Obstetrics and Gynecology Commons^™

Poorly Controlled Diabetes Mellitus Alters Placental Structure, Efficiency, And Plasticity., Jackson Nteeba, Kaela M. Varberg, Regan L. Scott, Mikaela E. Simon, Khursheed Iqbal, Michael J. Soares

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: The hemochorial placenta provides a critical barrier at the maternal-fetal interface to modulate maternal immune tolerance and enable gas and nutrient exchange between mother and conceptus. Pregnancy outcomes are adversely affected by diabetes mellitus; however, the effects of poorly controlled diabetes on placental formation, and subsequently fetal development, are not fully understood.

RESEARCH DESIGN AND METHODS: Streptozotocin was used to induce hyperglycemia in pregnant rats for the purpose of investigating the impact of poorly controlled diabetes on placental formation and fetal development. The experimental paradigm of hypoxia exposure in the pregnant rat was also used to assess properties of …

Executive Summary Of The Early-Onset Breast Cancer Evidence Review Conference., David Chelmow, Mark D Pearlman, Amy Young, Laura Bozzuto, Sandra Dayaratna, Myrlene Jeudy, Mallory E Kremer, Dana Marie Scott, Julia Sage OʼHara

Department of Obstetrics and Gynecology Faculty Papers

The Centers for Disease Control and Prevention launched the Bring Your Brave campaign to increase knowledge about early-onset breast cancer, defined as breast cancer in women aged 18-45 years. The American College of Obstetricians and Gynecologists convened a panel of experts in breast disease from the Society for Academic Specialists in General Obstetrics and Gynecology to review relevant literature, validated tools, best practices, and practice guidelines as a first step toward developing educational materials for women's health care providers about early-onset breast cancer. Panel members conducted structured literature reviews, which were then reviewed by other panel members and discussed at …

Pregnancy Management In A Patient With Stickler Syndrome., Julie Gomez, Stephanie M. Rice, Mona M. Makhamreh, Huda B. Al-Kouatly

Department of Obstetrics and Gynecology Faculty Papers

BACKGROUND: Stickler syndrome is a collagen disorder that can affect multiple organ systems. It is characterized by ocular abnormalities, hearing loss, midfacial hypoplasia, hypermobility, and joint abnormalities. The phenotypic expression of Stickler syndrome can vary among those affected. Since Stickler syndrome is a collagen disorder, it is possible to expect pregnancy complications similar to those reported in other collagen disorders. To our knowledge, there is only one case report in the literature on the management of pregnancy and delivery of a patient with Stickler syndrome.

METHODS/CASE REPORT: A 37-year-old primigravid woman with a diagnosis of Stickler syndrome presented at 9 …

Phrenic Nerve Injury Secondary To Extracorporeal Membrane Oxygenation In Pregancy: A Case Report, Cheryl Godcharles, Melody Safarzadeh, Emily A. Oliver, Amanda Roman, Huda B. Al-Kouatly

Department of Obstetrics and Gynecology Faculty Papers

Extracorporeal membrane oxygenation (ECMO) is used to provide acute respiratory and/or hemodynamic support to patients with severe, refractory respiratory failure. Phrenic nerve injury with subsequent hemidiaphragm paralysis should be included in the differential diagnosis of pregnant women with persistent hypoxia after ECMO cannulation.

Elagolix Treatment For Up To 12 Months In Women With Heavy Menstrual Bleeding And Uterine Leiomyomas, James A Simon, Ayman Al-Hendy, David F Archer, Kurt T Barnhart, Linda D Bradley, Bruce R Carr, Thomas Dayspring, Eve C Feinberg, Veronica Gillispie, Sandra Hurtado, Jinhee Kim, Ran Liu, Charlotte D Owens, Ozgul Muneyyirci-Delale, Alice Wang, Nelson B Watts, William Schlaff

Department of Obstetrics and Gynecology Faculty Papers

Objective: To investigate the safety and efficacy of elagolix, an oral gonadotropin-releasing hormone antagonist, with hormonal add-back therapy for up to 12 months in women with heavy menstrual bleeding associated with uterine leiomyomas.

Methods: Elaris UF-EXTEND was a phase 3 extension study that evaluated an additional 6 months (up to 12 months total) of elagolix 300 mg twice daily with hormonal add-back therapy (estradiol 1 mg and norethindrone acetate 0.5 mg once daily) in women who completed an initial 6 months of the same treatment in one of two preceding phase 3 studies. The primary endpoint was the percentage of …

Maternal Viral Load Monitoring: Coverage And Clinical Action At 4 Kenyan Hospitals., Matthew Sandbulte, Melinda Brown, Catherine Wexler, May Maloba, Brad Gautney, Kathy Goggin, Elizabeth Muchoki, Shadrack Babu, Nicodemus Maosa, Sarah Finocchario-Kessler

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Kenya's guidelines for prevention of mother-to-child transmission of HIV (PMTCT) recommend routine viral load (VL) monitoring for pregnant and breastfeeding women.

METHOD: We assessed PMTCT VL monitoring and clinical action occurring between last menstrual period (LMP) and 6 months postpartum at 4 Kenyan government hospitals. Pregnant women enrolled in the HIV Infant Tracking System from May 2016-March 2018 were included. We computed proportions who received VL testing within recommended timeframes and who received clinical action after unsuppressed VL result.

RESULTS: Of 424 participants, any VL testing was documented for 305 (72%) women and repeat VL testing was documented for …

A Mobile Phone–Based Sexual And Reproductive Health Intervention For Female Sex Workers In Kenya: Development And Qualitative Study, Frances H. Ampt, Kelly L'Engle, Megan S. C. Lim, Kate F. Plourde, Emily Mangone, Collins Mudogo Mukanya, Peter Gichangi, Griffins Manguro, Margaret Hellard, Walter Jaoko, Paul A. Agius, Marleen Temmerman, Winnie Wangari, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Background: Female sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and sexually transmitted infection (STI) prevention and management, alcohol awareness, gender-based violence and rights, and health care utilization. The Women's Health Intervention using SMS for Preventing Pregnancy (WHISPER) mobile phone intervention uses a participatory development approach and behavior change theory to address these high-priority concerns of FSWs in Mombasa, Kenya.

Objective: This paper aimed to (1) describe …

Stepwise Implementation Of Vaginal Cleansing And Azithromycin At Cesarean Delivery To Decrease Postoperative Infections; A Quality Improvement Study, Julie Gomez, Ms, Johanna Quist-Nelson, Md, Laura Felder, Md, Daniele Dimascio, Md, Rebecca Eckler, Md, Amanda Paternostro, Md, Michael Posencheg, Md, Jason Baxter, Md, Vincenzo Berghella, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

We aimed to decrease our SSI rate by 30% by sequential implementation of vaginal cleaning1,2 and azithromycin3 for women who underwent a CD after having labored or experienced rupture of membranes.

Jefferson Postpartum Oxytocin Protocol Standardization, Julie Gomez, Ms, Farnaz Farhi, Md, Sara Hinton, Pharmd, Tara Biedrzycki, Pharmd, Deborah Cruz, Msn, Crnp, Jason Baxter, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

We aimed to reduce the variation and subsequent waste of postpartum oxytocin by standardizing the concentration available across the three maternity hospitals within the hospital enterprise system.

A Web-Based, Positive Emotion Skills Intervention For Enhancing Posttreatment Psychological Well-Being In Young Adult Cancer Survivors (Empower): Protocol For A Single-Arm Feasibility Trial, John M. Salsman, Laurie E. Mclouth, Michael Cohn, Janet A. Tooze, Mia Sorkin, Judith T. Moskowitz

Behavioral Science Faculty Publications

BACKGROUND: Adolescent and young adult cancer survivors (AYAs) experience clinically significant distress and have limited access to supportive care services. Interventions to enhance psychological well-being have improved positive affect and reduced depression in clinical and healthy populations but have not been routinely tested in AYAs.

OBJECTIVE: The aim of this protocol is to (1) test the feasibility and acceptability of a Web-based positive emotion skills intervention for posttreatment AYAs called Enhancing Management of Psychological Outcomes With Emotion Regulation (EMPOWER) and (2) examine proof of concept for reducing psychological distress and enhancing psychological well-being.

METHODS: The intervention development and testing are …

Religious, Socio-Cultural Norms And Gender Stereotypes Influence Uptake And Utilization Of Maternal Health Services Among The Digo Community In Kwale, Kenya: A Qualitative Study, Vernon Mochache, George Wanje, Lucy Nyaga, Amyn Lakhani, Hajara El-Busaidy, Marleen Temmerman, Peter Gichangi

Obstetrics and Gynaecology, East Africa

Background: Maternal health outcomes in resource-limited settings are typically influenced by supply-side factors affecting the provision of quality health services. The extent to which demand-side factors contribute to this influence is unclear. We aimed to explore how individual and community-wide factors influenced uptake and utilization of maternal health services among the Digo community residing in Kwale County of coastal Kenya.

Methods: Between March and December 2015, we conducted 5 focus group discussions (FGDs) and 15 in-depth interviews (IDIs) with members of the Digo community predominant in Kwale county, Kenya. Respondents were sampled purposively and included female (pregnant and …

Investigating Birth Outcomes Among Deaf Mothers: Hospital Vs. Home Births, Aashni Kamra

Undergraduate University Honors Capstones

This study examined birth outcomes among Deaf mothers who have given birth in a hospital setting versus a home setting. Deaf individuals are often marginalized in healthcare due to lack of accessibility, and therefore, the right to make their own informed decisions. This marginalization leads to inequality in health care, and oftentimes individuals within the Deaf community, with added intersectionalities, face even more discrimination. Deaf women face more health disparities in comparison to hearing women due to a variety of factors which include; lack of accessibility, medical professionals’ lack of cultural competency, and lack of inclusion in their healthcare decisions. …

Risk Factors For Postpartum Sepsis: A Nested Case-Control Study, Samina Bakhtawar, Sana Sheikh, Rahat Qureshi, Zahra Hoodbhoy, Beth Payne, Iqbal Azam Syed, Peter Von Dadelszen, Laura Magee

Community Health Sciences

Background: The Majority (99%) of maternal deaths occur in low and middle-income countries. The three most important causes of maternal deaths in these regions are postpartum hemorrhage, pre-eclampsia and puerperal sepsis. There are several diagnostic criteria used to identify sepsis and one of the commonly used criteria is systematic inflammatory response syndrome (SIRS). However, these criteria require laboratory investigations that may not be feasible in resource-constrained settings. Therefore, this study aimed to develop a model based on risk factors and clinical signs and symptoms that can identify sepsis early among postpartum women.
Methods: A case-control study was nested in an …

Adverse Childhood Experiences And Changing Levels Of Psychosocial Distress Scores Across Pregnancy In Kenyan Women, Pauline Samia, Shahirose Premji, Farideh Tavangar, Ilona S. Yim, Sikolia Wanyonyi, Mohamoud Merali, Wangira Musana, Geoffrey Omuse, Ntonghanwah Forcheh, Aliyah Dosani, Nicole Letourneau, The Maternal Infant Global Health Team (Might) Collaborators In Research

Paediatrics and Child Health, East Africa

Background: Adverse childhood experiences (ACEs) have been associated with deleterious effects on mental health in pregnancy.

Methods: The ACE International Questionnaire (ACE-IQ) was used to measure neglect, abuse, and household dysfunction. Longitudinal mixed effect modelling was used to test the effect of ACEs on pregnancy-related anxiety, depressive symptoms, and perceived stress at two time points (12–19 and 22–29 weeks) during pregnancy.

Results: A total of 215 women who were predominantly married (81%) and had attained tertiary education (96%) were enrolled. Total ACEs were significantly associated with depressive symptoms (r = 0.23, p < 0.05) and perceived stress (r = 0.18, p < 0.05). As depressive symptoms decreased, t (167) = −8.44, p < 0.001, perceived stress increased, t (167) = 4.60, p < 0.001, and pregnancy-related anxiety remained unchanged as pregnancy progressed. Contact sexual abuse (p < 0.01) and parental death or divorce (p = 0.01) were significantly associated with depression over time (p < 0.01). Total ACEs in this study were associated with depressive symptoms early but not late in pregnancy.

Conclusions: Higher total ACEs were positively associated with …

Maternal Inflammatory Markers For Chorioamnionitis In Preterm Prelabour Rupture Of Membranes: A Systematic Review And Meta-Analysis Of Diagnostic Test Accuracy Studies, Angela Koech, Geoffrey Omuse, Abraham Mukaindo, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: There is no consensus on the role of inflammatory markers in identifying chorioamnionitis in preterm prelabour rupture of membranes (PPROM). We set out to evaluate the accuracy of maternal blood C-reactive protein (CRP), procalcitonin and interleukin 6 (IL6) in diagnosis of histological chorioamnionitis and/or funisitis (HCA/Funisitis) in PPROM.

Methods: We searched MEDLINE, EMBASE and The Cochrane Library from inception to January 2020 for studies where maternal blood CRP, procalcitonin or IL6 was assessed against a reference standard of HCA/Funisitis in PPROM. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess methodological quality. Hierarchical summary …

Socioeconomic Status And Symptoms Of Anxiety And Depression In Pregnant Women, Meagan Mandabach

Honors Theses

Pregnancy is a period of great change in a woman’s body as her baby develops. During this period, women commonly experience symptoms of anxiety (Dennis et al., 2017) and depression (Shidhaye & Giri, 2014). Literature has suggested that socioeconomic status (SES) can contribute to the severity at which pregnant women experience anxiety and depression (Arora & Aeri, 2019; Field et al., 2008; Shagufta & Shams, 2019), and women of low socioeconomic status may be more likely to experience symptoms of anxiety and depression during pregnancy (Field et al., 2008). The present study aimed to assess the relationships between household income …

An Examination Of The Association Between State Medicaid Perinatal Services And Birth Outcomes, Joy Morgan Myers

Honors Theses

This thesis investigated the connection between socioeconomic status, healthcare coverage, and birth outcomes. The research question that was posed specifically looked at twenty perinatal services that states covered under Medicaid to varying degrees to see their association, if any, with premature birth rates and low birthweight rates. State-level and Mississippi county-level data were compiled regarding preterm birth rates, low birthweight rates, presumptive eligibility adoption, and coverage of twenty different perinatal services. Using these data, the correlation between state Medicaid expansion status and birth outcomes was first calculated in order to determine if variation in birth outcomes was associated with expanded …

Ccne1 Amplification As A Predictive Biomarker Of Chemotherapy Resistance In Epithelial Ovarian Cancer, Justin W. Gorski, Frederick R. Ueland, Jill M. Kolesar

Obstetrics and Gynecology Faculty Publications

Ovarian cancer is the most-deadly gynecologic malignancy, with greater than 14,000 women expected to succumb to the disease this year in the United States alone. In the front-line setting, patients are treated with a platinum and taxane doublet. Although 40-60% of patients achieve complete clinical response to first-line chemotherapy, 25% are inherently platinum-resistant or refractory with a median overall survival of about one year. More than 80% of women afflicted with ovarian cancer will recur. Many attempts have been made to understand the mechanism of platinum and taxane based chemotherapy resistance. However, despite decades of research, few predictive markers of …

Impact Of A Protocol Implementation On Identification And Referral Of Women At-Risk For Hereditary Breast Cancer, Chrysanthemum Davis Lawson

Evidence-Based Practice Project Reports

Breast cancer is the foremost new cancer diagnosis and the second highest cause of cancer death in American women (American Cancer Society, 2019). Hereditary breast cancer is most commonly caused by a mutation within the breast cancer susceptibility genes, BRCA 1 or 2, which increases women’s risk for breast cancer by five to ten-fold the average population (Mayo Clinic, 2019). The U.S. Preventive Services Task Force has assigned a Grade B recommendation advising health care providers to use a risk assessment tool, such as the Breast Cancer Genetics Referral Screening Tool (B-RST™), to recognize and provide medical management recommendations for …

The Evil Twin: The Case Of Heterotopic Pregnancy, Rashmi Jadhav, Vegas Brown, Gabriel Cabrera

West Florida Division GME Research Day 2020

• Heterotopic pregnancy occurs in about 1 in 30,000 naturally conceived pregnancies (5). The risk rises 1-3% for pregnancies occurring through assisted reproductive technologies (ART) (1).
• Isolated ectopic pregnancy affects an average of 1 in every 150 live births (1).
• A known pre-existing intrauterine pregnancy (IUP) can be falsely reassuring and delay the diagnosis of a potentially life-threatening concurrent ectopic pregnancy.
• Presentation is vague and 45% of patients have no symptoms (5).
• Differential Diagnoses: endometritis, incomplete miscarriage, ruptured ovarian cyst, non-GYN cause (ie: appendicitis or UTI).
• Risk Factors: Infertility treatment, in vitro fertilization (IVF), prior ectopic, prior tubal surgery, use of …