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Obstetric Anesthesiology

The 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 nearly 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 locally serves a mainly urban population and acts as a major 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 uniquely able 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.

Faculty

Education

Residents receive exposure to a variety of cases to learn basic 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. Obstetric faculty mentor rotating residents to undertake research projects and encourage them to present complex case studies at regional and national conferences. 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.

Research

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.

 

Meeting Abstracts:

Society of Obstetric Anesthesiology and Perinatology, SOAP Annual Meeting/ASA/IARS:

1.     Wong M, Ulrich A, Villamater E, Bharadwaj S. Elective cesarean delivery in a patient with VACTERL. (Live presentation)

2.     Wong MJ, Choi S, Galey J, Bharadwaj S. Elective cesarean delivery in a parturient with transverse myelitis. (Pre-recorded presentation)

3.     Wong M, Choi S, Bharadwaj S, Grewal A. Cesarean delivery in a parturient with repaired Ebstein’s anomaly and chronic right ventricular dysfunction. (Live presentation)

4.     Sudhakar S, Wong M, Lee K, Bharadwaj, S, Kodali BS. Elective cesarean delivery in a parturient complicated by placenta previa and placenta accreta spectrum and history of thoracolumbar spinal fusion with Harrington rods. (2021) Society for Obstetric Anesthesia and Perinatology Annual Meeting, Virtual.

5.     Choi S, Wong M, Lee K, Bharadwaj S, Galey J. Greater occipital nerve block as an adjunct in postdural puncture headache. (2021) Society for Obstetric Anesthesia and Perinatology Annual Meeting, Virtual.

6.     Gourdine A, Douglas T, Wong M, Bharadwaj S, Galey S, Kodali BS. Emergent cesarean delivery secondary to non-conventional presentation of uterine rupture in a patient with systemic lupus erythematosus. (2021) Society for Obstetric Anesthesia and Perinatology Annual Meeting, Virtual.

7.     Choi S, Wong M, Bharadwaj S, Galey J, Grewal A. Neuraxial anesthesia for cesarean section in a morbidly obese patient with severe dilated cardiomyopathy. (2021) International Anesthesia Research Society Annual Meeting, Virtual.

8.     Fernandes G, Li A, Joshi E, Arevalo D, Islam A, Lippert Lozano E, Zhu C,  Zhao M, Yazdi Y, Malinow A. Design of an extendable Tuohy needle for use in in epidural anesthesia for adult patients of all body- mass- indicies. Prsentation at the Annual Meeting of the American Society of Anesthesiology, Washington, D.C., 2020.

9.    Shannon A, Hendrickson E, Jung MS, Goetzinger K, Kodali B, Malinow A, Mazzeffi M: Epidemiology of maternal cardiac arrest and amniotic fluid embolism in Maryland: 2013-2017. SCCM Annual Critical Care Congress, Orlando FL, 2020.

10. Newhide DA, Karrupiah, Sankova S, Bharadwaj S, Malinow AM: Veno-Arterial ECMO rescue from massive pulmonary embolus maintains viable pregnancy. Case report submitted to the Annual Meeting of the Society for Obstetric Anesthesiology and Perinatology. 2020 (on-line). Recognized as one of “10 Best Case Reports”

 

Lecture Webinars:

Bhavani Shankar Kodali

1.     Kodali BS. Emotional Intelligence – Fostering collaboration in the workplace. Junior Faculty   Workshop. Department of Anesthesiology, University of Maryland School of Medicine. Baltimore, MD. February 25th, 2021.

2.     Kodali BS. Covid-19 in pregnancy. Webinar: Saudi Arabia Maternal Fetal Medicine and Anesthesiology combined Meeting. Riyadh, 2020

3.     Kodali BS. Post Covid-19 Stress Disorder. Lecture and Panel Discussion. Indian Society of Critical Care Medicine, Coimbatore Chapter, Webinar 2020

4.     Kodali BS. First Virtual Conference. Thrive Not Survive: How Pediatric Dentists from Around the World are Handling COVID-19.  Pediatric Sedation Outside the Operating Room. Boston Children Hospital, Harvard Medical School. Webinar 2020

5.     Kodali BS. First Virtual Conference. Challenging Sedation Cases: Ask the International Experts.  Pediatric Sedation Outside the Operating Room. Boston Children Hospital, Harvard Medical School. Webinar 2020

6.     Kodali BS. Capnography. A comprehensive Understanding. Mumbai Association of Anesthesiology for Post Graduate Students and Anesthesiologists (170 participants). Webinar 2020

7.     Kodali BS. Capnography. Where Are We Now? Indian Society of Anesthesiologists WEBCON Kerala 2020, India.

8.     Kodali BS. Maternal Collapse. Panel Discussion. Association of Obstetric Anesthesiologists of India. Webinar on Maternal Safety,2021, India.

9.     Kodali BS. Capnography as Applicable to Fire Fighters and Frontline Medics. Maryland Firefighter Consortium. Web Based Lecture. 2021

10.   Kodali BS. Maternal Collapse. Ramachandra Anesthesia Continuing Medical Education. Webinar 2021, India.

11.   Kodali BS. Moderator. Transport of Critically Pregnant Woman. YUVA FOGSI 2021

12.   Kodali BS. Panel Expert.  Maternal smorgasbord: Anuria /jaundice / shortness of breath/ unconscious patient. YUVA FOGSI 2021

Sobhana Bharadwaj:

11.  Bharadwaj S. Placenta Accreta Spectrum (PAS). Anesthesiologist Perspective. Association of Anesthesiologists of India, Webinar, 2021.

12.  Bharadwaj S. Placenta Acceta Spectrum: Learning the art of managing an actively bleeding mother.  Webinar Lecture: YUVA FOGSI 2021

13.  Bharadwaj S. ECMO in pregnancy. Our expeirence. Brigham and Women’s Hopsital Obstetric Anesthesiology Division. Harvard Meical School. 2021

Jessical Galey:

14.  Galey, J. Covid 19 in pregnancy. Departmental Grand Rounds. 2021

 

Recent Publications:

1.   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;Sep 8:1-4.

2.  Cojocaru L, Lankford A, Galey J, Bharadwaj S, Kodali BS, Kennedy, K, Goetzinger K, Turna OM. Surgical advances in the management of placenta accreta spectrum: establishing new expectations for operative blood loss. J Matern Fetal Neonatal Med;2020, Dec 3:1-10.

3.  Elsamadicy E, Yazdani S, Karuppiah A, Marcano I, Turan O, Kodali BS, Jessel R. Paraganglioma presenting as hypoxia and syncope in pregnancy. Anesthesia and Analgesia Practice 2021 Mar 8:15(3):e01411

4.  Karuppiah A, Galey J, Bharadwaj S, Elsamadicy E, Kodali BS. Peripartum management in Myelodysplastic syndrome guided by serial Thromboelastography. Anesthesia and Analgesia Practice 2021 Mar 15:15(3):e01403’

5.  Benhardt A. Kodali B. Epidural needle bevels are not the same. Indian Journal of Anaesthesia 2021;65:4:328-330.

6.  Wong MJ, Karuppiah A, Galey JH, Villamaer, E, Kodali BS, Bharadwaj S. Thromboelastography guiding decision-making for neuraxial labour analgesia in a patient with thrombocytopenia due to chronic portal hypertension. Anaesthesia Reports 2021Apr 7;9(1):59-60.

7.  Kodali BS. Novel system for quantifying blood loss. Correspondence. Anesth Analg 202 sep;131(3);e162-3.

8.  Lankford A, et al (Malinow AM) Clinical outcomes of pregnant and postpartum extracorporeal membrean oxygenation patients. Anesth Analg 2021 Mary 1:132(3)777-87.

 

Book chapters:

1.  Karuppiah A, Bharadwaj S, Kodali B. Capnography. The Year Book of Anesthesiology, a publication of the Indian College of Anaesthesiologists (ICA) Springer, 2020

2.  Jagannathan D and Kodali BS. Capnography. In Baheti DK and Laheri V, editors. Understanding Anesthetic Equipment & Procedures: A Practical Approach. New Delhi: Jaypee Brothers Medical Publishers. 2021

3.  Malinow AM, Kodali BS: Anesthesia for the Normal and High-Risk Pregnancy. ch. in Reece’s Clinical Obstetrics: Mother and Fetus. (EA Reece ed.) Fourth edition. Wolters-Kluwer, New York, 2021

 

Manuscripts Accepted: Electronic Format Not Yet in Print

1. Katz et al … (Kodali B, Bharadwaj S)… The Society for Obstetric Anesthesia and Perinatology (SOAP) COVID-19 Registry: An analysis of outcomes among pregnant women delivering during the initial SARS-CoV-2 outbreak in the United States. Anesthesia Analgesia April 8, 2021, Volume - Issue - 10.1213/ANE.0000000000005592

2. Kodali BS, Wong M. Routine dural puncture epidural. Caution warranted. Letter to the Editor. Anesthesia Analgesia 2021

 

Manuscripts under consideration:

Four.

 

Contributions of Members:

John Pallan:

John Pallan is spearheading the implementation of nitrous oxide for labor and delivery to start in July.

Khang Lee:

Pain Panel: Pain management, pain control and pain with medical conditions. A part of Antiracism meeting.

Michael Wong:

Development of Patient Education Material

Protocol of Intraveneous fentanyl analgesia for labor.

Preparation of teaching material for Arterial line placement and management for nurses.