About

Sindhu K Srinivas, MD, MSCE, is a Professor of Obstetrics and Gynecology at the Hospital of the University of Pennsylvania and a Senior Fellow at the Leonard Davis Institute at the University of Pennsylvania Perelman School of Medicine. She also serves as an Associate Scholar at the Center for Clinical Epidemiology and Biostatistics and as the Associate Chief Medical Officer for Quality and Safety at the Hospital of the University of Pennsylvania. Her educational background includes a B.S. in Biology from Trenton State College and NJMS, an M.D. from UMDNJ-NJ Medical School, and an M.S.C.E. in Clinical Epidemiology and Biostatistics from the University of Pennsylvania. Her professional work focuses on maternal-fetal medicine, quality and safety in healthcare, and addressing disparities in maternal health outcomes.

Research topics

• Medicine
• Internal medicine
• Sociology
• Intensive care medicine
• Gender studies
• Family medicine
• Surgery
• Emergency medicine
• Pediatrics
• Psychiatry
• Engineering
• Operations management
• Psychology

Selected publications

• Maternal Depression and Opioid Use After Cesarean Delivery

  Obstetrics and Gynecology · 2026-03-19

  articleSenior author

  OBJECTIVE: To evaluate the association between self-reported history of maternal depression by treatment status and opioid use after cesarean delivery. METHODS: This was a secondary analysis of a multicenter randomized trial of individuals who underwent cesarean delivery at 12 U.S. hospitals from 2020 to 2022. We evaluated two exposures for patients with a self-reported history of depression assessed on the enrollment form: treatment (pharmacologic or nonpharmacologic therapy during pregnancy) or no treatment. The primary outcome was inpatient oral opioid use in morphine milligram equivalents (MMEs) per day from 12 hours after cesarean delivery through hospital discharge. Secondary outcomes included outpatient opioid use (MMEs of opioid prescriptions through 6 weeks postpartum) and moderate-to-severe perceived pain (score 4 or higher) and interference in daily activities (score 4 or higher) on a validated questionnaire, the BPI (Brief Pain Inventory, score 1-10) at 1 week after discharge. Multivariable modeling (quantile regression for continuous outcomes and logistic regression for binary outcomes) evaluated the association between untreated or treated depression compared with no depression and the selected outcomes. RESULTS: Of 5,504 study participants, 1,507 (27.4%) had self-reported depression, of whom 663 (44.0%) were treated. Those with depression were more likely to have a chronic pain condition (19.5% untreated, 18.9% treated, and 8.5% no depression, P<.0001), to use tobacco (22.5% untreated, 18.9% treated, and 8.1% no depression, P<.0001), and to experience disordered sleep (median score [IQR] 57.9 [52.8-63.7] for untreated, 59.3 [53.8-64.2] for treated, and 55.7 [50.3-60.6] for no depression, P<.0001). In adjusted modeling, neither treated nor untreated depression was associated with inpatient postpartum MMEs. However, untreated depression was associated with higher outpatient MME use through 6 weeks postpartum (adjusted median difference 16.7 MMEs/d [95% CI, 8.9-24.5]) and higher moderate-to-severe perceived pain at 1 week after discharge. Both treated depression and untreated depression were associated with higher perceived pain interference in daily activities (adjusted odds ratio 1.44 [95% CI, 1.2-1.8] and 1.37 [95% CI, 1.1-1.7], respectively). CONCLUSION: Self-reported history of depression, regardless of treatment status, was not associated with increased post-cesarean delivery inpatient opioid use, but untreated depression was associated with increased opioid use through 6 weeks postpartum.

  PublisherDOI

• Exception from Informed Consent in Neonatal Research

  The Journal of Pediatrics · 2026-01-16

  article
  PublisherDOI

• Renewed focus on reducing the burden of pre-eclampsia

  Bulletin of the World Health Organization · 2026-04-30

  articleOpen access
  PublisherDOI

• Screening Using the Edinburgh Postnatal Depression Scale at Delivery Discharge as a Predictor of Postpartum Depression

  International Journal of Behavioral Medicine · 2026-03-23 · 1 citations

  articleOpen accessSenior author

  BACKGROUND: The objective of this study was to determine if Edinburgh Postnatal Depression Scale (EPDS) scores at delivery discharge are predictive of EPDS scores at 2-6 weeks postpartum. METHOD: This was a retrospective cohort study of all patients who delivered at an urban academic medical center from 6/2021 to 6/2022. Universal EPDS screening was implemented for all patients prior to discharge; a score of ≥ 9 was considered at risk for postpartum depression. Patients were re-screened at 2-6 weeks postpartum. The primary outcome was mean EPDS score at 2-6 weeks postpartum. RESULTS: One thousand six hundred three patients were included; 219 (13.7%) scored ≥ 9 at delivery discharge and 37 (2.3%) endorsed self-harm at delivery discharge. Mean EPDS score at the postpartum visit was significantly higher for patients who had an elevated EPDS at delivery discharge compared to those with a low-risk score (7.9 vs. 2.7, p < 0.001). Of patients who had an EPDS ≥ 9 at delivery discharge, 42.0% (92/219) continued to score ≥ 9 postpartum. Most patients who scored < 9 at delivery discharge continued to score low at 2-6 weeks postpartum (1270/1384, negative predictive value 91.8%). A small proportion of patients who had a low score at delivery discharge scored ≥ 9 at the postpartum visit (114/1384, 8.2%). CONCLUSION: EPDS screening at delivery discharge is feasible and identifies patients at risk of postpartum depression. Interventions should target patients with an elevated EPDS score at delivery discharge, as many patients will continue to score high at their postpartum visit. Rescreening at the postpartum visit remains important, as there are patients who will not be captured immediately postpartum.

  PublisherDOI

• Evaluating Risk-Adjusted Associations between Prenatal Care Utilization and Obstetric Outcomes in a Commercially Insured Patient Population

  American Journal of Perinatology · 2025-03-17

  articleSenior author

  Office prenatal care has followed a similar structure for the past century. It is largely unknown whether attendance at routine outpatient antenatal visits prevents major adverse maternal outcomes. This study examined associations between prenatal care utilization and adverse obstetric outcomes including severe maternal morbidity (SMM), preterm birth, and stillbirth in a large, commercially insured US patient population.This is a retrospective cohort study using an insurance claims database evaluating associations between prenatal care utilization and obstetric outcomes over 4 years (2017-2020). Prenatal care utilization was characterized based on the adequacy of prenatal care utilization (APNCU) index. The primary outcome was SMM (as per Centers for Disease Control). Secondary outcomes included preterm birth <37 weeks and stillbirth. Associations between exposure and outcome were investigated using logistic regression models in designated "low" and "medium" maternal risk groups, defined based on obstetric co-morbidity index (OB-CMI) scores modeled at the time of the first trimester and at delivery.A total of 297,453 patients were included: 78,100 in the sub-group who remained low-risk throughout pregnancy and 49,920 in the sub-group who remained medium-risk. The largest number of patients overall (29.9%) received "adequate plus" care, as defined by the APNCU index, while a plurality of low- and medium-risk patients received "intermediate" care (35.6 and 29.9%, respectively). One point seventy seven percent of patients experienced SMM, 8.63% delivered preterm, and 0.88% had stillbirth. Adjusted analysis comparing volume of prenatal care with these outcomes demonstrated no statistically significant associations, with the exception of preterm birth, which was positively associated with "adequate" and "adequate plus" care in low- and medium-risk patients. "Inadequate care" was not associated with any of the studied outcomes.Overall volume of prenatal care was not associated with a reduction in adverse obstetric outcomes. Clinical quality improvement and health policy efforts to improve prenatal care delivery models may need to bypass adherence to established guidelines in terms of gross visit number as a key metric and instead work to revise practices based on more meaningful clinical outcomes. · It is unknown whether receipt of routine prenatal care is associated with better pregnancy outcomes.. · There were no associations between amount of prenatal care and SMM or stillbirth.. · Preterm birth was associated with "adequate" and "adequate plus" care in low- and medium-risk patients.. · Likely suggesting higher utilization in the setting of concerning symptoms.. · "Inadequate" care was not associated with any of the studied adverse outcomes..

  PublisherDOI

• Racial and Ethnic Inequities in Cesarean Birth and Maternal Morbidity in a Low-Risk, Nulliparous Cohort

  UNC Libraries · 2025-05-14

  articleOpen access

  OBJECTIVE: To evaluate race and ethnicity differences in cesarean birth and maternal morbidity in low-risk nulliparous people at term. METHODS: We conducted a secondary analysis of a randomized trial of expectant management compared with induction of labor in low-risk nulliparous people at term. The primary outcome was cesarean birth. Secondary outcome was maternal morbidity, defined as: transfusion of 4 or more units of red blood cells, any transfusion of other products, postpartum infection, intensive care unit admission, hysterectomy, venous thromboembolism, or maternal death. Multivariable modified Poisson regression was used to evaluate associations between race and ethnicity, cesarean birth, and maternal morbidity. Indication for cesarean birth was assessed using multivariable multinomial logistic regression. A mediation model was used to estimate the portion of maternal morbidity attributable to cesarean birth by race and ethnicity. RESULTS: Of 5,759 included participants, 1,158 (20.1%) underwent cesarean birth; 1,404 (24.3%) identified as non-Hispanic Black, 1,670 (29.0%) as Hispanic, and 2,685 (46.6%) as non-Hispanic White. Adjusted models showed increased relative risk of cesarean birth among non-Hispanic Black (adjusted relative risk [aRR] 1.21, 95% CI 1.03-1.42) and Hispanic (aRR 1.26, 95% CI 1.08-1.46) people compared with non-Hispanic White people. Maternal morbidity affected 132 (2.3%) individuals, and was increased among non-Hispanic Black (aRR 2.05, 95% CI 1.21-3.47) and Hispanic (aRR 1.92, 95% CI 1.17-3.14) people compared with non-Hispanic White people. Cesarean birth accounted for an estimated 15.8% (95% CI 2.1-48.7%) and 16.5% (95% CI 4.0-44.0%) of excess maternal morbidity among non-Hispanic Black and Hispanic people, respectively. CONCLUSION: Non-Hispanic Black and Hispanic nulliparous people who are low-risk at term undergo cesarean birth more frequently than low-risk non-Hispanic White nulliparous people. This difference accounts for a modest portion of excess maternal morbidity.

  PublisherDOI

• Childhood sexual abuse and post‐cesarean pain

  Pregnancy · 2025-11-01

  articleOpen access

  Abstract Background Sexual abuse before the age of 10 is reported by 2.7% of US women. Chronic pain has been linked to sexual abuse, but little is known about acute postoperative pain in those with a sexual abuse history and no history of chronic pain. We hypothesized that those who report prepubertal sexual abuse experience more pain at 7 days after hospital discharge from a cesarean delivery. Objective To evaluate whether patients who report prepubertal sexual abuse experience more pain 7 days after hospital discharge from a cesarean delivery. Study Design Secondary analysis of a multicenter randomized trial of individuals who underwent cesarean at 31 US hospitals (2020–2022). Participants were excluded if they had chronic pain or were missing sexual abuse data. The primary outcome was moderate‐to‐severe worst pain (≥4 on a scale from 0 to 10), as assessed by the Brief Pain Inventory (BPI), 7 days after discharge. Secondary outcomes included BPI at 2 weeks post‐discharge and 6 weeks and 90 days postpartum, Pain Catastrophizing Scale (PCS) and Physical Function (PF) scores at 6 weeks, Milligram Morphine Equivalents (MME) use in 24 h before discharge, and opioid use measured at 90 days (number of prescriptions beyond discharge and total number of tablets taken after discharge). Maternal characteristics were compared between those with and without prepubertal sexual abuse. Multivariable modeling was performed adjusting for prepregnancy body mass index (BMI), family history of substance use disorders, and Edinburgh depression score ≥13 at randomization. Results Of the 4881 participants included in the analysis, 5.3% reported prepubertal sexual abuse. They were significantly more likely to have a BMI ≥30 (54% vs. 44%), a family history of substance use disorders (58% vs. 24%), and an Edinburgh depression score ≥ 13 (9% vs. 4%) (all p &lt; 0.05). Multivariable models showed that a BPI score ≥ 4 was significantly higher 7 days post‐discharge (75% vs. 57%; adjusted relative risk [aRR], 1.3 [1.2, 1.4]) in those reporting prepubertal sexual abuse. BPI scores remained significantly higher through 6 weeks (2 weeks: 42% vs. 30%; aRR, 1.3 [1.1, 1.6]; 6 weeks: 14% vs. 10%; aRR, 1.5 [1.01, 2.1]; 90 days: 5% vs. 5%; aRR, 0.9 [0.4, 1.8]). PCS score ≥ 12 (15% vs. 12%) and PF score below average (64% vs. 56%) were not significantly different at 6 weeks. Opioid use in the 24 h before discharge (median MME 22.5% vs. 15, p &lt; 0.01), additional opioid prescriptions after discharge (10% vs. 6%; aRR, 1.7 [1.1, 2.5]), and median total opioid tabs used after discharge (9% vs. 4 tabs, p &lt; 0.01) were all significantly higher among individuals reporting prepubertal sexual abuse. Conclusion In postpartum individuals who reported prepubertal sexual abuse, post‐cesarean pain through 6 weeks and prescription opioid use were significantly higher. These associations warrant further study.

  PublisherOA PDFDOI

• Comparative Analysis of Rate of Recurrence Using Sodium Hydroxide versus Phenol for Chemical Matrixectomies of Toenails

  Journal of the American Podiatric Medical Association · 2025-07-01

  article1st authorCorresponding

  BACKGROUND: Chemical matrixectomy using acidic phenol or alkaline sodium hydroxide (NaOH) is indicated when prevention of toenail growth is preferred. The literature reports outcomes for phenol and NaOH independently; however, no studies are found to compare recurrence rates. This study evaluates the efficacy of these chemicals in preventing nail growth recurrence while analyzing whether age, sex, and body mass index contribute to regrowth after chemical matrixectomy. METHODS: From July 1, 2019, to July 1, 2021, data were obtained for toenail removal procedures that include Current Procedural Terminology codes 11730, 11750, and 11732 and corresponding International Classification of Diseases, Tenth Revision code S61.309A. RESULTS: Descriptive statistical analyses were conducted on 138 patients who underwent partial or total chemical matrixectomy. A χ2 test, a Fisher exact test, and an independent two-sample test were used to compare health and demographic characteristics on only patients who underwent a chemical matrixectomy (n = 58), evaluating differences between NaOH and phenol. The mean patient age was 43.2 years. Most patients (72%) did not have a previous revision. Approximately 54% of patients underwent partial nail avulsions without chemical matrixectomies versus 44% who had chemical matrixectomies. No statistically significant differences were found between groups. Comparison of recurrence rates did not demonstrate a statistically significant difference between NaOH and phenol. No association was found between nail growth recurrence and age. CONCLUSION: Further investigation into application times, technique, and severity of deformity may provide further insight into factors leading to recurrence.

  PublisherDOI

• Audit and feedback is an effective implementation strategy to increase fidelity to a multi-component labor induction protocol designed to reduce obstetric inequities

  Implementation Science Communications · 2025-01-03

  articleOpen access

  BACKGROUND: Studies have demonstrated that standardizing labor induction (IOL), often with the use of protocols, may reduce racial inequities in obstetrics. IOL protocols are complex, multi-component interventions. To target identified implementation barriers, audit and feedback (A&F) was selected as an implementation strategy. Here, we aimed to understand the acceptability and effect of A&F on fidelity to this complex intervention through quantitative and qualitative approaches. METHODS: This secondary analysis of a type I hybrid effectiveness-implementation trial (10/2018-12/2022) compared 2 years before (PRE) to 2 years after (POST) implementation of an IOL protocol at two sites. Fidelity to each of 8 specific protocol components was collected via chart review. During the POST period, unit-aggregated A&F reports were distributed via email every 3 months to site clinicians. Reports tracked fidelity to protocol components over time. For this analysis, we compared component fidelity PRE to POST-implementation. Additionally, during the POST period, we compared fidelity by month after each A&F (Month#1 v. Month#2/3) to evaluate the effect of A&F over time. Acceptability of A&F reports was evaluated using qualitative interviews. RESULTS: 8509 labor inductions were included (PRE = 4214, POST = 4295). A&F reports were successfully distributed every 3 months for the 2-year POST period. PRE to POST-implementation, fidelity to 4 of the 8 components increased significantly (cervical Foley utilization, latent labor examination frequency, amniotomy timing, and intrauterine pressure catheter utilization), without change in the other 4 components. For 2 of those 4 components where improvement was noted, there was no difference in fidelity by month after A&F report; rather, there was sustained improvement across the POST-implementation period. On the other hand, for the remaining 2 components, fidelity peaked in the first month after each A&F report, with some decline in the following 2 months prior to the next A&F report. Qualitative analysis (n = 24) supported A&F acceptability, with A&F described as "motivating" and "helpful." CONCLUSIONS: A&F was an effective implementation strategy to promote fidelity to certain components of this labor induction protocol. With some decline in effect after the first month POST-A&F report, increased A&F frequency should be considered in future work targeting obstetric outcomes, as well as health inequities.

  PublisherOA PDFDOI

• Towards optimizing social drivers of health screenings in prenatal care: patient perspectives

  American Journal of Obstetrics & Gynecology MFM · 2025-02-07 · 2 citations

  letter
  PublisherDOI

Frequent coauthors

• William A. Grobman

  The Ohio State University

  980 shared

• Jay D. Iams

  Eunice Kennedy Shriver National Institute of Child Health and Human Development

  967 shared

• George A. Macones

  730 shared

• Kim Boggess

  698 shared

• Alan T. Tita

  Office of the Director

  667 shared

• Brian M. Casey

  The University of Texas Southwestern Medical Center

  631 shared

• Lorene A. Temming

  Atrium Medical Cente

  570 shared

• Anthony Sciscione

  527 shared