Obstetrics and Gynecology Commons^™

Trends In Management Of Overweight And Obesity In Obstetrics & Gynecology, Family Medicine And Pediatrics 2011-2015, Steven Lindheim, Stephanie Welsh, Nan Jiang, Amanda Hawkins, Lisa Kellar, Rose Maxwell, Leah D. Whigham

Obstetrics and Gynecology Faculty Publications

Purpose: To assess for improvement in the screening and management of overweight and obesity in the past 5 years among Obstetrician-Gynecologists (OB-GYN), Family Physicians (FP), and Pediatricians (Peds).

Methods: A retrospective pilot study was conducted, reviewing 150 charts of patients with overweight (body mass index [BMI] 25-29.9 kg/m2) and class I (BMI 30-34.9 kg/m2), class II (BMI 35-39.9 kg/m2), and class III obesity (BMI ≥ 40 kg/m2) between 2011 and 2015. Patients were from OB-GYN (n=50), Family Medicine, adult (FP-A) (n=50) and pediatric (FP-P) (n=28), and Peds (n=22) offices.

Results: 75% of patients were female; 35.5% had overweight, 40% had …

Vaginal Urinary Calculi Formation Secondary To Vaginal Mesh Exposure With Urinary Incontinence, Kara M. Griffiths, Geoffrey D. Towers, Jerome L. Yaklic

Obstetrics and Gynecology Faculty Publications

Background

Vaginal stones may form in the setting of mesh exposure with urinary incontinence. This report serves to help understand the presentation, evaluation, and management of vaginal urinary stones.

Case

A 68-year-old female presented with a vaginal calculus. She had a history of anterior and posterior polypropylene mesh placement for prolapse 7 years earlier and urinary incontinence. The stone was identified on a portion of exposed mesh and removed in office. Pathology confirmed urinary etiology. The exposed mesh resolved with topical estrogen. Cystourethroscopy excluded urinary fistula and bladder mesh erosion.

Conclusions

When identified, a vaginal calculus should be removed and …

Effect Of Continuous Local Anesthetic Use For Pain Control And Narcotic Use After Cesarean Section: A Randomized Trial, Jerome L. Yaklic, Rose Maxwell, Keira Urschel, S. Robinson, M. K. Dearmond, Steven R. Lindheim

Obstetrics and Gynecology Faculty Publications

Background: Post-operative pain control after Cesarean delivery is a major concern for both patients and physicians. The current literature provides mixed results on the effectiveness of the local continuous infiltration of anesthesia for pain control and reduction of morphine use. Methods: This was a randomized, double-blind, placebo controlled trial with a 1:1 group allocation. Fifty women who had a Cesarean delivery were randomly assigned to receive bupivacaine (Bupivacaine group) or saline (Saline group) delivered via locally placed catheters at the sub-fascial plane and at the uterine incision. Forty women (20 per group) completed the study. Total post-operative narcotic use and …

A Medical Malpractice Trial Where The Residents And Faculty Are The Judge And The Jury, Kelly A. Rabah

Obstetrics and Gynecology Faculty Publications

At the conclusion of this session, the learner should be able to:

• Name 3- 5 of the most common reasons for a medical malpractice claim

• Describe and compare negligence, types of error, and recklessness

• Explain 3-5 steps that should be taken to minimize risk for a malpractice suit

• Discuss the emotional toll that litigation causes and the personal and professional risks that may result

Changing The Algorithm In The Evaluation Of Pelvic Anatomy In The Infertile Patient: Is Hysterosalpingo Contrast Sonography With Saline-Air Device The Appropriate Test For Everyone?, Kathryn Coyne, Thomas C. Winter, Rose Maxwell, Steven Lindheim

Obstetrics and Gynecology Faculty Publications

The evaluation of the fallopian tubes is an essential part of the infertility workup, with abnormalities related to the fallopian tubes accounting for up to 40% of female subfertility.1 Laparoscopy is still considered the gold standard in the diagnostic evaluation of fallopian tubes, though the hysterosalpingogram (HSG) has long been recognized as complementary to laparoscopy, since tubal anatomy can be distinctly be seen.2 That said, previous investigations using laparoscopy as the gold standard demonstrate HSG has a sensitivity and specificity of 53% and 87%, respectively, for any tubal pathology and 46% and 95%, respectively, for bilateral tubal pathology.3

The Changing Tides In Gynecologic Surgery Minimally Invasive Options: What We Know And How Do We Improve Use, Training, Michael L. Galloway

Obstetrics and Gynecology Faculty Publications

Over the past twenty years gynecologic surgery has evolved from primarily abdominal approach to the current focus on minimally invasive surgical techniques. Minimally invasive techniques include vaginal and laparoscopic techniques. Evolution in laparoscopic technology and equipment has exploded to include multiple vessel sealing instruments of varying modalities, instruments with “wristed” capabilities and robotic assisted technology. Single port laparoscopy and natural orifice transluminal endoscopic surgery are other variations of laparoscopic technology.

Vaginal surgery is still touted as the “ultimate” minimally invasive surgery by ACOG; however, its use has not grown over this time. Many surgeons have had limited training in vaginal …

Detection Of The Dietary Xenoglycan N-Glycolylneuraminic Acid (Neu5gc) And Anti-Neu5gc Antibodies Within Reproductive Tracts Of Male And Female Infertility Subjects, Julie M. Sroga, Diana H. Wu, Fang Ma, Eilllen Tecle, Ilana B. Ressler, Rose Maxwell, Rachael Ferrari, Leah Whigham, Pascal Gagneux, Steven Lindheim

Obstetrics and Gynecology Faculty Publications

Objective

To assess the frequency of dietary xenoglycanNeu5Gc and antibodies in males and females and its impact on fertility.

Design

Prospective study of semen, uterine lavage, and follicular fluid from subjects undergoing infertility evaluation or in vitro fertilization (IVF) and fertile controls.

Setting

University based infertility program.

Participants

Males (n=23) and females (n=27) undergoing semen analysis and saline infusion sonography as part of their diagnostic evaluation and 37 women undergoing IVF were compared to fertile male (n=15) and female (n=14) controls.

Intervention

Neu5Gc was measured by affinity purified antibody staining on Western blots, flow cytometry, and by high performance liquid …

The Changing Tides In Gynecologic Surgery: Minimally Invasive Options What We Know And How Do We Improve Usage And Training, Michael L. Galloway

Obstetrics and Gynecology Faculty Publications

Over the past twenty years gynecologic surgery has evolved from primarily abdominal approach to the current focuson minimally invasive surgical techniques. Minimally invasive techniques include vaginal and laparoscopic techniques. Evolution in laparoscopic technology and equipment has exploded to include multiple vessel sealing instruments of varying modalities, instruments with “wristed” capabilities and robotic assisted technology. Single port laparoscopy and natural orifice transluminal endoscopic surgery notes are other variations of laparoscopic technology. Vaginal surgery is still touted as the “ultimate” minimally invasive surgery by ACOG, however, its use has not grown over this time. Many surgeons have had limited training in vaginal …

Challenges And Considerations In Optimizing Ovarian Stimulation Protocols In Oncofertility Patients, Kathryn Coyne, Makenzie Purdy, Kathleen O'Leary, Jerome L. Yaklic, Steven R. Lindheim, Leslie A. Appiah

Obstetrics and Gynecology Faculty Publications

The scope of cancer treatment in women of childbearing age has changed in the last decade. Fertility preservation is no longer an afterthought but central to multi-disciplinary cancer treatment planning and should be addressed due to the cytotoxic effects of cancer therapy. However, oncology patients present as a unique treatment challenge as the physician must balance the urgency of fertility preservation with the risks of delaying cancer therapy. Controlled ovarian stimulation (COS) is routinely applied in assisted reproductive technology but can be contraindicated in women with estrogen-receptor-positive tumors. This paper reviews some of the challenges to consider when using COS …

The Role Of Misoprostol In The Reduction Of Maternal Deaths In Low Resource Settings: A Systematic Review With Recommendations For Action, Melissa Anne Mcmillian

Master of Public Health Program Student Publications

Objective: The purpose of this systematic review is to determine the role misoprostol currently plays in the reduction of maternal deaths and implications for the future reduction of maternal deaths in low resource settings.

Methods: A comprehensive review of the literature was performed using the following databases: The Cochrane Database, Ebsco, MEDLINE, PubMed, and Electronic Journal Center (EJC). Articles were excluded based upon date published, overt data changes since publication, and setting of misoprostol interventions in tertiary or referral centers that have access to oxytocin. A total of 61 articles were included from 2002-2012 and demonstrated several methodologies and study …

Molecular Genetic Studies And Delineation Of The Oculocutaneous Albinism Phenotype In The Pakistani Population, Thomas J. Jaworek, Tasleem Kausar, Shannon M. Bell, Nabeela Tariq, Muhammad I. Maqsood, Asma Sohail, Muhammad Ali, Furhan Iqbal, Shafqat Rasool, Saima Riazuddin, Rehan S. Shaikh, Zubair M. Ahmed

Obstetrics and Gynecology Faculty Publications

Background: Oculocutaneous albinism (OCA) is caused by a group of genetically heterogeneous inherited defects that result in the loss of pigmentation in the eyes, skin and hair. Mutations in the TYR, OCA2, TYRP1 and SLC45A2 genes have been shown to cause isolated OCA. No comprehensive analysis has been conducted to study the spectrum of OCA alleles prevailing in Pakistani albino populations.

Methods: We enrolled 40 large Pakistani families and screened them for OCA genes and a candidate gene, SLC24A5. Protein function effects were evaluated using in silico prediction algorithms and ex vivo studies in human melanocytes. The effects of splice-site …

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

Obstetrics and Gynecology Faculty Publications

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

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

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

Master of Public Health Program Student Publications

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

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

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

Abnormal Placental Findings Associated With Non-Reassuring Fetal Monitoring And Excellent Neonatal Outcomes, Gary Ventolini, Shanthi Ramesh, Sheela M. Barhan, Ran Neiger

Obstetrics and Gynecology Faculty Publications

Objective: Obstetricians, Neonatologists, and Pathologists have studied gross histological analysis of human placentas in search of specific alterations in placental functions that can be correlated with neonatal outcomes. Our study assessed the prevalence of abnormal placental findings associated with non-reassuring fetal monitoring in labor requiring emergent instrumental or cesarean delivery, followed by an excellent neonatal outcome. Study Design: One hundred consecutive emergency deliveries, instrumental or cesarean, performed due to non-reassuring fetal monitoring while in labor were retrospectively evaluated. All patients were low-risk for obstetric complications, and had a singleton, term pregnancy. They had a normal antenatal routine testing and a …