Obstetrics and Gynecology Commons^™

Reassessing The Duration Of The Second Stage Of Labor In Relation To Maternal And Neonatal Morbidity., Katherine L. Grantz, Rajeshwari Sundaram, Ling Ma, Stefanie Hinkle, Vincenzo Berghella, Matthew K. Hoffman, Uma M. Reddy

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: To assess the morbidity associated with continuing the second-stage duration of labor, weighing the probability of spontaneous vaginal birth without morbidity compared with birth with serious maternal or neonatal complications.

METHODS: In a retrospective cohort, we analyzed singleton, vertex births at 36 weeks of gestation or greater without prior cesarean delivery (n=43,810 nulliparous and 59,605 multiparous women). We calculated rates of spontaneous vaginal birth and composite serious maternal or neonatal complications. Results were stratified by parity (nulliparous or multiparous) and epidural status (yes or no). Competing risks models were created for 1) spontaneous vaginal birth with no morbidity, 2) …

Pregnancy Outcomes Among Women With An Unintended Pregnancy: Findings From A Prospective Registry In Rural Pakistan, Sumera Aziz Ali, Shiyam Sunder Tikmani, Margo S. Harrison, Sarah Saleem, Robert L. Goldenberg, Elizabeth M. Mcclure, Omrana Pasha

Community Health Sciences

Background: Unintended pregnancies are an important public health issue in both developed and developing countries. An unintended pregnancy may affect maternal health seeking behavior during the antenatal and postpartum periods, which can adversely affect perinatal outcomes. Aim: The specific aim of our study was to measure antepartum, intrapartum, and postpartum pregnancy outcomes among women with unintended pregnancies in a rural Pakistani population.
Methods: Using a prospective maternal and newborn health registry in Thatta Pakistan, we evaluated temporal associations between unintended pregnancy and several dimensions of health seeking behavior including: antenatal care, preference for private versus government facility for antenatal care, …

Complications Of Subcutaneous Contraception: A Review., Rebecca C Ramdhan, Emily Simonds, Charlotte Wilson, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Over 62 million women in the United States are of childbearing age and 60% of them use contraception. Subcutaneous contraceptives include implantable contraceptives and subcutaneous injections. Implantable contraception involves subdermal time-release of synthetic progestin, which allows for several years of continuous, highly effective contraception. Its main effects are inhibition of ovulation and thickening of the cervical mucus. Many complications have been associated with subcutaneous contraception, including menstrual disturbances, headache, weight gain, acne, dizziness, mood disturbances, nausea, lower abdominal pain, hair loss, loss of libido, pain at the implant site, neuropathy, and follicular cysts. Using standard search engines, the complications of …

Z-Can: Prevention Of Unintended Pregnancy In An Emergency Setting, Marleen Temmerman, Cora Nally

Obstetrics and Gynaecology, East Africa

Prevention of unintended pregnancy is a primary strategy to reduce adverse pregnancy and birth outcomes related to Zika virus infection. Infection during pregnancy, either through a mosquito bite or sex with an infected partner, increases the risk of the child developing congenital microcephaly and other fetal brain abnormalities, resulting in the birth of a child with severe disabilities that will necessitate lifelong care.1,2

Pattern And Determinants Of Contraceptive Usage Among Women Of Reproductive Age From The Digo Community Residing In Kwale, Kenya: Results From A Cross-Sectional Household Survey, Vernon Mochache, Amyn Lakhani, Hajara El-Busaidy, Marleen Temmerman, Peter Gichangi

Family Medicine, East Africa

Background: Contraceptive usage has been associated with improved maternal and child health (MCH) outcomes. Despite significant resources being allocated to programs, there has been sub-optimal uptake of contraception, especially in the developing world. It is important therefore, to granulate factors that determine uptake and utilization of contraceptive services so as to inform effective programming.

Methods: Between March and December 2015, we conducted a cross-sectional survey among women of reproductive age (WRA) from the Digo community residing in Kwale County, Kenya. The study aimed to describe the pattern and determinants of contraceptive usage in this population. Respondents were selected using stratified, …

Factors Associated With Low Birthweight In Term Pregnancies: A Matched Case–Control Study From Rural Pakistan, Atif Habib, Camille R. Greenow, Shabina Arif, Sajid Bashir Soofi, Abid Hussain, Qamar Junejo, A Hussain, Fariha Shaheen, Kirsten I. Black

Department of Obstetrics & Gynaecology

Low birthweight (LBW) remains a significant public health problem in Pakistan and further understanding of factors associated with LBW is required. We conducted a hospital-based matched case control study to identify risk factors associated with LBW in a rural district of Pakistan. We found that illiteracy (AOR: 2.68; 95% CI: 1.59 - 4.38), nulliparity (AOR: 1.82; 95% CI: 1.26-2.44), having a previous miscarriage/abortion (AOR: 1.22; 95% CI: 1.06-2.35), having < 2 antenatal care (ANC) visits during last pregnancy (AOR: 2.43; 95% CI: 1.34-2.88), seeking ANC in third trimester (AOR: 3.62; 95% CI : 2.14-5.03), non-use of iron folic acid during last pregnancy (AOR: 2.72; 95% CI: 1.75-3.17), having hypertension during last pregnancy (AOR: 1.42; 95% CI: 1.13-2.20), being anemic (AOR: 2.67; 95% CI: 1.65-5.24) and having postpartum weight of <45 kg (AOR: 3.30; 95% CI : 1.97-4.52) were significantly associated with an increased odds of having a LBW baby. Our study identifies modifiable risk factors requiring immediate commitment from the health authorities.

Contraceptive Utilization Among New Exotic Dancers: A Cross-Sectional Study, Mishka Terplan, Caitlin E. Martin, Jennifer Nail, Susan G. Sherman

Obstetrics and Gynecology Publications

Background
Female exotic dancers are a population at high risk of unintended pregnancy. The objective of this study is to describe the reproductive health needs and contraceptive utilization of exotic dancers.

Methods
New exotic dancers (< 6 months dancing) from 26 clubs in Baltimore City/County completed a one-time survey.

Results
Of 117 participants, 96 (82%) had current contraceptive need. The mean age was 24 years, and 55% were black. Sex work (45%), alcohol use disorder (73%), illicit (44%; e.g., heroin, crack, cocaine), and injection drug use (8%) were common. The majority (66%) reported contraception use in the prior 6 months. Condoms were reported by 46% whereas 45% reported non-barrier methods, most commonly hormonal …

Extremely Preterm (23 Weeks) Vaginal Cephalic Delivery En Caul And Subsequent Postpartum Intraventricular Hemorrhage And Respiratory Distress: A Teaching Case., R. Malik, A. Sarfraz, R. Faroqui, W. Onyebeke, J. Wanerman

Journal Articles

En caul deliveries are defined as a fetus that is delivered completely contained within an amniotic sac and are considered to be less common than 1 in 80,000 live births. Vaginal en caul births compared to abdominal or cesarean are the rarest subtype. Most en caul births are associated with prematurity and low gravida. The combination of prematurity, high gravida, vaginal en caul birth, and severe postpartum complications has not previously been described. We report a woman with gravida of 12 delivering vaginally a neonate female en caul at the extremely preterm gestational age of 23 weeks. The neonate subsequently …

Management Of Bilateral Ectopic Pregnancies After Ovulation Induction Using Unilateral Salpingectomy And Methotrexate For The Remaining Ectopic With Subsequent Intrauterine Pregnancy, Quinton Katler, Lindsay Pflugner, Anjali Martinez

Obstetrics and Gynecology Faculty Publications

Bilateral ectopic pregnancy is a rare phenomenon which is found with increased frequency when using assisted reproductive technology (ART). This diagnosis is most often made incidentally and intraoperatively, as ultrasound and serial β-hCG trends have shown poor efficacy for accurate diagnosis. Management of bilateral ectopic pregnancies is most commonly reported using bilateral surgical removal of the ectopic pregnancy (salpingostomy and/or salpingectomy). We present a case of an ART patient with incidentally found bilateral tubal ectopic pregnancies, where multiple management strategies including medical and surgical techniques were used concurrently which resulted in a subsequent spontaneous intrauterine pregnancy. While the standard …

Twelve-Month Efficacy And Safety Data For The "Stress Incontinence Control, Efficacy And Safety Study": A Phase Iii, Multicenter, Prospective, Randomized, Controlled Study Treating Female Stress Urinary Incontinence Using The Vesair Intravesical Balloon, H. Winkler, K. Jacoby, S. Kalota, J. Snyder, K. Cline, K. Robertson, R. Kahan, L. Green, K. Mccammon, C. Rardin, +1 Author

Journal Articles

© 2018 Wolters Kluwer Health, Inc. Objectives The "Stress Incontinence Control, Efficacy and Safety Study" (SUCCESS) is a phase III study of the Vesair Balloon in women with stress urinary incontinence who had failed conservative therapy, and either failed surgery, were not candidates for surgery, or chose not to have surgery. The safety and efficacy of the balloon at 12 months is reported for those participants in the treatment arm who elected to continue with the SUCCESS trial beyond the primary end point at 3 months. Methods The SUCCESS trial is a multicenter, prospective, single-blinded, randomized, sham-controlled study. Participants were …

Two Successful Pregnancies Following Fertility Preservation In A Patient With Anaplastic Astrocytoma: A Case Report, A. Peyser, S. L. Bristow, A. Hershlag

Journal Articles

No abstract provided.

Severe Maternal Morbidity Associated With Systemic Lupus Erythematosus Flare In The Second Trimester Of Pregnancy., M. J. Blitz, A. Fleischer

Journal Articles

Pregnancy in women with systemic lupus erythematosus (SLE) is associated with an increased risk of adverse maternal and fetal outcomes. Here, we present a case of severe maternal morbidity in a 23-year-old primigravida with SLE and secondary Sjögren's syndrome who experienced a life-threatening multisystem flare at 17 weeks of gestational age. She presented to the emergency department complaining of cough with hemoptysis and shortness of breath. She developed hypoxic respiratory failure and was admitted to the intensive care unit. Bronchoscopy confirmed diffuse alveolar hemorrhage. Physical exam and laboratory evaluation were consistent with an active SLE flare, pancytopenia, and new-onset lupus …

Bacterial Spinal Epidural And Psoas Abscess In Pregnancy Associated With Intravenous Drug Use., T. N. Spiegel Strauss, S. L. Pachtman, B. Rochelson

Journal Articles

Spontaneous spinal epidural abscess (SEA) is a rare infection of the central nervous system. We report a case of a 25-year-old G3 P0020 at 36 weeks of gestational age with history of intravenous drug abuse presenting with acute-onset and severe back pain. Despite antibiotic therapy, pain worsened and she developed lower extremity weakness. Magnetic resonance imaging (MRI) revealed an SEA, and cesarean delivery was performed secondary to increasing weakness, followed by laminectomy (T9-12) and decompression of epidural abscess. Postoperative course was complicated by a psoas muscle abscess and persistent SEA refractory to antibiotic therapy, requiring surgical reexploration and extended treatment …

Compassionate Coverage: A Patient Access Linen System, J. M. Rabin, K. C. Farner, A. H. Brody, A. Peyser, M. Kline

Journal Articles

No abstract provided.

Pregnancy-Associated Spontaneous Pneumomediastinum: A Contemporary Review, Sonu Sahni, Narcisse Amine

Touro College of Osteopathic Medicine (New York) Publications and Research

Spontaneous pneumomediastinum (SPM), also referred to as mediastinal emphysema, is defined as the presence of free air in the mediastinal cavity without a clear and identifiable cause. Spontaneous pneumomediastinum, in general, is a relatively rare condition, more so in the setting of pregnancy or labor. Clinically, SPM may present as dyspnea, chest pain, and subcutaneous swelling, which may be of serious concern in the setting of pregnancy. A comprehensive literature review revealed that the majority of patients are primiparas, of a younger age, and have term or longer durations of pregnancy. The second stage of labor was found to be …

Robotic-Assisted Sacrocolpopexy With Versus Without Concomitant Midurethral Sling: A 2-Year Follow-Up Of Urinary Symptoms And Quality Of Life, J. S. Schachar, K. S. Williams, H. A. Winkler

Journal Articles

© 2018 Journal of Mid-life Health | Published by Wolters Kluwer - Medknow. Objective: The objective of this study was to assess long-term postoperative urinary incontinence (UI) symptoms and quality of life (QOL) in patients after robotic-assisted sacrocolpopexy (RASC) with or without concomitant midurethral sling (MUS). Materials and Methods: This is a cross-sectional survey of patients comparing long-term postoperative urinary symptoms and QOL measurements in women who underwent RASC with or without MUS. We included all patients from 2011 to 2014 who had RASC with or without MUS. All patients had preoperative urodynamic testing (UDS). Patients who demonstrated stress UI …

Insulin-Like Growth Factor 2: A Poor Prognostic Biomarker Linked To Racial Disparity In Women With Uterine Carcinosarcoma, A. R. Van Arsdale, R. C. Arend, M. J. Cossio, B. K. Erickson, Y. Wang, D. W. Doo, C. A. Leath, G. L. Goldberg, G. S. Huang

Journal Articles

© 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. The objective of this study was to investigate the relationship of insulin-like growth factor 2 (IGF2) expression and survival in women with uterine carcinosarcoma (UCS). Insulin-like growth factor 2 protein expression was determined by immunohistochemical staining of tumor tissues from 103 patients with UCS. The H-score (product of staining intensity and percentage positive cells) was quantified for the epithelial cytoplasmic (EC), epithelial nuclear (EN), and malignant stromal compartments. Multivariable Cox proportional hazard regression models were used to examine the relationship of IGF2 levels with progression-free survival (PFS) …

Future Implications Of Using Registered Dietitians In Multidisciplinary Polycystic Ovary Syndrome Treatment, Wendy M. Wolf, Rachel A. Wattick, Pamela J. Murray, Melanie Clemmer, Melissa D. Olfert

Faculty & Staff Scholarship

Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder in females with insulin resistance playing a key role in pathogenesis. The objective of this study was to investigate current trends and future implications of multidisciplinary PCOS clinics with inclusion of dietitians. A two-phase, formative investigation on practitioners was conducted through an anonymous survey followed by focus groups. Survey respondents included 261 health care providers from around the world; the majority (59%) representing multidisciplinary teams. Focus group participants included four dietitians, three physicians, a health psychologist and a licensed nutritionist. Primary barriers for future multidisciplinary clinics included: money/resources, insurance …

Among Patients With Endometriosis, Does The Use Of Serum Biomarkers, Versus Laparoscopic Surgery For Diagnosis And Staging Of The Disease Decrease The Incidence Of Disease Related Negative Outcomes, Ellyn C. Hexum

Theses and Graduate Projects

Objective: To determine the ability and efficacy of non-invasive serum biomarker testing as a replacement for laparoscopic surgery in the diagnosis and staging of endometriosis to decrease the incidence of negative disease outcomes, leading to improvement in the accuracy of diagnoses and patient tailored treatment protocols.

Background: Endometriosis is a debilitating inflammatory disease of the reproductive tract. Currently, the gold standard for the diagnosis and staging of endometriosis is exploratory laparoscopic surgery. The use of surgery as the source of achieving a definitive diagnosis holds the potential to increase the incidence of negative disease outcomes. Because of this, the use …

Adherence Mechanism Analysis: The Role Of Prsa Gene In Lactobacillus Acidophilus And Other Infectious Microorganisms, Nujuma Moussa

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

No abstract provided.

The Effects Of Hormone Replacement Therapy (Hrt) On Surgically Postmenopausal Women: A Review Of The Literature, Leslie M. Hertweck

Honors Undergraduate Theses

The primary purpose of this research was to examine the effects of HRT in women with acute estrogen deficiency from surgically induced menopause. The secondary purpose was to evaluate how HRT improves symptoms of acute estrogen deficiency and quality of life (QOL) in women using hormone supplementation. Peer reviewed articles published from 2000 to 2017 that were written in the English language with a focus on the use of HRT in women with acute estrogen deficiency after surgical menopause were evaluated for relevance. Evidence suggests the primary reason for decreased use of HRT is the associated risks outweighing the benefits; …

Midtrimester Transvaginal Ultrasound Cervical Length In Diamniotic Twin Pregnancies According To Chorionicity, Amanda Roman, Gabriele Saccone, Carolynn M. Dude, Danielle A. Peress, Giuseppe Maria Maruotti, Andrew Ward, Hannah Anastasio, Lorraine Dugoff, Pasquale Martinelli, Vincenzo Berghella

Department of Obstetrics and Gynecology Posters

Objective

To compare the mean and additional midtrimester TVCL screening cut offs in monochorionic diamniotic (MC/DA) twins and dichorionic diamniotic (DC/DA) twins and to assess the relationship between the TVCL values and spontaneous preterm birth (SPTB).

Twin Pregnancies And Incidence Of Spontaneous Preterm Delivery Stratified By Chorionicity, Amanda Roman, Gabriele Saccone, Yury Cruz, Giuseppe Maruotti, Mohamed Satti, Pasquale Martinelli, Vincenzo Berghella

Department of Obstetrics and Gynecology Posters

Objective: To identify the incidence of spontaneous preterm birth (SPTB) and indications for delivery in women with twin pregnancy stratified by chorionicity (monochorionic diamniotic and dichorionic diamniotic pregnancy).

Study Design: Multicenter retrospective cohort of all consecutive twin gestations from 2010 to 2017. They were stratified by chorionicity monochorionic diamniotic and dichorionic diamniotic pregnancy: Primary outcome was SPTB < 37 weeks. Secondary outcome was SPTB at <34, 32, and <28 weeks, gestational age at delivery and indications for delivery: maternal and fetal. Analysis: t-test, Fisher’s exact test and multivariable logistic regression.

Results: 510 women with twin pregnancies were identified. 158 (30.9%) were monochorionic diamniotic pregnancies, and 352 (69.0%) were dichorionic pregnancies. The gestational age at delivery was significantly shorter in the monochorionic compared to the dichorionic group of about 2 weeks (MD -2.20 weeks, …

Impact Of New “Triple I” Classification On The Incidence Of Clinical Chorioamnionitis And Antibiotic Use In Neonates, Amanda Roman, Yury Cruz, Amy J. Sloane, David Carola, Dorothy Mcelewee, Vincenzo Berghella, Zubair H. Aghai

Department of Obstetrics and Gynecology Posters

Objective

To evaluate the impact of the new classification “Triple I” on the incidence of chorioamnionitis during labor, need of antibiotics and diagnosis of neonatal sepsis.

Maternal Activity Level In Patients With Preterm Premature Rupture Of Membranes: A Prospective Observational Cohort Study, Amanda Roman, Nathan Watters, Denise Moses, Jenny Reisner, Andrea French, Alexis Gimovsky, Caroline Pessel, Burton Rochelson, Neil Seligman, Vincenzo Berghella

Department of Obstetrics and Gynecology Posters

Objective: To evaluate the level of maternal physical activity effect on the perinatal outcomes of women with preterm premature rupture of membranes (PPROM)

Study Design: This is a pilot, prospective, observational multicenter cohort study. We approached patients admitted between 23 0/7 weeks to 32 0/7 weeks gestation with confirmed PPROM between January of 2014 and June of 2017 All patients received corticosteroids and latency antibiotics. Enrollment was done on third day of admission. Delivery occurred at 34 weeks per protocol via induction of labor or cesarean section as obstetrically indicated; or sooner if chorioamnionitis was diagnosed or spontaneous preterm labor …

Predictors Of Preterm Birth After Physical Exam Indicated Cerclage In Singleton Pregnancies, Amanda Roman, Gabriele Saccone, Sarah Pachtman, Yury Cruz, Burt Rochelson, Adiel Fleischer, Pasquale Martinelli, Vincenzo Berghella

Department of Obstetrics and Gynecology Posters

Objective

To evaluate the predictors of preterm birth <32 weeks in women that underwent physical exam indicated cerclage (PEIC) in singleton pregnancy.

Targeted Treatment Of Advanced Ovarian Cancer: Spotlight On Rucaparib., Diana C Pearre, Krishnansu S Tewari

Articles, Abstracts, and Reports

The last 2 years have ushered in a new era in ovarian cancer therapy with the US Food and Drug Administration's (FDA) approval of poly-ADP ribose polymerase (PARP) inhibitors (PARPi). One of the deadliest cancers that women experience, ovarian cancer, is most often diagnosed in advanced stages. Although cytoreductive surgery and (platinum/taxane-based) chemotherapy can place the majority of patients into remission, most will experience a relapse of their disease in their lifetime. This has led to studies exploring the benefits and efficacy of maintenance treatment. This review will briefly discuss the history of maintenance therapy as well as focus on …

Root-Cause Analysis Of Persistently High Maternal Mortality In A Rural District Of Indonesia: Role Of Clinical Care Quality And Health Services Organizational Factors, Mohammad Afzal Mahmood, Ismi Mufidah, Steven Scroggs, Amna Rehana Siddiqui, Hafsa Raheel, Koentijo Wibdarminto, Bernardus Dirgantoro, Jorien Vercruyssen, Hayfaa A. Wahabi

Community Health Sciences

Background: Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants.
Method: Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records' review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays.
Findings: The root causes were found in poor quality of care, which caused …

Association Between Obesity, Surgical Route, And Perioperative Outcomes In Patients With Uterine Cancer, Entidhar Al Sawah, Jason L. Salemi, Mitchel Hoffman, Anthony N. Imudia, Emad Mikhail

Obstetrics & Gynecology Faculty Publications

Objective. To study temporal trends of hysterectomy routes performed for uterine cancer and their associations with body mass index (BMI) and perioperative morbidity. Methods. A retrospective review of the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) 2005-2013 databases was conducted. All patients who were 18 years old and older with a diagnosis of uterine cancer and underwent hysterectomy were identified using ICD-9-CM and CPT codes. Surgical route was classified into four groups: total abdominal hysterectomy (TAH), total vaginal hysterectomy (TVH), laparoscopic assisted vaginal hysterectomy (LAVH), and total laparoscopic hysterectomy (TLH) including both conventional and robotically assisted. …

Adnexal Torsion In A Patient With Müllerian Agenesis Undergoing Ovarian Stimulation: A Case Report, Erika P. New, Adrianne R. Mallen, Abigail C. Mancuso, Bradley J. Van Voorhis

Obstetrics & Gynecology Faculty Publications

Background: As assisted reproductive technologies become increasingly available to patients, more women with Müllerian agenesis may undergo ovarian stimulation and oocyte retrieval to have genetically-related offspring. The risk of ovarian torsion is increased in patients utilizing assisted reproductive technologies compared to patients who do not undergo these treatments.

Case: A 25-year-old G0 with Mayer-Rokitansky-Kuster-Hauser syndrome presented to the emergency room two days after oocyte retrieval with an acute abdomen. During laparoscopy, she was found to have torsion of her left ovary.

Summary and Conclusion: As more young women with Müllerian agenesis present for fertility treatment, this anatomically unique patient cohort …