2021
Call to Action: Maternal Health and Saving Mothers: A Policy Statement From the American Heart Association
Mehta LS, Sharma G, Creanga AA, Hameed AB, Hollier LM, Johnson JC, Leffert L, McCullough LD, Mujahid MS, Watson K, White CJ, Committee O. Call to Action: Maternal Health and Saving Mothers: A Policy Statement From the American Heart Association. Circulation 2021, 144: e251-e269. PMID: 34493059, DOI: 10.1161/cir.0000000000001000.Peer-Reviewed Original ResearchConceptsAmerican Heart AssociationMaternal healthMaternal outcomesHeart AssociationAmerican Heart Association MissionHigh maternal mortality rateMaternal mortality surveillanceReproductive health equityMaternal mortality rateDelivery of careMaternal morbidityCardiovascular diseaseMortality surveillanceSaving MothersChild healthMortality rateEpidemiological programEthnic disparitiesHealth equityTime courseHealthy lifeMother's lifeHealthCareOutcomesLabor prior to cesarean delivery associated with higher post-discharge opioid consumption
Ende HB, Landau R, Cole NM, Burns SM, Bateman BT, Bauer ME, Booth JL, Flood P, Leffert LR, Houle TT, Tsen LC. Labor prior to cesarean delivery associated with higher post-discharge opioid consumption. PLOS ONE 2021, 16: e0253990. PMID: 34242277, PMCID: PMC8270408, DOI: 10.1371/journal.pone.0253990.Peer-Reviewed Original ResearchConceptsDay of surgeryPostoperative pain scoresPain scoresOpioid utilizationOpioid useSurgical proceduresTime pointsHigher postoperative pain scoresPost-cesarean delivery painPost-discharge opioid consumptionAcute post-operative painComplications of CDMaximal pain scoresPost-cesarean analgesiaProspective cohort studyPost-operative painAdditional surgical proceduresNumeric rating scaleIdentification of womenAcademic medical centerNumber of tabletsSet of confoundersPhone two weeksOpioid consumptionOpioid requirementsThe Society for Obstetric Anesthesia and Perinatology Coronavirus Disease 2019 Registry: An Analysis of Outcomes Among Pregnant Women Delivering During the Initial Severe Acute Respiratory Syndrome Coronavirus-2 Outbreak in the United States
Katz D, Bateman BT, Kjaer K, Turner DP, Spence NZ, Habib AS, George RB, Toledano RD, Grant G, Madden HE, Butwick AJ, Lynde G, Minehart RD, Beilin Y, Houle TT, Sharpe EE, Kodali B, Bharadwaj S, Farber MK, Palanisamy A, Prabhu M, Gonzales NY, Landau R, Leffert L. The Society for Obstetric Anesthesia and Perinatology Coronavirus Disease 2019 Registry: An Analysis of Outcomes Among Pregnant Women Delivering During the Initial Severe Acute Respiratory Syndrome Coronavirus-2 Outbreak in the United States. Anesthesia & Analgesia 2021, 133: 462-473. PMID: 33830956, DOI: 10.1213/ane.0000000000005592.Peer-Reviewed Original ResearchMeSH KeywordsAdultAnalgesia, ObstetricalAnesthesia, GeneralAnesthesia, ObstetricalCase-Control StudiesCesarean SectionCOVID-19Delivery, ObstetricFemaleGestational AgeHumansInfant, PrematurePregnancyPregnancy Complications, InfectiousPremature BirthRegistriesRisk AssessmentRisk FactorsUnited StatesYoung AdultConceptsSARS-CoV-2 patientsSARS-CoV-2 infectionWeeks of gestationCesarean deliveryObstetric anesthesiaPositive SARS-CoV-2 polymerase chain reaction testSARS-CoV-2 polymerase chain reaction testAcute respiratory syndrome coronavirus 2 infectionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectionSARS-CoV-2-infected patientsSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreakSyndrome coronavirus 2 infectionMaternal respiratory failureAdverse pregnancy outcomesCoronavirus 2 infectionNeuraxial labor analgesiaUS cohort studyDays of deliveryUS medical centersPolymerase chain reaction testComposite outcome measureAnalysis of outcomesChain reaction testPeripartum outcomesAsymptomatic patients#MaternalStroke Trending Now
Miller EC, Leffert L. #MaternalStroke Trending Now. Neurology 2021, 96: 973-974. PMID: 33827955, DOI: 10.1212/wnl.0000000000011995.Peer-Reviewed Original ResearchThe Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia
Bauer ME, Arendt K, Beilin Y, Gernsheimer T, Perez Botero J, James AH, Yaghmour E, Toledano RD, Turrentine M, Houle T, MacEachern M, Madden H, Rajasekhar A, Segal S, Wu C, Cooper JP, Landau R, Leffert L. The Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia. Anesthesia & Analgesia 2021, 132: 1531-1544. PMID: 33861047, DOI: 10.1213/ane.0000000000005355.Peer-Reviewed Original ResearchConceptsSpinal epidural hematomaObstetric patientsNeuraxial proceduresImmune thrombocytopeniaEpidural hematomaGeneral anesthesiaRisk factorsObstetric risk factorsRisk-benefit discussionsDiagnosis of thrombocytopeniaRelevant professional societiesInterdisciplinary consensus statementGestational thrombocytopeniaThrombocytopenia etiologyHypertensive disordersPatient comorbiditiesCesarean deliveryProfessional societiesAirway examinationPotential morbidityPlatelet countPatient preferencesObstetric anesthesiaAirway equipmentAffected patients
2020
Gestational Hypertension: The Pregnancy Stress Test for Cognitive Impairment.
Leffert L, Prodan C, Peters N. Gestational Hypertension: The Pregnancy Stress Test for Cognitive Impairment. Neurology 2020, 96: 193-194. PMID: 33380499, DOI: 10.1212/wnl.0000000000011364.Peer-Reviewed Original ResearchPragmatic approach to neuraxial anesthesia in obstetric patients with disorders of the vertebral column, spinal cord and neuromuscular system
Walsh E, Zhang Y, Madden H, Lehrich J, Leffert L. Pragmatic approach to neuraxial anesthesia in obstetric patients with disorders of the vertebral column, spinal cord and neuromuscular system. Regional Anesthesia & Pain Medicine 2020, 46: 258-267. PMID: 33115718, DOI: 10.1136/rapm-2020-101792.Peer-Reviewed Original ResearchConceptsNeuraxial anesthesiaObstetric patientsSpinal cordCesarean delivery anesthesiaCesarean deliveryLabor analgesiaNeuraxial analgesiaVertebral columnCase seriesGeneral anesthesiaObstetrical patientsRetrospective studyDelivery anesthesiaPatient injuryAnesthesiaPatient harmPatientsNarrative reviewAvailable evidenceUnwarranted fearsNeuromuscular systemAdditional riskPresent unique challengesAnalgesiaCordGloving up for the fight against racial and ethnic disparities in obstetric anesthesia care
Lee A, Leffert L. Gloving up for the fight against racial and ethnic disparities in obstetric anesthesia care. Journal Of Clinical Anesthesia 2020, 67: 109988. PMID: 32711352, DOI: 10.1016/j.jclinane.2020.109988.Peer-Reviewed Original ResearchStroke 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 ResearchConceptsHemorrhagic 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
Risk Factors, Etiologies, and Screening Tools for Sepsis in Pregnant Women
Bauer ME, Housey M, Bauer ST, Behrmann S, Chau A, Clancy C, Clark EAS, Einav S, Langen E, Leffert L, Lin S, Madapu M, Maile MD, McQuaid-Hanson E, Priessnitz K, Sela HY, Shah A, Sobolewski P, Toledo P, Tsen LC, Bateman BT. Risk Factors, Etiologies, and Screening Tools for Sepsis in Pregnant Women. Anesthesia & Analgesia 2019, Publish Ahead of Print: &na;. PMID: 31743182, PMCID: PMC7543988, DOI: 10.1213/ane.0000000000003709.Peer-Reviewed Original ResearchConceptsSystemic inflammatory response syndromeQuick Sequential Organ Failure AssessmentRisk factorsDelivery hospitalizationsMaternal sepsisSepsis casesCommon causeMortality rateMaternal Early Warning CriteriaSequential Organ Failure AssessmentScreening toolHours of diagnosisTiming of antibioticsOrgan Failure AssessmentCohort of patientsInflammatory response syndromePotential risk factorsHalf of casesAcademic medical centerDate of deliveryQSOFA criteriaControl patientsAntibiotic therapyResponse syndromeSignificant morbidityIs 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 ResearchNational 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 ResearchConceptsOpioid 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 womenDon’t throw the baby out with the bathwater: spinal-epidural hematoma in the setting of obstetric thromboprophylaxis and neuraxial anesthesia
Leffert L, Horlocker T, Landau R. Don’t throw the baby out with the bathwater: spinal-epidural hematoma in the setting of obstetric thromboprophylaxis and neuraxial anesthesia. International Journal Of Obstetric Anesthesia 2019, 39: 7-11. PMID: 31202587, DOI: 10.1016/j.ijoa.2019.05.001.Peer-Reviewed Original ResearchAcute 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 Research
2018
Implementation of a Quality Improvement Initiative to Decrease Opioid Prescribing After Cesarean Delivery
Prabhu M, Dubois H, James K, Leffert LR, Riley LE, Bateman BT, Henderson M. Implementation of a Quality Improvement Initiative to Decrease Opioid Prescribing After Cesarean Delivery. Obstetrics And Gynecology 2018, 132: 631-636. PMID: 30095765, PMCID: PMC6105442, DOI: 10.1097/aog.0000000000002789.Peer-Reviewed Original ResearchConceptsOpioid refill ratesOpioid tabletsCesarean deliveryOpioid prescribingRefill ratesAnalgesic useMean numberProspective quality improvement studyNonopioid analgesic useDays of dischargeNumber of opioidsPhase 2Quality improvement protocolPhase 1Quality improvement studyQuality improvement initiativesQuality improvement effortsDischarge providersAnalgesic prescriptionOpioid prescriptionsSecondary outcomesDischarge prescriptionsPrimary outcomeΧ analysisOpioidsCanadian Stroke Best Practice Consensus Statement: Acute Stroke Management during pregnancy
Ladhani NNN, Swartz RH, Foley N, Nerenberg K, Smith EE, Gubitz G, Dowlatshahi D, Potts J, Ray JG, Barrett J, Bushnell C, Bal S, Chan WS, Chari R, Amrani M, Gandhi S, Hill MD, James A, Jeerakathil T, Jin A, Kirton A, Lanthier S, Lausman A, Leffert LR, Mandzia J, Menon B, Pikula A, Poppe A, Saposnik G, Sharma M, Bhogal S, Smitko E, Lindsay MP. Canadian Stroke Best Practice Consensus Statement: Acute Stroke Management during pregnancy. International Journal Of Stroke 2018, 13: 743-758. PMID: 30021491, DOI: 10.1177/1747493018786617.Peer-Reviewed Original ResearchConceptsAcute stroke managementStroke managementConsensus statementPost-stroke managementSecondary stroke preventionAcute stroke treatmentGroup of patientsInitial emergency managementBest available literatureStroke preventionAcute strokePostpartum managementAnesthetic managementHemorrhagic strokeStroke treatmentObstetric carePregnant womenMaternal healthPrior historyClinical considerationsConsensus documentPregnancyExpert consensusStrokeHealthcare professionalsThe Role of the Anesthesiologist in Preventing Severe Maternal Morbidity and Mortality
McQUAID E, Leffert LR, Bateman BT. The Role of the Anesthesiologist in Preventing Severe Maternal Morbidity and Mortality. Clinical Obstetrics & Gynecology 2018, 61: 372-386. PMID: 29319586, DOI: 10.1097/grf.0000000000000350.Peer-Reviewed Original ResearchMeSH KeywordsAirway ManagementAnesthesia, EpiduralAnesthesia, GeneralAnesthesiologistsAnesthetics, LocalBlood TransfusionEchocardiographyEpidural AbscessFemaleHeadacheHematoma, Epidural, SpinalHumansIntubation, IntratrachealMaternal DeathMeningitisMonitoring, PhysiologicObstetric Labor ComplicationsPhysician's RolePregnancyPuerperal DisordersRespiratory AspirationRisk FactorsConceptsObstetric anesthesiologistSevere maternal morbidityLife-saving interventionsMaternal morbidityCesarean deliveryUnstable patientsGeneral anesthesiaObstetric suiteObstetric proceduresBedside managementClinical scenariosAnesthesiologistsIntensivistsAnesthesiaGreater experienceDeliveryAnalgesiaMorbidityPatientsUnique roleMortalityCliniciansThe Society for Obstetric Anesthesia and Perinatology Consensus Statement on the Anesthetic Management of Pregnant and Postpartum Women Receiving Thromboprophylaxis or Higher Dose Anticoagulants
Leffert L, Butwick A, Carvalho B, Arendt K, Bates SM, Friedman A, Horlocker T, Houle T, Landau R, Dubois H, Fernando R, Houle T, Kopp S, Montgomery D, Pellegrini J, Smiley R, Toledo P. The Society for Obstetric Anesthesia and Perinatology Consensus Statement on the Anesthetic Management of Pregnant and Postpartum Women Receiving Thromboprophylaxis or Higher Dose Anticoagulants. Anesthesia & Analgesia 2018, 126: 928-944. PMID: 29099429, DOI: 10.1213/ane.0000000000002530.Peer-Reviewed Original ResearchConceptsHigh-dose anticoagulantsConsensus statementMaternal deathsObstetric anesthesiaNeuraxial proceduresPerinatology Consensus StatementPharmacodynamics of anticoagulantsUse of thromboprophylaxisRisk-benefit discussionsKey preventive measuresObstetric populationObstetric surgeryCesarean deliveryNeuraxial analgesiaVenous thromboembolismAnesthetic managementObstetric patientsDifficult airwayNeuraxial anesthesiaGeneral anesthesiaPostpartum womenPregnant womenFetal harmPostpartum periodLeading causeTiming and Risk Factors of Postpartum Stroke
Too G, Wen T, Boehme AK, Miller EC, Leffert LR, Attenello FJ, Mack WJ, D'Alton M, Friedman AM. Timing and Risk Factors of Postpartum Stroke. Obstetrics And Gynecology 2018, 131: 70-78. PMID: 29215510, PMCID: PMC6402829, DOI: 10.1097/aog.0000000000002372.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultCohort StudiesConfidence IntervalsCost-Benefit AnalysisDatabases, FactualFemaleHumansHypertension, Pregnancy-InducedMaternal AgeOdds RatioPatient DischargePatient ReadmissionPostpartum PeriodPre-EclampsiaPregnancyPregnancy, High-RiskPrognosisRetrospective StudiesRisk AssessmentStrokeTime FactorsYoung AdultConceptsChronic hypertensionDays of dischargeNationwide Readmissions DatabaseHypertensive diseasePostpartum strokeStroke readmissionDelivery hospitalizationsIndex hospitalizationOdds ratioUtilization Project Nationwide Readmissions DatabaseOptimal blood pressure managementDelivery hospitalization dischargeRetrospective cohort studyBlood pressure managementRisk of readmissionCases of strokeMajority of readmissionsCases of readmissionCalendar year 2013Hospitalization dischargeCohort studyHospital dischargeMedian timeReadmission riskRisk factors
2017
Canadian stroke best practice consensus statement: Secondary stroke prevention during pregnancy
Swartz RH, Ladhani NNN, Foley N, Nerenberg K, Bal S, Barrett J, Bushnell C, Chan WS, Chari R, Dowlatshahi D, Amrani ME, Gandhi S, Gubitz G, Hill MD, James A, Jeerakathil T, Jin A, Kirton A, Lanthier S, Lausman A, Leffert LR, Mandzia J, Menon B, Pikula A, Poppe A, Potts J, Ray J, Saposnik G, Sharma M, Smith EE, Bhogal S, Smitko E, Lindsay MP. Canadian stroke best practice consensus statement: Secondary stroke prevention during pregnancy. International Journal Of Stroke 2017, 13: 406-419. PMID: 29171360, DOI: 10.1177/1747493017743801.Peer-Reviewed Original ResearchMeSH KeywordsAnticoagulantsAntihypertensive AgentsCanadaCounselingDiabetes, GestationalDiabetic AngiopathiesFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsHypertensionIschemic Attack, TransientPlatelet Aggregation InhibitorsPostnatal CarePreconception CarePregnancyPregnancy Complications, CardiovascularPregnancy in DiabeticsPrenatal CareProfessional PracticeRisk FactorsSecondary PreventionStrokeConceptsSecondary stroke preventionStroke preventionConsensus statementUse of antithromboticsTransient ischemic attackBlood pressure managementIschemic stroke etiologyAspects of pregnancyHealth care professionalsGeneral management considerationsBest available literatureIschemic attackRecurrent strokeLipid managementStroke etiologyStroke riskFetal healthMaternal healthPrior historyFetal wellbeingCare professionalsClinical considerationsPregnancyConsensus documentExpert consensus