Obstetrics and Gynecology Commons^™

Do Not Forget Our Pregnant Women During The Covid-19 Pandemic, Gabriel Costa Osanan, Maria Fernanda Escobar Vidarte, Jack Ludmir

Department of Obstetrics and Gynecology Faculty Papers

No abstract provided.

Myomectomy Has Better Reproductive Outcomes Than Uterine Artery Embolization For Patients With Symptomatic Leiomyomas Who Wish Maintain Fertility, Suha Syed

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising Mara M, Maskova J, Fucikova Z, Kuzel D, Belsan T, Sosna O. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovascular and interventional radiology. 2008;31(1):73-85. https://doi.org/10.1007/s00270-007-9195-2

Physician Awareness And Adherence To Clinical Practice Guidelines In The Diagnosis Of Vaginitis Patients: A Retrospective Chart Review., Paul Nyirjesy, Wendy M. Banker, Tiffany M. Bonus

Department of Obstetrics and Gynecology Faculty Papers

Vaginitis is one of the main causes of primary care and gynecological visits in the United States. The most common infectious causes are bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis. A physician survey was conducted to measure awareness of vaginitis clinical guidelines and availability of in-office point-of-care (POC) diagnostic tools. Participants were asked to perform a chart review to evaluate diagnostic practices for their symptomatic vaginitis patients. A total of 333 physicians and 984 patient charts were included. Physicians were most familiar with VVC and BV diagnostic guidelines; fewer than half were aware of current trichomoniasis guidelines. Although access …

Pregnant Smokers Receiving Opioid Agonist Therapy Have An Elevated Nicotine Metabolite Ratio: A Replication Study., Henry R Kranzler, Yukiko Washio, Leah R Zindel, Kevin G Lynch, Dennis J. Hand, Rachel F Tyndale, Cheryl Oncken, Robert Schnoll

Department of Obstetrics and Gynecology Faculty Papers

INTRODUCTION: Pregnant women exposed chronically to opioids smoked more cigarettes per day (CPD) and had a higher nicotine metabolite ratio (NMR), 3-hydroxycotinine/cotinine, a biomarker of nicotine metabolism and clearance, than those not receiving opioids. We examined CPD and NMR in a group of pregnant smokers, a quarter of whom were receiving opioid agonist therapy (OAT).

AIMS AND METHODS: Pregnant smokers recruited to participate in a placebo-controlled trial of bupropion for smoking cessation provided a blood sample for measurement of NMR.

RESULTS: Half (52.4%) of the 124 women with NMR data were African American. OAT-treated women (n = 34, 27.4%; 27 …

Low Use Of Vacuum Extraction: Health Care Professionals’ Perspective In A University Hospital, Dar Es Salaam, Henrik Makokha-Sandell, Andrew Mgaya, Johanna Belachew, Helena Litorp, Hussein Kidanto, Birgitta Essén

Faculty of Health Sciences, East Africa

Background Use of vacuum extraction (VE) has been declining in low and middle income countries. At the highest referral hospital Tanzania, 54% of deliveries are performed by caesarean section (CS) and only 0.8% by VE. Use of VE has the potential to reduce CS rates and improve maternal and neonatal outcomes but causes for its low use is not fully explored.

Method During November and December of 2017 participatory observations, semi-structured in-depth interviews (n = 29) and focus group discussions (n = 2) were held with midwives, residents and specialists working at the highest referral hospital in Tanzania. Thematic analysis …

Contraceptive Methods In The United States: The Question Of Abortive Mechanisms, Tara Ferenczy

Senior Honors Theses

This thesis reviews the many methods of contraception available in the United States. Although society’s understanding of women’s health has become a major topic, there is still a significant deficit of information regarding how the accessible methods affect women’s bodies, specifically reproductive tissue. The thesis analyzes numerous contraceptive options focusing specifically on the mechanisms of action to determine whether options have abortifacient properties so that readers may develop educated opinions regarding medical and ethical uses. Information involving strengths and limitations of each technique and the effects on both the female body and the reproductive material assist in understanding the process …

Preconception Care Among Pregnant Women In An Urban And A Rural Health Facility In Kenya: A Quantitative Study, Joan Okemo, Marleen Temmerman, Mukaindo Mwaniki, Dorothy Kamya

Obstetrics and Gynaecology, East Africa

Preconception care (PCC) aims to improve maternal and fetal health outcomes, however, its utilization remains low in developing countries. This pilot study assesses the level and determinants of PCC in an urban and a rural health facility in Kenya. Unselected pregnant women were recruited consecutively at the Mother and Child Health (MCH) clinics in Aga Khan University Hospital, Nairobi (AKUH, N-urban) and Maragua Level Four Hospital (MLFH-rural). The utilization of PCC was defined as contact with any health care provider before current pregnancy and addressing pregnancy planning and preparation. A cross-sectional approach was employed and data were analyzed using SPSS …

Birth Preparedness And Complication Readiness Among Women Of Reproductive Age In Kenya And Tanzania: A Community-Based Cross-Sectional Survey, James Orwa, Samwel Gatimu, Michaela Mantel, Stanley Luchters, Micheal Mugerwa, Sharon Brownie, Leonard Subi, Secilia Mrema, Lucy Nyaga, Grace Edwards, Loveluck Mwasha, Kahabi Isangula, Edna Selestine, Sofia Jadavji, Rachel Pell, Columba Mbekenga, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Delayed health-seeking continues to contribute to preventable maternal and neonatal deaths in low resource countries. Some of the strategies to avoid the delay include early preparation for the birth and detection of danger signs. We aimed to assess the level of practice and factors associated with birth preparedness and complication readiness (BPCR) in Kenya and Tanzania.

Methods: We conducted community-based multi-stage cross-sectional surveys in Kilifi and Kisii counties in Kenya and Mwanza region in Tanzania and included women who delivered two years preceding the survey (2016–2017). A woman who mentioned at least three out of five BPCR components was …

Improving Data For Decision-Making: A Toolkit For Cervical Cancer Prevention And Control Programmes, Elkanah Omenge, Edwin Were, Oliver Rode, Kapten Muthoka, Michael Byczkowski, Heike Sartor, Davy Vanden Broeck, Dietmar Schmidt, Miriam Reuschenbach, Magnus Von Knebel Doeberitz

Obstetrics and Gynaecology, East Africa

Background: Screening of unvaccinated women remains essential to mitigate the high morbidity/mortality of cervical cancer. Here, we compared visual inspection with acetic acid (VIA), recommended by WHO as the most cost-effective screening approach in LMICs, with HPV-based screening, and usage of p16INK4a/Ki-67 dual stain cytology.

Methods: We prospectively enrolled women participating in a VIA-based cervical cancer screening program in two peri-urban health centers of Kenya. Consenting women had a VIA examination preceded by collection of a liquid-based cytology sample from the cervix stored in PreservCyt medium (Hologic®). Analysis of all samples included a hrHPV DNA test and evaluation of a …

The Quality Of Sexual Life After Vaginal Surgical Interventions, Maria Pană, Romina-Marina Sima, Oana-Denisa Bălălău, Anca-Daniela Stănescu, Liana Pleş, Mircea-Octavian Poenaru

Journal of Mind and Medical Sciences

Introduction. The malfunction of the supporting pelvic system generates signs and symptoms that require various procedures. The aim of our study was to evaluate whether vaginal surgical interventions for genital prolapse or urinary incontinence have an impact on patients’ sexual quality of life. Materials and methods. We studied 40 eligible women who underwent vaginal surgical procedures in Saint John Hospital, Bucharest. Patients completed a questionnaire 6 months after the intervention. Results. Patients who underwent vaginal surgery for prolapse were 50-64 years of age. The most frequent vaginal surgical intervention was vaginal hysterectomy (32.5%), followed by anterior and …

J. Diet Advancement For Cesarean Section Patients In Postpartum Unit, Fereshteh Pirayesh, Joan Gahan, Ari Meyers

Year of the Nurse: Clinical Scholarship Presentations

No abstract provided.

Preterm Birth Prevention In Appalachian Kentucky: Understanding Barriers And Facilitators Related To Transvaginal Ultrasound Cervical Length Surveillance Among Prenatal Care Providers, Anna Hansen, Mairead E. Moloney, Cynthia Cockerham-Morris, Jing Li, Niraj R. Chavan

Sociology Faculty Publications

Background: Appalachian Kentucky has higher-than-average rates of preterm birth (PTB)—a health disparity associated with increased maternal and fetal/neonatal morbidity and neonatal mortality. Transvaginal ultrasound (TVU) cervical length measurement is the best predictor of PTB risk, but is underutilized in Appalachia. This study explores prenatal care providers' TVU-related knowledge and practices, and identifies barriers and facilitators, which impact the adoption of this evidence-based technology.

Materials and Methods: This study recruited providers from three Appalachian Kentucky health care sites. Prenatal care providers took part in semistructured interviews and completed brief survey scales. Questions focused on PTB knowledge, TVU-related barriers, and suggestions for …

Applying The Robson Classification To Routine Facility Data To Understand The Caesarean Section Practice In Conflict Settings Of South Kivu, Eastern Dr Congo, Guy Mulinganya, Espoir Bwenge Malembaka, Melissa Lukula Akonkwa, Dieudonne´ Mpunga Mukendi, Etienne Kajibwami Birindwa, Ghislain Maheshe Balemba, Marleen Temmerman, Albert Mwembo Tambwe, Bart Criel, Ghislain Bisimwa Balaluka

Obstetrics and Gynaecology, East Africa

Introduction: Sub-Saharan Africa has low Caesarean (CS) levels, despite a global increase in CS use. In conflict settings, the pattern of CS use is unclear because of scanty data. We aimed to examine the opportunity of using routine facility data to describe the CS use in conflict settings.

Methods: We conducted a facility-based cross-sectional study in 8 health zones (HZ) of South Kivu province in eastern DR Congo. We reviewed patient hospital records, maternity registers and operative protocol books, from January to December 2018. Data on direct conflict fatalities were obtained from the Uppsala Conflict Data Program. Based on conflict …

Maternal And Perinatal Outcomes In Women With Eclampsia By Mode Of Delivery At Riley Mother Baby Hospital: A Longitudinal Case-Series Study, Philippe Amubuomombe Poli, Koech Irene, Richard Mogeni, Ann Mwangi, Andrew Cheruiyot, Elkanah Omenge

Obstetrics and Gynaecology, East Africa

Background: Eclampsia, considered a serious complication of preeclampsia, remains a life-threatening condition among pregnant women. It accounts for 12% of maternal deaths and 16–31% of perinatal deaths worldwide. Most deaths from eclampsia occurred in resource-limited settings of sub-Saharan Africa. This study was performed to determine the optimum mode of delivery, as well as factors associated with the mode of delivery, in women admitted with eclampsia at Riley Mother and Baby Hospital.

Methods: This was a hospital-based longitudinal case-series study conducted at the largest and busiest obstetric unit of the tertiary hospital of western Kenya. Maternal and perinatal variables, such as …

Frequency And Outcome Of Meconium Aspiration Syndrome In Babies Born With Meconium-Stained Liquor At Secondary Care Hospital In Pakistan: A Case Series Study, Abdul Moeed, Heeramani Lohana, Sarwat Urooj, Sheraz Ahmed, Khalil Ahmed, Khadija N Humayun

Department of Paediatrics and Child Health

Background: Meconium aspiration syndrome (MAS) in the newborn is characterized by hypoxia, hypercapnia, and acidosis. MAS is a leading cause of morbidity and mortality in neonates. The primary objective of this study was to estimate the frequency of meconium aspiration syndrome (MAP) in babies born with meconium-stained liquor. The secondary outcome was to estimate the meconium aspiration syndrome; in terms of hospital stay, complications, and mortality.
Methods: The study was done at Aga Khan Maternal and Child Care Centre, Hyderabad, Pakistan. Study design was case series and the duration of the study was of 6 months. All patients who fulfilled …

Pregnancy Cohorts And Biobanking In Sub-Saharan Africa: A Systematic Review, Jeffrey N. Bone, Kelly Pickerill, Mai-Lei Woo Kinshella, Marianne Vidler, Rachel Craik, Lucilla Poston, William Stones, Esperanca Sevene, Marleen Temmerman, Angela Koech

Obstetrics and Gynaecology, East Africa

Background: Technological advances and high throughput biological assays can facilitate discovery science in biobanks from population cohorts, including pregnant women. Biological pathways associated with health outcomes differ depending on geography, and high-income country data may not generalise to low-resource settings. We conducted a systematic review to identify prospective pregnancy cohorts in sub-Saharan Africa (SSA) that include biobanked samples with potential to enhance discovery science opportunity.

Methods: Inclusion criteria were prospective data collection during pregnancy, with associated biobanking in SSA. Data sources included: scientific databases (with comprehensive search terms), grey literature, hand searching applicable reference lists and expert input. Results were …

To Be Or Not To Be An Obstetrician / Gynaecologist, Iffat Ahmed, Abid Ashar

Department of Obstetrics & Gynaecology

Objectives: This qualitative study aimed to explore motivational sources of physicians, at the time of selection and while pursuing ObGyn career. Secondary aim was to explore challenges and strategies adapted by these physicians to overcome these challenges.
Methods: This is qualitative study with constrictive worldview. ObGyn residents and consultants of Aga Khan University, Karachi, were interviewed from July 2017 till Jan 2019, after ethical approval, using purposeful maximum variation sampling. Analysis were conducted by identifying keywords and phrases, these unedited verbatim with no assumptions provided basis for codes, which then clustered as trends. Emerging findings were discussed among authors and …

Life After Menopause: Quality Of Life In Women Diagnosed With Polycystic Ovarian Syndrome After The Childbearing Years, Katelyn Baker

Dissertations

Very little research has been conducted in regards to what happens after a woman diagnosed with PCOS is menopausal or post menopausal. This study researched the quality of life in women with PCOS before and after menopause in an attempt to compare the two groups.

Prognostic Value Of Blastocyst Grade After Frozen Euploid Embryo Transfer In Patients With Recurrent Pregnancy Loss, Gayathree Murugappan, Julia G Kim, Jonathan D Kort, Brent M Hanson, Shelby A Neal, Ashley W Tiegs, Emily K Osman, Richard T Scott, Ruth B Lathi

Department of Obstetrics and Gynecology Faculty Papers

Objective: To determine if trophectoderm (TE) grade or inner cell mass (ICM) grade have predictive value after euploid frozen embryo transfer (euFET) among RPL patients.

Design: Retrospective cohort study.

Setting: Single fertility center, 2012-2018.

Patients: Patients with ≥ 2 prior pregnancy losses performing PGT-A with ≥1 euploid embryo for transfer.

Interventions: All patients underwent ICSI, trophectoderm biopsy, blastocyst grading and vitrification, and single euFET. Outcome of the first transfer was recorded.

Main outcome measures: Live birth (LB) and clinical miscarriage (CM) rates.

Results: 660 euFET were included. In a binomial logistic regression analysis accounting for age, BMI, AMH and day …

A Conceptual Model For Residents As Teachers In Obstetrics And Gynecology, Bani M Ratan, Jocelyn T Greely, M Diane Jensen, Charlie C Kilpatrick

Faculty, Staff and Students Publications

BACKGROUND: The learning environment in obstetrics and gynecology (OB/GYN) may have intrinsic differences that require modifying existing resident as teacher models for high-quality teaching.

OBJECTIVE: To explore medical students' views of resident teaching on the OB/GYN clerkship in order to develop more effective educators.

METHODS: Between October 2017 and June 2018, we performed medical student focus groups at the end of the 2-month OB/GYN clerkship. Topics discussed included positive and negative teaching interactions with residents, barriers specific to the OB/GYN clerkship, and best methods for resident teaching. Qualitative analysis utilizing 3 reviewers and N-Vivo software were used to identify themes. …