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Q&A with the New Chair of OB/GYN

Sarah J. Kilpatrick, M.D., Ph.D., a nationally renowned expert in maternal-fetal medicine and women's health, is the newly appointed chair of the Department of Obstetrics and Gynecology at Cedars-Sinai. Dr. Kilpatrick was recruited from the University of Illinois at Chicago, where she was the head of OB/GYN and vice dean for the College of Medicine. She led major clinical, research, academic, and administrative initiatives, focusing on those that brought together different medical specialties with other health science disciplines.

Q: You have a very expansive approach and outlook on women's health. What are the advantages of combining OB/GYN with other specialties in a multidisciplinary setting?

A: The biggest advantage is that people don't think of their health as compartmentalized. Traditionally in medicine, we are all in our respective silos, but patients want a smooth transition of care throughout their lifetimes. Women start with a gynecologist, who's then often their obstetrician. Before age 40, they don't really seek much healthcare unless they're pregnant or need contraception. As they get older, it's nice if they can transition to other practices where the doctors already understand women's health and how it differs from men's. Essentially, it takes communication and integration with other departments, as well as a willingness to work together to best serve women patients and translate appropriate medical knowledge to them. The idea that there needs to be more focus on multidisciplinary teams is somewhat of a new concept in medicine in general. Cedars-Sinai is an ideal place for such a model.

Q: What challenges and opportunities have you identified in your first 30 days at Cedars-Sinai?

A: Cedars-Sinai is a big place filled with many intelligent, energetic people. The leadership is committed to retaining and attracting individuals who are interested in academic medicine and have an intellectual curiosity that ultimately brings the best care to patients. I think that's very inspiring. Cedars-Sinai has one of the top maternity delivery services in Southern California. Because of its size, its insistence on excellence at the academic level, and its financial stability compared to many other state institutions right now, Cedars-Sinai is in a unique position to reach a tremendous number of patients. As new discoveries are made at Cedars-Sinai, as well as nationally and internationally, novel treatments can be funneled to patients more quickly. And the types of patients we take care of here are quite varied — they represent the entire socioeconomic and cultural spectrum — and that's another very appealing aspect of this institution.

Q: Are there any areas in OB/GYN that need attention?

A: One area that I think needs more attention is family planning — the full spectrum of family planning, starting with contraceptive services. There are many recent developments in contraception, including new types of IUDs and implantable contraceptive agents. Making contraception available is a very important part of women's health, as is making sure women have the ability to choose what method they want to use.

Q: Will you see patients at Cedars-Sinai?

A: I'm a maternal-fetal medicine specialist, so I will see high-risk OB patients. My particular interest is the medical complications that can arise during pregnancy, including diabetes, thyroid disease, and hypertensive diseases. I like to remind people that pregnancy is also about the mother's health. As obstetricians, we take care of two patients. We constantly balance the mother's health with the well-being of the fetus. Women are willing to give up a lot to save their babies, so we have to be very careful about how we counsel women about decisions they may have to make. Also, health problems such as diabetes and hypertension can develop when women are pregnant.

Women who become diabetic during pregnancy have a 50 to 70 percent chance of becoming diabetic later in their lives, and the fact that we can actively identify the problem when they're pregnant means we can actually intervene.

After pregnancy, when the gestational diabetes goes away, we can counsel women about appropriate diet and exercise to help prevent later development of type 2 diabetes. Women who develop hypertension during pregnancy are also more likely to develop chronic hypertension later on. And the same might be true for thyroid disease.

Q: What is your research agenda?

A: My research is in the area of maternal mortality and maternal severe morbidity, which means severe illness in pregnant women, and looking at the issue of preventability. Unfortunately, in the United States, maternal mortality is increasing. That's a hot topic right now nationally, in part because of the data on California, where maternal mortality has increased over the past 10 years. The interventions are relatively simple — re-education and ongoing training for every professional providing obstetric services, including residents, nurses, attending physicians and anesthesiologists.

Q: What other issues do you see in research relating to women's health?

A: Historically, women's health has been very under-funded nationally. Funding has usually gone to disease-specific areas, and disease-specific areas typically have been studied with a focus on male subjects. Cardiovascular disease is the perfect example. The National Institute of Child Health and Human Development — one of the largest of the National Institutes of Health and the one that funds research on women's health — does not even include the word women in its name.

Q: What do you hope to accomplish in your first five years?

A: I would like to have obtained some major funding for a multidisciplinary-interdisciplinary mentoring program for women's health. I would like for Cedars-Sinai's OB/GYN program to have a stronger national reputation. Finally, I would like to really strengthen translational research, clinical outcomes, and the health services research arm of the Department.

This article originally appeared in the summer issue of Discoveries magazine. The interactive edition of Discoveries has exclusive videos and stories on the latest cutting-edge science, patient care and education advances at Cedars-Sinai. Visit discoveriesmagazine.org.

To request copies of the magazine, please e-mail Amanda.Busick@cshs.org