Uterotonics update.

Uterotonics are the mainstay of management for postpartum haemorrhage and an understanding of their use is essential for the obstetric anaesthetist. First-line uterotonics comprise oxytocin and carbetocin, which act on the oxytocin receptor, and recent research has shown that lower doses of first-line uterotonics can be used to adequate effect. The oxytocin receptor is known to undergo desensitisation with exposure to the agonist over time and with increasing concentrations.

Maternal-Fetal Conflicts in Anesthesia Practice.

Anesthesia clinicians often navigate a delicate balance between maternal and fetal safety. Interventions for at fetal well-being may introduce risks of harm to the mother and raise ethical dilemmas. Emergency procedures often focus on direct fetal safety, sidelining maternal physical and mental well-being.

Neuraxial labor analgesia: Initiation techniques.

The ideal technique for labor analgesia would have a quick onset, predictable quality, and adjustable depth and duration. Moreover, it would be easy to perform and have minimal maternal and fetal side effects. A catheter-based neuraxial approach encompasses these desirable characteristics and includes the epidural, combined spinal epidural, dural puncture epidural, and intrathecal catheter techniques.

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.

The Effect of the No Pain Labor & Delivery-Global Health Initiative on Cesarean Delivery and Neonatal Outcomes in China: An Interrupted Time-Series Analysis.

Background: The proportion of live births by cesarean delivery (CD) in China is significant, with some, particularly rural, provinces reporting up to 62.5%. The No Pain Labor & Delivery-Global Health Initiative (NPLD-GHI) was established to improve obstetric and neonatal outcomes in China, including through a reduction of CD through educational efforts.

The Most Influential Publications in Obstetric Anesthesiology, 1998-2017: Utilizing the Delphi Method for Expert Consensus.

Background: There have been many advances in obstetric anesthesiology in the past 2 decades. We sought to create a list of highly influential publications in the field using the Delphi method among a group of obstetric anesthesiology experts to create an important educational, clinical, and research resource.

Methods: Experts in the field, defined as obstetric anesthesiologists selected to present the Gerard W.

Risk Factors, Etiologies, and Screening Tools for Sepsis in Pregnant Women: A Multicenter Case-Control Study.

Background: Given the significant morbidity and mortality of maternal sepsis, early identification is key to improve outcomes. This study aims to evaluate the performance characteristics of the systemic inflammatory response syndrome (SIRS), quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA), and maternal early warning (MEW) criteria for identifying cases of impending sepsis in parturients. The secondary objective of this study is to identify etiologies and risk factors for maternal sepsis and to assess timing of antibiotics in patients diagnosed with sepsis.

Average and time-specific maternal prenatal inflammatory biomarkers and the risk of labor epidural associated fever.

Background: The use of labor epidural analgesia has been associated with intrapartum fever, known as labor epidural associated fever (LEAF). LEAF is most commonly non-infectious in origin and associated with elevated inflammatory cytokines.

Methods: The LIFECODES pregnancy cohort was designed to prospectively collect data to evaluate the association of maternal inflammatory biomarkers with preterm birth in women who delivered between 2007 and 2008 at Brigham and Women's Hospital.

Use of a novel non-invasive respiratory monitor to study changes in pulmonary ventilation during labor epidural analgesia.

Measuring continuous changes in maternal ventilation during labor neuraxial analgesia is technically difficult. Consequently, the magnitude of pulmonary minute ventilation (MV) alterations following labor analgesia remains unknown. We hypothesized that a novel, bio-impedance based non-invasive respiratory monitor would provide this information.

The effect of patient-selected or preselected music on anxiety during cesarean delivery: a randomized controlled trial.

Women undergoing cesarean delivery may have significant anxiety prior to surgery. Nonpharmacological approaches to anxiety reduction are favored in this patient population. The aim of this study was to determine the effects of patient-selected or preselected music on anxiety in parturients undergoing scheduled cesarean delivery.

Effect of class III and class IV obesity on oocyte retrieval complications and outcomes.

Objective: To assess the effect of class III (body mass index [BMI] 40-49.9 kg/m) and class IV obesity (BMI ≥ 50 kg/m) on oocyte retrieval complications and outcomes.

Design: Cohort study.

Identifying Barriers to Implementation of the National Partnership for Maternal Safety Obstetric Hemorrhage Bundle at a Tertiary Center: Utilization of the Delphi Method.

Background: In 2015, the National Partnership for Maternal Safety (NPMS) developed an obstetric hemorrhage consensus bundle to provide birthing facilities in the United States with consistent, validated practice guidelines for postpartum hemorrhage management. The process of implementing each bundle element at a large tertiary labor and delivery unit has not been described; we sought to identify practice deficiencies and perceived barriers to bundle implementation among multidisciplinary providers.

Methods: We conducted a prospective, cross-sectional, consensus-building study based on the Delphi method.

Predictors of Achieving Recommended Daily Physical Activity Among Anesthesiologists at a Large Tertiary Care Academic Center.

Background: The goal of the current study was to determine if the daily work patterns of anesthesiologists meet the recommended daily levels of activity.

Methods: Attending and resident anesthesiologists at a tertiary academic center were invited to participate. The subjects wore a pedometer during five regular clinical days at work and recorded the number of steps walked.

Labor therapeutics and BMI as risk factors for postpartum preeclampsia: A case-control study.

Objectives: This study aims at identifying associations between therapeutics used during labor and the occurrence of postpartum preeclampsia (PPPE), a poorly understood entity.

Study Design And Main Outcome Measures: This is a case-control study of women who received an ICD-9 code for PPPE (cases) during the years 2009-2011, compared to women with a normotensive term pregnancy, delivery and postpartum period until discharge (controls), matched on age (±1year) and delivery date (±3months). Cases were defined as women having a normotensive term pregnancy, delivery and initial postpartum period (48h post-delivery) but developing hypertension between 48h and 6weeks postpartum.

A prospective study of post-cesarean delivery hypoxia after spinal anesthesia with intrathecal morphine 150μg.

Introduction: Delayed respiratory depression is a feared complication of intrathecal morphine in patients undergoing cesarean delivery. The incidence, timing and risk factors for hypoxia in this population are not known.

Methods: Patients undergoing cesarean delivery under spinal anesthesia at a tertiary care center from October 2012 to March 2016 were included in the study.

The PETRA (Perinatal Emergency Team Response Assessment) Scale: A High-Fidelity Simulation Validation Study.

Objective: The objective of this study was to establish the validity and reliability of a new interdisciplinary teamwork assessment scale, the Perinatal Emergency Team Response Assessment (PETRA), to assess team dynamics during a simulated obstetric crisis.

Methods: This observational cohort study was conducted using high-fidelity simulation and multidisciplinary obstetric teams in order to evaluate the validity and reliability of the previously developed PETRA scale for the assessment of teamwork in the management of obstetric crises. Two high-fidelity simulations of preeclampsia and postpartum hemorrhage (PPH) were conducted 50 times; 42 were performed by multidisciplinary teams and eight (four "good," four "poor") were performed by actors.

Patterns of Opioid Prescription and Use After Cesarean Delivery.

Objective: To define the amount of opioid analgesics prescribed and consumed after discharge after cesarean delivery.

Methods: We conducted a survey at six academic medical centers in the United States from September 2014 to March 2016. Women who had undergone a cesarean delivery were contacted by phone 2 weeks after discharge and participated in a structured interview about the opioid prescription they received on discharge and their oral opioid intake while at home.

Cross-Disciplinary Perceptions of Structured Interprofessional Rounds in Promoting Teamwork Within an Academic Tertiary Care Obstetric Unit.

Background: In 2005, physician and nursing leaders at Brigham and Women's Hospital initiated structured interprofessional rounds (SIPRs) on the labor and delivery (L&D) suite to improve team communication. We performed a cross-sectional analysis of providers' perceptions of SIPRs and their effectiveness in improving teamwork. We hypothesized that on average, providers would perceive SIPRs as being effective in promoting teamwork, but ratings would differ among professional groups.

Dural Puncture Epidural Technique Improves Labor Analgesia Quality With Fewer Side Effects Compared With Epidural and Combined Spinal Epidural Techniques: A Randomized Clinical Trial.

Background: The dural puncture epidural (DPE) technique is a modification of the combined spinal epidural (CSE) technique, where a dural perforation is created from a spinal needle but intrathecal medication administration is withheld. The DPE technique has been shown to improve caudal spread of analgesia compared with epidural (EPL) technique without the side effects observed with the CSE technique. We hypothesized that the onset of labor analgesia would follow this order: CSE > DPE > EPL techniques.

A Randomized Controlled Trial of Music Use During Epidural Catheter Placement on Laboring Parturient Anxiety, Pain, and Satisfaction.

Background: Although music is frequently used to promote a relaxing environment during labor and delivery, the effect of its use during the placement of neuraxial techniques is unknown. Our study sought to determine the effects of music use on laboring parturients during epidural catheter placement, with the hypothesis that music use would result in lower anxiety, lower pain, and greater patient satisfaction.

Methods: We conducted a prospective, randomized, controlled trial of laboring parturients undergoing epidural catheter placement with or without music.

Maternal outcomes of term breech presentation delivery: impact of successful external cephalic version in a nationwide sample of delivery admissions in the United States.

Background: We aimed to define the frequency and predictors of successful external cephalic version in a nationally-representative cohort of women with breech presentations and to compare maternal outcomes associated with successful external cephalic version versus persistent breech presentation.

Methods: Using the Nationwide Inpatient Sample, a United States healthcare utilization database, we identified delivery admissions between 1998 and 2011 for women who had successful external cephalic version or persistent breech presentation (including unsuccessful or no external cephalic version attempt) at term. Multivariable logistic regression identified patient and hospital-level factors associated with successful external cephalic version.