Medical Specialties Commons^™

Understanding Maternity Care Coordination For Women Veterans Using An Integrated Care Model Approach, Kristin M. Mattocks, Aimee Kroll-Desrosiers, Rebecca L. Kinney, Sara Singer

Kristin M. Mattocks

BACKGROUND: An increasing number of women veterans are using VA maternity benefits for their pregnancies. However, because the VA does not offer obstetrical care, women must seek maternity care from non-VA providers. The growing number of women using non-VA care has increased the importance of understanding how this care is integrated with ongoing VA medical and mental health services and how perceptions of care integration impact healthcare utilization. Therefore, we sought to understand these relationships among a sample of postpartum veterans utilizing VA maternity benefits.

METHODS: We fielded a modified version of the Patient Perceptions of Integrated Care survey among …

An Analysis Of Major Issues For Culturally-Minded Professionals In Women's Health Care, Victoria Clark

Victoria Clark

Nadolol In Pregnancy: A Medical Student’S Reflection On Her Pregnancy, Rebecca King-Mallory, Shawndra Barker, Kaitlin Mcgrogan, Adam M. Franks

Adam M. Franks, MD

Hypertension is a common concern during pregnancy. Beta-blockers are one potential treatment, but third trimester exposure has correlated with an increased risk of perinatal events. Nadolol, a nonselective beta blocker, has properties that differ from those of its selective counterparts, including longer half-life, decreased protein binding, and renal excretion in the unchanged form. There is very limited data on the use of nadolol during pregnancy, and its safety has not been completely evaluated. This case study documents the perinatal outcomes of nadolol use throughout a medical student’s pregnancy and explores the experience in obtaining and undergoing medical care.

Anaemia In Pregnancy: Occurrence In Two Economically Different Clinic Populations Of Karachi, Saadiya Aziz Karim, Mohammad Khurshid, Javed H. Rizvi

Mohammad Khurshid

According to previous WHO standards, anaemia in pregnancy denoted a haemoglobin level of 11.0 gms/dl or less, but this is now considered to be variable1 as it differs from country to country depending on local reference ranges and socio-economic conditions. Each country should “lay down minimal acceptable standards” below which an individual is considered to be anaemic, taking into account the available fmancial and manpower resources and other health needs of the country2. There is a wide divergence in the quoted prevalence of anaemia in Pakistan and neigh­bouring countries.3-6 This study was undertaken to determine a range of haemoglobin levels …

A Case Study Of School Age Female Minority Athletes Who Became Pregnant, Floyd Jones Phd, Jennifer Y. Mak, Phyllis A. Jones Ed

Jennifer Y Mak

The purpose of this study is to provide an in-depth understanding of ''What had happened to the urban minority female athletes who became pregnant while playing high school basketball?'' The study wanted to provide a qualitative analysis of rich narrative data collected from questionnaire interviews of two separate groups (one in Pittsburgh, the other in New York City). The findings of this study suggest that in fact urban female African-Americans athletes still received benefits from sports participation.

Proyecto Mama: A Lifestyle Intervention In Overweight And Obese Hispanic Women: A Randomised Controlled Trial--Study Protocol, Lisa Chasan-Taber, Bess H. Marcus, Milagros C. Rosal, Katherine L. Tucker, Sheri J. Hartman, Penelope S. Pekow, Edward J. Stanek Iii, Barry Braun, Caren G. Solomon, Joanne Manson, Sarah L. Goff, Glenn Markenson

Sarah L. Goff MD

BACKGROUND: The proportion of women entering pregnancy overweight or obese has been rising and, in turn, is associated with adverse maternal and fetal outcomes. Gestational weight gain (GWG) exceeding Institute of Medicine (IOM) guidelines further increases health risks and has been independently associated with postpartum weight retention. Hispanic women are disproportionately affected by overweight and obesity, but have had limited access to interventions that promote healthy lifestyles due to cultural, socioeconomic, and language barriers. Therefore, the overall goal of this randomized controlled trial is to test the efficacy of a culturally and linguistically modified, individually-tailored lifestyle intervention to reduce excess …

Prenatal Oral Health Education In U.S. Dental Schools And Obstetrics And Gynecology Residencies, Megan Curtis, Hugh Silk, Judith A. Savageau

Judith A. Savageau

Prenatal oral health (POH) is an important health issue, but dental and obstetrical clinicians are not meeting the oral health needs of pregnant patients. This study evaluates how training contributes to this paradox with a national survey of sixty dental school deans and 240 obstetrics and gynecology residency program directors. Response rates were 53 percent and 40 percent for deans and program directors, respectively. According to the respondents, 94 percent of responding dental schools provided POH education, only 39 percent of responding residencies taught POH, and 65 percent of responding deans and 45 percent of responding program directors were aware …

Risk Of Early & Late Obstetric Complications In Women With Ivf- Conceived Pregnancies And Polycystic Ovary Syndrome (Pcos), N. A. Bagegni, J. Blaine, Bradley J. Van Voorhis, Anuja Dokras

Bradley J Van Voorhis

There is conflicting evidence on the association between PCOS and early and late obstetric complications. It is unclear if the reported risks are independent of BMI, preexisting hypertension and diabetes. We performed a retrospective chart review to examine the risk of early and late obstetrical complications after IVF in women with PCOS (n=130) compared to controls (n=130). The miscarriage rate was 17.7% in PCOS women and 15.4% in controls. PCOS was not associated with miscarriage independent of age and BMI. The prevalence of gestational DM (GDM) was similar in both groups (12% PCOS versus 11% controls). BMI was independently associated …

Defining Normal Igg Changes Throughout Pregnancy, Jena Taylor, Jona Conklin, Stephen K. Hunter, Ryan Empey, Eric M. Tyler, Ashley Christensen, Katelyn M. Talcott, Zuhair K. Ballas, Donna A. Santillan, Mark K. Santillan

Stephen K. Hunter

Immunoglobulin G (IgG) is the major serum immunoglobulin, accounting for roughly 75% of all immunoglobulin. IgG is the only class of immunoglobulin that crosses the placenta and it serves as the main immunologic barrier between the fetus and external environments. There has not been a clear consensus on what the normal values of IgG are throughout pregnancy. The aim of this study is to measure serum immunoglobulin G in each trimester of the pregnant female to determine a normal IgG profile throughout all trimesters in normal pregnancy.

The Influence Of Fetal Sex On Patterns Of Change In Anti-Mullerian Hormone During Pregnancy, Ryan Empey, Donna A. Santillan, Mark Santillan, Eric M. Tyler, Stephen K. Hunter, Elaine M. Smith, Barbara J. Stegmann

Donna A. Santillan

Maternal anti-mullerian hormone declines sharply between 13-15 weeks, likely as a result of feto-placental signaling. Fetal AMH levels are known to be widely disparate after the first trimester, with high levels in male and absent levels in female. However, it is unclear as to whether differing fetal AMH levels influence the pattern of change of maternal AMH. Our objective was to examine AMH throughout gestation to determine if the maternal concentration varies according to the gender of the fetus.

Anti-Müllerian Hormone Concentration Levels In Maternal Plasma During The First, Second And Third Trimester Of Pregnancy, Kelin Schultz, Barbara Stegmann, Mark Santillan, Donna Santillan, Elaine Smith, Bradley J. Van Voorhis

Donna A. Santillan

Follicle-Stimulating Hormone (FSH) drops rapidly in pregnancy but Anti-Mullerian Hormone (AMH) has not been shown to drop until about 12 weeks. Since the follicles that secrete AMH are thought to be FSH independent, AMH levels should slowly decline in the absence of FSH because when the follicles reach FSH dependence, they would die off. A study has presented data that suggests a decline in AMH levels suddenly starts at 12 weeks gestation. The present study agrees with a decline in AMH after the first trimester. There is a sharp decline in AMH at 12-16 weeks gestation indicating that the follicular …

Risk Of Early & Late Obstetric Complications In Women With Ivf- Conceived Pregnancies And Polycystic Ovary Syndrome (Pcos), N. A. Bagegni, J. Blaine, Bradley J. Van Voorhis, Anuja Dokras

Bradley J Van Voorhis

There is conflicting evidence on the association between PCOS and early and late obstetric complications. It is unclear if the reported risks are independent of BMI, preexisting hypertension and diabetes. We performed a retrospective chart review to examine the risk of early and late obstetrical complications after IVF in women with PCOS (n=130) compared to controls (n=130). The miscarriage rate was 17.7% in PCOS women and 15.4% in controls. PCOS was not associated with miscarriage independent of age and BMI. The prevalence of gestational DM (GDM) was similar in both groups (12% PCOS versus 11% controls). BMI was independently associated …

Placenta Pathology Evaluation: Are Cap Guidelines Useful? A Preliminary Analysis, Jennifer C. Steines, Adebukola M. Ogundoyin, Colleen K. Stockdale

Colleen Kennedy Stockdale

The College of American Pathologists (CAP) established a revised set of recommendations for placental evaluation in 1997. In review of the literature and anecdotally, there is discrepancy regarding placental submission to pathology. We evaluated adherence to CAP guidelines for placental pathology and clinical utility of the results.

The Influence Of Fetal Sex On Patterns Of Change In Anti-Mullerian Hormone During Pregnancy, Ryan Empey, Donna A. Santillan, Mark Santillan, Eric M. Tyler, Stephen K. Hunter, Elaine M. Smith, Barbara J. Stegmann

Stephen K. Hunter

Maternal anti-mullerian hormone declines sharply between 13-15 weeks, likely as a result of feto-placental signaling. Fetal AMH levels are known to be widely disparate after the first trimester, with high levels in male and absent levels in female. However, it is unclear as to whether differing fetal AMH levels influence the pattern of change of maternal AMH. Our objective was to examine AMH throughout gestation to determine if the maternal concentration varies according to the gender of the fetus.

Calcium And Vitamin D For The Reproductive Female, Rachel A. Maassen

Rachel A Maassen

The importance of calcium as well as its interdependence upon vitamin D is well established. Vitamin D acts via the vitamin D receptor, which is found in 37 different human tissues. Because of its rather ubiquitous localization, vitamin D is the topic of a great deal of associative research. However, caution must be exercised in interpreting these initial studies until clear evidence for causality becomes available. The purpose of this article is to review some of the known vitamin D and calcium associations as well as the current guidelines for calcium and vitamin D supplementation.

Placenta Pathology Evaluation: Are Cap Guidelines Useful? A Preliminary Analysis, Jennifer C. Steines, Adebukola M. Ogundoyin, Colleen K. Stockdale

Jennifer C. Steines Wagemester

The College of American Pathologists (CAP) established a revised set of recommendations for placental evaluation in 1997. In review of the literature and anecdotally, there is discrepancy regarding placental submission to pathology. We evaluated adherence to CAP guidelines for placental pathology and clinical utility of the results.

"Caught Between A Rock And A Hard Place: Obesity And Delivery Decisions", Mark Santillan

Mark K. Santillan

The incidence of obesity has achieved epidemic proportions. The increase in the proportion of women gaining more than 40 pounds during pregnancy and the related increased perinatal morbidity demonstrates how obesity has affected the reproductive outcomes for women. Individualized counseling and preparation for the needs of an obese woman in labor are at the cornerstone of managing obese women in labor and delivery.

Anti-Müllerian Hormone Concentration Levels In Maternal Plasma During The First, Second And Third Trimester Of Pregnancy, Kelin Schultz, Barbara Stegmann, Mark Santillan, Donna Santillan, Elaine Smith, Bradley J. Van Voorhis

Mark K. Santillan

Follicle-Stimulating Hormone (FSH) drops rapidly in pregnancy but Anti-Mullerian Hormone (AMH) has not been shown to drop until about 12 weeks. Since the follicles that secrete AMH are thought to be FSH independent, AMH levels should slowly decline in the absence of FSH because when the follicles reach FSH dependence, they would die off. A study has presented data that suggests a decline in AMH levels suddenly starts at 12 weeks gestation. The present study agrees with a decline in AMH after the first trimester. There is a sharp decline in AMH at 12-16 weeks gestation indicating that the follicular …

Improving Prenatal Education In A Health Center: A Pilot Study, Marcy Keddy Boucher, Hugh Silk, Judith A. Savageau, Katharine C. Barnard, Mary Flynn

Judith A. Savageau

Background: Currently, the timing and variety of health education topics that are covered during prenatal visits are decided upon by the individual physician caring for the patient. Consequently, some patients do not gain exposure to important subject matter that could potentially improve their satisfaction and pregnancy outcomes. Previously reported studies have found evidence that improved patient education may increase rates of breastfeeding (as well as duration), seat belt use during pregnancy, and decrease preterm low birth weight infants. In addition, one study has shown that when prenatal visits are targeted to specific objectives, the number of prenatal visits can …

In Vivo Ultrasonic Attenuation Slope Estimates For Detecting Cervical Ripening In Rats: Preliminary Results, Timothy A. Bigelow, Barbara L. Mcfarlin, William D. O'Brien Jr., Michael L. Oelze

Timothy A. Bigelow

To effectively postpone preterm birth, cervical ripening needs to be detected and delayed. As the cervix ripens, the spacing between the collagen fibers increases and fills with water, hyaluronan, decorin, and enzymes suggesting that the ultrasonic attenuation of the cervix should decrease. The decrease in ultrasonic attenuation may be detectable, leading to an effective means of detecting cervical ripening. Herein, the traditional attenuation slope-estimation algorithm based on measuring the downshift in center frequency of the ultrasonic backscattered signal with propagation depth was modified and applied to the cervix of rats. The modified algorithm was verified using computer simulations and an …