Obstetrics and Gynecology Commons^™

Pregnancy Rates From Intrauterine Insemination Are Equivalent Following 1- Versus 5-Day Letrozole Administration For Ovulation Induction: A Retrospective Study, Kaitlin Mcgrail, Susan Conway, John Storment, Sarah Buzhardt, Neil Chappell

School of Medicine Faculty Publications

Objective: To compare the efficacy of single-dose letrozole (25 mg) with a 5-day course (5 mg/day) for ovulation induction (OI). Design: Retrospective cohort study. Setting: Hospital. Patient(s): Patients undergoing first round of OI and intrauterine insemination with letrozole from January 2015 through December 2017. Intervention(s): Patients received letrozole as either a single 25 mg dose for 1 day (1D) versus 5 mg daily for 5 days (5D). A secondary analysis was performed on patients also receiving gonadotropins (GND). Main Outcome Measure(s): Pregnancy rate (PR) determined by positive human chorionic GND. Result(s): There were 847 patients included in the study, 302 …

Barriers To Maternal Retention In Hiv Care In Ghana: Key Differences During Pregnancy And The Postpartum Period., Kwame S. Sakyi, Margaret Y. Lartey, Caitlin E. Kennedy, Julie A. Dension, Luke C. Mullany, Prince G. Owusu, Emma Sacks, Emily A. Hurley, Pamela J. Surkan

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Maternal retention in HIV care is lower for women in the postpartum period than during pregnancy, but the reasons are poorly understood. We examined key differences in barriers to retention in HIV care during and after pregnancy.

METHODS: We conducted semi-structured, in-depth interviews with 30 postpartum women living with HIV. Participants were recruited from two tertiary facilities implementing Option B+ for prevention of mother-to-child HIV transmission in Accra, Ghana. We collected data from mothers who had disengaged from HIV care and those who were still engaged in care. The interviews were analyzed using principles adapted from grounded theory.

RESULTS: …

Gynecologic Surgrete, New Horizons Guyana 2019: An Experience Of A Lifetime For Global Health Engagement And Medical Readiness, Bethany L. Charron, Katherine L. Dengler, Bao Tram Nguyen, Ashley Coggins, Jason C. Massengill, Trisha J. Tomkins

Obstetrics and Gynecology Faculty Publications

New Horizons is an annual training exercise designated for military medical professionals and civil engineers to assist partner nations of Southern Command (SOUTHCOM), as well as provide exceptional training to U.S. military members.1 In Spring of 2019, a gynecologic surgery readiness training exercise (SURGRETE) team composed of 16 joint-service military healthcare professionals, specifically including a fellowship-trained female pelvic medicine and reconstructive surgery (FPMRS) surgeon, an FPMRS fellow, an obstetrics and gynecology (OB/GYN) specialist, three OB/GYN residents, and additional anesthesia, nursing, and surgical technician support, traveled to Guyana to participate in the New Horizons global health exercise. The mission of the …

Lessons From An Evidence-Based Medicine Exploration: When Transparency And Sensitivity (Analyses) Can Change The Take-Home Message, Nadi N. Kaonga, Toby Fitzgerald

Journal of Maine Medical Center

No abstract provided.

Strengthening The Evidence Base For Telehealth For Abortion Service Delivery, Nadi Kaonga

Journal of Maine Medical Center

Telehealth – which is the use of information and communication technology to provide clinical services to patients remotely – provides an opportunity to extend safe abortion services to women. A recent review article on telehealth for abortion service delivery found it to be acceptable, feasible and safe when compared to in-person service delivery. Despite the promising findings, the evidence base can and should be strengthened to optimize the impact of such services for women. Areas for improvement include evaluating the efficacy and effectiveness of telehealth implementations in more remote settings and with women across variable levels of technoliteracy, conducting cost-effectiveness …

Evaluation Of Geographic Disparities In Cervical Cancer Survival Across Maine, Kaylee Underkofler, Jason Lachance

Journal of Maine Medical Center

Introduction. National data exists suggesting the existence of geographic disparities in oncology care within the United States. It is unknown whether geographic disparities present a problem for women with gynecologic malignancies locally in Maine.

Methods. Data for each cervical cancer case diagnosed or treated under the MaineHealth system between 2007 and 2011 were acquired from the MaineHealth Network Registry. Average annual incidence and 5-year survival were calculated for each county in Maine and were mapped using geographic information systems (GIS) software. Next, cases were divided into 2 groups: those residing less than or equal to 60 miles from the sole …

A Novel Indication For Oocyte Cryopreservation Prior To Autologous Hematopoietic Cell Transplantation For Refractory Multiple Sclerosis, Neal R. Trulock, Luke Ying, Edward Zbella, Mark Sanchez

West Florida Division GME Research Day 2020

Multiple sclerosis (MS) is an immune mediated inflammatory diseases of the central nervous system characterized by focal ovoid like lesions of demyelination seen on MRI(1,2). The etiology of MS is unknown, however inflammation followed by CNS demyelination and axonal degeneration are known to be part of the pathologic processes that lead to the disease (1). The mean age of onset of MS is 28-31 years old and tends to affect women more often then men with a ratio of 2.3:1 (3,4) . Other risk factors associated with MS include vitamin D deficiency, smoking, and certain viruses (5). The pattern of …

Magnitude Of Screening For Gestational Diabetes Mellitus In An Urban Setting In Tanzania; A Cross-Sectional Analytic Study, Akampa Mukuve, Mariam Noorani, Ibrahim Sendagire, Miriam Mgonja

Faculty of Health Sciences, East Africa

Background

Medical screening detects risk factors for disease or presence of disease in otherwise well persons in order to intervene early and reduce morbidity and mortality. During antenatal care (ANC) it is important to detect conditions that complicate pregnancy, like gestational diabetes mellitus (GDM). Despite international and local guidelines recommending screening for GDM during ANC, there is evidence to suggest that the practice was not being carried out adequately. A major challenge may be lack of consensus on uniform GDM screening and diagnostic guidelines internationally and locally.

The primary objective was to determine the magnitude of screening for GDM among …

Delivery Of Sexual And Reproductive Health Interventions In Conflict Settings: A Systematic Review, Mariella Munyuzangabo, Dina Sami Khalifa, Michelle F. Gaffey, Mahdis Kamali, Fahad J. Siddiqui, Sarah Metek, Shailja Shah, Reena P. Jain, Daina Als, Amruta Radhakrishnan, Anushka Ataullahjan, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: It is essential to provide comprehensive sexual and reproductive health (SRH) interventions to women affected by armed conflict, but there is a lack of evidence on effective approaches to delivering such interventions in conflict settings. This review synthesised the available literature on SRH intervention delivery in conflict settings to inform potential priorities for further research and additional guidance development.
Methods: We searched MEDLINE, Embase, CINAHL and PsycINFO databases using terms related to conflict, women and children, and SRH. We searched websites of 10 humanitarian organisations for relevant grey literature. Publications reporting on conflict-affected populations in low-income and middle-income countries …

Extreme Elevations Of Alkaline Phosphatase In Pregnancy: A Case Report, Zachary Stanley, Katherine Vignes, Miriam Marcum

Obstetrics and Gynecology Faculty Publications

Background: The normal serum concentration of alkaline phosphatase (ALP) in adults over the age of 18 ranges from 37 to 116 U/L, while in pregnant women levels of up to twice that upper limit can still be normal. There have been very few reports of extreme elevations in ALP, and here we present the case of a 29-year-old pregnant woman with an incidentally found 30-fold increase.

Case: The patient, G6P2-1-2-4, received routine prenatal care, though presented to obstetric triage at 36 weeks and 1 day of gestation for diagnosis and management of viral rhinosinusitis and was found to have an …

Polycystic Ovarian Syndrome: Causes, Complications, And Treatments, Toni Tornberg

Biomedical Sciences Undergraduate Research

Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder prevalent in 6-10% of reproductive age women. The purpose of this review paper is to describe both genetic and environmental causes and symptoms of PCOS. Additionally, to summarize the complications women face with a PCOS diagnosis and present treatment and management options. The information forming this paper was compiled from various online heath journals. The results show that both clinical and biochemical examinations are used for the diagnosis of PCOS while the exact cause is unknown. Genetics and environmental factors, specifically the intrauterine environment, are discussed as causes. Management and treatment options …

Detection Of Types Of Hpv Among Hiv-Infected And Hiv-Uninfected Kenyan Women Undergoing Cryotherapy Or Loop Electrosurgical Excision Procedure, Elkanah Omenge, Jordan P. Emont, Aaron Ermel, Tao Liu, Victor Omodi, Yan Tong, Peter Itsura, Philip Tonui, Titus Maina, John M. Ong’Echa

Obstetrics and Gynaecology, East Africa

Objective: To assess the baseline types of HPV infection among HIV-positive and HIV-negative women in western Kenya undergoing cryotherapy or loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia.

Methods: A prospective observational study was conducted of baseline HPV characteristics of women undergoing visual inspection with acetic acid (VIA) and cryotherapy or LEEP. After a positive VIA in HIV-positive and HIV-negative women, data on demographics, CD4 count, and use of antiretroviral therapy and a cervical swab were collected. HPV typing was performed using the Roche Linear Array.

Results: Of 175 participants, 86 (49.1%) were HIV-positive and had a higher prevalence …

Persistence Of Oncogenic And Non-Oncogenic Human Papillomavirus Is Associated With Human Immunodeficiency Virus Infection In Kenyan Women, Yan Tong, Philip Tonui, Aaron Ermel, Elkanah Omenge, Nelson Wong, Titus Maina, Stephen Kiptoo, Kapten Muthoka, Patrick J. Loehrer, Darron R. Brown

Obstetrics and Gynaecology, East Africa

Objectives: Cervical cancer is caused by persistent infection with oncogenic, or “high-risk” types of human papillomaviruses, and is the most common malignancy in Kenyan women. A longitudinal study was initiated to investigate factors associated with persistent human papillomavirus detection among HIV-infected and HIV-uninfected Kenyan women without evidence of cervical dysplasia.

Methods: Demographic/behavioral data and cervical swabs were collected from HIV-uninfected women (n = 82) and HIV-infected women (n = 101) at enrollment and annually for 2 years. Human papillomavirus typing was performed on swabs (Roche Linear Array). Logistic regression models of human papillomavirus persistence were adjusted for demographic …

Video Analysis Of Newborn Resuscitations After Simulation-Based Helping Babies Breathe Training, Ingunn Anda Haug, Kari Holte, Catherine L. Chang, Carolyn Purington, Joar Eilevstjønn, Anita Yeconia, Hussein Kidanto, Hege L. Ersdal

Obstetrics and Gynaecology, East Africa

Background: Simulation-based Helping Babies Breathe (HBB) training is currently rolled-out in around 80 low-income countries with various results.

Method: Workflow was analyzed in 76 video-recorded newborn resuscitations performed by regularly HBB-trained nurse-midwives over 3 years in rural Tanzania.

Results: Actual newborn resuscitation practice deviated from HBB intention/guideline: most newborns underwent prolonged suction and stimulation before ventilation; ventilation was delayed and frequently interrupted. Nurse-midwives often worked together.

Conclusions:There is a gap between training intention and clinical practice. HBB trainings should focus more on urgency, ventilation skills, and team training. Combining clinical debriefing with HBB simulations could facilitate continuous learning and …

Achieving Accurate Estimates Of Fetal Gestational Age And Personalised Predictions Of Fetal Growth Based On Data From An International Prospective Cohort Study: A Population-Based Machine Learning Study, Russell Fung, Jose Villar, Ali Dashti, Leila Cheikh Ismail, Eleonora Staines-Uria, Eric O. Ohuma, Maria Carvalho, Shama Munim, Zulfiqar Ahmed Bhutta, International Fetal And Newborn Growth Consortium For The 21st Century (Intergrowth-21st)

Department of Obstetrics & Gynaecology

Background: Preterm birth is a major global health challenge, the leading cause of death in children under 5 years of age, and a key measure of a population's general health and nutritional status. Current clinical methods of estimating fetal gestational age are often inaccurate. For example, between 20 and 30 weeks of gestation, the width of the 95% prediction interval around the actual gestational age is estimated to be 18-36 days, even when the best ultrasound estimates are used. The aims of this study are to improve estimates of fetal gestational age and provide personalised predictions of future growth.
Methods: …

Advancing Human Health In The Decade Ahead: Pregnancy As A Key Window For Discovery: A Burroughs Wellcome Fund Pregnancy Think Tank., Yoel Sadovsky, Sam Mesiano, Graham J Burton, Michelle Lampl, Jeffrey C Murray, Rachel M Freathy, Anita Mahadevan-Jansen, Ashley Moffett, Nathan D Price, Paul H Wise, Derek E Wildman, Ralph Snyderman, Nigel Paneth, John Anthony Capra, Marcelo A Nobrega, Yaacov Barak, Louis J Muglia

Articles, Abstracts, and Reports

Recent revolutionary advances at the intersection of medicine, omics, data sciences, computing, epidemiology, and related technologies inspire us to ponder their impact on health. Their potential impact is particularly germane to the biology of pregnancy and perinatal medicine, where limited improvement in health outcomes for women and children has remained a global challenge. We assembled a group of experts to establish a Pregnancy Think Tank to discuss a broad spectrum of major gestational disorders and adverse pregnancy outcomes that affect maternal-infant lifelong health and should serve as targets for leveraging the many recent advances. This report reflects avenues for future …

Perceptions And Experiences Of Men And Women Towards Acceptability And Use Of Contraceptives In Underserved Areas Of Karachi, Pakistan: A Midline Qualitative Assessment Of Sukh Initiative, Karachi Pakistan, Sarah Saleem, Narjis Rizvi, Anam Feroz, Sayyeda Reza, Saleem Jessani, Farina Abrejo

Community Health Sciences

Background: Family planning (FP) is an essential component of Sustainable Development Goals (SDG) and contributes directly to SDG targets 3.7 and 5.6. In Pakistan, contraceptive use has remained stagnant over the past 5 years. This change has been very slow when compared to the FP2020 pledge. The Sukh initiative project was conceived and implemented to alleviate these challenges by providing access to quality contraceptive methods in some underserved areas of Karachi, Pakistan. A qualitative study was conducted to understand the perceptions and experiences of men and women towards acceptability and contraceptive use.
Methods: A qualitative study was conducted at ten …

Non-Adherence To Who Recommendations Regarding Infant Feeding Practices Results In Dilemma Of Malnourishment: A Community-Based Prospective Cohort Study Conducted In Karachi, Pakistan, Muhammad Osama, Anosh Aslam Khan, Sohaib Hasan Syed, Osama Mohiuddin, Ammar Hassan, Syeda Ramsha Zaidi, Neelofar Sami

Community Health Sciences

Background: The prevalence of chronic malnutrition and its associated morbid outcomes has been a significant cause of health loss globally, affecting millions of children hampering their mental, physical, social, and immune system development. World Health Organization's (WHO) recommendations presenting infant feeding guidelines have largely controlled this burden. However, developing countries including Pakistan have failed to promote these guidelines and still succumb to a huge burden of morbidity and mortality secondary to malnourishment among infants.
Methodology: Our study is a prospective cohort including 300 infants without predisposing congenital anomaly, followed from 6 months to 18 months of age. The primary outcome …

Robotic Surgery For Gynecologic Cancers: Indications, Techniques And Controversies., Kiran H Clair, Krishnansu S Tewari

Articles, Abstracts, and Reports

Minimally invasive surgery for gynecologic cancers is associated with fewer postoperative complications including less blood loss and quicker recovery time compared to traditional laparotomy. The robotic platform has allowed patients access to minimally invasive surgery due to its increased utilization by gynecologic oncologists. Many surgeons have embraced the robotic platform due to its technological advances over traditional laparoscopy including high-definition 3D optics, wristed instrumentation, camera stability and improved ergonomics. While robotic surgery continues as a mainstay in the management of gynecologic cancers, it remains controversial in regards to its cost effectiveness and more recently, its long-term impact on clinical and …

International Gestational Age-Specific Centiles For Umbilical Artery Doppler Indices: A Longitudinal Prospective Cohort Study Of The Intergrowth-21st Project, Lior Drukker, Eleonora Staines-Urias, José Villar, Fernando C. Barros, Maria Carvalho, Shama Munim, Rose Mcgready, Francois Nosten, James A. Berkley, Shane A. Norris, Ricardo Uauy, Stephen H. Kennedy, Aris T. Papageorghiou

Department of Obstetrics & Gynaecology

Background: Reference values for umbilical artery Doppler indices are used clinically to assess fetal well-being. However, many studies that have produced reference charts have important methodologic limitations, and these result in significant heterogeneity of reported reference ranges.
Objectives: To produce international gestational age-specific centiles for umbilical artery Doppler indices based on longitudinal data and the same rigorous methodology used in the original Fetal Growth Longitudinal Study of the INTERGROWTH-21^st Project.
Study design: In Phase II of the INTERGROWTH-21^st Project (the INTERBIO-21st Study), we prospectively continued enrolling pregnant women according to the same protocol from 3 of the original …