Medical Specialties Commons^™

A Look Into Postpartum T2dm Screening In Patients Diagnosed With Gdm, David Vincent Ream, Joshua Ferrell, Ashlee Nichole Tillery

South Atlantic Division GME Research Day 2025

No abstract provided.

Improving Knowledge And Confidence Of Family Nurse Practitioners In Offering The Hpv Vaccine, Leni Terano Fisher

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Introduction

Despite the recommendations of the United States Advisory Committee on Immunization Practices, HPV immunization lags behind other routine vaccines by up to 31%. Although there are many reasons for the low vaccine rate, provider hesitancy and lack of confidence significantly contribute to suboptimal HPV vaccine uptake.

Objectives

This project aimed to utilize evidence-driven interventions to increase family nurse practitioners' (FNPs) knowledge and confidence in offering the HPV vaccine.

Methods

Participants were given pre- and post-questionnaire surveys. The Wilcoxon Rank Test was used to compare, quantify, and measure the results of the eight-week data collection.

Results

The subjects were …

A Standardized Surgical Protocol For Placenta Accreta Spectrum Disorder At An Accreta Center Of Excellence, Ana Adams, Monica Rodriguez, Kate Hansen, Aysu Erdemir, Robert Cohen

North Texas Research Forum 2025

Introduction Placenta Accreta Spectrum Disorder (PASD) refers to a spectrum of abnormal invasion of the placenta into the uterus during pregnancy. PASD ranges in severity from involvement through the endometrial layer of the uterus to complete invasion involving other pelvic structures. This abnormal invasion can result in significant postpartum hemorrhage, often requiring large-volume transfusions, about six units of packed red blood cells on average. The maternal mortality rate associated with PASD is approximately 4-7%. The Society for Maternal-Fetal Medicine (SMFM) recommends that pregnancies complicated by PASD be delivered in hospitals with dedicated interdisciplinary teams, referred to as “Accreta Centers of …

Marginal Cord Insertion And Funic Presentation Mimicking Vasa Previa, Fran Franceschini Lopez, Andrew Tucker, Narinta Limtrakul, Manuel Rivera-Alsina

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

The Influence Of Senate Bill 8 On Permanent Sterilization In Texas Women: A Retrospective Analysis, Isabella Sciacca, Chrystal Stallworth, Cameron Stokes, Hannah Affleck, Timothy Kremer, Michele Mccarroll

North Texas Research Forum 2025

Introduction Of the 6.1 million pregnancies that occurred in the United States in 2011, 45% were unintended. Of those unintended pregnancies, 42% ended in elective abortion. In the United States, the most common contraceptive method used is permanent female sterilization. Senate Bill 8 (SB8), also known as the Texas Heartbeat Act, was put into effect on September 1st, 2021. This act virtually bans all abortions after six weeks gestation. This study is aimed at evaluating the association between the implementation of SB8 and patients who underwent permanent sterilization procedures. Methods Patients who underwent permanent sterilization in Texas within a multi-institute …

Large Mesenteric Cyst Casting Wide Differential Across Specialties, Jessica Harper, Katherine Kleinberg, Jose S. Saldivar

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Improvement In Prenatal Education And Involvement In Patient Care, Miranda Ibrahim, Christelle Reeves, Timothy Kremer

North Texas Research Forum 2025

BACKGROUND: While the attempt is to educate the patient (and their family members) and empower them in their medical decision making, integration of birth plans and discussion of such plans is not routinely implemented by most obstetrical providers. There is currently no standardized approach to the education and birth plan development/or the obstetrical patients. The goal of this project, therefore, is to develop a standardized approach to discussion of birth plans and, albeit indirectly, allow for an opportunity for education for obstetrical patients. METHODS: On a daily basis, through birth plan discussions with patients during routine obstetrical visits, and via …

Do Patients Who Receive Dexmedetomidine As An Adjunct To Spinal Anesthesia For Cesarean Delivery Achieve Longer Block Duration Compared To Those Who Receive Spinal Anesthesia With Local Anesthetic Alone?, Liana S. Garrison

Theses, Dissertations and Capstones

Problem Statement: Cesarean delivery is associated with significant postoperative pain, typically managed with spinal anesthesia using a local anesthetic. While opioids are often added as adjuncts, the addition of dexmedetomidine, an alpha-2 agonist, has emerged as a potential alternative that may enhance the efficacy of the spinal block in terms of pain management, potentially improving block duration and quality compared to local anesthetic alone.

Methodology: A literature review was conducted on the use of dexmedetomidine as an adjunct to spinal anesthesia for patients undergoing cesarean sections. Databases used for the search included PubMed, CINAHL Complete, and MEDLINE. The keywords used …

Implementation Of Screening For Vte Prophylaxis For The Prevention Of Vte In The Antepartum And Postpartum Period, Elizabeth Campos, Michelle Mieles, Aaron Poole

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Postpartum Glucose Testing And Primary Care Follow-Up For Women With Gestational Diabetes Mellitus: A Quality Improvement Project, Madeline Bartram, Anusha Hussain, Timothy Kremer

North Texas Research Forum 2025

BACKGROUND: Patients with gestational diabetes mellitus (GDM) have a 40-70% lifetime risk for developing type 2 diabetes mellitus, which is 9 times the risk of patients without a history of GDM. Joint association guidelines recommend a 75-gram, 2-hour oral glucose tolerance test (GTT) at 4 to 12 weeks postpartum for all patients with GDM, and to follow-up with a primary care physician. Currently, less than half of these patients do not receive the recommended postpartum glucose testing and/or follow-up. METHODS: For each GDM-affected pregnancy, two primary outcome measures were retrospectively collected from the clinic EHR: completion of the 75-gram GTT …

Planned Out Of Hospital Birth Maternal And Neonatal Outcomes In A Single Institution, Priyanka Vuppala, Juhi Singhal, Linda Haddox

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Fetal Presentation Confirmation On L&D With Ultrasound, Noelle Coen, Aaron Poole

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Incarcerated Gravid Uterus, Adelene Morrow, Aaron Poole

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Management Of Placenta Accreta Spectrum Disorder Diagnosed Prior To Viability, Anjali Patel, Virginia Lowe, Linda Haddox

Central & West Texas and San Antonio GME Research Day 2025

No abstract provided.

Abnormal Pap Smears In Pregnancy And The Potential For Fulminant Cervical Cancer: A Case Report And Review Of Staging And Contemporary Treatment, Aliya Nurani, Claud Crosby, Ashley Valenzuela, Meenah Dhir, Mikalah Maury, Stephen Salmieri, Anthony Royek

South Atlantic Division GME Research Day 2025

No abstract provided.

A Rare Case Of Vulvar Endometriosis, Taylor Penny, Shelby Freeberg, Brittany Stofko

South Atlantic Division GME Research Day 2025

No abstract provided.

A Rare Case Of Cutaneous Vulvar Leiomyoma Complicated By Postoperative Hematoma Formation, Ariel Moskowitz, Kimberly Udell

North Texas Research Forum 2025

Leiomyomas are benign, well-circumscribed, monoclonal smooth muscle tumors. While leiomyoma of the uterus are exceedingly common, soft tissue leiomyomas are rare and often misdiagnosed. While excisional therapy is the mainstay of treatment, wide vulvar excisions can cause significant discomfort and disfigurement of the vulva. Here we present a unique case of a vulvar hematoma excision complicated by hematoma formation. A 39-year-old female presented to the ambulatory gynecology clinic with a 4-month history of an enlarging vulvar mass. On exam, a 4-cm mass was seen arising from the right upper labium. Office biopsy showed a well-circumscribed spindle cell lesion without nuclear …

Pregnancy-Related Delusional Beliefs In Midlife And Late-Life Women: A Case Series, Dyuksha Arora, Ashita Adarsh, Kishor M. Manohar Rao, Anand R, Soumya Rajshekar Patil, Akshatha Cj

Digital Journal of Clinical Medicine

Pseudocyesis and delusional pregnancy represent rare but clinically significant presentations across psychiatric practice. While pseudocyesis involves a false belief of pregnancy accompanied by physical manifestations, delusion of pregnancy refers to a fixed belief of being pregnant despite clear contrary evidence. Both conditions pose considerable challenges as they involve close consultation and liaison between Obstetrics & Gynaecology and Psychiatry. There are a few studies from tertiary care general hospitals in India. Here we report two case series.

Case 1: A 43-year-old married woman from a rural background with an 8-year history of recurrent depressive disorder and dysthymia, presented with 3 months …

One Airway, One Disease In Pregnancy: A Prospective Observational Study On The Correlation Between Upper And Lower Airway Inflammation In Pregnant Women, Durga K, Yuvarajan S

Digital Journal of Clinical Medicine

Background: The well-established "One Airway, One Disease" concept recognizes the deep physiological and pathological connections between conditions affecting both the upper and lower respiratory tracts, most notably allergic rhinitis and asthma. During pregnancy, a woman's body undergoes significant immunological, hormonal, and physiological changes, which can profoundly influence and modulate existing or emerging airway inflammation.

Objective: This prospective observational study was designed with the primary objective of meticulously evaluating the correlation between upper and lower airway inflammation in pregnant women. We aimed to achieve this by assessing a range of clinical symptoms, objective functional parameters, and specific inflammatory markers.

Methods: We …

Methodological And Clinical Concerns In The Study On Postpartum Hypertension Management, Takaki Tanamoto, Kyosuke Kamijo, Yusuke Tsutsumi, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

[Introduction] We read with interest the recent study by Rosenfeld et al.¹ However, we have several clinical and methodological concerns about this study.¹

First, this study's propensity score matching (PSM) lacked key clinical confounders, including perinatal risk factors and the highest systolic/diastolic blood pressures. Smoking, alcohol use, and multifetal gestation, which influence blood pressure during pregnancy,²,³ potentially affect both primary and secondary outcomes. Additionally, the authors did not report standardized mean differences before and after PSM, which are essential for assessing balance.⁴

Diagnosis Of Hypertensive Disorders In Pregnancy, Rebecca Horgan, Yara Hage Diab, Maged Costantine, George Saade, Baha Sibai

Department of Obstetrics & Gynecology Faculty Publications

Hypertensive disorders of pregnancy, including chronic hypertension, superimposed preeclampsia, gestational hypertension, and preeclampsia, affect 10-20% of pregnancies and are a significant cause of maternal and perinatal mortality. The incidence of these disorders is rising due to factors such as advanced maternal age, obesity, assisted reproductive technology, and increased rates of preexisting comorbidities. Differentiating pregnancy-associated hypertension from pre-existing chronic hypertension is challenging, as the overlap between the two may be broadening due to the changing demographics of the pregnant population. This review critically evaluated the evidence regarding the current time periods recommended to make a diagnosis of a hypertensive disorder of …

Maternal Health Predictors In Ohio, Sritha Donepudi, Humza Khan

Scholarship in Medicine - All Papers

Background: Ohio has continued to have a maternal mortality rate higher than the average which has posed the question of how geographic location, socioeconomic status, and demographics affect these rates.
Objective: This paper aims to investigate the relationship between variables affecting maternal mortality rates in Ohio such as teen birth rates and primary care physician access with where one lives between Rural and Urban areas and their household income in order to provide more information for future research.
Methods: This paper utilized County Health Rankings and statistical and correlation analysis with SPSS to analyze rates across counties in Ohio.
Results: …

Treatment Of Ovarian Clear Cell Carcinoma: A Case Of Successful Management With Targeted Therapies., Sydney Pence, Kellie Rath, Aine Clements

Women’s Health Articles

No abstract provided.

Ai Significantly Improves Detection Of Prenatal Ultrasounds Suspicious For Major Congenital Heart Defects By Obgyn/Mfms, Jennifer Lam-Rachlin, Rajesh Punn, Sarina K. Behera, Miwa Geiger, Matthias Lachaoud, Nadine David, Sara Garmel, Matthew K. Janssen, Kendra Sylvestser, John Kennedy

Conference Presentation Abstracts

Objective: Congenital heart defects (CHDs) are a leading cause of infant morbidity and mortality partly due to low prenatal detection rates. We evaluated whether an artificial intelligence (AI) system can improve the detection of CHDs on fetal ultrasound exams among both general OBGYNs and MFM specialists. Study Design: The AI system analyzes all grayscale 2D ultrasound cines of an exam and detects 8 morphological findings associated with severe CHDs. The presence of any such finding should justify patient referral for further examination. The AI system identifies each finding as present, absent or inconclusive, and highlights frames where findings can be …

Cerebroplacental Doppler Ratio For The Prediction Of Adverse Perinatal Outcomes In Late-Onset Fetal Growth Restriction, Sonia Sajja, Onur Turkoglu, Torey Asao, Perry Friedman, Ray Bahado-Singh

Conference Presentation Abstracts

Objective: Late-onset fetal growth restriction (LO-FGR), defined as onset 3 32 weeks gestation, is the more common subgroup of FGR. The umbilical artery Doppler is usually unaffected. There are no subgroup-specific guidelines for monitoring pregnancies affected by LO-FGR. We compared the utility of the cerebroplacental Doppler ratio (CPR) to the Biophysical Profile (BPP), a widely endorsed FGR monitoring tool, for the prediction of adverse perinatal outcomes (APO). Study Design: This is a retrospective cohort study of LO-FGR, defined as estimated fetal weight < 10th%, from 2013-2018. Using logistic regression analysis, we determined whether low CPR < 5th% and BPP score £ 6 significantly independently predicted the composite APO defined as one or more complications: cord pH < 7.20, 5-minute Apgar score of < 5, operative or cesarean delivery secondary to non-reassuring fetal heart tracing, assisted respiration at birth, NICU admission, and/ or perinatal death. Secondarily, we also evaluated prediction of severe neonatal morbidity (SNM) defined in Table 1 (legend). Results: There were 233 cases of LO-FGR of which 76 (34%) had a low CPR percentile and 28 (13%) had a low BPP score. There were 22 (9.9%) cases with SNM of which 5 (2.1%) had a low CPR percentile and 4 (1.8%) had a low BPP score. A low CPR was associated with a significantly higher rate of individual and composite APO than cases with normal CPR percentile (p < 0.001) [Table 1]. Both a low CPR percentile and a low BPP score significantly predicted APO overall. CPR appeared to be a better predictor of the APO, controlling for gestational age at testing [Table 2]. Only BPP significantly predicted SNM: CPR (OR = 4.64, p = 0.13) and BPP (OR = 4.11, p = 0.038). Conclusion: A low CPR percentile was a significant independent predictor of perinatal complications in LO-FGR, including abnormal fetal heart rate tracing, smaller birthweight percentile, and NICU admission. CPR appeared superior to BPP overall. CPR should be considered as a fetal surveillance tool in LO-FGR.

Initiation Of Sterile Vaginal Preps Prior To Cesarean Sections: A Quality Improvement Project, Diane Gilbertson, Timothy Kremer, Kimberly Udell

North Texas Research Forum 2025

OBJECTIVE: Research on patients undergoing routine gynecological procedures with a vaginal preparation has demonstrated a significant reduction in post-operative infections by decreasing the burden of vaginal bacteria. Despite this research, as well as evidence that they reduce postpartum endometritis, especially in labor patients or those with ruptured membranes (Lui), vaginal preparations prior to cesarean section are not standard practice. Prior to the initiation of this quality improvement project, no patients delivering at Medical City Arlington received a vaginal preparation prior to a cesarean delivery. The goal of this quality improvement project is to improve clinical care, patient safety, and healthcare …

Retroperitoneal Schwannoma: An Abnormal Presentation Mimicking A Pelvic Mass, Isabella Sciacca, Christelle Reeves, Cameron Stokes, Steven Seligman

North Texas Research Forum 2025

Introduction: A schwannoma is an encapsulated nerve sheath tumor originating from differentiated Schwann cells. They are preferentially localized to the head, neck and extremities with a minor occurrence of 1-3% in the retroperitoneal space. Schwannoma symptoms often are asymptomatic due to slow growth but can present with symptoms according to their location. We report a case of a 45-year-old female with a retroperitoneal schwannoma that mimicked an ovarian mass. Case Summary: A 45-year-old female with a ten-year history of a right ovarian cyst presented with lower abdominal pain, early satiety, hematuria, low back pain and constipation. Transabdominal ultrasound showed right …

Optimization Of Venous Thromboembolism (Vte) Prophylaxis In Pregnancy And The Postpartum Period, Sereena Jivraj, Isabella Sciacca, Sherrie Dixon, Timothy Kremer

North Texas Research Forum 2025

Background: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolisms (PE) continues to be a leading cause of maternal mortality (MM) in the United States. VTE accounts for roughly 9-10% of all maternal deaths. Other countries have adopted anticoagulation protocols to reduce MM rates, but the US has yet to follow suit. The American College of Obstetricians and Gynecologists (ACOG), the American College of Chest Physicians (CHEST), and the Royal College of Obstetricians and Gynaecologists (RCOG) all vary in their guidelines for thromboembolism prophylaxis. Patients who deliver by Cesarean section (C-section) have higher incidences of MM due …

A Case Of Life Threatening Hemorrhage After In Office Drainage Of Suspected Bartholin Gland Cyst, Rebecca Johnson, Sandra Zhi, Megan Khuu, Robert Boccaccio

North Texas Research Forum 2025

Introduction: Labial masses are common in OBGYN clinics. They are benign the vast majority of times. Common causes are Bartholin cysts, epidermal inclusion cysts, labial warts, sebaceous cyst. We report a case of a 33 year old who presented for what appeared to be a benign Bartholin gland cyst but resulted in massive hemorrhage, exam under anesthesia, massive transfusion, and embolization. Case Summary: A 33 year old patient presents for a painless, non-enlarging labial mass that has been present for 3 weeks. History and physical exam were consistent with a commonly encountered condition, Bartholin gland cyst. Routine incision and drainage …

Improving Patients’ Postpartum Contraception Plans And Access To Postpartum Contraception, Rebecca Johnson, Timothy Kremer, Nicole Tenzel

North Texas Research Forum 2025

Introduction: ACOG recommends prenatal discussions with patients regarding their lifetime reproductive plans and postpartum contraception. Up to 40% of patients are not seen for postpartum visits and this rate is highest amongst populations with limited resources (ACOG Practice Bulletin: Optimizing Postpartum Care). By having consistent documentation amongst our clinic providers we aim to maximize patient education and choice in their postpartum contraception. Methods: The providers at our clinic were educated on where to document postpartum contraception discussions on the obstetric flow sheet under the “problems” tab. Providers were to document the discussion even if the patient declined postpartum contraception. Every …