Disclosures

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1. I am a gynecologic oncologist

Disclosures

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1. I am a gynecologic oncologist
2. I am a gynecologic oncologist

Disclosures

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1. I am a gynecologic oncologist
2. I am a gynecologic oncologist
3. I am a gynecologic oncologist

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Objectives

1. Define Dyad

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• What types of Dyads can we have in Obstetrics
• Maternal-Fetal
• Provider(s)-Patient
• The team: provider(s)-administration-nursing….
• All-Community

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How do you define a Dyad?

• Late 17th century (originally denoting the number two or a pair): from late Latin dyas, dyad-, from Greek duas, from duo ‘two’. Current senses date from the late 19th century.
• Oxford Dictionary: something that consists of two elements or parts.

"the mother–child dyad”

• In sociology, a dyad is a group of two people, the smallest possible social group
• Synonyms for DYAD: pair, couple, duo, twain, partnership, twosome, couplet, brace, companion, team.

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Medicaid Covered Benefits for Childbearing People

• Health systems are not experts in community-based perinatal supports.
• Keys to success:
• Engage, partner and collaborate with doulas and community health workers
• Develop alternative payment models through partnership with Medicaid
• Embed birth workers into established clinical practice teams and health systems
• Explore justice and equity frameworks to develop programs, research, interventions
• Evaluate the impact of varied models on disparities, perceptions and satisfaction

Objectives

1. Define Dyad

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• What types of Dyads can we have in Obstetrics
• Maternal-Fetal
• Provider(s)-Patient
• The team: provider(s)-administration-nursing….
• All-Community

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Maternal-Fetal

• Folks think about the obvious…the first 3 trimester
• 4^th Trimester

What challenges to mother’s face?

During visits with your maternity care provider after the birth, were you given enough information about…?

Impact of lack of postpartum follow up….

Impact of lack of postpartum follow up….

Impact of lack of postpartum follow up….

Objectives

1. Define Dyad

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• What types of Dyads can we have in Obstetrics
• Maternal-Fetal
• Provider(s)-Patient
• The team: provider(s)-administration-nursing….
• All-Community

Provider-Patient

CASE:

• Patient is a 19 yo G1P0 at 14 weeks who presented with vaginal bleeding.
• Speculum exam with a large fungating mass at the cervix. Ultrasound with singleton IUP.
• Gyn oncology referral and work up: at least IB3 poorly differentiated cervical cancer.
• Chemotherapy until mid-third trimester with timed c-section.
• Post delivery, definitive chemoradiation.
• Post treatment PET, NED.
• Follow up continuing.

How many Dyads do you identify?

CASE:

• Patient is a 19 yo G1P0 at 14 weeks who presented with vaginal bleeding.
• Speculum exam with a large fungating mass at the cervix. Ultrasound with singleton IUP.
• Gyn oncology referral and work up: at least IB3 poorly differentiated cervical cancer.
• Chemotherapy until mid-third trimester with timed c-section.
• Post delivery, definitive chemoradiation.
• Post treatment PET, NED.
• Follow up continuing.

How many Dyads do you identify?

Cancer in Pregnancy

• Cancer in pregnancy is a rare circumstance with the co-incidence being 1:1,000 pregnancies.
• Reporting difficult as registries not linked
• Miscarriages or terminations may not be reported ->incidence underestimated
• 3,500-6,000 new cases of malignancies diagnosed in pregnancy in the U.S. annually.
• Incidence of cancer in pregnancy may be rising:
• Due to the increased delay in childbearing with corresponding increase in maternal age.
• Tends to increase in countries where there is non-invasive prenatal testing

Annals of Oncology 0: 1–12, 2019

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Cancer in Pregnancy

• 20-30% of all malignant tumors emerge in women younger than age 45
• Population studies show no worse prognosis and no worse response to therapy in pregnant patients.
• Holds true for ovarian and cervical cancer

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Issues to consider

• Imaging
• Diagnostic imaging can be teratogenic
• Surgery
• Ideally in the mid second trimester
• Lowest morbidity to mother and fetus
• Chemotherapy
• Early exposure associated with a 10-20% risk of major malformations.
• Fetal benefit of treatment delay balanced against maternal risk.
• Ideal window is 14-35 weeks gestation
• Increased risk for IUGR, PPROM, preterm contractions

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Other things to consider….

Objectives

1. Define Dyad

​

• What types of Dyads can we have in Obstetrics
• Maternal-Fetal
• Provider(s)-Patient
• The team: provider(s)-administration-nursing….
• All-Community

The team: provider(s)-administration-nursing….�

Team Post Partum Depression

Case:

• Patient is a 28 yo G2P2 who is ~2 weeks post partum and she has a telehealth visit with her OB provider
• On the Edinburgh Postnatal Depression Scale

the patient scores a 12.

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• EPDS was specifically developed to identify women with PPD
• Most use it as a self-scored scale

The Problem

• Postpartum Depression (PPD) is the most common complication of childbirth.
• Maternal Mortality is skyrocketing in the US.
• Mental Health Conditions are the leading cause for Maternal Mortality, accounting for over 1/3 of deaths.
• PPD has significant impacts on the baby’s IQ, language development, behavior and susceptibility to mental health problems.

• PPD is underrecognized and undertreated
• Failure to seek treatment
• Delay in reaching services
• Only ~22% with symptoms receive treatment
• PPD has significant effects on child development
• Payment for PPD medical services ends too soon

Goals!!!!!!

Objectives

1. Define Dyad

​

• What types of Dyads can we have in Obstetrics
• Maternal-Fetal
• Provider(s)-Patient
• The team: provider(s)-administration-nursing….
• All-Community

Medicaid Covered Benefits for Childbearing People

• Health systems are not experts in community-based perinatal supports.
• Keys to success:
• Engage, partner and collaborate with doulas and community health workers
• Develop alternative payment models through partnership with Medicaid
• Embed birth workers into established clinical practice teams and health systems
• Explore justice and equity frameworks to develop programs, research, interventions
• Evaluate the impact of varied models on disparities, perceptions and satisfaction

Doulas

Thank you!