SOAP Annual Meeting Shines Spotlight on Innovative Observations and Exceptional Division Honors.

Observations provided Dr Emily Stockert and Dr Jessie Ansari
Observations are simply provided as a courtesy, and are not necessarily endorsed by the authors, the Division, or by Stanford. They do not constitute in any way, shape or form medical advice from a medical provider, nor do they create a physician-patient relationship. Treating individuals must use their own clinical judgment and be aware of and leverage evidence-based medicine when they prescribe or utilize treatments for patients.

• Post-Dobbs impact on maternal healthcare: Florida just passed a 6-week abortion ban, which means the entire Southeast of the US lacks access to abortion care, even in cases such as rape, anencephaly, or PPROM. Of note: PPROM <18 weeks carries dismal fetal prognosis and very high maternal morbidity and mortality if managed expectantly.
• Pregnancy tests are being ordered reflexively in every female in a certain age range which could lead to potential harm in abortion restrictive states
  • Indications for pre-op pregnancy testing:
    • pregnancy would obviate the need for surgery
    • significant (therapeutic) radiation to the pelvis
    • administration of chemotherapy
    • significant manipulation of pelvic organs
• Uterine tone scores at 2, 7 and 12 min after delivery (on a scale of 1 is worst possible thru 10 as best possible tone) can help guide treatment; 35% of cesareans will have hemorrhage, 12% major hemorrhage, and 7% will require transfusion
• Reach for CaCl in a hemorrhage after 2nd oxytocin bolus does not work. 3 gram of calcium gluconate is equivalent to 1 gram of calcium chloride. Give both slowly to avoid nausea, flushing, and bradycardia.
• Treat intraoperative cesarean pain aggressively - it is not uncommon, and PTSD from the childbirth experience is also a growing issue (maternal suicide remains a huge problem: breakthrough pain during C section occurs in up to 15% of intrapartum cesarean deliveries with epidural top up. We should do our best to recognize and replace nonfunctional catheters before surgery begins, and to actually believe patients when they endorse discomfort.
• Asking patients during cesarean “is it pressure or pain” is a poor distinction to make. If someone pressed their thumb over your eyeball as hard as they could, it would be both “pressure” and “painful”.
• Pain during postpartum tubal ligation is often only skin deep and right at the umbilicus. A possible mechanism is that embryologic umbilical innervation may come from the falciform at T4. If a patient has pain when the OB tests umbilicus despite a good bilateral level with their block, infiltrate the umbilicus with local anesthetic.
• In an ex-vivo study of uterine tissue, phenylephrine and ephedrine were found to significantly INCREASE myometrial contractility, however norepinephrine had no effect (note, this was ex-vivo so there was no indirect release of catecholamines from ephedrine)
• Beware of the maternal airway after atony and high oxytocin infusions
• People who completed OB anesthesia fellowships are overwhelmingly glad they did (even those many years out from fellowship and working in private practice or community settings).

Research:

• Stanford had 3 of the 6 best papers, and Jessica Ansari won the Best Research Paper Competition
• Eva Martinez presented one of the 6 papers in the Gertie Marx Research Competition
• Pervez Sultan won the Research in Education award
• Stanford OB Anesthesia also had 2 studies of the 8 oral presentations

Other awards:

• Teacher of the Year Award (> 10 Years): Clemens Ortner
• Diversity & Inclusivity Award: Cesar Padilla
• Distinguished Service Award: Brendan Carvalho
• Diversity & Inclusivity Mentored Grant: Claudia Sotillo, MD & Pervez Sultan

For a list of all Honorees, visit the 2024 SOAP Annual Meeting webpage.