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:
- Ensuring each woman obtains high-quality pain relief during and after her delivery.
- Identifying approaches for preventing and treating postpartum hemorrhage.
- Expanding knowledge related to women’s recovery after delivery.
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.
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.
Impact of enhanced recovery after caesarean delivery on maternal outcomes: A systematic review and meta-analysis.
Anaesthesia, critical care & pain medicine
Pervez, S., Sharawi, N., Blake, L., Habib, A. S., Brookfield, K. F., Carvalho, B.
BACKGROUND: This meta-analysis explores the impact of enhanced recovery after caesarean delivery (ERAC) on maternal outcomes.METHODS: We searched 4 databases (Web of Science, Embase, PubMed and CINAHL) in October 2020 without date limiters for studies quantitatively comparing ERAC implementation to a control group. The primary outcome was length of hospital stay and secondary outcomes included time to mobilization and time to urinary catheter removal, opioid consumption, readmission rates and cost savings. Mean differences and odds ratios (MD and OR with 95% confidence intervals) were calculated. Level of evidence was assessed using GRADE.RESULTS: Twelve studies involving 17,607 patients (9,693 without ERAC and 7,914 with ERAC) were included. ERAC was associated with reduced: length of hospital stay (MD -0.51 days [-0.94, -0.09]; p = 0.018; I2 = 99%), time to first mobilization (MD -11.05hours [-18.64, -3.46]; p = 0.004; I2 = 98%), time to urinary catheter removal (MD -13.19hours [-17.59, -8.79]; p < 0.001; I2 = 97% and opioid consumption (MD -21.85mg morphine equivalents [-33.19, -10.50]; p = < 0.001; I2 = 91%), with no difference in maternal readmission rate (OR 1.23 [0.96, 1.57]; p = 0.10; I2 = 0%). Three studies reported cost savings associated with ERAC. The GRADE level of evidence was rated as low or very low quality for all study outcomes.CONCLUSION: ERAC is associated with reduction in length of stay, times to first mobilization and urinary catheter removal and opioid consumption. ERAC does not significantly affect maternal hospital readmission rates following discharge. Further studies are required to determine which ERAC interventions to implement and which outcomes best determine ERAC efficacy.
View details for DOI 10.1016/j.accpm.2021.100935
View details for PubMedID 34390864
Evidence-based guidance for use of intrathecal morphine as an alternative to diamorphine for Caesarean delivery analgesia.
British journal of anaesthesia
Sultan, P., Carvalho, B.
Intrathecal morphine in combination with fentanyl is an effective and safe alternative to diamorphine for Caesarean delivery analgesia. Evidence suggests minimal differences in clinical efficacy and side-effects between intrathecal morphine and diamorphine. Recommended intrathecal morphine doses for Caesarean delivery analgesia are 100-150 ug.
View details for DOI 10.1016/j.bja.2021.06.023
View details for PubMedID 34362559
- Estimating Obstetric Anaesthesia Workload: Number of Deliveries Compared to Time-Based Workload TURKISH JOURNAL OF ANAESTHESIOLOGY AND REANIMATION Kowalczyk, J. J., Lipman, S. S., Carvalho, B. 2021; 49 (4): 292-297 Hide More
Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of abdominal wall, paraspinal, and chest wall blocks.
Regional anesthesia and pain medicine
El-Boghdadly, K., Wolmarans, M., Stengel, A. D., Albrecht, E., Chin, K. J., Elsharkawy, H., Kopp, S., Mariano, E. R., Xu, J. L., Adhikary, S., Altiparmak, B., Barrington, M. J., Bloc, S., Blanco, R., Boretsky, K., Borglum, J., Breebaart, M., Burckett-St Laurent, D., Capdevila, X., Carvalho, B., Chuan, A., Coppens, S., Costache, I., Dam, M., Egeler, C., Fajardo, M., Gadsden, J., Gautier, P. E., Grant, S. A., Hadzic, A., Hebbard, P., Hernandez, N., Hogg, R., Holtz, M., Johnson, R. L., Karmakar, M. K., Kessler, P., Kwofie, K., Lobo, C., Ludwin, D., MacFarlane, A., McDonnell, J., McLeod, G., Merjavy, P., Moran, E., O'Donnell, B. D., Parras, T., Pawa, A., Perlas, A., Rojas Gomez, M. F., Sala-Blanch, X., Saporito, A., Sinha, S. K., Soffin, E. M., Thottungal, A., Tsui, B. C., Tulgar, S., Turbitt, L., Uppal, V., van Geffen, G. J., Volk, T., Elkassabany, N. M.
2021; 46 (7): 571-580
BACKGROUND: There is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques.METHODS: We conducted an international consensus study involving experts using a three-round Delphi method to produce a list of names and corresponding descriptions of anatomical targets. After long-list formulation by a Steering Committee, the first and second rounds involved anonymous electronic voting and commenting, with the third round involving a virtual round table discussion aiming to achieve consensus on items that had yet to achieve it. Novel names were presented where required for anatomical clarity and harmonization. Strong consensus was defined as ≥75% agreement and weak consensus as 50% to 74% agreement.RESULTS: Sixty expert Collaborators participated in this study. After three rounds and clarification, harmonization, and introduction of novel nomenclature, strong consensus was achieved for the names of 16 block names and weak consensus for four names. For anatomical descriptions, strong consensus was achieved for 19 blocks and weak consensus was achieved for one approach. Several areas requiring further research were identified.CONCLUSIONS: Harmonization and standardization of nomenclature may improve education, research, and ultimately patient care. We present the first international consensus on nomenclature and anatomical descriptions of blocks of the abdominal wall, chest wall, and paraspinal blocks. We recommend using the consensus results in academic and clinical practice.
View details for DOI 10.1136/rapm-2020-102451
View details for PubMedID 34145070
Integrated trajectories of the maternal metabolome, proteome, and immunome predict labor onset.
Science translational medicine
Stelzer, I. A., Ghaemi, M. S., Han, X., Ando, K., Hedou, J. J., Feyaerts, D., Peterson, L. S., Rumer, K. K., Tsai, E. S., Ganio, E. A., Gaudilliere, D. K., Tsai, A. S., Choisy, B., Gaigne, L. P., Verdonk, F., Jacobsen, D., Gavasso, S., Traber, G. M., Ellenberger, M., Stanley, N., Becker, M., Culos, A., Fallahzadeh, R., Wong, R. J., Darmstadt, G. L., Druzin, M. L., Winn, V. D., Gibbs, R. S., Ling, X. B., Sylvester, K., Carvalho, B., Snyder, M. P., Shaw, G. M., Stevenson, D. K., Contrepois, K., Angst, M. S., Aghaeepour, N., Gaudilliere, B.
2021; 13 (592)
Estimating the time of delivery is of high clinical importance because pre- and postterm deviations are associated with complications for the mother and her offspring. However, current estimations are inaccurate. As pregnancy progresses toward labor, major transitions occur in fetomaternal immune, metabolic, and endocrine systems that culminate in birth. The comprehensive characterization of maternal biology that precedes labor is key to understanding these physiological transitions and identifying predictive biomarkers of delivery. Here, a longitudinal study was conducted in 63 women who went into labor spontaneously. More than 7000 plasma analytes and peripheral immune cell responses were analyzed using untargeted mass spectrometry, aptamer-based proteomic technology, and single-cell mass cytometry in serial blood samples collected during the last 100 days of pregnancy. The high-dimensional dataset was integrated into a multiomic model that predicted the time to spontaneous labor [R = 0.85, 95% confidence interval (CI) [0.79 to 0.89], P = 1.2 * 10-40, N = 53, training set; R = 0.81, 95% CI [0.61 to 0.91], P = 3.9 * 10-7, N = 10, independent test set]. Coordinated alterations in maternal metabolome, proteome, and immunome marked a molecular shift from pregnancy maintenance to prelabor biology 2 to 4 weeks before delivery. A surge in steroid hormone metabolites and interleukin-1 receptor type 4 that preceded labor coincided with a switch from immune activation to regulation of inflammatory responses. Our study lays the groundwork for developing blood-based methods for predicting the day of labor, anchored in mechanisms shared in preterm and term pregnancies.
View details for DOI 10.1126/scitranslmed.abd9898
View details for PubMedID 33952678
Chronic disabling postpartum headache after unintentional dural puncture during epidural anaesthesia: a prospective cohort study.
British journal of anaesthesia
Ansari, J. R., Barad, M., Shafer, S., Flood, P.
2021; 127 (4): 600-607
BACKGROUND: Unintentional dural puncture with an epidural needle complicates approximately 1% of epidural anaesthetics and causes an acute headache in 60-80% of these patients. Several retrospective studies suggest an increased risk of chronic headache. We assessed the relationship between unintentional dural puncture and chronic disabling headache, defined as one or more functionally limiting headaches within a 2-week interval ending 2, 6, and 12 months postpartum.METHODS: In this prospective observational study, parturients who experienced unintentional dural puncture were matched 1:4 with control patients. Patients completed questionnaires regarding characteristics of headache and back pain pre-pregnancy, during pregnancy, immediately postpartum, and at 2, 6, and 12 months postpartum. The primary outcome was prevalence of disabling headache in the past 2 weeks, assessed at 2 months postpartum. Secondary outcomes included prevalence and characteristics of headache and back pain at these time points.RESULTS: We enrolled 99 patients. At 2 and 6 months postpartum, the prevalence of disabling headache was greater among patients with unintentional dural puncture than matched controls (2 months, 74% vs 38%, relative risk 1.9, 95% confidence interval 1.2-2.9, P=0.009; 6 months, 56% vs 25%, relative risk 2.1, 95% confidence interval 1.1-4.0, P=0.033). There was no difference in the prevalence of back pain at any time point.CONCLUSIONS: Our prospective trial confirms retrospective studies that chronic headache is more prevalent among women who experienced unintentional dural puncture compared with controls who received uncomplicated neuraxial anaesthesia. This finding has implications for the. patient consent process and recommendations for long-term follow-up of patients who experience unintentional dural puncture.
View details for DOI 10.1016/j.bja.2021.05.020
View details for PubMedID 34548152
Gender Differences in Compensation in Anesthesiology in the United States: Results of a National Survey of Anesthesiologists.
Anesthesia and analgesia
Hertzberg, L. B., Miller, T. R., Byerly, S., Rebello, E., Flood, P., Malinzak, E. B., Doyle, C. A., Pease, S., Rock-Klotz, J. A., Kraus, M. B., Pai, S.
BACKGROUND: A gender-based compensation gap among physicians is well documented. Even after adjusting for age, experience, work hours, productivity, and academic rank, the gender gap remained and widened over the course of a physician's career. This study aimed to examine if a significant gender pay gap still existed for anesthesiologists in the United States.METHODS: In 2018, we surveyed 28,812 physician members of the American Society of Anesthesiologists to assess the association of compensation with gender and to identify possible causes of wage disparities. Gender was the primary variable examined in the model, and compensation by gender was the primary outcome. Compensation was defined as the amount reported as direct compensation on a W-2, 1099, or K-1, plus all voluntary salary reductions (eg, 401[k], health insurance). The survey directed respondents to include salary, bonuses, incentive payments, research stipends, honoraria, and distribution of profits to employees. Respondents had the option of providing a point estimate of their compensation or selecting a range in
Labor prior to cesarean delivery associated with higher post-discharge opioid consumption.
Ende, H. B., Landau, R., Cole, N. M., Burns, S. M., Bateman, B. T., Bauer, M. E., Booth, J. L., Flood, P., Leffert, L. R., Houle, T. T., Tsen, L. C.
2021; 16 (7): e0253990
BACKGROUND: Severe acute post-cesarean delivery (CD) pain has been associated with an increased risk for persistent pain and postpartum depression. Identification of women at increased risk for pain can be used to optimize post-cesarean analgesia. The impact of labor prior to CD (intrapartum CD) on acute post-operative pain and opioid use is unclear. We hypothesized that intrapartum CD, which has been associated with both increased inflammation and affective distress related to an unexpected surgical procedure, would result in higher postoperative pain scores and increased opioid intake.METHODS: This is a secondary analysis of a prospective cohort study examining opioid use up to 2 weeks following CD. Women undergoing CD at six academic medical centers in the United States 9/2014-3/2016 were contacted by phone two weeks following discharge. Participants completed a structured interview that included questions about postoperative pain scores and opioid utilization. They were asked to retrospectively estimate their maximal pain score on an 11-point numeric rating scale at multiple time points, including day of surgery, during hospitalization, immediately after discharge, 1st week, and 2nd week following discharge. Pain scores over time were assessed utilizing a generalized linear mixed-effects model with the patient identifier being a random effect, adjusting for an a priori defined set of confounders. A multivariate negative binomial model was utilized to assess the association between intrapartum CD and opioid utilization after discharge, also adjusting for the same confounders. In the context of non-random prescription distribution, this model was constructed with an offset for the number of tablets dispensed.RESULTS: A total of 720 women were enrolled, 392 with and 328 without labor prior to CD. Patients with intrapartum CD were younger, less likely to undergo repeat CD or additional surgical procedures, and more likely to experience a complication of CD. Women with intrapartum CD consumed more opioid tablets following discharge than women without labor (median 20, IQR 10-30 versus 17, IQR 6-30; p = 0.005). This association persisted after adjustment for confounders (incidence rate ratio 1.16, 95% CI 1.05-1.29; p = 0.004). Pain scores on the day of surgery were higher in women with intrapartum CD (difference 0.91, 95% CI 0.52-1.30; adj. p = <0.001) even after adjustment for confounders. Pain scores at other time points were not meaningfully different between the two groups.CONCLUSION: Intrapartum CD is associated with worse pain on the day of surgery but not other time points. Opioid requirements following discharge were modestly increased following intrapartum CD.
View details for DOI 10.1371/journal.pone.0253990
View details for PubMedID 34242277
Genetics and Gender in Acute Pain and Perioperative Opioid Analgesia.
Kwon, A. H., Flood, P.
2020; 38 (2): 341–55
Experimental and clinical acute pain research in relation to biological sex and genetics started in the 1980s. Research methods became more powerful and sensitive with the advancement in affordable gene sequencing methods and high-throughput genetic assays. Decades of research has identified several potential pharmaceutical targets, providing insights into future research direction, and understanding of acute pain and opioid analgesic effects in the clinical setting. However, there is insufficient evidence to make generalized recommendations for using genetic tests for clinical practice of acute pain management.
View details for DOI 10.1016/j.anclin.2020.01.003
View details for PubMedID 32336388
Impact of patient choice for different postcesarean delivery analgesic protocols on opioid consumption: a randomized prospective clinical trial.
Regional anesthesia and pain medicine
Carvalho, B., Sutton, C. D., Kowalczyk, J. J., Flood, P. D.
BACKGROUND: Choice of postcesarean delivery analgesic protocol may improve pain experience and reduce analgesic requirements.METHODS: Cesarean delivery patients were randomly assigned either to choose their postcesarean delivery analgesia protocol or to have no choice and receive routine care. Choices were low (50 mug intrathecal morphine), medium (identical to routine care: 150 mug intrathecal morphine), or high (300 mug intrathecal morphine with 600mg oral gabapentin). All groups received scheduled acetaminophen and ibuprofen. The primary outcome was oxycodone requirements 0-48hours postdelivery in those offered versus not offered a choice.RESULTS: Of 160 women enrolled, 120 were offered a choice and 40 were not offered a choice. There was no difference in oxycodone requirements or pain associated with choice, but those who had a choice expressed more satisfaction than those who did not have a choice (mean (95%CI) difference 5% (0% to 10 %), p=0.005). In the choice group, the high dose group required more oxycodone (5 (0 to 15)mg 0-24hours after delivery and 15 (10 to 25) mg at 24-48hours; p=0.05 and p=0.001) versus the low and medium groups. The low dose group had less pruritus (p=0.001), while the high dose group had more vomiting (p=0.01) requiring antiemetic treatment (p=0.04).CONCLUSION: Having a choice compared with no choice routine care did not reduce oxycodone requirements or pain scores. However, women have insight into their analgesic needs; women offered a choice and who chose the higher dose analgesic protocol required more oxycodone, and women who chose the lower dose protocol required less oxycodone. Despite providing additional analgesic (six times more intrathecal morphine plus gabapentin in high dose vs low dose protocols), we still did not equalize postcesarean oxycodone requirement differences between groups.TRIAL REGISTRATION NUMBER: NCT02605187.
View details for PubMedID 30867278
Association of Gestational Age with Postpartum Hemorrhage: An International Cohort Study
Butwick, A. J., Liu, C., Guo, N., Bentley, J., Main, E. K., Mayo, J. A., Shaw, G. M., Stephansson, O.
2021; 134 (6): 874-886
Risk factors for postpartum hemorrhage, such as chorioamnionitis and multiple gestation, have been identified in previous epidemiologic studies. However, existing data describing the association between gestational age at delivery and postpartum hemorrhage are conflicting. The aim of this study was to assess the association between gestational age at delivery and postpartum hemorrhage.The authors conducted a population-based retrospective cohort study of women who underwent live birth delivery in Sweden between 2014 and 2017 and in California between 2011 and 2015. The primary exposure was gestational age at delivery. The primary outcome was postpartum hemorrhage, classified using International Classification of Diseases, Ninth Revision-Clinical Modification codes for California births and a blood loss greater than 1,000 ml for Swedish births. The authors accounted for demographic and obstetric factors as potential confounders in the analyses.The incidences of postpartum hemorrhage in Sweden (23,323/328,729; 7.1%) and in California (66,583/2,079,637; 3.2%) were not comparable. In Sweden and California, the incidence of postpartum hemorrhage was highest for deliveries between 41 and 42 weeks' gestation (7,186/75,539 [9.5%] and 8,921/160,267 [5.6%], respectively). Compared to deliveries between 37 and 38 weeks, deliveries between 41 and 42 weeks had the highest adjusted odds of postpartum hemorrhage (1.62 [95% CI, 1.56 to 1.69] in Sweden and 2.04 [95% CI, 1.98 to 2.09] in California). In both cohorts, the authors observed a nonlinear (J-shaped) association between gestational age and postpartum hemorrhage risk, with 39 weeks as the nadir. In the sensitivity analyses, similar findings were observed among cesarean deliveries only, when postpartum hemorrhage was classified only by International Classification of Diseases, Tenth Revision-Clinical Modification codes, and after excluding women with abnormal placentation disorders.The postpartum hemorrhage incidence in Sweden and California was not comparable. When assessing a woman's risk for postpartum hemorrhage, clinicians should be aware of the heightened odds in women who deliver between 41 and 42 weeks' gestation.
View details for DOI 10.1097/ALN.0000000000003730
View details for Web of Science ID 000648691100012
View details for PubMedID 33760074
Association of Epidural Labor Analgesia With Offspring Risk of Autism Spectrum Disorders.
Wall-Wieler, E., Bateman, B. T., Hanlon-Dearman, A., Roos, L. L., Butwick, A. J.
Importance: Epidural labor analgesia (ELA) has been associated with an increased offspring risk of autism spectrum disorder (ASD). Whether this finding may be explained by residual confounding remains unclear.Objective: To assess the association between ELA and offspring risk of ASD.Design, Setting, and Participants: Longitudinal cohort study of vaginal deliveries of singleton live infants born from 2005 to 2016 from a population-based data set linking information from health care databases in Manitoba, Canada; offspring were followed from birth until 2019 or censored by death or emigration. Data were analyzed from October 19, 2020, to January 22, 2021.Exposures: Epidural labor analgesia.Main Outcomes and Measures: At least 1 inpatient or outpatient diagnosis of ASD in offspring aged at least 18 months. For the full population and a sibling cohort, inverse probability of treatment-weighted Cox proportional hazards regression analyses were used to control for potential confounders.Results: Of the 123 175 offspring included in this study (62 647 boys [50.9%]; mean [SD] age of mothers, 28.2 [5.8] years), 47 011 (38.2%) were exposed to ELA; 2.1% (985 of 47 011) of exposed vs 1.7% (1272 of 76 164) of unexposed offspring were diagnosed with ASD in the follow-up period (hazard ratio [HR], 1.25; 95% CI, 1.15-1.36). After adjusting for maternal sociodemographic, prepregnancy, pregnancy, and perinatal covariates, ELA was not associated with an offspring risk of ASD (inverse probability of treatment-weighted HR, 1.08; 95% CI, 0.97-1.20). In the within-siblings design adjusting for baseline covariates, ELA was not associated with ASD (inverse probability of treatment-weighted HR, 0.97; 95% CI, 0.78-1.22). Results from sensitivity analyses restricted to women without missing data who delivered at or after 37 weeks of gestation, firstborn infants only, and offspring with ASD classified with at least 2 diagnostic codes were consistent with findings from the main analyses.Conclusions and Relevance: In a Canadian population-based birth cohort study, no association between ELA exposure and an increased offspring risk of ASD was found.
View details for DOI 10.1001/jamapediatrics.2021.0376
View details for PubMedID 33871547
Antepartum and postpartum anemia: a narrative review.
International journal of obstetric anesthesia
Butwick, A. J., McDonnell, N.
Antepartum anemia impacts over a third of pregnant women globally and is associated with major maternal and perinatal morbidity, including peripartum transfusion, maternal death, maternal infection, preterm birth, and neurodevelopmental disorders among offspring. Postpartum anemia impacts up to 80% of women in low-income and rural populations and up to 50% of women in Europe and the United States, and is associated with postpartum depression, fatigue, impaired cognition, and altered maternal-infant bonding. Iron deficiency is the most common cause of maternal anemia because of insufficient maternal iron stores at the start of pregnancy, increased pregnancy-related iron requirements, and iron losses due to blood loss during parturition. Anemic women should undergo testing for iron deficiency; a serum ferritin cutoff level of 30 mug/L is commonly used to diagnose iron deficiency during pregnancy. The first-line treatment of iron deficiency is oral iron. Intravenous iron is a consideration in the following scenarios: a poor or absent response to oral iron, severe anemia (a hemoglobin concentration <80 g/L), rapid treatment for anemia in the third trimester, women at high risk for major bleeding (such as those with placenta accreta), and women for whom red blood cell transfusion is not an option. Given the high prevalence of antepartum and postpartum anemia, anesthesiologists are advised to partner with other maternal health professionals to develop anemia screening and treatment pathways.
View details for DOI 10.1016/j.ijoa.2021.102985
View details for PubMedID 33893005
Risk Factors for Postpartum Readmission Among Women After Having a Stillbirth.
American journal of obstetrics & gynecology MFM
DiTosto, J. D., Liu, C., Wall-Wieler, E., Gibbs, R. S., Girsen, A. I., El-Sayed, Y. Y., Butwick, A. J., Carmichael, S. L.
BACKGROUND: Compared to women with a livebirth, women with a stillbirth are more likely to have maternal complications during pregnancy and at birth, but risk factors related to their postpartum health are uncertain.OBJECTIVE: This study aimed to identify patient-level risk factors for postpartum hospital readmission among women after having a stillbirth.STUDY DESIGN: This is a population-based cohort study of 29,654 women with a stillbirth in California from 1997-2011. Using logistic regression models, we examined the association of maternal patient-level factors with postpartum readmission among women after a stillbirth within six weeks of hospital discharge and between six weeks and nine months after birth.RESULTS: Within six weeks after a stillbirth, 642 (2.2%) women had a postpartum readmission. Risk factors for postpartum readmission after a stillbirth were: severe maternal morbidity excluding transfusion (aOR= 3.02, 95% CI 2.28-4.00), transfusion at delivery but no other indication of severe maternal morbidity (aOR= 1.95, 95% CI 1.35-2.81), gestational hypertension or preeclampsia (aOR=1.93, 95% CI 1.54-2.42), pre-pregnancy hypertension (aOR= 1.80, 95% CI 1.36-2.37), diabetes (aOR= 1.78, 95% CI = 1.33-2.37), an antenatal hospitalization (aOR= 1.78, 95% CI 1.43-2.21), cesarean birth (aOR= 1.73, 95% CI 1.43-2.21), long (> 2 days for vaginal birth, > 4 days for cesarean birth) birth hospitalization length of stay (aOR= 1.59, 95% CI 1.33-1.89), non- Hispanic black race/ ethnicity (aOR= 1.38, 95% CI 1.08-1.76), and having less than a high school education (aOR= 1.35, 95% CI 1.02-1.80). From 6 weeks to 9 months, 1,169 (3.90%) women had a postpartum readmission; significantly associated risk factors were largely similar to those for earlier readmission.CONCLUSION: Women with comorbidities, birth-related complications, of non-Hispanic black race/ ethnicity, or with less education had increased odds of postpartum readmission after having a stillbirth, highlighting the importance of continued care for these women after birth hospitalization.TRIAL REGISTRATION: Not applicable.
View details for DOI 10.1016/j.ajogmf.2021.100345
View details for PubMedID 33705999
Positive predictive value of ICD-10 codes for placenta accreta syndrome: a single center validation study
Jotwani, A. R., Leonard, S. A., Butwick, A., Lyell, D. J.
MOSBY-ELSEVIER. 2021: S523–S524
View details for Web of Science ID 000621547401386
Proposed domains for assessing postpartum recovery: A concept elicitation study.
BJOG : an international journal of obstetrics and gynaecology
Sultan, P., Jensen, S. E., Taylor, J., El-Sayed, Y., Carmichael, S., Cella, D., Angst, M. S., Gaudilliere, B., Lyell, D. J., Carvalho, B.
To propose postpartum recovery domains.Concept elicitation study SETTING: Semi-structured interviews POPULATION: 10 writing committee members and 50 stakeholder interviews (23 postpartum women, 9 general obstetricians, 5 maternal fetal medicine specialists, 8 nurses and 5 obstetric anaesthetists).Alternating interviews and focus group meetings until concept saturation was achieved (no new themes in 3 consecutive interviews). Interviews were digitally recorded and transcribed, and an iterative coding process utilised to identify domains.The primary outcome was to identify recovery domains. We also report key symptoms and concerns. Discussion frequency and importance scores (0-100; 0=not important; 100=vitally important to recovery) were used to rank domains. Discussion frequency was used to rank factors helping and hindering recovery, and determine the greatest challenges experienced postpartum.34 interviews and 2 focus group meetings were performed. The 13 postpartum recovery domains identified, (ranked highest to lowest) were: psychosocial distress, surgical / medical factors, infant feeding and breast health, psychosocial support, pain, physical function, sleep, motherhood experience, infant health, fatigue, appearance, sexual function and cognition. The most frequently discussed factors facilitating postpartum recovery were: family support, lactation / breastfeeding support and partner support. The most frequently discussed factor hindering recovery was inadequate social support. The most frequent challenges reported were: breastfeeding (week 1), breastfeeding (week 3) and sleep (week 6).We propose 13 domains, which comprehensively describe recovery in women delivering in a single centre within the United States. This provides a novel framework to study the postpartum recovery process.
View details for DOI 10.1111/1471-0528.16937
View details for PubMedID 34536324
Use of Patient-Reported Outcome Measures to Assess Outpatient Postpartum Recovery: A Systematic Review.
JAMA network open
Sultan, P., Sharawi, N., Blake, L., Ando, K., Sultan, E., Aghaeepour, N., Carvalho, B., Sadana, N.
2021; 4 (5): e2111600
Outpatient postpartum recovery is an underexplored area of obstetrics. There is currently no consensus regarding which patient-reported outcome measure (PROM) clinicians and researchers should use to evaluate postpartum recovery.To evaluate PROMs of outpatient postpartum recovery using Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines.An initial literature search performed in July 2019 identified postpartum recovery PROMs and validation studies. A secondary search in July 2020 identified additional validation studies. Both searches were performed using 4 databases (Web of Science, Embase, PubMed, and CINAHL), with no date limiters. Studies with PROMs evaluating more than 3 proposed outpatient postpartum recovery domains were considered. Studies were included if they assessed any psychometric measurement property of the included PROMs in the outpatient postpartum setting. The PROMs were assessed for the following 8 psychometric measurement properties, as defined by COSMIN: content validity, structural validity, internal consistency, cross-cultural validity and measurement invariance, reliability, measurement error, hypothesis testing, and responsiveness. Psychometric measurement properties were evaluated in each included study using the COSMIN criteria by assessing (1) the quality of the methods (very good, adequate, doubtful, inadequate, or not assessed); (2) overall rating of results (sufficient, insufficient, inconsistent, or indeterminate); (3) level of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations assessment tool; and (4) level of recommendation, which included class A (recommended for use; showed adequate content validity with at least low-quality evidence for sufficient internal consistency), class B (not class A or class C), or class C (not recommended).In total, 15 PROMs (7 obstetric specific and 8 non-obstetric specific) were identified, evaluating outpatient postpartum recovery in 46 studies involving 19 165 women. The majority of psychometric measurement properties of the included PROMs were graded as having very-low-level or low-level evidence. The best-performing PROMs that received class A recommendations were the Maternal Concerns Questionnaire, the Postpartum Quality of Life tool, and the World Health Organization Quality of Life-BREF. The remainder of the evaluated PROMs had insufficient evidence to make recommendations regarding their use (and received class B recommendations).This review found that the best-performing PROMs currently available to evaluate outpatient postpartum recovery were the Maternal Concerns Questionnaire, the Postpartum Quality of Life tool, and the World Health Organization Quality of Life-BREF; however, these tools all had significant limitations. This study highlights the need to focus future efforts on robustly developing and validating a new PROM that may comprehensively evaluate outpatient postpartum recovery.
View details for DOI 10.1001/jamanetworkopen.2021.11600
View details for PubMedID 34042993
Society for Obstetric Anesthesia and Perinatology: Consensus Statement and Recommendations for Enhanced Recovery After Cesarean.
Anesthesia and analgesia
Bollag, L. n., Lim, G. n., Sultan, P. n., Habib, A. S., Landau, R. n., Zakowski, M. n., Tiouririne, M. n., Bhambhani, S. n., Carvalho, B. n.
The purpose of this article is to provide a summary of the Enhanced Recovery After Cesarean delivery (ERAC) protocol written by a Society for Obstetric Anesthesia and Perinatology (SOAP) committee and approved by the SOAP Board of Directors in May 2019. The goal of the consensus statement is to provide both practical and where available, evidence-based recommendations regarding ERAC. These recommendations focus on optimizing maternal recovery, maternal-infant bonding, and perioperative outcomes after cesarean delivery. They also incorporate management strategies for this patient cohort, including recommendations from existing guidelines issued by professional organizations such as the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists. This consensus statement focuses on anesthesia-related and perioperative components of an enhanced recovery pathway for cesarean delivery and provides the level of evidence for each recommendation.
View details for DOI 10.1213/ANE.0000000000005257
View details for PubMedID 33177330
Evaluation of Domains of Patient-Reported Outcome Measures for Recovery After Childbirth: A Scoping and Systematic Review.
JAMA network open
Sultan, P. n., Sadana, N. n., Sharawi, N. n., Blake, L. n., El-Boghdadly, K. n., Falvo, A. n., Ciechanowicz, S. n., Athar, W. n., Shah, R. n., Guo, N. n., Jensen, S. n., El-Sayed, Y. n., Cella, D. n., Carvalho, B. n.
2020; 3 (5): e205540
Despite the global delivery rate being approximately 259 deliveries per minute in 2018, postpartum recovery remains poorly defined.To identify validated patient-reported outcome measures (PROMs) used to assess outpatient and inpatient postpartum recovery, evaluate frequency of PROM use, report the proportion of identified PROMs used within each recovery domain, report the number of published studies within each recovery domain, summarize descriptive data (country of origin, year of study, and journal specialty) for published studies using PROMs to evaluate postpartum recovery, and report PROMs used to evaluate global postpartum recovery.This study followed PRISMA-ScR guidelines. A literature search of 4 databases (MEDLINE through PubMed, Embase, Web of Science, and CINAHL) was performed on July 1, 2019, to identify PROMs used to evaluate 12 author-defined domains of postpartum recovery. All psychometrically evaluated PROMs used to evaluate inpatient or outpatient postpartum recovery after all delivery modes were included.From 8008 screened titles and abstracts, 573 studies (515 outpatient and 58 inpatient) were identified in this review. A total of 201 PROMs were used to assess recovery for outpatient studies and 73 PROMs were used to assess recovery for inpatient studies. The top 5 domains (with highest to lowest numbers of PROMs) used to assess outpatient recovery were psychosocial distress (77 PROMs), surgical complications (26 PROMs), psychosocial support (27 PROMs), motherhood experience (16 PROMs), and sexual function (13 PROMs). Among inpatient studies, the top 5 domains were psychosocial distress (32 PROMs), motherhood experience (7 PROMs), psychosocial support (5 PROMs), fatigue (5 PROMs), and cognition (3 PROMs). The 3 most frequently used PROMs were the Edinburgh Postnatal Depression Scale (267 studies), Short-Form 36 Health Questionnaire (global recovery assessment; 40 studies), and Female Sexual Function Index (35 studies). A total of 24 global recovery PROMs were identified among all included studies. Most studies were undertaken in the United States within the last decade and were published in psychiatry and obstetrics and gynecology journals.Most PROMs identified in this review evaluated a single domain of recovery. Future research should focus on determining the psychometric properties of individual and global recovery PROMs identified in this review to provide recommendations regarding optimum measures of postpartum recovery.
View details for DOI 10.1001/jamanetworkopen.2020.5540
View details for PubMedID 32442292
Postpartum recovery: what does it take to get back to a baseline?
Current opinion in obstetrics & gynecology
Sultan, P. n., Carvalho, B. n.
2020; Publish Ahead of Print
Limited guidance exists regarding how to assess postpartum recovery. In this article, we discuss various aspects of inpatient and outpatient postpartum recovery.The postpartum period for many women includes sleep deprivation, maternal-neonatal bonding, breastfeeding, and integrating a new life into the family unit. Factors which impact inpatient quality of recovery include pain, nausea or vomiting, dizziness, shivering, comfort, mobilization, ability to hold and feed the baby, personal hygiene maintenance, and feeling in control. Outpatient recovery domains include psychosocial distress, surgical/medical factors, feeding and breast health, psychosocial support, pain, physical function, sleep, motherhood experience, infant health, fatigue, appearance / cosmetic factors, sexual function, and cognition. Postpartum recovery is likely to take longer than six weeks; however, no consensus regarding recovery duration exists among professional societies. Obstetric quality of recovery (ObsQoR) is a recommended measure of inpatient postpartum recovery; however, studies are needed to determine the optimum outpatient recovery assessment tool.Postpartum recovery is an important area that requires clinical and research attention. Future studies should focus on identifying and developing valid, reliable, and responsive measures of recovery as well as tracking and optimizing recovery domains following all delivery modes.http://links.lww.com/COOG/A65.
View details for DOI 10.1097/GCO.0000000000000684
View details for PubMedID 33395109
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- Nanji JA, Guo N, Riley ET, Carvalho B. Impact of intraoperative dexamethasone after scheduled cesarean delivery: a retrospective study. Int J Obstet Anesth. 2019 Jun 24. doi: 10.1016/j.ijoa.2019.06.006
- Nanji JA, Guo N, Riley ET, Faulkner B, Do C, Carvalho B. Evaluation of opioid use with split doses of oral opioids in a postcesarean delivery analgesia order set. Obstet Gynecol. 2019; 44(5): 575-585.
- Oji-Zurmeyer J, Ortner CM, Klein KU, Gries M, Kühn C, Schroffenegger T, Putz G, Jochberger S. National survey of obstetric anaesthesia clinical practices in the republic of Austria. Int J Obstet Anesth. 2019 Aug;39:95-98. doi: 10.1016/j.ijoa.2019.02.002. Epub 2019 Feb 15.
- Ortner CM, Macias P, Neethling E, Krishnamoorty V, Carvalho B, Dyer RA. Ocular sonography in pre-eclampsia: a simple technique to detect raised intracranial pressure? Int J Obstet Anesth. 2019 Sep 20.
- Ortner CM, Krishnamoorthy V, Neethling E, Flint M, Swanevelder JL, Lombard C, Fawcus S, Dyer RA. Point-of-Care Ultrasound Abnormalities in Late-Onset Severe Preeclampsia: Prevalence and Association With Serum Albumin and Brain Natriuretic Peptide. Anesth Analg. 2019 Jun;128(6):1208-1216. doi: 10.1213/ANE.0000000000003759.
- Patel SD, Sharawi N, Sultan P. Local anaesthetic techniques for post caesarean delivery pain. Submitted to Int J Obstet Anesth 2019 Nov;40:62-77
- Riley E, Akbar K, Carvalho B. Intra-aortic balloon pump for cesarean hysterectomy and massive hemorrhage in a parturient with placenta accreta and pulmonary embolus: a case report. J Med Ultrasound 2019;27:104-6
- Riley ET, Mangum K, Carvalho B, Butwick AJ. The crystalloid co-load as effective as colloid preload for preventing hypotension from spinal anesthesia for cesarean delivery. Turk J Anaesthesiol Reanim. 2019; 47(1): 35-40
- Sharawi N, Klima L, Shah R, Blake L, Carvalho B, Sultan P. Evaluation of patient-reported outcome measures of functional recovery following caesarean section: a systematic review using the consensus-based standards for the selection of health measurement instruments (COSMIN) checklist. Anaesthesia. 2019 Nov; 74(11):1439-1455.
- Sherman J, Hedli L, Kristensen-Cabrera A, Lipman S, Schwandt D, Lee H, Sie L, Halamek L, Austin N. Understanding the Heterogeneity of Labor and Delivery Units: Using Design Thinking Methodology to Assess Environmental Factors that Contribute to Safety in Childbirth. Am J Perinatol. 2019 Apr. doi: 10.1055/s-0039-168549
- Stewart M, Carvalho B, Tsui BCH. Electrical stimulation test for epidural catheter placement after receiving intrathecal local anesthetic during a combined spinal-epidural technique for Cesarean delivery: confirmation of the spinal nerve root as epidural site of action. Can J Anaesth. 2019 Nov 4
- Sultan P, Bampoe S, Shah R, N.Guo, J. Estes, Halpern S, Butwick A. Treatment of postpartum anemia using oral versus intravenous iron therapy: A systematic review. Am J Obstet Gynecol. 2019 Jul;221(1):19-29.e3.
- Sultan P, Bampoe S, Shah R, Guo N, Estes J, Stave C, Goodnough LT, Halpern S, Butwick AJ. Oral versus intravenous iron therapy for postpartum anemia: A systematic review and meta-analysis American Journal of Obstetrics and Gynecology 2019; 221: 19-29.e3
- Sutton CD, Carvalho B. Supraglottic airway rescue after failed fiberoptic intubation in a patient with osteogenesis imperfecta A A Pract. 2019 Jan 28. doi: 10.1213/XAA.0000000000000968.
- Terkawi AS, Bakri B, Alsadek AS, Alsibaee RH, Alasfar EM, Albakour AH, Aljouja AY, Alshaikhwais NA, Fares FA, Flood PD, Jnaid H Najib AA, Saloom DA, Zahra NA, Altirkawi KA. Women's health in northwestern syria: findings from healthy-syria 2017 study. Avicenna J Med. 2019; 9:94-106
- Ton TGN, Bennett MV, Incerti D, Peneva D, Druzin M, Stevens W, Butwick AJ, Lee HC. Maternal and Infant Adverse Outcomes Associated with Mild and Severe Preeclampsia during the First Year after Delivery in the United States. American Journal of Perinatology 2019 Feb 19. [Epub ahead of print]
- Wall-Wieler E, Carmichael SL, Gibbs RS, Lyell DL, Girsen AI, El-Sayed YY, Butwick AJ. Severe Maternal Morbidity among Stillbirth and Live Birth Deliveries in California Obstetrics and Gynecology 2019; 134: 310-17
- Weiniger CF, Maor A, Aptekman B, Carvalho B. Prospective investigation of the relationship between body habitus measurements and depth to epidural space and difficult neuraxial block in term pregnant women Acta Anaesthesiol Scand. 2019 Dec 31. doi: 10.1111/aas.13544.
- Yurashevich M, Carvalho B, Butwick AJ, Ando K, Flood P. Determinants of patient dissatisfaction with anesthesia care in labor and delivery. Anaesthesia 2019; 74:1112-1120
- Yurashevich M, Chow A, Kowalczyk J, Traynor AJ, Carvalho B. Preoperative fasting times for patients undergoing cesarean delivery: before and after a patient educational initiative. Turk J Anaesthesiol Reanim. 2019; 47(4): 282-286
- Ackland G, Gutierrez del Arroyo A, Sanchez J, Patel S, Phillips S, Reyes A, Sultan P, David A. Caspase-1 and epidural-related maternal fever. Br J Anaesth. 2018;120:e20-e21.
- Austin N, Kristensen-Cabrera A, Sherman J, Schwandt D, McDonald A, Hedli L, Lipman S, Daniels K, Lee H. Analyzing the heterogeneity of labor and delivery units: a quantitative analysis of space and design. PLoS One. 2018;13:e0209339.
- Bagdas D, Gurunc MS, Flood P, Papkee RL, Damaj MI. New insights on neuronal nicotinic acetylcholine receptors as targets for pain and inflammation: a focus on α7 nAChRs. Curr Neuropharmacol. 2018;16:415-25.
- Buchan T, Walkden M, Jenkins K, Sultan P, Bandula S. High frequency jet ventilation during cryoablation of small renal tumours. Cardiovasc Intervent Radiol. 2018;41:1067-73.
- Butwick AJ, Abreo A, Bateman BT, Lee HC, El-Sayed YY, Stephansson O, Flood P. Effect of body mass index on postpartum hemorrhage. Anesthesiology. 2018;128: 774-83.
- Butwick A, Bentley J, Leonard SA, Carmichael SL, EI-Sayed YY, Stephansson O, Guo N. Prepregnancy maternal body mass index and venous thromboembolism: a population based cohort study. BJOG. Nov 30. doi: 10.1111/1471-0528.15567. [Epub ahead of print]
- Butwick A, Bentley J, Wong CA, Snowden JM, Sun E, Guo N. United States state-level variation in the use of neuraxial analgesia during labor for pregnant women. JAMA Netw Open. 2018;1:e186567.
- Butwick AJ, Palanisamy A. Mode of anesthesia for cesarean delivery and maternal morbidity: can we overcome confounding by indication? Br J Anaesth. 2018;120:621-3.
- Butwick A, Walsh EM, Kuzniewicz M, Li SX, Escobar GJ. Accuracy of international classification of diseases, ninth revision, codes for postpartum hemorrhage among women undergoing cesarean delivery. Transfusion. 2018;58:998-1005.
- Butwick AJ, Wong CA, Guo N. Maternal body mass index and use of labor neuraxial analgesia: a population-based retrospective cohort study. Anesthesiology. 2018;129:448-58.
- Cobb B, Abir G, Carvalho B. Preoperative anterior thigh temperature does not correlate with perioperative temporal hypothermia during cesarean delivery with spinal anesthesia: secondary analysis of a randomized control trial. Int J Obstet Anesth. 2018;33:40-5.
- Darnall BD, Ziadni MS, Stieg RL, Mackey IG, Kao MC, Flood P. Patient-centered prescription opioid tapering in community outpatients with chronic pain. JAMA Intern Med. 2018; 178:707-8.
- Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, Watson PL, Weinhouse GL, Nunnally ME, Rochwerg B, Balas MC, van den Boogaard M, Bosma KJ, Brummel NE, Chanques G, Denehy L, Drouot X, Fraser GL, Harris JE, Joffe AM, Kho ME, Kress JP, Lanphere JA, McKinley S, Neufeld KJ, Pisani MA, Payen JF, Pun BT, Puntillo KA, Riker RR, Robinson BRH, Shehabi Y, Szumita PM, Winkelman C, Centofanti JE, Price C, Nikayin S, Misak CJ, Flood PD, Kiedrowski K, Alhazzani W. Executive summary: clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46:1532-48.
- Devlin JW, Skrobik Y, Rochwerg B, Nunnally M, Needham DM, Gelinas C, Pandharipande P, Slooter AA, Watson P, Weinhouse G, Kho ME, Centofan J, Price C, Harmon L, Misak C, Flood P, Alhazzani W. Methodological innovation in creating clinical practice guidelines: insights from the 2018 SCCM pain, agitation (sedation), delirium, immobility and sleep (disruption) guideline effort. Crit Care Med. 2018;46:1457-63.
- Du L, Wenning L, Migoya E, Xu Y, Carvalho B, Brookfield K, Witjes H, de Greef R, Lumbiganon P, Sangkomkamhang U, Titapant V, Duley L, Long Q, Oladapo OT. Population pharmacokinetic modeling to evaluate standard magnesium sulfate treatments and alternative dosing regimens for pregnant women with preeclampsia. J Clin Pharmacol. 2018 Nov 13. doi: 10.1002/jcph.1328. [Epub ahead of print]
- Eisenried A, Austin N, Cobb B, Akhbardeh A, Carvalho B, Yeomans DC, Tzabazis AZ. Correlation of changes in hemodynamic response as measured by cerebral optical spectrometry with subjective pain ratings in volunteers and patients: a prospective cohort study. J Pain Res. 2018;11:1991-8.
- Fedoruk K, Seligman KM, Carvalho B, Butwick AJ. Assessing the association between blood loss and postoperative hemoglobin after cesarean delivery: a prospective study of 4 blood loss measurement modalities. Anesth Analg. 2018 May 25. doi: 10.1213/ANE.0000000000003449. [Epub ahead of print]
- Fischer A, Ortner CM, Hartmann T, Jochberger S, Klein KU. Which medications are safe for breastfeeding? A synopsis for the anesthetist, obstetrician and pediatrician. Wien Med Wochenschr. 2018 Apr 24. doi: 10.1007/s10354-018-0637-z. [Epub ahead of print]
- Guo N, Robakis T, Miller C, Butwick A. Prevalence of depression among women of reproductive age in the United States.Obstet Gynecol. 2018;131:671-9.
- Ho PT, Carvalho B, Sun EC, Macario A, Riley ET. Cost-benefit analysis of maintaining a fully stocked malignant hyperthermia cart versus an initial dantrolene treatment dose for maternity units. Anesthesiology. 2018;129:249-59.
- Howle R, Ciechanowicz S, Heppolette C, Nakhjavani B, Sultan P. Validation of an obstetric quality of recovery scoring tool (ObsQoR-11) after emergency caesarean delivery. Br J Anaesth. 2018;121:e19-e20.
- Komatsu R, Carvalho B, Flood P. Prediction of pain, analgesia requirement and recovery of function after childbirth. Br J Anaesth. 2018;121:417-26.
- Leffert L, Butwick A, Arendt K, Bates S, Boehlen F, Fernando R, Friedman A, Horlocker T, Kopp S, Montgomery D, Pellegrini J, Smiley R, Toledo P, Carvalho B, Landau IR. The Society for Obstetric Anesthesia and Perinatology consensus statement on the anesthetic management of pregnant and postpartum women receiving thromboprophylaxis or higher dose anticoagulants. Anesth Analg. 2018; 126:928-44.
- Nanji JA, Carvalho B. Modern techniques to optimize neuraxial labor analgesia. Anesth Pain Med. 2018;13:233-40.
- Ng S, Sodha S, Habib AS, Carvalho B, Sultan P. High-dose versus low-dose local anesthetic for transversus abdominis plane block post-cesarean delivery analgesia - a meta-analysis. Br J Anaesth. 2018;120:252-63.
- Ortner CM, Krishnamoorthy V, Neethling E, Flint M, Swanevelder JL, Lombard C, Fawcus S, Dyer RA. Point-of-care ultrasound abnormalities in late onset severe preeclampsia: prevalence and association with serum albumin and brain natriuretic peptide. Anesth Analg. 2018 Sep 10. doi: 10.1213/ANE.0000000000003759. [Epub ahead of print]
- Palmer E, Ciechanowicz S, Reeve A, Harris S, Wong DJN, Sultan P. Operating room-to-incision interval and neonatal outcome in emergency caesarean section: a retrospective 5-year cohort study. Anaesthesia. 2018;73:825-31.
- Patel SD, Habib AS, Phillips S, Carvalho B, Sultan P. The effect of glycopyrrolate on the incidence of hypotension and vasopressor requirement during spinal anesthesia for cesarean delivery: a meta-analysis. Anesth Analg. 2018;126:552-8.
- Pushpanathan E, Setty T, Carvalho B, Sultan P. A systematic review of postoperative pain outcome measurements utilised in regional anesthesia randomized controlled trials. Anesthesiol Res Prac. 2018;2018:9050239.
- Riley ET. Comment on arachnoid and dura mater lesions. Reg Anesth Pain Med. 2018;43:332.
- Riley ET, Dyer RA, Carvalho B. Left uterine tilt for cesarean delivery significantly improves maternal hemodynamics and should not be considered outdated dogma. Anesthesiology. 2018;128:858-9.
- Seligman KM, Weiniger CF, Carvalho B. The accuracy of a handheld ultrasound device for neuraxial depth and landmark assessment: a prospective cohort trial. Anesth Analg. 2018;126:1995-8.
- Sharawi N, Carvalho B, Habib AS, Blake L, Mhyre JM, Sultan P. A systematic review evaluating neuraxial morphine and diamorphine associated respiratory depression following cesarean delivery. Anesth Analg. 2018;127:1385-95.
- Sloan R, Shapiro P, McKinley P, Bartels M, Shimbo D, Lauriola V, Karmally W, Choi C, Choo T, Scodes J, Flood P, Tracey KJ. Aerobic exercise training and systemic inflammation: results of a randomized controlled trial. J Am Heart Ass. 2018;7:e010201.
- Tan, M, Lipman S, Lee H, Sie L, Carvalho B. Evaluation of electronic medical records on nurses’ time allocation during cesarean delivery. J Patient Saf. 2018 Feb 26 doi: 10.1097/PTS.0000000000000467. [Epub ahead of print]
- Weber U, Schiefer J, Muehlbacher J, Bernardi M, Ortner CM, Jaksch P. High altitude trekking after lung transplantation: a prospective study using lung ultrasound to detect comet tails for interstitial pulmonary edema in lung transplant recipients and healthy volunteers. Transpl Int. 2018;31:1245-53.
- Weiniger CF, Akdagli S, Turval E, Carvalho B. Prospective observational investigation of capnography and pulse oximetry monitoring after cesarean delivery with intrathecal morphine. Anesth Analg. 2018 Jun 28. doi: 10.1213/ANE.0000000000003503. [Epub ahead of print]
- Weiniger CF, Cobb B, Wang RR. Carvalho B. Observational study using ultrasound to assess midline labor epidural analgesia placement and analgesic efficacy. J Ultrasound Med. 2018;37:1693-9.
- Zackler A, Flood P, Dajao R, Maramara L, Goetzl L. Suspected chorioamnionitis and myometrial contractility: mechanisms for increased risk of cesarean delivery and postpartum hemorrhage. Reprod Sci. 2018 Jan 1:1933719118778819. doi: 10.1177/1933719118778819. [Epub ahead of print]
- Abir G, Akdagli S, Butwick A, Carvalho B. Clinical and microbiological features of maternal sepsis: a retrospective study. Int J Obstet Anesth. 2017;29:26-33.
- Abir G, Mhyre J. Maternal mortality and the role of the obstetric anesthesiologist. Best Pract Res Clin Anaesthesiol. 2017;31:91-105.
- Bateman BT, Cole NM, Maeda A, Burns SM, Houle TT, Huybrechts KF, Clancy CR, Hopp SB, Ecker JL, Ende H, Grewe K, Corradini BR, Schoenfeld RE, Sankar K, Day LJ, Harris LC, Booth JL, Flood P, Bauer ME, Tsen LC, Leffert LR, Landau R. Patterns of opioid prescription and use after cesarean delivery. Obstet Gynecol. 2017;130:29-35.
- Betti F, Carvalho B, Riley ET. Intrathecal migration of an epidural catheter while using a programmed intermittent epidural bolus technique for labor analgesia maintenance: a case report. A A Case Rep. 2017;9:357-9.
- Brookfield KF, Elkomy M, Su F, Drover DR, Carvalho B. Optimization of maternal magnesium sulfate administration for fetal neuroprotection: application of a prospectively constructed pharmacokinetic model to the BEAM cohort. J Clin Pharmacol. 2017;57:1419-24.
- Butwick A. Improving post-caesarean analgesia: where to next? BJOG. 2017;124:1071.
- Butwick AJ, Ramachandran B, Hegde P, Riley ET, El-Sayed YY, Nelson LM. Risk factors for severe postpartum hemorrhage after cesarean delivery: case-control studies. Anesth Analg. 2017;125:523-32.
- Butwick AJ, Walsh EM, Kuzniewicz M, Li SX, Escobar GJ. Patterns and predictors of severe postpartum anemia after cesarean section. Transfusion. 2017;57:36-44.
- Carvalho B, Bateman B. Not too little, not too much: finding the goldilocks zone for spinal anesthesia to facilitate external cephalic version. Anesthesiology. 2017;127:596-8.
- Carvalho B, Butwick AJ. Postcesarean delivery analgesia. Best Pract Res Clin Anaesthesiol. 2017;31:69-79.
- Carvalho B, Mirza F, Flood P. Patient choice compared with no choice of intrathecal morphine dose for caesarean analgesia: a randomized clinical trial. Br J Anaesth. 2017;118:762-71.
- Carvalho B, Riley ET. Programmed intermittent epidural boluses (PIEB) for maintenance of labor analgesia: an incremental step before the next paradigm shift? Turk J Anaesthesiol Reanim. 2017;45:73-5.
- 13. Carvalho B, Weiniger CF. A perspective on hypercapnia events after cesarean delivery in women receiving intrathecal morphine. Anesth Analg. 2017;125:355-6.
- Carvalho B, Zheng LL, Butwick A. Comparative effectiveness of lower leg compression devices versus sequential compression devices to prevent postspinal hypotension during cesarean delivery. Anesth Analg. 2017;124:696-7.
- Chin KJ, McDonnell JG, Carvalho B, Sharkey A, Pawa A, Gadsden J. Essentials of our current understanding: abdominal wall blocks. Reg Anesth Pain Med. 2017;42:133-83.
- Cobb B, Lipman S. Cardiac arrest: obstetric CPR/ACLS. Clin Obstet Gynecol. 2017;60:425-30.
- Daniels K, Hamilton C, Crowe S, Lipman S, Halamek LP, Lee HC. Opportunities to foster efficient communication in labor and delivery using simulation. AJP Rep. 2017;7:e44-e48.
- Desai N, Carvalho B. General anaesthesia for caesarean section: is the end in sight for thiopental? Br J Hosp Med (Lond). 2017;78:358.
- Duffield A, McKenzie C, Carvalho B, Ramachandran B, Yin V, El-Sayed YY, Riley ET, Butwick AJ. Effect of a high-rate versus a low-rate oxytocin infusion for maintaining uterine contractility during elective cesarean delivery: a prospective randomized clinical trial. Anesth Analg. 2017;124:857-62.
- Duffield A, Sultan P, Riley ET, Carvalho B. Optimal administration of cefazolin prophylaxis for cesarean delivery. J Perinatol. 2017;37:16-20.
- Farr A, Holzer I, Einig S, Ortner CM, Lenz-Gebhart A, Lehner R. Outcomes and trends of peripartum maternal admission to the intensive care unit. Wien Klin Wochenschr. 2017;129:605-11.
- Jochberger S, Klein KU, Ortner CM. Schmerztherapie während der Geburt (Pain management during labor). Wien Med Wochenschr. 2017;167:368-73.
- Komatsu R, Carvalho B, Flood P. Recovery after nulliparous birth: a detailed analysis of pain analgesia and recovery of function. Anesthesiology. 2017;127;684-94
- Kowalczyk JJ, Bause GS. From Danielsville to doctor's day: Crawford W. Long, MD, the first surgical and first obstetric etherist. J Anesth Hist. 2017;3:31-2.
- Kumar G, Howard SK, Kou A, Kim TE, Butwick AJ, Mariano ER. Availability and readability of online patient education materials regarding regional anesthesia techniques for perioperative pain management. Pain Med. 2017;18:2027-32.
- Leffert LR, Dubois HM, Butwick AJ, Carvalho B, Houle TT, Landau R. Neuraxial anesthesia in obstetric patients receiving thromboprophylaxis with unfractionated or low-molecular-weight heparin: a systematic review of spinal epidural hematoma. Anesth Analg. 2017;125:223-31.
- Mayo-Wilson E, Li T, Fusco N, Bertizzolo L, Canner JK, Cowley T, Doshi P, Ehmsen J, Gresham G, Guo N, Haythornthwaite JA, Heyward J, Hong H, Pham D, Payne JL, Rosman L, Stuart EA, Suarez-Cuervo C, Tolbert E, Twose C, Vedula S, Dickersin K. Cherry-picking by trialists and meta-analysts can drive conclusions about intervention efficacy. J Clin Epidemiology. 2017;91:95-110.
- McKenzie C, Akdagli S, Abir G, Carvalho B. Postpartum tubal ligation: a retrospective review of anesthetic management at a single institution and a practice survey of academic institutions. J Clin Anesth. 2017;43:39-46.
- Miller CM, Cohn S, Akdagli S, Carvalho B, Blumenfeld YJ, Butwick AJ. Postpartum hemorrhage following vaginal delivery: risk factors and maternal outcomes. J Perinatol. 2017;37:243-8.
- Moy DM, Kim TE, Harrison TK, Leng JC, Carvalho B, Howard SK, Shum C, Kou A, Mariano ER; Anesthesiology-Directed Advanced Procedural Training (ADAPT) Research Group. Comparative echogenicity of an epidural catheter and 2 new catheters designed for ultrasound-guided continuous peripheral nerve blocks. J Ultrasound Med. 2017;36:2571-6.
- Nekhendzy V, Ramaiah VK, Collins J, Lemmens HJ, Most SP. The safety and efficacy of the use of the flexible laryngeal mask airway with positive pressure ventilation in elective ENT surgery: a 15-year retrospective single-center study. Minerva Anestesiol. 2017;83:947-55.
- Panigrahi AK, Yeaton-Massey A, Bakhtary S, Andrews J, Lyell DJ, Butwick AJ, Goodnough LT. A standardized approach for transfusion medicine support in patients with morbidly adherent placenta. Anesth Analg. 2017;125:603-8.
- Phillips S, Subair S, Husain T, Sultan P. Apnoeic oxygenation during maternal cardiac arrest in a parturient with extreme obesity. Int J Obstet Anesth. 2017;29:88-90.
- Rahman S, Walker D, Sultan P. Medical identification jewellery: an opportunity to save lives or an unreliable hindrance? Anaesthesia. 2017;72:1139-45.
- Riley ET. Comment on Montenigro et al., "Cumulative head impact exposure predicts later-life depression, apathy, executive dysfunction, and cognitive impairment in former high school and college football players". J Neurotrauma. 2017;34:1490.
- Riley ET, Carvalho B. Programmed intermittent epidural boluses (PIEB) for maintenance of labor analgesia: a superior technique to continuous epidural infusion? Turk J Anaesthesiol Reanim. 2017;45:65-6.
- Seligman K, Ramachandran B, Hegde P, Riley ET, El-Sayed YY, Nelson LM, Butwick AJ. Obstetric interventions and maternal morbidity among women who experience severe postpartum hemorrhage during cesarean delivery. Int J Obstet Anesth. 2017;31:27-36.
- Shaylor R, Weiniger CF, Austin N, Tzabazis A, Shander A, Goodnough LT, Butwick AJ. National and international guidelines for patient blood management in obstetrics: a qualitative review. Anesth Analg. 2017;124:216-32.
- Sultan P, Habib A, Carvalho B. Ambient operating room temperature: mother, baby or surgeon? Br J Anaesth. 2017;119:839.
- Sutton CD, Butwick AJ, Riley ET, Carvalho B. Nitrous oxide for labor analgesia: utilization and predictors of conversion to neuraxial analgesia. J Clin Anesth. 2017;40:40-5.
- Sutton CD, Carvalho B. Optimal pain management after cesarean delivery. Anesthesiol Clin. 2017;35:107-24.
- Sutton C, Carvalho B. What's trending now? An analysis of trends in internet searches for labor epidurals. Int J Obstet Anesth. 2017;30:52-7.
- Takazawa T, Choudhury P, Tong CK, Conway CM, Scherrer G, Flood PD, Mukai J, MacDermott AB. Inhibition mediated by glycinergic and GABAergic receptors on excitatory neurons in mouse superficial dorsal horn is location-specific but modified by inflammation. J Neurosci. 2017;37:2336-48.
- Van Erp M, Ortner CM, Jochberger S, Klein KU. Aktuelle versorgungskonzepte in der geburtshilflichen anästhesie (Recent standards in management of obstetric anesthesia). Wien Med Wochenschr. 2017;167:374-89.
- Wang M, He M, Wu B, Ke L, Han T, Wang J, Shan H, Ness P, Guo N, Liu Y, Nelson K. The association of elevated alanine aminotransferase levels with hepatitis E virus infections among blood donors in China. Transfusion. 2017;57:273-9.
- Weiniger CF, Carvalho B, Landau R. Optimal and timely triggers for vital signs-controlled, patient-assisted intravenous analgesia (VPIA) using remifentanil for labour and delivery analgesia. Anaesthesia. 2017;72:1155-6.
- Weiniger CF, Carvalho B, Stocki D, Einav S. Analysis of physiological respiratory variable alarm alerts among laboring women receiving remifentanil. Anesth Analg. 2017;124:1211-8.
- Ansari J, Carvalho B, Shafer S, Flood P. Pharmacokinetics and pharmacodynamics of drugs commonly used in pregnancy and parturition. Anesth Analg. 2016;122:786-804.
- Austin N, Goldhaber-Fiebert S, Daniels K, Arafeh J, Grenon V, Welle D, Lipman S. Building comprehensive strategies for obstetric safety: simulation drills and communication. Anesth Analg. 2016;123:1181-90.
- Brookfield KF, O'Malley K, El-Sayed YY, Blumenfeld YJ, Butwick AJ. Does time of delivery influence the risk of neonatal morbidity? Am J Perinatol. 2016;33:502-9.
- Brookfield KF, Su F, Drover DR, Elkomy MH, Adelus M, Lyell DJ, Carvalho B. Pharmacokinetics and placental transfer of magnesium sulfate in pregnant women. Am J Obstet Gynecol. 2016;214:737.e1-9.
- Butwick A, Blumenfeld Y, Brookfield K, Weiniger CF. Racial and ethnic disparities in mode of anesthesia for cesarean delivery. Anesth Analg. 2016;122:472-9.
- Butwick AJ, Tiouririne M. Evaluation of high-risk obstetric patients: a survey of US academic centers. J Clin Anesth. 2016;33:460-8.
- Carvalho B, George RB, Cobb B, McKenzie C, Riley ET. Implementation of programmed intermittent epidural bolus for the maintenance of labor analgesia. Anesth Analg. 2016;123:965-71.
- Carvalho B, Granot M, Sultan P, Wilson H, Landau R. A longitudinal study to evaluate pregnancy-induced endogenous analgesia and pain modulation. Reg Anesth Pain Med. 2016;41:175-80.
- Carvalho B, Mhyre JM. Moving beyond the 0-10 scale for labor pain measurement. Anesth Analg. 2016;123:1351-3.
- Carvalho B, Zheng M, Harter S, Sultan P. A prospective cohort study evaluating the ability of anticipated pain, perceived analgesic needs, and psychological traits to predict pain and analgesic usage following cesarean delivery. Anesthesiol Res Pract. 2016;2016:7948412 .
- Cobb B, Cho Y, Hilton G, Ting V, Carvalho B. Active warming utilizing combined intravenous fluid and forced-air warming decreases hypothermia and improves maternal comfort during cesarean delivery. Anesth Analg. 2016;122:1490-7.
- Darnall B, Wheeler A, Taub C, Mackey I, Wapnir I, Schultz C, Rico T, Flood P. An internet-based perioperative pain psychology treatment program: results of a randomized controlled trial in breast oncology surgery patients. J Pain. 2016;17:S106.
- Degos V, Flood P. Are epigenetic changes the key to the elusive mechanism for the long-lasting effects of anesthetic drugs that persist after emergence? Anesthesiology. 2016;124:530-1.
- Farber MK, Miller CM, Ramachandran B, Hegde P, Akbar K, Goodnough LT, Butwick AJ. Knowledge of blood loss at delivery among postpartum patients. Peer J. 2016;4:e2361.
- Flood P, Clark JD. Molecular interaction between stress and pain. Anesthesiology. 2016;124:994-5.
- Fragiadakis GK, Baca QJ, Gherardini PF, Ganio EA, Gaudilliere DK, Tingle M, Lancero HL, McNeil LS, Spitzer MH, Wong RJ, Shaw GM, Darmstadt GL, Sylvester KG, Winn VD, Carvalho B, Lewis DB, Stevenson DK, Nolan GP, Aghaeepour N, Angst MS, Gaudilliere BL. Mapping the fetomaternal peripheral immune system at term pregnancy. J Immunol. 2016;197:4482-92.
- Hilton G, Daniels K, Carvalho B. Simulation study assessing healthcare provider's knowledge of preeclampsia and eclampsia in a tertiary referral center. Simul Healthc. 2016;11:25-31.
- Hilton G, Daniels K, Goldhaber-Fiebert SN, Lipman S, Carvalho B, Butwick A. Checklists and multidisciplinary team performance during simulated obstetric hemorrhage. Int J Obstet Anesth. 2016;25:9-16.
- Hu LQ, Flood P, Li Y, Tao W, Zhao P, Xia Y, Pian-Smith MC, Stellaccio FS, Ouanes JP, Hu F, Wong CA. No pain labor & delivery: a global health initiative's impact on clinical outcomes in China. Anesth Analg. 2016;122:1931-8.
- Ioscovich A, Shatalin D, Butwick AJ, Ginosar Y, Orbach-Zinger S, Weiniger CF. Israeli survey of anesthesia practice related to placenta previa and accreta. Acta Anaesthesiol Scand. 2016;60:457-64.
- Lipman S, Cohen SE, Mhyre J, Carvalho B, Einav S, Arafeh J, Jeejeebhoy F, Cobb B, Druzin M, Katz V, Harney K. Challenging the 4- to 5-minute rule: from perimortem cesarean to resuscitative hysterotomy. Am J Obstet Gynecol. 2016;215:129-31.
- McKenzie CP, Carvalho B, Riley ET. The Wiley spinal catheter-over-needle system for continuous spinal anesthesia: a case series of 5 cesarean deliveries complicated by paresthesias and headaches. Reg Anesth Pain Med. 2016;41:405-10.
- McKenzie CP, Cobb B, Riley ET, Carvalho B. Programmed intermittent epidural boluses for maintenance of labor analgesia: an impact study. Int J Obstet Anesth. 2016;26:32-8.
- Miller CM, Ramachandran B, Akbar K, Carvalho B, Butwick AJ. The impact of postpartum hemoglobin levels on maternal quality of life after delivery: a prospective exploratory study. Ann Hematol. 2016;95:2049-55.
- Osmundson SS, Gould JB, Butwick AJ, Yeaton-Massey A, El-Sayed YY. Labor outcome at extremely advanced maternal age. Am J Obstet Gynecol. 2016;214:362.e1-7.
- Riley ET. Chronic traumatic encephalopathy and professional athletes: suicides are contagious. World Neurosurg. 2016;94:576-7.
- Sultan P, Halpern SH, Pushpanathan E, Patel S, Carvalho B. Effect of intrathecal morphine dose for cesarean delivery on maternal and neonatal outcomes: a meta-analysis. Anesth Analg. 2016;123:154-64.
- Sultan P, Seligman K, Carvalho B. Amniotic fluid embolism: update and review. Curr Opin Anaesthesiol. 2016;29:288-96.
- Sultan P, Weiniger CF, Carvalho B. Neuraxial blockade increases external cephalic version success: a well-known finding needing to be disseminated within the obstetric domain. Am J Obstet Gynecol. 2016;215:675-6.
- Sultan P, David AL, Fernando R, Ackland GL. Inflammation and epidural-related maternal fever: proposed mechanisms. Anesth Analg. 2016;122:1546-53.
- Sutton C, Butwick A. Can extra carbs improve perinatal outcomes? BJOG. 2016;123:518
- Tawfik V, Flood P. Electrical synapses: high-speed communication in the maintenance of neuropathic pain. Anesthesiology. 2016;124:13-5.
- Terkawi AS, Mavridis D, Flood P, Wetterslev J, Terkawi RS, Bin Abdulhak AA, Nunemaker MS, Tiouririne M. Does ondansetron modify sympathectomy due to subarachnoid anesthesia?: Meta-analysis, meta-regression, and trial sequential analysis. Anesthesiology. 2016;124:846-69.
- Traynor AJ, Aragon M, Gosh D, Choi R, Dingmann C, Bucklin BA. The obstetric anesthesia workforce survey: a 30-year update. Anesth Analg. 2016;122:1939-46.
- Van de Velde M, Carvalho B. Remifentanil for labor analgesia: an evidence-based narrative review. Int J Obstet Anesth. 2016;25:66-74.
- Weiniger CF, Sultan P, Dunn A, Carvalho B. Survey of external cephalic version for breech presentation and neuraxial blockade use. J Clin Anesth. 2016;34:616-22.
- Anast N, Kwok J, Carvalho B, Lipman S, Flood P. Intact survival after obstetric hemorrhage and 55 minutes of cardiopulmonary resuscitation. A A Case Rep. 2015;5:9-12.
- Beswick DM, Collins J, Nekhendzy V, Damrose EJ. Chondronecrosis of the larynx following use of the laryngeal mask airway. Laryngoscope. 2015;125:946-9.
- Blumenfeld YJ, El-Sayed YY, Lyell DJ, Nelson LM, Butwick AJ. Risk factors for prolonged postpartum length of stay following cesarean delivery. Am J Perinatol. 2015;32:825-32.
- Brookfield KF, El-Sayed YY, Chao L, Berger V, Naqvi M, Butwick AJ. Antenatal corticosteroids for preterm premature rupture of membranes: single or repeat course? Am J Perinatol. 2015;32:537-44.
- Butwick A, Blumenfeld Y, El-Sayed YY, Osmundson SS, Weiniger CF. Mode of anaesthesia for preterm caesarean delivery: secondary analysis from the Maternal-Fetal Medicine Units Network Caesarean Registry. Br J Anaesth. 2015;115:267-74.
- Butwick AJ, Carvalho B, Blumenfeld YJ, El-Sayed YY, Nelson LM, Bateman BT. Second-line uterotonics and the risk of hemorrhage-related morbidity. Am J Obstet Gynecol. 2015;212:e1-7.
- Butwick A, Columb M, Carvalho B. Vasopressors and spinal hypotension during cesarean delivery: what’s the latest? Br J Anaesth. 2015;114:183-6.
- Butwick A, Goodnough LT. Transfusion and coagulation management in major obstetric hemorrhage. Curr Opin Anaesthesiol. 2015;28:275-84.
- Butwick A, Gutierrez M, Hilton G. The impact of advanced maternal age on peripartum thromboelastographic coagulation profiles: a prospective observational exploratory study. Can J Anaesth. 2015;62:504-12.
- Camann W, McGovern C, Collins M, Baysinger C, Vallejo M, Anderson J, Wood C, Hawkins JL, Carvalho B, Rollins M, Bishop J, Brumley J. How to say “YES” to nitrous oxide for labor. SOAP Newsletter, Summer 2015.
- Carvalho B, Dyer RA. Norepinephrine for spinal hypotension during cesarean delivery: another paradigm shift? Anesthesiology. 2015;122:728-30.
- Carvalho B, Wong C. Drug labeling in the practice of obstetric anesthesia. Am J Obstet Gynecol. 2015;212:24-7.
- Carvalho B, Yun RD, Mariano ER. Continuous versus single-Injection peripheral nerve blocks: a pilot study comparing procedural time and estimated personnel cost. The Open Anesthesia Journal 2015;9:1-5.
- Cobb B, Lipman S. An update on the American Heart Association Scientific Statement on Cardiac Arrest in Pregnancy. Published in Circulation October 2015. SOAP Newsletter, Winter 2015.
- Creanga AA, Bateman BT, Butwick AJ, Rayleigh L, Maeda A, Kuklina E, Callaghan WM. Morbidity associated with cesarean delivery in the United States: is placenta accreta an increasingly important contributor? Am J Obstet Gynecol. 2015;213:384.e1-11.
- Edwards MR, Sultan P, Gutierrez Del Arroyo A, Whittle J, Karmali SN, Moonesinghe SR, Haddad FS, Mythen MG, Singer M, Ackland GL. Metabolic dysfunction in lymphocytes promotes postoperative morbidity. Clin Sci (Lond). 2015;129:423-437.
- Elkomy MH, Sultan P, Clavijo C, Galinkin JL, Carvalho B, Drover DR. Ondansetron pharmacokinetics in pregnant women and neonates: towards a new treatment for neonatal abstinence syndrome. Clin Pharmacol Ther. 2015;97:167-76.
- Flood P, Dexter F, Ledolter J and Dutton RP. Large heterogeneity in mean durations of labor analgesia among hospitals reporting to the American Society of Anesthesiologist’s Anesthesia Quality Institute. Anesth Analg. 2015;121:1283-9.
- Flood P, McKinley P, Monk C, Muntner P, Colantonio L, Goetzl L, Hatch M, Sloan R. Beat-to-beat heart rate and blood pressure variability and hypertensive disease in pregnancy. Am J Perinatol. 2015;32:1050-8.
- Girsen AI, Greenberg MB, El-Sayed YY, Carvalho B, Lyell DJ. Magnesium sulfate exposure and neonatal intensive care unit admission. J Perinatol. 2015;35:181-5.
- Golovanevski L, Ickowicz DE, Sokolsky-Papkov M, Domb AJ, Weiniger CF. Biocompatibility of an extended release bupivacaine formulation following site-directed nerve injection. J Bioact Compat Polym. 2015;30:114-125.
- Jeejeebhoy FM, Zelop CM, Lipman S, Carvalho B, Joglar J, Mhyre JM, Katz VL, Lapinsky SE, Einav S, Warnes CA, Page RL, Griffin RE, Jain A, Dainty KN, Arafeh J, Windrim R, Koren G, Callaway C. Cardiac arrest in pregnancy: a scientific statement from the American Heart Association. Circulation. 2015;132:1747-73.
- Karmali S, Jenkins N, Sciusco A, John J, Haddad F, Ackland GL; POM-X Study Investigators (Reyes A, Davies K, Edwards J, Whittle J, Barnett S, Moonesinghe S, Wyndham D, Bettini E, Lee S, Sultan P, Edwards M, Cain D, del Arroyo A). Randomized controlled trial of vagal modulation by sham feeding in elective non-gastrointestinal (orthopaedic) surgery. Br J Anaesth. 2015;115:727-35.
- Li Y, Flood P, Cornes S. Electroencephalography of seizure-like movements during general anesthesia with propofol: seizures or nonepileptic events? A A Case Rep. 2015;5:195-8.
- Liu YM, Patel SD, Mon W, Fernando R, Columb M, Sultan P. Maternal fever and epidural insertion: an OAA approved survey. Int J Obstet Anesth. 2015;24:S28.
- Paech M, Sng BL, Sia A, Ng L, Nathan E, Carvalho B. Methylnaltrexone to prevent intrathecal morphine-induced pruritus after caesarean delivery: a multicenter randomized clinical trial. Br J Anaesth. 2015;114:469-76.
- Rhee KY, Goetzl L, Unal R, Cierny J, Flood P. Relationship between plasma inflammatory cytokines and labor pain. Anesth Analg. 2015;121:748-51.
- Rodriguez CI, Kegeles LS, Levinson A, Ogden R, Mao X, Milak MS, Vermes D, Xie S, Hunter L, Flood P, Moore H, Shungu DC, Simpson HB. In vivo effects of ketamine on glutamate-glutamine and gamma-aminobutyric acid in obsessive-compulsive disorder. Psychiatry Res. 2015;233:141-7.
- Soltanifar D, Bogod D, Harrison S, Carvalho B, Sultan P. A survey of accepted practice following failed intubation for emergency caesarean delivery. Anesthesiol Res Pract. 2015;2015:192315.
- Soltanifar D, Carvalho B, Sultan P. Perioperative considerations of the patient with malaria. Can J Anaesth. 2015;62:304-18.
- Soltanifar D, Jacobs M, Jones T, McGlennan A, Sultan P. Spinal anaesthesia for emergency caesarean delivery in a parturient with falciparum malaria. Int J Obstet Anesth. 2015;24:91.
- Sultan P, Habib AS, Cho Y, Carvalho B. The effect of patient warming during caesarean delivery on maternal and neonatal outcomes: a meta-analysis. Br J Anesth. 2015;115:500-10.
- Valentine AR, Carvalho B, Lazo TA, Riley ET. Scheduled acetaminophen with as-needed opioids compared to as-needed acetaminophen plus opioids for post-cesarean pain management. Int J Obstet Anesth. 2015;24:210-6.
- Weiniger CF, Ezra Y, Dunn AL, Carvalho B. The utilization of spinal anesthesia for external cephalic version: a clinical practice cohort analysis. Int J Obstet Anesth. 2015;24:389-90.
- Wen L, Hilton G, Carvalho B. The impact of breastfeeding on maternal pain after vaginal and cesarean delivery. J Clin Anesth. 2015;27:33-8.
- Ahsan ZS, Carvalho B, Yao J. Incidence of failure of continuous peripheral nerve catheters for postoperative analgesia in upper extremity surgery. J Hand Surg Am. 2014;39:324-9.
- Austin N, Krishnamoorthy V, Dagal A. Airway management in cervical spine injury. Int J Crit Illn Inj Sci. 2014;4:50-6.
- Bateman BT, Tsen LT, Liu J, Butwick AJ, Huybrechts KF. Patterns of second-line uterotonic utilization in a large sample of delivery admissions in the United States. Anesth Analg. 2014;119:1344-9.
- Botto F, ... Sultan P, ... Wildes T. Vascular events in noncardiac surgery patients cohort evaluation (VISION) Writing Group. Myocardial Injury after noncardiac Surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology. 2014;120:564-78.
- Butwick AJ, Carvalho B, El-Sayed YY. Risk factors for severe obstetric morbidity in patients with uterine atony undergoing cesarean delivery. Br J Anaesth. 2014;113:661-8.
- Butwick AJ, Hass C, Wong J, Lyell D, El-Sayed Y. Retrospective study of peripartum and anesthetic outcomes in anticoagulated parturients. Int J Obstet Anesth. 2014;23:238-45.
- Caballero JA, Butwick AJ, Carvalho B, Riley ET. Preferred spoken language mediates differences in neuraxial labor analgesia utilization among racial and ethnic groups. Int J Obstet Anesth. 2014;23:161-7.
- Carvalho B. Strategies to optimize post-cesarean delivery analgesia. American Society of Anesthesiologists (ASA) refresher courses in anesthesiology. 2014 Volume 42.
- Carvalho B, Derby R, Horn JL. “Pseudo” shearing of a peripheral nerve catheter for interscalene block. Reg Anesth Pain Med. 2014;39:556-7.
- Carvalho B, Hilton G, Wen L, Weiniger CF. Prospective longitudinal cohort questionnaire assessment of laboring women's preference both pre- and post-delivery for either reduced pain intensity for a longer duration or greater pain intensity for a shorter duration. Br J Anaesth. 2014;113:468-73.
- Carvalho B, Zheng M, Aiono-Le Tagaloa L. A prospective observational study evaluating the ability of prelabor psychological tests to predict labor pain, epidural analgesic consumption, and maternal satisfaction. Anesth Analg. 2014;119:632-40.
- Cho Y, Carvalho B, Butwick A, Blumenfeld Y, Riley E. Elective caesarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial. BJOG. 2014;121:1748.
- Cierny JT, Unal ER, Flood P, Rhee KY, Praktish A, Olson TH, Goetzl L. Maternal inflammatory markers and term labor performance. Am J Obstet Gynecol. 2014;210;447.e1-6.
- D'Angelo R, Smiley RM, Riley ET, Segal S. Serious complications related to obstetric anesthesia: the serious complication repository project of the society for obstetric anesthesia and perinatology. Anesthesiology. 2014;120:1505-12.
- Daniels K, Oakeson A, Hilton G. Steps toward a national disaster plan for obstetrics. Obstet Gynecol. 2014;124:154-8.
- Ducloy-Bouthors AS, Susen S, Wong CA, Butwick A, Vallet B, Lockhart E. Medical advances in the treatment of postpartum hemorrhage. Anesth Analg. 2014;119:1140-7.
- 17. Elkomy MH, Sultan P, Drover DR, Ekaterina E, Galinkin JL, Carvalho B. Pharmacokinetics of prophylactic cefazolin in parturients undergoing cesarean delivery. Antimicrob Agents Chemother. 2014;58:3504-13.
- Flood P, Clark DJ. Genetic variability in the activity of monoamines: a window into the complexity of pain. Anesth Analg. 2014;119:1032-8.
- Flood P, Damaj MI. Nicotine is out: nicotinic agonists may have utility as analgesics. Anesth Analg. 2014;119:232-3.
- Flood P. Editorial commentary: "Progressive encephalomyelitis with rigidity and myoclonus: anesthesia and glycine receptor antibodies". A A Case Rep. 2014;2:86-7.
- Flood P, Raja SN. Balance in opioid prescription during pregnancy. Anesthesiology. 2014;120:163-4.
- Ickowicz DE, Golovanevski L, Domb AJ, Weiniger CF. Extended duration local anesthetic agent in a rat paw model. Int J Pharm. 2014;468:152-7.
- Ickowicz DE, Golovanevski L, Haze E, Domb AJ, Weiniger CF. Extended release local anesthetic agents in a postoperative arthritic pain model. J Pharm Sci. 2014;103:185-90.
- Ickowicz DE, Haim-Zada M, Abbas R, Touitou D, Nyska A, Golovanevski L, Weiniger CF, Katzhendler J, Domb AJ. Castor oil-citric acid co-polyester for tissue augmentation. Polym Adv Technol. 2014;25:SI1323-8.
- Kabiri D, Hants Y, Simons M, Shanwetter N, Weiniger CF, Gielchinsky Y, Ezra Y. Outcomes of subsequent pregnancies after conservative treatment for placenta accreta. Int J Gynaecol Obstet. 2014;127:206-10.
- Lipman S, Cohen S, Einav S, Jeejeebhoy F, Mhyre JM, Morrison LJ, Katz V, Tsen LC, Daniels K, Halamek LP, Suresh MS, Arafeh J, Gauthier D, Carvalho JC, Druzin M, Carvalho B. The Society for Obstetric Anesthesia and Perinatology consensus statement on the management of cardiac arrest in pregnancy. Anesth Analg. 2014;118:1003-16.
- Mariano ER, Yun RD, Kim TE, Carvalho B. Application of echogenic technology for catheters used in ultrasound-guided continuous peripheral nerve blocks. J Ultrasound Med. 2014;33:905-11.
- Peer L, Brezis ML, Shalit M, Carvalho B, Philip LD, Seri O, Weiniger CF. Evaluation of a prospectively administered written questionnaire to reduce the reported incidence of suspected latex anaphylaxis during elective cesarean delivery. Int J Obstet Anesth. 2014;23:335-40.
- Sharoni L, Weiniger CF. Anesthesia and external cephalic version. Curr Anesthesiol Rep. 2014;5:91-9.
- Soltanifer D, Afzal S, Harrison S, Sultan P. Caesarean delivery in a parturient with type III hereditary angioedema. Int J Obstet Anesth. 2014;23:398-9.
- Stocki D, Matot I, Einav S, Eventov-Friedman S, Ginosar Y, Weiniger CF. A randomized controlled trial of the efficacy and respiratory effects of patient-controlled intravenous remifentanil analgesia and patient-controlled epidural analgesia in laboring women. Anesth Analg. 2014;118:589-7.
- Sultan P, Edwards MR, Gutierrez Del Arroyo A, Cain D, Sneyd JR, Struthers R, Minto G, Ackland GL. Cardiopulmonary exercise capacity and preoperative markers of inflammation. Mediators Inflamm. 2014;2014:727451.
- Terkawi AS, Jackson, WM, Hansoti, S, Tabassum R, Flood P. Polymorphism in the ADRB2 gene explains a small portion of inter-subject variability in pain relative to cervical dilation in the first stage of labor. Anesthesiology. 2014;121:140-8.
- Udani A, Wang T, Hilton G, Harrison K. Physiology of pregnancy and postpartum hemorrhage: an innovative, interactive teaching approach. MedEdPORTAL Publications; 2014. Available from: https://www.mededportal.org/publication/9987.
- Weiniger CF, Carvalho B. The dilemma of vaginal breech delivery worldwide. Lancet. 2014;384:1183.
- Weiniger CF, Carvalho B. Analgesia following cesarean delivery: "Sometimes it takes a painful experience to make us change our ways" (proverbs 20:30). Isr Med Assoc J. 2014;16:171-2.
- Weiniger CF, Spencer PS, Weiss Y, Ginsberg G, Ezra Y. Reducing the cesarean delivery rates for breech presentations: administration of spinal anesthesia facilitates manipulation to cephalic presentation, but is it cost saving? Isr J Health Policy Res. 2014;3:5.