BIDMC OB/GYN Annual Report 2010 by Verus Design

OBSTETRICS AND GYNECOLOGY A GLOBAL PERSPECTIVE

A teaching hospital of Harvard Medical School

2010

Committed to Women’s Health

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A teaching hospital of Harvard Medical School

CONT ENT S Chair Message Who We Are

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Beth Israel Deaconess Medical Center History

Education Fellowship Training Program in Maternal-Fetal Medicine Fellowship Training Program in Reproductive Endocrinology & Infertility Fellowship Training Program in Urogynecology Reconstructive Pelvic Surgery Residency Training Program in Obstetrics & Gynecology Medical Student Education

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Clinical Maternal-Fetal Medicine Gynecologic Oncology Family Planning Reproductive Endocrinology & Infertility Minimally Invasive Surgery Urogynecology and Reconstructive Pelvic Surgery Clinical Genetics Neonatology Patient Safety and Quality Improvement Nursing and Social Work Procedure Statistics

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Research Program in Epidemiologic Research Preeclampsia and Hypertensive Disorders of Pregnancy Nutrition During Pregnancy Prenatal Diagnosis with Obstetric MRI Reproductive Endocrinology Research Ovarian Aging Stem Cell Research 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 Urogynecology and Pelvic Pain Medical Education Research

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Social Mission Community Health Consortium Global Womenâ&#x20AC;&#x2122;s Health Program Service-based Learning and Research Projects Parent Connection

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In and Around Boston Program Graduates 2010 - Where Are They Now

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CHAIRâ&#x20AC;&#x2122;S ME SSAGE

Beth Israel Deaconess Medical Center (BIDMC), a flagship teaching hospital of Harvard Medical School (HMS), is known for its exemplary patient care, leading-edge clinical and basic science research, and outstanding educational programs. As a major teaching hospital of HMS, we teach women's health to a third of HMS students. The Department of Obstetrics and Gynecology offers a residency program in obstetrics and gynecology to twenty residents, admitting 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. Our distinctive blend of academic rigor, combined with empathic and individualized care, makes us unique. We offer fellowship programs in Maternal-Fetal Medicine and in Reproductive Endocrinology and Infertility. A fellowship in Urogynecology is offered in conjunction with the Mount Auburn Hospital.

John Yeh, MD Chair of Obstetrics and Gynecology

Every clinical division of the Department conducts research, with projects ranging from basic laboratory research to outcomes research to population based studies. Many of the projects are interdisciplinary and involve collaborations with our colleagues at the BIDMC, Harvard Medical School, Harvard School of Public Health, MIT and other Boston and Cambridge based institutions. We believe that it takes a team effort to deliver safe and excellent health care. Our extraordinary group of attending physicians, fellows, residents, and medical students work in partnership with our worldrenowned nurses to care for patients. A tradition of service to community is at the core of both of our founding hospitals and remains an important part of our mission. Our diverse patient population hails from various ethnic and socioeconomic backgrounds and we are committed to eliminating disparities in access to care. We take great pride in providing innovative care, delivered with a personal touch.

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Hope Ricciotti, MD Vice 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 health care to a diverse community of women. Our services—delivered with a unique blend of patient-centered care and state of the art medical intervention—range from preventive women’s health care to minimally invasive and robotic gynecologic surgery to general gynecologic cancer care for women. While we operate in one of the most competitive teaching hospitals in the country, we 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, and consistently ranks among the top four in National Institutes of Health funding among independent hospitals nationwide, with funding totals 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 621 licensed beds, including 419 medical/surgical beds, 77 critical care beds and 60 OB/GYN beds. 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 the best and brightest students. 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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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

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 1995 – The Deaconess Hospital 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 livedonor 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 2002 – BIDMC becomes the only clinical trial site in Boston to test a new therapeutic AIDS vaccine on normal, healthy adults 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 receives JCAHO 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 to be recognized for their leadership and innovation in quality, safety and commitment to patient care as an American Hospital Association-McKesson Quest for Quality Prize® finalist. 2010 – BIDMC has been 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

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A major mission of our department is the training of medical students, residents and fellows.They are our future and this training is integral to our daily activities. â&#x20AC;&#x201D; John Yeh, MD Chair of Obstetrics and Gynecology

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FELLOWSHIP TRAINING PROGRAM IN MATERNAL-FETAL MEDICINE Kee-Hak Lim, MD Fellowship Director Sarosh Rana, MD Associate Fellowship Director The Maternal-Fetal Medicine Fellowship Training Program is an American Board of Obstetrics and Gynecology approved 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 American Board of Obstetrics and Gynecology (ABOG) Division of MFM to obtain Subspecialty Board Certification.

Kee-Hak Lim, MD Fellowship Director Maternal-Fetal Medicine

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 approved 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 assist fellows in developing a solid foundation of clinical skill while achieving a specific clinical area of expertise. The Assisted Reproductive Technology program is among the largest in the US and the sizable patient volume provides an opportunity for fellows to become involved in outcomes-oriented clinical research.

Alan Penzias, MD Fellowship Director Reproductive Endocrinology and Infertility

FELLOWSHIP TRAINING PROGRAM IN UROGYNECOLOGY AND RECONSTRUCTIVE PELVIC SURGERY Eman Elkadry, MD Fellowship Director The Fellowship Program in Urogynecology at Mt. Auburn Hospital is an American Board of Obstetrics and Gynecology approved, three-year clinical and research program. The educational objective is to train urogynecology and reconstructive pelvic surgeons who are capable of improving the quality of life of women with pelvic floor dysfunction. The program consists of outpatient urogynecologic evaluation, office-based procedures, teaching, research, and a comprehensive approach to surgical management. Surgical training includes laparoscopic, vaginal and abdominal procedures.

Eman Elkadry, MD Fellowship Director Urogynecology and Reconstructive Pelvic Surgery

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RESIDENCY TRAINING PROGRAM IN OBSTETRICS AND GYNECOLOGY Hope A. Ricciotti, MD Program Director 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. The unique blend of academic rigor and empathic, individualized care is what makes us unique. Our principle training site is BIDMC, which is adjacent to the Harvard Medical School campus in the Longwood Medical area. Several innovative teaching methodologies such as simulation, standardized patients, service-based learning, and off-site surgical rotations complement the traditional curriculum. Academic research projects are required and supported through call-free elective time, expert scientific consultation on study design, IRB approval and statistical analysis, and funding for project expenses.

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. â&#x20AC;&#x201D; Hope Ricciotti, MD, Residency Program Director

Susan Kilbride Medical Education Manager

ADMINISTRATIVE CHIEF RESIDENT Each year the faculty and resident select one chief resident to serve as Administrative Chief Resident.This honor is given to the resident who shows leadership, professionalism, clinical excellence, and interpersonal skills that allow them to lead the residency program, serve as liaison with the faculty, and help develop innovative teaching programs. Dr. Brett Young served in 2009-2010 academic year, and Dr. Kathryn Humm is serving in the 2010-2011 academic year.

Kathryn Humm, MD Administrative Chief Resident

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MEDICAL STUDENT EDUCATION Hope Ricciotti, MD Clerkship Director K. Meredith Atkins, MD Associate Clerkship Director L. Renata Vicari Clerkship Coordinator The Department of Obstetrics and Gynecology at BIDMC works to ensure that all Harvard Medical School students are prepared for the clinical and academic challenges of womenâ&#x20AC;&#x2122;s health by incorporating OB/GYN and womenâ&#x20AC;&#x2122;s health across the four-year Harvard Medical School Curriculum.

K. Meredith Atkins, MD Associate Clerkship Director

The Department offers a Core OB/GYN Clerkship experience for Harvard medical students placed in the BIDMC Primary Clinical Experience, clinical training for third-year Harvard medical students. This experience includes time on inpatient services, as well as a week in the ambulatory setting in both generalist and subspecialty practices. This sampling of OB/GYN experiences provides students with a sense of the many faces of modern obstetrics and gynecology. The obstetrics experience includes participation in normal deliveries, cesarean deliveries, high-risk obstetrics, and high-risk antepartum care. The gynecologic experience includes participation in general gynecology, minimally invasive surgery, gynecologic oncology, and urogynecologic surgery. OB/GYN students at the BIDMC are provided maximal exposure to core teaching faculty, a variety of teaching settings, and a diverse patient population. Each clerkship student is paired with a general OB/GYN faculty preceptor for a weekly general OB/GYN ambulatory experience. Fourth-year medical students from Harvard Medical School and selected students from outside institutions may take advanced electives, including Maternal-Fetal Medicine, Gynecologic Oncology, Women's Health in Urban Community Settings, and Reproductive Endocrinology and Infertility. Physician educators from the department are continually evaluating new teaching methods, tools, and technology in order to improve medical education. Projects include evaluation of student interaction with a virtual obstetrical patient; evaluation of the Resident as Teacher program; creation and evaluation of simulation programs in gynecology and obstetrics; and creation and evaluation of residency training simulation in minimally invasive surgical methods.

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Our mission is to enhance and improve obstetrical care delivered to pregnant women with a wide range of complex issues. â&#x20AC;&#x201D; Carolyn Zelop, MD, Division Director

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MATERNAL-FETAL FAMILY PLANNINGM ED ICINE Carolyn Zelop, MD Division Director EDUCATION EDUCATION The family planning curriculum provides residents and students The Medicine offers an intensive withMaternal-Fetal a wide range of exposureDivision to family planning counseling and educational environment for fellows, residents, medical program skills. Training in family planning in the BIDMC residency students, and attending staff.year Second andathird-year takes place during the PGY2 during five-weekresidents Family learn fromrotation. workingThe as part a teamplanning with theresident perinatal fellow Planning PGY2offamily rotates and the high-risk obstetricalConsult Chief Resident all academic through the Contraceptive clinic andonPERFORMS[?] and patient care matters.including Frequentmanual clinicalvacuum interchanges occurand ambulatory procedures aspiration with neonatology, genetics, radiology, renal D&E anesthesiology, cases. The division is committed to training OB/GYN medicine, endocrinology, hematology.asThe residents in abortion andand contraception, wellDivision as cultivating sponsors a weekly Perinatal Conference,health, a caseresearch, conference interests in public health, international and that brings faculty to optimally health caretogether policy as multidisciplinary integral components of family planning. The treat women with challenging obstetrical issues. Teaching in full range of contraceptive options, including hormonal, barrier, the clinical is supplemented by provided monthly resident implant andsetting intrauterine methods are by our residents didactic in these series clinics.presentations. The division-sponsored lecture series covers a wide range of topics and emphasizes the epidemiological CLINICAL CARE current practice and new technologies in evidence underlying The Division of Maternal-Fetal Medicine provides high-risk fertility regulation. obstetrical care to patients who have been referred from all CLINICAL CARE Approximately 40% of deliveries at Beth over New England. The clinical services of theCenter Division of Family Planning are focused Israel Deaconess Medical involve maternal-fetal on providing comprehensive, safe, and confidential medicine specialists. Maternal-Fetal Medicine facultyreproductive offer healthcare.ultrasound Through our division women havediagnoses, full accessand to high-level examinations, prenatal family planning education healthcare services, including genetic counseling servicesand at health facilities throughout pregnancy options abortion Massachusetts. Overcounseling, the last decade, theservices Division(medical has fostered abortion D&E), and comprehensive contraception close andand productive relationships with community-based counseling. A Contraceptive Consult outstanding clinic, under quality the direction OB/GYNs, and has strived to provide care of Dr. Haider, caters patient to women with chronic conditions or while enhancing convenience andmedical satisfaction. complex psychosocial situations. In addition, a Family Planning Ambulatory Procedure clinic under the direction ofplane, Dr. Haider Over 150 women were transported by helicopter, or provides management earlyand miscarriage, elective termination ambulance to BIDMC’s of Labor Delivery unit for acute care and year. medical the ambulatory last Ourabortion maternalintransport programsetting. supports hospitals throughout New England and has transported patients from as far away as Bermuda. Patients requiring high-level maternal-fetal medicine services and/or a level III neonatal intensive care nursery constitute the majority of transport cases.

Carolyn Zelop, MD Division Director

DIABETES AND PREGNANCY PROGRAM The Diabetes and Pregnancy Program is a joint collaborative service of Joslin Diabetes Clinic and BIDMC Maternal-Fetal Medicine, and offers specialized, state-ofthe-art diabetes care from a multidisciplinary team of providers to women with diabetes, including those who develop diabetes during pregnancy.

OB ULTRASOUND Our Antenatal Testing unit offers four rooms in our inpatient medical center devoted to obstetrical ultrasound for monitoring of inpatient and outpatient high-risk and postdate pregnancies. Our outpatient perinatal center, a clinical training site, performed over 10,000 ultrasound examinations last year.The Radiology Department at BIDMC devotes six rooms in the Shapiro Clinical Center to OB/GYN ultrasound with top-of-the-line 2D and 3D Faculty also collaborate with other related programs, such as imaging with real-time capability. Volume is the Advanced Fetal Care Center at Children’s Hospital of approximately 16,000 on-site OB/GYN Boston. This collaboration expands treatment options to examinations annually. Procedures include include invasive antenatal and peripartum procedures. These hysterosalpingography, sonohysterography, clinical advances help fetuses affected by highly debilitating amniocentesis, pelvic drainages, and congenital abnormalities and offer hope to their families. — Sadia Haider MD, MPH, Division Director villous sampling. guidance for chorionic

The Division of Family Planning provides access to comprehensive reproductive health care to women regardless of race/ethnicity, socioeconomic status, or citizenship.

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GYNECOLOGIC ONCOL OGY Christopher Awtrey, MD Interim Division Director EDUCATION EDUCATION Two residents rotate on the oncology service along with thirdTwo rotate on the oncology along withsubinterns thirdyear residents Harvard Medical School studentsservice and fourth-year year Harvard Medical School studentssponsors and fourth-year in gynecologic oncology. The division a weeklysubinterns in gynecologic oncology. The division a weekly Gynecologic Oncology Tumor Board, asponsors multidisciplinary Gynecologic OncologybyTumor Board, a multidisciplinary conference attended members of the gynecologic oncology conference attended by members of the gynecologic oncology service as well as pathologists, radiologists, medical oncologists, service as welltherapists, as pathologists, radiologists, medicalclinical oncologists, and radiation to discuss every patient's course and radiation to division discuss every patient'saclinical course treatmenttherapists, options. The also sponsors gynecologic and treatment options. Themonthly division research also sponsors a gynecologic oncology journal club and meetings. Residents oncology journalforclub and monthly researchatmeetings. are responsible daily rounds, assistance surgical Residents are responsible daily rounds, assistance surgical procedures, andfor presentation of patients at at Tumor Board. procedures, and presentation of patients at Tumor Board. Residents experience the full breadth of cancer care and risk Residents experience the full breadthgenetic of cancer care andsessions risk reduction by participating in cancer counseling reduction by participating in cancer genetic counseling sessions and medical chemotherapy ambulatory management. Clinical and medical chemotherapy ambulatory management. education also includes simulated surgical practice andClinical education alsoinincludes simulated surgical practice and where participation the colposcopy/laser ambulatory clinics, participation in the colposcopy/laser ambulatory clinics, where they are taught principles of colposcopy and the place of laser they are taught the principles of colposcopy and the place of surgery in gynecology. laser surgery in gynecology. CLINICAL CARE CLINICAL The DivisionCARE of Gynecologic Oncology works in a multidisciplinary The Division Gynecologic Oncology worksoncologists, in a fashion with of medical oncologists, radiation and multidisciplinary fashionoptimal with medical oncologists, radiation pathologists to provide treatment for women with cancer oncologists, and pathologists to provideofoptimal for of the reproductive tract. The spectrum offeredtreatment therapeutic women with cancer of the(encompassing reproductive tract. Theand spectrum of options includes surgery radical ultra-radical offered therapeutic options includes surgery (encompassing procedures), minimally invasive surgery, robotic surgery, radical andchemotherapy, ultra-radical procedures), minimally invasive surgery, radiation, and biological therapies. A clinical robotic radiation, chemotherapy, biological outreachsurgery, program is currently in operationand at Mount Auburn therapies. clinical of outreach currently in operation Hospital. AAnumber clinicalprogram trials areisopen to patient accrual at Mount Auburn Hospital. A number of clinical trials are open through the Dana-Farber/Harvard Cancer Center. The divisiontois patient accrual through the Dana-Farber/Harvard Center. also a participating institution of the Gynecologic Cancer Oncology The division is also aworks participating institution of the Group. The division in close collaboration withGynecologic Dr. Stephen Oncology The division works in close collaboration Cannistra,Group. MD, a nationally recognized medical oncologist with with Dr. Stephen Cannistra, MD, a nationally recognized medical particular expertise in ovarian cancer. oncologist with particular expertise in ovarian cancer.

Christopher Awtrey, MD Interim Division Director

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

â&#x20AC;&#x201D; Christopher Awtrey, MD, Interim Division Director â&#x20AC;&#x201D; Christopher Awtrey, MD, Interim Division Director

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COLPOSCOPY AND LASER SURGERY UNIT Elizabeth Buechler, MD Director

FAMILY PLANNING EDUCATION The family planning curriculum provides residents and students with a wide range of exposure to family planning counseling and skills. Training in family planning in the BIDMC residency program takes place during the PGY2 year during a five-week Family Planning rotation. The PGY2 family planning resident rotates through the Contraceptive Consult clinic and PERFORMS[?] ambulatory procedures including manual vacuum aspiration and D&E cases. The division is committed to training OB/GYN residents in abortion and contraception, as well as cultivating interests in public health, international health, research, and health care policy as integral components of family planning. The full range of contraceptive options, including hormonal, barrier, implant and intrauterine methods are provided by our residents in these clinics. The division-sponsored 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 Division of Family Planning are focused on providing comprehensive, safe, and confidential reproductive healthcare. Through our division 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. A Contraceptive Consult clinic, under the direction of Dr. Haider, caters to women with chronic medical conditions or complex psychosocial situations. In addition, a Family Planning Ambulatory Procedure clinic under the direction of Dr. Haider provides management of early miscarriage, elective termination and medical abortion in the ambulatory setting.

The Colposcopy, Laser and Electrosurgery Clinic is a referral clinic for patients with benign and preinvasive disease involving the vulva, vagina, and cervix. Most patients are referred for the evaluation of abnormal Pap smears.The Large Loop Excision of the Transformation Zone (LLETZ) or carbon dioxide laser is used in most cases as the treatment modality, both as an outpatient procedure and in the operating room. Patients who have human papilloma virus and have not responded to the usual modes of therapy are also referred for evaluation and treatment. Patients with abnormal smears during pregnancy are followed for evidence of developing invasive disease. Laser ablation, cervical conization, and evaporation of condyloma are performed using the carbon dioxide laser.

The Division of Family Planning provides access to comprehensive reproductive health care to women regardless of race/ethnicity, socioeconomic status, or citizenship. â&#x20AC;&#x201D; Sadia Haider MD, MPH, Division Director

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GYNECOLOGIC ONCOL OGY EDUCATION Two residents rotate on the oncology service along with thirdyear Harvard Medical School students and fourth-year subinterns 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, to discuss every patient's clinical course and treatment options. The division also sponsors a gynecologic oncology journal club and monthly research meetings. Residents are responsible for daily rounds, assistance at surgical procedures, and presentation of patients at Tumor Board. Residents experience the 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. CLINICAL CARE The Division of Gynecologic Oncology works in a multidisciplinary fashion with medical oncologists, radiation oncologists, and pathologists to provide optimal treatment for women with cancer of the reproductive tract. The spectrum of offered therapeutic options includes surgery (encompassing radical and ultra-radical procedures), minimally invasive surgery, robotic surgery, radiation, chemotherapy, and biological therapies. A clinical outreach program is currently in operation at Mount Auburn 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 Gynecologic Oncology Group. The division works in close collaboration with Dr. Stephen Cannistra, MD, a nationally recognized medical oncologist with particular expertise in ovarian cancer.

The Division of Gynecologic Oncology is dedicated to superior clinical care, teaching, and research for women with cancer of the reproductive tract. â&#x20AC;&#x201D; Christopher Awtrey, MD, Interim Division Director

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FAMILY PLANNING Sadia Haider MD, MPH Section Head

EDUCATION The family planning curriculum provides residents and students with a wide range of exposure to family planning counseling and skills. Training in family planning in the BIDMC residency program takes place during the PGY2 year during a five-week Family Planning rotation. The PGY2 family planning resident rotates through the Contraceptive Consult clinic and performs ambulatory procedures including manual vacuum aspiration and D&E cases. The section is committed to training OB/GYN residents in abortion and contraception, as well as cultivating interests in public health, international health, research, and health care policy as integral components of family planning. The full range of contraceptive options, including hormonal, barrier, implant and intrauterine methods are provided by our residents in these clinics. The section-sponsored lecture series covers a wide range of topics and emphasizes the epidemiological evidence underlying current practice and new technologies in fertility regulation.

Sadia Haider MD, MPH Section Head

CLINICAL CARE The clinical services of the Section of Family Planning are focused on providing comprehensive, safe, and confidential reproductive healthcare. Through our section 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. A Contraceptive Consult clinic caters to women with chronic medical conditions or complex psychosocial situations. In addition, a Family Planning Ambulatory Procedure clinic provides management of early miscarriage, elective termination

The Section of Family Planning provides access to comprehensive reproductive health care to women regardless of race/ethnicity, socioeconomic status, or citizenship. â&#x20AC;&#x201D; Sadia Haider MD, MPH, Section Head

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RE PRODUCTIV E ENDOCRINOL OGY AND INFERT ILITY Kim Thornton, MD Division Director EDUCATION The Division of Reproductive Endocrinology and Infertility (REI) has three reproductive endocrinology fellows who are actively involved in clinical and research endeavors. The PGY2 REI rotation is a five-week rotation during which time the resident rotates with the clinical fellow on the service. First-year residents participate in reproductive endocrine clinics during their ambulatory rotation. Residents and fellows participate in all inhospital medical management, surgical care, and in ambulatory patient care. Residents are encouraged to become involved in clinical or basic research projects. The division sponsors weekly and monthly conferences and a monthly lecture held at the Boston IVF clinical site featuring invited leaders in the field. The division also offers Harvard medical students an advanced clinical elective in Reproductive Endocrinology and Infertility. This course is designed to provide fourth-year medical students with an indepth working knowledge of the reproductive endocrine and infertility problems that face our patients.

The mission of the Division of Reproductive Endocrinology and Infertility (REI) is to provide a broad spectrum of investigative and therapeutic modalities for the full range of reproductive endocrine and fertility disorders.The division provides cutting-edge research and education for future physicians and the community. â&#x20AC;&#x201D; Kim Thornton, MD, Division Director

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Kim Thornton, MD Division Director

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CLINICAL CARE Division physicians include ten board-certified reproductive endocrinologists. The division offers a consultative reproductive endocrine clinic under the direction of Chairman John Yeh at the BIDMC Shapiro Center. This clinic provides the opportunity for residents and the clinical reproductive endocrine fellow to evaluate and manage reproductive aged women with complex reproductive endocrine disorders such as polycystic ovarian syndrome, ovarian failure as well as a myriad of other reproductive endocrine conditions. In addition, 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 Division has assisted in the birth of over 20,000 babies. Clinical services include ovulation induction and intrauterine insemination, in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), oocyte and embryo freezing, fertility preservation (oocyte and sperm cryopreservation) blastocyst culture, preimplantation genetic diagnosis (PGD), egg donation, and gestational carrier programs. The Division also offers a clinical program in fertility preservation for patients undergoing cancer treatment. Affiliated sites include Waltham, a Boston site (located four blocks from BIDMC), a site in Quincy, and satellite clinics throughout New England. Surgical procedures performed include diagnostic and operative endoscopy (laparoscopy/hysteroscopy) for developmental and acquired abnormalities of the reproductive tract. Major surgical procedures include surgery to correct developmental uterine anomalies, uterine fibroids, and severe endometriosis not amenable to endoscopic surgery. Recognizing the impact that stress has on fertility, a mind-bodymedicine program is offered utilizing a treatment approach that complements conventional medicine. The Mind/Body medicine program includes a wide range of specific treatment methods, including acupuncture, mind/body techniques, and yoga. In addition the Domar Center for Complementary Medicine also offers a full range of mental health counseling services .

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MINIMALLY INVASIVE S URGERY Hye-Chun Hur, MD Section Head EDUCATION 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 welltrained gynecologists by the end of the four-year curriculum. The caseload is augmented by outside rotations at Mount Auburn Hospital, Milton Hospital, and Beverly 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 month, bedside and operating theater teaching is carried out on all cases. Weekly staff and resident conferences are held to enhance evidence-based care. Monthly educational surgical committee meetings are held to discuss surgical planning for resident patients. A third-year resident works with the minimally invasive gynecology team in the inpatient operating room as well as in the ambulatory surgical setting. The program conducts a monthly skills session in the simulation laboratory, and the faculty teach in the resident didactic series on a monthly basis. Biannual resident workshops offer an intensive three-hour simulation 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 for the residency program and offers the residents the opportunity to be FLS-accredited prior to completing their OB/GYN training.

CLINICAL CARE The Minimally Invasive Surgery program provides patientcentered care with state-of-the-art equipment. Our minimally invasive gynecologic surgical specialists are fellowship-trained to perform advanced gynecologic surgeries using the latest techniques with a minimally invasive and robotic approach. 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.

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Hye-Chun Hur, MD Section Head

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The Program in Minimally Invasive Surgery is dedicated to advancing clinical care, research and education in this rapidly emerging field. â&#x20AC;&#x201D; Hye-Chun Hur, MD, Section Head

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UROGYNE COL OGY AND RE CONS TRUCTIVE PE LVIC S URGERY Janet Li, MD Section Head

Janet Li, MD Section Head

DIVISION OF UROGYNECOLOGY AT MOUNT AUBURN HOSPITAL Cambridge, MA Peter L. Rosenblatt, MD Division Director The Division at Mount Auburn is a large urogynecology and reconstructive pelvic surgery center in Massachusetts and is well established throughout 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.

EDUCATION The Section provides clinical instruction in the field of urogynecology and reconstructive pelvic surgery to medical students, residents, and clinical fellows. 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, a PGY3 gynecology resident rotates at Mount Auburn on the Urogynecology service for a ten week immersive experience. Curricula emphasize minimally invasive urogynecologic surgery, as well as an ambulatory experience that includes office evaluations and treatment for pelvic floor disorders.

CLINICAL CARE By offering a variety of treatment options for any specific condition, the section empowers women with the ability to actively participate in the decision-making aspect of their care. Clinical services include urodynamic testing, pelvic floor rehabilitation, and behavioral modification. A variety of approaches to pelvic floor reconstruction and treatment of incontinence include abdominal, vaginal, laparoscopic, and robotic. Surgeries include minimally invasive mid-urethral slings and a variety of vaginal, laparoscopic and robotic procedures for pelvic floor prolapse, including paravaginal cystocele repair, uterosacral ligament suspension, sacrocolpopexy and sacrocervicopexy, which is a popular alternative to hysterectomy for uterine prolapse, and graft-augmented repairs. In addition, the section performs laparoscopic and robotic supracervical hysterectomy and laparoscopic and robotic myomectomy.

The Section of Urogynecology and Reconstructive Pelvic Surgery provides comprehensive evaluation and management of female pelvic floor disorders, including urinary incontinence and pelvic organ prolapse. â&#x20AC;&#x201D; Janet Li, MD, Section Head

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CLINICAL GENETICS Catherine Bearce Nowak, MD Medical Director Lauren Briere, MS Licensed Genetic Counselor Karen Marchand, MS Licensed Genetic Counselor

EDUCATION Bi-monthly interdisciplinary rounds are held to discuss complex cases and fetal anomalies. The genetic counselors participate in OB/GYN resident education. Medical students, residents, and genetic counseling students participate in ambulatory consults. CLINICAL CARE Genetic counseling and evaluation is offered to individuals and families concerned about an increased risk for a pregnancy to be affected with a genetic condition, a birth defect, or mental retardation. 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. The goal of genetic counseling is to provide accurate information to enable individuals and families to make their own fully informed decisions. In the event of abnormal results, ongoing supportive counseling is provided, often in collaboration with the social work department. BIDMC offers prenatal diagnostic services including chorionic villus sampling, amniocentesis, fetal imaging by ultrasound and MRI, cytogenetic, biochemical, and molecular genetic analysis, and fetal blood testing. The program works closely with other divisions and departments, including Maternal-Fetal Medicine, Radiology, Cytogenetics, and Pathology to guide patient care and assure that results are accurately conveyed to both patients and providers.

The Clinical Genetics Program provides compassionate genetic counseling for families with concerns about genetic conditions and/or birth defects.

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NE ONATOLOGY DeWayne Pursley, MD, MPH Chair EDUCATION BIDMC is one of four clinical training sites for the ACGMEapproved 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. Currently, six of the eighteen fellows are receiving research mentoring from BIDMC neonatology faculty. Each year, the department of neonatology offers an American Academic of Pediatrics-approved training course in neonatal resuscitation to all obstetric 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 Childrenâ&#x20AC;&#x2122;s Hospital Boston, 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.

COCHRAN NEWBORN SERVICE The newborn nursery is staffed by the departmentâ&#x20AC;&#x2122;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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DeWayne Pursley, MD, MPH Chair

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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 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. Together with attending 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. Neonatalperinatal 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. â&#x20AC;&#x201D; DeWayne Pursley, MD, MPH, Neonatologist-in-Chief

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PAT IENT SAFET Y AND QUALITY IMPROVEM ENT Toni Golen, MD, Director of Labor and Delivery and Patient Safety Programs Mark Kobelin, MD, Chairperson, QA Committee Susan Mann, MD, Director of Team Training EDUCATION The OB/GYN Patient Safety and Quality Improvement process 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 â&#x20AC;&#x153;Morbidity and Mortalityâ&#x20AC;? rounds of important cases, with faculty leaders present to lead discussion. Once yearly, all attendings and house staff complete an Obstetrics Simulation exercise that is designed to replicate lowfrequency, high-risk events such as massive hemorrhage and eclampsia. Data on knowledge before and after the exercise are collected and significant improvement in knowledge is demonstrated as a result of the Simulation.

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Toni Golen, MD Director of Labor and Delivery and Patient Safety Programs

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CLINICAL CARE Patient safety is one of the greatest challenges facing our health care 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 health care is our over-arching 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. The OB/GYN Quality Assurance Committee performs case review. 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 nursing, representing general obstetrics and gynecology as well as the spectrum of subspecialties. Members of the quality assurance committee serve for a minimum of two years and render the commitment needed to achieve the goals of monitoring and enhancing quality patient care. While the Quality Assurance Committee assesses individual cases, the department also has Leadership Committees that develop systems for implementation of process improvement on a broader scale. Some examples of recent process improvements that have been put into action are universal deep vein thrombosis prophylaxis for all Obstetric patients undergoing Cesarean delivery, optimization of timing of surgical antibiotic prophylaxis, multi-dose regimen of Methotrexate for the treatment of ectopic pregnancy, the integration of LEAN modalities into 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 health care 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 health care 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 health care 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 health care organizations.

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NURSING AND S OCIAL WORK NURSING The nurses in OB/GYN at BIDMC are committed to caring for women and the full continuum of the lifecycle health care needs. The nurses in the Obstetrical Division care for patients in the labor and delivery, high-risk antepartum, postpartum, newborn nursery, and antepartum testing units. 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, full inpatient care, including management of complex gynecologic surgical and oncology patients.

SOCIAL WORK Barbara Sarnoff Lee, RN, LICSW Director The OB/GYN Social Work program 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 provides counseling and advocacy for those whose lives have been touched by community violence. Center staff are on call twenty-four hours a day, seven days a week to provide guidance and resource information to patients. Additionally, the Department of Social Work 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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The patients come to the BIDMC for the doctors, but when they go home, they remember the nurses. â&#x20AC;&#x201D; Barbara Stabile, RN, Nurse Manager, Labor and Delivery

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PROCE D URE STATIS TICS

BIDMC Gynecology Service July 1, 2009 - June 30, 2010 Surgery Type

Number

Abdominal Hysterectomies

312

Vaginal Hysterectomies

Laparoscopic Hysterectomies, total and vaginal

149

Operative Laparoscopic Procedures

352

Major surgical procedures for gynecologic cancer

Surgery for urinary incontinence and reconstructive pelvic procedures

Percent of gynecology care with resident participation

95%

BIDMC Obstetrical Service July 1, 2009 - June 30, 2010 Surgery Type

Number

Total Deliveries

4,410

Cesarean Deliveries - Total

1,666

Cesarean Deliveries - Primary

1,008

Cesarean Delivery Rate

Vaginal Birth After Cesarean Delivery

Forceps Deliveries

Vacuum Deliveries

Multifetal Delivered Vaginally

Low Birth Weight Infants (500-2500 Grams)

501

Percent of obstetric care with resident participation

80%

Affiliated Institutions Resident Gynecologic Surgery July 1, 2009 - June 30, 2010 Surgery Type

Number

Abdominal Hysterectomies

Vaginal Hysterectomies

Laparoscopic Hysterectomies, total and vaginal

Operative Laparoscopic Procedures

Major surgical procedures for gynecologic cancer

Surgery for urinary incontinence and reconstructive pelvic procedures

232

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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.

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RE SEARCH PROGRAM IN EPIDEMIOLOGIC RESEARCH Michele Hacker, ScD Director 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, the Program 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 Michele Hacker, ScD valued by our Director department. Residents and fellows have conducted research projects that have led to presentations at national meetings and publications in peer-reviewed journals. Topics include the evaluation of a rapid intrapartum test for Group B Streptococcus, risk of ectopic pregnancy after day-3 compared with day-5 embryo transfer, timing of antibiotics for cesarean delivery, post-operative pain after surgical treatment for prolapse, and simulation training for minimally invasive surgery and obstetric complications. Our interdepartmental collaborative efforts have advanced research and increased our understanding of disease and the delivery of health care. 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 womenâ&#x20AC;&#x2122;s health internationally. One of our former chief residents recently completed research on sexual violence and unintended pregnancies in the Democratic Republic of the Congo and continues to work in the area with the Harvard Humanitarian Initiative. Another resident is currently investigating knowledge of and attitudes towards cervical cancer and HPV vaccination among women in Zambia. Ongoing faculty research includes studies on maternal morbidity and contraceptive use by couples in Afghanistan. Our faculty, fellows, residents, and students are guided by the expertise of our department epidemiologist, Dr. Michele Hacker.

PREECLAMPSIA AND HYPERTENSIVE DISORDERS OF PREGNANCY Major breakthroughs in preeclampsia research have resulted from a 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. It complicates 5% of all pregnancies, and severe preeclampsia is one of the worldâ&#x20AC;&#x2122;s 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 a molecule that naturally occurs in the placenta, called sFlt-1, may cause the maternal syndrome when it is overabundant. Further research, in a collaboration with The Hospital for Sick Children in Toronto, discovered that a second protein, called soluble endoglin, when combined with sFlt-1, escalates preeclampsia to a severe, life-threatening state. The 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

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drug-based therapies for preeclampsia may still be years away, researchers are optimistic. Other preeclampsia research includes an NIH-funded investigation to evaluate the pathogenesis of the excess cardiovascular disease noted in women with a history of preeclampsia. The investigators are working on non-invasive techniques to evaluate pregnancy in an animal model of preeclampsia. A BIDMC OB/GYN researcher is also coleading 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 hypertension in pregnancy. This research program is directed by renal specialist S. Ananth Karumanchi, MD, Howard Hughes Medical Institute Investigator, who collaborates with Maternal-Fetal Medicine specialists Dr. Sarosh Rana and Dr. Kee-Hak Lim.

NUTRITION DURING PREGNANCY Research suggests that nutrition during pregnancy may have long-lasting effects on an infant's predisposition to chronic disease such as obesity and diabetes. Infants born larger and heavier than average are more likely to be heavier in childhood and frequently become overweight adults. The Nutrition During Pregnancy Study aims to compare the impact of the current standard nutrition recommendations for a healthy pregnancy to a novel dietary approach designed to reduce blood glucose levels after meals among women at high risk for having a large baby due to overweight. Professional health organizations have established comprehensive nutritional guidelines for pregnancy, but these diets are typically recommended without consideration of glycemic index. Consumption of a high glycemic load diet leads to high blood glucose levels after meals and may affect growth of the baby and its long-term predisposition to obesity. In this randomized clinical trial the goal is to compare the effects of a conventional low fat diet routinely recommended in pregnancy to a low GL load diet on infant birth weight and other measures of fetal growth among overweight or obese pregnant women. Results show that consuming a low GL diet during the second and/or third trimester of pregnancy results in longer pregnancy duration, greater infant head circumference,

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and improved maternal cardiovascular risk factors compared to women who consume a conventional low fat diet. The research is led by Tamara Takoudes, MD, Maternal-Fetal Medicine specialist at Beth Israel Deaconess Medical Center and researchers Erinn Rhodes, MD MPH (Study Director), Dorota Pawlak PhD, and David Ludwig, MD, PhD at Childrenâ&#x20AC;&#x2122;s Hospital Boston.

PRENATAL DIAGNOSIS WITH OBSTETRIC MRI To determine how imaging using obstetric MRI can improve prenatal diagnosis, an investigation is evaluating fetal central nervous system anomalies seen on MRI and comparing them with ultrasound 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 assessment of adnexal masses. Deborah Levine, MD, associate chief of Academic Affairs in the Department of Radiology and co-chief 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 (REI) conducts a robust array of both basic science and clinical research. The goals of the REI research lab are to study major genes and pathways involved in reproduction, with a special focus on the molecular pathways involved in oocyte maturation. As women age, ovarian dysfunction is a frequent cause of infertility, but the underlying molecular mechanisms are poorly understood. Researchers are searching for molecular markers of follicular selection, recruitment and ovarian aging. This work has tremendous potential for detecting protein targets for drug therapy of age-related ovarian dysfunction and infertility related to premature germ cell loss. Clinical research in the Division of Reproductive Endocrine and Infertility has focused on clinical outcomes related to assisted reproductive technology. Michele Hacker, ScD, MSPH and Dr. Alan Penzias have led efforts to perform rigorous analysis of the Boston IVF patient

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provides 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.

database, which contains records on more than 35,000 IVF cycles. Other recent projects include clinical trials evaluating the efficacy of long-term depot formulation of gonadotropin for ovulation induction and the efficacy of oocyte cryopreservation techniques. The Division has recently published the results of the FASTT trial, the largest single-center fertility study funded by NIH, and is also currently participating in the FORTT trial, another NIH-funded 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 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 “Induced pluripotent stem cells generated from patients with ALS can be differentiated into motor neurons” in Science 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. This sample bank, paired with clinical outcomes of the patients from whom they were drawn,

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 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, cell biology, prenatal diagnosis and Alzheimer’s disease. Dr. L.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.

AN ENDOSCOPIC POLARIZED SCANNING BIOPSY GUIDANCE TECHNIQUE Using principles of polarized light scattering spectroscopy, 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 accomplishment 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 subcellular organelles because it does not

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damage the 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.

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.

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 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 about one minute and present the information in real time. Suspicious areas can then be biopsied and the diagnosis verified. This approach should be vastly superior to the present strategies of performing a CA-125 test and ultrasound examination. It may also significantly improve the probability of locating early cancer during the significantly more invasive random biopsies.

DEVELOPMENT OF AN OPTICAL SPECTROSCOPIC TECHNIQUE FOR DETECTION OF ALZHEIMER'S DISEASE The goal of this collaboration with Bedford VA Medical Center is to develop a clinical optical spectroscopic technique for real-time non-invasive detection of Alzheimer's disease in vivo.

OPTICAL SPECTROSCOPIC TECHNIQUE FOR NONINVASIVE PRENATAL DIAGNOSIS Present techniques for prenatal diagnosis are invasive and present significant risks of fetal loss. Noninvasive prenatal diagnosis utilizing fetal nucleated red blood cells (fNRBC) circulating in maternal peripheral blood has received attention, since it poses no risk to the fetus, but differentiating fetal from adult NRBC remains a challenge. Recently we demonstrated that light

URGYNECOLOGY AND PELVIC PAIN Research in the Chronic Pelvic Pain Lab includes establishing the genetic basis of chronic pelvic pain syndrome (CPPS), developing the evidence-based diagnostic and treatment guidelines for CPPS and developing intravesical nanorobotic devices for bladder drug delivery. Lab director Jordan Dimitrakoff, MD, PhD, identified a unique cohort of patients with increased prevalence of CPPS and identified an area on chromosome 1 that contains a series of 30 relevant genes. Work is now underway to sequence those genes and identify, for the first time, which contribute to CPPS. The lab is also working on establishing a clinical epidemiologic definition for CPPS, investigating and characterizing biomarkers for the disease, and elucidating the genetic basis for it. The group is designing effective clinical trials and developing new drugs and drug delivery methods for treating CPPS, as well as interstitial cystitis and painful bladder syndrome. This latter goal is embodied in a collaborative project with MIT building on a nanotechnology device for the intravesical delivery of drugs directly into the bladder. The collaborators have built a prototype and are currently designing a clinical trial to test it in vivo. The lab has also contributed to the evidence-based clinical diagnosis and treatment of urologic CPPS thorugh a meta-analyses on the pharmacologic management of painful bladder syndrome/interstitial cystitis and chronic prostatitis/CPPS. Futher, collaborations throughout Harvard and with institutions

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outside of the Harvard community have brought together complementary and integrated expertise to the field of CPPS and have led to several often-cited publications. Jordan Dimitrakoff, MD, PhD is Director of the Urogynecology and Chronic Pelvic Pain Lab in the Department of OB/GYN

MEDICAL EDUCATION RESEARCH The department conducts educational research projects utilizing simulation, virtual patients, standardized patients, and innovative techniques in medical education. Communicating Bad News Simulation Training Module: A collaborative effort involving Dr. Jo Marie Janco, a third-year resident, Dr. Hope Ricciotti, and faculty from the Division of Medical Oncology is working to implement and evaluate simulated training modules for delivering bad news to patients to provide residents with training and evaluation in this important communication skill. Obstetrical Emergencies Simulation training: Dr. Toni Golen, Director of Quality Assurance, and third year Maternal-Fetal Medicine Fellow Mary Vadnais are evaluating an obstetrics emergencies simulation training program for faculty, fellows and residents for uncommon but serious clinical events 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 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.

Simulated Surgical Skills Training: Dr. Hye-Chun Hur, Director of the Minimally Invasive Surgery Program, is evaluating the Fundamentals of Laparoscopic Surgery (FLS) program as a training and assessment tool for surgical competence. The FLS program consists of a cognitive and psychomotor skills component, and is a joint educational effort initiated by SAGES, and supported by the American College of Surgeons. Simulator development: Dr. Chris Awtrey, Interim 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 going to the operating room with a patient. 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. Chris Awtrey and Dr. Anya Lyapis, chief resident, are studying 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.

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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, Community Health Consortium The Community Health Consortium develops projects in obstetric and gynecology for our culturally diverse population of urban and suburban women. Areas of focus include clinical care, research, medical education, and service-based learning projects. 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. Health care leaders from each center come together quarterly at BIDMC to plan clinical programs, public health research projects, educational endeavors, and public service.

GLOBAL WOMEN’S HEALTH PROGRAM The department is committed to improving global women’s health locally and internationally. Whether in Roxbury or Sub-Saharan Africa, Lucy Chie, MD, MPH (left) Director, Community Health Consortium much of women’s health is shaped by social, economic and political inequities. Our goal is to help our faculty and trainees develop an understanding of the social context of women’s lives and to provide learning experiences that foster culturally competent care practices. Our global women’s health program encourages trainees and faculty to participate in service-based learning projects and research globally. Residents may embark on projects during their second and third-year elective time. Residents may also choose to complete their longitudinal clinic in under-resourced areas of Boston, such as Dimock Health Center and South Cove Community Health Center. Trainees and faculty have also pursued formal coursework at the Harvard School of Public Health.

SERVICE-BASED LEARNING AND RESEARCH PROJECTS Research and Develoment • HPV vaccination in Zambia • Gestational trophoblastic disease research with Philippine General Hospital • Gender Based Violence project with Panzi hospital in the Democratic Republic of the Congo • Family Planning research to decrease maternal mortality in Kabul, Afghanistan • Consultation with Population Services International (PSI) to increase utilization of intrauterine and implantable contraception methods in developing countries • Work with the World Health Organization in Geneva, Switzerland, to update the global health research priorities by extracting from the Cochrane Childbirth and Pregnancy reviews • Policy work with USAID, individual countries, and international organizations to improve maternal and child health Education • Mentoring residents at South Cove Community Health Center serving immigrants form East Asia • Exchange program with Philippine General Hospital • Visiting residency at Moi Teaching and Referral Hospital, Kenya • Mentoring and research supervision of HPV vaccination, teen pregnancy, clinical preceptorships for residents at Dimock, which serves African-American and Latina populations in Roxbury

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GLOBAL WOME N’S HEALTH PROGRAM AREAS OF ACTIV ITY

JAPAN • KOREA • • UKRAINE • BOSTON • MEXICO • INDIA

• NICARAGUA

CONGO •

• KENYA • ZAMBIA

• SOUTH AFRICA

THE PARENT CONNECTION Christine Sweeney, LICSW Program Director Since 1999, the Department of OB/GYN has offered the Parent Connection, a unique, free-of-charge follow up 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 also care for new parents after they leave the medical center and help them realize that they are not alone in their struggles, New Moms groups give new parents an opportunity to meet other new parents, share experiences, ask questions and reduce isolation. The Parent Connection helps families begin parenting on a positive note.

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IN AND AROUND BOSTON Boston has so much more than exceptional medical facilities and worldclass educational institutions.The city is one of the most livable in America.The diverse neighborhoods, beautiful parks, major historical sites, and close proximity to the ocean and mountains bring people together from all over the world to create a city rich in culture. A day off in Boston is enough time to see art at 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, which plays lighter, more popular classics and show tunes, perform at Symphony Hall. And 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. In short, there are more things to do than most have time for!

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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 Phone:

617-667-2285

PROGRAM GRADUATES 2010

WHE RE ARE THEY NOW? Allegra Deucher, MD Harvard Medical Faculty Physicians Beth Israel Deaconess Medical Center Amanda Gann, MD Private Practice in Kirkland, WA Jason Knight, MD Fellowship in Gynecologic Oncology, Cleveland Clinic, Cleveland, Ohio Kyoko Okamura, MD, MPH Private Practice, BIDMC, Boston, MA Brett Young, MD Fellowship in Maternal Fetal Medicine, Massachusetts General Hospital, Boston, MA