Women's Health Commons^™

Fetal Body Composition And Organ Growth In Pregnancies Complicated By First-Trimester Vaginal Bleeding Status: Nichd Fetal 3d Study, Alexandra Jean-Louis, Jessica L Gleason, Zhen Chen, Kathryn A Wagner, Dian He, Roger Newman, William A Grobman, Robert Gore-Langton, Seth Sherman, Magdalena Sanz Cortes, Edward K Chien, Luis F Goncalves, Jagteshwar Grewal, Katherine L Grantz

Faculty, Staff and Students Publications

Objective

This study aimed to explore associations between self-reported first-trimester vaginal bleeding status and fetal body composition and organ volumes measured by three-dimensional (3D) ultrasound across pregnancy.

Study Design

The NICHD Fetal 3D Study (2015–2019) included individuals with singleton pregnancies at low risk for fetal growth abnormalities (n = 2,634). Fetal body composition measures of arm, abdomen, and thigh, and organ volumes including cerebellum, lung, kidney, and liver, were measured up to five times between 15 and 40 weeks using 3D ultrasound. Women were grouped by cumulative days of self-reported first-trimester vaginal bleeding: 0 (no bleeding, reference), 1, or …

Medical Students’ Perspectives On Dobbs V Jackson Women’S Health Organization, Victoria Lazarov, Cecilia Mastrogiacomo, Mikaela Koch, Kirsten Wohlars, Tova Ablove, Student Perspectives On Reproductive Rights Research Group

Cooper Rowan Medical Journal

Background: In June 2022, the Dobbs v Jackson Women’s Health Organization ruling overturned the previously upheld constitutional right to abortion. The resulting impact on medical training and student decision-making remains uncertain. This study aims to assess the nationwide impact of the Dobbs decision on medical students’ geographic residency preferences, specialty selection, and level of concern regarding civil and criminal charges for physicians providing abortion and fertility care.

Methods: An anonymous IRB-approved REDCap survey was distributed to American accredited medical schools across the United States and Israel between December 2022 and May 2023. Participants indicated specialty interests and geographic preferences for …

A Religious Etiology Of Genito-Pelvic Pain And Pain With Penetration, Emily L. Carlson

Theses and Graduate Projects

Pelvic pain during penetration (PPDP) has been described using various diagnostic terms, including vaginismus, dyspareunia, and vulvodynia. The most recent and comprehensive classification is Genito-pelvic pain/penetration disorder (GPPPD) which is characterized by psychological distress associated with pain during or in anticipation of vaginal penetration (DSM-5-TR; American Psychiatric Association [APA], 2022). The etiology of PPDP is multifactorial, involving a complex interplay of biological, psychological, and relational factors. Religious and cultural influences may play a significant role in shaping individuals’ experiences of sexual pain. This study investigated the etiology of PPDP in relation to the religious influences among women raised in Judeo-Christian …

A Qualitative Analysis Of The Lived Experience Of Active-Duty Servicewomen Receiving Perinatal Care Within The Military Health System., Caitlin Russell, Emily Balog, Anne Teitelman, Rosemary Polomano

Rowan-Virtua School of Osteopathic Medicine Departmental Research

OBJECTIVES: We explored the lived experiences of active-duty servicewomen (ADSW) accessing and receiving care during the perinatal period (from discovery of pregnancy to 1 year postpartum) within the Military Health System.

STUDY DESIGN: Using qualitative methods, we conducted semi-structured interviews between September 2022 and February 2023 with 23 ADSW participants who were pregnant or within their first year postpartum. Data were analyzed using inductive coding and thematic analysis techniques.

RESULTS: Participants reported bureaucratic hurdles and long wait times for accessing care, too little choice in providers, and inadequate coordination between civilian and military care providers. Those who experienced perinatal complications …

Effect Of Social Drivers Of Health On Screening For Type 2 Diabetes In Individuals With Gestational Diabetes During Delivery Hospitalization And 4-12 Weeks Postpartum, Ingmar N Bastian, Manisha Gandhi, Mark A Turrentine

Faculty, Staff and Students Publications

Objective: To prospectively evaluate postpartum diabetes screening rates among individuals with gestational diabetes mellitus (GDM) offered testing during the delivery hospitalization or at 4-12 weeks postpartum compared with historic outpatient-only screening and to assess the role of social and structural drivers of health.

Methods: This retrospective study compared patients with GDM who delivered between January 1 and December 31, 2023 (retrospective cohort), and underwent outpatient screening at 4-12 weeks postpartum with a 75-g 2-hour oral glucose tolerance test (OGTT) with a prospective cohort (June 24-November 5, 2024) of the first 100 patients who underwent screening in the immediate postpartum delivery …

A Multi-Modal Pelvic Mri Dataset For Deep Learning-Based Pelvic Organ Segmentation In Endometriosis, Xiaomin Liang, Linda A Alpuing Radilla, Kamand Khalaj, Haaniya Dawoodally, Chinmay Mokashi, Xiaoming Guan, Kirk E Roberts, Sunil A Sheth, Varaha S Tammisetti, Luca Giancardo

Faculty, Staff and Students Publications

Endometriosis affects approximately 190 million females of reproductive age worldwide. Magnetic Resonance Imaging (MRI) has been recommended as the primary non-invasive diagnostic method for endometriosis. This study presents new female pelvic MRI multicenter datasets for endometriosis and shows the baseline segmentation performance of two auto-segmentation pipelines: the self-configuring nnU-Net and RAovSeg, a custom network. The multi-sequence endometriosis MRI scans from two clinical institutions were collected. A multicenter dataset of 51 subjects with manual labels for multiple pelvic structures from three raters was used to assess interrater agreement. A second single-center dataset of 81 subjects with labels for multiple pelvic structures …

A Cancer Education Needs Assessment: Informing Middle-Aged Female Patients About The Relationships Between Obesity And Women’S Health Concerns In The Reproductive System, Breast, And Endometrial Health, Batul Mirza

MUSC Theses and Dissertations

Obesity significantly impacts women’s health, particularly among middle-aged women, by increasing the risk of hormone-sensitive cancers such as breast, endometrial, and reproductive system cancers. This study examines the educational needs of this demographic group regarding obesity-related cancer risks and explores effective intervention strategies. Obesity-induced mechanisms – hormonal imbalances, chronic inflammation, and insulin resistance – drive cancer susceptibility, emphasizing the need for targeted health education. The study employs a qualitative design, which includes interviews with subject matter experts (SMEs) and surveys of middle-aged women. The goal is to assess awareness, perceived barriers, and preferred learning methods. Findings suggest that with many …

Covid-19 Vaccine Attitudes And Behaviors Among Pregnant Women In Nairobi, Kenya With Diverse Socio-Economic And Educational Backgrounds, Jessica Schue, Ferdinand Okwaro, Ingrid Gichere, Daizy Cherono, Mandeep Sura, Emilly Miller, Berhaun Fesshaye, Prachi Singh, Marleen Temmerman

Centre of Excellence in Women and Child Health

Introduction: Pregnant women are at increased risk of severe manifestations of COVID-19, resulting in ICU admission, mechanical ventilation, and death compared to non-pregnant women. COVID-19 vaccines were approved for use in pregnant women in early 2022 by the World Health Organization, but permissive policies toward vaccine women differed by country. As education has been associated with vaccine uptake, this study sought to examine the association between socio-economic or educational status and vaccination behaviors, including reasons for vaccination or non-vaccination among pregnant women seeking health care services in Nairobi, Kenya.

Methods: This study administered a survey to pregnant women at the …

Placental Transfer Of Sars-Cov-2 Antibodies In Mother-Neonate Pairs: A Prospective Nested Cohort Study, Alex Mugo, Angela Koech, Liberty Cantrell, Moses Mukhanya, Isaac Mwaniki, Joseph Mutunga, Merryn Voysey, Rachel Craik, Marleen Temmerman, Geoffrey Omuse

Centre of Excellence in Women and Child Health

Background: Newborns depend on the transfer of IgG across the placenta to acquire protection against pathogens. We assessed the placental transfer of SARS-CoV-2 antibodies, primarily derived from infection, from seropositive pregnant women enrolled in a pregnancy cohort in Kilifi, Kenya.

Methods :The study was nested within a prospective observational multi-country cohort study. All available paired maternal delivery and cord blood samples were selected. Maternal sera were tested for SARS-CoV-2 receptor binding domain (RBD) IgM/IgG total antibodies using the Wantai assay. For positive samples, maternal and corresponding cord blood samples were tested for SARS-CoV-2 IgG antibodies against the spike (anti-spike) and …

Immediate Skin-To-Skin Contact And Postpartum Hemorrhagic Morbidity, Rachel L Wiley, Ipsita Ghose, Dana R Canfield, Minhazur R Sarker, Hector Mendez-Figueroa, Suneet Chauhan

Faculty, Staff and Students Publications

Objective: To examine rates of postpartum hemorrhagic (PPH) morbidity among patients who did and did not have immediate skin-to-skin contact (SSC).

Methods: This study was a retrospective cohort of all non-anomalous, term singleton vaginal births at a Level IV center over 2 years. Exclusion criteria included COVID-19. Immediate SSC was defined as at least 60 min of direct contact initiated between parturient and neonate within 10 min of birth. The primary outcome was a composite of maternal morbidity related to PPH compared among those with and without immediate SSC. We used multivariable Poisson regression adjusted for possible confounders with robust …

Higher Plasma Afb1 Concentration Is Associated With Increased Risk Of Hpv 16 And Hpv 18 Detection And Persistence Among Ugandan Women, Yan Tong, Miriam Nakalembe, Collins Mpamani, Carolyn Nakisige, Jane Namugga, Grace Banturaki, Philiph Tonui, Elkanah Orang'o

Obstetrics and Gynaecology, East Africa

Introduction: Aflatoxins are environmental hazards; potent carcinogenic and immunosuppressive agents that contaminates corn and other crops. A high proportion of hepatocellular carcinoma cases are caused by exposure to dietary aflatoxins. Cervical cancer is common among Ugandan women; this malignancy is caused by persistent infection with oncogenic HPV types. An analysis was performed to examine associations between plasma aflatoxin B1 (AFB1) detection and oncogenic HPV detection (HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) and persistence among Ugandan women.

Methods: Ugandan women were enrolled in a prospective cohort study. Annual cervical swabs …

Risk And Protective Factors Associated With Teenage Pregnancy And Intergenerational Interventions: A Scoping Review Protocol, Zamasomi Luvuno, Wilbroda Hlolosile Chiya, Silingene Joyce Ngcobo, Deshini Naidoo, Serwaa Omowale, Tracy Zhandire, Elizabeth Musili Joseph-Shehu, Busisiwe Purity Ncama, Sinegugu E Duma

Faculty, Staff and Student Publications

Introduction: Teenage pregnancy remains a critical global health issue, particularly in low- and middle-income countries. The intergenerational transmission of teenage pregnancy underscores the need for targeted interventions. Existing research on intergenerational approaches is fragmented, with varying methodologies and outcomes. This scoping review seeks to address this gap by answering the following research questions: What are the available intergenerational interventions for teenage pregnancy, and what are the associated risks and protective factors for early and late teenage pregnancy?

Methods and analysis: This study does not involve primary data collection and therefore does not require ethical approval. The review will be conducted …

Fluorescence-Guided Ureteral Identification In Robotic Surgery For Advanced Endometriosis: A Comparison Of Junior Versus Senior Surgeons, Linda A Alpuing Radilla, Qiannan Yang, Daniel Y Lovell, Tamisa Koythong, Brooke Thigpen, Luis E Delgadillo Chabolla, Qianqing Wang, Xiaoming Guan

Faculty, Staff and Students Publications

Identifying the ureters in patients with advanced endometriosis and severe pelvic adhesive disease can be challenging. Adhesiolysis along the deformed pelvic sidewall may increase the risk of prolonged operative time and incidental ureteral injury. This study aimed to evaluate the safety and surgical outcomes of using Indocyanine Green (ICG) under near-infrared fluorescence for intraoperative ureteral localization and preservation during robot-assisted laparoscopic surgery (RALS) for advanced endometriosis, comparing procedures performed by two junior surgeons to those performed by one senior surgeon. This was a retrospective observational case series conducted by three minimally invasive gynecologic surgeons (X.G., T.K., B.T.) at a single …

Is Less More? Maximizing Outcomes By Tailoring Treatments To Patients: Oncofertility And Oncomenopause, Janice S Kwon, Marie Plante, Martha Hickey, Annabelle Huguenin, Sarah Hmaidan, Terri Lynn Woodard

Faculty, Staff and Students Publications

Notable advances have been made in improving survival outcomes in various cancers, but some have incurred undesirable costs and effects to patients with respect to fertility and menopause. Patients are living longer with cancer, and patient reported outcomes are influencing decision-making by individuals and their health care providers. It is essential to evaluate existing standards of care on an ongoing basis and prioritize quality of life and long-term survivorship, particularly for interventions in early-stage cancers and risk-reducing strategies that often yield long-term life expectancy.

The Need To Integrate Mental Health Treatment Into The Care Of Mayer-Rokitansky-Küster-Hauser, Teni Davoudian, Emily Hills

Faculty, Staff and Students Publications

This mini review examines the psychological burdens of Mayer-Rokitansky-Küster-Hauser (MRKH) and encourages collaborations between medical and mental health providers who treat this condition. The psychological comorbidities of MRKH emerge in adolescence and persist into adulthood. For several years, The American College of Obstetricians and Gynecologists and researchers in this field have called for the provision of psychological counseling for individuals with MRKH. However, referrals to qualified mental health professionals remain sparse leaving many to confront the emotional complexities of MRKH with little to no support.

A Review Of Mirvetuximab Soravtansine-Gynx In Folate Receptor Alpha-Expressing Platinum-Resistant Ovarian Cancer, Judith A Smith, Patrick Medina, Mary Miao, Kathleen N Moore

Faculty, Staff and Student Publications

Purpose: To evaluate the pharmacology, efficacy, safety, and dosing and administration considerations (including adjusted ideal body weight [AIBW] dosing) for mirvetuximab soravtansine-gynx, a first-in-class folate receptor alpha (FRα)-directed antibody-drug conjugate for platinum-resistant ovarian cancer (PROC).

Summary: A literature search was conducted in PubMed using the terms "ovarian cancer" and "mirvetuximab soravtansine" of articles published from inception to April 16, 2024. Relevant publications, abstracts, and clinical trials were reviewed. Mirvetuximab soravtansine-gynx is dosed at 6 mg/kg AIBW every 3 weeks and comprises an FRα-binding antibody, a hydrophilic disulfide linker, and a maytansinoid DM4 payload. Mirvetuximab soravtansine-gynx binds to FRα, which induces …

Development Of A Light-Based Platform To Assess Cervical Mucus Barrier Function And Physical Mucus Properties, Elizabeth J. Buzbee

McKelvey School of Engineering Graduate Student Theses & Dissertations

Preterm birth is the leading cause of neonatal morbidity and mortality worldwide, yet current clinical tools for predicting its risk lack specificity and reliability. Cervical mucus plays a crucial role in maintaining pregnancy by forming a barrier that protects the uterus against infection. This study investigates the use of laser speckle rheology as a noninvasive technique to assess cervical mucus biomechanics. Synthetic cervical mucus was fabricated at varying hydration levels and tested using a conventional rheometer that confirmed that the mechanical properties of the synthetic mucus samples were representative of physiological cervical mucus. These results were compared to the complex …

Implementation Of An Adolescent Women’S Health And Wellness Education Program, Lauren Acker, Laynee Conner, Jennifer Cera

Doctor of Nursing Practice Projects: College of Nursing

Objectives: The goal of this research study was to provide scientific evidence supporting the importance and effectiveness of implementing a women’s health and wellness education course and its effect on (1) adolescent knowledge of sexual health and hygiene, (2) self-efficacy in menstrual management, and (3) self-empowerment in managing their own reproductive health.

Design: This was a mixed methods pilot study utilizing a pre/post-test single intervention efficacy trial. Quantitative and qualitative data were obtained.

Setting: The setting included two different sites including one outpatient ambulatory obstetrics/gynecology clinic and one community outreach center. Both sites were located within a midwestern metropolitan …

Impact Of Implementing An Updated Cervical Cancer Screening Protocol In The Primary Care Setting, Teri A. Koch

Evidence-Based Practice Project Reports

Cervical cancer is one of the most common types of cancer among women globally. Current screening methods by clinicians include cytology sampling, high-risk human papillomavirus sampling, or co-testing with both methods. These tests may detect cell changes before they become cancerous, yet the uptake of these methods has decreased in recent years (Aginga, 2022; Office of Disease Prevention and Health Promotion, 2023; Popalis et al., 2022; Sung et al., 2021). The primary purpose of this evidence-based practice project was to determine if the implementation of an updated cervical screening protocol improved the linkage of abnormal results to appropriate clinical follow-up …

Beyond Opioids: The Role Of Polysubstance Exposure In Neonatal Abstinence Syndrome Treatment And Hospitalization, Caelyn Harrison

Undergraduate Honors Theses

This thesis explores the impact of prenatal polysubstance exposure, specifically focusing on the need for pharmacological treatment for Neonatal Abstinence Syndrome (NAS) and the duration of their hospital stay. A retrospective analysis of 462 infants, including 121 exposed to polysubstances during pregnancy, showed significant associations between polysubstance exposure and adverse neonatal outcomes. Infants with prenatal polysubstance exposure were more likely to require pharmacological treatment for NAS (52.8%) compared to non-exposed infants (38.7%), as determined by chi-square analysis (χ²(1, N = 462) = 7.36, p = .007). Additionally, infants exposed to polysubstances experienced longer hospital stays on average (M = 14.88 …

The Association Between Economic Outcomes And Abortion: A Scoping Review, Larisa Nicole Stephenson

Capstone Experience: Master of Public Health

Background: Abortion access is not just an issue of autonomy, but an economic issue as well. Evidence of the intersectionality of abortion health care and economics has endured due to the financial cascading effects a denial of an abortion, or the inability to access an abortion, has on one’s personal, professional, and economic upward mobility. A change in recent policies impacting access to abortion warrants an updated synthesis examining the relationships between economic outcomes and abortion access for people of reproductive age in the United States (U.S.).

Aim: This scoping review summarizes evidence pertaining to the association …

A Comprehensive Literature Review Of Barriers To Hormone Therapy Utilization: Strategies For Improving Menopause Management In Women Aged 40-60, Suhan Lee

Capstone Experience: Master of Public Health

Menopause is a natural transition marked by the cessation of ovarian activity, often accompanied by vasomotor symptoms (VMS), genitourinary syndrome of menopause (GSM), and psychological changes that significantly impact women’s quality of life. Hormone therapy (HT) has been the primary treatment for managing menopausal symptoms, particularly VMS, providing substantial relief when initiated within 10 years of menopause. Despite its effectiveness, HT usage has declined dramatically over the past two decades primarily due to barriers such as stigma, safety, misinformation, provider hesitancy, financial barriers, and cultural beliefs. This comprehensive literature review explores key factors influencing HT decision-making, including the media’s role …

The State Of Abortion Training In Medical School And Family Medicine Residency Curricula: A Scoping Literature Review, Eric James Reece

Capstone Experience: Master of Public Health

This project aims to assess how abortion education has been integrated into medical training over the past decade, with a particular focus on understanding its current state in medical schools and family medicine residencies, including those offering specialized programs affiliated with RHEDI (Reproductive Health Education in Family Medicine) and TEACH (Training in Early Abortion for Comprehensive Healthcare). Given the ever-evolving legal landscape following the June 4^th, 2022 Supreme Court case of Dobbs v. Jackson Women’s Health Organization, this review explores how both federal- and state-level legal restrictions impact access to abortion training and attempts to identify gaps …

Literature Review: Prazosin Used For Ptsd In Pregnancy, Afshan Khan, Natali Sharma, Rebekah M. Dietrich, Martin Forsberg

Rowan-Virtua Research Day

Posttraumatic Stress Disorder (PTSD) affects 3–4% of pregnant and postpartum individuals and is associated with complications such as preterm birth, low birth weight, and postpartum depression. Pharmacologic treatment options during pregnancy are limited by concerns about fetal safety.

Methods: A literature review was conducted focusing on studies reporting maternal or neonatal outcomes following prazosin exposure in pregnancy.

Results: One observational study of 11 pregnancies found 54.5% had uneventful outcomes, with rates of preterm birth, miscarriage, and preeclampsia similar to the general population. Hypotension and limited lactation data remain concerns.

Conclusion: Early evidence suggests prazosin may be a relatively safe and …

Pain Management In Pregnant Women With Opioid Use Disorder: A Systematic Review, Adeena Javed

Rowan-Virtua Research Day

Background: The prevalence of opioid use disorder (OUD) among pregnant individuals has risen significantly, posing challenges in managing labor and postpartum pain. Factors such as opioid tolerance, opioid-induced hyperalgesia, and concerns about relapse complicate analgesic strategies. Despite these complexities, evidence-based guidelines for pain management in this population remain limited.

Hypothesis: Pregnant women with OUD experience disparities in pain management during labor and postpartum periods, leading to suboptimal outcomes.

Methods: A systematic review was conducted, analyzing peer-reviewed studies from databases including PubMed and Embase. Inclusion criteria encompassed studies focusing on pain management in pregnant women with OUD. Data extraction focused on …

Maternal Health And Nutrition: Combating Maternal Mortality Through Proper Nutrition, Archna Mahendru, Yeisanai Cardona Torres, Maya Blayne Partee, Katarina Rusinak

Rowan-Virtua Research Day

Maternal mortality is an increasing concern in the United States. According to the WHO, from 2018-2022 the Maternal Mortality Rate (MMR) was 23.3 deaths per every 100,000 live births. New Jersey's MMR exceeded this average at 26 per 100,000 during the same period, with 91% of cases deemed preventable. While medical care plays a crucial role, research shows that non-medical determinants such as food insecurity, lack of nutritional education, limited access to transportation, and systemic barriers to health care contribute significantly to maternal health outcomes. Among these factors, proper nutrition plays a critical role before and during pregnancy, particularly in …

Children Born To Mothers With Inflammatory Bowel Disease: A Review Of Pediatric Outcomes, Simran Gandhi, Kush Patel, Harmann Singh

Rowan-Virtua Research Day

Background: Inflammatory Bowel Disease (IBD), comprising Crohn’s disease and ulcerative colitis, frequently affects women during their reproductive years. While the impact of IBD on pregnancy has been widely studied, less is known about the long-term health outcomes in children born to affected mothers, particularly in the context of in utero exposure to immunosuppressive therapies.

Hypothesis: We hypothesize that children born to mothers with well-managed IBD experience normal growth and development, with minimal risk for immune-related complications, despite potential exposure to biologics and other IBD medications during gestation.

Methods: A literature review was conducted using PubMed and Google Scholar. Search terms …

The Physical And Mental Health Implications On Patients Of Childbearing Age Following The Dobbs Deicison, Jaclyn M. Schultz, Mariana A. Sales, Amy C. Nguyen, Chloe M. Triolo, Melissa K. Crisci

Rowan-Virtua Research Day

Background: In June 2022, the Supreme Court ruled to overturn Roe v. Wade in the Dobbs v. Jackson case which allowed for individual states to determine the legality of abortion. Thirteen states had “trigger” laws in place that immediately restricted abortion access. Since then, many states have enacted laws restricting access to abortion, increasing the total number of states where abortion is outlawed or heavily restricted.

Hypothesis: The goal of this review was to examine the potential implications of restricted access to abortion care on the physical and mental health of patients of childbearing age, which was hypothesized to be …

Musculoskeletal Changes In Pregnancy: Implications For Long-Term Bone & Joint Health, Jaylyn Thompson, Clarence Julian Clark Ii, Nayarith Lopez, Aziza Ndaw

Rowan-Virtua Research Day

Pregnancy and lactation represent significant physiological challenges to maternal skeletal health, with substantial implications for both short and long-term musculoskeletal integrity. Research emphasizes that lactation induces notable skeletal adaptations, with up to 10% bone mineral density loss occurring in trabecular-rich regions such as the spine and hip (1,5). While most women experience substantial recovery post-weaning, the research indicates that recovery patterns vary significantly, with some women experiencing incomplete restoration of bone mass, potentially compromising long-term skeletal strength (3).

The underlying mechanisms driving these changes are primarily hormonal, with elevated parathyroid hormone-related protein (PTHrP) and decreased estrogen levels during lactation facilitating …

Addressing Pain Management Practices And Potential Under-Medication Of Women During Iud Insertion Procedures, Malgorzata Zembrzuska

Rowan-Virtua Research Day

Intrauterine devices (IUDs) are among the most effective and safe contraceptive options available to women, yet their utilization often remains limited due in part to fear of pain, lack of adequate pain management during insertion, and absence of standardized clinical guidelines. This literature review explores current pain management strategies for IUD insertion and examines the potential under-medication of women during this procedure. Ten sources were reviewed, including randomized controlled trials, a clinical trial, linear regression analyses, and meta-analyses, with inclusion criteria focusing on pain interventions for IUD insertion in women over the past decade. Findings reveal that commonly used interventions—such …