Obstetrics and Gynecology Commons^™

The Obstetrical Management Of Hiv-Positive Pregnancy, Mihai George Loghin, Petre Gabriel Gorescki, Romina Marina Sima, Liana Pleș, Daniela Gabriela Balan, Ioana Paunica, Oana Denisa Bălălău

Journal of Mind and Medical Sciences

The human immunodeficiency virus (HIV) infection is a real public health problem in both developing and developed countries. HIV infection has not been treated efficiently for a long time, with HIV-positive women at increased risk of transmitting the infection to their newborns. Without the appropriate treatment, the evolution of the infection is relatively fast. Due to the antiretroviral treatment, the progression of the disease is blocked during the period of asymptomatic infection, and the risk of neonatal transmission is very low. HIV-positive patients undergoing antiretroviral therapy develop undetectable viremia and, in such situations, patients no longer have a risk of …

Modern Interpretation Of Risk Factors In Breast Cancer Of Women, Oana Denisa Bălălău, Răzvan Valentin Scăunașu, Octavian Gabriel Olaru, Anca Silvia Dumitriu, Stana Paunica, Liliana Florina Andronache, Anca Daniela Stănescu

Journal of Mind and Medical Sciences

Breast cancer is a major public health problem, being the most common cancer diagnosed in women and accounting for more than 1 in 10 new diagnoses of cancer each year. It is the most common neoplasm of women under the age of 40 and the second leading cause of cancer death in this age group, with more frequent detection of pathogenic mutations in breast cancer susceptibility genes. Women with BRCA1 and BRCA2 mutations are about 70% more likely to develop breast cancer. The incidence is rising in most countries and it is expected to have a growing trend in the …

Gestational Age Variation In Human Placental Drug Transporters, Laura Goetzl, Nune Darbinian, Nana Merabova, Lindsay C Devane, Sammanda Ramamoorthy

Faculty, Staff and Student Publications

Patient and providers' fear of fetal exposure to medications may lead to discontinuation of treatment, disease relapse, and maternal morbidity. Placental drug transporters play a critical role in fetal exposure through active transport but the majority of data are limited to the 3rd trimester, when the majority of organogenesis has already occurred. Our objective was to define gestational age (GA) dependent changes in protein activity, expression and modifications of five major placental drug transporters: SERT, P-gp, NET, BCRP and MRP3. Apical brush border membrane fractions were prepared from fresh 1st, 2nd and 3rd trimester human placentas collected following elective pregnancy …

Heterotopic Gestation In Polycystic Ovary Disease: Termination Of Tubal Pregnancy And Intrauterine Pregnancy Progressing To Term, Munawar Kaguta, Ahmed Jusabani, Ntiyakuze Gregory, Shweta Jaiswal, Zainab Fidaali, Pilly Ally, Davis Rubagumya, Miriam Mgonja, Farhat Seif

Obstetrics and Gynaecology, East Africa

Heterotopic pregnancy is rare. We report a 27-year-old lady with polycystic ovarian disease. She presented at our health facility with acute abdomen. Her evaluation revealed heterotopic pregnancy. High index of suspicion for heterotopic pregnancy in any woman with early pregnancy presenting with acute abdomen is crucial. Therefore, correct and early diagnosis allows appropriate management while it preserves the intrauterine pregnancy as in the index case.

Epidemiological Profile And Clinico-Pathological Features Of Pediatric Gynecological Cancers At Moi Teaching & Referral Hospital, Kenya, Anisa W. Mburu, Peter M. Itsura, Elkanah Omenge, Philiph K. Tonui, Elly B. Odongo, Afrin F. Shaffi, Hellen N. Muliro, Thomas N. Achia, Allan L. Covens, Barry P. Rosen

Obstetrics and Gynaecology, East Africa

Background: The main pediatric (0–18 years) gynecologic cancers include stromal carcinomas (juvenile granulosa cell tumors and Sertoli-Leydig cell tumors), genital rhabdomyosarcomas and ovarian germ cell. Outcomes depend on time of diagnosis, stage, tumor type and treatment which can have long-term effects on the reproductive career of these patients. This study seeks to analyze the trends in clinical-pathologic presentation, treatment and outcomes in the cases seen at our facility. This is the first paper identifying these cancers published from sub-Saharan Africa.

Method: Retrospective review of clinico-pathologic profiles and treatment outcomes of pediatric gynecologic oncology patients managed at MTRH between 2010 and …

Prenatal Drug Exposure And Its Effects On Fetal Development: Clinical And Health Education Implications, Johanna Marie Olo Tapangan

Senior Honors Theses

Prenatal drug exposure is a common clinical phenomenon in pregnancy cases. Pregnancy is a fragile period of time for both the mother and the fetus. Therefore, strict drug regulation is important to ensure the safety and wellbeing of the developing fetus. Certain drugs, once thought to be safe, have been found to have detrimental effects on the normal development of functioning organ systems in the fetus. Current research has identified drugs that when taken during pregnancy can result in the onset of fetal physical abnormalities, impaired brain development, and disrupted organogenesis and organ function. Thalidomide, losartan, opioids, alcohol, and caffeine …

La Política Cultural Del Aborto: Las Percepciones Y El Manejo Del Aborto En Arica, Chile, Eva Strelitz-Block

Independent Study Project (ISP) Collection

Chile has a long history of restricting access to legal abortion. Until 2017, when the government passed the law N° 21.030 decriminalizing abortion on three grounds, abortion was completely illegal. However, despite this movement towards decriminalization, legal abortion access is still very limited and highly restricted. In this criminalized, highly stigmatized environment, self-managed abortion has emerged as a way to transform the landscape of abortion. This qualitative, exploratory study seeks to explore perceptions of abortion and practices of abortion management both within and outside of the official healthcare system among women and people with the capacity to become pregnant and …

Assessing And Addressing Barriers To Fertility Preservation In Pediatric And Adolescent Patients At Risk For Infertility, Emily Burnett, Tennille Hilyard, Julie Strickland

Presentations

Fertility consultation is a recognized standard that should be offered to pediatric patients with fertility threatening diagnoses or undergoing fertility threatening therapy. The primary objective of this study is to determine how patients who did proceed with fertility preservation differ from those who declined the procedure. This study aims to assess barriers that may contribute to the underutilization of fertility preservation procedures after a formal consultation is completed.

Scaling Up Context-Tailored Clinical Guidelines And Training To Improve Childbirth Care In Urban, Low-Resource Maternity Units In Tanzania: A Protocol For A Stepped-Wedged Cluster Randomized Trial With Embedded Qualitative And Economic Analyses (The Partoma Scale-Up Study), Nanna Maaløe, Natasha Housseine, Jane Brandt Sørensen, Josephine Obel, Brenda Sequeira D'Mello, Monica Lauridsen Kujabi, Haika Osaki, Thomas Wiswa John, Rashid Saleh Khamis, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

While facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore, realistic, context-tailored clinical support is crucially needed to assist birth attendants in resource-constrained realities to provide best possible evidence-based and respectful care. Our pilot study in Zanzibar suggested that co-created clinical practice guidelines (CPGs) and low-dose, high-frequency training (PartoMa intervention) were associated with improved childbirth care and survival. We now aim to modify, implement, and evaluate this multi-faceted intervention in five high-volume, urban maternity units in Dar es Salaam, Tanzania (approximately 60,000 births …

Pgc1Α/Β Expression Predicts Therapeutic Response To Oxidative Phosphorylation Inhibition In Ovarian Cancer, Carmen Ghilardi, Catarina Moreira-Barbosa, Laura Brunelli, Paola Ostano, Nicolò Panini, Monica Lupi, Alessia Anastasia, Fabio Fiordaliso, Monica Salio, Laura Formenti, Massimo Russo, Edoardo Arrigoni, Ferdinando Chiaradonna, Giovanna Chiorino, Giulio Draetta, Joseph R Marszalek, Christopher P Vellano, Roberta Pastorelli, Mariarosa Bani, Alessandra Decio, Raffaella Giavazzi

Faculty, Staff and Student Publications

Ovarian cancer is the deadliest gynecologic cancer, and novel therapeutic options are crucial to improve overall survival. Here we provide evidence that impairment of oxidative phosphorylation (OXPHOS) can help control ovarian cancer progression, and this benefit correlates with expression of the two mitochondrial master regulators PGC1α and PGC1β. In orthotopic patient-derived ovarian cancer xenografts (OC-PDX), concomitant high expression of PGC1α and PGC1β (PGC1α/β) fostered a unique transcriptional signature, leading to increased mitochondrial abundance, enhanced tricarboxylic acid cycling, and elevated cellular respiration that ultimately conferred vulnerability to OXPHOS inhibition. Treatment with the respiratory chain complex I inhibitor IACS-010759 caused mitochondrial swelling …

Evaluating The Effect Of Neuraxial Analgesia On External Cephalic Version Success, Sarah Dreibelbis, Peter F. Schnatz, Edwin Newton

Transformative Medicine

Abstract

Background: External cephalic version (ECV) can be a helpful procedure in attempts to decrease the overall cesarean section rate. ECV involves the application of external pressure to the pregnant woman’s abdomen in attempts to turn the fetus to a vertex presentation and allow for subsequent vaginal delivery. Tocolytics are routinely used to increase ECV success rates, and neuraxial analgesia has been presented as another adjunct to increase overall success. The purpose of this quality improvement project is to evaluate the effect neuraxial analgesia may have on ECV success rates.

Methods: Patients scheduled for ECV between the dates of January …

Ovarian Reserve Parameters And Ivf Outcomes In 510 Women With Poor Ovarian Response (Por) Treated With Intraovarian Injection Of Autologous Platelet Rich Plasma (Prp), Yigit Cakiroglu, Aysen Yuceturk, Ozge Karaosmanoglu, Sule Yildirim Kopuk, Zeynep Ece Utkan Korun, Nola Herlihy, Richard T. Scott, Bulent Tiras, Emre Seli

Department of Obstetrics and Gynecology Faculty Papers

The aim of the current study was to characterize ovarian reserve parameters and IVF outcomes in women with a history of poor ovarian response (POR) treated with intraovarian injection of autologous platelet rich plasma (PRP). Reproductive age women (N=510; age range 30-45yo) diagnosed with POR based on Poseidon criteria were included in the study. PRP treatment resulted in higher AFC, higher serum AMH, lower serum FSH, and a higher number of mature oocytes and cleavage and blastocyst stage embryos. After PRP injection, 22 women (4.3%) conceived spontaneously, 14 (2.7%) were lost to follow up, and 474 (92.9%) attempted IVF. Among …

Placental Lesions And Differential Expression Of Pro-And Anti-Angiogenic Growth Mediators And Oxidative Dna Damage Marker In Placentae Of Ghanaian Suboptimal And Optimal Health Status Pregnant Women Who Later Developed Preeclampsia, Enoch Odame Anto, David Antony Coall, Emmanuel Akomanin Asiamah, Osei Owusu Afriyie, Otchere Addai-Mensah, Yaw Amo Wiafe, W. K. B. A. Owiredu, Christian Obirikorang, Max Efui Annani-Akollor, Nicholas Akinwale Titiloye, Eric Adua, Emmanuel Acheampong, Evans Asamoah Adu, Stephen Opoku, Agartha Odame Anto, Augustine Tawiah, Youxin Wang, Wei Wang

Research outputs 2022 to 2026

Background Angiogenic growth mediators (AGMs) and oxidative stress (OS) both play essential roles in normal placental vascular development and as such, placental alterations in these factors contribute to pre-eclampsia (PE). Suboptimal health status (SHS), an intermediate between health and disease, has been associated with imbalanced AGMs and OS biomarkers. Thus, SHS pregnant women may be at increased risk of developing PE and may present abnormal placental alteration and expression of AGMs and OS compared to optimal health status (OHS) pregnant women. We examined the histopathological morphology, immunohistochemical expression of AGMs antibodies and oxidative DNA damage marker in the placentae of …

Rare Occurrence Of Pseudomyxoma Peritonei (Pmp) Syndrome Arising From A Malignant Transformed Ovarian Primary Mature Cystic Teratoma Treated By Cytoreductive Surgery And Hipec: A Case Report, Francesca Ponzini, Luke Kowal, Mariam Ghafoor, Allison F Goldberg, Joanna Chan, Ryan Lamm, Shawnna Cannaday, Scott D. Richard, Avinoam Nevler, Harish Lavu, Wilbur Bowne, Norman G Rosenblum

Department of Surgery Faculty Papers

Background: Pseudomyxoma peritonei (PMP) syndrome is a disease process that typically occurs from ruptured appendiceal mucocele neoplasms. PMP syndrome arising from malignant transformation of an ovarian primary mature cystic teratoma (MCT) is a pathogenesis rarely encountered.

Case presentation: Herein, we report a 28-year-old patient evaluated and treated for a right ovarian mass and large volume symptomatic abdominopelvic mucinous ascites. Molecular profiling and genetic analysis revealed mutations in ATM, GNAS, and KRAS proteins while IHC demonstrated gastrointestinal-specific staining for CK20, CDX2, CK7, and SATB2. Peritoneal cytology showed paucicellular mucin. Diffuse peritoneal adenomucinosis (DPAM) variant of PMP arising from a ruptured ovarian …

Effects Of Integrating Family Planning With Maternal, Newborn, And Child Health Services On Uptake Of Voluntary Modern Contraceptive Methods In Rural Pakistan: Protocol For A Quasi-Experimental Study, Zahid Memon, Sophie Reale, Wardah Ahmed, Rachael Spencer, Talib Hussain Lashari, Zulfiqar Ahmed Bhutta, Hora Soltani

Centre of Excellence in Women and Child Health

Background: The uptake of modern contraceptive methods (MCMs) remains low, with 25% of women reporting their use in Pakistan. The overarching interventions covering service delivery platforms at facility and community levels necessitate the integration of family planning (FP) with maternal, newborn, and child health (MNCH) services.
Objective: The main aim of this study is to evaluate the impact of an integrated FP-MNCH service delivery model to increase coverage of MCMs in rural Pakistan. Moreover, we aim to measure the level of effectiveness of interventions regarding the uptake of MCMs.
Methods: A quasi-experimental, sequential, mixed methods study design with pre- and …

Factors Associated With Home Delivery In Rural Sindh, Pakistan: Results From The Global Network Birth Registry, Afreen Sadia, Shafaq Mahmood, Farnaz Naqvi, Seemab Naqvi, Zahid Soomro, Sarah Saleem

Community Health Sciences

Background: According to global estimates for 2017, nearly 295,000 maternal deaths occurred worldwide. Thus, approximately 810 women die every day due to pregnancy-related complications. This burden of maternal deaths in LMICs is primarily due to poor healthcare service utilization, as indicated by relatively low rates of institutional deliveries and skilled-birth attendance (SBA). We conducted this study with an aim to assess the factors associated with home delivery and its subsequent effect on the pregnancy outcome in rural Sindh, Pakistan.
Methods: Data for this study were taken from The Global Network's Maternal Newborn Health Registry (MNHR), which is a prospective, population-based …

Hyperammonemia Of Unknown Cause In A Young Postpartum Woman: A Case Report, Sadaf Hanif, Sher Muhammad Sethi

Section of Internal Medicine

Background: Hyperammonemia is a medical condition described as increased or elevated serum ammonia levels. High serum levels of ammonia can cause neurotoxicity. Sudden onset severe hyperammonemia may cause severe encephalopathy with brain damage. It can result in cerebral edema, emesis, seizures, hypotonia, and death. We report a young postpartum woman who had a sudden rise in serum ammonia levels after vaginal delivery.
Case presentation: A 24-year-old, married, postpartum Pakistani woman was admitted to the intensive care unit through the emergency department, with complaints of fever, severe abdominal pain with distension, and altered levels of consciousness. The patient had a medical …

Scaling Up Locally Adapted Clinical Practice Guidelines For Improving Childbirth Care In Tanzania: A Protocol For Programme Theory And Qualitative Methods Of The Partoma Scale-Up Study, Jane Brandt Sørensen, Natasha Housseine, Nanna Maaløe, Ib Christian Bygbjerg, Britt Pinkowski Tersbøl, Flemming Konradsen, Brenda Sequeira Dmello, Thomas Van Den Akker, Columba Mbekenga, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

Effective, low-cost clinical interventions to improve facility-based care during childbirth are critical to reduce maternal and perinatal mortality and morbidity in low-resource settings. While health interventions for low- and lower-middle-income countries are often developed and implemented top-down, needs and circumstances vary greatly across locations. Our pilot study in Zanzibar improved care through locally co-created intrapartum clinical practice guidelines (CPGs) and associated training (the PartoMa intervention). This intervention was context-tailored with health-care providers in Zanzibar and now scaled up within five maternity units in Dar es Salaam, Tanzania. This PartoMa Scale-up Study thereby provides an opportunity to explore the co-creation process …

Long-Term Survival Following Definitive Radiation Therapy For Recurrence Or Oligometastases In Gynecological Malignancies: A Landmark Analysis, Kelsey L Corrigan, Alison Yoder, Brian De, Lilie Lin, Anuja Jhingran, Melissa M Joyner, Patricia J Eifel, Lauren E Colbert, Karen H Lu, Ann H Klopp

Faculty, Staff and Student Publications

Objective: Radiation therapy (RT) may improve outcomes for patients with oligometastatic cancer. We sought to determine if there are long-term survivors treated with definitive RT for recurrent or oligometastatic gynecological cancer (ROMGC), and to evaluate the clinical and disease characteristics of these patients.

Methods: We performed a landmark analysis in 48 patients with ROMGC who survived for ≥5 years following definitive RT of their metastasis. Patient characteristics were extracted from the medical record. DFS was modeled using the Kaplan-Meier method.

Results: This cohort included 20 patients (42%) with ovarian cancer, 16 (33%) with endometrial cancer, 11 (23%) with cervical cancer, …

Tissue-Targeted Crispr-Cas9-Mediated Genome Editing Of Multiple Homeologs In F0 Generation Xenopus Laevis Embryos, Mark E Corkins, Bridget D Delay, Rachel K Miller

Faculty, Staff and Student Publications

Xenopus laevis frogs are a powerful developmental model that enables studies combining classical embryology and molecular manipulation. Because of the large embryo size, ease of microinjection, and ability to target tissues through established fate maps, X. laevis have become the predominant amphibian research model. Given that their allotetraploid genome has complicated the generation of gene knockouts, strategies need to be established for efficient mutagenesis of multiple homeologs to evaluate gene function. Here we describe a protocol to utilize CRISPR-Cas9-mediated genome editing to target either single alleles or multiple alloalleles in F0 X. laevis embryos. A single guide (sg) RNA is …