Message From Dr. Scott Reeves

The Department of Anesthesia's “can-do” mentality along with all that our beautiful city has to offer creates a wonderful environment in which to train, work and live.

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Obstetrical Anesthesia

The Pearl Tourville Pavilion, at the Medical University of South Carolina, is a tertiary obstetric center and has a busy Labor and Delivery Suite with 3200 deliveries per year, many of which are high-risk. The Pavilion is situated on the fourth floor of the Shawn Jenkins Children’s Hospital which opened in February of 2020. As a tertiary referral center, more than 30% of deliveries are high-risk, including patients with preeclampsia as well as cardiac, pulmonary, neurologic diseases and morbidly adherent placentation cases.  More than 75-80% of patients receive anesthetic care.

Faculty members in the Section of Obstetric Anesthesia offer expertise in obstetrical anesthesia care and are involved in the management of high-risk pregnancies.  They also are very closely engaged in the pre-delivery consultation/assessment and planning of high-risk deliveries for optimal patient outcomes. Staff anesthesiologists are available in the hospital 24 hours a day to provide care for obstetric patients. All staff anesthesiologists are extensively experienced in OB anesthesia.

Clinical Program

The Labor and Delivery suite has two operating rooms, four exam rooms and 17 rooms for laboring patients. The Mother and Baby Unit has 29 beds for pre and postnatal maternal care.  There are also 7 coupling units in the NNICU for mother and baby.  On the obstetric service, we continue to enjoy great relationships with our obstetric colleagues, including the Maternal Fetal Medicine group under the Chairmanship of Dr. Donna Johnson. Through the efforts of Jane Ward, nursing manager of the Labor and Delivery Unit, we have maintained a full nursing complement. This has allowed for an improvement in care delivery. The expansion of the Neonatal Intensive Care Unit and the recruitment of additional MFM faculty have led to an increase in our high-risk patient population. We are continually faced with interesting and challenging clinical problems.

  • Supporting Pain-Free Childbirth: The Section of Obstetric anesthesia supports any decision made by a patient regarding pain relief during labor and provides the information needed to answer any questions they may have. 
  • Preoperative consult: All our high-risk patients are seen by anesthesia staff on L&D if they are in-patients or in our preoperative assessment clinic if outpatients.  An assessment and plan are devised and discussed with the patient and OB colleagues
  • Labor Analgesia: We provide all major modalities of labor analgesia including combined spinal-epidural analgesia (CSE), patient-controlled epidural analgesia (PCEA), dural puncture epidural (DPE), nitrous oxide inhalation, and fentanyl PCA. Our epidural rate is approximately 70-80 percent for laboring patients. We provide a very efficient service for our laboring patients with an average response time of under 10 minutes for placement of a laboring epidural. All patients are given a brochure on labor epidural analgesia during their prenatal visit. 
  • Cesarean Delivery (CD): Our cesarean delivery rate is approximately 35 percent. 90 percent of our CDs are done under neuraxial block. The first 24 hours post-CD pain management is the responsibility of our team and we use a multimodal approach using neuraxial narcotics and scheduled acetaminophen and ketorolac and TAPS/QL block if needed.
  • Abnormally Invasive Placentation: We are a Center of Excellence for Placenta Accreta spectrum of cases.  The OB anesthesia faculty are involved in the preoperative assessment, planning and providing care for these cases. 

Training Program

Resident education is a major mission of the section. We have three residents (1 CA-1, 2, and 3) rotating on obstetrical anesthesia at all times. Rotations are done in epochs of 4 weeks. With a good balance of high-risk and normal pregnancies, we are confident that our residents get an education in obstetrical anesthesia that is second-to-none. During the preliminary stage, the new junior residents are closely supervised and advised about clinical techniques and management of high risk and normal patients. Residents always perform the techniques under direct supervision with adequate autonomy as they progress in their training. Board rounds along with the obstetricians are performed every morning and are a compulsory part of the clinical management. During this time, residents absorb considerable information about the patients in the labor and delivery area. The educational schedule for the 4 weeks is very rigorous and complete. There are daily scheduled discussions which spans the whole curriculum. OB simulation and team training exercises including drills for stat CD, OB hemorrhage and maternal cardiac arrest are also a key part of the training program. All residents are required to meet with Dr. Hebbar prior to start of the rotation in order to review the Goals and Objectives of the rotation. CA-1s take a pre-test at the beginning of the rotation. At the end of the rotation, all residents do a post-test and mock orals in OB anesthesia. We have representation by Dr. Gutman on the Departmental Education Committee, who ensures that our residents are directed to the most current body of literature for their OB education.

Research Program

There is on-going collaborative research work with our MFM Division. In addition, there is ongoing clinical research by our faculty. Residents are encouraged to be involved with ongoing research. Some of our research interests include epidural fever, labor analgesia modalities, post CD multimodal pain management strategies and hypothermia/shivering during CD.  We have had resident abstracts related to OB anesthesia presented at annual meetings of the Society for Obstetric Anesthesia and Perinatology (SOAP), IARS and ASA. We have published our research in peer reviewed OB and anesthesia journals.

Obstetric Anesthesia Faculty

Latha Hebbar MD, FRCA, FFARCS(I)
Director, Obstetric Anesthesia

David Gutman, M.D., MBA,- OB Anesthesia Fellowship, Mount Sinai, NY (Resident Education Committee member) 

Abhi Madamangalam, M.D.- OB Anesthesia Fellowship, Beth Israel Deaconess Medical Center, MA (ABA Oral Board examiner) 

Michael Marotta, M.D.- OB Anesthesia Fellowship, Mount Sinai, NY (SC State anesthesia representative on the Maternal Mortality and Morbidity review Committee)

Katherine Herbert, M.D.- OB Anesthesia Fellowship, Duke University, NC (QI Committee member)

Jennifer Matos, M.D.- Regional Anesthesia Fellowship, MUSC, SC

Joel Sirianni, M.D.- Associate Program Director, Residency Program

Burke Gallagher, M.D.