Obstetrics and Gynecology Commons^™

A Study Protocol For An Mhealth, Multi-Centre Randomized Control Trial To Promote Use Of Postpartum Contraception Amongst Rural Women In Punjab, Pakistan, Xaher Gul, Waqas Hameed, Sharmeen Hussain, Ishaque Sheikh, Junaid-Ur-Rehman Siddiqui

Community Health Sciences

Background: Provision of family planning services during the immediate post-partum phase is considered effective and cost-efficient for promoting healthy timing and spacing of pregnancies. This research aims to test the effectiveness of mobile phone-based interventions in promoting use of postpartum contraception. Moreover, it will also test the non-inferiority of text and voice messages compared to interactive phone-based counselling.
Methods: A three-arm, 10-month, multicentre, randomized controlled trial will be conducted at 15 social franchise (SF) health facilities in Punjab province of Pakistan. Pregnant women aged 15-44 years who are in their first or second trimester and have a mobile phone for …

The Gender-Based Violence And Recovery Centre At Coast Provincial General Hospital, Mombasa, Kenya: An Integrated Care Model For Survivors Of Sexual Violence, Marleen Temmerman, Emilomo Ogbe, Griffins Manguro, Iqbal Khandwalla, Mary Thiongo, Kishor N. Mandaliya, Lou Dierick, Markus Macgill, Peter Gichangi

Obstetrics and Gynaecology, East Africa

• Sexual violence (SV) is highly prevalent and a major public health problem globally. In Kenya, an estimated 32% of females and 18% of males were reported to have experienced SV before the age of 18 years.
• This paper presents a data set collected between 2007 and 2018 and describes the gender-based violence and recovery centre (GBVRC) model under which survivors of SV were cared for at a 24-hour public hospital in Mombasa, Kenya—including its development, implementation, achievements, and challenges.
• The GBVRC model is a partnership that provides (in addition to emergency healthcare) mental health support, paralegal services, and integrated cooperation …

Obgyn Surgical Prep Standardized Process Presentation, Cortney Hartman Mba-Hm, Cst, Crcst, Cis

Posters & Presentations

OBGYN Surgical Prep Presentation.

To lower the occurrences of SSIs and standardize the process of surgical preparation across Parkview Health System, the following changes were adopted on August 15, 2019.

This is version 2.0

• Infection Prevention Bundle
• Vaginal Prep Instructions
• Abdominal Prep Instructions
• Chlorohexidine-alcohol (Chloraprep)

Use Of Long‐Acting Reversible Contraception In A Cluster‐Random Sample Of Female Sex Workers In Kenya, Frances H. Ampt, Megan . S.C Lim, Paul A. Agius, Matthew F. Chersich, Griffins Manguro, Caroline M. Gichuki, Mark Stoové, Marleen Temmerman, Walter Jaoko, Margaret Hellard, Peter Gichangi, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Objective: To assess correlates of long-acting reversible contraceptive (LARC) use, and explore patterns of LARC use among female sex workers (FSWs) in Kenya.

Methods: Baseline cross-sectional data were collected between September 2016 and May 2017 in a cluster-randomized controlled trial in Mombasa. Eligibility criteria included current sex work, age 16–34 years, not pregnant, and not planning pregnancy. Peer educators recruited FSWs from randomly selected sex-work venues. Multiple logistic regression identified correlates of LARC use. Prevalence estimates were weighted to adjust for variation in FSW numbers recruited across venues.

Results: Among 879 participants, the prevalence of contraceptive use was 22.6% for …

Cranial And Intra-Axial Metastasis Originating From A Primary Ovarian Dysgerminoma., Tiffany L Beck, Hitomi Momose, Jeffrey M Dym, Vikas Y Rao, Randy Bohart, Bram H Goldstein

Articles, Abstracts, and Reports

Dysgerminomas are aggressive germ cell tumors that typically have a favorable prognosis, especially in patients diagnosed with early stage disease. We recount the history of a 23-year-old woman who was treated for a stage IA ovarian dysgerminoma in November 2017. Postoperatively, the patient was noncompliant insofar as obtaining routine lab evaluations; ten months later, she was diagnosed with a cranial metastasis that extended into the meninges. The patient subsequently underwent a posterior fossa craniotomy and adjuvant etoposide, bleomycin and cisplatin chemotherapy to which she initially responded; however, during cycle 4, she developed pancytopenia whereupon the chemotherapy was summarily discontinued. Thereafter, …

A New Woman-Controlled Contraceptive Vaginal Ring: A Global Step Forward, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

More than 40 years ago, the development of contraceptive vaginal rings began, based on the fact that the vaginal epithelium can absorb steroid hormones and the capacity of elastomers to release these hormones at almost constant rates. The growing interest in woman-controlled contraceptive methods has supported and accelerated the process.

Cervical Cancer In Tanzania: A Systematic Review Of Current Challenges In Six Domains., Ava S Runge, Megan E Bernstein, Alexa N Lucas, Krishnansu S Tewari

Articles, Abstracts, and Reports

Cervical cancer is the most common cancer in Tanzania. After excluding human immunodeficiency virus, lower respiratory infections, malaria, diarrheal diseases, and tuberculosis, cervical cancer kills more women than any other form of illness in the country. Unfortunately, Tanzania has a low doctor-to-patient ratio (1:50,000) and nearly 7000 women die each year from this disease. The clinical problem is further magnified by the country's lack of resources and prevailing poverty, sporadic cervical cancer screening, prevalence of high-risk oncogenic human papillomavirus subtypes, and relatively high rates of human immunodeficiency virus co-infection. In recent years, addressing the cervical cancer problem has become a …

Nasopharyngeal Carcinoma In Pregnancy: Management Approach Case Report At Moi Teaching And Referral Hospital, Eldoret-Kenya, Philip Tonui, Elly B. Odongo, Andrew Cheruiyot, Sahara Shurie, Elkanah Omenge

Obstetrics and Gynaecology, East Africa

Nasopharyngeal carcinoma is an uncommon tumour, which raises management dilemma in pregnant women. The condition has a considerable effect on the pregnancy outcome, considering the risk of preterm delivery. This paper reports a case of 26 years old Gravida 7 Para 6 admitted at 28 weeks of gestation with epistaxis, hematemesis and a neck mass. The head CT scan showed a right paranasal space soft tissue mass with bony destruction and bilateral cervical adenopathy, consistent with neoplastic carcinoma. Histopathological examination confirmed the diagnosis of nasopharyngeal carcinoma. Deterioration of the patient’s condition, necessitated emergency caesarean delivery at 32 weeks to accommodate …

A Phenomenological Investigation Of Women’S Infertility And Miscarriage Grief Experiences, Tristan Mcbain

Dissertations

Infertility and miscarriage are reproductive losses that often produce grief reactions in affected women. This phenomenological study investigated the grief experiences of infertility and miscarriage through the ambiguous loss and disenfranchised grief frameworks in order to better understand both the obscurity of reproductive loss and how the resulting grief may be invalidated.

Sixteen women volunteered to participate in this study and each fell into one of the following three categories: women affected by infertility without miscarriage (4); women affected by miscarriage without infertility (4); and women affected by infertility and miscarriage (8). A phenomenological hermeneutic approach was utilized to uncover …

Availability Of Long Acting Reversible Contraceptives For Adolescents In Urban Vs Rural West Virginia Counties, Brooke Andrews, Cameron Ross, Jennie L. Yoost

Marshall Journal of Medicine

The study objective was to evaluate long acting reversible contraceptive (LARC) method availability and access for adolescents in rural and urban counties in West Virginia (WV). A cross-sectional survey of Title X family planning providers throughout WV was conducted from January 2016-July 2017. This survey was sent to 226 family planning providers in WV to assess patterns of LARC availability. The survey assessed provider training level, LARC services provided and frequency, clinical practice, referral patterns, and comfort level providing adolescent LARC services. Survey results were analyzed by providers’ rural vs urban status, based on US census county codes. Survey responses …

Fetal Fibronectin Testing For Reducing The Risk Of Preterm Birth., Vincenzo Berghella, Gabriele Saccone

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: Fetal fibronectin (FFN) is an extracellular matrix glycoprotein localized at the maternal-fetal interface of the amniotic membranes, between chorion and decidua, where it is concentrated in this area between decidua and trophoblast. In normal conditions, FFN is found at very low levels in cervicovaginal secretions. Levels greater than or equal to 50 ng/mL at or after 22 weeks have been associated with an increased risk of spontaneous preterm birth. In fact, FFN is one of the best predictors of preterm birth in all populations studied so far, and can help in selecting which women are at significant risk for …

Developing Physician Educational Competencies For The Management Of Female Genital Cutting: A Call To Action, Holly G. Atkinson, Amaris Geisler

Publications and Research

Female genital cutting (FGC), also called female genital mutilation, is defined as “all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious, or other nontherapeutic reasons.” FGC can have significant health consequences, including multiple physical and psychological complications, throughout the life course. Despite violating numerous human rights and existing legal prohibitions, the practice continues. In the United States, FGC is becoming increasingly prevalent, however, physicians are not routinely trained to care for these patients. Despite the evidence of the need, there is a woeful lack of …

‘I’M Here To Save My Life’: A Qualitative Study Of Experiences Navigating A Cryotherapy Referral System For Human Papillomavirus-Positive Women In Western Kenya, Megan Huchko, Konyin Adewumi, Sandra Oketch, Ibrahim Saduma, Elizabeth Bukusi

Obstetrics and Gynaecology, East Africa

Background: We sought to understand the beliefs, social norms and logistical factors that affect human papillomavirus (HPV)-positive women’s uptake of cryotherapy treatment as part of a two-part cervical cancer screening strategy in rural Kenya.

Methods: In-depth interviews within a parent cluster-randomised trial.

Setting: Government-run county hospital in western Kenya.

Participants: 273 of 372 (73.4%) HPV-positive women who underwent cryotherapy

Results: Many women feared that an HPV infection meant they would develop cancer. Almost all women reported initial fear of the treatment procedure, followed by a more positive experience than anticipated. Lacking funds for transportation to the treatment site was the …

Sealing The Diagnosis Of Celiac Disease In Pregnancy, Ritu Nahar, Md, Avani Aman, Md

The Medicine Forum

Introduction

Celiac disease (CD) is an immune mediated condition that results from a reaction to dietary gluten and primarily affects the small intestine. Genetically predisposed individuals develop a chronic inflammatory state of the small intestine which leads to malabsorption. The disease is mediated by HLA DQ2 or DQ8 haplotypes, which bind the gliadin peptides of gluten, present the peptides to CD4+ T lymphocytes and trigger cytokine and B lymphocyte responses.1

The prevalence of CD in the United States is approximately 1% and can reach up to 4-5% in at-risk groups.2 Serologic study of asymptomatic elderly patients in the United Kingdom …

Antibiotics For Operative Vaginal Delivery: Practice-Changing Data., Vincenzo Berghella, Federica Bellussi

Department of Obstetrics and Gynecology Faculty Papers

No abstract provided.

Obstetrical Providers’ Comfort And Knowledge Of Screening, Brief Intervention, And Referral To Treatment, Dennis J. Hand, Aasta Mehta, Emily Rosenthal, Alice C. Fischer, Tamara Tatevosian, Carrie Malanga, Laura Hart, Debra Dalessandro, Kristin Walker

Department of Obstetrics and Gynecology Posters

Background

Rates of substance use during pregnancy have continued to rise through 2017. It is likely that obstetrical providers are encountering many pregnant persons who use substances either during prenatal care or postpartum. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based model that has been successfully implemented in some obstetrical settings, but its implementation has been sporadic. The objective of this study was to determine the baseline level of familiarity and use of SBIRT elements among obstetrical providers to identify needs for future SBIRT implementation efforts.

Methods

Participants were physicians, medical students, nurses, and other staff attending …

Exploring Parental Wishes And Personhood In The Grey Zones Of Neonatal Resuscitation, Alison Lindsay

Honors Projects

The intense societal debate churning around the moral status of fetuses includes topics such as qualifications for personhood, the role of the autonomous decisions of a fetus’ mother, and the obligations of society to protect fetuses. This paper analyzes extending this discussion to newborns in five sections. The first section presents a literature review of responses to a philosophical paper about the respective interests of parents and fetuses and newborns, elaborating on aspects of personhood and parental decision-making. The second section presents a literature review of medical and nursing discussion around resuscitation for extremely premature newborns, focusing on similar evaluations …

Getting To The Source: Safety Findings In Cervical Cancer Screening Using External Lab Databases, Miranda Aragon, Md, Sunny Lai, Md, Mph, Geoffrey Mills, Md, Phd

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objective

To investigate the feasibility of using external lab databases to locate Pap smear results completed at outside clinics.

How Providing Cervical Cancer Screening Results Via Cell Phone Affects Patient Follow-Up Rates In Western Kenya, Megan J. Huchko, Ibrahim Saduma, Cinthia Blat, Sandra Oketch, Elizabeth Bukusi

Obstetrics and Gynaecology, East Africa

Purpose: Human papillomavirus (HPV) testing is being more widely used in simplified cervical cancer screening protocols in low-resource settings. One challenge to successful implementation is the multiple visits necessary to provide results and follow-up. mHealth strategies may reduce visit burden by providing information through text message.

Methods: As part of a cluster-randomized trial to compare HPV testing in clinics and community health campaigns in western Kenya, we carried out a mixed-methods study to assess women's preferences and experiences with different strategies to receive their results. Women could opt to receive their HPV results via text message, cell phone call, home …

A Prospective, Population-Based Study Of Trends In Operative Vaginal Delivery Compared To Cesarean Delivery Rates In Low- And Middle-Income Countries, 2010-2016., Margo S. Harrison, Sarah Saleem, Sumera Ali, Omrana Pasha, Elwyn Chomba, Waldemar A. Carlo, Ana L. Garces, Nancy F. Krebs, K. Michael Hambidge, Shivaprasad S. Goudar, S. M. Dhaded, Bhala Kodkany, Richard J. Derman, Archana Patel, Patricia L. Hibberd, Fabian Esamai, Edward A. Liechty, Antoinette Tshefu, Adrien Lokangaka, Melissa Bauserman, Carl L. Bose, Fernando Althabe, Jose M. Belizan, Pierre Buekens, Janet L. Moore, Dennis D. Wallace, Menachem Miodovnik, Marion Koso-Thomas, Elizabeth M. Mcclure, Robert L. Goldenberg

Global Health Articles

OBJECTIVE: Few data are available on cesarean delivery and operative vaginal delivery trends in low- and middle-income countries. Our objective was to analyze a prospective population-based registry including eight sites in seven low- and middle-income countries to observe trends in operative vaginal delivery versus cesarean delivery rates over time, across sites.

STUDY DESIGN: A prospective population-based study, including home and facility births among women enrolled from 2010 to 2016, was performed in communities in Argentina, Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and Zambia. Women were enrolled during pregnancy and delivery outcome data were collected.

RESULTS: We analyzed 354,287 …