Ten faculty members of the Division of Obstetric Anesthesiology provide subspecialty care in the Labor and Delivery (L&D) Suites. Over the past year, the Division cared for around 2,000 parturients; thirty-one percent delivered by cesarean section. Seventy percent of women delivering vaginally received neuraxial labor analgesia. Obstetric anesthesiologists also cared for 60 patients undergoing gynecologic surgery performed in Labor and Delivery, and provided anesthesia for approximately one-third of the 100 fetal surgery cases performed at UMMC, including placental laser, fetal shunts and EXIT procedures (intubation of the neonatal trachea during continued placental perfusion). The team of obstetric anesthesiologists in the department has special expertise in the care of high-risk pregnancy.
UMMC serves a mainly urban population and is also a transport hospital for the rest of the State; eighty percent are maternal and/or fetal high-risk pregnancies,, including pregnancies complicated by: super-morbid obesity; coexisting cardiac, neurosurgical, spine and respiratory disease; extreme prematurity; severe preeclampsia; diabetes; fetal disease requiring surgery; and, morbidly adherent placentation. Compared to many academic medical centers, this high proportion of high-risk maternal cases makes University of Maryland Medical Center unique in its ability to provide critical care management during pregnancy. Our obstetric anesthesiologists have gained substantial expertise over the years in the management of these various co-morbidities in pregnancy. As well, the University of Maryland Medical Center includes the nation’s most prominent center for the care and study of patients suffering both Shock and Trauma. The obstetric anesthesiologists and maternal-fetal medicine specialists work with our colleagues in the R Adams Cowley Shock Trauma Center during the management of any critically injured pregnant patient.
With a recent increase in the number of both high risk and routine deliveries, a new Obstetrical Care Unit (OCU) opened in October 2018. The OCU is three times larger than our previous Unit, and has increased the anesthetizing locations to 25 beds. The OCU includes a state of the art communication systems along modalities to monitor and manage any routine or high-risk pregnancy in our labor, delivery, operating and recovery rooms. The Center has been designated as a ‘Center of Excellence’ by the Society of Obstetric Anesthesia and Perinatology (SOAP) in 2019.
Dr. Shobana Bharadwaj is the Program Director for the Obstetric Anesthesiology Fellowship Program. The Obstetric Anesthesiology fellow is an integral part of the perinatal care team along with Maternal-Fetal Medicine physicians and fellows, the Complex Obstetric Surgical Service directed by Dr. Ozhan Turan, and a multi-disciplinary program in simulation. Over the past 33 years, the Division of Obstetric Anesthesiology has trained over 30 fellows, many of whom have moved on to leadership roles in Obstetric Anesthesiology at other institutions. Currently, the Obstetric Anesthesiology Fellowship Program has trained a fellow from 2019 through 2021.
Our Division Chief of Obstetric Anesthesiology, Dr. Bhavani Shankar Kodali, has strengthened the leadership legacy of Dr. Andrew Malinow and Dr. Shobana Bharadwaj. The Division continues to set the standards for pregnancy care within the UMMC, in our University of Maryland System Hospitals and throughout the State of Maryland. For example, programmed intermittent epidural bolus (PIEB) has recently been initiated as our main labor analgesia regimen.
- Bhavani Shankar Kodali, MBBS, MD, Professor and Division Chief of Obstetric Anesthesiology
- Shobana Bharadwaj, MBBS, Assistant Professor and Fellowship Director
- Essam A. El-Maghrabi, MBChB, Assistant Professor
- Nicolas J. Dorsey, MD, PhD. Instructor
- Jessica Galey, MD, Assistant Professor
- Andrew Malinow, MD, Professor and Vice Chair for Academic Affairs
- Douglas Martz, MD, Associate Professor, Clinical Director and Vice Chair for Clinical Affairs
- John Pallan, MD, Assistant Professor
- Edwin Villamater, MD, Assistant Professor
Residents have variety of case mix to learn basics and advanced obstetric anesthesiology. The residents are fortunate to understand, learn and manage fellowship level cases. Each resident provides anesthesia for about 130 parturients during their training, including many opportunities for general anesthesia as well as all neuraxial techniques. The Division also hosts medical students during their junior and senior rotations in anesthesiology. The residents are encouraged to present complex case studies at regional and national conferences. The residents are encouraged to undertake research projects. In addition, all first-year obstetric residents as well as second year maternal-fetal medicine fellows rotate on the obstetric anesthesiology service.
The Division was one of the first groups nationwide to be approved for the ACGME fellowship in Obstetric Anesthesiology. Dr. Bharadwaj was instrumental in this process and serves as the Fellowship Director. The first ACGME OB Anesthesiology fellow began in July 2013. Each morning, faculty obstetric anesthesiologists conduct a daily educational session that is well received by both junior and senior anesthesiology residents who rotate on the service. Residents consistently score highly on the obstetric anesthesiology specific portions of the American Board of Anesthesiology in-training and American Board of Anesthesiology written exams. The fellowship provides unique opportunity to master critical management of complex obstetric cases. In addition, there is ample opportunity to undertake research projects in the field of coagulation in obstetrics, and maternal physiology. There are opportunities for basic science and translational clinical research. Click here to learn more about the Obstetric Anesthesiology fellowship.
Faculty contribute to journal articles pertaining to research, case reports, review articles and chapters in renowned textbooks, including Chestnut’s Obstetric Anesthesia and the Obstetric Anesthesia Handbook.
Karuppiah, A, Bharadwaj S, Crimmins S, Elsamadicy E, Rabin J, Kodali BS. Adaptation of labor and delivery to COVID-19. American Journal of Disaster Medicine 2020. In press
Lankford, A, Chow J, Hendrickson E, Jung, M, Kodali B, Malinow A, Goetzinger K, Mazzeffi M. Five year trends in maternal cardiac arrest in Maryland: 2013-2017. The Journal of Maternal Fetal Medicine 2020;In press.
Jagannathan, DK, Haung CC, Robinson J, Kodali B, Choi, L, Shea K, Elterman K, Palanisamy A. Accidental dural puncture during labor analgesia and obstetric outcomes in nulliparous women. International J Obstet Anesth 2019;38:46-51
Kodali BS, Choi L, Chau A, Harvey B, Brayanov J, Tsen LC, Palanisamy A. Use of novel non-invasive respirator monitor to study changes in pulmonary ventilation during labor epidural analgesia. J Clin Monit and Computing 2020;34(3)567-74.
Tanaka KA, Bharadwaj S, Hasan S, et al. Elevated fibrinogen, von Willebrand factor, and Factor VIII confer resistance to dilutional coagulopathy and activated protein C in normal pregnant women. Br J Anaesth. 2019;122(6):751-759. PMID:30916034.
Ende H, Kodali B. Anesthesia for the Morbidly Obese Pregnant Patient. In: Gunaydin B, Ismail S, eds. Obstetric Anesthesia for Co-Morbid Conditions. Cham: Springer International Publishing; 2018:53-67. https://doi.org/10.1007/978-3-319-93163-0_4.
Orr DL 2nd, Saxen MA, Kodali BS. A Review of Current Literature of Interest to the Office-Based Anesthesiologist. Anesth Prog. 2018;65(2):140-143. PMID:29952637.
Kodali BS, Bharadwaj S. Foetal surgery: Anaesthetic implications and strategic management. Indian J Anaesth. 2018;62(9):717-723. PMID:30237598.
Cox TR, Crimmins SD, Shannon AM, Atkins KL, Tesoriero R, Malinow AM. Liver lacerations as a complication of CPR during pregnancy. Resuscitation. 2018;122:121-125. PMID:29097198.
Malinow AM, Schuh RA, Alyamani O, Kim J, Bharadwaj S, Crimmins SD, Galey JL, Fiskum G, Polster BM. Platelets in preeclamptic pregnancies fail to exhibit the decrease in mitochondrial oxygen consumption rate seen in normal pregnancies. Biosci Rep. 2018;38(3):BSR20180286. PMID:29654168.
Alyamani O, Mazzeffi MA, Bharadwaj S, Galey JH, Yao R, Shah NG, Malinow AM. Venovenous Extracorporeal Membrane Oxygenation to Prolong Pregnancy: A Case Report. A A Pract. 2018;10(9):229-231. PMID:29708916.
Galey J, Bharadwaj S, Crimmins S, Hong CM, Malinow AM. Anesthetic Implications of an Obstetric Patient with Blue Rubber Bleb Nevus Syndrome. A A Case Rep. 2016;6(6):146-149. PMID:26579613.
Turan OM, Rosenbloom J, Galey JL, Kahntroff SL, Bharadwaj S, Turner SM, Malinow AM. The Relationship between Rostral Retraction of the Pannus and Outcomes at Cesarean Section. Am J Perinatol. 2016;33(10):951-956. PMID:27100522.