonde, Trinity Health
Rachel Stumpf, MPOG
Jerri Heiter, Trinity Health
Meridith Wade, MPOG
Rania Elkhateb, UAMS
Andrew Zileman, MPOG
Jennifer Woodbury, UCSF
Obstetric-Anesthesia Quality Subcommittee — Meeting Summary
Date/Time: 00:11–01:12 (ET)
Chair: Dr. Brandon Togioka (OHSU) Vice Chair: Dr. Wandana Joshi (Dartmouth)
Facilitator: Kate Buehler (MPOG)
1. Announcements
• Staffing change: Nicole Barrios stepped down; Kate Buehler now assisting with facilitation for
OB Subcommittee meetings.
• Upcoming meetings: Sep 10 & Dec 3 (1 p.m. ET). Invitations open to interested colleagues from
all sites; only MPOG-contributing sites may vote.
• New member: Dr. Emmarie Myers (Cleveland Clinic) welcomed.
2. February Meeting Recap
• Finalized Days-from-Delivery phenotype update.
• Clarified OB Champion role; outreach planned to sites lacking a champion.
• Launched ABX-06-OB (azithromycin for C-section) — now available on dashboards.
• Began reviewing potential measure topics for 2025
3. Literature Spotlight
• WOMAN-2 trial (15,000 anemic patients) showed no benefit from prophylactic IV tranexamic
acid (TXA) after vaginal delivery.
• Editorial review of four quality trials likewise found no prophylactic benefit; aligns with ACOG
statement (per chat).
4. PONV-05 Revision — Should midazolam be included as an acceptable antiemetic for prophylaxis?
• ASPIRE Quality Committee (Apr 2025) voted 65 % to add midazolam for the general surgical
metric.
• Obstetric data show 75% compliance without midazolam considered as antiemetic.
• Concerns raised:
o Rare OB use; minimal impact on compliance.
o Memory-loss risk during childbirth or fetal-loss scenarios.
o Meta-analysis quality and clinical relevance questioned.
• Vote result: Subcommittee rejected adding midazolam to PONV-05 for OB patients.
5. 2025 Measure-Build Priorities
Proposed metrics (all drawn from SOAP Center of Excellence):
Candidate Measure
Key Discussion Points
Epidural replacement rate
Documentation variability (not all sites have separate CSE/DPE notes);
algorithm likely feasible.
Core-temperature
monitoring in CD
Cost/access to bladder or zero-flux probes; link to outcomes
Multimodal analgesia
EHR often misses pre-/post-op meds; definition challenges.
Inadequate anesthesia
during CD
Not punitive; midazolam should be excluded; exclude planned GA
conversions? Consider intraop pain scores?
Unintentional dural
puncture (UDP)
Capture via procedure-note checkbox (“wet tap”), blood patch, CSF flow;
need standardized documentation.
Effort vs. Reliability Mapping (informal):
• High-reliability, low-effort: Inadequate anesthesia; core temperature.
• High-reliability, high-effort: Epidural replacement.
• Low-reliability, high-effort (current): Unintended Dural Puncture — but could shift left if sites
add a click-box.
Discussion Highlights
• Strong sentiment (Habib, Tsen) for prioritizing Unintended Dural Puncture despite effort—
importance of improving care for patients.
• Agreement that a simple checkbox in the neuraxial procedure note could immediately improve
data quality.
• Multimodal and intra-op pain measures need careful drug-list refinement (exclude routine
neuraxial opioids; IV-only opioids; precedex dosing nuances).
6. 2025 Measure Build Priority - Vote Results
1. Epidural replacement – highest priority.
2. Unintentional dural puncture – second priority.
(The pregnancy-phenotype update was deferred to next meeting.)
Action Items
#
Task
Responsible
Timeline
1
Initiate measure development for Epidural
Replacement and Unintentional Dural Puncture
(define phenotype logic, required data elements).
Kate Buehler &
MPOG Analytics
Team
Present draft measure
specs at Sep 10
meeting
2
Outreach to sites without OB Champions to
encourage designation and participation.
Dr. Joshi & Dr.
Togioka
Complete outreach
before Sep 10 meeting
3
Monitor ABX-06-OB adoption and collect early
dashboard feedback.
All site liaisons
Ongoing; initial
feedback in Sep
4
Add pregnancy-phenotype update to next agenda.
Brandon Togioka
By Sep 10
Next meeting: Wednesday, September 10, 2025 — 1 p.m. ET / 10 a.m. PT