Kathleen Carey Minor

All Publications

• Prenatal Diagnosis of a Large Lymphovascular Malformation. NeoReviews Chitkara, R., Teng, J., Rubesova, E., Matalon, D. R., Minor, K., Gilbert, M., Kobayashi, D., Hintz, S. 2025; 26 (11): e792-e799

  View details for DOI 10.1542/neo.26-11-073

  View details for PubMedID 41173299

• Virtual simulation training for postpartum hemorrhage in low-to-moderate-volume hospitals in the US. AJOG global reports Minor, K. C., Bianco, K., Mayo, J. A., Abir, G., Judy, A. E., Lee, H. C., Leonard, S. A., Ayotte, S., Hedli, L. C., Schaffer, K., Sie, L., Daniels, K. 2024; 4 (3): 100357

  Abstract

  Maternal mortality in the United States is rising and many deaths are preventable. Emergencies, such as postpartum hemorrhage, occur less frequently in non-teaching, rural, and urban low-birth volume hospitals. There is an urgent need for accessible, evidence-based, and sustainable inter-professional education that creates the opportunity for clinical teams to practice their response to rare, but potentially devastating events.To assess the feasibility of virtual simulation training for the management of postpartum hemorrhage in low-to-moderate-volume delivery hospitals.The study occurred between December 2021 and March 2022 within 8 non-academic hospitals in the United States with low-to-moderate-delivery volumes, randomized to one of two models: direct simulation training and train-the-trainer. In the direct simulation training model, simulation faculty conducted a virtual simulation training program with participants. In the train-the-trainer model, simulation faculty conducted virtual lessons with new simulation instructors on how to prepare and conduct a simulation course. Following this training, the instructors led their own simulation training program at their respective hospitals. The direct simulation training participants and students trained by new instructors from the train-the-trainer program were evaluated with a multiple-choice questionnaire on postpartum hemorrhage knowledge and a confidence and attitude survey at 3 timepoints: prior to, immediately after, and at 3 months post-training. Paired t-tests were performed to assess for changes in knowledge and confidence within teaching models across time points. ANOVA was performed to test cross-sectionally for differences in knowledge and confidence between teaching models at each time point.Direct simulation training participants (n=22) and students of the train-the-trainer instructors (n=18) included nurses, certified nurse midwives and attending physicians in obstetrics, family practice or anesthesiology. Mean pre-course knowledge and confidence scores were not statistically different between direct simulation participants and the students of the instructors from the train-the-trainer course (79%+/-13 versus 75%+/-14, respectively, P-value=.45). Within the direct simulation group, knowledge and confidence scores significantly improved from pre- to immediately post-training (knowledge score mean difference 9.81 [95% CI 3.23-16.40], P-value<.01; confidence score mean difference 13.64 [95% CI 6.79-20.48], P-value<.01), which were maintained 3-months post-training. Within the train-the-trainer group, knowledge and confidence scores immediate post-intervention were not significantly different compared with pre-course or 3-month post-course scores. Mean knowledge scores were significantly greater for the direct simulation group compared to the train-the-trainer group immediately post-training (89%+/-7 versus 74%+/-8, P-value<.01) and at 3-months (88%+/-7 versus 76%+/-12, P-value<.01). Comparisons between groups showed no difference in confidence and attitude scores at these timepoints. Both direct simulation participants and train-the-trainer instructors preferred virtual education, or a hybrid structure, over in-person education.Virtual education for obstetric simulation training is feasible, acceptable, and effective. Utilizing a direct simulation model for postpartum hemorrhage management resulted in enhanced knowledge acquisition and retention compared to a train-the-trainer model.

  View details for DOI 10.1016/j.xagr.2024.100357

  View details for PubMedID 38975047

  View details for PubMedCentralID PMC11227018

• Magnesium sulfate and risk of hypoxic ischemic encephalopathy in a high-risk cohort. American journal of obstetrics and gynecology Minor, K. C., Liu, J., Druzin, M. L., El-Sayed, Y. Y., Hintz, S. R., Bonifacio, S. L., Leonard, S. A., Lee, H. C., Profit, J., Karakash, S. D. 2024

  Abstract

  Hypoxic ischemic encephalopathy contributes to morbidity and mortality among neonates ≥ 360 weeks' gestation. Evidence of preventative antenatal treatment is limited. Magnesium sulfate has neuroprotective properties among preterm fetuses. Hypertensive disorders of pregnancy are a risk factor for hypoxic ischemic encephalopathy and magnesium sulfate is recommended for maternal seizure prophylaxis among patients with pre-eclampsia with severe features.1) Determine trends in incidence of hypertensive disorders of pregnancy, antenatal magnesium sulfate and hypoxic ischemic encephalopathy, 2) evaluate the association between hypertensive disorders of pregnancy and hypoxic ischemic encephalopathy and 3) evaluate if, among patients with hypertensive disorders of pregnancy, the odds of hypoxic ischemic encephalopathy is mitigated by receipt of antenatal magnesium sulfate. STUDY DESIGN: We conducted an analysis of a prospective cohort of live births ≥360 weeks' gestation between 2012-2018 within the California Perinatal Quality Care Collaborative registry, linked with the California Department of Health Care Access and Information files. We used Cochran-Armitage tests to assess trends in hypertensive disorders, encephalopathy diagnoses, and magnesium sulfate utilization, and compared demographic factors between patients with or without hypertensive disorders of pregnancy or treatment with magnesium sulfate. Hierarchical logistic regression models were built to explore if hypertensive disorders of pregnancy were associated with any severity and moderate/severe hypoxic ischemic encephalopathy. Separate hierarchical logistic regression models were built among those with hypertensive disorders of pregnancy to evaluate the association of magnesium sulfate with hypoxic ischemic encephalopathy.Among 44,314 unique infants, the diagnosis of hypoxic ischemic encephalopathy, maternal hypertensive disorders of pregnancy and the use of magnesium sulfate increased over time. Compared to patients with hypertensive disorders of pregnancy alone, patients with hypertensive disorders treated with magnesium sulfate represented a higher risk population. They were more likely to be publicly insured, born 36-38 weeks' gestation, be small for gestational age, have lower Apgar scores, require a higher level of resuscitation at delivery, have prolonged rupture of membranes, preterm labor, fetal distress, and undergo operative delivery (all p-values <0.002). Hypertensive disorders of pregnancy were associated with hypoxic ischemic encephalopathy (aOR 1.26, 95% CI 1.13-1.40, p-value <.001) and specifically moderate/severe hypoxic ischemic encephalopathy (aOR 1.26, 95% CI 1.11-1.42, p-value <.001). Among patients with hypertensive disorders of pregnancy, treatment with magnesium sulfate was associated with 29% reduction in the odds of neonatal hypoxic ischemic encephalopathy (aOR 0.71, 95% CI 0.52-0.97, p-value= 0.03) and a 37% reduction in the odds of moderate/severe neonatal hypoxic ischemic encephalopathy (aOR 0.63, 95% CI 0.42-0.94, p-value=0.03).Hypertensive disorders of pregnancy are associated with hypoxic ischemic encephalopathy and specifically, moderate/severe disease. Among people with hypertensive disorders, receipt of antenatal magnesium sulfate is associated with significant reduction in the odds of hypoxic ischemic encephalopathy and moderate/severe disease in a neonatal cohort admitted to the NICU ≥360 weeks' gestation. The findings of this observational study cannot prove causality and are intended to be hypothesis generating for future clinical trials on MgSO4 in term infants.

  View details for DOI 10.1016/j.ajog.2024.04.001

  View details for PubMedID 38580044

• Understanding the distinction between cleft lip and cleft palate: a critical step for successful prenatal detection. Current opinion in obstetrics & gynecology Minor, K., Chueh, J. 2023

  Abstract

  Orofacial clefts (OCs) are among the most common congenital anomalies, however, prenatal detection of cleft palate without cleft lip (CP) remains low. CP is associated with a higher risk of associated structural anomalies, recurrence risk and genetic aberrations. There is opportunity to optimize prenatal diagnosis, counseling and diagnostic genetic testing for OCs.Improving prenatal diagnosis of CP requires understanding that embryologically, the secondary palate develops from the 6th to the 10th week and fuses with the primary palate by the 12th week. Multiple first, second and third trimester 2D ultrasonographic markers for OCs have been described including the maxillary gap, frontal space, maxilla-nasion-mandible angle, retronasal triangle, palatino-maxillary diameter, equal sign, nonvisualization or gap in the soft to hard palate interface and loss of the superimposed line. We discuss the technique, evidence and limitations of each.Prenatal detection of OC can be optimized by employing 2D sonographic markers. Prenatal detection of CP may be improved by recognizing its high association with retrognathia/micrognathia.

  View details for DOI 10.1097/GCO.0000000000000852

  View details for PubMedID 36912278

• In Virtual Simulation is Teaching to Fish Better Than Giving a Fish? Bianco, K., Minor, K., Schaffer, K., Sei, L., Mayo, J., Leonard, S. A., Daniels, K. SPRINGER HEIDELBERG. 2023: 215A-216A

  View details for Web of Science ID 001043029500432

• A novel virtual simulation training improves providers' knowledge and confidence to manage obstetric emergencies Minor, K. C., Mayo, J. A., Bianco, K., Judy, A., Abir, G., Lee, H. C., Leonard, S. A., Sie, L., Ayotte, S., Daniels, K. I. MOSBY-ELSEVIER. 2023: S160

  View details for Web of Science ID 000909337400230

• Severity of small-for-gestational-age and morbidity and mortality among very preterm neonates. Journal of perinatology : official journal of the California Perinatal Association Minor, K. C., Bianco, K., Sie, L., Druzin, M. L., Lee, H. C., Leonard, S. A. 2022

  Abstract

  Evaluate the association between small for gestational age (SGA) severity and morbidity and mortality in a contemporary, population of very preterm infants.This secondary analysis of a California statewide database evaluated singleton infants born during 2008-2018 at 24-32 weeks' gestation, with a birthweight <15th percentile. We analyzed neonatal outcomes in relation to weight for gestational age (WGA) and symmetry of growth restriction.An increase in WGA by one z-score was associated with decreased major morbidity or mortality risk (aRR 0.73, 95% CI 0.68-0.77) and other adverse outcomes. The association was maintained across gestational ages and did not differ by fetal growth restriction diagnosis. Symmetric growth restriction was not associated with neonatal outcomes after standardizing for gestational age at birth.Increasing SGA severity had a significant impact on neonatal outcomes among very preterm infants.

  View details for DOI 10.1038/s41372-022-01544-w

  View details for PubMedID 36302849

• Preterm twin gestation: The association between severity of small for gestational age and neonatal outcomes Miller, H. E., Sie, L., Minor, K. C., Bianco, K., Druzin, M. L., Lee, H. C., Leonard, S. A. MOSBY-ELSEVIER. 2022: S391-S392

  View details for Web of Science ID 000737459400587

• Lessons learned in maternal cardiopulmonary arrest simulation: where should educational efforts be concentrated? Minor, K. C., Trepman, P., Miller, H. E., Judy, A., Arafeh, J., Jayaraman, T., Druzin, M. L., Harney, K. MOSBY-ELSEVIER. 2022: S718

  View details for Web of Science ID 000737459401488

• Does magnesium sulfate for hypertensive disease reduce the risk of neonatal hypoxic ischemic encephalopathy? Minor, K. C., Liu, J., El-Sayed, Y. Y., Druzin, M. L., Profit, J., Hintz, S., Bonifacio, S., Leonard, S. A., Karakash, S. MOSBY-ELSEVIER. 2022: S526

  View details for Web of Science ID 000737459401175

• Hypoxic ischemic encephalopathy: Do peripartum risk factors account for observed changes in incidence? Minor, K. C., Liu, J., El-Sayed, Y. Y., Druzin, M. L., Profit, J., Hintz, S., Bonifacio, S., Karakash, S. MOSBY-ELSEVIER. 2022: S210

  View details for Web of Science ID 000737459400295

• Outcomes in pregnancies complicated by IUGR before 32 weeks: does the degree of SGA matter? Minor, K., Bianco, K., Sie, L., Druzin, M. L., Lee, H. C., Leonard, S. A. MOSBY-ELSEVIER. 2021: S519

  View details for Web of Science ID 000621547401378