Obstetrics and Gynecology Commons^™

Identification Of Potential Missed Opportunities For Human Papillomavirus (Hpv) Vaccination In Women Referred To An Academic Colposcopy Clinic For Evaluation Of Abnormal Cervical Cytology, Benjamin J. Dorton, Allison F. Vitonis, Sarah Feldman

Benjamin J. Dorton. MD

Anterior Cervical Foraminotomy: Short Term Outcomes In Patients With Isolated Cervical Radiculopathy, Howard Eisenbrock, Mark Rivkin, Amir Dehdashti

Mark Rivkin

Intro: Anterior cervical foraminotomy (ACF) is a novel approach involving direct decompression of nerve from an offending agent without fusion. Historically, several anterior and posterior approaches were utilized to treat cervical radiculopathy. Anterior cervical discectomy necessitates fusion and is subject to adjacent segment disease as well as loss of ROM. Posterior laminoforaminotomy seldom allows for removal of disc fragment and is associated with higher postoperative pain. Methods: Between May 2010 and March 2013, 16 patients with one or two level cervical spondylosis with radiculopathy without myelopathy who failed conservative therapies such as anti-inflammatory medications, physical therapy or injections underwent anterior …

The Experience Of Disability In Families: A Synthesis Of Research And Parent Narratives, Philip Ferguson, Alan Gartner, Dorothy Lipsky

Philip M. Ferguson

This chapter focuses on the difficulties parents of those with intellectual disabilities face.

Response To Comment On: Goldberg Et Al. Circadian Variation In The Response To The Glucose Challenge Test In Pregnancy: Implications For Screening For Gestational Diabetes Mellitus. Diabetes Care 2012;35:1578-1584, Robert Goldberg, Chang Ye, Mathew Sermer, Philip Connelly, Anthony Hanley, Bernard Zinman, Ravi Retnakaran

Dr. Chang Ye

No abstract provided.

Recent Trends In Type-Specific Hpv Infection Rates In The United States, Elizabeth L. Dickson, R I. Vogel, X Luo, L S. Downs

Elizabeth L. Dickson, MD

Marquette Method Of Natural Family Planning [Project Website], Richard Fehring

Richard J Fehring

No abstract provided.

Comparison Of Abstinence And Coital Frequency Between Two Natural Methods Of Family Planning, Richard Fehring, Thomas Bouchard, Mary Schneider

Richard J Fehring

Problem Statement: The length of periodic abstinence, due to overestimation of the fertile phase of the menstrual cycle is often a reason for dissatisfaction, discontinuation, and user error with natural family planning (NFP) methods. The objective of this research was to compare the length of required abstinence (i.e., estimated fertility) and coital frequency between two NFP methods. Study Design: Analysis of existing data from a 12 month prospective comparison study in which participants were randomized into either an electronic hormonal fertility monitor (EHFM) group or a cervical mucus monitoring (CMM) group, both of which included a fertility algorithm as a …

A Multi-Institutional Study Of Outcomes In Stage I-Iii Uterine Carcinosarcoma, Elizabeth L. Dickson, R I. Vogel, P A. Gehrig, S Pierce, L Havrilesky, A A. Secord, J Dottino, Amanda Nickles Fader Md, Stephanie Ricci, Melissa A. Geller

Elizabeth Dickson, MD

Attitudes Of Women In Their Forties Toward The 2009 Uspstf Mammogram Guidelines: A Randomized Trial On The Effects Of Media Exposure, Autumn Davidson, Xun Liao, B. Magee

B. Dale Magee

OBJECTIVE: The objective of the study was to assess women's attitudes toward 2009 US Preventive Services Task Force mammography screening guideline changes and evaluate the role of media in shaping opinions. STUDY DESIGN: Two hundred forty-nine women, aged 39-49 years, presenting for annual examinations randomized to read 1 of 2 articles, and survey completion comprised the design of the study. RESULTS: Eighty-eight percent overestimated the lifetime breast cancer (BrCa) risk. Eighty-nine percent want yearly mammograms in their 40s. Eighty-six percent felt the changes were unsafe, and even if the changes were doctor recommended, 84% would not delay screening until age …

Role Of Multiple Births In Very Low Birth Weight And Infant Mortality, B. Magee

B. Dale Magee

OBJECTIVE: To determine the percentage of very-low-birth-weight (VLBW) infants (g) and infant deaths attributable to multiple births in the general population and in women aged 35+. STUDY DESIGN: The year 2000 Massachusetts birth certificate database with linked births-deaths was examined. Etiologic fractions (EF) for VLBW and infant mortality attributable to multiples were calculated for the general population and the 35+ age group. The percentages of multiples occurring in the 35+ age group were calculated. Infant deaths due to congenital anomalies and "perinatal conditions" were calculated. RESULTS: There were 81,582 resident births in Massachusetts in 2000. Of them 4.3% were multiples. …

Xk Aprosencephaly And Anencephaly In Sibs, Phillip Townes, Karen Reuter, E. Rosquete, B. Magee

B. Dale Magee

Recent studies have suggested a causal and pathogenetic relationship between holoprosencephaly and anencephaly. In support of the proposed relationship we report a sibship that includes anencephalic male twins and a female infant with a severe form of alobar holoprosencephaly, radial aplasia, and oligodactyly. The upper limb and brain malformations are considered to represent aprosencephaly syndrome. The coexistence of anencephaly and aprosencephaly within a sibship suggests that XK aprosencephaly syndrome may be an autosomal recessive disorder.

Doing The Best With What We Have: We Need Better: Informing Obstetric Policy With Administrative Data, Tiffany Moore Simas, B. Magee, Ellen Delpapa

B. Dale Magee

In this issue of Medical Care, Backes Kozhimannil and colleagues present data from the National Inpatient Sample on differences between rural and urban obstetric care. We applaud their efforts in examining this issue and agree that all women should be afforded safe deliveries, and ideally each woman’s experience would not be different. That being said, there are some practical considerations that must be applied to their analyses and recommendations. We would like to take this opportunity to capitalize on their efforts and speak to 2 other highly related implications for policy and practice.

Role Of Smoking In Low Birth Weight, B. Magee, Dale Hattis, Nancy Kivel

B. Dale Magee

OBJECTIVE: To assess the role of smoking on low birth weight (LBW). STUDY DESIGN: From Massachusetts for 1998, 79,904 birth certificates were reviewed. Birth weight, gestational age, plurality and maternal race were analyzed in relation to the mother's smoking status during the pregnancy. The etiologic fraction (EF) was calculated for smoking and LBW for the group as a whole as well as for various subgroups. RESULTS: A total of 11.7% of women acknowledged smoking during pregnancy. The overall LBW rate was 6.83%. The relative risk (RR) of LBW among smokers was 1.58. For all births the EF for smoking was …

Urinary Isoflavone Concentrations Are Inversely Associated With Cardiometabolic Risk Markers In Pregnant U.S. Women, Ling Shi, Heather Ryan, Emily Jones, Tiffany Moore Simas, Alice Lichtenstein, Qi Sun, Laura Hayman

Laura L. Hayman

Some evidence suggests that phytoestrogens, such as soy-derived isoflavones, may have beneficial effects on cardiovascular health and glycemic control. These data are mainly limited to postmenopausal women or individuals at elevated cardiometabolic risk. There is a lack of data for pregnant women who have elevated estrogen levels and physiologically altered glucose and lipid metabolism. We analyzed data from 299 pregnant women who participated in the NHANES 2001-2008 surveys. Multivariable linear regression analyses were used to examine the association between urinary concentrations of isoflavonoids and cardiometabolic risk markers, adjusted for body mass index, pregnancy trimester, total energy intake, dietary intake of …

Information Flow And Clinical Outcomes In A Fully Functional Perinatal Continuum Of Care, Donald Levick Md, Michael Sheinberg Md, Chad Meyerhoefer Phd, Mary Deily, Shin-Yi Chou Phd, Susan Sherer Phd

Donald Levick MD

No abstract provided.

A Randomized Clinical Trial Comparing Pelvic Floor Muscle Training To A Pilates Exercise Program For Improving Pelvic Muscle Strength, Patrick Culligan, Janet Scherer, Keisha Dyer, Jennifer Priestley, Geri Guingon-White, Donna Delvecchio, Margi Vangeli

Jennifer L. Priestley

Introduction and hypothesis The purpose of this study is to determine whether a Pilates exercise program and a pelvic floor muscle-training (PFMT) program could provide similar improvements in pelvic muscle strength. Methods Sixty-two women with little or no pelvic floor dysfunction were randomized to Pilates or PFMT. Each group had 24 biweekly 1-h sessions with either a physical therapist or Pilates instructor. Strength was measured via perineometry (cmH2O). Two questionnaires-pelvic floor distress inventory (PFDI-20) and pelvic floor impact questionnaire (PFIQ-7)-were also collected. Results At baseline, the Pilates and PFMT groups measured 14.9±12.5 and 12.5±10.4 cmH2O, respectively (p=0.41). Both the Pilates …

Evaluation Of A Transvaginal Mesh Delivery System For The Correction Of Pelvic Organ Prolapse: Subjective And Objective Findings At Least 1 Year After Surgery, Patrick Culligan, Paul Littman, Charbel Salamon, Jennifer Priestley, Amir Shariati

Jennifer L. Priestley

Objective: We sought to track objective and subjective outcomes ≥1 year after transvaginal mesh system to correct prolapse. Study Design: This was a retrospective cohort study of 120 women who received a transvaginal mesh procedure (Avaulta Solo, CR Bard Inc, Covington, GA). Outcomes were pelvic organ prolapse quantification values; Pelvic Floor Distress Inventory, Short Form 20/Pelvic Floor Impact Questionnaire, Short Form 7 scores; and a surgical satisfaction survey. “Surgical failure” was defined as pelvic organ prolapse quantification point >0, and/or any reports of vaginal bulge. Results: Of 120 patients, 116 (97%) were followed up for a mean of 14.4 months …

A Select Issue In The Postpartum Period: Contraception, Whitney Cowman, Abbey Hardy-Fairbanks, Jill Endres, Colleen Stockdale

Abbey J Hardy-Fairbanks

One half of pregnancies in the United States are unintended and associated with adverse pregnancy outcomes. The postpartum period is an important, yet underutilized, time to initiate contraception. The U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 provides evidence-based guidelines for choosing a contraceptive method and an update in 2011 specifically addresses contraceptive method use in the puerperium. The variety of contraceptive methods include hormonal contraception, lactational amenorrhea, barrier contraception, natural family planning, and sterilization. Ideally, counseling about contraceptive choice should begin early in pregnancy care and continue postpartum; it should also include a variety of teaching modalities. Specifically we …

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

Bradley J Van Voorhis

No abstract provided.

Long-Term Outcomes Among Women With Cervical Cancer Treated From 1960-1987, Christopher Yopp, Jo Benda, Colleen Stockdale, Jami Shepard, Amina Ahmed

Colleen Kennedy Stockdale

To determine long term survival among women treated for cervical cancer and to provide long-term information regarding mortality and morbidity following treatment. Among a cohort of young women treated for cervical cancer over a 27 year period, with survival available up to 48 years from initial diagnosis, there were no variables identified which impacted the duration of survival beyond the initial stage of cervical cancer at presentation.

Knockdown Of Mtdh Increases Drug Sensitivity To Hdac Inhibitor And Trail Combination Treatment In Endometrial Cancer Cells, Xiangbing Meng, Pavla Brachova, Shujie Yang, Zhi Xiong, Yuping Zhang, Kimberly Leslie

Xiangbing Meng

Understanding the molecular mechanisms of chemoresistance is vital to design therapies to restore chemosensitivity. MTDH mediates drug resistance by regulating expression of genes required for the control of apoptosis and cell cycle. These findings indicate that sensitivity to chemotherapy agents and combination treatment with HDAC inhibitor and TRAIL can be restored by manipulating MTDH, and hence depletion of MTDH is a potentially novel avenue for effective cancer therapy.

The Combination Of Paclitaxel And Gefitinib Inhibits Endometrial Cancer Cells By Inducing Mitotic Catastrophe: Proof Of Principle For Dual Therapy In Endometrial Cancer, Xiangbing Meng, Laura Laidler, Lina Albitar, Anna Holmes, Donghai Dai, Thomas Buekers, David Bender, Kimberly Leslie

Xiangbing Meng

Serous uterine endometrial cancer is a lethal disease for which new therapeutic regimens are urgently needed. Combinations of chemotherapeutic agents and small molecule growth factor inhibitors have demonstrated activity in cancers from other sites. Our objective was to determine whether such a combination using Paclitaxel and Gefitinib could be active in serous endometrial cancer cells.

Phase Ii Clinical Trial Of Ixabepilone In Patients With Recurrent Or Persistent Platinum- And Taxane-Resistant Ovarian Or Primary Peritoneal Cancer: A Gynecologic Oncology Group Study, Koen De Geest, John Blessing, Robert Morris, S. Diane Yamada, Bradley Monk, Susan Zweizig, Daniela Matei, Carolyn Muller, William Richards

Koen De Geest

PURPOSE Ixabepilone (BMS-247550) is a microtubule-stabilizing epothilone B analog with activity in taxane-resistant metastatic breast cancer. The Gynecologic Oncology Group conducted a phase II evaluation of the efficacy and safety of ixabepilone in patients with recurrent or persistent platinum- and taxane-resistant primary ovarian or peritoneal carcinoma. PATIENTS AND METHODS Patients with measurable platinum- and taxane-resistant ovarian or peritoneal carcinoma, defined as progression during or within 6 months of one prior course of treatment with each agent, received intravenous ixabepilone 20 mg/m(2) administered over 1 hour on days 1, 8, and 15 of a 28-day cycle. RESULTS Of 51 patients entered, …

A Phase Ii Study Of Docetaxel In Paclitaxel-Resistant Ovarian And Peritoneal Carcinoma: A Gynecologic Oncology Group Study, Peter Rose, John Blessing, Harrison Ball, James Hoffman, David Warshal, Koen Degeest, David Moore

Koen De Geest

OBJECTIVES: Docetaxel is an inhibitor of microtubule depolymerization and has demonstrated activity in paclitaxel-resistant breast cancer and gynecologic cancer. The Gynecologic Oncology Group (GOG) conducted a study of docetaxel in paclitaxel-resistant ovarian and peritoneal carcinoma to determine its activity, and nature and degree of toxicity, in this cohort of patients.

METHODS: Patients with platinum- and paclitaxel-resistant ovarian or peritoneal carcinoma, defined as progression while on or within 6 months of therapy, were eligible if they had measurable disease and had not received more than one chemotherapy regimen. Docetaxel at a dose of 100 mg/m(2) was administered iv over 1 h …

Lymphoid Enhancing Factor 1 (Lef-1) Overexpression In Epithelial Ovarian, Fallopian Tube And Peritoneal Cancer And Associations With Clinical Factors, Aine Clements, David Engle, Dawne Shelton, Traci Neff, Soo Park, David Bender, Amina Ahmed, Koen De Geest, Anna Button, John Engelhardt, Michael Goodheart

David P Bender

Lef-1 mRNA levels were statistically elevated in cases of ovarian, fallopian tube or peritoneal cancer when compared to non-cancerous controls. Among cancer cases, levels of Lef-1 were statistically different between stage and histology. Lef-1 overexpression may be predictive of poor overall survival. These findings suggest that Lef-1 overexpression may contribute to ovarian, fallopian tube and peritoneal carcinogenesis, and that further investigation is warranted.

The Combination Of Paclitaxel And Gefitinib Inhibits Endometrial Cancer Cells By Inducing Mitotic Catastrophe: Proof Of Principle For Dual Therapy In Endometrial Cancer, Xiangbing Meng, Laura Laidler, Lina Albitar, Anna Holmes, Donghai Dai, Thomas Buekers, David Bender, Kimberly Leslie

David P Bender

Serous uterine endometrial cancer is a lethal disease for which new therapeutic regimens are urgently needed. Combinations of chemotherapeutic agents and small molecule growth factor inhibitors have demonstrated activity in cancers from other sites. Our objective was to determine whether such a combination using Paclitaxel and Gefitinib could be active in serous endometrial cancer cells.

Women’S Health Educational Opportunities At The University Of Iowa’S Department Of Obstetrics And Gynecology, Marygrace Elson

Marygrace Elson

The Department of Obstetrics and Gynecology’s educational programs span a continuum of learners from undergraduate premedical students to continuing education for practicing providers in Iowa and nearby states. The Department of Obstetrics and Gynecology is committed to teaching women-centered, compassionate, evidence-based care and fostering life-long learning. The Department of Obstetrics and Gynecology is a part of the Roy J. and Lucille A. Carver College of Medicine and the University of Iowa Health Care at the University of Iowa.

Formative Feedback On A Patient-Based Assessment: Comparing Student Perceptions Of Two Feedback Methods, Marygrace Elson, Rick Axelson

Marygrace Elson

Introduction: Although formative feedback is widely recognized as an essential aid to student learning, there is little evidence regarding effective ways of providing formative feedback on structured clinical exams. This study compares students’ perceptions of immediate, face-to-face feedback with delayed, written on-line faculty feedback on their Obstetrics and Gynecology medical student clerkship patient-based assessment (PBA) at the University of Iowa.

Methods: 163 third year medical students performed the PBA between October 2009-10. Students were assigned to immediate face-to-face or delayed, written on-line feedback. Students were then invited to participate in an anonymous web-based survey. Independent samples t-tests were used to …

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

Mark K. 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.

Lumbar Vertebral Density And Mechanical Properties In Aged Ovariectomized Rats Treated With Estrogen And Norethindrone Or Norgestimate, Carla Vanin, Neil Maclusky, Debbie Chachra, Mehran Kasra, Marc Grynpas, Robert Casper

Debbie Chachra

OBJECTIVE: This study was designed to investigate the effects of estrogen alone or combined with two different progestins, norethindrone or norgestimate, on bone density and compressive mechanical properties in an aged rat model.

STUDY DESIGN: Twenty 11-month-old female Sprague-Dawley rats were sham operated (intact control) and 80 wee overiectomized. Three groups of 20 ovariectomized rats were implanted with Silastic silicon rubber (Dow Corning, Midland, Mich.) capsules containing 5% estradiol (wt/wt) in cholesterol. All rats in the intact control (group 1) and the ovariectomized (group 2) and the first of the overiectomized plus estrogen (group 3) groups were injected subcutaneously daily …