Obstetrics and Gynecology Commons^™

Professionally Responsible Counseling When A Fetal Anomaly Is Diagnosed By Ultrasound, F. A. Chervenak, L. B. Mccullough, A. Kurjak

Journal Articles

© The Author(s). 2020. Ethics plays an essential role in the clinical management of pregnancies complicated by fetal anomalies diagnosed by ultrasound. Utilizing the prima facie ethical principles of beneficence and respect for autonomy, this paper first explicates the ethical concept of the fetus as a patient. This ethical concept provides the basis for a comprehensive approach to counseling pregnant women about the management of pregnancies complicated by fetal anomalies. Practical, ethically justified guidance is given for counseling about decisions both before and after viabilities.

Epithelial Cells In Endometriosis And Adenomyosis Upregulate Sting Expression, H. Qu, L. Li, T. Wang, T. Seckin, J. Segars, I. Shih

Journal Articles

No abstract provided.

Toward The Quadruple Aim: Impact Of A Humanistic Mentoring Program To Reduce Burnout And Foster Resilience., A. W. Menzin, M. Kline, C. George, J. Schindler, A. C. Yacht, A. Fornari

Journal Articles

Objective:To assess the effect of a faculty development program (Mentoring and Professionalism in Training [MAP-IT]) that fosters humanism in medicine on elements of burnout and the development of resilience. Participants and Methods:The cohort of participants was drawn from a cross-section of disciplines and represented a diverse group of health professionals, including physicians, nurses, physician assistants, pharmacists, psychologists, social workers, and chaplains. The 106 participants were divided into 12 groups, each of which was facilitated by two or three leaders. Each group completed the MAP-IT curriculum from October 1, 2017, through July 31, 2018. All participants and leaders completed the Connor-Davidson …

Teaching Professional Formation In Response To The Covid-19 Pandemic., L. B. Mccullough, J. Coverdale, F. A. Chervenak

Journal Articles

In response to the COVID-19 pandemic, the Association of American Medical Colleges has called for a temporary suspension of clinical teaching activities for medical students. Planning for the continued involvement of learners in patient care during this pandemic should include teaching learners professional formation. The authors provide an ethical framework to guide such teaching, based on the ethical principle of beneficence and the professional virtues of courage and self-sacrifice from professional ethics in medicine. The authors show that these concepts support the conclusion that learners are ethically obligated to accept reasonable, but not unreasonable, risk. Based on this ethical framework, …

Universal Testing For Coronavirus Disease 2019 In Pregnant Women Admitted For Delivery: Prevalence Of Peripartum Infection And Rate Of Asymptomatic Carriers At Four New York Hospitals Within An Integrated Healthcare System., M. J. Blitz, B. Rochelson, A. C. Rausch, R. Solmonovich, W. Shan, A. Combs, M. Nimaroff

Journal Articles

No abstract provided.

Race/Ethnicity And Spatiotemporal Trends In Sars-Cov-2 Prevalence On Obstetrical Units In New York., M. J. Blitz, B. Rochelson, L. Prasannan, W. Shan, F. A. Chervenak, M. Nimaroff, E. Bornstein

Journal Articles

No abstract provided.

Fetal Diagnosis And Therapy During The Covid-19 Pandemic: Guidance On Behalf Of The International Fetal Medicine And Surgery Society, J Deprest, M Choolani, F Chervenak, D Farmer, K Lagrou, E Lopriore, L Mccullough, O Olutoye, L Simpson, G Ryan, +1 Additional Author

Journal Articles

No abstract provided.

Fetal Interventions In The Setting Of The Coronavirus Disease 2019 Pandemic: Statement From The North American Fetal Therapy Network, Mo Bahtiyar, A Baschat, J Deprest, S Emery, Wh Goodnight, A Johnson, L Mccullough, Js Moldenhauer, G Ryan, M Zaretsky, +3 Additional Authors

Journal Articles

No abstract provided.

Which Country Is Truly Developed? Covid-19 Has Answered The Question, Js Freed, Sy Kwon, Hj El, M Gottlieb, R Roth

Journal Articles

No abstract provided.

A Randomized Phase Ii Trial Of Epigenetic Priming With Guadecitabine And Carboplatin In Platinum-Resistant, Recurrent Ovarian Cancer, A. M. Oza, U. A. Matulonis, A. A. Secord, J. Nemunaitis, L. D. Roman, S. P. Blagden, S. Banerjee, W. P. Mcguire, B. Schwartz, D. Matei, +18 Additional Authors

Journal Articles

© 2020 American Association for Cancer Research Inc.. All rights reserved. Purpose: Platinum resistance in ovarian cancer is associated with epigenetic modifications. Hypomethylating agents (HMA) have been studied as carboplatin resensitizing agents in ovarian cancer. This randomized phase II trial compared guadecitabine, a second-generation HMA, and carboplatin (GþC) against second-line chemotherapy in women with measurable or detectable platinum-resistant ovarian cancer. Patients and Methods: Patients received either GþC (guadecitabine 30 mg/m2 s.c. once-daily for 5 days and carboplatin) or treatment of choice (TC; topotecan, pegylated liposomal doxorubicin, paclitaxel, or gemcitabine) in 28-day cycles until progression or unacceptable toxicity. The primary endpoint …

Detection Of High-Risk Human Papillomavirus Rna In Urine For Cervical Cancer Screening With Hpv 16 & 18/45 Genotyping, R. R. Padhy, A. Davidov, L. Madrigal, G. Alcide, A. Spahiu

Journal Articles

© 2020 The Authors Objective: To detect high-risk human papillomavirus (hrHPV) messenger-RNA (mRNA) in urine samples, compare their concordance with cervical samples including HPV 16 & 18/45 genotyping, and to determine the utility in detecting ≥ CIN 2 lesions. Methods: A cohort of 189 non-pregnant patients (age ≥ 25) was recruited in three groups: Group 1 with abnormal pap-smears and hrHPV positivity, Group 2 with normal pap-smears and hrHPV positivity, and Group 3 with normal pap-smears and hrHPV negativity. Urine samples were tested for hrHPV-mRNA and subsequent hrHPV-mRNA genotype if positive. High-risk HPV detection and genotyping were performed using Aptima …

A Case Of Non-Hpv Related Primary Endometrioid Adenocarcinoma Of The Cervix, K. Seay, B. Bustamante, S. Khutti, M. Frimer

Journal Articles

© 2020 Objective: Primary endometrioid adenocarcinoma of the cervix is a rare subtype of adenocarcinoma that has often been misclassified in the literature due to the lack of clear-cut diagnostic criteria. A new classification system has recently been developed that aims to provide clarity and reproducibility when diagnosing subtypes of endocervical adenocarcinoma. This case report demonstrates the difficulty in diagnosing primary endometroid adenocarcinoma, application of the new diagnostic guidelines, and a review of the literature of this rare non-HPV subtype. Case: A 76 year-old women presented with postmenopausal bleeding and was found to have an exophytic cervical mass. Biopsies showed …

Anti-Nmda Receptor Encephalitis With Neurologic Sequelae Refractory To Conservative Therapy With Complete Response To Adjuvant Therapy, A. Nizam, A. W. Menzin, J. S. Whyte

Journal Articles

© 2020 The Authors Background: Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis has been described in increasing frequency in association with benign, mature ovarian teratoma. Affected patients typically present with paraneoplastic limbic encephalitis with flu-like symptoms followed by altered mental status, acute psychiatric symptoms, seizures and amnesia. These symptoms can rapidly progressive if not treated aggressively with surgical resection. Profound neurological symptoms may require immunotherapy. Case: We present a case of anti-NMDA receptor encephalitis associated with a malignant immature teratoma in which symptoms were refractory to surgical management and initial immunotherapy. A complete neurologic response was only seen after initiating adjuvant chemotherapy. Conclusion: …

Mesonephric-Like Adenocarcinoma Of The Ovary With Co-Existent Endometriosis: A Case Report And Review Of The Literature, K. Seay, T. Akanbi, B. Bustamante, S. Chaudhary, G. L. Goldberg

Journal Articles

© 2020 The Authors Introduction: Mesonephric-like adenocarcinoma (MLA) is a rare malignant gynecologic neoplasm occurring in the uterine corpus and ovary. The morphological and immunohistochemical characteristics of MLA closely resemble that of cervical mesonephric adenocarcinomas, but whether they share a common histogenesis remains unclear. Two main theories for histogenesis of MLAs include the origination of these neoplasms from mesonephric remnants, as is the case for cervical mesonephric adenocarcinoma, versus the differentiation along a mesonephric pathway from Mullerian lesions. Case: A 67-year-old presented after a right salpingo-oophorectomy for a complex ovarian mass revealed a mesonephric-like adenocarcinoma of the ovary and endometriosis. …

Prediction Of Neonatal Birthweight Associated With Maternal Obesity And Diabetes, Laura Gleason, Rebekah Mccurdy, Md, Mph

Phase 1

Introduction: To design a model that will predict neonatal birth weight within obese mothers by diabetic status.

Methods: A secondary data analysis of an RCT (NCT 02909582) was utilized to create a neonatal birth weight prediction model. Women (n=325) with a BMI > 35 kg/m2 from a tertiary academic institution, 2016 – 2019, were included to estimate the risk of large for gestational age (LGA) infants and neonatal birth weight based on maternal prepregnancy BMI and diabetic status. LGA was defined as an infant birth weight > 90th percentile. Analysis included Chi-square, t-test, multivariate logistic and linear regression.

Results: Mean birthweight did …

Prenatal Perception Of Wic Breastfeeding Recommendation Affects First Month Postpartum Breastfeeding Outcomes, Qi Zhang, Lamichhane Rajan, Joanne Guthrie

Community & Environmental Health Faculty Publications

No abstract provided.

Does Maternal Methadone Dose Correlate With Severity Of Intrauterine Growth Restriction In Infants With Neonatal Abstinence Syndrome?, D. Friedman, J. Smith, M. Lafferty, Z. H. Aghai

Phase 1

Introduction : Previous studies demonstrate a relationship between maternal opioid use during pregnancy and smaller head circumference of infants with neonatal abstinence syndrome (NAS). The goal of this study is to correlate maternal methadone dose and severity of growth restriction in infants with NAS admitted to the neonatal intensive care unit (NICU).

Methods: This is a retrospective analysis of infants (≥35 weeks gestation) exposed to in utero methadone, born between August 2006 and May 2018, and admitted to a Philadelphia NICU for medical therapy for NAS. Growth parameters (birth weight, birth length, and birth head circumference) were compared between infants …

Evaluating The Utility Of Diagnostic Workups For Biliary Atresia In Neonates With Cholestatic Jaundice Following Prolonged Tpn, Melissa Austin, Zubair H. Aghai

Phase 1

Introduction: Parenteral nutrition associated cholestasis (PNAC) develops in 40-60% of premature infants following TPN for 2-4+ weeks. The incidence of biliary atresia is low and there is a 60-day, post-term window for corrective surgery. There is limited data on both the natural history of PNAC in premature infants following prolonged TPN, as well as the utility of diagnostic tools investigating biliary atresia in these patients.

Methods: A retrospective chart review using EMR data from the Intensive Care Nursey was performed with the following criteria: premature babies diagnosed with cholestasis, born at <1500 grams, and received TPN for 14 days. Ultimately 61 babies met criteria and data was collected and pooled to produce descriptive statistics and graphs describing laboratory trends.

Results: Median gestational age was 26 [IQR 25, …

The Utility Of Performing Cervical Length Follow-Up In Lower Risk Singleton, Varsha Kripalu, Rupsa Boelig, Md

Phase 1

Introduction: Short cervical length (<25 mm) during pregnancy is known to be an increased risk factor for preterm birth (<37 weeks). While interventions exist for women who have had prior preterm births, it is important to investigate the cost effectiveness of screening low risk women with an intermediate cervical length (26-29 mm).

Objective: To quantify the association between change in cervical length on follow up and the incidence of preterm birth in otherwise low risk women with an initial intermediate cervical length.

Methods: A retrospective cohort study was conducted, reviewing 108 charts of women who had an initial screening between 26 and 29 mm. Charts were reviewed for whether or not a follow-up ultrasound was recommended, whether or not the follow-up was performed, and the outcome of their deliveries.

Results: 93.5% (N=101) of women were recommended to get a follow-up ultrasound and 84% (N=85) completed their follow-up. …

Impact Of Excess Weight Gain On Risk Of Postpartum Infection In Class Iii Obesity, Courtney J. Mitchell, Lamani Adkins, Ann Tucker, Haywood Brown, Anne Siegel, Sarah Dotter-Katz

Obstetrics & Gynecology Faculty Publications

Objective: To assess the impact of gestational weight gain >20 pounds (more than Institute of Medicine [IOM] recommendations) on postpartum infectious morbidity in women with class III obesity.

Methods: This is a retrospective cohort of term, nonanomalous singleton pregnancies with body mass index ≥40 at a single institution from 2013 to 2017. Pregnancies with multiple gestation, late entry to care, and missing weight gain data are excluded. Primary outcome is a composite of postpartum infection (endometritis, urinary tract, respiratory, and wound infection). Secondary outcomes include components of composite, wound complication, readmission, and blood transfusion. Bivariate statistics compared demographics, pregnancy complications, …