Obstetrics and Gynecology Commons^™

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 …

Prepregnancy Diet Quality Index And Adverse Pregnancy Outcomes, Ummayhany Bharmal, George Saade, Philip Greenland, Brenda J. Smith, Andrea C. Kozai, Stephanie A. Fisher, Lauren Theilen, William Grobman, Noel Bairey Merz, Uma Reddy, Tetsuya Kawakita

Department of Obstetrics & Gynecology Faculty Publications

Introduction

Adverse pregnancy outcomes (APOs) are a major cause of maternal and neonatal morbidity.¹ Preconception diet quality is associated with APO risk,² but prior pregnancy-related indices had notable limitations.³ We developed the Prepregnancy Dietary Quality Index (PreP-DQI) to assess its association with APOs and cardiometabolic health.

Methods

This cohort study used data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (NuMoM2b) and the NuMoM2b-Heart Health Study (NuMoM2b-HHS),⁴,⁵ excluding individuals who delivered before 23 weeks of gestation, had fetal anomalies, missing dietary data, or had implausible caloric intake (below 1st percentile or above 99th percentile). All participants in the original studies …

Seasonal And Geographic Patterns Of Gastroschisis In Canada: Protective Effect Of Periconceptional Sunlight Exposure, Shiliang Liu, Shin Jie Yong, Dunjin Chen, Gavin C. Hughes, Claude L. Hughes

Department of Medicine Faculty Publications

Background: Gastroschisis is a right-sided, full-thickness defect with extra-amnionic herniation of abdominal contents directly into the amniotic cavity. The causes of gastroschisis remain obscure. We hypothesized that limited periconceptional sunlight exposure might lead to insufficient vitamin D during fetal development and play a role in gastroschisis etiology.

Methods: We conducted a population-based cohort study of infants conceived in Canada between April 2006 and March 2020. We used winter months (i.e., November and December) and northern geographic latitudes as indicators of insufficient sunlight exposure, while summer months (July and August) and southern geographic latitudes were considered as reference. We examined the …

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 …

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 …

Time Pressures And Sociocultural Constraints Affecting Access To Early Abortion Care Under Texas' "6-Week" Ban, Kari White, Whitney Arey, Anna Chatillon, Anitra D Beasley, Cecili Chadwick, Asha Dane'el, Ophra Leyser-Whalen, Tracy A Weitz

Faculty, Staff and Students Publications

Introduction: In 2021, Texas Senate Bill 8 (SB8) prohibited abortion after detection of embryonic cardiac activity and was often referred to as a "6-week ban." Limited evidence exists about how these laws intersect with people's processes seeking pregnancy confirmation and navigating barriers to abortion care.

Methods: Between October 2021 and August 2022, we recruited Texans ≥ 15 years of age who were seeking abortion using online ads and flyers placed in out-of-state abortion-providing facilities. Participants completed in-depth interviews, and we coded transcripts using inductive and deductive coding. This analysis explores participants' discussions of time needed for pregnancy confirmation, decision making, …

Intercornual Distance And Postoperative Reproductive Outcomes In Moderate-To-Severe Intrauterine Adhesions: A Retrospective Cohort Study, Yifu He, Xingping Zhao, Huan Huang, Changfa Shu, Xiaoming Guan, Jia Guo, Dabao Xu

Faculty, Staff and Students Publications

Study question: Does intercornual distance (ICD), as reflected by intrauterine stent size during hysteroscopic adhesiolysis, have an association with reproductive outcomes and provide information for postoperative risk stratification in women with moderate-to-severe intrauterine adhesions?

Summary answer: A smaller ICD was independently associated with a lower likelihood of clinical pregnancy within 1 year of the final hysteroscopy and may offer additional information for postoperative risk stratification in women with moderate-to-severe intrauterine adhesions.

What is known already: Reproductive outcomes following treatment for moderate-to-severe intrauterine adhesions vary considerably. Existing severity classifications offer limited discrimination within this group. The potential association between ICD and …

Surgical Outcomes And Learning Curve Of Robotic Single-Port Vaginal Natural Orifice Transluminal Endoscopic Surgery (Vnotes) Hysterectomy Using The Da Vinci Single-Port System, Qiannan Yang, Daniel Y Lovell, Xiaoming Guan

Faculty, Staff and Students Publications

Objective: This study aims to assess the surgical outcomes and learning curve of robotic single-port vaginal natural orifice transluminal endoscopic surgery (RSP-vNOTES) for hysterectomy in benign gynecologic conditions.

Materials and methods: A retrospective observational analysis was conducted of 97 consecutively enrolled patients who underwent RSP-vNOTES hysterectomy using the da Vinci (single-port) SP system between December 2023 and July 2025 at a single tertiary care center.

Results: Median procedural durations included a total operative time of 151 minutes, a port placement time of five minutes, a docking time of two minutes, a robotic console time of 78 minutes, and a hysterectomy …

A New Application For Bolt Cutters In Urogynecology: Challenging Removal Of An Impacted Pessary, Carolyn M. Payne, Courtney B. Ritchie, Tanaz R. Ferzandi

HCA Healthcare Journal of Medicine

Background

Pessaries are commonly used to treat pelvic organ prolapse. While these devices generally pose negligible risk, serious morbidity can be associated with neglected use.

Case Presentation

A 91-year-old woman began to experience acute pain related to an impacted pessary. An Exam in the operating room under anesthesia revealed that the pessary was deeply embedded within the vaginal canal and was noted to have a hard metal wire under a rubber exterior. An intraoperative orthopedic consult was obtained to facilitate discussion and selection of tools outside the typical gynecological scope to remove the pessary. A combination of bolt cutters and …

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 …

Impact Of Early Term Induction Of Labor On Cesarean Delivery And Maternal-Fetal Outcomes In Patients With Obesity: A Retrospective Cohort Study, Nathanael N. Hoskins, Priya Patel, Thomas Wasser, Xuezhi Jiang

Transformative Medicine

Introduction: Obesity (body mass index [BMI] ≥ 30 kg/m²) is increasingly prevalent in pregnancy and is associated with numerous complications, including gestational diabetes, hypertension, and higher cesarean delivery (CD) rate. There are many risks for patients with obesity during pregnancy; however, there is little evidence supporting early-term (37 0/7 to 38 6/7 weeks of gestation) induction of labor (IOL) to reduce complications. This study aimed to evaluate whether IOL in patients with obesity is associated with a decreased CD rate.

Methods: This retrospective cohort study included pregnancies that underwent IOL between 37 0/7 and 41 6/7 weeks of gestation from …

Opportunity For Increasing Applicant Diversity In Gynecologic Oncology Fellowships, Priyanka Raju Md, Tamara Lalovic Do, Alexandar Lalovic

Transformative Medicine

Introduction: The term healthcare disparity describes differences in access to medical care between population groups. Minimizing the care gap and improving access to care for historically minoritized populations will require a multifaceted approach. Increasing diversity in the healthcare workforce has the potential to lead to significant improvements aimed at minimizing inequity. Fellowship training programs in Gynecologic Oncology serve as the gatekeeper for the workforce of Gynecologic Oncologists. Efforts at improving diversity at the fellowship level are necessary to increase the diversity of practicing physicians. The objective of this study is to assess Gynecologic Oncology fellowship websites for information emphasizing a …

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 …

Breastfeeding Safety Following Maternal Anesthesia: A Guideline Development, Megan Honea, Mary Johnson

Doctoral Projects

Recommendations regarding breastfeeding following maternal anesthesia are inconsistent and often not up to date with current best practice guidelines. Previous recommendations have led to mothers unnecessarily “pumping and dumping” breast milk has benefits for both mother and baby. These benefits include (a) increasing the infant’s access to colostrum, (b) encouraging mother-baby bonding, (c) improving the mother’s breastfeeding experience, (d) and providing significant health benefits to the infant. The purpose of this scholarly project was to develop a set of evidence-based recommendations that focus on mothers who desire to breastfeed following general anesthesia. These recommendations will highlight maternal- fetal transfer of …

Disruption Of The Placenta–Brain Axis In Transgenic Mice Lacking Serotonin Transporter (Sert) In Trophoblast Cells, David T. Ellenberger, Zhen Lyu, Rosalind T. B. Herrington, Jessica A. Kinkade, Gustavo W. Leone, Ji Ying Sze, Nathan J. Bivens, R. Frank Baker, R. Michael Roberts, Trupti Joshi, Cheryl S. Rosenfeld

Biomedical Sciences

Serotonin reuptake inhibitors (SSRIs) are commonly prescribed to pregnant women experiencing depression. Such drugs, however, might adversely affect placenta and fetal brain development. Parietal trophoblast giant cells (pTGCs) in the mouse placenta are postulated to internalize maternal serotonin (5-HT) via transport through SERT, encoded by Slc6a4, and to provide the initial source of 5-HT to the emerging brain via the placental–brain axis. Genetic deletion of Slc6a4 in pTGCs has been hypothesized to impact placental and fetal brain development. A transgenic mouse line with high-affinity SERT, encoded by Slc6a4, was selectively deleted by pairing mice with Cre recombinase linked …

The Association Between Gestational Body Mass Index Change, Cesarean Section, And Other Pregnancy Outcomes: Research Protocol: Retrospective Cohort Analysis, Kirsten I. Black, Owen Streeter, Arianne Sweeting, Pejman Adily, Mark Lauer, Adrienne Gordon, Vincenzo Berghella, Belinda R. Bruce, Lauren Ferris, Bradley De Vries

Department of Obstetrics and Gynecology Faculty Papers

Increasingly the value of gestational weight gain (GWG) as a useful measure to predict obstetric outcomes including cesarean section is being questioned. We will undertake a retrospective cohort study of recorded births in 2023 from 24 to 42 weeks' gestation for women aged from 16 to 49 years in the United States. Using multivariable Robust Poisson Regression, maternal body mass index (BMI) and BMI gain will be modelled on the primary outcome of cesarean delivery. The primary analysis will be restricted to nulliparous women if there is interaction between parity and BMI or BMI gain. A sample of 716,392 births …

Assessing The Impact Of Maternal Oral Health On The Risk Of Adverse Birth Outcomes, May Amr Salama

Health Services Research Dissertations

Preterm birth (PTB) and low birth weight (LBW) are leading causes of neonatal morbidity and mortality. Maternal periodontal disease (PD) has been increasingly linked to these adverse birth outcomes (ABOs), yet questions about causality and treatment effectiveness persist due to study design heterogeneity and potential unmeasured confounding. These gaps hinder the development of clear clinical and public health guidelines. This dissertation addresses these gaps through three interconnected studies assessing the relationship between maternal oral health and ABOs.

The first study employed a meta-epidemiological analysis of 62 original studies from nine systematic reviews to evaluate the impact of unmeasured confounding on …

Using Robotic Single-Port Vnotes For Gynaecological Oncology: Omentectomy In A Patient With An Ovarian Granulosa Cell Tumor-A Case Study, Chunhua Zhang, Qing Li, Fang Fang, Xiaoming Guan

Faculty, Staff and Students Publications

Background: Robotic single-port transvaginal natural orifice transluminal endoscopic surgery (RSP-vNOTES) is an emerging minimally invasive approach that combines the advantages of robotic surgery with scarless transvaginal access. Its application in gynecologic oncology remains limited, particularly for omentectomy during ovarian cancer staging.

Methods: We present the case of a 45-year-old woman with an ovarian granulosa cell tumor (GCT) who underwent supplemental staging surgery following unilateral oophorectomy. Using a single-port robotic system via the transvaginal route, hysterectomy, right salpingo-oophorectomy, and omentectomy were performed. Key technical steps included enhanced visualization with gauze placement and use of an additional robotic arm for omental traction. …

Impact Of A Maternal Early Warning System And Severe Hypertension Safety Bundle On Timely Treatment Of Hypertensive Emergencies: A Quality Improvement And Health Equity Initiative, Towana D Sims, Lauren Shubert, Stacie Denning, Lena Shay, Celeste Green, Christina Davidson

Faculty, Staff and Students Publications

Background: Hypertensive disorders of pregnancy are a leading cause of pregnancy-related morbidity and mortality. Timely treatment of a hypertensive emergency has the potential to reduce preeclampsia-related morbidity and mortality.

Objective: To evaluate the impact of quality improvement and patient safety initiatives on timely treatment of hypertensive emergencies in pregnancy and racial and ethnic disparities.

Setting: Maternity teaching hospital in Texas Medical Center.

Population: Pregnant and postpartum women with hypertensive emergencies.

Methods: A retrospective chart review of all hospital deliveries with a hypertensive emergency was conducted from 1 January 2017 through 31 December 2024. During the study period, our hospital implemented …

Reproductive Impact Of Immune Checkpoint Inhibitor Therapy In Women With Melanoma, Quinn Rhodes, Terri L Woodard, Laura Detti, Michael Roth, Susan Shott, Jennifer Mcquade, Laurie J Mckenzie

Faculty, Staff and Students Publications

Objective: To study the reproductive impact of immune checkpoint inhibitor (ICI) therapy in cis-females with melanoma.

Design: Retrospective cross-sectional study that examined the reproductive outcomes of female patients exposed to systemic ICI therapy.

Subjects: Cis-female patients, aged 18-40 years, with advanced-stage melanoma and no prior sterilization procedures or exposure to other systemic antineoplastic therapies who underwent treatment with systemic ICI therapy.

Exposure: Systemic ICI treatment as first-line, only-line therapy for advanced-stage melanoma.

Main outcome measures: Menstrual cycle data, contraceptive use, antimüllerian hormone and follicle-stimulating hormone values, and reproductive outcomes (occurrence of pregnancy) during and after ICI exposure.

Results: There were …

Promoting Professionalism In Medical Education: A Toolbox For Effective Feedback And Remediation, Matthew R Carroll, Gal Barak, Tracy Byrne, Huma Farid

Faculty, Staff and Students Publications

No abstract provided.

Application Of The Surgical Apgar Score To Predict Intensive Care Unit Admission And Post-Operative Outcomes In Cesarean Hysterectomy For Placenta Accreta Spectrum, Emily Root, Jacqueline Curbelo, Patrick Ramsey, Jessian L Munoz

Faculty, Staff and Students Publications

Background and Objective: Placenta Accreta Spectrum (PAS) encompasses a continuum of abnormal placentation conditions associated with significant maternal and fetal morbidity. Management of PAS requires coordinated cesarean hysterectomy. Associated morbidities include blood transfusion, coagulopathy, and intensive care unit (ICU) admission. Accurate prediction of ICU admission allows for enhanced multidisciplinary management, coordination of care and utilization of resources. Scoring systems exist in other surgical specialties that can predict the likelihood of ICU admission, but these have not been applied to an obstetric population. The SAS is a 10-point scale that has been validated for the prediction of ICU-level care requirements within …

Hemorrhage-Related Maternal Morbidity Of Secondary Compared To Primary Postpartum Hemorrhage, Matthew R Carroll, Sarah Tounsi, Jessica L Gerard, Susan M Leong-Kee, Laurie S Swaim, Mark A Turrentine

Faculty, Staff and Students Publications

Objectives: To compare a composite hemorrhage-related maternal morbidity in individuals with secondary to primary postpartum hemorrhage and treatment interventions utilized.

Methods: A retrospective case-control study of deliveries complicated by secondary postpartum hemorrhage was performed at a tertiary care center. To estimate a clinically relevant increase of 50 % in the composite maternal hemorrhage-related maternal morbidity (35-53 % absolute increase) in individuals with secondary postpartum hemorrhage, a correlation coefficient of 0.2, at an 80 % power with a p < 0.05 with a two-sided test would require 95 individuals with secondary postpartum hemorrhage be matched to 95 individuals with a primary postpartum hemorrhage. Logistic regression analysis was used to evaluate the outcome of the composite of hemorrhage-related maternal morbidity.

Results: From January 2018 through December 2022, 33,026 deliveries occurred, and 94 individuals were identified that were admitted with secondary postpartum hemorrhage, …

Bladder Prolapse (Cystocele) Among African, Asian, And Middle Eastern Women: A Clinical And Socio-Cultural Perspective, Gayathri Delanerolle, Vindya Pathiraja, Tharanga Mudalige, Nirmala Rathnayake, Abirame Sivakumar, Wijamunige Nimesha Prashadini, Nihal Mohamed Al Riyami, Lamiya Al-Kharusi, Mohammad Haddadi, Fred Tweneboah-Koduah, Om Kurmi, George Uchenna Eleje, Peter Phiri, Lauri Romanzi, Sohier Elneil

Department of Obstetrics and Gynecology Faculty Papers

Bladder prolapse, also known as cystocoele, is the most common form of pelvic organ prolapse (POP), significantly affecting women's physical, sexual, and psychosocial health, particularly in low- and middle-income countries (LMICs). Despite its widespread prevalence and disabling consequences, bladder prolapse remains under-recognised and inadequately addressed in global health strategies. Prevalence estimates vary widely across regions, from 3%-64.6%, influenced by diagnostic methods and cultural reporting biases. Common risk factors include high parity, early childbirth, prolonged labour, poor postpartum care, malnutrition, obesity, and ageing. Clinical diagnosis often relies on simplified grading systems in resource-limited settings. Conservative treatments like pelvic floor muscle training …

At1-Aa Induced Hypertension During Pregnancy Contributes To Developmental Programming Of Hypertension In Female Offspring, Nathan Campbell, James P. Lemon, Melissa Helmich, Dylan Solise, Alexandra Demesa, Ella Goolsby, Evan Lamarca, Evangeline Deer, Denise C. Cornelius, Ty Turner, Lorena M. Amaral, Baoying Zheng, Babbette Lamarca

Pharmacology and Toxicology

Preeclampsia (PE), new-onset hypertension during pregnancy, is accompanied by organ dysfunction, in addition to placental dysfunction, and is associated with chronic inflammation and fetal growth restriction. Agonistic autoantibodies against the angiotensin II type 1 receptor (AT1-AA) are produced in PE women and induce a PE-like phenotype when infused into pregnant rats. PE offspring are at higher risk for cardiovascular disease and hypertension; however, AT1-AA’s role in these risks is unknown. Therefore, we hypothesized that AT1-AA exposure during pregnancy contributes to hypertension in adult offspring. We infused AT1-AA (1:40) starting on gestational day (GD) 14, allowed the dams to give birth, …

Estrogen And Obesity Synergistically Suppress Protein S Via Hif1Α, Enhancing Thrombosis Potential, Mohammad A. Mohammad, Narender Kumar, Sonali Ghosh, Ashley L. Paysse, Claudia Leonardi, Vijaya Pilli, Ma Lorena Duhaylungsod, Eric Lazartigues, Diana Polania-Villanueva, Sadaf Nouman, Logan A. Barrios, Rima Chattopadhyay, Rafika Yasmin, Alaina Guilbeau, Manoj Kumar, Tina H. Nguyen, Jovanny Zabaleta, Li Li, Luis Del Valle M.D., Mallory T. Barbier, Samarpan Majumder, Laurent O. Mosnier, Samarpan Majumder

School of Graduate Studies Faculty Publications

Venous thromboembolism (VTE) is a leading cause of morbidity and mortality, with risk heightened in premenopausal women with obesity or use estrogen-based oral contraceptives. When both risk factors are present, the thrombosis risk increases substantially. Protein S (PS), an essential anticoagulant cofactor, is downregulated by both estrogen and obesity, but the molecular basis for this suppression remains poorly defined. We investigated the effect of estrogen and obesity on PS expression using plasma samples from 157 women stratified by BMI and contraceptive use, alongside 40 mice categorized as lean or obese with or without estrogen pellet treatment. The levels of PS …