Obstetrics and Gynecology Commons^™

Diagnostic Challenge Of Perimenopause Molar Pregnancy In A 52-Year-Old Lady: Case Report, Willbroad Kyejo, Davis Rubagumya, Gregory Ntiyakuze, Nancy Matillya, Munawar Kaguta, Miriam Mgonja, Lynn Moshi

Family Medicine, East Africa

Introduction and importance: Gestational trophoblastic disease is an uncommon group of pregnancy-related dis- orders, with a course of trophoblastic proliferation, including hydatidiform mole (Agha et al., 2020), invasive and metastatic mole, choriocarcinoma, placental-site trophoblastic tumor, and epithelial trophoblastic tumor. Choriocarcinoma and trophoblastic tumor of the placenta are the most important tumors associated with pregnancy.

Case findings: A 52-year-old woman Para 2 Living 3, 3 years post-menopausal presented with prolong per vaginal bleeding for five weeks accompanied by lower abdominal pain. Diagnosis of gestational trophoblastic disease (choriocarcinoma type) was made by using beta HCG, radiology, and histology report. Patient underwent total …

Quality Of Life Among Cervical Cancer Patients Following Completion Of Chemoradiotherapy At Ocean Road Cancer Institute (Orci) In Tanzania, David H. Mvunta, Furaha August, Nazima Dharsee, Miriam H. Mvunta, Peter Wangwe, Matilda Ngarina, Brenda M. Simba, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

Objective:  Effective cancer treatment involves aggressive chemo-radiotherapy protocols that alter survivors’ quality of life (QOL). This has recently aroused the attention not only to focus on clinical care but rather to be holistic and client-centered, looking beyond morbidity and mortality. The study assessed the QOL and associated factors among patients with cervical cancer (CC) after the completion of chemoradiotherapy.

Methods: A cross-sectional analytical study was conducted at Ocean Road Cancer Institute (ORCI) from September to November 2020. A total of 323 CC patients were interviewed with a structured questionnaire of QOL, the European Organization for Research and Treatment …

A Retrospective Review Of Genital Fistula Occurrence In Nine African Countries, Carrie J. Ngongo, Thomas J. I. P. Raassen, Marietta Mahendeka, Ladeisha Lombard, Jos Van Roosmalen, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Female genital fistulas are abnormal communications that lead to urinary and/or fecal incontinence. This analysis compares the characteristics of women with fistulas to understand how countries differ from one another in the circumstances of genital fistula development.

Methods: This retrospective records review evaluated demographics and circumstances of fistula development for 6,787 women who sought fistula treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia, and Ethiopia.

Results: Most women developed fistula during childbirth, whether vaginal (3,234/6,787, 47.6%) or by cesarean section (3,262/6,787, 48.1%). Others had fistulas attributable to gynecological surgery …

Association Between Fetal Abdominal Growth Trajectories, Maternal Metabolite Signatures Early In Pregnancy, And Childhood Growth And Adiposity: Prospective Observational Multinational Interbio-21st Fetal Study, Jose Villar, Roseline Ochieng, Robert B. Gunier, Aris T. Papageorghiou, Stephen Rauch, Rose Mcgready, Julia M. Gauglitz, Fernando C. Barros, Manu Vatish, Shama Munim

Department of Obstetrics & Gynaecology

Background: Obesity predominantly affects populations in high-income countries and those countries facing epidemiological transition. The risk of childhood obesity is increased among infants who had overweight or obesity at birth, but in low-resource settings one in five infants are born small for gestational age. We aimed to study the relationships between: (1) maternal metabolite signatures; (2) fetal abdominal growth; and (3) postnatal growth, adiposity, and neurodevelopment.
Methods: In the prospective, multinational, observational INTERBIO-21st fetal study, conducted in maternity units in Pelotas (Brazil), Nairobi (Kenya), Karachi (Pakistan), Soweto (South Africa), Mae Sot (Thailand), and Oxford (UK), we enrolled women (≥18 years, …

Lenvatinib Plus Pembrolizumab In Japanese Patients With Endometrial Cancer: Results From Study 309/Keynote-775, Kan Yonemori, Mayu Yunokawa, Kimio Ushijima, Jun Sakata, Ayumi Shikama, Shinichiro Minobe, Tomoka Usami, Takayuki Enomoto, Kazuhiro Takehara, Kosei Hasegawa, Wataru Yamagami, Keiko Yamamoto, Shirong Han, Lea Dutta, Robert Orlowski, Takuma Miura, Vicky Makker, Keiichi Fujiwara

Faculty, Staff and Student Publications

Study 309/KEYNOTE-775 is a phase 3 open-label, randomized trial of lenvatinib plus pembrolizumab versus treatment of physician's choice (TPC) in patients with advanced endometrial cancer with progression after platinum-based therapy. Primary endpoints of superiority for lenvatinib plus pembrolizumab were met for progression-free survival (PFS) and overall survival (OS) in all-comers (ie, regardless of mismatch repair [MMR] status) and patients with MMR proficiency (pMMR). We present results for the Japanese subset. Patients were randomized to oral lenvatinib 20 mg/day plus intravenous pembrolizumab 200 mg every 3 weeks (Q3W; up to 35 cycles of pembrolizumab) or TPC (intravenous doxorubicin 60 mg/m

Use Of Breast Surveillance Between Women With Pathogenic Variants And Variants Of Uncertain Significance In Breast Cancer Susceptibility Genes, Sukh Makhnoon, Minxing Chen, Brooke Levin, Megan Ensinger, Kristin D Mattie, Generosa Grana, Sanjay Shete, Banu K Arun, Susan K Peterson

Faculty, Staff and Student Publications

BACKGROUND: Use of surveillance mammography and magnetic resonance imaging (MRI) has been understudied among women with variant of uncertain significance (VUS) compared to pathogenic and likely pathogenic variants (P/LP).

METHODS: Using data from two cancer settings, we calculated use of risk-reducing mastectomy (RRM) and surveillance during each 13-month span after genetic testing up to 6 years afterwards for a cohort of genetically elevated risk women.

RESULTS: Of 889 women, VUS carriers were less likely to undergo RRM compared to those with P/LP (hazard ratio [HR], 0.17; p =

CONCLUSION: The authors found that VUS, whether in high or moderate penetrance …

Prenatal Allostatic Load And Preterm Birth: A Systematic Review, Shahirose Sadrudin Premji, Gianella Santos Pana, Alexander Cuncannon, Paul E. Ronksley, Aliyah Dosani, K. Alix Hayden, Sharifa Bashir Lalani, Wangira Musana, Kiran Shaikh, Ilona S. Yim

Obstetrics and Gynaecology, East Africa

Objective: Allostatic load refers to cumulative neuroendocrine burden and has been postulated to mediate and moderate physiological and psychological stress-related responses. This may have important implications for the risk of preterm birth. This systematic review examines the evidence on the association between prenatal allostatic load and preterm birth.

Data sources: A comprehensive search of seven electronic databases was conducted from inception to August 23, 2022 to identify all English-language observational and mixed methods studies examining allostatic load and preterm birth with no year or geographic restrictions.

Study eligibility criteria: Studies were included if they measured allostatic load, evaluated as the …

Antenatal Dexamethasone For Improving Preterm Newborn Outcomes In Low-Resource Countries: A Cost-Effectiveness Analysis Of The Who Action-I Trial, Who Action Trial Collaborators, Katherine E. Eddy, Joshua P. Vogel, Nick Scott, Dagnachew Fetene, Shabina Ariff, Sajid Bashir Soofi, Lumaan Sheikh, Farrukh Raza, Almas Aamir

Department of Paediatrics and Child Health

Background: After considerable debate, there is now unequivocal evidence that use of antenatal corticosteroids improves outcomes in preterm neonates when used in women at risk of early preterm birth in reasonably equipped hospitals in low-resource countries. We aimed to evaluate the cost-effectiveness of dexamethasone administration in the management of preterm birth in a cohort of pregnant women from five low-resource countries.
Methods: We performed a cost-effectiveness analysis using data from 2828 women (and 3051 babies) who participated in the WHO ACTION-I trial, a multicentre, randomised, placebo-controlled trial that assessed the safety and efficacy of dexamethasone in pregnant women at risk …

Crucial Nuances In Understanding (Mis)Associations Between The Neonatal Microbiome And Cesarean Delivery, Alexa M Sassin, Grace J Johnson, Alison N Goulding, Kjersti M Aagaard

Faculty, Staff and Students Publications

As rates of Cesarean delivery and common non-communicable disorders (NCDs), such as obesity, metabolic disease, and atopy/asthma, have concomitantly increased in recent decades, investigators have attempted to discern a causal link. One line of research has led to a hypothesis that Cesarean birth disrupts the presumed normal process of colonization of the neonatal microbiome with vaginal microbes, yielding NCDs later in life. However, a direct link between a disrupted microbiota transfer at time of delivery and acute and/or chronic illness in infants born via Cesarean has not been causally established. Microbiota seeding from maternal vaginal or stool sources has been …

The Association Of Baseline Plasma Sars-Cov-2 Nucleocapsid Antigen Level And Outcomes In Patients Hospitalized With Covid-19, Angela J Rogers, Deborah Wentworth, Andrew Phillips, Katy Shaw-Saliba, Robin L Dewar, Neil R Aggarwal, Abdel G Babiker, Weizhong Chang, Nila J Dharan, Victoria J Davey, Elizabeth S Higgs, Norman Gerry, Adit A Ginde, J W Awori Hayanga, Helene Highbarger, Jeroen L Highbarger, Mamta K Jain, Virginia Kan, Kami Kim, Perrine Lallemand, Bradley G Leshnower, Joseph K Lutaakome, Gail Matthews, Ahmad Mourad, Eleftherios Mylonakis, Ven Natarajan, Maria L Padilla, Lavannya M Pandit, Roger Paredes, Sarah Pett, Srikanth Ramachandruni, M Tauseef Rehman, Brad T Sherman, D Clark Files, Samuel M Brown, Michael A Matthay, B Taylor Thompson, James D Neaton, H Clifford Lane, Jens D Lundgren

Faculty, Staff and Students Publications

BACKGROUND: Levels of plasma SARS-CoV-2 nucleocapsid (N) antigen may be an important biomarker in patients with COVID-19 and enhance our understanding of the pathogenesis of COVID-19.

OBJECTIVE: To evaluate whether levels of plasma antigen can predict short-term clinical outcomes and identify clinical and viral factors associated with plasma antigen levels in hospitalized patients with SARS-CoV-2.

DESIGN: Cross-sectional study of baseline plasma antigen level from 2540 participants enrolled in the TICO (Therapeutics for Inpatients With COVID-19) platform trial from August 2020 to November 2021, with additional data on day 5 outcome and time to discharge.

SETTING: 114 centers in 10 countries. …

The Kids Are Alright: A New Generation Of Educators, Gal Barak, Matthew Ryan Carroll, Andrea Dean

Faculty, Staff and Students Publications

Generational theory states that as a result of experiencing the same life-altering, world-wide events at key developmental ages, individuals of a given generation share unique perspectives, values, and traits compared to other generations as reported by Johnson and Romanello (

Use Of Telemedicine In An Obgyn Residency Clinic During Covid, Sarah Dreibelbis, Anna Grassi, Daniel Jiang, John Dougherty

Transformative Medicine

INTRODUCTION: Telemedicine can address healthcare disparities by improving access to care and eliminating barriers to in-office appointments. The primary goal of this study is to compare the number of completed telemedicine appointments to the number of completed in-office appointments for an OBGYN residency clinic during the early months of the COVID pandemic. The study also aims to evaluate patient demographics and types of visits performed using telemedicine. METHODS: All OBGYN residency clinic visits at a single institution from March 2020 – May 2020 were included and reviewed. Proportions of the visit type were evaluated for completion as well …

Integration Of Mouse Ovary Morphogenesis With Developmental Dynamics Of The Oviduct, Ovarian Ligaments, And Rete Ovarii, Jennifer Mckey, Dilara N Anbarci, Corey Bunce, Alejandra E Ontiveros, Richard R Behringer, Blanche Capel

Faculty, Staff and Student Publications

Morphogenetic events during the development of the fetal ovary are crucial to the establishment of female fertility. However, the effects of structural rearrangements of the ovary and surrounding reproductive tissues on ovary morphogenesis remain largely uncharacterized. Using tissue clearing and lightsheet microscopy, we found that ovary folding correlated with regionalization into cortex and medulla. Relocation of the oviduct to the ventral aspect of the ovary led to ovary encapsulation, and mutual attachment of the ovary and oviduct to the cranial suspensory ligament likely triggered ovary folding. During this process, the rete ovarii (RO) elaborated into a convoluted tubular structure extending …

Possible Gender Differences In The Level Of Perceived Social Support In Couples Who Are Experiencing Issues With Infertility., Maya Pinzon, Shawna Rotoli

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Objective The purpose of this study is to examine whether there are gender differences in the level of perceived social support in couples experiencing issues with fertility. Methods A total of 938 participants aged 18-47 years, with self-reported issues of infertility, were evaluated using the Multidimensional Scale of Perceived Social Support (MSPSS) which comprises three subscales which correspond with distinct sources of social support: significant other (SO), family, and friends. Differences between sexes for total score and for all subscale scores were subsequently analyzed using SPSS Statistics (IBM Corp, Armonk, USA). Results Mean total scores and scores on all subscales …

An Epi-Metabolomics Approach For Studying Epigenetic And Metabolic Changes In Alzheimer’S Disease Brain, Nadia Ashrafi, Sangeetha Vishweswaraiah, Ali Yilmaz, Sumeyya Akyol, Juozas Gordevicius, Stewart Graham

Conference Presentation Abstracts

No abstract provided.

Mild And Severe Traumatic Brain Injury Longitudinally Profiled Using High-Resolution Metabolomics, Ali Yilmaz, Sigal Liraz Zaltsman, Esther Shohami, Juozas Gordevicius, Jack E. Sherman, Ray Bahado-Singh, Stewart F. Graham

Conference Presentation Abstracts

No abstract provided.

“Do Not Detach The Placenta From My Baby's Cord” - Lotus Birth Case Series From Tanzania Tertiary Hospital, Willbroad Kyejo, Davis Rubagumya, Christian Mwalo, Lynn Moshi, Munawar Kaguta, Miriam Mgonja, Shweta Jaiswal

Family Medicine, East Africa

Introduction: Lotus birth is seldom practiced, with its prevalence being not well documented. There is no clear existing guideline or pathway for this practice. Safety in delivery as well as caring for newborn and her mother is of paramount importance. Hence, clarity for Lotus delivery in any set up is indispensable.

Cases findings: We have described on case series approach to women who opted to delivery without detachment of placenta. We have described delivery characteristics, neonatal clinical course, cord, and placenta manage- ment. In year 2022 at our center, we have received two cases of lotus delivery.

Conclusion and …

Pregnancy Following Robot-Assisted Laparoscopic Bilateral Endometriotic Cystectomy Rare Case Report Of Endometriosis Stage Iv, Willbroad Kyejo, Ally Zain Ismail, Brenda Moshi, Gregory Ntiyakunze, Nancy Matillya, Munawar Kaguta

Family Medicine, East Africa

Introduction and importance: Endometriosis is a common cause of infertility in women. In this case report we explain successful conception in deep-infiltrating ovarian endometriosis following robot-assisted surgery and androgenic agonist treatment.

Case presentation: A 38-year-old current Para 2, Living 2 presented 8 years ago with chronic lower abdominal pain, dysmenorrhea, and delayed conception. Advance endometriosis was highly suspected from the history and examination. Robot-assisted laparoscopic partial cystectomy was performed for the deep-infiltrating ovarian endometriosis. She was then discharged with postoperative androgenic agonists and with timed intercourse, she got pregnant within 9 months.

Clinical discussion: Advanced endometriosis (Stage III or …

Ambient Temperature During Pregnancy And Risk Of Maternal Hypertensive Disorders: A Time-To-Event Study In Johannesburg, South Africa, Chérie Part, Jean Le Roux, Matthew Chersichb, Shobna Sawry, Véronique Filippi, Nathalie Roos, Lee Fairlie, Britt Nakstad, Jeroen De Bont, Stanley Luchters

Institute for Human Development, East Africa

Hypertensive disorders in pregnancy are a leading cause of maternal and perinatal mortality and morbidity. We evaluate the effects of ambient temperature on risk of maternal hypertensive disorders throughout pregnancy. We used birth register data for all singleton births (22–43 weeks' gestation) recorded at a tertiary-level hospital in Johannesburg, South Africa, between July 2017–June 2018. Time-to-event analysis was combined with distributed lag non-linear models to examine the effects of mean weekly temperature, from conception to birth, on risk of (i) high blood pressure, hypertension, or gestational hypertension, and (ii) pre-eclampsia, eclampsia, or HELLP (hemolysis, elevated liver enzymes, low platelets). Low …

Menstrual Irregularities Following Covid-19 Vaccination: A Global Cross-Sectional Survey, Azza Sarfraz, Zouina Sarfraz, Muzna Sarfraz, Zainab Nadeem, Miguel Felix, Ivan Cherrez-Ojeda

Department of Paediatrics and Child Health

Introduction: The coronavirus disease 2019 (COVID-19) vaccination generates protective immunity against SARS-CoV-2 infection. There is no clear evidence of COVID-19 vaccine-induced menstrual irregularities.
Objective: To identify potential menstrual irregularities following COVID-19 vaccine among females.
Methods: A worldwide cross-sectional survey study was conducted from June 10, 2021, to July 10, 2021 using online mediums. The survey consisted of 15 questions divided into baseline characteristics, vaccination status and dosage, menstruation and relate factors, and thoughts and knowledge about menstrual irregularities. Non-probability convenience sampling method was used including 510 responses. The results were tabulated, with bivariate analysis and chi-square test results. The sensitivity …