Obsgynaecritcare

You are called to assess a pregnant woman who presents to your hospital complaining of shortness of breath. She is 36 weeks pregnant with twins and tells you she had been getting progressively short of breath over the last month but put it down to the physical effects of the twin pregnancy in her abdomen. However last night she couldn’t get her breath lying flat, had to sleep sitting up on 3-4 pillows and feels that “it is much worse”. On examination she has a respiratory rate of 24/min, SpO2 = 92%, HR 105/min, BP 95/45 and you can hear crepitations in both lung fields. Her initial blood tests come back showing a raised plasma BNP and a bedside ECHO is done by a helpful colleague – who says “subjectively her LV isn’t contracting very well”. Hi everyone, This week I sit down with Dr Faith Njue the most qualified person here in WA to discuss the rare but important disease – peripartum cardiomyopathy. (See Faith’s Bio below). Join us in our wide ranging discussion which touches on the diagnostic challenges, demographics, proposed mechanisms and general principles involved in managing these complex patients. Thanks Faith for a great discussion! Dr Faith Njue – Bio Faith Njue graduated from the University of Western Australia and completed cardiology training in Perth. She undertook further subspeciality training in advanced heart failure/ heart transplantation at Fiona Stanley Hospital and the University of Ottawa Heart Institute in Canada. Thereafter, she undertook further fellowship in cardio-obstetrics at the John Radcliffe hospital in Oxford (UK). She has special interest in women’s cardiovascular health, heart disease in pregnancy and heart failure. Faith runs the dedicated Western Cardiology cardio-obstetrics clinic, designed to support women at risk of or with pre-existing heart conditions, through preconception counselling, pregnancy and into the post-partum period. Cardio-obstetrics is an expanding subspecialty that focuses on prevention, early detection, and appropriate management of cardiovascular disease in pregnancy. She holds public consultant positions at Sir Charles Gairdner and Fiona Stanley hospitals. She is part of the Advanced heart Failure and Cardiac Transplant team at FSH. She is the cardiology clinical lead for High Risk pregnancy at FSH. REFERENCES Anaesthesia and peripartum cardiomyopathy Chapman, K. Njue F, Rucklidge M. BJA Education, Volume 23, Issue 12, 464 – 472 [https://www.bjaed.org/article/S2058-5349(23)00113-0/fulltext] Melanie Ricke-Hoch, Tobias J. Pfeffer, and Denise Hilfiker-Kleiner. Peripartumcardiomyopathy: basic mechanisms and hope for new therapies. Cardiovascular Research (2020) 116, 520–531. doi:10.1093/cvr/cvz252 [https://academic.oup.com/cardiovascres/article/116/3/520/5586231] Bauersachs J, König T, van der Meer P, et al. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail. 2019 Jul;21(7):827-843. doi: 10.1002/ejhf.1493. Epub 2019 Jun 27. PMID: 31243866 [https://europepmc.org/article/MED/31243866] 2018 ESC Guidelines for the Management of Cardiovascular Disease During Pregnancy. European Heart Journal 2018. Vol 39;3165-3241 [https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Cardiovascular-Diseases-during-Pregnancy-Management-of] Bromocriptine: Koenig T, Bauersachs J, Hilfiker-Kleiner D. Bromocriptine for the Treatment of Peripartum Cardiomyopathy. Card Fail Rev. 2018 May;4(1):46-49. doi: 10.15420/cfr.2018:2:2. PMID: 29892477; PMCID: PMC5971672 [https://pmc.ncbi.nlm.nih.gov/articles/PMC5971672/] Hilfiker-Kleiner D, Haghikia A, Berliner D, Vogel-Claussen J, Schwab J, Franke A, Schwarzkopf M, Ehlermann P, Pfister R, Michels G, Westenfeld R, Stangl V, Kindermann I, Kühl U, Angermann CE, Schlitt A, Fischer D, Podewski E, Böhm M, Sliwa K, Bauersachs J. Bromocriptine for the treatment of peripartum cardiomyopathy: a multicentre randomized study. Eur Heart J. 2017 Sep 14;38(35):2671-2679. doi: 10.1093/eurheartj/ehx355. PMID: 28934837; PMCID: PMC5837241. [https://pmc.ncbi.nlm.nih.gov/articles/PMC5971672/]

Hi everyone, This week I am joined again by Dr David Owen an obstetrician here at KEMH. We sit down to discuss uterine inversion – an acute obstetric emergency. Luckily this condition is relatively rare – however because of this there can be challenges in recognising and treating this condition even amongst experienced individuals. Should you be unlucky enough to encounter this rare condition, now having listened to our discussion you will be better prepared and confident you know what is required! Thanks again David for your research and preparation for this episode! [https://www.obsgynaecritcare.org/wp-content/uploads/2025/02/smzmw6us.png] [https://www.obsgynaecritcare.org/wp-content/uploads/2025/02/gwr5i3si.png] REFERENCES Uterine inversionPararajasingam, S.S. et al.BJA Education, Volume 24, Issue 4, 109 – 112 [https://www.bjaed.org/article/S2058-5349(24)00009-X/abstract] Unfortunately (as of Feb 2025) this article is not yet open access – but it is very good if you can get it through your hospital or college library.. 1. Uterine Inversion for the layperson – Cleveland Clinic [https://my.clevelandclinic.org/health/diseases/22326-uterine-inversion] https://youtu.be/bYIPkNfPDUI

Hi Everyone, Welcome to Part Two of our discussion with two of the founding members of the Placenta Accreta Spectrum Team here at KEMH Dr Matt Epee-Bekima and Dr David Owen. This team was conceived in 2017 and began operating in 2018 – and has now cared for over 75 women with PAS – including 24 alone this year (2024). In this episode we continue our initial discussion with a more detailed dive into: * Surgical management – team members, techniques and approach * Techniques for catastophic bleeding – manual aortic compression, vascular clamping, interventional radiology * Postpartum issues * Controversies (ICU vs HDU, leaving placenta in -situ) * Thoughts for the future Thanks Matt & David for sharing the experiences and knowledge learnt by the PAS team over the last 7 years. [https://www.obsgynaecritcare.org/wp-content/uploads/2024/12/PAS-cases-annual-KEMH.jpg] [https://www.obsgynaecritcare.org/wp-content/uploads/2024/12/The-PAS-team-members.jpg] REFERENCES https://www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Clinical-guidelines/Obs-Gyn-Guidelines/Placenta-Accreta.pdf?thn=0 [https://www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Clinical-guidelines/Obs-Gyn-Guidelines/Placenta-Accreta.pdf?thn=0]

[https://www.obsgynaecritcare.org/wp-content/uploads/2024/12/Spectrum-PAS.jpg] [https://www.obsgynaecritcare.org/wp-content/uploads/2024/12/Screening-PAS-in-WA-1024x570.jpg] Hi Everyone, This week I had the privilege of sitting down and recording two fascinating episodes with two of the founding members of the Placenta Accreta Spectrum Team from here at KEMH, Dr Matt Epee-Bekima and Dr David Owen. In this first episode we discuss the following: * Definitions and pathology of placenta accreta spectrum * What is the story behind the formation of the PAS team? * Screening / Identification / Diagnosis and referral * The optimisation and planning of the patient’s journey. REFERENCES King Edward Memorial Hospital website – The Placenta Accreta Spectrum guideline [https://www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Clinical-guidelines/Obs-Gyn-Guidelines/Placenta-Accreta.pdf?thn=0]

Hi Everyone, Join Graeme and I as we discuss two articles chosen from last months edition of IJOA (International Journal of Obstetric Anesthesia). In the first we discuss an article exploring whether the use of intermittent calf compression can reduce hypotension and vasopressor use in women undergoing caesarean section under spinal anaesthesia. The second article looks at the utility of preoperative electrical stimulation of acupressure points prior to caesarean section reduces postoperative pain and improves the quality of maternal recovery. There’s a sprinkling of our usual dad jokes at the end. For regular listeners to the show join us again later this month when we hopefully will have a couple of episodes dedicated to the management of placenta accreta spectrum and an interview with the founders of the placenta accreta service setup 7 years ago here at KEMH – see you then! REFERENCES International Journal of Obstetric Anesthesia [https://www.obstetanesthesia.com] Effect of pneumatic leg compression on phenylephrine dose for hypotension prophylaxis via variable rate infusion at cesarean delivery: an unblinded randomized controlled trial [https://www.obstetanesthesia.com/article/S0959-289X(24)00230-9/abstract] Transcutaneous electrical acupuncture point stimulation and quality of recovery following cesarean delivery: A randomized controlled trial [https://www.obstetanesthesia.com/article/S0959-289X(24)00278-4/abstract]