Scholars@Duke
Melissa Bauer

Melissa Bauer

Associate Professor of Anesthesiology
Anesthesiology, Women's
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Selected Publications

Near-miss and maternal sepsis mortality: A qualitative study of survivors and support persons.

Journal Article Eur J Obstet Gynecol Reprod Biol · August 2024 BACKGROUND: Prior studies have shown that maternal deaths due to sepsis occur due to delays in recognition, treatment, and escalation of care through medical chart reviews. This study was conducted to obtain the patient perspective for near-miss and matern ... Full text Link to item Cite

Moving from Principle to Practice: A Researcher's Guide to Co-Leading Engaged Research with Community Partners and Patients with Lived Experience to Reduce Maternal Mortality and Morbidity for Maternal Sepsis.

Journal Article Matern Child Health J · August 2024 OBJECTIVES: Maternal mortality and morbidity disproportionately affect birthing people from racialized populations. Unfortunately, researchers can often compound these poor outcomes through a lack of authentic community engagement in research beyond the ro ... Full text Link to item Cite

In Reply.

Journal Article Obstet Gynecol · August 1, 2024 Full text Link to item Cite

Characteristics and Outcomes of Obstetric Sepsis by Three Sets of Clinical Diagnostic Criteria: A Retrospective Study.

Journal Article Am J Perinatol · May 2024 OBJECTIVE: Pregnancy-related mortality in the United States is the highest of all developed nations with a reported rate of 17 deaths per 100,000 live births in 2014 to 2017. Sepsis-related mortality is a major component of pregnancy-related mortality. Sim ... Full text Link to item Cite

Performance Characteristics of Sepsis Screening Tools During Delivery Admissions.

Journal Article Obstet Gynecol · March 1, 2024 OBJECTIVE: To evaluate the screening performance characteristics of existing tools for the diagnosis of sepsis during delivery admissions. METHODS: This was a case-control study using electronic health record data, including vital signs and laboratory resu ... Full text Link to item Cite

Performance Characteristics of Sepsis Screening Tools During Antepartum and Postpartum Admissions.

Journal Article Obstet Gynecol · March 1, 2024 OBJECTIVE: To evaluate the performance characteristics of existing screening tools for the prediction of sepsis during antepartum and postpartum readmissions. METHODS: This was a case-control study using electronic health record data obtained between 2016 ... Full text Link to item Cite

Validating Parallel-Forms Tests for Assessing Anesthesia Resident Knowledge.

Journal Article J Med Educ Curric Dev · 2024 We created a serious game to teach first year anesthesiology (CA-1) residents to perform general anesthesia for cesarean delivery. We aimed to investigate resident knowledge gains after playing the game and having received one of 2 modalities of debriefing ... Full text Link to item Cite

Procalcitonin levels in pregnancy: A systematic review and meta-analysis of observational studies.

Conference Int J Gynaecol Obstet · November 2023 BACKGROUND: The utility of procalcitonin to identify obstetric sepsis is unknown. OBJECTIVE: To calculate the mean (range) procalcitonin in pregnancy among healthy women not in labor (group 1), healthy women in labor (group 2), and women with preterm prela ... Full text Link to item Cite

Alliance for Innovation on Maternal Health: Consensus Bundle on Sepsis in Obstetric Care.

Journal Article Obstet Gynecol · September 1, 2023 Sepsis in obstetric care is one of the leading causes of maternal death in the United States, with Black, Asian/Pacific Islander, and American Indian/Alaska Native obstetric patients experiencing sepsis at disproportionately higher rates. State maternal mo ... Full text Link to item Cite

Maternal deaths due to suicide and overdose in the state of Michigan from 2008 to 2018.

Journal Article Am J Obstet Gynecol MFM · February 2023 BACKGROUND: Recent reports indicate that the contribution of deaths related to suicide and overdose are increasing, and may be the leading contributors to maternal mortality up to one year postpartum. OBJECTIVE: This study aimed to provide a granular asses ... Full text Link to item Cite

Variation in Opioid Prescribing After Vaginal and Cesarean Birth: A Statewide Analysis.

Journal Article Womens Health Issues · 2023 INTRODUCTION: Our aim was to evaluate variation in opioid prescribing rates and prescription size following childbirth across providers and hospitals. METHODS: This retrospective cohort study analyzed claims data from a single-payer Preferred Provider Orga ... Full text Link to item Cite

Inadequate neuraxial anaesthesia in patients undergoing elective caesarean section: a systematic review.

Journal Article Anaesthesia · May 2022 Neuraxial anaesthesia is widely utilised for elective caesarean section, but the prevalence of inadequate intra-operative anaesthesia is unclear. We aimed to determine the prevalence of inadequate neuraxial anaesthesia for elective caesarean section; preva ... Full text Link to item Cite

Frequency and Risk Factors for Difficult Intubation in Women Undergoing General Anesthesia for Cesarean Delivery: A Multicenter Retrospective Cohort Analysis.

Journal Article Anesthesiology · May 2022 BackgroundEstimates for the incidence of difficult intubation in the obstetric population vary widely, although previous studies reporting rates of difficult intubation in obstetrics are older and limited by smaller samples. The goals of this stud ... Full text Cite

Genetic variants associated with sepsis.

Journal Article PLoS One · 2022 BACKGROUND: The variable presentations and different phenotypes of sepsis suggest that risk of sepsis comes from many genes each having a small effect. The cumulative effect can be used to create individual risk profile. The purpose of this study was to cr ... Full text Link to item Cite

Development and Validation of ML-DQA - a Machine Learning Data Quality Assurance Framework for Healthcare

Conference Proceedings of Machine Learning Research · January 1, 2022 The approaches by which the machine learning and clinical research communities utilize real world data (RWD), including data captured in the electronic health record (EHR), vary dramatically. While clinical researchers cautiously use RWD for clinical inves ... Cite

In Response.

Journal Article Anesth Analg · November 1, 2021 Full text Link to item Cite

Near-miss and maternal sepsis mortality: A qualitative study of survivors and support persons.

Journal Article Eur J Obstet Gynecol Reprod Biol · August 2024 BACKGROUND: Prior studies have shown that maternal deaths due to sepsis occur due to delays in recognition, treatment, and escalation of care through medical chart reviews. This study was conducted to obtain the patient perspective for near-miss and matern ... Full text Link to item Cite

Moving from Principle to Practice: A Researcher's Guide to Co-Leading Engaged Research with Community Partners and Patients with Lived Experience to Reduce Maternal Mortality and Morbidity for Maternal Sepsis.

Journal Article Matern Child Health J · August 2024 OBJECTIVES: Maternal mortality and morbidity disproportionately affect birthing people from racialized populations. Unfortunately, researchers can often compound these poor outcomes through a lack of authentic community engagement in research beyond the ro ... Full text Link to item Cite

In Reply.

Journal Article Obstet Gynecol · August 1, 2024 Full text Link to item Cite

Characteristics and Outcomes of Obstetric Sepsis by Three Sets of Clinical Diagnostic Criteria: A Retrospective Study.

Journal Article Am J Perinatol · May 2024 OBJECTIVE: Pregnancy-related mortality in the United States is the highest of all developed nations with a reported rate of 17 deaths per 100,000 live births in 2014 to 2017. Sepsis-related mortality is a major component of pregnancy-related mortality. Sim ... Full text Link to item Cite

Performance Characteristics of Sepsis Screening Tools During Delivery Admissions.

Journal Article Obstet Gynecol · March 1, 2024 OBJECTIVE: To evaluate the screening performance characteristics of existing tools for the diagnosis of sepsis during delivery admissions. METHODS: This was a case-control study using electronic health record data, including vital signs and laboratory resu ... Full text Link to item Cite

Performance Characteristics of Sepsis Screening Tools During Antepartum and Postpartum Admissions.

Journal Article Obstet Gynecol · March 1, 2024 OBJECTIVE: To evaluate the performance characteristics of existing screening tools for the prediction of sepsis during antepartum and postpartum readmissions. METHODS: This was a case-control study using electronic health record data obtained between 2016 ... Full text Link to item Cite

Validating Parallel-Forms Tests for Assessing Anesthesia Resident Knowledge.

Journal Article J Med Educ Curric Dev · 2024 We created a serious game to teach first year anesthesiology (CA-1) residents to perform general anesthesia for cesarean delivery. We aimed to investigate resident knowledge gains after playing the game and having received one of 2 modalities of debriefing ... Full text Link to item Cite

Procalcitonin levels in pregnancy: A systematic review and meta-analysis of observational studies.

Conference Int J Gynaecol Obstet · November 2023 BACKGROUND: The utility of procalcitonin to identify obstetric sepsis is unknown. OBJECTIVE: To calculate the mean (range) procalcitonin in pregnancy among healthy women not in labor (group 1), healthy women in labor (group 2), and women with preterm prela ... Full text Link to item Cite

Alliance for Innovation on Maternal Health: Consensus Bundle on Sepsis in Obstetric Care.

Journal Article Obstet Gynecol · September 1, 2023 Sepsis in obstetric care is one of the leading causes of maternal death in the United States, with Black, Asian/Pacific Islander, and American Indian/Alaska Native obstetric patients experiencing sepsis at disproportionately higher rates. State maternal mo ... Full text Link to item Cite

Maternal deaths due to suicide and overdose in the state of Michigan from 2008 to 2018.

Journal Article Am J Obstet Gynecol MFM · February 2023 BACKGROUND: Recent reports indicate that the contribution of deaths related to suicide and overdose are increasing, and may be the leading contributors to maternal mortality up to one year postpartum. OBJECTIVE: This study aimed to provide a granular asses ... Full text Link to item Cite

Variation in Opioid Prescribing After Vaginal and Cesarean Birth: A Statewide Analysis.

Journal Article Womens Health Issues · 2023 INTRODUCTION: Our aim was to evaluate variation in opioid prescribing rates and prescription size following childbirth across providers and hospitals. METHODS: This retrospective cohort study analyzed claims data from a single-payer Preferred Provider Orga ... Full text Link to item Cite

Inadequate neuraxial anaesthesia in patients undergoing elective caesarean section: a systematic review.

Journal Article Anaesthesia · May 2022 Neuraxial anaesthesia is widely utilised for elective caesarean section, but the prevalence of inadequate intra-operative anaesthesia is unclear. We aimed to determine the prevalence of inadequate neuraxial anaesthesia for elective caesarean section; preva ... Full text Link to item Cite

Frequency and Risk Factors for Difficult Intubation in Women Undergoing General Anesthesia for Cesarean Delivery: A Multicenter Retrospective Cohort Analysis.

Journal Article Anesthesiology · May 2022 BackgroundEstimates for the incidence of difficult intubation in the obstetric population vary widely, although previous studies reporting rates of difficult intubation in obstetrics are older and limited by smaller samples. The goals of this stud ... Full text Cite

Genetic variants associated with sepsis.

Journal Article PLoS One · 2022 BACKGROUND: The variable presentations and different phenotypes of sepsis suggest that risk of sepsis comes from many genes each having a small effect. The cumulative effect can be used to create individual risk profile. The purpose of this study was to cr ... Full text Link to item Cite

Development and Validation of ML-DQA - a Machine Learning Data Quality Assurance Framework for Healthcare

Conference Proceedings of Machine Learning Research · January 1, 2022 The approaches by which the machine learning and clinical research communities utilize real world data (RWD), including data captured in the electronic health record (EHR), vary dramatically. While clinical researchers cautiously use RWD for clinical inves ... Cite

In Response.

Journal Article Anesth Analg · November 1, 2021 Full text Link to item Cite

The Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia.

Journal Article Anesth Analg · June 1, 2021 Because up to 12% of obstetric patients meet criteria for the diagnosis of thrombocytopenia in pregnancy, it is not infrequent that the anesthesiologist must decide whether to proceed with a neuraxial procedure in an affected patient. Given the potential m ... Full text Link to item Cite

Maternal sepsis update.

Journal Article Curr Opin Anaesthesiol · June 1, 2021 PURPOSE OF REVIEW: Maternal sepsis is the second leading cause of maternal death in the United States. A significant number of these deaths are preventable and the purpose of this review is to highlight causes such as delays in recognition and early treatm ... Full text Link to item Cite

Labor prior to cesarean delivery associated with higher post-discharge opioid consumption.

Journal Article PLoS One · 2021 BACKGROUND: Severe acute post-cesarean delivery (CD) pain has been associated with an increased risk for persistent pain and postpartum depression. Identification of women at increased risk for pain can be used to optimize post-cesarean analgesia. The impa ... Full text Link to item Cite

Management of Nephrolithiasis in Pregnancy: Multi-Disciplinary Guidelines From an Academic Medical Center.

Journal Article Front Surg · 2021 Introduction: The management of nephrolithiasis during pregnancy can be stressful for urologists due to concerns for investigations and treatments that may pose risk of fetal harm, and unfamiliarity with optimal management of these complex patients. In res ... Full text Link to item Cite

Relationship between postpartum mood disorder and birth experience: a prospective observational study.

Journal Article Int J Obstet Anesth · November 2020 BACKGROUND: This study aims to investigate the relationship between the birth experience and the risk of developing postpartum depression or post-traumatic stress disorder. METHODS: In this prospective, longitudinal, observational study, women were assesse ... Full text Link to item Cite

New persistent opioid use after acute opioid prescribing in pregnancy: a nationwide analysis.

Journal Article Am J Obstet Gynecol · October 2020 OBJECTIVE: To evaluate the association between opioid prescribing during pregnancy and new persistent opioid use in the year following delivery. MATERIALS AND METHODS: This nationwide retrospective cohort study included patients aged 12-55 years in Optum's ... Full text Link to item Cite

User Perceptions of an Electronic Maternal Alerting System.

Journal Article A A Pract · September 2020 This survey study evaluates the user experience of an electronic maternal early warning system that generates automated pages. Survey domains included the system's effect on patient care, alarm fatigue, and continued use of the system. The response rate wa ... Full text Link to item Cite

Use of a Novel Electronic Maternal Surveillance System and the Maternal Early Warning Criteria to Detect Severe Postpartum Hemorrhage.

Journal Article Anesth Analg · September 2020 BACKGROUND: A leading cause of preventable maternal death is related to delayed response to clinical warning signs. Electronic surveillance systems may improve detection of maternal morbidity with automated notifications. This retrospective observational s ... Full text Link to item Cite

In Response.

Journal Article Anesth Analg · August 2020 Full text Link to item Cite

Extracorporeal Life Support in Pregnancy: A Systematic Review.

Journal Article J Am Heart Assoc · July 7, 2020 Background The use of extracorporeal life support (ECLS) has expanded to include unique populations such as peripartum women. This systematic review aims to (1) quantify the number of cases and indications for ECLS in women during the peripartum period rep ... Full text Link to item Cite

Obstetric Anesthesia During the COVID-19 Pandemic.

Journal Article Anesth Analg · July 2020 With increasing numbers of coronavirus disease 2019 (COVID-19) cases due to efficient human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States, preparation for the unpredictable setting of labor and d ... Full text Link to item Cite

Labor epidural analgesia and the risk of postpartum depression: A meta-analysis of observational studies.

Journal Article J Clin Anesth · May 2020 STUDY OBJECTIVE: This study aims to systematically review the literature to evaluate the association between labor epidural analgesia (LEA) and postpartum depression (PPD). DESIGN: Meta-analysis. SETTING: Obstetric patients delivering vaginally with or wit ... Full text Link to item Cite

Lumbar neuraxial procedures in thrombocytopenic patients across populations: A systematic review and meta-analysis.

Journal Article J Clin Anesth · May 2020 INTRODUCTION: There is currently no consensus regarding the minimum threshold platelet count to ensure safe neuraxial procedures. Numerous reports describe the safe performance of lumbar punctures in severely thrombocytopenic patients but reports of neurax ... Full text Link to item Cite

Author Correction: Maternal Sepsis: Recognition, Treatment, and Escalation of Care (Current Anesthesiology Reports, (2019), 9, 1, (55-59), 10.1007/s40140-019-00310-7)

Journal Article Current Anesthesiology Reports · March 1, 2020 The original version of this article contained two mistakes. In Table 2, under the “MEW criteria” heading, “DBP ˂ 100 mmHg” should read “DBP ˃ 100 mmHg.” The correct Table 2 is shown here. The first sentence of the 3rd paragraph under “Antibiotics” section ... Full text Cite

Incidence of Maternal Sepsis and Sepsis-Related Maternal Deaths in the United States

Journal Article Obstetrical and Gynecological Survey · February 1, 2020 Full text Cite

Risk Factors, Etiologies, and Screening Tools for Sepsis in Pregnant Women: A Multicenter Case-Control Study.

Journal Article Anesth Analg · December 2019 BACKGROUND: Given the significant morbidity and mortality of maternal sepsis, early identification is key to improve outcomes. This study aims to evaluate the performance characteristics of the systemic inflammatory response syndrome (SIRS), quick Sequenti ... Full text Link to item Cite

Incidence of Maternal Sepsis and Sepsis-Related Maternal Deaths in the United States.

Journal Article JAMA · September 3, 2019 This study uses National Readmissions Database data to characterize incidence of and mortality due to maternal sepsis within 42 days of delivery hospitalization discharge in the United States between 2013 and 2016. ... Full text Link to item Cite

Normal Range for Maternal Lactic Acid during Pregnancy and Labor: A Systematic Review and Meta-Analysis of Observational Studies.

Journal Article Am J Perinatol · July 2019 OBJECTIVE: This article systematically reviews the literature to establish the normal range of lactic acid in healthy pregnant women. STUDY DESIGN: Ovid MEDLINE, Embase.com, and Clinicaltrials.gov were searched to identify studies that reported maternal la ... Full text Link to item Cite

Virtual Reality Analgesia in Labor: The VRAIL Pilot Study-A Preliminary Randomized Controlled Trial Suggesting Benefit of Immersive Virtual Reality Analgesia in Unmedicated Laboring Women.

Journal Article Anesth Analg · June 2019 This pilot study investigated the use of virtual reality (VR) in laboring women. Twenty-seven women were observed for equivalent time during unmedicated contractions in the first stage of labor both with and without VR (order balanced and randomized). Nume ... Full text Link to item Cite

Maternal Sepsis: Recognition, Treatment, and Escalation of Care

Journal Article Current Anesthesiology Reports · March 15, 2019 Purpose of Review: The purpose of this article is to provide a brief review of maternal sepsis and the supporting literature for recognition and management. Recent Findings: Recent findings suggest that there is significant room for improvement in identify ... Full text Cite

Maternal leukocytosis after antenatal corticosteroid administration: a systematic review and meta-analysis.

Journal Article J Obstet Gynaecol · February 2018 Although it is known that corticosteroid administration causes leukocytosis, the magnitude and length of time this leukocytosis persists is unknown during pregnancy. This study aimed to establish the expected range of maternal leukocytosis in healthy pregn ... Full text Link to item Cite

Patterns of Opioid Prescription and Use After Cesarean Delivery.

Journal Article Obstet Gynecol · July 2017 OBJECTIVE: To define the amount of opioid analgesics prescribed and consumed after discharge after cesarean delivery. METHODS: We conducted a survey at six academic medical centers in the United States from September 2014 to March 2016. Women who had under ... Full text Link to item Cite

Risk of Epidural Hematoma after Neuraxial Techniques in Thrombocytopenic Parturients: A Report from the Multicenter Perioperative Outcomes Group.

Journal Article Anesthesiology · June 2017 BACKGROUND: Thrombocytopenia has been considered a relative or even absolute contraindication to neuraxial techniques due to the risk of epidural hematoma. There is limited literature to estimate the risk of epidural hematoma in thrombocytopenic parturient ... Full text Link to item Cite

Current applications of big data in obstetric anesthesiology.

Journal Article Curr Opin Anaesthesiol · June 2017 PURPOSE OF REVIEW: The narrative review aims to highlight several recently published 'big data' studies pertinent to the field of obstetric anesthesiology. RECENT FINDINGS: Big data has been used to study rare outcomes, to identify trends within the health ... Full text Link to item Cite

Maternal Deaths Due to Sepsis in the State of Michigan, 1999-2006.

Journal Article Obstet Gynecol · October 2015 OBJECTIVE: To identify maternal deaths due to sepsis in the state of Michigan, review the events leading to diagnosis, and evaluate treatment to identify areas for improvement. METHODS: A case series was collected for maternal deaths due to sepsis from a c ... Full text Link to item Cite

Maternal physiologic parameters in relationship to systemic inflammatory response syndrome criteria: a systematic review and meta-analysis.

Journal Article Obstet Gynecol · September 2014 OBJECTIVE: To establish the normal maternal range in healthy pregnant women for each component of the systemic inflammatory response syndrome (SIRS) criteria and compare these ranges with existing SIRS criteria. DATA SOURCES: PubMed, Embase, and ClinicalTr ... Full text Link to item Cite

Maternal sepsis mortality and morbidity during hospitalization for delivery: temporal trends and independent associations for severe sepsis.

Journal Article Anesth Analg · October 2013 BACKGROUND: Sepsis is currently the leading cause of direct maternal death in the United Kingdom. In this study, we aimed to determine frequency, temporal trends, and independent associations for severe sepsis during hospitalization for delivery in the Uni ... Full text Link to item Cite

Risk factors for failed conversion of labor epidural analgesia to cesarean delivery anesthesia: a systematic review and meta-analysis of observational trials.

Journal Article Int J Obstet Anesth · October 2012 BACKGROUND: This systematic review and meta-analysis evaluates evidence for seven risk factors associated with failed conversion of labor epidural analgesia to cesarean delivery anesthesia. METHODS: Online scientific literature databases were searched usin ... Full text Link to item Cite

Peripartum management of dual antiplatelet therapy and neuraxial labor analgesia after bare metal stent insertion for acute myocardial infarction.

Journal Article Anesth Analg · September 2012 A 31-year-old woman at 32 weeks' gestation presented with an ST segment elevation myocardial infarction with subsequent bare metal stent placement. A multidisciplinary team coordinated the delivery plan, including anticoagulation and delivery mode. Because ... Full text Link to item Cite