Obstetrics and Gynecology Commons^™

Salpingectomy For Ovarian Cancer Prevention: Video Education For The Surgeon, Emily Macarthur, Kara Long Roche, Joseph Sakran, Sunil H Patel, Peter Najjar, Karen H Lu, Megan Gornet, Anja S Frost, Meghan Walrath, Tom Bauer, Gyyong Oh, Rebecca Stone

Faculty, Staff and Student Publications

Given the unremitting obstacles to effectively screen for and treat ovarian cancer (OC), prevention is a necessary countermeasure. The recent discovery of the fallopian tube as the origin of the most common and deadly type of OC, high grade serous cancer (HGSC), makes prevention through salpingectomy possible (Madsen et al., 2015). Opportunistic salpingectomy (OS) is the practice of removing the post-reproductive fallopian tubes at the time of other intraperitoneal surgery, or for sterilization in lieu of tubal ligation, to decrease OC risk (Falconer et al., 2015). The safety, effectiveness, and reach of OS as a primary prevention strategy depends on …

Comparative Analysis Of Ultrasonographic Fetal Lung Texture In Twin And Singleton Fetuses, Nathan A. Keller, Luis A. Bracero, Christina Karras, Insaf Kouba, Frank Ian Jackson, Matthew J. Blitz, Sleiman R. Ghorayeb

Specialty Medicine Faculty Publications

Objectives: Increased fetal lung heterogeneity has been associated with term fetal lungs in singleton gestations. The objective of this study was to determine if fetal lung heterogeneity index (HI) differs between twin and singleton fetuses in the late second and third trimesters. Methods: Prospective cohort study of women with singleton and twin gestations with medically-indicated ultrasound examinations at 24 weeks of gestation onward. Grayscale transverse fetal lung images were obtained at the level of the four-chamber heart. A region of interest was selected in each fetal lung image. Fetal lung HI was determined with MATLAB software using a dithering technique …

Fetal Brain-Derived Exosomal Mirnas From Maternal Blood: Potential Diagnostic Biomarkers For Fetal Alcohol Spectrum Disorders (Fasds), Nune Darbinian, Monica Hampe, Diana Martirosyan, Ahsun Bajwa, Armine Darbinyan, Nana Merabova, Gabriel Tatevosian, Laura Goetzl, Shohreh Amini, Michael E Selzer

Faculty, Staff and Student Publications

Fetal alcohol spectrum disorders (FASDs) are leading causes of neurodevelopmental disability but cannot be diagnosed early in utero. Because several microRNAs (miRNAs) are implicated in other neurological and neurodevelopmental disorders, the effects of EtOH exposure on the expression of these miRNAs and their target genes and pathways were assessed. In women who drank alcohol (EtOH) during pregnancy and non-drinking controls, matched individually for fetal sex and gestational age, the levels of miRNAs in fetal brain-derived exosomes (FB-Es) isolated from the mothers’ serum correlated well with the contents of the corresponding fetal brain tissues obtained after voluntary pregnancy termination. In six …

Twist1 Drives Cytotoxic Cd8+ T-Cell Exhaustion Through Transcriptional Activation Of Cd274 (Pd-L1) Expression In Breast Cancer Cells, Xiaobin Yu, Jianming Xu

Faculty, Staff and Students Publications

In breast cancer, epithelial-mesenchymal transition (EMT) is positively associated with programmed death ligand 1 (PD-L1) expression and immune escape, and TWIST1 silences ERα expression and induces EMT and cancer metastasis. However, how TWIST1 regulates PD-L1 and immune evasion is unknown. This study analyzed TWIST1 and PD-L1 expression in breast cancers, investigated the mechanism for TWIST1 to regulate PD-L1 transcription, and assessed the effects of TWIST1 and PD-L1 in cancer cells on cytotoxic CD8+ T cells. Interestingly, TWIST1 expression is correlated with high-level PD-L1 expression in ERα-negative breast cancer cells. The overexpression and knockdown of TWIST1 robustly upregulate and downregulate PD-L1 …

Pain Outcomes In Adolescents With Surgically Confirmed Endometriosis: A Single Site Retrospective Cohort Analysis, Madeline Ross, Samantha Janssen, Priya Suvarna, Adam Booser, Ashli Lawson

Research Days

Background: In adolescents with significant dysmenorrhea, empiric therapy via analgesics and hormonal medications is considered gold standard. However, those with refractory pain may have endometriosis. Thus, it is recommended to engage in shared medical decision making with these patients regarding diagnostic laparoscopy. If endometriosis is detected intraoperatively, these lesions are often fulgurated or excised. There currently is a paucity of data regarding the benefits of diagnostic laparoscopy and destruction of lesions in the adolescent population.

Objectives/Goal: To evaluate long-term pain management outcomes and care patterns in adolescent patients undergoing surgical evaluation for endometriosis.

Methods/Design: This was a single-site, retrospective cohort …

Enhancing Peripartum Care Through Standardized Nurse Knowledge Exchange, Gabriela Ochoa

Master's Projects and Capstones

Problem Inconsistent handoff practices during patient transfers can cause mistakes and adverse outcomes. Hospital A's peripartum unit has no set policy for Nurse Knowledge Exchange (NKE) during transfers. This project will introduce a standard handoff guide to enhance communication and prevent harmful results after patient transfers.

Context The quality improvement project was conducted in a peripartum mesosystem within an urban hospital in Northern California. This specific area of the hospital comprised 21 postpartum rooms and nine laboring rooms.

Intervention The project involved a methodical strategy that encompassed engaging stakeholders, conducting a literature review, and analyzing data to pinpoint areas for …

Phase 1b Study Of Batiraxcept In Combination With Durvalumab In Patients With Platinum-Resistant Ovarian Cancer, Anne Knisely, Emily M Hinchcliff, Elisabeth Gardiner, Reshma Rangwala, Kathryn Lito, Bryan Fellman, Ying Yuan, Anil K Sood, Shannon N Westin, Karen H Lu, Amir A Jazaeri

Faculty, Staff and Student Publications

Combining an immune checkpoint inhibitor with batiraxcept (AVB-S6-500), an AXL inhibitor that acts via selective binding to growth arrest-specific protein 6 (GAS6), may improve anti-tumor immunity in platinum-resistant ovarian cancer (PROC). This phase 1b trial of durvalumab in combination with escalating doses of batiraxcept enrolled patients with recurrent PROC (NCT04019288). The primary objective was to determine the toxicity profile of the combination. Eleven patients were enrolled on the trial. No dose-limiting toxicities were observed, and no objective responses were noted. Median progression free survival (PFS) was 1.81 months (95% confidence interval (CI) 1.71–2.40), and median overall survival (OS) was 4.53 …

Characteristics And Clinical Outcomes Of Iud Insertion Under Conscious Sedation In Pediatric And Adolescent Patients, Alleana Corpin, Madeline Ross, Anne-Marie Priebe, Ashli A. Lawson

Research Days

Intrauterine devices (IUDs) are a favorable option for adolescents for contraception and menstrual suppression. However, few choose this option citing anxiety and concern for pain related to insertion procedure. Our institution proposes utilizing conscious sedation techniques for anxiolysis and analgesia during IUD insertion. The objective of this study was to identify characteristics of teens choosing conscious sedation for this procedure and likelihood of successful insertion.

Key Words: Intrauterine device (IUD), adolescent, conscious sedation

Case Of An Adolescent Girl With Familial Vulvar Leiomyoma, Madeline Ross, Charlene Dekonenko, Rebecca Rentea, Tazim Dowlut-Mcelroy

Research Days

Background

While uterine leiomyomas remain a common occurrence affecting nearly 30% of adult women above 35yo, leiomyomas can arise anywhere smooth muscle cells are located in the body. Vulvar leiomyomas are a particularly rare diagnosis, often misdiagnosed as Bartholin gland cyst, comprising 0.07% of vulvar tumors, and thought to arise from smooth muscle within the round ligament, erectile tissue, and dartos muscle. Even more rare is the presentation of vulvar leiomyoma in the adolescent population and family history of vulvar leiomyoma.

Case

We present the case of a 16yo girl who noticed a painless vulvar mass that had increased in …

Development Of An Endometriosis Toolkit To Support Clinicians In Providing Quality Care For Women, Rachel Hasbun

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Endometriosis is the abnormal growth of endometrium-like tissue outside the uterine cavity, affecting approximately 11% of women in the United States during their reproductive years. Diagnostic challenges stem from its varied clinical presentations, reliance on laparoscopy for definitive diagnosis, and limited awareness among practitioners and patients, potentially leading to diagnostic delays of up to 13 years.

Problem: The complexities of diagnosing endometriosis in primary care and specialty settings, combined with limited provider awareness and a lack of comprehensive resources, hinder timely and accurate identification. This leads to suboptimal treatment and care for women affected by the condition.

Methods: …

Jag1/2 Maintain Esophageal Homeostasis And Suppress Foregut Tumorigenesis By Restricting The Basal Progenitor Cell Pool, Haidi Huang, Yu Jiang, Jiangying Liu, Dan Luo, Jianghong Yuan, Rongzi Mu, Xiang Yu, Donglei Sun, Jihong Lin, Qiyue Chen, Xinjing Li, Ming Jiang, Jianming Xu, Bo Chu, Chengqian Yin, Lei Zhang, Youqiong Ye, Bo Cao, Qiong Wang, Yongchun Zhang

Faculty, Staff and Students Publications

Basal progenitor cells are crucial for maintaining foregut (the esophagus and forestomach) homeostasis. When their function is dysregulated, it can promote inflammation and tumorigenesis. However, the mechanisms underlying these processes remain largely unclear. Here, we employ genetic mouse models to reveal that Jag1/2 regulate esophageal homeostasis and foregut tumorigenesis by modulating the function of basal progenitor cells. Deletion of Jag1/2 in mice disrupts esophageal and forestomach epithelial homeostasis. Mechanistically, Jag1/2 deficiency impairs activation of Notch signaling, leading to reduced squamous epithelial differentiation and expansion of basal progenitor cells. Moreover, Jag1/2 deficiency exacerbates the deoxycholic acid (DCA)-induced squamous epithelial injury and …

Mammographic Density Mediates The Protective Effect Of Early-Life Body Size On Breast Cancer Risk, Marina Vabistsevits, George Davey Smith, Tom G Richardson, Rebecca C Richmond, Weiva Sieh, Joseph H Rothstein, Laurel A Habel, Stacey E Alexeeff, Bethan Lloyd-Lewis, Eleanor Sanderson

Faculty, Staff and Student Publications

The unexplained protective effect of childhood adiposity on breast cancer risk may be mediated via mammographic density (MD). Here, we investigate a complex relationship between adiposity in childhood and adulthood, puberty onset, MD phenotypes (dense area (DA), non-dense area (NDA), percent density (PD)), and their effects on breast cancer. We use Mendelian randomization (MR) and multivariable MR to estimate the total and direct effects of adiposity and age at menarche on MD phenotypes. Childhood adiposity has a decreasing effect on DA, while adulthood adiposity increases NDA. Later menarche increases DA/PD, but when accounting for childhood adiposity, this effect is attenuated. …

Surgical Approach To Urethral Diverticulum And Urethrovaginal Fistula With Mesh Erosion, Alicia Smith, Lauren Burton, Saifuddin Mama

Einstein Health Papers

INTRODUCTION AND HYPOTHESIS: This video illustrates a rare surgical case involving a urethral diverticulum, urethrovaginal fistula, and mesh erosion.

METHODS: We present a 58-year-old patient attending a tertiary care center with a suspected urethrovaginal fistula. Her concerns included stress urinary incontinence (SUI), recurrent urinary tract infection, and vaginal pain. The surgical history was notable for the placement of two different mesh slings during the same procedure to treat SUI. Preoperative evaluation and findings are illustrated in detail. The video uses a high-definition surgical camera to emphasize the initial intraoperative evaluation with localization of the fistula and diverticulum. We then demonstrate …

An Analysis Of Professional Education For Future Physicians To Address Implicit Racial Bias In Black Maternal Health, Jasmine Butler

Honors Theses

The history of medicine in the United States is littered with incidences of racism and exploitation of Black Americans. The extensive history of medical racism has continued to be perpetuated in healthcare today. Within the field of maternal health, the dark history of medicine shows its face with the treatment of black mothers. Black maternal health is a current public health crisis currently being exacerbated through discrimination in the form of implicit bias. Implicit bias is a current issue in our healthcare system that needs to be addressed through adequate training of both medical students and physicians. This qualitative research …

Long Acting Reversible Contraceptive Removal After Immediate Postpartum Insertion, Andrea Dousdebes Md

Dept. of Obstetrics & Gynecology Resident Research Day

No abstract provided.

Postoperative Telemedicine Use: Safety And Satisfaction After Benign Gynecologic Surgery, Chloe Smith Md

Dept. of Obstetrics & Gynecology Resident Research Day

No abstract provided.

Use Of Clomiphene Citrate As An Inhibitor Of Ovulation In An Oocyte Cryopreservation Cycle, Shelby Howard Md

Dept. of Obstetrics & Gynecology Resident Research Day

No abstract provided.

Genetic Testing After Abnormal Prenatal Ultrasound, Eleanor Germano Md

Dept. of Obstetrics & Gynecology Resident Research Day

No abstract provided.

Effect Of Residential Geographic Location On Adverse Pregnancy Outcomes In South-Central Louisiana, Aaliyah Keels Md

Dept. of Obstetrics & Gynecology Resident Research Day

No abstract provided.

Trends In Postpartum Birth Control Uptake Following Dobbs Decision, Deanna Dawson Md

Dept. of Obstetrics & Gynecology Resident Research Day

No abstract provided.

Agenda (Pdf), Department Of Obstetrics & Gynecology

Dept. of Obstetrics & Gynecology Resident Research Day

Agenda for the 36th Annual Dept. of Obstetrics & Gynecology Residents Research Day held Friday, May 10, 2024.

Case Report: Diagnosing & Treating Triple Negative Breast Cancer During Pregnancy, Sydney Mefford, Chloe Page

Posters

Pregnancy associated breast cancer (PABC) is rare and can be seen in every 1 in 3000 pregnant patients. It is associated with a high morbidity rate, especially in cases of Triple Negative Breast Cancer (TNBC).

Prevalence has increased as society grows to have pregnancies at later ages. Risk is elevated for 1 year after delivery of baby.

Sexual Function After Gender Affirming Surgery, Alicia R. Castellanos, Rachel Pope

Faculty Scholarship

Purpose of Review: Sexual function and satisfaction in the transgender community is a nascent field with a paucity of data due to the fast paced nature of improving upon surgical technique and variety of patient experiences. The authors aim to review the current literature for areas of success as well as areas of improvement in order to better the sexual health of the transgender community. Recent Findings: Gender dysphoria is a feeling of distress experienced by those whose gender assigned at birth is not in line with their gender identity. While social transition to the desired gender can suffice for …

Improving Quality Of Life In Menopausal Women Through A Best Practice Protocol: The Use Of Hormone Therapy, Mindfulness-Based Module And Exercise, Claire Czerwonka

Evidence-Based Practice Project Reports

Menopause is a normal process of aging, but many of the symptoms negatively impact women’s day-to-day quality of life (QOL), as well as activities of daily living, physical and mental health (ACOG, 2014). Generally, systemic estrogen hormone therapy is indicated for menopause-related vasomotor symptoms, but there is no research further addressing QOL issues or lifestyle management in addition to hormone therapy. The purpose of this evidence-base practice (EBP) project was to implement a menopause protocol to address QOL issues in menopausal women with the use of hormone replacement therapy, education through an online mindfulness module, and the use of exercise. …

Identification Of Potent Pan-Ephrin Receptor Kinase Inhibitors Using Dna-Encoded Chemistry Technology, Chandrashekhar Madasu, Zian Liao, Sydney E Parks, Kiran L Sharma, Kurt M Bohren, Qiuji Ye, Feng Li, Murugesan Palaniappan, Zhi Tan, Fei Yuan, Chad J Creighton, Suni Tang, Ramya P Masand, Xiaoming Guan, Damian W Young, Diana Monsivais, Martin M Matzuk

Faculty, Staff and Students Publications

EPH receptors (EPHs) are highly sought-after drug targets owing to their essential roles in maintaining appropriate cellular functions in both physiological and disease conditions. However, limited potency and specificity pose significant obstacles to the development of small-molecule inhibitors for EPHs. Here, using high-throughput DNA-encoded chemical library screenings, we developed potent and selective inhibitors of the EPH receptor kinase family. Our results also emphasize the therapeutic potential of our EPH inhibitors in cancer and endometriosis, a global health concern that causes chronic pain and often leads to infertility in women. This study showcases the robust pipeline of using DNA-encoded chemistry technology …

Contraception And Menstrual Management In Transmasculine And Gender-Diverse Individuals, Adrian Chiem, Maria Cristina Marcos, Beth I. Schwartz

Department of Obstetrics and Gynecology Faculty Papers

Purpose of Review This review outlines the current evidence on the contraceptive and menstrual management methods that are used for transmasculine or gender-diverse (TGD) individuals, as well as the gaps in the literature for this population.

Recent Findings Contraception and menstrual management continue to be an understudied area in the care of TGD individuals, with much of existing research extrapolated from cisgender populations. Emerging studies have looked at contraceptive and menstrual management choices and outcomes in adolescents and highlight the 52 mg LNG-IUD as an option that is efficacious for both indications, as well as high-dose progestin-only pills for menstrual …

A Multi-Modal Intervention To Decrease Hpv Vaccine Hesitancy And Increase Uptake In Young Adult Women, Rylee Cartales

Evidence-Based Practice Project Reports

Human Papillomavirus (HPV) is the leading cause of cervical cancer worldwide and the most common sexually transmitted disease, yet hesitancy towards the HPV vaccine remains high and uptake of the HPV vaccine remains remarkably low (CDC, 2021b). The purpose of this evidence-based practice (EBP) project was to determine if the implementation of a multimodal intervention including a motivational interview, strong provider recommendation, and educational materials will decrease HPV vaccine hesitancy and consequentially increase uptake of the vaccine. Eleven young adult women ages 18-26 from a rural outpatient Obstetrics and Gynecology (OBGYN) clinic in Indiana participated in this project. After agreeing …

Assessment Of Obgyn Department Research Collaboration And Satisfaction, Anne Bocage, Md, Melanie Hotz, Md, Julia Switzer, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• There are many simultaneous and similar research projects ongoing within the OB-GYN department, but with little collaboration. Additionally, it can be difficult to identify faculty, residents, and students with similar research interests.
• Collaboration between residents is shown to improve research productivity (1) and co-residents serve as effective research mentors (2).
• This project is aimed to assess the department's satisfaction with ongoing research and collaboration and to purpose an intervention for improvement.

Knowledge And Receptiveness Of Epidural Labor Analgesia By Parturients At Two Teaching Hospitals In Rwanda: A Cross-Sectional Study, Casey Fishman, Ba, Justin Do, Bs, Richita Bashyal, Mph, Fidele Hakorimana, Md

Health Equity and Quality Improvement (HEQI) Summit

Introduction

• Pain during labor can result in lasting psychological and physiological effects.¹ Although epidural analgesia is a first line pain management treatment and is used to reduce birth complications in many western countries, it is not commonly used in much of the world including Rwanda. The literature shows that African women have some of the lowest rates of pharmacological pain relief usage.
• Barriers to accessibility include; availability of equipment, staff with sufficient skills and monitoring, or myths and controversies surrounding labor.² Studies have found that some women believe that crying is a sign of weakness.³
• The aim …

Interprofessional Pilot Approach To Standardizing Nursing-Provider Driven Postpartum Urinary Retention Protocol, Mymy Nguyen, Mary Van Schaick, Md, Charlette E. Williams, Md, Anne Bocage, Md, Julia Switzer, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement: Postpartum urinary retention is a frequent cause of distress to new mothers, affecting 1 in 500 patients¹. It is imperative that patients receive prompt diagnosis and management to avoid long term sequelae of urogenital tract morbidity, including detrusor damage and bladder rupture². Although hospital protocols for urinary retention in the non-obstetric setting exist, management of urinary retention in the postpartum setting often varies by nursing-provider preference.

Project AIM: In this QI project, we developed a standardized protocol for postpartum urinary retention, and a comprehensive training model for provider and nursing teams. We assessed …