Medicine and Health Sciences Commons^™

A Needs Assessment Of Screening Of Non-Communicable Diseases In Prenatal Care At Chuk And Muhima District Hospital, Vaishali Mehta, Ilana Porges, Kaitlin Demarest, Alex Rugamba, Kelly Kaneza, Magnifique Irakoze, Md

Phase 1

Introduction: There has been a recent trend of women experiencing delays in management for high-risk pregnancies in Kigali, Rwanda. Physicians at the University Teaching Hospital of Kigali (CHUK) have observed a high incidence of women receiving obstetric care that were not screened appropriately. This points to an inconsistent screening method for non-communicable diseases (NCDs) prior to delivery and lack of streamlined care. The objective of this study is to assess the need for more robust screening of maternal NCDs.

Methods: This study, between June 2018-19, is a needs-assessment for the screening of NCDs among pregnant women (n=255) at CHUK. It …

Evaluating The Utility Of Diagnostic Workups For Biliary Atresia In Neonates With Cholestatic Jaundice Following Prolonged Tpn, Melissa Austin, Zubair H. Aghai

Phase 1

Introduction: Parenteral nutrition associated cholestasis (PNAC) develops in 40-60% of premature infants following TPN for 2-4+ weeks. The incidence of biliary atresia is low and there is a 60-day, post-term window for corrective surgery. There is limited data on both the natural history of PNAC in premature infants following prolonged TPN, as well as the utility of diagnostic tools investigating biliary atresia in these patients.

Methods: A retrospective chart review using EMR data from the Intensive Care Nursey was performed with the following criteria: premature babies diagnosed with cholestasis, born at <1500 grams, and received TPN for 14 days. Ultimately 61 babies met criteria and data was collected and pooled to produce descriptive statistics and graphs describing laboratory trends.

Results: Median gestational age was 26 [IQR 25, …

Prediction Of Neonatal Birthweight Associated With Maternal Obesity And Diabetes, Laura Gleason, Rebekah Mccurdy, Md, Mph

Phase 1

Introduction: To design a model that will predict neonatal birth weight within obese mothers by diabetic status.

Methods: A secondary data analysis of an RCT (NCT 02909582) was utilized to create a neonatal birth weight prediction model. Women (n=325) with a BMI > 35 kg/m2 from a tertiary academic institution, 2016 – 2019, were included to estimate the risk of large for gestational age (LGA) infants and neonatal birth weight based on maternal prepregnancy BMI and diabetic status. LGA was defined as an infant birth weight > 90th percentile. Analysis included Chi-square, t-test, multivariate logistic and linear regression.

Results: Mean birthweight did …

Down Regulation With Luteal Gnrh Agonist Therapy In Euploid Embryo Transfers Does Not Impact Pregnancy Rates, Isabelle Levin, Keri Bergin, Md, Dmitry Gounko, Joseph Lee, Alan Copperman, Md

Phase 1

Introduction : Gonadotropin-releasing hormone (GnRH) agonists have been used during assisted reproductive technology (ART) treatment for pituitary suppression and stimulation. Currently, clinical opinion is divided about whether GnRH agonist therapy improves pregnancy rates when used for luteal down-regulation in a frozen euploid embryo transfer (FET). This study evaluated the clinical utility of GnRH agonist down-regulation in single, euploid FET cycles.

Methods : A retrospective analysis was performed, using data from patients who underwent a single, euploid FET cycle from 2012 to 2019. Patients were segregated into two cohorts: Group A: single, euploid FET with down-regulation using GnRH agonist; Group B: …

A Needs Assessment Of Screening Of Non-Communicable Diseases In Prenatal Care At Chuk And Muhima District Hospital, Ilana Porges, Vaishali Mehta, Kaitlin Demarest, Alex Rugamba, Kelly Kaneza, Magnifique Irakoze, Md

Phase 1

Introduction: Delays in management of high risk pregnancies can result in significant morbidity for women seeking obstetric care. A trend of high incidence of pregnancy complications has been observed among women with non-communicable diseases (NCDs) receiving care at the University Teaching Hospital of Kigali (CHUK), which may suggest the need for more consistent screening of NCDs among pregnant women, and more streamlined care for those identified to be at highest risk for complications.

Methods: This study utilized a mixed method design to assess the need for screening of NCDs among pregnant women (n=255) who received obstetric care at CHUK between …

The Utility Of Performing Cervical Length Follow-Up In Lower Risk Singleton, Varsha Kripalu, Rupsa Boelig, Md

Phase 1

Introduction: Short cervical length (<25 mm) during pregnancy is known to be an increased risk factor for preterm birth (<37 weeks). While interventions exist for women who have had prior preterm births, it is important to investigate the cost effectiveness of screening low risk women with an intermediate cervical length (26-29 mm).

Objective: To quantify the association between change in cervical length on follow up and the incidence of preterm birth in otherwise low risk women with an initial intermediate cervical length.

Methods: A retrospective cohort study was conducted, reviewing 108 charts of women who had an initial screening between 26 and 29 mm. Charts were reviewed for whether or not a follow-up ultrasound was recommended, whether or not the follow-up was performed, and the outcome of their deliveries.

Results: 93.5% (N=101) of women were recommended to get a follow-up ultrasound and 84% (N=85) completed their follow-up. …

The Effect Of Perceived Physician Opinion On Breastfeeding In Women With Opioid Use Disorder Who Are Receiving Medication-Assisted Treatment, Lacey Murray, Meghan Gannon, Phd, Vanessa Short, Phd, Mph

Phase 1

Women who receive medication-assisted treatment (MAT) for opioid use disorder (OUD) are less likely to breastfeed than the general population despite the many possible benefits to the newborn. The ongoing study examines the effect of perceived physician opinion on the outcome of breastfeeding in women receiving MAT for OUD. Women who were receiving MAT for OUD at Thomas Jefferson University’s Family Center were given a survey during their third trimester (n=45), and at 1 month postpartum (n=33) to gather information on the perceived opinion of their physicians on how they should feed their baby and the importance of those opinions. …

Does Maternal Methadone Dose Correlate With Severity Of Intrauterine Growth Restriction In Infants With Neonatal Abstinence Syndrome?, D. Friedman, J. Smith, M. Lafferty, Z. H. Aghai

Phase 1

Introduction : Previous studies demonstrate a relationship between maternal opioid use during pregnancy and smaller head circumference of infants with neonatal abstinence syndrome (NAS). The goal of this study is to correlate maternal methadone dose and severity of growth restriction in infants with NAS admitted to the neonatal intensive care unit (NICU).

Methods: This is a retrospective analysis of infants (≥35 weeks gestation) exposed to in utero methadone, born between August 2006 and May 2018, and admitted to a Philadelphia NICU for medical therapy for NAS. Growth parameters (birth weight, birth length, and birth head circumference) were compared between infants …

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 …

17-Hydroxyprogesterone Caproate Does Not Prevent Preterm Birth In Women With A Twin Pregnancy And A Prior Singleton Spontaneous Preterm Birth, Breanna Valcarcel, Bs, Andrew Ward, Md, Huda Al-Kouatly, Md, Vincenzo Berghella, Md, Victoria Greenberg, Md

Phase 1

INTRODUCTION: Prior spontaneous preterm birth (sPTB) is a risk factor for recurrent sPTB. Weekly 17-hydroxyprogesterone caproate (17P) is used to prevent sPTB in singletons, but there is insufficient evidence on its benefit in twin pregnancies.

OBJECTIVE: We hypothesized that 17P weekly injections would reduce the likelihood of sPTB in women carrying a twin pregnancy with a history of singleton sPTB.

METHODS: We performed a retrospective case control study of women with a twin gestation and prior singleton sPTB between 2005 and 2016. The study group consisted of women with a twin gestation that received weekly 17P starting at 16 to …

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 …

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. …

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 …