Biography My clinical and epidemiological research has predominantly focused on investigating strategies to optimize the preventive and treatment of postpartum hemorrhage (PPH), a leading cause of maternal morbidity and mortality in the US. I have also performed health services and outcomes-based research studies related to the use of epidural labor pain relief, the most common method for providing pain relief in labor, and maternal complications including hypertensive disorders of pregnancy and depression. I have also clinical studies examining peripartum changes in maternal hematological and coagulation profiles using advanced point-of-care technologies, such as thromboelastography and clinical investigations of blood product usage in low and high-risk obstetric patients. My prior epidemiological research related to PPH has involved NIH-funded work investigating risk factors for severe PPH after cesarean delivery, the epidemiology of severe postpartum anemia, and population-based studies exploring the association between important clinical characteristics, such as body mass index and gestational age, and PPH risk. This body of work has required detailed epidemiological analyses of large-scale population-wide datasets involving claims, birth certificate, and clinical data. I have also led studies that have greatly expanded knowledge of epidural labor analgesia use in the United States. One of our landmark studies utilized national vital statistics (birth certificate) data to reveal substantial variation in the prevalence of epidural labor analgesia across US states, identifying a two-fold difference between the highest and lowest prevalence states, even after adjusting for patient case-mix and select state factors. This work provided crucial insights into regional disparities and informing policy discussions. We were also the first group to refute a purported association between epidural labor analgesia and autism spectrum disorder in the offspring. Our investigations into PPH, other major maternal morbidities such as eclampsia, and epidural labor analgesia have been published in leading journals, including JAMA Pediatrics, Anesthesiology, and the American Journal of Obstetrics and Gynecology. These publications have significantly contributed to the body of knowledge in obstetric anesthesiology and maternal health, and has received recognition by the lay media, including the New York Times. Role Faculty Location UCSF at Mission Bay UCSF at Mount Zion UCSF at Parnassus Category Clinical Education 12/05 - Obstetric Anesthesiology, Stanford University School of MedicineMS, 08/11 - Epidemiology, Stanford UniversityFRCA, 07/03 - Anesthesiology, Fellow of Royal College of Anaesthetists (UK)MBBS, 01/97 - Medicine, St. George's Hospital Medical School Publications Trends in Neuraxial Labor Analgesia Utilization by Race and Ethnicity among Nulliparous Individuals Undergoing Spontaneous Vaginal Delivery, United States, 2007 to 2022. Stockert E, Siadat S, Bateman BT, Martinez E, Butwick AJ, Leonard SA Navigating coagulopathy in obstetric hemorrhage: The role of point-of-care testing. Gill N, Butwick A, Bell SF Risk of postpartum hemorrhage with increasing first stage labor duration. Ladfors LV, Liu X, Sandström A, Lundborg L, Butwick AJ, Muraca GM, Snowden JM, Ahlberg M, Stephansson O Sterile water injections for back pain in labour. Muraca GM, Kramer JLK, Butwick AJ Variation in Hospital Neuraxial Labor Analgesia Rates in California. Parameshwar P, Guo N, Bentley J, Main E, Singer SJ, Peden CJ, Morris T, Ansari J, Butwick AJ Validity of ICD-10 diagnosis codes for placenta accreta spectrum disorders. Jotwani AR, Lyell DJ, Butwick AJ, Rwigi W, Leonard SA Trends in racial/ethnic disparities in postpartum hospital readmissions in California from 1997 to 2018. Tucker CM, Ma C, Mujahid MS, Butwick AJ, Girsen AI, Gibbs RS, Carmichael SL Evaluating tranexamic acid for the prevention and treatment of obstetric hemorrhage. Kowalczyk JJ, Cecconi M, Butwick AJ A validation of The California Maternal Quality Care Collaborative obstetric hemorrhage risk assessment tool in a Swedish population. Ladfors LV, Butwick A, Stephansson O Prevalence and predictors for postpartum sleep disorders: a nationwide analysis. Sultan P, Guo N, Kawai M, Barwick FH, Carvalho B, Mackey S, Kallen MA, Gould CE, Butwick AJ The role of viscoelastic hemostatic assays for postpartum hemorrhage management and bedside intrapartum care. Katz D, Farber M, Getrajdman C, Hamburger J, Reale S, Butwick A Predicting Placenta Accreta Spectrum Disorder: Are We There Yet? Ansari JR, Butwick AJ Anesthesia Considerations for Placenta Accreta Spectrum. Warrick CM, Sutton CD, Farber MM, Hess PE, Butwick A, Markley JC Knowledge Gaps in Placenta Accreta Spectrum. Carusi DA, Duzyj CM, Hecht JL, Butwick AJ, Barrett J, Holt R, O'Rinn SE, Afshar Y, Gilner JB, Newton JM, Shainker SA, Pan-American Society for the Placenta Accreta Spectrum Early Postpartum Hospital Encounters among Patients with Genitourinary and Wound Infections during Hospitalization for Birth. Leonard SA, Girsen AI, Trepman P, Carmichael SL, Darmawan K, Butwick AJ, Gibbs RS In Reply. Butwick A, Miller SE Red Blood Cell Transfusion in Patients With Placenta Accreta Spectrum: A Systematic Review and Meta-analysis. Miller SE, Leonard SA, Meza PK, Ku S, Ren LY, Lyell DJ, Sultan P, Butwick A Postpartum care visits among commercially insured women in the United States. Butwick AJ, Bentley J, Daw J, Sultan P, Girsen A, Gibbs RS, Guo N Early postpartum readmissions: identifying risk factors at birth hospitalization. Girsen AI, Leonard SA, Butwick AJ, Joudi N, Carmichael SL, Gibbs RS Update on Applications and Limitations of Perioperative Tranexamic Acid. Patel PA, Wyrobek JA, Butwick AJ, Pivalizza EG, Hare GMT, Mazer CD, Goobie SM Hospital-level variation in rates of postpartum hemorrhage in California. Davis R, Guo N, Bentley J, Sie L, Ansari J, Bateman B, Main E, Butwick AJ Association of neuraxial labor analgesia with autism spectrum disorder in children: a systematic review and meta-analysis. Lumbreras-Marquez MI, Capdeville G, Ferrigno AS, Villela-Franyutti D, Bain PA, Campos-Zamora M, Butwick AJ, Farber MK Subsequent risk of stillbirth, preterm birth, and small for gestational age: A cross-outcome analysis of adverse birth outcomes. Bane S, Simard JF, Wall-Wieler E, Butwick AJ, Carmichael SL A data-driven health index for neonatal morbidities. De Francesco D, Blumenfeld YJ, Maric I, Mayo JA, Chang AL, Fallahzadeh R, Phongpreecha T, Butwick AJ, Xenochristou M, Phibbs CS, Bidoki NH, Becker M, Culos A, Espinosa C, Liu Q, Sylvester KG, Gaudilliere B, Angst MS, Stevenson DK, Shaw GM, Aghaeepour N Accuracy of visual estimation of blood loss in obstetrics using clinical reconstructions: an observational simulation cohort study. Athar MW, Abir G, Seay RC, Guo N, Butwick A, Carvalho B Association of Medicaid Expansion With Neuraxial Labor Analgesia Use in the United States: A Retrospective Cross-Sectional Analysis. Xiao MZX, Whitney D, Guo N, Sun EC, Wong CA, Bentley J, Butwick AJ Trends in eclampsia in the United States, 2009-2017: a population-based study. Xiao MZX, Whitney D, Guo N, Bentley J, Shaw GM, Druzin ML, Butwick AJ Latest advances in postpartum hemorrhage management. Kumaraswami S, Butwick A Viscoelastic haemostatic point-of-care assays in the management of postpartum haemorrhage: a narrative review. Dias JD, Butwick AJ, Hartmann J, Waters JH The relationship between INTEM/HEPTEM coagulation time ratio and heparin plasma concentration in obstetric patients: an exploratory in vitro investigation. Katz D, Leffert L, Getrajdman C, Sison M, Shin DW, Lin HM, Butwick A Placenta Accreta Spectrum Disorders: Knowledge Gaps in Anesthesia Care. Warrick CM, Markley JC, Farber MK, Balki M, Katz D, Hess PE, Padilla C, Waters JH, Weiniger CF, Butwick AJ Epidural labour analgesia and autism spectrum disorder: is the current evidence sufficient to dismiss an association? Butwick AJ, Abrams DA, Wong CA Authors reply re: The Ten Group Classification System - First Things First. Ladfors LV, Muraca GM, Zetterqvist J, Butwick AJ, Stephansson O Current State and Future Direction of Postpartum Hemorrhage Risk Assessment. Ende HB, Butwick AJ Evidence Mounts Refuting an Association Between Epidural Use and Neurodevelopmental Adverse Outcomes in Children. Butwick AJ, Wall-Wieler E The association between postpartum hemorrhage and postpartum depression: A Swedish national register-based study. Liu C, Butwick A, Sand A, Wikström AK, Snowden JM, Stephansson O The Society for Obstetric Anesthesia and Perinatology Coronavirus Disease 2019 Registry: An Analysis of Outcomes Among Pregnant Women Delivering During the Initial Severe Acute Respiratory Syndrome Coronavirus-2 Outbreak in the United States. Katz D, Bateman BT, Kjaer K, Turner DP, Spence NZ, Habib AS, George RB, Toledano RD, Grant G, Madden HE, Butwick AJ, Lynde G, Minehart RD, Beilin Y, Houle TT, Sharpe EE, Kodali B, Bharadwaj S, Farber MK, Palanisamy A, Prabhu M, Gonzales NY, Landau R, Leffert L Association of Epidural Labor Analgesia With Offspring Risk of Autism Spectrum Disorders. Wall-Wieler E, Bateman BT, Hanlon-Dearman A, Roos LL, Butwick AJ Association of Gestational Age with Postpartum Hemorrhage: An International Cohort Study. Butwick AJ, Liu C, Guo N, Bentley J, Main EK, Mayo JA, Shaw GM, Stephansson O Antepartum and postpartum anemia: a narrative review. Butwick AJ, McDonnell N Risk factors for postpartum readmission among women after having a stillbirth. DiTosto JD, Liu C, Wall-Wieler E, Gibbs RS, Girsen AI, El-Sayed YY, Butwick AJ, Carmichael SL Association between Neuraxial Labor Analgesia and Neonatal Morbidity after Operative Vaginal Delivery. Butwick AJ, Wong CA, Lee HC, Blumenfeld YJ, Guo N In Reply. Butwick AJ, Wall-Wieler E Postpartum Hemorrhage: Wherefore Art Thou, Hyperfibrinolysis? Butwick AJ Accuracy of postpartum hemorrhage coding in the Swedish Pregnancy Register. Ladfors LV, Muraca GM, Butwick A, Edgren G, Stephansson O Evaluation of US State-Level Variation in Hypertensive Disorders of Pregnancy. Butwick AJ, Druzin ML, Shaw GM, Guo N Machine learning: the next frontier in obstetric anesthesiology? Butwick AJ, McCarthy RJ Opioid Prescription and Persistent Opioid Use After Ectopic Pregnancy. Wall-Wieler E, Shover CL, Hah JM, Carmichael SL, Butwick AJ Racial and Ethnic Disparities in Hospital-Based Care Associated with Postpartum Depression. Chan AL, Guo N, Popat R, Robakis T, Blumenfeld YY, Main E, Scott KA, Butwick AJ Maternal Health after Stillbirth: Postpartum Hospital Readmission in California. Wall-Wieler E, Butwick AJ, Gibbs RS, Lyell DJ, Girsen AI, El-Sayed YY, Carmichael SL How do I manage severe postpartum hemorrhage? Butwick A, Lyell D, Goodnough L A call for multidisciplinary cesarean delivery analgesia care. Weiniger CF, Ioscovich A, Butwick AJ Severe Maternal Morbidity Among Stillbirth and Live Birth Deliveries in California. Wall-Wieler E, Carmichael SL, Gibbs RS, Lyell DJ, Girsen AI, El-Sayed YY, Butwick AJ Assessing the Association Between Blood Loss and Postoperative Hemoglobin After Cesarean Delivery: A Prospective Study of 4 Blood Loss Measurement Modalities. Fedoruk K, Seligman KM, Carvalho B, Butwick AJ Maternal and Infant Adverse Outcomes Associated with Mild and Severe Preeclampsia during the First Year after Delivery in the United States. Ton TGN, Bennett MV, Incerti D, Peneva D, Druzin M, Stevens W, Butwick AJ, Lee HC The Crystalloid Co-Load: Clinically as Effective as Colloid Preload for Preventing Hypotension from Spinal Anaesthesia for Caesarean Delivery. Riley ET, Mangum K, Carvalho B, Butwick AJ Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis. Sultan P, Bampoe S, Shah R, Guo N, Estes J, Stave C, Goodnough LT, Halpern S, Butwick AJ United States State-Level Variation in the Use of Neuraxial Analgesia During Labor for Pregnant Women. Butwick AJ, Bentley J, Wong CA, Snowden JM, Sun E, Guo N Maternal Body Mass Index and Use of Labor Neuraxial Analgesia: A Population-based Retrospective Cohort Study. Butwick AJ, Wong CA, Guo N Effect of Maternal Body Mass Index on Postpartum Hemorrhage. Butwick AJ, Abreo A, Bateman BT, Lee HC, El-Sayed YY, Stephansson O, Flood P Prevalence of Depression Among Women of Reproductive Age in the United States. Guo N, Robakis T, Miller C, Butwick A The Society for Obstetric Anesthesia and Perinatology Consensus Statement on the Anesthetic Management of Pregnant and Postpartum Women Receiving Thromboprophylaxis or Higher Dose Anticoagulants. Leffert L, Butwick A, Carvalho B, Arendt K, Bates SM, Friedman A, Horlocker T, Houle T, Landau R, Dubois H, Fernando R, Houle T, Kopp S, Montgomery D, Pellegrini J, Smiley R, Toledo P, members of the SOAP VTE Taskforce Accuracy of international classification of diseases, ninth revision, codes for postpartum hemorrhage among women undergoing cesarean delivery. Butwick AJ, Walsh EM, Kuzniewicz M, Li SX, Escobar GJ Tranexamic Acid for the Management of Obstetric Hemorrhage. Butwick AJ, Deneux-Tharaux C, Sentilhes L Availability and Readability of Online Patient Education Materials Regarding Regional Anesthesia Techniques for Perioperative Pain Management. Kumar G, Howard SK, Kou A, Kim TE, Butwick AJ, Mariano ER A Standardized Approach for Transfusion Medicine Support in Patients With Morbidly Adherent Placenta. Panigrahi AK, Yeaton-Massey A, Bakhtary S, Andrews J, Lyell DJ, Butwick AJ, Goodnough LT Risk Factors for Severe Postpartum Hemorrhage After Cesarean Delivery: Case-Control Studies. Butwick AJ, Ramachandran B, Hegde P, Riley ET, El-Sayed YY, Nelson LM Neuraxial Anesthesia in Obstetric Patients Receiving Thromboprophylaxis With Unfractionated or Low-Molecular-Weight Heparin: A Systematic Review of Spinal Epidural Hematoma. Leffert LR, Dubois HM, Butwick AJ, Carvalho B, Houle TT, Landau R Nitrous oxide for labor analgesia: Utilization and predictors of conversion to neuraxial analgesia. Sutton CD, Butwick AJ, Riley ET, Carvalho B Effect of a High-Rate Versus a Low-Rate Oxytocin Infusion for Maintaining Uterine Contractility During Elective Cesarean Delivery: A Prospective Randomized Clinical Trial. Duffield A, McKenzie C, Carvalho B, Ramachandran B, Yin V, El-Sayed YY, Riley ET, Butwick AJ Comparative Effectiveness of Lower Leg Compression Devices Versus Sequential Compression Devices to Prevent Postspinal Hypotension During Cesarean Delivery. Carvalho B, Zheng LL, Butwick A Postcesarean delivery analgesia. Carvalho B, Butwick AJ National and International Guidelines for Patient Blood Management in Obstetrics: A Qualitative Review. Shaylor R, Weiniger CF, Austin N, Tzabazis A, Shander A, Goodnough LT, Butwick AJ Patterns and predictors of severe postpartum anemia after Cesarean section. Butwick AJ, Walsh EM, Kuzniewicz M, Li SX, Escobar GJ The impact of postpartum hemoglobin levels on maternal quality of life after delivery: a prospective exploratory study. Miller CM, Ramachandran B, Akbar K, Carvalho B, Butwick AJ Knowledge of blood loss at delivery among postpartum patients. Farber MK, Miller CM, Ramachandran B, Hegde P, Akbar K, Goodnough LT, Butwick AJ Evaluation of high-risk obstetric patients: a survey of US academic centers. Butwick AJ, Tiouririne M Maternal outcomes of term breech presentation delivery: impact of successful external cephalic version in a nationwide sample of delivery admissions in the United States. Weiniger CF, Lyell DJ, Tsen LC, Butwick AJ, Shachar B, Callaghan WM, Creanga AA, Bateman BT Racial and Ethnic Disparities in Mode of Anesthesia for Cesarean Delivery. Butwick AJ, Blumenfeld YJ, Brookfield KF, Nelson LM, Weiniger CF Does Time of Delivery Influence the Risk of Neonatal Morbidity? Brookfield KF, O'Malley K, El-Sayed YY, Blumenfeld YJ, Butwick AJ Labor outcome at extremely advanced maternal age. Osmundson SS, Gould JB, Butwick AJ, Yeaton-Massey A, El-Sayed YY In Response. Bateman BT, Butwick AJ, Huybrechts KF Transfusion and coagulation management in major obstetric hemorrhage. Butwick AJ, Goodnough LT Morbidity associated with cesarean delivery in the United States: is placenta accreta an increasingly important contributor? Creanga AA, Bateman BT, Butwick AJ, Raleigh L, Maeda A, Kuklina E, Callaghan WM Risk Factors for Prolonged Postpartum Length of Stay Following Cesarean Delivery. Blumenfeld YJ, El-Sayed YY, Lyell DJ, Nelson LM, Butwick AJ Second-line uterotonics and the risk of hemorrhage-related morbidity. Butwick AJ, Carvalho B, Blumenfeld YJ, El-Sayed YY, Nelson LM, Bateman BT The impact of advanced maternal age on peripartum thromboelastographic coagulation profiles: a prospective observational exploratory study. Butwick A, Gutierrez MC, Hilton G Antenatal corticosteroids for preterm premature rupture of membranes: single or repeat course? Brookfield KF, El-Sayed YY, Chao L, Berger V, Naqvi M, Butwick AJ Patterns of second-line uterotonic use in a large sample of hospitalizations for childbirth in the United States: 2007-2011. Bateman BT, Tsen LC, Liu J, Butwick AJ, Huybrechts KF Perioperative and transfusion outcomes in women undergoing cesarean hysterectomy for abnormal placentation. Brookfield KF, Goodnough LT, Lyell DJ, Butwick AJ Anesthetic management of a parturient with VACTERL association undergoing Cesarean delivery. Hilton G, Mihm F, Butwick A What's new in obstetric anesthesia in 2011? Reducing maternal adverse outcomes and improving obstetric anesthesia quality of care. Butwick A Managing patients with abnormal placentation: what are the best anesthetic and transfusion strategies? Butwick AJ Platelet counts and coagulation tests prior to neuraxial anesthesia in patients with preeclampsia: a retrospective analysis. Sultan P, Butwick A Continuous spinal anesthesia for Cesarean hysterectomy and massive hemorrhage in a parturient with placenta increta. Sultan P, Hilton G, Butwick A, Carvalho B Epidural catheter removal in patients on warfarin thromboprophylaxis: a more cautious interpretation of results required? Carvalho B, Mariano ER, Butwick AJ An in vitro investigation of the coagulation effects of exogenous oxytocin using thromboelastography in healthy parturients. Butwick A, Harter S Oxytocin for labour and caesarean delivery: implications for the anaesthesiologist. Dyer RA, Butwick AJ, Carvalho B How we treat: transfusion medicine support of obstetric services. Goodnough LT, Daniels K, Wong AE, Viele M, Fontaine MF, Butwick AJ The effectiveness of preemptive sphenopalatine ganglion block on postoperative pain and functional outcomes after functional endoscopic sinus surgery. Cho DY, Drover DR, Nekhendzy V, Butwick AJ, Collins J, Hwang PH The association between thromboelastographic parameters and total estimated blood loss in patients undergoing elective cesarean delivery. Butwick A, Ting V, Ralls LA, Harter S, Riley E The postoperative anaesthetic review. Sultan P, Jigajinni S, McGlennan A, Butwick A Retrospective analysis of anesthetic interventions for obese patients undergoing elective cesarean delivery. Butwick A, Carvalho B, Danial C, Riley E A survey of perioperative and postoperative anesthetic practices for cesarean delivery. Aiono-Le Tagaloa L, Butwick AJ, Carvalho B Obstetric hemorrhage during an EXIT procedure for severe fetal airway obstruction. Butwick A, Aleshi P, Yamout I Intraoperative forced air-warming during cesarean delivery under spinal anesthesia does not prevent maternal hypothermia. Butwick AJ, Lipman SS, Carvalho B Neuraxial anesthesia for cesarean delivery in a parturient with type 1 von Willebrand disease and scoliosis. Butwick AJ, Carvalho B Successful spinal blockade in a parturient with myotonia congenita. Butwick AJ, Riley ET The effect of colloid and crystalloid preloading on thromboelastography prior to Cesarean delivery. Butwick A, Carvalho B
