About

Naida Cole, MD, is an Assistant Professor of Anesthesia and Critical Care at the University of Chicago. Her professional focus includes research on ambulation during neuraxial analgesia in obese patients, as evidenced by her publication in the American Journal of Perinatology. She has also contributed to the understanding of patient safety challenges in obstetric anesthesia in Japan, with her work published in the Journal of Anesthesiology. Dr. Cole is actively involved in advancing clinical practices within her department, which is part of the University of Chicago Medicine, located at 5841 South Maryland Avenue, Chicago. She maintains a research network profile and can be contacted via nmcole@uchicago.edu.

Research topics

• Artificial Intelligence
• Computer Science
• Medicine
• Family medicine
• Anesthesia
• Medical education
• Surgery
• Nursing
• Psychology
• Internal medicine

Selected publications

• Closed-loop vasopressor systems for hemodynamic stability during cesarean delivery and maternal and neonatal outcomes: a systematic review and meta-analysis

  International Journal of Obstetric Anesthesia · 2025-09-05 · 1 citations

  reviewOpen accessSenior author

  BACKGROUND: Closed-loop vasopressor systems automate vasopressor administration using real-time hemodynamic biofeedback; clinical equipoise exists between closed-loop vasopressor systems and manual vasopressor titration. This review evaluates the performance and hemodynamic outcomes of closed-loop vasopressor systems vs. manual titration in cesarean delivery under spinal anesthesia. METHODS: Included studies compared closed-loop vasopressor systems with manual vasopressor administration for spinal hypotension in cesarean delivery. Primary outcomes were closed-loop vasopressor systems performance and hemodynamic measures. Performance was assessed with median performance error, median absolute performance error, wobble (intraindividual variation in performance error) and divergence (performance error over time). Meta-analyses were conducted for RCTs and observational studies separately. Risk of bias was assessed using Cochrane methodology. Data were reported as risk ratio (RR) or mean difference (MD) with 95 % confidence intervals (CI). RESULTS: Seven studies (n = 864) were included. In three RCTs (n = 654), wobble (MD -0.66 %; 95 % CI -1.29 to -0.02; P = 0.04), hypotension incidence (RR 0.67; 95 % CI 0.55 to 0.82; P < 0.01), and the highest and lowest systolic blood pressures values (MD -4.05 mmHg; 95 % CI -7.03 to -1.06; P < 0.01 and MD 5.39 mmHg; 95 % CI 2.17 to 8.60; P < 0.01, respectively) were minimized with closed-loop vasopressor systems, but no significant differences were observed in other primary outcomes. Maternal nausea was reduced with closed-loop vasopressor systems (RR 0.47; 95 % CI 0.26 to 0.85; P = 0.01; moderate quality of evidence). In four observational studies (n = 210), the pooled values for median absolute performance error, wobble, divergence of the system, hypotension incidence, highest and lowest systolic blood pressures, highest and lowest heart rates, total fluids, total phenylephrine and ephedrine dosages were statistically significant. Risk of bias was low to moderate for all studies. CONCLUSION: Closed-loop vasopressor systems may improve systolic blood pressure fluctuations in cesarean deliveries with spinal anesthesia compared to manually adjusted vasopressor dosing; however, more high-quality evidence is needed.

  PublisherDOI

• In Reply:

  Obstetrics and Gynecology · 2025-02-20

  article1st authorCorresponding

  In Reply: We thank Drs. Boucherie, Rousseau, and Quibel for their interest in our study in the December 2024 issue comparing the efficacy of methylergonovine and carboprost tromethamine for the treatment of uterine atony in cesarean delivery.1 The authors question the use of a uterine tone score as the primary outcome in our study. This validated numeric rating scale was chosen because it represents the most direct measure of the desired clinical effect of these uterotonic drugs; namely, firm contraction of the uterus. A previous trial evaluating the 0–10 uterine tone score in cesarean deliveries demonstrated good-to-excellent interrater reliability across health care professionals of varying experience levels.2 A more recent trial demonstrated a strong correlation between the obstetricians' estimate of uterine tone using this scoring system and subsequent severe hemorrhage and blood transfusion (Koons NJ, Stanwyck C, Xie J, Michel G, Lyell D, Carvalho B, et al. Uterine tone numeric rating score as an early indicator of major postpartum hemorrhage during cesarean delivery: a prospective observational study. Anesthesiology. In press). We agree that blood loss and transfusion requirements are clinically meaningful individual outcomes in uterine atony. Blood loss, transfusion requirements, and need for additional uterotonics were therefore among the reported secondary outcomes. However, powering the study to detect a meaningful difference in these outcomes would not have been feasible for this initial trial.

  PublisherDOI

• Ambulation during Neuraxial Analgesia in Obese Patients: A Pilot Study

  American Journal of Perinatology · 2025-02-10

  article

  Abstract Prior studies have yielded mixed results regarding ambulation with neuraxial analgesia and labor outcomes, and studies did not include a significant obese population. We sought to evaluate the feasibility of ambulation with optimized neuraxial analgesia in laboring nulliparous obese patients. This was a pilot study at the University of Chicago (approval no.: IRB 19-1600, CT NCT04504682). Inclusion criteria were delivery BMI of ≥35 kg/m2, nulliparity, and term gestation. Contraindications to ambulation or vaginal delivery conferred ineligibility. Combined spinal-epidural analgesia was initiated per our institution's policy. Following epidural catheter placement, serial blood pressure measurements and motor assessments including a straight leg test and a step stool test were completed per safety protocol. Patients who passed these assessments were enrolled. Patients were encouraged to ambulate for 20 minutes every hour while on fetal and uterine telemetry. Ambulation was discouraged after complete dilation. Demographics and delivery outcomes were collected. Our primary objective was to evaluate feasibility through acceptability, and safety via the number of falls, and percentage of patients with any ambulation. The study was closed early due to enrollment difficulties and in the setting of the COVID-19 pandemic. A total of 105 patients were identified for the trial: 20 were ineligible for the study, 20 could not be approached, and 40 declined study participation, leaving 25 patients who consented. Of those 25, 14 completed the study. Out of 14 participants, 11 were ambulated. The average BMI of these participants was 43 kg/m2. No patients fell during the trial. A pilot trial of ambulation during neuraxial analgesia among an obese nulliparous population demonstrated no safety concerns, but with concern regarding feasibility as there was low acceptance.

  PublisherDOI

• Anesthetic recommendations for maternal and fetal safety in nonobstetric surgery: a balancing act

  Current Opinion in Anaesthesiology · 2024-02-23 · 2 citations

  reviewSenior author

  PURPOSE OF REVIEW: Nonobstetric surgery during pregnancy is associated with maternal and fetal risks. Several physiologic changes create unique challenges for anesthesiologists. This review highlights physiologic changes of pregnancy and presents clinical recommendations based on recent literature to guide anesthetic management for the pregnant patient undergoing nonobstetric surgery. RECENT FINDINGS: Nearly every anesthetic technique has been safely used in pregnant patients. Although it is difficult to eliminate confounding factors, exposure to anesthetics could endanger fetal brain development. Perioperative fetal monitoring decisions require an obstetric consult based on anticipated maternal and fetal concerns. Given the limitations of fasting guidelines, bedside gastric ultrasound is useful in assessing aspiration risk in pregnant patients. Although there is concern about appropriateness of sugammadex for neuromuscular blockade reversal due its binding to progesterone, preliminary literature supports its safety. SUMMARY: These recommendations will equip anesthesiologists to provide safe care for the pregnant patient and fetus undergoing nonobstetric surgery.

  PublisherDOI

• A Case Report of Fluoroscopically Guided Epidural Catheter Placement in a Parturient with History of Tethered Cord, Super-Morbid Obesity, and Risk for Difficult Airway

  A&A Practice · 2024-04-01

  articleSenior author

  Tethered cord syndrome results from adherence of the conus medullaris to the sacrum and may be associated with high complication rates from neuraxial anesthesia. We present the case of a 32-year-old gravida 2 para 0 patient with a history of lipomyelomeningocele (one of several types of spina bifida) and tethered cord status post repair, residual low-lying conus medullaris, supermorbid obesity (body mass index of 58), and Mallampati IV airway, who underwent successful fluoroscopically guided epidural catheter placement for vaginal delivery. Risks and benefits of epidural catheter utilization and methods of placement are reviewed.

  PublisherDOI

• Bioequivalence and Pharmacokinetics of Intravenous Calcium during Cesarean Delivery

  Anesthesiology · 2024-10-03 · 3 citations

  article

  BACKGROUND: Few studies have assessed the dose ratio of calcium gluconate to calcium chloride or defined the time course of change in serum ionized calcium concentration after intravenous injection. METHODS: In a bioequivalence (dose ratio) trial, parturients undergoing cesarean delivery were randomly assigned to receive calcium chloride (0.5 g) or calcium gluconate (1.5 or 2 g) by 10-min intravenous infusion. Venous serum ionized calcium concentration was measured before calcium infusion and approximately 5, 10, 15, 30, and 60 min after infusion start. These data were combined with serum ionized calcium concentration measurements in parturients who received 1 g calcium chloride or saline placebo in two recent clinical trials to define the pharmacokinetics of intravenous calcium over the first hour during and after drug administration. RESULTS: The bioequivalence study enrolled 34 participants, from whom were collected 181 serum ionized calcium concentration measurements. The dose ratio of calcium gluconate to calcium chloride was 3.11 (95% CI, 2.77 to 3.48). Population pharmacokinetics of calcium were determined using 311 serum ionized calcium concentration measurements from 70 parturients. The pharmacokinetics of intravenous calcium were described by a two-compartment model with systemic clearance of 0.18 (95% CI, 0.07 to 0.27) l/min, distributional clearance of 1.25 (95% CI, 1.03 to 1.56) l/min, central volume of 10.9 (95% CI, 9.3 to 12.6) l, and peripheral volume of 16.5 (95% CI, 12.5 to 24.7) l. After adjusting for the dose ratio, calcium gluconate and calcium chloride had identical time courses. A 1-g infusion of calcium chloride resulted in a peak increase in serum ionized calcium concentration of 0.39 (0.38 to 0.42 mM), which decreased by half (29 [23 to 40] min) after initiation of the 10-min infusion. CONCLUSIONS: This study confirmed a 3:1 dose ratio of calcium gluconate to calcium chloride and estimated the pharmacokinetics over the first hour after intravenous delivery. These data inform clinical care and may guide future trials assessing calcium efficacy to reduce bleeding in obstetric patients.

  PublisherDOI

• Second-Line Uterotonics for Uterine Atony

  Obstetrics and Gynecology · 2024-09-26 · 4 citations

  article1st authorCorresponding

  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. RESULTS: A total of 1,040 participants were enrolled, with 100 randomized to receive one of the study interventions. Mean±SD 10-minute uterine tone scores were 7.3±1.7 after methylergonovine and 7.6±2.1 after carboprost, with an adjusted difference in means of -0.1 (95% CI, -0.8 to 0.6, P =.76). Additional second-line uterotonics were required in 30.0% of the methylergonovine arm and 34.0% in the carboprost arm (adjusted odds ratio 0.72, 95% CI, 0.27-1.89, P =.505), and geometric mean quantitative blood loss was 756 mL (95% CI, 636-898) and 708 mL (95% CI, 619-810) (adjusted ratio of geometric means 1.06, 95% CI, 0.86-1.31, P =.588), respectively. No differences were detected in the occurrence of other interventions for uterine atony or postpartum hemorrhage. CONCLUSION: No difference was detected in uterine tone scores 10 minutes after administration of either methylergonovine or carboprost for refractory uterine atony, indicating that either agent is acceptable. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , NCT03584854.

  PublisherDOI

• A survey of pregnant patients’ perspectives on the implementation of artificial intelligence in clinical care

  Journal of the American Medical Informatics Association · 2022 · 30 citations

  • Artificial Intelligence
  • Computer Science
  • Medicine

  OBJECTIVE: To evaluate and understand pregnant patients' perspectives on the implementation of artificial intelligence (AI) in clinical care with a focus on opportunities to improve healthcare technologies and healthcare delivery. MATERIALS AND METHODS: We developed an anonymous survey and enrolled patients presenting to the labor and delivery unit at a tertiary care center September 2019-June 2020. We investigated the role and interplay of patient demographic factors, healthcare literacy, understanding of AI, comfort levels with various AI scenarios, and preferences for AI use in clinical care. RESULTS: Of the 349 parturients, 57.6% were between the ages of 25-34 years, 90.1% reported college or graduate education and 69.2% believed the benefits of AI use in clinical care outweighed the risks. Cluster analysis revealed 2 distinct groups: patients more comfortable with clinical AI use (Pro-AI) and those who preferred physician presence (AI-Cautious). Pro-AI patients had a higher degree of education, were more knowledgeable about AI use in their daily lives and saw AI use as a significant advancement in medicine. AI-Cautious patients reported a lack of human qualities and low trust in the technology as detriments to AI use. DISCUSSION: Patient trust and the preservation of the human physician-patient relationship are critical in moving forward with AI implementation in healthcare. Pregnant individuals are cautiously optimistic about AI use in their care. CONCLUSION: Our findings provide insights into the status of AI use in perinatal care and provide a platform for driving patient-centered innovations.

  PublisherOA PDFDOI

• AJOG MFM Table of Contents

  American Journal of Obstetrics and Gynecology · 2021-07-28

  articleOpen access
  PublisherDOI

• Erratum to ‘The interrater reliability and agreement of a 0 to 10 uterine tone score in cesarean delivery’ [American Journal of Obstetrics &amp; Gynecology MFM 3/3 (2021) 100342]

  American Journal of Obstetrics & Gynecology MFM · 2021-12-03

  erratum1st authorCorresponding
  PublisherDOI

Frequent coauthors

• Brian T. Bateman

  Stanford Medicine

  30 shared

• Julian N. Robinson

  Worthing Hospital

  19 shared

• Ronan Sugrue

  Duke University

  16 shared

• Erica Holland

  Seattle Children's Hospital

  16 shared

• Laura A. Robinson

  Auburn University

  16 shared

• Ashley Taggart

  Brigham and Women's Hospital

  16 shared

• Xinling Xu

  Karolinska University Hospital

  16 shared

• Kara G. Fields

  Harvard University Press

  14 shared