Obstetrics and Gynecology Commons^™

Forced Dependency: The Subjugation Of Women Through Medicine In Ancient Greece And Rome, Evelyn J. Polovich

Binghamton University Undergraduate Journal

In the ancient Mediterranean men were in charge of every facet of life, including women’s medicine. They forced women out of the oversight of gynecology and reformed it into a method of control that they could assert in order to force women into a position of submission. This paper aims to bring the ways in which ancient medicine was influenced by cultural ideas and worked to subjugate women and allow men to gain further control over their autonomy. This research was inspired by the works of ancient physicians like Hippocrates, Soranus, and Galen, as well as contemporary sources that critique …

A Review Of Robotic Vnotes Surgery: Current Applications, Advantages, And Future Directions, Daniel Y Lovell, Qiannan Yang, Xiaoming Guan

Faculty, Staff and Students Publications

Over the past 500 years, the convergence of three distinct paths - vaginal surgery, laparoscopy, and robotic technologies - has enabled the development of robot-assisted vaginal natural orifice transluminal endoscopic surgery (RA-vNOTES). The ongoing evolution of vaginal surgery has led to contemporary procedures such as hysterectomy, myomectomy, sacrocolpopexy, adnexal interventions, and oncologic operations, applicable to a wide range of diagnoses and pathologies. This approach offers patients significant benefits, including superior cosmetic outcomes, less pain, lower infection rates, and faster recovery of baseline quality of life. Surgeons benefit from improved ergonomics, better visualization, the ability to use multiple instruments, and enhanced …

Improving Awareness Of Physician Ergonomics In Gynecologic Surgery, Priyanka Raju Md, Annika Eveland Md, Tamara Lalovic Do, Dominic Cammarano Do

Transformative Medicine

Introduction:
Surgeons experience disproportionately high rates of work-related musculoskeletal (MSK) disorders due to prolonged static postures, repetitive motions, and suboptimal instrument design. Gynecologic surgery, in particular, involves sustained non-neutral positioning and physical strain, yet formal ergonomic education is lacking. This study aimed to evaluate gynecologic surgeons’ awareness of ergonomic principles and determine whether targeted education improves knowledge and recognition of ergonomic risk factors during surgery.

Methods: A quality improvement intervention was implemented at a large teaching hospital. Eighty-three recorded gynecologic surgeries (open, laparoscopic, and vaginal) were analyzed for common postural deviations based on ergonomic guidelines. The most frequent errors were …

The Aftermath Of Overturning Roe V. Wade: A Review Of Legal, Social, And Health Implications, Eden Parks M.D.

Transformative Medicine

Roe versus Wade occurred in 1973 and was a landmark case in the United States. It guaranteed the right to abortion until 2022, when the Dobbs versus Jackson case was decided and the U.S. Supreme Court overturned Roe. This abolished the right to abortion and left it up to the states. The Dobbs decision has reshaped the framework for reproductive rights in the United States. This paper focuses on the multifaceted outcomes of the Dobbs decision, highlighting the legal, social and health implications. Through a study of recent research, legal analyses, and public health reports, this article assesses the …

Topical Lidocaine For Pain Control With Intrauterine Device Insertion: Does It Work?, Piper Gaudet, Jahnavi Ramakrishnan, Fariha Azam

Physician Assistant Capstones, 2020-current

Objective: To evaluate whether topical lidocaine improves the subjective perception of pain during the insertion of an intrauterine device (IUD) in women of childbearing age, compared to a placebo. Design: Mini-systematic literature review. Methods: An initial search of PubMed, CINAHL, and Scopus was conducted using the terms "pain control," "IUD," and "lidocaine," yielding 49 articles, of which 31 were screened and 26 excluded based on pre-designated inclusion criteria. After assessing five articles for eligibility, three met the criteria and were evaluated using Duke University's Clinical Appraisal Worksheet and the Oxford Centre for Evidence-Based Medicine table to determine their level of …

Use Of Topical Hemostatic Agents In A Gynecologic Patient With Coagulopathy, Alexis O'Connell, Syeda Zainab Shah

HCA Healthcare Journal of Medicine

Introduction

The use of topical hemostatic agents has become common during surgical interventions. There is a wide variety of substances available to augment clotting, ranging from physical agents to topical thrombin combinations. Application of these agents in gynecologic surgery in patients with existing coagulopathies has not been studied.

Case Presentation

A 62-year-old woman with an inferior vena cava filter and a history of multiple deep vein thromboses presented to the clinic with pelvic pain, stress urinary incontinence, and uterovaginal prolapse. She underwent a total vaginal hysterectomy, sacral colpopexy, tension-free vaginal tape sling, and cystourethroscopy. Warfarin was cross titrated to enoxaparin …

Longitudinal Assessment Of Intravillous Arterioles In Normal Pregnancy Using Superb Microvascular Imaging, R. Horgan, E. Sinkovskaya, G. Saade, E. Kalafat, A. Heeze, A. Abuhamad

Department of Obstetrics & Gynecology Faculty Publications

Objective

To use superb microvascular imaging (SMI) to longitudinally evaluate blood flow in intravillous arterioles (IVA) in pregnancy, and to develop reference ranges for IVA pulsatility index (PI) and peak systolic velocity (PSV) from 12 to 38 weeks' gestation.

Methods

The data for this study were obtained from the National Institutes of Health-funded Human Placenta Project. Eligible for inclusion were women aged 18-35 years, with a body mass index of <  30 kg/m², without comorbidities, with a singleton pregnancy conceived spontaneously and a gestational age of ≤ 13 + 6 weeks. Exclusion criteria were maternal or neonatal complications, fetal or umbilical cord anomalies, abnormal placental implantation and delivery <  37 weeks. Each participant underwent eight ultrasound examinations during pregnancy. Using SMI technology, the total number of IVA identified was recorded in a sagittal placental section at the level of cord insertion. The PI and PSV were measured in a total of six IVA (two in the central portion of the placenta, two peripherally towards the uterine fundal portion and two peripherally towards the lower uterine segment). Umbilical artery (UA)-PI was also obtained. Multilevel regression models were used to create reference ranges for IVA-PI and IVA-PSV at 12-38 weeks' gestation.

Results

A total of 90 women fulfilled the study criteria. IVA-PI decreased throughout pregnancy from a mean ± SD of 1.04 ± 0.23 in the first trimester (at 12-13 weeks) …

Trustworthiness Criteria For Meta-Analyses Of Randomized Controlled Studies: Obgyn Journal Guidelines., Vincenzo Berghella

Department of Obstetrics and Gynecology Faculty Papers

No abstract provided.

Guardians Of The Genitals: The Dermatogynecologic Duo, Alexis Arza, Erin Stitzlein

Transformative Medicine

No abstract provided.

Untargeted Metabolomic Biomarker Discovery For The Detection Of Ectopic Pregnancy, Onur Turkoglu, Ayse Citil, Ceren Katar, Ismail Mert, Robert A Quinn, Ray O Bahado-Singh, Stewart F Graham

Faculty, Staff and Students Publications

Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality in the first trimester. Using an untargeted metabolomic approach, we sought to identify putative plasma biomarkers using tandem liquid chromatography-mass spectrometry for the detection of tubal EP. This case-control study included the prospective recruitment of 50 tubal EP cases and 50 early intrauterine pregnancy controls. To avoid over-fitting, logistic regression models were developed in a randomly selected discovery group (30 cases vs. 30 controls) and validated in the test group (20 cases vs. 20 controls). In total, 585 mass spectral features were detected, of which 221 molecular features …

Segregation By Payer In Obstetrics And Gynecology Residency Ambulatory Care Sites, Kavita Vinekar, Neena Qasba, Hannah Reiser, Erika Banks, Kavita Arora, Brownsyne Edmonds, Karen George

Department of Obstetrics and Gynecology Faculty Papers

IMPORTANCE: Many teaching hospitals in the US segregate patients by insurance status, with resident clinics primarily composed of publicly insured or uninsured patients and faculty practices seeing privately insured patients. The prevalence of this model in obstetrics and gynecology residencies is unknown.

OBJECTIVES: To examine the prevalence of payer-based segregation in obstetrics and gynecology residency ambulatory care sites nationally and to compare residents' and program directors' perceptions of differences in quality of care between payer-segregated and integrated sites.

DESIGN, SETTING, AND PARTICIPANTS: This national survey study included all 6060 obstetrics and gynecology residents and 293 obstetrics and gynecology residency program …

Minimally Invasive Tissue Extraction: Continued Growth Through Simulation For Obgyn Residents, Angela Frankel, Md, Mph, Melanie Hotz, Md, Patrick Teefey, Md

Department of Obstetrics and Gynecology Posters

Background

• Minimally invasive surgery often requires tissue morcellation for extraction of large surgical specimens.¹
• Surgeon comfort with tissue morcellation in gynecologic surgery is vital in providing a minimally invasive (MIS) approach.
• However, OBGYN residents often feel underprepared to perform this skill independently.²
• While practicing tissue morcellation in the OR is ideal, simulation has been shown to improve resident technical skill without risking increased operative time or associated morbidity.³
• This intervention seeks to build upon a prior simulation exercise, with the ultimate goal of improving OB-GYN resident self-reported comfort with minimally invasive tissue extraction.

Exploring The Effects Of Amniotic Bladder Therapy On Female Sexual Dysfunction In Interstitial Cystitis/Bladder Pain Syndrome Patients, Jonathan D. Lutchka, Jack Vercnocke Md, David Pearlman Md, Aron Liaw Md, Nivedita Dhar Md

Medical Student Research Symposium

Introduction and Objectives: Female sexual dysfunction (FSD) is commonly associated with Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). FSD manifests as abnormalities in sexual desire, arousal, orgasm, pain, distress, and satisfaction. Our primary objective was to assess the impact of micronized amniotic membrane injections (AM) on FSD and lower urinary tract symptoms using comprehensive measures, including the multi-domain Female Sexual Function Index (FSFI), the Pain Visual Analog Scale (VAS), and the Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI).

Methods: Study participants included patients diagnosed with IC/BPS and FSD refractory to traditional therapies. Under general anesthesia, these …

A Randomized Trial Of Vaginal Antiseptic Preparation Solutions To Reduce Bacteria Colony Counts In Patients Undergoing Vaginal Surgery, James R. Saelens, Adam J. Langer, Andrew N. Boeckley, Natalie M. Castillo, Julie A. Desouza, Jennifer L. Drerup, Kelly M. Muterspaw, Hannah M. Stump, Rose A. Maxwell, Geoffrey Towers

Obstetrics and Gynecology Faculty Publications

Antiseptic preparation of surgical sites is known to reduce the rate of infective complications. However, surgical site infections (SSI) remain a leading cause of post-operative hospitalizations, increasing patient stress and cost for the healthcare system.1-7 In gynecologic surgery, preparation of the vagina is performed to reduce bacterial load prior to surgery, though it is known to remain contaminated.3 In the US, only solutions containing povidone-iodine (PI) are FDA approved for vaginal preparation; though, a 2018 ACOG Practice Bulletin lists chlorhexidine gluconate (CHG) with low (<4%) alcohol concentrations as a reasonable option for off-label use.3 Other preparations for vaginal surgery have been reported including baby shampoo (BS) and a commercially available preparation, containing PCMX (para-chloro-meta-xylenol, Techni-care®, chloroxylenol), that is marketed specifically for use with mucous membranes.8-12 There is a growing need to establish evidence-based alternatives to iodine for vaginal preparation for patients with allergies or sensitivity to iodine-containing products while minimizing postoperative irritation. One retrospective study comparing BS to PI in gynecologic surgeries showed a non-significant lower rate of surgical site infection with BS.9 One major challenge for determining effectiveness of surgical scrubs for reducing SSI is the relatively rare occurrence of postoperative infection. As an alternative proxy for infection colony counts of bacteria/fungi, before and after preparation, have been used.12,13 BS has been shown to reduce bacterial loads in non-gynecologic surgery, but there is limited data regarding its use in vaginal surgery, even though surgeons have been using BS in cases of iodine allergy or intolerance to other antiseptics.9-12CHG use in vaginal surgery has been debated due to concerns about vaginal irritation, however studies have demonstrated that alteration of the solution to 2-4% chlorhexidine with low (4%) alcohol concentration was associated with mild to no vaginal irritation. CHG showed similar reduction in post-incision bacterial counts and wound infections in cesarean delivery, and reduced colony counts during hysterectomy (when compared to PI).14-20 PCMX and CHG were shown to significantly reduce bacterial colonization of extracted root canals, and PCMX has been marketed specifically for vaginal antiseptic preparation.21 While some information on the effectiveness of these four antiseptic preparations has been documented in the literature, at this time there are no randomized controlled trials comparing these solutions in the context of vaginal surgery. Further evaluation and research of antiseptic solutions is warranted to provide evidence for best practices in minimizing infection and irritation. The purpose of this study was to compare the effectiveness of three antiseptic solutions with the standard, PI, for reducing bacterial colonies as a proxy for SSI, and to assess postoperative irritation and infection symptoms.

How To Create This Gynecological Task Trainer, Jami Monico, Karen S. Carlson

Posters and Presentations: Obsetrics & Gynecology

This document contains instructions for how to create a gynecological task trainer with a 3D-printed uterus and silicone cervix.

Retrospective Analysis Of Surgical Time Proficiency During Laparoscopic Myomectomies, Jeffrey Johnson, Kimberly Swan, Errick Arroyo

Continental, MidAmerica, & Mountain Divisions GME Research Day 2024

No abstract provided.

Successful Management Of Spontaneous Unilateral Twin Ectopic Pregnancy With Two-Step Dose Of Methotrexate, Lauren A. Forbes, Navya Nuthivana, Renee Morales

Department of Obstetrics & Gynecology Faculty Publications

The incidence of unilateral tubal twin pregnancy is 1/20,000–1/250,000 with about 100 reported cases. Four of the six cases that were medically managed were successful. A 24-year-old female presented to the emergency department (ED) with vaginal bleeding and abdominal cramping. She was hemodynamically stable without signs of an acute abdomen. Laboratory evaluation revealed she was pregnant with a serum beta-human chorionic gonadotropin (b-hCG) of 798 mIU/mL. Transvaginal ultrasound (TVUS) revealed a single left tubal pregnancy with a yolk sac. The patient elected medical management with body surface area (BSA)–based intramuscular (IM) methotrexate (MTX). On Day 4, the patient returned to …

Improving Cervical Cancer Screening Rates In The Primary Care Setting, Esmeralda Young

Student Scholarly Projects

Practice Problem: Cervical cancer screening with Pap is the recommended standard practice for women aged 21 to 65. The project aimed to increase low cervical cancer screening rates at a primary care clinic.

PICOT: The PICOT question that guided this project was: (P) In women 21 to 65 years old in the primary care setting (I), does proactive pre-scheduling of cervical cancer screenings (C) compared to current standard practice (O) affect cervical cancer screening rates (T) over eight weeks?

Evidence: The evidence strongly supported improving cervical cancer screening among the targeted population. Studies showed that Pap smear screening reduced the …

A Model To Integrate Mental Health Services With Gynecological Care, Simerjeet Singh, Theresa A. Moore, Hannah White

Undergraduate Research Symposium

Half of the world’s population experiences changes in life relating to gynecological health which may involve stigmatized conditions. Stigma is defined as unfavorable societal beliefs about a topic which impacts healthcare significantly. Menopause is a stage 12 months after a woman’s last menstrual cycle and the menopausal transition (MT) is the years leading up to this stage. Symptoms of MT may include night sweats and hot flashes accompanied by psychological changes. Postpartum depression (PPD) is a mental health condition that one in seven women experience after having a baby. PPD may occur during the first six months after delivery when …

Acceptability And Feasibility Of A Low-Cost Device For Gestational Age Assessment In A Low-Resource Setting: Qualitative Study, Angela Koech, Peris Muoga Musitia, Grace Mwashigadi, Mai-Lei Woo Kinshella, Marianne Vidler, Marleen Temmerman, Rachel Craik, J. Alison Noble, Peter Dadelszen Von Dadelszen, Aris T . Papageorghiou

Obstetrics and Gynaecology, East Africa

Background: Ultrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with artificial intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal transcerebellar diameter and head circumference.

Objective: The aim of this study was to assess the perceptions of pregnant women, their families, and health care workers regarding the feasibility and acceptability of the TraCer device in an appropriate setting.

Methods: A descriptive study using qualitative methods was conducted in …

Non-Pharmacological Management Of Idiopathic/Persistent Dyspareunia, Iveshia Ford

Capstone Showcase

Painful sexual intercourse, or dyspareunia, is a condition numerous women experience. An unknown, but still important, number of those affected find no relief with medication or surgery. Yet, it can be difficult for patients to discuss concerns with their provider. In addition, many providers do not have an adequate comfort level to discuss such topics. This paper aims to equip providers with non-pharmacological treatment options which include pelvic floor physical therapy, sex therapy and lifestyle changes. With the cultural shifts and changing ideas of sexuality in today’s age, it is important that clinicians remain versed in sexual health and patient …

Non-Pharmacological Management Of Idiopathic/Persistent Dyspareunia, Iveshia Ford

Capstone Showcase

Painful sexual intercourse, or dyspareunia, is a condition numerous women experience. An unknown, but still important, number of those affected find no relief with medication or surgery. Yet, it can be difficult for patients to discuss concerns with their provider. In addition, many providers do not have an adequate comfort level to discuss such topics. This paper aims to equip providers with non-pharmacological treatment options which include pelvic floor physical therapy, sex therapy and lifestyle changes. With the cultural shifts and changing ideas of sexuality in today’s age, it is important that clinicians remain versed in sexual health and patient …

Adult Granulosa Cell Tumor In Pregnancy: A New Case And A Review Of The Literature, Sofia Guidi, Vincenzo Berghella, Giovanni Scambia, Anna Fagotti, Annalisa Vidir, Stefano Restaino, Giuseppe Vizzielli, Frediano Inzani, Anna Franca Cavaliere

Department of Obstetrics and Gynecology Faculty Papers

Granulosa cell tumors are rare ovarian tumors that can arise during pregnancy. We present a new case of recurrent adult granulosa cell tumor (AGCT) in pregnancy and a systematic review of the literature. The new case described is a 41-year-old woman G5P1122 with a prior history of AGCT that was referred to our center at 29 weeks because of a symptomatic abdominal mass, compatible with a possible recurrence of AGCT. At 36 + 3 weeks, she underwent a cesarean delivery for preterm labor and a total hysterectomy with a radical surgical staging. A healthy female infant was delivered. The patient …

Uterine Artery Embolization Combined With Methotrexate For Broad Ligament Ectopic Pregnancy In A 30-Year Old Primigravida, Khurram Khaliq Bhinder, Azza Sarfraz, Zouina Sarfraz, Shaista Riaz, Samreen Aslam, Zouina Ameena

Department of Paediatrics and Child Health

We present the case of 30-year old primigravida female at 11 weeks' gestation who was diagnosed to have ectopic pregnancy on obstetric ultrasound. An MRI pelvis was ordered to assess invasion into the posterior myometrium which confirmed a single right-sided broad ligament-extra uterine pelvic ectopic pregnancy with extrinsic mass effect on the right lower uterine segment without frank myometrial invasion. On an urgent basis, a uterine artery embolization (UAE) was performed by targeting the right femoral artery. Selective catheterization was performed of both uterine arteries and the right side showed a major feeder of the gestational sac. Supplied dose of …

The Efficacy Of In Vitro Fertilization In Treating Infertility Due To Anovulatory Pcos In Comparison To Ovulation Induction Via Letrozole, Amanda Salay

Capstone Showcase

Abstract:

Introduction: Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder found in women of reproductive age that often causes infertility. The first-line treatment for infertility in anovulatory PCOS patients is ovulation induction. In vitro fertilization (IVF) is a third line treatment often used as a last resort. PCOS patients have higher failure risks of first- and second-line medications. Therefore, this review analyzes if adverse pregnancy outcomes (O) are reduced more with IVF (I) versus using letrozole for ovulation induction (C) in women aged 20-30 struggling with infertility due to anovulatory PCOS (P).

Methods: A literature search on Pubmed and EBSCOhost …

An Obstetrics And Gynecology Residency Program’S Approach To The Covid-19 Pandemic, Tiffany C. Chang, Brenda Nguyen, Chi Dola

HCA Healthcare Journal of Medicine

Background: The impact of COVID-19 on residency training nationwide has been substantial, and adapting to this unprecedented event has proven challenging for program directors throughout the United States. Here, the authors presented their initial experiences with restructuring an obstetrics and gynecology residency program during the pandemic. The authors outlined their strategies to maximize resident safety and address clinical care in outpatient and inpatient settings, resident education curriculum, resident wellness and consider the ethical dilemmas of health care providers during a pandemic.

Conclusion: With perspectives from other residency programs, the authors hope this review will serve as an initial building block …

Evaluation Of Geographic Disparities In Cervical Cancer Survival Across Maine, Kaylee Underkofler, Jason Lachance

Journal of Maine Medical Center

Introduction. National data exists suggesting the existence of geographic disparities in oncology care within the United States. It is unknown whether geographic disparities present a problem for women with gynecologic malignancies locally in Maine.

Methods. Data for each cervical cancer case diagnosed or treated under the MaineHealth system between 2007 and 2011 were acquired from the MaineHealth Network Registry. Average annual incidence and 5-year survival were calculated for each county in Maine and were mapped using geographic information systems (GIS) software. Next, cases were divided into 2 groups: those residing less than or equal to 60 miles from the sole …

Exploration Of The Effectiveness Of Naprotechnology In Women’S Healthcare, Cecilia Cerven

Honors Projects

Many women today struggle with abnormal menstrual cycles and the painful symptoms of reproductive disorders. The standard approach to treatment of infertility, irregular menses, polycystic ovarian syndrome (PCOS), endometriosis, hormonal abnormalities, premenstrual syndrome (PMS), and other pathophysiologic reproductive conditions is the prescription of a pill for symptom management or implementation of assisted reproductive technologies. However, many women may not feel comfortable with this treatment strategy due to ethical concerns or apprehension about potential side effects. The purpose of this paper is to assist in bridging the gaps in education to increase overall awareness of a new approach to women’s healthcare, …

Artificial Intelligence: A New Paradigm In Obstetrics And Gynecology Research And Clinical Practice, Pulwasha Iftikhar, Marcela V. Kuijpers, Azadeh Khayyat, Aqsa Iftikhar, Maribel Degouvia De Sa

Publications and Research

Artificial intelligence (AI) is growing exponentially in various fields, including medicine. This paper reviews the pertinent aspects of AI in obstetrics and gynecology (OB/GYN) and how these can be applied to improve patient outcomes and reduce the healthcare costs and workload for clinicians.

Herein, we will address current AI uses in OB/GYN, and the use of AI as a tool to interpret fetal heart rate (FHR) and cardiotocography (CTG) to aid in the detection of preterm labor, pregnancy complications, and review discrepancies in its interpretation between clinicians to reduce maternal and infant morbidity and mortality. AI systems can be used …

Impact Of The Affordable Care Act On The Cooper Women’S Care Center, Amanda Malik, Natali Franzblau

Cooper Rowan Medical Journal

Background: The Affordable Care Act (ACA) increased access to women’s health care by expanding Medicaid eligibility and requiring that insurance plans cover many gynecologic preventive services at no cost to patients. Before implementation of the ACA, pregnant women with low incomes qualified for Medicaid but childless adults of the same income did not, and though prenatal obstetrical visits were covered by plans at no or low cost to patients, most gynecologic services required out of pocket payments.

Objective: This study aimed to identify changes in the types of visits (gynecologic or obstetric) and patient demographics (including age, race, …