Obstetrics and Gynecology Commons^™

Vaginismus: Causes, Diagnosis, And Treatment Options, Heather Thomas

Best Integrated Writing

This paper provides a current review of the diagnosis, causes, and treatment outcomes for vaginismus. Of particular interest are predisposing factors, like a lack of sex education and a sexually restrictive upbringing, for the development of this disorder. Controversies surrounding US-based diagnostic criteria for female sexual dysfunction are also reviewed, and up-to-date and novel treatment options, like vaginal Botox injections, are described.

Beyond The Numbers: A Qualitative Exploration Of Patient Perspectives On Postpartum Care And Maternal Mortality, Kristen A. Waters

Master of Public Health Program Student Publications

Introduction

Montgomery County faces one of Ohio's highest maternal mortality rates, with notable disparities by race. Despite their importance in reducing maternal deaths, up to 40% of women nationwide do not attend a postpartum care (PPC) visit. While well researched guidelines exist regarding the content and timing of PPC visits, there is a lack of patient perspective on this topic, specifically in the Black-identifying population in an area with a significant burden of maternal mortality.

Methods

Semi-structured interviews and focus group sessions were conducted with 31 participants of maternal health community events in Dayton, OH. Participants were asked their opinions …

A Quality Improvement Project To Improve Provider Awareness Of Breastfeeding Resources, Rachel St. Bernard, Allie Vela, Rose A. Maxwell, Kelly Nagy

Obstetrics and Gynecology Faculty Publications

Breastfeeding is widely acknowledged for its significant benefits for mother and child. Despite the many advantages for breastfeeding, disparities in breastfeeding rates persist, particularly among non-Hispanic Black women in Montgomery County, OH. Rates for babies born in 2020 were low for those who were ‘ever’ breastfed (NH-Black 68.8% vs white 76.6% for ‘ever’ breastfed at hospital discharge) and even lower for those who were exclusively breastfed (NH-Black 38.2% vs. NH-white 57.9% exclusively breastfed at hospital discharge).1 Ohio's breastfeeding initiation rate remains among the lowest in the nation ranking 41st out of 50 states and falling short of the Healthy People …

Comparison Of Four Vaginal Antiseptic Preparation To Reduce Bacteria Colony Counts In Patients Undergoing Vaginal Surgery: A Randomized Trial, James R. Saelens, Adam J. Langer, Andrew N. Boeckley, Natalie M. Castillo, Julie A. Desouza, Jennifer L. Drerup, Kelly M. Muterspaw, Hannah M. Stump, Rose A. Maxwell, Geoffrey D. Towers

Obstetrics and Gynecology Faculty Publications

Introduction: Surgical site infections (SSI) remain a prominent complication of gynecologic procedures. The only FDA approved compound for preoperative vaginal preparation is povidone-iodine. Direct comparison of commonly used agents is needed to inform appropriate standards of care. The objective of this study is to compare the effectiveness of 10% povidone-iodine (PI), 4% chlorhexidine gluconate (CHG), baby shampoo (BS), and 3% para-chloro-meta-xylenol (PCMX) preparations for reducing bacterial and fungal colony counts and minimizing postoperative irritation after vaginal surgery. Materials and Methods: This is a single-blind, RCT conducted between 2018 and 2023 in patients 18 years or older who were undergoing surgeries …

An Analysis Of Comprehensive Sex Education As A Means Of Reducing Teenage Pregnancy Rates, Ben Hiett, Adriana Parella

Scholarship in Medicine - All Papers

Teenage pregnancy rates have been declining since the 1990s, yet teenage pregnancy remains a pressing public health concern given its associated negative maternal and infant complications. Many experts and advocates have placed an increasing emphasis on school programs that provide teenagers with comprehensive education on healthy sexual functioning, safe sex practices, and effective contraceptive use, pointing to them as a means of reducing unplanned teen pregnancies. However, there is still some debate regarding the effectiveness of comprehensive sex education compared to more limited programs that focus primarily on promoting abstinence. Using data from County Health Rankings and SIECUS, we compared …

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: …

An Evaluation Of The Association Between Female Reproductive Health Policy And Children's Health Outcomes, Kira Markowski, Rachel Bobko

Scholarship in Medicine - All Papers

Background: As policy pertaining to female reproductive health and education continues to be a central issue concerning Americans and a divisive focus of political campaigns, it is important to fully understand the ramifications of female reproductive health legislation not only on women’s health outcomes but also the health outcomes of children and adolescents.
Objective: We set out to identify how legislation and policy related to female reproductive health and education impacts the health and well-being of children and adolescents. By evaluating this relationship, we aim to show whether variations in policy correlate with variations in a child’s well-being as lawmakers …

The Relationship Between Socioeconomic Factors And Low Birth Rates In Ohio, Ryan Gora, Hannah Amin

Scholarship in Medicine - All Papers

Background: The incidence of low birth weight (LBW) has not substantially fallen over time despite advances in medical interventions. LBW has been linked to several chronic diseases in adulthood including type 2 diabetes (T2DM) and cardiovascular disease (CVD), making it a particularly salient public health issue.
Objective: To examine socioeconomic factors and diseases associated with LBW in Ohio between 2016-2022.
Methods: Using data from County Health Rankings, we identified socioeconomic factors predictive of LBW in Ohio between 2016-2022. We also examined the relationship between LBW and incidence of T2DM as well as food insecurity (FI). In addition, we investigated how …

Enhancing Patient’S Perceptions Of Cesarean Indications Through Teach-Back Methods, Naveena R. Daram, Malika L. Day, Rose A. Maxwell, Keith Reisinger-Kindle

Obstetrics and Gynecology Faculty Publications

Introduction

Cesarean section (C-section) deliveries are on the rise, with an increase from 23.5% in the 1990s to 32.2% in 2022. Research has shown that poor communication by health care providers can lead to negative outcomes. Patients’ understanding of their C-section indications has significant implications for their future obstetric health. Therefore, interventions are needed to ensure optimal communication between providers and patients to improve outcomes.

Materials and Methods

Sixty-eight participants were enrolled and randomized into traditional counseling or teach-back intervention groups. Phone interviews were used to capture data at 2 weeks and 6 months postoperatively. Chi square and Fisher’s Exact …

Objective Assessment Of Rupture Parameters In Intact And Acute Post-Cystorrhaphy Cadaveric Bladders, Geoffrey D. Towers, Dani G. Zoorob, Rose A. Maxwell, Ashley N. Reid, Jerome L. Yaklic, Jason C. Massengill

Obstetrics and Gynecology Faculty Publications

Background: Certain procedures, particularly those used to treat symptoms of bladder pain syndrome/interstitial cystitis (BPS/IC), involve filling the bladder to or over its capacity for visualization and/or relief of symptoms. Rarely, if excessive pressure or volume is used, bladders may rupture causing significant harm to the patient. The purpose of this study was to identify baseline data for pressure and volume when hydrodistention is attempted in explanted cadaveric bladders, as well as determine bladder rupture pressure changes in the acute post-cystorrhaphy state. Methods: Eight explanted cadaveric bladders were filled using a systematic digital pump system. Intravesical pressure and volume were …

A Randomized Trial Of Vaginal Antiseptic Preparation Solutions To Reduce Bacteria Colony Counts In Patients Undergoing Vaginal Surgery, James R. Saelens, Adam J. Langer, Andrew N. Boeckley, Natalie M. Castillo, Julie A. Desouza, Jennifer L. Drerup, Kelly M. Muterspaw, Hannah M. Stump, Rose A. Maxwell, Geoffrey Towers

Obstetrics and Gynecology Faculty Publications

Antiseptic preparation of surgical sites is known to reduce the rate of infective complications. However, surgical site infections (SSI) remain a leading cause of post-operative hospitalizations, increasing patient stress and cost for the healthcare system.1-7 In gynecologic surgery, preparation of the vagina is performed to reduce bacterial load prior to surgery, though it is known to remain contaminated.3 In the US, only solutions containing povidone-iodine (PI) are FDA approved for vaginal preparation; though, a 2018 ACOG Practice Bulletin lists chlorhexidine gluconate (CHG) with low (<4%) alcohol concentrations as a reasonable option for off-label use.3 Other preparations for vaginal surgery have been reported including baby shampoo (BS) and a commercially available preparation, containing PCMX (para-chloro-meta-xylenol, Techni-care®, chloroxylenol), that is marketed specifically for use with mucous membranes.8-12 There is a growing need to establish evidence-based alternatives to iodine for vaginal preparation for patients with allergies or sensitivity to iodine-containing products while minimizing postoperative irritation. One retrospective study comparing BS to PI in gynecologic surgeries showed a non-significant lower rate of surgical site infection with BS.9 One major challenge for determining effectiveness of surgical scrubs for reducing SSI is the relatively rare occurrence of postoperative infection. As an alternative proxy for infection colony counts of bacteria/fungi, before and after preparation, have been used.12,13 BS has been shown to reduce bacterial loads in non-gynecologic surgery, but there is limited data regarding its use in vaginal surgery, even though surgeons have been using BS in cases of iodine allergy or intolerance to other antiseptics.9-12CHG use in vaginal surgery has been debated due to concerns about vaginal irritation, however studies have demonstrated that alteration of the solution to 2-4% chlorhexidine with low (4%) alcohol concentration was associated with mild to no vaginal irritation. CHG showed similar reduction in post-incision bacterial counts and wound infections in cesarean delivery, and reduced colony counts during hysterectomy (when compared to PI).14-20 PCMX and CHG were shown to significantly reduce bacterial colonization of extracted root canals, and PCMX has been marketed specifically for vaginal antiseptic preparation.21 While some information on the effectiveness of these four antiseptic preparations has been documented in the literature, at this time there are no randomized controlled trials comparing these solutions in the context of vaginal surgery. Further evaluation and research of antiseptic solutions is warranted to provide evidence for best practices in minimizing infection and irritation. The purpose of this study was to compare the effectiveness of three antiseptic solutions with the standard, PI, for reducing bacterial colonies as a proxy for SSI, and to assess postoperative irritation and infection symptoms.

Obstetrics Emergency Labor And Delivery Case Simulations With Normal Vaginal Delivery Demonstration: A Hands-On Simulation For Clerkship Students, Emily A. Young, William A. Winter, Robyn N. D'Agostino, Rose A. Maxwell, Sheela Barhan, Marilyn Kindig

Obstetrics and Gynecology Faculty Publications

Introduction: Simulation is rarely used for medical student education in the field of obstetrics. This method is an effective model of learning for topics that are encountered in clinical situations and for topics that pose significant risk to patients when an untrained individual is involved. Methods: A 2-hour obstetric delivery simulation session was developed and incorporated into the third-year obstetrics and gynecology clerkship rotation at Wright State University Boonshoft School of Medicine. Medical students completed self-guided content reviews with resources provided prior to the session. During the session, each medical student conducted a normal vaginal delivery and one of the …

Postpartum Abdominal Binder Use For Pain Management After Vaginal Delivery – A Randomized Controlled Trial, Laura A. Bute, Elena Fuell-Wysong, Vijay K. Rings, Samantha M. Younglove, Rose A. Maxwell, Sheela Barhan

Obstetrics and Gynecology Faculty Publications

Objective: To investigate the impact of abdominal binder plus usual care versus usual care alone 26 after spontaneous vaginal delivery on pain severity scores. 27 28 Methods: A prospective randomized study was performed, recruiting patients on a Labor and 29 Delivery unit who were anticipating spontaneous vaginal delivery from 2019 to 2022. Patients 30 were randomly assigned to receive an abdominal binder plus usual care or usual care alone 31 within two hours postpartum. Primary outcomes were patient-reported immediate postpartum 32 pain score and average daily pain scores on days 0 and 1 postpartum (using a scale from 0 to …

Incidental Recognition Of Umbilical-Portal-Systemic Venous Shunt Diagnosed During Bpp For Decreased Fetal Movement, Kathleen Lundeberg, Adam Hiett

Obstetrics and Gynecology Faculty Publications

Background: The prevalence of prenatally diagnosed umbilical-portal systemic venous shunts (UPSVS) is reportedly rare, ranging from 0.003-0.209% [1]. Disruption in the normal development of the fetal venous system can be caused by primary failure of a system or by secondary occlusion of an already transformed system [2]. While UPSVS’s are rare, the downstream effects are potentially fatal, including intrauterine growth restriction, high output cardiac failure, associated neonatal morbidity and mortality, and thus necessitate early detection with appropriate monitoring.

Introduction: The patient was a 21-year-old G2P1001 who presented to the Maternal Fetal Medicine Ultrasound Genetics (MFMUG) clinic at 36w2d for a …

Integrating An Evidence Based Medicine Module Presentation Into The Ob-Gyn Clerkship, Judith Mathess, Betsy Gauthier, Zenab Saeed, Ngozi Anachebe, Rose A. Maxwell, Jason C. Massengill, Marilyn Kindig

Obstetrics and Gynecology Faculty Publications

Introduction: During the preclinical curriculum, students are introduced to EBM principles, however structured application to clinical medicine varies throughout clinical experiences. Application of EBM in a clinical educational environment affords students opportunities to practice required skills.

Methods: Students selected a patient case and formulated a question related to diagnosis ortreatment using the PICO framework. Students selected research publications related to the patient case, critically appraised their validity and generalization, and developed a comprehensive presentation involving a case summary and related EBM topics, which were evaluated by a faculty member using a rubric developed for the project. To assess the effectiveness …

Case Study: The Elusive Vaginal Leiomyoma, Fiona Hodges, Roziya Tursunova, Kelly Nagy, Halei Wong, Wright State University Boonshoft Som Department Of Obstetrics And Gynecology, Wright Patterson Air Force Base Department Of Obstetrics And Gynecology

Obstetrics and Gynecology Faculty Publications

This poster was presented at the September 2023 Armed Forces District Meeting.

A Close-Up Examination Of Racial Disparities In Infant And Maternal Outcomes In Montgomery County, Ohio, Kelsey M. Harman, Keith M. Reisinger-Kindle, Rose Maxwell

Obstetrics and Gynecology Faculty Publications

Background: Infant and maternal outcomes in Montgomery County, Ohio, are among the worst in the state and rival that of many low-income nations. This study compares maternal and infant outcomes across 3 zip codes in Montgomery County to discern factors that are influencing health outcomes for their residents. The zip codes represent 3 distinct communities with unique racial and socioeconomic makeups.  Methods: A cohort of maternal-infant dyads (n=5098) who delivered at Miami Valley Hospital and Good Samaritan Hospital from January 1, 2009, to January 1, 2019, were analyzed via retrospective chart review. Maternal (MCS) and infant (ICS) outcome composite scores …

A Case Of Spontaneous Adrenal Hemorrhage In Pregnancy, Benjamin Mallicoat, Kelly Nagy, Christopher Croom

Obstetrics and Gynecology Faculty Publications

A case study looking at a 25 year old patient at 31 weeks gestation with spontaneous adrenal hemorrhage.

Patient-Centered Focus Groups As A Catalyst For Anti-Racism Research And Quality Improvement In An Urban Academic Ob/Gyn Clinic, Samantha Brenner, Fiona Hodges, Tonia J. Rhone, Toni Tipton, Keith Reisinger-Kindle

Obstetrics and Gynecology Faculty Publications

Background •There is a known, pervasive existence of racism within OBGYN with resultant inequities and disparities in patient outcomes •Limited published perspectives of patients with racism in inpatient and outpatient OBGYN •The importance of centering patients’ voices in anti-racism research initiatives is clear •The objective of this study was to utilize patient-centered focus groups to prioritize anti-racism quality improvement and research investigations in the inpatient and outpatient setting

The Role Of Art In Teaching Virtual Anatomy During The Covid-19 Pandemic, Shaigan Bhatti, Ashwatha Thenappan, Rose A. Maxwell, Marilyn Kindig

Medical Student Research Symposium Abstracts and Posters

The purpose of this study is to determine whether drawing anatomical structures and teaching it virtually to others improves student confidence in remembering anatomy and improves student perceptions of OB/GYN anatomy in the obstetrics and gynecology core clerkship. Active recall is a superior method of learning and memory retention because it practices information retrieval. If one draws an anatomic region of the human body after visualization and then teaches it, the learner would be exercising retrieval thus promotion retention of the material. The specific act of writing things down on paper promotes memory retention. This study sets a precedence of …

Identifying Factors Underlying The Decision For Genetic Carrier Screening Among Women In Montgomery County, Sowon Kim, Rose A. Maxwell

Medical Student Research Symposium Abstracts and Posters

Genetic Carrier Screening (GCS) is a genetic test that allows patients to find out if they carry genes for certain genetic disorders. The results of the test enable patients to make changes to their family planning decisions and prenatal care when appropriate and allow them the opportunity to seek further medical and social support. Despite these health benefits and notable clinical utility of GCS, GCS has not been utilized in most nations due to moral and ethical controversy among the public. Previous studies have demonstrated patients’ ethnicity, socio-demographic (age, education) and economic factors were associated with the patient’s intention to …

Liposomal Bupivacaine Infiltration And Transversus Abdominis Plane Block Versus Standard Of Care For Post Caesarean Pain Control: A Retrospective Chart Review, Ellie Ganz, Darren Adams, Rose A. Maxwell, Theresa Roby, Marilyn Kindig

Medical Student Research Symposium Abstracts and Posters

Transversus abdominis plane (TAP) block and wound infiltration with local anesthetics are shown to reduce opiate use and pain scores when compared to controls who received narcotic pain medications. With the current opiate epidemic, finding different ways to control pain without opiates is important,-to prevent unnecessary use of these drugs and reduce the potential for addiction in patients having a Cesarean delivery who often times receive opiate medications on schedule regardless of their reported pain.

A Case Of Ruptured Cornual Pregnancy With Delivery Of A Viable Pre-Term Infant, Elana Miller, Elena Fuell-Wysong, Marilyn Kindig

Medical Student Research Symposium Abstracts and Posters

Interstitial and cornual ectopic pregnancies are rare forms of ectopic with high mortality rate. As such, they pose significant challenges in diagnosis, treatment, and follow up.

This patient was a 42 y/o female G2P1001 at 25+3 weeks gestational age who presented from an outside hospital after an episode of sudden onset abdominal pain with syncope. She was noted to have hypotension, tachycardia, lactic acidosis, and peritoneal free fluid. Physical exam was significant for peritoneal signs with abdominal guarding and rebound. Her pregnancy was complicated by advanced maternal age, THC use, and late presentation for prenatal care in the second trimester. …

Evaluating The Effectiveness Of Early Exposure: Obstetrics And Gynecology Two-Week Virtual Elective, Elisabeth N. Adkins, Marilyn Kindig, Rose A. Maxwell

Medical Student Research Symposium Abstracts and Posters

Clinical clerkships are an integral part of undergraduate medical education. Until now, clerkships have either been offered through simulation labs, didactics or in the healthcare setting dependent upon the pedagogical approach of each institutions’ curricula. Subsequent to coronavirus-2019, medical students had decreased accessibility to the aforementioned educational settings. This has provided an innovative opportunity for clerkship directors to provide the same clinical experience to students in a novel way –virtually.

Recently, the Larner College of Medicine at the University of Vermont created a two-week virtual simulated clerkship electiveencompassing the curricula taught throughout the OB/GYN clerkship. Until now, this virtual elective …

Neonatal Health Outcomes Following Water Immersion During Labor And Delivery, Ariel L. Lanier, Samantha L. Wiegand, David Mckenna

Medical Student Research Symposium Abstracts and Posters

Water birth is child delivery that occurs in a tub of water. Water birth delivery has been offered by Miami Valley Hospital in the Family Beginnings Birth Center since 1994. The first water birth delivery that was documented in a medical journal occurred in France in 1805, which reported that the delivery resulted in a healthy baby. Water birth deliveries have been growing in popularity in the United States as mothers are interested in the possible alleged benefits of water birth including shorter labor, less pain, improved maternal experience of childbirth, and more. Although there are many potential benefits, The …

Placental Hypoxia-Inducible Factor 1 Alpha In Early-Onset Preeclampsia As A Predictor Of Future Risk In Maternal And Fetal Health, Julie Slyby, Bryce Linkous, Sarah Scott, Chandni Chandiramani, Amy Hwang, Danielle Spanbauer, Melissa R. Kaufman, Traci Rackett, Kailey Nolan, Emily Stone, Rose A. Maxwell, David N. Dhanraj, Thomas L. Brown

Medical Student Research Symposium Abstracts and Posters

Preeclampsia is a life-threatening, pregnancy-associated disorder characterized by the rapid development of hypertension with renal dysfunction. While preeclampsia generally occurs later in pregnancy, early-onset preeclampsia (EOPE) can occur much earlier and is usually more devastating. Early-onset preeclampsia is also associated with an increased risk of maternal cardiovascular and metabolic disease in mothers later in life and neurocognitive dysfunction in their offspring. EOPE is strongly associated with abnormal placental development and fetal growth restriction during pregnancy.

Oncofertility Awareness And Attitudes Among Health Care Providers And Breast Cancer Patients In A Chinese Academic Setting1, John P. Zucal, Ewelina Biskup, Xin Zhaochen, Yun Sun, Yao Lu, Leslie C. Appiah, Hongwei Zhang, Steven R. Lindheim

Medical Student Research Symposium Abstracts and Posters

As cancer has become a major public health issue in China, fertility preservation remains limited despite the wide application of Assisted Reproductive Technology (ART) throughout the country.

Local Wound Infiltration With Liposomal Bupivacaine Decreases Post-Cesarean Pain Scores, Avni Gupta, Justin Williams, Rose A. Maxwell, Marilyn Kindig

Medical Student Research Symposium Abstracts and Posters

Surgical patients are routinely prescribed opioid analgesics that are strongly associated with drug overdose deaths. Liposomal bupivacaine is a long-acting local anesthetic that received FDA approval in 2011 for local surgical site infiltration to promote post-operative analgesia. This anesthetic has demonstrated an improvement in post-operative pain control in various surgical realms, indicating a decreased need for opiates and subsequently decreased risks. However, few studies have investigated its use at the time of cesarean delivery.

Gynecologic Surgrete, New Horizons Guyana 2019: An Experience Of A Lifetime For Global Health Engagement And Medical Readiness, Bethany L. Charron, Katherine L. Dengler, Bao Tram Nguyen, Ashley Coggins, Jason C. Massengill, Trisha J. Tomkins

Obstetrics and Gynecology Faculty Publications

New Horizons is an annual training exercise designated for military medical professionals and civil engineers to assist partner nations of Southern Command (SOUTHCOM), as well as provide exceptional training to U.S. military members.1 In Spring of 2019, a gynecologic surgery readiness training exercise (SURGRETE) team composed of 16 joint-service military healthcare professionals, specifically including a fellowship-trained female pelvic medicine and reconstructive surgery (FPMRS) surgeon, an FPMRS fellow, an obstetrics and gynecology (OB/GYN) specialist, three OB/GYN residents, and additional anesthesia, nursing, and surgical technician support, traveled to Guyana to participate in the New Horizons global health exercise. The mission of the …

Quality Improvement: Patient Education For Management Of Hypertension In Pregnancy, Kriti Goel

Scholarship in Medicine - All Papers

Objective: We introduced maternal hypertension education tools that address illiteracy in underserved populations. Through these tools, we aim to improve patients’ knowledge of their conditions. We also aim to determine if healthcare providers perceive a benefit to the use of the tools. Ultimately, we hope these changes will lead to better short- and long-term health outcomes for mother and child.

Methods: Pregnant women with any form of hypertension at Five Rivers Center for Women’s Health (FRHC) were surveyed during OB visits. The Patient Questionnaire includes objective knowledge questions on their condition and self-reported comprehension questions. Forty-five women were surveyed during …