Women's Health Institute Annual Report 2022

Dear Friends and Colleagues:

Over the past two years, the Women’s Health Institute of the Allegheny Health Network (AHN) has followed a phenomenal trajectory.

We have expanded our Centers of Excellence, particularly in pelvic health and endometriosis, and continue to build out our research portfolio.

In addition, AHN opened the second new labor and delivery unit in the state of Pennsylvania in more than a decade at AHN Wexford, for a total of five units. These new facilities expand access to obstetric care in the region at a time when dozens of labor and delivery units have closed regionally over the past 20 years.

Throughout our network, we continue to provide patients with expert routine and tertiary care in every subspecialty. Our providers are focused on offering high-quality, stateof- the-art care in a safe and compassionate environment, from birth through midlife/menopause.

We hope the information on the following pages will help you as you evaluate options for your patients. As a well-established presence in the western Pennsylvania community, we strongly believe the best possible outcomes depend on our ability to build strong relationships with you and your patients.

It is an honor to partner with you in the provision of vital care to your patients, and we are here should our services be of value to you.

Marcia Klein-Patel, MD, PhD
Chair, AHN Women’s Health Institute

Surgeons Engage Latest Technology in Uterine Fibroid Removal

Allegheny Health Network (AHN) gynecologic surgeons are using minimally invasive approaches in the removal of uterine fibroids, which affect up to 70% of women.1 These often benign growths can have a significant impact on women’s health, causing bleeding, urinary incontinence, infertility and anemia.

“Many patients underwent hysterectomies for uterine fibroids, which had obvious implications for reproductive health,” said Noah Rindos, MD, a gynecologist with AHN. “Thankfully, we’ve advanced beyond that. We’re now able to relieve these symptoms, with minimal disruption to their lives.”

Indeed, at AHN, uterine fibroid removal is being performed via minimally invasive laparoscopic myomectomy, which involves four small incisions. The procedure has fewer postoperative complications and less postoperative pain than open surgery. Recovery time is shorter; patients are usually discharged from the hospital the day of the procedure.

“We’ve really made an effort to incorporate stateof- the-art surgical approaches so that patients can recover and get back to their lives quickly, with minimal pain,” Dr. Rindos said.

Dr. Rindos and his colleagues have been working with interventional radiologists Andrew Klobuka, MD, and Benjamin Contrella, MD, to incorporate minimally invasive embolization techniques into clinical practice as part of developing AHN as a Center of Excellence for uterine fibroids.

Uterine fibroid embolization uses fluoroscopy guidance to deliver an agent that blocks the arteries that provide blood to fibroids, causing them to shrink. Nearly 90% of women who undergo the procedure experience significant or complete resolution of their fibroid-related symptoms.2

“We’re excited to provide a collaborative approach in the treatment of fibroids.” Dr. Rindos said. “While a myomectomy is generally not considered lifesaving surgery, I’ve had patients tell me after surgery that they haven’t felt this well in years and have their lives back.”

1. J Womens Health [Larchmt] 2018;27[11]:1359-1367.
2. Insights Imaging 2022;13[1]:106.

AHN Gynecologic Specialists Use Latest Surgical Approaches

Gynecologic oncologists within the Allegheny Health Network (AHN) Women’s Health Institute are using state-of-the-art robotic technologies for minimally invasive surgical treatment of benign and malignant uterine conditions, as well as other diseases of the reproductive tract.

“Patients want to have their surgeries done robotically— today, they expect that,” said Eirwen M. Miller, MD, a gynecologic oncologist at West Penn Hospital, part of AHN. “So many of our patients come to us having done online research about surgical approaches to hysterectomy. They know that many of these procedures are being performed robotically. They may not understand the specifics of the technology, or the effect on surgical outcomes, but they know that robotic surgery is the most contemporary approach to gynecologic surgery.”

Demonstrating the system’s commitment to robotic surgery, West Penn Hospital is equipped with four surgical systems from Intuitive Surgical: one da Vinci X® and three da Vinci Xis®. This investment means the hospital has the most robotic surgical platforms of any in the region, according to Dr. Miller.

First approved by the FDA in 2000, the newer generations of the da Vinci Surgical System, like those in use at West Penn, are designed to provide surgeons with increased range of motion, dexterity and visualization during procedures such as hysterectomy, surgical correction of pelvic organ prolapse, endometriosis resection and gynecologic cancer surgery.

Additionally, gynecologic oncologists at the Women’s Health Institute are using Firefly® near-infrared fluorescence imaging for visualization of sentinel lymph nodes. This technology is routinely used for endometrial cancer staging surgery, reducing the incidence of complete pelvic lymphadenectomy and associated morbidities.

However, the term “robotic” is a bit of a misnomer when describing procedures performed with the da Vinci system, Dr. Miller noted. With systems such as da Vinci, robots are not actually performing the surgery— surgeons are. Surgical expertise is still needed to interpret the images seen on the platform’s screen and guide the robotic arms and instruments.

“Really, it provides the best of both worlds—the expertise of skilled surgeons with the accuracy of 3D imaging and robotic technology,” Dr. Miller explained.

With the four da Vinci surgical systems at surgeons’ disposal, about 60% of gynecologic oncology procedures at West Penn are performed robotically, using minimally invasive, laparoscopic techniques. According to Dr. Miller, gynecologic surgeons perform approximately two-thirds of the robotic surgery volume at the hospital.

“The technology has changed our practice,” she said. “The fact that we have four da Vinci surgical systems demonstrates our commitment to utilizing most contemporary technologies, which are associated with the best patient outcomes. From the patient perspective, robotic surgery is associated with faster recovery, less pain and surgical blood loss as well as lower infection rates. This means we are providing our patients with the best care possible.”

da Vinci X® is a registered trademark of Intuitive Surgical and is used with permission. da Vinci Xi® is a registered trademark of Intuitive Surgical and is used with permission. Firefly® is a registered trademark of Intuitive Surgical and is used with permission.

AHN’s Midlife Program Sets Women’s Health Institute Apart

Midlife care has become a key component of the services offered by the Women’s Health Institute within Allegheny Health Network (AHN).

Too often, the specialty of women’s health focuses on pregnancy and the health of women of childbearing age, meaning patient care stops before menopause. However, AHN’s Women’s Health Institute uniquely includes specialists on staff who are focused specifically on midlife, when a woman’s body undergoes changes that can have significant effects on their health and well-being, according to Marcia Klein-Patel, MD, PhD.

Although she is an obstetrician-gynecologist by training, Dr. Klein-Patel, who is the chair of the AHN Women’s Health Institute, stepped away from obstetrics to focus on midlife care for women as they age. This subspecialty includes everything from the management of menopausal symptoms such as severe hot flashes, vaginal dryness, and sexual and pelvic health to urinary incontinence, bone loss and gynecologic cancers.

“When it comes to women’s health, we often talk about reproduction, but we don’t talk enough about what happens after women are no longer of reproductive age,” Dr. Klein-Patel said. “Sometimes, these subjects are difficult for women to talk about. However, we have created an environment at all of our practice locations where women can feel comfortable talking to our team about any and all health-related issues as they age.”

To meet these needs, the midlife program at the Women’s Health Institute features a multidisciplinary team of specialists that includes gynecologists, psychiatrists, psychologists, cardiologists, gastroenterologists, oncologists, pelvic floor therapists and sleep specialists, among others. The team ensures patients in their care are maintaining a healthy diet, exercising appropriately and receiving preventive medicine services, including routine vaccinations as well as cancer screenings.

“Our first priority is education—informing our patients why these services are so important,” Dr. Klein-Patel said. “After that, we want to help guide them through steps they can take to make sure they are living their best lives.”

Despite research highlighting the importance of midlife care in women’s health1 and studies indicating that patients want these services,2 few health systems are offering them.

“When a patient who is pregnant comes into an obstetrician’s office, they often say they want to make all of these health changes for their baby, which is wonderful,” Dr. Klein-Patel noted. “However, when a woman comes into my office, they realize they have about half of their life left to live and they want to make changes for themselves, and that’s so rewarding. It’s great to walk that path with them.”

1. Menopause 2022;25(10):1155-1164.
2. J Womens Health [Larchmt] 2014;23[6]:513-518.

Women’s Health Specialists Work Together to Make Life Easier for Fertility Patients

What’s better than having an excellent private-practice fertility specialist when getting pregnant hasn’t been easy? Having a team of specialists that may include a reproductive endocrinologist, a high-risk obstetrician, a pelvic floor physical therapist and a minimally invasive surgeon, according to Lori Homa, MD, the medical director of the Allegheny Health Network’s (AHN’s) Center for Reproductive Medicine.

“Because of our connection to Allegheny Women’s Health, we have a full scope of services for our fertility patients at our fingertips,” she said. “We all work together. It’s really nice to be able to offer that.”

The Center provides infertility care for all people who wish to conceive, including same-sex couples, transgender people, cisgender women with infertility and those born with uterine abnormalities.

Dr. Homa uses her expertise to develop a personalized journey for all patients that focuses on their unique needs. She has extensive experience assisting couples and individuals in conceiving in ways that work for them, including utilizing eggs and sperm from donors, transgender men and transgender women. The Center prides itself on being an accepting space for all individuals at every stage of their treatment.

Services include intrauterine insemination, in vitro fertilization, pre-implantation genetic testing and surgery for reproductive issues. The center’s success rates are higher than the national average.

“We have a wide range and scope of treatments available, and our embryologists are amazing,” Dr. Homa said. “We offer exceptional care for all aspects of fertility and for all people who want to expand their family.”

The Center also offers behavioral health counseling that can begin with preconception counseling and provide support throughout treatment.

Preconception counseling can enable physicians and patients to prepare ahead of time for a variety of issues that may arise either in treatment or during pregnancy, and allows patients to be in the best physical and emotional condition possible.

Plans are underway for the Center, which is currently located at both Allegheny General Hospital and a clinical practice in McCandless Township, to move to a new facility in Robinson Township, with all services at one location.

“For many patients, undergoing treatment can be an emotional and stressful time,” Dr. Homa said. “Having resources to support our patients both physically and emotionally is important.”

Female Pelvic Medicine Physicians Change Lives by Solving Challenging but Common Conditions

Some women wait years before addressing common pelvic floor conditions such as pelvic organ prolapse, pelvic pain and incontinence.

“There are women who have essentially chosen to be confined to their homes because they’re afraid to have a bowel or bladder accident in public,” said Lindsay Turner, MD, a urogynecologist with Allegheny Health Network (AHN) who specializes in female pelvic medicine and reconstructive surgery. “Fortunately, we have advanced treatment options available for women who have tried first- and second-line therapies without success.”

Up to 20% of women in the United States will undergo surgery for pelvic organ prolapse or stress incontinence by the time they’re 80 years of age.1 Because these conditions are more prevalent in postmenopausal women whose pelvic floor disorders may be exacerbated by loss of estrogen, it’s estimated that this number could rise to 50% by 2050 as the baby boomer generation ages.2

At AHN, Dr. Turner and her colleagues have helped many women eliminate incontinence, ending their reliance on pads or adult diapers and returning to their previously active lives. They also work with women who develop pelvic issues in the first 12 weeks after childbirth, a period that the American College of Obstetricians and Gynecologists has called “the fourth trimester.”

Fourth trimester issues can range from slow healing obstetrical lacerations to painful intercourse, prolapse and incontinence. Even women who have had a cesarean delivery are recovering from a large-scale surgery while caring for a newborn, and this can cause significant physical and psychological stress.

“Urinary incontinence, prolapse and pelvic pain are common in the postpartum period and can continue for years afterwards; as pelvic floor specialists, we can get involved earlier,” said Radhika Patnam, MD, a urogynecologist specializing in female pelvic medicine and pelvic pain. “The American College of Obstetricians and Gynecologists has begun focusing on the fourth trimester, and we hope to improve care during this important time.”

Some women do not have easy access to pelvic floor care. To address this issue, AHN urogynecologists operate out of several satellite offices and hospitals, including Hempfield, Bethel Park, Jefferson, Wexford, Forbes and Allegheny Valley.

“We are seeing patients in their own communities so that they have fewer barriers in accessing specialist services,” Dr. Turner said. “It’s difficult for many patients to navigate Pittsburgh, so we’re trying to overcome that by going to them.”

For women seeking surgery, AHN urogynecologists offer minimally invasive options such as vaginal, laparoscopic and robotic surgery. For women who wish to avoid surgery, our physicians may recommend office-based procedures, pelvic floor physical therapy, behavioral modifications or pharmacologic options.

“We are telling women these problems don’t have to be a part of their daily lives,” Dr. Turner said. “We can make a difference.”

1. Obstet Gynecol 2014;123[6]:1201-1206.
2. Obstet Gynecol 2019;134[5]:e126-e142.

Women’s Health Institute Researchers Lead Key Clinical Trials in Cancer, Other Diseases

There has been an unprecedented increase in research being conducted at the Allegheny Health Network (AHN) Women’s Health Institute, with physicians leading multiple clinical trials.

“Our physicians and specialists are leading a large number of clinical studies in a number of therapeutic areas,” said Thomas C. Krivak, MD, the director of gynecologic oncology at AHN.

“Having access to clinical trials within our oncology program is a cornerstone to offering our patients the best, state-of-the-art care,” added Sarah Crafton, MD, the director of the gynecologic oncology clinical trial program and a gynecologic oncologist with AHN. “Over the past five years, we have increased the number of open clinical trials and the number of patients screened and enrolled.”

Active gynecologic oncology trials

  • GOG 3049: a phase 3 study of upifitamab rilsodotin as post-platinum maintenance therapy for platinumsensitive, recurrent ovarian cancer; not yet open for enrollment;

  • a phase 2 study of lenvatinib, pembrolizumab and weekly paclitaxel for recurrent endometrial, epithelial ovarian, fallopian tube and primary peritoneal cancer;

  • NRG GY-019: a phase 3 clinical trial assessing paclitaxel/carboplatin/maintenance letrozole versus letrozole monotherapy in stage II to IV primary lowgrade serous ovarian or peritoneum carcinoma;

  • UAB 2031: a phase 2 study of carboplatin and mirvetuximab soravtansine in first-line treatment of advanced stage ovarian, fallopian tube or primary peritoneal cancer who are folate receptor positive; not yet open for enrollment;

  • GLORIOSA/GOG 3078: a phase 3 study of mirvetuximab soravtansine with bevacizumab versus bevacizumab as maintenance for folate receptorpositive recurrent platinum sensitive ovarian, fallopian tube and primary peritoneal cancer; not yet open for enrollment;

  • NRG GY-026: a phase 2 trial of paclitaxel/carboplatin/ trastuzumab and hyaluronidase-oysk versus paclitaxel/carboplatin/pertuzumab, trastuzumab and hyaluronidase-zzxf in newly diagnosed, stage I-IVB, HER2-positive endometrial serous carcinoma or carcinosarcoma; not yet open for enrollment;

  • Aravive/GOG 3059: a phase 3 study of AVB-S6-500/ paclitaxel in platinum-resistant, recurrent ovarian cancer; closed to enrollment;

  • GLORA-5/GOG 3035: a phase 3 study comparing oregovomab and chemotherapy in advanced epithelial ovarian, fallopian tube or primary peritoneal cancer;

  • GOG 3026: a phase 2 trial of ribociclib/letrozole in recurrent, low-grade serous ovarian or peritoneum carcinoma;

  • a phase 2 study of olaparib/cediranib in combination with cediranib/olaparib, olaparib/durvalumab, cediranib/durvalumab or olaparib/capivasertib in recurrent endometrial cancer;

  • a phase 3 study of batiraxcept with paclitaxel in platinum-resistant recurrent ovarian cancer;

  • a phase 1/2a/3 study of adding anlotinib/catequentinib to standard platinum-based chemotherapy in recurrent or metastatic endometrial, ovarian, fallopian, primary peritoneal or cervical carcinoma;

  • GOG 3053: a phase 3 trial of pembrolizumab versus placebo with adjuvant chemotherapy with or without radiotherapy in newly diagnosed high-risk endometrial cancer following surgery; closed to enrollment;

  • GOG 3064: a phase 3 study of pembrolizumab versus platinum doublet chemotherapy in mismatch repair deficient advanced or recurrent endometrial cancer in the first-line setting;

  • NRG GY-023: a phase 2 trial of durvalumab/olaparib/ cediranib versus olaparib/cediranib or durvalumab/ cediranib or standard-of-care chemotherapy in recurrent, platinum-resistant ovarian, primary peritoneal or fallopian tube cancer;

  • a phase 1 study of NX-0255/TIL in adults with advanced malignancies; and

  • SOROCK/NRG-CC008: a registry comparing salpingectomy with salpingo-oophorectomy to reducing ovarian cancer risk among BRCA1 carriers.

Active gynecology trials

  • prospective case-control study of cardiovascular changes in pregnancy-related hypertensive disorders;

  • prone positioning during delayed cord clamping: a pilot study to identify optimal neonatal positioning;

  • the impact of tamsulosin on duration of postoperative urinary retention in women undergoing pelvic reconstructive surgery;

  • knowledge, attitudes and beliefs toward HPV and postpartum HPV vaccination;

  • impact of COVID-19 on ambulatory and surgical care (OB/Gyn 2 health systems);

  • IMPreSIv: infant mortality prediction system with intervention management pilot study of the effects of first-line therapy on variant allele frequency of homologous recombination associated genes in advance stage ovarian cancer;

  • concomitant first- and second-line treatments for overactive bladder and adherence to pelvic floor physical therapy;

  • reliability of urinalysis in the immediate postpartum period;

  • PREPARE: PRenatal Video-Based Education and Post- PARtum Effects;

  • impact of retropubic lidocaine vs saline on postoperative urinary retention following midurethral sling;

  • analysis of surgical smoke generated during laparoscopic hysterectomy: particulate matter, volatile organic compounds and health risk assessment;

  • pharmacist attitudes towards administration of depotmedroxyprogesterone acetate for contraception in the outpatient setting;

  • Are the Ideas Feasible?: perceived barriers to initializing sexual health clinics for marginalized patient populations among clinicians in a mid-sized US city;

  • perceptions and preferences among pregnant people with substance use in an integrated substance and perinatal care program; and

  • enhancing newborn HCV detection.

Reproductive Infectious Disease Specialist Brings Unique Expertise to Institute

Although the field of reproductive infectious disease has been around since the 1970s, it’s rare for hospitals to have a specialist on staff.

At the Allegheny Health Network (AHN), Yasaswi Kislovskiy, MD, brings that expertise to the Women’s Health Institute, making sure patients receive the latest evidence-based treatments while tackling the systemic issues that place them at increased risk for reproductive infections in the first place.

Dr. Kislovskiy's presence at the Women’s Health Institute means patients have access to a highly trained specialist for complex conditions at the intersection of gynecology, obstetrics and infectious diseases. In addition, other physicians can call on her specialized knowledge to ensure even better care for their patients.

“Staying on top of the latest evidence-based approaches is a critical part of my job and enables me to provide highly specialized care for individual patients,” Dr. Kislovskiy said.

Dr. Kislovskiy focuses on providing trauma-informed treatment and the management of complex pelvic inflammatory diseases. Gynecologic care for people living with HIV and performing complex colposcopy to prevent cervical cancer are also within her skill set. An outpatient clinic treats patients who have chronic vaginal infections, odor, itching, discharge and/or pain.

In addition to treating the symptoms of an infection, Dr. Kislovskiy considers the larger systemic issues that lead to infections and related health concerns. She also cares for pregnant people in need of addiction-related support.

“We strive to combine technical expertise in treating infections and peripartum challenges with a deep knowledge of systemic issues and a focus on preventative health solutions,” said Dr. Kislovskiy, who is also co-director of AHN’s Perinatal Hope Program, a collaboration between the Women’s Health Institute and the Center for Inclusion Health. “Patients at the Women’s Health Institute benefit from having access to a specialist available at few other institutions in the United States.”

Transgender Care

For patients who are gender diverse, nonbinary and transgender, AHN’s Center for Inclusion Health has expanded its gender-affirming medical and surgical services, with a focus on providing access in a convenient and compassionate way.

Specialists working within the Center include plastic surgeons, endocrinologists, psychiatrists, obstetricians and gynecologists, urologists, orthopedists, and physical and occupational therapists.

As needed, behavioral health providers and social workers work side-by-side with specialists to help patients cope with common and complex mental health issues and social challenges. In addition, providers work closely with patients’ health plans to make sure they cover researchbacked services for gender affirmation.

AHN currently provides a wide range of primary care services and certain gender-affirming surgeries at multiple locations. Surgeons have experience performing several types of gender-affirming surgery, including breast reduction/augmentation, chest reconstruction/ masculinization, orchiectomy, hysterectomy, facial feminization surgery and trachea shave.

Helping Those With Childbirth Trauma

Some pregnant people experience extreme anxiety prior to cesarean delivery. This anxiety can lead to elevated heart rates, hypertension, difficulty breathing, panic and dissociation, all of which can cause health complications for both mother and child.

In fact, up to 44% of pregnant women classify their labor and delivery experience as traumatic.1 In addition, a 2021 report from the Centers for Disease Control and Prevention found that nearly 10% of all maternal deaths during infant delivery were linked to trauma and mental health conditions—roughly the same percentage as deaths attributed to hypertensive diseases in pregnancy.2

“Treating these patients has introduced me to the concept of trauma and post-traumatic stress disorder and what it’s like for survivors of trauma, especially childhood trauma, to go through childbirth,” said Tracey Vogel, MD, an obstetric anesthesiologist with Allegheny Health Network (AHN).

The Women’s Health Institute offers pregnant people experiencing childbirth-related trauma comprehensive care that includes obstetric and gynecologic services tailored to their specific needs, as well as fully integrated behavioral healthcare. The program addresses the need for trust and control that these patients have, and aims to improve their sense of self-worth and self-efficacy.

These services are offered to patients within the Obstetric Trauma Clinic at AHN, and the process begins as early in pregnancy as possible. After they are evaluated, patients work with the clinical team to develop a birth plan that makes them feel safe, Dr. Vogel added.

In general, the Obstetric Trauma Clinic follows the “4 Rs of trauma-informed care” developed by the Substance Abuse and Mental Health Services Administration—realize the trauma, recognize its impact on the patient, respond and resist retraumatization in the birthing experience.

This approach to care is “a way of understanding patients’ context, and then tailoring what we do to minimize their concerns or fears to get a better outcome,” Dr. Vogel said.

1. Acta Obstet Gynecol Scand 2018;97[6]:648-656.
2. Natl Vital Stat Rep 2020;69[2]:1-18.

Olivia’s Angels Supports Parents of Children With Life-Limiting Diagnoses

For most expecting parents, pregnancy is typically a time of joy. However, for those who have been told that their baby has a life-limiting condition, it can be filled with profound stress and grief. As a result, these families require specialized care and need support services.

To meet these needs, Allegheny Health Network (AHN) has established Olivia’s Angels, a perinatal palliative care program designed for parents who have learned their child may have a life-limiting or life-long condition, or who have lost a child during the birthing process.

“We wanted to create a comprehensive, specialized program that meets the unique needs of these parents,” explained Marta Kolthoff, MD, a clinical geneticist and an obstetrician-gynecologist in the maternal— fetal medicine program within AHN’s Women’s Health Institute. “Receiving such a diagnosis is devastating, and to not have resources as you’re going through this experience is challenging and traumatic.”

Olivia’s Angels was born out of Dr. Kolthoff’s role as a geneticist working with pregnant people to assess their risk for passing genetic disorders on to their children. Unfortunately, she said, it’s the geneticist who ends up informing parents that, as a result of genetic conditions or fetal malformations, their baby’s life may be brief.

The program includes geneticists, maternal—fetal medicine physicians, nurses and neonatal clinicians,as well as social workers, all of whom have been trained in perinatal death to ensure families receive compassionate care. All services are customized according to their individual needs and wishes, such as religious requirements.

“We’ve learned that perinatal palliative care is much more than just managing pregnancies,” Dr. Kolthoff said. “We ensure these families are adequately supported.”

Approximately one in 300 newborns will have lifelimiting diagnoses, according to the Centers for Disease Control and Prevention. Although disorders such as trisomy 18 or anencephaly are rare, they can collectively affect many pregnancies.

For those who opt to deliver their babies, Olivia’s Angels offers on-site support for both parents and families as well as medical care for newborns. This support also engages maternal—fetal medicine and newborn medicine specialists. In addition, AHN’s Olivia’s Angels Perinatal Palliative Care Program provides support for families who can care for their newborns at home and opt to do so.

“We’re expecting to have many more patients in Olivia’s Angels, which is a difficult thing to say but important to acknowledge,” Dr. Kolthoff said. “It really highlights the need for pregnant people to have access to prenatal diagnosis.”

Institute Provides Comprehensive Care to Pregnant People, Newborns

The Maternal—Fetal Medicine (MFM) and Newborn Medicine programs within the Allegheny Health Network (AHN) Women’s Health Institute work in tandem to provide high-quality care for pregnant people and their infants.

The MFM program has specialty programs for patients with specific needs, support for medically complicated pregnant people, palliative care, technical expertise in obstetric ultrasound and reproductive genetics, and patient navigation services to help guide them through their healthcare journey. This work is connected to that of the Newborn Medicine program, a department in the Pediatric Institute with a tight-knit team that combines cutting-edge technology with personal medicine to care for all babies and their families after birth.

Over the past 30 years, the obstetrics and gynecology practice at AHN has expanded from a single community hospital with just over 2,000 deliveries annually to a network with more than 8,000 deliveries a year, according to Ron Thomas, MD, the division director of the MFM program.

This expansion has allowed the AHN to invest in specialty initiatives such as the Diabetes in Pregnancy Program. Through this program, two full-time certified nurse practitioners provide consultation and management of pregestational and gestational diabetes throughout the network, under the supervision of MFM specialists. In addition, the Alexis Joy D’Achille Center for Perinatal Mental Health, through the Institute of Behavioral Health, is one of just two programs in the nation that offers care for mothers in cases of postpartum depression. The MFM team is also involved with the Perinatal Hope Program, which coordinates antepartum and postpartum care for patients with substance use disorders.

“The MFM staff are experts at medically complicated pregnancies and serve as a resource for other physicians in the network,” Dr. Thomas said. “For example, we have developed a detailed handbook for all practices in the network, explaining the conditions most likely to cause issues during labor.”

Technical expertise is also a key component of the MFM program. At AHN, all obstetric ultrasounds are performed by ultrasound technicians specially trained in obstetrics and gynecology and overseen by MFM physicians. This approach enables providers to find abnormalities earlier in the pregnancy, giving the patient and their care team time to plan for an optimal delivery, according to Dr. Thomas.

In addition, the MFM program offers genetic testing and includes a board-certified medical geneticist, Marta Kolthoff, MD, who counsels patients so they can understand the details of both the testing process and the test results.

The program also provides hands-on guidance for patients navigating the healthcare system. A nurse navigator within the MFM department coordinates consults, appointments, and transfers of care between centers. Patients who need to deliver at a tertiary care site have access to multi-specialty coordination of care to plan their delivery.

For babies born prematurely, those with congenital issues, or babies who have an infection, the Newborn Medicine program has the tools to provide lifesaving, hands-on care. The physical footprint of the Newborn Medicine program includes two level 3 neonatal intensive care units (NICUs), the highest level of certification a community hospital can achieve, located at two large centers: West Penn Hospital and Saint Vincent Hospital. The network includes several level 2 NICUs to care for babies who require less intensive care and attention, as well as regular newborn nurseries (level 1 NICUs) for healthy infants at every hospital in the network.

“The goal of the Newborn Medicine program is to provide care to all the newborns born in the AHN system, from the healthiest to the sickest,” said William McCarran, MD, the director of the Newborn Medicine program. “The program provides very complex, highlevel, family-centered care. The team provides cuttingedge care for the baby while also getting to know and caring for the baby’s family.”

OB-GYN Residency Program Prepares Future Specialists and Leaders

The Obstetrics and Gynecology Residency Program at the Allegheny Health Network (AHN) Women’s Health Institute strives to train residents to become compassionate, ethical physicians and surgeons committed to life-long learning and excellent patient care.

Led by program director and urogynecologist Erin Seifert Lavelle, MD, the accredited four-year program welcomes six residents annually, and is primarily based out of AHN’s West Penn Hospital in central Pittsburgh.

“Historically, we identified as a community program and most of our graduates went on to practice general OB-GYN. We really value OB-GYN specialty care and provide training that prepares young physicians to be exceptional OB-GYN physicians,” Dr. Lavelle said. “However, we also have a long history of encouraging scholarly activity, and are tremendously fortunate to have an endowment from the James and Marilyn Gilmore family dedicated to supporting resident education and research.”

Residents participate in research and quality improvement projects that impact the institute and AHN, as well as advocacy and legislative work. Many present their research nationally and publish in medical journals.

“In recent years, we have adopted a blended community-academic model, anchored by our core faculty and bolstered by our academic partnerships,” which include teaching responsibilities for students from Drexel University College of Medicine, and a research partnership with Johns Hopkins University,” Dr. Lavelle said. “Our program definitely provides residents the platform to go on to fellowship training if they choose;” and the last three candidates who have applied for fellowships have matched with leading subspecialty programs, including gynecologic oncology at University of Buffalo and urogynecology at Northwestern University and Johns Hopkins University.

The heart of the program remains robust clinical training. By design, according to Dr. Lavelle, residents are integrated into patient care from their first day within the program, with support from faculty and advanced practice providers.

This latter group includes treatment of pregnant people with substance use disorder as well as transgender and midlife or perimenopausal care, she added. As a Ryan Foundation Grant program, there is also an emphasis on complex family planning care.

Part of their training that goes beyond patient care includes work in patient advocacy and hospital leadership. AHN Women’s Health Institute residents oversee students from Drexel University College of Medicine and graduate as skilled clinical instructors as well as physicians. Regardless of the career path residents leaving the program ultimately choose, the program emphasizes hands-on, comprehensive training in the field.

“Because we’re incredibly busy here and offer every subspecialty, our residents are deeply involved across the entire spectrum of obstetrics and gynecology,” Dr. Lavelle said. “That hands-on experience is what draws our residents here, and it gives them the technical experience to succeed wherever their career path takes them.”

Women’s Health Institute Enhances Patient Experience With Data-Centric Approach

For the past five years, the Allegheny Health Network’s (AHN) Women’s Health Institute has used data to change the way women experience obstetric and gynecological care.

“We work in the only field that sees patients come into the hospital looking forward to something and leaving with something better—a baby,” said Bernard Peticca, MD, the patient experience officer for the Women’s Health Institute. “If we can’t provide a good patient experience, shame on us.”

As part of an ongoing process of evaluation and improvement, every patient who leaves the Women’s Health Institute receives a 40- to 70-question survey. Dr. Peticca’s team analyzes the data from patient responses to determine where doctors and staff can improve within 11 major focus areas, including facilities, patient communication, discharge planning and follow-up care.

For example, AHN has made a concerted effort to invest more time in patient education to provide nursing mothers “with a better understanding of how to take care of their own health,” Dr. Peticca said. In nursing mothers with hypertensive disorders of pregnancy, the right medication can prevent both maternal and newborn delivery complications.

In addition, Women’s Health Institute obstetricians are emphasizing what they call the fourth trimester, increasing communication with mothers during the first six to eight weeks after delivery.

“We want our patients to have the best possible experience,” Dr. Peticca said. “We’re also carefully looking at our patient’s feedback to assure that all the improvements and advances that we’ve achieved in patient experience are reaching all groups with total inclusion and no barriers.”

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