Lumbreras-Márquez, Mario Isaac
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Lumbreras-Márquez, Mario Isaac
Official Name
Lumbreras Márquez, Mario Isaac
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mlumbreras
Lumbreras-Marquez, M. I.
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ORCID
Scopus Author ID
55938270900
Researcher ID
AAZ-5337-2021

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Placental pathology lesions: International Society for Ultrasound in Obstetrics and Gynecology vs Society for Maternal-Fetal Medicine fetal growth restriction definitions

2024 , Maria J. Rodriguez-Sibaja , Ana J. Lopez-Diaz , Maria Y. Valdespino-Vazquez , Sandra Acevedo-Gallegos , Yubia Amaya-Guel , Dulce M. Camarena-Cabrera , Lumbreras-Márquez, Mario Isaac

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Cumulative sum learning curve for cordocentesis among maternal‐fetal medicine fellows in a low‐cost simulation model

2024 , Pérez-Estrada, Bibiana A. , Acevedo-Gallegos, Sandra , Lumbreras-Márquez, Mario Isaac , Gardner, Roxane , Gallardo, Juan Manuel

Objective: To determine the individual learning curves for cordocentesis in a low-cost simulator for maternal-fetal medicine (MFM) fellows. Methods: This observational, descriptive, educational, and prospective study was performed from July through November 2022. After an introductory course based on a standardized technique for cordocentesis, each second-year MFM fellow who accepted to participate in the study performed this procedure using a low-cost simulation model, and experienced operators supervised the cordocenteses. Learning curves were then created using cumulative sum analysis (CUSUM). Copyright © 1999-2024 John Wiley & Sons.

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Incorporating a postpartum hemorrhage bundle on the labor and delivery unit: a state-wide survey of anesthesiologists in Massachusetts

2023 , Villela-Franyutti, D. , Hackett, K. , Lumbreras-Márquez, Mario Isaac , Farber, M.K.

Postpartum hemorrhage (PPH) is a leading cause of preventable maternal morbidity and mortality, and multidisciplinary focus is a priority. The American College of Obstetricians and Gynecologists recommends use of a PPH bundle to facilitate early recognition and timely intervention. 1 As experts in critical care and transfusion, obstetric anesthesiologists play a vital role in PPH resuscitation. 2 However, anesthesiologists may be inconsistently engaged in PPH bundle implementation, and their attention to pre-delivery risk assessment, early recognition and development of institutional protocols is warranted. In this study, we sought to evaluate anesthesiologists’ perspectives on how PPH is managed at birthing facilities in the state of Massachusetts. Massachusetts has one of the lowest maternal mortality rates in the United States of America, but it is higher than that of other developed nations. 3 Moreover, PPH is a leading primary or secondary cause of maternal death in the state. 4 We hypothesized that anesthesia involvement in PPH bundle implementation varies across institutions and that there is the potential for improvement in PPH bundle implementation.Copyright © 2024 Elsevier Inc.

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Labor Analgesia Initiation With Dural Puncture Epidural Versus Conventional Epidural Techniques: A Randomized Biased-Coin Sequential Allocation Trial to Determine the Effective Dose for 90% of Patients of Bupivacaine

2023 , Ayumi Maeda , Diego Villela-Franyutti , Lumbreras-Márquez, Mario Isaac , Anarghya Murthy , Kara G. Fields , Samuel Justice , Lawrence C. Tsen

The dural puncture epidural (DPE) technique has a faster onset, better sacral spread, and improved bilateral coverage when compared to the conventional epidural (EPL) technique. Whether these qualities translate into a lower bupivacaine dose to provide initial analgesia is unknown. We sought to determine the effective dose of bupivacaine to achieve initial (first 30 minutes) labor analgesia in 90% of patients (ED90) with the DPE and EPL techniques, using a biased-coin, sequential allocation method. A total of 100 women of mixed parity with term, singleton gestation at ≤5 cm dilation with no major comorbidities were randomized to receive a DPE or an EPL technique. An experienced anesthesiologist performed these techniques and administered an allocated dose of plain bupivacaine diluted with isotonic sterile 0.9% saline to a total volume of 20 mL via the EPL catheter. Bupivacaine doses for each subject were determined by the response of the previous subject, using a biased-coin sequential allocation method, with success defined by a numeric rating scale (NRS) < 3 at 30 minutes. Outcome assessments were performed by an investigator blinded to the technique and bupivacaine dose. Sensory and motor blockade and maternal or fetal side effects were recorded every 5 minutes for the first 30 minutes. The ED90 of bupivacaine with each technique was estimated using centered isotonic regression. A total of 95 women were included in the final analysis. The ED90 of bupivacaine was estimated at 29.30 mg (90% confidence interval [CI], 28.55–31.56) with a DPE technique and 45.25 mg (90% CI, 42.80–52.03) with an EPL technique. Using a biased-coin, sequential allocation method, the DPE technique requires less bupivacaine to achieve effective initial analgesia (ED90) when compared to the EPL technique.

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Whole blood viscoelastic testing profile and mortality in patients hospitalized with acute COVID-19 pneumonia: A systematic review and meta-analysis

2024 , Spiezia, Luca , Campello, Elena , Simioni, Paolo , Lumbreras-Márquez, Mario Isaac

Background: Several studies have evaluated the possible association between whole blood viscoelastic testing (VET) parameters in patients hospitalized for acute Coronavirus disease 2019 (COVID-19) pneumonia and mortality. A few studies found no significant differences between survivors and non-survivors, though other studies identified potential predictors of COVID-19-related mortality. We conducted a systematic review and meta-analysis of the literature to evaluate the possible association between standard thromboelastometry/graphy parameters and mortality in patients hospitalized for acute COVID-19 pneumonia. Methods: Relevant studies were searched through MEDLINE, EMBASE, and Google Scholar from their inception until 15th June 2023. We aimed to identify any study including: i) adults admitted to intensive care units (ICU) or medicine wards (MW) for acute COVID-19 pneumonia; ii) viscoelastic testing; iii) mortality.

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Intended delivery mode and neonatal outcomes in pregnancies with fetal growth restriction

2023 , Rodriguez-Sibaja, Maria J. , Mendez-Piña, Miguel A. , Lumbreras-Márquez, Mario Isaac , Acevedo-Gallegos, Sandra , Velazquez-Torres, Berenice , Ramírez-Calvo, José A.

Objective: To compare neonatal outcomes in pregnancies with fetal growth restriction (FGR) by intended delivery mode.Methods: This is a retrospective cohort study of singleton pregnancies with FGR that were delivered ≥34.0 weeks gestation. Neonatal outcomes were compared according to the intended delivery mode, which the attending obstetrician determined. Of note, none of the subjects had a contraindication to labor. Crude and adjusted odds ratios (ORs) and corresponding confidence intervals (CIs) were calculated via logistic regression models to assess the potential association between intended delivery mode and neonatal morbidity defined as a composite outcome (i.e. umbilical artery pH ≤7.1, 5-min Apgar score ≤7, admission to the neonatal intensive care unit, hypoglycemia, intrapartum fetal distress requiring expedited delivery, and perinatal death). A sensitivity analysis excluded intrapartum fetal distress requiring emergency cesarean delivery from the composite outcome since only patients with spontaneous labor or labor induction could meet this criterion. Potential confounders in the adjusted effects models included maternal age, body mass index, hypertensive disorders, diabetes, FGR type (i.e. early or late), and oligohydramnios.

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Second-Line Uterotonics for Uterine Atony

2024 , Cole, Naida M. , Kim, Jimin J. , Lumbreras-Márquez, Mario Isaac , Fields, Kara G. , Mendez-Pino, Laura , Farber, Michaela K. , Carusi, Daniela A. , Toledo, Paloma , Bateman, Brian T.

Objective: To evaluate the comparative efficacy of two of the most commonly used second-line uterotonics—methylergonovine maleate and carboprost tromethamine. Methods: We conducted a double-blind randomized trial at two large academic perinatal centers in patients undergoing nonemergency cesarean delivery with uterine atony refractory to oxytocin, as diagnosed by the operating obstetrician. The intervention included administration of a single dose of intramuscular methylergonovine or carboprost intraoperatively at diagnosis. The primary outcome, uterine tone on a 0–10 numeric rating scale 10 minutes after study drug administration, was rated by operating obstetricians blinded to the drug administered. Secondary outcomes included uterine tone score at 5 minutes, administration of additional uterotonic agents, other interventions for uterine atony or hemorrhage, quantitative blood loss, urine output, postpartum change in serum hematocrit, transfusion, length of hospital stay, adverse drug or transfusion reactions, and postpartum hemorrhage complications. A sample size of 50 participants per group was planned to detect a 1-point difference (with estimated within-group SD of 1.5) in the mean primary outcome with 80% power at a two-sided α level of 0.05 while accounting for potential protocol violations. © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Association of neuraxial labor analgesia with autism spectrum disorder in children: a systematic review and meta-analysis

2022 , Lumbreras-Márquez, Mario Isaac , Capdeville, G. , Ferrigno, A.S. , Villela-Franyutti, D. , Bain, P.A. , Campos-Zamora, M. , Butwick, A.J. , Farber, M.K.

Conflicting results exist on the association between neuraxial labor analgesia (NLA) exposure in parturients and autism spectrum disorder (ASD) risk in their children. An assessment of the occurrence and extent of published studies up to December 16, 2021, was performed via systematic review and meta-analysis to provide the most up-to-date information on the potential association between NLA and ASD.

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Time to antibiotic initiation for suspected chorioamnionitis and factors associated with delayed treatment

2023 , Lumbreras-Márquez, Mario Isaac , Hale, John , Rowse, Olivia , Villela-Franyutti, Diego , Pearson, Jeffrey C. , Mohammadi, Somayeh , Murthy, Anarghya , Woods, Gregory T. , Diouf, Khady , Farber, Michaela K.

Intraamniotic infection can be associated with maternal bacteremia in 10% of cases. Prompt initiation of antibiotic treatment is critical to prevent maternal and fetal complications. At our quaternary center, the primary antibiotic regimen for suspected chorioamnionitis is ampicillin plus gentamicin. A preliminary quality improvement (QI) initiative evaluating the time from fever onset to antibiotic (ie, ampicillin and gentamicin) initiation in laboring patients at our institution suggested frequent delays of ≥1 hour for gentamicin. The aim of the present QI study was to determine the time to gentamicin treatment and specific factors associated with delayed gentamicin administration among patients with a new diagnosis of suspected chorioamnionitis.

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Abdominal circumference growth velocity as a predictor of adverse perinatal outcomes in small-for-gestational-age fetuses

2023 , Rodriguez-Sibaja, Maria J. , Villa-Cueva, Alejandra , Ochoa-Padilla, Maria , Rodriguez-Montenegro, Maria S. , Lumbreras-Márquez, Mario Isaac , Acevedo-Gallegos, Sandra , Gallardo-Gaona, Juan M. , Copado-Mendoza, Yazmin

Objective: To assess the predictive value of abdominal circumference growth velocity (ACGV) between the second and third trimesters to predict adverse perinatal outcomes in a cohort of small-for-gestational-age fetuses without evidence of placental insufficiency (i.e. fetal growth restriction). Material and methods: This is a single-center retrospective cohort study of all singleton pregnancies with small-for-gestational-age fetuses diagnosed and delivered at a quaternary institution. Crude and adjusted odds ratios (ORs) and corresponding confidence intervals (CIs) were calculated via logistic regression models to assess the potential association between abnormal ACGV (i.e. ≤10th centile) and adverse perinatal outcomes defined as a composite outcome (i.e. umbilical artery pH <7.1, 5-min Apgar score <7, admission to the neonatal intensive care unit, hypoglycemia, intrapartum fetal distress requiring expedited delivery, and perinatal death). Furthermore, the area under the receiver-operating characteristic curve (AUC) of three logistic regression models based on estimated fetal weight and ACGV for predicting the composite outcome is also reported.

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