Obstetrics and Gynecology Commons^™

Case Report: An Undiagnosed Bladder Diverticulum Resulting In Foley Catheter Perforation During Cesarean Section, A. Allison Roy, Nadim Bou Zgheib, Joseph Assaley

Marshall Journal of Medicine

A bladder diverticulum is diagnosed when herniated bladder mucosa forms an outpouching from the bladder. Bladder diverticula are uncommon and are significantly more common in males. The following case presents a patient with an undiagnosed bladder diverticulum which was incidentally perforated during foley catheter placement for a repeat cesarean section. The diagnosis can be difficult in those who are asymptomatic and lack risk factors, such as the following patient.

Ovarian Cysts, Vaginal Bleeding And Hypothyroidism In A 4-Year-Old Female With Down Syndrome: A Case Of Van Wyk-Grumbach Syndrome, Suniah S. Ayub, Ana Ruzic, Janice A. Taylor

Surgery Faculty Publications

Van Wyk-Grumbach Syndrome (VWGS) is a constellation of symptoms including precocious puberty without adrenarche, delayed bone age, ovarian cysts, and hypothyroidism. We report here a four-year-old Down Syndrome patient who presented for evaluation of abdominal distension, vaginal bleeding, and bilateral ovarian cysts. Her work-up and management demonstrates the importance of screening for hypothyroidism in Down Syndrome, as well as considering the diagnosis of VWGS when evaluating a patient with precocious puberty and an apparent intra-abdominal surgical process. Given the presence of ovarian masses, a surgical emergency such as ovarian torsion or rupture must be ruled out. Even when the diagnosis …

Constructing A Reference Framework For Ecep Evaluation: A Constructive Grounded Theory, Shelina Bhamani, Nasreen Husain

Department of Obstetrics & Gynaecology

The purpose of this research study, which is a thesis investigation, was to develop a reference framework that can help program staff to evaluate quality in Early Childhood Education (ECE) settings. The study was approached with three questions. This paper presents the first question of the study that enables practitioners to understand what are the variables that best define quality in early childhood education. The grounded theory, design was approached to explore the experiences of 20 ECE experts in the field. The data analysis revealed eight main indicators, that are, holistic development, interactive teaching, trained practitioners, conducive learning environment, safe …

One Year Symptom Severity And Health-Related Quality Of Life Changes Among Black African Patients Undergoing Uterine Fibroid Embolisation, Charles Mariara, Timona Obura, Nigel Hacking, William Stones

Obstetrics and Gynaecology, East Africa

Background: The main aim in the treatment of symptomatic fibroids by various modalities including uterine fibroid embolisation (UFE) is to alleviate symptoms and ultimately improve the quality of life. The efficacy of this modality of treatment in Black African women with significant fibroid burden and large uterine volumes is not clear. The main objective of the study was to examine potential changes in symptom severity among Black African patients 1 year following UFE for symptomatic uterine fibroids in a resource-constrained setting, rated using a validated questionnaire (UFS-QOL). Secondary outcomes examined were changes in quality of life and potential associations with …

Preeclampsia Biomarkers: An Assessment Of Maternal Cardiometabolic Health, Genevieve Eastabrook, Tuba Aksoy, Samantha Bedell, Debbie Penava, Barbra De Vrijer

Obstetrics & Gynaecology Publications

No abstract provided.

Is Pregnancy-Associated Melanoma Associated With Adverse Outcomes?, Maris S Jones, Jihey Lee, Stacey L Stern, Mark Faries

Articles, Abstracts, and Reports

BACKGROUND: Melanoma is the most common malignancy encountered during pregnancy. Conflicting data have led to ongoing confusion regarding pregnancy-associated melanoma (PAM) in the media and among the public. The objective of this study was to better characterize both the clinical presentation of PAM and its prognostic implications.

STUDY DESIGN: Female patients of reproductive age, with stage 0 to IV cutaneous melanoma, were identified from our prospectively maintained database. Clinical and histopathologic factors were analyzed with appropriate statistical methods. Univariable and then multivariable analysis were used on matched data to compare disease-free survival (DFS), overall survival (OS), and melanoma-specific survival (MSS) …

Expression Of Placental Regulatory Genes Is Associated With Fetal Growth, Maya A. Deyssenroth, Qian Li, Marina Lacasaña, Yoko Nomura, Carmen Marsit, Jia Chen

Publications and Research

The placenta is the principal organ regulating respiratory, nutritional, endocrine and metabolic functions on behalf of the developing fetus. Changes in gene expression patterns of placenta-specific genes may influence fetal growth. We profiled the expression of 17 genes related to placenta functioning in term placentas (n=677) to identify genes differentially expressed across birth weight categories [small (SGA), appropriate (AGA) and large (LGA) for gestational age]. ABCG2, CEBPB, CRH, GCM1, GPC3, INSL4, PGF and PLAC1 were inversely associated with LGA status, with odds ratios (ORs) and 95% confidence intervals (CI) ranging from GCM1 (OR=0.44, 95% CI: 0.29, 0.70) to CRH (OR=0.73, …

Cesarean In The Second Stage: A Possible Risk Factor For Subsequent Spontaneous Preterm Birth., Vincenzo Berghella, Alexis C. Gimovsky, Lisa D. Levine, Joy Vink

Department of Obstetrics and Gynecology Faculty Papers

No abstract provided.

The Development And Psychometric Analysis Of The Mu- Fertility Knowledge Assessment Scale, Qiyan Mu

Dissertations (1934 -)

Young women between the ages of 18 to 24 experience disproportionally high rates of negative sexual and reproductive health outcomes. Inadequate and inaccurate fertility knowledge can hinder a young woman’s self-care abilities in managing her sexual and reproductive health. There is no validated instrument to assess young women’s fertility knowledge. The primary purpose of this study is to develop and evaluate the psychometric properties of the MU-fertility knowledge assessment scale (MU-FKAS) for young women. The secondary purpose is to explore the relationships among young women’s individual and contextual factors, self-perceived fertility knowledge, actual fertility knowledge, and fertility health risks. A …

Intimate Partner Violence Among Hiv Infected And Uninfected Pregnant Women Delivering At A National Hospital In Tanzania: Using A Modified Screening Tool, Hussein Kidanto, Andrew H. Mgaya, Birgitta Essen

Obstetrics and Gynaecology, East Africa

Background: Worldwide Intimate Partner Violence (IPV) is a major public health problem, affecting all women and vulnerable groups such as HIV-infected women. This study aimed to test the applicability of assessment of IPV using a simple screening tool, among women giving birth at Muhimbili National Hospital in Tanzania, to estimate the prevalence and severity of IPV among HIV-infected and uninfected pregnant women, and to assess the odds of IPV among both groups of women.

Methods: A questionnaire including screening questions was applied to women delivered at Muhimbili National Hospital to identify those that experienced IPV. Demographics, HIV status, male partner’s …

Determinants Of Knowledge Of Critical Danger Signs, Safe Childbirth And Immediate Newborn Care Practices Among Auxiliary Midwives: A Cross Sectional Survey In Myanmar, Kyu Kyu Than, Alison Morgan, Minh Duc Pham, James G. Beeson, Stanley Luchters

Population Health, East Africa

Objectives The re-emergence of community-based health workers such as the auxiliary midwives (AMWs) in Myanmar, who are local female volunteers, has been an important strategy to address global health workforce shortages. The Myanmar government recommends one AMW for every village. The aim of this study is to investigate the current knowledge of critical danger signs and practices for safe childbirth and immediate newborn care of AMWs to inform potential task shifting of additional healthcare responsibilities.

Methods A cross-sectional survey was conducted from July 2015 to June 2016 in three hard-to-reach areas in Myanmar. Face-to-face interviews were conducted using a pretested …

Anthropometric Indices For Non-Pregnant Women Of Childbearing Age Differ Widely Among Four Low-Middle Income Populations, K Michael Hambidge, Nancy F. Krebs, Ana Garcés, Jamie E. Westcott, Lester Figueroa, Shivaprasad S. Goudar, Sangappa Dhaded, Omrana Pasha, Sumera Aziz Ali, Antoinette Tshefu

Community Health Sciences

Background: Maternal stature and body mass indices (BMI) of non-pregnant women (NPW) of child bearing age are relevant to maternal and offspring health. The objective was to compare anthropometric indices of NPW in four rural communities in low- to low-middle income countries (LMIC).
Methods: Anthropometry and maternal characteristics/household wealth questionnaires were obtained for NPW enrolled in the Women First Preconception Maternal Nutrition Trial. Body mass index (BMI, kg/m²) was calculated. Z-scores were determined using WHO reference data.
Results: A total of 7268 NPW participated in Equateur, DRC (n = 1741); Chimaltenango, Guatemala (n = 1695); North …

A Functional Algorithm For Weight Loss And Obesity Practice: Guide For Clinical Decision-Making For Treating Women, Jennifer A. Tice Williams

Dissertations

ABSTRACT

Background

Overweight and obesity have significant impact and consequences on women leading to reduced quality of life, comorbid conditions and premature mortality. Many healthcare providers lack adequate training and the time to properly treat overweight and obesity. Algorithms have been shown to improve clinical knowledge and save time.

Objectives

To develop an algorithm for weight loss assessment and treatment to aid in the clinical decision-making process while improving the quality of care for overweight and obese clients in an efficient manner that can be replicated.

Methods

After an extensive literature review to identify best-practice guidelines for weight loss a …

An Intravaginal Ring That Releases Three Antiviral Agents And A Contraceptive Blocks Shiv-Rt Infection, Reduces Hsv-2 Shedding, And Suppresses Hormonal Cycling In Rhesus Macaques, Nina Derby, Meropi Aravantinou, Jessica Kenney, Shweta R. Ugaonkar, Asa Wesenberg, Jolanta Wilk, Larisa Kizima, Aixa Rodriguez, Shimin Zhang, Olga Mizenina, Keith Levendosky, Michael L. Cooney, Samantha Seidor, Agegnehu Gettie, Brooke Grasperge, James Blanchard, Michael Piatak Jr., Jeffery D. Lifson, José Fernández-Romero, Thomas M. Zydowsky, Melissa Robbiani

Publications and Research

Women globally need access to multipurpose prevention technologies (MPTs) that prevent human immunodeficiency virus (HIV), sexually transmitted infections that increase HIV acquisition/transmission risk, and unintended pregnancy. Seeking an MPTwith activity against HIV, herpes simplex virus-2 (HSV-2), and human papillomavirus (HPV), we developed a prototype intravaginal ring (IVR), the MZCL IVR, which released the antiviral agents MIV-150, zinc acetate, and carrageenan (MZC for short) and the contraceptive levonorgestrel (LNG). Previously, we showed that an MZC gel has potent activity against immunodeficiency viruses, HSV-2, and HPVand that the MZCL (MZC with LNG) IVR releases all four components in macaques in vivo at …

Is Time Of Birth A Predictor Of Adverse Perinatal Outcome? A Hospital-Based Cross-Sectional Study In A Low-Resource Setting, Tanzania, Andrew H. Mgaya, Januarius Hinju, Hussein Kidanto

Faculty of Health Sciences, East Africa

Background Inconsistent evidence of a higher risk of adverse perinatal outcomes during off-hours compared to office hours necessitated a search for clear evidence of an association between time of birth and adverse perinatal outcomes.

Methods A cross-sectional study conducted at a tertiary referral hospital compared perinatal outcomes across three working shifts over 24 h. A checklist and a questionnaire were used to record parturients’ socio-demographic and obstetric characteristics, mode of delivery and perinatal outcomes, including 5th minute Apgar score, and early neonatal mortality. Risks of adverse outcomes included maternal age, parity, referral status and mode of delivery, and were assessed …

The Quest For Sustained Multiple Morbidity Reduction In Very Low-Birth-Weight Infants: The Antifragility Project., Joseph Kaempf, N M Schmidt, S Rogers, C Novack, M Friant, L Wang, N Tipping

Articles, Abstracts, and Reports

OBJECTIVE: Can a comprehensive, explicitly directive evidence-based guideline for all therapies that might affect the major morbidities of very low-birth-weight (VLBW) infants help a neonatal intensive care unit (NICU) further improve generally favorable morbidity rates? Can Antifragility principles of provider adaptive growth from stressors, enhanced infant risk assessment and adherence to effective therapies minimize unproven treatments and reduce all morbidities?

STUDY DESIGN: Prospectively planned observational trial in VLBW infants: control group born October 2011 to September 2013 and study group October 2013 to September 2015. Multi-disciplinary evidence-based review assigned all NICU treatments into one of four distinct categories: (1) always …

Whisper Or Shout Study: Protocol Of A Cluster-Randomised Controlled Trial Assessing Mhealth Sexual Reproductive Health And Nutrition Interventions Among Female Sex Workers In Mombasa, Kenya, Frances H. Ampt, Collins Mudogo, Peter Gichangi, Megan S. C. Lim, Griffins Manguro, Matthew Chersich, Walter Jaoko, Marleen Temmerman, Marilyn Laini, Stanley Luchters

Population Health, East Africa

Introduction New interventions are required to reduce unintended pregnancies among female sex workers (FSWs) in low- and middle-income countries and to improve their nutritional health. Given sex workers’ high mobile phone usage, repeated exposure to short messaging service (SMS) messages could address individual and interpersonal barriers to contraceptive uptake and better nutrition.

Methods In this two-arm cluster randomised trial, each arm constitutes an equal-attention control group for the other. SMS messages were developed systematically, participatory and theory-driven and cover either sexual and reproductive health (WHISPER) or nutrition (SHOUT). Messages are sent to participants 2–3 times/week for 12 months and include …

Prenatal Care Enhanced With Digital Health Tools Can Reduce Visit Frequency While Improving Patient Satisfaction, Kathryn I. Marko, Nihar Ganju, Anish Sebastian, Joshua Benham

Medicine Faculty Posters and Presentations

100 low-risk obstetric patients were enrolled to evaluate the use of digital health technology in prenatal care. 50 patients were placed on an alternate prenatal care schedule (8 visits), supplemented with an integrated technology platform of a mobile application and connected devices including a wireless weight scale and blood pressure cuff. The remaining 50 control patients received routine care, without the technology platform. Patients were evaluated for satisfaction and engagement throughout pregnancy.

Association Between Female Sexual Dysfunction And Fertility Among Women Of Reproductive Age At The Aga Khan University Hospital, Nairobi., Felix Mwembi Oindi

Master of Medicine in Obstetrics and Gynecology

Introduction: Sexual function plays an essential role in the bio-psychosocial wellbeing and quality of life of women and disturbances in sexual functioning often result in significant stress. Sexual dysfunction in women is a highly prevalent condition affecting up to 43% of women. Subfertility being a common problem affecting up to 20% of the population, causes significant psychosocial distress which might adversely affect sexual functioning and vice versa. However, despite the high prevalence of both conditions, little has been studied on the effects of subfertility on sexual functioning especially in sub-Saharan Africa. Objectives: This study primarily compared the prevalence of female …

Chlamydia Screening In Women At A University Student Health Center, Jaime K. Carroll, Karen Macauley

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidenced-based project was to increase chlamydia pre- screening and screening in women under age 25 presenting with urinary symptoms. Interventions included chlamydia pre-screening alerts embedded into the electronic medical record. Three-month evaluation showed a chlamydia pre-screening rate of 100% and an increase in chlamydia screening by 9%.