Obstetric Anesthesiology Research

Advancing Obstetric and Perinatal Anesthetic Care

Research Mission Statement

To advance knowledge in the field of obstetric anesthesiology and peripartum care through clinical, epidemiological, and outcomes-based research.

Research Vision Statement

To optimize and personalize maternal care provided by obstetric anesthesiologists.

 

Our Research Faculty

Our faculty are internationally recognized experts in obstetric anesthesiology. 

We aim to advance the health and well-being of mothers by:

  1. Ensuring each woman obtains high-quality pain relief during and after her delivery.
  2. Identifying approaches for preventing and treating postpartum hemorrhage.
  3. Expanding knowledge related to women’s recovery after delivery.

Featured Researchers

Brendan Carvalho, MD
CAP Profile

Pervez Sultan, MD
CAP Profile

Brian Bateman,MD,MSc
CAP Profile

Jessica Ansari, MD, MS
CAP Profile

How our research has changed practice

Research from our group has been instrumental in advancing maternal and peripartum care. Through our research, we have developed new protocols and approaches for preventing and managing postpartum hemorrhage, enhanced methods to manage mothers’ pain during labor and after cesarean delivery, improved knowledge of how drugs behave in the peripartum setting, and designed instruments to measure recovery after childbirth.

Research Recognition

Our faculty have gained recognition for their outstanding contributions to innovation and knowledge in peripartum care and obstetric anesthesiology. Our work has received funding support from the National Institute for Health, Stanford Maternal & Child Health Research Institute and industry partners. Our research has been recognized with the receipt of numerous scientific awards from several international medical societies.

At the Society of Obstetric Anesthesiology and Perinatology annual scientific meetings, the most prestigious obstetric anesthesia meeting in the world, we have won the Best Scientific Paper award on 3 occasions, and been a finalist for this award on 7 occasions. Our trainee-mentored research has been consistently recognized with an unprecedented 13 Resident/Fellow Research Presentation awards in the past 18 years. We have also received scientific meeting research awards from the American Society of Anesthesiology, Obstetric Anaesthetists’ Association of Great Britain, and the Canadian Anesthesiologists' Society.

Our work has been published in high-impact scientific journals on numerous occasions (see all publications). We have produced and contributed towards several national guidelines and consensus statements produced by the Society of Obstetric Anesthesiology and Perinatology, the American Heart Association and the World Health Organization.

Our obstetric anesthesia facility was the first in the nation to be designated as a Society for Obstetric Anesthesia and Perinatology Center of Excellence, and Brendan Carvalho was appointed as President of the Society for Obstetric Anesthesia and Perinatology between 2017 and 2018.

Recent Publications

Brendan Carvalho
Professor of Anesthesiology, Perioperative and Pain Medicine (Adult MSD) and, by courtesy, of Obstetrics and Gynecology (Maternal Fetal Medicine)

Publications

  • The evaluation of the performance of ChatGPT in the management of labor analgesia. Journal of clinical anesthesia Ismaiel, N., Nguyen, T. P., Guo, N., Carvalho, B., Sultan, P. 2024; 98: 111582

    Abstract

    ChatGPT4 is a leading large language model (LLM) chatbot released by OpenAI in 2023. ChatGPT4 can respond to free-text queries, answer questions and make suggestions regarding virtually any topic. ChatGPT4 has successfully answered anesthesia and even obstetric anesthesia knowledge-based questions with reasonable accuracy. However, ChatGPT4 has yet to be challenged in obstetric anesthesia clinical decision-making.In this study, we evaluated the performance of ChatGPT4 in the management of clinical labor analgesia scenarios compared to expert obstetric anesthesiologists.Eight clinical questions with progressively increasing medical complexity were posed to ChatGPT4.The ChatGPT4 responses were rated by seven expert obstetric anesthesiologists based on safety, accuracy and completeness of each response using a five-point Likert rating scale.ChatGPT4 was deemed safe in 73% of responses to the presented obstetric anesthesia clinical scenarios (27% of responses were deemed unsafe). None of the ChatGPT4 responses were unanimously deemed to be safe by all seven expert obstetric anesthesiologists. Moreover, ChatGPT4 responses were overall partly accurate (score 4 out of 5) and somewhat incomplete (score 3.5 out of 5).In summary, approximately one quarter of all responses by ChatGPT4 were deemed unsafe by expert obstetric anesthesiologists. These findings may suggest the need for more fine-tuning and training of LLMs such as ChatGPT4 specifically for clinical decision making in obstetric anesthesia or other specialized medical fields. These LLMs may come to play an important future role in assisting obstetric anesthesiologists in clinical decision making and enhancing overall patient care.

    View details for DOI 10.1016/j.jclinane.2024.111582

    View details for PubMedID 39167880

  • Comparison of artificial intelligence large language model chatbots in answering frequently asked questions in anaesthesia. BJA open Nguyen, T. P., Carvalho, B., Sukhdeo, H., Joudi, K., Guo, N., Chen, M., Wolpaw, J. T., Kiefer, J. J., Byrne, M., Jamroz, T., Mootz, A. A., Reale, S. C., Zou, J., Sultan, P. 2024; 10: 100280

    Abstract

    Patients are increasingly using artificial intelligence (AI) chatbots to seek answers to medical queries.Ten frequently asked questions in anaesthesia were posed to three AI chatbots: ChatGPT4 (OpenAI), Bard (Google), and Bing Chat (Microsoft). Each chatbot's answers were evaluated in a randomised, blinded order by five residency programme directors from 15 medical institutions in the USA. Three medical content quality categories (accuracy, comprehensiveness, safety) and three communication quality categories (understandability, empathy/respect, and ethics) were scored between 1 and 5 (1 representing worst, 5 representing best).ChatGPT4 and Bard outperformed Bing Chat (median [inter-quartile range] scores: 4 [3-4], 4 [3-4], and 3 [2-4], respectively; P<0.001 with all metrics combined). All AI chatbots performed poorly in accuracy (score of ≥4 by 58%, 48%, and 36% of experts for ChatGPT4, Bard, and Bing Chat, respectively), comprehensiveness (score ≥4 by 42%, 30%, and 12% of experts for ChatGPT4, Bard, and Bing Chat, respectively), and safety (score ≥4 by 50%, 40%, and 28% of experts for ChatGPT4, Bard, and Bing Chat, respectively). Notably, answers from ChatGPT4, Bard, and Bing Chat differed statistically in comprehensiveness (ChatGPT4, 3 [2-4] vs Bing Chat, 2 [2-3], P<0.001; and Bard 3 [2-4] vs Bing Chat, 2 [2-3], P=0.002). All large language model chatbots performed well with no statistical difference for understandability (P=0.24), empathy (P=0.032), and ethics (P=0.465).In answering anaesthesia patient frequently asked questions, the chatbots perform well on communication metrics but are suboptimal for medical content metrics. Overall, ChatGPT4 and Bard were comparable to each other, both outperforming Bing Chat.

    View details for DOI 10.1016/j.bjao.2024.100280

    View details for PubMedID 38764485

    View details for PubMedCentralID PMC11099318

  • In Response. Anesthesia and analgesia Mootz, A. A., Carvalho, B., Sultan, P., Nguyen, T. P., Reale, S. C. 2024; 138 (6): e37-e38

    View details for DOI 10.1213/ANE.0000000000006979

    View details for PubMedID 38771606

  • Associations between anxiety, sleep, and blood pressure parameters in pregnancy: a prospective pilot cohort study. BMC pregnancy and childbirth Miller, H. E., Simpson, S. L., Hurtado, J., Boncompagni, A., Chueh, J., Shu, C. H., Barwick, F., Leonard, S. A., Carvalho, B., Sultan, P., Aghaeepour, N., Druzin, M., Panelli, D. M. 2024; 24 (1): 366

    Abstract

    The potential effect modification of sleep on the relationship between anxiety and elevated blood pressure (BP) in pregnancy is understudied. We evaluated the relationship between anxiety, insomnia, and short sleep duration, as well as any interaction effects between these variables, on BP during pregnancy.This was a prospective pilot cohort of pregnant people between 23 to 36 weeks' gestation at a single institution between 2021 and 2022. Standardized questionnaires were used to measure clinical insomnia and anxiety. Objective sleep duration was measured using a wrist-worn actigraphy device. Primary outcomes were systolic (SBP), diastolic (DBP), and mean (MAP) non-invasive BP measurements. Separate sequential multivariable linear regression models fit with generalized estimating equations (GEE) were used to separately assess associations between anxiety (independent variable) and each BP parameter (dependent variables), after adjusting for potential confounders (Model 1). Additional analyses were conducted adding insomnia and the interaction between anxiety and insomnia as independent variables (Model 2), and adding short sleep duration and the interaction between anxiety and short sleep duration as independent variables (Model 3), to evaluate any moderating effects on BP parameters.Among the 60 participants who completed the study, 15 (25%) screened positive for anxiety, 11 (18%) had subjective insomnia, and 34 (59%) had objective short sleep duration. In Model 1, increased anxiety was not associated with increases in any BP parameters. When subjective insomnia was included in Model 2, increased DBP and MAP was significantly associated with anxiety (DBP: β 6.1, p = 0.01, MAP: β 6.2 p < 0.01). When short sleep was included in Model 3, all BP parameters were significantly associated with anxiety (SBP: β 9.6, p = 0.01, DBP: β 8.1, p < 0.001, and MAP: β 8.8, p < 0.001). No moderating effects were detected between insomnia and anxiety (p interactions: SBP 0.80, DBP 0.60, MAP 0.32) or between short sleep duration and anxiety (p interactions: SBP 0.12, DBP 0.24, MAP 0.13) on BP.When including either subjective insomnia or objective short sleep duration, pregnant people with anxiety had 5.1-9.6 mmHg higher SBP, 6.1-8.1 mmHg higher DBP, and 6.2-8.8 mmHg higher MAP than people without anxiety.

    View details for DOI 10.1186/s12884-024-06540-w

    View details for PubMedID 38750438

    View details for PubMedCentralID 2941423

  • Strategies for optimising early detection and obstetric first response management of postpartum haemorrhage at caesarean birth: a modified Delphi-based international expert consensus. BMJ open Pingray, V., Williams, C. R., Al-Beity, F. M., Abalos, E., Arulkumaran, S., Blumenfeld, A., Carvalho, B., Deneux-Tharaux, C., Downe, S., Dumont, A., Escobar, M. F., Evans, C., Fawcus, S., Galadanci, H. S., Hoang, D. T., Hofmeyr, G. J., Homer, C., Lewis, A. G., Liabsuetrakul, T., Lumbiganon, P., Main, E. K., Maua, J., Muriithi, F. G., Nabhan, A. F., Nunes, I., Ortega, V., Phan, T. N., Qureshi, Z. P., Sosa, C., Varallo, J., Weeks, A. D., Widmer, M., Oladapo, O. T., Gallos, I., Coomarasamy, A., Miller, S., Althabe, F. 2024; 14 (5): e079713

    Abstract

    There are no globally agreed on strategies on early detection and first response management of postpartum haemorrhage (PPH) during and after caesarean birth. Our study aimed to develop an international expert's consensus on evidence-based approaches for early detection and obstetric first response management of PPH intraoperatively and postoperatively in caesarean birth.Systematic review and three-stage modified Delphi expert consensus.International.Panel of 22 global experts in PPH with diverse backgrounds, and gender, professional and geographic balance.Agreement or disagreement on strategies for early detection and first response management of PPH at caesarean birth.Experts agreed that the same PPH definition should apply to both vaginal and caesarean birth. For the intraoperative phase, the experts agreed that early detection should be accomplished via quantitative blood loss measurement, complemented by monitoring the woman's haemodynamic status; and that first response should be triggered once the woman loses at least 500 mL of blood with continued bleeding or when she exhibits clinical signs of haemodynamic instability, whichever occurs first. For the first response, experts agreed on immediate administration of uterotonics and tranexamic acid, examination to determine aetiology and rapid initiation of cause-specific responses. In the postoperative phase, the experts agreed that caesarean birth-related PPH should be detected primarily via frequently monitoring the woman's haemodynamic status and clinical signs and symptoms of internal bleeding, supplemented by cumulative blood loss assessment performed quantitatively or by visual estimation. Postoperative first response was determined to require an individualised approach.These agreed on proposed approaches could help improve the detection of PPH in the intraoperative and postoperative phases of caesarean birth and the first response management of intraoperative PPH. Determining how best to implement these strategies is a critical next step.

    View details for DOI 10.1136/bmjopen-2023-079713

    View details for PubMedID 38719306

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