University of Pennsylvania Health System

ObGyn Update | Penn Medicine

Tuesday, September 30, 2014

Marisa's Story: Defying the Odds in the Intensive Care Nursery

Marisa Mackintosh and her husband were ecstatic to learn they were expecting twins. But when Marisa was three months along, an ultrasound revealed that the babies were having growth problems. Here, she shares the story of her family's difficult journey and the neonatal intensive care team that saved her babies' lives.

When my husband and I learned I was pregnant with twins, we were overwhelmed with surprise, immense joy and anticipation. We dreamt of welcoming them home and introducing them to our beautiful daughter, who was 16 months old at the time. The twins were due August 28, 2013, and we believed we would soon have three healthy and happy children nestled safely under our roof.

Our vision quickly came to a halt at 15 weeks after an emergency ultrasound revealed that one of our babies wasn’t growing well. We were asked to prepare for the unimaginable possibility of losing one or even both babies.

The following weeks were dark and uncertain. Regular ultrasounds were both reassuring and terrifying. 17 weeks became 20 weeks, which became 24 weeks. Of course, we did not want to deliver then, but reaching 24 weeks, we learned, was a milestone. Another ultrasound at 27 weeks showed two babies, growing and defying the odds, though dangerously imbalanced in size and health.

My doctor offered us the opportunity to tour the Intensive Care Nursery (ICN) at Pennsylvania Hospital to get acquainted in the event that we would spend time there. We walked through a door labeled “CHOP Newborn Care at Pennsylvania Hospital” and were greeted warmly by a neonatologist who, with kindness and patience, gave us insight into the world of prematurity. Then a nurse manager gave us a tour, which provided a glimpse of life in the ICN.

One week later, at 28 weeks gestation, the babies decided it was time. On June 7, 2013, we welcomed our miracles William and Daniel (Will and Danny), weighing 2 lbs 12 oz and 1 lb 13 oz, respectively. At this moment, Will and Danny began the fight of their lives. But they – and we – were not alone.

Over the next four months, we witnessed neonatal intensive care at Pennsylvania Hospital's ICN and the Children's Hospital of Philadelphia at its absolute finest. The doctors made decisions that were simultaneously life-saving and delicately mindful of long-term health. The nurses were by our boys’ sides, 24 hours a day, 7 days a week, providing expert care and love when we – with terrible pain – had to leave at night.

It is immensely difficult to think about those days. It conjures up images of our tiny sons connected to devices, separated from us – and each other – by technology. But when reflecting on that time, it is impossible to forget that we were part of something truly incredible. The team at Pennsylvania Hospital became our family, who hugged us, cried with us, answered our endless questions, loved our children – and who celebrated with us when we finally brought our two babies home after 81 and 116 days.

In honor of Neonatal Intensive Care Awareness Month, we want to thank the very special people at Penn Medicine’s ICNs. They give themselves to our babies, and they provide hope to parents. For that we are truly grateful, this month and forever.


Thursday, September 5, 2013

MENTORING SCHOLARS IN WOMEN’S HEALTH

THE WOMEN’S HEALTH SYMPOSIUM PROGRAM COMES TO PHILADELPHIA
The Department of Obstetrics and Gynecology at the University of Pennsylvania
hosted the annual NICHD Women’s Reproductive Health Research (WRHR) Symposium in
October 2012. Over 80 scholars, Ob/Gyn chairs and research program directors from 17
programs across the country attended this two-day event. Highlights included research
presentations by former and current scholars, career development panel, workshop on NIH
funding and grantsmanship and a keynote lecture by Dr. Alan Guttmacher, director of the Eunice
Kennedy Shriver National Institute of Child Health and Development (NICHD).

The WRHR program, initiated in 1998 by the NICHD, provides obstetrician-gynecologists
who recently completed postgraduate clinical training to further their education and
experience in basic, translational, and clinical research under the guidance of a senior
investigator and mentor. The goal is to create a talented pool of investigators with expertise
in women’s health. Chair of the Department of Obstetrics and Gynecology at the University of
Pennsylvania Health System, Deborah A. Driscoll, MD, is the principal investigator for the WRHR
program.

“The WRHR program is a prestigious award, with our department being one of only 17 universities
nationwide chosen to participate,” says Dr. Driscoll. “But most importantly it enables us to
leverage our strong research infrastructure and provide research training to promising junior
faculty to prepare them for a career in academic medicine.”

Samuel Parry, MD, director of the maternal-fetal medicine division and a former WRHR scholar
explains: “Depending on their experience, scholars are chosen for two to five-year awards
and are required to devote at least 75 percent of their effort to their research program under
the guidance of an assigned mentor.”

A scholar’s research may be spent in the basic sciences, translational or clinical investigation
in a variety of fields including gamete biology, imprinting, preterm birth, maternal fetal
health and development, and gynecologic oncology.

The rest of the scholar’s time is spent in clinical and teaching activities.

The research program director, Dr. Christos Coutifaris, works with the mentor to
monitor the scholar’s academic progress and assist with future grant applications and
the transition to independent funding.

Michal Elovitz, MD, associate professor of obstetrics and gynecology, director of the
Maternal and Child Health Research Program in the Center for Research on Reproduction
and Women’s Health, is a former WRHR scholar who is currently mentoring Jamie Bastek, MD, MSCE.

“My own work as a WRHR scholar helped me obtain NIH funding, as well as the necessary research
time, resources and mentorship to be able to pursue a career in maternal-fetal medicine,” says
Dr. Elovitz. “Now, as a mentor myself, I can guide scholars to target a specific research interest,
and work with them to nurture their own research careers.”

Current Penn WRHR scholar, Dr. Bastek agrees. She is currently working on a project in
conjunction with the Penn cartographic modeling lab to research environmental exposures
within Philadelphia that may affect pre-term
birth rates.

“Being a WRHR scholar has afforded me the opportunity to perform grant-funded research, to focus my research interests with the guidance of mentors who have been successful in research, and to pursue a research-based career in maternal-fetal medicine,” says Dr. Bastek. “It’s also
given me the opportunity to make sure
I am in a place where I can do my own grant-funded research at the end of my WRHR scholarship.”

Wednesday, August 28, 2013

PARENTHOOD REDEFINED


FERTILITY RESEARCH IS KEY IN BRCA CARRIERS
The Basser Research Center for BRCA 1 and 2 at the University of Pennsylvania focuses on the
prevention and treatment of cancers associated with the BRCA gene mutation. The BRCA mutation
increases a person’s lifetime risk for developing breast and ovarian cancer, as well as other types of cancer. “Our mission is to advance the research and the clinical care for BRCA1 and 2 using the resources available through the Basser Center,” says Executive Director of the Basser Research Center for BRCA, Susan Domchek, MD. “We want to create better choices for individuals  with these gene mutations and to eliminate the development of cancer in these individuals altogether.” Clarisa Gracia, MD, director of the Fertility Preservation Program at Penn Fertility Care, is currently working on a research project with the Basser Center to assess ovarian reserve and  attitudes toward parenthood in BRCA mutation carriers.“For women with a BRCA 1 or 2 mutations, their risk for ovarian cancer is up to 45 percent compared to two percent in women without the mutation,” says Dr. Gracia. “Risk reducing strategies, such as oophorectomy, shorten the reproductive lifespan, and part of this study will investigate how knowledge of BRCA carrier status impacts a woman’s reproductive decisions and attitudes about parenthood.”For example, a 35-year-old single woman with a BRCA mutation may decrease her chances of getting ovarian cancer by having her ovaries removed. If she is not yet prepared to have a child, then  oocyte or embryo cryopreservation may allow her the opportunity to have biological children even after her ovaries are removed.

Couples who know one of them has the BRCA mutation may feel a sense of urgency to have children faster, or wish to pursue IVF with preimplantation genetic diagnosis in order to avoid passing the gene mutation to their offspring. The study will also aim to learn more about how a BRCA mutation can influence a woman’s ovarian  reserve. “A study recently found that breast cancer patients with BRCA1 mutations undergoing IVF do not respond as well to ovarian stimulation as non-carriers,” says  Lauren Johnson, MD, a fellow in reproductive endocrinology at the Hospital of the University of Pennylvania and co-investigator of the study. “That finding suggests BRCA1 carriers may be at risk for ovarian insufficiency.” The Penn Medicine study will assess ovarian reserve of BRCA carriers and non-carriers using standard laboratory tests and ultrasonography.“This finding may have significant implications for the  application of assisted reproductive technologies in BRCA carriers,” says Dr. Johnson.  BRCA research through the Basser Center, as well as the advances in fertility technologies is providing more options for women with a BRCA mutation than ever before. “Knowledge really is power, and research on the reproductive issues associated with BRCA mutations may provide important information to help women make decisions about their reproductive future,” says Dr. Gracia. “As fertility preservation strategies and reproductive technologies have improved over the past decade, more women with BRCA mutations are pursuing technologies such as embryo and oocyte cryopreservation, and preimplantation genetic diagnosis.”

Tuesday, August 27, 2013

PENN GYNECOLOGIC ONCOLOGY

OUTSTANDING, INTEGRATED CARE FOR TREATING PATIENTS WITH CANCER
Chief of Gynecologic Oncology Mark A. Morgan, MD, says now more than ever, it’s important
for women with cancer to receive their care within an organization that facilitates the continuum
of care across all disciplines. “It’s important to care for the whole person – especially when
we are treating cancer. This means integrating services that treat diabetes, obesity,
hypertension and cardiovascular disease, as well as providing preventative services and genetic
counseling,” says Dr. Morgan. “No institution in the Philadelphia region is better prepared to
take care of women like this than Penn Medicine.”

Gynecologist and Director of Minimally Invasive Surgery at Pennsylvania Hospital
Sarah H. Kim, MD, agrees: “Women may have co-morbidities, other malignancies, or require a
 level of care not all hospitals are equipped to handle. At Penn, women can come here knowing
 they have the full support of the entire health care system.” Drs. Morgan and Kim have recently
joined Penn’s gynecologic oncology program. “Gynecologic oncology is a bit of a hybrid,”
explains Dr. Morgan. “Technically, we are surgeons, but we give chemotherapy and work closely
with radiation therapists.” Dr. Morgan says in his new role, he plans to continue the collaboration
with the Abramson Cancer Center and the Basser Research Center for BRCA to provide the ultimate
continuum of care for women.

SURGERY WITH ROBOTIC PRECISION
Dr. Kim, who completed her residency and fellowship at Penn, specializes in minimally
invasive robotic surgery for gynecologic cancers such as uterine and ovarian cancer.
“Today, the majority of surgery I perform for cancer is minimally invasive, robotic surgery,”
she says. “Women who have this type of surgery benefit from less blood loss, shorter hospital stays
and fewer incisions.” Dr. Kim, who trains residents and fellows in robotic surgery, says with
robotic surgery, she can “push the envelope” a little further to remove cancer.

PENN GYNECOLOGIC ONCOLOGY
“We can take out more lymph nodes, and get better biopsy samples, so staging cancer is easier
and more accurate,” says Dr. Kim. “We can even remove more ovarian masses laparoscopiclly,
when in the past it would have required a bigger incision.” Dr. Kim adds, at Penn, her patients
will benefit from the exciting research from an academic institution on the cutting edge of new
therapies. “Teaching and furthering research is a big part of my clinical philosophy,” says Dr. Kim.
“At Penn, I feel like I can make more of an impact not only with the exciting translational research happening right here, but also with the patients I work with who can benefit from the latest and greatest techniques and treatment modalities.”

NEW AND MORE THERAPIES MEAN INDIVIDUALIZED CARE
“Because of our expanded network, and our presence in the surrounding Philadelphia communities,
we can offer a strong core of services within an academic institution throughout the entire
Philadelphia region,” says Dr. Morgan. “Women at Penn receive exceptional cancer care, as well
as access to innovative therapies and clinical research not available anywhere else.”
Those innovative therapies include immunotherapy, which uses a patient’s own tumor cells to
fight cancer and prevent recurrence.

“Between genetic research like the BRCA research happening at the Basser Center, research in
Mark Morgan, MD & Sarah Kim, MD
immunotherapy and the already strong established clinical centers like the Jordan Center for Gynecologic Cancer, Penn has all the pieces of the cancer puzzle to complete,” says Dr. Morgan.
“I think these are the things that make Penn stand out — newer approaches to cancer care and more and more targeted therapies individually designed to work with each woman’s body.”

Tuesday, February 12, 2013

Penn Medicine Welcomes the following physicians to our team


Jamie Bastek, MD, assistant professor of obstetrics and gynecology in the maternal-fetal medicine division joined the department in July 2012.  Dr. Bastek is also a Women's Reproductive Health Research Scholar; her research is focused on preterm birth.










Lorraine Dugoff, MD, joined the department of obstetrics and gynecology and divisions of maternal-fetal medicine and reproductive genetics as an associate professor in January 2012.  Dr. Dugoff is an expert on prenatal genetic diagnosis and adverse pregnancy outcomes. Dr. Dugoff was formerly the director of prenatal diagnosis at the University of Colorado.






Celeste Durnwald, MD, an assistant professor in obstetrics and gynecology in the division of maternal-fetal medicine joined the department in January 2012. Dr. Durnwald was formerly  the co-director of the diabetes in pregnancy program at The Ohio State University. Her clinical focus is maternal fetal medicine and she specializes in the management of diabetes during pregnancy.Dr. Durnwald is director of the Diabetes in Pregnancy Program.






Alhambra Frarey, MD, joined Penn Ob/Gyn Associates as an assistant professor of obstetrics and gynecology in August 2012 and provides obstetric and gynecologic care.










Heidi Harvie, MD, MSCE, assistant professor of obstetrics and gynecology was appointed director of Penn Urogynecology at Pennsylvania Hospital. She treats a variety of conditions, including incontinence and uterine prolapse, using minimally invasive surgical techniques like robotic-assisted surgery.









Pamela Neff, MD, a gynecologist and former Penn resident, joined Dr. Wanda Ronner’s practice at Pennsylvania Hospital in August 2012.  Her clinical focus includes gynecology and minimally invasive gynecologic surgery.










Sara Pentlicky, MD, MPH, assistant professor of obstetrics and gynecology joined the Penn Family Planning and Pregnancy Loss Center in July 2012.  She also sees gynecology patients at Penn Ob/Gyn Associates.










Dana Shanis, MD, joined Penn Ob/Gyn Associates in August 2012. Dr. Shanis also sees patients at Penn Health for Women in Radnor, PA. She specializes in general obstetrics and gynecology and the gynecologic care of women who have had bone marrow and stem cell transplants.







Peter J. Vasquez, MD, joined the department of obstetrics and gynecology and Penn Ob/Gyn Associates after completing a residency at HUP in July 2012. Dr. Vasquez provides obstetric and gynecologic care.








Matthew VerMilyea, PhD, joined Penn Fertility Care as the director of the embryology and andrology
laboratories.

To refer a patient to any of the above physicians, please call the physician referral line, 877.937.PENN (7366).