Obstetrics and Gynecology Commons^™

Cost-Effectiveness Of A Family Planning Voucher Program In Rural Pakistan, Edward Ivor Broughton, Waqas Hameed, Xaher Gul, Shabnum Sarfraz, Imam Yar Baig, Monica Villanueva

Community Health Sciences

Introduction: This study reports on the effectiveness and efficiency from the program funder's perspective of the Suraj Social Franchise (SSF) voucher program in which private health-care providers in remote rural areas were identified, trained, upgraded, and certified to deliver family planning services to underserved women of reproductive age in 29 districts of Sindh and 3 districts of Punjab province, Pakistan between October 2013 and June 2016.
Method: A decision tree compared the cost of implementing SSF to the program funder and its effects of providing additional couple years of protection (CYPs) to targeted women, compared to business-as-usual. Costs included vouchers …

Results Of A Pilot Study In The U.S. And Vietnam To Assess The Utility And Acceptability Of A Multi-Level Pregnancy Test (Mlpt) For Home Monitoring Of Hcg Trends After Assisted Reproduction., Tara Shochet, Ioanna A Comstock, Nguyen Thi Nhu Ngoc, Lynn M Westphal, Wendy R Sheldon, Ly Thai Loc, Jennifer Blum, Beverly Winikoff, Paul D Blumenthal

Obstetrics and Gynecology Faculty Publications

Background

To evaluate the utility and acceptability of using multi-level pregnancy tests (MLPTs) at home to monitor hCG trends following assisted reproductive technology (ART).

Methods

One hundred and four women presenting for ART at either Stanford Medicine Fertility and Reproductive Health Clinic (Stanford, CA) or Hung Vuong Hospital (Ho Chi Minh City, Vietnam) participated in this pilot study. Women were asked to perform the MLPT at home, primarily on days when they were also scheduled to receive standard clinic-based serum hCG testing. These tests were administered up to 6 times over the 6-week period following embryo transfer or intrauterine insemination …

Maternal Intuition Of Fetal Gender, Michael Mcfadzen, David P. Dielentheis, Ronda Kasten, Maharaj Singh, Joe Grundle

Journal of Patient-Centered Research and Reviews

Purpose: Fetal gender speculation is a preoccupation of many expecting parents, and pregnant women commonly profess to intuitively know the gender of their unborn babies. This study objectively compared pregnant mothers’ perceptions of fetal gender to sonographically proven gender determinations. Also, success rates from previously published studies, noninvasive prenatal testing and a myriad of gender determination methods were observed and reported for context.

Methods: All pregnant women presenting for second-trimester screening ultrasound (at 17–23 weeks gestation) in the obstetrics department of a single health center were asked to participate. A medical sonographer described the ultrasound examination, obtained appropriate consent and …

Anthropometric Indices For Non-Pregnant Women Of Childbearing Age Differ Widely Among Four Low-Middle Income Populations, K Michael Hambidge, Nancy F. Krebs, Ana Garcés, Jamie E. Westcott, Lester Figueroa, Shivaprasad S. Goudar, Sangappa Dhaded, Omrana Pasha, Sumera Aziz Ali, Antoinette Tshefu

Community Health Sciences

Background: Maternal stature and body mass indices (BMI) of non-pregnant women (NPW) of child bearing age are relevant to maternal and offspring health. The objective was to compare anthropometric indices of NPW in four rural communities in low- to low-middle income countries (LMIC).
Methods: Anthropometry and maternal characteristics/household wealth questionnaires were obtained for NPW enrolled in the Women First Preconception Maternal Nutrition Trial. Body mass index (BMI, kg/m²) was calculated. Z-scores were determined using WHO reference data.
Results: A total of 7268 NPW participated in Equateur, DRC (n = 1741); Chimaltenango, Guatemala (n = 1695); North …

Prenatal Care Enhanced With Digital Health Tools Can Reduce Visit Frequency While Improving Patient Satisfaction, Kathryn I. Marko, Nihar Ganju, Anish Sebastian, Joshua Benham

Medicine Faculty Posters and Presentations

100 low-risk obstetric patients were enrolled to evaluate the use of digital health technology in prenatal care. 50 patients were placed on an alternate prenatal care schedule (8 visits), supplemented with an integrated technology platform of a mobile application and connected devices including a wireless weight scale and blood pressure cuff. The remaining 50 control patients received routine care, without the technology platform. Patients were evaluated for satisfaction and engagement throughout pregnancy.

Epigenetic Modifications Of Human Placenta Associated With Preterm Birth, Drissa Toure

Theses & Dissertations

Preterm birth is a complex multifactorial process. Despite the well-known role of the placenta in supporting the fetal development and maternal-fetal tolerance, the placental epigenetic modifications and preterm birth (PTB) remains poorly understood and under investigated. Various maternal and environment factors can influence epigenetic programming during fetal development to affect the functioning and structures of organs, including the placenta, which can lead to adverse pregnancy outcomes, including PTB. The understanding of the placental epigenetic alterations and maternal determinants associated with PTB are apparently indispensable for the development of actual diagnosis and methods of prevention and treatment of premature labor. The …

The Effects Of Continuous Insulin Pump Therapy On Glycemic Control In Pregnant Type 1 Diabetics, Kimberly Kelsey

Scholarly and Creative Works Conference (2015 - 2021)

Type 1 Diabetes Mellitus accounts for approximately 5% of the diabetic population (CDC, 2015). Numerous complications must be avoided when a diabetic is insulin dependent. Women who are diabetic who are planning to conceive a family have special considerations. Little research has been focused into how to best manage Type 1 diabetics during pregnancy. Since Type 1 diabetes is predominantly diagnosed between birth and 30 years of age, many Type 1 diabetics have potential to become pregnant without knowing how to best manage their diabetes. Poor glycemic control in diabetics has been related to miscarriages, stillbirths, malformations, and macrosomia (Lapolla, …

The Disappearance Of Nyoman And Ketut, Laura Michelle Garvie

Independent Study Project (ISP) Collection

No abstract provided.

Maternal Characteristics And Obstetrical Complications Impact Neonatal Outcomes In Indonesia: A Prospective Study., Trisari Anggondowati, Ayman A E El-Mohandes, S Nurul Qomariyah, Michele Kiely, Judith J Ryon, Reginald F Gipson, Benjamin Zinner, Anhari Achadi, Linda L Wright

Medicine Faculty Publications

BACKGROUND: We investigated associations between maternal characteristics, access to care, and obstetrical complications including near miss status on admission or during hospitalization on perinatal outcomes among Indonesian singletons.

METHODS: We prospectively collected data on inborn singletons at two hospitals in East Java. Data included socio-demographics, reproductive, obstetric and neonatal variables. Reduced multivariable models were constructed. Outcomes of interest included low and very low birthweight (LBW/VLBW), asphyxia and death.

RESULTS: Referral from a care facility was associated with a reduced risk of LBW and VLBW [AOR = 0.28, 95% CI = 0.11-0.69, AOR = 0.18, 95% CI = 0.04-0.75, respectively], stillbirth …

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 …

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, …

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 …

Implementation Of Warning Tool To Improve Maternal Newborn Health Outcomes In A Developing Country, Sana Sheikh, Rahat Qureshi, Sidrah Nausheen, Rozina Sikandar Sultanali

Department of Obstetrics & Gynaecology

Objective: To improve health outcomes through the implementation of national early warning sign tool for babies delivered through emergency caesarean section in off-work hours.

Methods: This comparative clinical study was conducted at the Aga Khan Hospital for Women and Children, Karachi, from April to August 2014, and comprised women who had an emergency caesarean section. Maternal and perinatal outcomes were compared of patients in Group A and Group B which represented individuals before and after the implementation of the national early warning score respectively.

Results: Of the 200 participants, there were 100(50%) in each group. The overall mean age was …

Unintended Pregnancies Among Married Women In Sindh Pakistan: Role Of Lady Health Workers, Sumera Aziz Ali, Unaib Rabbani

Community Health Sciences

Background: Unintended pregnancies, which pose substantial risks to both mothers and children, account for 24% of all pregnancies in Pakistan. Door to door visits and service provision by lady health workers (LHWs) may be related to the reduction of such pregnancies, particularly in rural areas. This study aimed to determine the association of knowledge about Lady Health Visitors (LHWs) and door to door visits by LHWs with unintended pregnancies among rural women.
Methods: We conducted a community-based, nested case-control study of 800 pregnant women, identified from the database of an active surveillance mechanism, which registers and follows all pregnant women …

Predictors Of Modern Contraceptive Usage Among Women In Rural Pakistan: Physical Access To Services Stills A Major Barrier, Sumera Aziz Ali, Zafar Fatmi

Community Health Sciences

Background: The predictors of contraceptive use may vary in urban and rural areas. Studies have largely focused on the factors predicting contraceptive usage in urban areas. We studied the predictors of contraceptives in one of the rural districts of Pakistan.
Methods: A nested case-control design was used on The Global Network’s Maternal Newborn Health Registry (MNHR) in district Thatta Pakistan between June 2011 to July 2012. Pregnant women before their index pregnancy, who did not use (n = 200 cases) and those used any modern contraceptive method (n = 600 controls), were compared. Logistic regression was used to as certain …

The Role Of Social Networks In Breastfeeding Duration, Jordyn T. Wallenborn

Theses and Dissertations

Background: The United States has one of the lowest rates of breastfeeding in the world. Studies hypothesize that inadequate social support from healthcare providers, family members, and employers may have contributed to the low breastfeeding rate. This study aims to: 1) examine the importance of each individual (father, maternal grandmother, paternal grandmother, obstetrician, and pediatrician) within the social support network on breastfeeding initiation and duration, 2) determine the relationship between type of prenatal care provider and time to breastfeeding cessation, and 3) examine the role of breastfeeding intention and confidence as mediators in the association between workplace support and breastfeeding …

Association Between Pregnancy Intention And Maternal Characteristics, Outcomes, And Cost Of Care: A Pilot Study, Kristy M. Kelel, Kiley B. Vander Wyst, Danielle M. Greer, Danish Siddiqui

Journal of Patient-Centered Research and Reviews

Background: An estimated 51% of pregnancies in the United States are unintended. In Wisconsin, unplanned pregnancies account for 40% of all pregnancies and cost $148 million in public funds. Unintended pregnancy, which creates increased hardship for mothers and threatened well-being of infants, has been recognized as an important health, social and economic problem.

Purpose: To determine the pregnancy intentions of postpartum women and the maternal characteristics, outcomes and costs of care associated with unintended pregnancies at a large urban hospital in Milwaukee, Wisconsin.

Methods: Postpartum women were surveyed prior to discharge. The 20-item survey included whether or not the woman …

Women’S Experiences With Prenatal Care: A Mixed-Methods Study Exploring The Influence Of The Social Determinants Of Health, Karen A. D'Angelo, Janelle K. Bryan, Brenda Kurz

Journal of Health Disparities Research and Practice

Background & Purpose: Racial and ethnic disparities pervade birth outcomes in the United States and the state of Connecticut. While Connecticut’s infant mortality rate is less than the national average, rates for the state’s Black/African American and Hispanic/Latino communities exceed it. This study explored how prenatal care in Connecticut may be enhanced to address these disparities.

Methods: In spring 2013, seven focus groups and two semi-structured interviews were conducted (n=47). Participants also self-administered brief surveys. Recruited by local service providers, participants were 18 or older, pregnant and/or in the first year post-partum at the time. Most self-identified as …

Syrian Refugee Women In Jordan: Family Planning Preferences And Barriers In A Host Community, Hilary Smith

Independent Study Project (ISP) Collection

The aims of this pilot study were to research and analyze the availability of birth control and family planning resources among Syrian refugee women at a reproductive age. This study took place in the host community of Karak, Jordan. Syrian women are a vulnerable population based solely on their gender. But being refugee women makes them more vulnerable and sometimes, their needs do not get met. This study is important because it will look into reproductive health aspects for this vulnerable population to ensure that there is satisfaction among women about their own health. This cross-sectional study sought to answer …

A Preliminary Study Of Intergenerational Differences In Masxha Regarding Practice And Attitudes Towards Zulu Traditions During Pregnancy And Birth, Momoko Oyama

Independent Study Project (ISP) Collection

In the Zulu culture, several traditions and rituals are practiced during a woman’s pregnancy and perinatal period. However, as urbanization spreads and western influences strengthen, these rituals risk being lost. This project aims to capture existing knowledge of these traditions and to assess the intergenerational changes in practice and attitudes towards practicing the rituals.

Information on Zulu traditions practiced during a woman’s pregnancy and perinatal period was collected through two interviews and a focus group consisting of three elderly women in Masxha, a Black township in KwaZulu-Natal. Following the interviews and focus group, 32 Masxha residents were recruited to complete …

Comparative Effects Of Ballooning Intracervical Catheter And Prostaglandin Pessary On Cervical Ripening, Raheela Baloch, Qamarunissa Muhabat, Fakhrunissa Waheed, Waqarunissa Ahmed

Department of Obstetrics & Gynaecology

Labor is induced to stimulate the uterine contraction in effort to have vaginal birth. Induction may be advocated to reduce fetal or neonatal morbidity and mortality. Indication of labor needs to be considered when risk and benefits analysis indicates that delivering the baby is safe option for mother or both rather than continuing the pregnancy and when there are no clear indications for caesarean section and no contraindication for vaginal delivery.

The Road Into The Future Of Health Care: The Importance Of Addressing Access To Health Facilities In Transportation Infrastructure Investment Decisions, Nicola (Nikki) Van Den Heever

Independent Study Project (ISP) Collection

Background: One school of thought argues that transportation infrastructure is not an ultimate end goal of development and therefore shouldn’t be addressed within development funding decisions while the other argues that transportation infrastructure is the crucial foundation from which all development efforts are based and therefore needs to be addressed within development funding decisions. Within this framework, there is a lack of academic and other research addressing how physical access to health care for pregnant women can better be addressed when making decisions regarding funding of transportation infrastructure projects.

Purpose: To demonstrate the importance of considering access to health care …

Comparing Effectiveness Of Active And Passive Client Follow-Up Approaches In Sustaining The Continued Use Of Long Acting Reversible Contraceptives (Larc) In Rural Punjab: A Multicentre, Non-Inferiority Trial, Waqas Hameed, Syed Khurram Azmat, Moazzam Ali, Muhammad Ishaque, Ghazunfer Abbas, Erik Munroe, Rebecca Harrison, Wajahat Hussain Shamsi, Ghulam Mustafa, Omar Farooq Khan

Community Health Sciences

Background: The use of long-acting reversible contraceptive (LARC) methods is very low in Pakistan with high discontinuation rates mainly attributed to method-related side effects. Mixed evidence is available on the effectiveness of different client follow-up approaches used to ensure method continuation. We compared the effectiveness of active and passive follow-up approaches in sustaining the use of LARC-and within 'active' follow-up, we further compared a telephone versus home-based approach in rural Punjab, Pakistan.
Methods: This was a 12-month multicentre non-inferiority trial conducted in twenty-two (16 rural- and 6 urban-based) franchised reproductive healthcare facilities in district Chakwal of Punjab province, between November …

Mater: Innovative Programs For Maternal Addiction Education Treatment And Research, Meghan Gannon Phd Msph

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Gestational Hormone Profiles Predict Human Maternal Behavior At 1-Year Postpartum, Laura M. Glynn, Elyssia Poggi Davis, Curt A. Sandman, Wendy A. Goldberg

Psychology Faculty Articles and Research

In many non-human species, including primates, gestational reproductive hormones play an essential role in the onset of maternal motivation and behaviors. We investigated the associations between prepartum estradiol and progesterone and maternal behavior at 1-year postpartum in 177 women. Blood was obtained at five gestational time points and an index of quality of maternal care was determined using a well-validated mother-child interaction protocol. Women who exhibited higher quality maternal care at 1-year postpartum were characterized by unique gestational profiles of estradiol, progesterone and the estrogen to progesterone ratio; specifically by slower accelerations and levels of these hormone trajectories beginning in …

Maternal Healthcare In Eastern Uganda: The Three Delays, Mothers Making Empowered Choices, And Combatting Maternal Mortality, Emma Gier

Independent Study Project (ISP) Collection

Maternal and child health has been noted as an international concern and issue. While access to maternal healthcare has improved in Uganda since 2000, maternal mortality rates have remained high in the country as of 2015. However, maternal and child healthcare are inherently important in promoting sustainable and positive development. For that reason, I have explored maternal healthcare in Uganda’s Eastern region, specifically in Mbale Town and surrounding rural areas including Kween and Manafwa districts. Specifically I have looked at what factors influence women’s decision to give birth in a health centre or hospital, versus at home. I have also …

Antenatal Glucocorticoid Treatment Is Associated With Diurnal Cortisol Regulation In Term-Born Children, M. N. Edelmann, Curt A. Sandman, Laura M. Glynn, D. A. Wing, Elyssia Poggi Davis

Psychology Faculty Articles and Research

Due to the rapid developmental changes that occur during the fetal period, prenatal influences can affect the developing central nervous system with lifelong consequences for physical and mental health. Glucocorticoids are one of the proposed mechanisms by which fetal programing occurs. Glucocorticoids pass through the blood-brain barrier and target receptors throughout the central nervous system. Unlike endogenous glucocorticoids, synthetic glucocorticoids readily pass through the placental barrier to reach the developing fetus. The synthetic glucocorticoid, betamethasone, is routinely given prenatally to mothers at risk for preterm delivery. Over 25% of the fetuses exposed to betamethasone will be born at term. Few …

Doulas Could Improve Foreign-Born Women’S Perinatal And Postpartum Satisfaction And Increase Health Providers’ Cultural Competency In A Multicultural Urban Area Of The United States., Crystal Kazik

Sustainability and Social Justice

Doulas act as a cultural bridge between clients and providers through the support, advocacy, and education they provide. Unfortunately, migrant women may be at a disadvantage for accessing and benefiting from their services due to a variety of socioeconomic and cultural factors including predisposed ideas of care and structure based on experiences in native countries, language barriers, lower health literacy, and a lack of awareness and understanding from hospital/clinic staff.

A strategic multifaceted approach utilizing doulas, such as Boston Medical Center’s collaborative and culturally competent model, may greatly improve foreign-born women’s experience and satisfaction with healthcare when pregnant and giving …