Obstetrics and Gynecology Commons^™

‘What About The Mother?’ Women׳S And Caregivers׳ Perspectives On Caesarean Birth In A Low-Resource Setting With Rising Caesarean Section Rates, Helena Litorp, Andrew Mgaya, Hussein Kidanto, Sara Johnsdotter, Birgitta Essén

Faculty of Health Sciences, East Africa

Objective in light of the rising caesarean section rates in many developing countries, we sought to explore women׳s and caregivers׳ experiences, perceptions, attitudes, and beliefs in relation to caesarean section.

Design qualitative study using semi-structured individual in-depth interviews, focus group discussions, and participant observations. The study relied on a framework of naturalistic inquiry and data were analysed using thematic analysis.

Setting a public university hospital in Dar es Salaam, Tanzania.

Participants we conducted a total of 29 individual interviews, 13 with women and 16 with caregivers, and two focus group discussions comprising five to six caregivers each. Women had undergone …

Pregnancy Apps: A Closer Look At The Implications For Childbirth Educators, Christine Frazer, Leslie Hussey, Emily Bosch, Michelle Squire

Walden Faculty and Staff Publications

Most pregnant women download an average of three pregnancy apps during their gestational period. There are no set standards in place for what needs to be included in an app’s description leaving consumers to decide for themselves when it comes to selecting the right app to download. The childbirth educator must be knowledgeable about pregnancy apps, in-tune as to what apps their clientele download, and how to analyze them for credibility. This article presents characteristics associated with women of childbearing age (i.e. Millennial/Net generation); the reasons why pregnant women are turning to apps; the limitations of apps, and the childbirth …

Effect Of Pelvic Floor Muscle Training Among Pregnant Black African Population On The Risk Of Postpartum Urinary Incontinence, A Single Blind Randomized Control Trial, Samuel Ngugi

Master of Medicine in Obstetrics and Gynecology

Trial registration: The study was registered at the Pan African Clinical Trial Registry and a unique identification number issued PACTR201407000850309. Background: Pelvic Floor Muscle Training (PFMT) in the antenatal period has been found to be an effective primary prevention intervention in the Caucasian population in reducing the risk of postpartum Urinary incontinence. Objective: This study was primarily designed to determine the effect of PFMT introduced in the second trimester amongst pregnant black African population on the risk of six weeks postpartum Urinary Incontinence. Secondary objectives included investigating the risk of postpartum Urinary Incontinence, the effect of mode of delivery on …

Child Marriage Legislation In The Asia-Pacific Region, Elisa Scolaro, Aleksandra Blagojevic, Brigitte Fillion, Venkatraman Chandra-Mouli, Lale Say, Joar Svanemyr, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Child marriage is a human rights violation that robs a girl of her childhood, puts her health, growth, and development at risk, disrupts her education, limits her opportunities for empowerment and social development, and increases her risk of exposure to violence and abuse (for a review of the evidence on the negative effects of child marriage on girls and their children, see Parsons et al. 2015, in this issue). While child marriage is not mentioned specifically in the 1989 Convention on the Rights of the Child (CRC), the Convention does contain a provision requiring governments to abolish “traditional practices prejudicial …

‘What About The Mother?’ Women׳S And Caregivers׳ Perspectives On Caesarean Birth In A Low-Resource Setting With Rising Caesarean Section Rates, Helena Litorp, Andrew Mgaya, Hussein Kidanto, Sara Johnsdotter, Birgitta Essén

Obstetrics and Gynaecology, East Africa

Objective: in light of the rising caesarean section rates in many developing countries, we sought to explore women׳s and caregivers׳ experiences, perceptions, attitudes, and beliefs in relation to caesarean section.

Design: qualitative study using semi-structured individual in-depth interviews, focus group discussions, and participant observations. The study relied on a framework of naturalistic inquiry and data were analysed using thematic analysis.

Setting: a public university hospital in Dar es Salaam, Tanzania.

Participants: we conducted a total of 29 individual interviews, 13 with women and 16 with caregivers, and two focus group discussions comprising five to six caregivers each. Women had undergone …

Quality Of Care For Pregnant Women And Newborns—The Who Vision, Ӧ. Tuncalp, W. M. Were, C. Maclennan, O. T. Oladapo, A. M. Gulmezoglu, R. Bahl, B. Daelmans, M. Mathai, L. Say, F. Kristensen, Marleen Temmerman, F. Bustreo

Obstetrics and Gynaecology, East Africa

In 2015, as we review progress towards Millennium Development Goals (MDGs), despite significant progress in reduction of mortality, we still have unacceptably high numbers of maternal and newborn deaths globally. Efforts over the past decade to reduce adverse outcomes for pregnant women and newborns have been directed at increasing skilled birth attendance.1,2 This has resulted in higher rates of births in health facilities in all regions.3 The proportion of deliveries reportedly attended by skilled health personnel in developing countries rose from 56% in 1990 to 68% in 2012.4 With increasing utilisation of health services, a higher proportion of avoidable maternal …

Obstetrician-Gynecologists’ Knowledge Of Health Disparities And Barriers Among American Indian/Alaska Native Women In Washington State, Katherine M. Jones, Greta B. Raglan, Sophia M. Lannon, Jay Schulkin

Journal of Health Disparities Research and Practice

Background: Health disparities between American Indian/Alaska Native (AI/AN) women and other races/ethnicities have long been noted. Obstetricians-Gynecologists (Ob-Gyn) play a significant role in well-woman care and are often the first and most frequent point of medical contact for women, particularly among minority and low-income women.

Objective: This study aimed to assess Ob-Gyns’ knowledge, beliefs, and practices related to health disparities among AI/AN women.

Method: A self-administered questionnaire, consisting of questions about knowledge, beliefs, and practices of health disparities among AI/AN women, was mailed to 722 members of The American College of Obstetricians and Gynecologists (ACOG) practicing in the state of …

Do I Buy It? How Aidettm Training Changes Residents’ Values About Communication Skills In Doctor-Patient Interactions, Andrea Braverman, Phd, Austin Katona, B.Sc., Elisabeth Kunkel, Md, Leo Katz, Md, Matthew Keller, Md, Constantine Daskalakis, Sc.D, Jennifer Jasmine Arfaa, Phd, Mhsa

Department of Obstetrics and Gynecology Presentations and Grand Rounds

OBJECTIVES

Acquiring communication and interpersonal skills is an important part of providing patient-centered care and improving patient satisfaction. This study explores whether residents’ own values about patient communication change over time.

Comparing Neonatal Respiratory Morbidity In Neonates Delivered At Term By Elective Caesarean Section With And Without Dexamethasone: Retrospective Cohort Study, Anita Dileep, Neelofur Babar Khan, Sana Sadiq Sheikh

Department of Obstetrics & Gynaecology

Objective: To assess the effect of dexamethasone on neonatal respiratory morbidity in babies delivered by early term elective lower segment Caesarean section. Method: The retrospective cohort study was conducted at a secondary level hospital in Karachi. It reviewed the medical record of pregnant women and their babies who were delivered by elective lower segment Caesarean section between January 1 and June 30, 2013, at 37-38+6 weeks of pregnancy. The women were divided into exposed group (Group A) who received prophylactic dexamethasone, and non-exposed group (Group B) who did not receive dexamethasone Neonatal respiratory morbidity was compared between the two groups. …

Impact Of Self Regulation Skills On Students Academic Grades, Abeer Kathawala, Shelina Bhamani

Department of Obstetrics & Gynaecology

This research aimed to explore if self-regulation skills had any effect on the academic outcomes of young children in private schools of Karachi, Pakistan. Quantitative research method was used to determine the impact of self-regulation upon the academic outcome of young children by utilizing Early School Self-Regulation Scale-Care Giver Version (Bhamani, 2012).The sample size consisted of randomly chosen 210 children, studying in grades 1 and 2 from seven different private schools in Karachi. The results of the research show that selfregulation skills had a significant impact on the academic outcome of young children in private schools of Karachi, b = …

Accelerating The Dual Elimination Of Mother-To-Child Transmission Of Syphilis And Hiv: Why Now?, James Kiarie, Chandra K. Mishra, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Even though the elimination of congenital syphilis has been on the maternal and child health (MCH) agenda for over a decade, elimination has not yet been achieved; what, then, are the factors currently facilitating the elimination of mother-to-child transmission (MTCT) of syphilis?

Which Role Do Midwives And Gynecologists Have In Smoking Cessation In Pregnant Women?–A Study In Flanders, Belgium, Katrien De Wilde, Inge Tency, Sarah Steckel, Marleen Temmerman, Hedwig Boudrez, Lea Maes

Obstetrics and Gynaecology, East Africa

Objectives: The objectives of our study were (1) to explore knowledge, beliefs and practice among mid-wives and gynecologists concerning a smoking cessation policy for pregnant women and their partners and (2) to examine if midwives and gynecologists do have a role in smoking cessation in pregnant women.

Method: We performed a qualitative study using semi-structured interviews with nine midwives and eight gynecologists. Data were analyzed using deductive content analysis, based on the 5 A’s frame-work (Ask–Advise–Assess–Assist–Arrange).

Results: The national smoking cessation policy seemed to be insufficiently known. “Ask” and “Advise" were part of a standard prenatal consultation, the next three …

Assessing Predictors Of Contraceptive Use And Demand For Family Planning Services In Underserved Areas Of Punjab Province In Pakistan: Results Of A Cross-Sectional Baseline Survey, Syed Khurram Azmat, Moazzam Ali, Muhammad Ishaque, Ghulam Mustafa, Waqas Hameed, Omar Farooq Khan, Ghazunfer Abbas, Marleen Temmerman, Erik Munroe

Community Health Sciences

Background: Although Pakistan was one of the first countries in Asia to launch national family planning programs, current modern contraceptive use stands at only 26% with a method mix skewed toward short-acting and permanent methods. As part of a multiyear operational research study, a baseline survey was conducted to understand the predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan. This paper presents the baseline survey results; the outcomes of the intervention will be presented in a separate paper after the study has been completed.
Method: A cross-sectional baseline household survey …

The Effect Of An Educational Intervention On Knowledge And Intent To Participate In Cervical Cancer Screening, Ann Marie Trapp

Evidence-Based Practice Project Reports

Globally, cervical cancer ranks third among cancers affecting women (Arbyn et al., 2013). In the United States, approximately 12,000 women are diagnosed with cervical cancer and approximately 4,000 women die yearly (Centers for Disease Control and Prevention, 2014). Papanicolaou (Pap) screening is an effective means of detecting precancerous cell changes of the cervix with early cervical cancer diagnosis carrying a 91% five-year survival rate (Gonzalez et al., 2012). The purpose of this evidence-based practice project was to identify interventions that increase adherence to cervical cancer screening and to implement best practices to reduce unnecessary deaths related to late diagnoses of …

Obstetric Transition In The World Health Organization Multicountry Survey On Maternal And Newborn Health: Exploring Pathways For Maternal Mortality Reduction., Solange Da Cruz Chaves, José Guilherme Cecatti, Guillermo Carroli, Pisake Lumbiganon, Carol J. Hogue, Rintaro Mori, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objective: To test whether the proposed features of the Obstetric Transition Model-a theoretical framework that may explain gradual changes that countries experience as they eliminate avoidable maternal mortality-are observed in a large, multicountry, maternal and perinatal health database; and to discuss the dynamic process of maternal mortality reduction using this model as a theoretical framework.

Methods: This was a secondary analysis of a cross-sectional study by the World Health Organization that collected information on more than 300 000 women who delivered in 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East, during a 2-4-month …

Analysis Of Embryo Scoring And Comparison Of Clinic Performance In In-Vitro Fertilization, James W. Whistler

Master's Theses

Clinical Assisted Reproductive Technology (ART) practices seek to make improvements in embryo quality and resultant procedural success rates. There is a significant variance in live birth rates among clinics nationwide. The goal of this thesis is make comparisons of embryo quality among clinics and understand these differences. This analysis focuses on the stage between egg retrieval and embryo transfer. Because the currently accepted embryo scoring methods are not directly proportional to performance, a new scoring methodology is proposed and applied. Data provided by the Society for Assisted Reproductive Technology (SART) consisting of 36,836 patient cycles from 40 anonymous clinics nationwide …

Urinary Phthalate Metabolite Concentrations And Blood Glucose Levels During Pregnancy, Candace A. Robledo, Jennifer D. Peck, Julie A. Stoner, Antonia M. Calafat, Hélène Carabin, Linda Cowan, Jean R. Goodman

School of Medicine Publications

Purpose: To examine associations between phthalate metabolite urinary concentrations during early pregnancy and blood glucose levels obtained at the time of screening for gestational diabetes mellitus (GDM).

Methods: Upon initiation of prenatal care, women with a mean gestational age of 12.8 weeks were recruited for a study of environmental chemical exposures (n = 110) and provided a spot urinary specimen. Blood glucose concentrations (mg/dl) were obtained from the electronic medical record for those patients who did not experience a pregnancy loss and did not transfer care to another facility prior to glucose screening (n = 72). Urinary concentrations of nine …

Patient Centered Infertility Care: The Health Care Provider’S Perspective, Alana Streisfield, Nurun Chowdhury, Rebecca Cherniak, Heather Shapiro

Patient Experience Journal

This study describes what health care providers (HCPs) of fertility services perceive their patients to value most, as well as HCPs’ self-evaluation in provision of patient centered infertility care (PCIC). The Patient Centeredness Questionnaire Infertility (PCQ-I) was administered to all clinic staff and completed by approximately 60%. Mean scores and standard deviations were calculated for each dimension as well as for the global score. HCPs ranked staff communication as the highest of the dimensions and accessibility of care as the lowest, respectively indicating areas of strength and weakness. Degree of variance within scoring was used as a marker of consistency …

Routine Surveillance Of Patients With Hypertensive Disorders In Pregnancy, Johanna Quist-Nelson, Md, Lauren Cooper, Md, Abigail Wolf, Md

Department of Obstetrics and Gynecology Presentations and Grand Rounds

BACKGROUND

• Hypertensive disorders in pregnancy carry morbidity and mortality for mothers and infants
• Hypertensive disorders include a full spectrum from gestational hypertension and preeclampsia to eclampsia.
• In 2013 the American College of Obstetricians and Gynecologists released an executive summary with new task force recommendations for closer monitoring of patients with hypertensive disorders including:

Twice weekly blood pressure monitoring

Weekly office visits

Ultrasound surveillance of fetal growth

Weekly laboratory surveillance

Delivery at 37 weeks for patients with gestational hypertension and preeclampsia without severe features

Urine Proteomics Identifies Preeclampsia Subphenotypes, Michelle R. Axe

Undergraduate Honors Thesis Projects

Preeclampsia is a perinatal complication of unknown etiology, resulting in 76,000 maternal deaths and 500,000 infant deaths annually₁. The Nationwide Children’s Center for Perinatal Research was the first cohort to propose that preeclampsia is rooted in protein misfolding. We aimed to characterize the misfolded protein components of maternal urine samples and to determine if distinct molecular profiles exist for clinical preeclampsia phenotypes. A total of 86 maternal urine samples from Yale-New Haven Hospital were analyzed for this study, from six clinical preeclampsia subphenotypes- pregnant control (n=10), idiopathic proteinuria (n=15), mild preeclampsia (n=14), superimposed preeclampsia (n=12), typical severe preeclampsia …

Targeted Single Molecule Sequencing Methodology For Ovarian Hyperstimulation Syndrome., Funda Orkunoglu-Suer, Arthur F. Harralson, David Frankfurter, Paul Gindoff, Travis J. O'Brien

Genomics and Precision Medicine Faculty Publications

BACKGROUND: One of the most significant issues surrounding next generation sequencing is the cost and the difficulty assembling short read lengths. Targeted capture enrichment of longer fragments using single molecule sequencing (SMS) is expected to improve both sequence assembly and base-call accuracy but, at present, there are very few examples of successful application of these technologic advances in translational research and clinical testing. We developed a targeted single molecule sequencing (T-SMS) panel for genes implicated in ovarian response to controlled ovarian hyperstimulation (COH) for infertility.

RESULTS: Target enrichment was carried out using droplet-base multiplex polymerase chain reaction (PCR) technology (RainDance®) …

Exploring Racial Disparity In St. Louis City Fetal-Infant Death, Hadi Danawi, Marie Peoples

Walden Faculty and Staff Publications

The perinatal periods of risk (PPOR) methodology was used to analyze resident fetal and infant deaths in St. Louis City, Missouri, for the years 1999 - 2008. The PPOR approach is mapped into four periods: Maternal Health/Prematurity (MHP), Maternal Care (MC), Newborn Care (NC), and Infant Health (IF). Both Blacks and Whites experienced excess fetal-infant death within the MHP periods. Recognizing specific periods of increased risk provides key information to transform data into action. Findings allow childbirth educators, community members, and policy-makers to further explore barriers limiting maternal care.

Maine's Breastfeeding Gap: How Initiation And Duration Differ By Socioeconomic Status, Zoe Miller

Thinking Matters Symposium Archive

The preventive health benefits of breastfeeding for both mothers and children are widely recognized. Leading health authorities recommend exclusive breastfeeding for the first six months of life.

Though breastfeeding rates in the United States have been increasing for the past decade, significant disparities continue across race and socioeconomic status.

Mindfulness: Being Present In The Moment, Stephanie Ann Stathas, Christine Frazer

Walden Faculty and Staff Publications

This article serves to enlighten childbirth educators’ knowledge about mindfulness and the mother-baby benefits associated with incorporating mindfulness- based interventions into practice. Jon Kabat-Zinn, who developed the Mindfulness Based Stress Reduction program, brought the concept of mindfulness into the world of healthcare and mainstream society. Mindfulness is the practice of bringing awareness to the here and now using a variety of methods. Nancy Bardacke has taken the practice of mindfulness further and developed a program for expecting mothers, known as Mindfulness Based Childbirth and Parenting. This program has been shown to reduce stress responses that may be harmful to a …

The Role Of Ultrasound In The Lebanese Outreach Setting, Reem Abu-Rustum, Fouad M. Ziade, Hadi Danawi

Walden Faculty and Staff Publications

A cross-sectional study was carried out on 669 patients to assess the role of introducing ultrasound into obstetrical outreach in Lebanon. Data were collected, and descriptive statistics were performed. Sonographic findings were compared using Chi-square tests between underserved Lebanese and Syrian refugee mothers. Ultrasound plays a significant role in properly dating pregnancies in addition to identifying at-risk fetuses and detecting placental abnormalities. Medical providers need to make sonographic evaluation in the Lebanese outreach obstetrical setting more available and more systematic in order to secure a safe outcome for underserved Lebanese and Syrian refugee mothers and offspring.

Categorizing Fetal Heart Rate Variability With And Without Visual Aids, Amanda Jane Ashdown

Psychology Theses & Dissertations

This present study examined the ability of clinicians and novices to correctly categorize fetal heart rate (FHR) variability with and without the use of exemplars. Clinicians and undergraduate students were asked to inspect FHR images and determine into which of four categories they belonged. Each participant took part in three conditions: one in which they were provided exemplars of prototypical FHR variability to use during their categorization task, another in which they were provided exemplars of nonprototypical FHR variability to use in their task, and a control condition in which no exemplars were available. The results showed that experts were …

Knowledge And Attitude Towards Rape And Child Sexual Abuse – A Community-Based Cross-Sectional Study In Rural Tanzania, Muzdalifat Abeid, Projestine Muganyizi, Siriel Massawe, Rose Mpembeni, Elisabeth Darj, Pia Axemo

Obstetrics and Gynaecology, East Africa

Background, Violence against women and children is globally recognized as a social and human rights concern. In Tanzania, sexual violence towards women and children is a public health problem. The aim of this study was to determine community knowledge of and attitudes towards rape and child sexual abuse, and assess associations between knowledge and attitudes and socio-demographic characteristics.

Methods, A cross-sectional study was undertaken between May and June 2012. The study was conducted in the Kilombero and Ulanga rural districts in the Morogoro Region of Tanzania. Men and women aged 18–49 years were eligible for the study. Through a three-stage …

El Rol Del Parto Mapuche En El Mundo De La Medicina Moderna / The Role Of Mapuche Birth In A World Of Modern Medicine, Nita Chai

Independent Study Project (ISP) Collection

Research Question: Is there existing demand for Mapuche birth practices and what are the barriers to incorporating them in the Chilean healthcare system? Objective: Analyze the current role of Mapuche birth practicesby determining what is the demand from the Mapuche for their use, describing the quality of communication between Mapuche women andmodern professionals, and identifying the perspectives of modern professionals on Mapuche birth practices. Background: Childbirth is an integral process for the human race. For many indigenous communities, the arrival of a new life holds cultural significance that is recognized through ceremonies during or after childbirth. Chile has implemented health …

Preliminary Analysis Of In Utero Low-Level Arsenic Exposure And Fetal Growth Using Biometric Measurements Extracted From Fetal Ultrasound Reports, Matthew A. Davis, John Higgins, Zhigang Li, Diane Gilbert-Diamond, Emily R. Baker, Amar Das, Margaret R. Karagas

Dartmouth Scholarship

Background: Early life exposure to arsenic is associated with decreased birth weight in highly exposed populations but little is known about effects of low-level arsenic exposure on growth in utero.

Methods: Using a sample of 272 pregnancies from New Hampshire we obtained biometric measurements directly from fetal ultrasound reports commonly found in electronic medical records. We used information extraction methods to develop and validate an automated approach for mining biometric measurements from the text of clinical reports. As a preliminary analysis, we examined associations between in utero low-level arsenic exposure (as measured by maternal urinary arsenic concentration) and fetal growth …

Metformin Prevents Aggressive Ovarian Cancer Growth Driven By High-Energy Diet: Similarity With Calorie Restriction, Zaid Al-Wahab, Ismail Mert, Calvin Tebbe, Jasdeep Chhina, Miriana Hijaz, Robert T. Morris, Rouba Ali-Fehmi, Shailendra Giri, Adnan Munkarah, Ramandeep Rattan

Department of Obstetrics and Gynecology Research Publications

Caloric restriction (CR) was recently demonstrated by us to restrict ovarian cancer growth in vivo. CR resulted in activation of energy regulating enzymes adenosine monophosphate activated kinase (AMPK) and sirtuin 1 (SIRT1) followed by downstream inhibition of Akt-mTOR. In the present study, we investigated the effects of metformin on ovarian cancer growth in mice fed a high energy diet (HED) and regular diet (RD) and compared them to those seen with CR in an immunocompetent isogeneic mouse model of ovarian cancer. Mice either on RD or HED diet bearing ovarian tumors were treated with 200 mg/kg metformin in drinking …