Additional Research Presentations

Title: Ergonomics for the Obstetrician

Presenter: Abigail Barger, MD, PGY-2

Mentors: Stephen Davis, MD, and Tetsuya Kawakita, MD

Abstract

Objective

To identify an ergonomic assessment of obstetricians in the operating room to better improve physician health outcomes and avoid work-related injuries

Methods

All consenting EVMS OBGYN physicians who participate in cesarean sections will be photographed while operating. The photographs will be analyzed using the ergonomic tools, REBA and RULA. An occupational health and safety specialist will assist with analysis of the photographs. To decrease potential for bias, the physicians will not be notified when they will be photographed. The physician demographics and a pain questionnaire will be collected after completion of the photographs. Details about the cesarean section case will be collected retrospectively, including length of case, start time, patient BMI. The ergonomic scores will be compared among physicians, case details, and overall. The demographics and pain questionnaires will be compared to collected ergonomic evaluation results. ANOVA and T-test calculations will be done to compare data.

Hypothesis

We hypothesize that more senior physicians will score higher on the pain questionnaire, and that all Obstetricians will score high enough to require improvement with ergonomics during cesarean sections.

Title: Effectiveness of patient financial penalties on appointment non-adherence in academic obstetrics and gynecology clinics

Presenter: Lauren Forbes, MD, MPH, PGY-2

Mentor: Peter Takacs, MD, PhD, MBA, CPE

Abstract

Background

Academic outpatient clinics have appointment non-adherence rates between 8-20%. Among Eastern Virginia Medical School (EVMS) Department of Obstetrics and Gynecology (OBGYN) outpatient clinics, the appointment non-adherence rate is about 11% with a range of 8-27% depending on specialty clinic. As unfilled appointments represent a financial loss of the system, patient-directed financial penalties emerged as a strategy to offset departmental losses.

Objective

The aim of this study is to evaluate the effectiveness of patient financial penalties on appointment non-adherence within each of the EVMS OBGYN outpatient clinics. Secondary aims are to:

1. Determine the percent of patients who fulfill the financial penalty
2. Calculate the total amount of financial penalties received by the Department
3. Determine patient or clinic-level characteristics associated with receiving or paying the financial penalty

Methods

This is a retrospective policy effectiveness-implementation hybrid design of all patients with appointments at each of the EVMS OBGYN outpatient clinics from May 1, 2018 to April 30, 2022. As a department-wide patient financial penalty policy for appointment non-adherence was implemented on May 1, 2020, two years of administrative date will be analyzed prior to and following implementation.

Hypothesis

We hypothesize that implementing a department-wide patient financial penalty policy for appointment non-adherence will decrease the EVMS OBGYN appointment non-adherence rate by 30% over two years.

Title: Rates of chorioamnionitis in patients undergoing cervical ripening with OFFB for premature rupture of membranes

Presenter: Madison Seward, MD, PGY-2

Mentor: Alissa Thieke, MD

Abstract

Objectives

To compare the rate of chorioamnionitis between patients with premature rupture of membranes undergoing cervical ripening with an old-fashioned foley bulb and patients with premature rupture of membranes who received misoprostol for cervical ripening.

Methods

We propose a retrospective cohort study using data collected from the CSL database. We will include women with singleton gestation, at >34 weeks (as this is the gestational age at which induction of labor is recommended for PROM), with rupture of membranes, and cervical dilation of less than three centimeters. Within this group we will compare rates of chorioamnionitis in those who underwent mechanical cervical dilation with an old fashioned foley bulb and those who underwent cervical ripening with misoprostol. The primary outcome is chorioamnionitis. Secondary outcomes will include time to delivery, mode of delivery, NICU admissions, and postpartum endometritis. Chi-square test will be used to analyze categorical variables. Student t-test or Man-Whitney u-test will be used for continuous variables. Multivariable logistic regression will be used to calculate adjusted odds ratios with 95% confidence intervals.

Hypothesis

We hypothesize there will be no increased rates of chorioamnionitis in women with premature rupture of membranes undergoing cervical ripening with OFFB in comparison to those who received misoprostol.

Title: Rate of deterioration of umbilical artery Doppler indices in fetuses with severe early-onset fetal growth restriction

Name: Lindsay Gould, MD, PGY-2

Mentor: Juliana G. Martins, MD

Objective

Fetal growth restriction (FGR), or failure of the fetus to achieve weight within population-based norms, is a common problem affecting 10% of all pregnancies. Though there is not currently an international consensus agreement on the ideal management strategy for FGR, current evidence strongly supports the use of UA Doppler for fetal surveillance. Although studies have demonstrated varied sensitivity and specificity between the 3 UA Doppler indices, it is unknown which index predicts more advanced stages of placental deterioration, such as A/REDV. This study aims to examine risk factors for development of A/REDV in fetuses with early-onset severe FGR and to determine time intervals of deterioration from decreased UA end-diastolic velocity to A/REDV using PI, RI, or S/D ratio.

Methods

This retrospective cohort study includes all singleton pregnancies diagnosed with severe (EFW or AC <3%) and early onset (diagnosed between 20 0/7 – 31 6/7 week of gestation) fetal growth restriction among MFM patients at EVMS from 2005-2020. A query was built through the Viewpoint ultrasound database to search for all pregnancies meeting the criteria, and charts were reviewed longitudinally from diagnosis to delivery. EFW and UA Doppler PI, RI and S/D ratio were obtained on each ultrasound examination. Inpatient records were reviewed to obtain pregnancy outcomes.

Hypothesis

We hypothesize that decreased end-diastolic velocity by S/D ratio is more prevalent in early-onset severe FGR than the other Doppler indices. Additionally, we hypothesize the time interval from abnormal S/D ratio to A/REDV is longer than the time intervals from abnormal PI or RI to A/REDV.

Title: Timing of fetal growth ultrasound in morbid obese patients for the detection of fetal growth abnormalities

Presenter: Elizabeth Miller, MD, PGY-2

Mentors: Juliana Martins, MD, and Tetsuya Kawakita, MD

Abstract

Objective

Limited data exist with regards to the assessment of fetal growth in patients with class III obesity. Clinical assessment of fetal size by abdominal palpation and accurate measurement of fundal height is more challenging in patients with obesity and therefore, expert opinion recommends a growth ultrasound every four to six weeks in the third trimester. However, guidelines for fetal growth assessment are currently lacking.

The main objective of this study is to evaluate the rate of fetal growth abnormalities, including large for gestational age (LGA) and fetal growth restriction (FGR) based on third trimester ultrasounds performed in patients with class III obesity.

Methods

A total of 200 patients with class III obesity and no other co-morbidities (including hypertension, diabetes etc) who had a third trimester fetal growth ultrasound between 28 to 40 weeks of gestation will be identified from our database and reviewed retrospectively. A control group will be selected from a center population by matching each case of fetus with maternal obesity with two fetuses in a control group (400 controls) with similar crown-lump length (±5mm) in the first trimester and similar biometry in the second trimester and date of study (±2 months).

Hypothesis

The rate of fetal growth abnormalities is overall low in morbid obese patient without other comorbidities such as hypertension or diabetes and that a gestational age of 32 weeks and above is associated with a higher prevalence of growth abnormalities.