Obstetrics and Gynecology Commons^™

Towards A New Global Strategy For Women’S, Children’S And Adolescents’ Health, Marleen Temmerman, Rajat Khosla, Zulfiqar Ahmed Bhutta, Flavia Bustreo

Obstetrics and Gynaecology, East Africa

The year 2015 marks a defining moment for the health of women, children, and adolescents. It is the end point of the United Nations’ millennium development goals, and their transition to the sustainable development goals, and also the 20th anniversary of the International Conference on Population and Development’s plan of action and the Beijing Declaration and platform of action.

This is a moment of reflection as well as celebration. Although great strides have been made in reducing maternal and child mortality, showing that change is possible, many countries are lagging behind in reaching millennium development goal 4 (to reduce the …

Role Of The Hospitalist And Maternal Fetal Medicine Physician In Obstetrical Inpatient Care., Lisa D. Levine, Jay Schulkin, Brian M. Mercer, Daniel O'Keeffe, Vincenzo Berghella, Thomas J. Garite

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: The objective of this study was to evaluate the role of hospitalists and Maternal Fetal Medicine (MFM) subspecialists in obstetrical inpatient care.

STUDY DESIGN: This electronic survey study was offered to members of the American College of Obstetrics & Gynecology (ACOG; n = 1,039) and the Society for Maternal-Fetal Medicine (SMFM; n = 1,813).

RESULTS: Overall, 607 (21%) respondents completed the survey. Overall, 35% reported that hospitalists provided care in at least one of their hospitals. Compared with ACOG respondents, a higher frequency of SMFM respondents reported comfort with hospitalists providing care for all women on labor and delivery …

Evidence For Differential Viral Oncolytic Efficacy In An In Vitro Model Of Epithelial Ovarian Cancer Metastasis, Jessica G. Tong, Yudith Ramos Valdes, John W. Barrett, John C. Bell, David Stojdl, Grant Mcfadden, J. Andrea Mccart, Gabriel E. Dimattia, Trevor G. Shepherd

Obstetrics & Gynaecology Publications

Epithelial ovarian cancer is unique among most carcinomas in that metastasis occurs by direct dissemination of malignant cells traversing throughout the intraperitoneal fluid. Accordingly, we test new therapeutic strategies using an in vitro three-dimensional spheroid suspension culture model that mimics key steps of this metastatic process. In the present study, we sought to uncover the differential oncolytic efficacy among three different viruses—Myxoma virus, double-deleted vaccinia virus, and Maraba virus—using three ovarian cancer cell lines in our metastasis model system. Herein, we demonstrate that Maraba virus effectively infects, replicates, and kills epithelial ovarian cancer (EOC) cells in proliferating adherent cells and …

Pregnancy And Pertussis: Why The Change In Tdap Administration?, Marietta Sperry

Books, Presentations, Posters, Etc.

Background and new guidelines vs. old guidelines. Systematic review of obstacles, recommendations, and conclusions.

Family Planning Knowledge, Attitudes, And Practices Among Married Men And Women In Rural Areas Of Pakistan: Findings From A Qualitative Need Assessment Study, Ghulam Mustafa, Syed Khurram Azmat, Waqas Hameed, Safdar Ali, Muhammad Ishaque, Wajahat Hussain, Aftab Ahmed, Erik Munroe

Community Health Sciences

This paper presents the findings of a qualitative assessment aimed at exploring knowledge, attitudes, and practices regarding family planning and factors that influence the need for and use of modern contraceptives. A descriptive exploratory study was conducted with married women and men aged between 15 and 40. Overall, 24 focus group discussions were conducted with male and female participants in three provinces of Pakistan. The findings reveal that the majority knew about some modern contraceptive methods, but the overall contraceptive use was very low. Knowledge and use of any contraceptive method were particularly low. Reasons for not using family planning …

Simulated Diabetic Ketoacidosis Therapy In Vitro Elicits Brain Cell Swelling Via Sodium-Hydrogen Exchange And Anion Transport., Keeley L Rose, Andrew J Watson, Thomas A Drysdale, Gediminas Cepinskas, Melissa Chan, C Anthony Rupar, Douglas D Fraser

Obstetrics & Gynaecology Publications

A common complication of type 1 diabetes mellitus is diabetic ketoacidosis (DKA), a state of severe insulin deficiency. A potentially harmful consequence of DKA therapy in children is cerebral edema (DKA-CE); however, the mechanisms of therapy-induced DKA-CE are unknown. Our aims were to identify the DKA treatment factors and membrane mechanisms that might contribute specifically to brain cell swelling. To this end, DKA was induced in juvenile mice with the administration of the pancreatic toxins streptozocin and alloxan. Brain slices were prepared and exposed to DKA-like conditions in vitro. Cell volume changes were imaged in response to simulated DKA therapy. …

Two Novel Genetic Variants In The Mineralocorticoid Receptor Gene Associated With Spontaneous Preterm Birth, Inge Christiaens, Q. Wei Ang, Lindsay N. Gordon, Xin Fang, Scott Williams

Dartmouth Scholarship

Background: Preterm birth is the leading cause of mortality and morbidity in newborn infants. Its etiology is multifactorial with genes and environmental factors, including chronic maternal stress, contributing to its risk. Our objective was to investigate whether single nucleotide polymorphisms (SNPs) in genes involved in the stress response are associated with spontaneous preterm birth using a candidate gene approach.

Methods: A total of 210 cases (singleton spontaneous preterm birth at <37 >weeks) and 412 controls (singleton term birth at 38–42 weeks without a history of preterm birth) were studied. High quality maternal DNA was available from saliva samples of 190 cases …

Confident Difference Criterion: A New Bayesian Differentially Expressed Gene Selection Algorithm With Applications., Fang Yu, Ming-Hui Chen, Lynn Kuo, Heather Talbott, John S. Davis

Journal Articles: Obstetrics & Gynecology

BACKGROUND: Recently, the Bayesian method becomes more popular for analyzing high dimensional gene expression data as it allows us to borrow information across different genes and provides powerful estimators for evaluating gene expression levels. It is crucial to develop a simple but efficient gene selection algorithm for detecting differentially expressed (DE) genes based on the Bayesian estimators.

RESULTS: In this paper, by extending the two-criterion idea of Chen et al. (Chen M-H, Ibrahim JG, Chi Y-Y. A new class of mixture models for differential gene expression in DNA microarray data. J Stat Plan Inference. 2008;138:387-404), we propose two new gene …

A Qualitative Exploration Of The Emotional Wellbeing And Support Needs Of New Mothers From Afghanistan Living In Melbourne, Australia, Alana Russo, Belinda Lewis, Andrew Joyce, Belinda Crockett, Stanley Luchters

Population Health, East Africa

Background: The Afghan community is a priority population for many health and social services within the southeast region of Melbourne, which is home to the largest population of Afghanistan-born people within the state of Victoria. The majority of Afghan women arriving in Australia are of childbearing age, and evidence suggests that they are at increased risk of emotional challenges following birth as a result of the refugee and migration experience. This research aimed to explored the experiences of Afghan women living in Melbourne throughout pregnancy, birth, and early motherhood, and gain insight into the aspects of their experiences that they …

Sexual And Reproductive Health Research And Research Capacity Strengthening In Africa: Perspectives From The Region., Richard Adanu, Michael T. Mbizvo, Adama Baguiya, Vincent Adam, Beyene W. Ademe, Augustine Ankomah, Godwin N. Aja, Ademola J. Ajuwon, Olapeju A. Esimai, Taofeek Ibrahim, Dintle K. Mogobe, Özge Tunçalp, Venkatraman Chandra-Mouli, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Developing the capacity to effectively carry out public health research is an integral part of health systems at both the national and global levels and strengthening research capacity is recognized as an approach to better health and development in low- and middle-income countries (LMICs). Especially fields such as sexual and reproductive health (SRH) would require inter-disciplinary teams of researchers equipped with a range of methodologies to achieve this. In November 2013, as part of the International Family Planning Conference in Addis Ababa, Ethiopia, a group of African researchers came together to discuss the gaps and strategies to improve sexual and …

‘What About The Mother?’ Women׳S And Caregivers׳ Perspectives On Caesarean Birth In A Low-Resource Setting With Rising Caesarean Section Rates, Helena Litorp, Andrew Mgaya, Hussein Kidanto, Sara Johnsdotter, Birgitta Essén

Faculty of Health Sciences, East Africa

Objective in light of the rising caesarean section rates in many developing countries, we sought to explore women׳s and caregivers׳ experiences, perceptions, attitudes, and beliefs in relation to caesarean section.

Design qualitative study using semi-structured individual in-depth interviews, focus group discussions, and participant observations. The study relied on a framework of naturalistic inquiry and data were analysed using thematic analysis.

Setting a public university hospital in Dar es Salaam, Tanzania.

Participants we conducted a total of 29 individual interviews, 13 with women and 16 with caregivers, and two focus group discussions comprising five to six caregivers each. Women had undergone …

Pregnancy Apps: A Closer Look At The Implications For Childbirth Educators, Christine Frazer, Leslie Hussey, Emily Bosch, Michelle Squire

Walden Faculty and Staff Publications

Most pregnant women download an average of three pregnancy apps during their gestational period. There are no set standards in place for what needs to be included in an app’s description leaving consumers to decide for themselves when it comes to selecting the right app to download. The childbirth educator must be knowledgeable about pregnancy apps, in-tune as to what apps their clientele download, and how to analyze them for credibility. This article presents characteristics associated with women of childbearing age (i.e. Millennial/Net generation); the reasons why pregnant women are turning to apps; the limitations of apps, and the childbirth …

Child Marriage Legislation In The Asia-Pacific Region, Elisa Scolaro, Aleksandra Blagojevic, Brigitte Fillion, Venkatraman Chandra-Mouli, Lale Say, Joar Svanemyr, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Child marriage is a human rights violation that robs a girl of her childhood, puts her health, growth, and development at risk, disrupts her education, limits her opportunities for empowerment and social development, and increases her risk of exposure to violence and abuse (for a review of the evidence on the negative effects of child marriage on girls and their children, see Parsons et al. 2015, in this issue). While child marriage is not mentioned specifically in the 1989 Convention on the Rights of the Child (CRC), the Convention does contain a provision requiring governments to abolish “traditional practices prejudicial …

Effect Of Pelvic Floor Muscle Training Among Pregnant Black African Population On The Risk Of Postpartum Urinary Incontinence, A Single Blind Randomized Control Trial, Samuel Ngugi

Master of Medicine in Obstetrics and Gynecology

Trial registration: The study was registered at the Pan African Clinical Trial Registry and a unique identification number issued PACTR201407000850309. Background: Pelvic Floor Muscle Training (PFMT) in the antenatal period has been found to be an effective primary prevention intervention in the Caucasian population in reducing the risk of postpartum Urinary incontinence. Objective: This study was primarily designed to determine the effect of PFMT introduced in the second trimester amongst pregnant black African population on the risk of six weeks postpartum Urinary Incontinence. Secondary objectives included investigating the risk of postpartum Urinary Incontinence, the effect of mode of delivery on …

‘What About The Mother?’ Women׳S And Caregivers׳ Perspectives On Caesarean Birth In A Low-Resource Setting With Rising Caesarean Section Rates, Helena Litorp, Andrew Mgaya, Hussein Kidanto, Sara Johnsdotter, Birgitta Essén

Obstetrics and Gynaecology, East Africa

Objective: in light of the rising caesarean section rates in many developing countries, we sought to explore women׳s and caregivers׳ experiences, perceptions, attitudes, and beliefs in relation to caesarean section.

Design: qualitative study using semi-structured individual in-depth interviews, focus group discussions, and participant observations. The study relied on a framework of naturalistic inquiry and data were analysed using thematic analysis.

Setting: a public university hospital in Dar es Salaam, Tanzania.

Participants: we conducted a total of 29 individual interviews, 13 with women and 16 with caregivers, and two focus group discussions comprising five to six caregivers each. Women had undergone …

Quality Of Care For Pregnant Women And Newborns—The Who Vision, Ӧ. Tuncalp, W. M. Were, C. Maclennan, O. T. Oladapo, A. M. Gulmezoglu, R. Bahl, B. Daelmans, M. Mathai, L. Say, F. Kristensen, Marleen Temmerman, F. Bustreo

Obstetrics and Gynaecology, East Africa

In 2015, as we review progress towards Millennium Development Goals (MDGs), despite significant progress in reduction of mortality, we still have unacceptably high numbers of maternal and newborn deaths globally. Efforts over the past decade to reduce adverse outcomes for pregnant women and newborns have been directed at increasing skilled birth attendance.1,2 This has resulted in higher rates of births in health facilities in all regions.3 The proportion of deliveries reportedly attended by skilled health personnel in developing countries rose from 56% in 1990 to 68% in 2012.4 With increasing utilisation of health services, a higher proportion of avoidable maternal …

Obstetrician-Gynecologists’ Knowledge Of Health Disparities And Barriers Among American Indian/Alaska Native Women In Washington State, Katherine M. Jones, Greta B. Raglan, Sophia M. Lannon, Jay Schulkin

Journal of Health Disparities Research and Practice

Background: Health disparities between American Indian/Alaska Native (AI/AN) women and other races/ethnicities have long been noted. Obstetricians-Gynecologists (Ob-Gyn) play a significant role in well-woman care and are often the first and most frequent point of medical contact for women, particularly among minority and low-income women.

Objective: This study aimed to assess Ob-Gyns’ knowledge, beliefs, and practices related to health disparities among AI/AN women.

Method: A self-administered questionnaire, consisting of questions about knowledge, beliefs, and practices of health disparities among AI/AN women, was mailed to 722 members of The American College of Obstetricians and Gynecologists (ACOG) practicing in the state of …

Do I Buy It? How Aidettm Training Changes Residents’ Values About Communication Skills In Doctor-Patient Interactions, Andrea Braverman, Phd, Austin Katona, B.Sc., Elisabeth Kunkel, Md, Leo Katz, Md, Matthew Keller, Md, Constantine Daskalakis, Sc.D, Jennifer Jasmine Arfaa, Phd, Mhsa

Department of Obstetrics and Gynecology Presentations and Grand Rounds

OBJECTIVES

Acquiring communication and interpersonal skills is an important part of providing patient-centered care and improving patient satisfaction. This study explores whether residents’ own values about patient communication change over time.

Accelerating The Dual Elimination Of Mother-To-Child Transmission Of Syphilis And Hiv: Why Now?, James Kiarie, Chandra K. Mishra, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Even though the elimination of congenital syphilis has been on the maternal and child health (MCH) agenda for over a decade, elimination has not yet been achieved; what, then, are the factors currently facilitating the elimination of mother-to-child transmission (MTCT) of syphilis?

Which Role Do Midwives And Gynecologists Have In Smoking Cessation In Pregnant Women?–A Study In Flanders, Belgium, Katrien De Wilde, Inge Tency, Sarah Steckel, Marleen Temmerman, Hedwig Boudrez, Lea Maes

Obstetrics and Gynaecology, East Africa

Objectives: The objectives of our study were (1) to explore knowledge, beliefs and practice among mid-wives and gynecologists concerning a smoking cessation policy for pregnant women and their partners and (2) to examine if midwives and gynecologists do have a role in smoking cessation in pregnant women.

Method: We performed a qualitative study using semi-structured interviews with nine midwives and eight gynecologists. Data were analyzed using deductive content analysis, based on the 5 A’s frame-work (Ask–Advise–Assess–Assist–Arrange).

Results: The national smoking cessation policy seemed to be insufficiently known. “Ask” and “Advise" were part of a standard prenatal consultation, the next three …

Comparing Neonatal Respiratory Morbidity In Neonates Delivered At Term By Elective Caesarean Section With And Without Dexamethasone: Retrospective Cohort Study, Anita Dileep, Neelofur Babar Khan, Sana Sadiq Sheikh

Department of Obstetrics & Gynaecology

Objective: To assess the effect of dexamethasone on neonatal respiratory morbidity in babies delivered by early term elective lower segment Caesarean section. Method: The retrospective cohort study was conducted at a secondary level hospital in Karachi. It reviewed the medical record of pregnant women and their babies who were delivered by elective lower segment Caesarean section between January 1 and June 30, 2013, at 37-38+6 weeks of pregnancy. The women were divided into exposed group (Group A) who received prophylactic dexamethasone, and non-exposed group (Group B) who did not receive dexamethasone Neonatal respiratory morbidity was compared between the two groups. …

Impact Of Self Regulation Skills On Students Academic Grades, Abeer Kathawala, Shelina Bhamani

Department of Obstetrics & Gynaecology

This research aimed to explore if self-regulation skills had any effect on the academic outcomes of young children in private schools of Karachi, Pakistan. Quantitative research method was used to determine the impact of self-regulation upon the academic outcome of young children by utilizing Early School Self-Regulation Scale-Care Giver Version (Bhamani, 2012).The sample size consisted of randomly chosen 210 children, studying in grades 1 and 2 from seven different private schools in Karachi. The results of the research show that selfregulation skills had a significant impact on the academic outcome of young children in private schools of Karachi, b = …

Assessing Predictors Of Contraceptive Use And Demand For Family Planning Services In Underserved Areas Of Punjab Province In Pakistan: Results Of A Cross-Sectional Baseline Survey, Syed Khurram Azmat, Moazzam Ali, Muhammad Ishaque, Ghulam Mustafa, Waqas Hameed, Omar Farooq Khan, Ghazunfer Abbas, Marleen Temmerman, Erik Munroe

Community Health Sciences

Background: Although Pakistan was one of the first countries in Asia to launch national family planning programs, current modern contraceptive use stands at only 26% with a method mix skewed toward short-acting and permanent methods. As part of a multiyear operational research study, a baseline survey was conducted to understand the predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan. This paper presents the baseline survey results; the outcomes of the intervention will be presented in a separate paper after the study has been completed.
Method: A cross-sectional baseline household survey …

The Effect Of An Educational Intervention On Knowledge And Intent To Participate In Cervical Cancer Screening, Ann Marie Trapp

Evidence-Based Practice Project Reports

Globally, cervical cancer ranks third among cancers affecting women (Arbyn et al., 2013). In the United States, approximately 12,000 women are diagnosed with cervical cancer and approximately 4,000 women die yearly (Centers for Disease Control and Prevention, 2014). Papanicolaou (Pap) screening is an effective means of detecting precancerous cell changes of the cervix with early cervical cancer diagnosis carrying a 91% five-year survival rate (Gonzalez et al., 2012). The purpose of this evidence-based practice project was to identify interventions that increase adherence to cervical cancer screening and to implement best practices to reduce unnecessary deaths related to late diagnoses of …

Urinary Phthalate Metabolite Concentrations And Blood Glucose Levels During Pregnancy, Candace A. Robledo, Jennifer D. Peck, Julie A. Stoner, Antonia M. Calafat, Hélène Carabin, Linda Cowan, Jean R. Goodman

School of Medicine Publications

Purpose: To examine associations between phthalate metabolite urinary concentrations during early pregnancy and blood glucose levels obtained at the time of screening for gestational diabetes mellitus (GDM).

Methods: Upon initiation of prenatal care, women with a mean gestational age of 12.8 weeks were recruited for a study of environmental chemical exposures (n = 110) and provided a spot urinary specimen. Blood glucose concentrations (mg/dl) were obtained from the electronic medical record for those patients who did not experience a pregnancy loss and did not transfer care to another facility prior to glucose screening (n = 72). Urinary concentrations of nine …

Obstetric Transition In The World Health Organization Multicountry Survey On Maternal And Newborn Health: Exploring Pathways For Maternal Mortality Reduction., Solange Da Cruz Chaves, José Guilherme Cecatti, Guillermo Carroli, Pisake Lumbiganon, Carol J. Hogue, Rintaro Mori, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objective: To test whether the proposed features of the Obstetric Transition Model-a theoretical framework that may explain gradual changes that countries experience as they eliminate avoidable maternal mortality-are observed in a large, multicountry, maternal and perinatal health database; and to discuss the dynamic process of maternal mortality reduction using this model as a theoretical framework.

Methods: This was a secondary analysis of a cross-sectional study by the World Health Organization that collected information on more than 300 000 women who delivered in 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East, during a 2-4-month …

Analysis Of Embryo Scoring And Comparison Of Clinic Performance In In-Vitro Fertilization, James W. Whistler

Master's Theses

Clinical Assisted Reproductive Technology (ART) practices seek to make improvements in embryo quality and resultant procedural success rates. There is a significant variance in live birth rates among clinics nationwide. The goal of this thesis is make comparisons of embryo quality among clinics and understand these differences. This analysis focuses on the stage between egg retrieval and embryo transfer. Because the currently accepted embryo scoring methods are not directly proportional to performance, a new scoring methodology is proposed and applied. Data provided by the Society for Assisted Reproductive Technology (SART) consisting of 36,836 patient cycles from 40 anonymous clinics nationwide …

Patient Centered Infertility Care: The Health Care Provider’S Perspective, Alana Streisfield, Nurun Chowdhury, Rebecca Cherniak, Heather Shapiro

Patient Experience Journal

This study describes what health care providers (HCPs) of fertility services perceive their patients to value most, as well as HCPs’ self-evaluation in provision of patient centered infertility care (PCIC). The Patient Centeredness Questionnaire Infertility (PCQ-I) was administered to all clinic staff and completed by approximately 60%. Mean scores and standard deviations were calculated for each dimension as well as for the global score. HCPs ranked staff communication as the highest of the dimensions and accessibility of care as the lowest, respectively indicating areas of strength and weakness. Degree of variance within scoring was used as a marker of consistency …

Routine Surveillance Of Patients With Hypertensive Disorders In Pregnancy, Johanna Quist-Nelson, Md, Lauren Cooper, Md, Abigail Wolf, Md

Department of Obstetrics and Gynecology Presentations and Grand Rounds

BACKGROUND

• Hypertensive disorders in pregnancy carry morbidity and mortality for mothers and infants
• Hypertensive disorders include a full spectrum from gestational hypertension and preeclampsia to eclampsia.
• In 2013 the American College of Obstetricians and Gynecologists released an executive summary with new task force recommendations for closer monitoring of patients with hypertensive disorders including:

Twice weekly blood pressure monitoring

Weekly office visits

Ultrasound surveillance of fetal growth

Weekly laboratory surveillance

Delivery at 37 weeks for patients with gestational hypertension and preeclampsia without severe features

Urine Proteomics Identifies Preeclampsia Subphenotypes, Michelle R. Axe

Undergraduate Honors Thesis Projects

Preeclampsia is a perinatal complication of unknown etiology, resulting in 76,000 maternal deaths and 500,000 infant deaths annually₁. The Nationwide Children’s Center for Perinatal Research was the first cohort to propose that preeclampsia is rooted in protein misfolding. We aimed to characterize the misfolded protein components of maternal urine samples and to determine if distinct molecular profiles exist for clinical preeclampsia phenotypes. A total of 86 maternal urine samples from Yale-New Haven Hospital were analyzed for this study, from six clinical preeclampsia subphenotypes- pregnant control (n=10), idiopathic proteinuria (n=15), mild preeclampsia (n=14), superimposed preeclampsia (n=12), typical severe preeclampsia …