Department of
Obstetrics and Gynecology

• Pubmed Publications
• Journal Articles (Non-PubMed)

Sleep apnea during pregnancy

My Roles: Co-PI with Dr. Mihaela Bazalakova

Research Focus: Sleep apnea during pregnancy: evaluation of referral process, assessment of screening tools, development of new tools, and evaluation of obstetric outcomes

The purpose of this study is multi-fold. The overarching goal is to harness the database of women referred for sleep apnea screening that we created for quality improvement purposes to further improve the quality of care for pregnant women who may have sleep apnea. However, we also seek to compare groups of women and analyze the questionnaires to develop a more optimal screening tool. 

Transdermal Lidocaine Patch for post-Cesarean pain control for women with obesity: a singleblind randomized controlled trial. (The ObLido Trial)

Sponsor(s): Department of Obstetrics and Gynecology: Startup Funds

My Roles: PI

Research Focus: To determine whether 5% lidocaine patches placed around the skin incision following Cesarean delivery will reduce the total dose of opioids received in the first 24 hours after surgery

The purpose of this study is to determine whether transdermal lidocaine administered at the time of Cesarean delivery and for 12 hours postoperatively will reduce the total dose of opioids received. Our hypothesis is that a lidocaine patch will reduce the total dose of opioids received in the immediate 24 hours postdelivery. Secondary outcomes will include patient self-reported pain scores, patient-reported incidence of side effects, such as pruritis, development of objective complications, such as serious skin reactions (examples are acute generalized exanthematous pustolosis, Stevens-Johnson syndrome, and toxic epidermal necrolysis), hypersensitivity, nausea, and nervousness. Other outcomes collected will include length of stay, time to first rescue analgesic medication, total dose of opioids in 48 hours, use of supplemental oxygen during hospitalization, total dose of opioids during hospitalization, breastfeeding rates, both exclusive and in combination with formula use, amount of opioid prescribed at discharge and whether refills were requested or administered, rates of chronic pain at six weeks postpartum, and six week Edinburgh Depression Screen scores. Neonatal outcomes such as five-minute Apgar scores and development of adverse outcomes will also be collected.

Post-Cesarean Birth Pain Management: Evaluation of Opioid Use Before and After Implementation of a Standardized Analgesic Regimen (aka: Standardized Analgesic Regimen and Post-cesarean Opioids (SARPO) Study)

Sponsor(s): Department of Obstetrics and Gynecology

My Roles: PI, mentoring Dr. Melissa Meyer, OB Resident Physician

Research Focus: To measure the total MME administered inpatient following cesarean birth.

The purpose of this study is to measure the morphine milligram equivalents (MME) dose of opioids used post-cesarean birth pre and post implementation of a standardized postoperative order set.

Post-operative respiratory compromise following Cesarean birth: the impact of obesity and opioids

Research Focus: The purpose of this study is to measure the composite rate of respiratory events among post-Cesarean patients and to measure the effect of obesity (by body mass index class) and opioids on such respiratory events.

Qualitative QI Project: Semi-structured interviews to understand women’s experiences and perspectives receiving prenatal care while pregnant with obesity

My Roles: PI, collaborating with Nicholas Schmuhl and Corrine Voils

Research Focus: Qualitative Obstetric Obesity Quality Improvement Initiative

The purpose of this intervention is to query women with obesity about their perspectives, preferences, and experiences with prenatal care, query preferred terminology, and also to seek input on potential programs that could be developed to facilitate a healthy pregnancy. 

The impact of Cesarean incision bupivacaine injection on opioid use and pain after Cesarean delivery: the cesarean incision bupivacaine injection study (CIBI)

My Roles: PI

Research Focus: The purpose of this project is to determine whether our patients who receive bupivacaine injections in their Cesarean incision have improved pain or less opioid use after Cesarean delivery.

Cesarean birth is the most common major surgical procedure performed in the United States, with rate of about 31.9% of deliveries. Pain management following cesarean birth involves a combination of opioid and non-opioid analgesia. Prescription opioid abuse and dependence has increased rapidly in the United States over the past two decades, with a four-fold increased rate of unintentional overdose using prescription opioids from 2000-2010. An evaluation by the Centers for Disease Control and Prevention found that patients can indeed become addicted to opioids following treatment of acute pain, including after Cesarean birth.

The literature on the benefits of local incisional injections of local anesthetic and analgesic agents suggests it may be beneficial. Lidocaine injection at the incision site has been studied, but with and without epinephrine, with subsequent reduction in both post-cesarean opioid use and reduced post-cesarean pain. Bupivacaine has been less well studied with some studies suggesting that it is effective at reducing post-cesarean pain and others suggesting it is not.

A small number of obstetricians at UPH-Meriter currently attempt to decrease postpartum opioid use and pain by injecting bupivacaine into the Cesarean incision site. This is not a universal practice. Therefore, this project would consist of performing a chart review to determine which patients did or did not receive the exposure (injection of bupivacaine into the cesarean incision site) to determine whether this impacted the primary or secondary outcome, which would be opioid consumption and pain scores, respectively.

The impact of penicillin allergy on risk for surgical site infection in Cesarean deliveries (SSI/PCN)

My Roles: PI

Research Focus: The purpose of this project is to determine whether our patients with penicillin allergy have a higher risk of developing a surgical site infection that those who do not. If so, this would imply that penicillin allergy is contributing to surgical site infections. If there is a difference, this would prompt the surgical site infection committee to potentially change our approach to antibiotic prophylaxis in women with penicillin allergy who are undergoing Cesarean delivery.

Penicillin allergy is reported in 10-20% of the population, and most patients reporting penicillin allergy receive second-line surgical site infection prophylaxis, which are typically less effective. Cesarean delivery is the second most common surgical procedure in the United States, and carries a high risk of surgical site infection. However, no prior published studies have queried whether penicillin allergy increases this risk. For the past several quarters and years, Meriter Hospital’s rate of surgical site infection has exceeded the expected rate, and efforts to reduce this rate are ongoing.

Assessment of in-hospital pain control and opioid use after Cesarean delivery and its correlation with pre-existing anxiety disorders

Sponsor(s): Department of Obstetrics and Gynecology

My Roles: PI, mentoring Dr. John Poehlmann, resident physician

Research Focus: In this study, we propose to evaluate the interaction between pre-existing anxiety via a pre-existing diagnosed anxiety disorder listed in the medical history, and postpartum pain control, via both self-reported pain scores in the first 24 hours after delivery and total opioid dose in the first 24 hours after delivery among women who underwent Cesarean delivery. We will also assess whether the indications for Cesarean delivery impacted postpartum pain and opioid use.

University of Wisconsin School of Medicine and Public Health

Antony and residency grad Meyer published in Journal of Maternal-Fetal & Neonatal Medicine

Katie Antony, MD, of the UW Ob-Gyn Division of Maternal-Fetal Medicine, and Melissa Meyer, MD, 2021 UW Ob-Gyn residency graduate, co-authored a new article in the Journal of Maternal-Fetal & Neonatal Medicine.

In “A standardized post-cesarean analgesia regimen reduces postpartum opioid use”, Antony and Meyer evaluated a standardized protocol of pain medications after C-section delivery. The protocol included scheduled acetaminophen and NSAIDs, with opioids for breakthrough pain. The study compared cumulative opioid use in the nine months before and nine months after the protocol was implemented. They also compared patient pain scores before and after the protocol.

Read the whole study here!

Antony published in Wisconsin Medical Journal

A new study by Katie Antony, MD, of the UW Ob-Gyn Division of Maternal-Fetal Medicine, was published in the Wisconsin Medical Journal. “Obstructive Sleep Apnea in Pregnancy: Early Lessons From Our Sleep Pregnancy Clinic” is eligible for continuing education credit.

In the publication, Antony and co-authors describe the prevalence of obstructive sleep apnea during pregnancy, outline interventions used in their clinic to increase the number of people completing indicated testing for sleep apnea during pregnancy, and discuss potential barriers to increasing testing.

You can read the whole publication (and complete the continuing education activity) here.

Grand Rounds: Department Research Day

On May 13, 2021, the UW Department of Obstetrics and Gynecology hosted Department Research Day, featuring exceptional presentations on fundamental, clinical, and quality improvement research. Recorded presentations from Department Research Day are available now.

To start the morning, Kimberly Gregory, MD, MPH of Cedars-Sinai Obstetrics and Gynecology Department presented the keynote lecture “Patient Reported Outcomes in Ob/Gyn: What are they? Who Cares? And Why?”.

In the lecture, Gregory differentiated between three measures of patient outcomes, outlined types of patient-reported outcomes used in ob-gyn clinical care, and described how these measures can drive quality improvement efforts.

Other presentations at Department Research Day included:

“Bone Loss and Osteoporosis Risk in Younger Gynecologic Cancer Patients”, presented by graduating gynecologic oncology fellow Janelle Sobecki, MD, MA

“Connecting the Dots: The Role of Endothelial-Immune Interaction in the Pathophysiology of Preeclampsia”, presented by Derek Boeldt, PhD, of the Division of Reproductive Sciences

“Post-Cesarean Pain”, presented by Katie Antony, MD, of the Division of Maternal-Fetal Medicine

You can watch the lectures from Department Research Day here.

Antony earns board certification from American Board of Obesity Medicine

Huge congratulations to Katie Antony, MD, of the UW Ob-Gyn Division of Maternal-Fetal Medicine, who recently earned her third board certification! Antony studied for and passed the American Board of Obesity Medicine certification exam.

Over the years, Antony has worked to improve care for pregnant patients with obesity, from clinical recommendations and protocols to communication strategies for patients about obesity. In the process of preparing for the exam, Antony reports learning a lot about preferred terminology, best approaches for discussing obesity, and interventions that are effective at improving health.

 “The CME classes I took to study for this and the exam were generally covered by a combination of CME funds from the department and a faculty development grant, so I wanted to express my gratitude to the department for supporting this endeavor,” Antony says.

Congratulations on this incredible achievement, Dr. Antony!

Schmuhl and Antony co-author article in BMC Pregnancy and Childbirth

A new article in the journal BMC Pregnancy and Childbirth examines prenatal care experiences for women with obesity. Medical student Danielle Hurst is lead author on the article, with co-authors Nicholas Schmuhl, PhD, of the UW Ob-Gyn Division of Reproductive Sciences and Katie Antony, MD, of the UW Ob-Gyn Division of Maternal-Fetal Medicine.

“Prenatal care experiences among pregnant women with obesity in Wisconsin, United States: a qualitative quality improvement assessment” used interviews with women who had delivered within the last 36 months to learn about women’s experience with prenatal care, and to gauge their interest in potential prenatal education programs aimed at helping women with high BMIs have a healthy pregnancy. The article includes selected quotes from interviews with study participants, and insights gained around provider communication, patient education, and more:

“Health care teams can take steps to increase the inclusivity of clinic environments and care for pregnant women with high BMIs. This is imperative to reducing the bias and stigma experienced by this population. Ultimately, obstetric healthcare providers need to become more sensitive and confident when discussing the implications of high BMIs with women and acknowledge that women with high BMIs may have had negative experiences with healthcare providers in the past. In response to these experiences, women have found ways to initiate, advocate, and supplement their healthcare.”

Read the whole study here.

Racine published in Wisconsin Medical Journal

A new study published in the Wisconsin Medical Journal by UW Ob-Gyn maternal-fetal medicine fellow Jenna Racine, MD sought to survey birthing centers in Wisconsin to better understand barriers to disclosing their level of maternal care. The article was co-authored by UW-Madison Prevention Research Center Deputy Director Kate Gillespie, DNP, Cynthie Wautlet, MD, of the UW Ob-Gyn Division of Academic Specialists in Ob-Gyn, and Katie Antony, MD, of the UW Ob-Gyn Division of Maternal-Fetal Medicine.

“Barriers to Self-Disclosing Level of Maternal Care: What Are Wisconsin Hospitals Worried About?” found that:

“Birthing centers in Wisconsin need further guidance on how to complete a self-assessment of their LOMC. In order to increase self-disclosure of LOMC, statewide perinatal organizations will need to continue to emphasize the benefits of releasing this information. Organizations should also provide additional support to level 1 and 2 birthing centers and improve maternal and neonatal care overall.”

Read the whole study here!

UW Obstetrics and Gynecology - Edit Blog Post.htm

Our congratulations to Katie Antony, MD, of the UW Ob-Gyn Division of Maternal-Fetal Medicine! The UW SMPH CHS Faculty Appointments and Promotions Committee approved Antony’s promotion to Associate Professor (CHS), effective July 1, 2021.

Antony joined the department in 2015. Please help us congratulate Dr. Antony on this exciting achievement!

UW Ob-Gyn brings research, developments to 2021 SMFM Conference

Faculty, residents, fellows, researchers and more brought numerous posters and presentations to the virtual 2021 Society for Maternal-Fetal Medicine Annual Meeting at the end of January! Learn more about the wealth of research shared by our colleagues at the conference:

PRESENTATION:

Racial disparities in post-operative pain experience and treatment following cesarean birth

John Poehlmann; Tiffany Green, Katie Antony, Amy Godecker

POSTERS:

Trouble with the curve: Is an ultrasound growth curve needed to predict SGA infants?

Bradley Bosse; Jacquelyn Adams, Melissa Meyer, John Poehlmann, Janine Rhoades, Igor Iruretagoyena

Obtaining accurate blood pressures: A quality improvement initiative to increase obstetric nursing knowledge and confidence

Matt Wagar; Jacquelyn Adams, Amy Godecker, Katie Antony

Prediction of vaginal delivery utilizing intrapartum transperineal ultrasound

Stephanie Peace; Melissa Meyer, Jacquelyn Adams, Katie Antony; Luther Gaston

Comparing 32-week vs 36-week growth ultrasound for prediction of LGA infants in obese gravidae

John Poehlmann; Jacquelyn Adams, Melissa Meyer, Jenna Racine, Janine Rhoades, Igor Iruretagoyena

Impact of a Standardized Post-Cesarean Analgesia Regimen on Postpartum Opioid Use

Melissa Meyer; Katie Antony

The impact of pre-existing maternal anxiety on pain and opioid use following cesarean birth

John Poehlmann; Amy Godecker, Katie Antony

Blood pressure pattern of women with hypertensive disorders of pregnancy is highly affected by obesity

Narmin Mukhtarova (MFM research intern); Kara Hoppe co-authored

Postpartum blood pressure of Black women is significantly higher compared to non-Black women

Narmin Mukhtarova (MFM research intern); Kara Hoppe co-authored

Did institutional changes and patient behaviors surrounding COVID-19 affect perinatal outcomes?

Jenna Racine; Igor Iruretagoyena, Kara Hoppe

Distance matters. The effect of distance to the hospital on estimated blood loss.

Kara Hoppe; Alexa Lowry

Blood pressure pattern pre-pregnancy through 42-day postpartum of women with preeclampsia, gestational, and chronic hypertension

Narmin Mukhtarova (MFM research intern); Kara Hoppe

Antony’s OBLido study published in AJOG MFM

A study by Katie Antony, MD, of the UW Ob-Gyn Division of Maternal-Fetal Medicine, was published in the American Journal of Obstetrics and Gynecology – Maternal-Fetal Medicine! Jackie Adams, MD, of the MFM Division, and Laura Jacques, MD, of the Division of Academic Specialists in Ob-Gyn, co-authored the study.

“Lidocaine patches for postcesarean pain control in obese women: a pilot randomized controlled trial” assessed the impact of using lidocaine patches around cesarean incisions in patients with obesity in their overall opioid use.

The pilot study included 61 participants, who were randomized into trial or placebo group. The study assessed cumulative opioid dose within 24 hours after cesarean delivery, as well as pain and patent satisfaction:

“This pilot suggests that 5% lidocaine patches applied superior and lateral to the cesarean incision are not effective at reducing the average total dose of morphine milligram equivalents administered in the first 24 hours after cesarean delivery among women with obesity, and they did not seem to improve median pain scores. An appropriately powered randomized trial would not be expected to demonstrate reduction in opioid use or pain." 

Read the whole study here!

Jacobson publishes on severe COVID infection in pregnancy in Case Reports in Women’s Health

A new article by Maternal-Fetal Medicine fellow Jennifer Jacobson, MD outlines treatment of a severe COVID-19 infection in a pregnant patient, offering insight into care for other such patients in the future.

“Use of dexamethasone, remdesivir, convalescent plasma and prone positioning in the treatment of severe COVID-19 infection in pregnancy: A case report” is online now, and will appear in the January 2021 volume of Case Reports in Women’s Health:

“Severe infection with COVID-19 virus in pregnancy offers unique management challenges for the obstetrician and critical care specialist. We report the case of a woman at 26 weeks of gestation with acute respiratory distress syndrome secondary to COVID-19 infection treated with dexamethasone, remdesivir, convalescent plasma and mechanical ventilation. Cesarean delivery was performed at 29 weeks due to worsening maternal status. This case offers insight into the assessment and successful use of treatment strategies, including dexamethasone, remdesivir, convalescent plasma, early prone positioning, conservative fluid management, permissive hypoxia and low tidal volume parameters with ventilator support for pregnancies affected by severe COVID-19 infection.”

UW Ob-Gyn MFM faculty Katie Antony, MD, Michael Beninati, MD, and Kara Hoppe, DO are co-authors on this case report. Read the whole article here. Amazing work, Dr. Jacobson!

Golos earns UW ICTR Translational Basic and Clinical pilot award

Ted Golos, PhD, of the UW Ob-Gyn Division of Reproductive Sciences, received a Translational Basic and Clinical pilot award from the UW-Madison Institute for Clinical and Translational Research! Katie Antony, MD, of the UW Ob-Gyn Division of Maternal-Fetal Medicine, is a collaborator on the grant.

“Nonhuman Primate Placental Therapy” will build on information learned from the NICHD’s Human Placenta Project – researchers will “uniquely demonstrate the feasibility of using placenta-targeted nanoparticles with primate maternal-fetal interface specificity.”

Congratulations, Dr. Golos!