Medicine and Health Sciences Commons^™

The Role Of Misoprostol In The Reduction Of Maternal Deaths In Low Resource Settings: A Systematic Review With Recommendations For Action, Melissa Anne Mcmillian

Master of Public Health Program Student Publications

Objective: The purpose of this systematic review is to determine the role misoprostol currently plays in the reduction of maternal deaths and implications for the future reduction of maternal deaths in low resource settings.

Methods: A comprehensive review of the literature was performed using the following databases: The Cochrane Database, Ebsco, MEDLINE, PubMed, and Electronic Journal Center (EJC). Articles were excluded based upon date published, overt data changes since publication, and setting of misoprostol interventions in tertiary or referral centers that have access to oxytocin. A total of 61 articles were included from 2002-2012 and demonstrated several methodologies and study …

Coccygeal Fracture Pain Cured By Sacral Neuromodulation: A Case Report, Erica R. Hope, Daniel Gruber

Obstetrics and Gynecology Faculty Publications

No abstract provided.

Antiseptics And Disinfectants For The Treatment Of Bacterial Vaginosis: A Systematic Review, Hans Verstraelen Verstraelen, Rita Verhelst, Kristien Roelens, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: The study objective was to assess the available data on efficacy and tolerability of antiseptics and disinfectants in treating bacterial vaginosis (BV).

Methods: A systematic search was conducted by consulting PubMed (1966-2010), CINAHL (1982-2010), IPA (1970-2010), and the Cochrane CENTRAL databases. Clinical trials were searched for by the generic names of all antiseptics and disinfectants listed in the Anatomical Therapeutic Chemical (ATC) Classification System under the code D08A. Clinical trials were considered eligible if the efficacy of antiseptics and disinfectants in the treatment of BV was assessed in comparison to placebo or standard antibiotic treatment with metronidazole or clindamycin …

Limiting The Caesarean Section Rate In Low Risk Pregnancies Is Key To Lowering The Trend Of Increased Abdominal Deliveries: An Observational Study, Ilse Delbaere, Hendrik Cammu, Evelyne Martens, Inge Tency, Guy Martens, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: As the rate of Caesarean sections (CS) continues to rise in Western countries, it is important to analyze the reasons for this trend and to unravel the underlying motives to perform CS. This research aims to assess the incidence and trend of CS in a population-based birth register in order to identify patient groups with an increasing risk for CS.

Methods: Data from the Flemish birth register ‘Study Centre for Perinatal Epidemiology’ (SPE) were used for this historic control comparison. Caesarean sections (CS) from the year 2000 (N = 10540) were compared with those from the year 2008 (N …

Transforming Growth Factor Alpha (Tgfα) Regulates Granulosa Cell Tumor (Gct) Cell Proliferation And Migration Through Activation Of Multiple Pathways., Cheng Wang, Xiangmin Lv, Chao Jiang, Crystal M. Cordes, Lan Fu, Subodh M. Lele, John S. Davis

Journal Articles: Obstetrics & Gynecology

Granulosa cell tumors (GCTs) are the most common ovarian estrogen producing tumors, leading to symptoms of excessive estrogen such as endometrial hyperplasia and endometrial adenocarcinoma. These tumors have malignant potential and often recur. The etiology of GCT is unknown. TGFα is a potent mitogen for many different cells. However, its function in GCT initiation, progression and metastasis has not been determined. The present study aims to determine whether TGFα plays a role in the growth of GCT cells. KGN cells, which are derived from an invasive GCT and have many features of normal granulosa cells, were used as the cellular …

Maternal Tetanus Toxoid Vaccination And Neonatal Mortality In Rural North India, A. Singh, S. Pallikadavath, R. Ogollah, W. Stones

Obstetrics and Gynaecology, East Africa

Objectives: Preventable neonatal mortality due to tetanus infection remains common. We aimed to examine antenatal vaccination impact in a context of continuing high neonatal mortality in rural northern India.

Methods and Findings: Using the third round of the Indian National Family Health Survey (NFHS) 2005-06, mortality of most recent singleton births was analysed in discrete-time logistic model with maternal tetanus vaccination, together with antenatal care utilisation and supplementation with iron and folic acid. 59% of mothers reported receiving antenatal care, 48% reported receiving iron and folic acid supplementation and 68% reported receiving two or more doses of tetanus toxoid (TT) …

Association Of Intimate Partner Violence And Childhood Sexual Abuse With Cancer-Related Well-Being In Women, Ann L. Coker, Diane R. Follingstad, Lisandra S. Garcia, Corrine M. Williams, Timothy N. Crawford, Heather M. Bush

Obstetrics and Gynecology Faculty Publications

BACKGROUND: Limited evidence suggests that intimate partner violence (IPV) may be associated with poorer cancer outcomes. We hypothesized that timing and type of IPV as well as childhood sexual abuse (CSA) may negatively affect depression, perceived stress, and cancer-related well-being.

METHODS: This was a cross-sectional study of women diagnosed with either breast, cervical, or colorectal cancer in the prior 12 months included in the Kentucky Cancer Registry. Consenting women were interviewed by phone (n=553). Multivariate analysis of covariance (MANCOVA) was used to determine the association between IPV (37% lifetime prevalence) and type, timing, and the range of correlated cancer-related well-being …

Prevention Of Postpartum Depression Related To Mode Of Birth Delivery, Ashley Palumbo, Andrea Vanmeter

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

Postpartum depression (PPD) is moderate to severe depression in women after birth. It may occur up to one year after birth, most often in first three months, and affects 10-20% of mothers. Our purpose for reviewing the literature is to identify a potential link between PPD and mode of delivery and to inform the postpartum woman of any increased risk she may have to the development of postpartum depression.

Non-Pharmacological Pain Management Techniques In Neonates, Emily Hudson, Ricky Voetberg, Stephanie Swanson

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

Research based evidence supports non-pharmacological techniques for pain management in neonates. Hospitalized neonates undergo multiple painful procedures, and poorly treated pain leads to negative effects in neonates. Pharmacological techniques have many adverse effects. The benefits of non-pharmacological techniques include fewer adverse effects, ease of implementation, and less cost. The purpose of this study is to determine the most effective non-pharmacological technique for reducing procedural pain in neonates.

A Review Comparing The Most Beneficial Regimens Of Cleansing An Umbilical Cord Before Detachment, Caitlyn Seegers, Mary Burkholder, Ellen Moore

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

This review was conducted because an umbilical cord infection is one of the leading causes of death in neonates. “Newborn cord care practices may directly contribute to infections, which account for a large proportion of the four million annual global neonatal deaths (Alam).” Previous studies have shown that there are multiple ways to care for an umbilical cord stub before detachment. Chemical and natural regimens have been proven to be significant in decreasing omphalitis in neonates. One of the most susceptible areas to bacterial colonization for a neonate is the umbilicus. The purpose of this study is to determine the …

Kangaroo Mother Care For Premature And Low Birthweight Infants, Emma Rahn, Bethany Hotchkiss

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

Due to an overwhelming number of babies born prematurely each year, new Interventions are being Introduced and studied. Kangaroo Mother Care (KMC), the prolonged skin-to-skin contact between mother/father and the infant, has been studied and has been shown to be a more beneficial alternative to care for both the infant and the parents. The purpose of this paper Is to compare the holistic outcome of KMC to that of conventional care (incubators and radiators). The research team consisted of two Cedarville nursing students, Emma Rahn and Bethany Hotchkiss. For our paper, the Iowa model was used to guide our research. …

Improved Quality Of Management Of Eclampsia Patients Through Criteria Based Audit At Muhimbili National Hospital, Dar Es Salaam, Tanzania. Bridging The Quality Gap, Hussein Kidanto, Peter Wangwe, Charles D. Kilewo, Lennarth Nystrom, Gunnila Lindmark

Faculty of Health Sciences, East Africa

Background Criteria-based audits (CBA) have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the use of a CBA to improve quality of care among eclampsia patients admitted at a University teaching hospital in Dar es Salaam Tanzania.

Objective The prevalence of eclampsia in MNH is high (≈6%) with the majority of cases arriving after start of convulsions. In 2004–2005 the case-fatality rate in eclampsia was 5.1% of all pregnant women admitted for delivery (MNH obstetric data base). A criteria-based audit (CBA) was used to evaluate the …

Review Of Pain Control Methods After An Episiotomy, Abigail L. Tomlinson, Sarah J. Firmin

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

In 2007, 443,000 episiotomies were performed. Because this procedure is used often, pain management after episiotomy is a priority for many women. Mothers may be reluctant to use pharmacological treatment due to the potential negative side effects to both mother and baby. Because of this concern, a number of researchers have investigated alternative methods of managing pain, particularly after episiotomies are performed. The purpose of this review is to determine the best evidence-based practice for controlling pain related to an episiotomy.

A Literature Review Of Outcomes Related To Delayed And Spontaneous Pushing In Women During The Second Stage Of Labor, Lydia Douglas, Katherine Drake, Sarah Schmidt

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

There are 267 births each minute throughout the world, employing one of two different pushing methods: delayed and spontaneous (withhold pushing after full dilation until irresistible urge); and immediate (push as soon as completely dilated). There are inconsistencies and gaps in research regarding the two methods of pushing in terms of maternal and fetal outcomes.

Methods Of Screening To Detect Postpartum Depression, Anna Elliot, Shelby Young

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

Postpartum depression is a mood altering condition that affects 10-20% of women after childbirth. Symptoms include an inability to perform activities of daily living, feelings of inadequacy/worthlessness, a discouraged outlook on life, altered sleeping pattern, overall worried feelings, and exhaustion. Screening is better than normal routine care in detecting postpartum depression, but only a small percentage of women are receiving screening. The focus of this study is to find the better evidence-based screening practice for nurses to detect postpartum depression: the Edinburgh Postnatal Depression Scale (EPDS) or the Postpartum Depression Screening Scale (PDSS).

Skin-To-Skin Care Related To Thermoregulation, Becky Wunderlich, Hannah Elwell

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

Skin-to-skin contact can reduce neonatal mortality or morbidity by 18-42%. After birth temperature regulation is essential in newborn babies. Skin-to-skin benefits include: regulating heart rate, temperature, and respirations; greater weight gain. The purpose of this study is to determine if skin-to-skin care is more efficient in stabilizing the temperature of a full-term infant than using a radiant warmer. If so, why are radiant warmers still used on health full-term infants if skin-to-skin has more benefits?

Neonate Abstinence Syndrome And Therapeutic Interventions, Erica Danner

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

The impact of drug use by mothers to fetus’ in utero is critical not only to their growth and development but also has huge implications for sudden withdrawal at birth. Medication is used for neonates along with many other therapeutic techniques. With drug use for pregnant mothers rising, the incidence for NAS is significant. Hospitals are faced with lengthy hospital stays for neonates as well as providing environments appropriate for these newborns. Neonatal Abstinence Syndrome has risen in opioid dependency alone from 26.4% in 2000 to 41.7% in 2008. As national drug use is increasing, Neonatal Abstinence Syndrome (NAS) congruently …

Pulse Oximetry Testing For Screening For Congenital Heart Defects In Newborns: A Literature Review Of The Effectiveness And Accuracy, Amanda Custer, Bethany Teixeira

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

Pulse oximetry detects the level of oxygen in the blood. A deficiency of oxygen can indicate the presence of CHD. Congenital Heart Defects (CHD) are the number one birth defect in newborns • CHD contributes to 3% of infant mortality and 46% of deaths from congenital malformations in the first year of life

Early Vs. Delayed Umbilical Cord Clamping, Jerilyn Cox, Kristen Givens, Katie Grayton

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

Nearly 4 million infants are born annually in the United States. Events during birth can have life-long implications. Early cord clamping is associated with a decreased risk of jaundice, whereas delayed cord clamping is associated with a decreased risk of anemia. Parents deserve knowledge and autonomy concerning care of their infants.

Breastfeeding Among Infants With Neonatal Abstinence Syndrome And Mothers Addicted To Narcotics, Landon Bundenthal

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

50,000 infants born in the U.S yearly receive medical treatment for maternal drug use while pregnant. Breastfeeding is associated with decreased maternal use of drugs or alcohol. Breast milk lessens side effects of drug withdrawal for infant. Breastfeeding is associated with decreased cases of necrotizing enter colitis and a significant decrease in hospitalization time. Drug dependent mothers have very low rate of breastfeeding. The purpose of this study is to determine if mothers who are using opioids or methadone should be encouraged to breastfeed.

Umbilical Cord Care: Cord Detachment And Prevention Of Infection, Tania Lacombe, Mary Miller, Grace Ziegler

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

There are nearly 4 million neonatal deaths worldwide each year, with one-third of those related to infections. The longer the umbilical cord remains attached, the more likely an infection will develop. Uneducated guardians may utilize improper cleaning techniques, which increases infection rates. Guardians desire to know the best method of care for their neonate.

Preventing Perineal Trauma During Labor, Kaela Johnson, Claire Vanderhart

Pharmacy and Nursing Student Research and Evidence-Based Medicine Poster Session

Around 85% of mothers experience perineal trauma during labor. Effects include pain, discomfort, dyspareunia, increased risk of infection, urinary and fecal incontinence, and weakened pelvic floor muscles. The purpose of this study is to determine the best method of practice to prevent perineal trauma related to vaginal delivery of a fetus.

Association Of Gestational Weight Gain And Pre-Pregnancy Body Mass Index With Adverse Pregnancy Outcome, Shama Munim, Humaira Maheen

Department of Obstetrics & Gynaecology

Objective: To determine the association between gestation weight gain (GWG) and adverse pregnancy outcome in a Pakistani population.
Study Design: Analytical study.
Place and Duration of Study: The Aga Khan University, Karachi, from February 2003 to 2007.
Methodology: This study used secondary data of 4,735 women from a large cohort study on fetal growth. Pre-pregnancy BMI was categorized according to the recommendations from the institute of medicine (IOM, 2009) and gestation weight gain (GWG) was noted. Chi-square test was used to find the association of GWG and pre-pregnancy BMI with low birth weight (LBW), preterm delivery, large for gestational age …

Prevalence And Determinants Of Human Papillomavirus Infection And Cervical Lesions In Hiv-Positive Women In Kenya, H De Vuyst, N R. Mugo, M H. Chung, K P. Mckenzie, E Nyongesa-Malava, V Tenet, J W. Njoroge, S R. Sakr, C Jlm Meijer, P Jf Snijders, Farzana Rana, S Franceschi

Pathology, East Africa

Background: We assessed the association of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) with various characteristics, CD4 count and use of combination antiretroviral therapy (cART) among HIV-positive women.

Methods: Cross-sectional study of 498 HIV-positive women who underwent HPV PCR-based testing, cytology, and systematic cervical biopsy.

Results: In all, 68.7% of women were HPV-positive, 52.6% had high-risk (hr) HPV, and 40.2% multiple type infections. High-risk human papillomavirus-positivity did not vary significantly by age but it was negatively associated with education level. The most frequent types in 113 CIN2/3 were HPV16 (26.5%), HPV35 (19.5%), and HPV58 (12.4%). …

Mongolian Women's Voices: A Case Study On Maternal Healthcare, Pregnancy, And Birth In Ulaanbaatar's Public Hospitals, Amelia Olmsted

Independent Study Project (ISP) Collection

Mongolia is a country undergoing an incredible amount of change. Last year, in 2011, they had the fastest growing economy in the world, with a 17.2% increase in their GDP, according to the World Bank. A mere 22 years ago, Mongolia was a communist country, and today they are a parliamentary democracy. The country has opened itself up to the rest of the world and a free market economy, and experienced a very drastic shift in this direction in the early 1990's. Many Mongolians will tell you that the mindset of Mongolia's citizens has made a drastic shift since communism …

Cabergoline Therapy For Macroprolactinoma During Pregnancy: A Case Report., Hira Shahzad, Aisha Sheikh, Lumaan Sheikh

Department of Medicine

Background: We assessed the safety of Cabergoline therapy during pregnancy in a lady with hyperprolactinemia intolerant to Bromocriptine.

Case presentation: We report the case of a 31 year old lady who presented to us with uncontrolled hyperprolactinemia. A pituitary Macroadenoma was demonstrated by MRI. Due to intolerance to Bromocriptine, Cabergoline was started. The patient improved and subsequently conceived. MRI in the second trimester demonstrated further reduction in the tumor size. It was decided to continue Cabergoline throughout pregnancy to ensure further reduction in tumor size until delivery and to hold Cabergoline during postpartum period to allow for an adequate interval …

Antenatal Care And The Occurrence Of Low Birth Weight Delivery Among Women In Remote Mountainous Region Of Chitral, Pakistan, Z. Ahmed, S. Khoja, Suha S. Tirmizi

Obstetrics and Gynaecology, East Africa

Objective: Low birth weight (LBW) is closely associated with perinatal morbidity and bears an increased risk for subsequent infant morbidity. The study aimed to assess low birth weight delivery factors among women in Chitral, Pakistan.

Methodology: Mixed Methodology was adopted. Structured data collection tool was used to collect information from medical records of 1316 mothers, followed by interviews and focus group discussions to understand the causes and their remedies. The main outcome measure was infants born with low birth weight LBW (<2.5kg).

Result: There was a significant association between the occurrence of low birth weight and maternal education, paternal education, …

Living With Uncertainty: Acting In The Best Interests Of Women, Erica Gollub, Zena Stein

HWCOM Faculty Publications

A recent multi-country study on hormonal contraceptives (HC) and HIV acquisition and transmission among African HIV-serodiscordant couples reported a statistically significant doubling of risk for HIV acquisition among women as well as transmission from women to men for injectable contraceptives. Together with a prior cohort study on African women seeking health services, these data are the strongest yet to appear on the HC-HIV risk. This paper will briefly review the Heffron study strengths and relevant biological and epidemiologic evidence; address the futility of further trials; and propose instead an alternative framework for next steps. The weight of the evidence calls …

Epidemiologic Features Of Vulvovaginal Candidiasis Among Reproductive-Age Women In India, Sujit D. Rathod, Jeffrey D. Klausner, Karl Krupp, Arthur R. Rhinegold, Purnima Madhivanan

HWCOM Faculty Publications

Background. Vulvovaginal candidiasis is characterized by curd-like vaginal discharge and itching, and is associated with considerable health and economic costs. Materials and Methods. We examined the incidence, prevalence, and risk factors for vulvovaginal candidiasis among a cohort of 898 women in south India. Participants completed three study visits over six months, comprised of a structured interview and a pelvic examination. Results. The positive predictive values for diagnosis of vulvovaginal candidiasis using individual signs or symptoms were low (<19%). We did not find strong evidence for associations between sociodemographic characteristics and the prevalence of vulvovaginal candidiasis. Women clinically diagnosed with bacterial vaginosis had a higher prevalence of vulvovaginal candidiasis (Prevalence 12%, 95% CI 8.2, 15.8) compared to women assessed to be negative for bacterial vaginosis (Prevalence 6.5%, 95% 5.3, 7.6); however, differences in the prevalence of vulvovaginal candidiasis were not observed by the presence or absence of laboratory-confirmed bacterial vaginosis. Conclusions. For correct diagnosis of vulvovaginal candidiasis, laboratory confirmation of infection with Candida is necessary as well as assessment of whether the discharge has been caused by bacterial vaginosis. Studies are needed of women infected with Candida yeast species to determine the risk factors for yeast’s overgrowth.

Intraabdominal Cysts Turn Out To Be Distended Large Bowel - An Electively Terminated Fetus With Isolated Imperforate Anus, Yu Shi, Maria Giraldo-Isaza, John Farber

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

Patient:

Clinical History: A 19-week male fetus of a 36-year old G7P4 mother was found by ultrasound to have intrabdominal "cysts" and oligo-anhydramnios. At 15 weeks of pregnancy, by ultrasound examination, two intraabdominal cysts measuring 1.1x0.7x0.4 cm and 1.4x1.0x1.0 cm were noted. At 19 week gestation, the ultrasound was performed again showing anhydromaio, ascites, a normal appearing bladder, and multiple cystic structures in the abdomen most likely consistent with dilation of bowel (Figure 1A, B). The mother was consulted and opted to proceed with KCL injection and induction of labor. The nonviable fetus was delivered at 19 5/7 week gestation. …