Clinical Focus


  • Maternal and Fetal Medicine

Academic Appointments


Professional Education


  • Board Certification: Obstetrics and Gynecology, American Board of Obstetrics and Gynecology (2011)
  • Board Certification: Maternal and Fetal Medicine, American Board of Obstetrics and Gynecology (2015)
  • Fellowship:Albert Einstein Medical Center Obstetrics and Gynecology Residency (2012) NY
  • Residency:Albert Einstein Medical Center Obstetrics and Gynecology Residency (2009) NY
  • Medical Education:University at Buffalo School of Medicine (2005) NY

All Publications


  • Physician Work-Life Integration: Challenges and Strategies for Improvement. Clinical obstetrics and gynecology Karakash, S., Solone, M., Chavez, J., Shanafelt, T. 2019

    Abstract

    Increasing evidence shows physician well-being is linked to patient outcomes, patient and physician satisfaction, and workforce retention. Physician well-being is a broad construct that includes various dimensions of distress (stress, anxiety, fatigue, burnout) and professional fulfillment (meaning in work, engagement). Work-life integration (WLI) is one important component of physician well-being. We will review the current state of WLI among physicians as well as some strategies to improve this aspect of physician well-being. We address this topic through the lens of obstetrics and gynecology, including a discussion of specialty-specific characteristics that present unique challenges and opportunities to improve WLI.

    View details for PubMedID 30950862

  • Cerclage Location and Gestational Age at Delivery. AJP reports Estrada, F., Karakash, S., SeeToe, T., Weedon, J., Minkoff, H. 2019; 9 (2): e195–e199

    Abstract

    Objective Multiple authors have suggested cerclage position is a determinant of "success." We assessed the interaction between cervical length (CL), cerclage height (cerH), proximal residual length (PRL), gestational age at delivery, and rate of delivery≤34 weeks, in this study. Study Design Present study is a retrospective cohort study of all cerclages placed at Maimonides Medical Center from 2006 to 2016. Outcomes: gestational age at delivery and delivery before 34 weeks; predictors: PRL, cerH, CL; and indications for cerclage: history (Hx), physical exam (PE), and ultrasound (US) indicated cerclage. A general linear model was used to predict power-transformed age at delivery from cerH, CL, and indication for cerclage. Subanalyses by indication were conducted. Logistic regression was used for delivery≤34 weeks. Results The cerH by indication did not reach statistical significance ( p =0.090). When stratified by indications, the effect of cerH on age at delivery was apparent for Hx (adjusted R 2 =0.18, p <0.001) and PE (adjusted R 2 =0.43, p =0.004) cerclages but not for US cerclages (adjusted R 2 =0.08, p =0.206). Logistic regression predicting delivery ≤ 34 weeks ( n =29) produced similar results. Conclusions For Hx and PE indicated cerclages, the location of the stitch may influence the timing of delivery. Specifically, the higher the cerclage, the more advanced the gestational age at delivery.

    View details for DOI 10.1055/s-0039-1688778

    View details for PubMedID 31263629

  • Preterm birth occurrence among Asian women relative to their place of birth Girsen, A., Mayo, J. A., Datoc, I., Karakash, S., El-Sayed, Y. Y., Shaw, G. M. MOSBY-ELSEVIER. 2019: S352
  • Human Metapneumovirus Infection and Acute Respiratory Distress Syndrome During Pregnancy OBSTETRICS AND GYNECOLOGY Fuchs, A., McLaren, R., Saunders, P., Karakash, S., Minkoff, H. 2017; 130 (3): 630–32

    Abstract

    Human metapneumovirus has recently been recognized as an important cause of severe respiratory viral infections and of viral infections in patients admitted to intensive care units. Little is known about the course of this infection in pregnancy.A late-preterm primigravid woman was admitted to the intensive care unit for acute respiratory distress syndrome and subsequently diagnosed with human metapneumovirus. Because of worsening maternal respiratory status, she was intubated and a primary cesarean delivery was performed. The patient's respiratory status continued to decline postpartum, and she ultimately required extracorporeal membrane oxygenation. She was treated supportively until her respiratory status improved, at which time she was extubated and weaned off extracorporeal membrane oxygenation and subsequently discharged home.Human metapneumovirus can lead to severe respiratory illness during pregnancy.

    View details for PubMedID 28796690

  • Fetal proximal humeral epiphysis as an indicator of term gestation in different ethnic groups JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE Garg, D., Homel, P., Hirachan, T., Mor, A., Patel, K., Karakash, S., Haberman, S. 2017; 30 (20): 2505–9

    Abstract

    Accurate pregnancy dating is critical for appropriate clinical management. Our aim was to determine the time of appearance of proximal humeral epiphysis (PHE), consistency of its appearance among ethnic groups and whether 3D imaging helps with its visualization.A cross-sectional study was done on 360 patients with 563 scans in different ethnic groups between August 2013 and July 2015. Inclusion criteria were singleton pregnancies (34-40+  weeks of gestation), well dated by <20 weeks sonogram.PHE was not seen at 34 (n = 44) or 35 weeks (n = 36) and was present at gestational ages 36 (n = 3), 37 (n = 126), 38 (n = 96), 39 (n = 100) and 40 weeks (n = 28) in 2%, 12%, 51%, 75% and 100%, respectively. PHE was seen in 20 of 50 (60%) African-Americans, 22 of 61 (64%) south Asians, 41 of 72 (57%) Caucasians, 45 of 86 (48%) Hispanics and 41 of 80 (49%) Asians.Appearance of PHE did increase with gestational age, prior to 40 weeks, it was not uniformly present and was seen as early as 36 weeks independent of ethnic group.

    View details for PubMedID 27819180

  • Please put on your own oxygen mask before assisting others: a call to arms to battle burnout AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Atallah, F., McCalla, S., Karakash, S., Minkoff, H. 2016; 215 (6): 731-+

    Abstract

    Burnout among healthcare workers has reached epidemic proportions. Obstetrician/Gynecologists are not exceptions. Burnout is a phenomenon that can be difficult to distinguish from other entities, but one that has far-reaching consequences that can be deleterious both to physicians and to their patients. Most worrisome are its insidious nature, its contagiousness, and its relationship to depression. To date there has been a paucity of solutions proven to effectively fight burnout, and the implementation of those that may be helpful has been fragmented. An aggressive and multi-pronged approach is warranted that focus at the individual, departmental, institutional and national levels. Potential solutions should take into account external and internal factors, as well as issues of feasibility, impact and cost. Interventions that may play a role include cognitive-behavioral therapy, enhanced communication, physician wellbeing programs, improving work conditions, and advocacy efforts.

    View details for PubMedID 27567563

  • Patterns of Internet Use by Pregnant Women, and Reliability of Pregnancy-Related Searches MATERNAL AND CHILD HEALTH JOURNAL Narasimhulu, D., Karakash, S., Weedon, J., Minkoff, H. 2016; 20 (12): 2502–9

    Abstract

    Objective To assess patterns of e-health use in pregnancy in an underserved racially diverse inner-city population, and to assess the accuracy of pregnancy-related information obtained from the Internet. Methods A cross sectional study of 503 pregnant/postpartum women belonging to an underserved racially diverse inner-city population who completed a survey regarding e-health use. To assess accuracy, four independent expert-reviewers rated the first 10 webpages on Google searches for each of five questions based upon those in ACOG bulletins. Results 70.8 % of pregnant/postpartum women belonging to an underserved racially diverse inner-city population were e-health users. E-health users were younger (mean age 29.4 vs. 31.2, P = 0.009), more likely to be nulliparous (50.3 vs. 21.3 %, P < 0.001), have English as their primary language (62.3 vs. 49.1 %, P = 0.014) and have a college/graduate education (78 vs. 26.6 %, P < 0.001). While 60 % of these women said e-health influenced decision making, only 71.3 % of them discussed their searches with their provider. Expert reviewers determined that the online information was fairly accurate (mean score: +1.48 to +4.33 on a scale of -5 to +5) but not uniformly accurate, and there was at least one webpage with inaccurate information for every question. Conclusions for practice Pregnant women frequently use e-health resources but do not routinely share their findings with their providers. Most, but not all, information obtained is accurate. Therefore it is important for providers to discuss their patients' use, and help to guide them to reliable information.

    View details for PubMedID 27456311

  • Resolution of superimposed pre-eclampsia, and improvement in umbilical artery flow in a surviving twin after intrauterine demise of its co-twin JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH Narasimhulu, D. M., Karakash, S., Rankin, L., Minkoff, H. 2015; 41 (9): 1473–77

    Abstract

    Pre-eclampsia has a progressive clinical course, and is only cured by delivery of the placenta. We report a 30-year-old G1P0 with dichorionic twins, discordant growth and chronic hypertension who developed superimposed pre-eclampsia in her 21st week of gestation. After intrauterine demise of the severely growth-restricted twin, the superimposed pre-eclampsia resolved. The surviving twin initially had absent end diastolic flow, which resolved after the demise. A healthy 1935-g neonate with Apgar 9/9 was delivered at 34 weeks. Antenatal resolution of pre-eclampsia is extremely rare and resolution of superimposed pre-eclampsia has not, to our knowledge, been reported.

    View details for PubMedID 26096469