Obstetrics and Gynecology Commons^™

Conjoined Twins And Abortion Restrictions: Navigating 'Ban State' Challenges, A Case Report, Beau Morgan Nrp

Pursuit - The Journal of Undergraduate Research at The University of Tennessee

This case report highlights an unusual scenario of a conjoined twin pregnancy resulting from intrauterine insemination in a state with restrictive abortion laws. Despite a diagnosis deemed not compatible with life, the patient faced legal barriers preventing termination within their home state. Forced to seek care out-of-state, the patient underwent a successful termination at ten weeks and three days after lengthy and expensive travel. This case stresses the complex challenges posed by restrictive abortion laws, impacting patient access to essential medical interventions. The case demonstrates the critical intersections between medical care, medical ethics, legal constraints, and patient outcomes in managing …

Patterns Of Recurrent Preterm Birth: An Individual Patient Data Meta-Analysis, Charlotte E. Van Dijk, Annemijn A. De Ruigh, Benjamin Y. Gravesteijn, Brenda M. Kazemier, Vincenzo Berghella, John Owen, Roberto Eduardo Bittar, Rashmi Bagga, Joan M. G. Crane, Andrew H. Shennan, Birgit Arabin, Ben Willem Mol, Eva Pajkrt, C. Emily Kleinrouweler

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: Pregnant patients with a previous spontaneous preterm birth are at high risk for recurrent (spontaneous) preterm birth. We investigated whether the number of previous spontaneous preterm births, gestational age of the previous birth and cervical length could stratify patients into different risk groups for recurrence to investigate whether there is a risk group that does not require additional interventions.

DATA SOURCES: A systematic search of MEDLINE and EMBASE was conducted from 1995 until April 2025.

STUDY ELIGIBILITY CRITERIA: Studies that were included were prospective studies with original individual patient data available that reported on asymptomatic pregnant individuals with ≥1 …

Repair Of Uterine Rupture With Placenta Accreta At 22 Weeks, Followed By Cesarean Hysterectomy Delivery Of Healthy Neonate At 32 Weeks, Molly Dickinson, Thomas Jefferson University, Marco Goldberg, Mae Florendo, Andrew Chau, Corrado Minimo, Kate Stampler, Jay Goldberg

Einstein Health Papers

Introduction: Uterine rupture at previable gestational ages is almost always treated with evacuation of the pregnancy, followed by uterine repair or hysterectomy. Case Presentation: A 40-year-old woman with one prior cesarean section presented at 22 weeks of gestation with an acute abdomen. Imaging noted hemoperitoneum with areas of bulging in the anterior uterine wall. Laparoscopy converted to a laparotomy through a midline incision, noted an actively bleeding 2 cm area of uterine rupture with protruding placental tissue. The uterine rupture was surgically closed with sutures. The patient was kept in the hospital for the remainder of her pregnancy. At 32 …

Identification Of De Novo Variants From Parent-Proband Duos Via Long-Read Sequencing, Leandros Boukas, Emmanuèle C. Délot, Georgia Pitsava, Christine Lambert, Cairbre Fanslow, Primo Baybayan, Sami Belhadj, Bojan Losic, John Harting, Krista Bluske, Jonathan Lotempio, Huda B. Al-Kouatly, Rachid Karam, William J. Rowell, Changrui Xiao, Eric Vilain, Seth I. Berger

Department of Obstetrics and Gynecology Faculty Papers

While de novo variants cause many Mendelian disorders, their detection currently requires sequencing of the proband and both biological parents. This is not feasible when only one parent is available, a limitation for millions of families. Here, we develop duoNovo, which identifies de novo variants from parent-proband duos using long-read sequencing followed by haplotype reconstruction and detection of identical-by-descent haplotype blocks. We sequenced 104 trios with PacBio HiFi sequencing and applied duoNovo to each of the 208 duos constructed by masking one parent, classifying over 55 million variants according to their de novo status. We evaluated duoNovo's performance against classifications …

Benefits, Challenges, And The Way Forward: Medical Specialists' Perception On Family Physician Integration In Healthcare System In Tanzania, Juvenalius Anselm, Roselyter Riang’A, Neelam Ismail, Davis Rubagumya, Jesca Munishi, Sumayyah Saudin, Lynn Moshi, Willbroad Kyejo, Nancy Matillya

Family Medicine, East Africa

Background Family medicine provides comprehensive care by integrating biomedical, behavioral, and social sciences. While established in some sub-Saharan countries, it remains new and unintegrated in Tanzania’s public health system. Its integration is vital for healthcare reform to enhance patient care and system quality.This study aimed to understand the perceptions of medical specialists regarding the integration of family physicians into the Tanzanian healthcare system.

Methods A descriptive qualitative study was conducted through in-depth interviews with ten medical specialists from Aga Khan Hospital and Muhimbili National Hospital in Dar es Salaam. Thematic analysis was employed in this study.

Results Integration of family …

Effect Of Dental Treatments On Reduction Of Preterm Birth: A Systematic Review And Meta-Analysis, Camille Thomas, Shakil Ahmed, Vincenzo Berghella, Romina Brignardello-Petersen, Mohamed El-Rabbany, Catherine Devion, Stefania Ronzoni

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: Periodontal disease is associated with increased risk of preterm birth. Effective management during pregnancy may reduce preterm birth, though clinical trial evidence has been inconsistent. This study aimed to assess whether treating dental disease during pregnancy reduces preterm birth.

DATA SOURCES: A systematic search was performed of EMBASE, MEDLINE, PubMed, Cochrane Library, and trial registries up to December 2023 and re-run in January 2025.

STUDY ELIGIBILITY CRITERIA: Randomized controlled trials (RCTs) enrolling pregnant persons with any dental disease randomized to receive dental treatment vs no treatment were included. No language restriction was applied.

STUDY APPRAISAL AND SYNTHESIS METHODS: Data …

A Physician Survey On Research And Implementation Priorities For Caffeine Citrate Use In Newborn Care In Sub-Saharan Africa, Olufunke Bolaji, Osayame Ekhaguere, Franck Houndjahoue, Nicholas Embleton, Helen Nabwera

Centre of Excellence in Women and Child Health

Background:Evidence on caffeine citrate (CC) for apnoeaof prematurity (AOP) originate from high-income countries. This study aimed to develop consensus on research design for evidence in sub-Saharan Africa (SSA).

Methods:We surveyed physicians in newborn units across SSA to assess their opinions on CC research and their preferred study designs.

Participants rated four study designs:a) an observational before-and-after study; a randomized controlled trial (RCT) of b) caffeine versus placebo; c) caffeine versus aminophylline; d) a traditional or stepped wedge cluster trial.  They  assessed  each  design  using  a  Likert  scale  for  evidence, feasibility, and ethics considerations.

Results:Ninety-two   newborn   physicians …

Renin-Angiotensin-Aldosterone System In Preeclampsia: Pathophysiological Insights And Links To Vascular Dementia, Robin C. Finch, Jenny Lutshumba, Elizabeth Mirsky, Esther Ndashaala, Kelsey Bullens, Emma Smith

Pediatrics Faculty Publications

Pre-eclampsia, a condition characterized by new-onset hypertension during pregnancy and one or more indices of organ damage, is a major driver of both short and long-term maternal health outcomes. Individuals with a history of pre-eclampsia are at increased risk for cardiovascular, renal, and other chronic diseases. Recent studies have linked pre-eclampsia history with increased risk of dementia later in life, underscoring the importance of new guidelines emphasizing blood pressure control to reduce the risk of cognitive decline. Unfortunately, neither mechanisms underlying causes of pre-eclampsia nor their links with cognitive function are well understood. Vascular contributions to cognitive impairment and dementia …

Osteopathic Manipulative Medicine As An Adjunctive Approach To Improve Pelvic Perfusion And Fertility-Related Physiologic Markers, Ashton Dodd, Yanielisse Bellinger, Marsha Chevalier, Annaliese Taylor, Jacob Warner-Palacio, Aurora Jeanes, Nathan Barnhurst

Annual Research Symposium

No abstract provided.

Molecular Profiling And Tumor Biomarker Analysis Of Gog281/Logs: A Positive Late-Phase Trial Of Trametinib For Recurrent/Persistent Low-Grade Serous Ovarian Carcinoma, Robert L. Hollis, Austin Miller, Heather A. Lankes, Kwong-Kwok Wong, William Rodgers, David Millan, Karen Carty, Robert L. Coleman, Kathleen N. Moore, Angeles Alvarez Secord, David M. O'Malley, John K. Chan, Andrea R. Hagemann, Stephanie Gaillard, Saketh R. Guntupalli, Mitchell I. Edelson, Peter G. Rose, Oliver Dorigo, Susana Banerjee, Ailith Ewing, Michael Churchman, Anil K. Sood, C. Simon Herrington, Charlie Gourley, David M. Gershenson

Abington Jefferson Health Papers

PURPOSE: Low-grade serous ovarian carcinoma (LGSOC) is a distinct form of ovarian cancer characterized by younger patient age and relative chemoresistance. The GOG281/LOGS trial (NCT02101788) investigated the efficacy of the MEK inhibitor trametinib compared with physician's choice standard-of-care (SOC) in patients with LGSOC with persistent/recurrent disease. The study demonstrated significantly improved progression-free survival (PFS) in the trametinib-treated arm.

EXPERIMENTAL DESIGN: Two hundred and sixty patients with recurrent/persistent LGSOC were enrolled and randomly assigned in GOG281. We performed molecular analysis of 170 patients with available tumor specimens, comprising whole-exome sequencing and phospho-ERK (pERK) IHC, to identify biomarkers of clinical benefit from …

Tumor Necrosis Factor Alpha Inhibition Improves Fetal Growth In A Rat Model Of Preeclampsia, Laura E. Coats, Nathan Campbell, Dylan Solise, Gabrielle M. Chamoun, Adam Z. Rawls, Alexandra Demesa, Ty Turner, Baoying Zheng, Barbara T. Alexander, Babbette Lamarca

Physiology & Biophysics

Introduction

Artificial Intelligence In Medical Ethics Education: A Descriptive Study Of Eight Models In Multiple Choice Question Generation, John Obeid, Christopher Bobier, Alex Gillham, Adam Omelianchuk, Daniel Hurst

Center for Medical Ethics and Health Policy Staff Publications

Introduction: Integrating artificial intelligence (AI) into medical education poses barriers and opportunities for medical educators. One of those opportunities is content creation for medical ethics assessment. Assessing the performance of AI in generating multiple choice questions (MCQs) in ethics that aligns with United States Medical Licensing Examination (USMLE) is important. The present study evaluates the performance of eight AI models-GPT-4 Turbo, GPT-3.5 Turbo 0125, o1 Mini, o1 Preview, GPT-4, Claude 3.5 Sonnet, Claude 3 Opus, and Gemini-in regard to the relevance, clarity, and accuracy of generated ethics-based MCQs.

Methods: Each of the eight models was tasked with generating two sets …

Exploring Physician Views On Birth Method And Route Of Delivery, Vivian Nguyen, Vincenzo Berghella, Md

Alpha Omega Alpha Research Symposium Posters

Purpose: In the United States, rates of cesarean deliveries (CD) have been increasing. Despite recommendations from the American College of Obstetrics and Gynecology to prevent increasing rates of CDs, planned CD has been associated with lower rates of perinatal deaths and better maternal outcomes when compared to planned vaginal delivery (VD). However, the data is limited, so it is important that we conduct randomized controlled trials (RCTs) comparing maternal and perinatal outcomes in planned CD vs planned vaginal delivery (VD) for nulliparous, term, single, vertex pregnancies. The purpose of study is to survey obstetricians and gynecologists (ob/gyns) on their …

Pregnancy Outcomes Among Women With And Without Hiv Infections Who Underwent Excisional Treatment For High-Grade Cervical Intraepithelial Neoplasia: A Retrospective Cohort Study In Low-Resource Settings, Poli Amubuomombe, Peter Itsura, Philiph Tonui, Elkanah Orang'o, Benjamin Odongo, Patrick Loehrer, Susan Cu-Uvin

Obstetrics and Gynaecology, East Africa

Objective The standard treatment for high-grade squamous intraepithelial lesions is excisional involving the uterine cervix, while surveillance is an acceptable approach for low-grade squamous intraepithelial lesions. There is controversy about excisional treatment on pregnancy outcomes. The objective of this study was to determine pregnancy outcomes in women living with and without HIV who underwent excisional treatment for high-grade cervical intraepithelial lesions.

Design This retrospective cohort study compared the pregnancy outcomes of women with and without HIV who were or were not treated for cervical intraepithelial lesions. A cohort of 488 women with and without HIV infection who did or did …

Intraoperative Care And Complications Of Symptomatic Adolescent And Young Adult Patients Undergoing Laparoscopy To Diagnose And/Or To Treat Endometrioses: A Multi-Institutional Review., Jacquelyn R. Evans, Katherine Bergus, Lindsey Asti, Lesley L. Breech, Ruiqi Cen, Yuan Yuan Gong, S Paige Hertweck, Holly R. Hoefgen, Anne H. Horne, Ashli A. Lawson, Seema Menon, Kathleen E. O'Brien, Shashwati Pradhan, Brenna Rachwal, Yolanda R. Smith, Priya Suvarna, Sarah Van Son, Geri Hewitt

Manuscripts, Articles, Book Chapters and Other Papers

STUDY OBJECTIVE: This multi-institutional, retrospective study explores the risks of laparoscopy for diagnosis and treatment of endometriosis to facilitate shared medical decision-making in patients age < 22 years old with chronic pain considering surgery.

METHODS: A retrospective review of patients less than 22 years old who had surgically proven endometriosis at eight pediatric hospitals was completed. Patient demographics, operative interventions, concurrent procedures, and complications were evaluated.

RESULTS: There were 284 patients with pathologically confirmed endometriosis with a median age of 16.86 years (15.51, 18.06). During the index procedure, diagnostic biopsy alone was performed (35.92%), followed by ablation (29.93%), excision (20.07%), excision and ablation (12.68%), and cryoablation (1.41%). Most common …

Prevalence And Risk Factors For Laparoscopic Managed Ectopic Pregnancies At A Tertiary Referral Hospital - A 10-Year Synopsis: A Cross Sectional Study, Steve Mutiso, Eric Mugambi

Obstetrics and Gynaecology, East Africa

Background Ectopic pregnancies (EP) are a common pregnancy associated complication. They are associated with significant morbidity, and rarely mortality, if not managed properly. EP have a myriad of predisposing factors that help identify patients at risk and facilitate early diagnosis and intervention. We set out to conduct an audit of EP managed surgically at our hospital for a 10-year period and discern the incidence, prevalence and risk factors of their occurrence.

Methods This study was designed as a Retrospective Clinical Audit based at the Aga Khan University Hospital (AKUH). Study population was all women admitted to AKUH with a diagnosis …

International Normative Charts For Twin Weight, Length, And Head Circumference At Birth, By Gestational Age And Sex: The Twin Neonatal Cross-Sectional Study Of The Intergrowth-21st Project, Francesca Giuliani, Sonia Deantoni, Enrico Bertino, Yasmin A. Jaffer, Manorama Purwar, Fernando C. Barros, Leila Cheikh Ismail, Wu Qingqing, Ilaria Stura, Maria Carvalho

Obstetrics and Gynaecology, East Africa

Assessing the size of twins at birth using charts developed for singletons may over diagnose small for gestational age in this sub-population. The study aimed to produce international, twin-specific, newborn size normative charts by gestational age and sex. This longitudinal observational study in eight geographically diverse settings prospectively collected data between May 2009 and August 2013 from healthy pregnant women and their newborn twins. The participants were enrolled as part of the INTERGROWTH-21st study, and recruited based on World Health Organization recommendations for evaluation of anthropometric measures. All the women met, in addition to the underlying population characteristics of low …

Normative Growth Trajectories Of Fetal Brain Regions Validated By Satisfactory Maturation Of Neurodevelopmental Domains At 2 Years Of Age, Madeleine Wyburd, Stephen Kennedy, Michelle Fernandes, Nicola Dinsdale, Linde Hesse, Robert Gunier, Leila Ismail, Eric Ohuma, Michael Gravett, Maria Carvalho

Obstetrics and Gynaecology, East Africa

We previously constructed a qualitative, 3D ultrasound derived atlas of the normative spatiotemporal dynamics of fetal brain maturation. Here, using the same healthy multi-national cohort, we applied deep learning methods to 4205 fetal brain scans from 18–27 weeks’ gestation, to produce an extensive, quantitative description of the growth of 16 fetal brain structures associated with satisfactory domain-specific neurodevelopmental scores at 2 years of age. The methodology, which is publicly available, takes less than 10 seconds per scan. We define 28 region-specific, functionally relevant, normative growth trajectories, a ratio between the relative volumes of the insular (rILV) and parietal (rPLV) lobes …

The Use Of A Standardized Checklist For Image Acquisition: An Obstetric Ultrasound Quality Improvement Study, Ingrid Gichere, Nidhi Leekha, Sikolia Wanyonyi

Obstetrics and Gynaecology, East Africa

Introduction A complete anatomical survey during the mid-trimester ultrasound is critical for detecting fetal anomalies. In sub-Saharan Africa, detection rates remain low, contributing to a significant disease burden. This study evaluated whether implementing a standardized electronic checklist, based on existing guidelines, would improve image acquisition.

Methods We carried out a pre- and post-intervention quasi-experimental quality improvement study. An electronic checklist replaced the previous ultrasound report template. A baseline review involved 385 mid-trimester scans conducted between November 2022 and December 2023. Following checklist implementation and targeted sonographer training, 238 scans were reassessed from July to December 2024. The image acquisition rate …

Qualitative Exploration Of Factors Associated With Covid-19 Vaccination Among Pregnant Women In Kenya, Violet Naanyu, Ferdinand Okwaro, Ingrid Gichere, Mandeep Sura, Prachi Singh, Berhaun Fesshaye, Marleen Temmerman

Centre of Excellence in Women and Child Health

The COVID-19 pandemic significantly disrupted societies worldwide, and COVID-19 vaccination has been identified as instrumental in the fight against the pandemic. While studies have examined uptake of COVID-19 vaccination, more research is needed to gain a better understanding of the factors influencing pregnant women’s decisions to get vaccinated. In this study, we used a cross-sectional descriptive qualitative study to explore the attitudes, beliefs, and behaviors related to COVID-19 vaccination during pregnancy in Kenya. A total of 50 in-depth interviews were conducted between October 2023 to March 2024 with a purposively drawn sample of 25 pregnant and 25 postpartum women during …