Outcomes of neoadjuvant chemotherapy and radical hysterectomy for locally advanced cervical cancer at Kigali University Teaching Hospital, Rwanda: a retrospective descriptive study.

Background: Half of countries in Africa lack access to radiation (RT), which is essential for standard treatment of locally advanced cervical cancers. We evaluated outcomes for patients treated with neoadjuvant chemotherapy (NACT) followed by radical hysterectomy in settings where no RT is available.

Methods: We performed a retrospective descriptive study of all patients with FIGO stage IB2-IIA2 and some exceptional stage IIB cases who received NACT and surgery at Kigali University Teaching Hospital in Rwanda.

Factors Affecting Immediate Use of Contraception Among Women Hospitalised for Abortion in Two Public Hospitals in Kigali, Rwanda: A Cross Sectional Study.

Background: The 2019-20 Rwanda demographic health survey revealed an overall use of modern contraceptives of 58% but participants were not likely to use family planning in the postpartum period. Three quarters of participants intended to use contraception only after they had resumed menses and not breastfeeding. This study intended to measure post-abortion contraception uptake and to evaluate factors affecting immediate post abortion contraception uptake among patients consulting two public hospitals in Kigali, Rwanda.

Ultrasound Image Quality Comparison Between a Handheld Ultrasound Transducer and Mid-Range Ultrasound Machine.

: Not all labor and delivery floors are equipped with ultrasound machines which can serve the needs of both obstetricians and anesthesiologists. This cross-sectional, blinded, randomized observational study compares the image resolution (RES), detail (DET), and quality (IQ) acquired by a handheld ultrasound, the Butterfly iQ, and a mid-range mobile device, the Sonosite M-turbo US (SU), to evaluate their use as a shared resource. : Seventy-four pairs of ultrasound images were obtained for different imaging purposes: 29 for spine (Sp), 15 for transversus abdominis plane (TAP) and 30 for diagnostic obstetrics (OB) purposes.

Group prenatal care and improved birth outcomes: Results from a type 1 hybrid effectiveness-implementation study.

To compare birth outcomes for patients receiving Expect With Me (EWM) group prenatal care or individual care only, we conducted a type 1 hybrid effectiveness-implementation trial (Detroit and Nashville, 2014-2016). Participants entered care <24 weeks gestation, had singleton pregnancy, and no prior preterm birth (N = 2402). Mean participant age was 27.

Healthcare provider challenges to early detection of cervical cancer at primary healthcare level in Rwanda.

Our objective was to assess the health facility related factors that cause delays in cervical cancer diagnosis at a primary healthcare level in Rwanda. Healthcare providers in outpatient clinics at 10 health centers in Kigali city and the Eastern province of Rwanda were surveyed. Eighty-five healthcare providers participated; 83.

Complete Hydatidiform Mole and Coexisting Fetus With Gastroschisis: A Case Report Highlighting the Importance of Diagnostic Genotyping.

Twin pregnancy with a complete hydatidiform mole and a coexisting fetus (CHMCF) is an extremely rare occurrence, described only by a handful of published series and cases reports. The majority of the literature on CHMCF examines prenatal care and follow-up in relation to the increased risk of gestational trophoblastic neoplasia (GTN). At present, few reports elaborate on the diagnostic process and differential diagnosis, especially in the context of recent molecular advances in risk stratification for GTN.

Assessment of perinatal outcomes of pregnant women with severe versus simple malaria.

Objective: Malaria in pregnancy is associated with adverse perinatal outcomes. The objective was to compare outcomes of simple and severe malaria and to determine whether they vary by trimester or severity of infection.

Methods: Prospective cohort study performed in 3 hospitals in Rwanda.

Black Pregnant Women "Get the Most Judgment": A Qualitative Study of the Experiences of Black Women at the Intersection of Race, Gender, and Pregnancy.

Background: Pronounced racial disparities in maternal and infant health outcomes persist in the United States. Using an ecosocial and intersectionality framework and biopsychosocial model of health, we aimed to understand Black pregnant women's experiences of gendered racism during pregnancy.

Methods: We conducted semistructured interviews with 24 Black pregnant women in New Haven, Connecticut.

Second Trimester Heterotopic Triplet Pregnancy with Intrauterine Twin Pregnancy and Ruptured Interstitial Pregnancy: A Maternal Near-Miss Case Report.

Heterotopic pregnancy is defined as the occurrence of simultaneous intrauterine and extrauterine pregnancies. It is a rare, potentially life-threatening condition and infrequent in natural conceptions. Here, we report a case of spontaneous heterotopic triplet pregnancy with ruptured cornual ectopic pregnancy and simultaneous twin intrauterine pregnancies at 18 weeks of gestation.

Obstetrics and Gynecology Residents Can Accurately Classify Benign Ovarian Tumors Using the International Ovarian Tumor Analysis Rules.

Objectives: Recognition of benign versus malignant tumors is essential in gynecologic ultrasound (US). The International Ovarian Tumor Analysis (IOTA) rules have been proposed as part of resident US training. The objective of this study was to examine whether they could be accurately used by obstetrics and gynecology residents in Rwanda.

Increased Rwandan Access to Obstetrician-Gynecologists Through a U.S.-Rwanda Academic Training Partnership.

Objective: To evaluate the first 5 years of the Human Resources for Health Rwanda program from the program onset in the July 2012-2016 academic years, and its effects on access to care through examination of: 1) the number of trained obstetrician-gynecologists (ob-gyns) who graduated from the University of Rwanda and the University of Rwanda-Human Resources for Health program and 2) a geospatial analysis of pregnant women's access to Rwandan public hospitals with trained ob-gyns.

Methods: We used GPS coordinates in this cross-sectional study to identify public (government) hospitals with ob-gyns in 2011 (before initiation of the program) compared with 2016 (year 5 of the program). We compared access to care for the years 2011 and 2016 through geocoding the proportion of pregnant women within 10 and 25 km from these hospitals and compared the travel time to these hospitals in the two time periods.

Point of care ultrasound: does the presence of ascites in severe pre-eclampsia correlate with poor maternal and neonatal outcome?

Objective: Ascites in severe pre-eclampsia may impact foetal and maternal outcomes. The objective was to determine the prevalence of ascites in women with severe pre-eclampsia by point of care (POC) ultrasound and to determine whether it correlates with higher perinatal risks.

Methods: Prospective cohort study of patients admitted with severe pre-eclampsia at 2 teaching hospitals in Kigali, Rwanda.

Investigating Intimate Partner Violence Victimization and Reproductive Coercion Victimization among Young Pregnant and Parenting Couples: a longitudinal study.

Objective: Intimate partner violence (IPV) victimization and reproductive coercion place young women at risk for poor health. However, very few studies have examined the associations between IPV victimization and reproductive coercion among young couples nor investigated these associations longitudinally.

Method: Data were collected during 2007-2011 from 296 pregnant adolescent and young couples enrolled in a prospective study.

Transforming prenatal care: Multidisciplinary team science improves a broad range of maternal-child outcomes.

Every 8 seconds a baby is born in the United States. Maternal and newborn care are the nation's most expensive clinical services, and despite spending more per capita on health services, the United States experiences worse perinatal outcomes than most other developed countries, and even worse than many developing countries when it comes to maternal and infant mortality, preterm birth, and other comorbid conditions. We established a transdisciplinary clinical research team nearly 2 decades ago to improve maternal and child health through an innovative approach to maternal care delivery: group prenatal care.

Area-level deprivation and preterm birth: results from a national, commercially-insured population.

Background: Area-level deprivation is associated with multiple adverse birth outcomes. Few studies have examined the mediating pathways through which area-level deprivation affects these outcomes. The objective of this study was to investigate the association between area-level deprivation and preterm birth, and examine the mediating effects of maternal medical, behavioural, and psychosocial factors.

Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda.

Background: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda.

Methods: The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors.

Results: In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019.

Teaching obstetric ultrasound at Mulago Hospital - Kampala, Uganda.

Background: Mulago Hospital is a high volume referral hospital under the Makerere University School of Medicine and Health Sciences. Basic obstetric ultrasound is a useful skill that can aid patient care.

Objectives: The purpose of the study was to assess the effectiveness of an intervention implemented to teach basic ultrasound skills to medical students and house officers at Mulago Hosptial, Kampala, Uganda.

Association Between Maternal Comorbidities and Emergency Department Use Among a National Sample of Commercially Insured Pregnant Women.

Objectives: Evidence suggests that, despite routine engagement with the health system, pregnant women commonly seek emergency care. The objectives of this study were to examine the association between maternal comorbidities and emergency department (ED) use among a national sample of commercially insured pregnant women.

Methods: We conducted a retrospective cohort study using multipayer medical claims data maintained by the Health Care Cost Institute for women ages 18 to 44 years with a live singleton birth in 2011 (N = 157,786).

Maternal Medical Complexity: Impact on Prenatal Health Care Spending among Women at Low Risk for Cesarean Section.

Background: Obstetric procedures are among the most expensive health care services, yet relatively little is known about health care spending among pregnant women, particularly the commercially-insured.

Objective: The objective of this study was to examine the association between maternal medical complexity, as a result of having one or more comorbid conditions, and health care spending during the prenatal period among a national sample of 95,663 commercially-insured women at low risk for cesarean delivery.

Methods: We conducted secondary analyses of 2010-2011 inpatient, outpatient, and professional claims for health care services from the Health Care Cost Institute.

Effect of breastfeeding on postpartum depressive symptoms among adolescent and young adult mothers.

Purpose: To describe the association between breastfeeding and postpartum depressive symptoms among a sample of adolescent and young adult mothers and to determine whether breastfeeding difficulty moderates this association.

Materials And Methods: Data were derived from a prospective cohort of pregnant adolescent and young adult females (ages 14-21) as they transitioned to parenthood. This analysis uses data collected during pregnancy and at 6 months postpartum among mothers (n = 137) who initiated breastfeeding.

Stress and behavioral risk among young expectant couples.

Few studies have explored stress and coping among adolescents who are expecting a baby. In particular, young men's experiences during pregnancy have largely been ignored, despite the fact that a young man's experiences and behaviors carry implications for his own, his partner's and his child's health. This study examined the association between maternal and paternal experiences of stress during pregnancy with one's own and one's partner's health behaviors and depressive symptoms among 294 young expectant couples in the U.

Exploring Trajectories and Predictors of Depressive Symptoms Among Young Couples During Their Transition to Parenthood.

Objectives Young parents may be particularly vulnerable to poor mental health during the postpartum period. Little research exists, however, to adequately describe trajectories of depressive symptoms during their transition to parenthood, particularly among young fathers. Therefore, we aim to explore trajectories of depressive symptoms from pregnancy through 1 year postpartum among young expectant mothers and their partners.

Masculine Ideology, Sexual Communication, and Sexual Self-Efficacy Among Parenting Adolescent Couples.

This study examined the relationship between traditional masculine role norms (status, toughness, anti-femininity) and psychosocial mechanisms of sexual risk (sexual communication, sexual self-efficacy) among young, low-income, and minority parenting couples. Between 2007 and 2011, 296 pregnant adolescent females and their male partners were recruited from urban obstetrics clinics in Connecticut. Data regarding participants' beliefs in masculine role norms, frequency of general sex communication and sexual risk communication, and sexual self-efficacy were collected via computer-assisted self-interviews.

Psychological and relational correlates of intimate partner violence profiles among pregnant adolescent couples.

We sought to identify relationship and individual psychological factors that related to four profiles of intimate partner violence (IPV) among pregnant adolescent couples: no IPV, male IPV victim only, female IPV victim only, mutual IPV, and how associations differ by sex. Using data from a longitudinal study of pregnant adolescents and partners (n = 291 couples), we used a multivariate profile analysis using multivariate analysis of covariance with between and within-subjects effects to compare IPV groups and sex on relationship and psychological factors. Analyses were conducted at the couple level, with IPV groups as a between-subjects couple level variable and sex as a within-subjects variable that allowed us to model and compare the outcomes of both partners while controlling for the correlated nature of the data.