Society for Obstetric Anesthesia and Perinatology. Palm Desert, California. May 4–7, 2005

Society for Obstetric Anesthesia and Perinatology . Palm Desert, California. May 4–7, 2005

The 37th Annual Meeting of the Society for Obstetric Anesthesia and Perinatology (SOAP) was held May 4–7, 2005, at the JW Marriott Desert Springs Resort and Spa, Palm Desert, California. More than 480 attendees from 17 countries attended the meeting—a 20% increase from last year.

The SOAP program committee fulfilled and surpassed its mission: to provide anesthesiologists, obstetricians, and other physicians and allied health specialties with the knowledge that will reinforce past learning as well as disseminate new concepts, practices, and skills involving anesthesia and analgesia for pregnant women. The 4-day meeting featured scientific presentations in the oral and poster formats, the Gertie Marx and Zuspan Award symposia, Best Paper Presentations, “What's New in Obstetric Medicine,” The Fred Hehre Lecture, Distinguished Service Award, “Breakfast with the Experts,” and panel discussions. The scientific program committee reviewed 173 abstracts, of which 151 were accepted.

On the first day, a preconference workshop on Neonatal Resuscitation and certification was filled to capacity. The day concluded with the SOAP Opening Reception, hosted in a stunning outdoor venue.

The second day started with the opening of the regular sessions and the Gertie Marx Symposia, which honors Gertie Marx, who dedicated her life to obstetric anesthesia and teaching. The six best abstracts submitted by a resident or fellow competed for the award. The results of the Gertie Marx Symposia are as follows: first place, Keri J. Ashpole, M.D. (Wake Forest University, Winston-Salem, North Carolina), “Maternal Cardiac Output Changes Occurring with Phenylephrine and Ephedrine Infusions after Spinal Anesthesia for Elective Cesarean Section”; second place, Ming Fang, M.D. (Johns Hopkins University, Baltimore, Maryland), “Prostaglandin E2 Receptors Regulate Endothelial Nitric Oxide Synthase Expression: Clinical Implication in Modulation of Uterine Tone for Human Pregnancy”; and third place, Brittany Clyne, M.D. (Wake Forest University), “Expression of Calcitonin Gene-related Peptide (CGRP) and Somatostatin (SST) in Neurons Innervating the Uterine Cervix.”

The Distinguished Service Award was then presented to Frederick Zuspan, M.D. (Professor and Chairman Emeritus Department of Obstetrics and Gynecology, Ohio State University College of Medicine and Public Health, Columbus, Ohio), for his contributions to the Society and the specialty of obstetric anesthesia. The first oral scientific presentations were delivered. The Fred Hehre Lecture was given by James Eisenach, M.D. (FM James III Professor of Anesthesiology, Wake Forest University School of Medicine), on “Pain and Delivery—Why, What and When?” Pain is a sensoriemotional experience with a large degree of interindividual differences. Afferent innervation of the cervix not only forms the neural basis of labor pain, but also these nerve fibers become spontaneously active and increase their response to distension when exposed to estrogen. These nerves may play a role in cervical ripening. The sensitization of these nerves may also play a role in chronic pelvic pain after delivery.

After lunch, the “What's New in Obstetrics?” lecture was delivered by Errol Norwitz, M.D., Ph.D. (Associate Professor, Department Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut). Maternal and prenatal morbidity and mortality issues were addressed. Fetal fibronectin and salivary estriol are useful in identifying women at risk for preterm birth. However, intensive prenatal care, bed rest, and broad-spectrum antibiotics were of no benefit in preventing preterm birth, whereas screening for lower genital tract infection and agents beyond 48 h were of limited benefit. The use of progesterone has proven helpful and may prevent preterm birth by (1) interfering with oxytocin binding and action, (2) differentially regulating prostaglandin-A and -B, (3) interfering with corticotropin releasing hormone regulation of placental gene expression, and (4) inhibiting decidual prostaglandin release. In addition, the risks of postterm pregnancy were discussed, with increased risks of stillbirth, macrosomia, meconium, fetal distress, uteroplacental insufficiency, and encephalopathy. Then, the Zuspan Award Symposium occurred, consisting of four presenters whose studies had participation by an obstetrician. The winner was Meraj Siddiqui, M.D. (Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada), for “Complications of Exteriorized versus In Situ Uterine Repair at Cesarean Section under Spinal Anesthesia.”

The day concluded with the Annual Business Meeting. The offices elected were Linda Polley, M.D. (University of Michigan, Ann Arbor, Michigan), Second Vice President; Andrew Harris, M.D. (Johns Hopkins University), ASA Delegate; and Rakesh Vadhera, M.D., F.R.C.A. (University of Texas Medical Branch, Galveston, Texas), Director at Large. The 41st Annual Meeting will be held in Washington, D.C., in 2009. The SOAP Research in Education Award was presented to Moeen Panni, M.D. (Duke University, Durham, North Carolina), for “Current State of Academic OB Anesthesia: What Experiences Are Anesthesiology Trainees Receiving?”

The third day opened with Oral Presentation No. 2, with four scientific presentations. A new lecture this year was “What's New in Obstetric Medicine?” from Raymond Powrie, M.D., F.R.C.P., F.A.C.P. (Brown Medical School, Providence, Rhode Island), of the North American Society of Obstetric Medicine (NASOM). NASOM is an organization of internal medicine physicians specializing in the medical care of obstetric patients. An increasing percentage of maternal deaths are due to “medical” causes, with cardiac disease the commonest single category of maternal mortality in the United Kingdom. A strong case was made for preventing maternal death from pulmonary embolism by (1) using acetylsalicylic acid (aspirin), stocking, and intermittent compression devices and (2) targeted heparin prophylaxis for women with risk factors (routine heparin use not warranted). Meanwhile, the use of heparin to treat maternal thrombophilias has dramatically increased to reduce the risk of late pregnancy loss. Preventing maternal deaths from preeclampsia may be accomplished by treating severe hypertension and avoiding fluid overload. Recent data suggest that nifedipine in patients receiving magnesium causes no higher rate of hypotension than placebo. Expect to see more NASOM–SOAP interactions in the future.

The first Poster Review covered 35 scientific presentations. A Panel Discussion on the International Aspects of Obstetric Anesthesia included panelists from Barbados, Brazil, and Kuwait and a report from trips to educate physicians in the countries of Turkey, Croatia, Ghana, and Georgia. The challenges faced by physicians in other countries and opportunities to improve maternal and neonatal care were highlighted.

The scientific program on the fourth day began with Breakfast with the Experts, where participants discussed cases in a problem-based learning format. Brenda Bucklin, M.D. (University of Colorado Health Sciences Center, Denver, Colorado), delivered “The Gerard Ostheimer Lecture: What's New in OB Anesthesia?,” where almost 1,000 references were reviewed and the best and most pertinent papers were highlighted. The second Poster Review of 35 papers was then conducted. A Pro/Con Debate: Is Cell Salvage a Safe Technique for the Obstetric Patient? was then conducted by Jonathan Waters, M.D. (Magee Women's Hospital, University of Pittsburg, Pittsburgh, Pennsylvania), and Paula Santrach, M.D. (Mayo Clinic, University of Minnesota Medical School, Minneapolis, Minnesota). Common areas of agreement included the use of leukocyte reduction filters and the need for an increased dose of RhoG immune globulin (human) if cell salvage techniques are used. Disagreement occurred over the risk of amniotic fluid embolism and overall safety of cell salvage during cesarean deliveries.

After lunch, the Poster Case Reports, “You Did What? The Best Case Reports of the Year!,” reviewed 54 intriguing cases. The Best Paper Presentations by the top six papers of the meeting followed. The Best Paper was awarded to Ruth Landau, M.D., Ph.D. (University Hospital of Geneva, Geneva, Switzerland), for “Polymorphism of μ-Opioid Receptor (A118G) Affects Intrathecal Fentanyl ED⁵⁰for Labor Analgesia.” The A118G variant showed an ED⁵⁰of 16 μg compared with an ED⁵⁰of 26 μg intrathecal fentanyl for labor analgesia (P < 0.0009). The Research Hour covered new techniques and approaches in obstetric anesthesia research, along with understanding the pros and cons of different statistical techniques. The annual SOAP Banquet, complete with slide show, presentation of social awards, a comedian–magician, and a country and western band provided a wonderful conclusion to the day and to the meeting.

Cedars-Sinai Medical Center, Los Angeles, California. mark.zakowski@cshs.org