Medicine and Health Sciences Commons^™

Transvaginal Ultrasonography In Ovarian Cancer Screening: Current Perspectives, John R. Van Nagell Jr., John T. Hoff

Obstetrics and Gynecology Faculty Publications

Transvaginal ultrasonography (TVS) is an integral part of all major ovarian cancer screening trials. TVS is accurate in detecting abnormalities in ovarian volume and morphology, but is less reliable in differentiating benign from malignant ovarian tumors. When used as the only screening test, TVS is sensitive, but has a low positive predictive value. Therefore, serum biomarkers and tumor morphology indexing are used together with TVS to identify ovarian tumors at high risk for malignancy. This allows preoperative triage of high-risk cases to major cancer centers for therapy while decreasing unnecessary surgery for benign disease. Ovarian cancer screening has been associated …

Grant Application: Randomized Comparison Of Two Internet-Supported Natural Family Planning Methods, Richard J. Fehring

Randomized Comparison of Two Internet-Supported Methods of Natural Family Planning

No abstract provided.

Comparison Of Abstinence And Coital Frequency Between Two Natural Methods Of Family Planning, Richard J. Fehring, Thomas Bouchard, Mary Schneider

Randomized Comparison of Two Internet-Supported Methods of Natural Family Planning

Problem Statement: The length of periodic abstinence, due to overestimation of the fertile phase of the menstrual cycle is often a reason for dissatisfaction, discontinuation, and user error with natural family planning (NFP) methods. The objective of this research was to compare the length of required abstinence (i.e., estimated fertility) and coital frequency between two NFP methods.

Study Design: Analysis of existing data from a 12 month prospective comparison study in which participants were randomized into either an electronic hormonal fertility monitor (EHFM) group or a cervical mucus monitoring (CMM) group, both of which included a fertility algorithm as …

Prenatal Programming Of Hepatic Glucose And Cholesterol Regulation In Male Rat Offspring By Chronic Intermittent Hypoxia, Waseem Iqbal

Electronic Thesis and Dissertation Repository

Obstructive sleep apnea (OSA) is a chronic disorder involving repetitive interruptions in breathing during sleep. Sufferers of OSA are exposed to chronic intermittent hypoxia (CIH), characterized by cyclical reductions in oxygen availability. A number of studies have established a link between OSA and various cardiovascular and metabolic comorbidities in adulthood, including hypertension, obesity, and type II diabetes. While the consequences of OSA in adults have been well described, the cross-generational impact of this condition and potential effects on fetal development are not known. Epidemiological and animal studies have demonstrated that physiological insults during pregnancy lead to diminished growth of offspring …

Screening For Tuberculosis In Pregnancy: Do We Need More Than A Symptom Screen? Experience From Western Kenya, R J. Kosgei, D Szkwarko, S Callens, P Gichangi, Marleen Temmerman, A-B Kihara, J J. Sitienei, E J. Cheserem, P M. Ndavi, A J. Reid, E J. Carter

Obstetrics and Gynaecology, East Africa

Objectives: 1) To explore the utility of tuberculosis (TB) symptom screening for symptoms of ⩾2 weeks’ duration in a routine setting, and 2) to compare differences in TB diagnosis between human immunodeficiency virus (HIV) infected and non-HIV-infected pregnant women in western Kenya.

Design: Comparative cross-sectional study among pregnant women with known HIV status screened for TB from 2010 to 2012, in Eldoret, western Kenya.

Results: Of 2983 participants, respectively 34 (1%), 1488 (50.5%) and 1461 (49.5%) had unknown, positive and negative HIV status. The median age was respectively 30 years (interquartile range [IQR] 26–35) and 26 years (IQR 24–31) in …

Conscientious Objection To Provision Of Legal Abortion Care, Brooke R. Johnson Jr, Eszter Kismödi, Monica V. Dragoman, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Despite advances in scientific evidence, technologies, and human rights rationale for providing safe abortion, a broad range of cultural, regulatory, and health system barriers that deter access to abortion continues to exist in many countries. When conscientious objection to provision of abortion becomes one of these barriers, it can create risks to women’s health and the enjoyment of their human rights. To eliminate this barrier, states should implement regulations for healthcare providers on how to invoke conscientious objection without jeopardizing women’s access to safe, legal abortion services, especially with regard to timely referral for care and in emergency cases when …

Primary Healthcare Providers’ Views On Improving Sexual And Reproductive Healthcare For Adolescents In Bolivia, Ecuador, And Nicaragua, Lina Jaruseviciene, Miguel Orozco, Marcia Ibarra, Freddy Cordova Ossio, Bernardo Vega, Nancy Auquilla, Joel Medina, Anna C. Gorter, Peter Decat, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objectives: To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health (ASRH) care in their communities can be improved.

Methods: Overall, 126 healthcare providers (46 from Bolivia, 39 from Ecuador, and 41 from Nicaragua) took part in this qualitative study. During a series of moderated discussions, they provided written opinions about the accessibility and appropriateness of ASRH services and suggestions for its improvement. The data were analyzed by employing a content analysis methodology.

Results: Study participants emphasized managerial issues such as the prioritization of adolescents as a patient group and …

Grand Multiparity: Is It Still A Risk In Pregnancy?, Andrew H. Mgaya, Siriel N. Massawe, Hussein Kidanto, Hans N. Mgaya

Faculty of Health Sciences, East Africa

Background The association of grand multiparity and poor pregnancy outcome has not been consistent for decades. Classifying grand multiparous women as a high-risk group without clear evidence of a consistent association with adverse outcomes can lead to socioeconomic burdens to the mother, family and health systems. We compared the maternal and perinatal complications among grand multiparous and other multiparous women in Dar es Salaam in Tanzania.

Methods A cross-sectional study was undertaken at Muhimbili National Hospital (MNH). A standard questionnaire enquired the following variables: demographic characteristics, antenatal profile and detected obstetric risk factors as well as maternal and neonatal risk …

The Effect Of Marriage On Stage At Diagnosis And Survival In Women With Cervical Cancer, Sanae El Ibrahimi

UNLV Theses, Dissertations, Professional Papers, and Capstones

Marriage is associated with improved health outcomes for many conditions. Married persons enjoy financial stability, social and emotional support, and tend to have better control of health risk behaviors compared to the unmarried. The marriage scene is changing continuously. Americans are marrying less or delaying the engagement to an older age. They are divorcing more, they choose cohabitation as an alternative to marriage, or engage in premarital relationships. As a consequence, barely half of Americans were married in 2011 compared to close to three quarters of Americans were married in the sixties. With the increase of the unmarried population - …

Executive Summary: Randomized Comparison Of Two Internet-Supported Methods Of Natural Family Planning, Richard J. Fehring, Mary Schneider

Randomized Comparison of Two Internet-Supported Methods of Natural Family Planning

Only 0.2% of US women use modern methods of natural family planning, i.e., the basal body temperature and the cervical mucus methods of natural family planning (NFP). The reason that such few women use NFP methods is because they are often ineffective, they are difficult to use, there is lack of access to properly trained NFP teachers, a lack of motivation to use a behavioral method, and health professionals are reluctant to prescribe NFP methods. One way to potentially increase the use of NFP methods is to provide easy access to an effective but simplified NFP method that uses a …

Maternal Anaemia And Duration Of Zidovudine In Antiretroviral Regimens For Preventing Mother-To-Child Transmission: A Randomized Trial In Three African Countries, Benn K.D. Sartorius, Matthew F. Chersich, Mary Mwaura, Nicolas Meda, Marleen Temmerman, Marie Louise Newell, Timothy M. M. Farley, Stanley Luchters, The Kesho Bora Study Group

Obstetrics and Gynaecology, East Africa

Background: Although substantiated by little evidence, concerns about zidovudine-related anaemia in pregnancy have influenced antiretroviral (ARV) regimen choice for preventing mother-to-child transmission of HIV-1, especially in settings where anaemia is common.

Methods: Eligible HIV-infected pregnant women in Burkina Faso, Kenya and South Africa were followed from 28 weeks of pregnancy until 12–24 months after delivery (n = 1070). Women with a CD4 count of 200-500cells/mm3 and gestational age 28–36 weeks were randomly assigned to zidovudine-containing triple-ARV prophylaxis continued during breastfeeding up to 6-months, or to zidovudine during pregnancy plus single-dose nevirapine (sd-NVP) at labour. Additionally, two cohorts were …

Prenatal Development: Annotated Bibliography, Victoria J. Molfese, Amanda Prokasky, Kathleen Moritz Rudasill, Ibrahim H. Acar, Xiaoqing Tu, Kate Sirota, Brian Keiser

Department of Child, Youth, and Family Studies: Faculty Publications

For decades, researchers have investigated how events in the prenatal period impact women and their infants. These studies, particularly by researchers in the medical, neuroscience, and behavioral science fields, led to discoveries of important information regarding the prenatal events that were strongly associated with mortality (or death) and morbidity (or incidences of injury, pathology and abnormalities/anomalies, and neurobehavioral sequelae) in the neonatal and infancy periods. Among the many common findings from early research studies, two are particularly noteworthy. First, maternal and fetal risk conditions arising in the prenatal period do not do so in isolation. Sameroff and Chandler characterized this …

Incidence And Outcome Of Small For Gestational Age Fetuses: An Experience From A Secondary Care Hospital, Riffat Bano, Nousheen Asim, Ammara Mushtaq, Mehreen Adhi, Noureen Afzal

Department of Obstetrics & Gynaecology

The objective of the study was to determine the frequency and outcome of Small for Gestational Age (SGA) foetuses, and its association with the mode of delivery, foetal birthweight, maternal age and gestational age. It was a hospital-based descriptive study, conducted at Aga Khan Hospital for Women, Karachi, from January 2009 to December 2010. Mode of deliveries, foetal birthweight, maternal age and gestational age of SGA foetuses were recorded and analszed. Of a total of 6024 deliveries during the study period, 722(11.98%) had SGA foetuses. Maternal age in such cased ranged between 20-40 years in 588(81.44%), while 406(56.23%) of these …

Can Urethral Retroresistance Pressures Predict Midurethral Sling Outcomes?, Patrick J. Culligan, Jennifer Lewis-Priestley, Linda Blackwell, Susan B. Tate

Jennifer L. Priestley

OBJECTIVE: To determine whether preoperative urethral resistance pressure (URP) measurements could predict success or failure of a tension-free vaginal tape (TVT) sling. METHODS: Subjects came from a previously published study comparing URP measurements to a validated urinary incontinence symptom survey (UISS). We contacted patients from that study to determine whether they had subsequently undergone TVT surgery. Within that cohort, we determined the “current” (i.e., postoperative) UISS and Sandvik urinary incontinence severity score. Success of a TVT sling in this group was defined in 4 ways: (1) postoperative UISS score < 3, (2) postoperative UISS score < 75% of the preoperative score, (3) …

A Randomized Clinical Trial Comparing Pelvic Floor Muscle Training To A Pilates Exercise Program For Improving Pelvic Muscle Strength, Patrick Culligan, Janet Scherer, Keisha Dyer, Jennifer Priestley, Geri Guingon-White, Donna Delvecchio, Margi Vangeli

Jennifer L. Priestley

Introduction and hypothesis The purpose of this study is to determine whether a Pilates exercise program and a pelvic floor muscle-training (PFMT) program could provide similar improvements in pelvic muscle strength. Methods Sixty-two women with little or no pelvic floor dysfunction were randomized to Pilates or PFMT. Each group had 24 biweekly 1-h sessions with either a physical therapist or Pilates instructor. Strength was measured via perineometry (cmH2O). Two questionnaires-pelvic floor distress inventory (PFDI-20) and pelvic floor impact questionnaire (PFIQ-7)-were also collected. Results At baseline, the Pilates and PFMT groups measured 14.9±12.5 and 12.5±10.4 cmH2O, respectively (p=0.41). Both the Pilates …

Evaluation Of A Transvaginal Mesh Delivery System For The Correction Of Pelvic Organ Prolapse: Subjective And Objective Findings At Least 1 Year After Surgery, Patrick Culligan, Paul Littman, Charbel Salamon, Jennifer Priestley, Amir Shariati

Jennifer L. Priestley

Objective: We sought to track objective and subjective outcomes ≥1 year after transvaginal mesh system to correct prolapse. Study Design: This was a retrospective cohort study of 120 women who received a transvaginal mesh procedure (Avaulta Solo, CR Bard Inc, Covington, GA). Outcomes were pelvic organ prolapse quantification values; Pelvic Floor Distress Inventory, Short Form 20/Pelvic Floor Impact Questionnaire, Short Form 7 scores; and a surgical satisfaction survey. “Surgical failure” was defined as pelvic organ prolapse quantification point >0, and/or any reports of vaginal bulge. Results: Of 120 patients, 116 (97%) were followed up for a mean of 14.4 months …

The G-Protein-Coupled Estrogen Receptor Agonist G-1 Suppresses Proliferation Of Ovarian Cancer Cells By Blocking Tubulin Polymerization., Cheng Wang, Xiangmin Lv, Chunbo He, G Hua, M-Y Tsai, John S. Davis

Journal Articles: Obstetrics & Gynecology

The G-protein-coupled estrogen receptor 1 (GPER) has recently been reported to mediate the non-genomic action of estrogen in different types of cells and tissues. G-1 (1-[4-(6-bromobenzo[1,3] dioxol-5yl)-3a,4,5,9b-tetrahydro-3H-cyclopenta[c]quinolin-8-yl]-ethanone) was developed as a potent and selective agonist for GPER. G-1 has been shown to induce the expression of genes and activate pathways that facilitate cancer cell proliferation by activating GPER. Here we demonstrate that G-1 has an anticancer potential with a mechanism similar to vinca alkaloids, the commonly used chemotherapy drugs. We found that G-1 blocks tubulin polymerization and thereby interrupts microtubule assembly in ovarian cancer cells leading to the arrest of …

Validation Of Verbal Autopsy Tool For Ascertaining The Causes Of Stillbirth, Sidrah Nausheen, Sajid B. Soofi, Kamran Sadiq, Atif Habib, Ali Turab, Zamir Suhag, Zaid Bhatti, Imran Ahmed, Zulfiqar A. Bhutta, Zahid Memon, Rajiv Bahl, M. Imran Khan, Shireen Bhutta

Department of Obstetrics & Gynaecology

Objective: To assess performance of the WHO revised verbal autopsy tool for ascertaining the causes of still birth in comparison with reference standard cause of death ascertained by standardized clinical and supportive data.
Methods: All stillbirths at a tertiary hospital in Karachi, Pakistan were prospectively recruited into study from August 2006- February 2008. The reference standard cause of death was established by two senior obstetricians within 48 hours using the ICD coding system. Verbal autopsy interviews using modified WHO tool were conducted by trained health workers within 2- 6 weeks of still birth and the cause of death …

Developmental Genes Targeted For Epigenetic Variation Between Twin-Twin Transfusion Syndrome Children, Carmen J. Marsit, Devin C. Koestler, Debra Watson-Smith, Charlotte M. Boney

Dartmouth Scholarship

Background: Epigenetic mechanisms are thought to be critical in mediating the role of the intrauterine environment on lifelong health and disease. Twin-twin transfusion syndrome (TTTS) is a rare condition wherein fetuses share the placenta and develop vascular anastomoses, which allow blood to flow between the fetuses. The unequal flow results in reciprocal hypo- and hypervolemia in the affected twins, striking growth differences and physiologic adaptations in response to this significant stressor. The donor twin in the TTTS syndrome can be profoundly growth restricted and there is likely a nutritional imbalance between the twins. The consequences of TTTS on fetal programming …

Plan B Topic: Annotated Resource List, Payton Roberts

Undergraduate Research Award

No abstract provided.

Selling Art: An Empirical Assessment Of Advertising On Fertility Clinics' Websites, Jim Hawkins

Indiana Law Journal

Scholarship on assisted reproductive technologies (ART) has emphasized the commercial nature of the interaction between fertility patients and their physicians, but little attention has been paid to precisely how clinics persuade patients to choose their clinics over their competitors’. This Article offers evidence about how clinics sell ART based on clinics’ advertising on their websites. To assess clinics’ marketing efforts, I coded advertising information on 372 fertility clinics’ websites. The results from the study confirm some suspicions of prior ART scholarship while contradicting others. For instance, in line with scholars who are concerned that racial minorities face barriers to accessing …

Selling Art Or Selling Out?: A Response To Selling Art: An Empirical Assessment Of Advertising On Fertility Clinics' Websites, Jody L. Madeira

Indiana Law Journal

Roundtable on Regulating Assisted Reproductive Technology 2012

Jordanian Ethical Perceptions Of Preimplantation Genetic Diagnosis, Sarah C. Miller

Independent Study Project (ISP) Collection

Preimplantation Genetic Diagnosis (PGD) is a procedure that can be done during In Vitro Fertilization (IVF), involving genetic and chromosomal screening of fertilized embryos prior to implantation into a woman’s uterus. After PGD, only the embryos possessing the desired characteristics are implanted, while the other embryos are frozen for future use, or discarded. PGD is used for family balancing (gender selection for balancing the gender dynamic within a family), gender selection to screen out sex-linked diseases, or a broader genetic screening for diseases known to be present in the patient’s family history.

Many ethical questions have been raised about PGD, …

Cryotherapy Following Visual Inspection With Acetic Acid And Lugol's Iodine (Via/Vili) In Khwisero, Western Kenya: Lesson From The Field Affecting Policy And Practice, Sammy Ngichabe, Patricia Muthaura, Christine W. Murungi, J. Muyoka, Elkanah Omenge, L Muchiri

Obstetrics and Gynaecology, East Africa

Background: Cervical cancer can be prevented and mortality/morbidity reduced by early detection and referral. Developing countries are likely to benefit from more cost effective methods of screening and treatment. Visual inspection with acetic acid and Lugol`s iodine (VIA/VILI) offers a see and treat solution thus an affordable and efficient way to identify pre-malignant lesions. Immediate treatment with cryotherapy can be offered if pre-malignant lesions are found on visual inspection. Cryotherapy is a simple procedure that is curative for dysplasia; it is likely to benefit cervical dysplasia cases picked early in resource poor settings, however there are several factors that …

Wilson’S Disease In Pregnancy: Case Series And Review Of Literature, Ayesha Malik, Ali Khawaja, Lumaan Sheikh

Department of Obstetrics & Gynaecology

Background: Wilson’s disease is a rare, autosomal recessive inherited disorder characterized by impaired liver metabolism of copper leading to decreased biliary excretion and incorporation of ceruloplasmin levels mainly in the liver and brain. Untreated Wilson’s disease has been shown to cause subfertility and even in cases where pregnancy occurs, it often results in spontaneous miscarriage.

Case presentations: We present four cases of successful pregnancy outcomes in three patients diagnosed with Wilson’s disease along with the literature review. All the patients were managed with zinc sulphate without any postnatal complications.

Conclusion: Patients with Wilson’s disease receiving regular treatment who remain asymptomatic …

Is There A Viability-Vulnerability Tradeoff? Sex Differences In Fetal Programming, Curt A. Sandman, Laura M. Glynn, Elyssia Poggi Davis

Psychology Faculty Articles and Research

OBJECTIVE: In this paper we evaluate the evidence for sex differences in fetal programming within the context of the proposed viability-vulnerability tradeoff.

METHODS: We briefly review the literature on the factors contributing to primary and secondary sex ratios. Sex differences in fetal programming are assessed by summarizing previously published sex difference findings from our group (6 studies) and also new analyses of previously published findings in which sex differences were not reported (6 studies).

RESULTS: The review and reanalysis of studies from our group are consistent with the overwhelming evidence of increasing risk for viability among males exposed to environmental …

The Challenge Of Early Inpatient Postpartum Depression Screening, Elizabeth A. Berger Do, John C. Smulian Md, Mph, Joanne Quiñones Md, Msce, Rory L. Marraccini Md, Amy Wu Bs, Elizabeth A. Smulian Bs, Sandra L. Curet Md

John C Smulian MD, MPH

No abstract provided.

Participation In Perinatal Interventional Research: Which Characteristics Matter?, Hai-Yen T. Nguyen Md, Joanne Quiñones Md, Msce, Daniel G. Kiefer Md, Anita Kurt Phd, Rn, Felisa Saldutti, John C. Smulian Md, Mph

John C Smulian MD, MPH

No abstract provided.

The Association Between Hospital Obstetrical Volume And Maternal Postpartum Complications, Kathy Kyser, Xin Lu, Donna Santillan, Mark Santillan, Stephen Hunter, Alison Cahill, Peter Cram

Stephen K. Hunter

OBJECTIVE: The purpose of this study was to examine the relationship between delivery volume and maternal complications. STUDY DESIGN: We used administrative data to identify women who had been admitted for childbirth in 2006. Hospitals were stratified into deciles that were based on delivery volume. We compared composite complication rates across deciles. RESULTS: We evaluated 1,683,754 childbirths in 1045 hospitals. Decile 1 and 2 hospitals had significantly higher rates of composite complications than decile 10 (11.8% and 10.1% vs 8.5%, respectively; P < .0001). Decile 9 and 10 hospitals had modestly higher composite complications as compared with decile 6 (8.8% and …

A Select Issue In The Postpartum Period: Contraception, Whitney Cowman, Abbey Hardy-Fairbanks, Jill Endres, Colleen Stockdale

Abbey J Hardy-Fairbanks

One half of pregnancies in the United States are unintended and associated with adverse pregnancy outcomes. The postpartum period is an important, yet underutilized, time to initiate contraception. The U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 provides evidence-based guidelines for choosing a contraceptive method and an update in 2011 specifically addresses contraceptive method use in the puerperium. The variety of contraceptive methods include hormonal contraception, lactational amenorrhea, barrier contraception, natural family planning, and sterilization. Ideally, counseling about contraceptive choice should begin early in pregnancy care and continue postpartum; it should also include a variety of teaching modalities. Specifically we …