Medical Specialties Commons^™

A Comparative Analysis Of Hysterectomy Outcomes: Robotic Single-Port Vs Traditional Transvaginal Notes Approaches, Qiannan Yang, Daniel Y Lovell, Juliana Wu, Chunhua Zhang, Xiaoming Guan

Faculty, Staff and Students Publications

Introduction: This study aimed to explore the feasibility and safety of robotic single port vaginal natural orifice transluminal endoscopic surgery (RSP-vNOTES) hysterectomy when compared with traditional vaginal natural orifice transluminal endoscopic surgery (T-vNOTES) hysterectomy.

Methods: In this study, the clinical data of 135 patients who underwent RSP-vNOTES or T-vNOTES hysterectomy performed by a single minimally invasive gynecologic surgeon from January 2017 to September 2024 were retrospectively analyzed. Clinical characteristics, surgical outcomes, perioperative complications, and postoperative pain scores were collected and analyzed.

Results: A total of 79 patients underwent T-vNOTES hysterectomy and 56 patients underwent RSP-vNOTES hysterectomy. Compared to the T-vNOTES …

Investigating The Impact Of Phthalate Exposures From Personal Care Products On Uterine Fibroid Incidence And Prevalence In Us-Born Black Women, Ella Brissett

CMC Senior Theses

Uterine fibroids are benign tumors composed of smooth muscle cells and connective tissue that develop within or on the walls of the uterus. Despite being non-cancerous, they can severely affect quality of life by causing heavy bleeding, chronic pain, and reproductive complications. Fibroids are typically found in women of reproductive age, but they disproportionately affect Black women, who experience higher incidence and severity. The underlying causes of this disparity is poorly understood; however, an emerging body of research is highlighting the role of phthalates, endocrine-disrupting chemicals found in many personal care products, in exacerbating fibroid development. Through a critical analysis …

Improving Postpartum Outcomes Through Therapeutic Individual And Group Occupational Therapy Sessions In Hospitalized Antepartum Patients, Melissa C. Learish

Graduate Theses, Dissertations, and Problem Reports (ETD)

Extended hospitalization in the postpartum period is occasionally medically indicated due to a variety of diagnoses, but can pose challenges to the psychosocial well-being of pregnant women, such as social isolation, anxiety, alteration of normal life routines, and less preparation for postpartum life. In acute care settings, however, maternal management tends to focus on physical stabilization rather than holistic maternal care, including opportunities for emotional support, occupational engagement, and postpartum planning. This doctoral capstone project was designed to assess the effect of individualized and group-based occupational therapy interventions for antepartum women who have been hospitalized for extended periods of time, …

Quality Over Quantity: Doula Perspectives On Equity, Access, And Quality Of Care In Black Maternal Health Outcomes, Terry-Ann E. Lynch

West Chester University Graduate Theses, Dissertations, and Final Projects

Black maternal mortality in the United States is a public health crisis. There are a plethora of reasons as to why maternal and fetal deaths disproportionately impact Black women. From a public health perspective, health disparities are an area of concern in marginalized communities, with Black maternal mortality being a risk factor. “According to the Centers for Disease Control and Prevention (CDC), in 2021, the maternal mortality rate for non-Hispanic Black (subsequently, Black) women was 69.9 deaths per 100,000 live births, 2.6 times the rate for non-Hispanic White (subsequently, White) women (26.6)” Maternal Mortality Rates in the United States, 2021” …

Association Of Prenatal Exposure To Phthalates And Phenols With Adverse Pregnancy Outcomes, Misa Hayasaka, Diana Aboukhater, George Saade, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

OBJECTIVE:

To evaluate the association between prenatal exposures to phthalates and phenols and adverse pregnancy outcomes, including preterm birth (PTB), small-for-gestational-age (SGA) birth weight, and gestational diabetes mellitus (GDM).

METHODS:

This study analyzed data from the Environmental Influences on Child Health Outcomes consortium, which harmonized longitudinal data on more than 30,000 pregnancies and 57,000 children from 69 cohorts across the United States and Puerto Rico. Pregnancy outcomes included PTB, SGA, and GDM, identified from medical records or self-reports. Generalized estimating equations models with Poisson distribution and robust variance were used to estimate relative risks (RRs) and 95% CIs per interquartile …

Timing Of Delivery In Preeclampsia: Time To Reconsider?, Rebecca Horgan, Ahmed S. Z. Moustafa, Mackenzie Mchugh, Tetsuya Kawakita, Baha Sibai, George Saade

Department of Obstetrics & Gynecology Faculty Publications

The article discusses the need to reassess the timing of delivery in cases of preeclampsia, a condition affecting 2%–8% of pregnancies and linked to significant maternal and neonatal risks. It highlights that existing guidelines, primarily based on older studies, may not adequately reflect current clinical practices and advancements in neonatal care. The authors suggest that planned delivery at 34–36 weeks of gestation may offer maternal benefits without increasing short-term neonatal morbidity, while also emphasizing the importance of considering long-term outcomes for both mothers and infants. They advocate for further research, including large-scale randomized trials, to better understand the implications of …

Diagnostic Dilemma: Appendiceal Endometriosis Mimicking Acute Appendicitis In A Pregnant Patient, Samantha Perez, Abigail Haythron, Trey Doss, Keisha Reddick

South Atlantic Division GME Research Day 2025

No abstract provided.

Contribution Of Low Birthweight To Neonatal Intensive Care Unit Admission Among Newborns Delivered At Hca Hospitals In The State Of Georgia: A Mediation Analysis, Brinkley Bray, Bailey Brown, Katelyn Crumbley, Taylor Templeton-Jager, Anthony Royek, Anthony Kondracki

South Atlantic Division GME Research Day 2025

No abstract provided.

Improving Mmr Vaccine Administration Among Rubella Non-Immune Postpartum Women – A Quality Improvement Project, Renée Ricci, Erika Olsen, Final Patel, Stephanie Tootle, Dina Linfoot, Anthony Royek, Eric Shaw

South Atlantic Division GME Research Day 2025

No abstract provided.

39 Week Labor Induction Versus Expectant Management And Cesarean Section Rates In Low-Risk Multiparous Women, A Tanner Fincher, Brendon Cornett, Michael G. Flynn, Sylwia Blawat, Mikalah Maury, Anthony Royek, Arthur M. Baker

South Atlantic Division GME Research Day 2025

No abstract provided.

Milk-Alkali Syndrome In Pregnancy: The Hidden Risk Of Over-The-Counter Calcium Supplementation, Lilly Mcincrow, Anna Bryce Tucker, Samantha Perez, Nanette Woodward, Anthony B. Royek

South Atlantic Division GME Research Day 2025

No abstract provided.

Addison's Disease In Pregnancy: A Case Report And Literature Review, Eleanora Stark, Reese Groover, Andrew Royek, Anthony B. Royek, Marshall Akin

South Atlantic Division GME Research Day 2025

No abstract provided.

Severe Rhabdomyolysis During First Trimester Pregnancy: A Case Report, Cameron Holsomback, Anna Bryce Tucker, Andrew Royek, Tanner Fincher, Anthony B. Royek

South Atlantic Division GME Research Day 2025

No abstract provided.

Pregnancy Management In A Patient With Branchio-Oto-Renal Syndrome And A History Of Renal Transplant, Lilly Mcincrow, Sara Hitt, Nanette Woodward, Anthony B. Royek

South Atlantic Division GME Research Day 2025

No abstract provided.

Maternal Retinoblastoma And Fetal Surveillance During Pregnancy: Is This Hereditary Or Not?, Bethany Bowling, Shea Mcgrinder, Amanda Royek, Reese Groover, Anthony B. Royek

South Atlantic Division GME Research Day 2025

No abstract provided.

Complement-Mediated Microangiopathic Hemolytic Anemia (Cm-Maha) In A Postpartum Patient Whose Index Pregnancy Was Complicated By Pre-Eclampsia, Sara Hitt, Samantha Perez, Anthony B. Royek, Mariah Piazza

South Atlantic Division GME Research Day 2025

No abstract provided.

Spontaneous Uterine Rupture In The Second Trimester: Risk Factors And Clinical Instincts, Lauren Wells, Shea Mcgrinder, Amanda Royek, Bethany Bowling, Anthony B. Royek

South Atlantic Division GME Research Day 2025

No abstract provided.

Use Of Indocyanine Green Angiography To Reduce Postoperative Complications In Post-Mastectomy Breast Reconstruction: An Umbrella Review, William R. Clifton, Phil Moon, Emily V. Clifton, Julia C. Stager, Spencer R. Anderson

South Atlantic Division GME Research Day 2025

No abstract provided.

A Case Of Twin Gestation In A Rudimentary Uterine Horn Resulting In Rupture: The Importance Of Education And Imaging, Shelby Freeberg, Taylor Penny, Joa Allen

South Atlantic Division GME Research Day 2025

No abstract provided.

Nutritional Management Of Low Birth Weight And Preterm Infants In Low- And Low Middle-Income Countries, Maha Azhar, Rahima Yasin, Sawera Hanif, Sharib Afzal Bughio, Jai K. Das, Zulfiqar Ahmed Bhutta

Institute for Global Health and Development

Introduction: Preterm and low birth weight (LBW) infants are at an increased risk of morbidity and mortality compared with their term counterparts, with more than 20 million LBW infants born each year, the majority in lower middle-income countries (LMICs). Given the increased vulnerability and higher nutritional needs of these infants, optimizing feeding strategies may play a crucial role in improving their health outcomes.
Methods: We updated evidence of Every Newborn Series published in The Lancet 2014 by identifying relevant systematic reviews, extracting low-income country (LIC) and LMIC data, and conducting revised meta-analysis for these contexts.
Results: We found 15 reviews; …

Effectiveness And Safety Of Intravenous Iron Therapy In Outpatient Obstetrical Clinic For Treatment Of Iron-Deficiency Anemia During Pregnancy, Ellen M. Murrin, Olivia S. Lebeau, Lillian Singer, Mark A. Kassab, Peyton Kalan, Julie Costanzo, Scott A. Sullivan, George L. Maxwell, George R. Saade, Antonio F. Saad

Department of Obstetrics & Gynecology Faculty Publications

Background

Iron-deficiency anemia (IDA) affects over one-third of pregnant patients globally, contributing to severe maternal morbidity and adverse neonatal outcomes. Oral iron supplementation, while cost-effective, is limited by poor absorption, significant gastrointestinal side effects, and poor adherence. The use of intravenous (IV) iron addresses many of these concerns, including eliminating GI side effects and the need for daily therapy. However, administration of IV iron in pregnant patients is typically restricted to specialized infusion centers or hospitals due to concerns about acute side effects, cost, resource utilization, the need for fetal heart rate monitoring, and extended infusion times.

Methods

This descriptive …

Defining Dysphoric Milk Ejection Reflex: Using Premenstrual Dysphoric Disorder As A Framework For Proposing Preliminary Diagnostic Criteria, Megan Howard, Teni Davoudian, Nicole H Cirino

Faculty, Staff and Students Publications

Dysphoric Milk Ejection Reflex (D-MER) is a distinct neurobiological condition characterized by negative alterations in mental state in response to milk letdown during lactation. Symptoms vary by patient and can include feelings of sadness, anxiety or agitation. Importantly, the symptoms are brief, typically lasting no more than 5 minutes. Prevalence has been found between 6 and 27% of lactating women, but studies show heterogeneity, due in part to inconsistent definition. D-MER is not currently classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD), which presents a challenge for researchers of the …

Prenatal Alcohol Exposure Inhibits Transient Expression Of Autophagy And Synaptic Proteins In Developing Brain, Monica Hampe, Nune Darbinian, Nana Merabova, Armine Darbinyan, Jamal Hamze, Uday Bharai, Yuri Persidsky, Mary F Morrison, Shohreh Amini, Laura Goetzl, Michael E Selzer

Faculty, Staff and Student Publications

Introduction: Neuronal apoptosis and consequent inhibition of autophagy, with loss of synaptic connections are central events in the genesis of fetal alcohol spectrum disorders (FASD). However, studies of molecular mechanisms of autophagy in human fetal brain are limited. Recently, prenatal exposure to EtOH was associated with reduced miRNA-9 levels in fetal brain-derived exosomes (FB- Es) isolated from maternal plasma, which correlated with small eyes, an anatomical hallmark of fetal alcohol syndrome (FAS). Since miR-9 targets several genes that regulate synaptic plasticity, EtOH-induced inhibition of miR-9 could potentially result in dysregulation of genes involved in synaptogenesis/plasticity.

Methods: Rats were fed a …

In Utero Alcohol And Tobacco Exposure, Maternal Depression, And Maternal Obesity Are Associated With Impaired Oligodendrocyte Differentiation In The Developing Brain, Uday Bharai, Jamal Hamze, Benjamin Zhang, Monica Hampe, Emily Sparks, Nana Merabova, Gabriel Tatevosian, Armine Darbinyan, Mary F Morrison, Laura Goetzl, Nune Darbinian, Michael Selzer

Faculty, Staff and Student Publications

Introduction: Fetal alcohol spectrum disorder (FASD) is the leading preventable cause of pediatric cognitive disability and is associated with dysmyelination. We examined possible clinical co-determinants that might interact with EtOH in impairing oligodendrocyte (OL) development. Women who drink, including pregnant women, also disproportionately suffer from depression (mDepression), which we have shown is a risk factor for FASD. Might depression during pregnancy contribute to OL pathology? Maternal obesity (mObesity) also inhibits white matter development in fetal brain. Finally, tobacco exposure inhibits not only OL development, but also the production of structural proteins, such as actin. Our human biobank derived from voluntarily …

Association Of Maternity Care Deserts With Maternal And Pregnancy-Related Mortality, Rula Atwani, Lindsay Robbins, George Saade

Department of Obstetrics & Gynecology Faculty Publications

OBJECTIVE:

To evaluate the association between the level of maternity care access and maternal and pregnancy-related mortality.

METHODS:

This was a cross-sectional analysis of county-level data in the United States from January 2018 to December 2021. Using the level of maternity care access, we categorized counties into desert, low access, moderate access, and full access. The primary outcome of interest was maternal mortality rate per 100,000 live births. A secondary outcome was pregnancy-related mortality rate per 100,000 live births. Absolute risk differences and adjusted incidence rate ratios were calculated for maternal mortality and pregnancy-related mortality with multivariable negative binomial mixed-effects …

Association Between The Intensity Of Exercise In The First Trimester And Early Second Trimester And The Risk Of Gestational Diabetes, Takaki Tanamoto, Misa Hayasaka, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

Objective

Although some studies show that exercise decreases the incidence of gestational diabetes mellitus (GDM), the optimal exercise intensity during pregnancy remains unclear. We examined GDM risk according to exercise intensity in pregnant individuals.

Methods

We analyzed data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers‐to‐Be (nuMoM2b), a prospective study enrolling nulliparous individuals in the first trimester. Participants with pregestational diabetes or delivery before 20 weeks were excluded. Exercise intensity during the first (6–13 weeks’ gestation) and early second (16–21 weeks’ gestation) trimesters was categorized by metabolic equivalent of task hours per week (MET‐hr/week) as none, low intensity (< 7.5), moderate intensity (7.5–14.9), or high intensity (≥ 15). The primary outcome was GDM; secondary outcomes included preeclampsia, gestational hypertension, preterm birth, small‐for‐gestational‐age birth, and stillbirth. Adjusted relative risks (aRRs) with 95% confidence intervals (CIs) were calculated using a generalized linear mixed‐effects model with a Poisson distribution and robust error variance, controlling for the random effects of individuals and potential confounders.

Results …

Association Of Mean Arterial, Systolic, And Diastolic Blood Pressure Trends In Early Pregnancy With Superimposed Preeclampsia With Severe Features In Pregnancies Complicated By Chronic Hypertension, Tetsuya Kawakita, Justin M. Leach, George R. Saade, Kim Boggess, Lorraine Dugoff, Brenna L. Hughes, Joseph Bell, Kjersti Aagaard, Rodney K. Edwards, Kelly Gibson, David M. Haas, Lauren Plante, Torri Metz, Brian Casey, Sherri Longo, Matthew K. Hoffman, Kara K. Hoppe, Methodius Tuuli, Michelle Y. Owens, Heather Frey, Todd Rosen, Uma M. Reddy, Wendy Kinzler, Emily Su, Iris Krishna, Mary E. Norton, Daniel Skupski, Yasser Y. El-Sayed, Ronald Librizzi, Mounira Habli, Shauna Williams, Gabriella Pridjian, David S. Mckenna, Sarah Osmundson, Joanne Quinones, Zorina Galis, Lorie Harper, Namasivayam Ambalavanan, Jeff M. Szychowski, Alan T.N. Tita

Department of Obstetrics & Gynecology Faculty Publications

OBJECTIVE: To evaluate the association of longitudinal systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in early pregnancy with later development of superimposed preeclampsia with severe features in pregnancies complicated by mild chronic hypertension.

METHODS: This secondary analysis used data from the CHAP (Chronic Hypertension and Pregnancy) trial, a multicenter randomized controlled trial that involved pregnant individuals with chronic hypertension. Participants were categorized based on the development of superimposed preeclampsia with severe features. Longitudinal blood pressure measurements from enrollment to the development of superimposed preeclampsia with severe features or delivery were assessed using regression models. …

Longitudinal Assessment Of Fetal Myocardial Performance Index In Normal Pregnancy Using Spectral Tissue Doppler, R. Horgan, E. Sinkovskaya, E. Kalafat, G. Saade, A. Abuhamad

Department of Obstetrics & Gynecology Faculty Publications

Objective

Although spectral tissue Doppler imaging is recognized as the optimal method for assessing the fetal myocardial performance index (MPI), longitudinal reference ranges for fetal MPI measured using spectral tissue Doppler have not been established. Our objective was to use spectral tissue Doppler data to establish gestational-age-specific reference ranges from 12–33 weeks for left and right ventricular fetal MPI.

Methods

This was a prospective longitudinal study of women aged 18–35 years, with a body mass index below 30 kg/m² and a singleton pregnancy conceived spontaneously. Fetal MPI measurements were obtained in the first, second and third trimesters and MPI was …

Interobserver Variability Regarding Adequacy Of Oropharyngeal Exposure For Transoral Robotic Surgery May Necessitate Staging Endoscopy: Evaluating Tors Exposure, Colleen Schinderle, Kevin J. Carlson, Reem Sharaf Alddin, Jeffery J. Houlton, Matthew J. Bak, Daniel W. Karakla, Jonathan R. Mark

Department of Otolaryngology (ENT) Faculty Publications

[First paragraph] Transoral robotic surgery (TORS) for the treatment of oropharyngeal cancer has become centered at tertiary referral centers. To avoid treatment delays or multiple anesthetics, the need for repeat operative endoscopy may be questioned when the diagnosis has been made at an outside institution. However, inadequate visualization of relevant anatomy can preclude TORS candidacy and may lead to procedure abortion or conversion to an open technique.²,³ To evaluate this dilemma, we explored the ability to assess oropharyngeal exposure for TORS candidacy via operative endoscopic photo-documentation.

Comparison Of Transversus Abdominis Plane Block Versus Intrathecal Clonidine In Lower Segment Caesarean Section - A Prospective Observational Study, Christy Maria Paul, Dr Somsundar R G Associate Professor, Dr Archana B N Assistant Professor, Dr. Shivakumar G Pofessor And Hod

Digital Journal of Clinical Medicine

Comparison of Transversus Abdominis Plane Block versus Intrathecal Clonidine in Lower Segment Caesarean Section - A Prospective Observational Study

Background and Objective: In the majority of abdominal procedures, transverse abdominis plane block, one of the fascial plane blocks, has been used extensively to treat post-operative pain. Ultrasound has gained popularity in the management of cesarean patients due to its ease of use and reduced adverse effects.To assess the effectiveness of ultrasound guided transverse abdominus plane block with intrathecal clonidine for post surgical pain control in lower segment cesarean patients.

Material and Methods: This prospective observational study was done in …