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In this episode, Dr. Sharon Reale shares with us the results of her study titled Frequency and Risk Factors for Difficult Intubation in Women Undergoing General Anesthesia for Cesarean Delivery: A Multicenter Retrospective Cohort Analysis. As Dr. Reale pointed out during this Podcast, most of the available literature regarding the obstetric airway comes from data outside of the United States. Dr. Reale’s study strength resides in the use of a centralized extensive database, the Multicenter Perioperative Outcomes Group (MPOG).

Here are the links to the studies mentioned during our Podcast:
Frequency and Risk Factors for Difficult Intubation in Women Undergoing General Anesthesia for Cesarean Delivery: A Multicenter Retrospective Cohort Analysis- https://pubmed.ncbi.nlm.nih.gov/35188971/
Serious Complications Related to Obstetric Anesthesia-
https://pubmed.ncbi.nlm.nih.gov/24845921/
Airway changes during labor and delivery – https://pubmed.ncbi.nlm.nih.gov/18292672/
Failed intubation in obstetrics: a self-fulfilling prophecy? –https://pubmed.ncbi.nlm.nih.gov/17126002/
Anesthesia-related maternal mortality in the United States: 1979-2002. – https://pubmed.ncbi.nlm.nih.gov/21173646/
Pregnancy-Related Mortality in the United States, 2011–2013- https://pubmed.ncbi.nlm.nih.gov/28697109/

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In this episode, Dr. Jennifer Dominguez, a leading expert in topics related to morbid obesity, particularly Obstructive Sleep Apnea (OSA), talks with us regarding the importance of early recognition and management of OSA during Pregnancy. To guide our discussion, we conversed regarding the recently published consensus statement titled- The Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology Consensus Guideline on the Screening, Diagnosis, and Treatment of Obstructive Sleep Apnea in Pregnancy publication is an excellent reference for all those caring for patients with a known or suspected diagnosis of OSA. In this episode, we emphasized the intra (e.g., intrathecal morphine) and postoperative care (e.g., monitoring) of the parturient with a known or suspected OSA.

Here are the links to the study discussed during our Podcast:
Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology Consensus Guideline on the Screening, Diagnosis, and Treatment of Obstructive Sleep Apnea in Pregnancy
https://pubmed.ncbi.nlm.nih.gov/37411038/
Obesity in Pregnancy – https://pubmed.ncbi.nlm.nih.gov/35857661/
Monitoring
Quantifying the incidence of clinically significant respiratory depression in women with and without obesity class III receiving neuraxial morphine for post-cesarean analgesia: a retrospective cohort study – https://pubmed.ncbi.nlm.nih.gov/34053816/
Prospective Observational Investigation of Capnography and Pulse Oximetry Monitoring After Cesarean Delivery With Intrathecal Morphine – https://pubmed.ncbi.nlm.nih.gov/29958217/
Incidence of respiratory depression after epidural administration of morphine for cesarean delivery: findings using a continuous respiratory rate monitoring system https://pubmed.ncbi.nlm.nih.gov/30477999/
Enough But Not Too Much: Monitoring for Neuraxial Morphine-Associated Respiratory Depression in Obstetric Patients – https://pubmed.ncbi.nlm.nih.gov/31313670/
Society for Obstetric Anesthesia and Perinatology Consensus Statement: Monitoring Recommendations for Prevention and Detection of Respiratory Depression Associated With Administration of Neuraxial Morphine for Cesarean Delivery Analgesia – https://pubmed.ncbi.nlm.nih.gov/31082964/

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In this episode, Dr. Pervez Sultan, a leading expert in creating obstetric Patient Reported Outcome Measurements (PROMs), including the validated Obstetric quality of recovery (OBsQoR-10), discusses their future in our field. And let me tell you, their future is PROMising, from using it as a benchmark score to compare amongst institutions to analyzing results between obstetricians and anesthesiologists alike to explore which technique(s) (e.g., uterus exteriorization vs. no exteriorization; intrathecal morphine doses) provide the best functional recovery for our patients.
Here are the links to the papers discussed during our Podcast:

Scoping review of postpartum recovery measures – https://pubmed.ncbi.nlm.nih.gov/32442292/
Proposed domains of postpartum recovery https://pubmed.ncbi.nlm.nih.gov/34536324/
Best measures of postpartum:
Global recovery – https://pubmed.ncbi.nlm.nih.gov/34042993/
Pain https://pubmed.ncbi.nlm.nih.gov/34016441/
Sleep – https://pubmed.ncbi.nlm.nih.gov/34013345/
Depression https://pubmed.ncbi.nlm.nih.gov/35749118/
Anxiety https://pubmed.ncbi.nlm.nih.gov/37402438/
ERAC – Beyond the pain scores https://pubmed.ncbi.nlm.nih.gov/32585468/
Obstetric Quality of Recovery-10 item measure
​UK multicenter cohort study https://pubmed.ncbi.nlm.nih.gov/37226593/
US https://pubmed.ncbi.nlm.nih.gov/33345919/
​Portuguese https://pubmed.ncbi.nlm.nih.gov/35487408/
​Turkish https://pubmed.ncbi.nlm.nih.gov/36301286/
Hebrew https://pubmed.ncbi.nlm.nih.gov/37717463/
Japanese https://pubmed.ncbi.nlm.nih.gov/37334251/
Core outcome set for ERAC https://pubmed.ncbi.nlm.nih.gov/35511169/

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In this interview, I discuss with Dr. Perlas, the Director of the Anesthesia POCUS fellowship at the University of Toronto, the role of ultrasound for spine sonoanatomy and the future of gastric ultrasound. Dr. Perlas describes the patient population that benefits the most when using ultrasound for neuraxial analgesia and advises that we should practice this technique with patients with normal anatomy. Besides, she goes over several clinical scenarios where gastric ultrasound may benefit.

Here are the links to the papers discussed during our Podcast.
https://pubmed.ncbi.nlm.nih.gov/25493689/
https://pubmed.ncbi.nlm.nih.gov/29230709/
https://pubmed.ncbi.nlm.nih.gov/27669557/
https://pubmed.ncbi.nlm.nih.gov/35103759/

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n a previous interview (PPH part 1) with Dr. Michaela Farber, we discussed the importance of fibrinogen concentrate. During this interview, Dr. Collis and Dr. Bell help us understand the importance of early recognition of hypofibrinogenemia and replacement of this important coagulation factor. Our guests have over a decade of experience using viscoelastic hemostatic assays (VHA) and implementing algorithms to help guide early recognition and prompt fibrinogen replacement.
Here are the links to the papers discussed during the interview-
https://pubmed.ncbi.nlm.nih.gov/30322667/
https://pubmed.ncbi.nlm.nih.gov/25024304/ – OBS1
https://pubmed.ncbi.nlm.nih.gov/28969312/ – OBS2
https://pubmed.ncbi.nlm.nih.gov/25586727/
https://pubmed.ncbi.nlm.nih.gov/22805300/
https://pubmed.ncbi.nlm.nih.gov/26683982/
https://pubmed.ncbi.nlm.nih.gov/25064078/
https://pubmed.ncbi.nlm.nih.gov/17087729/
https://pubmed.ncbi.nlm.nih.gov/36696216/

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Postpartum hemorrhage remains an important and preventable cause of maternal mortality worldwide. In this interview, Dr. Michaela Farber provides us with a phenomenal timeline from the landmark study that highlighted the importance of fibrinogen as an early plasma biomarker to predict severe postpartum hemorrhage to the current evidence for the use of fibrinogen concentrate and tranexamic acid.
Here are the links to the papers discussed during our Podcast
pubmed.ncbi.nlm.nih.gov/32282388/
pubmed.ncbi.nlm.nih.gov/17087729/
www.ncbi.nlm.nih.gov/pmc/articles/PMC4166889/

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We have tremendously increased the safety and efficacy of our Neuraxial blocks. The consequences of our success have resulted in a limited number of general anesthesia cases for trainees during their obstetric anesthesia rotation. In this episode, I discuss with Dr. Delgado, author of the review article The Current Role of General Anesthesia for Cesarean delivery, what can be done to improve our ability to be prepared when general anesthesia (GA) is needed. We discussed various topics ranging from predicting patients at risk for GA, to using a rapid sequence spinal technique to avoid GA, and the need for high-fidelity simulations to maintain our skills when general anesthesia is needed.

Here are the links to the papers discussed during our Podcast
https://link.springer.com/article/10.1007/s40140-021-00437-6
https://pubs.asahq.org/anesthesiology/article/136/5/697/135639/Frequency-and-Risk-Factors-for-Difficult
https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.14296
https://pubmed.ncbi.nlm.nih.gov/30789362/
https://pubs.asahq.org/anesthesiology/article/106/6/1096/8207/A-Series-of-Anesthesia-related-Maternal-Deaths-in

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In this episode, I had the pleasure of discussing intraoperative pain with Susanna Stanford. Susanna is a patient who experienced intraoperative pain, and knowing she was not alone, she has actively raised awareness of this issue. In her own words, “Being able to feel major abdominal surgery is every bit as horrific as it sounds.” Her recommendations and those proposed by Plaat and colleagues (a paper she co-authored) in their article titled Prevention and management of intraoperative pain during caesarean section under neuraxial anaesthesia: a technical and interpersonal approach should be acknowledged by every anesthesiologist who attends to the obstetric patient. Here are the links to the articles mentioned during the podcast.
pubmed.ncbi.nlm.nih.gov/27717633/
www.ncbi.nlm.nih.gov/pmc/articles/PMC9311138/
pubmed.ncbi.nlm.nih.gov/35325933/
pubmed.ncbi.nlm.nih.gov/35332526/
pubmed.ncbi.nlm.nih.gov/35064923/

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Unfortunately, the United States has the highest maternal mortality rate among developed nations, and the COVID pandemic brought to the limelight the impact of racial and ethnic disparities in health outcomes. According to the CDC, systemic racism is a public health threat. In this interview, I discuss with Dr. Lee, author of the article Causes of health inequities, how racism, not race, is related to worst maternal health outcomes.

Here are the links to the articles/historical events mentioned during our podcast:
https://www.cdc.gov/reproductivehealth/maternal-mortality;
https://pubmed.ncbi.nlm.nih.gov
https://www.nejm.org;
https://cup.columbia.edu/book/racism-not-race/;
https://pubmed.ncbi.nlm.nih.gov
https://blackmaternalhealthcaucus-underwood.house.gov/Momnibus;
https://pubmed.ncbi.nlm.nih.gov/33237843/;
https://pubmed.ncbi.nlm.nih.gov/35830955/
https://www.cdc.gov/tuskegee/tuskegee-remembrance/index.html
https://www.history.com/news/the-father-of-modern-gynecology-performed-shocking-experiments-on-slaves

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In this episode, we discuss the leading causes of maternal mortality in the US and our state of CT. We discuss available resources at the national (https://saferbirth.org/patient-safety-bundles/) and local level (https://www.accessmhct.com) to help us flatten the curve of the rising maternal mortality in the US. Here you can find the links to the articles mentioned during this recording. https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html
https://portal.ct.gov/-/media/DPH/Maternal-Mortality/CT-MMR-Evaluation-Report-2015-2017-FINAL-PRINT.pdf
https://pubmed.ncbi.nlm.nih.gov/26996986/
https://www.sciencedirect.com/science/article/abs/pii/S0304395908003990
https://pubmed.ncbi.nlm.nih.gov/28930940/
https://pubmed.ncbi.nlm.nih.gov/33079866/
https://www.mcpapformoms.org