Medicine and Health Sciences Commons^™

One Man's Pregnancy Story, Yvonne S. Marquez, Paige A. Perez

Capstones

Pregnancy is a challenging time for anyone. For LGBTQ people there are unique obstacles that make it especially difficult to navigate a medical system that was not built for them. Finn Schubert is trans and six months pregnant. He’s loving the experience but stressed by insurance claim denials, concerns for his safety, and medical incompetence.

This capstone project includes a 20-minute documentary, text, and a photo essay.

Risk-Factor Induced Changes In The Breast Microenvironment Facilitate Inflammatory Breast Cancer Progression And Lymphovascular Invasion, Wintana Balema, Wintana Balema

Dissertations & Theses (Open Access)

Inflammatory breast cancer (IBC) is a rapidly progressing, rare and highly lethal form of breast cancer. IBC is a clinical diagnosis, requiring >1/3 involvement on the affected breast and/or skin by erythema, and disease onset of < 6 months. The clinical symptoms of IBC vary in severity and presentation, these include redness, warmth, skin thickening and bruised or pink/purple discoloration appearance and skin changes such as peau d’orange. These skin symptoms are not attributed to inflammation, rather IBC is characterized by florid lymphovascular tumor emboli clogging dermal lymphatics. This leads to “classic” symptoms of breast swelling and skin edema or discoloration. To date, unique genomic drivers which differentiate IBC from non-IBC invasive breast cancers have not been identified highlighting a role for the microenvironment. Several epidemiological studies have unveiled subtype-specific risk factors associated with IBC that are known to alter the microenvironment. Obesity is an established risk factor for all subtypes of IBC. Never-breastfeeding increases risk for developing the most aggressive, triple-negative IBC. Further, never breastfeeding is associated with later clinical stage and worse outcomes. We worked to model these overlapping risk factors to understand microenvironment changes that may lead to the lymphatic change’s indicative of IBC.

First, we investigated the association of a “classic” triad of clinical IBC signs with overall survival among patients to demonstrate the most overt clinical findings of lymphatic involvement were impacting prognosis. We evaluated a triad of IBC signs, including swollen involved breast, nipple change, and diffuse skin change, using breast medical photographs from patients enrolled on a prospective IBC registry. We reported that the …

Impact Of The Maternity Care Changes Of The Covid-19 Pandemic On Pregnant Women And Their Birth Partners: An Integrative Literature Review, Rebekah Kemp

Master of Science in Nursing Final Projects

Introduction: In March 2020, the novel coronavirus originating out of Wuhan in China and spreading rapidly worldwide, became known as the COVID-19 pandemic. Patients with pre-existing conditions, such as the elderly and pregnant women, are among those most vulnerable to severe infection due to COVID-19. Increased pulmonary expansion in the respiratory tract make pregnant women more susceptible to viral respiratory infections and exacerbation of illnesses like COVID-19. Another major concern correlated with the pandemic and pregnancy is its effect on pregnant women’s mental health. Unique physiological and psychological changes place pregnant women at an increased risk for experiencing mental health …

Role Of Decorin At The Fetal-Maternal Interface, Chidambra D. Halari

Electronic Thesis and Dissertation Repository

The human placenta is an invasive tumor-like structure, this invasion being physiological. A subset of placental trophoblast called extra-villous trophoblast invades the uterine decidua and remodels uterine arteries into low-resistance, high-flow tubes to permit adequate flow of maternal blood to nourish the fetus. A poor extra-villous trophoblast invasion and uterine arterial remodeling can lead to fetal growth restriction and a serious pregnancy-associated maternal disease preeclampsia. Decorin, a leucine-rich proteoglycan produced by uterine decidual cells restrains multiple trophoblast functions: self-renewal and differentiation of trophoblast stem cells, migration, invasion, proliferation and endovascular differentiation. Additionally, decidual overproduction of decorin was associated with preeclampsia, …

The Eat Sleep Console Approach: An Evaluation Of Impact, Outcomes And Continuation Of Care, Stefanie Disilvio

Doctor of Nursing Practice (DNP) Manuscripts

Neonatal Opioid Withdrawal Syndrome (NOWS), a subgroup of Neonatal Abstinence Syndrome (NAS), is a constellation of postnatal symptoms that occurs due to the abrupt cessation of intrauterine opioid exposure. Historically, these infants have been evaluated and treated by the Finnegan Neonatal Abstinence Scoring Tool (FNAST) (Appendix A). Recent evidence supports the use of the Eat Sleep Console Approach (ESC) (Appendix B) as an alternative to the FNAST. The ESC model focuses on the comfort and care of these infants by maximizing nonpharmacologic methods and increasing family involvement in the treatment of their infant. The purpose of this project was to …

No One Should Have To Give Birth Alone: An Analysis Of The Efficacy Of Community-Based Doula Programs Serving Ethnic Minorities In San Francisco, Maria Margaret Nelson

Master's Projects and Capstones

Adverse birth outcomes for both the parent and the child disproportionately affect people of color. Evidence demonstrates that one of the ways to mitigate these negative consequences is through the utilization of a doula, a trained birth companion that is not a medical provider but whose role it is to physically and emotionally support the patient through pregnancy, birth, and postpartum. Community-based doula programs, where the doula is of the same cultural background as the client, are particularly effective in improving birth outcomes in communities of color by providing culturally competent care and helping to navigate a healthcare system that …

Development Of A Project To Improve Prenatal Education At A Rural Medically Assisted Treatment Center Focused On Neonatal Abstinence Syndrome And Parenting Skills., Tracey Brink

Doctor of Nursing Practice Papers

Abstract

Background: Many women who suffer from substance use disorder syndrome (SUDS) have low self-esteem and can be labeled as “unfit parents” which can impede infant bonding and maternal sobriety. Parent and self-efficacy are associated with improved maternal-infant attachment and sobriety (Adams, et.al. 2021). The earlier prenatal education is implemented, the more empowered the mothers will feel to be able to help their infants and themselves.

Setting: A medically assisted treatment center (MAT) for pregnant women who presents with SUDS. The six-bed inpatient facility is in a rural county in central Kentucky.

Purpose: To create an educational program about parent …

An Assessment Of Pregnant Women's Value And Utilization Of Oral Health Care During Pregnancy, Angelica M. Sanchez

Dental Hygiene ETDs

The intention of this survey was to examine the value and utilization of dental services during pregnancy, to identify the value being placed on oral health and dental services during pregnancy. Also, to assess if the women received oral health education from obstetric providers. Pregnancy temporarily increases the risk of periodontal diseases, the prevalence of periodontal diseases is very high during pregnancy, 60-75% of women can be affected. Previous literature suggests that poor oral health is linked to adverse pregnancy outcomes such as pre-term births, low birth weights, and pre-eclampsia. Data was obtained and collected using REDCap. Utilizing the collected …

Implicit Bias Training For Perinatal Nursing, Racheal Lakine-Harden

Dissertations

Problem: Maternal and fetal morbidity and mortality is a rising health care crisis in the United States. Black women are disproportionately affected. Clinician implicit bias and medical racism have been named as factors in this crisis. Recommendations to address this public health peril include; educating and raising awareness among front-line perinatal nursing staff on implicit bias and its consequences for Black women. The purpose of this project is to evaluate the impact of implicit bias training on nurses’ awareness of implicit bias, attitudes, and beliefs about disparities, and the likelihood to engage in behaviors to reduce or address racial bias …

Implementation Of Quantitative Blood Loss Tool To Detect Postpartum Hemorrhage After Vaginal Delivery, Rachael Williams

Dissertations

Problem Maternal deaths and comorbidities related to postpartum hemorrhage (PPH) continue to be high despite being quite preventable. The delay in recognition and treatment of PPH due to the use of imprecise estimated blood loss (EBL) instead of precise measurement using quantitative blood loss (QBL) attributes to this issue.

Methods For this quality improvement (QI) project, a descriptive, observational design was used to gather quantitative data regarding QBL implementation instead of EBL as well as the number of PPH’s identified. A pilot cohort of staff nurses participated by documenting QBL two hours after each delivery. The nurses were given an …

The Impact Of A Lifestyle Intervention On Risk Factors Of Cardiovascular Disease And Type Ii Diabetes Among At-Risk Hispanic Women, Kathryn A. Wagner

Doctoral Dissertations

Cardiovascular disease and type 2 diabetes are global epidemics affecting approximately 127 and 21 million people in the U.S., respectively. Women who are overweight, obese or who develop glucose intolerance during pregnancy represent high-risk groups for the development of cardiovascular disease and type 2 diabetes. Hispanic women are both more likely to begin their pregnancies as overweight or obese and have a higher prevalence of type 2 diabetes, compared to non-Hispanic whites. However, prior lifestyle interventions have largely been limited to non-Hispanic whites. Therefore, this research assessed how culturally tailored lifestyle modification may affect cardiovascular disease and type 2 diabetes …

Community Health Worker Program - Substance Use Disorder In Pregnancy, Alicia Claire Kletter Dnp

Doctor of Nursing Practice (DNP) Projects

Background Substance use disorder (SUD) in pregnancy is a concern for mother, baby and community. Healthcare policies are increasingly calling for diversification of the workforce to meet healthcare needs. Community health workers (CHWs) are understood from the literature to be effective at bridging the gap between patient and healthcare provider, especially for vulnerable populations. Local Problem California’s Central Valley is majority Latinx and faces challenges from poverty, lack of medical resources, unemployment and SUD at rates which are higher than other communities. Combine SUD with pregnancy and the need for robust social connections, psychological support, and physical healthcare become even …

Pregnancy Education In Rural Areas, Kayla Tinsley

Doctor of Nursing Practice Scholarly Project

Educating of the pregnancy population before, during and after pregnancy can help to ensure a healthy pregnancy and in turn reduce maternal mortality. The purpose of this research project was to understand education provided in the clinic and hospital setting in a rural area by those who take care of and talk to pregnant women and their support persons. A descriptive research design was utilized to discover the important education topics that are discussed, and the routine tests that are done throughout the pregnancy, during labor and at delivery, and even ask how prepared they feel they are equipped to …

Utilizing Community Health Workers To Support Latinx Women With Substance Use Disorder During Pregnancy, Alicia Claire Kletter

DNP Qualifying Manuscripts

Community health workers in the Latinx community, sometimes called promotores de salud, are employed in a variety of medical settings to help increase access to health promoting services such as awareness, education, and screening. Given their deep understanding of the culture and community in which they work, community health workers in Latinx communities are increasingly included in the healthcare team for their cultural sensitivity and versatility with hard- to-reach populations, including the support of pregnant women and children. An integrative review of the literature seeks to understand if community health workers can improve outcomes for pregnant women who also suffer …

The Role Of Mitochondrial Dysfunction In Causing Hypertension During Pregnancy As Observed In The Rupp Model Of Preeclampsia, Michael Franks

Honors Theses

Preeclampsia (PE) is a disease characterized by new-onset hypertension in the third trimester of pregnancy, endothelial dysfunction, and placental ischemia. Contributory to these characteristics are circulating factors such as agonistic autoantibodies to the angiotensin I type II receptor (AT1-AA), CD4+ T cells, natural killer cells (NK), and oxidative stress, which I will show to contribute to renal and placental mitochondrial dysfunction during pregnancy. The adoptive transfer of CD4+ T cells from the Reduced Uterine Perfusion Pressure (RUPP) rat model of PE to a healthy normal pregnant rat has been shown to result in many of these characteristics, including AT1-AA production. …

Benefits Of Exercise In Pregnant Women, Jenna Renee Barretto

Nursing | Senior Theses

Exercise is an important lifestyle habit to include in one's daily routine. Remaining physical activity during pregnancy is important. According to the CDC, pregnant women should, “Get at least 150 minutes of moderate-intensity aerobic activity during pregnancy and the postpartum period.” (Centers for Disease Control and Prevention, 2021). This paper will encompass a range of topics that highlight the benefits of exercise from a physiological as well as a mental health standpoint. Although more research needs to be conducted to solidify the benefits of exercise, the articles that were collected demonstrate how it can help mothers have a healthy pregnancy. …

Moms And Vaccines: A Cross-Sectional Survey Assessing Covid-19 Vaccine Acceptance Among Pregnant People In East Tennessee, Sara Burnette

Chancellor’s Honors Program Projects

No abstract provided.

Comparing An Evidence-Based Screening Tool To Standard Substance Abuse Screening Questions In Identifying Pregnant Women At Risk For Substance Abuse, Nicole Y. Romero

Doctor of Nursing Practice Scholarly Projects

The purpose of the study project was to compare a nonspecific substance screening questionnaire with a well validated, evidence-based substance screening tool designed specifically for the pregnant population Evidence has shown use of an evidence-based screening tool improves maternal and fetal outcomes and reduces the risk of missed cases, stereotyping, and stigma. This study project utilized the social learning theory model, which defines human behavior as a reciprocal, continuous interaction among cognitive, behavioral, and environmental determinants. A pilot observational study project was conducted within a focal organization in a specified women’s health clinic over a 12-week period comparing their currently …

Maternal-Fetal Attachment And Its Relationship To Quality Of Life In Pregnant Women With Diabetes, Cheryl Ann Angel

Dissertations

Background: Maternal-fetal attachment (MFA) is the bond between a mother and her unborn child during pregnancy. Pregnant women with diabetes are considered high-risk and their numbers are expected to increase as levels of obesity rise and women wait longer to have children. This researcher has observed health care providers instructing pregnant women with diabetes about diabetes self-management (DSM) activities such as “dietary management” and encouraging the women to make those changes for their baby. However, some women remained unable to successfully engage in DSM behaviors despite having exhibited signs of MFA, e.g., expressing “thoughts of the fetus” to health care …

Online Support For Families Affected By Opioid Use Disorder, Sharonda Hill

Doctor of Nursing Practice Projects

Families who care for children with neonatal abstinence syndrome (NAS) face many challenges and may be lacking support. The purpose of this project was to provide evidence-based information to families caring for NAS children through an established online support group, To the Moon and Back. Nola Pender’s Health Promotion Model was the theoretical model used to guide this project. An intervention to deliver support and information was implemented through three sessions. During these sessions participants were educated on evidenced-based tools to help their children with behavioral self- regulation and communication with providers. Data was collected through pre and post assessments …

Birthplace Decision Making Experiences Of The Ugep Women Of Southern Nigeria, Thomas Okoi Ofem

Walden Dissertations and Doctoral Studies

The purpose of this basic qualitative study was to explore and describe how behavioral, normative, and control beliefs shape women's birthplace decision-making experiences. The study sought to better understand how Ugep women of southern Nigeria decided where to give birth after attending antenatal care. Using the theory of planned behavior as a framework, a purposeful sample of nine women aged 25 to 35 years who attended antenatal clinic at least twice at the selected primary health facility but gave birth at home during the past year was recruited. Data collection was through face-to-face, semistructured interviews. Audio recordings of interviews were …

Evaluating Providers’ Knowledge, Attitudes And Intentions Toward Assessing Pregnancy Desires In Women Of Childbearing Age, Sydney Hahn

DNP Projects

Abstract

Background: Unintended pregnancies account for over half of all pregnancies in the United States. Unintended pregnancies can lead to abortion, socioeconomic difficulties, medical complications, psychological issues, and political issues. Unintended pregnancies are potentially harmful to both the mother and the baby. Healthy People 2030 listed reducing the number of unintended pregnancies as one of their family planning objectives.

Purpose: The purpose of this DNP project was to evaluate providers’ knowledge, attitudes, and intentions toward assessing pregnancy desires in women of childbearing age. Methods: The study was a one-group pre/post intervention design. The data was gathered via a convivence sample …

Low- And High-Wattage Vaping During Pregnancy Influence Aortic Structure And Function In Rat Offspring, James Ian Frazier

Graduate Theses, Dissertations, and Problem Reports

Introduction: Electronic cigarettes (e-cigs) are being marketed as a healthier alternative to traditional cigarettes, yet the health consequences of e-cig usage (also called vaping) are still being investigated. E-cigs are easily customized for user preferences. For example, the choice of flavors, nicotine concentration, and/or the temperature (i.e., wattage) used to heat the e-liquid can be selected in many devices. Emerging evidence suggests that vaping during pregnancy impairs cerebral vascular function in rodent offspring. In this study, we sought to investigate the potential effects of changes to e-cig device wattage (i.e., 5W vs. 30W) with maternal vaping during pregnancy on vascular …

Maternal Occupational Exposure To Organic Solvents And Noise: Maternal Effects And Infant Outcomes, Kristen Van Buren

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Introduction: Several maternal occupational exposures have not yet been studied for potential reproductive harm or have inconsistent findings in the literature. Despite the challenges, identification of potential risk factors, specifically reproductive toxicants, is necessary to mitigate and prevent adverse health outcomes for working mothers and their infants. The purpose of this study was to examine maternal occupational exposure to organic solvents and noise to small-for-gestational age (SGA) and preterm birth (PTB) among infants. Additionally, the study sought to examine maternal occupational exposure to noise and presence of gestational diabetes (GDM) and pregnancy-related hypertension among participant mothers.

Methods: The study population …

A Serological Analysis Of Sars-Cov-2 Infection In The Obstetric Population, Sophia Rose

CMC Senior Theses

In December 2019, the surfacing and spread of a novel coronavirus, SARS-CoV-2, resulted in the global COVID-19 pandemic. As a viral antigen, SARS-CoV-2 poses a particular threat to the obstetric population due to physiological and immunological changes that women face during pregnancy. While recent studies have found that SARS-CoV-2 may have better clinical outcomes as compared to other betacoronaviruses, adverse pregnancy events such as ICU admission, preeclampsia, and/or preterm birth have been associated with COVID-19. Progress has been made in better understanding the pathophysiology of SARS-CoV-2 in pregnancy, but there is still much to be known about the interaction …

Vaping During Pregnancy: Effects On Vascular And Behavioral Outcomes In Offspring, Eiman A. Aboaziza

Graduate Theses, Dissertations, and Problem Reports

Electronic cigarette (e-cig) use is increasing due to aggressive marketing, tempting flavors, and seemingly higher acceptability in the community (lesser perceived social stigma) despite unproven claims of safety. In an alarming trend, pregnant women smokers have turned to novel “modified risk” products, such as e-cigs, in response to heavy marketing of e-cigs as safer alternatives to cigarettes and a tool to help quit smoking. This is despite proven detrimental effects of nicotine on a growing fetus, and scarcity of information regarding toxicity of e-liquid (with and without nicotine) on child development. Moreover, rampant e-cig use among youth (nearly 4 million …