Medicine and Health Sciences Commons^™

Anticipation, Accompaniment, And A Good Death In Perinatal Care., Bryanna S. Moore, Brian S. Carter, Bryan Beaven, Katie House, Joel House

Manuscripts, Articles, Book Chapters and Other Papers

The ethics of perinatal care, and the experiences of families who receive such care, remains a nascent area of inquiry. It can be hard to see how existing "good death" constructs apply to the experiences of fetal patients and their families. In this paper, we explore two themes raised by a case at our fetal health center: anticipation and accompaniment. In this case, a mother presented to our fetal health center; her unborn son, our fetal patient, was diagnosed with life-threatening hypoplastic left heart syndrome and endocardial fibroelastosis. The parents were told that their son's life expectancy, upon birth, was …

Safety Of Endoscopic Retrograde Cholangiopancreatography (Ercp) In Pregnancy: A Systematic Review And Meta-Analysis, Mohamed Azab, Shishira Bharadwaj, Mahendran Jayaraj, Annie S. Hong, Pejman Solaimani, Mohamad Mubder, Hyeyoung Yeom, Ji Won Yoo, Michael L. Volk

School of Medicine Faculty Publications

Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is a technically challenging procedure rarely associated with severe postprocedure complications. Hormonal changes during pregnancy promote cholelithiasis, but there are limited clinical data available on the outcomes of ERCP in pregnant women. ERCP techniques without irradiation were recently introduced as potential alternative. We performed a systematic review and meta-analysis to assess the safety of ERCP in pregnancy and to compare outcomes of radiation versus nonradiation ERCP. Materials and Methods: A systematic search of PubMed, Medline/Ovid, Web of Science, and Google Scholar through April 18th, 2018 using PRISMA and MOOSE guidelines identified 27 studies reporting the …

Las Dos Cosas Versus Exclusive Breastfeeding: A Culturally And Linguistically Exploratory Intervention Study In Hispanic Mothers Living In Kentucky, Ana Maria Linares, Diana Cartagena, Mary Kay Rayens

Nursing Faculty Publications

INTRODUCTION: Formula supplementation among infants of breastfeeding Hispanic immigrants is common practice known as las dos cosas. The purpose of this study was to assess the feasibility, effectiveness, and acceptability of a culturally and linguistically diverse intervention to promote exclusive breastfeeding (EBF) for the first 6 months.

METHODS: A sample of 39 Hispanic pregnant women was recruited and randomly assigned to intervention (n = 20) and control groups (n = 19). The intervention included a peer counselor and professional support, and mothers were followed from pregnancy to 6 months after birth.

RESULTS: After the study, women assigned to …

Addressing Postpartum Smoking Relapse Among Low-Income Women: A Randomized Control Trial, Kristine Alaniz, Bruce Christiansen, Tingting Sullivan, Lisette Khalil, Michael C. Fiore

Journal of Patient-Centered Research and Reviews

Purpose: Smoking during pregnancy can have dire consequences for both the baby and mother. Low-income pregnant women smoke at particularly high rates. Among women who quit during pregnancy, postpartum relapse is high. This randomized control trial tested the effect of adding postpartum assistance to an existing smoking cessation program (First Breath) designed for low-income women.

Methods: Of 185 study participants, 94 women were randomly assigned to the standard First Breath program (control) and 91 to an enhanced program. First Breath consisted of evidence-based smoking cessation counseling provided at every prenatal visit. The enhanced program included all First Breath services plus …

Routine Late Trimester Ultrasound For The Detection Ofsmall-For-Gestational-Age And Growth-Restricted Fetus Inlow-Risk Pregnancy: A Randomised Controlled Trial, Sikolia Wanyonyi, Doreen Osoro, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objectives: To compare the proportion of small-for-gestational-age and fetal growth-restricted fetuses detected in women offered a routine growth ultrasound to those either offered selective or no ultrasound in the third trimester.

Methods: An open-label randomised control trial was conducted at the Aga Khan University Hospital, Nairobi. Eligible women were randomised into either the intervention or control group. Women in the intervention arm had a mandatory third trimester ultrasound for fetal growth performed between 36 weeks 0 days to 37 weeks 6 days. Those in the control group had a selective growth scan done if the clinician suspected abnormal fetal growth. …

Cervical Assessment By Ultrasound For Preventing Preterm Delivery., Vincenzo Berghella, Gabriele Saccone

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: Measurement of cervical length by ultrasound is predictive of preterm birth (PTB). There are three methods of ultrasound cervical assessment: transvaginal (TVU), transabdominal (TAU), and transperineal (TPU, also called translabial). Cervical length measured by TVU is a relatively new screening test, and has been associated with better prediction of PTB than previously available tests. It is unclear if cervical length measured by ultrasound is effective for preventing PTB. This is an update of a review last published in 2013.

OBJECTIVES: To assess the effectiveness of antenatal management based on transvaginal, transabdominal, and transperineal (also called translabial) ultrasound screening of …

Fetal Fibronectin Testing For Reducing The Risk Of Preterm Birth., Vincenzo Berghella, Gabriele Saccone

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: Fetal fibronectin (FFN) is an extracellular matrix glycoprotein localized at the maternal-fetal interface of the amniotic membranes, between chorion and decidua, where it is concentrated in this area between decidua and trophoblast. In normal conditions, FFN is found at very low levels in cervicovaginal secretions. Levels greater than or equal to 50 ng/mL at or after 22 weeks have been associated with an increased risk of spontaneous preterm birth. In fact, FFN is one of the best predictors of preterm birth in all populations studied so far, and can help in selecting which women are at significant risk for …

Understanding Maternity Care Coordination For Women Veterans Using An Integrated Care Model Approach, Kristin M. Mattocks, Aimee Kroll-Desrosiers, Rebecca L. Kinney, Sara Singer

Kristin M. Mattocks

BACKGROUND: An increasing number of women veterans are using VA maternity benefits for their pregnancies. However, because the VA does not offer obstetrical care, women must seek maternity care from non-VA providers. The growing number of women using non-VA care has increased the importance of understanding how this care is integrated with ongoing VA medical and mental health services and how perceptions of care integration impact healthcare utilization. Therefore, we sought to understand these relationships among a sample of postpartum veterans utilizing VA maternity benefits.

METHODS: We fielded a modified version of the Patient Perceptions of Integrated Care survey among …

Effect Of Pregnancy On Growth Of Intracranial Meningiomas, Ayesha Quddusi, Muhammad Shahzad Shamim, Quratulain Virani

Section of Neurosurgery

Meningiomas are the most common benign primary intracranial tumours in adults. Their rapid growth during pregnancy has been well reported. Moreover, the relationship of increased progesterone expression during pregnancy and extensive tumour growth has been debated. In this review, we discuss not only the effect of progesterone on meningiomal growth but also other mechanisms involved in gestational meningiomas.

Placental Micrornas In Pregnancies With Early Onset Intrauterine Growth Restriction And Preeclampsia: Potential Impact On Gene Expression And Pathophysiology., Zain Awamleh, Gregory B Gloor, Victor K M Han

Paediatrics Publications

BACKGROUND:
A normally developed placenta is integral to a successful pregnancy. Preeclampsia (PE) and intrauterine growth restriction (IUGR) are two common pregnancy related complications that maybe a result of abnormal placental development. Placental microRNAs (miRNAs) have been investigated as potential biomarkers for these complications, as they may play a role in placental development and pathophysiology by influencing gene expression. The purpose of this study is to utilize next-generation sequencing to determine miRNA and gene expression in human placental (chorionic villous) samples from three distinct patient groups with early-onset (EO) PE, IUGR, or PE + IUGR.

METHODS:
Placental tissues were collected …

Chemotherapy Is Avoided During The First Trimester Of Pregnancy, When Is The Safest Time To Start Treatment During The Second Or Third Trimester?, Elyce Cardonick, Emily Eicheldinger, John P. Gaughan

Cooper Medical School of Rowan University Faculty Scholarship

ABSTRACT

Background

Cancer occurs in approximately 1:1000 pregnancies. When chemotherapy cannot be delayed until postpartum, beginning chemotherapy is based on presumed safety after organogenesis is completed during the first trimester. The safest gestational age to start chemotherapy after the first trimester is unknown.

Patients and Methods

In an observational cohort of pregnant women diagnosed and treated for cancer at multiple centers, pregnancy outcomes for the mother, and clinical outcomes for the neonate were analyzed according to the gestational age in weeks of pregnancy at first chemotherapy cycle. Outcomes including birth weight, fetal growth restriction, congenital malformations, and perinatal complications for …

Maternal Morbidity Outcomes In Idiopathic Moyamoya Syndrome In New York State, Hajere J. Gatollari Mph, Amelia K. Boehme Ph.D., E. Sander Connolly M.D., Alexander M. Friedman M.D., Mitchell S.V. Elkind M.D., Joshua Z. Willey M.D., Eliza C. Miller M.D.

Rowan-Virtua Research Day

Background: Pregnancy is associated with an increased risk of stroke in young women. Idiopathic moyamoya syndrome (IMMS) is a rare condition characterized by progressive narrowing of large cerebral arteries resulting in flimsy collaterals prone to rupture or thrombosis. Data are limited on pregnancy outcomes in women with IMMS. We hypothesized that IMMS would be associated with increased pregnancy morbidity, including stroke.

Conclusion: Pregnancies within 1 year prior or any time after IMMS diagnosis did not have increased maternal morbidity compared to unexposed pregnancies after adjusting for age and clustering of women with multiple pregnancies. Prospective studies are needed to better …

Associations Of First Trimester Co-Use Of Tobacco And Cannabis With Prenatal Immune Response And Psychosocial Well-Being, Kristin Ashford, Amanda Fallin-Bennett, Andrea Mccubbin, Amanda T. Wiggins, Sheila Barnhart, Joshua A. Lile

Perinatal Research and Wellness Center Faculty Publications

PURPOSE: This study aims to describe the association of first trimester co-use of tobacco and cannabis with maternal immune response and psychosocial well-being, relative to tobacco use only.

METHODS: A preliminary midpoint analysis included 138 pregnant women with biologically verified tobacco use, 38 of whom (28%) also tested positive for recent cannabis use. Maternal perceived stress (Perceived Stress Scale), depressive symptoms (Edinburgh Postnatal Depression Scale), and serum immune markers (IL-1β, IL-2, IL-6, IL-8, IL-10, TNFα, CRP, MMP8), were collected, although cytokine data were only available for 122 women.

RESULTS: Participant average age was 29.1 years, approximately half had a high …

An Analysis Of Major Issues For Culturally-Minded Professionals In Women's Health Care, Victoria Clark

Senior Honors Theses

Women's health care professionals, such as general physicians, obstetricians and gynecologists, midwives, nurses, and doulas, in the US need to be aware of cultural issues and disparities. Minorities and migrant women experience cultural challenges and disparities when receiving health care in the US. Without cultural sensitivity, patient care is compromised. Pregnancy and childbirth practices vary widely by culture, and potential differences in perspectives, beliefs, and treatment of these are critical issues for women’s health care professionals to study. Female genital cutting (FGC), obstetric fistulas (OF), and female cancer are also discussed in this paper.

An Analysis Of Major Issues For Culturally-Minded Professionals In Women's Health Care, Victoria Clark

Victoria Clark

Usefulness Of An Expanded Health Belief Model With Added Constructs (Self-Efficacy And Ecological System Measures) In Modeling Compliance With Healthy Lifestyle Recommendations In Women With A Recent History Of Gestational Diabetes, Phyllis M. Woodson

Health Services Research Dissertations

Problem Statement: Gestational diabetes (GDM) has been reported to affect as many as 18% of all pregnancies in the U.S. This diagnosis is costly and presents health risks to both baby and mother. The main risk to the mother with a history of GDM is her increased risk for diabetes which has been estimated at 35% to 60% in the following 10 to 20 years; more recent studies report a 7 to 8 times occurrence in the following 3 to 6 years. It is recommended that lifestyle efforts of eating healthfully and exercise can reduce this risk

Methods: Subjects (n=153) …

Takotsubo Cardiomyopathy In Pregnancy: A Case Report And Literature Review, Felix Oindi, Evan Sequeira, Herman Ryan Sequeira, Steve Mutiso

Obstetrics and Gynaecology, East Africa

Background: Takotsubo cardiomyopathy is rare in pregnancy and is characterized by left ventricular dysfunction with apical ballooning. This transient cardiac dysfunction may affect women of childbearing age in the antepartum, intrapartum or postpartum period. Most patients respond well to medical management with resolution of cardiac dysfunction within weeks.

Case presentation: A 35-year-old female in her second pregnancy presented with severe preeclampsia at 31 weeks of gestation. She subsequently developed severe substernal chest pain and workup showed a stress induced cardiomyopathy prior to her delivery via caesarean section. She had full recovery of her cardiac function by 12 weeks postpartum after …

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.

Adult-Onset Still’S Disease Triggered By Pregnancy, Saleem Abdulkarim, Fredrick Otieno, Sayed Karar

Internal Medicine, East Africa

Adult-onset Still’s disease (AOSD) is an inflammatory disorder with arthritis, quotidian fever, evanescent rash, elevated white cell count, elevated ferritin, and abnormal liver function tests. The diagnosis requires the exclusion of other inflammatory, infectious, and malignant conditions. Onset of AOSD, though rare, has been known to occur in pregnancy. We present a 28-year-old woman diagnosed with AOSD at 3 months gestation.

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 …

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 …

Advanced Cardiovascular Life Support (Acls) And Obstetrical Critical Care (Ob Cc) Education For High Risk Labor And Delivery Nurses In Caring For Growing Population Of High Risk Patients, Tracey E. Mcmillan

Interprofessional Research and Innovations Council

Advanced Cardiovascular Life Support (ACLS) and Obstetrical Critical Care (OB CC) education for high risk Labor and Delivery nurses in caring for growing population of high risk patients

Tracey E. McMillan RNC, BSN

Clinical Nurse III

Labor and Delivery Unit Coordinator

BACKGROUND: Many studies show that an increasing number of pregnant women in the United States have chronic health conditions such as hypertension, diabetes, and chronic heart disease. The factors that place a pregnancy at risk can be divided into four categories: existing health conditions, age, lifestyle factors and conditions of pregnancy. The recent statistics from the Centers for Disease …

Risk Factors For Gestational Diabetes In Upstate New York Women & Implications For Practice, Margaret Versteegen

Legacy Theses & Dissertations (2009 - 2024)

Gestational diabetes mellitus (GDM) is a form of diabetes, or abnormal blood glucose (sugar) metabolism, diagnosed during pregnancy. Pregnant, non-diabetic women who are initially noted to experience high blood glucose levels during their pregnancy are considered to have GDM (ADA, 2016b). GDM has significant implications for infant and maternal morbidity and mortality, with adverse pregnancy outcomes such as infant macrosomia, difficult birth requiring cesarean section, and postpartum hemorrhage (Kamana, Shakya, & Zhang, 2015). In the majority of cases, GDM goes away once the baby is born, but around 5-10% of women with GDM go on to have type 2 diabetes …