- Obstetrics and Gynecology
Clinical Assistant Professor, Obstetrics & Gynecology - Maternal Fetal Medicine
Board Certification: American Board of Obstetrics and Gynecology, Maternal and Fetal Medicine (2023)
Board Certification: American Board of Preventive Medicine, Clinical Informatics (2022)
Board Certification, American Board of Preventative Medicine, Clinical Informatics (2022)
Fellowship: Stanford University Clinical Informatics Fellowship (2021) CA
Fellowship: Stanford University Maternal Fetal Medicine Fellowship (2021) CA
Board Certification: American Board of Obstetrics and Gynecology, Obstetrics and Gynecology (2019)
Residency: Stanford University Medical Center (2017) CA
Medical Education: Washington University in St Louis Registrar (2013) MO
Practice patterns and telehealth usage of maternal fetal medicine providers by US region and urbanicity
MOSBY-ELSEVIER. 2022: S175-S176
View details for Web of Science ID 000737459400241
Telehealth barriers in maternal fetal medicine providers by patient insurance status
MOSBY-ELSEVIER. 2022: S735
View details for Web of Science ID 000737459401514
Barriers to telehealth usage by maternal fetal medicine providers by US region and urbanicity
MOSBY-ELSEVIER. 2022: S88-S89
View details for Web of Science ID 000737459400099
Enhanced recovery after surgery for cesarean delivery.
Current opinion in obstetrics & gynecology
PURPOSE OF REVIEW: The aim of this article is to describe enhanced recovery after surgery (ERAS) and its application to cesarean delivery.RECENT FINDINGS: ERAS is a standardized, multidisciplinary approach to improving the care of surgical patients, from the preoperative planning through the surgery and postoperative period. ERAS is associated with many benefits, including improved patient outcomes and satisfaction as well as reduced length-of-stay and cost. Obstetric implementation of ERAS protocols has lagged compared to other surgical subspecialties. Given the volume of cesarean deliveries worldwide, improving the quality and cost of care through broad application of ERAS could have significant benefits.SUMMARY: ERAS pathways specific to cesarean delivery should be implemented and can improve the quality of care provided.
View details for DOI 10.1097/GCO.0000000000000616
View details for PubMedID 32068543
- Acceptability of postnatal mood management through a smartphone-based automated conversational agent MOSBY-ELSEVIER. 2020: S62
- Effect of an automated conversational agent on postpartum mental health: A randomized, controlled trial MOSBY-ELSEVIER. 2020: S91
Abnormal uterine bleeding patterns determined through menstrual tracking among participants in the Apple Women's Health Study.
American journal of obstetrics and gynecology
BACKGROUND: Use of menstrual tracking data to understand abnormal bleeding patterns has been limited because of lack of incorporation of key demographic and health characteristics and confirmation of menstrual tracking accuracy.OBJECTIVE: This study aimed to identify abnormal uterine bleeding patterns and their prevalence and confirm existing and expected associations between abnormal uterine bleeding patterns, demographics, and medical conditions.STUDY DESIGN: Apple Women's Health Study participants from November 2019 through July 2021 who contributed menstrual tracking data and did not report pregnancy, lactation, use of hormones, or menopause were included in the analysis. Four abnormal uterine bleeding patterns were evaluated: irregular menses, infrequent menses, prolonged menses, and irregular intermenstrual bleeding (spotting). Monthly tracking confirmation using survey responses was used to exclude inaccurate or incomplete digital records. We investigated the prevalence of abnormal uterine bleeding stratified by demographic characteristics and used logistic regression to evaluate the relationship of abnormal uterine bleeding to a number of self-reported medical conditions.RESULTS: There were 18,875 participants who met inclusion criteria, with a mean age of 33 (standard deviation, 8.2) years, mean body mass index of 29.3 (standard deviation, 8.0), and with 68.9% (95% confidence interval, 68.2-69.5) identifying as White, non-Hispanic. Abnormal uterine bleeding was found in 16.4% of participants (n=3103; 95% confidence interval, 15.9-17.0) after accurate tracking was confirmed; 2.9% had irregular menses (95% confidence interval, 2.7-3.1), 8.4% had infrequent menses (95% confidence interval, 8.0-8.8), 2.3% had prolonged menses (95% confidence interval, 2.1-2.5), and 6.1% had spotting (95% confidence interval, 5.7-6.4). Black participants had 33% higher prevalence (prevalence ratio, 1.33; 95% confidence interval, 1.09-1.61) of infrequent menses compared with White, non-Hispanic participants after controlling for age and body mass index. The prevalence of infrequent menses was increased in class 1, 2, and 3 obesity (class 1: body mass index, 30-34.9; prevalence ratio, 1.31; 95% confidence interval, 1.13-1.52; class 2: body mass index, 35-39.9; prevalence ratio, 1.25; 95% confidence interval, 1.05-1.49; class 3: body mass index, >40; prevalence ratio, 1.51; 95% confidence interval, 1.21-1.88) after controlling for age and race/ethnicity. Those with class 3 obesity had 18% higher prevalence of abnormal uterine bleeding compared with healthy-weight participants (prevalence ratio, 1.18; 95% confidence interval, 1.02-1.38). Participants with polycystic ovary syndrome had 19% higher prevalence of abnormal uterine bleeding compared with participants without this condition (prevalence ratio, 1.19; 95% confidence interval, 1.08-1.31). Participants with hyperthyroidism (prevalence ratio, 1.34; 95% confidence interval, 1.13-1.59) and hypothyroidism (prevalence ratio, 1.17; 95% confidence interval, 1.05-1.31) had a higher prevalence of abnormal uterine bleeding, as did those reporting endometriosis (prevalence ratio, 1.28; 95% confidence interval, 1.12-1.45), cervical dysplasia (prevalence ratio, 1.20; 95% confidence interval, 1.03-1.39), and fibroids (prevalence ratio, 1.14; 95% confidence interval, 1.00-1.30).CONCLUSION: In this cohort, abnormal uterine bleeding was present in 16.4% of those with confirmed menstrual tracking. Black or obese participants had increased prevalence of abnormal uterine bleeding. Participants reporting conditions such as polycystic ovary syndrome, thyroid disease, endometriosis, and cervical dysplasia had a higher prevalence of abnormal uterine bleeding.
View details for DOI 10.1016/j.ajog.2022.10.029
View details for PubMedID 36414993
Use of Telehealth During the COVID-19 Pandemic Among Practicing Maternal-Fetal Medicine Clinicians.
Telemedicine journal and e-health : the official journal of the American Telemedicine Association
Background: Limited knowledge exists about the drivers of telehealth use among obstetricians during COVID-19 in the United States. We investigated the use of live video visits by Maternal-Fetal Medicine (MFM) clinicians, the factors associated with use and interest in future use. Methods: We drew survey data from 373 clinicians on two outcomes: (1) use of any (vs. no) live video visits during COVID-19 and (2) among users, the extent of live video use. Bivariate and multivariate logistic regressions quantified the association between predisposing (demographic and practice setting characteristics) and enabling factors (prepandemic telehealth use, structural and perceived patient barriers) and each outcome. Results: During the pandemic, 88% reported any use, a jump from 29% prepandemic utilization. Users (vs. nonusers) were younger (p=0.02); tended to provide comprehensive prenatal care (p=0.01) and/or inpatient care (p=0.02), practice in university settings (p=0.01), engage in various telehealth modalities prepandemic (p ≤ 0.01), and to perceive challenges with technical (p < 0.01), reimbursement (p=0.05), and patient barriers to internet or data plan access (p ≤ 0.001). After adjusting for covariates, only prepandemic communication through patient portal (adjusted odds ratio [aOR]=3.85; 95% confidence interval [CI]=1.33-11.12), perceived patient access barriers (aOR=5.27; 95% CI=1.95-14.23), and practice in multiple versus university settings (aOR=0.18; 95% CI=0.06-0.56) remained significantly associated with use. Approximately 44% were high users. Prepandemic ultrasound use (aOR=1.92; 95% CI=1.17-3.16), perceived patient access barriers (aOR=1.85; 95% CI=1.12-3.06) and Midwest versus North practice location (aOR=0.46; 95% CI=0.21-0.98) predicted high use. Among high users, 99% wanted to continue offering video visits. Conclusions: We found widespread use of live video obstetric care by MFM clinicians and continued interest in use postpandemic.
View details for DOI 10.1089/tmj.2022.0346
View details for PubMedID 36251953
- Design and methods of the Apple Women's Health Study: a digital longitudinal cohort study AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY 2022; 226 (4)
Management of brain tumors presenting in pregnancy: a case series and systematic review.
American journal of obstetrics & gynecology MFM
2021; 3 (1): 100256
Patients who present with brain tumors during pregnancy require unique imaging and neurosurgical, obstetrical, and anesthetic considerations. Here, we review the literature and discuss the management of patients who present with brain tumors during pregnancy. Between 2009 and 2019, 9 patients were diagnosed at our institution with brain tumors during pregnancy. Clinical information was extracted from the electronic medical records. The median age at presentation was 29 years (range, 25-38 years). The most common symptoms at presentation included headache (n=5), visual changes (n=4), hemiparesis (n=3), and seizures (n=3). The median gestational age at presentation was 20.5 weeks (range, 11-37 weeks). Of note, 8 patients (89%) delivered healthy newborns, and 1 patient terminated her pregnancy. In addition, 5 patients (56%) required neurosurgical procedures during pregnancy (gestational ages, 14-37 weeks) because of disease progression (n=2) or neurologic instability (n=3). There was 1 episode of postneurosurgery morbidity (pulmonary embolism [PE]) and no surgical maternal mortality. The median length of follow-up was 15 months (range, 6-45 months). In cases demonstrating unstable or progressive neurosurgical status past the point of fetal viability, neurosurgical intervention should be considered. The physiological and pharmacodynamic changes of pregnancy substantially affect anesthetic management. Pregnancy termination should be discussed and offered to the patient when aggressive disease necessitates immediate treatment and the fetal gestational age remains previable, although neurologically stable patients may be able to continue the pregnancy to term. Ultimately, pregnant patients with brain tumors require an individualized approach to their care under the guidance of a multidisciplinary team.
View details for DOI 10.1016/j.ajogmf.2020.100256
View details for PubMedID 33451609
Postpartum Depression Among Women with Cardiac Disease: Considerations During the Delivery Admission
SPRINGER HEIDELBERG. 2020: 246A
View details for Web of Science ID 000525432601113
- Comparing insulin, metformin, and glyburide in treating diabetes in pregnancy and analyzing obstetric outcomes MOSBY-ELSEVIER. 2020: S481
- Cervical insufficiency, cerclage, and early preterm birth: differences among racial/ethnic subgroups MOSBY-ELSEVIER. 2020: S540
Obstetric outcomes for women receiving newer generation antiepileptic drugs: retrospective cohort study using claims database
MOSBY-ELSEVIER. 2019: S344–S345
View details for Web of Science ID 000454249401299
- Readmission following discharge on labetalol or nifedipine for management of hypertensive disorders of pregnancy MOSBY-ELSEVIER. 2019: S341
- Adverse Pregnancy Outcomes Among Women With Urinary Tract Infections: Comparing Sensitive and Resistant Organisms LIPPINCOTT WILLIAMS & WILKINS. 2017: 37S
- Glomus Tumor Excision With Clitoral Preservation JOURNAL OF LOWER GENITAL TRACT DISEASE 2016; 20 (2): e20-e21
- Uropathogens and antibiotic resistance temporal trends among pregnant women: updated assessment and comparison from 2005-2014 MOSBY-ELSEVIER. 2016: S338–S339
Improving cervical cancer screening rates in an urban HIV clinic.
2014; 26 (9): 1186-93
Human immunodeficiency virus (HIV)-infected women are at increased risk of invasive cervical cancer; however, screening rates remain low. The objectives of this study were to analyze a quality improvement intervention to increase cervical cancer screening rates in an urban academic HIV clinic and to identify factors associated with inadequate screening. Barriers to screening were identified by a multidisciplinary quality improvement committee at the Washington University Infectious Diseases clinic. Several strategies were developed to address these barriers. The years pre- and post-implementation were analyzed to examine the clinical impact of the intervention. A total of 422 women were seen in both the pre-implementation and post-implementation periods. In the pre-implementation period, 222 women (53%) underwent cervical cancer screening in the form of Papanicolaou (Pap) testing. In the post-implementation period, 318 women (75.3%) underwent cervical cancer screening (p < 0.01). Factors associated with lack of screening included fewer visits attended (pre: 4.2 ± 1.5; post: 3.4 ± 1.4; p < 0.01). A multidisciplinary quality improvement intervention was successful in overcoming barriers and increasing cervical cancer screening rates in an urban academic HIV clinic.
View details for DOI 10.1080/09540121.2014.894610
View details for PubMedID 24625234
View details for PubMedCentralID PMC4065211