Medical Specialties Commons^™

Double Balloon Cervical Ripening Catheter For Control Of Massive Hemorrhage In A Cervical Ectopic Pregnancy, N Zambrano, J Reilly, M Moretti, Nisha Lakhi

NYMC Faculty Publications

Cervical pregnancy can be complicated by perfuse vaginal bleeding. Mechanical compression directed at tamponing the cervical vessels can control hemostasis. There are several types of balloon catheters that have been described for cervical compression. However use of a double balloon catheter is a novel approach for cervical tamponade, as one balloon is positioned below the external cervical os and the second balloon is situated above in the internal cervical os. This compresses the cervix from internal os to external os between the two balloons, forming a "cervical sandwich." We describe this method of cervical tamponade using a silicone double balloon …

Infection Control In Labor And Delivery Room, Learning From The Small Hospital Based Project, Savera Aziz Ali, Sumera Aziz Ali

School of Nursing & Midwifery

Background: It has been estimated that around 36% of the neonatal deaths occur due to infection in the lower and middle income countries. Infection control is a more substantial area of concern, particularly in Labor and delivery room. Multiple factors can cause infection in the labor room, therefore it is important to assess various factors of maternal and neonatal infection. Hence we explored multiple factors through this project and developed the action plan to address those factors effectively.
Methods: During our Leadership and Management course, we conducted a project in Labor room pertaining to a prevalent issue. The whole process …

Placental Genetic Variations In Vitamin D Metabolism And Birthweight., Tsegaselassie Workalemahu, Sylvia E Badon, Michal Dishi-Galitzky, Chunfang Qiu, Michelle A Williams, Tanya Sorensen, Daniel A Enquobahrie

Articles, Abstracts, and Reports

INTRODUCTION: Vitamin D has pleiotropic functions that regulate fetal growth and development. We investigated associations of common placental genetic variations in vitamin D metabolism with birthweight.

METHODS: The study was conducted among participants (506 maternal-infant pairs) of a pregnancy cohort study. Data were collected using interviewer-administered questionnaires and post-delivery medical record abstraction. DNA, extracted from placental samples collected at delivery, was genotyped for eight single nucleotide polymorphisms (SNPs) in five vitamin D metabolism genes (CUBN, LRP2, VDR, GC, and CYP2R1). Linear and logistic regression models were used to evaluate associations of SNPs with birthweight and risk of low birthweight, respectively. …

Reply., Anthony M. Vintzileos Md, John C. Smulian Md, Mph

Department of Obstetrics & Gynecology

No abstract provided.

Surrogate Pregnancy After Prenatal Diagnosis Of Spina Bifida., Lynnette J. Mazur, Mary Kay Kisthardt, Helen H. Kim, Laura M. Rosas, John Lantos

Manuscripts, Articles, Book Chapters and Other Papers

Some pregnancies today involve infertile individuals or couples who contract with a fertile woman to carry a pregnancy for them. The woman who carries the pregnancy is referred to as a "gestational carrier." The use of such arrangements is increasing. Most of the time, these arrangements play out as planned; sometimes, however, problems arise. This article discusses a case in which a fetal diagnosis of spina bifida led the infertile couple to request that the gestational carrier terminate the pregnancy, and the gestational carrier did not wish to do so. Experts in the medical and legal issues surrounding surrogacy discuss …

Group Medical Visits To Provide Gynecologic Care For Women Affected By Breast Cancer, Sally R. Greenwald, Sarah Watson, Mindy Goldman, Tami S. Rowen

Journal of Patient-Centered Research and Reviews

Purpose

Women with breast cancer have complex and unique gynecologic needs that are challenging to effectively and comprehensively meet in a traditional gynecology visit format. Group medical visits are an effective and well-received model of care in other disease settings and can provide comprehensive health education as an adjunct to one-on-one evaluation and treatment. There are limited data regarding the use of this type of health care delivery in providing gynecology-focused care to women affected by breast cancer.

Methods

A group medical visit model was created for gynecology providers to see new breast cancer patient consults. From May 2012 to …

Self-Reported Tobacco Use And Correlation With Umbilical Cord Blood Cotinine Levels At Delivery Among Appalachian Gravidas, Jesse Cottrell, Brenda L. Mitchell, Pooja N. Sangani, D'Andrea S. Thomas, Monica A. Valentovic

Marshall Journal of Medicine

The detrimental effects of cigarette use during pregnancy are well documented. Studies have shown that cigarette smoking while pregnant is associated with multiple adverse outcomes including: pre-term birth, placental abruption, placenta previa, fetal growth restriction, stillbirth, increased rate of birth defects, and increased risk of sudden infant death syndrome. Cotinine is the primary metabolite of nicotine and allows for measurement of active as well as passive exposure. Cotinine freely cross the placental barrier and maternal concentrations are closely correlated with newborn plasma levels. The aim of this study was to compare maternally reported rates of tobacco use to fetal umbilical …

Effect Of Puerperal Infections On Early Neonatal Mortality: A Secondary Analysis Of Six Demographic And Health Surveys, Saverio Bellizzi, Quique Bassat, Howard L. Sobel, Mohamed M. Ali, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Around 1.5 million annual neonatal deaths occur in the first week of life, and infections represent one of the major causes in developing countries. Neonatal sepsis is often strictly connected to infection of the maternal genital tract during labour.

Methods: The association between signs suggestive of puerperal infection and early neonatal mortality (life) was performed using Demographic and Health Surveys (DHS) data of six countries, conducted between 2010 and 2013. The population attributable fraction (PAF) was generated using the estimates on early neonatal mortality of a 1990-2013 systematic analysis for the Global Burden of Disease Study.

Results: Signs of …

Caesarean Sections And For-Profit Status Of Hospitals: Systematic Review And Meta-Analysis, Ilir Hoxha, Lamprini Syrogiannouli, Xhyljeta Luta, Kali Tal, David C. Goodman

Dartmouth Scholarship

Objective: Financial incentives may encourage private for-profit providers to perform more caesarean section (CS) than non-profit hospitals. We therefore sought to determine the association of for-profit status of hospital and odds of CS.

Design: Systematic review and meta-analysis. Data sources: MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from the first year of records through February 2016. Eligibility criteria: To be eligible, studies had to report data to allow the calculation of ORs of CS comparing private for-profit hospitals with public or private non-profit hospitals in a specific geographic area. Outcomes: The prespecified primary outcome was the adjusted OR …

Maternal And Newborn Health In Karnataka State, India: The Community Level Interventions For Pre-Eclampsia (Clip) Trial's Baseline Study Results., Mrutynjaya B. Bellad, Marianne Vidler, Narayan V. Honnungar, Ashalata Mallapur, Umesh Ramadurg, Umesh Charanthimath, Geetanjali Katageri, Shashidhar Bannale, Avinash Kavi, Chandrashekhar Karadiguddi, Sumedha Sharma, Tang Lee, Jing Li, Beth Payne, Laura Magee, Peter Von Dadelszen, Richard Derman, Shivaprasad S. Goudar

Department of Obstetrics and Gynecology Faculty Papers

Existing vital health statistics registries in India have been unable to provide reliable estimates of maternal and newborn mortality and morbidity, and region-specific health estimates are essential to the planning and monitoring of health interventions. This study was designed to assess baseline rates as the precursor to a community-based cluster randomized control trial (cRCT)-Community Level Interventions for Pre-eclampsia (CLIP) Trial (NCT01911494; CTRI/2014/01/004352). The objective was to describe baseline demographics and health outcomes prior to initiation of the CLIP trial and to improve knowledge of population-level health, in particular of maternal and neonatal outcomes related to hypertensive disorders of pregnancy, in …

The Effects Of Asking A Fertility Intention Question In Primary Care Settings: A Systematic Review Protocol, Paul A. Henning, Carolyne K. Burgess, Heidi E. Jones, Wendy V. Norman

Publications and Research

Background: Planning for pregnancy has been associated with reduced unwanted pregnancies and improved pregnancy outcomes. Despite the benefits of planned pregnancy, there are no guideline recommendations on routine counseling regarding pregnancy intention in primary care settings. The objective of the systematic review is to determine the effectiveness of incorporating questions of pregnancy intention into primary care.

Methods: A systematic search of the literature will be conducted for any studies comparing questions of pregnancy intention in primary care settings with no intervention or a control intervention. Types of studies will include randomized controlled trials, non-randomized trials, and observation studies. Participants …

Non-Invasive Placental Perfusion Imaging In Pregnancies Complicated By Fetal Heart Disease Using Velocity-Selective Arterial Spin Labeled Mri, Zungho Zun, Greg Zaharchuk, Nickie Niforatos Andescavage, Mary T. Donofrio, Catherine Limperopoulos

Pediatrics Faculty Publications

The placenta is a vital organ for fetal growth and development during pregnancy. Congenital heart disease (CHD) is a leading cause of morbidity and mortality in newborns. Despite the parallel development of the placenta and fetal heart early in pregnancy, very few studies suggested an association between placental dysfunction and fetal CHD. In this study, we report placental perfusion of healthy pregnancies and pregnancies complicated by fetal CHD measured using advanced fetal MRI techniques. We studied forty-eight pregnant women (31 healthy volunteers and 17 with fetal CHD) that underwent fetal MRI during their second or third trimester of pregnancy. Placental …

Hypoactive Sexual Desire Disorder: International Society For The Study Of Women's Sexual Health (Isswsh) Expert Consensus Panel Review., Irwin Goldstein, Noel N Kim, Anita H Clayton, Leonard R Derogatis, Annamaria Giraldi, Sharon J Parish, James Pfaus, James A Simon, Sheryl A Kingsberg, Cindy Meston, Stephen M Stahl, Kim Wallen, Roisin Worsley

Obstetrics and Gynecology Faculty Publications

The objective of the International Society for the Study of Women's Sexual Health expert consensus panel was to develop a concise, clinically relevant, evidence-based review of the epidemiology, physiology, pathogenesis, diagnosis, and treatment of hypoactive sexual desire disorder (HSDD), a sexual dysfunction affecting approximately 10% of adult women. Etiologic factors include conditions or drugs that decrease brain dopamine, melanocortin, oxytocin, and norepinephrine levels and augment brain serotonin, endocannabinoid, prolactin, and opioid levels. Symptoms include lack or loss of motivation to participate in sexual activity due to absent or decreased spontaneous desire, sexual desire in response to erotic cues or stimulation, …

Movement To Outpatient Hysterectomy For Benign Indications In The United States, 2008-2014., Gaby Moawad, Emelline Liu, Chao Song, Alex Z Fu

Obstetrics and Gynecology Faculty Publications

Introduction

The past decade has witnessed adoption of conservative gynecologic treatments, including minimally invasive surgery (MIS), alongside steady declines in inpatient hysterectomies. It remains unclear what factors have contributed to trends in outpatient benign hysterectomy (BH), as well as whether these trends exacerbate disparities.

Materials and methods

Retrospective cohort of 527,964 women ≥18 years old who underwent BH from 2008 to 2014. BH surgical approaches included: open/abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), and robotic-assisted hysterectomy (RH). Quarterly frequencies were calculated by care setting and surgical approach. We used multilevel logistic regression (MLR) using the most recent year …

Trends In Management Of Overweight And Obesity In Obstetrics & Gynecology, Family Medicine And Pediatrics 2011-2015, Steven Lindheim, Stephanie Welsh, Nan Jiang, Amanda Hawkins, Lisa Kellar, Rose Maxwell, Leah D. Whigham

Obstetrics and Gynecology Faculty Publications

Purpose: To assess for improvement in the screening and management of overweight and obesity in the past 5 years among Obstetrician-Gynecologists (OB-GYN), Family Physicians (FP), and Pediatricians (Peds).

Methods: A retrospective pilot study was conducted, reviewing 150 charts of patients with overweight (body mass index [BMI] 25-29.9 kg/m2) and class I (BMI 30-34.9 kg/m2), class II (BMI 35-39.9 kg/m2), and class III obesity (BMI ≥ 40 kg/m2) between 2011 and 2015. Patients were from OB-GYN (n=50), Family Medicine, adult (FP-A) (n=50) and pediatric (FP-P) (n=28), and Peds (n=22) offices.

Results: 75% of patients were female; 35.5% had overweight, 40% had …

Vaginal Urinary Calculi Formation Secondary To Vaginal Mesh Exposure With Urinary Incontinence, Kara M. Griffiths, Geoffrey D. Towers, Jerome L. Yaklic

Obstetrics and Gynecology Faculty Publications

Background

Vaginal stones may form in the setting of mesh exposure with urinary incontinence. This report serves to help understand the presentation, evaluation, and management of vaginal urinary stones.

Case

A 68-year-old female presented with a vaginal calculus. She had a history of anterior and posterior polypropylene mesh placement for prolapse 7 years earlier and urinary incontinence. The stone was identified on a portion of exposed mesh and removed in office. Pathology confirmed urinary etiology. The exposed mesh resolved with topical estrogen. Cystourethroscopy excluded urinary fistula and bladder mesh erosion.

Conclusions

When identified, a vaginal calculus should be removed and …

Effect Of Continuous Local Anesthetic Use For Pain Control And Narcotic Use After Cesarean Section: A Randomized Trial, Jerome L. Yaklic, Rose Maxwell, Keira Urschel, S. Robinson, M. K. Dearmond, Steven R. Lindheim

Obstetrics and Gynecology Faculty Publications

Background: Post-operative pain control after Cesarean delivery is a major concern for both patients and physicians. The current literature provides mixed results on the effectiveness of the local continuous infiltration of anesthesia for pain control and reduction of morphine use. Methods: This was a randomized, double-blind, placebo controlled trial with a 1:1 group allocation. Fifty women who had a Cesarean delivery were randomly assigned to receive bupivacaine (Bupivacaine group) or saline (Saline group) delivered via locally placed catheters at the sub-fascial plane and at the uterine incision. Forty women (20 per group) completed the study. Total post-operative narcotic use and …

Transcriptomic And Bioinformatics Analysis Of The Early Time-Course Of The Response To Prostaglandin F2 Alpha In The Bovine Corpus Luteum., Heather Talbott, Xiaoying Hou, Fang Qiu, Pan Zhang, Chittibabu Guda, Fang Yu, Robert A. Cushman, Jennifer R. Wood, Cheng Wang, Andrea S. Cupp, John S. Davis

Journal Articles: Obstetrics & Gynecology

RNA expression analysis was performed on the corpus luteum tissue at five time points after prostaglandin F2 alpha treatment of midcycle cows using an Affymetrix Bovine Gene v1 Array. The normalized linear microarray data was uploaded to the NCBI GEO repository (GSE94069). Subsequent statistical analysis determined differentially expressed transcripts ± 1.5-fold change from saline control with P ≤ 0.05. Gene ontology of differentially expressed transcripts was annotated by DAVID and Panther. Physiological characteristics of the study animals are presented in a figure. Bioinformatic analysis by Ingenuity Pathway Analysis was curated, compiled, and presented in tables. A dataset comparison with similar …

Opportunities And Challenges In Realizing Universal Access To Obstetric Ultrasound In Sub-Saharan Africa, Sikolia Wanyonyi, Charles Muriuki Mariara, Sudhir Vinayak, William Stones

Obstetrics and Gynaecology, East Africa

The potential benefits of obstetric ultrasound have yet to be fully realized in sub-Saharan Africa (SSA), despite the region bearing the greatest burden of poor perinatal outcomes. We reviewed the literature for challenges and opportunities of universal access to obstetric ultrasound and explored what is needed to make such access an integral component of maternity care in order to address the massive burden of perinatal morbidity and mortality in SSA. Original peer-reviewed literature was searched in various electronic databases using a ‘realist’ approach. While the available data were inconclusive, they identify many opportunities for potential future research on the subject …

Prenatal Screening For Aneuploidy: Should Cfdna Replace Traditional Methods?, Rachel Watson

Physician Assistant Scholarly Project Posters

In 2011, advances in research in medical genetics led to the advent of prenatal cell-free DNA (cfDNA) or also known simply as non-invasive prenatal screening or testing (NIPS). This screen consists of analyzation of placental DNA circulating in maternal blood. NIPS has had a major impact on prenatal screening for aneuploidy. Mixed opinions and data exist as to whom this test is most appropriate for. The sensitivity and specificity of this screen in detecting common fetal aneuploidies has been well documented as superior to other screens in high-risk populations, but less so in low-risk obstetric populations. This paper will compare …

Risk Of Glucose Intolerance And Gestational Diabetes Mellitus In Relation To Maternal Habitual Snoring During Early Pregnancy., Chunfang Qiu, Wayne Lawrence, Bizu Gelaye, Lee Stoner, Ihunnaya O Frederick, Daniel A Enquobahrie, Tanya K Sorensen, Michelle A Williams

Articles, Abstracts, and Reports

BACKGROUND: Obstructive sleep apnea (OSA) or habitual snoring is known to be associated with impaired glucose tolerance and type 2 diabetes among both men and non-pregnant women. We examined the association of habitual snoring during early pregnancy with risk of impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM).

METHODS: A cohort of 1,579 women was interviewed during early pregnancy. We collected information about snoring frequency during early pregnancy. Results from screening and diagnostic tests for IGT and GDM were abstracted from medical records. Multivariate logistic regression models were fitted to estimate odds ratios (OR) and 95% confidence intervals (95% …

The Impact Of A Referral Card-Based Intervention On Intimate Partner Violence, Psychosocial Health, Help-Seeking And Safety Behaviour During Pregnancy And Postpartum: A Randomized Controlled Trial, An-Sofie Van Parys, Ellen Deschepper, Kristien Roelens, Marleen Temmerman, Hans Verstraelen

Obstetrics and Gynaecology, East Africa

Background: We aimed to investigate the impact of a referral-based intervention in a prospective cohort of women disclosing intimate partner violence (IPV) on the prevalence of violence, and associated outcomes psychosocial health, help-seeking and safety behaviour during and after pregnancy.

Methods: Women seeking antenatal care in eleven Belgian hospitals were consecutively invited from June 2010 to October 2012, to participate in a single-blind randomized controlled trial (RCT) and handed a questionnaire. Participants willing to be interviewed and reporting IPV victimisation were randomised. In the Intervention Group (IG) participants received a referral card with contact details of services providing assistance and …

“The Co-Authors Of Pregnancy”: Leveraging Men’S Sense Of Responsibility And Other Factors For Male Involvement In Antenatal Services In Kinshasa, Drc, Michelle M. Gill, John Ditekemena, Aimé Loando, Vicky Ilunga, Marleen Temmerman, Franck Fwamba

Obstetrics and Gynaecology, East Africa

Background: Despite efforts to improve male involvement (MI), few male partners typically attend antenatal care (ANC). MI in ANC and interventions to prevent mother-to-child HIV transmission have been demonstrated to be beneficial for the HIV-positive mother and her child. This study aimed to explore factors influencing partner attendance and highlight interventions with potential to improve MI within a Congolese context.

Methods: This was an exploratory, qualitative study conducted in two urban and two semi-urban catchment areas of Kinshasa, DRC in June–September 2016. Two women-only and two men-only focus group discussions (FGDs) were held; participants were recruited from ANC clinics and …

L’Expérience De Femmes Ayant Subi Une Grossesse Non Désirée Au Sénégal : Une Étude Qualitative, Fatou Mbow, Nafissatou Diop

Reproductive Health

Au Sénégal, l’avortement n’est autorisé que lorsque la vie de la mère est menacée. Depuis 2013, le Comité de plaidoyer pour l’accès à l’avortement médicalisé au Sénégal (plus connu sous le nom de « Taskforce ») mène des activités de plaidoyer pour une révision de la loi. L’avortement est maintenant plus ouvertement discuté, mais la voix des femmes victimes de grossesse non désirée n’est pas entendue. Cette étude documente l’expérience de ces femmes pour fournir des évidences pour le plaidoyer. L’autorisation de l'avortement médicalisée contribuera à respecter les droits humains et de santé des femmes, ainsi qu’à réduire les conséquences …

Senegal: Explorer Le Processus De La Collaboration Multisectorielle Mise En Place Pour L’Étude Qualitative, Fatou Mbow, Nafissatou Diop, Awa Diop Dabo, Awa Tounkara Cissé, Seynabou Ba Diakhaté

Reproductive Health

En 2015, STEP UP a mené une étude qualitative sur l’expérience de femmes ayant subi une grossesse non désirée suite à un viol ou inceste dans la région de Dakar, Sénégal, en partenariat avec le Comité de plaidoyer pour l’accès à l’avortement médicalisé, plus connu sous le nom de «Taskforce». L’objectif général de l’étude était de développer une meilleure compréhension de la vie de ces femmes et d’apporter leur voix au débat sur la légalisation de l’avortement médicalisé. Cette étude de cas examine les caractéristiques de la collaboration, comment elle a été efficace, les leçons apprises, et les recommandations formulées …

Bangladesh: Using Strong Evidence And Strategic Collaboration To Increase Access To Menstrual Regulation With Medication, Nancy Termini Lachance, Sharif M.I. Hossain

Reproductive Health

Through close cooperation with the Ministry of Health and Family Welfare of Bangladesh, and other partners, STEP UP generated strong evidence and cultivated ongoing collaboration that contributed to policy changes and program expansions to increase access to menstrual regulation with medication (MRM). Study results demonstrate that MRM is acceptable and effective in Bangladesh, and has thus been legalized and folded into the national FP program and scaled up nationwide. However, ongoing observation and studies are still needed to understand whether the efficacy and acceptability of MRM remains the case when services are delivered at scale on a national level. Furthermore, …

Introduction And Approval Of Menstrual Regulation With Medication In Bangladesh: A Stakeholder Analysis, Fauzia Akhter Huda, Sadia Afrin, Bidhan Krishna Sarker, Hassan Rushekh Mahmood, Anadil Alam

Reproductive Health

Despite the significant progress that the government of Bangladesh has made toward introducing menstrual regulation with medication (MRM) into the national health program, there has been no systematic documentation on the introduction of MRM in Bangladesh, and on the approval process of local manufacturing of the mifepristone-misoprostol combination for menstrual regulation. This Research Report presents findings from the stakeholder analysis which was initiated to document the entire process of introducing MRM in the country. Findings from key informant interviews indicated some crucial factors that facilitated the process; these are presented here according to a four-part policy analysis framework: context, content, …

Harmonizing National Abortion And Pregnancy Prevention Laws And Policies For Sexual Violence Survivors With The Maputo Protocol, Jill Thompson, Chi-Chi Undie, Avni Amin, Ronald Johnson, Rajat Khosla, Ian Askew, Leopold Ouedraogo, Triphonie Nkurunziza, Sarah Rich, Elizabeth Westley, Melissa Garcia

Reproductive Health

In April 2016, the Population Council, the World Health Organization (WHO), and the International Consortium for Emergency Contraception (ICEC) convened a three-day regional technical meeting aimed at helping participating countries meet their obligations under the Maputo Protocol to protect and promote the reproductive health rights of women and girls, with a special emphasis on survivors of sexual and intimate partner violence. Participants included representatives from six countries in sub-Saharan Africa—Botswana, Ethiopia, Kenya, Malawi, Rwanda, and Zambia—as well as international and regional experts on reproductive health, law, and human rights. Presentations and discussions focused primarily on the prevention and management of …

Maternal And Fetal Outcome In Renal Transplant Recipients, Wajeeha Syed, Lumaan Sheikh

Department of Obstetrics & Gynaecology

Objective: To determine maternal and fetal outcome in renal transplant recipients.
Methodology: Retrospective analysis of the antenatal patients with renal transplant
was done between January 1st 2005 till December 31st 2015 and maternal
and fetal outcomes were determined. Data was entered and analyzed in SPSS
version 20.
Results: 08 pregnancies in 07 women who had undergone renal transplant
were included in this study. The mean age at the time of transplantation was
25.29 ±5.5 years (16-32 years). 25% cases had gestational diabetes mellitus,
75% had anemia and 50% had urinary tract infection. The mean birth weight
of babies was 2210 …

Case Of Xanthogranulomatous Oophoritis, Bushra Khan, Aliya Aziz, Rashida Ahmed

Department of Obstetrics & Gynaecology

Xanthogranulomatous inflammation is characterized by destruction of the tissues of the organ involved and replacement by chronic inflammatory cells such as lymphocytes, plasma cells, occasional neutrophils with or without multinucleated or Touton giant cells. Exact aetiology is not known but the theory of infection with organisms like Proteus, E coli, and Bacteroides fragilis is most popular. Xanthogranulomatous inflammation of the female genital tract is not common and usually involves the endometrium; however, xanthogranulomatous inflammation of the ovaries is a rare entity.