Investigating disparity in labor epidural analgesia management in black vs. white women: a retrospective case-control study (2018-2022).

Background: Disparities in labor epidural analgesia (LEA) management could reduce maternal satisfaction and increase risk. We compared times from the first administration of breakthrough pain medication (top-up) to LEA replacement to evaluate disparities across race.

Methods: In this retrospective cohort study (01-01-2018 to 12-31-2022), all patients with LEA and maternal race/ethnicity of non-Hispanic White or Black were eligible.

Quality Improvement in the Digital Age: The Promise of Using Informatics to Improve Obstetric Anesthesia Care.

Informatics describes the study and use of processes for obtaining and utilizing data. In the clinical context, these data are then used to inform and educate providers to improve patient care. In the current digital age, informatic solutions can help clinicians to understand past or current quality issues (afferent tools), to benchmark personal performance against national averages (feedback tools), and to disseminate information to encourage best practice and quality care (efferent tools).

A Mobile Post Anesthesia Care Unit Order Reminder System Improves Timely Order Entry.

Transition to the postanesthesia care unit (PACU) requires timely order placement by anesthesia providers. Computerized ordering enables automated order reminder systems, but their value is not fully understood. We performed a single-center, retrospective cohort study to estimate the association between automated PACU order reminders and primary outcomes (1) on-time order placement and (2) the degree of delay in placement.

Development and Validation of an Automated, Real-Time Predictive Model for Postpartum Hemorrhage.

Objective: To develop and validate a predictive model for postpartum hemorrhage that can be deployed in clinical care using automated, real-time electronic health record (EHR) data and to compare performance of the model with a nationally published risk prediction tool.

Methods: A multivariable logistic regression model was developed from retrospective EHR data from 21,108 patients delivering at a quaternary medical center between January 1, 2018, and April 30, 2022. Deliveries were divided into derivation and validation sets based on an 80/20 split by date of delivery.

Neuraxial clonidine is not associated with lower post-cesarean opioid consumption or pain scores in parturients on chronic buprenorphine therapy: a retrospective cohort study.

Purpose: Adequate post-cesarean delivery analgesia can be difficult to achieve for women diagnosed with opioid use disorder receiving buprenorphine. We sought to determine if neuraxial clonidine administration is associated with decreased opioid consumption and pain scores following cesarean delivery in women receiving chronic buprenorphine therapy.

Methods: This was a retrospective cohort study at a tertiary care teaching hospital of women undergoing cesarean delivery with or without neuraxial clonidine administration while receiving chronic buprenorphine.

Implementation of an Epidural Rounding Reminder in the Electronic Medical Record Improves Performance of Standardized Patient Assessments during Labor.

Background: Poorly functioning labor epidural catheters lead to pain and dissatisfaction. Regular catheter assessment ensures timely identification of malfunction and may improve safety by facilitating rapid and successful conversion to general anesthesia for emergency cesarean. Informatics-based systems encourage standardization of care to identify epidural malfunctions earlier.

Risk assessment tools to predict postpartum hemorrhage.

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality, and accurate risk assessments may allow providers to anticipate and prevent serious hemorrhage-related adverse events. Multiple category-based tools have been developed by national societies through expert consensus, and these tools assign low, medium, or high risk of hemorrhage based on a review of each patient's risk factors. Validation studies of these tools show varying performance, with a wide range of positive and negative predictive values.

Development of clinical risk-prediction models for uterine atony following vaginal and cesarean delivery.

Background: Uterine atony is the most common cause of postpartum hemorrhage and is associated with substantial morbidity. Prospectively identifying women at increased risk of atony may reduce the incidence of subsequent adverse events. We sought to develop and evaluate clinical risk-prediction models for uterine atony following vaginal and cesarean delivery, using prespecified risk factors identified from systematic review.

Current State and Future Direction of Postpartum Hemorrhage Risk Assessment.

In the United States, postpartum hemorrhage is a leading preventable cause of maternal mortality and morbidity. To reduce morbidity from postpartum hemorrhage, risk assessment is an important starting point for informing decisions about risk management and hemorrhage prevention. Current perinatal care guidelines from the Joint Commission recommend that all patients undergo postpartum hemorrhage risk assessment at admission and after delivery.

Labor prior to cesarean delivery associated with higher post-discharge opioid consumption.

Background: Severe acute post-cesarean delivery (CD) pain has been associated with an increased risk for persistent pain and postpartum depression. Identification of women at increased risk for pain can be used to optimize post-cesarean analgesia. The impact of labor prior to CD (intrapartum CD) on acute post-operative pain and opioid use is unclear.

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.

Background: Obesity is a suspected risk factor for respiratory depression following neuraxial morphine for post-cesarean analgesia, however monitoring guidelines for obese obstetric patients are based on small, limited studies. We tested the hypothesis that clinically significant respiratory depression following neuraxial morphine occurs more commonly in women with body mass index (BMI) ≥40 kg/m compared with BMI <40 kg/m.

Methods: We conducted a single-center, retrospective chart review (2006-2017) of obstetric patients with clinically significant respiratory depression following neuraxial morphine, defined as: (1) opioid antagonist administration; (2) rapid response team activation (initiated in April 2010); or (3) tracheal intubation due to a respiratory event.

Improving ACGME Compliance for Obstetric Anesthesiology Fellows Using an Automated Email Notification System.

Background: The Accreditation Council for Graduate Medical Education establishes minimum case requirements for trainees. In the subspecialty of obstetric anesthesiology, requirements for fellow participation in nonobstetric antenatal procedures pose a particular challenge due to the physical location remote from labor and delivery and frequent last-minute scheduling.

Objectives: In response to this challenge, we implemented an informatics-based notification system, with the aim of increasing fellow participation in nonobstetric antenatal surgeries.

Risk Factors for Atonic Postpartum Hemorrhage: A Systematic Review and Meta-analysis.

Objective: To identify and quantify risk factors for atonic postpartum hemorrhage.

Data Sources: PubMed, CINAHL, EMBASE, Web of Science, and and ClinicalTrials.gov databases were searched for English language studies with no restrictions on date or location.

A cluster quasi-randomized controlled trial of an interactive, monthly obstetric anesthesiology curriculum: impact on resident satisfaction and knowledge retention.

Background: Increasingly, evidence supports the use of educational paradigms that focus on teacher-learner interaction and learner engagement. We redesigned our monthly obstetric anesthesia resident didactics from a lecture-based curriculum to an interactive format including problem-based learning, case discussion, question/answer sessions, and simulation. We hypothesized that the new curriculum would improve resident satisfaction with the educational experience, satisfaction with the rotation, and knowledge retention.