Obstetrics and Gynecology Commons^™

Improving Pregnancy Outcomes In Low- And Middle-Income Countries, Robert L. Goldenberg, Elizabeth M. Mcclure, Sarah Saleem

Community Health Sciences

This paper reviews the very large discrepancies in pregnancy outcomes between high, low and middle-income countries and then presents the medical causes of maternal mortality, stillbirth and neonatal mortality in low-and middle-income countries. Next, we explore the medical interventions that were associated with the very rapid and very large declines in maternal, fetal and neonatal mortality rates in the last eight decades in high-income countries. The medical interventions likely to achieve similar declines in pregnancy-related mortality in low-income countries are considered. Finally, the quality of providers and the data to be collected necessary to achieve these reductions are discussed. It …

Incidence Of Unintended Pregnancy Among Female Sex Workers In Low-Income And Middle-Income Countries: A Systematic Review And Meta-Analysis, Frances H. Ampt, Lisa Willenberg, Paul A. Agius, Matthew Chersich, Stanley Luchters, Megan S. C. Lim

Population Health, East Africa

Objectives: To determine the incidence of unintended pregnancy among female sex workers (FSWs) in lowincome and middle-income countries (LMICs).

Design: We searched MEDLINE, PsychInfo, Embase and Popline for papers published in English between January 2000 and January 2016, and Web of Science and Proquest for conference abstracts. Meta-analysis was performed on the primary outcomes using random effects models, with subgroup analysis used to explore heterogeneity.

Participants: Eligible studies targeted FSWs aged 15–49 years living or working in an LMIC.

Outcome measures: Studies were eligible if they provided data on one of two primary outcomes: incidence of unintended pregnancy and incidence …

Stratification Of Ovarian Tumor Pathology By Expression Of Programmed Cell Death-1 (Pd-1) And Pd-Ligand- 1 (Pd-L1) In Ovarian Cancer, Maureen L. Drakes, Swati Mehrotra, Monica Aldulescu, Ronald K. Potkul, Yueying Liu, Anne Grisoli, Cara Joyce, Timothy O'Brien, M. Sharon Stack, Patrick J. Stiff

Mathematics and Statistics: Faculty Publications and Other Works

Background

Ovarian cancer is the major cause of death among gynecologic cancers with 75% of patients diagnosed with advanced disease, and only 20% of these patients having a survival duration of five years. Treatments blocking immune checkpoint molecules, programmed cell death (PD-1) or its ligand PD-ligand- I (PD-L1) have produced a beneficial and prolonged effect in a subgroup of these patients. However, there is debate in the literature concerning the prognostic value of the expression of these molecules in tumors, with immunotherapy responsiveness, and survival.

We evaluated the immune landscape of the ovarian tumor microenvironment of patients, by measuring the …

Difference In The Level Of Utilization And Determinants Of Preconception Care Among Pregnant Women In Aga Khan University Hospital And Maragua Level Four Hospital., Joan Okemo

Master of Medicine in Obstetrics and Gynecology

Background: Preconception care (PCC) is an important form of primary health care that aims to identify risks, offer patient education and evidence based interventions prior to conception in order to improve maternal and fetal short and long term health outcomes. Despite the benefits of PCC, the global levels of utilization are still low, more so in developing countries and in the rural settings. This study aimed to determine the difference in the level and determinants of PCC in both urban and rural settings in Kenya. Objectives: The primary objective of this study was to compare PCC among pregnant women in …

Uterine Necrosis After Uterine Artery Embolization For Symptomatic Fibroids, Steve Mutiso, Felix Oindi, Nigel Hacking, Timona Obura

Obstetrics and Gynaecology, East Africa

Introduction: Uterine artery embolization (UAE) is a minimally invasive intervention that is used in the treatment of fibroids. UAE can lead to complications including postembolization syndrome, postprocedure pain, infection, endometrial atrophy leading to secondary amenorrhea, and uterine necrosis. Uterine necrosis afer UAE is very rare and hence poses a clinical dilemma for any clinician in its identifcation and management. We document a case of uterine necrosis afer UAE and conduct a literature review on its causation, clinical features, and management principles.

Case: A patient presented one month afer UAE with abdominal pain and abdominal vaginal discharge. Her work-up revealed features …

Banning Abortion In Cases Of Down Syndrome: Important Lessons For Advances In Genetic Diagnosis, Rebecca Reingold, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

In December 2017, Ohio passed into law legislation that prohibited physicians from performing abortions if the pregnant woman’s decision was influenced by her belief that the fetus has Down syndrome. Physicians who perform abortions in these cases would face fourth-degree felony charges and revocation of their medical license. No other state bans abortion specifically for Down syndrome, but several ban abortions in cases of genetic diseases. Lower courts have struck down most such laws, holding they violate the constitutional rights of women. In February 2018, a federal district court judge blocked enforcement of Ohio’s law pending a final determination.

This …

Iron Isomaltoside Is Superior To Iron Sucrose In Increasing Hemoglobin In Gynecological Patients With Iron Deficiency Anemia., Richard Derman, Eloy Roman, Gioi N. Smith-Nguyen, Maureen M. Achebe, Lars L. Thomsen, Michael Auerbach

Global Health Articles

No abstract provided.

Successful Use Of Balloon Tamponade In The Management Of Postpartum Hemorrhage In A Case Of Bicornuate Uterus, Erum Saleem, Ayesha Basharat

Department of Obstetrics & Gynaecology

Worldwide 50%–70% of all cases of maternal morbidity have been attributed to postpartum hemorrhage. This report discusses a case of bicornuate uterus in a term pregnancy. The delivery was by cesarean section, which was followed by massive postpartum hemorrhage, managed successfully with balloon tamponade. This is the second reported case of successful management of post partum hemorrhage in a bicornuate uterus with balloon tamponade. A 22-year-old primigravida at 39 weeks of gestational age presented with vaginal leaking of clear fluid. Cesarean section was done due to meconium stained liquor in early labor; with an incidental finding of bicornuate uterus followed …

Regular Exercise Throughout Pregnancy And Maternal Recovery Postpartum, Rachel Jenkins

Graduate Theses & Dissertations

Abstract

Introduction: The American College of Obstetricians and Gynecologists recommends that “women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength-conditioning exercises before, during, and after pregnancy.”1 Many pregnant mothers seek guidance regarding exercise regimens’ safety and efficacy. This paper is a systematic review of the current literature on the topic of exercise regimens performed throughout pregnancy and maternal postpartum recovery.

Purpose: To determine if following the American College of Obstetricians and Gynecologists recommendation to engage in regular aerobic and strength-conditioning exercises throughout pregnancy contributes to easier deliveries as measured by the number of caesarean sections, time …

Stress Urinary Incontinence In Collegiate Female Athletes: Prevalence And Impact, Marie Bouchard

Master's Projects and Capstones

Abstract

Introduction, definition: Urinary incontinence is the involuntary leaking of urine (a few drops to a few milliliters). It can happen while exercising with no urge to urinate (stress urinary incontinence), with a sudden urge to urinate (overactive bladder or urgency urinary incontinence), or a combination of the two (mixed urinary incontinence). This issue is very common among female athletes. However, because of the reluctance to discuss this problem, it remains underdiagnosed and undertreated.

Methods:An anonymous and confidential survey was distributed to the 90 University of San Francisco female student athletes from seven different varsity sports in December 2017. …

Intermittent Fetal Heart Rate Monitoring Using A Fetoscope Or Hand Held Doppler In Rural Tanzania: A Randomized Controlled Trial, Paschal Francis Mdoe, Hege L. Ersdal, Estomih R. Mduma, Jeffrey M. Perlman, Robert Moshiro, Peter T. Wangwe, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

Background: Neonatal mortality is a global challenge, with an estimated 1.3 million intrapartum stillbirths in 2015. The majority of these were found in low resource settings with limited options to intrapartum fetal heart monitoring devices. This trial compared frequency of abnormal fetal heart rate (FHR) detection and adverse perinatal outcomes (i.e. fresh stillbirths, 24-h neonatal deaths, admission to neonatal care unit) among women intermittently assessed by Doppler or fetoscope in a rural low-resource setting.

Methods: This was an open-label randomized controlled trial conducted at Haydom Lutheran Hospital from March 2013 through August 2015. Inclusion criteria were; women in labor, …

Osteopathic Manipulative Medicine In Pregnancy, Xinhua Chen, Maria Nguyen, Sophia Vogiatzidakis

Rowan-Virtua Research Day

Women experience physiologic and structural changes during pregnancy. Osteopathic manipulative medicine (OMM) involves the examination of the whole patient, including body, mind, and spirit. This involves treatment of any stresses placed on the body, including the structural changes in the maternal body. Clinical studies thus far on OMM in pregnancy have shown when used during pregnancy, it improves musculoskeletal pain such as low back pain, and may positively affect some labor and delivery outcomes. The purpose of this study was to evaluate the effectiveness of OMM during pregnancy in reducing the rate of cesarean section and several other labor and …

A Rare But Life Threatening Case Of Labile Blood Pressures In Pregnancy, Kelsey Carrio, Aarti Aggarwal, Susan Mcgroarty

Rowan-Virtua Research Day

Pheochromocytoma is a rare but life threatening adrenal secreting tumor. The infrequency with which it is encountered makes pheochromocytoma, especially in pregnancy, a formidable diagnostic challenge.

Although a pheochromocytoma is rare, it is good to keep it in differential diagnosis as a possible cause of labile BP with headaches and significant orthostatic BP. It is critical to recognize this condition to institute an appropriate therapy & surgical intervention to prevent mortality.

Intimate Partner Violence, Forced First Sex And Adverse Pregnancy Outcomes In A Sample Of Zimbabwean Women Accessing Maternal And Child Health Care, Simukai Shamu, Stephen Munjanja, Christina Zarowsky, Patience Shamu, Marleen Temmerman, Naeemah Abrahams

Obstetrics and Gynaecology, East Africa

Background: Intimate partner violence (IPV) remains a serious problem with a wide range of health consequences including poor maternal and newborn health outcomes. We assessed the relationship between IPV, forced first sex (FFS) and maternal and newborn health outcomes.

Methods: A cross sectional study was conducted with 2042 women aged 15–49 years attending postnatal care at six clinics in Harare, Zimbabwe, 2011. Women were interviewed on IPV while maternal and newborn health data were abstracted from clinic records. We conducted logistic regression models to assess the relationship between forced first sex (FFS), IPV (lifetime, in the last 12 months and …

Does Courtesy Bias Affect How Clients Report On Objective And Subjective Measures Of Family Planning Service Quality? A Comparison Between Facility- And Home-Based Interviews, Waqas Hameed, Muhammad Ishaque, Xaher Gul, Junaid-Ur-Rehman Siddiqui, Sharmeen Hussain, Wajahat Hussain, Aftab Ahmed, Asma Balal

Community Health Sciences

Purpose: Despite a general understanding that exit interviews being conducted at service providers' facilities may influence clients' responses favorably to health professionals, there is very little evidence available that demonstrates the extent to which this problem exists. This study aimed at assessing and comparing clients' perceptions of the quality of family planning services and their satisfaction levels between facility- and home-based interviews.
Methods: A cross-sectional survey was conducted among clients receiving family planning services across three service delivery channels - nongovernmental organization (NGO) clinics, social franchise (SF) centers, and outreach camps. The survey took place from December 2015 to January …

A Care Bundle Including Antenatal Corticosteroids Reduces Preterm Infant Mortality In Tanzania A Low Resource Country, Augustine Massawe, Hussein Kidanto, Robert Moshiro, Edna Majaliwa, Flora Chacha, Aisa Shayo, Paschal Mdoe, Prisca Ringia, Mary Azayo, Georgina Msemo

Faculty of Health Sciences, East Africa

Background Preterm neonatal mortality (NM) has remained high and unchanged for many years in Tanzania, a resource-limited country. Major causes of mortality include birth asphyxia, respiratory insufficiency and infections. Antenatal corticosteroids (ACS) have been shown to significantly reduce mortality in developed countries. There is inconsistent use of ACS in Tanzania.

Objective To determine whether implementation of a care bundle that includes ACS, maternal antibiotics (MA), neonatal antibiotics (NA) and avoidance of moderate hypothermia (temperature < 36°C) targeting infants of estimated gestational age (EGA) 28 to 34 6/7 weeks would reduce NM (< 7 days) by 35%.

Methods A Pre (September 2014 to May 2015) and Post (June 2015 to June 2017) Implementation strategy was used and introduced at three University-affiliated and one …

Intermittent Fetal Heart Rate Monitoring Using A Fetoscope Or Hand Held Doppler In Rural Tanzania: A Randomized Controlled Trial, Paschal Francis Mdoe, Hege Ersdal, Estomih Mduma, Jeffrey M. Perlman, Robert Moshiro, Peter Wangwe, Hussein Kidanto

Faculty of Health Sciences, East Africa

Background: Neonatal mortality is a global challenge, with an estimated 1.3 million intrapartum stillbirths in 2015. The majority of these were found in low resource settings with limited options to intrapartum fetal heart monitoring devices. This trial compared frequency of abnormal fetal heart rate (FHR) detection and adverse perinatal outcomes (i.e. fresh stillbirths, 24-h neonatal deaths, admission to neonatal care unit) among women intermittently assessed by Doppler or fetoscope in a rural low-resource setting.

Methods: This was an open-label randomized controlled trial conducted at Haydom Lutheran Hospital from March 2013 through August 2015. Inclusion criteria were; women in labor, …

Extracellular Vesicle Rnas Reflect Placenta Dysfunction And Are A Biomarker Source For Preterm Labour., Shannon Fallen, David Baxter, Xiaogang Wu, Taek-Kyun Kim, Oksana Shynlova, Min Young Lee, Kelsey Scherler, Stephen Lye, Leroy Hood, Kai Wang

Articles, Abstracts, and Reports

Preterm birth (PTB) can lead to lifelong complications and challenges. Identifying and monitoring molecular signals in easily accessible biological samples that can diagnose or predict the risk of preterm labour (PTL) in pregnant women will reduce or prevent PTBs. A number of studies identified putative biomarkers for PTL including protein, miRNA and hormones from various body fluids. However, biomarkers identified from these studies usually lack consistency and reproducibility. Extracellular vesicles (EVs) in circulation have gained significant interest in recent years as these vesicles may be involved in cell-cell communication. We have used an improved small RNA library construction protocol and …

Expectant Fathers’ Participation In Antenatal Care Services In Papua New Guinea: A Qualitative Inquiry, Jessica Davis, Cathy Vaughan, Justine Nankinga, Lisa Davidson, Hellen Kigodi, Eileen Alalo, Liz Comrie-Thomson, Stanley Luchters

Population Health, East Africa

Background: The importance of engaging men in maternal and child health programs is well recognised internationally. In Papua New Guinea (PNG), men’s involvement in maternal and child health services remains limited and barriers and enablers to involving fathers in antenatal care have not been well studied. The purpose of this paper is to explore attitudes to expectant fathers participating in antenatal care, and to identify barriers and enablers to men‘s participation in antenatal care with their pregnant partner in PNG.

Methods: Twenty-eight focus group discussions were conducted with purposively selected pregnant women, expectant fathers, older men and older women across …

Web-Based Glucose Monitoring Using The Telcare® Wireless System For Management Of Pregnant Women With Pregestational Diabetes., Marc A. Vengrove Do, Facp, Emma Qureshey Md, Helai Hesham Md, Meredith Rochon Md, Joshua Cohen Bs, John C. Smulian Md, Mph

Department of Medicine

No abstract provided.