Medical Specialties Commons^™

An Investigation Of The Effects Of Pitocin For Labor Induction And Augmentation On Breastfeeding Success, Megan J. Lewis

Scripps Senior Theses

Rates of labor induction and augmentation have been increasing in recent decades (Glantz, 2005). According to the Listening to Mothers II survey, half of all labors in the U.S. are induced or augmented with Pitocin or other synthetic form of the hormone oxytocin (Declercq et al., 2006). Oxytocin, a naturally occurring hormone released in the pituitary gland, is involved in the stimulation of uterine contractions during labor and in the milk ejection reflex during breastfeeding, and research suggests it also has various effects on the brain, such as eliciting maternal behavior. However, studies have shown that exogenous oxytocin can interfere …

Comparison Of Conventional Cervical Cytology Versus Visual Inspection With Acetic Acid (Via) Among Hiv-Infected Women In Western Kenya, Hillary Mabeya, Kareem Khozaim, Tao Liu, Elkanah Omenge, David Chumba, Latha Pisharodi, J. Carter, Susan Cu-Uvin

Obstetrics and Gynaecology, East Africa

Objective: To determine the accuracy of visual inspection with Acetic Acid (VIA) versus conventional Pap smear as a screening tool for cervical intraepithelial neoplasia (CIN)/cancer among HIV-infected women.

Materials and Methods: 150 HIV-infected women attending the Moi Teaching and Referral Hospital HIV clinic in Eldoret underwent conventional Pap smear, VIA, colposcopy and biopsy. VIA and Pap smears were done by nurses while colposcopy and biopsy were done by a physician. Receiver Operating Characteristic (ROC) analysis was conducted to compare the accuracies between VIA and Pap smear in sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results: Among …

The Pregnancy Project: Impact Of Ultrasound Use During Pregnancy Care, Paige Ricci

Annual Undergraduate Conference on Health and Society

Use of ultrasounds during pregnancy continues to increase and there is much debate as to what the best practice is regarding their use, for what types of patients, at what volume level. Current evidence suggests, the extended routine use of ultrasound technology should be for all women that present complications to screen for structural anomalies during pregnancy. However, others have suggested that excessive ultrasound use may be both unnecessary, costly and potentially harmful. Evidence further suggests that mothers find the use of technology to be security enhancing during pregnancy and through the process of care, and that ultrasound use is …

Rates Of Iucd Discontinuation And Its Associated Factors Among The Clients Of A Social Franchising Network In Pakistan, Syed Khurram Azmat, Babar Tasneem Shaikh, Waqas Hameed, Mohsina Bilgrami, Ghulam Mustafa, Muhammad Ali, Muhammad Ishaque, Wajahat Hussain, Aftab Ahmed

Community Health Sciences

Background: Modern Intrauterine contraceptive device (IUCD) is very safe, highly effective reversible and inexpensive family planning method which offers 5-10 years of protection against pregnancy. The contraceptive use in Pakistan has been merely 30% for over a decade with IUCD being the least used method. Higher discontinuation rates are documented in developing countries; however no such data is available for Pakistan. Marie Stopes Society (MSS) established a social franchise outlets network branded as 'SURAJ' (Sun) in Pakistan to provide quality family planning services. This study attempts to determine IUCD discontinuation rates and its associated risk factors. Using a semi-structured questionnaire, …

Outer Space And Oocyte Developmental Competence., Andrew J Watson

Obstetrics & Gynaecology Publications

No abstract provided.

Barriers And Perceptions Regarding Different Contraceptives And Family Planning Practices Amongst Men And Women Of Reproductive Age In Rural Pakistan: A Qualitative Study, Syed Khurram Azmat, Ghulam Mustafa, Waqas Hameed, Muhammad Ali, Aftab Ahmed, Mohsina Bilgrami

Community Health Sciences

Background: Pakistan ranks as one of the most poorest and most populous in the world with poor reproductive health indicators. This study helps in understanding barriers and perceptions regarding Family Planning (FP), modern contraception, quality of care and free of charge FP services amongst men and women in rural Pakistan.
Methods: Employing purposive sampling and Focus Group Discussion (FGD) technique, this qualitative study was conducted with men and women of reproductive age in Pakistan. A total of eight FGDs were conducted in Sindh and Punjab provinces. Being descriptive in nature, the study provided a thematic analysis of the relevant health …

Puerperal Fever From Hippocrates To Pasteur, Hunter A. Hammill

Houston History of Medicine Lectures (2006-2012)

The death of a mother in childbirth leaving a newborn deserted is a sort of a desecration. This was a frequent event for early physicians. It was felt to be caused by miasmas or punishment from the gods. DaVinci felt the cause was milk stasis, Hippocrates - lochia, Virchow - weather. Then came Semmelweis, Pasteur and Lister. They started a battle with ignorance, hospital administration, budget and academic politics. Ending with the murder of Semmelweis!

Reducing Emergency Births By Modification In Oxytocin Utilization, Gary Ventolini, Michael L. Galloway, Sheela M. Barhan, Marc R. Belcastro

Obstetrics and Gynecology Faculty Publications

Background: The purpose of our study was to explore the correlation between the amount of oxytocin use and emergency vacuum, forceps, cesarean births and neonatal intensive care unit (NICU) response to fetal distress. In 2004, we restricted the criteria for oxytocin utilization for labor induction and augmentation.

Methods: This retrospective study was carried out at a large private university tertiary care hospital- affiliated, and included data from the years 2005 to 2007. We utilized hospital data from vital statistics, labor and delivery, central pharmacy and NICU. Information obtained included maternal characteristics, annual birth data, indication and numbers of emergency vacuum, …

Spontaneous Bilateral Tubal Pregnancy, Aisha Syed Wali, Rozilla Sadia Khan

Department of Obstetrics & Gynaecology

With the increase in incidence of ectopic pregnancy over the decades, bilateral ectopic pregnancy is also increasing. It is usually associated with assisted reproductive techniques (ART) but in recent years few cases of spontaneous bilateral ectopic pregnancy have been reported. Gynaecologists should be aware of this and that ultrasonography has limitations in diagnosis. In cases of ectopic pregnancy where contralateral adnexa is not clearly identified on ultrasound and fertility needs to be conserved, patient should be managed by experts in well equipped centres. A case of spontaneous bilateral tubal pregnancy that remained undiagnosed till laparotomy, is described.

Cholesterol Side-Chain Cleavage Gene Expression In Theca Cells: Augmented Transcriptional Regulation And Mrna Stability In Polycystic Ovary Syndrome, Jessica K. Wickenheisser, Jessica M. Biegler, Valen L. Nelson-Degrave, Richard S. Legro, Jerome F. Strauss Iii, Jan M. Mcallister

Obstetrics and Gynecology Publications

Hyperandrogenism is characteristic of women with polycystic ovary syndrome (PCOS). Ovarian theca cells isolated from PCOS follicles and maintained in long-term culture produce elevated levels of progestins and androgens compared to normal theca cells. Augmented steroid production in PCOS theca cells is associated with changes in the expression of genes for several steroidogenic enzymes, including CYP11A1, which encodes cytochrome P450 cholesterol side-chain cleavage. Here, we further examined CYP11A1 gene expression, at both the transcriptional and post-transcriptional level in normal and PCOS theca cells propagated in long-term culture utilizing quantitative RT-PCR, functional promoter analyses, and mRNA degradation studies. The minimal …

Mouse Rc/Btb2, A Member Of The Rcc1 Superfamily, Localizes To Spermatid Acrosomal Vesicles, Jiannan Wang, Maria E. Teves, Xuening Shen, David R. Nagarkatti-Gude, Rex A. Hess, Scott C. Henderson, Jerome F. Strauss Iii, Zhibing Zhang

Obstetrics and Gynecology Publications

Mouse RC/BTB2 is an unstudied protein of the RCC1 (Regulator of Chromosome Condensation) superfamily. Because of the significant remodeling of chromatin that occurs during spermiogenesis, we characterized the expression and localization of mouse RC/BTB2 in the testis and male germ cells. The Rc/btb2 gene yields two major transcripts: 2.3 kb Rc/btb2-s, present in most somatic tissues examined; and 2.5 kb Rc/btb2-t, which contains a unique non-translated exon in its 5′-UTR that is only detected in the testis. During the first wave of spermatogenesis, Rc/btb2-t mRNA is expressed from day 8 after birth, reaching highest levels of expression at day …

Moyamoya Disease In Pregnancy: Management After Intracranial Bypass Grafting, Alexis C. Gimovsky, Charles Macri, Susanne L. Bathgate, D. E. Ross

Obstetrics and Gynecology Faculty Publications

Moyamoya disease (MD) is a chronic, progressive cerebrovascular disease distinguished by bilateral stenosis or occlusion of the arteries around the circle of Willis with resulting prominent arterial collateral circulation. We describe a pregnant woman in whom this diagnosis was confirmed by cerebral angiogram and treated with bilateral superficial temporal artery-middle cerebral artery (STA-MCA) bypass grafting prior to conception. The patient was managed with strict blood pressure monitoring and low-dose aspirin antepartum, intrapartum, and postpartum. The patient presented in spontaneous labor at term and underwent a spontaneous vaginal delivery without complications.

Tetanus Toxoid, Reduced Diphtheria Toxoid And Acellular Pertussis Vaccination And Influenza Vaccination Of Pregnant And Postpartum Women, Colleen M. Mccormick

Master of Public Health Program Student Publications

Introduction: Infants ≤2 months are at greatest risk for morbidity/mortality from pertussis. Tdap vaccines given in late pregnancy or postpartum can protect infants from pertussis. Pregnancy increases risks for maternal and perinatal complications. Influenza vaccine (FLUV) given in pregnancy can protect women and newborns.

Objectives: To determine Tdap and FLUV rates in pregnant and postpartum patients and identify factors associated with vaccination.

Methods: Miami Valley Hospital delivery records from 01/2009-12/2011 were retrospectively reviewed. Data reviewed included age, insurance, race/ethnicity, and county of residence. Descriptive statistics analyzed prevalence of immunization, timing, and demographics. Chi-square and odds ratios detected differences between characteristics. …

Delayed Versus Early Umbilical Cord Clamping, Bracha Yaffa Sachs

The Science Journal of the Lander College of Arts and Sciences

Immediate cord clamping is a part of the active management of the third stage of labor. Active management is standard birth protocol because it significantly reduces the risk of maternal postpartum hemorrhaging. However, since recent evidence advocates delayed cord clamping, various medical practitioners and health organizations would like to incorporate delayed cord clamping in place of immediate cord clamping as a part of standard birth protocol. Proposed benefits include a serious decline in the prevalence of anemia, especially, in countries where anemia is endemic, as well as a decrease in the risk of intraventricular hemorrhage and late onset sepsis. Although …

Preserved Ex Vivo Inflammatory Status In Decidual Cells From Women With Preterm Labor And Subclinical Intrauterine Infection, Violeta Castro-Leyva, Aurora Espejel-Nunez, Gerardo Barroso, Veronica Zaga-Clavellina, Arturo Flores-Pliego, Iyari Morales-Mendez, Silvia Giono-Cerezo, Scott W. Walsh, Guadalupe Estrada-Gutierrez

Obstetrics and Gynecology Publications

Objective

To compare the inflammatory response preserved ex vivo by decidual cells isolated from women who experienced preterm labor with and without subclinical intrauterine infection.

Methods

Fetal membranes were obtained after cesarean section from 35 women who delivered before 37 weeks of gestation following spontaneous preterm labor, with no clinical evidence of intrauterine infection. Decidua was microbiologically tested and cultured. Concentrations of anti-inflammatory cytokines (IL-2, IL-4, IL-10), pro-inflammatory cytokines (IL-6, IL-8, IL-1β and TNF-α), and matrix metalloproteinases (MMP-1, MMP-2, MMP-3, MMP-7, MMP-8, MMP-9) were measured in the supernatants using Bio-Plex, and prostaglandin E2 (PGE2) was measured by enzyme immunoassay.

Results …

Preterm Birth And The Perception Of Risk Among African Americans, Gwendolyn Simpson Norman

Wayne State University Dissertations

Background: African American women deliver preterm at a rate that is two to three times that of their white counterparts, and after decades of research, this disparity in birth outcomes still remains unexplained. While factors including income, education, neighborhood conditions, infection and stress have all been associated with prematurity, no combination of these factors has explained why the disparity persists. Recently, however, racism-specific stress has emerged as a possible factor contributing to this disparity. This study was designed to learn how preterm birth was explained by African Americans directly impacted by prematurity. Methods: Interviews were conducted with African American women …

Sexually Transmitted Diseases (Stds), Donald E. Greydanus, Jane Seyler, Hatim A. Omar

Pediatrics Faculty Publications

High rates of unprotected sexual behavior in adolescents result in millions of cases of STDs in the world. This chapter reviews factors inducing high STD rates, specific STDs, and their management based on 2010 U.S. Centers for Disease Control and Prevention (CDC) STD guidelines. Clinicians should screen all their sexually active adolescent patients for STDs and provide preventive education as well as treatment measures.

Parwarish Markaz: Integrated Services For The Optimal Development Of Children Ages 0-3, Shelina Bhamani

Department of Obstetrics & Gynaecology

No abstract provided.

Attitudes, Beliefs, And Practices Of Providers And Key Opinion Leaders On Emergency Contraception In India, M.E. Khan, Deepthi S. Varma, Isha Bhatnagar, Anvita Dixit, Martha Brady

Reproductive Health

The Population Council undertook this study to assess the knowledge, attitudes, and practices regarding emergency contraception (ECP) among providers in public and private facilities and pharmacies in India. The objectives of the study were to: assess providers' knowledge of ECP's biological mechanism; understand providers' knowledge and attitudes about ECP's safety, effectiveness, and availability as an OTC drug; and identify providers' definitions of “repeated use” and profiling women who are “repeated users” of ECP. This study's findings show that most providers, including doctors and some KOLs, were incorrectly informed about ECP's mechanism of action. Service guidelines are necessary for accurate and …

Providers' And Key Opinion Leaders' Attitudes, Beliefs, And Practices Regarding Emergency Contraception In Nigeria, Babatunde A.O. Ahonsi, Salisu Mohammed Ishaku, Araoyinbo Idowu, Ayodeji Oginni

Reproductive Health

Despite significant progress in product development, procurement, and distribution in the past few decades, emergency contraception’s (EC) capacity to benefit many women in countries such as Nigeria is hampered by a number of potential barriers, that are not well understood. The Population Council, with support from the International Consortium for Emergency Contraception, documented EC-related knowledge, attitudes, and practices among providers in Nigeria as well as perceptions of key opinion leaders who help shape the policy environment for EC and family planning in general. Findings suggest significant gaps in Nigeria, potentially necessitating continuous training and re-training to help dispel misperceptions and …

Retroperitoneal Lymph Node Dissection With Concomitant Ivc Thrombectomy, Caval Wall Resection, And Grafting For Metastatic Nsgt, Tariq Hakky, Timothy Kim, Alejandro R. Rodriguez, Paul Armstrong, Devanand Mangar, Philippe E. Spiess

Obstetrics & Gynecology Faculty Publications

INTRODUCTION: The management of a post-chemotherapy retroperitoneal mass secondary to testicular cancer can present a surgical challenge when involving adjacent organs or major vascular structures. We present the first video of a retroperitoneal lymph node dissection (RPLND) with IVC (inferior vena cava) thrombectomy, caval wall resection resulting from metastatic non-seminomatous germ cell testis (NSGCT) cancer.

METHODS: In this surgical video, we highlight important surgical considerations in the management of a post-chemotherapy retroperitoneal mass with direct IVC wall invasion and level 2 thrombus in such a patient.

RESULTS: A 34 year old man underwent a right inguinal orchiectomy for a mixed …

Contraception In Adolescents, Donald E. Greydanus, Carolyn M. Lentzsch-Parcells, Hatim A. Omar

Pediatrics Faculty Publications

The age of adolescence is the time when most adolescents in the world begin to be sexually active with resultant millions of pregnancies and sexually transmitted diseases (STDs). This chapter considers methods of contraception for these adolescents, including oral contraceptives, transdermal contraception, minipills, intra-vaginal ring, injectable contraception, intrauterine devices (IUDs), barrier contraceptives, implants, and others. It is important for clinicians caring for sexually active youth to provide information regarding contraception and appropriate contraceptive prescriptions.

Reminder Systems For Self Uterine Massage In The Prevention Of Postpartum Blood Loss, S. K. Ngichabe, B. W. Gatinu, M. A. Nyangore, R. Karuga, Sikolia Wanyonyi, Jn Kiarie

Obstetrics and Gynaecology, East Africa

Background: Uterine massage may significantly reduce post partum blood loss and could be patient-driven.

Objective: To assess the effectiveness of an alarm reminder system for self uterine massage in the prevention of post partum blood loss.

Design: A random controlled trial.

Setting: Meru District Hospital, Kenya.

Subjects: One hundred and twenty seven (127) women were randomly assigned to a 15 minute alarm reminder system (71) and non-alarm (56) control arm during the fourth stage of labour.

Results: Uterine massage compliance was better in the alarm group compared to the non-alarm group ( Average massage …

Does Cerclage Improve Neonatal Outcomes In A Molar Pregnancy And A Coexistent Fetus? A Case Report, Eduardo Aguin, Victor Aguin, Ligia Cisneros, Tina Aguin, Cosmas Van De Ven, Ray Bahado-Singh

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Complete hydatiform mole and coexistent viable fetus is very rare. The use of a cervical cerclage for cervical indications in the presence of this condition has never been reported. Although the diagnosis was made postnatal, the objective is to present a case with good neonatal outcome.

Case presentation

A patient presented with vaginal spotting around 23 weeks. She has a history of four preterm deliveries. Her cervix was dilated and a cerclage was placed. She presented again with PPROM around 25 weeks. She went into spontaneous preterm labor and delivered a viable fetus that is a healthy girl …

Factors Associated With Failed Induction Of Labour In A Secondary Care Hospital, Neelofur Babar Khan, Iffat Ahmed, Ayesha Malik, Lumaan Sheikh

Department of Obstetrics & Gynaecology

Objective: To assess the factors associated with failed induction of labour (IOL) in a secondary care hospital.
Method: This is a retrospective cross sectional study on women admitted for labour induction in Aga Khan Hospital for women Karimabad from 1st Jan, 2009 to 31st Dec, 2009. Induction was considered successful if the patient delivered vaginally and failed if it ended up in Caesarean Section.
Result: Eighteen percent of our pregnant population who underwent induction of labour failed to deliver vaginally. About 25% of 328 nulliparous women had failed induction. With a Bishop score of <5 in 84.3%. In 28.2% with prolonged latent phase of more than 20 hours in Caesarean section had to be performed.
Conclusion: Nulliparity, poor Bishop score and …

Conduct Problems In Children Attending Pre-Primary Schools In Rural Areas Of Pakistan, Shelina Bhamani, Nadia Ayub

Department of Obstetrics & Gynaecology

The aim of this study was to explore the conduct problems faced by school going children in the rural areas of Pakistan. Two hypotheses were formulated to explore the significant differences between the intervention and non-intervention groups and gender on the variables of conduct and internalization. The data ofa total 386 young children were collected from three different regions, who were enrolled in government pre-primary classes. The children under study comprised two kinds of schools: intervention schools that had early childhood interventions, and non-intervention schools. The data analysis revealed no significant difference between children in intervention and non-intervention schools. However; …

Conscientious Objection And Reproductive Health Service Delivery In Sub-Saharan Africa, V. M. Lema

Obstetrics and Gynaecology, East Africa

Lack of access to quality reproductive health services is the main contributor to the high maternal mortality and morbidity in sub-Saharan Africa (SSA). This is partly due to a shortage of qualified and experienced health care providers. However conscientious objection amongst the available few is a hitherto undocumented potential factor influencing access to health care in SSA. Provision of certain reproductive health services goes counter to some individual’s religious and moral beliefs and practices. Health providers sometimes refuse to participate in or provide such services to clients/patients on moral and/or religious grounds. While the rights to do so are protected …

Key Opinion Leaders' Views Regarding Emergency Contraception In India, M.E. Khan, Isha Bhatnagar, Deepthi S. Varma, Anvita Dixit

Reproductive Health

This policy brief explores the views of key opinion leaders (KOLs) in the field of reproductive health and family welfare on provision of emergency contraception (ECPs). The study’s objective was to gain a better understanding of how the attitudes and beliefs of KOLs might influence policy and program implementation, either encouraging or opposing ECP promotion and service delivery. Results suggest strong support by the majority of KOLs to continue the sale of ECP as an over-the-counter drug. KOLs also emphasized the importance of comprehending and addressing the main barriers to ECP provision and use: poor knowledge, lack of training, moral …

Providers' Attitudes And Practices Regarding Emergency Contraception In India: Key Findings, M.E. Khan, Isha Bhatnagar, Deepthi S. Varma, Anvita Dixit

Reproductive Health

This policy brief reports key findings of a study in India that explored providers’ knowledge of how emergency contraception (ECP) works and its safety and effectiveness, their perceptions of the frequency of repeat use, their provision of ECP, and their attitudes toward women who seek it. Many of the findings of this study are encouraging. Most providers believed that ECP is an effective and safe method to prevent pregnancy and that it cannot induce abortion, and half supported the over-the-counter provision of ECP. Nevertheless, the study revealed many biases and gaps in knowledge. Recommendations include a number of ways to …

Increasing Access To Family Planning And Reproductive Health Services Through Community Work: A Case Study Of A Dual Cadre Model In India, Jaleel Ahmad, Isha Bhatnagar, M.E. Khan

Reproductive Health

Before the introduction of Accredited Social Health Activists (ASHAs) in India, mid-level auxiliary nurse midwives (ANMs) were responsible for community health education and services such as antenatal care, delivery, IUCD insertion, and sterilization referrals. The Population Council studied how community extension work and some primary care responsibilities have been shifted to ASHAs, who are tasked with identifying pregnant women; facilitating ANC check-ups; motivating women for institutional deliveries during ANC checkups; and organizing child immunization. Establishing dual worker cadres in India by shifting community extension tasks from ANMs to local ASHAs has been well conceived. Task shifting has allowed ANMs, as …