Obstetric Anesthesia
Subcommittee Meeting
June 3, 2026
Agenda
Announcements
In the News
February Meeting Recap
Measure Updates: NCR-01-OB & UDP-01-OB
Measure Review: ABX-01-OB
2026-2027 Priorities Discussion
SOAP Patient Safety Award: Dr. Daniel Berenson
General Anesthesia Definition Update
•OB Subcommittee voted in September 2025 to update the GA definition for cesarean
delivery to no longer consider cases with only nitrous oxide administration as general
anesthesia.
•The Coordinating Center has been working on updating the underlying phenotypes to
reflect this change in the GA for cesarean delivery measures (GA01, GA-02, GA-03).
•This change has not yet been released to production as 12 underlying phenotypes,
including Obstetric Anesthesia Type, required revisions to accommodate updates to
the Anesthesia Technique: General phenotype as requested by the Pediatric and
Obstetric Subcommittees.
•We anticipate the updates to production to go live in July –apologies for the delay!
In the News
In the News
February Meeting Recap
•Subcommittee requested updates to the NCR-01-OB (Neuraxial Catheter Replacement)
measure results to clarify passed/flagged criteria in the QI Reporting Tool (dashboard)
•Recommended UDP-01-OB (Unintended Dural Puncture) measure limit inclusion criteria to
labor epidurals and cesarean deliveries. Also voted to simplify denominator to ‘per delivery’
•2026 priorities discussed:
–Advance UDP-01-OB measure
–Develop IONV/PONV prophylaxis measure for cesarean delivery
–Incorporate brief obstetric research presentations into OB Subcommittee agendas
Proposed new measure: Spinal placement after
Epidural for cesarean delivery
•At the February meeting, the Subcommittee discussed a potential new measure to
examine spinal placement after labor epidural for patients requiring cesarean delivery
•Would this be best as an additional measure or should spinals be added for
consideration as part of the existing NCR-01-OB measure?
•Poll Question
UDP-01-OB: Unintended Dural Puncture
Description: Percentage of patients undergoing neuraxial epidural anesthesia for an
obstetric procedure with evidence of an unintended dural puncture.
Excludes: Patients receiving neuraxial techniques for non-obstetric indications
Measure Time Period:
Neuraxial Anesthesia Start to 14 days after Neuraxial Anesthesia Start
Success: Neuraxial epidural anesthesia administered without evidence of unintended
dural puncture.
Threshold: ≤ 2%
UDP-01-OB: Obstetric Procedures Included
All patients requiring neuraxial anesthesia for one of the following obstetric procedures:
–Childbirth (includes labor epidurals, cesarean deliveries, and cesarean hysterectomies as
determined by Obstetric Anesthesia Type value codes >0)
–External Cephalic Version
–Surgical CPT: 59412
–Anesthesia CPT: 01958
UDP-01-OB: Neuraxial Techniques Included
•The following neuraxial procedures are considered for this measure:
–Combined Spinal Epidural
–Epidural
–Caudal
–Multiple (will likely include cases with spinal + epidural or unclear documentation)
•The following neuraxial procedures are NOT considered for this measure:
–No neuraxial technique (value code 0)
–Spinal (neuraxial value code 3)
–Neuraxial –Unknown Type (neuraxial procedure performed but MPOG is unable to determine
type, value code 5)
UDP-01-OB Logic for determining UDP
Documentation of inadvertent dural puncture includes any of the following:
oInadvertent dural puncture (ID: 50291) documented on the case
oEpidural Blood Patch
oMPOG Concept ID (50507) documented on a subsequent case within 14 days after initial
procedure
oSurgical CPT code for Epidural Blood Patch (CPT: 62273) is found in MPOG within 14 days of
neuraxial procedure for the initial obstetric case
oICD-10 codes:
G96.0 Cerebrospinal fluid leak, unspecified
G97.0 Cerebrospinal fluid leak from spinal puncture
G97.41 Accidental puncture or laceration of dura during a procedure
O74.5 Spinal and epidural anesthesia-induced headache during labor and delivery
O89.4 Spinal and epidural anesthesia-induced headache during the puerperium
oICD-9 code: 349.31 Accidental puncture or laceration of dura during a procedure
Additional Logic Discussion
Would capturing administration of these medications and/or block placement improve
identification of possible UDP?
•Caffeine
–Acetaminophen/Butalbital/Caffeine 325/50/60 - ID:10009
–Caffeine/Sodium benzoate - ID: 10091
•Butalbital/acetaminophen (Fioricet) - ID: 10766
•Sphenopalatine Ganglion (SPG) Block - CPT: 64505
•Poll Questions
Important Definitions
•Numerator: # of UDP
•Denominator: # of total deliveries (hospital-based metric; per patient rather than
per procedure)
•Obstetric Encounter: # 14-day obstetric encounters
–Obstetric procedures with a neuraxial procedure performed more than 14 days later will be
considered a new obstetric encounter.
2026-2027 Priorities Vote
•Create a new measure for spinal placement after neuraxial catheter placement
•Create a pregnancy phenotype that can identify whether a patient was pregnant at the
time of non-obstetric surgery with a 1-week margin of error
•Create a new cesarean delivery specific IONV/PONV measure
•Poll Question
