Obstetrics and Gynecology Commons^™

Improving Obstetrics In Family Medicine Residency Clinics: A Quality Improvement Study, Garima Chawla, Jessica J.F. Kram, Bonnie Bobot, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Background: Prenatal care/deliveries within our family medicine clinics have declined, perhaps because patients are unaware that our clinics provide these services. With lower volumes, clinicians may feel less comfortable with current skills/knowledge of obstetric (OB) care.

Purpose: Increase family medicine clinic OB numbers, patient awareness, and clinician comfort/knowledge in OB.

Methods: English-facile patients (18–50 years), residents and faculty at Aurora family medicine residency clinics were included. Patients were provided preintervention surveys upon check-in. Residents/faculty were surveyed via Survey Monkey. Changes made based on initial survey results were: 1) increasing systemwide awareness that our caregivers provide OB care, through fliers at …

Evolution Of Knowledge, Awareness, And Practices Regarding Zika Virus From 2016 To 2017, Quinton Katler, Prachi Godiwala, Charles J. Macri, Beth Pineles, Gary Simon, Aileen Chang, Homa Ahmadzia

Obstetrics and Gynecology Faculty Publications

Objective. Our team created a knowledge, attitudes, and practice (KAP) survey in order to assess changes over time in healthcare provider and community member awareness of Zika virus symptoms, transmission, treatment, and current and future concerns.

Study Design. The cross-sectional survey was issued at an academic medical center in Washington, DC, and via an online link to healthcare providers and community members between June and August 2016. Survey distribution was then repeated the following year, from March to April 2017. Outcomes were compared by survey year and healthcare provider versus community member status using SAS Program Version 9.4.

Results. Significant …

Geographic Disparities In The Distribution Of The U.S. Gynecologic Oncology Workforce: A Society Of Gynecologic Oncology Study, Stephanie Ricci, Ana Tergas, Kara Roche, Melissa Fairbairn, Kimberly Levinson, Micael Lopez-Acevedo, +Several Additional Authors

Obstetrics and Gynecology Faculty Publications

A recent ASCO workforce study projects a significant shortage of oncologists in the U.S. by 2020, especially in rural/underserved (R/US) areas. The current study aim was to determine the patterns of distribution of U.S. gynecologic oncologists (GO) and to identify provider-based attitudes and barriers that may prevent GOs from practicing in R/US regions. U.S. GOs (n = 743) were electronically solicited to participate in an on-line survey regarding geographic distribution and participation in outreach care. A total of 320 GOs (43%) responded; median age range was 35–45 years and 57% were male. Most practiced in an urban setting (72%) at …

Factors Associated With Women's Intention To Request Caesarean Delivery In Dar Es Salaam, Tanzania, C G. Misaeli, B A. Kamala, A H. Mgaya, Hussein Kidanto

Faculty of Health Sciences, East Africa

Background. In the past decade, the rate of caesarean section (CS) has increased dramatically in many parts of the world. At Muhimbili National Hospital (MNH) there has been a dramatic rise in the caesarean section rate over the past decade.

Objective. To determine the incidence of maternal request for CS and factors associated with intention to request caesarean section at the MNH antenatal clinic.

Methods. We conducted a cross-sectional study from August to October 2014. A structured questionnaire gathered participants’ background and obstetric information, perceptions and opinions regarding a request for caesarean section, and the respective reasons for …

Factors Associated With Low Birthweight In Term Pregnancies: A Matched Case-Control Study From Rural Pakistan, Atif Habib, Greenow Cr, S Ariff, Sajid Bashir Soofi, A Hussain, Q Junejo, A Hussain, F Shaheen, K Black

Woman and Child Health

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

Prevalence Of High Risk Hpv In Hiv+ And Hiv-Women With Cervical Dysplasia At The Moi Teaching And Referral Hospital, Seth Kirui, Kirtika Patel, Elkanah Omenge

Obstetrics and Gynaecology, East Africa

Background: Cervical cancer, caused by Human Papillomavirus, is the second commonest cancer among women. HIV+ women are at a higher risk of acquiring HPV, developing pre-cervical cancer lesions (dysplasia) and cervical cancer. Early diagnosis is key to prevention of cervical cancer but reduced sensitivities and specificities of available screening methods pose challenges. The role of HPV in VIA related dysplasia has not been extensively interrogated. We sought to understand HPV infection in the context of HIV status and its relationship to VIA dysplasia

Objectives: To compare prevalence of high risk HPV in HIV positive and HIV negative women with and …

Women And Substance Use: A Qualitative Study On Sexual And Reproductive Health Of Women Who Use Drugs In Delhi, India, Vartika Sharma, Avina Sarna, Waimar Tun, Lopamudra Ray Saraswati, Ibou Thior, Ira Madan, Stanley Luchters

Population Health, East Africa

Objectives: To explore contextual factors that increase vulnerabilities to negative sexual and reproductive health (SRH) outcomes and possible differences in SRH-related behaviours and the needs of women who use drugs (WUD) through non-injecting and injecting routes.

Design: Qualitative study design using semi-structured in-depth interviews.

Participants: Twenty women who injected drugs in the past 3months and 28 women who reported using drugs through non-injecting routes in the past 1month.

Setting: Interviews were conducted at community-based, drop-in centres in Delhi, India.

Results: Study findings illustrate that WUD were sexually active and had multiple sex partners including clients of sex work. Transient relationships …

Educating Before Birth Via Talking To The Baby In The Womb: Prenatal Innovations, Shelina Bhamani

Department of Obstetrics & Gynaecology

Education is the only major weapon that enables nations to progress socio-economically and gives a huge rise to their human development index. More so, it is considered to be the most fundamental requirement for poverty eradication, for addressing socio-political issues and for stabilizing peace and harmony among nations. Education is a lifelong process and does not have a preset parameter for its accessibility and provision (Sharkey, 1998). Learning is innate and natural and the human mind is set to learn since its conception. Additionally, in the recent era, investigations are focused on education and learning even before birth and extensive …

Reducing Postoperative Opioids After Minimally Invasive Gynecologic Surgery With Multimodal Pain Control, Kevin D. White, William C. Wallace, Nadim Zgheib

Marshall Journal of Medicine

Introduction:

We evaluated the efficacy of a multimodal pain regimen that approaches pain control by utilizing different mechanisms of action. This novel protocol utilizing liposomal bupivacaine, acetaminophen, tramadol and oxycodone as needed in reducing the overall opioid use by patients after undergoing robotic-assisted total laparoscopic hysterectomy in an obese population that is heavily afflicted by the opioid epidemic.

Materials and Methods:

We conducted a retrospective study wherein a sample of 100 (50 multimodal group and 50 controls) were taken from 433 eligible cases conducted over a 1 year period. Patient medical records were evaluated for demographics, surgical characteristics, opioid type …

Contingency Management For Smoking Cessation In Pregnancy, Jacob Miller, Brady Reynolds, Courtney Crain, Hisham Keblawi, Lynne J. Goebel

Marshall Journal of Medicine

This pilot study examined the feasibility of applying Contingency Management (CM), where the woman receives financial compensation for abstinence from smoking. Eleven subjects were recruited from Marshall’s OB clinic for the program. CO levels were measured daily using online video recording. Quit rates were determined at the end of pregnancy. Birth outcomes were measured at delivery. 21 pregnant smokers from Marshall’s OB clinic were used as the control group. The results demonstrated a trend toward improved rates of smoking abstinence in CM participants as compared with the control group. Our study also showed a trend towards improved birth outcomes in …

Sheehan’S Syndrome: It Is Time To Become More Proactive In Identifying This Disease, Yara E. Tovar, Waseem Ahmed, Madhulika Urella, Ayman H. Elkadry, Rodhan A. Khthir

Marshall Journal of Medicine

Sheehan’s syndrome typically occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage and can present with varying degrees of pituitary insufficiency. It is more common in underdeveloped countries, and is frequently diagnosed years after delivery due to its nonspecific signs and symptoms. Failure to lactate is a common initial symptom, while many women also report amenorrhea or oligomenorrhea. This article presents a 26-year-old female with a history of hypertension, who presented to the hospital for diarrhea, vomiting, and dizziness. Her blood pressure was 80/40 mmHg, requiring aggressive fluid resuscitation, after which it remained borderline. Further testing …

Severe Uterine Bleeding, Catherine Olubummo

Publications and Research

No abstract provided.

A Pilot Study For Enhancing Postpartum Discharge Instructions For Incision Care: Assessment Of Comprehension, Rebekah Jo Mccurdy, Md, Rebecca Lawrence, Bs, Sarah Cohen, Bs, Jason K. Baxter, Md, Mscp

CwiC Posters

Literacy and Health Care

• 14.5% of United States is illiterate 1

• Reading level of most medical forms is 10th grade 2

Improving Outcomes with a Visual Aid

• Cesarean Surgical Site Infection (SSI) rate is 5% 3

• A patient with a SSI can be 2 times as expensive 4

• Visual aids improve information recall 8 and confidence in wound care 5

Study Objectives

1. To evaluate the readability of the cesarean wound care discharge instructions relative to the patient population’s reading level

2. To conduct a pilot Randomized Control Trial (RCT) to evaluate the effectiveness of …

First Trimester Medication Abortion Practice In The United States And Canada, Heidi E. Jones, Katharine O'Connell White, Wendy V. Norman, Edith Guilbert, E. Steve Lichtenberg, Maureen Paul

Publications and Research

We conducted a cross-sectional survey of abortion facilities from professional networks in the United States (US, n = 703) and Canada (n = 94) to estimate the prevalence of medication abortion practices in these settings and to look at regional differences. Administrators responded to questions on gestational limits, while up to five clinicians per facility reported on 2012 medication abortion practice. At the time of fielding, mifepristone was not approved in Canada. 383 (54.5%) US and 78 (83.0%) Canadian facilities participated. In the US, 95.3% offered first trimester medication abortion compared to 25.6% in Canada. While 100% of providers were …

Impact Of Maternal Vaccination Timing And Influenza Virus Circulation On Birth Outcomes In Rural Nepal., Naoko Kozuki, Joanne Katz, Janet A Englund, Mark C Steinhoff, Subarna K Khatry, Laxman Shrestha, Jane Kuypers, Luke C Mullany, Helen Y Chu, Steven C Leclerq, James M Tielsch

Global Health Faculty Publications

Objective

To describe the effect of maternal vaccination on birth outcomes in rural Nepal, modified by timing of vaccination in pregnancy and influenza virus activity.

Methods

A secondary analysis was conducted using data from two annual cohorts of a randomized controlled trial. A total of 3693 pregnant women from Sarlahi District were enrolled between April 25, 2011, and September 9, 2013. All participants were aged 15–40 years and received a trivalent inactivated influenza vaccine or placebo. The outcome measures included birth weight, pregnancy length, low birth weight (<2500 g), preterm birth, and small‐for‐gestational‐age birth.

Results

Data were available on birth weight for 2741 births and on …

The Psychological Influence Of The Diagnosis Of Breast Cancer On Therapeutic Options Selection, Razvan V. Scaunasu, Stefan Voiculescu, Bogdan Popescu, Cristina Cozma, Radu Jecan, Cristian Balalau

Journal of Mind and Medical Sciences

The therapeutic management decision-making process for breast cancer is complex, and is influenced by multiple factors including patient age, comorbidities, ethnicity, education, and availability of immediate or delayed reconstruction options. Our study analysed 276 patients diagnosed with breast cancer in the “Colțea” Clinical Hospital between 2014 and 2015. Mean patients age was 61.24, median 62, with a range of 31 to 89 years. Younger age was associated with a less advanced local disease and younger patients were more likely to choose and benefit from conservative surgery. Most patients (61.76%) came from rural areas. Place of origin had a significant influence …

Cesarean Scar Defects And Placental Abnormalities – A 3 Year Survey Study, Denisa Oana Bălălău, Nicolae Bacalbașa, Anca D. Stănescu

Journal of Mind and Medical Sciences

The placenta is an essential organ for embryonic and fetal development, ensuring nutrient uptake, gas exchange (via the mother's blood supply), waste elimination, thermo-regulation, immunological and hormonal factors, etc. The most common placental abnormalities are represented by placenta previa, and a morbidly adherent placenta (in the form of accreta, increta, and percreta placenta). This study was performed on a sample of 99 patients diagnosed with abnormalities of placentation who underwent cesarian delivery during a period of 3 years in Bucur Maternity Hospital. Seven patients were diagnosed with morbidly adherent placenta (5 accreta and 2 percreta subtypes), the others having placenta …

Development Of A Unifying Target And Consensus Indicators For Global Surgical Systems Strengthening: Proposed By The Global Alliance For Surgery, Obstetric, Trauma, And Anaesthesia Care (The G4 Alliance), Adil H. Haider, John W. Scott, Colin D. Gause, Mira Meheš, Grace Hsiung, Albulena Prelvukaj, Dana Yanocha, Lauren M. Baumann, Faheem Ahmed, Asad Latif

Section of General Surgery

After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health …

Use Of Palliative Cisplatinum For Advanced Cervical Cancer In A Resource-Poor Setting: A Case Series From Kenya, Elkanah Omenge, Peter Itsura, Philip Kipkirui Tonui, Hellen N. Muliro, Barry Rosen, Luc Van Lonkhuijzen

Obstetrics and Gynaecology, East Africa

Purpose: To evaluate the effectiveness and feasibility of cisplatinum for palliative treatment of advanced cervical cancer in a resource-poor setting.
Methods: An observational case series is reported from a university teaching hospital in Kenya. All women presenting with advanced cervical cancer and planned for palliative cisplatinum therapy from 2010 to 2014 were included. Women were treated with cisplatinum 50 mg/m2 every 4 weeks in an outpatient setting. Data on tumor stage and symptoms control were prospectively collected in an electronic database. The main outcome measure was control of symptoms such as bleeding, discharge, and pain.
Results: Of the women who …

When The Health System Fails You: Maternal Care Under Kenya’S 2017 Nurses' Strike, Tessa Coughtrey-Davenport

Independent Study Project (ISP) Collection

This study focuses on the 2017 nurses’ strike and how the crippling of the public health system impacted maternal care in Kisumu, Kenya. Kenya has one of the highest maternal mortality ratios in the world, and there have been many efforts to reduce this, such as delivery with a Skilled Birth Attendant and attending antenatal care visits, all of which are centered around a functioning health system. The research team used a combination of interviews with key populations and analysis of service delivery data at local health centers to evaluate the effects of the strike on maternal care. The study …