Obstetrics and Gynecology Commons^™

E-Learning For Research Capacity Strengthening In Sexual And Reproductive Health: The Experience Of The Geneva Foundation For Medical Education And Research And The Department Of Reproductive Health And Research, World Health Organization, Karim Abawi, Venkatraman Chandra-Mouli, Igor Toskin, Mario Philip Festin, Lynn Gertiser, Raqibat Idris, Hanan Hamamy, Moazzam Ali, Ameyo Masakhwe Bonventure, Marleen Temmerman, Aldo Campana

Obstetrics and Gynaecology, East Africa

Abstract: Technological advancement has resulted in the increasing use of e-learning and online education, initially in high-income countries and increasingly in low- and middle-income countries.

Background: In 2010, the Geneva Foundation for Medical Education and Research, in collaboration with the World Health Organization and partner institutions, developed an online postgraduate course “From Research to Practice: Training Course in Sexual and Reproductive Health Research”. This course takes advantage of the advancing Internet technology to provide training opportunities to health professionals mostly from low- and middle-income countries whose access to quality education is constrained by time, financial resources, or both.

Case presentation: …

The Dna Default And Its Discontents: Establishing Modern Parenthood, Katharine Baker

All Faculty Scholarship

Most contemporary family law scholarship assumes that propriety of a DNA default for establishing parenthood - a presumption that, in the absence of marriage, whoever had the sex with the mother that resulted in the child should be the father of the child. This article problematizes that DNA default. It demonstrates how the DNA default necessarily magnifies the legal and social importance of sex, discounts the legal significance of women's reproductive labor, and marginalizes all children living outside the binary, heteronormative norm that a genetic regime necessarily edifies. When scrutinized, the DNA default looks just as moralistic and exclusionary as …

Tx-004hr Improves Sexual Function As Measured By The Female Sexual Function Index In Postmenopausal Women With Vulvar And Vaginal Atrophy: The Rejoice Trial., Sheryl A Kingsberg, Leonard Derogatis, James A Simon, Ginger D Constantine, Shelli Graham, Brian Bernick, Gina Gasper, Sebastian Mirkin

Obstetrics and Gynecology Faculty Publications

INTRODUCTION: TX-004HR is an investigational, applicator-free, vaginal soft gel capsule containing low-dose solubilized 17β-estradiol. The phase 3, randomized, double-blinded, placebo-controlled, multicenter REJOICE trial has shown TX-004HR to be safe and effective for the treatment of moderate to severe dyspareunia in postmenopausal women with vulvar and vaginal atrophy (VVA).

AIM: To evaluate the effect of TX-004HR on female sexual dysfunction in postmenopausal women with VVA.

METHODS: The REJOICE study compared the effects of 12-week treatment with TX-004HR (4, 10, or 25 μg) with placebo in postmenopausal women (40-75 years old) with VVA and a most bothersome symptom of moderate to severe …

Referral Pattern Of Emergencies In Obstetrics: Implications For Defining Scope Of Services And Policy, Rahat Najam Qureshi, Rozina Sikandar Sultanali, Zahra Hoodbhoy, Raffat Bano, Nigar Jabeen

Department of Obstetrics & Gynaecology

Objective: To analyse referral pattern of high-risk obstetric cases from secondary to tertiary care hospitals and to assess their maternal and neonatal outcomes.

Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised all referred obstetric cases from secondary-level hospitals to tertiary-level care within and outside the Hospital between January 2011 and December 2014. Day and time of referral, reason for referral as well as maternal and neonatal outcomes were collected. SPSS 19 was used for data analysis.

Results: Of the 634 obstetric referrals, 279(44%) patients were referred to the study site, while 355(56%) …

Does Age Influence Knowledge And Attitudes About Intrauterine Devices?, Sara Edwards, Lisa Perriera, Md, Mph, Rebecca J. Mercier Md Mph

CwiC Posters

Primary objectives:

• Are there differences in attitudes and beliefs about IUDs based on age?
• We hypothesized that older women may be more familiar with the negative outcomes of earlier models of the IUD and therefore may hold more negative attitudes toward IUDs.

Mind And Body Training To Improve Functioning And Coping With Chronic Pain: A Pilot Study, Olga Valieva, Leah M. Welsh, Betty Amuzu, Niraj Nijhawan, Jessica J.F. Kram

Journal of Patient-Centered Research and Reviews

Background: Patients with chronic pain are often crippled by psychological distress, depression and fear. These patients also can develop altered pain perception, with enhanced brain activity in pain-responsive regions and those associated with anxiety/depression. Exercise and meditation can impact pain-reducing brain areas and positively influence pain characteristics.

Purpose: To alter pain center activity by reducing the activation of the higher brain and deactivation of the lower brain with somatocognitive and meditative practices, with secondary aim of reducing anxiety/depression and improve overall quality of life.

Methods: We conducted a pilot study on mentally competent adult women with stable chronic pain who …

Proceedings Of 2016 Aurora Scientific Day

Journal of Patient-Centered Research and Reviews

This supplement includes select abstracts presented at the 42nd annual Aurora Scientific Day research symposium, held May 25, 2016, in Milwaukee, Wisconsin. Aurora Scientific Day provides a forum for original research conducted by faculty, fellows, residents, students and other allied health professionals affiliated with Aurora Health Care, a not-for-profit health system comprised of integrated hospitals and clinics across eastern Wisconsin and northeastern Illinois.

Association Between Pregnancy Intention And Maternal Characteristics, Outcomes, And Cost Of Care: A Pilot Study, Kristy M. Kelel, Kiley B. Vander Wyst, Danielle M. Greer, Danish Siddiqui

Journal of Patient-Centered Research and Reviews

Background: An estimated 51% of pregnancies in the United States are unintended. In Wisconsin, unplanned pregnancies account for 40% of all pregnancies and cost $148 million in public funds. Unintended pregnancy, which creates increased hardship for mothers and threatened well-being of infants, has been recognized as an important health, social and economic problem.

Purpose: To determine the pregnancy intentions of postpartum women and the maternal characteristics, outcomes and costs of care associated with unintended pregnancies at a large urban hospital in Milwaukee, Wisconsin.

Methods: Postpartum women were surveyed prior to discharge. The 20-item survey included whether or not the woman …

Criteria-Based Audit To Improve Quality Of Care Of Foetal Distress: Standardising Obstetric Care At A National Referral Hospital In A Low Resource Setting, Tanzania, Andrew H. Mgaya, Helena Litorp, Hussein L. Kidanto, Lennarth Nyström, Birgitta Essén

Obstetrics and Gynaecology, East Africa

Background, In Tanzania, substandard intrapartum management of foetal distress contributes to a third of perinatal deaths, and the majority are term deliveries. We conducted a criteria-based audit with feedback to determine whether standards of diagnosis and management of foetal distress would be improved in a low-resource setting.

Methods, During 2013–2015, a criteria-based audit was performed at the national referral hospital in Dar es Salaam. Case files of deliveries with a diagnosis of foetal distress were identified and audited. Two registered nurses under supervision of a nurse midwife, a specialist obstetrician and a consultant obstetrician, reviewed the case files. Criteria for …

Maternal Arsenic Exposure And Gestational Diabetes And Glucose Intolerance In The New Hampshire Birth Cohort Study, Shohreh F. Farzan, Anala Gossai, Yu Chen, Lisa Chasan-Taber, Emily Baker, Margaret Karagas

Dartmouth Scholarship

Background: Gestational diabetes mellitus (GDM) is a major pregnancy complication with detrimental effects for both mothers and their children. Accumulating evidence has suggested a potential role for arsenic (As) exposure in the development of GDM, but current studies have not assessed As exposure from water, urine or toenail samples.

Methods: We investigated the association between As exposure and risk of glucose intolerance and GDM among 1151 women enrolled in the New Hampshire Birth Cohort Study. Arsenic was measured in home well water and via biomarkers (i.e., maternal urine collected ~24–28 weeks gestation and toenail clippings collected 2 weeks postpartum).

Results: …

Losing Ground: Awareness Of Congenital Cytomegalovirus In The United States, Sara M. Doutre, Tyson S. Barrett, Janelle Greenlee, Karl R. White

Journal of Early Hearing Detection and Intervention

One in 150 infants is born with cytomegalovirus (CMV) and one in 750 will have lifelong disabilities due to CMV. Even though congenital CMV is the leading viral cause of congenital disabilities and the leading non-genetic cause of childhood hearing loss, most adults have never heard of it. Data from the 2015 and 2016 HealthStyles^TM surveys were analyzed and compared to data from similar studies and show an awareness rate of 7% for US adults (5% for men and 9% for women), a statistically significant decrease from 2005 and 2010 studies. Predictors of awareness include gender and education level. …

Improving Standards Of Care In Obstructed Labour: A Criteria-Based Audit At A Referral Hospital In A Low-Resource Setting In Tanzania, Andrew H. Mgaya, Hussein Kidanto, Lennarth Nystrom, Birgitta Essén

Faculty of Health Sciences, East Africa

Objective In low-resource settings, obstructed labour is strongly associated with severe maternal morbidity and intrapartum asphyxia, and consequently maternal and perinatal deaths. This study evaluated the impact of a criteria-based audit of the diagnosis and management of obstructed labour in a low-resource setting.

Methods A baseline criteria-based audit was conducted from October 2013 to March 2014, followed by a workshop in which stakeholders gave feedback on interventions agreed upon to improve obstetric care. The implemented interventions included but were not limited to introducing standard guidelines for diagnosis and management of obstructed labour, agreeing on mandatory review by specialist for cases …

Breech Delivery At A University Hospital In Tanzania, Ulf Högberg, Catrin Claeson, Lone Krebs, Agneta Skoog Svanberg, Hussein Kidanto

Faculty of Health Sciences, East Africa

Background There is a global increase in rates of Cesarean delivery (CD). A minor factor in this increase is a shift towards CD for breech presentation. The aim of this study was to analyze breech births by mode of delivery and investigate short-term fetal and maternal outcomes in a low-income setting.

Methods The study design was cross-sectional and the setting was Muhimbili National Hospital (MNH), Dar-es-Salaam, Tanzania. Subjects were drawn from a clinical database (1999–2010) using the following inclusion criteria: breech presentation, birth weight ≥ 2,500 g, single pregnancy, fetal heart sound at admission, and absence of pregnancy-related complication as …

Criteria-Based Audit To Improve Quality Of Care Of Foetal Distress: Standardising Obstetric Care At A National Referral Hospital In A Low Resource Setting, Tanzania, Andrew H. Mgaya, Helena Litorp, Hussein Kidanto, Lennarth Nyström, Birgitta Essén

Faculty of Health Sciences, East Africa

Background In Tanzania, substandard intrapartum management of foetal distress contributes to a third of perinatal deaths, and the majority are term deliveries. We conducted a criteria-based audit with feedback to determine whether standards of diagnosis and management of foetal distress would be improved in a low-resource setting.

Methods During 2013–2015, a criteria-based audit was performed at the national referral hospital in Dar es Salaam. Case files of deliveries with a diagnosis of foetal distress were identified and audited. Two registered nurses under supervision of a nurse midwife, a specialist obstetrician and a consultant obstetrician, reviewed the case files. Criteria for …

Obstetric Patients In Intensive Care Unit: Perspective From A Teaching Hospital In Pakistan, Rahat Qureshi, Sheikh Irfan Ahmed, Amir Raza, Ayesha Khurshid, Uzma Chishti

Department of Obstetrics & Gynaecology

Objective: Review of obstetric cases admitted to the intensive care unit.
Design: Ten year retrospective review of individual patients' medical records.
Participants: Records of obstetric patients admitted from 2005-2014.
Setting: Aga Khan University Hospital Karachi.
Main outcome Measures: Diagnosis at the time of admission, associated risk factors, and intervention required aspects of management and rate of mortality.
Findings: A total of 194 obstetric patients were admitted out of which 86.2% of patients had ventilator support. Mortality was not seen to be significantly associated with parity and antenatal/postnatal status. The median age of patients was 34 years, minimum length of stay …

Addressing The Intersection Between Alcohol Consumption And Antiretroviral Treatment: Needs Assessment And Design Of Interventions For Primary Healthcare Workers, The Western Cape, South Africa, M. Schneider, M. Chersich, Marleen Temmerman, C. D. Parry

Obstetrics and Gynaecology, East Africa

Background: At the points where an infectious disease and risk factors for poor health intersect, while health problems may be compounded, there is also an opportunity to provide health services. Where human immunodeficiency virus (HIV) infection and alcohol consumption intersect include infection with HIV, onward transmission of HIV, impact on HIV and acquired immunodeficiency syndrome (AIDS) disease progression, and premature death. The levels of knowledge and attitudes relating to the health and treatment outcomes of HIV and AIDS and the concurrent consumption of alcohol need to be determined. This study aimed to ascertain the knowledge, attitudes and practices of primary …

Women’S Experiences With Prenatal Care: A Mixed-Methods Study Exploring The Influence Of The Social Determinants Of Health, Karen A. D'Angelo, Janelle K. Bryan, Brenda Kurz

Journal of Health Disparities Research and Practice

Background & Purpose: Racial and ethnic disparities pervade birth outcomes in the United States and the state of Connecticut. While Connecticut’s infant mortality rate is less than the national average, rates for the state’s Black/African American and Hispanic/Latino communities exceed it. This study explored how prenatal care in Connecticut may be enhanced to address these disparities.

Methods: In spring 2013, seven focus groups and two semi-structured interviews were conducted (n=47). Participants also self-administered brief surveys. Recruited by local service providers, participants were 18 or older, pregnant and/or in the first year post-partum at the time. Most self-identified as …

Syrian Refugee Women In Jordan: Family Planning Preferences And Barriers In A Host Community, Hilary Smith

Independent Study Project (ISP) Collection

The aims of this pilot study were to research and analyze the availability of birth control and family planning resources among Syrian refugee women at a reproductive age. This study took place in the host community of Karak, Jordan. Syrian women are a vulnerable population based solely on their gender. But being refugee women makes them more vulnerable and sometimes, their needs do not get met. This study is important because it will look into reproductive health aspects for this vulnerable population to ensure that there is satisfaction among women about their own health. This cross-sectional study sought to answer …

Secondary Postpartum Hemorrhage Due To Spontaneous Uterine Artery Rupture After Normal Vaginal Delivery Managed By Selective Arterial Embolization, Mili Thakur, Henry O. Adekola, Radwan Asaad, Bernard Gonik

Department of Obstetrics and Gynecology Research Publications

Secondary postpartum hemorrhage due to an intraperitoneal bleed following a vaginal delivery is extremely rare. We present a case of spontaneous rupture of the uterine artery following a normal vaginal delivery with a delayed presentation, which resulted in significant morbidity. This case discusses the presentation and management of this rare obstetrical emergency. The report also discusses the role of selective arterial embolization in management of secondary postpartum hemorrhage.

A Preliminary Study Of Intergenerational Differences In Masxha Regarding Practice And Attitudes Towards Zulu Traditions During Pregnancy And Birth, Momoko Oyama

Independent Study Project (ISP) Collection

In the Zulu culture, several traditions and rituals are practiced during a woman’s pregnancy and perinatal period. However, as urbanization spreads and western influences strengthen, these rituals risk being lost. This project aims to capture existing knowledge of these traditions and to assess the intergenerational changes in practice and attitudes towards practicing the rituals.

Information on Zulu traditions practiced during a woman’s pregnancy and perinatal period was collected through two interviews and a focus group consisting of three elderly women in Masxha, a Black township in KwaZulu-Natal. Following the interviews and focus group, 32 Masxha residents were recruited to complete …