2018
Timing 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
Neuraxial Anesthesia in Obstetric Patients Receiving Thromboprophylaxis With Unfractionated or Low-Molecular-Weight Heparin
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. Anesthesia & Analgesia 2017, 125: 223-231. PMID: 28628578, DOI: 10.1213/ane.0000000000002173.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAnesthesia, ConductionAnesthesia, ObstetricalAnesthesiologyAnestheticsAnticoagulantsCesarean SectionDelivery, ObstetricFemaleHematoma, Epidural, SpinalHeparinHeparin, Low-Molecular-WeightHumansMiddle AgedNerve BlockPregnancyPregnancy Complications, CardiovascularThrombosisYoung AdultConceptsSpinal epidural hematomaCases of SEHNeuraxial anesthesiaObstetric patientsVenous thromboembolismWeight heparinAnesthesia Closed Claims Project databaseSystematic reviewPractice changePostpartum venous thromboembolismVaginal delivery hospitalizationsWeight heparin doseRisk of thromboembolismLarge-scale registriesMajority of womenEnglish-language studiesAnticoagulated womenDelivery hospitalizationsPharmacological thromboprophylaxisAnticoagulant doseCesarean deliveryEpidural hematomaHeparin doseVaginal deliveryGeneral anesthesiaRisk Factors for Pregnancy-Associated Stroke in Women With Preeclampsia
Miller EC, Gatollari HJ, Too G, Boehme AK, Leffert L, Marshall RS, Elkind MSV, Willey JZ. Risk Factors for Pregnancy-Associated Stroke in Women With Preeclampsia. Stroke 2017, 48: 1752-1759. PMID: 28546324, PMCID: PMC5539968, DOI: 10.1161/strokeaha.117.017374.Peer-Reviewed Original ResearchConceptsPregnancy-associated strokeRisk factorsChronic hypertensionProthrombotic stateOdds ratioMultivariable conditional logistic regression modelsConditional logistic regression modelsNew York State hospitalsIndependent risk factorVascular risk factorsSeverity of preeclampsiaLogistic regression modelsRace/ethnicityPregnancy complicationsSevere preeclampsiaMultivariable analysisInpatient DatabaseProthrombotic conditionsPreeclampsiaHigh riskClose monitoringNew York State DepartmentState HospitalCoagulopathyBilling data
2016
Risk of Pregnancy-Associated Stroke Across Age Groups in New York State
Miller EC, Gatollari HJ, Too G, Boehme AK, Leffert L, Elkind MS, Willey JZ. Risk of Pregnancy-Associated Stroke Across Age Groups in New York State. JAMA Neurology 2016, 73: 1461-1467. PMID: 27775757, DOI: 10.1001/jamaneurol.2016.3774.Peer-Reviewed Original ResearchConceptsPregnancy-associated strokePregnant/postpartum womenRisk of strokeIncidence risk ratioRisk factorsPostpartum womenAge groupsNonpregnant womenStroke riskOlder womenCumulative riskAge-specific incidence ratiosPost partumCalendar year 2003Cerebral venous thrombosisStroke risk factorsTransient ischemic attackVascular risk factorsOverall median ageLogistic regression modelsActive smokingChronic hypertensionIschemic attackNPAS groupCerebrovascular events
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 apneaPatient Characteristics and Outcomes After Hemorrhagic Stroke in Pregnancy
Leffert LR, Clancy CR, Bateman BT, Cox M, Schulte PJ, Smith EE, Fonarow GC, Schwamm LH, Kuklina EV, George MG. Patient Characteristics and Outcomes After Hemorrhagic Stroke in Pregnancy. Circulation Cardiovascular Quality And Outcomes 2015, 8: s170-s178. PMID: 26515206, DOI: 10.1161/circoutcomes.115.002242.Peer-Reviewed Original ResearchConceptsStroke risk factorsSubarachnoid hemorrhage patientsHemorrhagic strokeRisk factorsHS patientsHospital mortalityHemorrhage patientsDiseases-Ninth Revision codesBlood pressure criteriaGuidelines-Stroke registryPregnancy-related strokeAssociation of pregnancyNonpregnant female patientsConditional logistic regressionFisher's exact testWilcoxon rank sum testRank sum testGuidelines-StrokeSevere preeclampsiaHome dischargeIschemic strokeNonpregnant womenPatient characteristicsRisk patientsIndependent ambulationHypertensive Disorders and Pregnancy-Related Stroke
Leffert LR, Clancy CR, Bateman BT, Bryant AS, Kuklina EV. Hypertensive Disorders and Pregnancy-Related Stroke. Obstetrics And Gynecology 2015, 125: 124-131. PMID: 25560114, PMCID: PMC4445352, DOI: 10.1097/aog.0000000000000590.Peer-Reviewed Original ResearchConceptsTraditional stroke risk factorsPregnancy-associated strokeHypertensive disordersPregnancy hospitalizationsStroke risk factorsStroke-related complicationsStroke riskRisk factorsOdds ratioNationwide Inpatient SampleCongenital heart diseaseCross-sectional studyComplication rateStroke hospitalizationsInpatient SampleHeart diseaseNationwide rateHospitalizationPregnancyStrokeLogistic regressionCongenital coagulationDisordersConfidence intervalsComplications
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
Epidemiology 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 management
2012
The Association of Maternal Race and Ethnicity and the Risk of Postpartum Hemorrhage
Bryant A, Mhyre JM, Leffert LR, Hoban RA, Yakoob MY, Bateman BT. The Association of Maternal Race and Ethnicity and the Risk of Postpartum Hemorrhage. Anesthesia & Analgesia 2012, 115: 1127-1136. PMID: 22886840, DOI: 10.1213/ane.0b013e3182691e62.Peer-Reviewed Original ResearchOutcomes of hospitalization in pregnant women with CNS neoplasms: a population-based study
Terry AR, Barker FG, Leffert L, Bateman BT, Souter I, Plotkin SR. Outcomes of hospitalization in pregnant women with CNS neoplasms: a population-based study. Neuro-Oncology 2012, 14: 768-776. PMID: 22513749, PMCID: PMC3367848, DOI: 10.1093/neuonc/nos078.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultBostonBrain NeoplasmsCesarean SectionChildDelivery, ObstetricFemaleFetal Growth RetardationFollow-Up StudiesHospitalizationHumansMaternal MortalityObstetric Labor, PrematurePregnancyPregnancy Complications, NeoplasticPregnancy OutcomeRetrospective StudiesRisk FactorsSpinal NeoplasmsSurvival RateYoung AdultConceptsBenign brain tumorsIntrauterine growth restrictionMalignant brain tumorsNationwide Inpatient SamplePopulation-based studyCNS neoplasmsBrain tumorsCaesarean deliveryPreterm laborSpine tumorsPregnancy outcomesMaternal mortalityPregnancy-related admissionsAdverse pregnancy outcomesRetrospective cohort studyOutcomes of hospitalizationLogistic regression modelsPregnancy complicationsCohort studyHyperemesis gravidarumSurgical patientsObstetric riskPregnant womenInpatient SampleGrowth restrictionPeripartum Subarachnoid Hemorrhage
Bateman B, Olbrecht V, Berman M, Minehart R, Schwamm L, Leffert L. Peripartum Subarachnoid Hemorrhage. Anesthesiology 2012, 116: 324-333. PMID: 22166951, DOI: 10.1097/aln.0b013e3182410b22.Peer-Reviewed Original ResearchConceptsSubarachnoid hemorrhageHypertensive disordersRisk factorsPregnancy-related admissionsIndependent risk factorIntracranial venous thrombosisNationwide Inpatient SampleAfrican American raceVariety of etiologiesRange of etiologiesSickle cell diseaseIdentified admissionsHospital deathMaternal morbidityNonpregnant patientsNonpregnant womenIndependent predictorsMalignant etiologySevere headacheVenous thrombosisNonpregnant controlsPregnancy resultsVenous bleedingInstitution experienceInpatient Sample