2020 Department Report | UCSF | Obstetrics, Gynecology & Reproductive Sciences

UCSF Department of Obstetrics, Gynecology & Reproductive Sciences Department Report 2020

Contents Overview • • • • • • •

W elcome from the Chair S trategic Plan F inancial Summary D epartment at a Glance P ractice Locations F aculty Directory E ndowed Professorships

Divisions/ORU • C enter for Reproductive Sciences • O bstetrics, Gynecology and Gynecologic Subspecialties • G ynecologic Oncology • M aternal-Fetal Medicine • R eproductive Endocrinology & Infertility • Z uckerberg San Francisco General Obstetrics and Gynecology

Making a Difference • O ur Global Reach • C ommunity Connections

Mission Areas • • • • •

P atient Care R esearch E ducation A dvocacy D iversity, Equity & Inclusion

Our mission is to improve the lives and health of all women through excellence, innovation and leadership in patient care, scientific discovery, education, advocacy, and diversity, equity and inclusion.

Notable • R ecognizing Uta Landy, PhD • R emembering Robert M. Jaffe, MD • H elp Advance Women’s Health: Make a Gift of Support 490 Illinois Street, Floor 10 San Francisco, CA 94143 https://obgyn.ucsf.edu/ @UCSF_ObGynRS

© 2021 The Regents of the University of California Erika Pham, Project Manager, Strategic Initiatives Wendy Turner, Communications Manager Design: Sean Brainerd/volume11creative Photography: Steve Babuljak, Matt Beardsley, Noah Berger, Chloe Jackman, Susan Merrell, Amy Osborne, Barbara Ries, Verndean Tortorelli, Expecting Justice, and Hawkeye Photo Appreciation to those who contributed to the report.

2 | UCSF Obstetrics, Gynecology & Reproductive Sciences

OVERVIEW

Welcome from the Chair The Department of Obstetrics, Gynecology and Reproductive Sciences is committed to providing patient-centered, data-driven care to our patients regardless of race, ethnicity, religious affirmation, or gender affirmation. Our commitment is rooted in our strong foundation in education, research, and clinical care that works to reduce or eliminate barriers which have prevented some groups from receiving equitable care, inclusive training, or unbiased discovery.

The challenges of this past year have intensified our commitments and focused our attention. As a department, we led initiatives aimed at leveraging the voices of those disadvantaged by structures that have compromised health, training, education, and career opportunities.

During COVID-19 we created clinical protocols to best care for our patient population and shared them broadly with our colleagues across the country. We adjusted our schedules to prepare for a surge and worked together every day to keep our patients and each other safe. We mobilized to launch national registries and research on the impacts of COVID-19 throughout pregnancy. Recognizing the need to support our patients who were fearful but in need of

care, we launched the UCSF Women’s Health Webinar Series that now has over 4,000 participants attending live and recorded sessions.

I am proud of the care we deliver, the future leaders we’re developing, the innovative discoveries we’re uncovering, and the conversations we are leading. I have the deepest gratitude for the members of this Department. They have risen to the challenges of this year and have truly embodied our mission by leading the way.

Amy P. Murtha, MD Professor and Chair Edward C. Hill, M.D., Endowed Chair in Obstetrics, Gynecology and Reproductive Sciences Department of Obstetrics, Gynecology & Reproductive Sciences University of California, San Francisco

Department Report 2020 | 3

OVERVIEW

Strategic Plan Current initiatives for our Strategic Plan include continuing the collaborative process between division faculty and investigators while extending into areas such as staff engagement, staff appreciation, assuring diversity of our department members, recruitment, and the addition of Diversity, Equity & Inclusion as a strategic priority. Other current initiatives include: + Recruitments -V ice Chair and Associate Chair for Equity, Inclusion & Structural Change -D irector, Center for Reproductive Sciences -D ivision Director, Obstetrics, Gynecology & Gynecologic Subspecialties + Establishment of Women’s Health service line with two leadership positions -V ice President for Women’s Health -C hief Medical Officer for Women’s Health + Clinical Volume Recovery Plan due to COVID-19 -F ocus on revenue generating areas such as CRH, Gyn Surgery, and MFM/PDC Consults -E nsure efficiencies in existing partnerships and also expand collaborative partnerships + Health Equity -P artner with UCSF Health System/ZSFG to advance racial justice -R eproductive Health Equity and Birth Justice CORE -U CSF EMBRACE: Perinatal Care for Black Families -S ACRED Birth Research Study -L eadership Development Program for Black Women + Expansion of clinical footprint in San Mateo, Marin, and East Bay

Department Executive Leadership Amy Murtha, MD, Department Chair Synthia Mellon, PhD, Interim Director, Center for Reproductive Sciences Andrea Jackson, MD, MAS, Interim Division Director, Obstetrics, Gynecology & Gynecologic Subspecialties Lee-may Chen, MD, FACS, FACOG, Division Director, Gynecologic Oncology Jessica Opoku-Anane, MD, MS, Interim Division Director, Minimally Invasive Gynecologic Surgery & Urogynecology Mary Norton, MD, Vice Chair, Clinical & Translational Genetics; Division Director, MaternalFetal Medicine Marcelle Cedars, MD, Vice Chair, Clinical Programs; Division Director, Reproductive Endocrinology & Infertility Rebecca Jackson, MD, Interim Vice Chair, Education; Division Director, Zuckerberg San Francsico General Sara Whetstone, MD, MHS, Interim Vice Chair, Equity, Inclusion & Structural Change LaMisha Hill, PhD, Interim Associate Chair, Equity, Inclusion & Structural Change Vanessa Jacoby, MD, MAS, Vice Chair, Research Connie Yu, MHA, Associate Chair of Administration & Finance

+ New Departmental Intranet launched in Spring 2020 + Town Halls focused on creating a system of accountability, including measurable goals, around DEI work + Reboot of SHINE (previously Thrive) with two individual workgroups focusing on Professional Development and Events & Recognition

Department Administrative Staff Leadership Connie Yu, MHA, Associate Chair of Administration & Finance Beth Glascock, MPA, Chief Financial Officer Brenda Kittredge, MBA, Director of Operations Mary Beth Blasnek, MS, Division Administrator, Zuckerberg San Francisco General Kirsten Hutchinson, Division Administrator, Reproductive Endocrinology & Infertility Lan Pham, MPA, Division Administrator, Mission Bay, Mount Zion, Parnassus

4 | UCSF Obstetrics, Gynecology & Reproductive Sciences

OVERVIEW

Financial Summary State Funds 1%

Other Revenues 1%

ZSFG Affiliation 4% Other Clinical Funds 11%

Annual Funding Category

Fiscal 2020

Clinical Enterprise Revenues UCSF Health

41,899,159

Other Clinical Revenue (PSA, etc.)

4,046,388

ZSFG Affiliation Agreement & Profee

8,995,979

Gift Funds 11%

FY20 Revenue

54,941,526 Extramural Funds Federal Local

33,692,492 244,799

Private

35,271,045

State

2,499,374

Med Center Funds 23%

Sponsored Funds 49%

71,707,709 State 4%

Gifts & Endowment Income Gifts/Endowments

Federal 47%

16,018,534 16,018,534

Other Revenue (e.g. IDCR, STIP, Recharge)

1,575,952

State General Fund

2,078,102

Extramural Funds

3,654,054 Grand Total

146,321,823 Private 49%

Local 0.34%

Department Report 2020 | 5

OVERVIEW

Department at a Glance

#1

Obstetrics and Gynecology Program in Schools of Medicine

by U.S. News & World Report

2,914 Deliveries

#1

#1

Obstetrics and Gynecology Program in Graduate Schools in the U.S. News & World Report

122,174 Patient Visits

NIH Research Funding for Obstetrics and Gynecology departments

576

$64.9M

Total Publications in 2020

Total Extramural Grants and Contracts Revenue in FY19-20

Staff 36% Non-Faculty Academics 3%

9 Faculty Hires

Residents, Trainees, PostDocs, Students 12%

TOTAL 719

Diversity By Category

Recall Faculty 2% Faculty Emeriti 3% Faculty 17%

# of Faculty and Staff by Division/Group

Central Administration 5% OGGS 11%

Staff

31%

% UIM

MFM 24% PostDocs

GynOnc 3%

87%

% Female

Residents

MIGS/ Urogyn 1%

17%

% UIM

REI 11%

ZSFG 33%

83%

% Female Faculty

Volunteer Clinical Faculty 27%

38 Staff Hires

CRS 12%

6 | UCSF Obstetrics, Gynecology & Reproductive Sciences

86%

% Female

49%

% UIM

63%

% Female

25%

% UIM

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

OVERVIEW

Practice Locations Mission Bay Campus Center for Reproductive Health 499 Illinois Street, Suite 600 Fertility Practice Fertility Preservation Betty Irene Moore Women’s Hospital 1855 Fourth Street Labor & Delivery Fetal Treatment Center Gynecologic Surgeries Gynecologic Oncology Surgeries Women’s Health Resource Center Ron Conway Family Gateway Medical Building 1825 Fourth Street Prenatal Diagnostic Center Obstetrics Practice Gynecology Practice Gynecologic Oncology Practice Bakar Cancer Hospital 1855 Fourth Street Gynecologic Oncology Practice Owens Street Practice 1500 Owens Street, Suite 380 Minimally Invasive Gynecologic Surgery Urogynecology

Mount Zion Campus Women’s Health Building 2356 Sutter Street Gynecology Practice General Obstetrics Practice Dysplasia Clinic Center for Reproductive Health Women’s Option Center Women’s Health Primary Care Young Women’s Program

Zuckerberg San Francisco General Hospital & Trauma Center 1001 Potrero Avenue Obstetrics/Gynecology Gynecologic Oncology Women’s Options Center Family Birth Center

Satellite Practices Gynecologic Oncology Greenbrae, Santa Rosa Prenatal Diagnostic Center Fremont, Greenbrae, Monterey, Santa Rosa, San Mateo, Berkeley, Walnut Creek Fetal Treatment Center Oakland Benioff Children’s Hospital Oakland Obstetrics, Gynecology Berkeley, San Mateo

Department Report 2020 | 7

OVERVIEW

Faculty Directory Center for Reproductive Sciences Department of Ob, Gyn & RS Aditi Bhargava, PhD Marco Conti, MD Susan Fisher, PhD Jennifer Fung, PhD Stephanie Gaw, MD, PhD Roy Gerona, PhD Linda C. Giudice, MD, PhD, MSc Steven C. Hall, PhD Diana Laird, PhD Synthia Mellon, PhD Paolo F. Rinaudo, MD, PhD Joshua Robinson, PhD Frederick Schaufele, PhD Dan Wagner, PhD Departments, School of Medicine Robert Blelloch, MD, PhD (Urology) Adrian Erlebacher, MD, PhD (Laboratory Medicine) Holly Ingraham, PhD (Cellular Molecular Pharmacology) Tippi Mackenzie, MD (Surgery) Emin Maltepe, MD, PhD (Pediatrics) Todd Nystul, PhD (Anatomy) Aleksander Rajkovic, MD, PhD (Pathology) Nadia Roan, PhD (Urology) Gynecologic Oncology Edwin A. Alvarez, MD Jocelyn Chapman, MD Lee-may Chen, MD, FACS, FACOG Karen Smith-McCune, MD, PhD Megan Swanson, MD, MPH Stefanie Ueda, MD Maternal-Fetal Medicine Rebecca Hess Amirault, CNM, MSN Victoria Berger, MD Talia Borgo, RN, MSN, CNM Tammy Brunk, DNP, CNM, FNP-BC Shilpa P. Chetty, MD Jacquelyn Chyu, MD Katherine Connolly, MD *Jennifer Duffy, MD, MHS Sheri Foote, CNM Melinda I. Fowler, CNM, MSN Kate Frometa, CNM Stephanie Gaw, MD, PhD Neda Ghaffari, MD Juan M. Gonzalez, MD, MS, PhD Roxanna Irani, MD, PhD *Deborah Karasek, PhD Miriam Kuppermann, PhD, MPH Ben C. Li, MD Amy Murtha, MD Mary E. Norton, MD Amy Padula, PhD, MSc Annalisa Post, MD

Larry Rand, MD Patricia Robertson, MD Frederico Rocha, MD, MS Melissa Rosenstein, MD, MAS *Nasim Sobhani, MD Teresa Sparks, MD Mari-Paule Thiet-Akram, MD Carol Thomason, CNM Vanessa Tilp, CNM, MSN Laura Weil, CNM, MSN, MPH Tracey Woodruff, PhD, MPH Sasha Yamnik, CNM, MSN Amanda Yeaton-Massey, MD Marya G. Zlatnik, MD, MMS Minimally Invasive Gynecologic Surgery & Urogynecology *Alexander Berger, MD Alison F. Jacoby, MD Abner Korn, MD Jeannette Lager, MD, MPH Jessica Opoku-Anane, MD, MS Obstetrics, Gynecology, and Gynecologic Subspecialties Amy (Meg) Autry, MD *Katherine Brown, MD, MAS Naghma Farooqi, MD Elena Gates, MD Mindy Goldman, MD Joanne Gras, DO *Mitzi Hawkins, MD Nazaneen Homaifar, MD, MBA Tushani D. Illangasekare, MD Andrea Jackson, MD, MAS Vanessa Jacoby, MD, MAS Deborah D. Kamali, MD Kiran Kavipurapu, DO, JD, MPH Robyn Lamar, MD, MPH Felicia Lester, MD, MPH, MS Nancy Milliken, MD Malini Nijagal, MD, MPH Gaetan Pettigrew, MD Tami Rowen, MD, MS Nicholas Rubashkin, MD, MA, PhD(c) George F. Sawaya, MD Karen A. Scott, MD, MPH Tania Basu Serna, MD, MPH Vasiliki Tatsis, MD, MS, MBA Sara Whetstone, MD, MHS Tricia Wright, MD, MS Reproductive Endocrinology & Infertility Yanett Anaya, MD Hakan Cakmak, MD, PhD Marcelle I. Cedars, MD Victor Y. Fujimoto, MD Linda C. Giudice, MD, PhD, MSc Heather G. Huddleston, MD Eleni Greenwood Jaswa, MD, MSc

8 | UCSF Obstetrics, Gynecology & Reproductive Sciences

Evelyn Mok-Lin, MD Martha Noel, MD Paolo F. Rinaudo, MD, PhD Mitchell P. Rosen, MD, HCLD Thalia Segal, MD Zuckerberg San Francisco General Hospital Deborah Anderson, CNM, MSN *Antonia Biggs, PhD Carol Camlin, PhD, MPH Deborah Cohan, MD, MPH Craig Cohen, MD, MPH Holly Cost, CNM, MSN (SFDPH) Philip Darney, MD, MSc Ana Delgado, CNM, MS Julio Diaz-Abarca, CNM, MSN (SFDPH) Eleanor Drey, MD, EdM Alison El Ayadi, ScD, MPH Linda Ennis, CNM, MS Diana Greene Foster, PhD Lori Freedman, PhD Asmara Gebre, CNM, MS Daniel Grossman, MD Cynthia Harper, PhD Margy Hutchison, CNM, MSN Rebecca Jackson, MD Carole Joffe, PhD Laurie Jurkiewicz, CNM, MS (SFDPH) Rachel L. Kaplan, PhD, MPH Rebekah Kaplan, CNM, MSN Jennifer Kerns, MD, MS, MPH Katrina Kimport, PhD Abner Korn, MD Karen Meckstroth, MD, MPH Biftu Mengesha, MD, MAS Suellen Miller, CNM, PhD Kara Myers, CNM, MS Sara Newmann, MD, MPH Misa Perron-Burdick, MD Andrea Pfeffer, CNM, MSN Lauren Ralph, PhD, MPH Carmen Rivera, CNM, MS (SFDPH) Sarah CM Roberts, DrPH Corinne Rocca, PhD, MPH Dominika Seidman, MD, MAS Jody Steinauer, MD, PhD Naomi Stotland, MD Ushma Upadhyay, MPH, PhD Dilys Walker, MD *joined in FY21

ENDOWED PROFESSORSHIPS

Jody Steinauer, MD, PhD

Tracey Woodruff, PhD, MPH

Philip D. Darney Distinguished Professor Director, Bixby Center for Global Reproductive Health Director, Kenneth J. Ryan Residency Training Program Dept. of Obstetrics, Gynecology & Reproductive Sciences Zuckerberg San Francisco General Hospital University of California, San Francisco

Director of and Alison S. Carlson Endowed Professor for the Program on Reproductive Health and the Environment, Professor in the UCSF Department of Obstetrics, Gynecology, and Reproductive Sciences and the Philip R. Lee Institute for Health Policy Studies

The Philip D. Darney Distinguished Professorship in Family Planning & Reproductive Health ensures that UCSF will in perpetuity provide support for a researcher, clinician, teacher, and advocate who will promote safe abortion and family planning research and advocate for policies to advance reproductive health.

Dr. Jody Steinauer was recently awarded this professorship. She was selected for her participatory leadership style, commitment to equity and inclusion, and track record of accomplishments as a provider, educator and researcher.

The Alison S. Carlson Endowed Professor for the Program on Reproductive Health and the Environment was established to provide a stable source of funding for faculty and the work of PRHE. In particular it will support the research, teaching, and service activities of PRHE in the Department of Obstetrics, Gynecology, and Reproductive Sciences.

Dr. Tracey Woodruff was awarded this endowed professorship in 2019. She was appointed for her expertise in the field of environmental and reproductive health, and for the commitment of the entire PRHE team to create a healthier environment for human reproduction and development through advancing scientific research, clinical care, and health policies that prevent exposures to harmful chemicals in our environment.

Department Report 2020 | 9

DIVISIONS

Marco Conti, MD Director, Center for Reproductive Sciences (through October 2019); Fred Gellert Endowed Professor

Diana Laird, PhD and Steven Cincotta at work in Laird Lab.

Center for Reproductive Sciences

The Center for Reproductive Sciences (CRS), founded in 1977, is an Organized Research Unit comprised of basic science researchers and physician scientists drawn from multiple UCSF departments. With its research programs, the CRS interfaces with other divisions and groups in our department including REI, MFM and the Program on Reproductive Health and the Environment The mission of the CRS is threefold: + Promote high quality, cutting edge research in the field of reproductive sciences + Facilitate the transfer of concepts developed in the laboratory to clinical applications

Synthia Mellon, PhD

+ Provide an integrated interdisciplinary training program for future leaders in the field of reproductive sciences.

Interim Director, Center for Reproductive Sciences

CRS faculty members use state of the art techniques to expand knowledge of reproductive processes. Molecular, cellular, and genetic approaches are used to address fundamental aspects of reproductive sciences, and results are translated to our understanding, diagnosis, and treatment of reproductive disorders. The CRS houses two tissue banks (placenta and endometrial) that are national resources and funded by the NIH for all investigators.

NUMBER OF FACULTY:

22 14 Total

from Ob, Gyn & RS

CRS investigators’ areas of focus: + Gametogenesis

NUMBER OF STAFF:

+ Primordial germ cell development and migration

17

+ Early embryo development including cell fate decisions and stem cell biology + Endometrial development and regeneration + Placentation + Immunology of pregnancy

10 | UCSF Obstetrics, Gynecology & Reproductive Sciences

from Ob, Gyn & RS

50+

Postdoctoral fellows

1

Graduate Student Researcher

DIVISIONS

Obstetrics, Gynecology and Gynecologic Subspecialties The Obstetrics, Gynecology and Gynecologic Subspecialties Division (OGGS) offers comprehensive obstetrical and gynecology services provided by faculty physicians and nurse practitioners across all of our practice sites. Faculty lead specialized programs for the care of women with fibroids and endometriosis. Inpatient and outpatient surgical procedures are performed in the UCSF Health operating rooms at Mission Bay and Mount Zion.

Comprehensive inpatient obstetric services in the Mission Bay Labor and Delivery Unit are provided by our faculty, in partnership with midwives and maternal-fetal medicine faculty.

U.S. News and World Report rank our care seventh in the country. We provide routine and specialized care aimed at maintaining health and treating disease. As part of our well-women gynecology care, we provide consultation and continuing care for a broad spectrum of conditions. All of our practitioners value collaborative decision-making as the most effective way to give each person the most appropriate care.

A patient meets with resident Amanda Compadre, MD at the Gynecologic Surgery & Urogynecology Clinic on Owens Street

During FY20 the Minimally Invasive Gynecologic Surgery and Urogynecology faculty formed a separate division to offer specialized surgical services.

NUMBER OF FACULTY:

26 Total

2

Fellows

10

Staff members

NUMBER OF PATIENTS:

20,000+ per year

FELLOWSHIPS PROGRAMS: OBGYN Research OBGYN Hospitalist

Dana Gossett, MD, MSCI

Andrea Jackson, MD, MAS

Director, Division of Obstetrics, Gynecology & Gynecologic Subspecialties (through May 2020); Grace Marie Waldrop Chair in Obstetrics and Gynecology

Interim Director, Division of Obstetrics, Gynecology & Gynecologic Subspecialties

Department Report 2020 | 11

DIVISIONS

Gynecologic Oncology The Gynecologic Oncology Division (GynOnc) provides services in our Department and through the National Cancer Institute-designated Helen Diller Family Comprehensive Cancer Center. Aligning women’s health and cancer care missions, our Division turns the Department’s mission into action through patient care, scientific discovery, education, and advocacy.

The Division is dedicated to providing high-quality and personalized cancer treatment to women with gynecologic malignancies in the new state-of-the-art UCSF Bakar Precision Cancer Medicine Building, the Bakar Cancer Hospital, as well as our outreach sites.

This work includes shaping evidence-based clinical practice guidelines, pioneering cancer genetic services, improving patient safety practices for better outcomes, supporting cutting-edge and innovative cancer research, and educating the leaders for tomorrow in the Gynecologic Oncology field.

Our Division is working diligently to be the top regional referral center in the San Francisco Bay Area for gynecologic cancer, including cervical, ovarian, fallopian tube, peritoneal, uterine, endometrial, vulva, vaginal, and trophoblastic cancer patients. The Division hosts a weekly tumor board to discuss patients’ treatment options and symptom management with our multidisciplinary team of radiologists, pathologists, radiation oncologists, palliative care specialists, nurses, and genetic counselors. With cutting-edge technology, including sentinel lymph node mapping surgery and precision medicine through molecular characterization of tumors to identify targeted therapeutics, our faculty are committed to delivering the most comprehensive and compassionate care possible.

Lee-may Chen, MD, FACOG, FACS Director, Division of Gynecologic Oncology; John A. Kerner, MD Distinguished Professorship in Gynecologic Oncology

NUMBER OF FACULTY:

6

Total

Fellows

NUMBER OF PATIENTS:

5,000+ visits per year

12 | UCSF Obstetrics, Gynecology & Reproductive Sciences

3

3

Staff members

FELLOWSHIP PROGRAMS: UCSF /KPSF Gynecologic Oncology

DIVISIONS

Juan González Velez, MD, PhD and Naghma Farooqi, MD during an L&D shift

Mary Norton, MD

Maternal-Fetal Medicine The Maternal-Fetal Medicine Division (MFM) provides clinical care and expertise in routine and high-risk obstetrics, including labor and delivery, antepartum care of patients with complex medical conditions, obstetrical ultrasound, prenatal diagnosis, and fetal therapy. It is a critical stakeholder in the Department’s and UCSF Health’s obstetrical strategy. The Betty Irene Moore Women’s Hospital and the Benioff Children’s Hospital at Mission Bay enable our obstetrics and MFM specialist teams to utilize the latest technology and expanded capabilities in providing family-centered obstetric care. The Division has vital clinical/translational and basic research programs in pregnancy outcomes, patient decision-making, placental biology, reproductive genetics, preterm birth, and environmental reproductive health. Also, it has a fully accredited fellowship in Maternal-Fetal Medicine and a combined fellowship in MFM and clinical genetics.

The National Institutes of Health have honored several junior faculty members with Career Development (K) Awards. In highrisk obstetrics, the UCSF Health at Mission Bay boasts bestin-class service provided by our outstanding clinical faculty, including MFM specialists, obstetricians, and Certified NurseMidwives (CNM). We also have excellent genetic counselors and several ongoing research programs in perinatal medicine, and we take pride in our focus on quality throughout the entire patient experience. Our Mission Bay patient rooms support a comfortable patient and family-friendly atmosphere.

Director, Division of Maternal-Fetal Medicine; Vice Chair of Clinical and Translational Genetics; and David E. Thorburn, MD, and Kate McKeeThorburn Endowed Chair in Perinatal Medicine and Genetics

NUMBER OF FACULTY:

35 Total

11

Fellows

59

Staff members

Nearly

3,000

deliveries at our Mission Bay facility NUMBER OF PATIENTS:

22,000+ OB visits at our four locations (including visits done by MFM and OGGS providers as well as postpartum visits)

FELLOWSHIP PROGRAMS: • Maternal-Fetal Medicine • UCSF Preterm Birth Initiative • Combined Maternal-Fetal Medicine/ Medical Genetics

Department Report 2020 | 13

DIVISIONS

Mitchell P. Rosen, MD, HCLD, stands in front of a cryostorage unit full of eggs and embryos

Reproductive Endocrinology & Infertility The Reproductive Endocrinology & Infertility Division’s (REI) patient-facing Center for Reproductive Health (CRH) has grown as a multidisciplinary practice of infertility with collaborations between urology, genetics, and psychology to complement divisional expertise in endocrinology, andrology, and embryology. CRH offers a broad range of services across the reproductive lifespan from childhood through menopause and has expanded fertility preservation to non-cancer patients, including transgender patients or those with genetic risk for reproductive loss. Increasingly, CRH is working with adolescents and teens with hormonal or anatomic abnormalities and has a growing practice in pre-implantation genetic testing and recurrent pregnancy loss, with a focus on identifying critical genetic fingerprints that might prevent successful pregnancy.

The CRH’s Fertility Preservation Program commits to seeing patients newly diagnosed with cancer within 48 hours and receives one such “urgent” referral on average every other day. This program collaborates closely with multiple disciplines from the UCSF Helen Diller Family Comprehensive Cancer Center and throughout Northern California. Also situated within the REI division is the UCSF Multidisciplinary Clinic for Women with Polycystic Ovarian Syndrome (PCOS). This first of its kind clinic offers comprehensive care and clinical trial opportunities to women with PCOS. All REI clinical programs serve as a platform for research and education, and the division is committed to training a new generation of REI specialists through its robust fellowship program.

Marcelle Cedars, MD Director, Division of Reproductive Endocrinology & Infertility

NUMBER OF FACULTY:

12 6 Total

Fellows

NUMBER OF PATIENTS:

35

Staff members

22,000+ annually

14 | UCSF Obstetrics, Gynecology & Reproductive Sciences

FELLOWSHIP PROGRAMS: Reproductive Endocrinology and Infertility (REI)

DIVISIONS

Women’s Health Center Staff & Faculty team members

Zuckerberg San Francisco General Obstetrics and Gynecology The Division of Obstetrics and Gynecology at ZSFG provides comprehensive obstetric, midwifery, and gynecologic services to San Francisco families. The division is located at Zuckerberg San Francisco General and Trauma Center and features a state-of-the-art Family Birth Center that offers births attended by midwives or physicians, labor support by trained doulas, and nurses who are specially trained to support patients who are culturally diverse and mostly low income. ZSFG’s certified nurse-midwifery faculty are national experts in supporting physiologic birth and were the first practice to implement CenteringPregnancy ®, an innovative and patient-centered group prenatal care model in the western United States.

As a certified Baby-Friendly Hospital, we are a recognized leader in breastfeeding support. Additionally, the ZSFG division offers a two-year fellowship in Family Planning that focuses on creating leaders in research, teaching, and clinical skills in abortion and contraceptive care. All fellows also complete a Master’s degree in clinical research.

The Bixby Center for Global Reproductive Health, housed within this division, is a multidisciplinary group of social scientists and clinicians working on the most pressing reproductive health problems in the U.S. and abroad. They conduct research, training, evaluation, and policy analysis in family planning, abortion, adolescent reproductive health, sexually transmitted infections (STIs), including HIV, and maternal health.

Importantly, the Division has engaged in strategic planning and goal setting related to anti-racism, equity, inclusion, and structural change across clinical care, education, research, and advocacy.

Rebecca Jackson, MD Chief of Obstetrics and Gynecology, Zuckerberg San Francisco General Hospital NUMBER OF FACULTY:

24 4

clinical faculty

12

Family Planning Fellows

NUMBER OF PATIENTS:

25,000+

PhD faculty in the Bixby Center for Global Reproductive Health

FELLOWSHIP PROGRAMS: Complex Family Planning

Department Report 2020 | 15

MAKING A DIFFERENCE

Lake Victoria fishing community in Siaya County, Kenya

Mobility and Sustainable East Africa Research in Community Health (SEARCH) research teams retreat in Kisumu, Kenya

Our Global Reach

Reducing Stigma

Our Department’s clinical and research efforts extend far beyond the Bay Area to Africa, Central & South America, and Southeast Asia.

We have built decades-long partnerships to conduct research, train the next generation of UCSF and our in-country colleagues, support clinical care, and advance health policy that improves the health and empowerment of women and transgender people.

Dr. Carol Camlin is leading ground-breaking research on how stigma related to HIV can decline. Her most recent publication, Pathways for reduction of HIV-related stigma: a model derived from longitudinal qualitative research in Kenya and Uganda, contributes new theory to how we view stigma and HIV.

Evidence-based reproductive health research and data from ANSIRH social scientists help expand access to abortion and contraception in countries throughout the world. Our East Africa Preterm Birth Initiative works to reduce the number of preterm births and to save the lives of preterm infants and their mothers, by improving quality of care and engaging in discovery research. UCSF partners with the University of Zimbabwe College of Health Sciences (UZCHS) with the shared goal of controlling Zimbabwe’s HIV/AIDS epidemic and contributing to global policy. Family AIDS Care & Education Services (FACES) in Kenya supports the care and treatment of over 55,000 persons living with HIV and serves as a platform for conducting cutting edge research on HIV prevention and treatment.

The study entailed in-depth qualitative interviews with community leaders and community members in eight rural communities in Uganda and Kenya over the span of 3 years. Based on this data, Dr. Camlin and her team developed a theoretical model of pathways through which HIV-related stigma may decline driven in large part by universal testing and treatment efforts.

Dr. Camlin’s work informs what investments and policies can reduce stigma, which is critical for improving the health of people living with HIV. The paper is available in the International Journal of the International AIDS Society, Volume 23, Issue 12

Dr. Camlin with Drs. Harsha Thirumurthy and Kawango Agot in Kisumu, Kenya to launch their “Owete” study

16 | UCSF Obstetrics, Gynecology & Reproductive Sciences

MAKING A DIFFERENCE

Dr. Mike Chirenje and the Harare Family Care Clinical Research team at the UZ-UCSF CTU in Harare, Zimbabwe

FACES technical leadership team in Kisumu, Kenya

Zimbabwe Clinical Trials for COVID, HIV/AIDS Research

Family AIDS Care & Education Services (FACES)

The University of Zimbabwe-UCSF Clinical Trials Unit (UZ-UCSF CTU), is one of 35 CTUs worldwide and is also a site for NIAID’s new COVID-19 Prevention Trials Network (CoVPN).

This unit, led by principal investigator Z. Mike Chirenje, MD, FRCOG, from the Bixby Center and program manager, Jennifer Tuveson McElroy, successfully recompeted for a third 7-year CTU award (now in Year 15, with $6M annual core and protocol funding), ensuring continued contributions to the NIH HIV/AIDS research agenda through 2027.

The UZ-UCSF CTU’s seven clinical research sites in Harare, Zimbabwe will continue participation in all four NIH HIV clinical trials networks to advance four key areas of research emphasis: 1. HIV prevention 2. HIV vaccines 3. HIV/AIDS adult therapeutics

Family AIDS Care & Education Services (FACES), a collaboration between our Department and the Kenya Medical Research Institute (KEMRI) is working towards an HIVfree future for all through high-quality research, health care services, and training.

To prevent and treat HIV effectively, every child, adolescent, and adult must have access to services that meet their needs, both in and outside of the clinic. In Kisumu County in western Kenya, too many people’s health care and other basic needs go unmet. As a result, the HIV prevalence there is more than three times higher (17.5%) than the national rate (4.9%).

FACES approach consists of three core strategies: conducting medical and social research to improve care, delivering highquality health services, and building capacity through local training and global partnerships.

Attaining UNAIDS’ 95-95-95 targets by 2030 is within reach and our highest priority.

4. HIV/AIDS maternal, adolescent and pediatric therapeutics

Department Report 2020 | 17

COMMUNITY CONNECTIONS

The Healing Story Wall at the National Center of Excellence in Women’s Health, Mount Zion

Volunteers with donations for ZSFG’s Patient Pantry

Women’s Health Resource Center

Zuckerberg San Francisco General Hospital Patient Pantry

Since 2012, the UCSF Women’s Health Resource Center (WHRC) has received an annual grant from the Mount Zion Health Fund (MZHF), to support patients and community members who express financial challenges in obtaining prenatal and postpartum education, lactation supplies, and breast pump rentals.

With MZHF support, WHRC partnered with Legal Aid at Work, a non-profit legal services organization, to create a multifaceted program to advance the health of UCSF low income pregnant and parenting clients. Over 200 patients have received legal support and education on employment protection and lactation accommodation rights. The Legal Aid at Work team provided 12 in-services to OB providers and staff and presented this topic in the Zooming through Pregnancy to Parenthood webinar series.

After COVID-19 hit, the Patient Pantry was concieved to provide patients at the Obstetrics Midwifery & Gynecology Clinic (5M) with a bag full of supplies and groceries to help them shelter in place. Medical director, Misa Perron-Burdick, MD encountered countless patients with loss of employment and basic needs shortages. Through her organization and a volunteer effort of neighbors, ZSFG Hospital employees, and UCSF medical students, the 5M Patient Pantry was born.

20 8

UCSF student volunteers, neighbors and local organizations clinical sites supplied

50+

patient homes visited

1,000+ deliveries

NUMBER OF CLASSES CONVERTED TO ZOOM:

243

NUMBER OF PEOPLE IN WHRC CLASSES DURING COVID:

2,275

Supplies are donated by individuals, local companies, and via food drives. Volunteers deliver brown paper bags filled with food and supplies to community clinics that serve pregnant people and directly to home-quarantined patients. The Family Birth Center held food drives to support the Pantry, and nurses and midwives volunteer regularly. Additionally, the Pantry teamed up with social workers and nutritionists to offer pregnant people other community resources.

Thanks to the Patient Pantry, every pregnant person in the clinic and each family that delivers at Zuckerberg San Francisco General is offered a bag of food and supplies.

18 | UCSF Obstetrics, Gynecology & Reproductive Sciences

COMMUNITY CONNECTIONS

Monique LeSarre PSYD, MA inspires as BWHL co-directors Andrea Jackson, MD, MAS & Judy Young, MPH listen at BWHL Initiative launch

National Center of Excellence in Women’s Health The UCSF National Center of Excellence (CoE) in Women’s Health was one of the first six such federally designated Centers in 1996. The Center advances women’s health, transforms women’s lives through its sex and gender focus and support of rigorous research, innovative clinical care, educational curricula, inclusive leadership development, and respectful community partnerships.

2020 Highlights: + Research: Funded PRIORITY, a national registry to study pregnant people and COVID-19; Participated in its Reproductive Health Equity and Birth Justice Core + Clinical Care: Cared for over 11,000 unique patients in Women’s Health Primary Care, converting quickly and safely to video visits with the onset of COVID-19. Providers volunteered for frontline work in the COVID-19 Respiratory Care Clinics. + Education: Contributed to the analysis and dissemination of learnings from a novel UC-wide Medical School Curriculum on Climate Change and Health, all the more relevant as wildfires challenged CA once again. + Leadership: Supported key women’s health leadership recruitments. + Community: Distributed PPE, food and other resources in SF and Oakland in collaboration with community partners.

Joined GLIDE’s Justice Pilgrimage to Alabama with 25 UCSF Leaders.

Black Women’s Health & Livelihood Initiative The UCSF Black Women’s Health & Livelihood Initiative (BWHL) was launched in November 2019 by the National Center of Excellence in Women’s Health with a mission to address root causes of health care disparities for Black women and to achieve wellness and empowerment across the lifespan.

BWHL focuses on current systemic health care inequities for Black women through 6 key areas: Justice & Equity; Health & Wellness; Community Building; Education; Leadership; and Construction of Knowledge & Research.

To directly address the powerful and prevalent condition that Black women live in, BWHL creates paths at UCSF and in Bay Area communities so that Black women can lead, thrive and contribute our optimal potential at work, home, and in our communities.

The events of 2020 have further highlighted the need to address the disparities for Black women. The Black Women’s Health & Livelihood Initiative places UCSF in a national movement to address the current realities of health care inequities for Black women.

BWHL Guiding Principles: Center Black women Partner with Black women Demonstrate that Black Women’s Lives Matter Engage with Community Allies Leadership by Black Women

Department Report 2020 | 19

PATIENT CARE

New life in Labor & Delivery at UCSF Benioff Children’s Hospital at Mission Bay

Patient Care This year our Patient Care mission focus started with restructuring systems and redefining governance. Labor & Delivery was re-imagined and plans got underway to build out a distinctive Minimally Invasive Gynecologic Surgery & Urogynecology Division. New leadership positions such as Vice President and Chief Medical Officer for UCSF Women’s Health Services were created.

These strengthened foundations proved crucial as COVID-19 emerged.

Medical directors, clinical faculty, and staff at UCSF and ZSFG worked diligently and under great pressure to come up with action plans on short notice. Cost reduction efforts were quickly undertaken in hopes of avoiding layoffs. In-person visits were converted to telehealth sessions, as we formulated new ways to serve the pregnant people and families who still needed our expert care.

20 | UCSF Obstetrics, Gynecology & Reproductive Sciences

“ The simple act of the team coming together made a huge impact on this clinic’s operations and even more importantly it made a measurable difference to the Department by avoiding staff layoffs thanks to these creative cost reductions.”

–M irha Buric, Administrative Director for Mount Zion OBGYN, YWP, MIGS, and UroGyn on the implementation of a robust system for organizing their clinical workplace.

PATIENT CARE

Team Lily: Dignity, Autonomy, Support Introducing Team Lily, a new Zuckerberg San Francisco General Hospital multidisciplinary care team. Team Lily provides wrap-around services to pregnant and postpartum people who have significant barriers to accessing clinic-based care, primarily those experiencing homelessness, substance use disorders, incarceration, intimate partner violence, and/or mental illness.

Resident Amanda Compadre, MD and Alexander Berger, MD, MPH visit with a patient

Everything Changed Yet the Needs Remained A pregnant person with abnormal genetic results.

A woman with debilitating pelvic pain. A couple waiting to receive time-sensitive infertility treatment.

None of these patients’ medical needs stopped because of COVID-19. While other systems slowed operations and services, Women’s Health at UCSF could not. We worked diligently to secure our front line ensuring that all patients continued to receive the high-quality care they expected from UCSF. As shelter-in-place orders were issued, we implemented safe steps necessary to keep our doors open and were among the first to establish protocols to bring patients back into clinic safely. We shifted most visits to a secure video option, created a new cadence of prenatal care balancing video with in-person visits, and offered obstetric ultrasound, genetic counseling and gynecologic care.

We kept in mind the diversity and disparities in our patient populations, and through a lens of equity, determined how to reach our most vulnerable groups. Our teams doubled-down to provide patients with extra support, reassurance, and excellent and safe care across all of Women’s Health in this unprecedented time.

Team Lily strives for experiences filled with dignity, grounded in autonomy, and which uplift individual or parenting goals. They are committed to dismantling structural racism and challenging barriers to care, health, and well-being such as stigma and discrimination.

What began as a collaboration between the ZSFG divisions of Obstetrics & Gynecology, Psychiatry, and Solid Start has expanded to include partnerships with Pediatrics, Public Health Nursing, methadone clinics, jail health services, and organizations working with people affected by homelessness and/or substance use in San Francisco.

The Team: Dominika Seidman, MD, MAS, Cynthia Gutierrez, Teresa Rondone, Rebecca Schwartz, LCSW, Jennifer Annunziata, MD and Melanie Thomas, MD, MS

TEAM LILY’S IMPACT: Averted

10

cases of congenital syphilis

Achieved clinicbased, rather than emergency room-based, care for the majority of Team Lily patients

Averted

Supported

foster care placements by helping patients not yet in recovery enter residential treatment with their babies

patients to enter recovery from substance use during pregnancy

10

50

Arranged stable housing for more than 90% of participants

Department Report 2020 | 21

PATIENT CARE

Cameron, Maggie and their new baby

Zooming Through Pregnancy After shelter-in-place was enacted, Nazaneen Homaifar, MD, MBA proposed we innovate and scale our ability to reach our patients to update them on the rapidly changing landscape of COVID-19. The resulting Women’s Health Webinar series, launched in April 2020, provided critical and timely updates on outpatient and inpatient care across our department and facilitated forums in which patients and community members could ask their questions.

A Letter from a Patient “There was a big knowledge and experience gap between me and my partner around pregnancy and birth. She’s a family medicine physician; I’m a middle school math teacher.

I tried as hard as I could to narrow the margin by reading books and listening to podcasts.

In the months leading up to our baby’s birth, it became clear that the COVID-19 pandemic would play a big role in our hospital stay. At that point, it was hard to know what birthing knowledge would be transferable to our future experience at UCSF. The Women’s Health Webinars were incredibly helpful and reassuring.

The fact that the webinars were led by the doctors, nurses, and midwives we’d eventually work with gave me confidence going into what was previously a scary scenario. Even when the pandemic ends, I would highly recommend continuing the program! I loved being able to watch the sessions, both live and recorded, with my partner, and talk about the great information they shared!” ~Cameron

22 | UCSF Obstetrics, Gynecology & Reproductive Sciences

3877+ YouTube views of Women’s Health Webinar Series and Zooming through Pregnancy to Parenthood Series

1259+ Unique views of Women’s Health Webinar series around COVID-19 and its impact on our different divisions.

1129+ Unique views of Zooming through Pregnancy to Parenthood webinars (Series co-created by Nazaneen Homaifar, MD, MBA and Sasha Yamnik, CNM).

RESEARCH

A nasal swab sample from a baby whose mother has COVID-19, is examined in the Gaw Lab as part of the PRIORITY study

Diana Laird, PhD, Principal Investigator of Laird Lab

Research

A Virtual Visit to the Labs

Our Research pillar centered on providing resource support for our research community. Grant writing, statistical expertise, and funding resources were made readily available to our clinical, basic, and social scientists. Vice Chair of Research, Vanessa Jacoby, MD, MAS led bi-monthly research meetings developed as networking, communication, and information opportunities for researchers and their teams.

COVID-19 disruptions were felt heavily in research as labs shuttered and in-person clinical trials discontinued. Our resilient research community pivoted and quickly organized to initiate a registry and studies on how COVID-19 might impact pregnant people and reproduction. Research focused on physical and psycho-social aspects and fostered synergy between our research enterprise and the educational, clinical, and community engagement arms of our Department.

RESEARCH HIGHLIGHTS

First Research Fellow in General Obstetrics and Gynecology started this July Innovative developmental biologist Dr. Dan Wagner joined the CRS National recruitment for next CRS director underway

The Laird Lab research focuses on how early events in cellular development of egg and sperm affect future fertility, aging, and the transmission of disease. Diana Laird, PhD and her team examine the ovaries and testis of fetal mice to explore these questions. Their paper detailing a link between epigenetics and quality control in mice testis is published in Nature Cell Biology.

Parallel studies are underway in the ovaries. Their aim is to understand how the development of cells that are precursors to eggs might affect the viability of future eggs to undergo fertilization and support the growth of a healthy embryo in both young and aging ovaries.

The Rinaudo laboratory, led by Paolo Rinaudo, MD, PhD examines how in vitro fertilization and in vitro culture during the pre-implantation period affect fetal and adult development. Fetal adaptations to adverse conditions in utero can lead to specific diseases in adults, including diabetes, high blood pressure, and coronary heart disease.

The Rinaudo laboratory has created a mouse model of IVF for better analyzing longterm health outcome. One avenue of research analyzes in utero and postnatal growth of IVF conceived mice (blood pressure, glucose tolerance, fat content, and growth). A second avenue of research analyzes how molecular mechanisms are altered in embryos following culture in vitro with the goal to optimize culture conditions, identify the healthiest embryos, and improve health outcomes.

Paolo Rinaudo, MD, PhD

Department Report 2020 | 23

RESEARCH

The Gaw Lab, leading a nationwide study on the effects of SARS-CoV-2 in pregnant women

COVID-19 Research Studies PRIORITY (Pregnancy CoRonavIrus Outcomes RegIsTrY) is a nationwide study of pregnant people with COVID-19. This study led by Stephanie Gaw, MD, PhD and Vanessa Jacoby, MD, MAS was created to help patients and healthcare providers better understand how COVID-19 impacts pregnant people and their newborns. Samples from mothers and babies from around the country are transferred to the Gaw Lab for processing, storage, and analysis.

Work from this project will help unravel the mechanisms of mother-to-child transmission, as well as maternal-fetal immune responses to the virus and how abnormal responses may impact pregnancy outcomes and infant health.

UCSF ASPIRE (Assessing the Safety of Pregnancy In the CoRonavirus PandEmic) seeks to understand how COVID-19 infection affects the health and wellbeing of pregnant people and their babies. ASPIRE is focused on the first trimester, a critical and vulnerable period when a baby’s organ systems and placenta form develop. Investigators Heather Huddleston, MD, Eleni Jaswa, MD, MSc, and Marcelle Cedars, MD hope this study will provide critical information to guide the care of pregnant people; protect the safety of their babies and families; and help those considering pregnancy in the future understand what it means to be pregnant in this new era.

The HOPE study (Healthy Outcomes of Pregnancy for Everyone through Science, Partnership, and Equity) led by Laura Jelliffe-Pawlowski, PhD, MS, Larry Rand, MD, and Karen Scott, MD, MPH aims to determine how COVID-19 affects pregnancy and infant outcomes. The study examines how the virus and factors associated with the pandemic, such as stress and social distancing, might affect a newborn’s health and a birthing person’s risk for certain kinds of adverse pregnancy outcomes, like preterm birth and preeclampsia. Particular focus is placed on how the pandemic affects low-income people and Black and Brown birthing persons.

CIRUS COVID-19 Impacts on Reproduction in the United States

The CIRUS Study (COVID-19’s Impacts on Reproduction in the US) led by Jennifer Kerns, MD, MS, MPH, and Nadia Diamond-Smith, PhD, MS, and colleagues is a longitudinal study of women in the US designed to determine the impact of COVID-19 and the associated shelter-in-place guidelines on maternal and reproductive health care access, experiences, and use over time, including prenatal care, birthing experiences, postpartum care, as well as miscarriage, abortion, and contraceptive care. It additionally seeks to explore differences due to COVID-19 in access and experience by race/ethnicity.

24 | UCSF Obstetrics, Gynecology & Reproductive Sciences

RESEARCH

Patient at UCSF Benioff Children’s Hospital Oakland

SACRED Birth Study The SACRED Birth Study is designed for, by, and with Black mothers and Black birthing people to share information about their patient experiences in hospital settings during labor, birth, and postpartum in six key areas:

Safety, Autonomy, Communication, Racism, Empathy, and Dignity.

Principal Investigator Karen Scott, MD, MPH created this study to amplify the voices, lived experiences, wisdom, and humanity of Black mothers and birthing people, Black women-led community-based organizations (CBOs), and Black women scholars particularly in this time of COVID-19.

This study uses a new survey tool called a PatientReported Experience Measure of OBstetric racism. The PREM-OB Scale allows for Black mothers and birthing people to share information about their unique patient experiences. The information gained will help hospitals, health plans, scientists, funders, and the public better understand how racism and other forms of discrimination and neglect affect the way hospitals provide care, services, and support to Black birthing people.

Department Report 2020 | 25

EDUCATION

Amy Murtha, MD, addresses room of learners during the Annual Medical Student Dinner

Education Our education program shined this year and was named #1 in the country in the “Best Obstetrics & Gynecology Programs” category by US News & World Report. While the pandemic presented major challenges to in-person learning, our Medical Education, Continuing Medical Education (CME), and Graduate Medical Education (GME) programs quickly and creatively transformed to virtual environments and greatly expanded the reach of our expert teachers. Record numbers of volunteer clinical faculty onboarded to help educate our medical students.

A standout group of interns started amidst the pandemic, and eight of our chief residents matched to fellowships this year. Residents and educational leadership kept us focused on confronting racism and health equity in learning environments. Our Fellowship programs fared well during accreditation site visits and continue to make an impact beyond UCSF.

Virtual Visiting Elective Scholarship Program (VESP) UCSF sponsors the Visiting Elective Scholarship Program (VESP) to expose fourth year medical students who are under-represented in medicine and committed to working with underserved populations to UCSF. This program has been a powerful recruitment tool in increasing diversity amongst our residency programs, including OB-GYN. This year, all visiting sub-internships were cancelled due to COVID-19. In lieu of in-person experience, we created a virtual VESP experience to introduce students to our residency program, facilitate connections between faculty and residents, and allow us to provide support around application and interview preparation. Virtual VESP students have been invited to participate in resident didactics as well as virtual resident events such as Latinas en Medicina.

FELLOWSHIP PROGRAMS: + Maternal-Fetal Medicine +R eproductive Endocrinology and Infertility +C ombined Maternal-Fetal Medicine/ Medical Genetics +G ynecologic Oncology +C omplex Family Planning

Past years:

This year:

students each year

faculty members,

4-5

+F emale Pelvic Medicine and Reconstructive Surgery

This year:

+O BGYN Research

students from 27 medical schools across the country

+O BGYN Hospitalist +V A Women’s Health +P reterm Birth Initiative Transdisciplinary Research +H EAL +G loCal

26 | UCSF Obstetrics, Gynecology & Reproductive Sciences

32

12 11 6

residents, and fellows volunteered to serve as mentors

EDUCATION

Verónica González, MD, clinical fellow of MaternalFetal Medicine

Verónica González: Med Student to Fellow Verónica González, MD, brings our Education mission to life. As a first-generation college student with a passion for research and an intent to enter medicine, she joined the inaugural cohort of medical students in our Undergraduate Research Internship (URI).

Dr. González made an immediate impact on the program with her drive, energy, and research project on disparities in access for minimally invasive gynecological surgery.

After graduating from Berkeley with degrees in Chicano Studies and Biology, she attended the UCSF School of Medicine and dedicated herself to research and volunteer work that paid forward her own mentorship experiences.

In 2015, Dr. González matched in OB-GYN at UT Austin and completed the circle by returning to UCSF as an MFM Fellow in 2019, which also marked the tenth anniversary of the initial URI cohort. She can now be found studying placental samples from mothers with COVID-19 in the Gaw Lab on Parnassus.

UNDERGRADUATE RESEARCH INTERNSHIP (URI) FACTOIDS + Launch: 2009 by Dr. Patricia Robertson & partners + Design: Pathway program for underrepresented-in-medicine premed students + Focus: Research projects, clinical shadowing, didactics, leadership training, mentoring, and medical school application support

MEDICAL STUDENT EDUCATION HIGHLIGHTS & INNOVATIONS

600 s tudents annually in OB-GYN courses

11 clerkship sites 335 instructors 10 students in 2020 successfully matched into OB-GYN residencies

+U ndergraduate Research Internship +A nti-Racist core curriculum +G ender & Sexual Diversity curriculum +S imulator/Hands-On curriculum

Department Report 2020 | 27

EDUCATION

Midwifery, OB-GYN, and Learners: A Collaboration

Resident Tamandra Morgan, MD, visits with colleagues in the L&D doctors’ hub

The midwifery programs at Mission Bay and ZSFG contribute to the unique culture of collaboration that exists between midwives, obstetricians, and learners. Faculty midwives teach UCSF learners not only how to evaluate a cervix and stitch up a perineum but how to enter a room, participate in patient-centered shared decision-making, and respectfully hold space for labor as it takes its course.

National Remote OBGYN Resident Didactics Due to COVID-19, programs across the country pooled resources and expertise to continue didactic activities for residents. National Remote OB-GYN Resident Didactics launched in April 2020.

Our innovative program has midwifery students working on labor and delivery in interprofessional teams alongside OB-GYN and ED residents. We were one of four sites across the country on an ACOG and ACNM Josiah H. Macy grant for development of an interprofessional curriculum for OB-GYN residents and midwifery students.

RESIDENT DIDACTICS

210

average # of participants in the live lectures

This year the midwives transitioned to teaching our interprofessional classes and medical student OB lectures on Zoom. With the return of students to clinical rotations, the midwives continued their teaching. During prenatal visits or while catching babies, there is nearly always a pair of learning eyes, hands, and heart at their side as students and trainees observe the midwives at their work.

CONTINUING MEDICAL EDUCATION – COVID-19 STATS + Grand Rounds went virtual averaging 50% more attendees than the in-person lectures + “OB-GYN: What does the Evidence Tell Us” class was held virtually and had the most registrants in its history

2,560 3,500 average # of recorded views for each lecture

average # of downloads for lectures delivered in April

“ The National Didactic program gave me a new respect for our ability to reach each other across the country to inspire and elevate every resident’s learning.”

– OBGYN Resident Didactics Program participant

RESIDENCY PROGRAM HIGHLIGHTS & INNOVATIONS More than

600

applications annually

80

applicants are interviewed for 10 available spots

40

residents represent 30 different medical schools across the country

55%

of our residents are underrepresented in medicine

28 | UCSF Obstetrics, Gynecology & Reproductive Sciences

Over

50%

pursue addition subspecialty training after graduation In 2020, Chief Resident Arthurine Zakama, MD, and colleagues launched the “A-Z Scholarship” funding residency application fees to students underrepresented in medicine

ADVOCACY

PTBi Doula Trainees on the steps of Genentech Hall at Mission Bay

Advocacy More than ever, science, evidence, and access are being threatened. Recognizing the need to advance our values and translate research into actionable plans and policies, our Department created an Advocacy Strategy Committee, led by Daniel Grossman, MD. The committee’s charge is to streamline and strengthen our collective efforts through resource and best-practice sharing.

We define advocacy as activities aimed to influence policy or practice that ultimately benefit our patients. Our advocacy work manifests in many forms such as op-eds, educating legislators, expert witness testimony, scientific publications, community engagement, patient education and teaching. Organizations such as the Bixby Center, the Preterm Birth Initiative, the Program for Reproductive Health and the Environment, and the UCSF National Center for Excellence in Women’s Health specialize in advocacy pertaining to women’s and transgender people’s health and reproductive autonomy.

“The US is an outlier in many things, including public funding of abortion care and paid parental leave. We should be supporting pregnant people to have access to all of the medical care and recovery time that they need. Evidence-based policy change can make that happen.”

– Daniel Grossman. MD Advocacy Strategic Committee Chair ANSIRH Director

Department Report 2020 | 29

ADVOCACY

Dr. Ushma Upadhyay of ANSIRH and Dr. Justin Diedrich before meeting with FDA officials to brief them on the safety of telemedicine for abortion.

Advancing New Standards in Reproductive Health (ANSIRH) Researchers from ANSIRH were instrumental in providing data to inform the enactment of The College Student Right to Access Act. This legislative bill mandates that medication abortion care be made available at all UC & CSU health centers. Ushma Upadhyay, MPH, PhD’s study estimated the demand for medication abortion among students and explored barriers in seeking abortion care off-campus. Daniel Grossman, MD, and Sarah Raifman, MS led a second study to determine whether student health centers have the capacity to provide medication abortion care on campus. ANSIRH testimony and critical evidence helped pass this bill.

In June 2020, the US Supreme Court struck down an abortion restriction in Louisiana in Medical Services v.

Russo, resting in part on evidence on abortion safety and existing barriers to access from ANSIRH researchers.

Sarah Roberts, DrPH co-led the preparation of a friend-ofthe-court brief summarizing the extensive research on the safety of abortion, the harms of denying people a wanted abortion, and the impacts of the law’s requirement that abortion providers obtain admitting privileges. The brief was signed by more than 50 social scientists based at research universities and institutions throughout the US.

Dr. Sanjay Gupta interviewing Dr. Tracey Woodruff for CNN Special Report, “A Toxic Tale”

Program on Reproductive Health and the Environment (PRHE) PRHE’s mission is to create a healthier environment for human reproduction and development through advancing scientific inquiry, clinical care, and health policies that prevent exposures to harmful chemicals in our environment.

In 2019, Sanjay Gupta, MD, interviewed Tracey Woodruff, PhD, MPD, for a CNN special report focusing on national environmental policies. PRHE continued to make an impact with chemical policy analysis, recommendations to put science and health at the forefront of EPA, and environmental health research despite COVID-19 restrictions.

PRHE manages one cohort of the ECHO study, the largest NIH study to date following children over a 7-year period to examine how harmful chemicals and pollutants influence their health and development. PRHE’s community research coordinators kept the study moving forward with new protocols and assisted patients with food and other essential needs during these difficult times. PRHE also co-developed the Navigation Guide systematic review methodology to better evaluate the quality and strength of the evidence on how hazardous chemicals affect reproductive health.

30 | UCSF Obstetrics, Gynecology & Reproductive Sciences

The Navigation Guide is being used globally across 15 systematic reviews with input from 200 of the world's leading environmental scientists from over 35 countries.

ADVOCACY

Daniel Grossman, MD moderating a panel of national experts on threats and opportunities for abortion access during a Bixby event.

Bixby Center for Global Reproductive Health In this unprecedented year, Bixby members: +R apidly innovated clinical care so patients could safely get compassionate contraception and abortion care +P ioneered new research to understand the impacts of COVID-19 on reproductive health +D eepened the commitment to equity and anti-racism across clinical care, research, training, and advocacy +L aunched a new advocacy fellowship to train members to ensure their evidence and expertise shapes the debate at this critical moment Bixby members worked to bring physicians on board supporting the Justice & Equity in Maternity Care Act which would remove mandated physician supervision for midwives.

Jody Steinauer, MD, PhD submitted the letter from 71 ACOG members to the Assembly Business and Professions Committee. Nicholas Rubashkin, MD, MA, PhD(c), Katherine Brown, MD, MAS, and others testified to the CA Medical Board. Biftu Mengesha, MD, MAS published an op-ed in CalMatters urging the legislature to pass the bill. Stephanie Frazin, MD served as the medical expert in a meeting with staff for a state Senator. The board started the meeting planning to oppose the bill, but flipped to unanimous support after the testimony from our physicians.

“ We had 4 physicians give testimony. The Board moved to oppose and then heard the testimony and then retracted their oppose position and then one by one they all voted to support. It was one of the most emotional things I have experienced in a long time, to hear them retract their opposition after hearing from physicians trained by and working with CNMs. They turned the tide for us, and I am so grateful you pulled that together!”

– Holly Smith of CNMA

Department Report 2020 | 31

DIVERSITY, EQUITY & INCLUSION

Diversity, Equity & Inclusion

Strengthening the Foundation

Promoting equity in health – patient care, research, and education – has been a longstanding value of our Department. The challenging events of this year and the courage and determination displayed by so many has shown us that as a Department we are obligated and called upon to do more and to do better in order to answer this call to justice.

The Vice Chair for Equity, Inclusion, and Structural Change role was the outgrowth of the Department’s priority to cultivate an equitable, inclusive, and liberating professional and clinical environment for patients, learners, staff, and faculty. A task force specifically charged with creating the job description for this role engaged in critical conversations and reflected on the needed structural change in our Department to accomplish our vision. The faculty/staff Vice/Associate Chair dyad will partner with the Chair in leading the strategic planning for our Department’s equity and inclusion efforts. Sara Whetstone, MD, MHS, and LaMisha Hill, PhD, were appointed as interim faculty vice chair and associate chair, respectively.

In 2019, we began the process of strengthening this commitment through a series of facilitated town hall conversations engaging faculty, staff, and learners. Our goal for the town halls was to deepen our understanding of the impact of racism and inequity on our patients and each other, and to work towards eliminating racism in our structures, processes, institutions, communities, and practices.

This difficult year amplified the disparities and the lived experiences of BIPOC communities in our country. Repeated racial traumas layered on top of devastating health inequities during the COVID-19 pandemic further emphasized the need for action. We created a Vice Chair of Equity, Inclusion & Structural Change position and have integrated racial affinity workgroups into our leadership continuing education. Most importantly, we have been challenged to think more critically about privilege and our role in racial equity.

Goals of the Vice Chair role: + Advance health equity in our clinical services and communities + Build a culture and infrastructure that enables a data-driven approach for continuous improvement and accountability around DEI efforts + Promote boundary-spanning and collaborative partnerships and leverage university resources

Sara Whetstone, MD, MHS

LaMisha Hill, PhD

Interim Vice Chair, Equity, Inclusion & Structural Change

Interim Associate Chair, Equity, Inclusion & Structural Change

Leadership Council Affinity Groups The violent acuity of racism in this country requires that our Department prioritize and integrate the work of racial justice as individuals, teams, and systems. While this core responsibility must be shared by all, the fulfillment, burdens, leadership, and implementation of this work is experienced differently by staff and faculty of color as compared to white staff and faculty. In these racial affinity groups for leadership council members, we have created space for reflection, bravery, healing, and action while explicitly exploring the role our racial identities play in the work of racial justice.

+ Support the recruitment, development, and retention of a diverse faculty, staff, and learner community, focusing on the promotion of a supportive and accountable climate

32 | UCSF Obstetrics, Gynecology & Reproductive Sciences

DIVERSITY, EQUITY & INCLUSION

Team members of BWHL at Oakland Black Joy Parade

Black Women’s Health & Livelihood Initiative: Healing & Justice Recognizing the impact of relentless racial trauma, exacerbated by the events of 2020, BWHL led a series of grounding and healing meditation sessions guided by Ramona Laughing Brook Webb. Sessions provided safe space for Black community healing.

In response to COVID-19, BWHL help found Oakland Mutual Aid Collective (OMAC), a grassroots effort organized by intergenerational women of color, to source and distribute basic needs supplies to underserved communities most impacted by the spread of COVID-19 as an act of solidarity with their larger communities.

Nancy Milliken, MD, and Judy Young, MPH, were invited by the Chancellor’s Office to join a group of UCSF leaders to travel with GLIDE’s Center for Social Justice on its 3rd Justice Pilgrimage to Alabama. This journey was transformative in deepening understanding of our nation’s history of racial injustice and terrorism, how this legacy continues to manifest today, and the urgent work needed now at UCSF and in San Francisco to dismantle racism so all individuals and our society can thrive. The UCSF leaders continue to meet weekly with GLIDE leaders to explore our path forward. Judy’s personal story of the Alabama Pilgrimage was highlighted in UCSF Saturday Night Stories, The Courageous: Shining Light on Racial Injustice.

OMAC has distributed

35,400+ surgical disposable masks and

14,450+ reusable cloth masks to Oakland’s most vulnerable communities OMAC continues to raise funds to distribute PPE to meet the needs of community members through the remainder of the year.

Department Report 2020 | 33

DIVERSITY, EQUITY & INCLUSION

PTBi joined with Black Women for Wellness and other advocates in Sacramento to testify for SB 464

California Preterm Birth Initiative: Starting with Equity Funded by Lynne and Marc Benioff, PTBi-CA works handin-hand with several community organizations to create and secure novel policies and programs that serve as interventions to help eliminate the deep racial disparities in preterm birth and improve outcomes for babies born too soon. PTBi-CA starts at the root of the issue by redefining the crisis of premature birth through social justice and racial equity and is committed to anti-racism work.

As a catalytic funder and research partner, we helped our Collective Impact partner Expecting Justice design and launch a pilot program to provide $1000 unconditional monthly income supplements to 150 Black and Pacific Islander women in San Francisco throughout their pregnancy and for the first six months of their baby’s life.

The groundbreaking program made headlines nationwide when San Francisco Mayor London Breed announced its launch September 2020.

Earlier in the year, we celebrated the passage of SB 464 – the California Dignity in Pregnancy and Childbirth Act. Our Policy Core members were among those who had previously testified for the bill in Sacramento alongside its originator, Los Angeles-based “Black Women for Wellness.” SB 464 requires all perinatal healthcare providers in California to undergo implicit bias training to curb the impact of bias on maternal health. The policy will also make California’s data collection of pregnancy-related deaths more robust by including racial and ethnic identity.

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BreOnna (Breezy) Powell, PTBi Community Advisory Board member and part of the team of moms behind the Abundant Birth Project

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Recognizing Uta Landy, PhD After being an integral part of the Bixby community since its inception 21 years ago, Uta Landy, PhD retired from her positions as National Director of the Fellowship in Family Planning and founding Director of the Ryan Residency Training Program.

Under her leadership, The Fellowship in Family Planning was officially recognized

by ABOG and ACGME as the fifth Ob-Gyn subspecialty in Complex Family Planning. + Founder: Kenneth J. Ryan Residency Training Program in Abortion and Family Planning + Director: Fellowship in Family Planning + Author: “Medical Education in Sexual & Reproductive Health”

Remembering Robert M. Jaffe, MD This year marked the passing of the esteemed and beloved Dr. Robert M. Jaffe. Dr. Jaffe was a Professor Emeritus of Obstetrics, Gynecology and Reproductive Sciences and Physiology and served as chair of this department from 1973 to 1995.

Dr. Jaffe was a pioneer in reproductive endocrinology and infertility (REI). He received many honors and awards, including the Distinguished Scientist Award from the American Society of Reproductive Medicine and the Syndey H. Ingbar Distinguished Service Award for numerous contributions to the Endocrine Society. He was former President of the Endocrine Society’s Hormone Foundation, a public education affiliate, later renamed the Hormone Health Network, and was an elected member of the Institute of Medicine (now the National Academy of Medicine) and the Association of American Physicians.

Dr. Jaffe’s vision for the Department when he was recruited to UCSF from the University of Michigan was to build an academic obstetrics and gynecology department with full clinical services and a robust research program. He established the Reproductive Endocrinology Center (now called the Center for Reproductive Sciences) and over the years mentored several generations of physicians and physician scientists who became leaders in REI. He also led the NIH Reproductive Scientist Development Program (housed at UCSF) for over 25 years, which has enabled OBGYNsin-training to have mentored research in basic and translational science with commitments from their institutions to support them as faculty. Dr. Jaffe, along with Dr. Samuel Yen, co-edited Yen and Jaffe’s Reproductive Endocrinology - a key resource for learners and teachers in the field, now in its 8th edition.

Dr. Jaffe will be dearly missed by his many friends and colleagues at UCSF and throughout the world.

– Talmadge E. King Jr., MD Dean, UCSF School of Medicine Vice Chancellor – Medical Affairs

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How to Make a Gift: Help Advance Women’s Heath: Make a Gift of Support Philanthropic contributions from patients and friends help drive our team at the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences to make even greater strides in developing new treatments and cures that make a difference. Your giving also empowers us to continue attracting and educating the brightest young minds in science. Join us today to ensure that our department remains a place where patients can count on the very best care. Together, we will make a difference in the lives of women in the Bay Area and worldwide.

+ By Mail: Mail a check payable to UCSF Foundation to the address below. Please include instructions on the memo line or attach a note telling us how you would like to designate your gift (e.g.

Women’s Health or name a specific program or faculty member).

UCSF Foundation PO Box 45339 San Francisco, CA 94145-0339 + Online: Make a gift online using a major credit card at makeagift.ucsf.edu/womenshealth + By Phone: Please call (877) 499-UCSF (877-4998273) to give by credit card over the phone. + Payroll Deduction (for UCSF employees): Learn more about the Employee Giving Program at giving.ucsf.edu/employee-giving Please contact Dawn Mitchell at 510-502-3417 or Dawn.Mitchell@ucsf.edu with questions or for information on other giving options, including gifts of stock, wire transfers, and planned gifts.

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