About

Professor Kara Bruce joined Carolina Law faculty in 2024. Her research focuses on bankruptcy law and procedure with particular emphasis on enforcement issues in consumer bankruptcy cases. She is a coauthor of the sixth edition of the Law of Bankruptcy and the fifth and sixth editions of Problems and Materials on Secured Transactions. Additionally, she is a contributing editor to the Bankruptcy Law Letter. Professor Bruce has served as the Robert M. Zinman Scholar in Residence at the American Bankruptcy Institute in Arlington, Virginia. She is a dedicated classroom teacher and has received several teaching awards, including the University of Toledo’s Outstanding Teacher Award, the University of Toledo College of Law’s Outstanding Professor Award (selected by the graduating class), and the Beth Eisler Teaching Award (selected by the first-year class). Prior to joining Carolina Law, she was a faculty member at the University of Oklahoma College of Law and the University of Toledo College of Law, and worked as an attorney in the Bankruptcy and Restructuring Group of Locke Lord Bissell & Liddell LLP in Chicago, Illinois. She has also served as a visiting professor at Willamette University School of Law and Loyola University Chicago School of Law.

Research topics

• Medicine
• Nursing
• Demography
• Surgery
• Internal medicine
• Obstetrics
• Pathology
• Environmental health
• Oncology

Selected publications

• Postpartum post-traumatic stress symptoms and their association with mood and parenting stress

  American Journal of Obstetrics & Gynecology MFM · 2024-09-19

  letterOpen access
  PublisherOA PDFDOI

• Use of Postpartum Hemorrhage Checklist during Vaginal Deliveries: A Quality Improvement Study

  American Journal of Perinatology · 2024-03-07 · 2 citations

  article1st authorCorresponding

  OBJECTIVE: Postpartum hemorrhage (PPH) protocols improve patient safety and reduce utilization of blood products; however, few data exist on sustainability of PPH checklist use, how use affects care delivery, and variation of use among patient subgroups. This study aimed to (1) examine compliance with PPH checklist use during vaginal deliveries, (2) evaluate whether checklist use varied by patient and/or care team characteristics, and (3) evaluate whether checklist use was associated with increased use of recommended medications/interventions. STUDY DESIGN: This was a quality improvement study performed from April 2021 through June 2023. A multidisciplinary team developed a revised PPH checklist and used quality improvement methodology to increase checklist use following vaginal birth. Data were collected from medical records and clinician survey. Control charts were generated to track checklist use and evaluate special cause variation. Chi-square tests and logistic regression were used to evaluate variation in medications/interventions and across subgroups. RESULTS: During the study period, there were 342 cases of PPH at the time of vaginal birth. The checklist was used in 67% of PPH cases during the 20-month period after implementation in a setting where no checklist was previously being used. We found no statistically significant differences in checklist use by patient or health care team characteristics. Use of tranexamic acid, carboprost, and misoprostol were significantly associated with checklist use. CONCLUSION: This study demonstrated successful implementation of a checklist protocol where no checklist was previously being used, with sustained use in an average of 67% of PPH cases over 20 months. Checklist use was consistent across subgroups and was associated with higher use of interventions shown to lower blood loss. KEY POINTS: · Our study showed sustainability of PPH checklist use over a 20-month period.. · PPH checklist use was associated with increased use of interventions known to reduce blood loss.. · Checklist was used consistently across patient subgroups; may help address inequities in obstetric outcomes..

  PublisherDOI

• Identification of postpartum symptom informedness and preparedness typologies and their associations with psychological health: A latent class analysis

  Midwifery · 2024-07-24 · 1 citations

  articleOpen access

  BACKGROUND: Birthing parents, defined as postpartum women and people with various gender identities who give birth, commonly experience challenging postpartum symptoms. However, many report feeling uninformed and unprepared to navigate their postpartum health. OBJECTIVE: To identify typologies of postpartum symptom informedness and preparedness using latent class analysis (LCA) and to examine the associated patient and healthcare characteristics. METHODS: We used survey data from a large, multi-method, longitudinal research project Postnatal Safety Learning Lab. Participants were recruited using convenience sampling and enrolled between November 2020 and June 2021. LCA was used to identify subgroups of birthing parents with different symptom informedness and preparedness using 10 binary variables (N = 148). Bivariate analysis was conducted to examine the association between characteristics and each typology. FINDINGS: The 3-class models had better fit indices and interpretability for both informedness and preparedness typologies: High, High-moderate, and Moderate-low. The sample characteristics were different by typologies. In the modified discrimination in medical settings assessment, we found higher discrimination scores in the moderate-low informedness and preparedness typologies. The moderate-low preparedness typology had a higher percentage of birthing parents who did not have private insurance, underwent cesarean section, and planned for formula or mixed infant feeding. The median PHQ-4 scores at 4 weeks postpartum were lower among those in high informedness and preparedness typologies. CONCLUSION: In our sample, 18 to 21 % of birthing parents were in the moderate-low informedness or preparedness typologies. Future research and practice should consider providing tailored information and anticipatory guidance as a part of more equitable and supportive care.

  PublisherDOI

• HPA axis dysregulation and postpartum depression and anxiety symptoms in breastfeeding vs bottle-feeding parents

  Psychoneuroendocrinology · 2024-11-27 · 10 citations

  articleOpen access1st authorCorresponding
  PublisherOA PDFDOI

• Association between pre-delivery anemia and postpartum acute care utilization – North Carolina, 2018-2021

  American Journal of Obstetrics and Gynecology · 2023-01-01

  articleOpen access1st authorCorresponding
  PublisherOA PDFDOI

• Cumulative blood loss and maternal early warning system triggers

  American Journal of Obstetrics and Gynecology · 2023-01-01

  articleOpen access
  PublisherOA PDFDOI

• Hemoglobin on Admission for Childbirth and Postpartum Acute Care Use in a Southeastern Health Care System

  American Journal of Perinatology · 2023-12-06 · 1 citations

  article1st authorCorresponding

  OBJECTIVE: Our objective was to evaluate whether hemoglobin on admission for childbirth is associated with postpartum acute care use (ACU). STUDY DESIGN: We conducted a retrospective cohort study of patients giving birth at a southeastern quaternary care hospital from January 2018 through June 2021 using electronic health records. Predelivery hemoglobin was categorized as <9, 9- < 10, 10- < 11, 11- < 12, and ≥12 g/dL. Acute care was defined as a visit to obstetric triage, the emergency department, or inpatient admission within 90 days postpartum. Generalized estimating equations quantified the crude and multivariable-adjusted association between predelivery hemoglobin and ACU. RESULTS: Among 8,677 pregnancies, 1,467 (17%) used acute care in the system within 90 days postpartum. In unadjusted models, those with predelivery hemoglobin <9 had twice the risk of postpartum ACU compared to those with hemoglobin ≥12 (95% confidence interval [CI]: 1.59-2.69), with a decrease in risk for each increase in hemoglobin category (9- < 10 g/dL: risk ratio [RR]: 1.47, CI: 1.21-1.79; 10- < 11 g/dL: RR: 1.44, CI: 1.26-1.64; 11- < 12 g/dL: RR: 1.20, CI: 1.07-1.34). The adjusted model showed a similar trend with smaller effect estimates (<9 g/dL: RR: 1.50, CI: 1.14-1.98; 9- < 10 g/dL: RR: 1.22, CI: 1.00-1.48; 10- < 11 g/dL: RR: 1.22, CI: 1.07-1.40; 11- < 12 g/dL: RR: 1.09, CI: 0.98-1.22). CONCLUSION: Low hemoglobin at childbirth admission was associated with increased postpartum ACU. Low hemoglobin on admission could signal to providers that additional follow-up, resources, and ongoing support are warranted to identify and address underlying health needs. Because hemoglobin is routinely assessed during the childbirth hospitalization, this indicator may be especially valuable for risk assessment among patients with limited prior engagement in health care. KEY POINTS: · Low hemoglobin on admission for birth is associated with postpartum acute care use.. · Hemoglobin on admission may aid in risk-stratification during childbirth hospitalization.. · Point-of-care metrics may help identify high-risk patients with limited preventive health care..

  PublisherDOI

• Vital signs associated with class I-IV blood loss within 24 hours of birth

  American Journal of Obstetrics and Gynecology · 2023-01-01

  articleOpen access
  PublisherOA PDFDOI

• Increasing postpartum hemorrhage checklist use: a quality improvement initiative

  American Journal of Obstetrics and Gynecology · 2023-01-01

  articleOpen access
  PublisherOA PDFDOI

• Trends in Postpartum Contraceptive Use in 20 U.S. States and Jurisdictions: The Pregnancy Risk Assessment Monitoring System, 2015–2018

  Women s Health Issues · 2022-12-01 · 4 citations

  articleOpen access1st authorCorresponding
  PublisherOA PDFDOI

Frequent coauthors

• Elizabeth Kemigisha

  African Population and Health Research Center

  10 shared

• Els Leye

  Ghent University

  8 shared

• Kristien Michielsen

  KU Leuven

  6 shared

• Alison M. Stuebe

  University of North Carolina at Chapel Hill

  6 shared

• Gily Coene

  Vrije Universiteit Brussel

  6 shared

• Kristin P. Tully

  6 shared

• Anna B. Ninsiima

  Makerere University

  5 shared

• Gad Ndaruhutse Ruzaaza

  Mbarara University of Science and Technology

  5 shared

Awards & honors

• University of Toledo’s Outstanding Teacher Award
• University of Toledo College of Law’s Outstanding Professor…
• Beth Eisler Teaching Award