Obstetrics and Gynecology Commons^™

Unmet Need For Contraception And Unintended Pregnancies Among Women Of Reproductive Age Group: A Situation Analysis, Sumera Aziz Ali, Savera Aziz Ali

School of Nursing & Midwifery

Each year approximately 210 million pregnancies occur worldwide and more than one-third (75 to 80 million) of these are unintended, more than half of these (46 million) unintended pregnancies undergo unsafe abortions. In Pakistan 16% of the births are reported to be unwanted and if the unwanted fertility is eliminated, total fertility in Pakistan would be 3.1 births per woman. Total demand for family planning in Pakistan is 55%, while the contraceptive prevalence rate is 35% and unmet need for family planning is 20%. Reasons for unmet need and unintended pregnancy include lack of permission, fear of side effects, poor …

Impact Of Peak/Mid Luteal Estradiol On Pregnancy Outcome After Intracytoplasmic Sperm Injection, Rehana Rehman, Zahir Hussain, Huma Zahir, Rakhshaan Khan

Department of Biological & Biomedical Sciences

Abstract

Objective: To compare peak to mid estradiol ratio with the probability of successful conception after intracytoplasmic

sperm injection.

Method: The quasi-experimental study was conducted in an infertility clinic at Islamabad from June 2010 till August

2011, and comprised couples subjected to intra-cytoplasmic sperm injection. Down-regulation of ovaries was

followed by calculated stimulation, ovulation induction, oocytes retrieval, intra cytoplasmic sperm injection, in vitro

maturation of embryos and finally blastocysts transfer. Serum estradiol was measured by enzyme-linked

immunosorbent assay on ovulation induction day and the day of embryo transfer. Failure of procedure was detected

by beta human chorionic gonadotropin5-25mIU/ml (Group I; …

Pregnancy Anxiety And Prenatal Cortisol Trajectories, Heidi S. Kane, Christine Dunkel Schetter, Laura M. Glynn, Calvin J. Hobel, Curt A. Sandman

Psychology Faculty Articles and Research

Pregnancy anxiety is a potent predictor of adverse birth and infant outcomes. The goal of the current study was to examine one potential mechanism whereby these effects may occur by testing associations between pregnancy anxiety and maternal salivary cortisol on 4 occasions during pregnancy in a sample of 448 women. Higher mean levels of pregnancy anxiety over the course of pregnancy predicted steeper increases in cortisol trajectories compared to lower pregnancy anxiety. Significant differences between cortisol trajectories emerged between 30 to 31 weeks of gestation. Results remained significant when adjusted for state anxiety and perceived stress. Neither changes in pregnancy …

'There Are A Lot Of New People In Town: But They Are Here For Soccer, Not For Business' A Qualitative Inquiry Into The Impact Of The 2010 Soccer World Cup On Sex Work In South Africa, Marlise L. Richter, Fiona Scorgie, Matthew F. Chersich, Stanley Luchters

Population Health, East Africa

Background: Sports mega-events have expanded in size, popularity and cost. Fuelled by media speculation and moral panics, myths proliferate about the increase in trafficking into forced prostitution as well as sex work in the run-up to such events. This qualitative enquiry explores the perceptions of male, female and transgender sex workers of the 2010 Soccer World Cup held in South Africa, and the impact it had on their work and private lives.

Methods: A multi-method study design was employed. Data consisted of 14 Focus Group Discussions, 53 sex worker diaries, and responses to two questions in surveys with …

Responding To Change In Reproductive Endocrinology Fellowships, William Schlaff, Md

Department of Obstetrics and Gynecology Faculty Papers

Thirty years ago, in the days when I was a reproductive endocrinology fellow, the field looked far different than it does today. Reproductive endocrinologists at that time were most assuredly the experts in diagnosing and treating infertility, but were often, if not usually the go-to doctors for patients with congenital uterovaginal anomalies, endometriosis, and those in need of complicated endoscopic procedures. The REI was not only the authority on polycystic ovary syndrome and other hormonal problems, but often the leader in addressing clinical issues in contraception, abnormal uterine bleeding, and menopause. In the early to mid-1980’s infertility treatment, such as …

Systematic Review Of Facility-Based Sexual And Reproductive Health Services For Female Sex Workers In Africa, Ashar Dhana, Stanley Luchters, Lizzie Moore, Yves Lafort, Anuradha Roy, Fiona Scorgie, Matthew Chersich

Population Health, East Africa

Background: Several biological, behavioural, and structural risk factors place female sex workers (FSWs) at heightened risk of HIV, sexually transmitted infections (STIs), and other adverse sexual and reproductive health (SRH) outcomes. FSW projects in many settings have demonstrated effective ways of altering this risk, improving the health and wellbeing of these women. Yet the optimum delivery model of FSW projects in Africa is unclear. This systematic review describes intervention packages, service-delivery models, and extent of government involvement in these services in Africa.

Methods: On 22 November 2012, we searched Web of Science and MEDLINE, without date restrictions, for …

A Study Protocol: Using Demand-Side Financing To Meet The Birth Spacing Needs Of The Underserved In Punjab Province In Pakistan, Syed Khurram Azmat, Moazzam Ali, Waqas Hameed, Ghulam Mustafa, Ghazanfer Abbas, Muhammad Ishaque, Mohsina Bilgrami, Marleen Temmerman

Community Health Sciences

Background: High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women's health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan.
Methods/design: This study will use quasi-experimental design with control arm and be implemented in: six government …

Rationale, Design, And Cohort Enrolment Of A Prospective Observational Study Of The Clinical Performance Of The New Contraceptive Implant (Femplant) In Pakistan, Syed Khurram Azmat, Waqas Hameed, Anja Lendvay, Babar Tasneem Shaikh, Ghulam Mustafa, Muhammad Ahmed Siddiqui, Sajid Brohi, Asif Karim, Muhammad Ishaque, Wajahat Hussain

Community Health Sciences

Introduction: The use of hormonal implants has gained positive traction in family planning programs in recent times. Compared to other popular methods, such as long-term reversible intrauterine devices, the use of hormonal implants as a family planning method has distinct advantages in terms of long-term efficiency and better user compliance and availability. This paper presents a study protocol to document and evaluate the efficacy, safety, and acceptability of Femplant (contraceptive implant) in Pakistan during the first year of its use among married women of reproductive age (18-44 years) at clinics in two provinces of Pakistan (Sindh and Punjab).
Materials and …

Anterior Cervical Foraminotomy: Short Term Outcomes In Patients With Isolated Cervical Radiculopathy, Howard Eisenbrock, Mark Rivkin, Amir R. Dehdashti

Research Day

Intro: Anterior cervical foraminotomy (ACF) is a novel approach involving direct decompression of nerve from an offending agent without fusion. Historically, several anterior and posterior approaches were utilized to treat cervical radiculopathy. Anterior cervical discectomy necessitates fusion and is subject to adjacent segment disease as well as loss of ROM. Posterior laminoforaminotomy seldom allows for removal of disc fragment and is associated with higher postoperative pain.

Methods: Between May 2010 and March 2013, 16 patients with one or two level cervical spondylosis with radiculopathy without myelopathy who failed conservative therapies such as anti-inflammatory medications, physical therapy or injections underwent anterior …

Global Causes Of Maternal Death: A Who Systematic Analysis, Lale Say, Doris Chou, Alison Gemmill, Özge Tunçalp, Ann-Beth Moller, Jane Daniels, A Metin Gülmezoglu, Marleen Temmerman, Leontine Alkema

Obstetrics and Gynaecology, East Africa

Background: Data for the causes of maternal deaths are needed to inform policies to improve maternal health. We developed and analyzed global, regional, and sub-regional estimates of the causes of maternal death during 2003–09, with a novel method, updating the previous WHO systematic review.

Methods: We searched specialized and general bibliographic databases for articles published between Jan 1, 2003, and Dec 31, 2012, for research data, with no language restrictions, and the WHO mortality database for vital registration data. On the basis of pre-specified inclusion criteria, we analyzed causes of maternal death from datasets.

We aggregated country level estimates to …

Predictors Of Vaccination Card Retention In Children 12-59 Months Old In Karachi, Pakistan, Sana Sadiq Sheikh, Syed Asad Ali

Department of Obstetrics & Gynaecology

Objective: To determine the factors associated with retaining the vaccination card among care takers of 12-59 months old children in Karachi, Pakistan.
Methods: This was an analytical cross-sectional study in Karachi. Households were randomly selected throughout a multistage cluster sampling technique. Data was collected for 504 children of 12- 59 months of age. Questionnaire was administered to caretakers to gather information regarding the children's vaccination status, socio-demographic characteristics and reviewing their vaccination cards. Statistical analysis was done by SPSS 19 using logistic regression.
Results: Among 462 vaccinated children, caretakers of 33% provided vaccination cards. Odds of card retention decrease if …

Support Desired By Women Following Termination Of Pregnancy For A Fetal Anomaly, Aarti Ramdaney

Dissertations and Theses (Open Access)

With the rapidly evolving field of prenatal testing, there is a growing need to provide support for women pursuing a termination of pregnancy following the discovery of a fetal anomaly. Previous studies have documented that women in this situation often feel unsupported after the procedure, but the type of resources desired by this population remains undetermined. A longitudinal study was performed in 51 women terminating for a fetal anomaly at a private clinic at the time of the procedure, at 6 weeks, and at 3 months following the event. Surveys were kept anonymous and investigated the awareness and utilization of …

Cancer Diagnosis During Pregnancy: Evaluating The Challenges Faced By Oncologists, Shannon Kaye Mulligan

Dissertations and Theses (Open Access)

Cancer during pregnancy is occurring more often than in the past, and it is estimated that cancer is diagnosed in approximately 1/1000 pregnancies. A consensus exists that management of these patients should prioritize survival of the mother and minimize teratogenic effects to the fetus, and utilize a multidisciplinary approach, involving medical oncology, surgical oncology, radiation oncology, radiology, and a maternal fetal medicine specialist. In spite of this consensus, there is not a standardized approach for treating cancer in women diagnosed during pregnancy. Due to the relative infrequency of this situation in the oncologic setting, the aims of this study were …

Latinas And The Traditional Genetic Counseling Model: A Qualitative Study, Stephanie Thompson

Dissertations and Theses (Open Access)

The traditional genetic counseling model reflects an individualized counseling session that includes the presentation of information about genes, chromosomes, personalized risk assessment, and genetic testing and screening options. Counselors are challenged to balance providing educational information with discussion of implications of this information in an allotted amount of time. The aim of this study was to explore the perceptions of pregnant Latinas on the benefits and limitations of the traditional prenatal genetic counseling model and to determine the specific preferences for receiving prenatal genetic counseling. Data were collected through focus groups and one-on-one, semi-structured interviews of twenty-five Spanish speaking Latinas …

Partner Support During Pregnancy And Its Influence On Maternal Health Behaviors, Sarah Capponi, Msii, Katelyn Cohen, Msii, Mazvita Nyamukapa, Mph, Jason K. Baxter, Md, Brett Worly, Md

Department of Obstetrics and Gynecology Presentations and Grand Rounds

Abstract

Introduction: Paternal support during pregnancy is considered a predictor of positive birth outcomes. Little research has focused on partner involvement and its impact on maternal health habits such as smoking and alcohol consumption during pregnancy.

Methods:

• This was a cross sectional study

• Pregnant women (n=198) between the ages of 18 – 44 and their partners (n=60)

• Women who identified their partner as their main support

• Norbeck Social Support Questionnaire (scale from 5 - 35)

• ANOVA and Student’s t-test were used to evaluate Norbeck scores and smoking/ drinking status

• Study personnel interviewed subjects to assess reliance on a partner

  Results: …

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Prior Ultrasound-Indicated Cerclage: What Should The Management Be In Next Pregnancy?, Anju Suhag, Md, Jordana Reina, Md, Laura Sanapo, Md, Maria Giraldo, Sushma Potti, Md, Vincenzo Berghella, Md

Department of Obstetrics and Gynecology Presentations and Grand Rounds

Abstract

Objective: To evaluate pregnancy outcomes of women with prior history of ultrasound-indicated cerclage (UIC) for short cervix who in subsequent pregnancy either were followed by transvaginal ultrasound cervical length(TVU CL)screening or received a history-indicated cerclage (HIC).

Materials and Methods: Retrospective cohort study was performed from 1993-2012, involving women with an index singleton pregnancy and history of UIC. Prior UIC was defined as cerclage placed for CLinstitution, women with prior history of UIC were managed in their subsequent pregnancy either by TVU CL screening or by HIC, at the physician's discretion(Figure). In the TVU CL group, if CL became24wks, an …

The Effect Of Commercial Tests For Aneuploidy Screening Using Cell-Free Fetal Dna On Rates Of Invasive Testing In Clinical Practice, Adetola Louis-Jacques Md, Courtney R. Burans Ms, Cgc, Sarah Robinson, Elizabeth A. Schofield, Joanne Quiñones Md, Msce, John C. Smulian Md, Mph, Meredith Rochon Md

Department of Obstetrics & Gynecology

No abstract provided.

Use Of Commercial Tests For Aneuploidy Screening Using Cell-Free Fetal Dna In Clinical Practice (Poster), Adetola Louis-Jacques Md, Courtney R. Burans Ms, Cgc, Sarah Robinson, Elizabeth A. Schofield, Joanne Quiñones Md, Msce, John C. Smulian Md, Mph, Meredith Rochon Md

Department of Obstetrics & Gynecology

No abstract provided.

Why 'Down Under' Is A Cut Above: A Comparison Of Rates Of And Reasons For Caesarean Section In England And Australia, Samantha J. Prosser, Yvette D. Miller, Rachel Thompson, Maggie Redshaw

Dartmouth Scholarship

Background: Most studies examining determinants of rising rates of caesarean section have examined patterns in documented reasons for caesarean over time in a single location. Further insights could be gleaned from cross-cultural research that examines practice patterns in locations with disparate rates of caesarean section at a single time point.

Methods: We compared both rates of and main reason for pre-labour and intrapartum caesarean between England and Queensland, Australia, using data from retrospective cross-sectional surveys of women who had recently given birth in England (n = 5,250) and Queensland (n = 3,467).

Does Cervical Ripening Via Intracervical Balloon Placement Increase The Risk Of Chorioamnionitis In Patients With Premature Rupture Of Membranes At Term?, Irena B. Cabrera Md, Joanne Quiñones Md, Msce, Danielle E. Durie Md, Jacob Rust, John C. Smulian Md, Mph, William E. Scorza Md

Department of Obstetrics & Gynecology

No abstract provided.

Amniotic Fluid Index Or Deepest Vertical Pocket?, Joanne Quiñones Md, Msce, R Melody Reynolds Md, Daniel G. Kiefer Md, Meredith Rochon Md, Katie Karabasz-Brown, John C. Smulian Md, Mph

Department of Obstetrics & Gynecology

No abstract provided.

Rct Evaluating Safety & Efficacy Of Sodium Hyaluronate/Carboxymethylcellulose At Cesarean Delivery, Daniel G. Kiefer Md, Jolene C. Muscat Md, Jarrett Santorelli Bs, Martin R. Chavez Md, Cande V. Ananth Phd, Mph, John C. Smulian Md, Mph, Anthony M. Vintzileos Md

Department of Obstetrics & Gynecology

No abstract provided.

The Baby Friendly Hospital Initiative, Kathryn E. Brackett

Senior Honors Theses

Abstract

The Baby-Friendly Hospital Initiative (BFHI) is a worldwide movement started by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) that is aimed at providing hospitals with a certification that guarantees the best possible patient-centered care for mothers and infants. It focuses on breastfeeding as optimal infant nutrition, and implements strategies to encourage and support mothers to breastfeed their infants exclusively for six months after birth. The Ten Steps to Successful Breastfeeding are a set of 10 simple, easy to understand guidelines developed by WHO and UNICEF for implementing this initiative in the hospital setting and …

Spousal Discordance On Fertility Preference And Its Effect On Contraceptive Practice Among Married Couples In Jimma Zone, Ethiopia, Tizta Tilahun, Gily Coene, Marleen Temmerman, Olivier Degomme

Obstetrics and Gynaecology, East Africa

Objectives: To assess spousal agreement levels regarding fertility preference and spousal communication, and to look at how it affects contraceptive use by couples. Methods: We conducted a cross-sectional study to collect quantitative data from March to May 2010 in Jimma zone, Ethiopia, using a multistage sampling design covering six districts. In each of the 811 couples included in the survey, both spouses were interviewed. Concordance between the husband and wife was assessed using different statistics and tests including concordance rates, ANOVA, Cohen’s Κ and McNemar’s test for paired samples. Multivariate analysis was computed to ascertain factors associated with contraceptive use. …

Perinatal Distress In Women In Low- And Middle-Income Countries: Allostatic Load As A Framework To Examine The Effect Of Perinatal Distress On Preterm Birth And Infant Health, Shahirose Sadrudin Premji

School of Nursing & Midwifery

In low- and middle-income countries (LMIC), determinants of women's and children's health are complex and differential vulnerability may exist to risk factors of perinatal distress and preterm birth. We examined the contribution of maternal perinatal distress on preterm birth and infant health in terms of infant survival and mother-infant interaction. A critical narrative and interpretive literature review was conducted. Peer-reviewed electronic databases (MEDLINE, Embase, Global Health, CINHAL), grey literature, and reference lists were searched, followed by a consultation exercise. The literature was predominantly from high-income countries. We identify determinants of perinatal distress and explicate changes in the hypothalamic-pituitary-adrenal axis, sympathetic, …

Effects Of Hazardous And Harmful Alcohol Use On Hiv Incidence And Sexual Behaviour: A Cohort Study Of Kenyan Female Sex Workers, Matthew F. Chersich, Wilkister Bosire, Nzioki King’Ola, Marleen Temmerman, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Aims: To investigate putative links between alcohol use, and unsafe sex and incident HIV infection in sub-Saharan Africa.

Methods: A cohort of 400 HIV-negative female sex workers was established in Mombasa, Kenya. Associations between categories of the Alcohol Use Disorders Identification Test (AUDIT) and the incidence at one year of unsafe sex, HIV and pregnancy were assessed using Cox proportional hazards models. Violence or STIs other than HIV measured at one year was compared across AUDIT categories using multivariate logistic regression.

Results: Participants had high levels of hazardous (17.3%, 69/399) and harmful drinking (9.5%, 38/399), while 36.1% abstained from alcohol. …

Improving Anatomical Knowledge Retention In Medical Students Entering The Surgery And Obstetrics And Gynecology Clinical Rotations By Nesting Interactive Modules, Samantha Ahle, Jill Krapf, Kirsten Marie Brown, Juliet Lee, Gisela Butera, Ellen Goldman, Myriam Ferzli, Rosalyn A. Jurjus

GW Research Days 2014

Background: It is well documented in the medical education literature that students retain minimal anatomy knowledge when transitioning from pre-clinical didactics to clinical application on the wards. In a previous study at our own institution we were able to quantify this knowledge deficit in students on surgical clerkships, specifically surgery and obstetrics and gynecology (OB/GYN). Using our previous data, we designed an integrated, nested clinical teaching model utilizing e-modules to review clinically relevant surgical anatomy during their clinical rotations.

Objective: The goal of this study is to evaluate the impact of a newly designed method of teaching clinically relevant anatomy …

The Intersection Of Depression, Partner Violence And Poverty During The Perinatal Period, Catherine L. Kothari

Dissertations

Problem: Despite the wealth of research documenting the individual links between maternal depression, partner violence, and poverty, important gaps remain regarding their combined interactions, and their variation related to perinatal timing (pregnancy and postpartum). The current dissertation examined the interplay of these phenomena across perinatality.

Methods: This dissertation utilized secondary analysis of telephone survey data from a representative sample of women recruited during their postpartum hospital stay and interviewed four times over the subsequent 18 months. Linear regression was used for predictive modeling of fixed effects, and generalized estimating equation regression was used for multivariate analysis of temporal trends.

Findings: …

Attendance At Cervical Cancer Screening And Use Of Diagnostic And Therapeutic Procedures On The Uterine Cervix Assessed From Individual Health Insurance Data (Belgium, 2002-2006), Marc Arbyn, Valérie Fabri, Marleen Temmerman, Cindy Simoens

Obstetrics and Gynaecology, East Africa

Objective: To assess the coverage for cervical cancer screening as well as the use of cervical cytology, colposcopy and other diagnostic and therapeutic interventions on the uterine cervix in Belgium, using individual health insurance data.

Methods: The Intermutualistic Agency compiled a database containing 14 million records from reimbursement claims for Pap smears, colposcopies, cervical biopsies and surgery, performed between 2002 and 2006. Cervical cancer screening coverage was defined as the proportion of women aged 25-64 that had a Pap smear within the last 3 years.

Results: Cervical cancer screening coverage was 61% at national level, for the target population of …

Complementary And Alternative Medicine Use In Women During Pregnancy: Do Their Healthcare Providers Know?, Lisa Strouss, Amy Mackley, Ursula Guillen, David A Paul, Robert Locke

Student Papers, Posters & Projects

BACKGROUND: The National Institutes of Health reported in 2007 that approximately 38% of United States adults have used at least one type of Complementary and Alternative Medicine (CAM). There are no studies available that assess general CAM use in US pregnant women.The objectives of our study were to determine the prevalence and type of CAM use during pregnancy at one medical center; understand who is using CAM and why they are using it; and assess the state of patients' CAM use disclosure to their obstetrical providers.

METHODS: A cross-sectional survey study of post-partum women was done to assess self-reported CAM …