Obstetrics and Gynecology Commons^™

An Unusual Cause Of Postpartum Bleeding: Choriocarcinoma Following Term Pregnancy, Erika R. Olsen, Sarah Hitt, James Burke

South Atlantic Division GME Research Days 2026

No abstract provided.

Automation And Autonomy In The Ivf Laboratory: Concepts And Implications For Embryologists, Jacques Cohen, Gerardo Mendizabal-Ruiz, Giles Anthony Palmer, Giuseppe Silvestri, Mina Alikani

EVMS School of Health Professions Faculty Publications

Automation is regarded as the next phase in the evolution of laboratory IVF. Despite technological advances, most laboratory procedures remain operator-dependent, contributing to variability in performance and outcomes. While automation has improved reproducibility and efficiency in many areas of medicine, its adoption in IVF has been slow. This review examines how automation may be integrated into IVF laboratories through a set of conceptual distinctions. Automation refers to the execution of procedural steps by machine-controlled systems, whereas autonomy describes the degree to which such systems can operate without human intervention. This review distinguishes between static automation, which maintains or monitors the …

Advancing Screening For Intimate Partner Violence In Pregnant Individuals Throughout The Perinatal Period To Prevent Adverse Pregnancy And Maternal Outcomes, Emilia R. Valdez

Nursing | Senior Theses

Background: Intimate Partner Violence experienced by pregnant individuals contributes to adverse pregnancy outcomes and maternal health. A mother’s exposure to Intimate Partner Violence (IPV) can affect their ability to carry a healthy pregnancy to term (38 – 40 weeks gestational age) and places them at risk for comorbidities including; Preterm birth, Intrauterine Growth Restriction, Low Birth Weight/ Small for Gestational Age, Premature Rupture of Membranes and Miscarriage. The incidence of IPV screening is not accessible to all pregnant individuals due to healthcare providers lack of education, time constraints in the workplace, bias and discomfort towards IPV. The implementation of IPV …

Comparing Nurse-Led Holistic Pain Relief Strategies And Sole Pharmacological Use In Enhancing Maternal Satisfaction, Reducing Pain, And Lowering Obstetric Interventions During Childbirth, Jessica C. Moore

Nursing | Senior Theses

Background: Childbirth has become heavily reliant on pharmacological management and obstetric interventions such as epidural use, labor induction, and cesarean deliveries (C-sections) even among low-risk pregnancies. While necessary in some cases, excessive reliance on pharmacological interventions can negatively impact the experience of birthing as a whole. Non-pharmacological interventions (NPIs) such as breathing techniques, positioning, hydrotherapy, massage, aromatherapy and continuous support have shown to be effective in reducing pain and supporting physiologic labor. The gaps in education and lack of standard implementation result in inconsistent application in practice. Purpose: This research proposal aims to evaluate the effectiveness of nurse-led NPIs compared …

Characteristics Of Women Who Fast During Pregnancy: Findings From The Kuwait Birth Cohort Study, Abdullah Al-Taiar, Ali H. Ziyab, Reem Al Sabah, Ahmed N. Albatineh, James Blando, Majeda S. Hammoud

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Fasting during pregnancy is a widespread practice in Muslim communities, yet its health implications remain poorly understood. A lack of conceptual frameworks and limited understanding of the characteristics of women who fast during pregnancy have hindered research in this area. This study examines the differences in several nutritional biomarkers between women who fasted and those who did not and identifies factors associated with fasting behaviour. We analysed data from the Kuwait Birth Cohort in which information on fasting, sociodemographic characteristics and health behaviours was collected via structured interviews between 2017 and 2021. Clinical and laboratory data were extracted from medical …

Development Of A Semi-Mechanistic Population Pharmacokinetic Model For Predicting Tenofovir Disoproxil Fumarate And Tenofovir Alafenamide Exposure In Plasma And Cellular Matrices During Pregnancy And Postpartum, Yifan Yu, Kristina M. Brooks, Gustavo F. Doncel, Brookie M. Best, Mark A. Marzinke, Mark Mirochnick, Peter Anderson, Landon Myer, Connie Celum, Renee Heffron, Jenell Coleman, Dvora Joseph Davey, Craig W. Hendrix, Jeremiah D. Momper, Robert Bies, Rachel K. Scott

CONRAD Publications

Background and Objective

Tenofovir (TFV)-based regimens are backbones of both HIV treatment and pre-exposure prophylaxis during pregnancy. Multiple studies have shown up to one-third decreases in dried blood spot tenofovir-diphosphate concentrations during pregnancy among participants taking tenofovir disoproxil fumarate (TDF). Currently, there are no mechanism-based models describing the pharmacokinetics of tenofovir diphosphate (the active anabolite) in peripheral blood mononuclear cells (PBMCs) of pregnant individuals receiving TDF or tenofovir alafenamide (TAF), and the mechanisms behind observed differences between dried blood spots and PBMCs remain unclear.

Methods

To address this gap, we developed a semi-mechanistic model to simultaneously describe the pharmacokinetics of …

Micrornas Regulated By Pregnancy Target Antiviral And Cancer Immunity Overlapping With The Hiv Interactome, Paula F. T. Cezar-De-Mello, Jonathan M. Dreyfuss, Pai-Lien Chen, Hidemi Yamamoto, Xiaoming Gao, Hui Pan, Charles Morrison, Gustavo F. Doncel, Robert L. Barbieri, Raina N. Fichorova

CONRAD Publications

Innate immunity predictors of HIV-1 risk and pathogenesis vary with reproductive hormones, pregnancy, and lactation, yet the underlying mechanisms remain unclear. We hypothesized that pregnancy-associated physiological adaptations alter systemic microRNA (miRNA) expression, thereby regulating immunity, pathogenesis and susceptibility to infection. We analyzed 174 serum samples from 88 participants in a longitudinal cohort from Uganda and Zimbabwe across pre-pregnancy (PP), pregnancy (P), and postpartum breastfeeding (BF). Cell-free peripheral blood miRNAs (n = 2083) were profiled using HTG EdgeSeq. Pregnancy-specific miRNAs were identified by intersecting differentially expressed (DE) miRNAs from P vs. PP and P vs. BF comparisons. miRNA targets and pathways …

Impact Of Contraceptive Initiation On The Cervicovaginal Mucosa: Results From The Umpala Multicentre Partially Randomized Patient-Preference Interventional Trial, Betty Njoroge, Nelly Mugo, Carolina Herrera, Karen Dominguez, Louise A. Ouattara, Nazita Yousefieh, Neelima Chandra, Agnieszka Kurczewska, Stephanie Nartey, Julie Lewis, Andrea R. Thurman, Matilda Saina, Raina N. Fichorova, Jacques Ravel, Reem Sharaf Alddin, Nicola Richardson-Harman, Kenneth Ngure, Gustavo F. Doncel

CONRAD Publications

Background: Long-acting contraceptives are widely used, providing superior efficacy and systemic safety; however, the impact of contraceptive initiation on female genital tract function and health has been understudied.

Methods: Non-pregnant, HIV-uninfected women aged 18–50 years were enrolled in a dual-centre partially randomized patient-preference interventional trial (NCT04814927) and allowed to choose one of four contraceptive options, etonogestrel contraceptive implant, depot medroxyprogesterone acetate subcutaneous injection, levonorgestrel intrauterine device, and copper IUD, with a minimum target of 12 participants per arm and site. Sampling took place at baseline, 1 and 3 months after contraceptive initiation, and 1 month post-contraceptive discontinuation. Primary outcomes focused …

Vitamin D Status During Pregnancy Modulates The Effect Of Pre-Pregnancy Obesity On Gestational Diabetes Mellitus Risk: A Birth Cohort Study, Ali H. Ziyab, Abdullah Al-Taiar, Reem Al-Sabah, Majeda S. Hammoud, Saeed Akhtar

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Objective:

To determine whether gestational vitamin D status modulates the effect of pre-pregnancy obesity on gestational diabetes mellitus (GDM) risk while stratifying by maternal age.

Design:

Birth cohort.

Setting:

A major maternity hospital in Kuwait.

Participants:

Pregnant women in their second/third trimester of gestation were enrolled. Pre-pregnancy body mass index (BMI, kg/m²) was categorized as under/normal weight (< 25.0), overweight (25.0 to < 30.0), and obesity (≥30.0). Gestational 25-hydroxyvitamin D concentrations were categorized as deficiency (< 50 nmol/L) or insufficiency/sufficiency (≥50 nmol/L). GDM status was ascertained according to international guidelines. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated using logistic regression.

Results:

Data from 957 pregnant women were analyzed, with GDM affecting 166 (17.4%) pregnancies. Pre-pregnancy obesity and gestational vitamin D deficiency was ascertained in 275 (28.7%) and 533 (55.7%) pregnant women, respectively. The association between pre-pregnancy obesity and GDM risk differed according …

Factors Influencing Obstetric Ultrasound Examination Duration In A Tertiary Fetal Center, Juliana Gevaerd Martins, Diana Aboukhater, Tetsuya Kawakita, Maya Vishna, Salimah Navaz Gangji, Alfred Abuhamad

Department of Obstetrics & Gynecology Faculty Publications

Objective

To quantify scan duration across commonly performed obstetric ultrasound examinations in a tertiary fetal imaging center and to evaluate whether exam type, maternal body mass index (BMI), and sonographer experience independently influence scan time.

Methods

We conducted a retrospective cohort study of singleton pregnancies undergoing diagnostic obstetric ultrasound between January 2023 and May 2024 at a high-volume tertiary care center. Ultrasounds were categorized into five exam types: dating/viability (6-10 weeks), detailed first-trimester (11-14 weeks), detailed second-trimester anatomic survey (18-22 weeks), fetal echocardiography (22-24 weeks), and second/third-trimester growth/Doppler (24-38 weeks) scans. Scan duration was defined using ultrasound image timestamps from …

Osmotic Dilators Vs. Foley Balloons: Bayesian Secondary Analyses Of The Dilafol Trial, Antonio F. Saad, Elenir B. C. Avritscher, Claudia Pedroza, Xiao Han, George R. Saade

Department of Obstetrics & Gynecology Faculty Publications

Background: Dilapan-S, a synthetic osmotic dilator used for pre-induction cervical ripening, has proven to be as effective as the Foley balloon in terms of vaginal versus cesarean delivery and has been associated with increased patient satisfaction. Nevertheless, its ability to lower cesarean rates and its cost-effectiveness remain poorly studied.

Objectives: To estimate the likelihood that synthetic osmotic dilators reduce cesarean deliveries and to evaluate their health system costs (2026 US$) and incremental cost-effectiveness compared to the Foley balloon during cervical ripening.

Study Design: Secondary Bayesian analyses were conducted using data from the single-center DILAFOL randomized controlled trial, which enrolled 419 …

Evaluating The Mediating Role Of Gestational Phthalate And Replacement Biomarkers In The Associations Between Race/Ethnicity And Birthweight, Amir J. Lueth, Danielle R. Stevens, Sarahna A. Moyd, Elena Sinkovskaya, Ann Przybylska, Antonia M. Calafat, Julianne C. Botelho, George Saade, Alfred Abuhamad, Kelly K. Ferguson

Department of Obstetrics & Gynecology Faculty Publications

Background

Gestational exposure to phthalates is higher among non-Hispanic black (NHB) women than non-Hispanic white (NHW) women and may contribute to racial/ethnic differences in birthweight z-scores.

Objective

We aimed to investigate whether gestational phthalate and replacement biomarkers mediate the association between race/ethnicity and birthweight z-scores.

Methods

We analyzed data from 271 pregnancies in the Human Placenta and Phthalates study, a prospective cohort recruited from 2017 to 2020. Urinary phthalate metabolite concentrations were measured at up to eight time points during pregnancy and averaged to represent gestational exposure. Metabolites were grouped by parent compound. Linear regression models estimated associations in phthalate …

Health Behavior Profiles In Early Pregnancy Are Associated With Adverse Pregnancy Outcomes And Maternal Blood Pressure 2-7 Years After Delivery, Andrea C. Kozai, Bethany Barone Gibbs, Lisa D. Levine, Abbi D. Lane, Mitali Ray, William Grobman, Philip Greenland, Matthew K. Hoffman, C. Noel Bairey Merz, Phyllis C. Zee, Lisa Mims, Natalie A. Cameron, George Saade, Robert M. Silver, Natalie A. Bello, Eliza C. Miller, Uma M. Reddy, Judith H. Chung, Kara M. Whitaker, Janet M. Catov

Department of Obstetrics & Gynecology Faculty Publications

Background

The joint effects of individual health behaviors on pregnancy health are rarely considered. We examined associations between combinations of first trimester health behaviors with adverse pregnancy outcomes (APOs) and blood pressure (BP) 2-7 years after delivery, and estimated the proportion of associations with later BP mediated by APOs.

Methods

Participants in the nuMoM2b Heart Health Study prospective cohort were included. Physical activity, diet, sleep duration, and smoking were scored using the Life's Essential 8 framework. APOs included hypertensive disorders of pregnancy, preterm birth, gestational diabetes, small-for-gestational-age birth, or stillbirth. We constructed latent profiles of health behaviors using the Life's …

Neurotensin Drives Theca Cell Migration During Ovulation In Primates, Jessica S. Miller, Megan A. G. Sage, Thomas E. Curry Jr., Diane M. Duffy

Department of Biomedical and Translational Sciences Faculty Publications

Theca cells are a critical steroidogenic cell type of the ovarian follicle and corpus luteum. The ovulatory luteinizing hormone (LH) surge (or human chorionic gonadotropin (hCG)) stimulates theca cell relocation from the stroma surrounding the dominant follicle to full integration into the developing corpus luteum. Luteinizing hormone/human chorionic gonadotropin also stimulates granulosa cells to produce local mediators of ovulation, including the peptide neurotensin (NTS). To determine if hCG-stimulated NTS regulates theca cell relocation within the ovulatory follicle, vehicle or an NTS receptor antagonist was injected into a macaque dominant follicle, and ovaries were removed 48 h after hCG administration. Additional …

Timelines Of Care: Analyzing Treatment Access For Women With Ongoing Reproductive Health Needs, Nyla M. Keith

Honors Undergraduate Theses

Mandates in the United States created pressure on an already strained healthcare system post-COVID-19 pandemic. With new regulations placed upon abortion care forcing the closing of low-cost health clinics such as Planned Parenthood, legislation that has made health insurance more expensive, and rising pharmaceutical prices, women’s OB/GYN care in America has struggled to meet patient needs. A cross-sectional survey was developed and distributed to four clinics in the Orlando area to assess patients' perceived access to care and identify barriers to receiving OB/GYN care. The survey took approximately 10 – 15 minutes to complete, was available in print and online …

Importance Of Placental Evaluation In Pregnancies At High Risk For Placenta Accreta Spectrum: Expert Clinical Perspective, Rebecca H. Jessel, Alesha White, Hope Y. Yu, Amie L. Hollard, Meena Khandelwal, Carolyn M. Zelop, Jennifer Philips, Alireza A. Shamshirsaz, John C. Kingdom, Alfred Abuhamad, Christina L. Herrera, Pan American Society For Placenta Accreta Spectrum (Pas2)

Department of Obstetrics & Gynecology Faculty Publications

Background

Placenta accreta spectrum (PAS) is a leading cause of obstetric morbidity and peripartum hysterectomy. Rising cesarean delivery rates, advanced maternal age, and assisted reproductive technologies have increased its incidence. Early, standardized diagnosis is essential for multidisciplinary planning and improved outcomes, yet formal screening guidelines are lacking.

Objective

To raise awareness of the importance of antenatal screening for PAS, summarize key clinical and imaging risk factors, and propose a standardized mid-trimester ultrasound protocol for high-risk patients.

Methods

An expert panel convened under the Pan-American Society for the Placenta Accreta Spectrum (PAS2) reviewed available evidence, risk stratification models, and prior consensus …

Acute Fatty Liver Of Pregnancy And Fetal Fatty Acid Oxidation Disorders: A Systematic Review, Dante Varotsis, Sarah Araji, Rebecca Horgan, Jennifer E. Powel, Rodney Mclaren Jr., Brian Kirmse, Mona Makhamreh, Huda B. Al-Kouatly

Department of Obstetrics & Gynecology Faculty Publications

OBJECTIVE:

To evaluate the association between maternal acute fatty liver of pregnancy (AFLP) and fetal fatty acid oxidation (FAO) disorders and to define the clinical and genetic characteristics of mothers with AFLP and their fetuses affected by FAO disorders, we performed a systematic literature review of all reported cases of AFLP that underwent genetic testing for FAO disorders.

DATA SOURCES:

We searched PubMed, Ovid MEDLINE, Cochrane Library, CINAHL (EBSCO), Scopus, and ClinicalTrials.gov. Terms included were related to AFLP and FAO testing.

METHODS OF STUDY SELECTION:

We conducted a systematic literature review from inception through May 18, 2025, to evaluate the …

Cervicovaginal Lavage Fluid Iron And Manganese Levels In Women With And Without Vaginitis, Barbara Kozma, David Ratonyi, Bence Kozma, Peter Takacs, Attila G. Sipos

Department of Obstetrics & Gynecology Faculty Publications

Transition metals such as iron and manganese are critical for cellular metabolism, redox balance, and immune function, and they also influence host–pathogen interactions. Vaginitis is characterized by mucosal inflammation that may alter local trace-element homeostasis. We hypothesize that inflammatory conditions such as vaginitis may be associated with altered cervicovaginal iron and manganese levels. We performed a prospective, single-center cohort study at the University of Debrecen (Hungary) between April 2023 and April 2024, enrolling 80 women ≥ 18 years with vulvovaginal complaints. Participants were assessed at baseline and at weeks 4, 8, and 12 with clinical evaluation and cervicovaginal lavage (CVL) …

Considerations For The Analysis Of Urinary Environmental Chemical Concentrations During Pregnancy, Danielle R. Stevens, Kaleigh Hinton, Katie M. O'Brien, Jessie P. Buckley, Barrett M. Welch, Jason A. Watts, Antonia M. Calafat, Julianne C. Botelho, Elena Sinkovskaya, Ann Przybylska, George Saade, Alfred Abuhamad, Kelly K. Ferguson

Department of Obstetrics & Gynecology Faculty Publications

Background:

Pregnancy physiology may impact indicators of hydration, affecting exposure assessment in gestational studies with urinary chemical biomarkers.

Methods:

We aimed to characterize hydration and demonstrate the impact of different methods for standardizing urinary chemical biomarker concentrations on exposure descriptives in the Human Placenta and Phthalates Study (n = 303, 2017-2020), a prospective pregnancy cohort with eight study visits between 12 and 38 weeks of gestation. We assessed trajectories and predictors of hydration using urine flow rate (UFR) and specific gravity (SG). Likewise, we examined trajectories and predictors of mono-n-butyl phthalate (MBP), for which concentrations were unstandardized or standardized via …

Prepregnancy Overweight And Obesity In Kuwait Birth Cohort Study, Abdullah Al-Taiar, Ali H. Ziyab, Eelaf A. Husain, Maryam M.Y. Mohammad, Maryem A. Shamsah, Noor Salah Alali, Reem Sharaf-Alddin, Majeda S. Hammoud

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Objectives: This study aimed to estimate the prevalence of prepregnancy obesity and overweight, and to identify a set of sociodemographic factors that could guide weight management interventions for women prior to conception.

Design, Sample, and Measurements: Pregnant women (N = 989) were recruited in the Kuwait Birth Cohort Study during the period June 2017 to February 2020. Prepregnancy weight and height were self-reported, while current weight and height were measured in a standardized procedure. Data on sociodemographic factors were collected through face-to-face interviews conducted by a trained data collector. Multinomial logistic regression was used to investigate the association between sociodemographic …

Severe Maternal Morbidity According To Sickle Cell Disease Genotype, Tetsuya Kawakita, Natsume Furukawa, Sora A. Jones, Salimah Navaz Gangji

Department of Obstetrics & Gynecology Faculty Publications

Background

Sickle cell disease (SCD) is a genetic hemoglobinopathy that disproportionately affects individuals of African descent and is associated with elevated risks of maternal complications. However, the contribution of specific SCD genotypes to severe maternal morbidity (SMM) and postpartum readmission remains poorly characterized at the population level.

Objective

We sought to examine the association between SCD genotypes-hemoglobin SS (HbSS) disease, hemoglobin SC (HbSC) disease, sickle thalassemia, and sickle cell trait-and SMM, hospital readmission, and related adverse maternal outcomes.

Study design

This was a retrospective cohort study using the Nationwide Readmissions Database from 2016 through 2022, representing over 20 million weighted …

Risk Of Gestational Diabetes By Aerobic And Resistance Exercise During The First And Second Trimesters, Takaki Tanamoto, George Saade, Leryn J. Reynolds, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

Objective

While some studies have shown that exercise reduces the incidence of gestational diabetes mellitus (GDM), there is limited evidence on whether aerobic or resistance exercise is more beneficial. This study aimed to examine the rate of GDM according to the type of exercise during early pregnancy.

Study design

We analyzed data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), a prospective cohort of individuals enrolled during the first and second trimesters. We excluded participants with pregestational diabetes or delivery < 20 weeks. The primary exposure was either aerobic or resistance exercises in the first or second trimester. For each trimester, the metabolic equivalent of task hours per week (MET-h/week) was calculated for each exercise. Participants were grouped as follows: "Aerobic exercise" (≥7.5 MET-h/week from aerobic exercises), "Resistance exercise" (≥2 times/week from resistance exercises), "Both types of exercise" (≥7.5 MET-h/week from aerobic exercise and ≥2 times/week from resistance exercises), and "Insufficient exercise" (≤7.5 MET-h/week from aerobic exercise and ≤2 times/week from resistance exercises). Our primary outcome was GDM. Adjusted relative risks (aRRs) with 95% confidence intervals (95% CIs) were calculated using modified Poisson regression, adjusting for potential confounders.

Results

In both the first and second trimesters, analyses included 9049 individuals. In the first trimester, individuals who performed …

The Taper Sign: Sonographic Representation Of Uterine Dehiscence In Severe Cases Of Placenta Accreta Spectrum, Uma Deshmukh, Anna M. Modest, Alfred Abuhamad, Alireza A. Shamshirsaz, Jonathan L. Hecht, Scott A. Shainker

Department of Obstetrics & Gynecology Faculty Publications

Introduction: Prenatal diagnosis of placenta accreta spectrum (PAS) depends on reliable ultrasound markers and skilled image interpretation. Existing PAS markers emphasize placental features suggestive of abnormal adherence and require advanced image optimization. However, emerging hypotheses suggest that uterine dehiscence—not placental invasion—is the central mechanism underlying PAS, particularly in severe (Grade 3) disease. Despite this, few established ultrasound markers address this uterine dehiscence. We describe a novel ultrasound marker, the taper sign, which uniquely represents the uterine dehiscence in severe PAS with anterior placenta previa, and outline a standardized technique for image acquisition and interpretation.

Methods: This descriptive report details the …

Racial Differences In Adverse Pregnancy Outcomes And Incident Hypertension: A Mediation Analysis, Lucia C. Petito, Xiaoning Huang, C. Noel Bairey, Natalie Bello, Janet Catov, Ernesto Licon, Abbi Lane, David M. Haas, Lisa D. Levine, Rebecca B. Mcneil, Eliza Miller, Uma M. Reddy, Bethany Barone Gibbs, George Saade, Lauren Theilen, Laura E. Wiener, Brian M. Mercer, Hyagriv N. Simhan, Lynn M. Yee, Philip Greenland, William A. Grobman, Sadiya S. Khan

Department of Obstetrics & Gynecology Faculty Publications

Background

Adverse pregnancy outcomes (APOs) are associated with increased hypertension risk. Black women experience higher rates of APOs and hypertension compared with White women, but whether APOs contribute to Black-White hypertension disparities remains unknown.

Methods

The nuMoM2b-HHS (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be-Heart Health Study) prospectively recruited nulliparous pregnant people at 8 US centers (2010-2013) with follow-up 2 to 7 years postpartum (2014-2017). Race, which represents a social construct, was self-identified. The primary outcome was incident hypertension at follow-up. APOs included hypertensive disorders of pregnancy, preterm birth, and small-for-gestational age birth. Potential confounders (psychological health, social factors, and health behaviors) …

Vaginal Pra1 Identifies Clinically Relevant Candida Albicans Vaginitis And Excludes Asymptomatic Colonization: An Exploratory Study, Elena Roselletti, Barbara Kozma, David Ratonyi, Alexandra Kunkli, Bence Kozma, Peter Takacs, Duncan Wilson

Department of Obstetrics & Gynecology Faculty Publications

Background

Accurate interpretation of Candida detection in women with vulvovaginal symptoms remains difficult, because organism recovery may reflect either clinically relevant infection or nonpathogenic colonization. We have recently demonstrated that the secreted fungal zinc-binding protein, Pra1 is responsible for driving the inflammatory immunopathology of VVC. We therefore reasoned that PRA1 expression by Candida albicans in the vagina may act as a diagnostic tool to discriminate between commensal colonisation and active disease.

Methods

We conducted a 12-week prospective, single-center exploratory biomarker analysis nested within a registered parent clinical trial. Nine women with vulvovaginal symptoms provided cervicovaginal lavage samples and clinical data …

Trends In Glp-1 Based Therapy Use Before And After Pregnancy, Nansi S. Boghossain, Lauren Mcabee, Antonio F. Saad, Maged M. Costantine, Marwan Ma'ayeh, Joseph A. Ewing

Department of Obstetrics & Gynecology Faculty Publications

[Introduction] Glucagon-like peptide-1 (GLP-1)-based therapies are increasingly prescribed for the treatment of type 2 diabetes and obesity, with rapid uptake of newer agents such as semaglutide and tirzepatide [1, 2]. These medications improve glycemic control and promote weight loss and are now widely used among reproductive-aged individuals [2, 3]. However, GLP-1-based therapies are typically discontinued prior to pregnancy because of limited safety data and potential fetal risks, and current guidance recommends avoiding use during pregnancy [3]. As prescribing expands, a growing number of individuals entering pregnancy may have recent exposure to GLP-1-based …

Low-Lying Placenta Is Associated With Increased Risk Of Hemorrhage And Severe Maternal Morbidity: A Nationwide Analysis, May Abiad, Giulia Bonanni, Nikan Zargarzadeh, Ali Javinani, Scott A. Shainker, Anna M. Modest, George R. Saade, Kjersti Aagaard, Alireza A. Shamshirsaz

Department of Obstetrics & Gynecology Faculty Publications

Background

Placenta previa (PP) is a well-recognized obstetric complication with established maternal risks, particularly hemorrhage, that contribute significantly to maternal morbidity. In contrast, low-lying placenta (LLP) has historically been grouped with previa in both coding and clinical practice, limiting our ability to study its imparted associated outcomes as a distinct entity. However, in 2017, coding revisions allowed for a parsed diagnosis of LLP and PP and enabled the current study of differentiated associated outcomes.

Objectives

To describe and compare the independent rates of hemorrhage and severe maternal morbidity (SMM) associated with LLP and PP relative to normal placentation.

Methods

We …

Hospital Cesarean Delivery Rankings By Overall, Low-Risk, And Reliability-Adjusted Metrics, Tetsuya Kawakita, Regan N. Theiler, George Saade

Department of Obstetrics & Gynecology Faculty Publications

Importance: The Society for Maternal-Fetal Medicine (SMFM) low-risk cesarean delivery metric aims to improve comparability, but the extent to which additional patient-level adjustment and reliability profiling alter hospital rankings is not well characterized.

Objectives: To evaluate how hospital cesarean delivery rankings differ across overall, SMFM-defined low-risk, and reliability-adjusted low-risk approaches, and to identify hospital characteristics associated with reliability-adjusted low-risk rates.

Design, Setting, and Participants: This cross-sectional study used data from the 2022 National Inpatient Sample, a nationally representative all-payer database, on individuals aged 11 to 55 years who were hospitalized for childbirth. Data were analyzed from October 2025 through June …

Limits Of Machine Learning For Predicting Stillbirth At Term: A Population-Based Cohort Of 302,192 Pregnancies In Northern Italy, M. Benuzzi, T. Kawakita, F. Monari, B. Melis, G. Guariglia, A. La Marca, I. Neri, G. Saade, F. Facchinetti, I. El Moudden

Department of Obstetrics & Gynecology Faculty Publications

Background

Objective

Study Design

Contribution Of Comorbidities And Pregnancy Complications To Severe Maternal Morbidity In The United States, Tetsuya Kawakita, Sora A. Jones, Natsume Furukawa, George Saade

Department of Obstetrics & Gynecology Faculty Publications

Objective: To quantify the extent to which rising rates of severe maternal morbidity (SMM) in the United States from 2016 to 2022 are attributable to increasing prevalence of maternal risk factors, including advanced maternal age, obesity, pregestational diabetes mellitus, gestational diabetes, chronic hypertension, and hypertensive disorders of pregnancy (HDP).

Methods: We conducted a retrospective cohort study using the Nationwide Readmissions Database from 2016 to 2022, representing more than 25 million weighted delivery hospitalizations. The primary outcome of SMM was identified with the Centers for Disease Control and Prevention's 21-condition algorithm; a secondary outcome excluded transfusion to improve specificity. Temporal trends …