Obstetrics and Gynecology Commons^™

Pessary Versus Cerclage Versus Expectant Management For Cervical Dilation With Visible Membranes In The Second Trimester., Alexis C. Gimovsky, Anju Suhag, Amanda Roman, Burton L. Rochelson, Vincenzo Berghella

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: We evaluated pessary for dilated cervix and exposed membranes for prolonging pregnancy compared to cerclage or expectant management.

METHODS: Multicenter retrospective cohort study of women, 15-24 weeks, singleton pregnancies, dilated cervix ≥2 cm and exposed membranes. Women received pessary, cerclage or expectant management. Primary outcome was gestational age (GA) at delivery. Secondary outcomes were time until delivery, preterm premature rupture of membranes (PPROM) and neonatal survival.

RESULTS: About 112 women met study criteria; 9 - pessary, 85 - cerclage and 18 - expectant management. Mean GA at delivery was 22.9 ± 4.5 weeks with pessary, 29.2 ± 7.5 weeks …

A Medical Malpractice Trial Where The Residents And Faculty Are The Judge And The Jury, Kelly A. Rabah

Obstetrics and Gynecology Faculty Publications

At the conclusion of this session, the learner should be able to:

• Name 3- 5 of the most common reasons for a medical malpractice claim

• Describe and compare negligence, types of error, and recklessness

• Explain 3-5 steps that should be taken to minimize risk for a malpractice suit

• Discuss the emotional toll that litigation causes and the personal and professional risks that may result

Characterization Of Bacterial Pathogens Involved In Aerobic Vaginitis: Prevalence, Strain Characterization And Sequelae, Leslie A. Lafferty

Graduate School of Biomedical Sciences Theses and Dissertations

Aerobic vaginitis (AV) is a more recently defined infection that involves aerobic pathogenic bacteria that replace the normal flora of the vaginal tract. It is commonly mistaken for other vaginal infections, such as bacterial vaginosis (BV), because they share many common symptoms. AV leads to complications during pregnancy, such as premature delivery and amnion infection, and is diagnosed by indications that range from vaginal discharge to inflammation. Because this infection is difficult to diagnose differentially from other vaginal infections, it is important to determine what pathogens are involved in AV so that we may have the ability to detect them. …

Positive Deviance, Contraceptive Self-Efficacy And Social Desirability In Sexually Active Adolescent Females : A Mixed Methods Approach., Ashley D. Miller

Electronic Theses and Dissertations

Unintended pregnancy is an issue that impacts women of all ages, ethnicities, and socioeconomic statuses. It also impacts the child that results and the society in which they live. In the United States, adolescents experience unintended pregnancy more than adolescents in other countries. The purpose of this dissertation was to explore the factors that contribute to successful contraceptive use among adolescent females (ages 13-18) seeking reproductive health services at a local family planning clinic. The theoretical framework of contraceptive self-efficacy (CSE) was used to frame this understanding. The exploration was conducted in three ways: a critical review of the literature …

Intimate Partner Violence In Early Adolescence: The Role Of Gender, Socioeconomic Factors And The School, A. J. Mason-Jones, P De Koker, S. M. Eggers, Marleen Temmerman, E. Leye, P. J De Vries, H De Vries

Obstetrics and Gynaecology, East Africa

Background: Intimate partner violence (IPV) among adolescents is common worldwide, but our understanding of perpetration, gender differences and the role of social-ecological factors remains limited.

Objectives: To explore the prevalence of physical and sexual IPV perpetration and victimisation by gender, and associated risk and protective factors.

Methods: Young adolescents (N=2 839) from 41 randomly selected public high schools in the Western Cape region of South Africa (SA), participating in the PREPARE study, completed a self-administered questionnaire.

Results: The participants’ mean age was 13.65 years (standard deviation 1.01), with 19.1% (541/2 839) reporting being victims/survivors of IPV and 13.0% (370/2 839) …

Effect Of Body Mass Index On Outcome Of Labour Induction, Farheen Yousuf, Tahira Naru, Sana Sheikh

Department of Obstetrics & Gynaecology

The retrospective study to explore the adverse effect of obesity on pregnancy and labour was conducted at Aga Khan University Hospital, Karachi, Pakistan, and comprised data of all patients booked between 12-14 weeks and required induction of labour from January 1 to December 31, 2012. Women were grouped into two body mass index categories: normal weight (23 kg/m2). Obesity increased the risk of development of gestational hypertension and diabetes. Therefore obese women were more likely to be induced due to medical indication whether primiparous or multiparous adjusted odds ratio =2.89(95% confidence interval 1.29-6.48) and 2.77 (95% confidence interval 1.07-7.19) respectively. …

Nipt Results Indicative Of Maternal Neoplasms: Genetic Counselors' Preferences And Attitudes, Meagan E. Giles

Dissertations and Theses (Open Access)

Performing non-invasive prenatal testing (NIPT) on a pregnant woman with a chromosomally abnormal neoplasm may incidentally lead to the diagnosis of cancer due to the coexistence of circulating tumor and placental DNA. Published information regarding NIPT’s accuracy for neoplasm screening is limited, and guidance for patient management is currently lacking. This challenges clinicians’ ability to counsel patients regarding the implications of these results, which often is the responsibility of a genetic counselor. Over three hundred board-eligible/certified genetic counselors were surveyed regarding their awareness, preferences, and attitudes towards NIPT’s ability to indicate maternal neoplasms. Despite 95% of this cohort being aware …

Doulas Could Improve Foreign-Born Women’S Perinatal And Postpartum Satisfaction And Increase Health Providers’ Cultural Competency In A Multicultural Urban Area Of The United States., Crystal Kazik

Sustainability and Social Justice

Doulas act as a cultural bridge between clients and providers through the support, advocacy, and education they provide. Unfortunately, migrant women may be at a disadvantage for accessing and benefiting from their services due to a variety of socioeconomic and cultural factors including predisposed ideas of care and structure based on experiences in native countries, language barriers, lower health literacy, and a lack of awareness and understanding from hospital/clinic staff.

A strategic multifaceted approach utilizing doulas, such as Boston Medical Center’s collaborative and culturally competent model, may greatly improve foreign-born women’s experience and satisfaction with healthcare when pregnant and giving …

The Effects Of Iron Deficiency Anemia And Iron Supplementation In Pregnancy, Anna J. Cox

Senior Honors Theses

Iron deficiency anemia (IDA) is a condition that occurs in both underdeveloped and developed countries worldwide. This disorder is diagnosed in an individual who presents the common signs and symptoms of anemia along with consistently low clinical markers of stored iron. Iron deficiency (ID) usually precedes a diagnosis of IDA as the insufficient amount of iron often goes undetected until one’s quality of life is diminished. Certain populations, such as women who are pregnant or of reproductive age, are particularly at risk for ID and the development of IDA. During pregnancy, the recommended dietary allowance (RDA) for iron is greater …

Changing The Algorithm In The Evaluation Of Pelvic Anatomy In The Infertile Patient: Is Hysterosalpingo Contrast Sonography With Saline-Air Device The Appropriate Test For Everyone?, Kathryn Coyne, Thomas C. Winter, Rose Maxwell, Steven Lindheim

Obstetrics and Gynecology Faculty Publications

The evaluation of the fallopian tubes is an essential part of the infertility workup, with abnormalities related to the fallopian tubes accounting for up to 40% of female subfertility.1 Laparoscopy is still considered the gold standard in the diagnostic evaluation of fallopian tubes, though the hysterosalpingogram (HSG) has long been recognized as complementary to laparoscopy, since tubal anatomy can be distinctly be seen.2 That said, previous investigations using laparoscopy as the gold standard demonstrate HSG has a sensitivity and specificity of 53% and 87%, respectively, for any tubal pathology and 46% and 95%, respectively, for bilateral tubal pathology.3

Breastfeeding Education For Fathers: An Intervention To Increase Breastfeeding Rates, Jill Marie Frisz

Evidence-Based Practice Project Reports

If every infant were breastfed within an hour of birth, exclusively breastfed until six months, and given breastmilk up to two years, almost 800,000 lives would be saved annually (who, 2014). Nationally, breastfeeding rates drop significantly from three to six months. A search of literature yielded significant evidence as fathers for facilitators to increase breastfeeding rates. The purpose of this evidence based practice (EBP) project was to determine the effects of best practice measures to educate fathers about breastfeeding to increase anytime breastfeeding rates. The social support theory and ACE Star model guided the literature search and implementation of this …

Interventions For Improving Pregnancy Outcomes In Antenatally Diagnosed Or Suspected Morbidly Adherent Placenta, Rinku Sengupta, Alexis C. Gimovsky, Shuqin Wei, Anthony Akinloye Bamigboye, Vincenzo Berghella, Amanda R. Amorim Adegboye, William Donald Fraser

Department of Obstetrics and Gynecology Faculty Papers

This is the protocol for a review and there is no abstract. The objectives are as follows:

To assess the benefits and harms associated with clinical interventions for improving outcomes in women with antenatally diagnosed or suspected MAP. We will compare conventional caesarean hysterectomy with uterine conservation treatments (together with adjunct measures) in women who have been diagnosed antenatally with, or suspected to have, MAP.

Performance Of Sentinel Lymph Node Biopsy In High-Risk Endometrial Cancer., Jessie Ehrisman, Angeles Alvarez Secord, Andrew Berchuck, Paula S Lee, Nicola Di Santo, Micael Lopez-Acevedo, Gloria Broadwater, Fidel A Valea, Laura J Havrilesky

Obstetrics and Gynecology Faculty Publications

OBJECTIVE: To determine the rate and performance of sentinel lymph node (SLN) mapping among women with high-risk endometrial cancers.

METHODS: Patients diagnosed between 2012 and 2015 with uterine cancer of grade 3 endometrioid, clear cell, serous or carcinosarcoma histology and who underwent SLN mapping prior to full pelvic lymph node dissection were included. Subjects underwent methylene blue or ICG injection for laparoscopic (N = 16) or robotic-assisted laparoscopic (N = 20) staging. Outcomes included SLN mapping rates, SLN and non-SLN positive rates, false negative SLN algorithm rate, and the negative predictive value (NPV) of the SLN algorithm. Fisher's exact test …

Recruitment Feasibility Study For Reducing Postpartum Smoking Among Low-Income And Hispanic Women, Helai Hesham Md, Sandra L. Curet Md, Suresh G. Nair Md, Hope Kincaid Mph, Cph, Cynthia Beitler, Lourdes T. Matos, Clare Lenhart Phd, Mph

Department of Obstetrics & Gynecology

No abstract provided.

Contraception, Abortion And Assisted Fertility Among Muslim Women A Look At Islamic Culture And Policy In Iran And Afghanistan, Hayley Jacobsen

What All Americans Should Know About Women in the Muslim World

Discourse on women's reproductive rights through the lens of Muslim culture. The use of contraception, assisted fertility and abortion, are analyzed in Iran and Afghanistan. The culture surrounding family planning is detailed through a woman’s community, family, religion and the laws that govern the society they live in, which all influence her decision making in these matters. This piece stands as a cultural analysis of women's agency specifically in Middle Eastern Muslim culture, as it stands as a part of a global women's rights movement.

Obstetric Violence Within The Brazilian Healthcare System: A Critical Analysis Of The Childbirth Narratives Of Tupinambá Indigenous Women From The Olivença, Ilhéus Community, Cassandra Fareira

Independent Study Project (ISP) Collection

The objective of this research project is to hear the personal narratives of Tupinambá Indigenous Brazilian women living in the Olivença community in Ilheus, Bahia regarding their experiences giving birth in order to discern the prevalence of various forms of obstetric violence within their experiences. In the context of this study the term "obstetric violence," derived from an extensive literature review, encompasses 1) physical abuse, 2) the unethical imposition of medical interventions, 3) the denial or lack of privacy, 4) undignified care which includes verbal abuse, 5) discrimination, 6) abandonment, neglect or the refusal to grant assistance, 7) detention in …

The Changing Roles And Reputations Of Dais In Rural Uttarakhand: An Investigation Into The Maternal Health Services Of Villages In Okhalkanda Block In Nainital, Jenna Davis

Independent Study Project (ISP) Collection

The dai, once a prominent figure in Indian maternal health, now faces marginalization as the government of India adopts the goal of universal institutional delivery. Under pressure from international discourse that Skilled Birth Attendants (SBAs) were more effective at lowering Maternal Mortality Rate (MMR) than Traditional Birth Attendants (TBAs) like dais (World Health Organization), dai training was discontinued and left in the hands of NGOs, while concurrently women and ASHAs were monetarily incentivized for every institutional birth (Park, 419). Yet in rural, isolated, or hilly areas like Okhalakanda block in Uttarakhand, institutional delivery is a long way from universal—only …

A Comparative Study Of Women’S Health Care: Non-Syrian Refugee Women Living In Amman And Syrian Refugee Women Living In Refugee Camps, Megan Kerstein

Independent Study Project (ISP) Collection

The purpose of this study is to compare access and quality of women’s health care in Amman for non-Syrian refugee women and women’s health care in Syrian refugee camps. I also sought to understand how women’s health care could be improved in both Amman and in Syrian refugee camps. I hypothesized that Syrian refugee women in camps will have less access and lower quality women’s health care since refugee camps’ funding is limited, making medical equipment and women’s health care providers short. Since women in Amman often have more stable family situations and jobs, I thought they would have more …

Effective Interventions To Reduce The Increase In Elective Cesarean Sections In Low Risk Women, Kimberly Kelsey, Crystal Hunter, Brianna-Kirsten Tan, Sara Shea, Heather Holland, Sasha Riley, Mary Uy, Tenzin Tsomo, Fasha Ruys-Solorzano, Dolma Tso

Student Research Posters

According to the Annals of Family Medicine, the amount of babies born via cesarean section has increased from 4.5% in 1965 to 26.1% in 2002 and nearly 40% of all cesarean sections are repeats. After an extensive literature review, results showed that patients need to be educated about the risks and benefits of vaginal delivery and cesarean delivery. It was also found that there needs to be policy changes to decrease the amount of cesarean sections done and increase the labor and delivery support without using interventions. Further study should be focused on morbidity and mortality very low birth weight …

Hypertensive Disorders Of Pregnancy In Rural Maharashtra: A Preventative Approach To Risk Factor Reduction Through Lifestyle Interventions, Jess Wiken

Independent Study Project (ISP) Collection

The primary purpose of this study is to assess the contribution and correlation between lifestyle behaviors and modifiable risk factors (MRF) established in adolescence and during pregnancy with development of hypertensive disorders of pregnancy (HDP) exclusive to preeclampsia (PE), eclampsia, and pregnancy induced hypertension (PIH). MRF include but are not exclusive to diet and nutrition, physical activity, and Mishri use. Associations of HDP with increased premature cardiovascular risk in the affected woman and child indicate the importance of healthy lifestyle modifications that promote cardiovascular health and longevity and reduction of risk factors through prevention. While cardiac conditions are primarily associated …