For the average anesthesiologist, the thought of working on the OB “floor” brings either delight or terror. The schizophrenic nature of the day – from routine labor epidurals and scheduled cesarean sections, to stat life-threatening emergencies – can lead to exhaustion and anxiety. Patients in general are presenting sicker and with more complex issues, and the labor suite is no different. According to the Blue Cross Blue Shield maternal health report between 2014 and 2018, the pregnancy rate for women between the ages of 35 to 44 (considered advanced maternal age) increased by 9% (asamonitor.pub/40q0p1k). There is an increase in the prevalence of preexisting medical conditions in all pregnant patients, including hypertension, diabetes, obesity, anxiety, depression, and substance abuse. Pregnancy-specific physiology mixed with preexisting conditions can make for critical conditions that affect both baby and parturient. What if there was a way to predict which patients may be at risk for severe maternal morbidity?

We present an article titled “Critical Care of the Crashing Parturient” that explores this question and discusses the obstetric comorbidity index score, as well as the Sequential Organ Failure Assessment score. Point-of-care ultrasound may provide needed information on potential postpartum hemorrhage patients before decompensation. Point-of-care testing, using rotational thromboelastometry (“ROTEM”), or thromboelastography (“TEG”), gives the user a representation of hemostasis by graph. You’ll also find an article that delves into the benefits and shortcomings of these two predominant viscoelastic testing systems.

Once there is a diagnosed postpartum hemorrhage, what is the best blood product to treat it? The article “The Utility of Fibrinogen Concentrate in Obstetric Anesthesia” discusses the advantage of administering fibrinogen concentrate.

With the increased complexity of pregnant patients, are anesthesiology residency programs adequately training our future anesthesiologists? The aptly titled “Is Obstetric Anesthesia Training Receiving Enough Attention?” addresses if the curriculum is comprehensive enough.

The article “Who’s That in the Delivery Room?” answers questions about doulas and their education, training, and role. There are also informative articles in the online version of the May 2023 Monitor, including “High-Risk Obstetric Patients – More Needs to be Done!,” “3D Printing: The Next Frontier for the Patient Experience in Obstetric Anesthesia,” and “Opioid Use Disorder in Pregnancy.”

The future of obstetric anesthesia is exciting and bright, with new challenges and triumphs around every bend!