Obstetrics and Gynecology Commons^™

Invasive Placental Disease: The Impact Of A Multi-Disciplinary Approach To Management, John C. Smulian Md, Mph, Ana-Liza Pascual, Helai Hesham Md, Emma Qureshy Ms1, M Bijoy Thomas Md, Amy M. Depuy Md, Amanda B. Flicker Md, William E. Scorza Md

Department of Obstetrics & Gynecology

No abstract provided.

Evidence And Knowledge Gaps On The Disease Burden In Sexual And Gender Minorities: A Review Of Systematic Reviews, Karel Blondeel, Lale Say, Doris Chou, Igor Toskin, Rajat Khosla, Elisa Scolaro, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Sexual and gender minorities (SGM) include individuals with a wide range of sexual orientations, physical characteristics, and gender identities and expressions. Data suggest that people in this group face a significant and poorly understood set of additional health risks and bear a higher burden of some diseases compared to the general population. A large amount of data is available on HIV/AIDS, but far less on other health problems. In this review we aimed to synthesize the knowledge on the burden of communicable and non-communicable diseases, mental health conditions and violence experienced by SGM, based on available systematic reviews. We conducted …

Principles Of Fatigue In Residency Education: A Qualitative Study, Taryn S Taylor, Christopher J Watling, Pim W Teunissen, Tim Dornan, Lorelei Lingard

Obstetrics & Gynaecology Publications

BACKGROUND: Proposals to implement fatigue-management strategies in residency education assume that medicine shares the view of other risk-adverse industries that fatigue is hazardous. This view is an essential underpinning of fatigue-management strategies that other industries have embedded as part of their workplace occupational health and safety programs. We sought to explore how residents understand fatigue in the context of their training environment.

METHODS: We interviewed 21 residents in 7 surgical and nonsurgical programs at Western University in 2014. All participants met the inclusion criteria of routinely working 24-hour call shifts while enrolled in their training program. Data collection and analysis …

Intrahepatic Cholestasis Of Pregnancy With Severe Elevation Of Bile Acids In The Setting Of Acute Hepatitis C Infection, Megan L. Lawlor, Agatha S. Critchfield

Obstetrics and Gynecology Faculty Publications

Intrahepatic cholestasis of pregnancy (ICP) is a complication of pregnancy resulting in elevation of serum bile acid levels. ICP is often associated with underlying liver disease, including hepatitis C. Bile acids in relationship to the acute infection of hepatitis C virus have not yet been delineated in the literature. A 26-year-old gravida 4 para 2103 with dichorionic, diamniotic twin gestation and history of intravenous drug abuse developed ICP in the setting of acute hepatitis C infection. In addition to clinical symptoms of pruritus and right upper quadrant pain, she developed severe elevation in bile acids, 239 micromol/L, and transaminitis aspartate …

Effect Of Metformin On Body Mass Index In Adolescent Females With Polycystic Ovary Syndrome, Alissa Briggs, Mandakini Sadhir, Maya Todd, Hatim A. Omar

Pediatrics Faculty Publications

Polycystic ovary syndrome (PCOS) is often associated with obesity, insulin resistance, irregular menstrual periods and pelvic pain. Treatment involves hormonal methods for regulation of menstrual cycle, lifestyle changes and metformin for improving insulin resistance and weight. The aim of our study was to compare changes in body mass index (BMI) of adolescent female with PCOS treated with metformin as compared to lifestyle modification only. Participants: Adolescent and young adult females aged I0-25 years diagnosed with PCOS seen for at least two visits for at least one year on the same treatment. Based on treatment plan, participants were categorized as metformin …

Oocyte Cryopreservation, Esther Gellis

The Science Journal of the Lander College of Arts and Sciences

Anti-mitotic therapies are a form of therapy used to treat cancer patients. The use of these treatments on females can result in fertility complications. Therefore, prior to treatment, women must seek ways to preserve their ability to conceive children after receiving treatment. This study analyzes the outcomes of oocyte cryopreservation and its many variables. Three important variables that can affect the outcome of oocyte cryopreservation are age, cryopreservation method and cryoprotectants. Evidence indicates that human oocyte cryopreservation can enable a woman to preserve her ability to give birth to a healthy child, following anti-mitotic therapies. Hundreds of babies have been …

L’Expérience De Femmes Ayant Subi Une Grossesse Non Désirée Au Sénégal : Une Étude Qualitative [Compte Rendu De La Rencontre De Partage Des Résultats], Fatou Mbow, Nafissatou Diop, Babacar Mane

Reproductive Health

Dans le cadre du projet Strengthening Evidence for Programming on Unintended Pregnancy (STEP UP), et sur financement de DFID, une étude qualitative a été menée dans la région de Dakar au Sénégal par le Population Council en partenariat avec la Taskforce sur l’expérience des femmes ayant subi une grossesse non désirée suite à un viol ou un inceste pour apporter la voix de ces femmes au débat sur la légalisation de l’avortement médicalisée. Une rencontre plus large, dont ce rapport est la synthèse, a été organisée en janvier 2016 par la Direction de la Santé de la Reproduction et de …

L’Expérience De Femmes Ayant Subi Une Grossesse Non Désirée Au Sénégal : Une Étude Qualitative, Fatou Mbow, Nafissatou Diop, Seynabou Ba Diakhaté, Awa Tounkara Cissé, Fatou Ndiaye Turpin

Reproductive Health

No abstract provided.

Effects Of Inositol(S) In Women With Pcos: A Systematic Review Of Randomized Controlled Trials, Vittorio Unfer, John E. Nestler, Zdravko A. Kamenov, Nikos Prapas, Fabio Facchinetti

Obstetrics and Gynecology Publications

Polycystic ovary syndrome (PCOS) is a common endocrine disorder, with complex etiology and pathophysiology, which remains poorly understood. It affects about 5–10% of women of reproductive age who typically suffer from obesity, hyperandrogenism, ovarian dysfunction, and menstrual irregularity. Indeed, PCOS is the most common cause of anovulatory infertility in industrialized nations, and it is associated with insulin resistance, type 2 diabetes mellitus, and increased cardiovascular risk. Although insulin resistance is not included as a criterion for diagnosis, it is a critical pathological condition of PCOS. The purpose of this systematic review is the analysis of recent randomized clinical trials of …

Attitudes And Factors Affecting Acceptability Of Self-Administered Cervicovaginal Sampling For Human Papillomavirus (Hpv) Genotyping As An Alternative To Pap Testing Among Multiethnic Malaysian Women., Mahirah Ma'som, Nirmala Bhoo-Pathy, Nazrila Hairizan Nasir, Jerome Bellinson, Shridevi Subramaniam, Yuntong Ma, Siew-Hwei Yap, Pik-Pin Goh, Patti Gravitt, Yin Ling Woo

Global Health Faculty Publications

OBJECTIVE: The objective of this study was to determine the attitudes and acceptability of self-administered cervicovaginal sampling compared with conventional physician-acquired Papanicolaou (Pap) smear among multiethnic Malaysian women.

METHOD: A cross-sectional study was carried out via interviewer-administered surveys from August 2013 through August 2015 at five government-run, urban health clinics in the state of Selangor. Subjects were participants from an ongoing community-based human papillomavirus (HPV) prevalence study who answered a standard questionnaire before and after self-sampling. The cervicovaginal self-sampling for HPV genotyping was performed using a simple brush ('Just for Me'; Preventive Oncology International, Hong Kong). Detailed data on sociodemographics, …

A Case Of Recurrent Rudimentary Horn Ectopic Pregnancies Managed By Methotrexate Therapy And Laparoscopic Excision Of The Rudimentary Horn, Gaby N. Moawad, Elias D. Abi Khalil

Obstetrics and Gynecology Faculty Publications

This report presents a case of a 31-year-old woman successfully treated medically for a noncommunicating rudimentary horn ectopic pregnancy who presented with a second, successive rudimentary horn pregnancy. Patient underwent laparoscopic excision of right rudimentary horn and right salpingectomy after failed methotrexate therapy. Given the potential for rupture and recurrence, serious efforts should be made to excise a uterine rudimentary horn.

First Described Case Of Group B Streptococcus Pelvic Abscess In A Patient With No Medical Comorbidities, Paul Tyan, Elias Abi-Khalil, Karthik Dwarki, Gaby N. Moawad

Obstetrics and Gynecology Faculty Publications

Background. Group B Streptococcus is an organism that commonly infects a wide range of hosts including infants in the first week of life, pregnant women, and older age adults as well as adults with underlying medical comorbidities.

Case. Large pelvic abscess in a nonpregnant patient found to be caused by Group B Streptococcuswas treated successfully with IR guided drainage and antibiotics.

Conclusion. Though rare, GBS can still be a cause of invasive infection even in individuals who are nonpregnant and have no underlying comorbidities. Empiric antibiotic coverage for this organism should be kept in mind when treating an abscess.

Testing The Feasibility Of Remote Patient Monitoring In Prenatal Care Using A Mobile App And Connected Devices: A Prospective Observational Trial, Kathryn Marko, Jill M. Krapf, Andrew C. Meltzer, Julia Oh, Nihar Ganju, Anjali Martinez, Sheetal Sheth, Nancy D. Gaba

Obstetrics and Gynecology Faculty Publications

BACKGROUND:

Excessive weight gain and elevated blood pressure are significant risk factors for adverse pregnancy outcomes such as gestational diabetes, premature birth, and preeclampsia. More effective strategies to facilitate adherence to gestational weight gain goals and monitor blood pressure may have a positive health benefit for pregnant women and their babies. The impact of utilizing a remote patient monitoring system to monitor blood pressure and weight gain as a component of prenatal care has not been previously assessed.

OBJECTIVE:

The objective of this study is to determine the feasibility of monitoring patients remotely in prenatal care using a mobile phone …

Promoting The Use Of Elective Single Embryo Transfer In Clinical Practice., Tamara Tobias, Fady I Sharara, Jason M Franasiak, Patrick W Heiser, Emily Pinckney-Clark

Obstetrics and Gynecology Faculty Publications

BACKGROUND: The transfer of multiple embryos after in vitro fertilization (IVF) increases the risk of twins and higher-order births. Multiple births are associated with significant health risks and maternal and neonatal complications, as well as physical, emotional, and financial stresses that can strain families and increase the incidence of depression and anxiety disorders in parents. Elective single embryo transfer (eSET) is among the most effective methods to reduce the risk of multiple births with IVF.

MAIN BODY: Current societal guidelines recommend eSET for patientsprognosis, yet even this approach is not widely applied. Many patients and clinicians have been reluctant to …

Eregistries: Electronic Registries For Maternal And Child Health, J. Frederik Frøen, Sonja L. Myhre, Michael J. Frost, Doris Chou, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: The Global Roadmap for Health Measurement and Accountability sees integrated systems for health information as key to obtaining seamless, sustainable, and secure information exchanges at all levels of health systems. The Global Strategy for Women’s, Children’s and Adolescent’s Health aims to achieve a continuum of quality of care with effective coverage of interventions. The WHO and World Bank recommend that countries focus on intervention coverage to monitor programs and progress for universal health coverage. Electronic health registries - eRegistries - represent integrated systems that secure a triple return on investments: First, effective single data collection for health workers to …

Genetic And Epigenetic Mechanisms Of Complex Reproductive Disorders, Bhavi P. Modi

Theses and Dissertations

Common, complex disorders are polygenic and multifactorial traits representing interactions between environmental, genetic and epigenetic risk factors. More often than not, contributions of these risk factors have been studied individually and this is especially true for complex reproductive traits where application of genomic technologies has been challenging and slow to progress. This thesis explores the potential of genetic and epigenetic components contributing to a better understanding of the biological pathways underlying disease risk in two specific female complex reproductive traits - polycystic ovary syndrome (PCOS) and preterm premature rupture of membranes (PPROM). The PCOS projects focus on characterization of a …

Pelvic Floor Muscle Training In Management Of Postpartum Pelvic Floor Dysfunctions: A Literature Review, Rebecca S. Tanner

Honors Undergraduate Theses

Women can face a wide range of pelvic floor dysfunctions following pregnancy, ranging from urinary incontinence to pelvic pain. Unfortunately, these problems are not routinely checked for in postpartum check-ups and women do not always bring it to the physician’s attention. Strengthening of the pelvic floor muscles may be able to help women prevent these disorders and improve these women’s lifestyles.

The purpose of this thesis was to review and analyze different trials to determine if different pelvic floor dysfunctions (urinary incontinence, sexual dysfunction, and pelvic girdle pain) can be treated using pelvic floor muscle training in the postpartum. After …

Barriers To Exclusive Breastfeeding Among Mothers During The First Four Weeks Postpartum, Jessy V. Thomas

Walden Dissertations and Doctoral Studies

According to the World Health Organization, breastfeeding is natural and the most effective way of nourishment to feed infants and young children to ensure child health and survival. Currently, the World Health Organization, the American Academy of Pediatrics, and other health organizations recommend exclusive breastfeeding during the first 6 months of life. Although exclusive breastfeeding has been shown to reduce the occurrence of adverse health outcomes to the infant and mother, the duration of exclusive breastfeeding remains relatively low in the United States. The theory of planned behavior was used as a theoretical framework for this study. The purpose of …

Education Intervention Of Preconception Screening In Primary Care, Tracy Schuler

Doctor of Nursing Practice (DNP) Projects

Problem: The risk of a poor pregnancy outcome among women of reproductive age in Providence, Rhode Island is indicated by the high rates of unintended pregnancies, low multivitamin use prior to pregnancy, obesity, and smoking. Although recommended, health professionals often fail to routinely screen and educate women of reproductive age for preconception risk factors. Purpose: Evaluate the efficacy of an educational intervention on preconception risk factors, lifestyle modifications, and current screening recommendations; and introduce a preconception tool and education sheet among a population of health care providers. Method: Preconception health material and a modified preconception screening tool …

Comparing Single And Dual Console Systems In The Robotic Surgical Training Of Graduating Ob/Gyn Residents In The United States, Emad Mikhail, Jason L. Salemi, Stuart Hart, Anthony N. Imudia

Obstetrics & Gynecology Faculty Publications

Objective. To assess the impact of a single versus dual console robotic system on the perceptions of program directors (PD) and residents (RES) towards robotic surgical training among graduating obstetrics and gynecology residents. Design. An anonymous survey was developed using Qualtrics, a web-based survey development and administration system, and sent to obstetrics and gynecology program directors and graduating residents. Participants. 39 program directors and 32 graduating residents (PGY4). Results. According to residents perception, dual console is utilized in about 70% of the respondents’ programs. Dual console system programs were more likely to provide a robotics …

Evidence-Based Cesarean Delivery For The Nonobstetrician, Joshua D. Dahlke, Hector Mendez-Figueroa, Jeffrey D. Sperling, Lindsay Maggio, Brendan D. Connealy, Suneet P. Chauhan

Obstetrics & Gynecology Faculty Publications

Cesarean delivery (CD) is one of the most common major surgeries performed in the United States and worldwide. Surgical techniques evaluated in well-designed randomized controlled trials (RCTs) that demonstrate maternal benefit should be incorporated into practice. The objective of this review is to provide a summary of surgical techniques of the procedure and review the evidence basis for them for the nonobstetrician. The following techniques with the strongest evidence should be commonly performed, when feasible: (1) prophylactic antibiotics with a single dose of ampicillin or first-generation cephalosporin prior to skin incision; (2) postpartum hemorrhage prevention with oxytocin infusion of 10 …

Association Between Fellowship Training, Surgical Volume, And Laparoscopic Suturing Techniques Among Members Of The American Association Of Gynecologic Laparoscopists, Emad Mikhail, Lauren Scott, Branko Miladinovic, Anthony N. Imudia, Stuart Hart

Obstetrics & Gynecology Faculty Publications

Study Objective. To compare surgical volume and techniques including laparoscopic suturing among members of the American Association of Gynecologic Laparoscopists (AAGL) according to fellowship training status. Design. A web-based survey was designed using Qualtrics and sent to AAGL members. Results. Minimally invasive gynecologic surgery (FMIGS) trained surgeons were more likely to perform more than 8 major conventional laparoscopic cases per month (63% versus 38%, , OR [95% CI] = 2.78 [1.54–5.06]) and were more likely to perform laparoscopic suturing during these cases (32% versus 16%, , OR [95% CI] = 2.44 [1.25–4.71]). The non-fellowship trained (NFT) surgeons …

Fmic Annual Report 2016 | English, French Medical Institute For Mothers And Children

FMIC Reports

No abstract provided.

Breastfeeding Education For Women With Diabetes, Pregnancy-Induced Hypertension And Multiple Gestations, Oluwapelumi Adefunmike Adeboyejo

Walden Dissertations and Doctoral Studies

Breastfeeding is considered a public health concern due to increased maternal/infant mortality and morbidity rates associated with persistent low rates in breastfeeding. Providing early breastfeeding education for women with diabetic, pregnancy-induced hypertension and multiple gestations can result in higher persistence rates and a decrease in maternal and infant mortality and morbidity rates. This quality improvement project provided early prenatal breastfeeding education for women with diabetes, pregnancy-induce hypertension and multiple gestations at a private clinic in Long Beach, Southern California. Evidence-based literature reviews were conducted through CINAHL and Medline (2009-2014). The descriptive study used for the project was made up questionnaires …

Promoting Shared Decision Making Through Patient Education Of Labor Inductions, Lenora W.Y. Low

Walden Dissertations and Doctoral Studies

The induction of labor is medically indicated for many conditions in which delivering the baby outweighs the risk of continuing the pregnancy. Patients admitted for the induction of labor require adequate information to actively participate in decision making that affects their plan of care. The purpose of this quality improvement project was to improve the quality of healthcare delivery and promote patient engagement by providing consistent education using a teaching tool. The project question addressed the impact of a labor-induction teaching tool on improving patient education, participation, and overall satisfaction. The Plan-Do-Study-Act (PDSA) model was used to plan, implement, and …

The Changing Tides In Gynecologic Surgery Minimally Invasive Options: What We Know And How Do We Improve Use, Training, Michael L. Galloway

Obstetrics and Gynecology Faculty Publications

Over the past twenty years gynecologic surgery has evolved from primarily abdominal approach to the current focus on minimally invasive surgical techniques. Minimally invasive techniques include vaginal and laparoscopic techniques. Evolution in laparoscopic technology and equipment has exploded to include multiple vessel sealing instruments of varying modalities, instruments with “wristed” capabilities and robotic assisted technology. Single port laparoscopy and natural orifice transluminal endoscopic surgery are other variations of laparoscopic technology.

Vaginal surgery is still touted as the “ultimate” minimally invasive surgery by ACOG; however, its use has not grown over this time. Many surgeons have had limited training in vaginal …

Reasons For Tubal Sterilisation, Regret And Depressive Symptoms, Karina M. Shreffler, Arthur L. Greil, Julia Mcquillan, Kami L. Gallus

Department of Sociology: Faculty Publications

Objective—To examine the associations between sterilisation reasons, regret, and depressive symptoms.

Study Design—Black, Hispanic, and non-Hispanic White US women ages 25–45 who participated in the National Survey of Fertility Barriers (NSFB) and reported a tubal sterilisation surgery were included in the sample for this study (n=837). Logistic regression was used to examine how characteristics of the sterilisation surgery (reasons for sterilisation, time since sterilisation, and new relationship since sterilisation) are associated with the odds of sterilisation regret, and linear regression was used to examine associations between sterilisation regret, sociodemographic factors, and depressive symptoms.

Results—Findings revealed that 28 …

Geospatial Analysis Of Food Environment Demonstrates Associations With Gestational Diabetes., Mk Kahr, Ma Suter, J Ballas, Sm Monga, W Lee, M Hu, Cd Shope, A Chesnokova, L Krannich, En Griffin, J Mastrobattista, Ga Dildy, Sl Strehlow, R Ramphul, Et Al.

Faculty Publications

BACKGROUND: Gestational diabetes mellitus (GDM) is one of most common complications of pregnancy, with incidence rates varying by maternal age, race/ethnicity, obesity, parity, and family history. Given its increasing prevalence in recent decades, covariant environmental and sociodemographic factors may be additional determinants of GDM occurrence. OBJECTIVE: We hypothesized that environmental risk factors, in particular measures of the food environment, may be a diabetes contributor. We employed geospatial modeling in a populous US county to characterize the association of the relative availability of fast food restaurants and supermarkets to GDM. STUDY DESIGN: Utilizing a perinatal database with >4900 encoded antenatal and …

Examination Of The Relationship Between Caesarean Section Births And Attention Deficit Hyperactivity Disorder, Breea M. Rosas

All Master's Theses

Attention Deficit/Hyperactivity Disorder, a neurological disorder characterized by inattentive and hyperactive behaviors, has become increasingly more prevalent (CDC, 2010). Recent research has found associations between this disorder and Caesarean section births (Amiri et al., 2012; Juarez et al., 2008). The current study examined the relationship between C-section birth and self-reported symptoms of ADHD by college students on the Internal Restlessness Scale (Weyandt et al., 2003). Results of the study indicate a significant difference in mean ratings of ADHD symptoms between C-section and vaginally born participants (t = 3.683, p < .000). The current study supports previous findings of a relationship between C-sections and ADHD.

Comparison Of Risk Factors And Survival Of Type 1 And Type Ii Endometrial Cancers, Tahira Y. Malik, Uzma Chishti, Aliya Aziz, Irfan Sheikh

Department of Obstetrics & Gynaecology

Objective: To compare risk factors and progression free survival of type 1 & 2 endometrial cancers.
Methods: A retrospective analysis of 149 patients with early stage endometrial carcinoma treated between 1997 and 2012 in Aga Khan University Hospital, Karachi was performed.
Results: A total of 149 patients were analyzed. Type I tumors accounted for 92% of cases in the study while 8% were type II tumors. The mean age, BMI, parity, co-morbidities (hypertension & Diabetes), family history and history of polycystic disease were comparable in both groups. Overall better survival (113 Vs 24 months) was observed for type I endometrial …