Obstetrics and Gynecology 2022

Composite score to predict hepatitis C viral infection in newborn through vertical transmission.

Faculty Mentor’s Name: Dr. Tony Wen
Email:
Phone Number: (352) 273-7562
Project Category: Translational
International Component or Travel: No

Research Project Description:

This is Mr Paul Wasuwanich’s summer research project under mentor of Dr. Robert Egerman and myself.
Objective- Retrospective analysis of cohort of pregnant women with active hepatitis C viral infection to develop a composite scoring system to predict risk for newborn infection.

Method- Retrospective chart review of cohort of pregnant women delivered at Shands hospital with known active hepatitis C viral infection and newborn follow up within the UFL health care system. Maternal demographic, social, medical, obstetrical and fetal / ultrasound factors and pregnancy / labor management will be analyzed to develop a composite scoring system to predict newborn / infant infection through vertical transmission.

Student t-test and multi- regression analysis will be conducted to develop this prediction model. The model will be tested for sensitivity and specificity.

Psychiatric Sequela of Unexpected and Emergent Perinatal and Postpartum Outcomes

Faculty Mentor’s Name: Dr. Dikea Roussos-Ross
Email: kroussos@ufl.edu
Phone Number: (352) 273-7660
Project Category: Case Review
International Component or Travel: No

Research Project Description:

Background and Significance – Perinatal and postpartum mood disorders affect up to 20% of pregnant women. Specific emergent stressors at the time of delivery may significantly increase a woman’s risk of developing anxiety disorders and depressive disorders. The purpose of this study is to determine whether there is an increased incidence of anxiety and/or mood disorders in women whose pregnancies have been affected by the above scenarios. The proposed study will be a retrospective chart analysis. We will utilize electronic medical records from patients who delivered at UF Health Shand’s Hospital in Gainesville.

Hypothesis and Rationale – We hypothesize that there will be an increased incidence of postpartum psychiatric disorders in mothers who experienced complications during pregnancy and delivery. Prior research has suggested some links between perinatal unspecific life-stressors and postpartum mood disorders.

Specific Aims – This study aims to determine specific risk factors for postpartum anxiety and mood disorders. The results of this study will be useful to those involved in the care of patients at higher risk for these psychiatric disorders.

Methods and Materials – We will request medical record numbers of all mothers who delivered at UF Health Shand’s Hospital between 01/01/2015 and 01/01/2022, as well as their infants. MRNs will be requested from the Institutional Data Repository (IDR) with the CTSI. We will request MRNs from all patients (anticipating approximately 5,000 women and 5,000 infants) but will record data on a random sample of no more than 1,000 mothers and their infants (N = 2000).
Each participant dyad will be assigned a study identification number that has no link to the medical record number, such that no medical record number will be recorded in our data collection tool. We will use REDCap for data collection. We will record all available data. Unavailable data will be recorded in REDCap as “not documented” or “not available.”

Plan for Data Analysis – We will extract the following information for each mother:

General:

  • Age
  • Race
  • Insurance status
  • Marital status
  • Past medical history
  • Past surgical history
  • Allergies
  • Medications
  • Problem list
    Pregnancy:
  • Obstetric history (parity, gravida)
  • Responses to “Healthy Start” screening tool
  • Number of prenatal visits attended
  • Urine drug screen results during pregnancy
  • Number of triage visits during pregnancy
  • Number of ED visits during pregnancy
  • Diagnoses of injuries during pregnancy
  • Diagnosis of complications during pregnancy
  • Referrals to mood clinic counseling during pregnancy
    Delivery:
  • Delivery type (e.g. vaginal, C-section)
  • Complications of delivery
  • Birth outcomes (GA, APGAR, weight)
    Postpartum:
  • Responses to Edinburgh Postpartum Depression Survey
  • Attendance of postpartum visits
  • Reported symptoms associated with anxiety disorder
  • Reported symptoms associated with depressive mood disorders
  • Referrals to postpartum psychiatric counseling
  • Diagnosis of postpartum psychiatric disorder
  • Treatment of postpartum psychiatric disorder

And the following information for each infant:

  • Diagnosis of complications during pregnancy
  • Diagnosis of in utero substance exposure
  • Delivery type (e.g. vaginal, C-section)
  • Complications of delivery
  • Birth outcomes (GA, APGAR, weight)
  • Number of primary care visits attended at 2 months
  • Immunizations at 2 months
  • Number of ED visits at 2 months
  • Congenital Malformations

Once data has been extracted, we will conduct correlation and chi-square analyses examining associations between postpartum psychiatric conditions and complications that arose during pregnancy and delivery.

Data safety

We will extract all de-identified retrospective data into RedCap using a study identification number. No identifying information will be printed out in paper form or kept on personal laptops or home computers. There will be no link between assigned study identification number and the MRN.

The extraction process will be as follows:

  1. We will compile a list of MRNs for both mothers and infants.
  2. We will assign numbers to each participant dyad for use in REDCap only.
  3. We will extract data from the medical record and build a secure REDCap database.
  4. Completed participants will be indicated with a code (completed/not completed).
  5. After data is abstracted and checked, the list of MRNs will be electronically destroyed.

Role of Medical Student – As an MS1, I will be responsible for reviewing patient charts, collecting and analyzing data, preparing a manuscript, and preparing a poster. This will be done under the mentorship of Dr. Roussos-Ross. I will be working on this project for 40 hours per week for 8-10 weeks during the summer.

References

  1. Aris-Meijer J, Bockting C, Stolk R, et al. What If Pregnancy Is Not Seventh Heaven? The Influence of Specific Life Events during Pregnancy and Delivery on the Transition of Antenatal into Postpartum Anxiety and Depression. Int J Environ Res Public Health. 2019;16(16):2851. Published 2019 Aug 9.
  2. Bay F, Sayiner FD. Perception of traumatic childbirth of women and its relationship with postpartum depression. Women Health. 2021;61(5):479-489. doi:10.1080/03630242.2021.1927287
  3. van der Zee-van den Berg AI, Boere-Boonekamp MM, Groothuis-Oudshoorn CGM, Reijneveld SA. Postpartum depression and anxiety: a community-based study on risk factors before, during and after pregnancy. J Affect Disord. 2021;286:158-165. doi:10.1016/j.jad.2021.02.062
  4. Urbanová E, Škodová Z, Bašková M. The Association between Birth Satisfaction and the Risk of Postpartum Depression. Int J Environ Res Public Health. 2021;18(19):10458. Published 2021 Oct 5. doi:10.3390/ijerph181910458
  5. Bell AF, Carter CS, Davis JM, et al. Childbirth and symptoms of postpartum depression and anxiety: a prospective birth cohort study. Arch Womens Ment Health. 2016;19(2):219‐227.
  6. Farren J, Jalmbrant M, Falconieri N, et al. Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study. Am J Obstet Gynecol. 2020;222(4):367.e1-367.e22. doi:10.1016/j.ajog.2019.10.102
  7. Zhao XH, Zhang ZH. Risk factors for postpartum depression: An evidence-based systematic review of systematic reviews and meta-analyses. Asian J Psychiatr. 2020;53:102353. doi:10.1016/j.ajp.2020.102353
  8. Dadi AF, Miller ER, Bisetegn TA, Mwanri L. Global burden of antenatal depression and its association with adverse birth outcomes: an umbrella review. BMC Public Health. 2020;20(1):173. Published 2020 Feb 4. doi:10.1186/s12889-020-8293-9
  9. Werner EA, Gustafsson HC, Lee S, et al. PREPP: postpartum depression prevention through the mother-infant dyad. Arch Womens Ment Health. 2016;19(2):229-242. doi:10.1007/s00737-015-0549-5
  10. Sun L, Wang S, Li XQ. Association between mode of delivery and postpartum depression: A systematic review and network meta-analysis. Aust N Z J Psychiatry. 2021;55(6):588-601. doi:10.1177/0004867420954284
  11. Nakić Radoš S, Tadinac M, Herman R. Anxiety During Pregnancy and Postpartum: Course, Predictors and Comorbidity with Postpartum Depression. Acta Clin Croat. 2018;57(1):39-51. doi:10.20471/acc.2017.56.04.05
  12. Berns HM, Drake D. Postpartum Depression Screening for Mothers of Babies in the Neonatal Intensive Care Unit. MCN Am J Matern Child Nurs. 2021;46(6):323-329. doi:10.1097/NMC.0000000000000768
  13. 7. Meltzer-Brody S, Howard LM, Bergink V, et al. Postpartum psychiatric disorders. Nat Rev Dis Primers. 2018;4:18022. Published 2018 Apr 26.
  14. Solberg Ø, Dale MT, Holmstrøm H, Eskedal LT, Landolt MA, Vollrath ME. Long-term symptoms of depression and anxiety in mothers of infants with congenital heart defects. J Pediatr Psychol. 2011;36(2):179-187. doi:10.1093/jpepsy/jsq054
  15. Johns AL, Hershfield JA, Seifu NM, Haynes KA. Postpartum Depression in Mothers of Infants With Cleft Lip and/or Palate. J Craniofac Surg. 2018;29(4):e354-e358. doi:10.1097/SCS.0000000000004319

Surgical conversion factors in urogynecology

Faculty Mentor’s Name: Dr. Jessica Heft
Email: jmo44@ufl.edu
Phone Number: (352) 318-2292
Project Category: Clinical
International Component or Travel: No

Research Project Description:

Urogynecology surgeries are typically performed laparoscopically (+/- robotic) or vaginally. Sometimes the route of surgery is changed intraoperatively due to a variety of potential factors.
Our team is performing a retrospective review of our 10-year patient database to determine what factors may influence intraoperative conversion rates. We will specifically be looking at age, prior surgeries, BMI, and operative complications.
A medical student would work alongside Drs. Heft, Weber, and Demtchouk to review relevant patient histories, demographics, anatomy, and intraoperative events. We have a database for these patients which makes finding subjects much easier.

This project will be appropriate for submission to a conference and as a manuscript to a journal.

To Coarct or Not to Coarct: Looking for Clues to Enhance Accurate Prenatal Diagnosis

Faculty Mentor’s Name: Dr. Reem Abu-Rustum
Email: raburustum@ufl.edu
Phone Number: (352) 273-7660
Project Category: Clinical
International Component or Travel: No

Research Project Description:

Background:

This study is being conducted to determine if the ascending aorta diameter (AAo) and descending aorta diameter (DAo), as viewed in the standard right ventricular outflow tract (RVOT) view, can be used as a ratio to increase specificity of prenatal diagnosis of coarctation of the aorta (CoA). The right ventricular outflow tract view is required according to the AIUM Practice Parameter for the Performance of Fetal Echocardiography (doi:10.1002/jum.15188). It demonstrates the cross section of the ascending aorta and descending aorta at the level of the branching of the pulmonary arteries. This view has not been evaluated to determine normal parameters for these measurements during pregnancy. If normograms can be established, then this view could potentially be assessed to determine if it is possible to differentiate true coarctation of the aorta from a false positive. False diagnosis of coarcation of the aorta creates more stress for patients as they are subjected to increased fetal surveillance and arrangement of delivery at tertiary care centers capable of caring for infants with coarctation of the aorta.

Specific Aims:

Hypothesis: The standard RVOT view of the fetal heart can be used to increase specificity of diagnosis for fetal CoA.

Primary Aim: Establish normograms for the diameter of the AAo, DAo and AA/DA ratio in the RVOT view (according to the AIUM Practice Parameter) during the second and third trimesters of pregnancy.

Secondary Aim: To evaluate the role of the ratio of the AAo diameter to DAo diameter as imaged in the RVOT view in differentiating a true diagnosis of coarctation of the aorta (CoA) from a false CoA.

Role of Medical Student:

Medical student will aid in review and input of patient information. This will require appropriate IRB education modules for student to complete. Student will then be given list of variables to review selected charts for and input into RedCap. If student has knowledge of statistics, they would also have the ability to use this skill in evaluation of data to help in the determination of normograms and the statistical analysis of determining if AAo diameter to DAo diameter ratio is useful in the evaluation of fetal CoA.