Obstetrics and Gynecology Commons^™

Reducing Postoperative Opioids After Minimally Invasive Hysterectomy With Enhanced Recovery, Kevin D. White, Shirin Azadi, Amanda Pauley, Dr. Brenda L Mitchell,, Nadim Bou Zgheib

Amanda Pauley

I

Introduction:

We evaluated the efficacy of various strategies utilized for the control of postoperative pain after minimally invasive hysterectomy. The primary enhanced recovery after surgery (ERAS) protocol of interest utilized premedication (acetaminophen, celecoxib and pregabalin), then intraoperative subcutaneous liposomal bupivacaine followed by scheduled oral acetaminophen and ibuprofen postoperatively. Patients also had tramadol and oxycodone as needed for moderate or severe breakthrough pain, respectively.

Materials and Methods:

We conducted a retrospective cohort study that included all patients who underwent minimally invasive hysterectomy (total laparoscopic hysterectomy and laparoscopic-assisted vaginal hysterectomy) for both benign and oncologic indications over a 2-year period. We ...

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.

National Policies And Care Provision In Pregnancy And Childbirth For Twins In Eastern And Southern Africa: A Mixed-Methods Multi-Country Study, Claudia Hanson, Stephen Munjanja, Agnes Binagwaho, Bellington Vwalika, Andrea B. Pembe, Elsa Jacinto, George K. Chilinda, Kateri B. Donahoe, Sikolia Wanyonyi, Peter Waiswa, Muchabayiwa F. Gidiri, Lenka Benova

Obstetrics and Gynaecology, East Africa

Background: High-risk pregnancies, such as twin pregnancies, deserve particular attention as mortality is very high in this group. With a view to inform policy and national guidelines development for the Sustainable Development Goals, we reviewed national training materials, guidelines, and policies underpinning the provision of care in relation to twin pregnancies and assessed care provided to twins in 8 Eastern and Southern African countries: Kenya, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe.

Methods and findings: We located policies and guidelines by reviewing national repositories and by contacting experts to systematically map country-level maternal and newborn training materials, guidelines, and ...

Menopause From An Integrative Historical And Evolutionary Perspective, Alison M. Moore

Journal of Evolution and Health

No abstract provided.

Impact Of Patient Safety Bundle For Management Of Morbidly Adherent Placenta On Estimated Blood Loss, Aislinn Crank, Johanna Quist-Nelson, Md, Arbor Quist, Msph

Phase 1

Introduction: Establishment of centers of excellence for care of patients with morbidly adherent placentas (MAP) has been described to improve patient outcomes. We compared maternal estimated blood loss (EBL) for patients with MAP delivered before and after the implementation of a protocol for management of MAP.

Objective: To assess the impact of a new protocol for management of MAP.

Methods: This is a retrospective cohort of patients at TJUH who had a MAP between 2007 and 2018. In 2015 our center developed a protocol as a patient safety bundle for the management of MAP. Pre-protocol and post-protocol groups were compared ...

Association Between Hypertensive Disorders And Fetal Growth Abnormalities In Class Ii And Iii Obese Women, Mary Ferrante, Bs, Rebekah Mccurdy, Md, Mph

Phase 1

Introduction: Studies have shown that hypertension in pregnancy can lead to small for gestational age newborns while obesity can lead to large for gestational age newborns. However, little research has been done to study the influence of both disorders on birthweight.

Objective: To assess the effect of both maternal obesity and a hypertensive disorder on neonatal birthweight and to identify the specific growth abnormality(s) present if a discrepancy exists. We hypothesize that obese women diagnosed with hypertensive disorders are more likely to deliver neonates with growth abnormalities compared to obese women without hypertensive disorders.

Methods: This is a nested ...

Long Term Effects Of Ovum Donation On Donors, Danielle Garfunkel, Andrea Braverman

Phase 1

Introduction: As infertility affects 17% of couples, IVF has become a key, increasingly prevalent option for couples with oocyte donors providing eggs to infertile women in ~13.7% of IVF cycles. Despite the growing prevalence of donation, there are no long-term follow up studies on the emotional and health effects of donation. We cannot appropriately counsel patients regarding the risks of the donation procedure without understanding its effects.

Objective: This study sets out to identify the long-term effects of oocyte donation on donors’ mental state and physical health and how the attitudes and concerns of oocyte donors regarding their donation ...

Reducing Postoperative Opioids After Minimally Invasive Hysterectomy With Enhanced Recovery, Kevin D. White, Shirin Azadi, Amanda Pauley, Dr. Brenda L Mitchell,, Nadim Bou Zgheib

Marshall Journal of Medicine

I

Introduction:

We evaluated the efficacy of various strategies utilized for the control of postoperative pain after minimally invasive hysterectomy. The primary enhanced recovery after surgery (ERAS) protocol of interest utilized premedication (acetaminophen, celecoxib and pregabalin), then intraoperative subcutaneous liposomal bupivacaine followed by scheduled oral acetaminophen and ibuprofen postoperatively. Patients also had tramadol and oxycodone as needed for moderate or severe breakthrough pain, respectively.

Materials and Methods:

We conducted a retrospective cohort study that included all patients who underwent minimally invasive hysterectomy (total laparoscopic hysterectomy and laparoscopic-assisted vaginal hysterectomy) for both benign and oncologic indications over a 2-year period. We ...

Failure Of Effective Contraception In Opioid Addicted Mothers: A Disparity In Planned And Actual Usage, Robert C. Bowers, Makenzie Hatfield Kresch, Amy Roy, Danielle Lancaster, Jennie L. Yoost

Marshall Journal of Medicine

The ongoing opioid epidemic in West Virginia has given rise to a unique population of opioid-addicted obstetric patients. Appropriate education, counseling, and implementation of contraception is of extreme importance among this high risk patient population. This study was a retrospective chart review aimed at evaluating contraception choice and initiation rates among patients enrolled in a maternal buprenorphine maintenance program compared to non-opioid addicted patients. Rates of planned contraception initiation were compared between the two groups. Rates of actual contraception initiation were also compared. Contraceptive choices were then placed into one of three tiers based on efficacy, and rates of initiation ...

Patient Perceptions Of Planned Organ Removal During Hysterectomy, Zeinab Kassem, Chad M. Coleman, Andrew S. Bossick, Wan-Ting Su, Roopina Sangha, Ganesa Wegienka

Journal of Patient-Centered Research and Reviews

Purpose: Previous reports indicate many women may not have a firm grasp on likely outcomes of different hysterectomy procedures. This study aimed to assess women’s self-reported expectations of how they think their anatomy will change after hysterectomy.

Methods: Women scheduled for hysterectomy at a tertiary care hospital, for non-oncological reasons, reported their planned procedure type and the organs they understood would be removed 2 weeks prior to surgery. Patient reports and electronic medical records were reviewed, and kappa statistics (κ) were calculated to assess agreement for all women and within subgroups.

Results: Most of the 456 study participants (mean ...

Does A History Of Sexual And Physical Childhood Abuse Contribute To Hiv Infection Risk In Adulthood? A Study Among Post-Natal Women In Harare, Zimbabwe, Simukai Shamu, Patience Shamu, Christina Zarowsky, Marleen Temmerman, Tamara Shefer, Naeemah Abrahams

Obstetrics and Gynaecology, East Africa

Background: Sexual and physical abuse in childhood creates a great health burden including on mental and reproductive health. A possible link between child abuse and HIV infection has increasingly attracted attention. This paper investigated whether a history of child physical and sexual abuse is associated with HIV infection among adult women.

Methods: A cross sectional survey was conducted among 2042 postnatal women (mean age = 26y) attending six public primary health care clinics in Harare, Zimbabwe within 6 weeks post-delivery. Clinic records were reviewed for mother’s antenatal HIV status. Participants were interviewed about childhood abuse including physical or sexual abuse ...

The Influence Of Obstetrician And Gynecologists' Avoidance Behaviors On Maternal Morbidities, Nakisha Rene'e Boulware

Walden Dissertations and Doctoral Studies

The prevalence of maternal morbidities continues to increase in U.S. women of lower socioeconomic status and non-Hispanic Black women despite the efforts of health care practitioners to reduce the disparities. Two decades of research has shown that physicians avoid patients based on insurance and socioeconomic status or their malpractice history. Reducing maternal illness and complications is one of the federal government's top 10 maternal health indicators in the Healthy People 2020 initiative. The purpose of this study was to evaluate the influence of malpractice allegations on patients at high-risk for maternal morbidity. Supported by the theoretical foundation of ...

Missed Opportunities In Women's Health: Post-Abortion Care, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Around the world, 56 million induced abortions took place annually in 2010–14, which was about 25% of all pregnancies. Abortion rates vary widely across regions, do not differ significantly by income level or legal status of abortion^,1 and depend on many factors, one of the key ones being a lack of access to modern contraceptives.¹ Safe abortion, however, depends on the legal climate, and countries with restrictive abortion laws are far more likely to have illegal and unsafe abortions. Abortionrelated complications are an important and preventable cause of maternal mortality, accounting for 8–9% of maternal deaths ...

Incidence And Contributing Factors Of Glucose Intolerance In Saudi Postpartum Women: Sub-Group Analysis From Rahma Study, Hayfaa Wahabi, Amel Fayed, Safaa M. S. T Tunkar, Ali Al-Hazmi, Amna R. Siddiqui

Community Health Sciences

Objectives: The objectives of this study were to determine incidence and risk factors of glucose intolerance one year after delivery in a sub-cohort of Riyadh Mother and Baby Cohort Study (RAHMA) study.
Methods: This is a follow-up study of a sub-cohort from RAHMA study from King Khalid University Hospital (KKUH). All women from RAHMA database who completed one year since delivery at KKUH were contacted by phone to participate in the study. Previously collected data from RAHMA registry for each participant were linked to this study data. Clinical data measured for each participant included current weight and height to calculate ...

Portable Pelvic Exam Positioning Device For Enhanced Workflow And Patient Comfort, Hannah Levy, Elliott Perow, Sean Haynie

Phase 1

Background: Pelvic exams are often performed in settings other than designated obstetrics and gynecology suites. In these other settings, the equipment that is traditionally used to position the patient, such as a bed fitted with stirrups, may not be available. Therefore, physicians often improvise a solution to elevate the pelvis, such as using inverted bedpans, pillows or blankets. However, the lack of an appropriate device to position patients decreases patient and physician comfort, causes workflow inefficiency and leads to suboptimal examination due to inadequate provider visualization.

Methods: Over the course of five months, input from patients and providers alike was ...

Management Of The Third Stage Of Labor In Second-Trimester Deliveries: How Long Is Too Long?, Jessica J F Kram

Jessica Kram, MPH

No abstract provided.

Opportunities For Linking Research To Policy: Lessons Learned From Implementation Research In Sexual And Reproductive Health Within The Anser Network, Anser, Emilomo Ogbe, Dirk Van Braeckel, Marleen Temmerman, Elin C. Larsson, Ines Keygnaert, Wilson De Los Reyes Aragón, Feng Cheng, Gunta Lazdane

Obstetrics and Gynaecology, East Africa

Background: The uptake of findings from sexual and reproductive health and rights research into policy-making remains a complex and non-linear process. Different models of research utilisation and guidelines to maximise this in policy-making exist, however, challenges still remain for researchers to improve uptake of their research findings and for policy-makers to use research evidence in their work.

Methods: A participatory workshop with researchers was organised in November 2017 by the Academic Network for Sexual and Reproductive Health and Rights Policy (ANSER) to address this gap. ANSER is a consortium of experienced researchers, some of whom have policy-making experience, working on ...

"Our Voices Matter": A Before-After Assessment Of The Effect Of A Community-Participatory Intervention To Promote Uptake Of Maternal And Child Health Services In Kwale, Kenya., Vernon Mochache, Eunice Irungu, Hajara El-Busaidy, Marleen Temmerman, Peter Gichangi

Obstetrics and Gynaecology, East Africa

Background: Community-participatory approaches are important for effective maternal and child health interventions. A community-participatory intervention (the Dialogue Model) was implemented in Kwale County, Kenya to enhance uptake of select maternal and child health services among women of reproductive age.

Methods: Community volunteers were trained to facilitate Dialogue Model sessions in community units associated with intervention health facilities in Matuga, Kwale. Selection of intervention facilities was purposive based on those that had an active community unit in existence. For each facility, uptake of family planning, antenatal care and facility-based delivery as reported in the District Health Information System (DHIS)-2 was ...

Introducing E-Consents In A Clinical Setting, Jesse Weiss, Donna A. Santillan, Kellie Thomas, Heather Davis, Mark K. Santillan, Debra Sue Brandt

Proceedings in Obstetrics and Gynecology

Preeclampsia (PE) is a multiorgan hypertensive-disorder in pregnancy that causes significant maternal-fetal mortality and morbidity. The diagnostics and therapeutics for PE are limited due to its unclear etiology. Using the UI Maternal Fetal Tissue Bank, our lab has demonstrated that copeptin is robustly predictive of PE. To investigate copeptin further, we developed the Rule Out Pre-Eclampsia Study (ROPE). The ROPE study recruits women admitted to Labor and Delivery for evaluation of PE. Women are admitted for PE evaluation at all hours. Research team members are not available at all times to obtain consent which limits recruitment. Our project aimed to ...

Betamethasone: A Novel Therapeutic Intervention For Preeclampsia, Sabrina M. Scroggins, Donna A. Santillan, Jeremy A. Sandgren, Gary L. Pierce, Curt D. Sigmund, Justin L. Grobe, Mark K. Santillan

Proceedings in Obstetrics and Gynecology

The early pathogenesis of preeclampsia (PE) involves a systemic inflammatory immune response. Recent data demonstrate that increased circulating arginine vasopressin (AVP) in humans is predictive of PE and that infusion of AVP in mouse dams phenocopies the pregnancy-specific cardiovascular and immune alterations observed in human PE. Specifically, AVP suppresses anti-inflammatory cytokines and cells. Betamethasone (BMTZ), commonly given to women at risk for preterm birth, is both an AVP and immune response modulator. We hypothesize that early treatment with BMTZ will prevent the development of AVP-induced PE.