2020
Stroke in Pregnancy: A Focused Update.
Miller EC, Leffert L. Stroke in Pregnancy: A Focused Update. Anesthesia & Analgesia 2020, 130: 1085-1096. PMID: 31124843, PMCID: PMC7035913, DOI: 10.1213/ane.0000000000004203.Peer-Reviewed Original ResearchMeSH KeywordsAdultBrain IschemiaDelivery, ObstetricFemaleHumansIntracranial HemorrhagesPregnancyPregnancy ComplicationsStrokeConceptsHemorrhagic strokeCesarean deliveryPregnant womenIschemic strokeGeneral anesthesiaObstetric anesthesiologistHigh-risk obstetriciansLarge stroke trialsPregnancy-related strokeHigh-risk groupRisk of herniationMaternal strokeObstetric indicationsTherapeutic anticoagulationExtremity weaknessStroke neurologistsAcute strokeDevastating complicationNeuraxial analgesiaNonpregnant womenStroke subtypesIntracranial hypertensionRecent strokeVaginal deliveryStroke trials
2019
Is Insufficient Evidence Sufficient?
Leffert LR. Is Insufficient Evidence Sufficient? Anesthesia & Analgesia 2019, 129: 1202-1204. PMID: 31613810, DOI: 10.1213/ane.0000000000004437.Peer-Reviewed Original ResearchFemaleHumansObstetricsPost-Dural Puncture HeadachePregnancyPregnancy ComplicationsRetrospective StudiesNational Partnership for Maternal Safety: Consensus Bundle on Obstetric Care for Women With Opioid Use Disorder.
Krans EE, Campopiano M, Cleveland LM, Goodman D, Kilday D, Kendig S, Leffert LR, Main EK, Mitchell KT, O'Gurek DT, D'Oria R, McDaniel D, Terplan M. National Partnership for Maternal Safety: Consensus Bundle on Obstetric Care for Women With Opioid Use Disorder. Obstetrics And Gynecology 2019, 134: 365-375. PMID: 31306323, DOI: 10.1097/aog.0000000000003381.Peer-Reviewed Original ResearchMeSH KeywordsFemaleHumansMaternal Health ServicesObstetricsOpioid-Related DisordersPatient SafetyPregnancyPregnancy ComplicationsWomen's HealthConceptsOpioid use disorderUse disordersConsensus BundleMaternal safetySubstance useObstetric careMajor patient safety issuePatient safety bundlePerinatal Quality CollaborativesNeonatal health outcomesHealth carePregnancy-associated morbidityEvidence-based recommendationsWomen's health careHealth care providersMaternity care settingsQuality improvement initiativesPatient safety issuesHealth care servicesNational PartnershipPublic health crisisSafety bundleFetal safetyEvidence-based practicePostpartum womenAcute Fatty Liver of Pregnancy: Pathophysiology, Anesthetic Implications, and Obstetrical Management.
Naoum EE, Leffert LR, Chitilian HV, Gray KJ, Bateman BT. Acute Fatty Liver of Pregnancy: Pathophysiology, Anesthetic Implications, and Obstetrical Management. Anesthesiology 2019, 130: 446-461. PMID: 30707120, PMCID: PMC7037575, DOI: 10.1097/aln.0000000000002597.Peer-Reviewed Original ResearchMeSH KeywordsAnesthesia, ObstetricalDelivery, ObstetricDisease ManagementFatty LiverFemaleHumansPregnancyPregnancy Complications
2015
Treatment patterns and short-term outcomes in ischemic stroke in pregnancy or postpartum period
Leffert LR, Clancy CR, Bateman BT, Cox M, Schulte PJ, Smith EE, Fonarow GC, Kuklina EV, George MG, Schwamm LH. Treatment patterns and short-term outcomes in ischemic stroke in pregnancy or postpartum period. American Journal Of Obstetrics And Gynecology 2015, 214: 723.e1-723.e11. PMID: 26709084, DOI: 10.1016/j.ajog.2015.12.016.Peer-Reviewed Original ResearchConceptsAcute stroke reperfusion therapyStroke reperfusion therapyShort-term outcomesTissue plasminogen activatorGuidelines-Stroke registryPregnancy-related strokeReperfusion therapyIschemic stroke patientsIschemic strokeNonpregnant womenPostpartum womenStroke patientsPlasminogen activatorPostpartum periodIntravenous tissue plasminogen activator useIntravenous tissue plasminogen activatorFavorable short-term outcomesTissue plasminogen activator useAcute reperfusion therapyCatheter-based thrombolysisGreater stroke severityMajor systemic bleedingNonpregnant women 18Symptomatic intracranial hemorrhageHistory of hypertensionElevated Upper Body Position Improves Pregnancy-Related OSA Without Impairing Sleep Quality or Sleep Architecture Early After Delivery
Zaremba S, Mueller N, Heisig AM, Shin CH, Jung S, Leffert LR, Bateman BT, Pugsley LJ, Nagasaka Y, Duarte IM, Ecker JL, Eikermann M. Elevated Upper Body Position Improves Pregnancy-Related OSA Without Impairing Sleep Quality or Sleep Architecture Early After Delivery. CHEST Journal 2015, 148: 936-944. PMID: 25905714, DOI: 10.1378/chest.14-2973.Peer-Reviewed Original ResearchConceptsUpper airway cross-sectional areaAirway cross-sectional areaApnea-hypopnea indexUpper body elevationCross-sectional areaUpper body positionBody positionSleep architectureEarly postpartum womenUpper bodyInstitutional review board approvalUpper airway resistanceSeverity of OSABody elevationTotal sleep timeReview board approvalMassachusetts General HospitalRespiratory safetySevere OSAAcoustic pharyngometryNonpregnant patientsPostpartum patientsAirway resistanceCrossover studySleep apneaContinuous Positive Airway Pressure with Pressure Support Ventilation Is Effective in Treating Acute-Onset Bilateral Recurrent Laryngeal Nerve Palsy
Leung Y, Fikry K, Shah B, Madapu M, Gaz RD, Leffert LR, Jiang Y. Continuous Positive Airway Pressure with Pressure Support Ventilation Is Effective in Treating Acute-Onset Bilateral Recurrent Laryngeal Nerve Palsy. A & A Case Reports 2015, 4: 155-157. PMID: 26035222, DOI: 10.1213/xaa.0000000000000150.Peer-Reviewed Original ResearchConceptsVocal cord paralysisContinuous positive airway pressurePositive airway pressureAirway pressureNerve injuryBilateral recurrent laryngeal nerve injuryBilateral recurrent laryngeal nerve palsyRecurrent laryngeal nerve injuryRecurrent laryngeal nerve palsyBilateral vocal cord paralysisAirway management strategiesEmergent surgical interventionLaryngeal nerve injuryLaryngeal nerve palsyIntraoperative nerve injuryPressure support ventilationNerve palsyFacemask ventilationSecure airwaySerious complicationsCord paralysisSupport ventilationSurgical interventionPotential complicationsNeck surgeryWhat’s New in Obstetric Anesthesia
Leffert L. What’s New in Obstetric Anesthesia. Anesthesia & Analgesia 2015, 120: 1065-1073. PMID: 25811260, DOI: 10.1213/ane.0000000000000686.Peer-Reviewed Original ResearchAnesthesia, ObstetricalDelivery, ObstetricFemaleHumansHypertension, Pregnancy-InducedInfantInfant, NewbornMaternal HealthMaternal Health ServicesMaternal MortalityNeonatologyPerinatal MortalityPerinatologyPostpartum HemorrhagePregnancyPregnancy ComplicationsPregnancy OutcomeRisk AssessmentRisk FactorsPregnancy complications in women with rare tumor suppressor syndromes affecting central and peripheral nervous system
Terry AR, Merker VL, Barker FG, Leffert L, Bateman BT, Souter I, Plotkin SR. Pregnancy complications in women with rare tumor suppressor syndromes affecting central and peripheral nervous system. American Journal Of Obstetrics And Gynecology 2015, 213: 108-109. PMID: 25687565, DOI: 10.1016/j.ajog.2015.02.013.Peer-Reviewed Original Research
2014
Opioid Abuse and Dependence during Pregnancy
Maeda A, Bateman BT, Clancy CR, Creanga AA, Leffert LR. Opioid Abuse and Dependence during Pregnancy. Anesthesiology 2014, 121: 1158-1165. PMID: 25405293, DOI: 10.1097/aln.0000000000000472.Peer-Reviewed Original ResearchConceptsOpioid abuseObstetrical outcomesIntrauterine growth restrictionNationwide Inpatient SampleObstetrical morbidityPlacental abruptionPreterm laborCesarean deliveryMaternal deathsPremature rupturePregnant womenCardiac arrestRelevant confoundersInpatient SampleGrowth restrictionPreventive strategiesTherapeutic interventionsPregnancyLogistic regressionNationwide trendsHospitalizationPrevalenceAbuseOutcomesUnited States
2013
Clinical care for opioid-using pregnant and postpartum women: the role of obstetric providers
Jones HE, Deppen K, Hudak ML, Leffert L, McClelland C, Sahin L, Starer J, Terplan M, Thorp JM, Walsh J, Creanga AA. Clinical care for opioid-using pregnant and postpartum women: the role of obstetric providers. American Journal Of Obstetrics And Gynecology 2013, 210: 302-310. PMID: 24120973, PMCID: PMC7213596, DOI: 10.1016/j.ajog.2013.10.010.Peer-Reviewed Original ResearchMeSH KeywordsAnalgesics, OpioidBuprenorphineConfidentialityDose-Response Relationship, DrugEmergency Service, HospitalFemaleHumansLabor PainLabor, ObstetricMental DisordersMethadoneNarcotic AntagonistsOpiate Substitution TreatmentOpioid-Related DisordersPain, PostoperativePhysician-Patient RelationsPostnatal CarePregnancyPregnancy ComplicationsPrenatal CareReferral and ConsultationTriageConceptsPregnant womenObstetric providersPostpartum periodPregnant patientsMixed opioid agonist/antagonistOpioid-dependent pregnant patientsOpioid-dependent pregnant womenOpioid agonist/antagonistHigh-quality obstetric careMedication-assisted withdrawalTherapeutic opioid useAcute pain managementHigh relapse rateDrug use disordersClinical care issuesIntense medical careBest possible outcomeOpioid withdrawalOpioid usePain managementRelapse rateObstetric carePostpartum womenComprehensive careClinical careEpidemiology of Obstetric-Related ICU Admissions in Maryland
Wanderer JP, Leffert LR, Mhyre JM, Kuklina EV, Callaghan WM, Bateman BT. Epidemiology of Obstetric-Related ICU Admissions in Maryland. Critical Care Medicine 2013, 41: 1844-1852. PMID: 23648568, PMCID: PMC3716838, DOI: 10.1097/ccm.0b013e31828a3e24.Peer-Reviewed Original ResearchMeSH KeywordsAbortion, InducedAdolescentAdultAnesthesia, ObstetricalBlack PeopleCerebrovascular DisordersEmergency Service, HospitalFemaleHeart DiseasesHumansInfectionsIntensive Care UnitsLength of StayLiver FailureMarylandMaternal AgeMedicaidPatient AdmissionPatient TransferPregnancyPregnancy ComplicationsPregnancy, EctopicPuerperal DisordersPulmonary EmbolismRespiratory InsufficiencyUnited StatesWounds and InjuriesYoung AdultConceptsICU admissionPregnancy-related hypertensive diseaseRate of sepsisCritical care managementAppropriate International ClassificationClinical Modification codesTransfer of womenEctopic pregnancyAnesthetic complicationsHypertensive diseaseICU populationICU utilizationPostpartum patientsPulmonary embolismGenitourinary infectionsSevere morbidityCommon diagnosisCerebrovascular diseaseObstetric servicesPostpartum periodPostpartum conditionsCardiac diseaseInternational ClassificationAdmissionCare managementNeurofibromatosis type 1 and pregnancy complications: a population-based study
Terry AR, Barker FG, Leffert L, Bateman BT, Souter I, Plotkin SR. Neurofibromatosis type 1 and pregnancy complications: a population-based study. American Journal Of Obstetrics And Gynecology 2013, 209: 46.e1-46.e8. PMID: 23535241, DOI: 10.1016/j.ajog.2013.03.029.Peer-Reviewed Original ResearchMeSH KeywordsAdultCesarean SectionFemaleFetal Growth RetardationHumansHypertension, Pregnancy-InducedInfant, NewbornInternational Classification of DiseasesLogistic ModelsMaternal MortalityNeurofibromatosis 1Obstetric Labor, PrematurePre-EclampsiaPregnancyPregnancy ComplicationsRetrospective StudiesUnited StatesConceptsNeurofibromatosis type 1Diagnosis of NF1Deep venous thrombosis/pulmonary embolismPopulation-based retrospective cohort studyVenous thrombosis/pulmonary embolismType 1Pregnancy-related admissionsPregnancy-related hospitalizationsRetrospective cohort studyGeneral obstetric populationAcute cardiac eventsIntrauterine growth restrictionMultivariable logistic regressionPopulation-based studyGestational hypertensionMaternal morbidityObstetric populationPregnancy complicationsPreterm laborCardiac eventsCesarean deliveryCohort studyPeripartum complicationsPulmonary embolismCerebrovascular disease
2011
Influence of Patient Comorbidities on the Risk of Near-miss Maternal Morbidity or Mortality
Mhyre J, Bateman B, Leffert L. Influence of Patient Comorbidities on the Risk of Near-miss Maternal Morbidity or Mortality. Anesthesiology 2011, 115: 963-972. PMID: 21934482, DOI: 10.1097/aln.0b013e318233042d.Peer-Reviewed Original ResearchMeSH KeywordsAdultComorbidityFemaleHumansLogistic ModelsMaternal MortalityPregnancyPregnancy ComplicationsRiskConceptsNear-miss morbidityMorbidity/mortalityMaternal morbidityNear-miss maternal morbidityImportant medical comorbiditiesEnd-organ injuryHigh-quality intrapartum careSystemic lupus erythematosusNationwide Inpatient SampleHigh-risk groupLength of stayMiss morbidityMedical comorbiditiesObstetric complicationsPulmonary hypertensionPatient comorbiditiesLupus erythematosusIntrapartum carePregnant womenNational burdenInpatient SampleMaternal characteristicsObstetric diseasesPublic health investmentDelivery outcomes