Obstetrics and Gynecology Commons^™

Podium Presentation: Racial Inequities And Breastfeeding In A Nicu: A Quality Improvement Project, Emilia C. Garcia

Providence Nurse Research Conference (2022 - present)

No abstract provided.

Podium Presentation: Identifying Barriers To Quality Mother-Infant Interactions In The Nicu Through Naturalistic Systematic Observations, Christine Neugebauer, Miranda Cox, Melissa Deckert, Ann M. Mastergeorge

Providence Nurse Research Conference (2022 - present)

No abstract provided.

Podium Presentation: Continuous Labor Epidural Placement Trends Among Parturients: An Evidence-Based Practice Project, Aleksandr A. Lyakhov, Teresa Bigand, Amanda Affleck, Kenn Daratha, Kris Daratha

Providence Nurse Research Conference (2022 - present)

Background:

Childbirth is very painful, and unmanaged pain may reduce patient satisfaction or lead to other complications. Evidence indicates that pain severity is lower among parturient women administered analgesia via a continuous labor epidural (CLE) and that maternal request is sufficient indication for CLE placement to manage labor pain. In some cases, a medical induction of labor may be scheduled, offering an opportunity for proactive pain management from hospital staff. Yet, trends on timing of CLE placement among parturient women with scheduled labor induction versus spontaneous labor in hospitals in Eastern Washington at one health system are unclear.

Purpose:

The ...

The Development Of Maternal Medication Assisted Treatment Learning Modules, Katie Nadalsky, Rebecca Penders

Providence Nurse Research Conference (2022 - present)

No abstract provided.

Identifying Predictors For Inflammation-Induced Preterm Birth: A Murine Study, Tzu Ning Liu Bs, Jose Galaz Md, Nardhy Gomez-Lopez Phd

Medical Student Research Symposium

Introduction: Preterm birth is the leading cause of neonatal morbidity and mortality worldwide. A large proportion of preterm deliveries is affected by intra-amniotic inflammation, which can occur in the presence (intra-amniotic infection) or absence (sterile intra-amniotic inflammation) of microbes. Studies have shown an association between intra-amniotic inflammation, cervical shortening, and changes in the cervicovaginal microbiome. However, their causal relationships are unknown. This study aims to determine the causality of intra-amniotic inflammation, cervical shortening, and cervicovaginal microbiome alterations.

Methods: Pregnant C57BL/6 dams received an ultrasound-guided intra-amniotic injection of an endotoxin lipopolysaccharide (LPS) or the alarmin interleukin-1 alpha (IL-1 alpha) on ...

Discharged Against Medical Advice In The Postpartum Period: Why Should We Care?, Gurbani Bedi Bs, Mariam Ayyash Md, Mscr, Monique Swain Md

Medical Student Research Symposium

Objective: To understand reasons and events surrounding postpartum discharges against medical advice (AMA) in an urban population in Detroit, Michigan.

Methods: A retrospective chart review was conducted looking at women who left AMA in the postpartum period from Henry Ford Hospital in Detroit, Michigan between 2013 and 2021.

Results: 111 women (0.18%) left AMA in the postpartum period between 2013 and 2021. 35.1% of women were Black, 53% were White, 11.7% were of other races. 4.5% of women had home births and were brought in by EMS shortly after delivery. 44.1% of women had preterm ...

Language Preference Impact On The Outcomes Of Those Lost To Follow-Up After A Diagnosis Of Pregnancy Of Unknown Location, Erin A. Leestma, Mayra A. Shafique, Megan Mcnitt, Annmarie Vilkins

Medical Student Research Symposium

Pregnancy of unknown location (PUL) is a temporary diagnosis when there is a positive pregnancy test but an intrauterine gestational sac and/or fetal pole are not visualized with ultrasonography. The three potential outcomes for such a pregnancy are failed pregnancy, an early intrauterine pregnancy or an ectopic/abnormal pregnancy. Given the serious associated morbidity of ectopic pregnancy, these PUL require strict follow up of bHCG levels to help the clinician determine the likely outcome of the PUL (failed vs early vs ectopic) and choose the best intervention (expectant management, surgical management or medical management). One potential barrier to follow-up ...

The Molecular Mechanisms Of Hepatic Mitochondrial Dysfunction In Growth-Restricted Offspring With Hyperlipidemia, Shelby L. Oke

Electronic Thesis and Dissertation Repository

Intrauterine growth restriction (IUGR) is a pathological condition characterized by low birth weight and poor organ development. Growth of the fetal liver is often compromised at the expense of other vital organs, thereby leading to hepatic dyslipidemia in the affected offspring. As such, epidemiological studies suggest an inverse relationship between birth weight and long-term metabolic health, while the occurrence of postnatal catch-up growth can exacerbate this relationship. Animal studies have shown that IUGR offspring exhibit impaired mitochondrial function, which likely contributes to the later development of metabolic pathologies. That said, the molecular mechanisms by which mitochondria are affected remain unknown ...

Group B Streptococcus Infection During Pregnancy And Infancy: Estimates Of Regional And Global Burden, Bronner P. Gonçalves, Simon R. Procte, Proma Paul, Jaya Chandna, Alexandra Lewin, Farah Seedat, Artemis Koukounari, Ziyaad Dangor, Shannon Leahy, Amina Abubakar

Institute for Human Development

Background: Group B streptococcus (GBS) colonisation during pregnancy can lead to invasive GBS disease (iGBS) in infants, including meningitis or sepsis, with a high mortality risk. Other outcomes include stillbirths, maternal infections, and prematurity. There are data gaps, notably regarding neurodevelopmental impairment (NDI), especially after iGBS sepsis, which have limited previous global estimates. In this study, we aimed to address this gap using newly available multicountry datasets.

Methods: We collated and meta-analysed summary data, primarily identified in a series of systematic reviews published in 2017 but also from recent studies on NDI and stillbirths, using Bayesian hierarchical models, and estimated ...

Save Lives And Sanitize: Prevention Of Surgical Site Infections Post-Cesarean Section Through Increased Hand Hygiene Compliance, Lindsay N. Nance

Master's Projects and Capstones

Problem: Surgical site infections (SSIs) occur in 3-15% of cesarean sections, making SSIs one of the most common hospital-acquired infections (HAIs). Surgical site infections (SSIs) have increased within a Labor & Delivery (L&D) unit in a large California teaching hospital for the past three years, affecting reimbursement and creating a range of adverse outcomes for patients. Performance of consistent and thorough hand hygiene practices is key to preventing infection, yet the unit’s hand hygiene compliance of 66.7% is well below the facility’s target goal of 90%. Based on recommendations from the organization’s Infection Prevention & Control (IPC ...

Utilizing Training And Educational Materials To Increase Hand Hygiene Compliance Of Healthcare Providers Participating In Cesarean Sections, Christopher Natividad

Master's Projects and Capstones

Surgical site infections (SSIs) are one of the most common complications of Cesarean section (C-section) procedures. The incidence of SSIs after C-section procedures at Hospital X has increased in each of the past three years. The Labor and Delivery (L&D) unit at Hospital X performs approximately 4,500 C-sections each year. Observation of these procedures illustrated a lack of adhesion to hand hygiene policies and protocols. This quality improvement project involved informing staff members of the poor hand hygiene compliance rates, and re-educating them regarding proper hand hygiene behavior using flyers, emails, and addressing them at shift change. Data collection focused on hand hygiene compliance among staff members involved in the C-section procedure. Staff members were observed entering and exiting the operating room to determine if they performed hand hygiene upon entry or exit. Hand hygiene compliance increased by 8.8% among all staff members. Obstetric (OB) nurse hand hygiene compliance increased by 28.6%. While overall hand hygiene compliance increased, it was not statistically significant; however, the increase in OB nurse compliance is statistically significant. Implementation of educating the OB nurses proved to be successful, and future interventions were recommended to continue to monitor and improve hand hygiene compliance.

Counting Every Drop: Preventing Maternal Mortality With Quantifying Blood Loss Through Triton Scale, Summer Le

Master's Projects and Capstones

Postpartum (PP) hemorrhage is one of the leading causes of maternal mortality (AWHONN, 2021). In each of the past three years, the percentage of PP hemorrhage has increased at Hospital X. The PP unit at Hospital X performs around 4,500 total deliveries each year. While the standard of care for PP blood loss is to specifically measure blood in milliliters as Quantifying Blood Loss (QBL) for Labor and Delivery (L&D), it is not yet the standard of care in the 24 hours postpartum after delivery (ACOG, 2019). This quality improvement project involved educating nurses about measuring blood loss – specifically past the initial measuring in L&D – using the Triton Scale and proper documentation of QBL onto EPIC, the hospital’s electronic patient record system (EPIC). This included creating an instructional video for the Triton Scale, flyers on how to document QBL, emails of changes and implementation, and surveys on nurses’ feedback for QBL implementation. Data collection focused on daily auditing of the nurses’ QBL documentation for the first two voids of a vaginal delivery, QBL for the first four hours of enhanced recovery after surgery (ERAS), and the first eight hours ERAS with ambulation. If a patient hemorrhages, the focus shifts to determine when the nurse notified the Medical Doctor (MD) or Obstetric (OB) rapid response. QBL compliance increased by 96% among all nurses in the PP unit. While QBL compliance increased, it was not statistically significant; however, important steps towards attaining this goal were found. Nurses have demonstrated significant improvements in the ability to use the Triton scale and the ability to properly document their ...

A Two-Step Approach To Increase Breastfeeding Adherence In Mothers With Preterm Infants, Jessica J. Glinski

Evidence-Based Practice Project Reports

Breastfeeding provides multiple benefits for mothers and infants. An overwhelming amount of evidence indicates that breastmilk optimizes infant growth and develops the immune system (Yu et al., 2018). Apart from the health benefits for infants, the immediate effects of breastfeeding for mothers include a decreased risk for hemorrhage, stress, and postpartum depression (Flemming, 2021). A mother’s psychological state impacts lactation success, mainly by affecting milk ejection (Dabas et al., 2019). Despite evidence suggesting that relaxation techniques are beneficial for all human beings, it is one of the least commonly used approaches for postpartum mothers (Joseph et al., 2019). The ...

Genetic Origins Of Polycystic Ovarian Syndrome (Pcos): An Analysis Of The Genetic Correlation Between Pcos And Insulin Receptor Mutations, Lauren Henry

Undergraduate Theses

Polycystic Ovarian Syndrome (PCOS) remains an extremely common, yet understudied syndrome experienced by 6-12% of females of reproductive age. Not only does it cause painful side effects manifesting both physically and mentally, but it also poses a threat to the fertility of those affected. For this reason, a more in-depth analysis to better understand how to detect this condition early and prevent fertility complications later is certainly warranted. PCOS is suspected to be primarily genetic due to correlations among immediate female family members. Based on previous research, a good starting point for analysis is the INSR gene. Various mutations within ...

Bilateral Teratomas In Pediatric Patient With Unilateral Ovarian Torsion, David Ho, Maya Borowczak, Archana Verma

Stratford Campus Research Day

Ovarian torsion is a surgical emergency found in both pediatric and adult populations. It involves the full or partial rotation of the vessels that supply the ovary, resulting in ischemia. In this report, we present the case of a pediatric patient arriving to the Pediatric Emergency Department (PED) for evaluation of right lower quadrant (RLQ) abdominal pain, who was found to have an ovarian torsion. In this particular case, the patient’s ovarian torsion was due to a teratoma, and imaging would later identify an additional smaller teratoma on the contralateral side. This case shows the importance of considering ovarian ...

Screening And Follow Up For Postpartum Depression: How To Improve Practice, Mallory Matusik

Evidence-Based Practice Project Reports

Postpartum depression (PPD) is one of the most common mental health conditions, affecting one in seven women during their reproductive years (American College of Obstetricians and Gynecologists [ACOG], 2018). The purpose of this evidence-based practice (EBP) project was to improve screening and management of PPD using the Edinburgh Postnatal Depression Scale (EPDS) screening tool and a protocol for appropriate treatment and follow up care for PPD. A protocol was created by the project leader with information on screening and diagnosis, follow up, and treatment for PPD. The protocol also included information on how to assess for suicidal and/or homicidal ...

Targeting Metabolic Adaptations To Anti-Angiogenic Therapy In Ovarian Cancer, Deanna M. Glassman, Deanna Glassman

The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences Dissertations and Theses (Open Access)

ABSTRACT

Background: Ovarian cancer is the most lethal gynecologic malignancy. Despite modest clinical improvements with anti-VEGF antibody (AVA) therapy, adaptive resistance is nearly ubiquitous and additional therapeutic options are limited. A dependence on glutamine metabolism, via the enzyme glutaminase (GLS), is a known mechanism of adaptive resistance.

Purpose: To assess the efficacy of a glutaminase inhibitor as a means of exploiting the metabolic vulnerability of glutamine dependence that develops as a result of adaptive resistance to AVA therapy.

Experimental Design: We used a glutaminase inhibitor (GLSi) synthesized at MD Anderson Cancer Center for all in vitro and in vivo experiments ...

The Effects Of Hormonal Contraceptive Use On Perceptions Of Social Stress In Women, Ashton Jones

Biological Sciences Undergraduate Honors Theses

Hormonal contraceptives are widely used due to their efficiency in preventing pregnancy. Although women are often informed of the physical effects of hormonal contraceptives, there is little emphasis on mental effects, such as increased rates of depression and changes in social perception. The current study examined perceptions of social stress among women before beginning hormonal contraceptives, and two months after using hormonal contraceptives. I hypothesized that women would experience increased social stress after beginning hormonal contraceptives, compared to a control group of women who were also assessed twice. Results did not support this hypothesis; there was no difference in interpersonal ...

Impact Of Homologous Recombination Status And Responses With Veliparib Combined With First-Line Chemotherapy In Ovarian Cancer In The Phase 3 Velia/Gog-3005 Study, Elizabeth M Swisher, Carol Aghajanian, David M O'Malley, Gini F Fleming, Scott H Kaufmann, Douglas A Levine, Michael J Birrer, Kathleen N Moore, Nick M Spirtos, Mark S Shahin, Thomas J Reid, Michael Friedlander, Karina Dahl Steffensen, Aikou Okamoto, Vasudha Sehgal, Peter J Ansell, Minh H Dinh, Michael A Bookman, Robert L Coleman

Kimmel Cancer Center Faculty Papers

Objective: In the Phase 3 VELIA trial (NCT02470585), PARP inhibitor (PARPi) veliparib was combined with first-line chemotherapy and continued as maintenance for patients with ovarian carcinoma enrolled regardless of chemotherapy response or biomarker status. Here, we report exploratory analyses of the impact of homologous recombination deficient (HRD) or proficient (HRP) status on progression-free survival (PFS) and objective response rates during chemotherapy.

Methods: Women with Stage III-IV ovarian carcinoma were randomized to veliparib-throughout, veliparib-combination-only, or placebo. Stratification factors included timing of surgery and germline BRCA mutation status. HRD status was dichotomized at genomic instability score 33. During combination therapy, CA-125 levels ...

Early Neonatal Mortality Is Modulated By Gestational Age, Birthweight And Fetal Heart Rate Abnormalities In The Low Resource Setting In Tanzania – A Five Year Review 2015–2019, Aisa Shayo, Pendo Mlay, Emily Ahn, Hussein Kidanto, Michael Espiritu, Jeffrey Perlman

Obstetrics and Gynaecology, East Africa

Background: Early Neonatal mortality (ENM) (<7days) remains a signifcant problem in low resource settings. Birth asphyxia (BA), prematurity and presumed infection contribute signifcantly to ENM. The study objectives were to determine: frst, the overall ENM rate as well as yearly ENM rate (ENMR) from 2015 to 2019; second, the infuence of decreasing GA (<37weeks) and BW (<2500g) on ENM; third, the contribution of intrapartum and delivery room factors and in particular fetal heart rate abnormalities (FHRT) to ENM; and fourth, the Fresh Still Birth Rates (FSB) rates over the same time period.

Methods: Retrospective cohort study undertaken in a zonal referral teaching hospital located in Northern Tanzania. Labor and delivery room data were obtained from 2015 to 2019 and included BW, GA, fetal heart rate (FHRT) abnormalities, bag mask ventilation (BMV) during resuscitation, initial temperature, and antenatal steroids use. Abnormal outcome was ENM<7days. Analysis included t tests, odds ratios (OR), and multivariate regression analysis.

Results: The overall early neonatal mortality rate (ENMR) was 18/1000 livebirths over the 5 years and did not change signifcantly comparing 2015 to 2019. Comparing year 2018 to 2019, the overall ENMR decreased signifcantly (OR 0.62; 95% confdence interval (CI) 0.45 ...