• 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. 

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. 

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.

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.

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.

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.

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.

University of Wisconsin School of Medicine and Public Health

Hartenbach, Antony, Ehrenthal, Greene publish interdisciplinary research in Green Journal

“Peripartum Blood Transfusion Among Rural Women inthe United States” is an excellent example of cross-divisional research – the article was co-authored by Katie Antony, MD, of the UW Ob-Gyn Division of Maternal-Fetal Medicine, Division of Reproductive and Population Health Director Deborah Ehrenthal, MD, and Division of Population Health members Madelyne Greene, PhD RN, Emily Schrider, PhD, and Daphne Kuo, PhD.

The study came out of a work group formed by Hartenbach and others to look at rural maternal outcomes. Before being published in the Green Journal, it was presented as an abstract at the 2019 ACOG national meeting.

The population-based retrospective cohort study evaluated peripartum transfusion rates for rural women compared with urban women in the United States. The study found that:

“The odds of blood transfusion were higher for women in rural areas. The results indicate that the rurality of the county where the birth occurred was associated with more transfusion. This may reflect differences in maternity and blood banking services in rural hospitals and warrants further study to identify opportunities for intervention.”

Read the whole paper here. Congratulations to Dr. Hartenbach and the entire publication team!