UPMC Magee-Womens Hospital (MWH) offers an obstetric-specific, six-bed intensive care unit (ICU) to care for medically complicated peripartum cases, is one of just a few such units that exist nationally, and is separate from the 14 bed Adult Medical ICU. Women with severe preeclampsia, hemorrhaging, and complex medical comorbidities are treated in this unit during their perinatal course. In this unique ICU setting, mother and baby can cohabitate and family are welcome. The unit is managed primarily by maternal fetal medicine specialists with occasional supervision by critical care medicine faculty. OB anesthesiology fellows frequently interact in an interdisciplinary fashion in the anesthetic care of critically-ill pregnant women.
Adult Medical-Surgical ICU
The MWH Adult Medical-Surgical ICU is a state of the art multidisciplinary unit that admits critically ill patients from internal medicine and related sub-specialty services such as obstetrics and gynecology and oncology, as well as general, bariatric, gynecologic/oncology, urology, orthopedic, breast, and ENT surgery. The Adult ICU prides itself in providing multidisciplinary patient-centered care, aided in large part by the deliberate architectural design of the unit that was inspired by input from former patients, their family members, and ICU care providers. Fellows are involved in the care of ventilator-dependent expecting mothers.
TEG and Cell Salvage
Over the past decade, MWH Anesthesiology has implemented two technologies crucial to the care of obstetric patients: thromboelastrography (TEG) and cell salvage. TEG is readily-available for the measurement of blood and serves as a method to monitor in real time what hematologic components are lacking in obstetrical hemorrhage. TEG is utilized routinely, in addition to platelet count and other modalities, in the clinical evaluation of pregnancy-related disorders such as severe preeclampsia and pregnancy related thrombocytopenia, as well as patients with bleeding disorders. Cell salvage technology is used for the management of obstetrical bleeding problems. MWH also offers a Bloodless Medicine Service for those who cannot conscientiously accept blood transfusions. Our OB Fellowship Program has a special and close association with the Division of Transfusion Medicine.
MWH anesthesiologist Dr. Jonathan Waters, who is a globally-recognized expert in these techniques, was instrumental in the introduction of the service at MWH. The services are operated by anesthesia technologists who provide around the clock support.
Transfusion Medicine/Neurology Rotation
OB Anesthesiology fellows are offered the opportunity to spend elective time with the transfusion medicine division and the Department of Neurology in a unique one-month rotation that allows for additional education on the two topics in OB anesthesiology that require additional knowledge, and unfortunately where many complications occur: neurological symptoms and hematological disorders. Dr. Janet Waters (Chief of Women’s Neurology) coordinates the neurology portion of the elective and Dr. Lirong Qu (Department of Pathology) coordinates the transfusion portion of the elective.
For additional information, visit the Department of Neurology website and the Department of Pathology’s website (Division of Transfusion Medicine).
Rapid Response System
The MWH ICU and Emergency Medicine patient care teams manage the Hospital Rapid Response System. Ensuring that critically ill patients receive the right care in the right place and at the right time plays a critical role in keeping MWH a national leader in tertiary women’s’ health care. The team responds to the various conditions that occur within the hospital. Condition O (obstetric-specific condition) responders include anesthesiologists, obstetricians, labor and delivery personnel, nurses, and neonatologists. Condition O calls encompass all major-medical emergencies concerning maternal or fetal well-being. Dedicated staff members provide compassionate, patient-centered, and evidence-based care, and are driven by a commitment to lifelong learning. Education concerning the various conditions, particularly Condition O, is reinforced by a monthly high-fidelity simulation course which fellows attend periodically and is supported by WISER.
Fetal Diagnosis and Treatment
The Fetal Diagnosis and Treatment Center, located at MWH in partnership with UPMC Children's Hospital of Pittsburgh, is an active and well-established program that specializes in fetal diagnosis and in utero fetal therapy. Expertise in women’s health and pregnancy is the foundation of this center and its continuum of care, from evaluation to treatment of fetal abnormalities. The robustness of the program comes from the ability to involve multiple medical fields within the university in a coordinated effort. When a problem is found, an interdisciplinary team consisting of anesthesiologists, pediatric specialists, and others is quickly pulled together to establish a coordinated treatment plan. Fellows are expected to participate in these cases.
Fetal procedures performed routinely include: percutaneous umbilical cord blood sampling, fetal transfusion, and various fetal uterine laparoscopic laser procedures with one or more EXIT procedures per year. Fellows participate in these procedures, as well as other non-obstetrical surgeries for obstetrical patients.
- Video: Local doctors find life-saving treatment for medical mystery, WPXI News, February 19, 2013
Research
Numerous research opportunities are offered to OB fellows, as well as participation in the Magee-Womens Research Institute (MWRI) programs and biweekly presentations. Fellows receive a total of three months of research time and can be arranged by request. Several OB anesthesiology fellowship faculty members conduct NIH-supported research projects and serve as valuable resources for research development and implementation.
Quality Assurance and Improvement
MWH/UPMC’s very active quality assurance/quality improvement (QA/QI) program conducts several conferences a year that are devoted to interdisciplinary matters. The Wolff Center at UPMC offers just-in-time classes - free, interactive, one- to two-hour QI workshops – and a six-month Quality Education series for clinical and operational leaders. Fellows are encouraged to participate in the funded Institute for Healthcare Improvement Basic Certificate in Quality & Safety, an on-line learning module providing basic knowledge and certification in QA.
Fellows present at multidisciplinary QI meetings as well as at standing quarterly MWH resident/fellow patient safety leadership committee meetings. Fellows are expected to participate in or develop their own QA/QI project to be implemented during the fellowship year.
ABA Certification
For fellows who are in the process of obtaining American Board of Anesthesiology (ABA) certification after residency, the UPMC Anesthesiology Residency Program supports their preparation for the exams in various ways. A key word program is available via our intranet for the written board, along with an annual oral board exam course conducted by an ABA board examiner. We are fortunate to have several ABA board examiners who are engaged in anesthesiology education. ABA board examiners and senior attending staff offer ABA oral practice exams throughout the year, which can be arranged at the fellows’ convenience.