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OBSTETRICS AND GYNECOLOGY A GLOBAL PERSPECTIVE

A teaching hospital of Harvard Medical School

2012

Committed to Women’s Health


A teaching hospital of Harvard Medical School

CONT ENT S Chair Message Who We Are Beth Israel Deaconess Medical Center History Education Fellowship Training Program in Maternal–Fetal Medicine Fellowship Training Program in Reproductive Endocrinology & Infertility Fellowship Training Program Female Pelvic Medicine and Reconstructive Surgery Residency Training Program in Obstetrics & Gynecology Medical Student Education Clinical Obstetrics and Gynecology Maternal-Fetal Medicine/High-Risk Obstetrics and Genetic Counseling Gynecologic Oncology Family Planning Reproductive Endocrinology & Infertility Minimally Invasive Gynecologic Surgery Female Pelvic Medicine & Reconstructive Surgery Neonatology Patient Safety and Quality Improvement Nursing and Social Work Procedure Statistics Research Program in Epidemiologic Research Preeclampsia and Hypertensive Disorders of Pregnancy Prenatal Diagnosis with Obstetric MRI Reproductive Endocrinology Research Stem Cell Research Ovarian Aging Optical Diagnosis of Disease An Endoscopic Polarized Scanning Biopsy Guidance Technique Confocal Light Scattering Spectroscopic (CLASS) Microscope Early Detection of Ovarian Cancer with Spectroscopy Optical Spectroscopic Technique for Noninvasive Prenatal Diagnosis Spectroscopic Technique for Detection of Alzheimer's Disease Medical Education Research Social Mission Community Health Consortium Global & Community Health Program Service-Based Learning and Research Projects Parent Connection In and Around Boston Publications

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CHAIR’S ME SSAGE

Beth Israel Deaconess Medical Center (BIDMC), a major teaching hospital of Harvard Medical School, is known for its quality and value in patient care, leading-edge clinical and basic science research, and outstanding educational programs. Our distinctive blend of academic rigor, combined with empathic family-centered care, makes us unique. As a flagship teaching hospital of Harvard Medical School, the faculty in the Department of Obstetrics and Gynecology at BIDMC teaches obstetrics and gynecology to a third of all Harvard Medical students. The department offers a residency program in obstetrics and gynecology to twenty residents, with five residents per year. Our intimate program gives residents a feeling of individuality that is partnered with an emphasis on evidence-based medicine and research. We offer fellowship programs in Maternal–Fetal Medicine and in Reproductive Endocrinology and Infertility. An accredited fellowship in Female Pelvic Medicine and Reconstructive Surgery is offered in partnership with the Mount Auburn Hospital in Cambridge, MA. An OB/GYN Clinical Informatics Fellowship is offered in collaboration with the BIDMC Division of Informatics. Through close collaborations with other departments at the medical center and at Harvard Medical School, the department has a varied research portfolio. Our programs reflect the diversity that is valued in our department, and include clinical, basic science, public health, health care quality, and educational projects. Our collaborations on the pathogenesis of preeclampsia have led to exciting basic research findings and potential new clinical therapies. The department also places special emphasis on epidemiology and public health policy as it relates to women’s health both in the United States and globally. The department is a leader in the effort to improve patient safety and in outcomes based research. Our simulation and team training curricula, which include team-based training exercises, are nationally renowned. Finally, in concert with Harvard Medical School, the department is a leader in educational research in women’s health. We believe that it takes a team effort to deliver quality healthcare. Our extraordinary group of attending physicians, fellows, residents and medical students work in partnership with our world-renowned nurses and staff to care for patients. A tradition of service to community is at the core of our founding hospitals and remains an important part of our mission. Our diverse patient population hails from various racial, ethnic and socioeconomic backgrounds, and we are committed to eliminating health disparities. We take great pride in providing innovative care with a personal touch.

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Hope Ricciotti, MD Acting Chair of Obstetrics and Gynecology


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A teaching hospital of Harvard Medical School

WHO WE ARE

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY The Department of Obstetrics and Gynecology provides comprehensive and compassionate care to a diverse community of women. Our services, delivered with our unique brand of patient and family-centered care, range from preventive women’s health care to the most complex state-of-the-art methods for the most critical patients. We deliver almost 5,000 babies annually and are currently expanding to incorporate 1,200 more deliveries through our partnership with Atrius Health. While we are proud to be one of the most sought-after teaching hospitals in the country, we always encourage collegiality and a commitment to highly personalized care. BETH ISRAEL DEACONESS MEDICAL CENTER Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School. It consistently ranks among the top four in National Institutes of Health funding among independent hospitals nationwide, with funding totaling nearly $200 million annually. BIDMC researchers run more than 850 active sponsored projects and 500 funded and non-funded clinical trials. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. Located in the heart of Boston’s medical community, it hosts nearly three quarters of a million patient visits annually with 649 licensed beds; including 440 medical/surgical beds, 77 critical care beds and 60 OB/GYN beds. Our level III Neonatal Intensive Care Unit has an average daily census of 40 babies. HARVARD MEDICAL SCHOOL Established in 1782, the Harvard Medical School mission is “to create and nurture a community of the best people committed to leadership in alleviating human suffering caused by disease.” Under the leadership of BIDMC endocrinologist, Dean Jeffrey Flier, MD, Harvard Medical School attracts some of the best and brightest students from around the country. More than 5,000 students apply for the 165 openings at HMS annually. Every class exhibits sparks of creativity and broad interests, making its members tomorrow's medical leaders.

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BID MC HISTORY 1960 – Beth Israel Hospital develops the first implantable cardiac pacemaker. 1972 – Beth Israel Hospital implements the first Rights of Patients statement in the nation. 1983 – The Deaconess Hospital performs the first successful liver transplant in New England. 1986 – Beth Israel Hospital delivers the first baby conceived through in vitro fertilization in Massachusetts. 1991 – Beth Israel researchers are the first to discover evidence that abnormalities in the visual system of the brain can help explain symptoms of dyslexia. 1995 – The Deaconess Hospital performs New England’s first minimally invasive coronary bypass surgery and implants the first deep brain stimulator for the treatment of Parkinson’s disease in New England. 1998 – Beth Israel Deaconess Medical Center (BIDMC) performs the first adult live donor liver transplant in New England. 1998 – BIDMC cardiothoracic surgeon William Cohn, MD, is issued a patent for the Cohn cardiac stabilizer, allowing coronary artery bypass surgery to be performed without the use of a heart-lung machine. 2003 – BIDMC researchers discover the probable cause of preeclampsia and publish the results in The New England Journal of Medicine and The Journal of Clinical Investigation. 2005 – BIDMC reports the involvement of s-Flt1 factor in preeclampsia in the New England Journal of Medicine. 2006 – BIDMC reports a team training method for patient safety in obstetrics in the Journal of the American Medical Association.

2006 – US News & World Report “Best Hospitals” places BIDMC among the top hospitals nationally in six clinical specialties: hormonal disorders, digestive disorders, respiratory care, heart and heart surgery, cancer care, and kidney diseases. 2007 – The Department of Obstetrics and Gynecology at BIDMC is the first recipient of Blue Cross Blue Shield of MA Health Care Excellence Award for patient safety programs. 2007 – The Department of Obstetrics and Gynecology at BIDMC receives Joint Commission award for excellence in patient safety and innovation. 2008 – BIDMC reports in the journal Nature that the COMT gene, known already for its role in schizophrenia, has been found to play a role in preeclampsia. 2009 – US News & World Report ranks BIDMC in the Top 50 among the nation’s hospitals in the care and treatment of heart and heart surgery; cancer care; digestive disorders; kidney diseases; geriatrics; gynecology; ears, nose and throat care and diabetes (in conjunction with the Joslin Clinic). 2009 – Beth Israel Deaconess Medical Center is among three hospitals nationally recognized for leadership and innovation in quality, safety and commitment to patient care as an American Hospital Association-McKesson Quest for Quality Prize® finalist. 2010 – BIDMC awarded $38.2 million in funding from the National Institutes of Health (NIH) as part of the American Recovery and Reinvestment Act of 2009 (ARRA). BIDMC scientists received a total of 69 grants across all medical center departments

2011 – Beth Israel Deaconess Medical Center is the first hospital nationally to meet federal electronic health record requirements with its own software technology that supports all quality, safety and efficiency goals in the American Recovery and Reinvestment Act (ARRA). 2011 – US News & World Report" has named BIDMC Top Hospital. This includes "Honorable Mention" for the Gynecology Division. 2011 – Beth Israel Deaconess Medical Center named topranked healthcare information company in the nation and 12th overall in InformationWeek 500, a list of the top technology innovators in the United States. 2012 – The International Board of Lactation Consultant Examiners (IBLCE) and International Lactation Consultant Association (ILCA) recognized BIDMC for excellence in lactation care. 2012 – Becker's Hospital Review, a private health industry publisher, named BIDMC to its list of 100 Great Hospitals of 2012. 2012 – BIDMC ranked as a leading hospital by US News and World Report and named BIDMC among 148 of the nation’s approximately 5,000 hospitals that performed well enough to rank in even one specialty, placing the medical center in the top 3 percent of all hospitals nationally.

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“Compassionate, individualized care with an emphasis on cultural awareness is at the heart of our mission to teach the art and science of medicine to medical students, residents and fellows, reflecting the core values of our department.” — Hope Ricciotti, MD Acting Chair of Obstetrics and Gynecology

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FELLOWSHIP TRAINING PROGRAM IN MATERNAL-FETAL MEDICINE Steven J. Ralston, MD, MPH Fellowship Director Sarosh Rana, MD Associate Fellowship Director The Maternal-Fetal Medicine Fellowship Training Program is an American Board of Obstetrics and Gynecology (ABOG) approved three-year clinical and research fellowship. Fellows spend 12 months on clinical rotations, eighteen months on research and six months of additional clinical time for electives and subspecialty exploration. Each fellow receives mentoring from a team tailored to the fellow's goals and interests. The fellowship offers excellent basic and clinical research opportunities; as well as extensive clinical experience in high-risk obstetrics, prenatal genetics, sonography and ultrasound-guided procedures. Fellows complete all of the requirements of the ABOG Division of MFM to obtain Subspecialty Board Certification. CURRENT FELLOWS Academic Year 2012-2013 William Schnettler, MD Melissa March, MD Kedak Baltajian, MD

WHERE ARE THEY NOW? Program Graduate 2012 Michelle Silasi, MD Faculty Physician, Maternal-Fetal Medicine Yale University School of Medicine New Haven, CT

FELLOWSHIP TRAINING PROGRAM IN REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY Alan Penzias, MD Fellowship Director The Reproductive Endocrinology Fellowship Training Program is an American Board of Obstetrics and Gynecology (ABOG) approved three-year clinical and research fellowship. Fellows learn well-rounded skills that enable them to embark on academic career paths, where they are capable of practicing clinical REI and providing leadership through teaching and research. The faculty assists fellows in developing a solid foundation of clinical skill, while achieving a specific clinical area of expertise. CURRENT FELLOWS Academic Year 2012-2013 Kara Nguyen, MD Kathryn Humm, MD Werner Neuhausser, MD, PhD

Steven J. Ralston, MD, MPH Fellowship Director Maternal-Fetal Medicine

Alan Penzias, MD Fellowship Director Reproductive Endocrinology and Infertility

WHERE ARE THEY NOW? Program Graduate 2012 Vasiliki Moragianni, MD Faculty Physician, Reproductive Endocrinology and Infertility Boston IVF Waltham and Boston Eman Elkadry, MD Fellowship Director Female Pelvic Medicine & Reconstructive Surgery

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FELLOWSHIP TRAINING PROGRAM IN FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY Eman Elkadry, MD Fellowship Director The Fellowship Program in Female Pelvic Medicine & Reconstructive Surgery at Mt. Auburn Hospital is an Accreditation Council for Graduate Medical Education (ACGME) approved three-year clinical and research program. The educational objective is to train physicians in female pelvic medicine and reconstructive pelvic surgery to become capable of improving the quality of life for women with pelvic floor dysfunction. The program consists of outpatient urogynecologic evaluations, office-based procedures, teaching, research and a comprehensive approach to surgical management. Surgical training includes laparoscopic, vaginal and abdominal procedures; as well as exposure to robotic surgery. CURRENT FELLOWS Academic Year 2012-2013 Amos Adelowo, MD, MPH Sonia Adams, MD Sybil Dessie, MD

WHERE ARE THEY NOW? Program Graduate 2012 Costas Apostolis, MD Director, Urogynecology and Pelvic Reconstructive Surgery Akron General Medical Center Akron, OH

RESIDENCY TRAINING PROGRAM IN OBSTETRICS AND GYNECOLOGY Hope A. Ricciotti, MD Program Director Celeste Royce, MD Associate Program Director Monica Mendiola, MD Assistant Program Director Yvonne Gomez-Carrion, MD Director of Resident Surgical Practice Ronald Marcus, MD Director, Resident Ambulatory Practice Anastasia Koniaris, MD Associate Director, Resident Ambulatory Practice Martina DiNapoli Residency Coordinator

Martina DiNapoli Residency Coordinator

The Residency Program in Obstetrics and Gynecology at BIDMC is the "small college" residency experience of Harvard Medical School. The residents and faculty take great pride in providing cutting-edge care, delivered with a personal touch and respect for diversity. Our special blend of academic rigor and empathic, individualized care is what makes us unique. Our principal training site is Beth Israel Deaconess Medical Center, which is adjacent to the Harvard Medical School campus in the Longwood Medical Area. Several innovative teaching methodologies such as simulation, Resident-as-Teacher Program, global and community health tracks, team training and offsite surgical rotations complement the traditional curriculum. Academic research projects are strongly supported through call-free elective time, expert scientific consultation on study design, IRB approval and statistical analysis and funding for project expenses.

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ADMINISTRATIVE CHIEF RESIDENT Each year the faculty and residents elect one chief resident to serve as Administrative Chief Resident. This honor is given to the resident who demonstrates leadership, professionalism, clinical excellence and interpersonal skills that allow him or her to lead the residency program, serve as liaison to the faculty and help develop innovative teaching programs. Dr. Jo Marie Janco served in the 2011-2012 academic year and Dr. Kristin Bixel is serving in the current 2012–2013 academic year. CURRENT RESIDENTS Academic Year 2012-2013 Chief Residents: Class of 2013 Sarah Averbach, MD Kristin Bixel, MD Mimi Fradinho, MD Julia Head, MD Stephanie Jones, MD PGY 3: Class of 2014 Katharine Barnes, MD Lara Harvey, MD, MPH Lisa Hofler, MD, MPH Kristin Hung, MD Lily Wu, MD PGY 2: Class of 2015 Margaret Chory, MD Emily Holden, MD Yetunde Ibrahim, MD Annie Liu, MD Nandini Raghuraman, MD PGY 1: Class of 2016 Katie Armstrong, MD Katie Johnson, MD Zoe McKee, MD Bri Anne McKeon, MD Sara Won, MD

WHERE ARE THEY NOW? Program Graduates 2012 Lauren Cadish, MD Fellowship in Female Pelvic Medicine and Reconstructive Surgery University of California, Irvine Irvine California Sybil Dessie, MD Fellowship in Female Pelvic Medicine and Reconstructive Surgery Mount Auburn Hospital/BIDMC Cambridge, MA Jo Marie Janco, MD Fellowship in Gynecologic Oncology Mayo Clinic Rochester, MN Marianne Muchura, MD Faculty Physician, Obstetrics and Gynecology Cambridge Health Alliance Cambridge, MA Julie Rhee, MD Fellowship in Reproductive Endocrinology and Infertility Washington University in St. Louis Medical School St. Louis, MO

Kristin Bixel, MD Administrative Chief Resident

“BIDMC offers rigorous clinical and surgical instruction in a most supportive and collegial environment. I have made great friends and found exceptional mentors, both of whom will remain in my life throughout my career.” — Kristin Bixel, MD, Administrative Chief Resident

Celeste Royce, MD Associate Program Director

Monica Mendiola, MD Assistant Program Director

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MEDICAL STUDENT EDUCATION K. Meredith Atkins, MD Clerkship Director Malcolm Mackenzie, MD Associate Clerkship Director L. Renata Vicari Clerkship Coordinator The Harvard Medical School OB/GYN Core Clerkship at the Beth Israel Deaconess Medical Center places third year students in an environment where they can be exposed to the depth and breadth of experiences that occur in the delivery of care in women’s reproductive health. In addition to providing knowledge, our goal is to engage students with a range of opportunities to develop and refine clinical reasoning and procedural skills and to promote awareness and understanding of cultural differences in women’s health and reproductive care. We want students to understand their role within a health care team and the value of systems of care, and encourage students to be active, self-directed learners. We ask that students prepare for patient care by reading about their patients and working to develop a reflective attitude towards their own work. We want students to understand our responsibility as care givers and the importance of the work that we do in caring for women through the range of their life experiences.

K. Meredith Atkins, MD Clerkship Director

Students are responsible for participating with their teams in the care of patients on Labor and Delivery, in the Postpartum Units and on the Gynecology Inpatient Service. Each student is paired with an OB/GYN Generalist Core Preceptor, with whom they attend weekly ambulatory sessions. Core Preceptors are selected for their dedication to and talent in teaching. The ambulatory clinics are designed to facilitate student learning by promoting both continuity in patient care as well as continuity in student learning with a faculty member. In addition to department Grand Rounds and Resident run didactic sessions on each service, students have 2-3 hours of weekly didactic sessions. Faculty and Senior Residents/Fellows provide small group sessions on core OB/GYN topics in addition to skills sessions on examinations, suturing, teamwork, and knot tying. In addition, there is a multidisciplinary conference with Psychiatry on interviewing that is attended by students, faculty and residents. Fourth-year medical students from Harvard Medical School and selected students from outside institutions may take advanced electives: • Obstetrics Sub-Internship Toni Golen, MD, Vice Chair, Quality, Safety & Performance Improvement • Gynecology Oncology Chris Awtrey, MD, Division Director of Gynecologic Oncology • Women’s Health in Urban Community Settings Lucy Chie, MD, Director of the Community Health Consortium • Reproductive Endocrinology and Infertility Kim Thornton, MD, Division Director of REI • Female Pelvic Medicine and Reconstructive Surgery Roger Lefevre, MD, Course Director, FPMRS

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Malcolm Mackenzie, MD Associate Clerkship Director


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OBS TETRICS & GYNECOL OGY Hope Ricciotti, MD Division Director Toni Golen, MD Medical Director, Labor & Delivery & Postpartum Renee Goldberg, MD Medical Director, OB/GYN Community Practice Sandra Mason, MD Medical Director, Shapiro OB/GYN Generalist Practice Faculty K. Meredith Atkins, MD Laura Bookman, MD Ira Chan, MD Lucy Chie, MD, MPH Janet Chollet, MD Allegra Deucher, MD Anjelica Garza, MD Yvonne Gomez-Carrion, MD Diane Kaufman, MD Cindy Kobelin, MD

Marc Kobelin, MD Susan Lincoln, MD Ronald Marcus, MD Monica Mendiola, MD Isabel Morais, MD Hope Ricciotti, MD Celeste Royce, MD Jennifer Scott, MD, MBA, MPH

PERINATAL STATISTICS TOTAL DELIVERIES

EDUCATION The Division of General Obstetrics & Gynecology provides care for patients which is the foundation for resident and medical student training. Residents spend all four years of training working with the faculty in the ambulatory and in-patient settings, and are well prepared to work as independent practitioners in general practice upon graduation. In the ambulatory setting, residents are exposed to faculty in a variety of settings including hospitalbased practices, suburban settings, and in our affiliated community health centers. This allows them a breadth of diverse patient care experiences, exposure to faculty with a variety of interests and expertise, as well as exposure to ways to contribute to the education of patients and service to community for a lifetime. CLINICAL CARE The Division of General Obstetrics & Gynecology provides comprehensive women’s health services ranging from well woman care, obstetrical care, gynecologic and menopause management and beyond. Working in concert with our maternal-fetal and gynecologic specialists, the obstetrician/gynecologists oversee and coordinate exceptional care and treatment for each patient. Our physicians are available both at the medical center and at several other locations in the greater Boston community. Locations include Beth Israel Deaconess Medical Center, Brookline, Chelsea, Chestnut Hill, Lexington, and Needham, as well as the community health centers Bowdoin Street Health Center, The Dimock Center, South Cove Community Health Center and Fenway Health. Our deep, abiding commitment to provide care for all women of all socioeconomic, ethnic, racial and sexually diverse backgrounds is unyielding.

AY 10 AY 11 AY 12

4410 4944 4506

CESAREAN DELIVERY RATE AY 10 AY 11 AY 12

38% 36% 35%

CESAREAN DELIVERY RATE AMONG LOW RISK WOMEN HAVING THEIR FIRST BABY AY 10 AY 11 AY 12

19.8% 18.2% 21.4%

VBAC SUCCESS RATE AY 10 AY 11 AY 12

63% 68% 69%

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MAT ERNAL-FETAL M EDICINE / HIGH-RIS K OBS TETRICS AND CLINICAL GENE TICS Steven J. Ralston, MD, MPH Division Director Maternal-Fetal Medicine Faculty Achilles Athanassiou, MD Karen O’Brien, MD Sarosh Rana, MD Clinical Genetics Faculty Catherine Bearce Nowak, MD, Medical Director Lauren Briere, MS,Licensed Genetic Counselor Karen Marchand, MS, Clinical Manager, Licensed Genetic Counselor Kristin Levandowski, MS, Provisional Licensed Genetic Counselor Other Affiliated Faculty Deborah Levine, MD – Associate Chief of Academic Affairs, Department of Radiology Mary Vadnais, MD, MPH – Clinical MFM Faculty, Harvard Vanguard Medical Associates Deborah Platek, MD – Clinical MFM Faculty, Harvard Vanguard Medical Associates EDUCATION The Division of Maternal-Fetal Medicine and Clinical Genetics offers a comprehensive educational environment for fellows, residents, medical students and attending staff. Second and third-year residents learn from working as part of a team with the Maternal-Fetal Medicine fellow and the High-Risk Obstetrical Chief Resident on all academic and patient care matters. Frequent clinical interchanges occur with anesthesiology, neonatology, genetics, radiology, nephrology, endocrinology and hematology. Faculty and fellows staff morning sign-out on Labor and Delivery, and the Division sponsors a weekly Perinatal Conference that brings together multidisciplinary faculty to optimally treat women with challenging obstetrical issues. Teaching in the clinical setting is supplemented by bimonthly resident didactic series presentations. CLINICAL CARE The Division of Maternal-Fetal Medicine provides high-risk obstetrical care to patients who have been referred from all over New England. Maternal-Fetal Medicine faculty offer targeted and specialized ultrasound examinations, prenatal diagnosis and genetic counseling services at BIDMC as well as a variety of health care facilities throughout Massachusetts. The Division continues to foster a close and productive relationship with community-based OB/GYNs, family practitioners, and midwives, providing outstanding quality care while enhancing patient convenience and satisfaction.

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Steven J. Ralston, MD, MPH Division Director


Over 150 women were transported by helicopter, plane or ambulance to BIDMC’s Labor and Delivery unit for acute care last year. Our maternal transport program supports hospitals throughout New England and has transported patients from as far away as Bermuda. Patients requiring Maternal-Fetal Medicine services or Level III neonatal intensive care nursery services constitute the majority of transport cases. The Maternal-Fetal Medicine faculty also collaborates with other related programs, such as the Advanced Fetal Care Center at Boston Children’s Hospital. This collaboration offers diverse diagnostic and treatment options including invasive antenatal and peripartum procedures. These clinical advances help fetuses affected by congenital abnormalities and offer hope and guidance to their families. The Clinical Genetics faculty works alongside the Maternal-Fetal Medicine faculty to provide counseling and support for women and families at risk for pregnancies complicated by genetic disease, birth defects or intellectual disability. Counseling is also available for individuals or couples who have experienced infertility or recurrent pregnancy loss. Program staff meets one-on-one with families to discuss their concerns, provide risk assessments and to aid in decision making regarding additional testing. Families receiving complex genetic information receive a letter summarizing the information discussed during their genetic counseling session.

PRENATAL DIAGNOSIS The Center for Maternal-Fetal Medicine provides obstetrical ultrasound and consultative services for pregnancies at risk for fetal abnormalities and adverse pregnancy outcomes. Patients receive state-of-the art diagnostic care with standard 2D, 3D and 4D capability. The Center is outfitted and staffed to perform diagnostic procedures including chorionic villus sampling (CVS) and amniocentesis as well as a variety of therapeutic procedures such as fetal blood transfusions and shunting. Finally, the Center also includes an antenatal testing unit for all pregnancies. The Division of Maternal Fetal Medicine provided consultations to nearly 6,000 women and families experiencing a high risk pregnancy in the last year. The volume in the unit has doubled in the past six months and is projected to exceed 12,000 ultrasound examinations in the coming year.

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GYNE COLOGIC ONCOLOGY Christopher Awtrey, MD Division Director Faculty Leslie Garrett, MD Christopher McCann, DO Affiliated Faculty Stephen Cannistra, MD – Director, Gynecologic Medical Oncology Panagiotis A. Konstantinopoulos, MD, PhD – Medical Oncology Jonathan Hecht, MD, PhD – Pathology - Perinatal, Placental, Gynecology EDUCATION The Division of Gynecologic Oncology offers a unique, patient-centered academic environment for trainees. Three residents rotate on the Gynecologic Oncology service, along with third-year Harvard Medical School students and fourth-year sub-interns in gynecologic oncology. The Division sponsors a weekly Gynecologic Oncology Tumor Board, a multidisciplinary conference attended by members of the gynecologic oncology service as well as pathologists, radiologists, medical oncologists and radiation therapists who gather to discuss every patient’s clinical course and treatment options. The Division also sponsors a gynecologic oncology journal club and monthly research meetings. The residents are responsible for daily rounds, assistance in surgical procedures and presentations at Tumor Board. Residents experience a full breadth of cancer care and risk reduction by participating in cancer genetic counseling sessions and medical chemotherapy ambulatory management. Clinical education also includes simulated surgical practice and participation in the colposcopy/laser ambulatory clinics where they are taught the principles of colposcopy and the place of laser surgery in gynecology and graduate with certification in laser surgery. As a testament to the fine teaching of the Division, almost every graduating class over the past decade has had one graduate continue their training in a Gynecologic Oncology fellowship.

The Division of Gynecologic Oncology is dedicated to superior clinical care, teaching, and research for women with cancer of the reproductive tract. — Christopher Awtrey, MD, Division Director

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Christopher Awtrey, MD Division Director


CLINICAL CARE The Division of Gynecologic Oncology works in a patient-centered multidisciplinary fashion with medical oncologists, radiation oncologist and pathologists to provide optimal treatment for women with cancer of the reproductive tract. The spectrum of offered therapeutic options includes open surgery (encompassing radical and ultra-radical procedures), minimally invasive surgery, robotic surgery, radiation, chemotherapy and biological therapies. Clinical outreach programs are in operation at Mount Auburn Hospital, Lawrence General Hospital, Anna Jacques Hospital and Brockton Hospital. A number of clinical trials are open to patient accrual through the Dana-Farber/ Harvard Cancer Center. The Division is also a participating institution of the national Gynecologic Oncology Group (GOG) clinical trials, a group whose mission is entwined with our own - to promote excellence in the quality and integrity of clinical and basic scientific research in the field of gynecologic malignancies. The Division works in close collaboration with Dr. Stephen Cannistra, MD, a nationally recognized medical oncologist with particular expertise in ovarian cancer.

Christopher McCann, DO

During academic year 2011, the Division of Gynecologic Oncology provided complex surgical care to nearly 500 patients, including approximately 200 patients diagnosed with cancer.

Leslie Garrett, MD

COLPOSCOPY AND LASER SURGERY UNIT Elizabeth Buechler, MD Director The Colposcopy, LASER and Electrosurgery Clinic is a referral based clinic for patients with benign and pre-invasive disease involving the vulva, vagina and cervix. Most patients are referred for the evaluation of abnormal Pap tests, persistent high-risk HPV tests and DES exposure.Women with abnormal Pap testing during pregnancy are followed for evidence of developing invasive disease. Patients who have condyloma or other vulvar lesions, and have not responded to the usual modes of therapy are also referred for evaluation and treatment.When indicated, treatment with LEEP (loop electrosurgical excision procedure) or LASER is performed either in the office or operating room. Second year residents train in this unit and have the opportunity to achieve LASER certification.

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FAMILY PLANNING Maureen Paul, MD Section Head Faculty Shiao-Yu Lee, MD Boris Orkin, MD Phillip Stubblefield, MD EDUCATION The Family Planning curriculum provides residents and students with a wide range of exposure to family planning counseling and skills as part of The Ryan Program. Training in family planning in the BIDMC residency program takes place during the second year of residency on a five-week Family Planning rotation. The family planning resident rotates through the Contraceptive Consult Clinic and performs ambulatory procedures including manual vacuum aspiration, medical abortion and D&E cases. The Division is committed to training residents in abortion and contraception; as well as cultivating interests in public health, global and community health, research and healthcare policy as integral components of family planning. The full range of contraceptive options, including hormonal, barrier, implant and intrauterine methods, is provided by our residents in these clinics. The sectionsponsored lecture series covers a wide range of topics and emphasizes the epidemiological evidence underlying current practice and new technologies in fertility regulation. CLINICAL CARE The clinical services of the Section of Family Planning are focused on providing comprehensive, safe and confidential reproductive healthcare. Through our department women have full access to family planning education and healthcare services; including pregnancy options counseling, abortion services (medical abortion and D&E), and comprehensive contraception counseling. The BIDMC Contraceptive Consult Clinic caters to women with complex medical conditions or psychosocial situations. In addition, a BIDMC Family Planning Ambulatory Procedure clinic provides management of early miscarriage, elective termination, medical abortion and Essure sterilization. Offsite family planning experiences include Planned Parenthood, Women’s Health Services, Fenway Health and The Dimock Center, which expose residents to the variety of ways family planning services are delivered to heterogeneous populations via different healthcare delivery systems. Physicians in the Section of Family Planning include Dr. Maureen Paul and Dr. Phillip Stubblefield, as well as clinical faculty Dr. Shiao-Yu Lee and Dr. Boris Orkin, who have been involved with resident training for the past fourteen years.

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Maureen Paul, MD, MPH Section Head


RE PROD UCTIV E ENDOCRINOL OGY AND INFERTILITY Kim Thornton, MD Division Director Faculty Michael Alper, MD Steven Bayer, MD Brian Berger, MD Merle Berger, MD Alice Domar, PhD Benjamin Lannon, MD

Vasiliki Moragiani, MD Selwyn Oskowitz, MD Alan Penzias, MD David Ryley, MD Rita Sneeringer, MD Alison Zimon, MD

Kim Thornton, MD Division Director

EDUCATION The Division of Reproductive Endocrinology and Infertility (REI) offers a robust educational program for residents and fellows. The second year resident REI rotation is five-weeks, during which time the residents participate in the clinical services at Boston IVF, the principal clinical site of the REI Division of BIDMC, which includes consultations, ambulatory surgery, and advanced reproductive technology procedures. Residents are also responsible for REI patient activities that take place at BIDMC, including medical management of inpatients, gynecologic surgery, and in ambulatory patient care for the fellow-led Reproductive Endocrinology ambulatory clinic at the Beth Israel Deaconess Medical Center. The academic program available to residents and fellows is robust, with residents encouraged to become involved in clinical and/or basic research projects that are conducted jointly with members of the division. Residents and fellows regularly attend national meetings, where they have the opportunity to present their research. The Division sponsors monthly conferences at BIDMC, in addition to monthly Boston IVF Grand Rounds, a lecture series held at Boston IVF featuring invited leaders in the field who speak on a variety of reproductive endocrinology and infertility topics, as well as monthly Boston IVF journal club. CLINICAL CARE The REI division includes eleven board-certified reproductive endocrinologists. The Division's full service clinical reproductive endocrine and infertility unit at Boston IVF delivers state-of-the-art fertility care. It is one of the largest assisted reproductive technology (ART) programs in the United States. Over the years, the faculty have assisted in the birth of over 25,000 babies. Clinical services include ovulation induction, intrauterine insemination, in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), blastocyst culture and embryo freezing. Additional services include pre-implantation genetic diagnosis and screening (PGD), egg donation and gestational carrier

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programs, as well as fertility preservation (oocyte and sperm cryopreservation) for patients who desire to preserve their reproductive options. Surgical procedures performed include diagnostic and operative endoscopy (laparoscopy/hysteroscopy) for developmental and acquired abnormalities of the reproductive tract, procedures to correct developmental uterine anomalies, uterine fibroids and severe endometriosis. In addition to the main facility in Waltham, Massachusetts, Boston IVF has sites in Boston, Quincy, Maine, Rhode Island and satellite clinics throughout New England. Recognizing the impact that stress has on fertility, the Division offers complimentary care through the Domar Center, a Mind/Body medicine program that utilizes a treatment approach that is complementary to conventional medicine. The Mind/Body medicine program includes a wide range of specific mind/body techniques designed to elicit the relaxation response, as well as acupuncture, yoga and nutritional counseling. In addition, the Domar Center for Complementary Medicine offers a full range of mental health counseling services.

“Member of the Division of Reproductive Endocrinology and Infertility work to advocate within our community for the reproductive rights and options available for all patients impacted by infertility.” — Kim Thornton, MD, Division Director

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*** Clinical pregnancy determined by presence of fetal heart rate on ultrasound. A comparison of success rates may not be meaningful because patient medical characteristics and treatment approaches may vary from center to center. Date obtained from the Society of Assisted Reproductive Technology Clinical Outcomes Reporting System (SART CORS). D EPA RTM EN T OF OBS TETRICS A N D G Y NECOL OG Y

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MINIMALLY INVASIVE GYNE COLOGIC SURGERY Hye-Chun Hur, MD Division Director Faculty Louise P. King, MD, JD EDUCATION The Minimally Invasive Gynecologic Surgery Division provides comprehensive training to residents and REI fellows, as well as faculty development programs. Principles and surgical skills in pelvic/abdominal, vaginal and minimally invasive procedures are taught in a progressive manner over the course of the residency program. This approach allows residents to develop the competencies expected of well -trained gynecologists by the end of the four-year curriculum. The gynecologic training experience is enhanced by outside rotations at Mount Auburn Hospital, Needham, and Milton Hospital, as well as by ambulatory hysteroscopy and surgery in the Shapiro Clinical Center and in private offices. In addition to daily inpatient management and teaching rounds with the Gynecology Attending of the Week, there is regular teaching at the bedside and in the operating theater on all cases. Weekly staff and resident conferences are held to enhance evidencebased care. Educational surgical meetings are held on a monthly basis with a gynecologic surgical committee to discuss surgical planning for resident patients. Third-year residents rotate with the Minimally Invasive Gynecologic Surgery (MIGS) team in the inpatient operating room as well as in the ambulatory surgical setting. Monthly skills sessions in the simulation laboratory, and resident didactic series are conducted on a bimonthly basis. Biannual GYN resident workshops offer an intensive three-hour simulation learning experience for all residents in the program. The residents participate in a structured Fundamentals of Laparoscopic Surgery (FLS) program that includes didactic and skills training in laparoscopic techniques. Passing the FLS cognitive and skills examination is a requirement during the third year of the residency program and offers the residents the opportunity to be FLS-accredited prior to completing their OB/GYN training.

Hye-Chun Hur, MD Section Head

OPERATIVE STATISTICS OPERATIVE LAPAROSCOPY AY 10 AY 11 AY 12

352 548 436

LAPAROSCOPIC HYSTERECTOMY AY 10 AY 11 AY 12

149 268 302

ROBOTIC MYOMECTOMY AY 10 AY 11 AY 12

5 16 12

ROBOTIC HYSTERECTOMY AY 10 AY 11 AY 12

44 80 110

Residents experience a tremendous volume of minimally invasive surgical patients resulting in our graduates consistently ranking in the 80th-90th percentile of procedure numbers nationally. CLINICAL CARE The MIGS division provides patient-centered care with state-of-the-art equipment. Our minimally invasive gynecologic surgical specialists are fellowship-trained to perform advanced gynecologic surgeries using the latest minimally invasive techniques, which include traditional laparoscopic and robotic approaches. Laparoscopic hysterectomies, removal of ovaries and ovarian cysts, myomectomies, surgical treatment of endometriosis, robotic surgery and hysteroscopic sterilizations are some of the many services offered. Louise P. King, MD, JD

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FEMALE PELV IC MEDICINE AND RE CONS TRUCT IVE SURGERY Janet Li, MD Section Head Faculty David Chapin, MD Roger Lefevre, MD EDUCATION The Female Pelvic Medicine and Reconstructive section at BIDMC provides clinical training to medical students, residents, clinical fellows as well as faculty development. BIDMC and Mount Auburn Hospital have a collaborative relationship and share in the academic mission of training medical students, residents and fellows. The hospitals also collaborate on research projects related to urogynecology and pelvic reconstructive surgery. Residents from the gynecologic service at BIDMC participate in urogynecologic procedures as part of their four-year gynecology experience. In addition, each third year resident rotates at Mount Auburn on the Urogynecology service for a ten-week immersive experience. Curricula emphasize minimally invasive and robotic urogynecologic surgery, as well as an ambulatory experience that includes office evaluations and treatment for pelvic floor disorders. CLINICAL CARE Treatment is provided for a wide variety of pelvic floor disorders in women of all ages; including urinary incontinence, overactive bladder, interstitial cystitis, genitourinary fistulae, recurrent urinary tract infections, pelvic organ prolapse, fecal incontinence and urethral disorders. The section offers comprehensive evaluation and management of pelvic floor disorders. In-office testing includes urodynamics and cystourethroscopy. In-office treatments include tibial nerve stimulation, bladder instillations and periurethral injections. We offer a broad range of surgical treatments for pelvic floor disorders; including abdominal, vaginal, laparoscopic and robotic approaches. Surgeries include minimally invasive mid-urethral sling, hysterectomy, paravaginal cystocele repair, anterior colporrhaphy, posterior colporrhaphy, uterosacral ligament vaginal vault suspension, sacrospinous ligament vaginal vault suspension, sacrocolpopexy, graft-augmented repairs and interstim. During Academic Year 2012, 265 surgical procedures for the correction of incontinence and prolapse were performed by our faculty.

Janet Li, MD Section Head

Boston Urogynecology Associates Division of Urogynecology at Mount Auburn Hospital, Cambridge, MA Peter L. Rosenblatt, MD Division Director Faculty Anthony DiSciullo, MD Eman Elkadry, MD Katherine Hanaway, MD Leka Hota, MD The Division at Mount Auburn is a large urogynecology and reconstructive pelvic surgery center in Massachusetts, and serves all of New England as a referral center for basic and complex evaluation and management of pelvic floor disorders such as urinary incontinence, overactive bladder and pelvic organ prolapse.

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NE ONATOLOGY DeWayne Pursley, MD, MPH Chair EDUCATION BIDMC is one of four clinical training sites for the ACGME approved Harvard Neonatal-Perinatal Medicine training program. This is the largest training program of its kind in the United States. Fellows in this program rotate monthly through BIDMC, providing care to newborns and their families, and honing their team leadership and patient management skills in the NICU and high-risk antepartum consultation service. Each year, the Department of Neonatology offers an American Academic of Pediatrics-approved training course in neonatal resuscitation to all OB/GYN and anesthesia residents. First-year residents receive their initial training, while all other residents are offered annual refresher courses. The department also offers formal clinical training through Harvard Medical School. During their core pediatrics rotation at Boston Children’s Hospital, third year medical students have a one-week rotation through the BIDMC newborn nursery, and fourth year students are offered a month-long elective sub-internship in the NICU. CLINICAL CARE The Neonatal Intensive Care Unit (NICU) provides care to over 1,200 newborns each year. Almost 900 of these newborns require admission to the unit, while the remainder are evaluated and triaged to the newborn nursery. The NICU averages a daily census of more than 40 babies. The multidisciplinary NICU team provides comprehensive, familyoriented care. The team includes physicians, nurses, neonatal respiratory therapists, social workers, neonatal dieticians, an occupational therapist and a pharmacist. Members of the team are extensively trained in the care of high-risk newborns and provide a full range of services for neonatal patients and comprehensive support for their families. Through a tightly integrated consultation system with the maternal-fetal medicine staff, genetic counselors, and Boston Children's Hospital pediatric subspecialists; the NICU team tracks all maternal admissions likely to result in the delivery of a newborn requiring intensive care and then provides necessary care in a coordinated multidisciplinary model. The NICU provides cutting-edge therapy, including therapeutic hypothermia and inhaled nitric oxide. It also makes potentially groundbreaking clinical research protocols available to eligible patients.

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DeWayne Pursley, MD, MPH Chair


Together with faculty neonatologists and neonatal-perinatal fellows, neonatal nurse practitioners and physician assistants provide around-the-clock coverage in the NICU and participate in the teaching of Harvard Medical School students as well as nurse practitioner and other pre-professional students. Neonatal-perinatal fellows play an important clinical role in the NICU, providing triage, consultative, and admission support, as well as ongoing care. During monthly rotations they continue to bring new knowledge and clinical innovations to the department, which support the unit's goal of providing care at the leading edge of medicine.

The Department of Neonatology is committed to providing personalized, high-quality care to newborn patients and their families. — DeWayne Pursley, MD, MPH, Neonatologist-in-Chief

COCHRAN NEWBORN SERVICE The newborn nursery is staffed by the department’s pediatricians, neonatologists, and pediatric nurse practitioners. The nursery provides comprehensive newborn care to those infants whose primary pediatric providers are not members of the BIDMC staff. This service has grown substantially over recent years and in 2009 provided care to over 2,400 newborns. All nursery babies undergo hearing screening under a program that was among the first universal newborn screening programs developed in Massachusetts, and that has been lauded by the Massachusetts Department of Public Health for its quality and service. Car seat position and fit testing is also performed for indicated infants prior to discharge.

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PAT IE NT SAFET Y AND PERFORM ANCE IMPROVEM ENT Toni Golen, MD, Vice Chair, Quality, Safety & Performance Improvement Medical Director, Labor & Delivery & Postpartum Marc Kobelin, MD Co-Chairperson, QA Committee Susan Mann, MD Director of Team Training EDUCATION The OB/GYN Patient Safety and Process Improvement structure at Beth Israel Deaconess Medical Center monitors and improves the quality of care delivered to the obstetric and gynecologic patient population. Each month a Chief Resident presents a Grand Rounds review of complex cases, describing cases that offer educational value to the department as a whole. The presentations include a review of the scientific medical literature, detailed case review and a description of process improvements that came about as a result of what was learned from the case. In addition, residents from all of the services present monthly “Morbidity and Mortality” rounds of important cases with faculty leaders present to lead discussions. Once yearly, all attending physicians and house staff complete an Obstetrics Simulation exercise that is designed to replicate low-frequency high-risk events, such as massive hemorrhage and eclampsia. Data on knowledge before and after the exercise is collected and significant improvement in knowledge is demonstrated as a result of the simulation. The Department is a national example of Simulation work in Obstetrics and Gynecology and is a member of the ACOG Simulation Consortium. CLINICAL CARE Patient safety is one of the greatest challenges facing our healthcare system. According to the Institute of Medicine Report published in 2000, between 44,000 and 98,000 deaths occur in hospitals in the United States every year due to adverse events. Improving the safety of childbirth and women’s healthcare is our overarching goal. This is achieved through careful analysis of cases, identification of opportunities for systematic process improvement, compliance with regulatory guidelines, and an environment of just culture. Beth Israel Deaconess Medical Center’s institutional goal of the elimination of preventable harm is embedded in the department’s quality improvement projects. Through teamwork, simulation, and transparency surrounding adverse events, we look critically at ourselves and identify opportunities to prevent adverse outcomes.

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Toni Golen, MD


The structure of our patient safety systems include traditional case review, project-based quality improvement projects and sentinel event analysis. The OB/GYN Quality Assurance Committee performs case review in which cases are chosen for review based on indicators defined by The Joint Commission, ACOG and Harvard Risk Management Foundation. Additionally, staff members in the OB/GYN department are encouraged to submit questions to the Quality Assurance Committee if they have a specific concern regarding a patient’s care. The Committee consists of staff including attending physicians, residents and nurses, representing general obstetrics and gynecology as well as the spectrum of subspecialties. Members of the Quality Assurance Committee serve as volunteers and make the commitment needed to achieve the goals of monitoring and enhancing quality patient care. While the Quality Assurance Committee assesses individual cases, the department has leadership committees that develop systems for the implementation of process improvement on a broader scale. Some examples of recent process improvements that have been put into action are postpartum vaccination to prevent the spread of pertussis, enhanced practice to prevent retained surgical items, the integration of LEAN modalities for improving patient safety during cesarean delivery and the introduction of blunt needles to decrease accidental needle sticks.

ACCOMPLISHMENTS The Department of Obstetrics and Gynecology is a national leader in the movement to systematically improve patient safety and healthcare quality. In 2007, the department was the proud recipient of the prestigious John M. Eisenberg Award for Patient Safety and Quality from The Joint Commission.The award recognizes the department's leadership and dedication to improving the quality of healthcare and patient safety through innovation. In addition to this award, in 2007 Blue Cross Blue Shield of Massachusetts (BCBSMA) awarded the Beth Israel Deaconess Medical Center's Department of Obstetrics & Gynecology as the first recipient of its Health Care Excellence Award.The award, which carries a $100,000 prize, was created to recognize exceptional achievement in improving the safety and efficacy of healthcare in Massachusetts.Today, Beth Israel Deaconess has among the lowest Adverse Outcome Index of any comparable tertiary hospital reporting to the National Perinatal Information Center, a nonprofit organization that collects national data. As a direct result of the obstetrics unit's work, there are now statewide initiatives in Massachusetts, Maryland and the District of Columbia to introduce obstetrical team training.The model is replicable and widely adaptable for other healthcare organizations.

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NURS ING Phyllis West, RN Nursing Director Barbara Stabile, RN Nurse Manager, Labor & Delivery Deirdre Woolley, RN Nurse Manager, Antepartum & Post-Partum Gina Murphy, RN Nurse Manager, Gynecology The nurses in Obstetrics and Gynecology at BIDMC are committed to caring for women in the full continuum of the lifecycle health care needs. The obstetric nurses care for patients in the Labor and Delivery unit, the newborn nursery, the high-risk antepartum floor, the postpartum floor and the Center for Maternal-Fetal Medicine. Nurses also provide patient education through drop-in Childbirth Education classes, one-on-one education about baby and maternal care after delivery and certified lactation support. Gynecologic nurses provide operative care and full inpatient care, including management of complex gynecologic surgical and oncology patients.

SOCIAL WORK Barbara Sarnoff Lee, LICSW Director of Social Work and Patient/Family Engagement OB/GYN Social Workers Betsy Barnet, LICSW Nina Douglas, LICSW Susan Remy, LICSW Sheleagh Somers-Alsop, LICSW Gail Wolfsdorf, LICSW Glady Thomas, Community Resource Specialist OB/GYN Social Work provides care, consultation and education to patients, families and staff at BIDMC. The social work staff has expertise in women's health issues across the developmental lifecycle. They also have specialized knowledge as it pertains to high-risk pregnancies, HIV/AIDS in women, perinatal bereavement, pregnancy termination, gynecological cancers, child welfare issues, substance abuse, domestic violence and menopause. In addition to the direct clinical care and counseling with patients and families, the Social Work Department sponsors several specialty programs. The Center for Violence Prevention and Recovery (CVPR) encompasses Safe Transitions, a domestic violence intervention program and the Rape Crisis Intervention Program; and addresses the health risks associated with violence. The Center also provides counseling and advocacy for those whose lives have been touched by community violence. Center staff is on call twenty-four hours a day, seven days a week to provide guidance and resource information to patients. Additionally, the CVPR facilitates support groups to provide a forum for patients and staff to share their stories and strategies for survival. Ongoing outreach efforts are made to local colleges and community groups to initiate training and education around violence prevention strategies.

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“We are privileged to care for patients at this very special time in their lives.We respect that privilege and do everything we can to make the birth experience an empowering and positive one” — Barbara Stabile, RN Nurse Manager, Labor & Delivery


PROCE DURE S TAT IST ICS

BIDMC Gynecology Service July 1, 2011 – June 30, 2012 Surgery Type

Number

Abdominal Hysterectomy

120

Vaginal Hysterectomy

47

Laparoscopic Hysterectomy

302

Operative Laparoscopy

436

Major surgical procedures for gynecologic cancer

112

Surgery for urinary incontinence and reconstructive pelvic procedures

378

Robotic Myomectomy

12

Robotic Hysterectomy

110

BIDMC Obstetrical Service July 1, 2011 – June 30, 2012 Surgery Type

Number

Total Deliveries

4506

Cesarean Deliveries – Total

1577

Cesarean Deliveries – Primary

947

Cesarean Delivery Rate

35%

Vaginal Birth after Cesarean Delivery

115

Vaginal Birth after Cesarean Delivery Success Rate

69%

Forceps Delivery

21

Vacuum Delivery

68

Multifetal Delivered Vaginally

28

Low Birth Weight Infants (500-2500 Grams)

457

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Michele Hacker, ScD, MSPH Director, Program in Epidemiologic Research

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BIDMC is a major research affiliate of Harvard Medical School and ranks fourth among independent hospitals nationwide in National Institutes of Health funding.


RE SEARCH PROGRAM IN EPIDEMIOLOGIC RESEARCH Michele Hacker, ScD, MSPH Director Laura Dodge, MPH Research Assistant Anna Merport Modest, MPH Research Assistant The Program in Epidemiologic Research supports research throughout the department, from basic science research to focus groups to placebo-controlled randomized clinical trials. The Program provides assistance with study design, study implementation, data collection and management, data analysis, manuscript preparation and grant writing. This assistance is available to all members of the department and, in particular, aims to foster and advance the research endeavors of residents and fellows. Our clinical, basic science, public health and educational research projects reflect the diversity that is so valued by our department. Residents and fellows conduct research projects that are routinely presented at national meetings and published in peer-reviewed journals. Study designs include prospective and retrospective observational studies, randomized controlled trials, mixed-methods surveys and experimental animal models. Recent studies have addressed topics such as the timing of voiding on the ability to accurately assess the cervix with transvaginal ultrasonography, postoperative pain after surgical treatment for prolapse, in vitro fertilization outcomes in young women, the association of fetal abdominal circumference measurement with iatrogenic preterm delivery, simulation training for minimally invasive surgery and obstetric complications and a structured didactic and hands-on curriculum to teach accurate assessment of the cervix with transvaginal ultrasound. Our collaborative efforts with other departments and institutions have advanced research and increased our understanding of disease and the delivery of healthcare. Our collaborations on the pathogenesis of preeclampsia have led to exciting research findings and new potential clinical therapies. An ongoing study of gene expression in pregnancies complicated by intrauterine growth restriction holds similar promise.

The Department places special emphasis on epidemiology and public health policy as it relates to women’s health among vulnerable and underserved populations both locally and internationally. Residentinitiated projects include an investigation of patientcollected samples for human papillomavirus (HPV) testing among women with limited access to medical care in Boston, a multidisciplinary team approach to reducing the incidence of cesarean delivery in China and an evaluation of postpartum intrauterine device placement in Uganda. Our faculty partners on research initiatives with the Harvard Humanitarian Initiative; along with academic, governmental and nongovernmental international partners to broaden our understanding of women's health needs in humanitarian crises. Specifically, we are engaged in collaborations aimed at further understanding sexual violence in Eastern Democratic Republic of Congo, gender inequitable practices in South Sudan and post-election violence in Kenya. Our faculty, fellows, residents, and students are guided by the expertise of our department epidemiologist, Dr. Michele Hacker. Research Faculty Lev Perelman, PhD Director, Biomedical Imagining & Spectroscopy Laboratory Sarosh Rana, MD Director of Perinatal Research Saira Salahuddin, PhD, MBBS Research Coordinator Dawn McCullough, RN Research Nurse Affiliated Research Scientists S. Ananth Karumanchi, MD, PhD – Department of Medicine Yunping Li, MD - Department of Anesthesia Jonathan Hecht, MD, PhD – Department of Pathology Panagiotis A. Konstantinopoulos, MD, PhD – Department of Medicine Deborah Levine, MD – Department of Radiology

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PREECLAMPSIA AND HYPERTENSIVE DISORDERS OF PREGNANCY Major breakthroughs in preeclampsia research have resulted from collaboration between the Department of Obstetrics and Gynecology and the Department of Medicine at Beth Israel Deaconess Medical Center. Preeclampsia affects 200,000 pregnancies each year in the United States and often leads to premature births. Worldwide, it complicates 5% of all pregnancies, and severe preeclampsia is one of the leading causes of maternal and fetal mortality. The BIDMC OB/GYN collaborative research team has discovered key pieces of evidence to help diagnose and eventually treat this disease. First, the researchers found that sFlt-1, a molecule that naturally occurs in the placenta, may cause the maternal syndrome when it is overabundant. Further research, stemming from collaboration with The Hospital for Sick Children in Toronto, discovered that a second protein, soluble endoglin, escalates preeclampsia to a severe lifethreatening state when combined with sFlt-1. This work has led to BIDMC patent filings on methods of diagnosing and treating preeclampsia. BIDMC researchers are testing the hypothesis that these two molecules can be used as biomarkers in various clinical settings as a helpful tool for clinicians to make a more prompt and accurate diagnosis of preeclampsia. Prospective studies are currently ongoing, and although drug-based therapies for preeclampsia may still be a few years away, researchers are optimistic. Other preeclampsia research includes an investigation to evaluate the pathogenesis of the excess cardiovascular disease noted in women with a history of preeclampsia. The investigators are also working on non-invasive techniques to evaluate pregnancy in an animal model of preeclampsia. In addition, a BIDMC OB/GYN researcher is co-leading a multi-center randomized controlled clinical trial across several hospitals in the United States and Canada that is evaluating the role of optimal blood pressure management for patients with gestational hypertension. This research program is directed by renal specialist S. Ananth Karumanchi, MD, Howard Hughes Medical Institute Investigator, who collaborates with Maternal-Fetal Medicine specialist Dr. Sarosh Rana.

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PRENATAL DIAGNOSIS WITH OBSTETRIC MRI To determine how imaging using obstetric MRI can improve prenatal diagnoses, an investigation is evaluating fetal central nervous system anomalies seen on MRI and comparing them with ultrasound results to correlate imaging findings with postnatal outcomes. Other research interests in the Department include imaging of abdominopelvic pain in pregnancy, optimizing imaging techniques for fetal MRI and the assessment of adnexal masses. Deborah Levine, MD, Associate Chief of Academic Affairs in the Department of Radiology and CoChief of Ultrasound and Director of OB/GYN Ultrasound, leads these projects. Dr. Levine is also Senior Deputy Editor of the journal Radiology. REPRODUCTIVE ENDOCRINOLOGY RESEARCH The Division of Reproductive Endocrinology and Infertility conducts a robust array of both basic science and clinical research. The research goals in the laboratory at Boston IVF include understanding the fundamental aspects of oocyte maturation and preservation through vitrification. In addition, the study of preimplantation genetic diagnosis techniques hold promise for the development of strategies to further improve IVF outcomes and reduce the burden of multiple pregnancies. Clinical research in the Division has focused on clinical outcomes related to assisted reproductive technology. Drs. Michele Hacker and Alan Penzias have led efforts to perform rigorous analysis of the Boston IVF patient database, which contains records on more than 52,000 in vitro fertilization cycles. Other recent projects include the evaluation of cumulative pregnancy rates following in vitro fertilization and predictors of multiple gestations following assisted reproductive technology. The Division has published the results of the FASTT trial, the largest single-center fertility study funded by the NIH; and is currently participating in the FORTT trial, another NIHfunded clinical trial to determine the best course of fertility treatment for women of advanced reproductive age. STEM CELL RESEARCH The Division has enhanced its existing collaboration with the Harvard Stem Cell Institute and Harvard University’s Department of Stem Cell and Regenerative Biology. Kevin Eggan, PhD, directs a laboratory that focuses on how developmental and environmental cues induce heritable variation in chromatin structure and how these variations regulate developmental potency, cell fate and gene expression. In addition, Dr. Eggan’s lab uses nuclear


elucidation of cell biology. Dr. Lev T. Perelman, who conceived of and developed biomedical light scattering spectroscopy, is Director of the Biomedical Imaging and Spectroscopy Laboratory in the Department of Obstetrics and Gynecology at BIDMC.

transfer and other approaches to develop human embryonic and induced pluripotent stem cell lines that carry the genes responsible for human neurodegenerative disease. Dr. Eggan’s publication in Science, “Induced pluripotent stem cells generated from patients with ALS can be differentiated into motor neurons,” was cited by Time Magazine as the Top Medical Breakthrough of 2008. OVARIAN AGING Division researchers bridge basic science with clinical research through the use of a discarded blood sample bank that was established in early 2008. These samples, paired with clinical outcomes of the patients from whom they were drawn, provide an extremely powerful asset for establishing biomarkers of reproductive health. This dovetails with our basic science research efforts to conduct studies on ovarian aging and the impact of disease states, including polycystic ovary syndrome, on reproductive success. OPTICAL DIAGNOSIS OF DISEASE Biomedical light scattering spectroscopy has become a major field in medical optics as it enables non-invasive detection of disease, such as pre-cancer and early cancer, in various human organs without the need for exogenous contrast agents. The technology has recently been applied to non-invasive detection of early precancerous changes in epithelial tissues and tissue characterization on the sub-cellular scale. A BIDMC OB/GYN research team originally described biomedical light scattering spectroscopy in 1998, and in 2000 and 2001 they described the application of the technique to various organs. Current research involves the application of optics and spectroscopy for early detection of disease such as gastrointestinal and gynecological cancers, Alzheimer’s disease, prenatal diagnosis and the

AN ENDOSCOPIC POLARIZED SCANNING BIOPSY GUIDANCE TECHNIQUE Using principles of polarized light scattering spectroscopy, Dr. Perelman's group developed an endoscopic polarized scanning biopsy guidance technique that underwent a pilot clinical test at the BIDMC Interventional Endoscopy Center. The technology was used to successfully guide esophageal biopsies in patients, detecting and mapping sites of invisible dysplasia missed by the current standard-of-care. This NIH-funded breakthrough was described in Nature Medicine in 2010. CONFOCAL LIGHT SCATTERING SPECTROSCOPIC (CLASS) MICROSCOPE The confocal light scattering spectroscopic (CLASS) microscope, first described in 2007, represents a significant new step in the ability to observe the functions of sub-cellular organelles because it does not damage living cells. It also approaches the spatial resolution of electron microscopy, and it functions without the need for exogenous contrast agents that could interfere with inherent cell functioning. This project has been supported by several NIH and NSF grants including an NSF Major Research Instrumentation grant. EARLY DETECTION OF OVARIAN CANCER WITH POLARIZED LIGHT SCATTERING SPECTROSCOPY Polarized light scattering spectroscopy is a potentially powerful diagnostic screening tool that aims to enable physicians to survey ovaries in patients with high levels of CA-125 and/or a family history of ovarian cancer in a minimally invasive fashion and to determine with high probability the presence of dysplasia or early cancer. The microscope will perform measurements on most of the surface of the ovary in approximately one minute and present the information in real time. Suspicious areas can then be biopsied to verify the diagnosis. This approach should be vastly superior to the present strategies of performing a CA-125 test and an ultrasound examination. It may also significantly improve the probability of locating early cancer during the significantly more invasive technique of performing random biopsies.

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COMMUNICATING BAD NEWS SIMULATION TRAINING MODULE Dr. Jo Marie Janco, then a third-year resident, Dr. Hope Ricciotti and faculty from the Division of Medical Oncology collaborated to implement and evaluate simulated training modules for delivering bad news to patients in order to provide residents with training and evaluation in this important communication skill.

OPTICAL SPECTROSCOPIC TECHNIQUE FOR NONINVASIVE PRENATAL DIAGNOSIS Present techniques for prenatal diagnosis are invasive and present significant risks of fetal loss. Non-invasive prenatal diagnosis that utilizes fetal nucleated red blood cells (fNRBC) circulating in the maternal peripheral blood has received attention because it poses no risk to the fetus, but differentiating fetal from adult NRBC remains a challenge. Recently, we demonstrated that light scattering spectroscopy is capable of reliably distinguishing fetal NRBC from adult NRBC without tagging, fixation or risk of cell damage. This project, supported by a new NIH R01 grant, may facilitate development of a clinically useful method for fNRBC enrichment and recovery from peripheral maternal blood and lead to minimally invasive prenatal genetic testing. DEVELOPMENT OF AN OPTICAL SPECTROSCOPIC TECHNIQUE FOR DETECTION OF ALZHEIMER'S DISEASE The goal of this collaboration with the Bedford VA Medical Center is to develop a clinical optical spectroscopic technique for real-time non-invasive detection of Alzheimer's disease in vivo. MEDICAL EDUCATION RESEARCH The department conducts educational research projects utilizing simulation, virtual patients, standardized patients, and innovative techniques in medical education.

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OBSTETRICAL EMERGENCIES SIMULATION TRAINING Dr. Toni Golen, Vice Chair of Quality, Safety and Performance Improvement and former Maternal-Fetal Medicine Fellow, Dr. Mary Vadnais, evaluated an obstetrics emergencies simulation training program for faculty, fellows and residents for uncommon but serious clinical events in order to determine the optimal training frequency and the perceived effect of the program on abilities to perform clinical care. OBSTETRICAL VIRTUAL PATIENT PROJECT Dr. Hope Ricciotti developed a normal pregnancy virtual patient funded by the Macy Foundation as part of a series produced by the Shapiro Institute for Education and Research. The educational effect of the OB Virtual Patient as a teaching tool was evaluated in a randomized, controlled study of Harvard Medical Students. RESIDENT AS TEACHER PROGRAM Drs. Hope Ricciotti and K. Meredith Atkins currently lead a program using simulated medical student teaching encounters to train residents in teaching skills using a videotaped format with immediate faculty feedback and self-reflection. This project has led to a similar Resident as Teacher in the O.R. Project, still in its initial phase, under the direction of Dr. Ricciotti and recent resident graduate, Dr. Lauren Cadish. SIMULATED SURGICAL SKILLS TRAINING Dr. Hye-Chun Hur, Division Director of Minimally Invasive Gynecologic Surgery, is involved in several educational studies evaluating the role of simulation teaching and assessment for gynecologic surgical training. Areas of study include simulation training for traditional laparoscopic suturing, simulation teaching for basic concepts of electrosurgery and simulation training for robotic surgery.


SIMULATOR DEVELOPMENT Dr. Christopher Awtrey, Division Director of Gynecologic Oncology, developed and evaluated a novel laparoscopic simulator to train residents in pelvic surgery suturing skills. The Pelv-sim is a modified box trainer that can be used by trainees and faculty to hone their suturing skill before seeing patients in the operating room. Currently, Dr. Awtrey is developing and testing a laparoscopic sacrocolpopexy box trainer that simulates one of the most technically difficult advanced gynecologic procedures for the treatment of women with pelvic organ prolapse.

SLEEP DEPRIVATION AND SURGICAL SKILLS Dr. Christopher Awtrey and former resident Dr. Anna Lyapis studied the effect of sleep deprivation on faculty surgical skills using a virtual reality trainer. TEACHING SCRIPTS IN OB/GYN Dr. K. Meredith Atkins is leading a project to investigate the use of teaching scripts in the field of OB/GYN as a way to improve the teaching of medical students. ROBOTIC SURGERY CURRICULUM Dr. Janet Li, Section Head of Female Pelvic Medicine and Reconstructive Surgery, is developing a curriculum to teach robotic surgery to residents. She is conducting a project that will evaluate the residents' attitudes and opinions regarding robotic surgery before and after institution of the curriculum.

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The BIDMC OB/GYN Department is committed to closing the gap in health care disparities.

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SOCIAL MIS SION COMMUNITY HEALTH CONSORTIUM Lucy Chie, MD, MPH Director The Community Health Consortium leads and develops projects in obstetrics and gynecology for our culturally diverse population of urban and suburban women. The community health centers, which serve women from a wide range of ethnic backgrounds as well as gay, lesbian, bisexual and transgender communities, are staffed by our core teaching faculty and serve as ambulatory sites for the resident practice and medical student programs. Healthcare leaders from each center come together quarterly at BIDMC to plan clinical programs, public health research projects, educational endeavors and public service. A Harvard Medical School student elective entitled “OB/GYN and Women's Health in Urban Community Settings" is also offered as part of the fourth-year elective options.

Lucy Chie, MD, MPH (left) Director, Community Health Consortium

GLOBAL AND COMMUNITY HEALTH PROGRAM Jennifer Scott, MD, MBA, MPH Director Whether in Roxbury, Massachusetts or Sub-Saharan Africa, much of women's health is shaped by social, economic, and political inequities. Our goal is to help faculty, staff, and trainees develop a global understanding of women's health and to foster culturally competent care practices that meet the needs of the communities we serve. We are committed to advancing reproductive health care in an equitable, ethical, and dynamic manner, both locally and globally. Our Global and Community Health Program encourages faculty, staff and trainees to participate in service-based projects and research initiatives in collaboration with local and international partners. Residents may also choose to conduct their longitudinal clinics in medically underserved communities of Boston, such as The Dimock Center and South Cove Community Health Center. We encourage residents to contribute their Jennifer Scott, MD, MBA, MPH Director, Global Health & Community second and third year elective time towards global and Health Program community health initiatives. Numerous global and community health educational opportunities exist with the department, the BIDMC Global Health curriculum and the broader Harvard community at Harvard Medical School and Harvard School of Public Health. The Program provides mentorship for faculty, staff and trainees to meaningfully contribute to women’s health as providers, researchers and advocates. The Program works with numerous partners to support innovative approaches and models to global health delivery that engage community partners and build capacity.

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SERVICE-BASED LEARNING AND RESEARCH PROJECTS Global Health Initiatives 2011-2012 • Clinical resident electives in Nepal with Nyaya Health International • Clinical resident elective in Botswana at Scottish Livingstone Hospital • Clinical support of the urogynecologic surgical program at Panzi Hospital in Democratic Republic of Congo in collaboration with Harvard Humanitarian Initiative • BIDMC inter-departmental collaboration and consultation on global women’s health initiatives in India, Zimbabwe, Gabon, Botswana, and China • Collaboration with the Human Resources for Health (HRH) Program in Rwanda to support graduate medical education and training for Obstetrics and Gynecology • Obstetric anesthesia clinical and research collaboration in China • Obstetric ultrasound training and research collaboration on a Gates Foundation funded program in Ghana • Family planning research at Mulago Hospital in Kampala, Uganda evaluating postpartum IUD insertion • Gender-based violence, human rights violations, and gender equality research in Democratic Republic of the Congo, Kenya, and South Sudan in collaboration with academic, governmental, and non-governmental international partners • Academic medical education collaborations with HMS and the Department with partners in Ukraine, China, and Vietnam • Collaboration with World Health Organization working groups to inform maternal and child health policies and reproductive endocrine and infertility policies

Prior Global Health Initiatives • Mentoring residents at South Cove Community Health Center serving immigrants from East Asia • Exchange program with Philippine General Hospital • Visiting residency at Moi Teaching and Referral Hospital, Kenya • Mentoring, clinical preceptorships for residents, and research supervision at the Dimock Center; which serves African-American and Latina populations in Roxbury. Projects have included: HPV vaccination, teen pregnancy and IUD utilization preceptorships for residents

Community Health Initiatives • Mentoring, clinical preceptorships, and research supervision for residents at South Cove Community Health Center serving immigrants from East Asia. Recent projects have included health literacy and hepatitis B infection in pregnancy. • Mentoring, clinical preceptorships, and research supervision for residents at The Dimock Center, which serves African-American and Latina populations in Roxbury. Recent projects have included: HPV vaccination, teen pregnancy, and IUD utilization. • HPV detection study and health education curriculum for an urban shelter population • Health education and outreach for women in correctional facilities • Collaboration with community-based organizations to improve access to women’s health care for patients from minority populations

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GLOBAL WOMEN’S HEALTH PROGRAM AREAS OF ACTIVITY CHINA • JAPAN • KOREA • • UKRAINE • BOSTON

NEPAL •

• GENEVA, SWITZERLAND

• MEXICO • INDIA NICARAGUA •

• HAITI

• SOUTH SUDAN UGANDA • • KENYA CONGO • RWANDA • GABON • • ZAMBIA

GHANA •

PHILIPPINES •

BOTSWANA • • SOUTH AFRICA

THE PARENT CONNECTION Christine Sweeney, LICSW Program Director Since 1999, the Department of OB/GYN has offered the Parent Connection, a unique complimentary post-partum service, which aims to help families adjust to parenting. Mentoring Mom volunteers call new parents weekly throughout the first twelve weeks post-delivery to offer encouragement and support. Mentors are trained to recognize the symptoms of postpartum mood disorders and help patients get connected to appropriate resources in the community or medical center. Mentoring Moms care for new parents after they leave the medical center and help them realize that they are not alone in their struggles. The program also offers groups for new moms at several different community locations. These groups provide new parents an opportunity to meet other new parents, share experiences, ask questions and reduce isolation. One of the groups is specifically for working moms that meets during evening hours. The program’s most recent initiative is aimed at expectant couples. Titled, “Becoming Parents” the Parent Connection offers a monthly workshop outlining typical newborn behavior, postpartum adjustment and strategies to help parents survive the fourth trimester! By continuing support after leaving the medical center, the Parent Connection aims to help families begin parenting on a positive note.

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IN AND AROUND BOSTON Boston offers much more than exceptional medical facilities and world-class educational institutions. While relatively small, the city is considered one of the most livable in America, combining an Old World feel with a modern and stylish urban look. The diverse neighborhoods, beautiful parks, major historical sites and close proximity to the ocean and mountains attract people from all over the world to create a city rich in culture. Affectionately referred to as “the hub”; the city has a rich history, is a major trading port and plays host to people from every corner of the globe. A day off in Boston is enough time to see artwork in the Museum of Fine Arts or the Isabella Stewart Gardner Museum; or visit the Museum of Science and experience hands-on exhibits, laser shows and IMAX films that are fun for all ages. The Theatre District boasts the Opera House, Colonial Theatre, Wilbur Theatre, Shubert Theatre and the Wang Center for the Performing Arts. The Boston Ballet, known for its classical and modern works, is one of the best in the world. The renowned Boston Symphony Orchestra and the Boston Pops perform at Symphony Hall. Just down the street from the medical center is Fenway Park, home of the World Champion Boston Red Sox, just one of the many exciting athletic teams followed by avid New England sports fans. The city is both pedestrian and bicyclist friendly with the nation’s first transit system comprising of subway, bus and commuter rail systems. Most destinations within the city are even within walking distance. Boston is a safe and clean city, so those walks are often a pleasure!

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PUBL ICAT IONS – 2 0 1 2 MANUSCRIPTS Awtrey CS. Nomograms for predicting endometrial cancer recurrence. Comment on: Nomograms to predict isolated locoregional or distant recurrence among women with uterine cancer. Gynecol Oncol. 2012 Jun; 125(3):513-4. Bhan I, Powe CE, Berg AH, Ankers E, Wenger JB, Karumanchi SA, Thadhani RI. Bioavailable vitamin D is more tightly linked to mineral metabolism than total vitamin D in incident hemodialysis patients. Kidney Int. 2012 Jul;82(1):84-9. doi:10.1038/ki.2012.19. Bixel K, Silasi M, Zelop CM, Lim KH, Zsengeller Z, Stillman IE, Rana S. Placental origins of angiogenic dysfunction in mirror syndrome. Hypertens Pregnancy. 2012;31(2):211-7. Branch-Elliman W, Golen TH, Gold HS, Yassa DS, Baldini LM, Wright SB. Risk Factors for Staphylococcus aureus Postpartum Breast Abscess. Clin Infect Dis. 2012 Jan; 54(1):71-7. David S, Mukherjee A, Ghosh CC, Yano M, Khankin EV, Wenger JB, Karumanchi SA, Shapiro NI, Parikh SM. Angiopoietin-2 may contribute to multiorgan dysfunction and death in sepsis. Crit Care Med. 2012 Aug 10. [Epub ahead of print] Dodge LE, Haider S, Hacker MR. Using a simulated patient to assess referral for abortion services in the United States. Journal of Family Planning and Reproductive Health Care, 2012 Oct;38(4):246-51. Dodge LE, Haider S, Hacker MR. Knowledge of state-level abortion laws and regulations among front-line staff at facilities providing abortion services. Women’s Health Issues. 2012, 22(5):e415-e420. Faupel-Badger JM, Wang Y, Staff AC, Karumanchi SA, Stanczyk FZ, Pollak M, Hoover RN, Troisi R. Maternal and cord steroid sex hormones, angiogenic factors, and insulin-like growth factor axis in African-American preeclamptic and uncomplicated pregnancies. Cancer Causes Control. 2012 May;23(5):779-84. doi:10.1007/s10552-012-9934-9. Haggerty CL, Seifert ME, Tang G, Olsen J, Bass DC, Karumanchi SA, Ness RB. Second trimester anti-angiogenic proteins and preeclampsia. Pregnancy Hypertens. 2012 Apr 1;2(2):158-163. Hagmann H, Thadhani R, Benzing T, Karumanchi SA, Stepan H. The promise of angiogenic markers for the early diagnosis and prediction of preeclampsia. Clin Chem. 2012 May;58(5):837-45. Review. Hota LS, Hanaway K, Hacker MR, Disciullo A, Elkadry E, Dramitinos P, Shapiro A, Ferzandi T, Rosenblatt PL. TVT-Secur (Hammock) versus TVT-Obturator: a randomized trial of suburethral sling operative procedures. Female Pelvic Med Recontr Surg 2012;18:41-45. Hung KJ, Scott J, Ricciotti HA, Johnson TR, Tsai AC. Community-Level and Individual-Level Influences of Intimate Partner Violence on Birth Spacing in Sub-Saharan Africa. Obstet Gynecol. 2012 May; 119(5):975-82. Kapur NK, Wilson S, Yunis AA, Qiao X, Mackey E, Paruchuri V, Baker C, Aronovitz MJ, Karumanchi SA, Letarte M, Kass DA, Mendelsohn ME, Karas RH. Reduced endoglin activity limits cardiac fibrosis and improves survival in heart failure. Circulation. 2012 Jun 5;125(22):2728-38 Karipcin FS, Moragianni VA, Milette B, Kinzer DR, Thornton KL, Barrett B, Penzias AS. The effect of steroid and antibiotic treatment during assisted hatching on IVF outcomes. Clinical Medicine Insights: Reproductive Health, 2012.

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Khankin EV, Hacker MR, Zelop CM, Karumanchi SA, Rana S. Intravital high-frequency ultrasonography to evaluate cardiovascular and uteroplacental blood flow in mouse pregnancy. Pregnancy Hypertens. 2012, 2:84-92. Khankin EV, Mandala M, Colton I, Karumanchi SA, Osol G. Hemodynamic, vascular, and reproductive impact of FMS-like tyrosine kinase 1 (FLT1) blockade on the uteroplacental circulation during normal mouse pregnancy. Biol Reprod. 2012 Feb 29;86(2):57. Konstantinopoulos PA, Awtrey CS. Management of ovarian cancer: a 75-year-old woman who has completed treatment. JAMA. 2012 Apr 4; 307(13):1420-9. Lannon BM, Choi B, Hacker MR, Dodge LE, Malizia BA, Barrett CB, Wong WH, Yao MWM, Penzias AS. Predicting personalized multiple birth risks after in vitro fertilization—double embryo transfer. Fertility and Sterility, 2012;98:69-76. Lely AT, Salahuddin S, Holwerda KM, Karumanchi SA, Rana S. Circulating lymphangiogenic factors in preeclampsia. Hypertens Pregnancy. 2012 Sep 7. [Epub ahead of print] Li F, Hagaman JR, Kim HS, Maeda N, Jennette JC, Faber JE, Karumanchi SA, Smithies O, Takahashi N. eNOS deficiency acts through endothelin to aggravate sFlt-1-induced pre-eclampsia-like phenotype. J Am Soc Nephrol. 2012 Apr;23(4):652-60. Mackenzie M. Laparoscopic intracorporeal cinch knots: changing the square knot paradigm. Journal of Minimally Invasive Gynecology. 2012. 2012 Mar-Apr;19(2):225-35. March MI, Warsof SL, Chauhan SP. Fetal biometry: relevance in obstetrical practice. Clin Obstet Gynecol. 2012 Mar;55(1):281-7. Mijal RS, Holzman CB, Rana S, Karumanchi SA, Wang J, Sikorskii A. Mid-pregnancy levels of angiogenic markers as indicators of pathways to preterm delivery. J Matern Fetal Neonatal Med. 2012 Jul;25(7):1135-41. Moragianni VA, Hacker MR, Craparo FJ. The impact of length of second stage of labor on shoulder dystocia outcomes: a retrospective cohort study. Journal of Perinatal Medicine, 2012. J. Perinat. Med. 40:97-100. Moragianni VA, Hamar BD, McArdle C, Ryley DA. Management of a cervical heterotopic pregnancy presenting with firsttrimester bleeding: case report and review of the literature. Fertil Steril, 2012 Jul;98(1):89-9. Moragianni VA, Jones SML, Ryley DA. The effect of body mass index on the outcomes of first assisted reproductive technology cycles. Fertil Steril, 2012 Jul;98(1):102-8. Ogbechie OA, Hacker MR, Dodge LE, Patil MM, Ricciotti HA. Confusion regarding cervical cancer screening and chlamydia screening among sexually active young women. Sex Transm Infect. 2012 Feb; 88(1):35-7. Patten IS, Rana S, Shahul S , Rowe GC, Jang C, Liu L, Hacker MR , Rhee JS , Mitchell J, Mahmood F , Hess P , Farrell C, Koulisis N, Khankin EV, Burke SD, Tudorache I, Bauersachs J, Monte F , Hilfiker-Kleiner D, Karumanchi SA , Arany Z. Cardiac Angiogenic Imbalance Leads to Peri-partum Cardiomyopathy. Nature. 2012;485:333-9. Penzias AS. Recurrent IVF failure: other factors. Fertil Steril, 2012;97(5):1033-8. Petruzziello-Pellegrini TN, Yuen DA, Page AV, Patel S, Soltyk AM, Matouk CC, Wong DK, Turgeon PJ, Fish JE, Ho JJ, Steer BM, Khajoee V, Tigdi J, Lee WL, Motto DG, Advani A, Gilbert RE, Karumanchi SA, Robinson LA, Tarr PI, Liles WC, Brunton JL, Marsden PA. The CXCR4/CXCR7/SDF-1 pathway contributes to the pathogenesis of Shiga toxin-associated hemolytic uremic syndrome in humans and mice. J Clin Invest. 2012 Feb 1;122(2):759-76. doi: 10.1172/JCI57313.

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Quant H, Arden D, Takoudes T, Rana S. Angiogenic factors and pregnant woman with new onset seizures. Hypertension in Pregnancy, 2012;31(2):207-10 .DOI:10.3109/10641955.2011.638960. Rajakumar A, Cerdeira AS, Rana S, Zsengeller Z, Edmunds L, Jeyabalan A, Hubel CA, Stillman IE, Parikh SM, Karumanchi SA. Transcriptionally active syncytial aggregates in the maternal circulation may contribute to circulating soluble fmslike tyrosine kinase 1 in preeclampsia. Hypertension. 2012 Feb;59(2):256-64. Rana S Powe CE, Salahuddin S, Verlohren S, Perschel FH, Levine RJ, Lim KH, Wenger JB, Thadhani R, Karumanchi SA. Angiogenic Factors and the Risk of Adverse Outcomes in Women with Suspected Preeclampsia. Circulation. 2012; 125(7):911-9. Rana S, Hacker MR, Merport Modest A, Salahuddin S, Lim KH, Verlohren S, Perschel FH, Karumanchi SA. Circulating angiogenic factors and risk of adverse maternal and perinatal outcomes in twin pregnancies with suspected preeclampsia. Hypertension. 2012 Aug;60(2):451-8. Ricciotti HA, Dodge LE, Head J, Atkins KM, Hacker MR. A novel resident-as-teacher training program to improve and evaluate obstetrics and gynecology resident teaching skills. Med Teach. 2012; 34(1):e52-7. Schnettler WT, Hacker MR, Barber R, Rana S. Management of abnormal serum markers in the absence of aneuploidy or neural tube defects. J Matern Fetal Neonatal Med. 2012 2012 Oct;25(10):1895-8. Shahul S, Rhee J, Hacker MR, Gulati G, Mitchell JD, Hess P, Mahmood F, Arany Z, Rana S, Talmor D. Subclinical left ventricular dysfunction in preeclamptic women with preserved left ventricular ejection fraction: A 2D speckle tracking imaging study. Circulation: Cardiovascular Imaging. 2012 Aug 13. [Epub ahead of print] Stillman IE, Karumanchi SA. Vasculitis is an antiangiogenic state. J Am Soc Nephrol. 2012 Jan;23(1):8-10. Tang JR, Karumanchi SA, Seedorf G, Markham N, Abman SH. Excess soluble vascular endothelial growth factor receptor-1 in amniotic fluid impairs lung growth in rats: linking preeclampsia with bronchopulmonary dysplasia. Am J Physiol Lung Cell MolPhysiol. 2012 Jan 1;302(1):L36-46. Vadnais MA, Dodge LE, Awtrey CS, Ricciotti HA, Golen TH, Hacker MR. Assessment of long-term knowledge retention following single-day simulation training for uncommon but critical obstetrical events. J Matern Fetal Neonatal Med. 2012 Sep; 25(9):1640-5. Vadnais, M, Rana S, Quant H, Salahuddin S, Dodge L, Lim KH, Karumanchi SA, Hacker M. The impact of magnesium sulfate therapy on angiogenic factors in preeclampsia. Pregnancy Hypertens. 2012; 2(1): 16-21. Vikse BE, Irgens LM, Karumanchi SA, Thadhani R, ReisĂŚter AV, SkjĂŚrven R. Familial Factors in the Association between PreEclampsia and Later ESRD. Clin J Am Soc Nephrol. 2012 Sep 6. [Epub ahead of print] Wang A, Holston AM, Yu KF, Zhang J, Toporsian M, Karumanchi SA, Levine RJ. Circulating anti-angiogenic factors during hypertensive pregnancy and increased risk of respiratory distress syndrome in preterm neonates. J Matern Fetal Neonatal Med. 2012 Aug;25(8):1447-52. Wang A, Karumanchi SA. Relaxin' with endothelial progenitor cells. Blood. 2012 Jan 12;119(2):326-7. Young BC, Hacker MR, Dodge LE, Golen TH. Timing of antibiotic administration and infectious morbidity following cesarean delivery: incorporating policy change into workflow. Arch Gynecol Obstet. 2012 May; 285(5):1219-24. Young B, Hacker MR, Rana S. Physicians' knowledge of future vascular disease in women with preeclampsia. Hypertens Pregnancy. 2012;31(1):50-8.

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Yu XD, Branch DW, Karumanchi SA, Zhang J. Preeclampsia and retinopathy of prematurity in preterm births. Pediatrics. 2012 Jul;130(1):e101-7. ZsengellĂŠr ZK, Ellezian L, Brown D, HorvĂĄth B, Mukhopadhyay P, Kalyanaraman B, Parikh SM, Karumanchi SA, Stillman IE, Pacher P. Cisplatin nephrotoxicity involves mitochondrial injury with impaired tubular mitochondrial enzyme activity. J Histochem Cytochem. 2012 Jul;60(7):521-9. ABSTRACTS Adams SR, Dodge LE, Dramitinos P, Elkadry E. Do patient goals vary with stage of prolapse? A follow up study of goal achievement. 2012. To be presented as a poster at the annual meeting of the American Urogynecologic Society. Adams SR, Hacker MR, Rosenblatt P, Merport A, Elkadry E. Informed consent for sacrocolpopexy: is counseling effective in achieving patient comprehension? Presented at the 38th Annual Scientific Meeting of the Society of Gynecologic Surgeons, Baltimore MD. Adelowo A, Hacker MR, Merport A, Elkadry E. Do symptoms of voiding dysfunction predict urinary retention? 2012. Presented at the 38th Annual Scientific Meeting of the Society of Gynecologic Surgeons, Baltimore, MD. Averbach S et al. Acceptability of the IUD among women who opted out of a randomized controlled trial of intracesarean insertion of the Copper-T 380A in Kampala, Uganda. 2012. To be presented as a poster at the 20th World Congress of Gynecology and Obstetrics. Bixel K, Hur HC, Merport Modest A, Kiang M, Singer S. Impact of perceptions of patient safety on planning and implementation of surgical safety checklists. 2012. Presented at the 41st AAGL Global Congress on Minimally Invasive Gynecology. Bixel K, Merport Modest A, McCann A. Treatment and outcomes of patients diagnosed with carcinoma confined to the abdomen. 2012. Presented as an oral presentation at the annual meeting of the New England Association of Gynecologic Oncologists. Dessie S, Adams SR, Hacker MR, Merport Modest A, Elkadry EA. Bladder habits and attitudes in an ethnically diverse population. 2012. To be presented as a poster at the annual meeting of the American Urogynecologic Society. Hawkins L, Schnettler W, Hacker M, Merport Modest A, Rodriquez D. Association of third trimester abdominal circumference with timing of delivery. 2012. Presented as an oral presentation at the 22nd World Congress on Ultrasound in Obstetrics. Hofler L, Owen L, Dodge LE, Hacker MR, Haider S. Patient satisfaction and procedure wait times for uterine evacuation with manual and electric vacuum aspiration. 2012. To be presented as a poster at the annual meeting of the Society for Family Planning. Hofler L, Merport Modest A, Dodge LE, Owen L, Hacker MR, Haider S. Patient satisfaction and procedure characteristics of uterine evacuation using a vacuum aspiration with and without sharp curettage. 2012. To be presented as a poster at the annual meeting of the Central Association of Obstetricians and Gynecologists. Hur HC, Green I, Merport Modest A, Milad M. 2012. Assessment of OB/GYN Resident Knowledge of Electrosurgery Concepts. To be presented at the 41st AAGL Global Congress on Minimally Invasive Gynecology (November 2012). Lely TA, Salahuddin S, Holwerda KM, Karumanchi SA, Rana S. Circulating Lymphangiogenic Factors in Preeclampsia. Poster Presentation, XVIII ISSHP World Congress, Geneva, Switzerland, July 9-12, 2012. Malizia BA, Dodge LE, Sisti JS, Penzias AS, Hacker MR. Increased body mass index (BMI) is a risk factor for poor fertilization among women undergoing in vitro fertilization (IVF). 2012. To be presented as a poster at the annual meeting of the American Society of Reproductive Medicine.

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Moragianni VA, Mullen A, Penzias AS, Berger BM. Antral follicle count measurement in oocyte donors is not associated with recipient IVF outcomes. 2012. To be presented as a poster at the annual meeting of the Society for Gynecologic Investigation. Moragianni VA, Alper MM. Recurrent pregnancy loss in a patient with sex chromosome mosaicism: a case report and review of the literature. 2012. To be presented as a poster at the Annual Meeting of the Society of Gynecologic Investigation. Rana S, Hacker M, Merport A, Salahuddin S, Verlohren S, Perschel F, Karumanchi A. 2012. Angiogenic factors and risk of preeclampsia related adverse outcomes in twin pregnancies. Presented at the XVIII International Society for the Study of Hypertension in Pregnancy World Congress, Geneva, Switzerland. Rana S, Hacker MR, Salahuddin S, Karumanchi SA. Angiogenic factors and the risk of adverse outcomes in twin gestation. 2012. To be presented as a poster at the annual meeting of the Society for Gynecologic Investigation. Schaarschmidt W, Rana S, Stepan H. The course of sFlt1 and PlGF reflects different progression pattern in early- versus late onset preeclampsia and HELLP syndrome. Poster Presentation, XVIII ISSHP World Congress, Geneva, Switzerland, July 9-12, 2012. Scott J, Averbach S, Merport Modest A, Hacker MR, Murphy M, Cornish S, Spencer D, VanRooyen M. 2012. An Assessment of Gender Equitable Norms in South Sudan. Presented at the Women’s Health 2012 Congress, Washington DC. Shahul S, Rhee JS, Rana S, Hacker MR, Mitchell J, Hess P, Mahmood F, Talmor D. Subclinical left ventricular dysfunction in preeclamptic women with preserved left ventricular ejection fraction: a 2D speckled tracking imaging study. Poster Presentation, XVIII ISSHP World Congress, Geneva, Switzerland, July 9-12, 2012. Wu LH, Humm KC, Dodge LE, Sakkas D, Hacker MR, Penzias AS. IVF outcomes are paradoxically poorer under age 25. 2012. To be presented as a poster at the annual meeting of the American Society of Reproductive Medicine. Yiu T, Averbach S, Hacker MR, Merport A, Walker H, Dimitrakoff J, Ricciotti H. 2012. The association between Mycoplasma genitalium and preterm delivery at an urban community health center. Presented at the Women’s Health 2012 Congress, Washington DC.

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DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

A teaching hospital of Harvard Medical School

website: http://bidmc.org/MedicalEducation/Departments/ObstetricsGynecology/Residency.aspx

617-667-2285


BIDMC OB/GYN Annual report 2012