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A Rare Case Of Lethal Campomelic Dysplasia, Ahmad El-Sheikhah, Mahy Mohsen, Sief El-Eslam A. Ali, Rasha Taher, Armia Michael, Shymaa S. Ali, Ahmed M. Abbas 2017 Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt

A Rare Case Of Lethal Campomelic Dysplasia, Ahmad El-Sheikhah, Mahy Mohsen, Sief El-Eslam A. Ali, Rasha Taher, Armia Michael, Shymaa S. Ali, Ahmed M. Abbas

POG In Press

Campomelic dysplasia is a rare and mostly lethal congenital malformation. It is known as an autosomal dominant disorder due to mutations in SOX9, a member of the SOX (SRY-related HMG box) gene family. Here we report a case of a 26 years old primigravida married for 3 years with a history of consanguinity. She was impregnated by intracytoplasmic sperm injection (ICSI) due to male factor infertility. This mostly lethal skeletal anomaly was diagnosed by detailed ultrasonography in the late second trimester. She underwent an induction of labor termination due to intrauterine fetal demise.


The Effects Of Continuous Insulin Pump Therapy On Glycemic Control In Pregnant Type 1 Diabetics, Kimberly Kelsey 2017 Dominican University of California

The Effects Of Continuous Insulin Pump Therapy On Glycemic Control In Pregnant Type 1 Diabetics, Kimberly Kelsey

Senior Theses and Capstone Projects

Type 1 Diabetics have various ways of managing their diabetes that have been studied for their effectiveness. Pregnancy in the Type 1 Diabetic has been understudied. It is known that Diabetics in general have poorer pregnancy outcomes because of poor glycemic control. This coupled with the fact that the body needs 3-4 times more insulin as pregnancy comes to an end makes managing blood glucose levels challenging for diabetics (Lowdermilk, 2016, p. 689). For the Type 1 Diabetic, there are two main ways to control diabetes: multiple daily injections using at least two type of insulin and continuous subcutaneous insulin ...


Why American Parents Circumcise Their Sons: An Integrative Review Of Literature, Lacy Lauber 2017 DePaul University

Why American Parents Circumcise Their Sons: An Integrative Review Of Literature, Lacy Lauber

Grace Peterson Nursing Research Colloquium

Background: Since medical evidence supports both pros and cons of routine neonatal male circumcision, expectant and new parents are left to make the decision to circumcise their sons on their own. There is limited research as to why American parents choose to circumcise their newborn sons.

Objectives: The purpose of this integrative literature review is to identify the reasons behind parental decision making in neonatal male circumcision in the United States. Understanding motivating factors in parental decision-making can highlight areas of prenatal education for expectant parents.

Method: An integrative literature review was conducted utilizing these online databases: PubMed, The Cumulative ...


Sheehan’S Syndrome: It Is Time To Become More Proactive In Identifying This Disease, Yara E. Tovar, Waseem Ahmed, Madhulika Urella, Ayman H. Elkadry, Rodhan A. Khthir 2017 Marshall University Joan C. Edwards School of Medicine

Sheehan’S Syndrome: It Is Time To Become More Proactive In Identifying This Disease, Yara E. Tovar, Waseem Ahmed, Madhulika Urella, Ayman H. Elkadry, Rodhan A. Khthir

Ayman Elkadry

Sheehan’s syndrome typically occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage and can present with varying degrees of pituitary insufficiency. It is more common in underdeveloped countries, and is frequently diagnosed years after delivery due to its nonspecific signs and symptoms. Failure to lactate is a common initial symptom, while many women also report amenorrhea or oligomenorrhea. This article presents a 26-year-old female with a history of hypertension, who presented to the hospital for diarrhea, vomiting, and dizziness. Her blood pressure was 80/40 mmHg, requiring aggressive fluid resuscitation, after which it remained borderline ...


Reducing Postoperative Opioids After Minimally Invasive Gynecologic Surgery With Multimodal Pain Control, Kevin D. White, William C. Wallace, Nadim Zgheib 2017 Marshall University Joan C. Edwards School of Medicine

Reducing Postoperative Opioids After Minimally Invasive Gynecologic Surgery With Multimodal Pain Control, Kevin D. White, William C. Wallace, Nadim Zgheib

William C. Wallace

Introduction: We evaluated the efficacy of a multimodal pain regimen that approaches pain control by utilizing different mechanisms of action. This novel protocol utilizing liposomal bupivacaine, acetaminophen, tramadol and oxycodone as needed in reducing the overall opioid use by patients after undergoing robotic-assisted total laparoscopic hysterectomy in an obese population that is heavily afflicted by the opioid epidemic. Materials and Methods: We conducted a retrospective study wherein a sample of 100 (50 multimodal group and 50 controls) were taken from 433 eligible cases conducted over a 1 year period. Patient medical records were evaluated for demographics, surgical characteristics, opioid type ...


Quality Improvement Study For Postpartum Hypertension Readmissions, Molly K. Lepic, Sara M. Stanenas, Carla J. Kelly, Deborah Simpson, Jeffrey A. Stearns 2017 Department of Obstetrics and Gynecology, Aurora Sinai Medical Center

Quality Improvement Study For Postpartum Hypertension Readmissions, Molly K. Lepic, Sara M. Stanenas, Carla J. Kelly, Deborah Simpson, Jeffrey A. Stearns

Journal of Patient-Centered Research and Reviews

Background: Hospital readmission rates are a focus of the Centers for Medicare and Medicaid Services. This was identified as a system opportunity to improve health care quality and patient education in order to reduce preventable readmissions. In 2009, 27% of obstetric readmissions were due to hypertensive disease, and preventable readmissions regarding hypertension are flagged as an area for quality improvement in our health care system. There is limited evidence on specific management of postpartum hypertension.

Purpose: Identify risk factors in our community and reduce postpartum readmissions for hypertension within our hospital.

Methods: We performed a retrospective chart review from November ...


Improving Obstetrics In Family Medicine Residency Clinics: A Quality Improvement Study, Garima Chawla, Jessica J.F. Kram, Bonnie Bobot, Dennis J. Baumgardner 2017 Department of Family Medicine, Aurora University of Wisconsin Medical Group

Improving Obstetrics In Family Medicine Residency Clinics: A Quality Improvement Study, Garima Chawla, Jessica J.F. Kram, Bonnie Bobot, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Background: Prenatal care/deliveries within our family medicine clinics have declined, perhaps because patients are unaware that our clinics provide these services. With lower volumes, clinicians may feel less comfortable with current skills/knowledge of obstetric (OB) care.

Purpose: Increase family medicine clinic OB numbers, patient awareness, and clinician comfort/knowledge in OB.

Methods: English-facile patients (18–50 years), residents and faculty at Aurora family medicine residency clinics were included. Patients were provided preintervention surveys upon check-in. Residents/faculty were surveyed via Survey Monkey. Changes made based on initial survey results were: 1) increasing systemwide awareness that our caregivers provide ...


Conference Proceedings: Aurora Scientific Day 2017, 2017 Aurora Health Care

Conference Proceedings: Aurora Scientific Day 2017

Journal of Patient-Centered Research and Reviews

This supplement includes select abstracts presented at the 43rd Annual Aurora Scientific Day research symposium on May 24, 2017. Aurora Scientific Day hosts a forum for original research conducted by faculty, fellows, residents, and other allied health professionals affiliated with Aurora Health Care, an integrated health system headquartered in Milwaukee, Wisconsin.


Evolution Of Knowledge, Awareness, And Practices Regarding Zika Virus From 2016 To 2017, Quinton Katler, Prachi Godiwala, Charles J. Macri, Beth Pineles, Gary Simon, Aileen Chang, Homa Ahmadzia 2017 George Washington University

Evolution Of Knowledge, Awareness, And Practices Regarding Zika Virus From 2016 To 2017, Quinton Katler, Prachi Godiwala, Charles J. Macri, Beth Pineles, Gary Simon, Aileen Chang, Homa Ahmadzia

Obstetrics and Gynecology Faculty Publications

Objective. Our team created a knowledge, attitudes, and practice (KAP) survey in order to assess changes over time in healthcare provider and community member awareness of Zika virus symptoms, transmission, treatment, and current and future concerns.

Study Design. The cross-sectional survey was issued at an academic medical center in Washington, DC, and via an online link to healthcare providers and community members between June and August 2016. Survey distribution was then repeated the following year, from March to April 2017. Outcomes were compared by survey year and healthcare provider versus community member status using SAS Program Version 9.4.

Results ...


Geographic Disparities In The Distribution Of The U.S. Gynecologic Oncology Workforce: A Society Of Gynecologic Oncology Study, Stephanie Ricci, Ana Tergas, Kara Roche, Melissa Fairbairn, Kimberly Levinson, Micael Lopez-Acevedo, +several additional authors 2017 George Washington University

Geographic Disparities In The Distribution Of The U.S. Gynecologic Oncology Workforce: A Society Of Gynecologic Oncology Study, Stephanie Ricci, Ana Tergas, Kara Roche, Melissa Fairbairn, Kimberly Levinson, Micael Lopez-Acevedo, +Several Additional Authors

Obstetrics and Gynecology Faculty Publications

A recent ASCO workforce study projects a significant shortage of oncologists in the U.S. by 2020, especially in rural/underserved (R/US) areas. The current study aim was to determine the patterns of distribution of U.S. gynecologic oncologists (GO) and to identify provider-based attitudes and barriers that may prevent GOs from practicing in R/US regions. U.S. GOs (n = 743) were electronically solicited to participate in an on-line survey regarding geographic distribution and participation in outreach care. A total of 320 GOs (43%) responded; median age range was 35–45 years and 57% were male. Most practiced ...


Reducing Postoperative Opioids After Minimally Invasive Gynecologic Surgery With Multimodal Pain Control, Kevin D. White, William C. Wallace, Nadim Zgheib 2017 Marshall University Joan C. Edwards School of Medicine

Reducing Postoperative Opioids After Minimally Invasive Gynecologic Surgery With Multimodal Pain Control, Kevin D. White, William C. Wallace, Nadim Zgheib

Marshall Journal of Medicine

Introduction:

We evaluated the efficacy of a multimodal pain regimen that approaches pain control by utilizing different mechanisms of action. This novel protocol utilizing liposomal bupivacaine, acetaminophen, tramadol and oxycodone as needed in reducing the overall opioid use by patients after undergoing robotic-assisted total laparoscopic hysterectomy in an obese population that is heavily afflicted by the opioid epidemic.

Materials and Methods:

We conducted a retrospective study wherein a sample of 100 (50 multimodal group and 50 controls) were taken from 433 eligible cases conducted over a 1 year period. Patient medical records were evaluated for demographics, surgical characteristics, opioid type ...


Contingency Management For Smoking Cessation In Pregnancy, Jacob Miller, Brady Reynolds, Courtney Crain, Hisham Keblawi, Lynne J. Goebel 2017 Marshall University

Contingency Management For Smoking Cessation In Pregnancy, Jacob Miller, Brady Reynolds, Courtney Crain, Hisham Keblawi, Lynne J. Goebel

Marshall Journal of Medicine

This pilot study examined the feasibility of applying Contingency Management (CM), where the woman receives financial compensation for abstinence from smoking. Eleven subjects were recruited from Marshall’s OB clinic for the program. CO levels were measured daily using online video recording. Quit rates were determined at the end of pregnancy. Birth outcomes were measured at delivery. 21 pregnant smokers from Marshall’s OB clinic were used as the control group. The results demonstrated a trend toward improved rates of smoking abstinence in CM participants as compared with the control group. Our study also showed a trend towards improved birth ...


Sheehan’S Syndrome: It Is Time To Become More Proactive In Identifying This Disease, Yara E. Tovar, Waseem Ahmed, Madhulika Urella, Ayman H. Elkadry, Rodhan A. Khthir 2017 Marshall University Joan C. Edwards School of Medicine

Sheehan’S Syndrome: It Is Time To Become More Proactive In Identifying This Disease, Yara E. Tovar, Waseem Ahmed, Madhulika Urella, Ayman H. Elkadry, Rodhan A. Khthir

Marshall Journal of Medicine

Sheehan’s syndrome typically occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage and can present with varying degrees of pituitary insufficiency. It is more common in underdeveloped countries, and is frequently diagnosed years after delivery due to its nonspecific signs and symptoms. Failure to lactate is a common initial symptom, while many women also report amenorrhea or oligomenorrhea. This article presents a 26-year-old female with a history of hypertension, who presented to the hospital for diarrhea, vomiting, and dizziness. Her blood pressure was 80/40 mmHg, requiring aggressive fluid resuscitation, after which it remained borderline ...


A Pilot Study For Enhancing Postpartum Discharge Instructions For Incision Care: Assessment Of Comprehension, Rebekah Jo McCurdy, MD, Rebecca Lawrence, BS, Sarah Cohen, BS, Jason K. Baxter, MD, MSCP 2017 Thomas Jefferson University

A Pilot Study For Enhancing Postpartum Discharge Instructions For Incision Care: Assessment Of Comprehension, Rebekah Jo Mccurdy, Md, Rebecca Lawrence, Bs, Sarah Cohen, Bs, Jason K. Baxter, Md, Mscp

CWIC Posters

Literacy and Health Care

• 14.5% of United States is illiterate 1

• Reading level of most medical forms is 10th grade 2

Improving Outcomes with a Visual Aid

• Cesarean Surgical Site Infection (SSI) rate is 5% 3

• A patient with a SSI can be 2 times as expensive 4

• Visual aids improve information recall 8 and confidence in wound care 5

Study Objectives

1. To evaluate the readability of the cesarean wound care discharge instructions relative to the patient population’s reading level

2. To conduct a pilot Randomized Control Trial (RCT) to evaluate the effectiveness of a visual aid ...


The Psychological Influence Of The Diagnosis Of Breast Cancer On Therapeutic Options Selection, Razvan V. Scaunasu, Stefan Voiculescu, Bogdan Popescu, Cristina Cozma, Radu Jecan, Cristian Balalau 2017 Carol Davila University, Colțea Clinical Hospital, Department of General Surgery, Bucharest, Romania

The Psychological Influence Of The Diagnosis Of Breast Cancer On Therapeutic Options Selection, Razvan V. Scaunasu, Stefan Voiculescu, Bogdan Popescu, Cristina Cozma, Radu Jecan, Cristian Balalau

Journal of Mind and Medical Sciences

The therapeutic management decision-making process for breast cancer is complex, and is influenced by multiple factors including patient age, comorbidities, ethnicity, education, and availability of immediate or delayed reconstruction options. Our study analysed 276 patients diagnosed with breast cancer in the “Colțea” Clinical Hospital between 2014 and 2015. Mean patients age was 61.24, median 62, with a range of 31 to 89 years. Younger age was associated with a less advanced local disease and younger patients were more likely to choose and benefit from conservative surgery. Most patients (61.76%) came from rural areas. Place of origin had a ...


Cesarean Scar Defects And Placental Abnormalities – A 3 Year Survey Study, Denisa Oana Bălălău, Nicolae Bacalbașa, Anca D. Stănescu 2017 Carol Davila University, Bucur Maternity Hospital, Department of Obstetrics & Gynecology, Bucharest, Romania

Cesarean Scar Defects And Placental Abnormalities – A 3 Year Survey Study, Denisa Oana Bălălău, Nicolae Bacalbașa, Anca D. Stănescu

Journal of Mind and Medical Sciences

The placenta is an essential organ for embryonic and fetal development, ensuring nutrient uptake, gas exchange (via the mother's blood supply), waste elimination, thermo-regulation, immunological and hormonal factors, etc. The most common placental abnormalities are represented by placenta previa, and a morbidly adherent placenta (in the form of accreta, increta, and percreta placenta). This study was performed on a sample of 99 patients diagnosed with abnormalities of placentation who underwent cesarian delivery during a period of 3 years in Bucur Maternity Hospital. Seven patients were diagnosed with morbidly adherent placenta (5 accreta and 2 percreta subtypes), the others having ...


Management Of Vaginal Wall Perforation During A Second Trimester Dilation And Evacuation, Heather R. Williams, Abbey J. Hardy-Fairbanks, Colleen K. Stockdale, Stephanie Radke 2017 University of Iowa Carver College of Medicine, Iowa City, Iowa

Management Of Vaginal Wall Perforation During A Second Trimester Dilation And Evacuation, Heather R. Williams, Abbey J. Hardy-Fairbanks, Colleen K. Stockdale, Stephanie Radke

Proceedings in Obstetrics and Gynecology

Background: We report an unusual case involving vaginal perforation associated with second trimester dilation and evacuation. Review of the literature fails to identify additional reports.

Case: A 22 year G3P1011 female at 16 weeks gestation referred for evaluation following incomplete dilation and evacuation was found to have vaginal perforation, and communication with the peritoneal cavity on pelvic examination. Examination under anesthesia and laparoscopy confirmed multiple vaginal perforations with intraperitoneal defects and hematomas but no viscus involvement. Cervical dilation was accomplished with osmotic dilators placed under ultrasound guidance during exam under anesthesia, with evacuation completed approximately 16 hours later without further ...


A Rare Case Of Posterior Uterine Rupture With Neonatal Survival During Trial Of Vaginal Birth After Cesarean Section, Ahmed M. Abbas, Armia Michael, Mohamed Nagy 2017 Department of Obstetrics and Gynecology, Faculty of Medicine; Assiut University, Assiut, Egypt

A Rare Case Of Posterior Uterine Rupture With Neonatal Survival During Trial Of Vaginal Birth After Cesarean Section, Ahmed M. Abbas, Armia Michael, Mohamed Nagy

Proceedings in Obstetrics and Gynecology

Posterior wall uterine rupture is a rare complication. Trial of vaginal birth after cesarean section (CS) is a predisposing factor especially when associated with augmentation of labor. Here we report a case of intrapartum uterine rupture during the second stage of labor in a multiparous woman trying vaginal birth after previous CS. Emergency laparotomy was done and the baby was saved. Repair of the site of the rupture in layers with complete hemostasis was achieved.


A Rare Case Of Giant Dermoid Cyst With Ipsilateral Paratubal Cystadenoma During Pregnancy, Ahmed M. Abbas, Yasser Khamis, Armia Michael, Abdelrahman M. Abdelkader 2017 Department of Obstetrics and Gynecology, Faculty of Medicine; Assiut University, Assiut, Egypt

A Rare Case Of Giant Dermoid Cyst With Ipsilateral Paratubal Cystadenoma During Pregnancy, Ahmed M. Abbas, Yasser Khamis, Armia Michael, Abdelrahman M. Abdelkader

Proceedings in Obstetrics and Gynecology

Dermoid cysts are considered the most common ovarian cysts in adolescents and pregnant women. In rare cases, they can attain a huge size. Paratubal cysts are also common in adolescents. They are usually simple cysts present in the broad ligament. In this case, we report a giant dermoid cyst with ipsilateral paratubal serous cystadenoma discovered during pregnancy of a 20-year-old primigravida. Both cysts were managed conservatively, and then removed successfully at the time of cesarean section by cystectomy.


Uncommon Case Of Hydrosalpinx-Induced Adnexal Torsion In A Postmenopausal Woman, Ahmed M. Abbas, Shymaa S. Ali, Armia Michael, Ahmed A. Mohamed 2017 Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt

Uncommon Case Of Hydrosalpinx-Induced Adnexal Torsion In A Postmenopausal Woman, Ahmed M. Abbas, Shymaa S. Ali, Armia Michael, Ahmed A. Mohamed

Proceedings in Obstetrics and Gynecology

Adnexal torsion is a twisting of the adnexa, including the ovary and/or the fallopian tube, around its own vascular axis. Most cases of adnexal torsion occur in women of reproductive age and only rarely in postmenopausal women. Here, we report a case of 58-year-old woman, postmenopausal for 6 years, who presented with acute lower abdominal pain. Ultrasound scan showed a right-sided, well-circumscribed, cystic mass measuring 50x57 mm with low level echoes. Doppler evaluation revealed no blood flow signals inside the mass. Abdominal exploration revealed right adnexal torsion. Salpingo-oophorectomy was done and histopathological examination revealed a twisted, gangrenous hydrosalpinx with ...


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