Obstetrics and Gynecology Commons^™

Sleepiness In Pregnancy And Adverse Perinatal Outcomes, Rachel Friedlander, Xiaoning Huang, Phyllis Zee, Sadiya S. Khan, Philip Greenland, Francesca L. Facco, Judith Chung, William A. Grobman, Shalini Manchanda, Uma M. Reddy, George R. Saade, Robert M. Silver, Lynn M. Yee

Department of Obstetrics & Gynecology Faculty Publications

Background

Sleep disorders in pregnancy have been associated with adverse pregnancy outcomes including hypertensive disorders of pregnancy, preterm birth, and gestational diabetes mellitus, yet these findings are largely from retrospective studies. Using data from a prospective study that used validated tools to assess sleepiness in pregnancy, we aimed to assess the association of sleepiness in pregnancy with adverse pregnancy outcomes.

Methods

In this secondary analysis of data from a large, diverse prospective cohort of nulliparous individuals conducted at eight United States medical centers, those with self-reported sleep data were included. Sleepiness was evaluated in early (6-13 weeks) and mid-pregnancy (22-29 …

Meta-Analysis: Diabetes Mellitus And The Risk Of Endometrial Cancer, Tricia Ho, Marika Ongpauco, Han Ha Ngoc Nguyen

Physician Assistant Studies | Graduate Research Papers

Background: Many studies have looked at the relationship between diabetes mellitus and development of endometrial cancer. This study provides an updated systematic review and meta-analysis of the estimated effect of diabetes and the risk of endometrial cancer.

Methods: Some studies were found on databases such as PubMed and Iceberg. The remaining studies were extracted from the initial studies found. Binary data was collected and the raw data was imputed into a Fixed Effects Model.

Results: A total of 25 studies were included in this meta-analysis, generating statistically significant results (p < 0.001, OR 2.05, 95% Cl 1.92-2.19).

Discussion: Diabetes is found to be …

Accuracy Of Estimated Fetal Weights As You Progress Through Residency, Madison Pearson, Lauren Robertson, Emily Coughlin, James Baron, Mark Sanchez

West Florida Division GME Research Day 2026

No abstract provided.

Integration Of Ai Resources To Enhance Obstetric And Gynecology Resident Education, Victoria Ruggiero, Cameron Stokes, Nicole Tenzel

North Texas GME Research Forum 2026

Background: Graduate medical education faculty, while responsible for overseeing the clinical training of their residents, are additionally tasked with providing effective resident education. AI offers a potential solution to enhance development and delivery of educational topics to their trainees, while decreasing the time needed to prepare formal education resources. This study aims to evaluate resident satisfaction for different learning tools generated by AI platforms while also assess their retention of clinical content.

Methods: Three topics related to menopause were identified: (1) Menopause Physiology and Diagnosis, (2) Hormonal Therapy for Treatment of Vasomotor Symptoms, and (3) Treatment of Genitourinary symptoms. Evidence-based …

Incidence Of False-Positive Tubal Occlusion On Hysterosalpingography (Hsg) Due To Tubal Spasm: A Case Series, Elena Korytnikova, Ben Duplaga, Mark Sanchez

West Florida Division GME Research Day 2026

No abstract provided.

Massive Subcutaneous Emphysema Following Robot-Assisted Total Laparoscopic Hysterectomy: A Case Report, Alia Valdez, Isabella Sciacca, Charmaine Oladell

North Texas GME Research Forum 2026

Background Subcutaneous emphysema is the presence of air within subcutaneous tissues, often presenting as swelling and palpable crepitus. Air may spread along fascial planes and arise from traumatic, iatrogenic, infectious, or spontaneous sources. In laparoscopic surgery, it is most commonly related to carbon dioxide insufflation. Reported incidence following laparoscopic procedures ranges from 2% to 24%, depending on procedure type, surgical duration, insufflation pressure, and patient factors. In gynecologic laparoscopy, incidence has been reported as low as 2.3% in some studies, with rates up to 10–15% in others, particularly with higher intraabdominal pressures. Although often benign, extensive subcutaneous emphysema may lead …

Prognostic Impact Of Sentinel Lymph Node Dissection In High-Risk Uterine Serous Carcinoma, Katie Johnson, Chrystal Stallworth, Prakriti Srivastava, Abel Moron, Brandon Roane, Hannah Affleck, Michele Mccarroll

North Texas GME Research Forum 2026

Objective: To assess overall survival (OS) for patients undergoing surgical staging with sentinel lymph node dissection (SLND) in patients with high risk uterine serous carcinoma (USC).

Methods: Patients diagnosed with USC that underwent surgical staging with SLND from the years 2018-2022 were included for analysis utilizing the Surveillance, Epidemiology, and End Results (SEER) national database. Patients were stratified by pathologic lymph node (LN) assessment into true SLND group (1-2 pelvic LN retrieved) and false SLND group (> 2 pelvic LN retrived). Patients with 0 LN retrieved were excluded from the data. OS was recorded in months from time of primary …

Induced Vaginal Delivery In Pregnant Patient With Enlarging Choroidal Hemangioma, Sandra Zhi, Allison Burkes, Monica Saripella, Bhagyashri Pandey, Keith Storts, Kishan Patel, J William Harbour

North Texas GME Research Forum 2026

INTRODUCTION: Sturge Weber Syndrome (SWS) is a rare congenital neurocutaneous disorder affecting capillary formation, classically presenting with a facial port-wine birthmark and seizures. Associated symptoms vary by individual but may include additional brain and eye manifestations such as cognitive impairment, headache, stroke-like episodes, and glaucoma or visual field defects. Because SWS results from a sporadic mutation, it does not carry specific contraindications to pregnancy regarding fetal risk. However, pregnancies in patients with SWS should be managed by an multidisciplinary team and closely monitored for acute neurological and ophthalmologic complications. In childbirth, previous case reports have favored Cesarean section over vaginal …

Improving Cord Gas Collection Rates On Labor & Delivery, Sandra Zhi, Diane Gilbertson, Ifeoluwa Adesina-Aina, Sarah Moore, Jack Graham

North Texas GME Research Forum 2026

Background: Cord blood gas measurements are helpful to determine the acid-base status of a neonate after delivery and can determine risk for neonatal encephalopathy. Collection usually occurs right after delivery of the infant and after the umbilical cord has been cut and clamped. The OBGYN residents are currently trained to draw cord blood for gas analysis if clinical status of the neonate is subpar, but there exist other indications for drawing cord blood to send for cord gases as recommended by the American College of Obstetricians and Gynecologists as well as the American Academy of Pediatrics. This project will focus …

Implementation Of Standardized Screening And Patient Education Regarding Hpv Vaccination Within An Ob-Gyn Clinic, Kristina Krupa, Nicole Tenzel

North Texas GME Research Forum 2026

Background: Each year, millions of women become infected with Human Papillomavirus Virus (HPV). The HPV virus can cause multiple types of cancer including cervical, vaginal, vulvar, penile, anal, vaginal, and oropharyngeal. HPV vaccination has the potential to prevent majority of these cancers. Despite this, a large portion of the United States population remains unvaccinated. Standardizing screening protocols and patient education materials within our OBGYN clinic can help educate patients about the HPV vaccine benefits and facilitate shared decision-making regarding vaccination.

Methods: This ongoing quality improvement project was initially created as a single-phase initiative that involved implementation of a screening questionnaire …

New-Onset Atrial Fibrillation In Labor: A Case Report And Review Of Recommendations, Margaret Carrig, Megan Kohman, Jessica Richter, Cristina Enrique

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Intra-Amniotic Infection (Iai) Prevention, Shelbie Clement, Deanna Conley

Articles, Abstracts, and Reports

No abstract provided.

Comparing Nurse-Led Holistic Pain Relief Strategies And Sole Pharmacological Use In Enhancing Maternal Satisfaction, Reducing Pain, And Lowering Obstetric Interventions During Childbirth, Jessica C. Moore

Nursing | Senior Theses

Background: Childbirth has become heavily reliant on pharmacological management and obstetric interventions such as epidural use, labor induction, and cesarean deliveries (C-sections) even among low-risk pregnancies. While necessary in some cases, excessive reliance on pharmacological interventions can negatively impact the experience of birthing as a whole. Non-pharmacological interventions (NPIs) such as breathing techniques, positioning, hydrotherapy, massage, aromatherapy and continuous support have shown to be effective in reducing pain and supporting physiologic labor. The gaps in education and lack of standard implementation result in inconsistent application in practice. Purpose: This research proposal aims to evaluate the effectiveness of nurse-led NPIs compared …

Adjunctive Technologies To Electronic Fetal Monitoring: Promise, Pitfalls, And Lessons Learned, Rebecca Horgan, George Saade

Department of Obstetrics & Gynecology Faculty Publications

Despite widespread use, electronic fetal monitoring (EFM) has not demonstrably reduced perinatal morbidity or mortality, and likely contributed to the rise in cesarean delivery. To improve its utility, a number of adjunctive approaches have been introduced over the past three decades, including fetal pulse oximetry, ST segment analysis (STAN), and maternal oxygen supplementation. Each intervention was supported by strong physiologic rationale, yet none achieved widespread clinical adoption due to inconsistent evidence of benefit and, in some cases, potential harm. This review critically evaluates landmark studies on EFM adjuncts, highlights the limitations that have impeded progress, and outlines emerging innovations, including …

The Association Between Maternal-Fetal Medicine Physician Density And Pregnancy Outcomes, Tetsuya Kawakita, Rula Atwani, Misa Hayasaka, Lindsay Robbins, George Saade

Department of Obstetrics & Gynecology Faculty Publications

Objective

We sought to examine the association between maternal-fetal medicine (MFM) physician density and adverse pregnancy outcomes at the state level.

Study Design

This was a cross-sectional analysis of publicly available, state-level data from 2018 to 2021, including Natality, Multiple Cause-of-Death, and Fetal Death databases. The number of active MFM physicians per year was obtained for each state from the American Medical Association Masterfile. The primary exposure was the density of MFM per state, categorized into three groups: (1) low density (< 30 MFM physicians per 100,000 live births), (2) moderate density (30-59 MFM physicians per 100,000 live births), and (3) high density (≥60 MFM physicians per 100,000 live births). Our primary outcome was maternal mortality during pregnancy and up to 42 days postdelivery. Our secondary outcomes were pregnancy-related mortality up to 365 days postdelivery and stillbirth. We calculated adjusted incident rate ratios (aIRR) and average marginal effect (AME) with 95% confidence intervals (95% CI) using multivariable negative binomial mixed effects regression models.

Results

Overall, there were 14,792,743 live births, 3,440 maternal mortalities, 4,980 pregnancy-related mortalities, and 90,848 stillbirths included. The …

Mediating Effect Of Social Determinants Of Health Between Race And Phthalate Biomarkers In Pregnancy, Tetsuya Kawakita, Misa Hayasaka, Carole Barake, Trinity Soto, Jillian Fleming, Amir Lueth, Stevens Danielle, Alfred Abuhamad, Ann Pryzybylska, Elena Sinkovskaya, Kelly K. Ferguson, George Saade

Department of Obstetrics & Gynecology Faculty Publications

Introduction

Prenatal phthalate exposure is linked to adverse reproductive and developmental outcomes and is consistently higher among non‐Hispanic Black compared to non‐Hispanic White pregnant individuals, yet the factors responsible for these disparities are poorly characterized. We sought to quantify Black–White differences in repeated urinary concentrations of phthalate biomarkers during pregnancy and to estimate the extent to which neighborhood‐level social determinants of health (SDoH) mediate these disparities.

Methods

This secondary analysis used data from the Human Placenta Project Study, a prospective observational cohort study conducted at two academic institutions between 2016 and 2018. Eligible participants had singleton pregnancies, were recruited before …

Contribution Of Comorbidities And Pregnancy Complications To Severe Maternal Morbidity In The United States, Tetsuya Kawakita, Sora A. Jones, Natsume Furukawa, George Saade

Department of Obstetrics & Gynecology Faculty Publications

Objective: To quantify the extent to which rising rates of severe maternal morbidity (SMM) in the United States from 2016 to 2022 are attributable to increasing prevalence of maternal risk factors, including advanced maternal age, obesity, pregestational diabetes mellitus, gestational diabetes, chronic hypertension, and hypertensive disorders of pregnancy (HDP).

Methods: We conducted a retrospective cohort study using the Nationwide Readmissions Database from 2016 to 2022, representing more than 25 million weighted delivery hospitalizations. The primary outcome of SMM was identified with the Centers for Disease Control and Prevention's 21-condition algorithm; a secondary outcome excluded transfusion to improve specificity. Temporal trends …

Acute Fatty Liver Of Pregnancy And Fetal Fatty Acid Oxidation Disorders: A Systematic Review, Dante Varotsis, Sarah Araji, Rebecca Horgan, Jennifer E. Powel, Rodney Mclaren Jr., Brian Kirmse, Mona Makhamreh, Huda B. Al-Kouatly

Department of Obstetrics & Gynecology Faculty Publications

OBJECTIVE:

To evaluate the association between maternal acute fatty liver of pregnancy (AFLP) and fetal fatty acid oxidation (FAO) disorders and to define the clinical and genetic characteristics of mothers with AFLP and their fetuses affected by FAO disorders, we performed a systematic literature review of all reported cases of AFLP that underwent genetic testing for FAO disorders.

DATA SOURCES:

We searched PubMed, Ovid MEDLINE, Cochrane Library, CINAHL (EBSCO), Scopus, and ClinicalTrials.gov. Terms included were related to AFLP and FAO testing.

METHODS OF STUDY SELECTION:

We conducted a systematic literature review from inception through May 18, 2025, to evaluate the …

Estetrol (E4) For The Treatment Of Moderate To Severe Vasomotor Symptoms In Postmenopausal Women - Efficacy And Safety Results From The Phase 3 E4comfort I Multicenter, Placebo-Controlled Study, Tommaso Simoncini, Céline Bouchard, Marie Cloes, Mélanie Taziaux, Santiago Palacios, Sebastião Freitas De Medeiros, Valeriu Vrabii, David F. Archer, Nick Panay

Department of Obstetrics & Gynecology Faculty Publications

Objective

To evaluate the efficacy and safety of estetrol in reducing moderate to severe vasomotor symptoms in postmenopausal women.

Methods

Multicenter, randomized, parallel group (1:1:1), placebo-controlled, double-blind, phase 3 study in hysterectomized and non-hysterectomized participants aged 40-65 years. A total of 640 participants with seven or more moderate to severe hot flashes daily or 50 weekly received estetrol 15 mg, estetrol 20 mg, or placebo for 12 weeks. Co-primary endpoints were the change in frequency and severity of moderate to severe vasomotor symptoms from baseline to weeks 4 and 12. Comparisons versus placebo were made using a mixed-effects model for …

Cervicovaginal Lavage Fluid Iron And Manganese Levels In Women With And Without Vaginitis, Barbara Kozma, David Ratonyi, Bence Kozma, Peter Takacs, Attila G. Sipos

Department of Obstetrics & Gynecology Faculty Publications

Transition metals such as iron and manganese are critical for cellular metabolism, redox balance, and immune function, and they also influence host–pathogen interactions. Vaginitis is characterized by mucosal inflammation that may alter local trace-element homeostasis. We hypothesize that inflammatory conditions such as vaginitis may be associated with altered cervicovaginal iron and manganese levels. We performed a prospective, single-center cohort study at the University of Debrecen (Hungary) between April 2023 and April 2024, enrolling 80 women ≥ 18 years with vulvovaginal complaints. Participants were assessed at baseline and at weeks 4, 8, and 12 with clinical evaluation and cervicovaginal lavage (CVL) …