Obstetrics and Gynecology Commons^™

Monitoring Of Birth Registry Coverage And Data Quality Utilizing Lot Quality Assurance Sampling Methodology: A Pilot Study, Shiyam Sunder Tikmani, Sarah Saleem, Elizabeth Mcclure, Farnaz Naqvi, Farina Abrejo, Zahid Soomro, Dennis Wallace, Robert L. Goldenberg

Community Health Sciences

Background: Effectively monitoring the coverage and quality of data in low-resource settings is challenging. Lot quality assurance sampling (LQAS) is a method to classify coverage as adequate or inadequate. The aim of this pilot study is sought to determine the coverage and quality of a birth registry in a rural district in Pakistan.
Methods: This survey was conducted in 14 clusters of Thatta, Pakistan. LQAS methodology was used to monitor the birth registry from December 2015 to February 2016. We randomly selected 19 villages from each cluster. We used a short questionnaire to review the quality of data collection for …

Additive Drug-Specific And Sex-Specific Risks Associated With Co-Use Of Marijuana And Tobacco During Pregnancy: Evidence From 3 Recent Developmental Cohorts (2003-2015)., Suena H Massey, Daniel K Mroczek, David Reiss, Emily S Miller, Jessica A Jakubowski, Eileen K Graham, Shannon M Shisler, Meaghan Mccallum, Marilyn A. Huestis, Jody M Ganiban, Daniel S Shaw, Leslie D Leve, Rina D Eiden, Laura R Stroud, Jenae M Neiderhiser

Institute of Emerging Health Professions Faculty Papers

BACKGROUND: Methodologic challenges related to the concomitant use (co-use) of substances and changes in policy and potency of marijuana contribute to ongoing uncertainty about risks to fetal neurodevelopment associated with prenatal marijuana use. In this study, we examined two biomarkers of fetal neurodevelopmental risk-birth weight and length of gestation-associated with prenatal marijuana use, independent of tobacco (TOB), alcohol (ALC), other drug use (OTH), and socioeconomic risk (SES), in a pooled sample (N = 1191) derived from 3 recent developmental cohorts (2003-2015) with state-of-the-art substance use measures. We examined differential associations by infant sex, and multiplicative effects associated with co-use of …

Trends And Determinants Of Stillbirth In Developing Countries: Results From The Global Network’S Population-Based Birth Registry, Sarah Saleem, Shiyam Sunder Tikmani, Elizabeth M. Mcclure, Janet L. Moore, Iqbal Azam Syed, Sangappa M. Dhaded, Shivaprasad S. Goudar, Ana Garces, Sumera Aziz Ali, Farnaz Naqvi

Community Health Sciences

Background: Stillbirth rates remain high, especially in low and middle-income countries, where rates are 25 per 1000, ten-fold higher than in high-income countries. The United Nations' Every Newborn Action Plan has set a goal of 12 stillbirths per 1000 births by 2030 for all countries.
Methods: From a population-based pregnancy outcome registry, including data from 2010 to 2016 from two sites each in Africa (Zambia and Kenya) and India (Nagpur and Belagavi), as well as sites in Pakistan and Guatemala, we evaluated the stillbirth rates and rates of annual decline as well as risk factors for 427,111 births …

Improving Pregnancy Outcomes In Low- And Middle-Income Countries, Robert L. Goldenberg, Elizabeth M. Mcclure, Sarah Saleem

Community Health Sciences

This paper reviews the very large discrepancies in pregnancy outcomes between high, low and middle-income countries and then presents the medical causes of maternal mortality, stillbirth and neonatal mortality in low-and middle-income countries. Next, we explore the medical interventions that were associated with the very rapid and very large declines in maternal, fetal and neonatal mortality rates in the last eight decades in high-income countries. The medical interventions likely to achieve similar declines in pregnancy-related mortality in low-income countries are considered. Finally, the quality of providers and the data to be collected necessary to achieve these reductions are discussed. It …

Stratification Of Ovarian Tumor Pathology By Expression Of Programmed Cell Death-1 (Pd-1) And Pd-Ligand- 1 (Pd-L1) In Ovarian Cancer, Maureen L. Drakes, Swati Mehrotra, Monica Aldulescu, Ronald K. Potkul, Yueying Liu, Anne Grisoli, Cara Joyce, Timothy O'Brien, M. Sharon Stack, Patrick J. Stiff

Mathematics and Statistics: Faculty Publications and Other Works

Background

Ovarian cancer is the major cause of death among gynecologic cancers with 75% of patients diagnosed with advanced disease, and only 20% of these patients having a survival duration of five years. Treatments blocking immune checkpoint molecules, programmed cell death (PD-1) or its ligand PD-ligand- I (PD-L1) have produced a beneficial and prolonged effect in a subgroup of these patients. However, there is debate in the literature concerning the prognostic value of the expression of these molecules in tumors, with immunotherapy responsiveness, and survival.

We evaluated the immune landscape of the ovarian tumor microenvironment of patients, by measuring the …

Difference In The Level Of Utilization And Determinants Of Preconception Care Among Pregnant Women In Aga Khan University Hospital And Maragua Level Four Hospital., Joan Okemo

Master of Medicine in Obstetrics and Gynecology

Background: Preconception care (PCC) is an important form of primary health care that aims to identify risks, offer patient education and evidence based interventions prior to conception in order to improve maternal and fetal short and long term health outcomes. Despite the benefits of PCC, the global levels of utilization are still low, more so in developing countries and in the rural settings. This study aimed to determine the difference in the level and determinants of PCC in both urban and rural settings in Kenya. Objectives: The primary objective of this study was to compare PCC among pregnant women in …

Uterine Necrosis After Uterine Artery Embolization For Symptomatic Fibroids, Steve Mutiso, Felix Oindi, Nigel Hacking, Timona Obura

Obstetrics and Gynaecology, East Africa

Introduction: Uterine artery embolization (UAE) is a minimally invasive intervention that is used in the treatment of fibroids. UAE can lead to complications including postembolization syndrome, postprocedure pain, infection, endometrial atrophy leading to secondary amenorrhea, and uterine necrosis. Uterine necrosis afer UAE is very rare and hence poses a clinical dilemma for any clinician in its identifcation and management. We document a case of uterine necrosis afer UAE and conduct a literature review on its causation, clinical features, and management principles.

Case: A patient presented one month afer UAE with abdominal pain and abdominal vaginal discharge. Her work-up revealed features …

Iron Isomaltoside Is Superior To Iron Sucrose In Increasing Hemoglobin In Gynecological Patients With Iron Deficiency Anemia., Richard Derman, Eloy Roman, Gioi N. Smith-Nguyen, Maureen M. Achebe, Lars L. Thomsen, Michael Auerbach

Global Health Articles

No abstract provided.

Banning Abortion In Cases Of Down Syndrome: Important Lessons For Advances In Genetic Diagnosis, Rebecca Reingold, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

In December 2017, Ohio passed into law legislation that prohibited physicians from performing abortions if the pregnant woman’s decision was influenced by her belief that the fetus has Down syndrome. Physicians who perform abortions in these cases would face fourth-degree felony charges and revocation of their medical license. No other state bans abortion specifically for Down syndrome, but several ban abortions in cases of genetic diseases. Lower courts have struck down most such laws, holding they violate the constitutional rights of women. In February 2018, a federal district court judge blocked enforcement of Ohio’s law pending a final determination.

This …

Stress Urinary Incontinence In Collegiate Female Athletes: Prevalence And Impact, Marie Bouchard

Master's Projects and Capstones

Abstract

Introduction, definition: Urinary incontinence is the involuntary leaking of urine (a few drops to a few milliliters). It can happen while exercising with no urge to urinate (stress urinary incontinence), with a sudden urge to urinate (overactive bladder or urgency urinary incontinence), or a combination of the two (mixed urinary incontinence). This issue is very common among female athletes. However, because of the reluctance to discuss this problem, it remains underdiagnosed and undertreated.

Methods:An anonymous and confidential survey was distributed to the 90 University of San Francisco female student athletes from seven different varsity sports in December 2017. …

Regular Exercise Throughout Pregnancy And Maternal Recovery Postpartum, Rachel Jenkins

Graduate Theses & Dissertations

Abstract

Introduction: The American College of Obstetricians and Gynecologists recommends that “women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength-conditioning exercises before, during, and after pregnancy.”1 Many pregnant mothers seek guidance regarding exercise regimens’ safety and efficacy. This paper is a systematic review of the current literature on the topic of exercise regimens performed throughout pregnancy and maternal postpartum recovery.

Purpose: To determine if following the American College of Obstetricians and Gynecologists recommendation to engage in regular aerobic and strength-conditioning exercises throughout pregnancy contributes to easier deliveries as measured by the number of caesarean sections, time …

Successful Use Of Balloon Tamponade In The Management Of Postpartum Hemorrhage In A Case Of Bicornuate Uterus, Erum Saleem, Ayesha Basharat

Department of Obstetrics & Gynaecology

Worldwide 50%–70% of all cases of maternal morbidity have been attributed to postpartum hemorrhage. This report discusses a case of bicornuate uterus in a term pregnancy. The delivery was by cesarean section, which was followed by massive postpartum hemorrhage, managed successfully with balloon tamponade. This is the second reported case of successful management of post partum hemorrhage in a bicornuate uterus with balloon tamponade. A 22-year-old primigravida at 39 weeks of gestational age presented with vaginal leaking of clear fluid. Cesarean section was done due to meconium stained liquor in early labor; with an incidental finding of bicornuate uterus followed …

Intermittent Fetal Heart Rate Monitoring Using A Fetoscope Or Hand Held Doppler In Rural Tanzania: A Randomized Controlled Trial, Paschal Francis Mdoe, Hege L. Ersdal, Estomih R. Mduma, Jeffrey M. Perlman, Robert Moshiro, Peter T. Wangwe, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

Background: Neonatal mortality is a global challenge, with an estimated 1.3 million intrapartum stillbirths in 2015. The majority of these were found in low resource settings with limited options to intrapartum fetal heart monitoring devices. This trial compared frequency of abnormal fetal heart rate (FHR) detection and adverse perinatal outcomes (i.e. fresh stillbirths, 24-h neonatal deaths, admission to neonatal care unit) among women intermittently assessed by Doppler or fetoscope in a rural low-resource setting.

Methods: This was an open-label randomized controlled trial conducted at Haydom Lutheran Hospital from March 2013 through August 2015. Inclusion criteria were; women in labor, …

A Rare But Life Threatening Case Of Labile Blood Pressures In Pregnancy, Kelsey Carrio, Aarti Aggarwal, Susan Mcgroarty

Rowan-Virtua Research Day

Pheochromocytoma is a rare but life threatening adrenal secreting tumor. The infrequency with which it is encountered makes pheochromocytoma, especially in pregnancy, a formidable diagnostic challenge.

Although a pheochromocytoma is rare, it is good to keep it in differential diagnosis as a possible cause of labile BP with headaches and significant orthostatic BP. It is critical to recognize this condition to institute an appropriate therapy & surgical intervention to prevent mortality.

Osteopathic Manipulative Medicine In Pregnancy, Xinhua Chen, Maria Nguyen, Sophia Vogiatzidakis

Rowan-Virtua Research Day

Women experience physiologic and structural changes during pregnancy. Osteopathic manipulative medicine (OMM) involves the examination of the whole patient, including body, mind, and spirit. This involves treatment of any stresses placed on the body, including the structural changes in the maternal body. Clinical studies thus far on OMM in pregnancy have shown when used during pregnancy, it improves musculoskeletal pain such as low back pain, and may positively affect some labor and delivery outcomes. The purpose of this study was to evaluate the effectiveness of OMM during pregnancy in reducing the rate of cesarean section and several other labor and …

Intimate Partner Violence, Forced First Sex And Adverse Pregnancy Outcomes In A Sample Of Zimbabwean Women Accessing Maternal And Child Health Care, Simukai Shamu, Stephen Munjanja, Christina Zarowsky, Patience Shamu, Marleen Temmerman, Naeemah Abrahams

Obstetrics and Gynaecology, East Africa

Background: Intimate partner violence (IPV) remains a serious problem with a wide range of health consequences including poor maternal and newborn health outcomes. We assessed the relationship between IPV, forced first sex (FFS) and maternal and newborn health outcomes.

Methods: A cross sectional study was conducted with 2042 women aged 15–49 years attending postnatal care at six clinics in Harare, Zimbabwe, 2011. Women were interviewed on IPV while maternal and newborn health data were abstracted from clinic records. We conducted logistic regression models to assess the relationship between forced first sex (FFS), IPV (lifetime, in the last 12 months and …

Does Courtesy Bias Affect How Clients Report On Objective And Subjective Measures Of Family Planning Service Quality? A Comparison Between Facility- And Home-Based Interviews, Waqas Hameed, Muhammad Ishaque, Xaher Gul, Junaid-Ur-Rehman Siddiqui, Sharmeen Hussain, Wajahat Hussain, Aftab Ahmed, Asma Balal

Community Health Sciences

Purpose: Despite a general understanding that exit interviews being conducted at service providers' facilities may influence clients' responses favorably to health professionals, there is very little evidence available that demonstrates the extent to which this problem exists. This study aimed at assessing and comparing clients' perceptions of the quality of family planning services and their satisfaction levels between facility- and home-based interviews.
Methods: A cross-sectional survey was conducted among clients receiving family planning services across three service delivery channels - nongovernmental organization (NGO) clinics, social franchise (SF) centers, and outreach camps. The survey took place from December 2015 to January …

A Care Bundle Including Antenatal Corticosteroids Reduces Preterm Infant Mortality In Tanzania A Low Resource Country, Augustine Massawe, Hussein Kidanto, Robert Moshiro, Edna Majaliwa, Flora Chacha, Aisa Shayo, Paschal Mdoe, Prisca Ringia, Mary Azayo, Georgina Msemo

Faculty of Health Sciences, East Africa

Background Preterm neonatal mortality (NM) has remained high and unchanged for many years in Tanzania, a resource-limited country. Major causes of mortality include birth asphyxia, respiratory insufficiency and infections. Antenatal corticosteroids (ACS) have been shown to significantly reduce mortality in developed countries. There is inconsistent use of ACS in Tanzania.

Objective To determine whether implementation of a care bundle that includes ACS, maternal antibiotics (MA), neonatal antibiotics (NA) and avoidance of moderate hypothermia (temperature < 36°C) targeting infants of estimated gestational age (EGA) 28 to 34 6/7 weeks would reduce NM (< 7 days) by 35%.

Methods A Pre (September 2014 to May 2015) and Post (June 2015 to June 2017) Implementation strategy was used and introduced at three University-affiliated and one …

Intermittent Fetal Heart Rate Monitoring Using A Fetoscope Or Hand Held Doppler In Rural Tanzania: A Randomized Controlled Trial, Paschal Francis Mdoe, Hege Ersdal, Estomih Mduma, Jeffrey M. Perlman, Robert Moshiro, Peter Wangwe, Hussein Kidanto

Faculty of Health Sciences, East Africa

Background: Neonatal mortality is a global challenge, with an estimated 1.3 million intrapartum stillbirths in 2015. The majority of these were found in low resource settings with limited options to intrapartum fetal heart monitoring devices. This trial compared frequency of abnormal fetal heart rate (FHR) detection and adverse perinatal outcomes (i.e. fresh stillbirths, 24-h neonatal deaths, admission to neonatal care unit) among women intermittently assessed by Doppler or fetoscope in a rural low-resource setting.

Methods: This was an open-label randomized controlled trial conducted at Haydom Lutheran Hospital from March 2013 through August 2015. Inclusion criteria were; women in labor, …

Extracellular Vesicle Rnas Reflect Placenta Dysfunction And Are A Biomarker Source For Preterm Labour., Shannon Fallen, David Baxter, Xiaogang Wu, Taek-Kyun Kim, Oksana Shynlova, Min Young Lee, Kelsey Scherler, Stephen Lye, Leroy Hood, Kai Wang

Articles, Abstracts, and Reports

Preterm birth (PTB) can lead to lifelong complications and challenges. Identifying and monitoring molecular signals in easily accessible biological samples that can diagnose or predict the risk of preterm labour (PTL) in pregnant women will reduce or prevent PTBs. A number of studies identified putative biomarkers for PTL including protein, miRNA and hormones from various body fluids. However, biomarkers identified from these studies usually lack consistency and reproducibility. Extracellular vesicles (EVs) in circulation have gained significant interest in recent years as these vesicles may be involved in cell-cell communication. We have used an improved small RNA library construction protocol and …

Expectant Fathers’ Participation In Antenatal Care Services In Papua New Guinea: A Qualitative Inquiry, Jessica Davis, Cathy Vaughan, Justine Nankinga, Lisa Davidson, Hellen Kigodi, Eileen Alalo, Liz Comrie-Thomson, Stanley Luchters

Population Health, East Africa

Background: The importance of engaging men in maternal and child health programs is well recognised internationally. In Papua New Guinea (PNG), men’s involvement in maternal and child health services remains limited and barriers and enablers to involving fathers in antenatal care have not been well studied. The purpose of this paper is to explore attitudes to expectant fathers participating in antenatal care, and to identify barriers and enablers to men‘s participation in antenatal care with their pregnant partner in PNG.

Methods: Twenty-eight focus group discussions were conducted with purposively selected pregnant women, expectant fathers, older men and older women across …

Caesarean Section Rate Amongst Obstetricians At A Tertiary-Care Hospital Of Karachi, Iffat Ahmed, Dureshahwar Kanwar, Munazza Akhtar, Azra Amerjee

Department of Obstetrics & Gynaecology

Objective: To analyze the Caesarean Section (CS) rate among different groups of consultants dealing with Nulliparous Term Singleton pregnancy with Vertex (NTSV) presentation delivering at a tertiary care hospital of Karachi over four months.
Methods: This is a secondary analysis of a retrospective data that analyzed factors affecting the CS-rate of NTSV patients. Patients with CS (n=106) were taken as cases and vaginal deliveries (n=106) as controls. This was an unmatched retrospective case-control study.
Results: Mean age of patients was 26.6(SD: 4.2) years. Mean gestational-age was 38.6(SD: 1.0) weeks. Likelihood of CS was slightly less in patients who were attended …

Routine Antenatal Ultrasound In Low- And Middle-Income Countries: First Look - A Cluster Randomised Trial, Robert L. Goldenberg, Robert O. Nathan, David Swanson, Sarah Saleem, Waseem Mirza, Fabian Esamai, David Muyodi, Ana L. Garces, Lester Figueroa, Elwyn Chomba

Community Health Sciences

Objective: Ultrasound is widely regarded as an important adjunct to antenatal care (ANC) to guide practice and reduce perinatal mortality. We assessed the impact of ANC ultrasound use at health centers in resource-limited countries.
Design: Cluster randomized trial.
Settings: Clusters within five countries (Democratic Republic of Congo, Guatemala, Kenya, Pakistan and Zambia).
Methods: Clusters were randomized to standard ANC or standard care plus two ultrasounds and referral for complications. The study trained providers in intervention clusters to perform basic obstetric ultrasounds.
Main Outcome Measures: The primary outcome was a composite of maternal mortality, maternal near-miss mortality, stillbirth, and neonatal mortality. …

Web-Based Glucose Monitoring Using The Telcare® Wireless System For Management Of Pregnant Women With Pregestational Diabetes., Marc A. Vengrove Do, Facp, Emma Qureshey Md, Helai Hesham Md, Meredith Rochon Md, Joshua Cohen Bs, John C. Smulian Md, Mph

Department of Medicine

No abstract provided.

Book Review: Surrogacy: A Human Rights Violation By Renate Klein, Sheela Saravanan

Dignity: A Journal of Analysis of Exploitation and Violence

No abstract provided.

The Effect Of Hepatitis C On Maternal Bile Acid Level And The Fetal Left Ventricular Tei Index, Kelly Cummings, Jesse Cottrell, Songthip Ounpraseuth, Ryan Stone, David G. Chaffin, Everett Magann

Marshall Journal of Medicine

Hepatitis C (HCV) is a common form of liver disease encountered in pregnancy. The purpose of this study is to evaluate if hepatitis C is associated with elevated maternal serum bile acids and abnormal fetal cardiac function measured by the left ventricular Tei index in the absence of intrahepatic cholestasis of pregnancy. This is a prospective cohort study on pregnant women with hepatitis C seen through Marshall University’s high-risk obstetrics clinic from 2013 to 2014. Women with hepatitis C had a laboratory evaluation and an ultrasound on the fetus to calculate the left ventricular Tei index. Demographic information and delivery …

The Needs Of Women Treated For Ovarian Cancer: Results From A #Gyncsm Twitter Chat, Teresa Hagan Thomas, Karin Nauth-Shelley, Michael A. Thompson, Deanna J. Attai, Matthew S. Katz, David Graham, Dee Sparacio, Christina Lizaso, Audun Utengen, Don S. Dizon

Journal of Patient-Centered Research and Reviews

Purpose: Ovarian cancer is the most fatal of all gynecologic cancers, with a high relapse rate regardless of stage. Women treated for ovarian cancer, therefore, likely have supportive care needs that extend well beyond the time frame of first-line therapy. Unfortunately, there is minimal data describing these needs. The purpose of this qualitative study is to understand the supportive care needs of women with ovarian care at the end of treatment.

Methods: To better understand the issues faced by women with ovarian cancer, we conducted a public Twitter chat in collaboration with gynecologic cancer social media (#gyncsm). Both quantitative and …

Integration Of Maternal Postpartum Services In Maternal And Child Health Services In Kaya Health District (Burkina Faso): An Intervention Time Trend Analysis, Danielle Yugbaré Belemsaga, Anne Goujon, Halima Tougri, Abou Coulibaly, Olivier Degomme, Els Duysburgh, Marleen Temmerman, Seni Kouanda

Obstetrics and Gynaecology, East Africa

Background: The Missed Opportunities in Maternal and Infant Health (MOMI) project aimed at reducing maternal and newborn mortality and morbidity within the year after childbirth in four sub-Saharan African countries. MOMI interventions including the integration of maternal and infant services in the postpartum (PP) period at day 6–10, week 6–8, and month 9 were implemented from September 2013 to December 2015. We hereby assess the effect of integrating maternal postpartum care (PPC) in infant immunization services in Kaya health district in Burkina Faso.

Methods: We apply a longitudinal mixed method on monthly monitoring data collected from 12 months before the …

Predictors Of Low Birth Weight And 24-Hour Perinatal Outcomes At Muhimbili National Hospital In Dar Es Salaam, Tanzania: A Five-Year Retrospective Analysis Of Obstetric Records, Benjamin Anathory Kamala, Andrew Hans Mgaya, Matilda Michael Ngarina, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

Abstract

Introduction: The global prevalence of low birth weight (LBW) is 16%, representing more than 20 million infants worldwide, of which 96% are born in low-income countries. This study aimed to determine the prevalence, predictors and perinatal outcomes of LBW newborns.

Methods: We conducted a retrospective analysis of data obtained from the hospital's obstetric and neonatal database. Descriptive statistics and multivariate logistic regression were performed with 95% confidence intervals (CI).

Results: The prevalence of LBW was 21% (n = 8,011) and two-thirds of these were delivered at term. Seven percent of newborns were stillbirths and 2% died within 24hrs after …

The Effectiveness Of A "Patient Discharge Information" Booklet In Patient Education Program In Saudi Arabia, Amani Al Rebeh

Annual Graduate Student Symposium

The purpose of this research was to investigate the effectiveness of the Patient Discharge Information (PDI) booklet on the knowledge, attitude, and behaviors of participants who were cesarean patients in local hospitals in Saudi Arabia. This study investigated the following two research questions: (1) does the participant have information, resources, and understand basic personal health information regarding her health conditions including diagnosis, treatment, self-care management, medication instructions, normal expected symptoms, dangerous signs and what to do, as well as lifestyle changes?; and (2) how does patient discharge information provided by the hospital make a difference in participants’ knowledge, attitude, and …