Jerome (Jeff) Federspiel, MD, PhD is a maternal fetal medicine fellow in the Department of Ob/Gyn at Duke University Medical Center, Durham, NC. He's also the recipient of one of the Foundation's 2019 research grants for his project on venous thromboembolism (VTE). Under the mentorship of our founding Board Member Dr. Andra James, Dr. Federspiel will attempt to determine the incidence of VTE following cesarean delivery for patients considered to be at elevated risk of VTE, and thus requiring prophylaxis. His study will also develop a decision sciences model for practical application in preventing VTE following cesarean.
We wanted to understand and share a little more about what this study entails, and we asked Dr. Federspiel a series of questions. Here's what he had to say...
FWGBD: Your project has a very clear goal of developing a decision sciences model for providers. How did you come up with this project goal?
Dr. Federspiel: I am a practicing high-risk obstetrician and a health services researcher, so I enjoy studying challenging, clinically-relevant topics. This question fits the bill! Women who have recently had a cesarean section are at significantly elevated risk of VTE, compared with patients without a recent pregnancy; and VTE complications and treatment are a significant cause of maternal morbidity and mortality in the United States. However, options to reduce the risk of VTE (such as blood thinning injections) have risks of their own, so the decision to start taking them is not always straightforward. We hope this project will help providers and patients make informed decisions about whether preventative options should be used.
FWGBD: What are the signs of elevated risk of VTE? How prevalent is this elevation?
Dr. Federspiel: There are a number of different risk factors that can predispose a patient to VTE after a cesarean delivery, including a personal or family history of VTE, preeclampsia (a form of high blood pressure in pregnancy), obesity, a cesarean delivery in which more blood was lost than average, and having an urgent or emergent cesarean delivery. While only approximately 4 in 1000 women will have a VTE after cesarean delivery, for many women with multiple risk factors, the risk can be much higher.
FWGBD: What originally inspired you to work in obstetrics / gynecology?
Dr. Federspiel: Every day as a high-risk obstetrician is a new challenge! I enjoy the fast paced nature of the work and the variety of cases I see on a daily basis. It is an unbelievable privilege to be present with patients and their families for some of the most important of life’s moments.
FWGBD: Can you tell us what it has been like working with your mentor, Dr. James?
Dr. Federspiel: Dr. James is an internationally-known expert in blood disorders occurring during pregnancy, and I am extremely fortunate to have her guidance on this project! She is not only an expert in this disease area, but is also unbelievably generous with her time and expertise.
FWGBD: What’s next for you after the completion of this project?
Dr. Federspiel: As part of this project, we are identifying areas where additional study would allow us to provide more certain answers to patients and providers about the risks and benefits of different prevention strategies for VTE, and the next phase of this research would be additional studies to fill those gaps in knowledge.