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Obstetric Anesthesiology

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.

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 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.

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.

Recent Publications

Kodali BSBharadwaj S. Foetal surgery: Anaesthetic implications and strategic management. Indian J Anaesth. 2018;62(9):717-723. PMID:30237598.

Malinow AM, Schuh RA, Alyamani O, Kim J, Bharadwaj S, Crimmins SD, Galey JLFiskum GPolster 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 OMazzeffi MABharadwaj SGaley 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.

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.

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.

Turan OM, Rosenbloom J, Galey JLKahntroff SLBharadwaj 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.

Galey JBharadwaj S, Crimmins S, Hong CMMalinow AM. Anesthetic Implications of an Obstetric Patient with Blue Rubber Bleb Nevus Syndrome. A A Case Rep. 2016;6(6):146-149. PMID:26579613.