Proceedings in Obstetrics and Gynecology
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Nina N. Moreira, MD, MS
Full text linkDr. Nina N. Moreira is an Associate in the Maternal Fetal Medicine Division of Obstetrics and Gynecology at the University of Iowa Hospitals and Clinics. She received a BS in Molecular, Cellular and Developmental Biology from Yale University. She completed her MD from the University of Texas Southwestern Medical Center at Dallas Southwestern Medical School. She completed an Obstetrics and Gynecology Residency at the University of Texas Southwestern/Parkland Health and Hospital System. She completed a Maternal-Fetal Medicine Fellowship in the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology at the University of Iowa Hospital and Clinics. She received a MS in Translational Biomedicine from the University of Iowa. Dr. Moreira sees patients in the Maternal Fetal Medicine and Prenatal Genetics Clinics
Gregory S. Skopec, MD
Full text linkDr. Gregory Skopec is a Clinical Associate Professor of General Obstetrics and Gynecology at the University of Iowa Hospital and Clinics. He received a BA from the University of Northern Iowa, an MD from the University of Iowa College of Medicine and completed a residency in Obstetrics and Gynecology at the University of Iowa Hospitals and Clinics. Dr. Skopec worked as a private practitioner in Cedar Rapids, Iowa, before returning to the University of Iowa Hospitals and Clinics to serve as a clinical physician and on the medical faculty. He specializes in working with and teaching others to use obstetric and gynecological models and simulations. He stays busy with his active family as well
Preoperative evaluation of patients with ovarian masses using the risk of malignancy index 4 model
Full text linkObjective: To evaluate the performance of the RMI 4 in discriminating benign from malignant ovarian masses.Study Design: Cross-sectional study.Setting: Assiut Women Health Hospital- Egypt.Materials and methods: This was an observational cross-sectional study involving 91 patients at Women's Health Hospital, Assiut University, Egypt during the period between January, 2016 and January, 2017. Women with ovarian masses planned for surgical management were recruited from the outpatient gynecology clinic of the hospital. Risk of malignancy index (RMI 4) was calculated for all study participants. Biopsies obtained from the ovarian masses after surgical intervention were sent to the pathology lab for histopathological examination. The histopathologic diagnosis of the ovarian masses is considered the gold standard for diagnosis.Results: The mean age of patients in the benign group was 34.83±16.28 years versus 43.43±15.91 in the malignant group. There were 12 postmenopausal patients (15.6%) in the benign group versus 4 postmenopausal patients (28.6%) in the malignant group (p=0.0001). An ultrasound score of 4 was recorded in 85.7% of patients in the malignant group versus only 6.5% in the benign group (p=0.0001). Additionally, tumor size ≥ 7 cm was observed in 85.7% of patients in the malignant group versus 55.8% in the benign group (p=0.0001). The mean value of CA-125 was significantly higher in malignant group than the benign group (142.09±41.50 versus 54.51±32.86 ml, respectively) with p=0.01. RMI 4 had a sensitivity of 75%, specificity of 97.3%, PPV of 85.7%, NPV of 94.8 % and an overall accuracy of 93.4%.Conclusions: RMI 4 is a simple and reliable tool in the primary evaluation of patients with ovarian masses. It can further be used to discriminate benign from malignant ovarian masses with high sensitivity and accuracy
Prevalence, attitudes and knowledge of misoprostol for self-induction of abortion in women presenting for abortion at Midwestern reproductive health
Full text linkExpansive restrictions to legal abortion have led to reports of self-induced termination of undesired pregnancies with misoprostol obtained without a prescription or provider. This study seeks to describe the prevalence of women seeking or employing misoprostol for self-induced abortion and how they access information.Women are accessing information regarding misoprostol for self-induction of abortion on the internet and as barriers to legal abortion increase, women may be more likely to self-induce abortion
Obstetrics in Uganda: a reflection
Full text linkAfter having been immersed in rural maternal care in Uganda and completing my Ob/Gyn clerkship at the University of Iowa, I appreciate even more how limited the resources, technology, and preventive measures truly are and how incredibly fortunate we are to practice medicine in the United States. We have hospitals with sterile equipment, post-partum hemorrhage and mass transfusion protocols, access to emergency transport services, and so much more to maximize good outcomes. This experience gave me so much insight and encouraged me to pursue my interests in global women’s health but also to appreciate the training I’m receiving in the United States so that I can work to improve maternal mortality both in countries like Uganda and here at home in the US
Simulation training in forceps assisted vaginal birth: trainee competence, clinical behavior and procedural competence
Full text linkTo determine whether simulation training in forceps assisted vaginal delivery affected: · The confidence of the trainee in offering and performing forceps assisted vaginal delivery before and after the intervention · The frequency with which forceps assisted vaginal delivery is offered to the parturient compared to vacuum assisted vaginal delivery
The foundation for a successful career in academic medicine
Full text linkAfter being exposed to all facets of medicine, I have found Obstetrics and Gynecology to be the most challenging, artistic and amazing field in medicine. The University of Iowa Obstetrics and Gynecology Residency Program shaped my personality to become a successful academic obstetrician and gynecologist. With the confidence built at the University of Iowa, Department of Obstetrics and Gynecology I saw Fetal Surgery/ Maternal Fetal Medicine as an opportunity to combine these two passions and I did it, thanks to my residency program at Iowa
Regulatory dendritic cell treatment prevents the development of vasopressin-induced preeclampsia
Full text linkThe concept that persistent feto-placental intolerance is important in the pathogenesis of preeclampsia (PE) has been demonstrated by our lab and others. Arginine vasopressin (AVP) infusion during pregnancy induces cardiovascular, renal, and immune alterations in mice consistent with human PE. These findings identify AVP as a potential contributor to poor fetal tolerance and the development of PE. In addition to their conventional immuno-stimulatory role, dendritic cells (DCs) also play a vital role in immune tolerance. In contrast to conventional DCs, regulatory DCs (DCregs) express low levels of co-stimulatory markers, produce anti-inflammatory cytokines, induce T regulatory cells, and promote tolerance. In mice, DCregs are able to prevent pro-inflammatory responses and induce antigen-specific tolerance. Given these known functions of DCregs, we hypothesize that DCregs will prevent the development of AVP-induced PE
The University of Iowa residency training program in Obstetrics and Gynecology and impact of recent state abortion legislation
Full text linkImpact of state legislation on the University of Iowa residency progam in Obstetrics and Gynecology
Impact of vasopressin receptors on regulation of immune response in preeclampsia
Full text linkPreeclampsia is a common disorder of pregnancy resulting in increased blood pressure and end organ effects. The pathogenesis of preeclampsia is multi-factorial. Arginine vasopressin (AVP) is increased in preeclampsia, and the chronic infusion of AVP throughout gestation has previously been shown to be sufficient to produce a phenotype of preeclampsia in C57BL/6J mice representative of some of the cardiovascular and renal events seen in humans. Alterations in T-helper cell populations and their effector cytokines are also known to occur in preeclampsia. Therefore, we proposed that the increased secretion of AVP may be responsible for the immune changes that occur in preeclampsia. We also hypothesized that known pharmacological AVP antagonist, vaptans, may be able to reverse the effects of AVP infusion