Obstetrics and Gynecology Commons^™

The Role Of Misoprostol In The Reduction Of Maternal Deaths In Low Resource Settings: A Systematic Review With Recommendations For Action, Melissa Anne Mcmillian

Master of Public Health Program Student Publications

Objective: The purpose of this systematic review is to determine the role misoprostol currently plays in the reduction of maternal deaths and implications for the future reduction of maternal deaths in low resource settings.

Methods: A comprehensive review of the literature was performed using the following databases: The Cochrane Database, Ebsco, MEDLINE, PubMed, and Electronic Journal Center (EJC). Articles were excluded based upon date published, overt data changes since publication, and setting of misoprostol interventions in tertiary or referral centers that have access to oxytocin. A total of 61 articles were included from 2002-2012 and demonstrated several methodologies and study …

Limiting The Caesarean Section Rate In Low Risk Pregnancies Is Key To Lowering The Trend Of Increased Abdominal Deliveries: An Observational Study, Ilse Delbaere, Hendrik Cammu, Evelyne Martens, Inge Tency, Guy Martens, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: As the rate of Caesarean sections (CS) continues to rise in Western countries, it is important to analyze the reasons for this trend and to unravel the underlying motives to perform CS. This research aims to assess the incidence and trend of CS in a population-based birth register in order to identify patient groups with an increasing risk for CS.

Methods: Data from the Flemish birth register ‘Study Centre for Perinatal Epidemiology’ (SPE) were used for this historic control comparison. Caesarean sections (CS) from the year 2000 (N = 10540) were compared with those from the year 2008 (N …

Antiseptics And Disinfectants For The Treatment Of Bacterial Vaginosis: A Systematic Review, Hans Verstraelen Verstraelen, Rita Verhelst, Kristien Roelens, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: The study objective was to assess the available data on efficacy and tolerability of antiseptics and disinfectants in treating bacterial vaginosis (BV).

Methods: A systematic search was conducted by consulting PubMed (1966-2010), CINAHL (1982-2010), IPA (1970-2010), and the Cochrane CENTRAL databases. Clinical trials were searched for by the generic names of all antiseptics and disinfectants listed in the Anatomical Therapeutic Chemical (ATC) Classification System under the code D08A. Clinical trials were considered eligible if the efficacy of antiseptics and disinfectants in the treatment of BV was assessed in comparison to placebo or standard antibiotic treatment with metronidazole or clindamycin …

Transforming Growth Factor Alpha (Tgfα) Regulates Granulosa Cell Tumor (Gct) Cell Proliferation And Migration Through Activation Of Multiple Pathways., Cheng Wang, Xiangmin Lv, Chao Jiang, Crystal M. Cordes, Lan Fu, Subodh M. Lele, John S. Davis

Journal Articles: Obstetrics & Gynecology

Granulosa cell tumors (GCTs) are the most common ovarian estrogen producing tumors, leading to symptoms of excessive estrogen such as endometrial hyperplasia and endometrial adenocarcinoma. These tumors have malignant potential and often recur. The etiology of GCT is unknown. TGFα is a potent mitogen for many different cells. However, its function in GCT initiation, progression and metastasis has not been determined. The present study aims to determine whether TGFα plays a role in the growth of GCT cells. KGN cells, which are derived from an invasive GCT and have many features of normal granulosa cells, were used as the cellular …

Maternal Tetanus Toxoid Vaccination And Neonatal Mortality In Rural North India, A. Singh, S. Pallikadavath, R. Ogollah, W. Stones

Obstetrics and Gynaecology, East Africa

Objectives: Preventable neonatal mortality due to tetanus infection remains common. We aimed to examine antenatal vaccination impact in a context of continuing high neonatal mortality in rural northern India.

Methods and Findings: Using the third round of the Indian National Family Health Survey (NFHS) 2005-06, mortality of most recent singleton births was analysed in discrete-time logistic model with maternal tetanus vaccination, together with antenatal care utilisation and supplementation with iron and folic acid. 59% of mothers reported receiving antenatal care, 48% reported receiving iron and folic acid supplementation and 68% reported receiving two or more doses of tetanus toxoid (TT) …

Association Of Intimate Partner Violence And Childhood Sexual Abuse With Cancer-Related Well-Being In Women, Ann L. Coker, Diane R. Follingstad, Lisandra S. Garcia, Corrine M. Williams, Timothy N. Crawford, Heather M. Bush

Obstetrics and Gynecology Faculty Publications

BACKGROUND: Limited evidence suggests that intimate partner violence (IPV) may be associated with poorer cancer outcomes. We hypothesized that timing and type of IPV as well as childhood sexual abuse (CSA) may negatively affect depression, perceived stress, and cancer-related well-being.

METHODS: This was a cross-sectional study of women diagnosed with either breast, cervical, or colorectal cancer in the prior 12 months included in the Kentucky Cancer Registry. Consenting women were interviewed by phone (n=553). Multivariate analysis of covariance (MANCOVA) was used to determine the association between IPV (37% lifetime prevalence) and type, timing, and the range of correlated cancer-related well-being …

Adverse Maternal Outcomes For Women With Different Health Insurance Statuses In Nevada, Jay J. Shen, Hong Wei

Nevada Journal of Public Health

Objective. Nevada women with unfavorable health insurance status may face greater barriers than women in the rest of the nation, since the development of healthcare infrastructure in Nevada is running behind population growth. This study examines the relationship between health insurance status and adverse maternal outcomes in Nevada.

Methods. Hospital discharge information of 33,149 women aged 13 or older who delivered in 2004 was abstracted from the 2004 State Inpatient Data for Nevada. A total of 13 measures of complications associated with pregnancy were identified, including preterm labor, hypertensive disorders of pregnancy, gestational diabetes, ante-partum hemorrhage, membrane disorders, cesarean section, …

Improved Quality Of Management Of Eclampsia Patients Through Criteria Based Audit At Muhimbili National Hospital, Dar Es Salaam, Tanzania. Bridging The Quality Gap, Hussein Kidanto, Peter Wangwe, Charles D. Kilewo, Lennarth Nystrom, Gunnila Lindmark

Faculty of Health Sciences, East Africa

Background Criteria-based audits (CBA) have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the use of a CBA to improve quality of care among eclampsia patients admitted at a University teaching hospital in Dar es Salaam Tanzania.

Objective The prevalence of eclampsia in MNH is high (≈6%) with the majority of cases arriving after start of convulsions. In 2004–2005 the case-fatality rate in eclampsia was 5.1% of all pregnant women admitted for delivery (MNH obstetric data base). A criteria-based audit (CBA) was used to evaluate the …

Association Of Gestational Weight Gain And Pre-Pregnancy Body Mass Index With Adverse Pregnancy Outcome, Shama Munim, Humaira Maheen

Department of Obstetrics & Gynaecology

Objective: To determine the association between gestation weight gain (GWG) and adverse pregnancy outcome in a Pakistani population.
Study Design: Analytical study.
Place and Duration of Study: The Aga Khan University, Karachi, from February 2003 to 2007.
Methodology: This study used secondary data of 4,735 women from a large cohort study on fetal growth. Pre-pregnancy BMI was categorized according to the recommendations from the institute of medicine (IOM, 2009) and gestation weight gain (GWG) was noted. Chi-square test was used to find the association of GWG and pre-pregnancy BMI with low birth weight (LBW), preterm delivery, large for gestational age …

Adverse Maternal Outcomes In Nevada: Does Asthma Matter?, Jay J. Shen, Hong Wei, Robin Mukalian

Nevada Journal of Public Health

Objective. Asthma is a common clinical complication of pregnancy and women with asthma are at greater risk of having complications. This study compared adverse maternal outcomes between women with asthma and women without asthma in Nevada.

Methods. A total of 64,664 hospital discharges of delivery were abstracted from the Nevada 2003-2004 hospital discharges and thirteen adverse maternal outcomes were examined. Logistic regression was applied to compare the maternal outcomes between women with and without asthma.

Results. Women with asthma were more likely to have pre-eclampsia (OR [CI] 1.73 [1.13, 2.65]), transient hypertension of pregnancy (OR [CI] 1.76 [1.11, 2.78]), pregnancy-induced …

Prevalence And Determinants Of Human Papillomavirus Infection And Cervical Lesions In Hiv-Positive Women In Kenya, H De Vuyst, N R. Mugo, M H. Chung, K P. Mckenzie, E Nyongesa-Malava, V Tenet, J W. Njoroge, S R. Sakr, C Jlm Meijer, P Jf Snijders, Farzana Rana, S Franceschi

Pathology, East Africa

Background: We assessed the association of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) with various characteristics, CD4 count and use of combination antiretroviral therapy (cART) among HIV-positive women.

Methods: Cross-sectional study of 498 HIV-positive women who underwent HPV PCR-based testing, cytology, and systematic cervical biopsy.

Results: In all, 68.7% of women were HPV-positive, 52.6% had high-risk (hr) HPV, and 40.2% multiple type infections. High-risk human papillomavirus-positivity did not vary significantly by age but it was negatively associated with education level. The most frequent types in 113 CIN2/3 were HPV16 (26.5%), HPV35 (19.5%), and HPV58 (12.4%). …

Antenatal Care And The Occurrence Of Low Birth Weight Delivery Among Women In Remote Mountainous Region Of Chitral, Pakistan, Z. Ahmed, S. Khoja, Suha S. Tirmizi

Obstetrics and Gynaecology, East Africa

Objective: Low birth weight (LBW) is closely associated with perinatal morbidity and bears an increased risk for subsequent infant morbidity. The study aimed to assess low birth weight delivery factors among women in Chitral, Pakistan.

Methodology: Mixed Methodology was adopted. Structured data collection tool was used to collect information from medical records of 1316 mothers, followed by interviews and focus group discussions to understand the causes and their remedies. The main outcome measure was infants born with low birth weight LBW (<2.5kg).

Result: There was a significant association between the occurrence of low birth weight and maternal education, paternal education, …

Mongolian Women's Voices: A Case Study On Maternal Healthcare, Pregnancy, And Birth In Ulaanbaatar's Public Hospitals, Amelia Olmsted

Independent Study Project (ISP) Collection

Mongolia is a country undergoing an incredible amount of change. Last year, in 2011, they had the fastest growing economy in the world, with a 17.2% increase in their GDP, according to the World Bank. A mere 22 years ago, Mongolia was a communist country, and today they are a parliamentary democracy. The country has opened itself up to the rest of the world and a free market economy, and experienced a very drastic shift in this direction in the early 1990's. Many Mongolians will tell you that the mindset of Mongolia's citizens has made a drastic shift since communism …

Cabergoline Therapy For Macroprolactinoma During Pregnancy: A Case Report., Hira Shahzad, Aisha Sheikh, Lumaan Sheikh

Department of Medicine

Background: We assessed the safety of Cabergoline therapy during pregnancy in a lady with hyperprolactinemia intolerant to Bromocriptine.

Case presentation: We report the case of a 31 year old lady who presented to us with uncontrolled hyperprolactinemia. A pituitary Macroadenoma was demonstrated by MRI. Due to intolerance to Bromocriptine, Cabergoline was started. The patient improved and subsequently conceived. MRI in the second trimester demonstrated further reduction in the tumor size. It was decided to continue Cabergoline throughout pregnancy to ensure further reduction in tumor size until delivery and to hold Cabergoline during postpartum period to allow for an adequate interval …

Intraabdominal Cysts Turn Out To Be Distended Large Bowel - An Electively Terminated Fetus With Isolated Imperforate Anus, Yu Shi, Maria Giraldo-Isaza, John Farber

Department of Pathology, Anatomy, and Cell Biology Resident's Posters

Patient:

Clinical History: A 19-week male fetus of a 36-year old G7P4 mother was found by ultrasound to have intrabdominal "cysts" and oligo-anhydramnios. At 15 weeks of pregnancy, by ultrasound examination, two intraabdominal cysts measuring 1.1x0.7x0.4 cm and 1.4x1.0x1.0 cm were noted. At 19 week gestation, the ultrasound was performed again showing anhydromaio, ascites, a normal appearing bladder, and multiple cystic structures in the abdomen most likely consistent with dilation of bowel (Figure 1A, B). The mother was consulted and opted to proceed with KCL injection and induction of labor. The nonviable fetus was delivered at 19 5/7 week gestation. …

The Study Of Hiv And Antenatal Care Integration In Pregnancy In Kenya: Design, Methods, And Baseline Results Of A Cluster-Randomized Controlled Trial, Janet M. Turan, Rachel L. Steinfeld, Maricianah Onono, Elizabeth A. Bukusi, Meghan Woods, Starley B. Shade, Sierra Washington, Reson Marima, Jeremy Penner, Marta L. Ackers, Dorothy Mbori-Ngacha, Craig R. Cohen

Pathology, East Africa

Background: Despite strong evidence for the effectiveness of anti-retroviral therapy for improving the health of women living with HIV and for the prevention of mother-to-child transmission (PMTCT), HIV persists as a major maternal and child health problem in sub-Saharan Africa. In most settings antenatal care (ANC) services and HIV treatment services are offered in separate clinics. Integrating these services may result in better uptake of services, reduction of the time to treatment initiation, better adherence, and reduction of stigma.

Methodology/Principal Findings: A prospective cluster randomized controlled trial design was used to evaluate the effects of integrating HIV treatment into ANC …

Randomized Comparison Of Two Internet-Supported Natural Family Planning Methods (Final Efficacy Results), Richard J. Fehring

Randomized Comparison of Two Internet-Supported Methods of Natural Family Planning

Both Internet provided NFP methods were effective with correct use but the electronic hormonal monitoring method was statistically better with a typical use of only 7 unintended pregnancies per 100 women over 12 months of use compared with 19 with the traditional cervical mucus monitoring method.

Satisfaction of using the hormonal method increased over time but motivation decreased, i.e., they had a desire to achieve a pregnancy.

A high discontinuation rate contributed to the limitation of the study.

However, this Internet based method of providing NFP with professional support is efficient and effective for select motivated couples.

25(Oh)D3 And Cardiovascular Risk Factors In Female Nonhuman Primates., Matthew J Jorgensen, Lawrence L Rudel, Matthew Nudy, Jay R Kaplan, Thomas B Clarkson, Nicholas M Pajewski, Peter F Schnatz

Division of Internal Medicine Faculty Papers & Presentations

OBJECTIVE: To determine if interindividual differences in plasma concentrations of 25-hydroxyvitamin D(3) (25(OH)D(3)) have pathophysiologic significance, we evaluated a cohort of female monkeys, seeking to identify associations with clinically relevant cardiovascular risk factors, including age, abdominal obesity (waist circumference), and high-density lipoprotein cholesterol (HDL-C).

METHODS: One hundred fifty-five female vervet monkeys (Chlorocebus aethiops sabaeus) aged 3-25 years consumed a typical western diet for 7-8 weeks that provided a woman's equivalent of approximately 1000 IU/day of vitamin D(3). Measurements of vitamin D(3) and HDL-C concentrations, as well as waist circumference, were obtained.

RESULTS: Among young monkeys (aged 3-5 years), compared to …

Common Respiratory Issues In Ambulatory Obstetrics., Kelly M Orzechowski, Richard C Miller

Department of Obstetrics and Gynecology Faculty Papers

This article reviews the diagnosis and management of the most common respiratory conditions complicating pregnancy--asthma and influenza. We also review strategies for smoking cessation in pregnancy as, in addition to exacerbating all other pulmonary conditions, smoking is the most modifiable risk factor for poor pregnancy outcome. Moreover, the obstetrician frequently encounters each of these conditions in the ambulatory setting. A thorough knowledge of the normal pregnancy-induced physiological respiratory changes combined with a comprehensive understanding of how to manage these conditions, will provide the obstetrician with the armamentarium needed to optimize health outcomes for mothers and their fetuses.

Effectiveness Of A Peer-Led Hiv Prevention Intervention In Secondary Schools In Rwanda: Results From A Non-Randomized Controlled Trial, Kristien Michielsen, Roxanne Beauclair, Wim Delva, Kristien Roelens, Ronan Van Rossem, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: While the HIV epidemic is levelling off in sub-Saharan Africa, it remains at an unacceptably high level. Young people aged 15-24 years remain particularly vulnerable, resulting in a regional HIV prevalence of 1.4% in young men and 3.3% in young women. This study assesses the effectiveness of a peer-led HIV prevention intervention in secondary schools in Rwanda on young people’s sexual behavior, HIV knowledge and attitudes.

Methods: In a non-randomized longitudinal controlled trial, fourteen schools were selected in two neighboring districts in Rwanda Bugesera (intervention) and Rwamagana (control). Students (n= 1950) in eight intervention and six control schools participated …