Obstetric Anesthesia
Subcommittee Meeting
February 11, 2026
Agenda
Announcements
In the News
December Meeting Recap
Neuraxial Catheter Replacement (NCR-01-OB) Measure Update
New Measure Discussion: Unintended Dural Puncture (UDP-01-OB)
2026 Subcommittee Plans
Congratulations, Dr. Reale!
•Dr. Sharon Reale has accepted the role of
OB Subcommittee Vice Chair!
•Dr. Reale serves as the Obstetric Anesthesia
Fellowship Program Director for Brigham &
Women’s Hospital
•Thank you to all who applied for the Vice
Chair position –impressive candidates!
In the News
December Meeting Recap
•Voted to pause development on the pregnancy trimester phenotype –will first investigate
alternative approaches for capturing gestational age at time of delivery.
•Discussed PONV prophylaxis recommendations for cesarean delivery and voted to move
forward with a new IONV/PONV measure specific to the obstetric population.
oCD will be removed from PONV-5 (% adult patients with appropriate prophylaxis for PONV)
oGlycopyrrolate will be considered an acceptable antiemetic for prophylaxis
oAtropine and midazolam will not be considered appropriate prophylaxis
•Reviewed proposed specifications and preliminary data for a new measure examining
neuraxial catheter replacement for childbirth.
NCR-01-OB: Neuraxial Catheter Replacement for OB
Description: Percentage of patients undergoing neuraxial anesthesia for labor or cesarean
delivery with evidence of neuraxial catheter replacement.
Threshold: <6%
Measure Time Period:
Obstetric Neuraxial Anesthesia Start to Obstetrics Delivery Date/Time*
*If Obstetrics Delivery Date/Time is not available, will default to anesthesia end.
Success: Epidural anesthesia administered without evidence of a second epidural
placement procedure for the same obstetric delivery.
NCR-01-OB Exclusion Criteria
Excludes:
•Cesarean hysterectomy (as determined by Obstetric Anesthesia Type value codes
4 & 8)
•Patients receiving neuraxial anesthesia for any procedure other than labor
epidural or cesarean delivery
•Patients undergoing obstetric procedures without neuraxial anesthesia (value
code 0), with spinal anesthesia (value code 3), or via unknown neuraxial type
(value code 5), as determined by Anesthesia Technique: Neuraxial
•Obstetric cases with neuraxial start time documented after Obstetrics Delivery
Date/Time
NCR-01-OB Logic for determining Epidural Replacement
A case is flagged if multiple neuraxial procedures are documented for the same
delivery, as determined by any of the following:
–Same MPOG Case ID:
Two or more neuraxial procedure notes* are recorded within the same MPOG Case ID, based on
Obstetric Anesthesia Type codes 1, 2, 3, or 5.
–Separate MPOG Case IDs for the Same Delivery:
Two or more neuraxial procedure notes* are recorded for the same patient under different MPOG
Case IDs, based on Obstetric Anesthesia Type codes 6 or 7.
*Procedure Note Assessment Logic:
–If one or more procedure notes contain child notes, restrict assessment only to procedure notes
with child notes attached
Flag for 2 or more such notes > 20 min apart
–If procedure notes do not contain child notes, assess all procedure notes
Flag for 2 or more such notes >45 minutes apart.
Example Flagged
Case
2 procedure notes with
‘child notes’ >20
minutes apart
Example Child Notes
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 both labor epidurals and cesarean deliveries as determined by
Obstetric Anesthesia Type value codes >0)
–Postpartum Tubal Ligation
–Surgical CPT: 58600, 58605, 58611, 58615, 58661, 58670, 58671
–Anesthesia CPT: 00851
–External Cephalic Version
–Surgical CPT: 59412
–Anesthesia CPT: 01958
–Transvaginal Cerclage Placement
–Surgical CPT: 59320
–Anesthesia CPT: 00948
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 (ID: 50507) documented on a subsequent case within 14 days after initial
procedure
oA secondary case for Epidural Blood Patch (CPT: 62273) is found in MPOG within 336 hours (14 days )
of neuraxial procedure start for the initial obstetric case where a neuraxial procedure was
performed.
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
Measure Denominator Discussion
•The measure denominator could be based upon the following:
oNeuraxial Procedures: # of neuraxial placements (opportunities to cause DP)
oObstetric Procedures: # of total obstetric procedures requiring neuraxial
anesthesia
oDelivery: # of total deliveries (hospital-based metric; per patient rather than
per procedure)
oObstetric Encounter: # 14-day obstetric encounters
•Recommend assessing UDP within a 14-day obstetric encounter
•Obstetric procedures with a neuraxial procedure performed more than 14 days
later will be considered a new obstetric encounter.
Measure Numerator Discussion
•Numerator = # unintended dural punctures (UDP)
•Problem:
oWe can't tell which neuraxial procedure resulted in an UDP when using CPT and ICD
billing codes
•Potential Solution:
oRather than flagging all cases associated with the UDP, we propose assessing UDP
within a 14-day ‘obstetric encounter’
•Quality Measure Logic
oIdentify the first obstetric case with a documented neuraxial anesthesia procedure
oAssess for evidence of an UDP based upon case documentation, CPT, or ICD codes
within 14 days of that procedure
oIf evidence of UDP is found, assign it to the initial obstetric case
oThis will categorize this 14-day obstetric encounter as having an UDP
September 2025 Meeting Recap:
Voted to ‘flag’ all associated cases
September 2025 Meeting Recap:
Voted for measure to be ‘Departmental Only’
(Not available for provider feedback emails)
September 2025 Meeting Recap:
Voted to add provider attribution -
Attribution rules to be specified.
Case Flagging and Provider Attribution Discussion
•The committee voted to flag all cases:
oWe propose only flagging the first case
oWe can't accurately attribute UDP to a specific procedure
oIf we flag more than one case the rate will be falsely elevated
•The committee voted that this be a department only measure
oThis would be the plan
oNo individual provider feedback emails
•The committee voted to add provider attribution
oWe propose no provider attribution
oWe can't accurately determine which provider was associated with the UDP
•Recommendation: Departmental only measure focused on 14-day obstetric
encounter, rather than per obstetric/anesthetic procedure rate
MPOG Sites with variable mapped to MPOG UDP Concept
2026 Planning Discussion
•New Measures:
–UDP-01-OB: Unintended Dural Puncture
–PONV-06-OB: IONV/PONV Prophylaxis for Cesarean Deliveries
–Other ideas?
•New Phenotypes:
–Neuraxial Anesthesia Start Time
–Gestational Age at time of Delivery
–Other phenotypes needed for research or QI work?
•MPOG Research Project Presentations (Poll)
