Obstetrics and Gynecology Commons^™

Preclinical Evaluation Of Artesunate As An Antineoplastic Agent In Ovarian Cancer Treatment, Anthony Mcdowell Jr., Kristen S. Hill, Joseph Robert Mccorkle, Justin W. Gorski, Yilin Zhang, Ameen A. Salahudeen, Frederick R. Ueland, Jill M. Kolesar

Obstetrics and Gynecology Faculty Publications

BACKGROUND: Ovarian cancer is the deadliest gynecologic malignancy despite current first-line treatment with a platinum and taxane doublet. Artesunate has broad antineoplastic properties but has not been investigated in combination with carboplatin and paclitaxel for ovarian cancer treatment.

METHODS: Standard cell culture technique with commercially available ovarian cancer cell lines were utilized in cell viability, DNA damage, and cell cycle progression assays to qualify and quantify artesunate treatment effects. Additionally, the sequence of administering artesunate in combination with paclitaxel and carboplatin was determined. The activity of artesunate was also assessed in 3D organoid models of primary ovarian cancer and RNAseq …

Considerations Of Expanded Carrier Screening: Lessons Learned From Combined Malonic And Methylmalonic Aciduria., Marie Cosette Gabriel, Stephanie M. Rice, Jennifer L. Sloan, Matthew H. Mossayebi, Charles P. Venditti, Huda B. Al-Kouatly

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: Expanded carrier screening (ECS) utilizes high-throughput next-generation sequencing to evaluate an individual's carrier status for multiple conditions. Combined malonic and methylmalonic aciduria (CMAMMA) due to ACSF3 deficiency is a rare inherited disease included in such screening panels. Some cases have been reported with metabolic symptoms in childhood yet other cases describe a benign clinical course, suggesting the clinical phenotype is not well defined.

METHODS/CASE REPORT: Clinical and laboratory findings during the prenatal period were obtained retrospectively from medical records.

RESULTS: A 37-year-old nulliparous woman and her partner were each identified as carriers of ACSF3 variants and presented at 9 …

Psychological Experience And Coping Strategies Of Patients In The Northeast Us Delaying Care For Infertility During The Covid-19 Pandemic., David B Seifer, William D Petok, Alisha Agrawal, Tanya L Glenn, Arielle H Bayer, Barry R Witt, Blair D Burgin, Harry J Lieman

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: On March 17, 2020 an expert ASRM task force recommended the temporary suspension of new, non-urgent fertility treatments during an ongoing world-wide pandemic of Covid-19. We surveyed at the time of resumption of fertility care the psychological experience and coping strategies of patients pausing their care due to Covid-19 and examined which factors were associated and predictive of resilience, anxiety, stress and hopefulness.

METHODS: Cross sectional cohort patient survey using an anonymous, self-reported, single time, web-based, HIPPA compliant platform (REDCap). Survey sampled two Northeast academic fertility practices (Yale Medicine Fertility Center in CT and Montefiore's Institute for Reproductive Medicine …

Vulvar Lichen Sclerosus In Women Of Reproductive Age, Elysha Kolitz, Laura Gammon, Melissa Mauskar

Faculty, Staff and Students Publications

Vulvar lichen sclerosus (vLS) is an inflammatory skin condition that predominantly affects the vulvar and perianal regions. Approximately 50% of cases present prior to menopause; however, there is a paucity of data on vLS in women of reproductive age as well as during their pregnancies. A retrospective review was performed at two tertiary referral centers to better describe cases of vLS in women of reproductive age. Thirty-three patients with a mean age of 40 years met inclusion criteria. In this group, vulvar pruritus was the most common presenting symptom (52%); 61% had biopsy-proven vLS, 42% had at least one autoimmune …

A Public Health Approach For Deciding Policy On Infant Feeding And Mother-Infant Contact In The Context Of Covid-19, Nigel Rollins, Nicole Minckas, Fyezah Jehan, Rakesh Lodha, Daniel Raiten, Claire Thorne, Philippe Van De Perre, Mija Ververs, Neff Walker, Rajiv Bahl

Department of Paediatrics and Child Health

The COVID-19 pandemic has raised concern about the possibility and effects of mother-infant transmission of SARS-CoV-2 through breastfeeding and close contact. The insufficient available evidence has resulted in differing recommendations by health professional associations and national health authorities. We present an approach for deciding public health policy on infant feeding and mother-infant contact in the context of COVID-19, or for future emerging viruses, that balances the risks that are associated with viral infection against child survival, lifelong health, and development, and also maternal health. Using the Lives Saved Tool, we used available data to show how different public health approaches …

Conducting Household Surveys On Reproductive Health In Urban Settings: Lessons From Karachi, Pakistan, Mirbaz Khan, Sidrah Nausheen, Imtiaz Hussain, Kristy Hackett, Kaneez Zehra, Khalid Feroz, David Cannin, Iqbal Shah, Sajid Bashir Soofi

Department of Paediatrics and Child Health

Background: Data collection is the most critical stage in any population health study and correctly implementing fieldwork enhances the quality of collected information. However, even the most carefully planned large-scale household surveys can encounter many context-specific issues. This paper reflected on our research team's recent experience conducting surveys for a quasi-experimental evaluation of a reproductive health program in urban areas of Karachi, Pakistan. We aim to describe the issues encountered and lessons learned from this process, and present some potential solutions for conducting future household surveys in similar urban environments.
Methods: The study followed a three-stage random sampling design. Initially, …

Perinatal Maternal Mood Disorders, Sarah Elizabeth Hirsh Cokenakes, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

1. To identify the spectrum of peripartum mood disorders, their features, diagnostic criteria, and treatments.
2. To review FDA pregnancy safety categories and lactation categories for commonly prescribed mood medications.
3. To identify the role of family physicians in identifying and treating peripartum mood disorders.

Effect Of Consumption Of Animal Milk Compared To Infant Formula For Non-Breastfed/Mixed-Fed Infants 6-11 Months Of Age: A Systematic Review (Protocol), Aamer Imdad, Julie Melissa Ehrlich, Joseph Catania, Emily Tanner-Smith, Abigail Smith, Olivia Tsistinas, Zulfiqar Ahmed Bhutta

Woman and Child Health

Introduction: Prevalence rates of breastfeeding remain low even though the World Health Organization (WHO) and the American Academy of Pediatrics recommend exclusive breast feeding for the first 6 months of life in combination with appropriate complementary feeding beyond six 6 months of age. There have been several studies that address the implication of drinking animal milk and/or infant formula on children's health and development when breast feeding is not offered during the first year of life. Vast improvements have been made in infant formula design, which may increase its benefits compared with animal's milk. The objective of this review is …

Effects Of Intravenous Iron Versus Oral Iron For Treatment Of Anemia In Pregnancy On Maternal And Fetal Outcomes: A Systematic Review And Meta-Analysis, Sarah Chen, Julia Burd, Md, Rupsa Boelig, Md

Phase 1

Introduction: Anemia during pregnancy can lead to preterm birth, low fetal birthweight, and poorer neonatal neurological outcomes. The purpose of this study was to compare maternal and fetal outcomes following intravenous (IV) versus oral iron supplementation for iron-deficiency anemia during pregnancy.

Methods: We searched MEDLINE, OVID, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) comparing IV versus oral iron supplementation for iron-deficiency anemia during pregnancy. Studies were included in this meta-analysis if they reported maternal and fetal hematologic outcomes. The relative risk (RR) or standard mean difference (SMD) of IV iron supplementation …

Needs Analysis For Breastfeeding Education At Thomas Jefferson University Hospital, Michal Norry, Julia Switzer, Md

Phase 1

Purpose: There are currently gaps in breastfeeding education for OB/GYN and Family Medicine residents, consequently affecting their confidence in this area of patient care. To address this issue, we are conducting an analysis of the efficacy of the current curriculum to highlight areas for future improvement.

Methods: PGY1-4 residents in the departments of Family Medicine (FM) and Obstetrics and Gynecology (OB/GYN) completed a pre-test before their required annual breastfeeding education on August 6, 2020. We used a validated pre-test from the American Academy of Pediatrics (AAP) which included items assessing the training. Learners self-selected one of two didactic sessions: in …

Strategic Design Development For Malawian Public Health Center Labor & Delivery Suites, Kayla Holston, Mph, Meghan Gannon, Phd, Msph, Christopher Harnish, March, Zayithwa Fabiano, Mbbs, Luis Gadama, Mbbs, Mmed

Phase 1

Introduction: Maternity ward pre-, peri-, and postnatal room sharing creates concerns regarding maternal privacy (particularly confidentiality and dignity), paternal involvement in birthing process, and staff workflow efficiency. This study aimed to understand the current state of the aforementioned concerns and their impact on maternal child bonding and maternal mental health at Queen Elizabeth Central Hospital (QECH).

Methods: At discharge, mothers of birth (MOBs) were surveyed on pre-, peri-, and postnatal experience with regard to privacy and paternal involvement in the birthing process, and then assessed using the Mother to Infant Bonding Scale and Edinburg Depression Scale. Father of births (FOBs) …

Factors Influencing Efficacy And Satisfaction In Prenatal Counseling For Families With Single Ventricle Heart Disease, Taylor Hartzel Houlihan, Jack Rychik, Md

Phase 1

Introduction: The Fetal Heart Program at Children’s Hospital of Philadelphia offers prenatal counseling to families with congenital heart disease diagnoses. This center has yet to examine family satisfaction with counseling, especially those with complicated single ventricle diagnoses. While families may receive sufficient education about their child’s condition, better communication may be needed to prepare them for potential neurological and behavioral complications.

Methods: Through chart review, 355 patient families with single ventricle diagnoses who utilized CHOP prenatal counseling within the past 10 years were identified. Retrospective surveys including Likert scales and open-ended questions were distributed by email. 65 responses were …

Levonorgestrel Intrauterine Device Use For Medical Indications In Nulliparous Adolescents And Young Adults., Beth I Schwartz, Morgan Alexander, Lesley L Breech

Department of Obstetrics and Gynecology Faculty Papers

PURPOSE: Intrauterine devices (IUDs) are highly effective at preventing pregnancy. Levonorgestrel (LNG) IUDs also have beneficial effects on menstrual bleeding and abdominal and pelvic pain. Although there are increasing data on use of IUDs for contraception in adolescents and for medical indications in adults, there are extremely limited data on LNG IUD use for medical indications in adolescents. Our objective is to describe the characteristics and experiences of LNG IUD use in nulliparous adolescents and young women using IUDs for medical indications.

METHODS: We conducted a retrospective chart review of all nulliparous patients aged 22 years and younger who underwent …

Racial Discrepancies In Interpregnancy Intervals And Postpartum Contraception Receipt In Centering Pregnancy Prenatal Care, Amulya Raju, Ms, Dennis Hand, Phd

Phase 1

Non-Hispanic black women are disproportionately affected by higher rates of shorter interpregnancy intervals. The purpose of this study is to identify whether the Centering Pregnancy model of group prenatal care (GPC) can reduce this health disparity by increasing postpartum contraception receipt.

This retrospective chart analysis measures consistency in contraception intent versus actual postpartum receipt in populations of women who received either individual or GPC. The main predictors were: race, insurance type (public or private), marital status, and type of prenatal care. The main outcomes were: type of contraception received, consistency with contraception intent, and presence of a short interpregnancy interval. …

510 Contemporary Trends In Cesarean Delivery Rates And Indications, Sara Jaber, Christina Blanchard, Michelle Y. Lu

Conference Presentation Abstracts

Objective

The American College of Obstetrics and Gynecology (ACOG) introduced updated guidelines for labor management (2014) and fetal heart rate interpretation in an attempt to reduce cesarean delivery (CD) rates – especially the primary CD. We sought to describe CD rates and indications at a single center in order to assess the impact of these guidelines on trends in clinical practice.

Study Design

Retrospective cohort study of women ≥ 23 weeks gestation delivering at a single tertiary care referral center from 2013 - 2018. Demographic characteristics, mode of delivery, and main CD indication were ascertained by individual chart review. Main …

Health Disparities Among Pregnant Women Diagnosed With Covid-19 In Philadelphia, Vasundhara Acharya, Emily Oliver, Mbbs, Danielle Tsevat, Md, Guillermo Gurza, Md, Rupsa Boelig, Md

Phase 1

Introduction:

The CDC has cited language barriers and racial discrimination as some of the social determinants of health during the COVID-19 pandemic. This study aims to investigate the socioeconomic factors that affect COVID-19 diagnosis and outcomes in pregnant women. We hypothesize that women whose primary language is not English will have higher rates of COVID-19 compared to women whose primary language is English.

Methods:

This is a retrospective cohort study of women who delivered at TJUH between 04/13/2020 and 06/31/2020. Data on demographics, SARS-CoV-2 PCR, maternal, fetal, neonatal outcomes were collected. The primary outcome was the proportion of English …

Steamn Spin, Kathryn Sommer, Christina Stiebris, Kelley Yuan, Morgan Hutchinson, Md, Aaron Herl, Rachel Smith, Jessica Gaulton, Md, Mph, Eddie Chang, Md, Mba

Phase 1

Sanitize and dry your breast pump parts within minutes.

Safety Of Daily Low-Dose Aspirin Use During Pregnancy In Low-Income And Middle-Income Countries, Vanessa L. Short, Matthew Hoffman, Mrityunjay Metgud, Avinash Kavi, Shivaprasad S. Goudar, Jean Okitawutshu, Antoinette Tshefu, Carl L. Bose, Saleem Jessani, Sarah Saleem

Community Health Sciences

Background: The daily use of low-dose aspirin may be a safe, widely available, and inexpensive intervention for reducing the risk of preterm birth. Data on the potential side effects of low-dose aspirin use during pregnancy in low- and middle-income countries are needed.
Objective: This study aimed to assess differences in unexpected emergency medical visits and potential maternal side effects from a randomized, double-blind, multicountry, placebo-controlled trial of low-dose aspirin use (81 mg daily, from 6 to 36 weeks' gestation).
Study design: This study was a secondary analysis of data from the Aspirin Supplementation for Pregnancy Indicated Risk Reduction In Nulliparas …

A Scoping Review: Overview Of Current Respectful Maternity Care Research By Research Approach And Study Location, Hannah L. Shuman, Annika M. Grupp, Lauren A. Robb, Gurbani Bedi, Miloni Shah, Andrea Janis, Caroline G. Caldart, Ryan Melikian, Urvashi Gupta, Janki K. Vaghasia, Aishwarya Panneerselvam, Aisha Kazeem, Ndidiamaka N. Amutah-Onukagha, Diane L. Levine

Medical Student Research Symposium

Introduction: Disrespectful care during childbirth contributes to poor health outcomes, perpetuates disparities, and encourages childbirth outside of healthcare facilities. To measure disrespectful care, investigators use many research approaches. Most research has focused on low/low-middle income countries. This scoping review aims to 1) summarize current research and research approaches to analyze whether these approaches identify the same types of mistreatment and 2) identify gaps in current research analyzing disrespectful care during childbirth.

Methods: Following PRISMA guidelines, this review utilized search terms to filter articles from the Pubmed database. Using specific criteria, articles were then excluded by title and abstract, then full …

Understanding M6a’S Role In The Myometrium During Gestation, Lindsay Jenkins, Arren Simpson, Jennifer Condon Phd, Jeyasuria Pancharatnam Phd

Medical Student Research Symposium

Epigenetic modifications, such as DNA methylation, mainly affects the function of genes through regulating the transcription or translation processes, without altering the DNA sequences. The regulation of m⁶A modification is dynamic and reversible and is established by m⁶A methyltransferases (“writers”), such as methyltransferase-like protein 3 (METTL3). It is removed by m6A demethylases (“erasers”), such as α-ketoglutarate-dependent dioxygenase alkB homolog 5 (ALKBH5). The effects of m6A modification on RNA metabolism depend on the recognition by different m⁶A -binding proteins (“readers”), including the YT521-B homology (YTH) domain family and the heterogeneous nuclear ribonucleoproteins (HNRNPs). We believe …

Does Delay In The Diagnosis Of Rudimentary Horn Pregnancy In Patients With Unicornuate Uteri Impact Treatment Outcomes?, Victoria Webber, Megan Fee, Damla Gonullu, Jessica Rausch, Omosalewa Itauma, Chidinma Abara, Awoniyi Awonuga

Medical Student Research Symposium

OBJECTIVE: Rudimentary horn pregnancy (RHP) is a very rare form of ectopic pregnancy (EP) that tends to rupture in the second trimester. Similar to other EPs, the treatment of RHPs is excision, hence delay in diagnosis (DID) can be detrimental. Our objective is to determine whether DID of RHP in patients with unicornuate uteri (UCU) impacts the treatment outcome.

DESIGN: Retrospective cohort study of published case reports in PubMed database.

MATERIALS AND METHODS: A computerized PubMed search of case reports of RHP from 2007 to 2020 was performed using the key words; unicornuate uterus, rudimentary horn, pregnancy, case. Data was …

Knowledge And Practices: Risk Perceptions Of Covid-19 And Satisfaction With Preventive Measures At Workplace Among Maternity Care Providers In Pakistan, Rubina Izhar, Samia Husain, Muhammad Ahmad Tahir, Sonia Husain

Medical College Documents

Introduction: While all healthcare services across the globe deferred non-urgent surgeries, labor wards provided maternity care during the COVID-19 pandemic continuously. This study assesses the knowledge and practices of obstetricians and midwives about personal protective equipment (PPE); their risk perception of COVID-19 and satisfaction with the preventive measures adopted at their workplace.
Methods: A questionnaire designed according to the World Health Organization’s advice on rational use of personal protective equipment for COVID-19 was administered to 452 Pakistani maternity care providers between 1 July and 30 July 2020.
Results: Most (85%) had adequate knowledge and 78.8% had good practices regarding PPE …

Caesarean Birth By Maternal Request: A Poorly Understood Phenomenon In Low- And Middle-Income Countries., Margo S. Harrison, Ana Garces, Lester Figueroa, Fabian Esamai, Sherri Bucher, Carl Bose, Shivaprasad Goudar, Richard Derman, Archana Patel, Patricia L. Hibberd, Elwyn Chomba, Miusaku Mwenechanya, Michael Hambidge, Nancy F. Krebs

Global Health Articles

BACKGROUND: While trends in caesarean birth by maternal request in low- and middle-income countries are unclear, age, education, multiple gestation and hypertensive disease appear associated with the indication when compared with caesarean birth performed for medical indications.

METHODS: We performed a secondary analysis of a prospectively collected population-based study of home and facility births using descriptive statistics, bivariate comparisons and multilevel mixed-effects logistic regression.

RESULTS: Of 28 751 patients who underwent caesarean birth and had a documented primary indication for the surgery, 655 (2%) were attributed to caesarean birth by maternal request. The remaining 98% were attributed to maternal and …

Mithramycin And Analogs For Overcoming Cisplatin Resistance In Ovarian Cancer, David Schweer, J. Robert Mccorkle, Jurgen Rohr, Oleg V. Tsodikov, Frederick R. Ueland, Jill M. Kolesar

Obstetrics and Gynecology Faculty Publications

Ovarian cancer is a highly deadly malignancy in which recurrence is considered incurable. Resistance to platinum-based chemotherapy bodes a particularly abysmal prognosis, underscoring the need for novel therapeutic agents and strategies. The use of mithramycin, an antineoplastic antibiotic, has been previously limited by its narrow therapeutic window. Recent advances in semisynthetic methods have led to mithramycin analogs with improved pharmacological profiles. Mithramycin inhibits the activity of the transcription factor Sp1, which is closely linked with ovarian tumorigenesis and platinum-resistance. This article summarizes recent clinical developments related to mithramycin and postulates a role for the use of mithramycin, or its analog, …

Mutyh As An Emerging Predictive Biomarker In Ovarian Cancer, Megan L. Hutchcraft, Holly H. Gallion, Jill M. Kolesar

Obstetrics and Gynecology Faculty Publications

Approximately 18% of ovarian cancers have an underlying genetic predisposition and many of the genetic alterations have become intervention and therapy targets. Although mutations in MutY homolog (MUTYH) are best known for MUTYH associated polyposis and colorectal cancer, it plays a role in the development of ovarian cancer. In this review, we discuss the function of the MUTYH gene, mutation epidemiology, and its mechanism for carcinogenesis. We additionally examine its emerging role in the development of ovarian cancer and how it may be used as a predictive and targetable biomarker. MUTYH mutations may confer the risk of ovarian …

Disparities In Cardiovascular Disease Outcomes Among Pregnant And Post-Partum Women, Mohamed M Gad, Islam Y Elgendy, Ahmed N Mahmoud, Anas M Saad, Toshiaki Isogai, Isadora Sande Mathias, Rabel Misbah Rameez, Johnny Chahine, Hani Jneid, Samir R Kapadia

Faculty, Staff and Students Publications

Background

The incidence of cardiovascular disease among pregnant women is rising in the United States. Data on racial disparities for the major cardiovascular events during pregnancy are limited.

Methods and Results

Pregnant and post‐partum women hospitalized from January 2007 to December 2017 were identified from the Nationwide Inpatient Sample. The outcomes of interest included: in‐hospital mortality, myocardial infarction, stroke, pulmonary embolism, and peripartum cardiomyopathy. Multivariate regression analysis was used to assess the independent association between race and in‐hospital outcomes. Among 46 700 637 pregnancy‐related hospitalizations, 21 663 575 (46.4%) were White, 6 302 089 (13.5%) were Black, and 8 914 …

Inclusion Of Pregnant Individuals Among Priority Populations For Coronavirus Disease 2019 Vaccination For All 50 States In The United States., A. Grünebaum, L. B. Mccullough, A. Litvak, F. A. Chervenak

Journal Articles

No abstract provided.

Professionally Responsible Coronavirus Disease 2019 Vaccination Counseling Of Obstetrical And Gynecologic Patients, F. A. Chervenak, L. B. Mccullough, E. Bornstein, L. Johnson, A. Katz, R. Mcleod-Sordjan, M. Nimaroff, B. L. Rochelson, A. Tekbali, A. Warman, K. Williams, A. Grünebaum

Journal Articles

© 2021 Elsevier Inc. The development of coronavirus disease 2019 vaccines in the current and planned clinical trials is essential for the success of a public health response. This paper focuses on how physicians should implement the results of these clinical trials when counseling patients who are pregnant, planning to become pregnant, breastfeeding or planning to breastfeed about vaccines with government authorization for clinical use. Determining the most effective approach to counsel patients about coronavirus disease 2019 vaccination is challenging. We address the professionally responsible counseling of 3 groups of patients—those who are pregnant, those planning to become pregnant, and …

Postpartum Hemorrhage Management: Improving Quality And Patient Safety Through Multidisciplinary Simulation Training, Beverly Mayfield

DNP Research Projects

Abstract

Purpose: To evaluate the effectiveness of a multidisciplinary moderate fidelity simulated postpartum hemorrhage (PPH) educational intervention on accurate and timely adherence to a standard PPH protocol during simulated PPH events.

Methods: The study design was a quasi-experimental one group pretest- posttest time series utilizing a convenience sample of multidisciplinary nurses, nursing assistants, laboratory, and physician staff working at one rural hospital with an annual birthrate less than 100. The intervention was an educational in situ PPH moderate fidelity scenario with pre-brief and debrief. Change in performance was evaluated using unannounced PPH simulation drills at three one-month intervals following the …

Effects Of Maternal Obesity And Gestational Diabetes Mellitus On The Placenta: Current Knowledge And Targets For Therapeutic Interventions, Samantha Bedell, Janine Hutson, Barbra De Vrijer, Genevieve Eastabrook

Obstetrics & Gynaecology Publications

Obesity and gestational diabetes mellitus (GDM) are becoming more common among pregnant women worldwide and are individually associated with a number of placenta-mediated obstetric complications, including preeclampsia, macrosomia, intrauterine growth restriction and stillbirth. The placenta serves several functions throughout pregnancy and is the main exchange site for the transfer of nutrients and gas from mother to fetus. In pregnancies complicated by maternal obesity or GDM, the placenta is exposed to environmental changes, such as increased inflammation and oxidative stress, dyslipidemia, and altered hormone levels. These changes can affect placental development and function and lead to abnormal fetal growth and development …