Clinical Focus

  • Obstetrics and Gynecology
  • Maternal Fetal Medicine

Professional Education

  • BA, Cornell University, English (1999)
  • MPH, University of Texas (2000)
  • PhD, University of Miami Miller School of Medicine, Epidemiology (2006)
  • Residency:University of Miami/Jackson Memorial Medical Center (2012) FL
  • Medical Education:University of Miami Miller School of Medicine (2008) FL

Stanford Advisors

Research & Scholarship

Current Research and Scholarly Interests

Currently recruiting patients for a prospective study of magnesium sulfate PK/PD in pregnant women and neonates exposed to magnesium for neuroprotection, tocolysis, and preeclampsia.


Journal Articles

  • Maternal bladder cancer diagnosed at routine first-trimester obstetric ultrasound examination. Obstetrics and gynecology Yeaton-Massey, A., Brookfield, K. F., Aziz, N., Mrazek-Pugh, B., Chueh, J. 2013; 122 (2): 464-467


    Bladder cancer is exceedingly rare in pregnancy and most commonly presents with gross hematuria.We describe two patients with the incidental finding of maternal bladder masses identified during routine first-trimester obstetric ultrasonographic evaluation and an ultimate diagnosis of carcinoma. After referral for urology evaluation and biopsy confirmation of bladder cancer, patients underwent surgical resection during their pregnancies without the need for further treatment and had uncomplicated pregnancy courses.The distended maternal urinary bladder at the time of first-trimester ultrasonographic evaluation offers a unique opportunity for examination and early diagnosis of incidental maternal bladder carcinoma.

    View details for DOI 10.1097/AOG.0b013e31828c5a4d

    View details for PubMedID 23884261

  • Maternal death in the emergency department from trauma. Archives of gynecology and obstetrics Brookfield, K. F., Gonzalez-Quintero, V. H., Davis, J. S., Schulman, C. I. 2013


    PURPOSE: Trauma during pregnancy is among leading causes of non-pregnancy-related maternal death (MD). This study describes risk factors for MD from trauma during pregnancy in a large urban population. METHODS: We queried an urban Level One Trauma Center registry for the medical records of pregnant women suffering trauma from 1990 to 2007. Associations were examined between maternal demographics, injury mode details, injury characteristics, and risk of maternal death upon arrival to the emergency room. RESULTS: Overall, 351 patients were identified. Most traumas was caused by motor vehicle collision (71.8 %), accounting for 78.9 % of MD, followed by gun shot wound (10.3 %), stabbing (8.5 %), falls (4.3 %), and assaults (4 %). Abdominal and head injuries were more frequent in cases of MD compared with patients admitted to the hospital (33.3 vs. 25.1 % abdominal, 55.6 vs. 29.4 % head; p < 0.001). A greater proportion of MDs were characterized by lack of restraint use (66.7 %) compared to women admitted to the hospital (47.7 %) and women discharged after observation (43.1 %); p = 0.014. ER deaths had more negative base excess scores than women who were admitted or discharged (-14 vs. -3 vs. -2; p < 0.001), lower blood pH values (6.96 vs. 7.40 vs. 7.44; p < 0.001), greater Injury Severity Scores (ISS) (44.4 vs. 11.49 vs. 2.66; p < 0.001), and lower Revised Trauma Scores (RTS) (0.5 vs. 7.49 vs. 7.83; p < 0.001). CONCLUSIONS: Lack of restraint use in the pregnant population is associated with increased MD. Although not validated in the pregnant population, the ISS and RTS were associated with maternal mortality outcomes.

    View details for PubMedID 23467794

  • Duration of membrane rupture and risk of perinatal transmission of HIV-1 in the era of combination antiretroviral therapy AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Cotter, A. M., Brookfield, K. F., Duthely, L. M., Quintero, V. H., Potter, J. E., O'Sullivan, M. J. 2012; 207 (6)


    The objective of the study was to determine whether the duration of membrane rupture of 4 or more hours is a significant risk factor for perinatal transmission of human immunodeficiency virus (HIV) in the era of combination antiretroviral therapy (ART).This was a prospective cohort study of 717 HIV-infected pregnant women-infant pairs with a delivery viral load available who received prenatal care and delivered at our institution during the interval 1996-2008.The cohort comprised 707 women receiving ART who delivered during this interval. The perinatal transmission rate was 1% in women with membranes ruptured for less than 4 hours and 1.9% when ruptured for 4 or more hours. For 493 women with a delivery viral load less than 1000 copies/mL receiving combination ART in pregnancy, there were no cases of perinatal transmission identified up to 25 hours of membrane rupture. Logistic regression demonstrated only a viral load above 10,000 copies/mL as an independent risk factor for perinatal transmission.Duration of membrane rupture of 4 or more hours is not a risk factor for perinatal transmission of HIV in women with a viral load less than 1000 copies/mL receiving combination ART.

    View details for DOI 10.1016/j.ajog.2012.10.862

    View details for Web of Science ID 000311483300020

    View details for PubMedID 23103331

  • Conservative management of nontubal ectopic pregnancies FERTILITY AND STERILITY Verma, U., English, D., Brookfield, K. 2011; 96 (6): 1391-U375


    To report successful conservative management of nontubal ectopic pregnancies.Retrospective case series.University tertiary-care hospital.Sixty-four women with diagnosis of nontubal ectopic pregnancies (cervical, cornual, and cesarean section scar) were treated with minimally invasive procedures.Systemic methotrexate alone or combined with ultrasound-guided fetal intracardiac injection of potassium chloride.Success of the treatment, preservation of the uterus, rate of serious complications, and the need for additional interventions.Conservative treatment was successful in 63 patients with nontubal ectopic pregnancies. One patient had rupture of cornual pregnancy and underwent cornual resection. None of the patients in this case series required hysterectomy. This series included four patients with heterotopic pregnancies, three of whom continued intrauterine pregnancy to term gestation after conservative treatment. Seven patients experienced minimal morbidity that was treated with additional nonsurgical interventions.Conservative management and fertility preservation is feasible in most nontubal ectopic pregnancies.

    View details for DOI 10.1016/j.fertnstert.2011.09.021

    View details for Web of Science ID 000298119700029

    View details for PubMedID 21962919

  • Malnutrition as a predictor of poor postoperative outcomes in gynecologic cancer patients ARCHIVES OF GYNECOLOGY AND OBSTETRICS Kathiresan, A. S., Brookfield, K. F., Schuman, S. I., Lucci, J. A. 2011; 284 (2): 445-451


    Poor nutritional status has been associated with increased postoperative morbidity and mortality in surgical patients. The purpose of this study is to evaluate if decreased nutritional parameters correlate with increased postoperative complications regardless of other risk factors in the gynecologic cancer patient.A retrospective chart review was performed among women who underwent surgical management for gynecologic malignancies from October 2006 to June 2008. Variables included age, race, medical comorbidities, cancer type/stage, preoperative albumin, absolute lymphocyte count (ALC), and body mass index (BMI), estimated blood loss (EBL), intraoperative blood transfusion (BT), intraoperative or postoperative complications, intensive care unit (ICU) admissions, hospital readmissions, reoperations, and cancer recurrence.Three hundred gynecologic oncology patients with preoperative nutritional parameters were included in the study. Decreased albumin was significantly associated with more postoperative complications (p < 0.001), hospital readmissions (p = 0.01), reoperations (p = 0.03), ICU admissions (p < 0.001), and cancer recurrence (p < 0.001). Decreased ALC and BMI preoperatively was also significantly associated with higher incidence of cancer recurrence (p = 0.01, p = 0.01). Surgical cases involving increased EBL (p = 0.01, p < 0.001) and more BT (p < 0.001, p < 0.001) had significantly more postoperative complications and more ICU admissions. Multivariable logistic regression found preoperative albumin to be an independent predictor of increased postoperative complications.Decreased albumin is significantly associated with more postoperative complications, hospital readmissions, reoperations, ICU admissions, and cancer recurrence. This nutritional parameter is an important predictor of postoperative morbidity and mortality. Thus, it is important to assess nutritional status preoperatively and offer nutritional support or alternate treatment options if necessary.

    View details for DOI 10.1007/s00404-010-1659-y

    View details for Web of Science ID 000292651600029

    View details for PubMedID 20803205

  • Vasopressin versus a combination of vasopressin and tourniquets: a comparison of blood loss in patients undergoing abdominal myomectomies AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY Kathiresan, A. S., Brookfield, K. F., Gonzalez-Quintero, V. H., Verma, U. 2011; 51 (1): 79-83


    To compare blood loss and need for blood transfusions in women who underwent abdominal myomectomies after receiving vasopressin or combined vasopressin and tourniquet.A retrospective chart review was performed reviewing abdominal myomectomies that took place at our institution. Subjects were divided into three groups: no intervention, vasopressin, or combined vasopressin and tourniquet. Blood loss, need for blood transfusion, and drop in hemoglobin and hematocrit were compared across all groups.One-hundred and thirty-two subjects were included in the study. No statistically significant difference was found between groups in blood loss, drop in hemoglobin or hematocrit, or blood transfusions.Combined vasopressin and tourniquets was not associated with a statistically significant decrease in blood loss or need for blood transfusion.

    View details for DOI 10.1111/j.1479-828X.2010.01253.x

    View details for Web of Science ID 000287094600015

    View details for PubMedID 21299514

  • Excessive Weight Gain among Obese Women and Pregnancy Outcomes AMERICAN JOURNAL OF PERINATOLOGY Flick, A. A., Brookfield, K. F., de la Torre, L., Tudela, C. M., Duthely, L., Gonzalez-Quintero, V. H. 2010; 27 (4): 333-338


    We evaluated pregnancy outcomes in obese women with excessive weight gain during pregnancy. A retrospective study was performed on all obese women. Outcomes included rates of preeclampsia (PEC), gestational diabetes, cesarean delivery (CD), preterm delivery, low birth weight, very low birth weight, macrosomia, 5-minute Apgar score of <7, and neonatal intensive care unit (NICU) admission and were stratified by body mass index (BMI) groups class I (BMI 30 to 35.9 kg/m(2)), class II (36 to 39.9 kg/m(2)), and class III (>or=40 kg/m(2)). Gestational weight change was abstracted from the mother's medical chart and was divided into four categories: weight loss, weight gain of up to 14.9 pounds, weight gain of 15 to 24.9 pounds, and weight gain of more than 25 pounds. A total 20,823 obese women were eligible for the study. Univariate analysis revealed higher rates of preeclampsia, gestational diabetes, Cesarean deliveries, preterm deliveries, low birth weight, macrosomia, and NICU admission in class II and class III obese women when compared with class I women. When different patterns of weight gain were used as in the logistic regression model, rates of PEC and CD were increased. Excessive weight gain among obese women is associated with adverse outcomes with a higher risk as BMI increases.

    View details for DOI 10.1055/s-0029-1243304

    View details for Web of Science ID 000275746400011

    View details for PubMedID 20013581

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