Obstetrics and Gynecology Commons^™

Inflammatory Mediators And The Rage Pathway In Placental Tissues Of Pregnancies Complicated By Severe Preeclampsia, Neelima Chandra, Thomas D. Kimble, Kathleen R. Heim, Sharon M. Anderson, Andrew P. Wong, Andrea R. Thurman, Gustavo F. Doncel

CONRAD Publications

Introduction: Preeclampsia (PE) is a complex multisystem disorder of pregnancy associated with abnormal placentation, vascular anomalies, and systemic inflammation and hypertension. Previous research assessing inflammatory triggers of the condition used plasma, amniotic fluid, or explant samples. Studies using placental tissue from either vaginal or cesarean deliveries are confined to semiquantitative analysis using subjective scoring methods and generally involve a small sample size.

Methods: In this study, we have quantified the expression of inflammatory mediators by immunohistochemical image analysis of archived placental tissues obtained from cesarean delivery of preeclamptic, chorioamnionitic, and normal pregnancies.

Results: Among the inflammatory mediators, we found a …

Treatment Of Ovarian Clear Cell Carcinoma: A Case Of Successful Management With Targeted Therapies., Sydney Pence, Kellie Rath, Aine Clements

Women’s Health Articles

No abstract provided.

Maternal Lipidomics For The Accurate Prediction Of Fetal Cyanotic Congenital Heart Defects, Onur Turkoglu, Nadia Ashrafi, Ali Yilmaz, Romana Ashrafi Mimi, Abdullah Khan, Perry Friedman, Ciara Talbot, Stewart Graham, Ray Bahado-Singh

Conference Presentation Abstracts

Objective: Late diagnosis of cyanotic congenital heart defects (CCHD) significantly increases newborn morbidity and mortality. However, a significant percentage of CCHD cases remain undetected prenatally. Our objectives were therefore to evaluate the accuracy of maternal serum lipidomic markers for the prenatal detection of CCHD and also to elucidate the pathogenesis of these disorders. Study Design: This prospective case-control study included 40 cases of CHD (22 cyanotic, 18 acyanotic) and 39 unaffected controls. Maternal serum samples were profiled via a combination of Ultra-High-Performance Liquid Chromatography coupled with Mass Spectrometry and Nuclear Magnetic Resonance. The mean of each lipid specie was compared …

Cerebroplacental Doppler Ratio For The Prediction Of Adverse Perinatal Outcomes In Late-Onset Fetal Growth Restriction, Sonia Sajja, Onur Turkoglu, Torey Asao, Perry Friedman, Ray Bahado-Singh

Conference Presentation Abstracts

Objective: Late-onset fetal growth restriction (LO-FGR), defined as onset 3 32 weeks gestation, is the more common subgroup of FGR. The umbilical artery Doppler is usually unaffected. There are no subgroup-specific guidelines for monitoring pregnancies affected by LO-FGR. We compared the utility of the cerebroplacental Doppler ratio (CPR) to the Biophysical Profile (BPP), a widely endorsed FGR monitoring tool, for the prediction of adverse perinatal outcomes (APO). Study Design: This is a retrospective cohort study of LO-FGR, defined as estimated fetal weight < 10th%, from 2013-2018. Using logistic regression analysis, we determined whether low CPR < 5th% and BPP score £ 6 significantly independently predicted the composite APO defined as one or more complications: cord pH < 7.20, 5-minute Apgar score of < 5, operative or cesarean delivery secondary to non-reassuring fetal heart tracing, assisted respiration at birth, NICU admission, and/ or perinatal death. Secondarily, we also evaluated prediction of severe neonatal morbidity (SNM) defined in Table 1 (legend). Results: There were 233 cases of LO-FGR of which 76 (34%) had a low CPR percentile and 28 (13%) had a low BPP score. There were 22 (9.9%) cases with SNM of which 5 (2.1%) had a low CPR percentile and 4 (1.8%) had a low BPP score. A low CPR was associated with a significantly higher rate of individual and composite APO than cases with normal CPR percentile (p < 0.001) [Table 1]. Both a low CPR percentile and a low BPP score significantly predicted APO overall. CPR appeared to be a better predictor of the APO, controlling for gestational age at testing [Table 2]. Only BPP significantly predicted SNM: CPR (OR = 4.64, p = 0.13) and BPP (OR = 4.11, p = 0.038). Conclusion: A low CPR percentile was a significant independent predictor of perinatal complications in LO-FGR, including abnormal fetal heart rate tracing, smaller birthweight percentile, and NICU admission. CPR appeared superior to BPP overall. CPR should be considered as a fetal surveillance tool in LO-FGR.

Artificial Intelligence System Accurately Detects Fetal Ultrasound Findings Suspicious For Major Congenital Heart Defects, Carolyn M. Zelop, Jennifer Lam-Rachlin, Alisa Arunamata, Rajesh Punn, Sarina K. Behera, Matthias Lachaud, Nadine David, Greggory R. Devore, Andrei Rebarber, Sara Garmel

Conference Presentation Abstracts

Objective: Prenatal detection of congenital heart defects (CHD) improves patient outcomes. Despite advances in imaging techniques and equipment, prenatal diagnosis remains low. We evaluated the accuracy of an artificial intelligence (AI) system to detect 2nd trimester (2T) ultrasound studies suspicious for CHD. Study Design: The AI system analyzes all grayscale 2D ultrasound cines of a study and detects 8 morphological findings suspicious for CHD. The findings were selected such that most major forms of CHD would feature at least one such finding, and the presence of any of these would flag the study for referral for further examination. We retrospectively …

Ai Significantly Improves Detection Of Prenatal Ultrasounds Suspicious For Major Congenital Heart Defects By Obgyn/Mfms, Jennifer Lam-Rachlin, Rajesh Punn, Sarina K. Behera, Miwa Geiger, Matthias Lachaoud, Nadine David, Sara Garmel, Matthew K. Janssen, Kendra Sylvestser, John Kennedy

Conference Presentation Abstracts

Objective: Congenital heart defects (CHDs) are a leading cause of infant morbidity and mortality partly due to low prenatal detection rates. We evaluated whether an artificial intelligence (AI) system can improve the detection of CHDs on fetal ultrasound exams among both general OBGYNs and MFM specialists. Study Design: The AI system analyzes all grayscale 2D ultrasound cines of an exam and detects 8 morphological findings associated with severe CHDs. The presence of any such finding should justify patient referral for further examination. The AI system identifies each finding as present, absent or inconclusive, and highlights frames where findings can be …

Formulation Development Of Dual-Compartment Topical Inserts Combining Tenofovir Alafenamide And Elvitegravir For Flexible On-Demand Hiv Prevention, Vivek Agrahari, M. Melissa Peet, Neelima Chandra, Prakash Ramalingam, Pardeep K. Gupta, Sriramakamal Jonnalagadda, Onkar N. Singh, Timothy J. Mccormick, Gustavo F. Doncel, Meredith R. Clark

Department of Obstetrics & Gynecology Faculty Publications

Pre-exposure prophylaxis (PrEP) has emerged as a prominent approach for the prevention of HIV infections. While the latest advances have resulted in effective oral and injectable product options, there are still gaps in on-demand, event-driven, topical products for HIV prevention that are safe and effective. Here we describe the formulation development of a dual-compartment topical insert containing tenofovir alafenamide fumarate (TAF) and elvitegravir (EVG) that may be administered when needed, vaginally or rectally, pre- or post-coitus, for flexible HIV prophylaxis. Specifically, we describe the lab-scale formulation development, preclinical mucosal safety and pharmacokinetics (PK) testing in rabbits, long-term stability, and scale-up …

Association Of Maternity Care Deserts With Maternal And Pregnancy-Related Mortality, Rula Atwani, Lindsay Robbins, George Saade

Department of Obstetrics & Gynecology Faculty Publications

OBJECTIVE:

To evaluate the association between the level of maternity care access and maternal and pregnancy-related mortality.

METHODS:

This was a cross-sectional analysis of county-level data in the United States from January 2018 to December 2021. Using the level of maternity care access, we categorized counties into desert, low access, moderate access, and full access. The primary outcome of interest was maternal mortality rate per 100,000 live births. A secondary outcome was pregnancy-related mortality rate per 100,000 live births. Absolute risk differences and adjusted incidence rate ratios were calculated for maternal mortality and pregnancy-related mortality with multivariable negative binomial mixed-effects …

Longitudinal Assessment Of Intravillous Arterioles In Normal Pregnancy Using Superb Microvascular Imaging, R. Horgan, E. Sinkovskaya, G. Saade, E. Kalafat, A. Heeze, A. Abuhamad

Department of Obstetrics & Gynecology Faculty Publications

Objective

To use superb microvascular imaging (SMI) to longitudinally evaluate blood flow in intravillous arterioles (IVA) in pregnancy, and to develop reference ranges for IVA pulsatility index (PI) and peak systolic velocity (PSV) from 12 to 38 weeks' gestation.

Methods

The data for this study were obtained from the National Institutes of Health-funded Human Placenta Project. Eligible for inclusion were women aged 18-35 years, with a body mass index of <  30 kg/m², without comorbidities, with a singleton pregnancy conceived spontaneously and a gestational age of ≤ 13 + 6 weeks. Exclusion criteria were maternal or neonatal complications, fetal or umbilical cord anomalies, abnormal placental implantation and delivery <  37 weeks. Each participant underwent eight ultrasound examinations during pregnancy. Using SMI technology, the total number of IVA identified was recorded in a sagittal placental section at the level of cord insertion. The PI and PSV were measured in a total of six IVA (two in the central portion of the placenta, two peripherally towards the uterine fundal portion and two peripherally towards the lower uterine segment). Umbilical artery (UA)-PI was also obtained. Multilevel regression models were used to create reference ranges for IVA-PI and IVA-PSV at 12-38 weeks' gestation.

Results

A total of 90 women fulfilled the study criteria. IVA-PI decreased throughout pregnancy from a mean ± SD of 1.04 ± 0.23 in the first trimester (at 12-13 weeks) …

Timing Of Delivery In Preeclampsia: Time To Reconsider?, Rebecca Horgan, Ahmed S. Z. Moustafa, Mackenzie Mchugh, Tetsuya Kawakita, Baha Sibai, George Saade

Department of Obstetrics & Gynecology Faculty Publications

The article discusses the need to reassess the timing of delivery in cases of preeclampsia, a condition affecting 2%–8% of pregnancies and linked to significant maternal and neonatal risks. It highlights that existing guidelines, primarily based on older studies, may not adequately reflect current clinical practices and advancements in neonatal care. The authors suggest that planned delivery at 34–36 weeks of gestation may offer maternal benefits without increasing short-term neonatal morbidity, while also emphasizing the importance of considering long-term outcomes for both mothers and infants. They advocate for further research, including large-scale randomized trials, to better understand the implications of …

Association Between Adverse Pregnancy Outcomes And Awareness Of Cardiovascular Risk Factors: A Numom2b-Hhs Secondary Analysis, Elizabeth M. Wendl, Amanda A. Allshouse, Ashley Goodwin, Bri Hobbs, Philip Greenland, Lisa Levine, William Grobman, George R. Saade, Natalie Cameron, C. Noel Bairey Merz, Caroline Rouse, Sarah Rogan, Judith H. Chung, Lauren H. Theilen, National Heart, Lung, And Blood Institute Numom2b Heart Health Study Network

Department of Obstetrics & Gynecology Faculty Publications

Background

Adverse pregnancy outcomes (APOs) affect 10%-20% of pregnancies and are associated with increased risk of cardiovascular disease.

Objective

To determine whether the history of APO is associated with a person's awareness of their cardiovascular risk factors (CRF) 2-7 years postpartum.

Methods

This is a secondary analysis of a multicenter cohort study in which nulliparous pregnant people were enrolled in the first trimester and followed prospectively. Participants with a CRF (hypertension, dyslipidemia, and/or prediabetes/diabetes) at follow-up were included. We excluded participants with: pre-gestational diabetes, chronic hypertension, dyslipidemia during the index pregnancy or subsequent pregnancy, and non-fasting blood draws. The exposure …

Effectiveness And Safety Of Intravenous Iron Therapy In Outpatient Obstetrical Clinic For Treatment Of Iron-Deficiency Anemia During Pregnancy, Ellen M. Murrin, Olivia S. Lebeau, Lillian Singer, Mark A. Kassab, Peyton Kalan, Julie Costanzo, Scott A. Sullivan, George L. Maxwell, George R. Saade, Antonio F. Saad

Department of Obstetrics & Gynecology Faculty Publications

Background

Iron-deficiency anemia (IDA) affects over one-third of pregnant patients globally, contributing to severe maternal morbidity and adverse neonatal outcomes. Oral iron supplementation, while cost-effective, is limited by poor absorption, significant gastrointestinal side effects, and poor adherence. The use of intravenous (IV) iron addresses many of these concerns, including eliminating GI side effects and the need for daily therapy. However, administration of IV iron in pregnant patients is typically restricted to specialized infusion centers or hospitals due to concerns about acute side effects, cost, resource utilization, the need for fetal heart rate monitoring, and extended infusion times.

Methods

This descriptive …

Impacts Of Ramadan Fasting During Pregnancy On Pregnancy And Birth Outcomes: An Umbrella Review, Abdullah Al-Taiar, Md Estiar Rahman, May Salama, Ali H. Ziyab, Wilfried Karmaus

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Background

Despite a large number of primary research studies, and systematic and narrative reviews, there is no consensus on the impact of fasting during Ramadan while pregnant on pregnancy and birth outcomes. Currently, there is no evidence-based guideline for Muslim women regarding Ramadan fasting during pregnancy and clinicians cannot provide firm recommendations.

Objectives

To review the current evidence regarding the impact of Ramadan fasting during pregnancy on pregnancy and birth outcomes.

Search Strategy

We conducted an umbrella review of all systematic and narrative reviews examining the impacts of fasting during Ramadan while pregnant on pregnancy and birth outcomes by searching …

The Role Of Doulas In The Health Care Continuum For Pregnant People With Substance Use Disorder: Perspectives Of Patients, Doulas, And Healthcare Providers, Dashaunda Taylor, Derek A. Chapman, Caitlin E. Martin, Cynthia C. F. Romero, Gerard Moeller

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Objectives/Goals: The goals of this research are to 1) determine the prevalence of perinatal doula services use in Virginia, with a focus on individuals with substance use disorders (SUD), 2) evaluate awareness of doulas among pregnant and postpartum people with SUD, and 3) assess provider knowledge and interaction with doulas for the care of this population. Methods/Study Population: Both quantitative and qualitative methods will be used to evaluate patient and healthcare provider knowledge regarding doula services and the patient–doula–healthcare provider relationship. Surveys and semi-structured interviews will be administered to doulas, pregnant and postpartum women, and healthcare providers in this mixed-methods …

Wilson’S Disease Presenting As Acute Hepatitis In Pregnancy With Successful Maternal And Neonatal Outcomes: A Case Report, Paribesh Gyawali, Ranjan Regmi, Shambu Khanal, Rajan Bhandari, Shivani Gupta, Gunjan Arora

Graduate Medical Education Research Journal

Background: Wilson’s disease is a rare genetic disorder characterized by copper accumulation, leading to multi-organ symptoms. It affects between 1 in 30,000 to 1 in 100,000 individuals, with a mean age at diagnosis of 13.2 years. The diagnosis may be overlooked due to its numerous presentations, which can range from non-specific symptoms such as fever, fatigue, and behavioral changes to fulminant hepatic failure. Its clinical manifestations vary widely, making diagnosis during pregnancy particularly challenging. Wilson’s disease complicates pregnancy, as untreated cases can lead to significant morbidity and mortality; excess copper can disrupt metabolic processes and contribute to recurrent miscarriages.

Case: …

Effect Of Social Vulnerability Index On Betamethasone Timing In Patients At Risk Of Preterm Birth, Lizelle Comfort, Gillian Piltch, David Krantz, Frank Ian Jackson, Matthew J. Blitz, Burton Rochelson

Specialty Medicine Faculty Publications

Background/Objectives: Several social vulnerability index (SVI) components have been associated with adverse obstetrical outcomes and provider bias. The objective of this study is to assess whether betamethasone administration timing among patients at risk for preterm birth differs by social vulnerability index. Methods: A multicenter retrospective cohort study of pregnant people at a large academic healthcare system between January 2019 and January 2023. Patients with live singleton gestations at risk for preterm birth who received at least one dose of intramuscular betamethasone for fetal lung maturity from 22 to 34 weeks were included. Patients aged less than 18, who received late-preterm …

Protocol For Culturing Patient-Derived Organoids Of Cervical Cancer, Rui Wang, Timothy Harris, Dalissa Negrón-Figueroa, David Lo, Allison Judge, D'Shaunique Walters, Bo Jiang, Lauren E Colbert

Faculty, Staff and Student Publications

Herein, we present a protocol for culturing patient-derived organoids (PDOs) of cervical cancer that includes workflows for tumor biopsy/resection tissue and cytobrush-sampled cells. We describe steps for PDO culture initiation, including rinsing, gentle dissociation, Lymphoprep separation, and cell assessment, as well as seeding cells from surgical and cytobrush tissue digestion. We then provide guidance on PDO maintenance and passage and techniques for producing conditioned medium. Overall, this protocol serves as a valuable guide for establishing and maintaining cervical cancer PDOs. For complete details on the use and execution of this protocol, please refer to Colbert et al.

The Camden Study - A Pregnancy Cohort Study Of Pregnancy Complications And Birth Outcomes In Camden, New Jersey, Usa., Stephanie Shiau, Xinhua Chen, Ayana April-Sanders, Ellen C Francis, Shristi Rawal, Megan Hansel, Kehinde Adeyemi, Zorimar Rivera-Núñez, Emily S Barrett

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Pregnancy is a unique stage of the life course characterized by trade-offs between the nutritional, immune, and metabolic needs of the mother and fetus. The Camden Study was originally initiated to examine nutritional status, growth, and birth outcomes in adolescent pregnancies and expanded to study dietary and molecular predictors of pregnancy complications and birth outcomes in young women.

METHODS: From 1985-2006, 4765 pregnant participants aged 12 years and older were recruited from Camden, NJ, one of the poorest cities in the US. The cohort reflects a population under-represented in perinatal cohort studies (45% Hispanic, 38% non-Hispanic Black, 17% White …

Do New Mothers In Their First-Year Postpartum Feel Prepared To Return To Daily Occupations?, Kim Rose, Jane L. Donat, Cedrica Durham, Bianca Haddock, Danyl Litumbe, Julia Otoski, Katsia Renaud

Occupational Therapy Annual Research Colloquium

Purpose: Our research aimed to explore if new mothers felt prepared to return to their daily lives and the role occupational therapy could have in helping prepare women to transition into their new role as mothers. Previous literature has found that limits to occupational engagement and occupational balance have adversely affected the well-being of new mothers.

Methods: This sequential, exploratory mixed methods study employed the RedCap survey platform to collect demographic information, information regarding women’s birth experience and to obtain consent. Twenty-two women who filled out the survey met the inclusion criteria, and ten were selected to proceed with the …

Targeted Maternal Chagas Disease Screening Among Individuals Born In A Chagas-Endemic Country., Alvaro Proaño, Neil C Shah, Sneider A Gutierrez Guarnizo, Monica Miranda-Schaeubinger, Michael Z Levy, Robert H Gilman, Dustin D Flannery

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Chagas disease is a neglected tropical disease caused by the parasite Trypanosoma cruzi that affects 6 million people worldwide. In the United States, Chagas is estimated to affect 43 000 women of reproductive age. Pregnant persons with Chagas are at risk for congenital transmission to the newborn, which accounts for nearly a quarter of all new cases. In 2022, a US multidisciplinary expert working group4 developed recommendations for increased clinician-directed screening for Chagas. They concluded that women of reproductive age who were born in endemic countries should be tested due to vertical transmission risk. In 2024, Clark and Bern outlined …