MPOG OB Subcommittee:
Past, Present, and Future
October 16, 2026
Brandon Togioka MD
Professor and Vice Chair of Clinical Research, Anesthesiology, OHSU
SOAP Board of Directors, Executive Committee and Secretary
MPOG Obstetrics Subcommittee Chair
Thank You Valued Contributors!
Sharon Reale
(Harvard)
Teshi Kaushik
(Alabama)
Daniel Berenson
(Harvard)
Shashank Shetter
(Oklahoma)
Kate Buehler
(Michigan)
Wandana Joshi
(Dartmouth)
Sharon Abramovitz
(Cornell)
Brendan Carvalho
(Stanford)
Christine Warrick
(Utah)
Melinda Mitchell
(Henry Ford)
Ashraf Habib
(Duke)
New Phenotypes
1. Quantitative Blood Loss (QBL)
â–ª Rationale: QBL provides an earlier, more objective, warning of significant hemorrhage
2. Dural Puncture Epidural (DPE)
â–ª Rationale: DPEs are an increasingly popular method of providing labor analgesia
3. Postdural Puncture Headache (PDPH)
â–ª Rationale: PDPH can be an indicator of poor technique, supervision, or quality
4. Pregnancy Phenotype
â–ª
Current Form: Differentiates not pregnant, likely pregnant, and postpartum
â–ª
Upcoming revision: Identifies gestational age from ICD-10 codes
Revised Measures
1. Abx 01: Prophylaxtic antibiotic timing for CD
â–ª
Description: Proportion of CD with appropriate timing of antibiotic administration
â–ª
Revision: Aminoglycoside will now be required when clindamycin is administered
2. GA-01 (GA during CD), GA-02 (GA after NA), GA-03 (GA after Epidural):
â–ª Revision: N
2
O without inhaled agent, neuromuscular blocking agent, or airway
placement will no longer be classified as GA
3. BP-04: Hypotension after neuraxial placement
â–ª
Description: Proportion of CD with < 5 min of hypotension between neuraxial
placement and neonate delivery
â–ª
Revision: Hypotension threshold increased from SBP < 90 to SBP < 100 mm Hg
New Measures
1. NCR-01: Proportion of neuraxial labor analgesia catheters requiring
replacement
â–ª
Rationale: Catheter replacement may indicate inadequate analgesia, maternal
discomfort, obstetric procedural delays, and risk of general anesthesia for CD
â–ª
Goal: Track and reduce replacement rates (target < 6%)
2. UDP-01: Proportion of patients receiving neuraxial labor analgesia with
evidence of unintended dural puncture (UDP) or postdural puncture
headache (PDPH)
â–ª
Rationale: UDP can cause a PDPH, need for epidural blood patch, prolonged
hospitalization, and potentially serious long-term complications
â–ª
Goal: Benchmark and reduce UDP (target ≤ 2%)
Measures Coming Soon
1. NCR-02: Proportion of neuraxial techniques requiring replacement in the
operating room to facilitate CD
â–ª
Rationale: Operating room catheter replacement may reflect a distinct quality issue, as
some institutions routinely replace labor epidurals with spinal anesthesia for CD
â–ª
Goal: Identify setting-specific causes of failure and inform QI efforts
2. PONV-06-OB: Proportion of patients undergoing CD who receive
appropriate prophylaxis for IONV/PONV
â–ª
Rationale: IONV/PONV is common during/following CD and it is associated with maternal
discomfort and delayed recovery
â–ª
Goal: Track and increase appropriate prophylaxis
