Obstetric Anesthesia Clinical Research
We are a clinical service devoted to providing the best possible care with an emphasis on patient safety and satisfaction. As an academic service, we are also committed to enhancing the healthcare of women through education, investigation and innovation.
"Altered Vasoactivity as a Marker for Pre-eclampsia"
In the first part of this study, we studied the role of endothelial dysfunction in preeclampsia by comparing non-invasive measurements of vasoactivity in patients with preeclampsia and uncomplicated pregnancies. 15 normal and 15 pre-eclamptic patients were studied. The vasoactivity of each patient was evaluated antenatally and then reevaluated at least 6 week postpartum. Measurements were made with a new device, the HDI Pulsewave-CR-2000, that analyzes the radial pulse wave and diastolic decay pattern with a computer program (modified Windkissel model). Generated data included:
- blood pressure
- cardiac output
- stroke volume
- large artery elasticity (capacitive compliance)
- small artery elasticity (oscillatory or reflective compliance)
- systemic vascular resistance
- total vascular impedence.
Our data showed significant differences in small artery compliance between the two groups.
The second part of the study is ongoing and is of a projected cohort of 200 pregnant patients being evaluated for new-onset hypertension. Our preliminary data suggests that such non-invasive measurements of arterial elasticity can differentiate patients with pre-eclampsia from those with simple gestational hypertension.
"A Controlled Trial of Acupuncture for Hot Flashes"
In menopause, hot flashes cause significant discomfort, sleep disturbance and mood lability in women. Traditionally, these symptoms have been managed by hormone replacement therapy. Recently, the medical profession has become more aware of the risks of hormone replacement therapy. Thus, the use of "alternative" therapies such as acupuncture has become more popular in this population, as well as in cancer patients who are not candidates for hormone therapy. While anecdotal evidence supports the use of alternative therapies, well-controlled randomized trials are needed to support their therapeutic benefit. This feasibility study is a multi-center randomized controlled trial, in which patients with significant history of hot flashes were randomized to groups in which they will receive acupuncture, sham acupuncture or usual care. The acupuncture protocol is based on the tenets of traditional Chinese medicine. Outcome measurements include frequency and severity of hot flashes, and other assessments of quality of life. We completed the clinical phase of this study in July 2006 and the resulting manuscript has been accepted for publication (Menopause, In press).
"Teaching Residents to Question/Challenge: An Experiential Approach"
Supported by a grant from FAER, this project teaches residents methods for questioning/challenging that will enhance their educational experience and optimize patient safety. At the Center for Medical Simulation, mock scenarios are modeled after an Obstetric L&D Unit. Residents participate in scenarios involving difficult situations for interpersonal as well as clinical reasons. A debriefing session follows, where trainees view videotapes of themselves and are taught productive, collaborative language with which they can solve potential conflicts. These techniques are based on theories introduced by other high-vigilance, team-dependent businesses, including the airline industry. Residents participate in a second mock scenario and are evaluated on their ability to use the newly acquired tools for constructive team-building. Written questionnaires and interactive computer-based video scenarios are used months later to evaluate durability and transferability of the lessons learned. Preliminary data has been presented internationally and in abstract form. We have submitted a manuscript for publication and are planning follow-up work.
"Explicit Interdisciplinary Communication During Obstetric Emergencies: A Simulator-based Study"
Experienced multi-disciplinary practitioners participate in an ongoing team-training course at the Center for Medical Simulation. Retrospective analysis of language used during a simulated obstetrical crisis demonstrated strengths and weaknesses in the communication patterns of participants. Notably, anesthesiologists are strong at stating or advocating information, but are less adept at soliciting information from their colleagues. In contrast, obstetricians are better at asking for information but poorer at sharing their own information or observations. This preliminary work has been presented in abstract form in Anesthesiology, and as an oral presentation at the annual meeting of the Society for Obstetric Anesthesia and Perinatology (May 2007). We are preparing a manuscript and planning follow-up work.