Obstetrics and Gynecology Commons^™

Involuntary Sterilization Among Hiv-Positive Garifuna Women From Honduras Seeking Asylum In The United States: Two Case Reports, Holly G. Atkinson, Deborah Ottenheimer

Publications and Research

Voluntary sterilization is one of the most widely used forms of contraception by women worldwide; however, involuntary sterilization is considered a violation of multiple human rights and grounds for asylum in the United States. Women have been disproportionately affected by this practice. We report two cases of involuntary sterilization in HIV-positive Garifuna women from Honduras who sought asylum in America and were medically evaluated at the request of their attorneys. Key lessons can be drawn from these cases with regard to the importance of medical evaluations in establishing persecution. These include the need for a detailed account of the events …

Bystander Program Effectiveness To Reduce Violence Acceptance: Rct In High Schools, Ann L. Coker, Heather M. Bush, Candace J. Brancato, Emily R. Clear, Eileen A. Recktenwald

Obstetrics and Gynecology Faculty Publications

Bystander-based violence prevention interventions have shown efficacy to reduce dating violence and sexual violence acceptance at the individual level yet no large randomized controlled trial (RCT) has evaluated this effect at the high-school level and over time. This rigorous cluster-randomized controlled trial addresses this gap by evaluating intervention effectiveness at both school and individual levels. Kentucky high schools were randomized to intervention or control conditions. In intervention schools educators provided school-wide ‘Green Dot’ presentations and bystander training with student popular opinion leaders. Each spring from 2010 to 2014; 73,044 students completed anonymous surveys with no missing data on relevant outcomes. …

The Relationship Between The Metabolic Responsiveness To A High-Fat Meal And An Acute Bout Of Moderateintensity Exercise Among Postpartum Women, Apoorva Tadakaluru

Masters Theses & Specialist Projects

Background: There has been very little research regarding the metabolic health of women during the postpartum period. Metabolic flexibility is the physiological ability to alter substrate oxidation in response to substrate availability and is a good indicator of overall metabolic health. Metabolic flexibility can be assessed by placing metabolic demands on the body and observing metabolic responsiveness- two examples of such metabolic stressors are lipid oxidation rates in response to a high-fat meal and as well as exercise. However, it is unknown whether postpartum women will respond similarly to these two different types of metabolic stressors. This information will allow …

(Video) Outreach Services To Treat Women Living With Obstetric Fistula: A Systematic Review, Pauline Pamela Pratt, Rashida Muhammad

GW Research Days 2016 - 2020

Background: Obstetric fistula is a condition experienced by women who because of prolonged labor become incontinent forming one or more holes in between the rectum and the vagina or the vagina and the bladder (Heller, A., 2017). The hole causes uncontrollable stool and urine to leak from the woman. For most women with obstetric fistula, the duration of the labor leading to fistula varied between 5 hours and 9 days, averaging 3.0 days long (Heller, A., 2017). Women who suffer from this from this condition are do not have access to quality medical care. While prevention is the priority and …

Morbid Obesity Is Associated With Postoperative Complications In Laparoscopic Hysterectomy, Margaret Berrigan, Maria Victoria Vargas, Alex Gu, Chapman Wei, Hannah Robinson, Paul Tyan, Gaby Moawad

GW Research Days 2016 - 2020

Background: The prevalence of obesity in American women is 38.3%. Hysterectomy is the second most common surgery in reproductive age women; most of these procedures are performed laparoscopically. From 2011 to 2015, 3.2% of women age 15-44 years underwent hysterectomy; 89.6% of these procedures were performed for management of medical conditions including uterine fibroids, menstrual disorders, uterine prolapse, and endometriosis. The high rates of obesity and hysterectomy in women demand better understanding of the relationship between obesity and postoperative complications following laparoscopic hysterectomy. Methods: We conducted a retrospective cohort study using the American College of Surgeons National Quality Improvement Database …

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

Faculty of Health Sciences, East Africa

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 birth. …

Prophylactic Antibiotics To Reduce Pelvic Infection In Women Having Miscarriage Surgery – The Aims (Antibiotics In Miscarriage Surgery) Trial: Study Protocol For A Randomized Controlled Trial, David Lissauer, Amie Wilson, Jane Daniels, Lee Middleton, Jon Bishop, Catherine Hewitt, Abi Merriel, Rahat Qureshi, Iffat Ahmed, Humera Ismail

Department of Paediatrics and Child Health

Background: The estimated annual global burden of miscarriage is 33 million out of 210 million pregnancies. Many women undergoing miscarriage have surgery to remove pregnancy tissues, resulting in miscarriage surgery being one of the most common operations performed in hospitals in low-income countries. Infection is a serious consequence and can result in serious illness and death. In low-income settings, the infection rate following miscarriage surgery has been reported to be high. Good quality evidence on the use of prophylactic antibiotics for surgical miscarriage management is not available. Given that miscarriage surgery is common, and infective complications are frequent and serious, …

Stress Of Infertility: Can The Couple Cope?, Faiza Alam, Taseer Ahmed Khan, Rehana Rehman

Department of Biological & Biomedical Sciences

No abstract provided.

Household Chores As The Main Source Of Physical Activity: Perspectives Of Pregnant Pakistani Women, Zahra Hoodbhoy, Rahat Qureshi, Romaina Iqbal, Qamarunissa Muhabat

Department of Paediatrics and Child Health

Objective: To understand the level of physical activity in pregnant women and to identify perceived facilitators and barriers faced by them.
Methods: This cross-sectional study was conducted from January to June 2016 at Aga Khan Maternity and Child Care Centre, Hyderabad, Pakistan, and comprised pregnant women attending the antenatal clinics. They were administered the pregnancy physical activity questionnaire while additional questions were asked to assess perceived barriers and facilitators in pregnancy. SPSS 19 was used for data analysis.
Results: Of the 455 subjects, 179(36%) were physically active. Their median metabolic equivalent of task hours per week was 14.65 (interquartile …

Comparison Of Serum And Cervical Cytokine Levels Throughout Pregnancy Between Preterm And Term Births, Kristin Ashford, Niraj R. Chavan, Amanda T. Wiggins, Molly Malany Sayre, Andrea Mccubbin, Agatha S. Critchfield, John O'Brien

Nursing Faculty Publications

Objective To assess differences in cytokine levels in cervicovaginal fluid (CVF) and serum across trimesters between women with preterm births (PTBs) and full-term births.

Study Design This multicenter study enrolled 302 women with a singleton gestation. CVF and serum cytokines, interleukin 1α (IL-1α), IL-1β, IL-6, IL-8, IL-10, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and matrix metalloproteinase (MMP)-8, were measured. Women with at least one cytokine assessment and noted PTB status in their medical record were retained in the study (N = 272). Data were analyzed using mixed modeling (main effects of PTBs and time/trimester).

Results For the CVF …

Recurrent Vulvar Carcinoma: Complex Surgical Treatment Via Perineal Excision And Reconstruction With Musculocutaneous Flap, Dragoș Popa, Cosmin V. Obleagă, Ștefan Paitici, Stelian Ș. Mogoanta, Ionică D. Vîlcea, Pouya Pourgolafshan, Cristian Gheorghe, Manuela I. Vasile, Raluca Câmpeanu, Cecil S. Mirea

Journal of Mind and Medical Sciences

Vulvar cancer is a malignant disease having a low frequency and with well-established surgical and oncological treatments based on the stage of the disease. The most important therapeutic problem encountered is represented by cases of perineal local regional recurrence, which are common in patients with large primary tumors and can occur even if the margins of the resection had no tumoral invasion.

We present a case study of a 64-year-old patient diagnosed one year ago with squamous vulvar carcinoma (G3) for which a vulvectomy was performed after neoadjuvant radiotherapy. The patient later developed local recurrence with invasion of the anal …

The Psychosocial Impact Of Vaginal Delivery And Cesarean Section In Primiparous Women, Ples Liana, Romina M. Sima, Delia Carp, Camelia Alexandroaia, Denisa O. Balalau, Anca D. Stanescu, Octavian G. Olaru

Journal of Mind and Medical Sciences

The aim of this study was to identify how the method of delivery and birth experience interfere with maternal psychological status early after puerperium. We conducted a prospective study on 148 women after puerperium from November 2017 to January 2018 in Bucur Maternity Hospital. Women that delivered vaginally mobilized in the first 6 hours in 73.7% of the cases, but for cesarean section after 12- 24 hours in 43.6% of the cases. Women described good support from the obstetrician in 58.1% of the cases. 90.5% of the women reported that the method of delivery did not have an impact on …

Pelvic Floor Disorders In Gynecological Malignancies. An Overlooked Problem?, Oana M. Bodean, Radu D. Marcu, Dan A. Spinu, Bogdan Socea, Camelia C. Diaconu, Octavian Munteanu, Nicoleta Taus, Monica Cirstoiu

Journal of Mind and Medical Sciences

Cervical, endometrial, ovarian, vulvar, and vaginal cancers affect women of a broad age spectrum. Many of these women are still sexually active when their cancer is diagnosed. Treatment options for gynecological malignancies, such as gynecological surgery, radiation, and chemotherapy, are proven risk factors for pelvic floor dysfunction. The prevalence of urinary incontinence, fecal incontinence, and sexual dysfunction before cancer treatment is still unclear. Hypotheses have been raised in the literature that these manifestations could represent early symptoms of pelvic cancers, but most remain overlooked even in cancer surviving patients.

The primary focus of therapy is always cancer eradication, but as …

Utilization Of Prevention Of Mother-To-Child Transmission (Pmtct) Services Among Pregnant Women In Hiv Care In Uganda: A 24-Month Cohort Of Women From Pre-Conception To Post-Delivery., Rhoda K Wanyenze, Kathy Goggin, Sarah Finocchario-Kessler, Jolly Beyeza-Kashesya, Deborah Mindry, Josephine Birungi, Mahlet Woldetsadik, Glenn J Wagner

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: We assessed the uptake of prevention of mother-to-child transmission (PMTCT) services in a cohort of HIV infected women in care at The AIDS Support Organization Jinja and Kampala in Uganda, who were trying to conceive, over a period of 24 months, to inform the strengthening of PMTCT service access for women in care.

RESULTS: Of the 299 women 127 (42.5%) reported at least one pregnancy within 24 months; 61 women (48.0%) delivered a live child. Of the 55 who had a live birth at the first pregnancy, 54 (98.2%) used antenatal care (ANC) starting at 15.5 weeks of gestation …

Maternal Death And Delays In Accessing Emergency Obstetric Care In Mozambique, Leonardo Antonio Chavane, Patricia Bailey, Osvaldo Loquiha, Martinho Dgedge, Marc Aerts, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Despite declining trends maternal mortality remains an important public health issue in Mozambique. The delays to reach an appropriate health facility and receive care faced by woman with pregnancy related complications play an important role in the occurrence of these deaths. This study aims to examine the contribution of the delays in relation to the causes of maternal death in facilities in Mozambique.

Methods: Secondary analysis was performed on data from a national assessment on maternal and neonatal health that included in-depth maternal death reviews, using patient files and facility records with the most comprehensive information available. Statistical models …

Impact Of Prenatal Stress On Offspring Glucocorticoid Levels: A Phylogenetic Meta-Analysis Across 14 Vertebrate Species, Zaneta M. Thayer, Meredith A. Wilson, Andrew W. Kim, Adrian V. Jaeggi

Dartmouth Scholarship

Prenatal exposure to maternal stress is commonly associated with variation in Hypothalamic Pituitary Adrenal (HPA)-axis functioning in ofspring. However, the strength or consistency of this response has never been empirically evaluated across vertebrate species. Here we meta-analyzed 114 results from 39 studies across 14 vertebrate species using Bayesian phylogenetic mixed-efects models. We found a positive overall efect of prenatal stress on ofspring glucocorticoids (d’=0.43) though the 95% Highest Posterior Density Interval overlapped with 0 (−0.16–0.95). Meta-regressions of potential moderators highlighted that phylogeny and life history variables predicted relatively little variation in efect size. Experimental studies (d’=0.64) produced stronger efects than …

Transabdominal Versus Transvaginal, Kyla Camille Gray

Grace Peterson Nursing Research Colloquium

Background: In the United States, there has been a 21% increase in the occurrence of premature births within the last two decades. These children are also more likely to require lifelong therapies, assistive technologies, mobility devices, and more supportive services throughout their time in school. Globally, preterm births, and their preventions, have become a topic of interest. One method that has had significant success rates is placing a cerclage to prevent cervical dilation; while simultaneously treating prophylactically for early delivery.

Objectives: The purpose of this integrative literature review was to focus on which placement of cerclages, transabdominal or transvaginal, …

Fenestration Of The Proximal Left Ovarian Vein., Mayank Patel, Joe Iwanaga, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

A fenestration in the left ovarian vein was found in a fresh-frozen female cadaver. The opening did not have any vessels or additional anatomical structures passing through it. The ovarian vein is also referred to as the female gonadal vein. This type of anatomical variation is clinically relevant in procedures that deal with the manipulation of the gonadal veins, specifically conditions such as ovarian vein thrombosis, ovarian vein stenosis, and pelvic congestion syndrome.

Women's Experiences Of Mistreatment During Childbirth: A Comparative View Of Home- And Facility-Based Births In Pakistan, Waqas Hameed, Bilal Iqbal Avan

Community Health Sciences

Introduction: Respectful and dignified healthcare is a fundamental right for every woman. However, many women seeking childbirth services, especially those in low-income countries such as Pakistan, are mistreated by their birth attendants. The aim of this epidemiological study was to estimate the prevalence of mistreatment and types of mistreatment among women giving birth in facility- and home-based settings in Pakistan in order to address the lack of empirical evidence on this topic. The study also examined the association between demographics (socio-demographic, reproductive history and empowerment status) and mistreatment, both in general and according to birth setting (whether home- or facility-based). …

Premenstrual Syndrome: Existence, Knowledge, And Attitude Among Female University Students In Karachi, Aleena Mohib, Amara Zafar, Areeba Najam, Hafsa Tanveer, Rehana Rehman

Department of Biological & Biomedical Sciences

Objective: The aim of this study was to investigate the existence, knowledge, and the attitude of female students towards premenstrual syndrome (PMS).
Methods: This cross-sectional study was conducted in three universities in Karachi, Pakistan. A total of 448 female students participated in the study. The clinical criterion of American College of Obstetricians and Gynecologists (ACOG) for PMS was used to assess the prevalence of PMS in the participants. The questionnaire was set in four parts, one each to assess the knowledge, the attitude, and practices regarding PMS and one to assess the gap between self-perceived PMS and actual PMS. Data …

Cortical Thinning And Neuropsychiatric Outcomes In Children Exposed To Prenatal Adversity: A Role For Placental Crh?, Curt A. Sandman, Megan M. Curran, Elyssia Poggi Davis, Laura M. Glynn, Kevin Head, Tallie Z. Baram

Psychology Faculty Articles and Research

Exposure to early life adversity may disrupt the development and maturation of neurons and brain circuits, which, in turn, underlie neurodevelopment and mental illnesses. During fetal life, maternal adversity is conveyed to the developing brain via several molecular signals, including the stress hormone corticotropin releasing hormone (CRH). Employing a large well characterized prospective cohort, we find that fetal exposure to placental-origin CRH levels predicts structural and functional brain outcomes in children. Specifically, elevated placental CRH levels portend thinning of selective cortical regions of exposed individuals, with commensurate cognitive and emotional deficits. Notably, the relations of placental-origin CRH to cortical thinning …

A Gender-Based Comparison In Health Behaviors And State Of Happiness Among University Students, Rehana Rehman, Amara Zafar, Aleena Mohib, Mukhtiar Baig

Department of Biological & Biomedical Sciences

Objective: The presence of good healthy behaviors among university students is imperative for their future life. This study aimed to compare positive health behaviors and state of happiness between the two genders of Bahria University (BU), Karachi, Pakistan.
Subjects and methods: This cross-sectional study was conducted at BU, Karachi, Pakistan. A total 813 students participated in this study. The healthquestionnaire, adapted from Health and Behavior Survey and the Subjective Happiness Scale, was used to assess self-reported happiness. The data were analyzed using IBM SPSS version 22.
Results: Overall self-reported health behaviors were found to be more prevalent in females as …

Capacity Building In Sub-Saharan Africa: Models Of Care, Patrick J. Loehrer, Barry Rosen, Elkanah Omenge, Julie R. Gralow

Obstetrics and Gynaecology, East Africa

No abstract provided.

Surgeon Volume, David L. Howard, Andrea Mcglynn, Joy A. Greer

Research Briefs

No abstract provided.

Immediate Versus Delayed Insertion Of The Levonorgestrel Intrauterine Device In Postpartum Adolescents: A Randomized Pilot Study., Reni Soon, Katie Mcguire, Jennifer Salcedo, Bliss Kaneshiro

Articles, Abstracts, and Reports

This pilot study assessed the feasibility of conducting a larger randomized controlled trial comparing the proportion of adolescents using a levonorgestrel intrauterine device (LNG IUD) at six months postpartum when it is inserted immediately after vaginal delivery (within 10 minutes after placental expulsion) compared to insertion four to six weeks postpartum. Pregnant adolescents (14 to 19 years) who desired a LNG IUD for postpartum contraception were randomized to insertion of the LNG IUD either within 10 minutes of delivery of the placenta or at 4-6 weeks postpartum. Study follow-up visits were conducted at 4-6 weeks postpartum, 10 weeks postpartum, and …

A Rare Case: Rupture Of Internal Pudendal And Uterine Artery In A Vaginal Delivery, Novera G. Chughtai, Raheela Mohsin Rizvi

Department of Obstetrics & Gynaecology

The management of puerperal hematomas after normal delivery has always been challenging for obstetricians. Vulvar, vulvovaginal, or paravaginal hematomas are common. On the other hand, retroperitoneal hematomas are uncommon and can be life-threatening. The diagnosis of vascular injury is rarely made preoperatively as atonic or traumatic postpartum hemorrhage (PPH), uterine rupture and amniotic fluid embolism are more common differential diagnoses. Injury to internal pudendal and uterine vessels is extremely rare in cases of vaginal delivery and, therefore, the literature on this topic is very scarce. We present a rare case of both internal pudendal and uterine artery rupture in a …

Uterine Arteriovenous Malformations After Suction Evacuation Of Missed Miscarriage, Arshia Javed, Reeta Chander, Zahra Hoodbhoy

Department of Obstetrics & Gynaecology

Uterine arteriovenous malformation (AVM) is an uncommon but life-threating source of bleeding. AVM is an abnormal connection between uterine arteries and veins. Patients typically present with vaginal bleeding following miscarriage (medical/surgical) or cesarean section. The treatment of choice depends on the symptoms, age, desire of fertility, localization and size of the lesion. Uterine artery embolization is the first choice in symptomatic patients of reproductive age group. We report a case of AVM presenting after dilation and evacuation with extensive lesion, which was successfully treated with bilateral uterine artery embolization.

A Rare Case: Rupture Of Internal Pudendal And Uterine Artery In A Vaginal Delivery, Novera G. Chughtai, Raheela Mohsin Rizvi

Department of Obstetrics & Gynaecology

The management of puerperal hematomas after normal delivery has always been challenging for obstetricians. Vulvar, vulvovaginal, or paravaginal hematomas are common. On the other hand, retroperitoneal hematomas are uncommon and can be life-threatening. The diagnosis of vascular injury is rarely made preoperatively as atonic or traumatic postpartum hemorrhage (PPH), uterine rupture and amniotic fluid embolism are more common differential diagnoses. Injury to internal pudendal and uterine vessels is extremely rare in cases of vaginal delivery and, therefore, the literature on this topic is very scarce. We present a rare case of both internal pudendal and uterine artery rupture in a …

Uterine Arteriovenous Malformations After Suction Evacuation Of Missed Miscarriage, Arshia Javed, Reeta Chander, Zahra Hoodbhoy

Department of Obstetrics & Gynaecology

Uterine arteriovenous malformation (AVM) is an uncommon but life-threating source of bleeding. AVM is an abnormal connection between uterine arteries and veins. Patients typically present with vaginal bleeding following miscarriage (medical/surgical) or cesarean section. The treatment of choice depends on the symptoms, age, desire of fertility, localization and size of the lesion. Uterine artery embolization is the first choice in symptomatic patients of reproductive age group. We report a case of AVM presenting after dilation and evacuation with extensive lesion, which was successfully treated with bilateral uterine artery embolization.

Resveratrol And Pterostilbene Exhibit Anticancer Properties Involving The Downregulation Of Hpv Oncoprotein E6 In Cervical Cancer Cells, Kaushiki Chatterjee, Dina Alsharif, Christina Mazza, Palwasha Syar, Mohamed Al Sharif, Jimmie E. Fata

Publications and Research

Cervical cancer is one of the most common cancers in women living in developing countries. Due to a lack of affordable effective therapy, research into alternative anticancer compounds with low toxicity such as dietary polyphenols has continued. Our aim is to determine whether two structurally similar plant polyphenols, resveratrol and pterostilbene, exhibit anticancer and anti-HPV (Human papillomavirus) activity against cervical cancer cells. To determine anticancer activity, extensive in vitro analyses were performed. Anti-HPV activity, through measuring E6 protein levels, subsequent downstream p53 effects, and caspase-3 activation, were studied to understand a possible mechanism of action. Both polyphenols are effective agents …