Obstetrics and Gynecology Commons^™

Social And Biological Determinants Of Pregnancy-Related Mortality And Morbidity In A Rural, Underserved Population, Anna Hansen

Theses and Dissertations--Sociology

Cases of severe maternal morbidity (SMM) and pregnancy-related mortality (PRM) are increasing in the US. Research concerning SMM and PRM has neglected women in Central Appalachia; a largely rural, health-disparate population. The aims of this study are two-fold: (1) Examine patient-level and place-based predictors of SMM/PRM via hierarchical logistic regression modeling, and (2) Elucidate Appalachian healthcare patients’ and providers’ experiences with SMM/PRM, perceptions of contributing factors, and insights on points of intervention.

This study uses a mixed methods approach guided by the WHO’s conceptual framework for action on social determinants of health to identify determinants of SMM and PRM among …

Risk Of Secondary Malignancies In Ovarian Cancer Survivors: 54,305 Patients Analyzed With 40 Years Of Follow-Up, A C. Casper, M W. Parsons, J Chipman, L M. Burt Jr, G Suneja, K A. Maurer, D K. Gaffney

View All Washington/Montana GME

Presented at the 2022 Virtual Northwest Medical Research Symposium

Factors Impacting Genomic Testing Rates Among Epithelial Ovarian Cancer Patients Across A Large Community-Based Healthcare System, Nicole M. Kretzer, Christopher J. Darus, Nancy Biery, Roshanthi Weerasinghe, Grace Li, Ann Vita, Shwetha Pindikuri, Amy S. Parrish, Charles W Drescher, Fernanda B. Musa

All Podium Presentations

Background: Epithelial ovarian cancer (EOC) accounts for the highest mortality of all gynecological cancers. NCCN guidelines recommend germline and somatic testing for all women with invasive EOC. Despite this recommendation, there is a large diversity in the types of testing patients receive even within a single healthcare system. Reported data of genetic testing for epithelial ovarian cancer (EOC) patients is largely based on patients treated at academic medical centers or patients who participate in clinical trials.

Purpose: This study sought to determine the rates of germline and somatic testing for epithelial ovarian cancer patients and identify factors that impact testing …

Patterns Of Genomic Testing For Epithelial Ovarian Cancer Across A Large Community-Based Health Care Network- A Real World Experience, Nicole M. Kretzer, Fernanda B. Musa, Christopher Darus, Nancy Biery, Roshanthi Weerasinghe, Grace Li, Ann Vita, Shwetha Pindikuri, Amy S. Parrish, Charles W Drescher

All Podium Presentations

Background: NCCN guidelines recommend germline and somatic tumor testing for all women with invasive epithelial ovarian cancer (EOC). Despite this recommendation, testing rates remain low and an optimal strategy to achieve the recommended testing has not been defined.

Purpose: We elected to review the patterns of germline and somatic tumor testing for patients with EOC across a large health care network to identify barriers to testing.

Methods: Clinical, pathologic, demographic and genomic testing (GT) information including involvement of a genetic counselor, specific test(s) ordered, test vendor, test turn-around time, and test results were obtained from the diverse dataset within the …

Not Of Woman Born? Extra-Uterine Destining And The Individual, Social, And Spiritual Implications Of Ectogenesis, Laura Johnson Dahlke

Ph.D. Dissertations (Open Access)

The development of ectogenesis or artificial womb technology is currently ongoing and likely to be in use in the near future. This qualitative study analyzes the potential individual, social and spiritual implications of ectogenesis. It argues that while there may be therapeutic benefits to the artificial womb, it will ultimately result in dehumanization and alienation from the body. While much of the current conversation about this technology addresses the health implications to the fetus and neonate, this dissertation investigates the possible impact of artificial wombs on women. It employs Martin Heidegger’s philosophy of technology as a model to assist in …

Intraoperative Post Partum Hemorrhage In A Patient With Dengue Fever, Usama Ahmed, Asiyah Aman

Department of Anaesthesia

A 33 year old obstetric patient with mild fever of undiagnosed etiology underwent emergency caesarean section under general anesthesia. She had platelet count of 98,000 per microliter and increased APTT of 37.8 s at the time of surgery. After uneventful anesthetic induction and delivery of fetus, slow and oozing type of bleeding led to massive hemorrhage. Patient remained vitally stable throughout perioperative phase and was extubated. Next day, patient's dengue IgM antibody was reported positive. Neonate was well and his dengue test was negative. Pregnant women are at high risk of developing severe complications of dengue fever with unclear mechanisms …

Busting Contraception Myths And Misconceptions Among Youth In Kwale County, Kenya: Results Of A Digital Health Randomised Control Trial, Peter Gichangi, Lianne Gonsalves, Jefferson Mwaisaka, Mary Thiongo, Ndema Habib, Michael Waithaka, Tigest Tamrat, Alfred Agwanda, Hellen Sidha, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objectives: The objective of this randomised controlled trial in Kenya was to assess the effect of delivering sexual and reproductive health (SRH) information via text message to young people on their ability to reject contraception-related myths and misconceptions.

Design and setting: A three-arm, unblinded randomised controlled trial with a ratio of 1:1:1 in Kwale County, Kenya.

Participants and interventions: A total of 740 youth aged 18–24 years were randomised. Intervention arm participants could access informational SRH text messages on-demand. Contact arm participants received once weekly texts instructing them to study on an SRH topic on their own. Control arm participants …

Delivery Room St Segment Analysis To Predict Short Term Outcomes In Near-Term And Term Newborns, Jørgen Linde, Anne Lee Solevåg, Joar Eilevstjønn, Ladislaus Blacy, Hussein Kidanto, Hege Ersdal, Claus Klingenberg

Obstetrics and Gynaecology, East Africa

Background: ST-segment changes to the fetal electrocardiogram (ECG) may indicate fetal acidosis. No large-scale characterization of ECG morphology immediately after birth has been performed, but ECG is used for heart rate (HR) assessment. We aimed to investigate ECG morphology immediately after birth in asphyxiated infants, using one-lead dry-electrode ECG developed for HR measurement.

Methods: Observational study in Tanzania, between 2013-2018. Near-term and term infants that received bag-mask ventilation (BMV), and healthy controls, were monitored with one-lead dry-electrode ECG with a non-diagnostic bandwidth. ECGs were classified as normal, with ST-elevations or other ST-segment abnormalities including a biphasic ST-segment. We analyzed ECG …

In Utero Exposure To 17Α-Hydroxyprogesterone Caproate And Risk Of Cancer In Offspring

Faculty, Staff and Student Publications

BACKGROUND: 17α-hydroxyprogesterone caproate is a synthetic progestogen initially approved in the 1950s to treat gynecologic and obstetrical conditions. Despite continued concerns about safety and short-term efficacy regarding the use of 17α-hydroxyprogesterone caproate for the prevention of preterm birth in pregnant women, little is known about the long-term effects of 17α-hydroxyprogesterone caproate on the health of the offsprings.

OBJECTIVE: To examine the association between in utero exposure to 17α-hydroxyprogesterone caproate and the risk of cancer in the offspring.

STUDY DESIGN: The Child Health and Development Studies was a population-based cohort of >18,000 mother-child dyads receiving prenatal care in the Kaiser Foundation …

Maternal Occupational Exposures And Fetal Growth In A Spanish Birth Cohort, Maribel Casas, Jesús Ibarluzea, Carmen Iñiguez, Loreto Santa-Marina, Michael D Swartz, Kristina W Whitworth

Faculty, Staff and Student Publications

While the epidemiologic literature suggests certain maternal occupational exposures may be associated with reduced measures of size at birth, the occupational literature employing fetal biometry data to assess fetal growth is sparse. The present study examines associations between maternal occupational exposures and ultrasound-measured fetal growth. We included 1,739 singleton pregnancies from the INfancia y Medio Ambiente (INMA) project (2003-2008). At 32 weeks of pregnancy, interviewers ascertained mothers' employment status and assessed job-related physical loads, work schedules, and job strain during pregnancy. Job titles were linked to a job-exposure matrix to estimate exposure to 10 endocrine disrupting chemical (EDC) groups. We …

A Novel Group Of Genes That Cause Endocrine Resistance In Breast Cancer Identified By Dynamic Gene Expression Analysis, Farnaz Allahbakhsh, Jacky Wu, Nan Deng, W Jim Zheng, Hulin Wu, Michihisa Umetani, Vahed Maroufy

Faculty, Staff and Student Publications

Breast cancer (BC) is the most common type of cancer diagnosed in women. Among female cancer deaths, BC is the second leading cause of death worldwide. For estrogen receptor-positive (ER-positive) breast cancers, endocrine therapy is an effective therapeutic approach. However, in many cases, an ER-positive tumor becomes unresponsive to endocrine therapy, and tumor regrowth occurs after treatment. While some genetic mutations contribute to resistance in some patients, the underlying causes of resistance to endocrine therapy are mostly undetermined. In this study, we utilized a recently developed statistical approach to investigate the dynamic behavior of gene expression during the development of …

Risk Factors And Compliance Of Surviving Sepsis Campaign: A Retrospective Cohort Study At Tertiary Care Hospital, Farheen Yousuf, Ayesha Malik, Ayesha Saba, Sana Sheikh

Department of Obstetrics & Gynaecology

Background and objective: Sepsis is one of the leading causes of direct maternal mortality in Pakistan. It is recommended that the first three hours after the presentation are crucial. During this time implementation of surviving sepsis campaign resuscitation bundles reduces maternal mortality. Our objective was to assess the factors contributing to puerperal sepsis and the compliance of "surviving sepsis campaign resuscitation bundles in puerperal sepsis" for the management of puerperal sepsis.
Methods: This was a retrospective record review for five years from January 2011-December 2015. All women who fulfilled the inclusion criteria of puerperal sepsis were included and data from …

Still Birth Classification: Application Of Relevant Condition At Death (Recode) Classification System In A Tertiary Care Hospital Of Pakistan, Urooj Kashif, Shelina Bhamani, Asma Patel, Zaheena Shamsul Islam

Department of Obstetrics & Gynaecology

Objectives: To determine the cause of stillbirth after application of relevant condition at death (ReCoDe) classification system.
Methods: This was a retrospective cross sectional study of 207 women diagnosed with stillbirth after 24 completed weeks of pregnancy at the Aga Khan University Hospital (AKUH), Karachi between 1st January 2015 and 31st December 2019. The primary objective was to find the cause of stillbirth according to the new classification of relevant condition at death (ReCoDe).
Results: There were a total of 32413 live births and 207 stillbirths during the study period thus stillbirth rate of 6 per 1000 live births. In …

An Analysis Of Georgia Mothers Who Gave Birth In 2015 And 2016 Without Receiving Prenatal Care, Joncel Stephens, Shanta R. Dube, Merrilee Gober

Journal of the Georgia Public Health Association

Background: The present study characterizes the population of women residing in the state of Georgia who did not receive prenatal care before giving birth to a live infant. The association between mother’s place of residence (rural/non-rural) and preterm delivery was also examined.

Methods: This study examined data obtained from the Georgia Department of Public Health which includes data for 7,062 mothers who did not receive prenatal care before giving birth to a live infant in Georgia in the years 2015 and 2016. Data on the resulting births was also studied. Descriptive analyses of the following variables were used …

Diagnostic Accuracy Of Calculated Tumor Volumes And Apparent Diffusion Coefficient Values In Predicting Endometrial Cancer Grade, Aminder Singh, Emanuele Neri

Faculty, Staff and Student Publications

BACKGROUND: Magnetic resonance imaging (MRI) has been shown to be an accurate imaging technique for the preoperative assessment of local staging of endometrial cancer and for evaluating the depth of myometrial invasion.

MATERIALS AND METHODS: This was a single-center retrospective study performed on patients with histopathologically proven endometrial carcinoma who underwent an MRI examination of the pelvis between October 2017 and May 2020.

RESULTS: In the present analysis, mean apparent diffusion coefficient (ADC) values for each histologic grade were 0.72 ± 0.13 × 10

CONCLUSION: Preoperative noninvasive radiological assessment for tumor volume, TV/ UV or tumor volume/uterine volume is important …

Update On Mri In Evaluation And Treatment Of Endometrial Cancer, Ekta Maheshwari, Stephanie Nougaret, Erica B Stein, Gaiane M Rauch, Ken-Pin Hwang, Ann H Klopp, Katherine E Maturen, Andrea G Rockall, Susanna I Lee, Elizabeth A Sadowski, Aradhana M Venkatesan

Faculty, Staff and Student Publications

Endometrial cancer is the second most common gynecologic cancer worldwide and the most common gynecologic cancer in the United States, with an increasing incidence in high-income countries. Although the International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer is a surgical staging system, contemporary published evidence-based data and expert opinions recommend MRI for treatment planning as it provides critical diagnostic information on tumor size and depth, extent of myometrial and cervical invasion, extrauterine extent, and lymph node status, all of which are essential in choosing the most appropriate therapy. Multiparametric MRI using a combination of T2-weighted sequences, …

Differential Gene Expression In Cord Blood Of Infants Diagnosed With Cerebral Palsy: A Pilot Analysis Of The Beam Cohort, Dwight J Rouse, Sean C Blackwell, Nina K Ayala, Antonio F Saad, Steve N Caritis, Eunice Kennedy Shriver National Institute Of Child Health And Human Development Maternal-Fetal Medicine Units Network

Faculty, Staff and Student Publications

The Beneficial Effects of Antenatal Magnesium clinical trial was conducted between 1997 and 2007, and demonstrated a significant reduction in cerebral palsy (CP) in preterm infants who were exposed to peripartum magnesium sulfate (MgSO4). However, the mechanism by which MgSO4 confers neuroprotection remains incompletely understood. Cord blood samples from this study were interrogated during an era when next-generation sequencing was not widely accessible and few gene expression differences or biomarkers were identified between treatment groups. Our goal was to use bulk RNA deep sequencing to identify differentially expressed genes comparing the following four groups: newborns who ultimately developed CP treated …

Expanding Our Knowledge Of Menstrual Irregularities Reported By Females With Tuberous Sclerosis Complex

Faculty, Staff and Student Publications

PURPOSE: The purpose of our study is to expand the knowledge regarding intrinsic reproductive dysfunction in females with TSC and to explore the impact of mTOR inhibitors (mTORi) on menstrual irregularity in the Tuberous Sclerosis Complex (TSC) community.

METHODS: An electronic survey composed of author-designed questions set out to evaluate reproductive history, presence of menstrual irregularities, mTORi use, as well as maternal reproductive history among females with TSC.

RESULTS: Of the 68 responses from females with TSC regarding age of menarche, the average age was 12.3 years. 56.5% (

CONCLUSIONS: Our data expands the knowledge regarding intrinsic menstrual dysregulation present …

Severe Crohn’S Disease With Intra-Abdominal Fistula: First Reported Case From Tanzania, Nadeem Kassam, Omar Aziz, Eric Aghan, Melchisedeck Mandwa, Caroline Ngimba, Hanifa Mbithe, Salim Surani, Casmir Wambura

Internal Medicine, East Africa

We describe a case of Crohn's disease occurring in a young Tanzanian female. Crohn’s disease is rare in Africa and not encountered normally. The presentation of Crohn’s disease overlaps with many other abdominal disorders that are common in an African setting, such as tuberculosis and schistosomiasis. The disease is probably underdiagnosed in Africa due to limitations in diagnostic testing and rarity.

Cesarean Skin-To-Skin Contact: Who Gets The Experience In The Operating Room?, Jessica S. Junk-Wilson

Graduate Theses/Dissertations

For the past decade, skin-to-skin contact immediately after birth has been the general recommendation for all births, as there is evidence that it provides many benefits for mothers and infants. Yet, research has shown that immediate skin-to-skin contact is not the standard practice after most Cesarean births. This study assessed access, incidence, and circumstances surrounding Cesarean skin-to-skin contact (CSSC) in the operating room and examined influencing maternal characteristics of age, education, race, and number of births via a survey of 2327 people. Women who experienced a Cesarean section birth in the past 10 years were recruited through Facebook groups for …