Cognitive Aids in Obstetric Crises

Authors: Ayumi Maeda, MD, Rebecca D. Minehart, MD

Institution: Massachusetts General Hospital, Boston

This PBLD was peer-reviewed by a panel of experts from the Society of Obstetric Anesthesia and Perinatology (SOAP) and has been endorsed by the SOAP Education Committee. 

Learners should identify a faculty mentor and walk through the case together, after perusing the pre-course work. Tweet your comments and questions using the links below, and experts will weigh in.

Required pre-work: Reading List
Learning objectives: At the conclusion of this session, the fellow will be able to:
  1. Describe the current evidence for use of cognitive aids during crises
  2. Evaluate pros and cons of using cognitive aids
  3. Create a personal version of a cognitive aid for an obstetric crisis and compare to existing cognitive aids
Instructions for Faculty Mentor:

Before proceeding with the case, perform an assessment of your fellow’s prior review of the teaching materials and current understanding of topic. Review key points of learning, clarify any questions, and identify areas for further investigation by the fellow.

Case stem:

A 32 year old G2P1 with a history of a cesarean delivery was admitted at 38 weeks estimated gestational age for a trial of labor after cesearean delivery (TOLAC). She is 61 inches tall, weighs 70kg and has no significant past medical history. Epidural was placed and her labor pain has been well controlled, but her labor has failed to progress and now you are called for a cesarean delivery.

After placing the patient in left uterine displacement (LUD), and confirming negative aspiration of the epidural catheter for blood or CSF, you bolus 5cc of buffered 2% Lidocaine with epinephrine through her epidural, and follow by another 5cc of the same solution 5 minutes later. One minute after the second bolus, the patient starts to complain of discomfort in her abdomen, pointing to the region of her suprapubic area, for which you bolus another 5cc of the lidocaine solution. 10 seconds later, she suddenly becomes unresponsive on her bed. She is now apneic and pulseless.

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