Alexander Butwick, MBBS, MS
Professor
Anesthesia
School of Medicine

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.

• Evaluating tranexamic acid for the prevention and treatment of obstetric hemorrhage.
  Current opinion in obstetrics & gynecology 2023 Kowalczyk JJ, Cecconi M, Butwick AJ
• A validation of The California Maternal Quality Care Collaborative obstetric hemorrhage risk assessment tool in a Swedish population.
  American journal of obstetrics & gynecology MFM 2023 Ladfors LV, Butwick A, Stephansson O
• The role of viscoelastic hemostatic assays for postpartum hemorrhage management and bedside intrapartum care.
  American journal of obstetrics and gynecology 2023 Katz D, Farber M, Getrajdman C, Hamburger J, Reale S, Butwick A
• Predicting Placenta Accreta Spectrum Disorder: Are We There Yet?
  Anesthesia and analgesia 2023 Ansari JR, Butwick AJ
• Anesthesia Considerations for Placenta Accreta Spectrum.
  American journal of perinatology 2023 Warrick CM, Sutton CD, Farber MM, Hess PE, Butwick A, Markley JC
• Knowledge Gaps in Placenta Accreta Spectrum.
  American journal of perinatology 2023 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.
  American journal of perinatology 2023 Leonard SA, Girsen AI, Trepman P, Carmichael SL, Darmawan K, Butwick AJ, Gibbs RS
• In Reply.
  Obstetrics and gynecology 2023 Butwick A, Miller SE
• Red Blood Cell Transfusion in Patients With Placenta Accreta Spectrum: A Systematic Review and Meta-analysis.
  Obstetrics and gynecology 2022 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.
  AJOG global reports 2022 Butwick AJ, Bentley J, Daw J, Sultan P, Girsen A, Gibbs RS, Guo N
• Early postpartum readmissions: identifying risk factors at birth hospitalization.
  AJOG global reports 2022 Girsen AI, Leonard SA, Butwick AJ, Joudi N, Carmichael SL, Gibbs RS
• Update on Applications and Limitations of Perioperative Tranexamic Acid.
  Anesthesia and analgesia 2022 Patel PA, Wyrobek JA, Butwick AJ, Pivalizza EG, Hare GMT, Mazer CD, Goobie SM
• Hospital-level variation in rates of postpartum hemorrhage in California.
  Transfusion 2022 Davis R, Guo N, Bentley J, Sie L, Ansari J, Bateman B, Main E, Butwick AJ
• Subsequent risk of stillbirth, preterm birth, and small for gestational age: A cross-outcome analysis of adverse birth outcomes.
  Paediatric and perinatal epidemiology 2022 Bane S, Simard JF, Wall-Wieler E, Butwick AJ, Carmichael SL
• Association of Medicaid Expansion With Neuraxial Labor Analgesia Use in the United States: A Retrospective Cross-Sectional Analysis.
  Anesthesia and analgesia 2022 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.
  Journal of hypertension 2022 Xiao MZX, Whitney D, Guo N, Bentley J, Shaw GM, Druzin ML, Butwick AJ
• Latest advances in postpartum hemorrhage management.
  Best practice & research. Clinical anaesthesiology 2022 Kumaraswami S, Butwick A
• Placenta Accreta Spectrum Disorders: Knowledge Gaps in Anesthesia Care.
  Anesthesia and analgesia 2022 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?
  British journal of anaesthesia 2022 Butwick AJ, Abrams DA, Wong CA
• Authors reply re: The Ten Group Classification System - First Things First.
  BJOG : an international journal of obstetrics and gynaecology 2022 Ladfors LV, Muraca GM, Zetterqvist J, Butwick AJ, Stephansson O
• Current State and Future Direction of Postpartum Hemorrhage Risk Assessment.
  Obstetrics and gynecology 2021 Ende HB, Butwick AJ
• Evidence Mounts Refuting an Association Between Epidural Use and Neurodevelopmental Adverse Outcomes in Children.
  JAMA network open 2021 Butwick AJ, Wall-Wieler E
• The association between postpartum hemorrhage and postpartum depression: A Swedish national register-based study.
  PloS one 2021 Liu C, Butwick A, Sand A, Wikström AK, Snowden JM, Stephansson O
• Association of Epidural Labor Analgesia With Offspring Risk of Autism Spectrum Disorders.
  JAMA pediatrics 2021 Wall-Wieler E, Bateman BT, Hanlon-Dearman A, Roos LL, Butwick AJ
• Association of Gestational Age with Postpartum Hemorrhage: An International Cohort Study.
  Anesthesiology 2021 Butwick AJ, Liu C, Guo N, Bentley J, Main EK, Mayo JA, Shaw GM, Stephansson O
• Risk factors for postpartum readmission among women after having a stillbirth.
  American journal of obstetrics & gynecology MFM 2021 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.
  Anesthesiology 2021 Butwick AJ, Wong CA, Lee HC, Blumenfeld YJ, Guo N
• In Reply.
  Obstetrics and gynecology 2020 Butwick AJ, Wall-Wieler E
• Postpartum Hemorrhage: Wherefore Art Thou, Hyperfibrinolysis?
  Anesthesia and analgesia 2020 Butwick AJ
• Accuracy of postpartum hemorrhage coding in the Swedish Pregnancy Register.
  Acta obstetricia et gynecologica Scandinavica 2020 Ladfors LV, Muraca GM, Butwick A, Edgren G, Stephansson O
• Evaluation of US State-Level Variation in Hypertensive Disorders of Pregnancy.
  JAMA network open 2020 Butwick AJ, Druzin ML, Shaw GM, Guo N
• Opioid Prescription and Persistent Opioid Use After Ectopic Pregnancy.
  Obstetrics and gynecology 2020 Wall-Wieler E, Shover CL, Hah JM, Carmichael SL, Butwick AJ
• Racial and Ethnic Disparities in Hospital-Based Care Associated with Postpartum Depression.
  Journal of racial and ethnic health disparities 2020 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.
  American journal of perinatology 2020 Wall-Wieler E, Butwick AJ, Gibbs RS, Lyell DJ, Girsen AI, El-Sayed YY, Carmichael SL
• How do I manage severe postpartum hemorrhage?
  Transfusion 2020 Butwick A, Lyell D, Goodnough L
• A call for multidisciplinary cesarean delivery analgesia care.
  American journal of obstetrics & gynecology MFM 2019 Weiniger CF, Ioscovich A, Butwick AJ
• Severe Maternal Morbidity Among Stillbirth and Live Birth Deliveries in California.
  Obstetrics and gynecology 2019 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.
  Anesthesia and analgesia 2019 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.
  American journal of perinatology 2019 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.
  Turkish journal of anaesthesiology and reanimation 2019 Riley ET, Mangum K, Carvalho B, Butwick AJ
• Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis.
  American journal of obstetrics and gynecology 2018 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.
  JAMA network open 2018 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.
  Anesthesiology 2018 Butwick AJ, Wong CA, Guo N
• Effect of Maternal Body Mass Index on Postpartum Hemorrhage.
  Anesthesiology 2018 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.
  Obstetrics and gynecology 2018 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.
  Anesthesia and analgesia 2018 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 …
• Accuracy of international classification of diseases, ninth revision, codes for postpartum hemorrhage among women undergoing cesarean delivery.
  Transfusion 2018 Butwick AJ, Walsh EM, Kuzniewicz M, Li SX, Escobar GJ
• Tranexamic Acid for the Management of Obstetric Hemorrhage.
  Obstetrics and gynecology 2017 Butwick AJ, Deneux-Tharaux C, Sentilhes L
• Availability and Readability of Online Patient Education Materials Regarding Regional Anesthesia Techniques for Perioperative Pain Management.
  Pain medicine (Malden, Mass.) 2017 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.
  Anesthesia and analgesia 2017 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.
  Anesthesia and analgesia 2017 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.
  Anesthesia and analgesia 2017 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.
  Journal of clinical anesthesia 2017 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.
  Anesthesia and analgesia 2017 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.
  Anesthesia and analgesia 2017 Carvalho B, Zheng LL, Butwick A
• Postcesarean delivery analgesia.
  Best practice & research. Clinical anaesthesiology 2017 Carvalho B, Butwick AJ
• National and International Guidelines for Patient Blood Management in Obstetrics: A Qualitative Review.
  Anesthesia and analgesia 2017 Shaylor R, Weiniger CF, Austin N, Tzabazis A, Shander A, Goodnough LT, Butwick AJ
• Patterns and predictors of severe postpartum anemia after Cesarean section.
  Transfusion 2016 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.
  Annals of hematology 2016 Miller CM, Ramachandran B, Akbar K, Carvalho B, Butwick AJ
• Knowledge of blood loss at delivery among postpartum patients.
  PeerJ 2016 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.
  Journal of clinical anesthesia 2016 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.
  BMC pregnancy and childbirth 2016 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.
  Anesthesia and analgesia 2016 Butwick AJ, Blumenfeld YJ, Brookfield KF, Nelson LM, Weiniger CF
• Does Time of Delivery Influence the Risk of Neonatal Morbidity?
  American journal of perinatology 2015 Brookfield KF, O'Malley K, El-Sayed YY, Blumenfeld YJ, Butwick AJ
• Labor outcome at extremely advanced maternal age.
  American journal of obstetrics and gynecology 2015 Osmundson SS, Gould JB, Butwick AJ, Yeaton-Massey A, El-Sayed YY
• In Response.
  Anesthesia and analgesia 2015 Bateman BT, Butwick AJ, Huybrechts KF
• Transfusion and coagulation management in major obstetric hemorrhage.
  Current opinion in anaesthesiology 2015 Butwick AJ, Goodnough LT
• Morbidity associated with cesarean delivery in the United States: is placenta accreta an increasingly important contributor?
  American journal of obstetrics and gynecology 2015 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.
  American journal of perinatology 2015 Blumenfeld YJ, El-Sayed YY, Lyell DJ, Nelson LM, Butwick AJ
• Second-line uterotonics and the risk of hemorrhage-related morbidity.
  American journal of obstetrics and gynecology 2015 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.
  Canadian journal of anaesthesia = Journal canadien d'anesthesie 2014 Butwick A, Gutierrez MC, Hilton G
• Antenatal corticosteroids for preterm premature rupture of membranes: single or repeat course?
  American journal of perinatology 2014 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.
  Anesthesia and analgesia 2014 Bateman BT, Tsen LC, Liu J, Butwick AJ, Huybrechts KF
• Perioperative and transfusion outcomes in women undergoing cesarean hysterectomy for abnormal placentation.
  Transfusion 2013 Brookfield KF, Goodnough LT, Lyell DJ, Butwick AJ
• Anesthetic management of a parturient with VACTERL association undergoing Cesarean delivery.
  Canadian journal of anaesthesia = Journal canadien d'anesthesie 2013 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.
  Anesthesia and analgesia 2012 Butwick A
• Managing patients with abnormal placentation: what are the best anesthetic and transfusion strategies?
  Anesthesiology 2012 Butwick AJ
• Platelet counts and coagulation tests prior to neuraxial anesthesia in patients with preeclampsia: a retrospective analysis.
  Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis 2012 Sultan P, Butwick A
• Continuous spinal anesthesia for Cesarean hysterectomy and massive hemorrhage in a parturient with placenta increta.
  Canadian journal of anaesthesia = Journal canadien d'anesthesie 2012 Sultan P, Hilton G, Butwick A, Carvalho B
• Epidural catheter removal in patients on warfarin thromboprophylaxis: a more cautious interpretation of results required?
  Regional anesthesia and pain medicine 2011 Carvalho B, Mariano ER, Butwick AJ
• An in vitro investigation of the coagulation effects of exogenous oxytocin using thromboelastography in healthy parturients.
  Anesthesia and analgesia 2011 Butwick A, Harter S
• Oxytocin for labour and caesarean delivery: implications for the anaesthesiologist.
  Current opinion in anaesthesiology 2011 Dyer RA, Butwick AJ, Carvalho B
• How we treat: transfusion medicine support of obstetric services.
  Transfusion 2011 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.
  International forum of allergy & rhinology 2011 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.
  Anesthesia and analgesia 2011 Butwick A, Ting V, Ralls LA, Harter S, Riley E
• The postoperative anaesthetic review.
  Journal of perioperative practice 2011 Sultan P, Jigajinni S, McGlennan A, Butwick A
• Retrospective analysis of anesthetic interventions for obese patients undergoing elective cesarean delivery.
  Journal of clinical anesthesia 2010 Butwick A, Carvalho B, Danial C, Riley E
• A survey of perioperative and postoperative anesthetic practices for cesarean delivery.
  Anesthesiology research and practice 2010 Aiono-Le Tagaloa L, Butwick AJ, Carvalho B
• Obstetric hemorrhage during an EXIT procedure for severe fetal airway obstruction.
  Canadian journal of anaesthesia = Journal canadien d'anesthesie 2009 Butwick A, Aleshi P, Yamout I
• Intraoperative forced air-warming during cesarean delivery under spinal anesthesia does not prevent maternal hypothermia.
  Anesthesia and analgesia 2007 Butwick AJ, Lipman SS, Carvalho B
• Neuraxial anesthesia for cesarean delivery in a parturient with type 1 von Willebrand disease and scoliosis.
  Journal of clinical anesthesia 2007 Butwick AJ, Carvalho B
• Successful spinal blockade in a parturient with myotonia congenita.
  International journal of obstetric anesthesia 2007 Butwick AJ, Riley ET
• The effect of colloid and crystalloid preloading on thromboelastography prior to Cesarean delivery.
  Canadian journal of anaesthesia = Journal canadien d'anesthesie 2007 Butwick A, Carvalho B