Obstetrics and Gynecology Commons^™

Cost-Effectiveness Of Low-Dose Aspirin For The Prevention Of Preterm Birth: A Prospective Study Of The Global Network For Women’S And Children’S Health Research, Jackie K Patterson, Simon Neuwahl, Norman Goco, Janet Moore, Shivaprasad S Goudar, Richard Derman, Matthew Hoffman, Mrityunjay Metgud, Manjunath Somannavar, Avinash Kavi, Jean Okitawutshu, Adrien Lokangaka, Antoinette Tshefu, Carl L Bose, Abigail Mwapule, Musaku Mwenechanya, Elwyn Chomba, Waldemar A Carlo, Javier Chicuy, Lester Figueroa, Nancy F Krebs, Saleem Jessani, Sarah Saleem, Robert L Goldenberg, Kunal Kurhe, Prabir Das, Archana Patel, Patricia L Hibberd, Emmah Achieng, Paul Nyongesa, Fabian Esamai, Sherri Bucher, Edward A Liechty, Brian W Bresnahan, Marion Koso-Thomas, Elizabeth M Mcclure

Department of Obstetrics and Gynecology Faculty Papers

Background: Premature birth is associated with an increased risk of mortality and morbidity, and strategies to prevent preterm birth are few in number and resource intensive. In 2020, the ASPIRIN trial showed the efficacy of low-dose aspirin (LDA) in nulliparous, singleton pregnancies for the prevention of preterm birth. We sought to investigate the cost-effectiveness of this therapy in low-income and middle-income countries.

Methods: In this post-hoc, prospective, cost-effectiveness study, we constructed a probabilistic decision tree model to compare the benefits and costs of LDA treatment compared with standard care using primary data and published results from the ASPIRIN trial. In …

Juvenile-Type Granulosa Cell Tumor In Pregnancy Presenting As A Ruptured Abdominal Mass, Odinaka Mogor, Steven Feinstein, Glen Friedman, Jose Salvador Saldivar, Melissa Mendez

HCA Healthcare Journal of Medicine

Introduction

Granulosa cell tumors (GCTs) are part of the sex cord-stromal tumors occurring with a rare incidence rate that only makes up about 2-5% of all ovarian malignancies.

Case Presentation

A 28-year-old woman, gravida 2, para 1, presented with a juvenile-type granulosa cell tumor at 31 weeks gestation, which appeared as a rapidly growing mass with rupture. She underwent an exploratory laparotomy with unilateral salpingo-oophorectomy, and consequently had a successful vaginal delivery. Post-operatively she was treated with paclitaxel and carboplatin chemotherapy regimen with no evidence of recurrence after one year.

Conclusion

Radical surgical management is recommended for these tumors due …

Factors Influencing Instrumental Birth Rates: An Evidence Based Project, Douglas Nanu, Gabriel Alemayehu, Chase Eby, Teresa Rangel

Providence Nursing Research Conference 2023 – Present

No abstract provided.

Oral Ibrexafungerp For Vulvovaginal Candidiasis Treatment: An Analysis Of Vanish 303 And Vanish 306, Oluwatosin Goje, Ryan Sobel, Paul Nyirjesy, Steven R Goldstein, Mark Spitzer, Brooke Faught, Shelagh Larson, Thomas King, Nkechi E Azie, David Angulo, Jack D Sobel

Department of Obstetrics and Gynecology Faculty Papers

Background: Ibrexafungerp is a novel antifungal treatment for acute vulvovaginal candidiasis (VVC). Using pooled data from two phase three studies (VANISH 303 and 306) in the treatment of acute VVC, this analysis sought to determine the effectiveness of ibrexafungerp in various patient subgroups that may impact outcomes. Materials and Methods: Data from VANISH 303 (NCT03734991) and VANISH 306 (NCT03987620) evaluating ibrexafungerp 300 mg twice daily (BID) for 1 day versus placebo, were pooled and analyzed to determine clinical cure rate, clinical improvement, and mycological cure at the test-of-cure visit (day 11 ± 3) and symptom resolution …

Generalisability Of Fetal Ultrasound Deep Learning Models To Low-Resource Imaging Settings In Five African Countries, Carla Sendra-Balcells, Víctor M. Campello, Jordina Torrents-Barrena, Yahya Ali Ahmed, Mustafa Elattar, Benard Ohene-Botwe, Pempho Nyangulu, William Stones, Sikolia Wanyonyi, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Most artificial intelligence (AI) research and innovations have concentrated in high-income countries, where imaging data, IT infrastructures and clinical expertise are plentiful. However, slower progress has been made in limited-resource environments where medical imaging is needed. For example, in Sub-Saharan Africa, the rate of perinatal mortality is very high due to limited access to antenatal screening. In these countries, AI models could be implemented to help clinicians acquire fetal ultrasound planes for the diagnosis of fetal abnormalities. So far, deep learning models have been proposed to identify standard fetal planes, but there is no evidence of their ability to generalise …

Ob-Gyn Resident Education Of Postpartum Care: A Needs Assessment, Melanie Hotz, Ms, Md, Cheryl Godcharles, Md, Ibclc, Julia Switzer, Md

Department of Obstetrics and Gynecology Posters

Background

• Increased recognition of the importance of the ‘fourth trimester’ and the pressing need to reduce maternal morbidity and mortality, has led to a renewed focus on postpartum care.
• Advanced Milestones for The Care of the Postpartum Patient include ability to effectively counsel patients on antenatal, intrapartum and postpartum complications, collaboration with other members of the health care team in postpartum care and application of innovative approaches to the management of patients in the postpartum period.¹
• The CREOG Learning objectives include several specific learning objectives regarding the diagnosis, management and counseling about normal postpartum recovery and complications of the …

Disparities In Contraception In Women With Cardiovascular Diseases In The Cardiac-Obstetrical Clinic, Laura Fiorini, Maria De Abreu Pineda, Jason K. Baxter, Rebekah J. Mccurdy, Andria Jones, Indranee Rajapreyar, Amanda Roman-Camargo

Department of Obstetrics and Gynecology Posters

Objective

- National Survey of Family Growth 2017-19 survey reported a 65.3% contraceptive use:

• 18% tubal, 5.6% vasectomy
• 18% hormonal therapy
• 8.4% intrauterine devices (IUD)
• 8.4% condoms

- To evaluate postpartum contraception plans and use in pregnant women with cardiovascular disease (CVD) after visits to the combined cardio-obstetric clinic

Mommy, Me, And We: Why Black Mothers Have Turned To Doulas, Janessa Harris

Crossings: Swarthmore Undergraduate Feminist Research Journal

Maternal mortality mates have disproportionately affected black mothers for far too long due to the lack of value that black bodies hold in medical spaces. Because of this concerns voiced by black people are often disregarded and ignored until the very last minute. But what if this was changed? This paper will focus on how black mothers have worked against Western medical systems that silence our voices, but instead turn to doulas who work to make these mothers feel seen, heard, and cared for. Through this, we make birthing a careful and collective effort to turn Mommy&Me to Mommy&We.

Metabolomics Of A Neonatal Cohort From The Alliance For Maternal And Newborn Health Improvement Biorepository: Effect Of Preanalytical Variables On Reference Intervals, Lena Jafri, Aysha Habib Khan, Muhammad Ilyas, Muhammad Imran Nisar, Javairia Khalid, Hafsa Majid, Aneeta Hotwani, Fyezah Jehan

Department of Pathology and Laboratory Medicine

Background: The study was conducted to determine reference interval (RI) and evaluate the effect of preanalytical variables on Dried blood spot (DBS)-amino acids, acylcarnitines and succinylacetone of neonates.
Methodology: DBS samples were collected within 48-72 hours of life. Samples were analyzed for biochemical markers on tandem mass spectrometer at the University of Iowa. Comparison of RI across various categorical variables were performed.
Results: A total of 610 reference samples were selected based on exclusion criteria; 53.2% being females. Mean gestational age (GA) of mothers at the time of delivery was 38.7±1.6 weeks; 24.5% neonates were of low birth weight and …

The Promise Of Telehealth For Abortion, Greer Donley, Rachel Rebouché

Book Chapters

The COVID-19 pandemic catalyzed a transformation of abortion care. For most of the last half century, abortion was provided in clinics outside of the traditional healthcare setting. Though a medication regimen was approved in 2000 that would terminate a pregnancy without a surgical procedure, the Food & Drug Administration required, among other things, that the drug be dispensed in person. This requirement dramatically limited the medication’s promise to revolutionize abortion because it subjected medication abortion to the same physical barriers of procedural care.

Over the course of the COVID-19 pandemic, however, that changed. The pandemic’s early days exposed how the …

Understanding Maternity Care Providers’ Use Of Data In Southern Tanzania, Regine Unkels, Fadhlun Alwy Al-Beity, Zamoyoni Julius, Elibariki Mkumbo, Andrea B. Pembe, Claudia Hanson, Helle Molsted-Alvesson

Obstetrics and Gynaecology, East Africa

Introduction: Health information management system data is collected for national planning and evaluation but is rarely used for healthcare improvements at subnational or facility-level in low-and-middle-income countries. Research suggests that perceived data quality and lack of feedback are contributing factors. We aimed to understand maternity care providers’ perceptions of data and how they use it, with a view to co-design interventions to improve data quality and use.

Methods: We based our research on constructivist grounded theory. We conducted 14 in-depth interviews, two focus group discussions with maternity care providers and 48 hours of observations in maternity wards to understand …

Adverse Maternal, Fetal, And Newborn Outcomes Among Pregnant Women With Sars-Cov-2 Infection: An Individual Participant Data Meta-Analysis, Emily R. Smith, Erin Oakley, Gargi Wable Grandner, Kacey Ferguson, Fouzia Farooq, Yalda Afshar, Mia Ahlberg, Homa Ahmadzia, Victor Akelo, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Introduction: Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies.

Methods: We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale.

Results: We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.

Pregnant women with …

Telecontraception – A Way To Address A Health Care Disparity A Preliminary Literature Review, Pamela D. Parker

MedEd Teaching Certificate Program

Unintended pregnancy continues to be a significant personal and public health concern in all countries. In 2015-2019 there were 121 million unintended pregnancies annually, corresponding to a global rate of 64 unintended pregnancies per 1000 women aged 15-49 years. While there are multiple contraception options available in general, access to them can be limited by a myriad of factors. Over the past two decades there has been an increase in mail order services for contraception that bypasses the traditional clinician office visit-examination-pharmacy model, thus increasing access for many women (and men). These companies have been proven to provide safe, convenient …

Abortion Pills, David S. Cohen, Greer Donley, Rachel Rebouché

Articles

Abortion is now illegal in roughly a third of the country, but abortion pills are more widely available than ever before. Though antiabortion advocates and legislators are attacking pills with all manner of strategies, clinics, websites, and informal networks are openly facilitating the distribution of abortion pills, legally and illegally, across the United States. This Article is the first to explain this defining aspect of the post-Roe environment and the novel issues it raises at the level of state law, federal policy, and on-the-ground advocacy.

This Article first details antiabortion strategies to stop pills by any means necessary. These tactics …

Vertical Transmission Of Sars-Cov-2 In A Twin Pregnancy, Tiffany C. Chang, Rebecca F. Herbert, Stacey N. Tran, Victoria M. Weprinsky, Bhaskari Burra, Chi Dola

HCA Healthcare Journal of Medicine

Transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in 2019 and rapidly evolved into the global coronavirus disease 2019 (COVID-19) pandemic. The emergence of a highly morbid disease has posed ongoing challenges in the diagnosis, management, and prevention of COVID-19. The uncertainty underlying medical decision making is further compounded by preexisting conditions, including pregnancy. Here, we report a twin pregnancy complicated by maternal COVID-19 and the vertical transmission of SARS-CoV-2. We hope that our experiences contribute to a better understanding of the disease in pregnancy and, ultimately, guide the development of effective treatment and prevention …

Comparison Of Pregnancy Complication Rates: Does Opioid Agonist Pharmacotherapy Make A Difference?, Alexa Pfeiffer Oms-Iii, Michael Falcone Oms-Iii, Pritha Aggarwal Oms-Iii, Andrea M. Bodine Md

Advances in Clinical Medical Research and Healthcare Delivery

Background: Over the past decade, the prevalence of opioid use disorder (OUD) in pregnant patients has increased by 131% with an associated increase in pregnancy complications. Opioid agonist pharmacotherapy (OAP) with methadone or buprenorphine is recommended by ACOG for the management of OUD. The objectives of our study are to compare the incidence of pregnancy complications among patients who at the time of their delivery used OAP, OAP plus any additional substance (OAP+), illicit or prescribed opioids, and no opioids.

Methods: We conducted a retrospective cohort study at Berkshire Medical Center in Pittsfield, MA, between January 1, 2018, through December …

Community Engagement For Birth Preparedness And Complication Readiness In The Community Level Interventions For Pre-Eclampsia (Clip) Trial In India: A Mixed-Method Evaluation, Avinash Kavi, Mai-Lei Woo Kinshella, Umesh Y Ramadurg, Umesh Charantimath, Geetanjali M Katageri, Chandrashekhar C Karadiguddi, Narayan V Honnungar, Shashidhar G Bannale, Geetanjali I Mungarwadi, Jeffrey N Bone, Marianne Vidler, Laura Magee, Ashalata Mallapur, Shivaprasad S Goudar, Mrutyunjaya Bellad, Richard Derman, Peter Von Dadelszen, The Clip India Working Group

Department of Obstetrics and Gynecology Faculty Papers

Objective: To describe the process of community engagement (CE) in northern Karnataka, India and its impact on pre-eclampsia knowledge, birth preparedness and complication readiness, pregnancy-related care seeking and maternal morbidity.

Design: This study was a secondary analysis of a cluster randomised trial of Community Level Interventions for Pre-eclampsia (CLIP). A total of 12 clusters based on primary health centre catchment areas were randomised to intervention or control. CE was conducted in intervention clusters. CE attendance was summarised according to participant group using both quantitative and qualitative assessment. Pre-eclampsia knowledge, birth preparedness, health services engagement and perinatal outcomes was evaluated within …

Does The Anastatica Hierochuntica Plant Shorten The Duration Of Labour? A Prospective Observational Study, Filiz Okumuş, Halime Öncü-Çelik, Nevin Şahin

Journal of Asian Midwives (JAM)

Objective: This study aims to investigate the effect of Anastatica Hierochuntica L. on the duration of labour in primiparous women.
Methods: A prospective, case-controlled study with an intervention (n=28) and control (n=29) group. Participants were not randomized; their preferences related to the use of the A. Hierochuntica L. determined the group in which they would be included. In the intervention group, Anastatica Hierochuntica L. was used by all women. Standard care continued for both the intervention and control group. The duration of the first and second stage of labour were evaluated and compared between groups.
Results: Participants’ mean of age …

Births In The Mountain West, 2016-2020, Corryn Richardson, Hira Ahmed, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet examines state-level data on births and health indicators from the National Center for Health Statistics (NCHS), a government health statistics unit of the Center for Disease Control and Prevention (CDC). This fact sheet presents data related to births in the Mountain West states of Arizona, Colorado, New Mexico, Nevada, and Utah.

Protocols For Postpartum Hemorrhage, Jackleen Chambers

Symposium of Student Scholars

The occurrence of postpartum hemorrhages (PH) within the healthcare system are on the rise. The detrimental effects that can occur are extremely serious and require an intervention of education and proper training. Labor and delivery units experience traumatic PHs due to lack of proper training regarding early warning signs and correct technical interventions needed for a quick turnaround. This project will use research from scholarly articles to take a closer look at statistical evidence based on the outcomes of being prepared versus underprepared. The project will discuss various methods on how to better prepare nurses to care for hemorrhagic situations. …