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Maria Jacqueline Small

Associate Professor of Obstetrics and Gynecology
Obstetrics and Gynecology, Maternal Fetal Medicine
4010 Duke South, Purple Zone, Box 3967, Durham, NC 27710

Selected Publications


Prevalence, impact and management of postmenopausal symptoms among postmenopausal women in Rwanda.

Journal Article Climacteric · December 2023 OBJECTIVE: This study aimed at evaluating the prevalence and management of postmenopausal symptoms among Rwandan women. METHODS: A descriptive cross-sectional study was conducted at the four largest Rwandan referral hospitals from August 2017 to March 2018 ... Full text Link to item Cite

Racial and Rural-Urban Disparities in Maternal Cardiac Disease Care in North Carolina: A Call to Action

Journal Article North Carolina Medical Journal · July 5, 2023 BackgroundCardiac disease is a leading cause of severe maternal morbidity (SMM). We sought to estimate the effects of race and rural-urban status on cardiac-specific severe maternal morbidity (“c ... Full text Cite

Racial and Rural-Urban Disparities in Maternal Cardiac Disease Care in North Carolina: A Call to Action.

Conference N C Med J · July 2023 BACKGROUND: Cardiac disease is a leading cause of severe maternal morbidity (SMM). We sought to estimate the effects of race and rural-urban status on cardiac-specific severe maternal morbidity ("cardiac SMM") in North Carolina. METHODS: This retrospective ... Full text Link to item Cite

Sonographic Evaluation of the Placenta in Fontan Patients: A Case Series.

Journal Article J Ultrasound Med · June 2023 Due to the advancements in pediatric cardiothoracic surgery and medical management, more individuals with congenital heart disease are reaching reproductive age. It is well established that individuals with Fontan circulation are at an increased risk for m ... Full text Link to item Cite

Evaluating the Association Between Fibrinogen and Rotational Thromboelastometry and the Progression to Severe Obstetric Hemorrhage.

Journal Article Clin Appl Thromb Hemost · 2023 AIM: This study aims to investigate the ability of fibrinogen and rotational thromboelastometry (ROTEM) parameters measured at obstetric hemorrhage protocol initiation to predict severe hemorrhage. METHODS: In this retrospective study we included patients ... Full text Link to item Cite

The Role of Family Members in Providing Support For Malawian Women With Preterm Infants During Infant Hospitalization.

Journal Article Neonatal Netw · November 11, 2022 Purpose: Family support is essential for women with preterm infants during hospitalization. In low-income countries, the additional burden of infant care due to shortages in nursing staff necessitates that family members (guardians) be physically present t ... Full text Link to item Cite

Risk Factors for Adverse Maternal Outcomes following Expectantly Managed Preterm Prelabor Rupture of Membranes.

Conference Am J Perinatol · June 2022 OBJECTIVE: We sought to characterize the incidence and risk factors associated with developing maternal morbidity following preterm prelabor rupture of membranes. STUDY DESIGN: Retrospective case-control study of patients with preterm prelabor rupture of m ... Full text Link to item Cite

Experiences of Malawian Mothers During Their Infants' Hospitalization.

Journal Article Adv Neonatal Care · April 1, 2022 BACKGROUND: Hospitalization of a newborn infant is stressful for all mothers. Hospitals in Malawi have limited nursing staff and support, so mothers are the primary care providers for their hospitalized infants. Few studies have explored the experience of ... Full text Link to item Cite

Black women health inequity: The origin of perinatal health disparity.

Journal Article J Natl Med Assoc · February 2021 Black enslaved women endured sexual exploitation and reproductive manipulation to produce a labor workforce on the southern plantations during the Antebellum Period. Health care inequity has continued from slavery and into the 21th century primarily due of ... Full text Link to item Cite

Assessment of perinatal outcomes of pregnant women with severe versus simple malaria.

Journal Article PLoS One · 2021 OBJECTIVE: Malaria in pregnancy is associated with adverse perinatal outcomes. The objective was to compare outcomes of simple and severe malaria and to determine whether they vary by trimester or severity of infection. METHODS: Prospective cohort study pe ... Full text Link to item Cite

Post-Traumatic Stress Disorder and Severe Maternal Morbidity.

Journal Article Obstet Gynecol Clin North Am · September 2020 Post-traumatic stress disorder (PTSD) accompanies miscarriage, intrauterine fetal demise, and preterm birth. Levels of PTSD may be higher for women who experience acute, life-threatening events during labor and delivery. Severe maternal morbidities or near ... Full text Link to item Cite

Obstetrics and Gynecology Residents Can Accurately Classify Benign Ovarian Tumors Using the International Ovarian Tumor Analysis Rules.

Journal Article J Ultrasound Med · July 2020 OBJECTIVES: Recognition of benign versus malignant tumors is essential in gynecologic ultrasound (US). The International Ovarian Tumor Analysis (IOTA) rules have been proposed as part of resident US training. The objective of this study was to examine whet ... Full text Link to item Cite

Seasonal variation in preeclampsia and eclampsia in Kigali

Journal Article Rwanda Medical Journal · March 1, 2020 Hypertensive disorders complicate up to 10% of all pregnancies. The World Health Organization estimates the incidence of preeclampsia and eclampsia to be higher in developing countries. OBJECTIVES: To document the prevalence of preeclampsia and eclampsia i ... Cite

An Observational Study on Early Dyadic Interactive Behaviors of Mothers With Early-Preterm, Late-Preterm, and Full-Term Infants in Malawi.

Journal Article Adv Neonatal Care · February 2020 BACKGROUND: Mother-infant interactions are necessary for infant growth and development. However, preterm birth is associated with less positive mother-infant interactions than full-term birth. Malawi has the highest preterm birth rate in the world, but stu ... Full text Link to item Cite

Emotional distress in mothers of early-preterm infants, late-preterm infants, and full-term infants in Malawi.

Journal Article Nurs Outlook · 2020 BACKGROUND: Mothers of preterm infants, early or late, report more distress than mothers of full-term infants. Malawi has the highest preterm birth rate in the world, but nothing is known about the relation of preterm birth to maternal mental health. PURPO ... Full text Link to item Cite

Addressing Maternal Deaths in North Carolina: Striving to Reach Zero.

Journal Article N C Med J · 2020 Maternal mortality in North Carolina remains a challenge to families, health systems, and communities. The Maternal Mortality Review Committee is part of the process required to prevent these events. In this commentary, we present an abbreviated descriptio ... Full text Link to item Cite

An overview of advances in global maternal health: From broad to specific improvements.

Journal Article Int J Gynaecol Obstet · July 2019 After the declaration of the Millennium Development Goals in 2000 by the United Nations, many stakeholders allocated financial resources to "global maternal health." Research to expand care and improve delivery of maternal health services has exponentially ... Full text Link to item Cite

Increased Rwandan Access to Obstetrician-Gynecologists Through a U.S.-Rwanda Academic Training Partnership.

Journal Article Obstet Gynecol · July 2019 OBJECTIVE: To evaluate the first 5 years of the Human Resources for Health Rwanda program from the program onset in the July 2012-2016 academic years, and its effects on access to care through examination of: 1) the number of trained obstetrician-gynecolog ... Full text Link to item Cite

Using fetal scalp stimulation with Doppler ultrasonography to enhance intermittent auscultation in low-resource settings: a diagnostic trial from Tanzania.

Journal Article BMC Pregnancy Childbirth · February 13, 2019 BACKGROUND: Hypoxia during labor contributes to 2.2 million intrapartum and early neonatal deaths each year. An additional 0.6-1.0 million cases of life-long disability occur because of fetal hypoxia during labor. It is known that fetal heart rate changes ... Full text Open Access Link to item Cite

Maternal and neonatal morbidity and mortality associated with preterm premature rupture of membranes prior to 34 week gestation at kigali university teaching hospital: A retrospective and prospective study

Journal Article Rwanda Medical Journal · January 1, 2019 BACKGROUND: Preterm premature rupture of membranes is an obstetric complication which has adverse perinatal effects and long-term morbidity and mortality. There is no published outcome data in Rwanda. OBJECTIVES: To assess maternal and neonatal outcomes at ... Cite

Preventability of maternal near miss and mortality in Rwanda: A case series from the University Teaching Hospital of Kigali (CHUK).

Journal Article PLoS One · 2018 OBJECTIVE: Assess the primary causes and preventability of maternal near misses (MNM) and mortalities (MM) at the largest tertiary referral hospital in Rwanda, Kigali University Teaching Hospital (CHUK). METHODS: We reviewed records for all women admitted ... Full text Link to item Cite

Global disparities in maternal morbidity and mortality.

Journal Article Semin Perinatol · August 2017 The disparity in maternal mortality for African American women remains one of the greatest public health inequities in the United States (US). To better understand approaches toward amelioration of these differences, we examine settings with similar dispar ... Full text Link to item Cite

340: Knowledge of Zika virus and patient prenatal screening and testing preferences

Conference American Journal of Obstetrics and Gynecology · January 2017 Full text Cite

Postpartum hemorrhage

Chapter · January 1, 2017 Traditionally, postpartum hemorrhage (PPH) is defined as blood loss in excess of 500 mL after a vaginal delivery and greater than 1000 mL following a cesarean delivery. Severe hemorrhage is the most common cause of maternal death worldwide accounting for a ... Full text Cite

Gastric Rupture in Pregnancy: Case Series from a Tertiary Institution in Rwanda and Review of the Literature

Journal Article AJP Reports · October 1, 2016 Background Gastric rupture is a rare, life-threatening condition during pregnancy. Case study We present three cases of gastric perforation during pregnancy and the puerperium. The first patient presented with gastric perforation 4 days following an uncomp ... Full text Cite

Comparison of the trends in risk factors and management of severe postpartum hemorrhage: Years 2000–2004 versus 2005–2008

Journal Article Journal of Reproductive Medicine · August 1, 2016 OBJECTIVE: To compare trends in the etiology and management of severe postpartum hemorrhage (PPH) during 2 time periods: 2000–2004 (Period 1) versus 2005–2008 (Period 2). STUDY DESIGN: Medical records with a diagnosis of PPH were identified by ICD-9 codes ... Cite

Comparison of the Trends in Risk Factors and Management of Severe Postpartum Hemorrhage Years 2000-2004 Versus 2005-2008.

Journal Article J Reprod Med · August 2016 OBJECTIVE: To compare trends in the etiology and management of severe postpartum hemorrhage (PPH) during 2 time periods: 2000-2004 (Period 1) versus 2005-2008 (Period 2). STUDY DESIGN: Medical records with a diagnosis of PPH were identified by ICD-9 codes ... Link to item Cite

Maternal near miss and mortality due to postpartum infection: a cross-sectional analysis from Rwanda.

Journal Article BMC Pregnancy Childbirth · July 20, 2016 BACKGROUND: The objective of this study is to evaluate 'near miss' and mortality in women with postpartum infections. METHODS: We performed a retrospective review of all patients referred to the University Teaching Hospital of Kigali (CHUK) between January ... Full text Link to item Cite

Abnormalities of Fetal Situs: An Overview and Literature Review.

Journal Article Obstet Gynecol Surv · January 2016 The incidence of congenital heart disease is most commonly reported in 8 per 1000 live births. Situs anomalies are among the least common forms of congenital heart disease. This study defines situs and describes the variations of fetal situs anomalies. Sit ... Full text Link to item Cite

Transfer function analysis of dynamic cerebral autoregulation in preeclampsia.

Journal Article Pregnancy Hypertens · October 2015 OBJECTIVE: The cerebral circulatory effects of preeclampsia on the latency (phase) and the efficiency (gain) of the cerebral autoregulatory response is unknown. Preeclampsia causes a progressive impairment of the cerebral autoregulatory response. We sought ... Full text Link to item Cite

Maternal near miss and mortality in a tertiary care hospital in Rwanda.

Journal Article BMC Pregnancy Childbirth · September 3, 2015 BACKGROUND: To determine the prevalence and factors associated with severe ('near miss') maternal morbidity and mortality in the University Teaching Hospital of Kigali-Rwanda. METHODS: We performed a cross sectional study of all women admitted to the terti ... Full text Link to item Cite

Social capital and hypertension in rural Haitian women.

Journal Article Matern Child Health J · December 2014 Hypertension is a major global public health risk and significant precursor to cardiovascular disease, stroke, diabetes and maternal mortality. A possible strategy to reduce chronic disease in resource-poor areas is social intervention. Research into the p ... Full text Link to item Cite

Prenatal maternal-fetal imaging for global health radiology

Journal Article · October 1, 2014 The state of maternal-fetal health in the developing world remains appalling despite growing global attention. Since the adoption of the Millennium Development goals, there has been increased deployment of resources towards this issue with little improveme ... Full text Cite

A comparison of Doppler waveform parameters versus flow-mediated vascular dilation of the brachial artery in pregnant women

Journal Article Pregnancy Hypertension · January 1, 2014 Objective Flow mediated dilation of the brachial artery is impaired with endothelial dysfunction. We previously identified that brachial artery waveforms were changed in preeclamptic women. We therefore sought to compare Doppler waveform analysis with flow ... Full text Cite

Predictors of failed trial of labor among women with an extremely obese body mass index.

Journal Article Am J Obstet Gynecol · December 2013 OBJECTIVE: The purpose of this study was to examine predictors associated with cesarean delivery (CD) among extremely obese women undergoing a trial of labor (TOL). STUDY DESIGN: Using a delivery database, we identified all pregnant women delivering at our ... Full text Link to item Cite

Hypertensive disease in pregnancy: an examination of ethnic differences and the Hispanic paradox.

Journal Article J Neonatal Perinatal Med · 2013 OBJECTIVE: The "Hispanic paradox" refers to the epidemiological finding that Hispanics in the US have better health outcomes than the average population despite what their aggregate socioeconomic determinants would predict. The aim of this study was to eva ... Full text Link to item Cite

Unmet health needs identified by Haitian women as priorities for attention: a qualitative study.

Journal Article Reprod Health Matters · June 2012 This 2009 qualitative study investigated Haitian women's most pressing health needs, barriers to meeting those needs and proposed solutions, and how they thought the community and outside organizations should be involved in addressing their needs. The impe ... Full text Link to item Cite

The role of the maternal-fetal medicine subspecialist in review and prevention of maternal deaths.

Journal Article Semin Perinatol · February 2012 The maternal-fetal medicine subspecialist plays a critical role in the evaluation and management of women with obstetrical and medical comorbidities. These women have a higher risk for obstetrical morbidity, "near miss," and maternal mortality. Maternal de ... Full text Link to item Cite

Near-miss maternal mortality: cardiac dysfunction as the principal cause of obstetric intensive care unit admissions.

Journal Article Obstet Gynecol · February 2012 OBJECTIVE: Evaluation of "near-miss" maternal mortality is a robust surveillance method to assess the quality of obstetric care and determinants of poor maternal outcome. To evaluate near-miss maternal mortality, we examined patient characteristics and mat ... Full text Link to item Cite

Peripartum management of two parturients with ornithine transcarbamylase deficiency.

Journal Article Int J Obstet Anesth · January 2012 Ornithine transcarbamylase deficiency is a rare X-linked disorder in which female carriers are usually heterozygous for the ornithine transcarbamylase deficiency gene. In pregnancy it has been associated with altered mental status, seizures, coma and death ... Full text Link to item Cite

Near miss maternal mortality in a multiethnic population.

Journal Article Ann Epidemiol · February 2011 PURPOSE: To determine the impact of ethnicity on "near miss"/severe obstetric morbidity in a multi-ethnic, tertiary care population. METHODS: We carried out a cross-sectional analysis using birth data for 12,774 women with Medicaid who gave birth between J ... Full text Link to item Cite

Intimate partner and nonpartner violence against pregnant women in rural Haiti.

Journal Article Int J Gynaecol Obstet · September 2008 OBJECTIVE: To examine the association between violence experienced by pregnant Haitian women in the previous 6 months and pregnancy-related symptom distress. METHODS: A total of 200 women seeking prenatal care at community health dispensaries in the Artibo ... Full text Link to item Cite

Does armed conflict impact maternal heath? A report from rural Haiti

Journal Article Journal of Neonatal-Perinatal Medicine · January 1, 2008 Objectives: Few works address the impact of armed conflict on obstetric outcomes, largely secondary to limitations in measurement of these outcomes. In settings where hospitalized data is routinely and consistently obtained, these sources may provide rapid ... Cite

Health seeking behavior among pregnant women in rural Haiti.

Journal Article Health Care Women Int · October 2006 The purpose of this study was to further knowledge of health care seeking behavior among pregnant women in rural Haiti. Eighty-two pregnant women were interviewed to assess care seeking behaviors during pregnancy, satisfaction with services, reliance on so ... Full text Link to item Cite

Second-trimester ductus venosus measurement and adverse perinatal outcome in fetuses with congenital heart disease.

Journal Article J Ultrasound Med · August 2006 OBJECTIVE: The purpose of this study was to determine whether Doppler velocimetry of the ductus venosus (DV) predicts adverse perinatal outcome in congenital heart disease (CHD). METHODS: We conducted a retrospective cohort study of all pregnant women unde ... Full text Link to item Cite

Determinants of HIV/AIDS risk behaviors in expectant fathers in Haiti.

Journal Article J Urban Health · July 2006 Haiti has an HIV/AIDS epidemic of the highest magnitude outside of sub-Saharan Africa. Factors such as relationship power imbalances, traditional gender role acceptance, and patriarchal belief systems that devalue women's sexuality have increased Haitian w ... Full text Link to item Cite

The influence of power on HIV risk among pregnant women in rural Haiti.

Journal Article AIDS Behav · May 2006 Given that condom use is not directly under a woman's control, the sexual division of power may play an important role in sexual behavior among pregnant women. We assessed the influence of factors related to the theory of gender and power (e.g., relationsh ... Full text Link to item Cite

Characteristics of preeclampsia- and eclampsia-related maternal death in rural Haiti.

Journal Article J Matern Fetal Neonatal Med · November 2005 OBJECTIVE: The maternal mortality ratio in Haiti remains one of the highest in the world at 600/100 000 live births. Preeclampsia- and eclampsia-related complications are one of the leading causes of maternal death. In this resource-limited setting, effect ... Full text Link to item Cite

Practical guidelines for diagnosing and treating fetal hydronephrosis

Journal Article Contemporary Ob/Gyn · December 1, 2004 Cite

Indications for fetal echocardiography.

Journal Article Pediatr Cardiol · 2004 Congenital heart disease is one of the most common congenital malformations diagnosed in liveborns. As more women undergo prenatal diagnosis, the need for screening fetal echocadiography increases. The fetal, maternal, and familial indications for fetal ec ... Full text Link to item Cite

Combined serum and ultrasound screening for detection of fetal aneuploidy.

Journal Article Semin Perinatol · April 2003 Experience gathered over the last decade from high-risk centers provide strong evidence that mid-trimester sonographic markers are sensitive for Down syndrome prediction. More recent data indicate that combining mid trimester sonography with traditional se ... Full text Link to item Cite

Cromolyn cream for recalcitrant idiopathic vulvar vestibulitis: results of a placebo controlled study.

Journal Article Sex Transm Infect · February 2001 OBJECTIVE: Patients with chronic idiopathic vulvar vestibulitis have increased mast cells when biopsied, and cromolyn has been suggested as a treatment. The purpose of this study was to assess the efficacy of 4% cromolyn cream in women with vulvar vestibul ... Full text Link to item Cite