BWH_ObGyn_2021-2022_AR_WEB

Department of Obstetrics and Gynecology Annual Report July 1, 2021 – June 30, 2022 Our Voices: Advocates for women’s health and reproductive rights

Our Voices: Advocates for women’s health and reproductive rights From Left to Right: Prof. Priya Lal, Dr. Mark Hornstein (REI Division Director), Melissa “Lissy” Rau, Marinna Jillian Rau, and Evan Rau. You can read about these two families’ reproductive journeys at our Center of Infertility and Reproductive Services on pages 56 - 57. Department of Obstetrics and Gynecology Annual Report July 1, 2021 – June 30, 2022

Table of Contents 4 Chair’s Report 20 Center for Fetal Medicine and Reproductive Genetics 6 Donor Stories 24 Family Planning Ruth N. White Research Fellowship 26 Fish Center for Women’s expands cancer expertise Gift benefits women from Health/Gynecology pregnancy through menopause 28 General Obstetrics and 7 Education Divisions Gynecology Specialists 8 Integrated Residency Program 10 Medical Student Education 32 Global Health 34 Gynecologic Oncology 13 Clinical Divisions 36 Maternal-Fetal Medicine 14 African Women’s Health Center 16 Brigham and Women’s and Reproductive Genetics Faulkner Hospital 40 Midwifery 42 Minimally Invasive 18 Brigham Obstetrics and Gynecology Group Gynecologic Surgery 44 Nursing and Clinical Services 46 Obstetrics and Center for Labor and Birth 2 Department of Obstetrics and Gynecology

48 Pediatric and Adolescent 68 Laboratory of Genital Tract Biology Gynecology 70 OB/GYN Epidemiology Center 52 Private Staff 72 Reproductive Endocrinology and Infertility Research 54 Reproductive Endocrinology and Infertility 74 Donor Stories 58 Urban Health Marinos bring social work resources to women in need Urogynecology: Higgins’ gift propels rare cancer research 60 Female Pelvic Medicine and Reconstructive Surgery 75 Research Support 62 Donor Stories Diana’s Fibroid Foundation 84 Administrative strengthens research for fibroid- Leadership related cancers Firsts fuel early detection efforts for ovarian cancer 63 Research Divisions 64 Cytogenetics Research 66 Gynecologic Oncology Laboratory *The photos featured in this report were taken prior to the Universal Mask Policy or were taken in compliance with mask guidelines. Table of Contents 3

Chair’s Report Nawal M. Nour, MD, MPH Dear Friends, The beginning of 2022 was marked by another surge in COVID cases that demanded we alter some internal procedures – hopefully among the last substantial impacts of the pandemic. A year ago, of course, we were all so hopeful in light of the vaccine rollout. Most of us never thought we’d still be so strongly affected by the pandemic – fueled by Omicron and its subvariants – a year later. Nonetheless, we continued – and will continue – to demonstrate our adaptability and collaboration in response to complicated situations. Early in the spring, the CDC released a report with news that was very hard to hear: U.S. maternal mortality rates had risen since 2019, especially among women of color. Compared to white patients, American Indian and Alaska Native women are twice as likely to die, and Black women three to four times as likely to die during and after childbirth, largely due to preventable illnesses. We have also just experienced a generation-defining event: Roe v. Wade was overturned. For the first time since since 1973, women and birthing people in the U.S. no longer have the legal right to safe termination of pregnancy. This contradicts much of what we work for every day in terms of reproductive justice and health equity. We already know the terrible effects of limiting access to legal pregnancy termination. Desperation drives women to seek out an unregulated or inexperienced “provider” or ingest dangerous substances and maternal mortality results. 4 Department of Obstetrics and Gynecology

In stark contrast to the disappointment of the overturning We stand of Roe, after many years among the top-rated departments with our in the U.S., the Brigham Department of Obstetrics & patients in Gynecology has been named Number 1 by U.S. News & World insisting on Report. To say I am proud of this achievement would be an equal access enormous understatement! to care and reproductive Even in the face of the discouraging news on maternal justice, and mortality and a national rollback of abortion rights, our task we will use is clear – and the same as it has always been. We will our voices continue to offer the highest quality, culturally sensitive, to advocate comprehensive, OB/GYN care possible. We stand with our for women’s patients in insisting on equal access to care and reproductive health and justice, and we will use our voices to advocate for women’s reproductive health and reproductive rights. rights. Sincerely, Nawal M. Nour, MD, MPH Chair, Obstetrics & Gynecology Kate Macy Ladd Professorship Harvard Medical School Chair’s Report 5

Donor Stories Ruth N. White Research Fellowship expands cancer expertise During the course of three years in the Ruth N. White Research Fellowship in Gynecologic Oncology at the Brigham, fellows explore new avenues of research focused on one unwavering purpose: to advance next-generation care for ovarian, cervical, and other gynecologic cancers. The fellowship’s success in cultivating talented, dedicated physician-scientists is made possible through the continued generosity of the Leaves of Grass Fund, which recently contributed $100,000 to sustain the program. “My ultimate goal as a gynecologic oncologist is to care for patients and their families as I would my own, bringing empathy borne from shared experience to their care,” says current fellow Jessica St. Laurent, MD. “I find great meaning in conducting research to advance our knowledge in the field of ovarian cancer and am thankful for this support of my education and start of my career.” Gift benefits women from pregnancy through menopause Susan Hellerstein, MD, MPH, views pregnancy as a key time to support women’s nutritional needs. The Brigham obstetrician-gynecologist offers hands-on live and virtual programs to make healthy eating more accessible for women through various life stages. To support these efforts, Brigham benefactors dedicated to maternal health and wellness efforts anonymously made a $200,000 gift. Part of their contribution is furthering Hellerstein’s research and education efforts, and part is being used at the discretion of Brigham President Robert S.D. Higgins, MD, MSHA. “The donors’ support for our work is greatly appreciated,” says Hellerstein. “Many patients feel intimidated when we say half your plate should include colorful vegetables. Our classes help at all stages of life, from giving moms and babies a healthy start, to giving older women a chance to put their health back on track.” 6 Department of Obstetrics and Gynecology

Education Divisions 44 Interns and Residents 59 Resident Publications 67 Faculty Members 18 Fellows Education Divisions 7

Integrated Residency Resident Research Day Program April 27, 2022 Amy Stagg, MD, Residency Program Director Each year residents present research before peers and faculty. The Division Members residents submitted the following Michael Muto, MD, Associate Director, BWH abstracts as resident research day Kat Pocius, MD, Associate Director, MGH oral presentations were cancelled Nawal Nour, MD, MPH, Chair, OB/GYN, BWH due to a COVID surge. Kate Macy Ladd Professorship, Harvard Medical School Jeffrey L. Ecker, MD, Chief, OB/GYN, MGH Presenters and Topics Joe V. Meigs Professor of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School Briana O’Leary – Implementation of Yara Núñez, Residency Program Manager a Pan-Ethnic Carrier Panel: Effect on Linda Kruse, Manager for Educational Programs Equity in Antenatal Screening Mission Nicola Perlman – Racial Differences in Indications for Obstetrical Toxicology Our mission is to train a diverse group of physicians Testing and Relationship of to become fully qualified, clinically excellent Indications to Test Results obstetrician-gynecologists who provide equitable care to all patients, advocate for reproductive Alexandria Williams – Mode justice, and lead in women’s health. Residents of Delivery and Unplanned participate in clinical activities at Brigham and Cesarean: Differences in Rates and Women’s Hospital, Massachusetts General Indication by Race, Ethnicity, and Hospital, Brigham and Women’s Faulkner Hospital, Sociodemographic Characteristics Boston Children’s Hospital, and Newton-Wellesley Hospital. There are currently 44 residents in the Marie Bangura – Female Genital four-year program. Cutting and Obstetric Outcomes 8 Department of Obstetrics and Gynecology Colleen Sinnott – Investigating Decreased Rates of Nulliparous Cesarean Deliveries during the COVID-19 Pandemic Golnaz Namazi – Deep Pelvic Side Wall Anatomy; A Case of Laparoscopic Management of Vaginal Vault Fistula to the Presacral Area Olivia Foley – An Orientation of ICU Nurses to Their Impact on the Professional Development of Young Physicians Logan Mauney – Association Between Peripartum Hysterectomy and Venous Thromboembolism Oliva Buck – Disparities in NSTV Rates and CS Indication Between Practice Groups within Mass General Brigham Sue Li – Risk of Venous Thromboembolism for Ovarian Cancer Patients during First-Line Therapy after Implementation of an Enhanced Recovery After Surgery (ERAS) Protocol Hilary Haber – Predicting the Need for Transfusion in Patients Undergoing Laparoscopic Hysterectomy

Our Voices Residents engage in a multifaceted approach to increase diversity, equity, and inclusion within the program and to expand health equity for all patients Our residency program has a vibrant and active students to answer questions about our program. Diversity, Inclusion, and Equity Committee that They also hosted social events for our residents and continues to accomplish a considerable amount led difficult discussions to support our residents each year with the support of our chairs, Dr. Nawal when significant national and local events occurred. Nour and Dr. Jeff Ecker. The committee helps lead multiple efforts in our department including Our Diversity, Inclusion, and Equity Chiefs also 1) recruitment of a diverse group of residents worked collaboratively with Dr. Elena Lagon and 2) review of the health care we provide and our own Dr. Carolina Bibbo who led the review of the health system through the resident-led health equity departmental Inequity Inbox, where all members of rounds and inequity inbox and 3) support of our the team can submit incidents of discrimination or residents and faculty that are underrepresented in unequal treatment of nurses, doctors, staff, or patients. medicine through social events and mentorship. These submissions were then used to determine cases and themes to be presented during the During the last academic year, our Diversity, Inclusion, resident-led Health Equity Rounds. Dr. Samantha and Equity Chief residents were Dr. Alexandra Truong, Dr. Marika Osterbur Badhey, and Dr. Olivia Williams and Dr. Marie Bangura with faculty Foley took the lead in organizing and presenting the mentors Dr. Mobolaji Ajao and Dr. Adeline Boatin. Health Equity departmental rounds at both Brigham They participated in residency recruitment efforts and Women’s and Massachusetts General Hospital. by attending virtual residency fairs; hosting a These presentations carefully examined barriers national virtual event for underrepresented students to health equity for our patients and brought about looking at our program; attending the CDI virtual significant changes to improve the care we provide social events; and interacting with prospective and the environment in which we deliver this care. Chiefs Opportunities they will pursue Incoming Interns Medical School Marie Bangura, MD FPMRS fellowship at Univ of Michigan Mary Kathryn Abel, MD, MAS Univ of CA, San Francisco Olivia Buck, MD MGH Research Isabela Covelli Velez, MD Univ of Washington Oliva Foley, MD Gyn Onc fellowship at Northwestern Lillian Dubiel, MD Univ of Maryland Hilary Haber, MD MIGS fellowship at NWH Matthew Mossayebi, MD, MPH Thomas Jefferson Univ Sue Li, MD Gyn Onc fellowship at U Penn Pepe Muniz Rodriguez, MD Mount Sinai Logan Mauney, MD MFM fellowship at MGH Juliet Musabeyezu, MD Harvard Golnaz Namazi, MD MIGS fellowship at Univ of CA Riverside Claire Packer, MD, MPH Oregon Health & Science Univ Briana O’Leary, MD MFM/Genetics fellowship at BWH Hadley Reid, MD, MHS Duke Univ Nicola Perlman, MD MFM fellowship at Stanford Shayla Reid, MD Northwestern Univ Colleen Sinnott, MD MFM fellowship at Yale Yoni Siden, MD, MPP, BSW Univ of Michigan Alexandria Williams, MD MFM fellowship at BWH Taylor Stewart, MD Univ of Wisconsin Awards given at Graduation Vatché Minassian, MD, MPH Irving Award, Excellence in GYN Teaching Faculty Daniela Carusi MD, MSc Safon Award, Excellence in OB Teaching Faculty BWH Gyn Clinic Front Desk & Clinic Staff Ella Adams Award Faculty Julianna Schantz-Dunn, MD, MPH Faculty Award for Mentorship Faculty Sharlay Butler, MD CREOG Teaching Award Faculty Chiamaka Onwuzurike, MD, MPH Faculty Wellness Award Faculty Hilary Haber, MD Wellness Award Resident Education Divisions 9

Medical Student Medical Student Teaching Education Activities by Faculty Natasha R. Johnson, MD, Clerkship Director • Practice of Medicine: Associate Professor, Harvard Medical School Dr. Natasha Johnson Division Members Nawal Nour, MD, MPH, Department Chair • Homeostasis 2 (PWY131): Kate Macy Ladd Professorship, Harvard Medical School Deborah Bartz, MD, MPH, Associate Clerkship Director Drs. Deborah Bartz and Associate Professor, Harvard Medical School Natasha Johnson Brianna Blaskey, MA, Clerkship Coordinator • OSCE Patient Doctor II: Linda Kruse, MPH, Academic Manager Andrea Pelletier, MS, MPH, Statistician Dr. Raina Fichorova Adele Bertschy, Education Project Coordinator • Patient Doctor II, Introduction Mission to the Pelvic Examination: Our mission is to engage active learners in obstetrics Dr. Elizabeth Yoselevsky and gynecology health care with a focus on diversity, inclusion, and eliminating health inequities. • Core Clerkship Didactic Series: The educational commitment of our teaching faculty spans across the entire medical school curriculum Drs. Mobolaji Ajao, Robert Barbieri, to 1) inspire students to consider obstetrics and Deborah Bartz, Joan Bengtson, gynecology as a specialty choice and 2) allow all Carolina Bibbo, Sharlay Butler, students to develop the foundational understanding Daniela Carusi, Karen Davidson, of the medical knowledge and skillset required in our Khady Diouf, Sarah Rae Easter, specialty as it overlaps with their patients in other Katherine Economy, Kathryn Fay, medical subspecialties. Through our teaching, we Janis Fox, Antonio Gargiulo, cultivate an inclusive, compassionate learning and Elizabeth Ginsburg, Catherine practice environment that celebrates the diversity Gordon, Kathryn Gray, Stephanie of our students and our patients. Guseh, Joan Hier, Mark Hornstein, Natasha Johnson, Kimberly 10 Department of Obstetrics and Gynecology Keefe Smith, Louise Perkins King, Sarah Lassey, Sarah Little, Vatché Minassian, Jeannine Miranne, Michael Muto, Sara Neill, Betty Ng, Charlotte Page, Emily Reiff, Becky Reimers, Julianna Schantz-Dunn, Nicole Smith, Brian Walsh, Michael Worley, Elena Yanushpolsky • Core Faculty Preceptors: Drs. Mobolaji Ajao, Raymond Anchan, Ross Berkowitz, Carolina Bibbo, Daniela Carusi, Khady Diouf, Sarah Rae Easter, Kathy Economy, Jon Einarsson, Elizabeth Ginsburg, Mark Hornstein, Kimberly Keefe-Smith, Louise Perkins King, Sarah Little, Vatché Minassian, Michael Muto, Chiamaka Onwuzurike, Emily Reiff, Julianna Schantz-Dunn, Nicole Smith, Serene Srouji, Barbara Wilkinson, Michael Worley, Jr. • Oral Examiners: Drs. Michelle Davis, Kevin Elias, Jerome Federschneider, Patience Gallagher, Joan Golub, Kathryn Gray, Lisa Gruenberg, Harneet Gujral, Susan Hellerstein, Dani Katz, Thomas McElrath, Kaitlin O’Connor, David Olson, Charlotte Page, Julianna Schantz- Dunn, Barbara Wilkinson • Weekly student case presentations: Drs. Deborah Bartz and Natasha Johnson

• IUD Simulation Sessions: Sarah Feldman, Colleen Feltmate, • Maternal-Fetal Medicine Course Donald Goldstein, Neil Horowitz, Drs. Deborah Bartz and Michael Muto, Michael Worley Director: Dr. Carolina Bibbo Natasha Johnson • Family Planning: Drs. Robert • Gynecologic Oncology Course • GYN Clinic: Drs. Deborah Bartz, Barbieri, Deborah Bartz, Kari Director: Dr. Ross Berkowitz Kari Braaten, Sharlay Butler, Braaten, Laurent Delli-Bovi, Daniela Carusi, Khady Diouf, Katherine Fay, Alisa Goldberg, • Family Planning Course Director: Alisa Goldberg, Natasha Johnson, Lauren Sobel, and Steffanie Wright Chiamaka Onwuzurike, Julianna Dr. Deborah Bartz Schantz-Dunn, Barbara Wilkinson • Essentials I and II: Drs. Deborah • Urogynecology Course Director: • OB/MFM Clinic: Drs. Saba Berhie, Bartz and Louise Perkins King Dr. Jeannine Miranne Carolina Bibbo, Daniela Carusi, • Transitions: Drs. Deborah Bartz, Khady Diouf, Sarah Rae Easter, • Surgical Anatomy Course: Katherine Economy, Kathryn Gray, Sarah Rae Easter, Joan Golub, Daniel Katz, Thomas McElrath, Catherine Gordon, Natasha Dr. Michael Muto Nawal Nour, Emily Reiff, Julianna Johnson, Kimberly Keefe Smith, Schantz-Dunn, Nicole Smith, Ruth Paula Kolbas, Jeannine Miranne, • Advanced Clinical Elective in Tuomala, Louise Wilkins-Haug Chiamaka Onwuzurike, Lauren Sobel, Zachary Walker Women’s Health: Dr. Stephanie Bird • MIGS Clinic: Drs. Mobolaji Ajao, • Research Mentors: Drs. Deborah • Advanced Clinical Elective in Louise Perkins King, and Jon Einarsson Bartz, Alisa Goldberg, Kathryn Women’s Health Family Planning: Gray, Elizabeth Janiak, Natasha Dr. Kari Braaten • CIRS Clinic: Drs. Raymond Anchan, Johnson, Louise Perkins King, Andrea Lanes, Thomas McElrath, • Advanced Integrated Science Rachel Ashby, Janis Fox, Antonio Jeannine Miranne, Nicole Smith Gargiulo, Elizabeth Ginsburg, Course in Human Genetics Mark Hornstein, Kimberly Keefe Advanced Clinical Electives (Reproductive Genetics): Smith, Serene Srouji, Brian Walsh, Dr. Kathryn Gray Elena Yanushpolsky • Fertility and Reproductive • Advanced Integrated Science • Gyn Onc Clinic: Drs. Ross Berkowitz, Endocrinology Course Director: Dr. Janis Fox Course in Sex- and Gender- Kevin Elias, Michelle Davis, Informed Medicine: Drs. Deborah Bartz, Elizabeth Janiak, Chiamaka Onwuzurike • Advanced Human Genetics – Prenatal Genetics: Dr. Kathryn Gray Division Awards/Honors/Promotions Fellow Teaching Award by core clerkship students: Dr. Catherine Gordon BWH Resident Teaching Awards by core clerkship students PGY1: Drs. Maryama Ismail, Avery Bramnik, Elizabeth Byrne PGY2: Drs. Jason Silberman, Thomas Kishkovich, Mackenzie Naert PGY3: Drs. Megan Bunnell, Rumbidzai Mushavi, Gregory Woods PGY4: Drs. Colleen Sinnott, Marie Bangura, Logan Mauney Deborah Bartz, MD, MPH • Course Director, Advanced Integrated Science Course: Sex- and Gender-Informed Medicine, HMS • Dr. William K. Rashbaum Teaching Award, Physicians for Reproductive Health • Excellence in Classroom Instruction Award, HMS Kathryn J. Gray, MD, PhD • Young Mentor Award, Excellence in Mentoring, Harvard Medical School Natasha Johnson, MD • Promotion to Associate Professor • Excellence in Residency Advising Award, Harvard Medical School Education Divisions 11

Our Voices Education Division launches new longitudinal reproductive justice curriculum at Harvard Medical School The Department of Obstetrics and Gynecology at Transitions to the Principal Clinical Experience Brigham and Women’s Hospital has had a long, proud (PCE) course, again aimed at the entire medical history teaching students, residents, and fellows in school first-year class rising to their PCE. Within comprehensive reproductive health, including complex the PCE in Obstetrics and Gynecology, all students family planning. Over the nearly 50-year right to engage with new course content that specifically legal, safe access to abortion in Massachusetts, addresses ob/gyn health inequities that fall along our teaching faculty, clinical practices, and learning the lines of intersecting race, class, sex, and curriculum have evolved. Today our teaching program gender minority identities. We have adopted the ensures an academically robust exposure to the HMS longitudinal themes of trauma-informed diversity and complexity of pregnancy decision- care, pain/substance abuse, and health equity into making our patients face. Our goal is to expose all our PCE curriculum through interactive videos. students to the full scope of reproductive options In addition, we have incorporated DEI and health and to meet our learners where they are while care disparities into our didactics and utilized deliberately educating them in the health and family APGO’s updated teaching cases. Lastly, all post- advantages of comprehensive pregnancy options. PCE students now learn from a required, highly interactive, case-based RJ curriculum within their The Education Division has had several Essentials II course. Based on the success of this accomplishments: objective metrics that RJ curriculum, it has recently been integrated into demonstrate an improved learning environment, the MIT/HMS Health Sciences and Technology effective teaching in best clinical care practices (HST) medical teaching program. to avoid bias and minimize inequity, and a formal research program that improves collaboration and This longitudinal RJ curriculum very deliberately mentorship among our students, residents, fellows reaches the entire medical school class, layering and faculty. A notable accomplishment in our greater depth and breadth into the content topic teaching program in 2021-2022 has been the to allow all students to graduate with a mature, development of a longitudinal reproductive justice well-informed understanding of the way reproductive (RJ) curriculum that now spans all four years of the health intersects with reproductive rights and HMS undergraduate medical program. Our teaching reproductive access specific to the diversity of regarding medically accurate, health-specific patient identities. Our commitment to the RJ learning abortion, adoption, and health equity starts within stems from a desire to improve sympathy and the endocrine pathophysiology course in the HMS to increase factual knowledge of comprehensive pre-clerkship year. As part of this teaching, the reproductive health within all students no matter entire medical school class meets and learns from their medical specialty interests for their future a patient who was faced with the unexpected in careers. In this way, our Education Division is pregnancy. We then further layer foundational contributing to an improved medical culture classroom knowledge regarding inequities in towards reproductive decision-making within the maternity care and maternal mortality in the whole physician workforce of the next generation. #1 Medical School for OB/GYN in the country according to U.S. News and World Report 12 Department of Obstetrics and Gynecology

Clinical Divisions 12 Clinical Divisions 15 Physician Assistants 17 Midwives 95,110 Office Visits Clinical Divisions 13

African Women’s Accomplishments in AY 21/22 Health Center • Educated health providers Nawal M. Nour, MD, MPH, Director nationally and internationally Chair, Department of Obstetrics and Gynecology on FGC issues Kate Macy Ladd Professorship Harvard Medical School • Networked with other community- Mission based organizations to improve healthcare access to immigrant The mission of the African Women’s Health Center and refugee populations of (AWHC) is to holistically improve the health of African descent immigrant and refugee women who have undergone female genital cutting (FGC). The Center provides • Facilitated efforts of COVID-19 community access to reproductive care for women who suffer long-term FGC complications. The testing, vaccine administration, Center’s vision is to focus on preventing FGC and and treatment with a healthcare to educate health providers on the cultural, health, equity lens and legal implications of the practice. • Dr. Nawal Nour was named Dr. Nour founded the African Women’s Health Center, which provides obstetric and gynecologic FIGO 2023 Congress Organizing care to vulnerable populations, in 1999. She Committee Chair performs defibulation procedures (plastic reconstruction of the scar) to women who suffer • Engaged our Global Health fellow the most severe form of FGC. The Center also focuses on research, community outreach, and and Harvard medical student in education, nationally and internationally. research on assessing sexual and reproductive health literacy “It’s our duty as physicians to listen to our patients and provide compassionate care. By doing so, we gain their trust, maintain their access to health care, serve their needs and improve their quality of life.” — Dr. Nawal Nour 14 Department of Obstetrics and Gynecology

Our Voices Helping immigrant and refugee women break down barriers The African Women’s Health Center is committed to by FGC. We provided access to culturally and providing holistic women’s reproductive health care. linguistically appropriate prevention, intervention, Immigrant and refugee women face disparities protection, and wrap around services. Working closely in sexual and reproductive health (SRH) outcomes with our interpreters and social workers, we have because of barriers to literacy, access, and been able to ensure patient safety through resources engagement. Despite the COVID-19 pandemic such as hotlines and shelters when needed. At hindering patient access to care and compounding the global level, the Center continues to support existing gender inequities, we continued to look community-based organizations that work directly after our vulnerable population of women affected on FGC to help raise awareness of these risks. Clinical Divisions 15

Brigham and Women’s Faulkner Hospital James A. Greenberg, MD Chief, Division of Gynecology, Brigham and Women’s Faulkner Hospital Vice Chair, Obstetrics and Gynecology, Brigham and Women’s Hospital Associate Professor, Harvard Medical School Division Members Patience Gallagher, MD Vatché A. Minassian, MD, MPH Julie D. Miner, MD Marcus Garcia, MD Jeannine M. Miranne, MD, MS Shannon E. Smith, MD Antonio R. Gargiulo, MD Tara Mould, MD Katherine Wang, MD Karen M. Girard, MD Betty Ng, MD Dale K. Weldon, MD Alisa B. Goldberg, MD, MPH Nawal Nour, MD, MPH Laurel Durning-Hammond, NP Meghan E. Grimes, MD Kaitlin A. O’Connor, MD Harneet Gujral, MD David C. Olson, MD Affiliated Physicians Shabnam Gupta, MD (MIGS Fellow) Charlotte Page, MD Ashley D. Ackerman, MD Gail A. Guzelian, MD Hannah J. Parker, MD Mobolaji Ajao, MD, MPH Lalita Haines, MD Louise Perkins King, MD Deborah A. Bartz, MD, MPH Susan Hellerstein, MD, MPH Charissa J. Pettyjohn, MD Joan M. Bengtson, MD Joan S. Hier, MD Julianna Schantz-Dunn, MD Stephanie C. Bird, MD Youngwu Kim, MD (Urogyn Fellow) M. Susan Schilling, MD Kari Braaten, MD, MPH Neeraj Kohli, MD, MBA Serene S. Srouji, MD Daniela Carusi, MD, MSc Paula Kolbas, MD Liza Swedarsky, MD Thomas J. Connolly, MD Lisa Lampert, MD Odette Taha, MD Khady Diouf, MD Randi D. Leigh, MD Alice C. Vincent, MD, PhD Lauren Ditrio, MD Taryn A. Lieberman, MD Zachary Walker, MD (REI Fellow) Vi Duong, MD (Urogyn Fellow) Evelyn B. Marsh, MD Tracy R. Zinner, MD Jon I. Einarsson, MD, PhD, MPH Megan M. McDowell, MD Barbara S. Frank, MD Maria R. Milcetic Comer, MD Mission Our mission is to provide the highest quality of primary and secondary obstetric and gynecologic care to patients in the community and to broaden access when needed to the advanced tertiary care facilities at our sister institution, Brigham and Women’s Hospital. 16 Department of Obstetrics and Gynecology

Accomplishments in AY 21/22 Our Voices • Surpassed 1,000 OR cases Working with MassHealth to provide socioeconomic for 2nd year in a row despite health equity COVID restrictions While advocating for women’s health and reproductive rights • Most efficient OR utilization of any is at the heart of our mission, equity in the delivery of that care is a special passion for our division. To that end, we were surgical service at BWFH proud to work with our colleagues at MassHealth to obtain coverage for transcervical RF ablation of myomas so that • Worked with MassHealth to obtain technologies which improve care for women are available to all women regardless of financial means. coverage for Sonata OperationsGyn Surgeries at BWFH Gyn Cases Robotic Cases 1200 1000 800 600 400 200 0 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Visits Ambulatory Visits 14000 12000 10000 8000 6000 4000 2000 0 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Clinical Divisions 17

Brigham Obstetrics and Gynecology Group Gail Guzelian, MD, Director Instructor, Harvard Medical School Division Members Ali Martin, PA-C Patience Gallagher, MD, Instructor, Harvard Medical School Katelyn Monroe, PA-C Caitlyn Schreib, PA-C Karen Girard, MD, Instructor, Harvard Medical School Lei Zhu, PA-C Meghan Grimes, MD, Lecturer, Harvard Medical School Sandra Ciarlone, RN Noreen Fitzgerald, RN Harneet Gujral, MD, Director of Gynecologic Surgery Britt Gappelberg, RN Instructor, Harvard Medical School Mary Hill, RN Holly Hughes, RN Lalita Jayasankar Haines, MD, Assistant Professor, Harvard Medical School Susan Kelly-Moran, RN Jennifer Settle, RN Maria R. Milcetic Comer, MD, Lecturer, Harvard Medical School Michelle Wall, RN Tara Mould, MD,Director of BOGG Physician Assistant Program Tionna Conley-Range, Lecturer, Harvard Medical School Sr. Administrative Assistant Ana Ramos, Practice Manager Betty Bet-Ling Ng, MD, Assistant Professor, Harvard Medical School David C. Olson, MD, Assistant Medical Director, BWH Ambulatory, Foxboro Instructor, Harvard Medical School Charlotte Page, MD, Instructor, Harvard Medical School Odette Taha, MD, Lecturer, Harvard Medical School Mission The mission of the Brigham Obstetrics and Gynecology Group is to provide inclusive, comprehensive, and compassionate care for the full range of patients seeking expert obstetrics and gynecology services. The faculty is committed to a practice that encourages patients to develop a long-term relationship with our providers who offer advice, education, and care over a lifetime. We provide care across a spectrum of age, race, gender identity, and sexual preference. We offer care at the BWH Ambulatory Care Center in Chestnut Hill, the BWH/MGH Health Care Center at Foxboro, Brigham and Women’s Health Care Center at Westwood, and at 500 Brookline Avenue, across from the BWH Main Campus in Boston. 18 Department of Obstetrics and Gynecology

Our Voices Brigham Care Redesign Incubator & Startup Program (BCRISP) allows for innovation in labor induction BOGG piloted a program to move the cervical ripening • “Really successful, only needed half a pill!” phase of induction of labor to the outpatient space. It began with a BCRISP project initiated by Dr. Harneet • “Had cervical ripening in triage Gujral and administered by our physician assistant, with prior pregnancy. More Ali Martin, PA-C. We started the project in an effort attention than if I had stayed in to move the first phase of the induction process off triage. Enjoyed the 1:1 with the the busy labor floor and into our outpatient spaces. doctor and nurse” Many studies have confirmed the safety of doing this. Our labor floor has become extremely busy, which • “All of the staff we had were wonderful, thank you! causes many delays in patients getting in on time to have cervical ripening initiated. The BCRISP project Gave a 4 on the CR process because it seemed set out to determine the feasibility of moving this to take several days, otherwise went well.” process to our offices and to gauge the acceptability and satisfaction of our patients with the process. • “The outpatient cervical ripening (compared Overall, it has been extremely successful with high patient satisfaction and without major complications. to cervical ripening in triage) was much On average patients rated their experience 4.8/5. more comfortable and less stressful...worked like a charm!” Here are some comments from our patients: • “Appreciated not having to be in the hospital” • “Really happy with the team and the whole process.” • “Had an amazing experience” • “Very pleased with the entire experience. Felt it • “Talked to other patients who had ripening in the was effective, well explained, straightforward, hospital and was glad to do it outpatient” and honest about the process.” • “Nurses/everyone were great. Friend went through it at the hospital a week before, and I was happy to have it in the office and go home. Had an amazing experience” 2022 YTD OR Visit Volume In 2022 Volume for BWH, for FY22 there were BWFH, FXB sites: (all locations): 1,052 223 35,127 deliveries Division Awards/Honors/Promotions In February 2022, the Ambulatory Obstetrics and Gynecology (OB/GYN) Medical Assistant Team and the Ambulatory Obstetrics and Gynecology (OB/GYN) Practice Assistant Team received a 2021 Pillars of Excellence Award in the category of Optimizing Collaboration. Clinical Divisions 19

Center for Fetal Medicine and Reproductive Genetics Louise Wilkins-Haug, MD, PhD, Director Yael Hoffman-Sage, MD, Director, Perinatal Consult Program Rosemary Reiss, MD, Co-Director, High Risk Ultrasound Kathryn Gray, MD, PHD, Physician Director, Reproductive Genetic Counseling Program Director Division Members Jennifer Cogan, Practice Manager Program Coordinators Saba Berhie, MD Jessica Glassman, Fetal Care Carolina Bibbo, MD Nursing Coordinator Daniela Carusi, MD Carol Luppi, RN, Consult Nurse Sandra Blackman, Consult Coordinator Karen Davidson, MD Coordinator Lisa Dunn-Albanese, MD Fetal Care Social Worker Sarah Rae Easter, MD Miah Newman, RN, Fetal Care Kara Belinsky, LICSW Katherine Economy, MD Nurse Coordinator Stephanie Guseh, MD Genetic Counseling Assistants Daniel Katz, MD Genetic Counselors Katie Gianforcaro, GCA Sarah Lassey, MD Lori Dobson, MS, CGC, Director, Jordan Sargent, GCA Sarah Little, MD Genetic Counseling, Reproductive Thomas McElrath, MD Genetics Program Manager Sonographers Emily Reiff, MD Sima Yershov, Chief Sonographer Thomas Shipp, MD Sophie Adams, MSc, MS, CGC Kerin Doherty Nicole Smith, MD, MPH Fetal Genetics Program Manager R. Dorothy Henry Elizabeth Yoselevsky, MD Monica Iarossi Meghan Dean, MS, CGC, Genetic Kristen Sanchez Counseling Operations Manager Kris Ann Trychon Brandi Zins Michelle Pacione, MS, CGC Abigail Sassaman, MS, CGC Courtney Studwell, MS, CGC Olivia Maher, MS, CGC Hannah Llorin, MS, CGC Mission The Center provides comprehensive and compassionate prenatal diagnosis, genetic assessment, and treatment to all pregnant persons whether planning a pregnancy or when complications arise. Inclusion of diverse providers, as well as equitable distribution of care, are priorities. Research and training in prenatal genetic screening and diagnostic services in addition to evaluation of fetal abnormalities and multifetal gestations remain ongoing commitments. 20 Department of Obstetrics and Gynecology

Accomplishments in AY 21/22 • Led by the genetic counselors, Hospital transitioned to MFM providers in 2021 with • CFM volume continues to expanding of genetic testing an additional 12,500 image options include single gene interpretations performed. increase, with over 700 patient non-invasive prenatal testing visits per month. We average (sgNIPT), molecular genetic • In Sept 2021, Dr. Elizabeth over 100 MD consults, 200 testing, and exome sequencing. genetic counseling visits, and 30 A comprehensive review of Yoselesky joined Drs. Lisa Dunn- diagnostic procedures per month. carrier screening labs was Albanese and Daniel Katz at the performed, and the genetic long-established program of • Perinatal consultation for counselors led a MGB Task MFM imaging and consultation Force to oversee enterprise-wide at Newton-Wellesley Hospital. maternal, fetal, and obstetric genetic carrier screening. The NWH MFM program now complications increased with the Genetic counseling assistants provides two MFM physicians advancement of virtual consults. were introduced to support for imaging and consultation We developed more specialized clinical operations related to five days a week in addition to consultative services, focusing expanded departmental genetic their increased involvement in on women with renal disease testing options. inpatient consultation and labor and diabetes, complex multiple and delivery. gestations, placenta accreta • The team evaluated the use of spectrum, and fetal anomalies. We • Other BWH-MFM satellite expanded the use of e-consults PGT-M for lower penetrance for improved provider-to-provider alleles, directed analysis of programs based at Emerson communication, removing the PGT-A testing results including Hospital and Exeter Hospital need for extra patient visits and mosaicism, and designed a Women’s Center also continued improving efficiency and clinical carrier screening program for to flourish bringing the services care coordination. patients using gamete donors. of the main campus to those birthing persons in the community. • The team designed operational • During 2021, MFM expanded their protocols for patients with fetal presence at Foxboro with onsite anomalies to incorporate genetic faculty provision of ultrasound counseling, diagnostic testing, services for obstetric patients. MFM counseling, and referral to Under the direction of Dr. Tom the Maternal Fetal Care Center Shipp, the MFM providers are at Boston Children’s Hospital. now on site four days a week and Existing genetic counseling approximately 4,500 obstetric protocols for aneuploidy, PGT, ultrasound studies were provided. and cardiac anomalies were Additionally, the general obstetric updated with current literature imaging at Newton-Wellesley and genetic testing strategies. CFM all visits by quarterly, July 2021 – March 2022 1200 1000 1029 978 1058 800 672 600 633 NST 559 336 CFM Consults 91 GC Consults 400 CFM Procedures Jan – Mar 22 200 274 302 Clinical Divisions 21 0 92 105 Jul – Sep 21 Oct – Dec 21

CFM Consults July 21 – March 22 140 120 126 116 108 100 102 102 80 95 88 91 84 60 40 20 0 Jul-21 Aug-21 Sep-21 Oct-21 Nov-21 Dec-21 Jan-22 Feb-22 Mar-22 Total GC Visits July 21 – March 22 250 200 167 230 233 241 209 197 195 194 198 150 100 50 0 Jul-21 Aug-21 Sep-21 Oct-21 Nov-21 Dec-21 Jan-22 Feb-22 Mar-22 Total CFM Procedures July 21 – March 22 45 40 42 35 37 33 34 29 30 30 31 24 28 25 20 15 10 5 0 Jul-21 Aug-21 Sep-21 Oct-21 Nov-21 Dec-21 Jan-22 Feb-22 Mar-22 22 Department of Obstetrics and Gynecology

Our Voices Increased collaboration among our MFM consultants, our genetic counselors, our fetal coordination team, and the Maternal-Fetal Care Center based at Boston Children’s Hospital Under the direction of Dr. Wilkins-Haug, and joined In June, Alireza Shamshirsaz, MD, FACOG, joined the by Drs. Hoffman-Sage, Gray, Reiss, and Guseh, we MFCC as the co-director and MFM interventionist lead. expanded our MFM consultative care by increasing With a joint appointment at BWH, Dr. Shamshirsaz our presence at the MFCC at Boston Children’s brings his training in fetal interventions. His goals are Hospital. We continued to improve the transition to continue to advance fetal therapies, expand the of care for delivery at Brigham and Women’s in services for pregnant persons seen at the MFCC, and collaboration with our fetal nurse, Miah Newman; engage trainees in further education in this area. He has our dedicated fetal program social worker, Kara pioneered novel fetal surgical techniques for neural Belinsky; program coordinator, Jess Glassman; and tube defects and twin-to-twin transfusion syndrome, our genetic counselors. The Fetal Care Program and he was part of the team that performed the at BWH works in close collaboration with the first successful fetoscopic repair to treat spina Maternal Fetal Care Center at Boston Children’s bifida in the U.S. Dr. Shamshirsaz is board certified Hospital. MFM consultations at BCH increased in OB/GYN and Maternal Fetal Medicine. and many of these pregnant individuals were then supported through the remainder of their Fetal Care Program – BWH Deliveries pregnancy with delivery at BWH to facilitate both BWH-NICU care and transfer to BCH as needed. 500 Actual Additionally, a Fetal Precision Genetic Program 450 193 Deliveries was initiated as a collaborative effort between the 400 two programs to provide pregnant persons with 350 354 Annualized a range for genetic options: noninvasive prenatal 300 316 testing, single gene NIPT, and diagnostic studies 250 271 of amniotic fluid by chromosome microarray 200 or sequencing. The existing genetic cord blood 150 program also continued to grow. For parents 100 facing the delivery of an infant with anticipated challenges whether surgical, developmental, 50 or genetic, Miah Newman, RN, in conjunction 0 with the fetal care social worker, Kara Belinksy, FY2020 FY2021 FY2022 developed a patient focused and informed Postpartum Connected Program to provide support through the last months of the pregnancy and the immediate postpartum. Division Awards/Honors/Promotions Kathryn J. Gray, MD, PhD • Society for Reproductive Investigation, ACE Award Clinical Divisions 23

Family Planning Accomplishments in AY 21/22 Alisa Goldberg, MD, MPH, Director • Provided abortion services without Associate Professor, Harvard Medical School interruption during the COVID pandemic Division Members Robert L. Barbieri, MD • Adapted our newly ACGME-approved Interim Chief of Obstetrics Kate Macy Ladd Distinguished Professor, Harvard Medical School Complex Family Planning Fellowship Deborah Bartz, MD, MPH (CFP) program to ACGME requirements Associate Professor, Harvard Medical School Kari P. Braaten, MD, MPH • Revised our fellowship selection Assistant Professor, Harvard Medical School Laurent Delli-Bovi, MD processes to enhance recruitment Assistant Professor, Harvard Medical School of candidates from marginalized Kathryn E. Fay, MD, MSc groups and continued adapting to Instructor, Harvard Medical School the virtual format Elizabeth Janiak, ScD, MA, MSc Assistant Professor, Harvard Medical School • Worked to implement practice Lauren Sobel, DO, MPH (Fellow) changes enabled by the ROE Act Steffanie Wright, MD, MPH (Fellow) (MA House Bill No. 5179) Tionna Conley-Range, Sr. Administrative Assistant Hannah Marden, Practice Manager • o Increased our gestational age cutoff for abortion services in collaboration with and guidance from colleagues across the country • o Removed parental consent requirements for teens ages 16 and older • Simplified our protocol for medication abortion • Continued our collaboration with Planned Parenthood League of Massachusetts for abortion services, clinical training, and research • Recruited a new faculty member, Dr. Fay, who is also serving as a WRHR scholar • Mentored BWH CFP fellows, BWH OBGYN residents, and a broad range of students from HMS and HSPH • Resumed in-person, community- building activities Mission The Family Planning Division carries on a longstanding Brigham and Women’s Hospital tradition of striving to improve the health of women, other pregnancy-capable individuals, and their families by providing family planning services commensurate with the highest standard of care to our diverse patient population in a non-judgmental, compassionate and supportive environment. Through our research, we seek to reduce undesired pregnancy and improve access to and the quality of abortion services. Through our teaching and mentorship, we aim to train a future generation of physicians and leaders committed to supporting reproductive autonomy and able to provide high-quality contraception, abortion, and pregnancy-loss care. 24 Department of Obstetrics and Gynecology

Our Voices Family Planning division use their voices to advocate for abortion access For 49 years abortion was legal throughout United States, out at the Massachusetts State House, and addressed policy and for 49 years Brigham and Women’s Hospital has leadership teams at the White House. All in an effort to share been providing abortion services and training the next what we see every day and what we know about abortion. generation of obstetrician-gynecologists to provide this life-saving care. In September of 2021, when the Supreme We know that abortion is an essential part of high-quality Court refused to block a Texas law that rendered abortion obstetrical care. It is necessary for gender equity and racial illegal after six weeks gestation, it became clear that the justice. It is part of the experience of parenthood. We know precedent set by Roe vs. Wade was likely to end. The final that abortion is an important consideration for people SCOTUS decision released on June 24, 2022, showed of all identities, but restrictions and criminalization complete disregard for the health and lives of women disproportionately impact members of marginalized and pregnancy-capable people and heralded the end communities. We know that abortion saves lives. We of federally protected reproductive rights in the U.S. know that the line between protecting someone’s health and saving their life is often thin or blurry. We know that We continued to provide the highest quality abortion care when abortion is illegal, doctors hesitate to intervene when and expanded our services later in gestation in accordance patients need it. We know that we will soon see deaths with changes to Massachusetts state law. Unified in our in the U.S. that would have been entirely preventable, just sense of purpose, our team wholeheartedly shifted our as we see in other countries where abortion is illegal. attention to using Our Voices to Advocate for Women’s Health and Reproductive Rights. We must continue to Facilitate timely, high-quality, comprehensive abortion care; Advocate for policies We used our voices in various forms and with diverse and practices that expand access to abortion and audiences. We used our voices to advocate for abortion promote equity; Educate the next generation of care at BWH for numerous patients, including many with physicians to provide comprehensive reproductive complex medical conditions, and some traveling from as health care, including abortion; Innovate by conducting far as Texas, Florida, and other countries. We used our research that advances the field of family planning and voices to ask for support from colleagues and administrators, expands access to abortion and contraception; Inspire prompting our community to think about how they could others to do their part to protect reproductive rights facilitate abortion access within our healthcare system. and access to health care; and Sustain and care for We used our voices, both oral and written, to educate. ourselves, so we can continue to do this work. We gave lectures, spoke on panels, published original We know that we as a profession must speak up. research, wrote opinion pieces, spoke to the media, spoke People’s lives depend on it. Division Awards/Honors/Promotions Partners In Excellence Award to BWH Family Alisa Goldberg, MD, MPH Planning Clinic for Patient Experience. • Invited speaker, Late-Breaking Research: Laurent Delli-Bovi, MD Mifepristone and misoprostol for undesired • Brookline Commission for Women, Brookline pregnancy of unknown location. American Congress of Obstetrics and Gynecology (ACOG) Annual Meeting Woman of the Year Award 2022 • Member, Board of Directors, Society of Family • Reproductive Equity Now, Champion of Choice Planning (SFP) Award 2022 • Launched the ASPIRE Center for Sexual and Kathryn Fay, MD, MSc Reproductive Health at Planned Parenthood • Selected Oral Presentation, Society of Family League of Massachusetts Planning Annual Meeting Elizabeth Janiak, ScD • Launched the ASPIRE Center for Sexual and Reproductive Health at Planned Parenthood League of Massachusetts Clinical Divisions 25

Fish Center for Women’s In the past year we have: Health/Gynecology inserted close to Stephanie Bird, MD, Director Assistant Professor, Harvard Medical School 123 IUDs and 12 Division Members Joan Bengtson, MD – retired 4/2022 Nexplanons Assistant Professor, Harvard Medical School Susan Hellerstein, MD, MPH Assistant Professor, Harvard Medical School Kari Braaten, MD, MPH Assistant Professor, Harvard Medical School Mission Women’s Health Associates provides a full range of gynecologic services to women from late teens through menopause in a friendly, personalized, and multidisciplinary setting. We are situated within the Fish Center for Women’s Health at 850 Boylston St. The Center also has providers in dermatology, GI, cardiology, endocrinology, nephrology, infectious disease, rheumatology, neurology, hematology, nutrition, pulmonology, sleep medicine, and social work in addition to our Menopause and Midlife Clinic. The mission of the Fish Center is to provide sex- and gender-based health care and to encourage women to advocate for themselves and their health. We believe we are unique and fortunate to be within a health center with such a mission and wide range of service offerings. As a general gynecology practice, with women’s health and reproductive rights at our core, we strive to ensure this through our care. We are all concerned with providing safe and timely access to the full range of gynecologic care, particularly for underserved groups. We have many Hispanic, international, and other non-English-speaking patients and are working on strategies for meeting the linguistic needs of these patients, including improving access to interpreter services and providing educational materials in a variety of languages. 26 Department of Obstetrics and Gynecology

Our Voices NuCook provides participants with a new approach to healthy eating Dr. Hellerstein has developed a program called NuCook survey shows that participation in the courses was that combines the expertise of a professional chef, associated with a statistically significant decrease a dietitian, a health coach, and a doctor to make in weight, improved dietary habits (increased fruit/ delicious and nutritious cooking easy and fun. First vegetable, fish, beans intake and decreased intake developed as an in-person study among pregnant of red meat, sugary beverages, and refined grains), women at the Brigham, NuCook has experienced as well as improved cooking confidence and efficacy. considerable growth since pivoting to an all-virtual format in response to the Covid-19 pandemic. Over Dr. Hellerstein has raised over $235,000 in the past two years, NuCook has expanded to offer philanthropic funding for this program. In 2021- 45 distinct cooking and nutrition classes with over 22, she was selected to participate in the Mass 120 recipes that are designed to address women’s Challenge start-up accelerator and worked with nutritional needs during pregnancy, perimenopause, students from two courses at the MIT Sloane menopause, and pandemic lifestyle changes. Using School innovation lab to develop NuCook. The the Harvard Healthy Plate framework, these data program is looking to expand within MGB and driven courses teach an evidence-based approach to beyond, with the hope to reach women with food healthy eating that can last a lifetime. Working with insecurity issues in addition to health challenges. Eva Katz, a chef from America’s Test Kitchen; Laura Klein, an expert in culinary wellness coaching from Harvard Medical School’s Lifestyle Medicine Program; and Andrea Roche, a women’s health dietitian, the experts work together to demystify the confusing information about healthy eating and provide a sustainable non-diet approach to cooking and eating. Over 6,000 women have participated in NuCook’s live-virtual and on-demand classes, and 99.7% have said they would recommend the classes to a friend. An evaluation of the educational efficacy of the courses using a pre-post course intervention In the past year we have had: Since 2006, we have: 6,500 an average of seen over ambulatory visits and 60 office 500 new PCOS 171 surgical procedures patients procedures per month Clinical Divisions 27

General Obstetrics and Gynecology Specialists Khady Diouf, MD, Director Assistant Professor, Harvard Medical School OB Division Members Continuity Care Providers PGY-2 Sharlay Butler, MD in Ambulatory OB and Gyn: Emily Burdette, MD, MPH Kathryn Fay, MD PGY 1, 2, 3, 4 Parisa Fallah, MD Chiamaka Onwuzurike, MD, MPH PGY-4 Allison Fitzgerald, MD Julianna Schantz-Dunn, MD, MPH Marie Bangura, MD Thomas Kishkovich, MD Jessyca Lima, PA-C Olivia Buck, MD Elizabeth Maxwell, MD Laura Sternberg, PA-C Olivia Foley, MD Ellen Murphy, MD Arlene Buck, RN Hilary Haber, MD Mackenzie Naert, MD, MS Laura Guajardo, RN Sue Li, MD Marika Osterbur Badhey, MD, PhD Amy Montero, RN Logan Mauney, MD Stephanie Schatzman-Bone, MD Susanna Pan, RN Golnaz Namazi, MD Jason Silberman, MD Charlene Carey, RN Brianna O’Leary, MD Samantha Truong, MD Loren Valdez, RN Nicola Perlman, MD Colleen Sinnott, MD PGY-1 GYN Division Members Alexandria Williams, MD Miriam Andrusier, MD Deborah Bartz, MD, MPH Avery Bramnik, MD Sharlay Butler, MD PGY-3 Elizabeth Byrne, MD Daniela Carusi, MD Megan Bunnell, MD Maryama Ismail, MD Kathryn Fay, MD Kelly Chacon, MD Kathleen Koenigs, MD Chiamaka Onwuzurike, MD, MPH Alexa Kanbergs, MD Amber Lalla, MD Julianna Schantz-Dunn, MD, MPH Elena Lagon, MD Katelin McDilda, MD Alisa Goldberg, MD, MPH Rumbidzai Mushavi, MD Talia (Melissa) Plummer, MD Connie Gassett, RN Rajesh Reddy, MD, MPH Mireya Taboada, MD, MPH Esther Liu, RN Roisin Mortimer, MBBCh Taniya Walker, MD Jennifer Mosaheb, RN Mackenzie Sullivan, MD Ally Young, MD, PhD Loren Valdez, RN Sara Tannenbaum, MD Catherine Pendleton, RN Brannon Weeks, MD Nadine Desanges, Practice Manager Gregory Woods, MD 28 Department of Obstetrics and Gynecology

Mission Our division aims to provide culturally competent and sensitive care to our culturally and socio-economically diverse patient population throughout the Boston area and beyond, while developing our OB/GYN residents to be excellent practitioners. Specifically, we aim to offer proven educational and patient-centered care models that have been shown to improve outcomes in marginalized populations. These include a group care model for antenatal and postpartum care as well as personalized lactation and nutrition services to our obstetric population. We also aim to provide state of the art gynecologic care, including surgical services and longitudinal care focusing on the comprehensive well- being of the population we aim to serve. Our division’s focused on retaining our diverse workforce to represent the patients we serve. Our internal programs are not only geared towards retaining our representative staff of multilingual and culturally diverse providers, but also to provide care that allows our patients to feel seen, heard, and taken care of. Accomplishments in AY 21/22 Clinical • We have continued to recruit patients from the OB clinic in the United Against Racism program of providing concordant doulas to our obstetric patients • Our group care models, including antenatal and postnatal care, are thriving and provide care for the patients who want it. Drs. Schantz- Dunn, Onwuzurike, and Butler run these sessions with OB nurses • Our OB PAs Laura Sternberg and Jessyca Lima provide support to our outpatient and inpatient resident care teams while providing longitudinal care to our pregnant patients • Our GYN PA Katie Anderson has started and will continue to be involved, with training, in increasing patient access to clinic visits and certain procedures such as hysterosalpingograms • Our ID specialists Drs Butler and Diouf provided e-consultation for COVID care and treatment during pregnancy to our providers during the pandemic Clinical Divisions 29

• Dr. Schantz-Dunn has continued Research Advocacy to champion the improvement • WRHR scholar Dr. Kathryn • In an effort led by Drs. Fay and of the induction experience for our patients and is part of the Fay joined our division in Bartz, the division published a labor induction taskforce December 2021 and will piece in the Green Journal in be conducting research on the wake of Roe vs. Wade being • Dr. Wilkinson completed her reproductive coercion overturned titled “Abortion as Essential Health Care and the bioethics fellowship and will • Our OB and GYN clinics are Critical Role your Practice can be bringing this expertise into Play in Protecting Abortion Access” the clinic recruitment sites for two large Boston-based studies: one on • Under the leadership of Adele • We continue to provide specialty attitudes towards postpartum contraception (BIBS study) and Bertschy, our division web page care in our GYN clinic with one on a RCT designed to was entirely recreated to reflect the complex contraception compare two behavioral our providers and programs clinic and colposcopy clinics. interventions to reduce HIV We have expanded use of our acquisition risk among African Over procedure room, which has immigrant women seen the expansion of office 9,000 hysteroscopies and multiple • Dr. Diouf is co-PI in a PCORI minor procedures, allowing GYN patient visits us to expand our use of the funded study designed to do and over main OR for more complex a comparative effectiveness procedures and surgeries of a one-on-one and a group 15,000 level intervention to reduce HIV Education acquisition among African born OB patients visits women in the United States for the year • Our global health fellow, Dr. Sarrah Shahawy, who also provided generalist care within the division, graduated and joined the academic faculty at Beth Israel in Boston 30 Department of Obstetrics and Gynecology

Our Voices Closing the health equity gap for postpartum patients Our division has championed group care models women to attend a postpartum education session both in the antepartum setting but also more recently regardless of ability to secure a babysitter or afford for our postpartum patients. The resounding patient transportation to the clinic. Three of our providers run experience from participants in our initial group these sessions. Participants attend two sessions: prenatal care graduates has been positive. While one in the late third trimester and one within two the focus of these sessions was mostly on labor weeks postpartum. These sessions aim to answer and delivery and infant feeding, we initiated targeted questions related to infant feeding, mood swings, sessions to address the gap left in postpartum physical expectations following delivery, sleep education. We made these sessions more accessible deprivation, and mental health. The overwhelming for patients by providing a virtual platform and response has been so far positive. We will continue offering it to all patients. Providing this forum also to listen to our patients’ needs and create programs addresses a health equity gap which allows ALL to tailor to their needs and improve their experience. Division Awards/Honors/Promotions Drs. Butler, Onwuzurike, and Schantz-Dunn were all honored by the graduating resident class of 2022 for the CREOG faculty award, Resident Wellness Award and Faculty Mentor Award, respectively. Clinical Divisions 31

Global Health “We often know what the scientific solution is to Khady Diouf, MD, Director many obstetric problems Assistant Professor, Harvard Medical School (i.e. misoprostol for postpartum hemorrhage, Division Members cesarean sections for Chiamaka Onwuzurike, MD, MPH protracted birth), but the Instructor, Harvard Medical School implementation of these Julianna Schantz-Dunn, MD, MPH solutions (availability Assistant Professor, Harvard Medical School of misoprostol in health Sarrah Shahawy, MD (Fellow) — graduated June 2022 centers, training providers Adele Bertschy, Administrative Assistant to perform cesarean sections, and creating Mission an effective referral tree) is often the challenge in Our division aims to provide patient-centered care many resource-limited locally through the African Women’s Health Center settings. Our goal in the and abroad through our close academic partnership Global OB/GYN program with Senegal. Our involvement with FIGO and the is to equip trained World Health Organization through female genital OB/GYNs to face and cutting will help shape policy agendas for future provide solutions to generations of marginalized women. Our fellowship the implementation will help train future leaders in global women’s challenges described health and advocacy. above through research, clinical training, and understanding the political and social landscape of resource- limited countries via our various partnerships in Haiti, Senegal, and Egypt.” — Dr. Khady Diouf 32 Department of Obstetrics and Gynecology

Our Voices Providing global health during a pandemic causes challenges, creative solutions As we slowly adapt to the new norm, our Division has ups and downs. Local activities include our PCORI had to revisit its engagement in global health. Our funded research on HIV behavioral interventions in surgical workshop activities in Senegal have been African immigrant women, which is a community on pause while we work out a model to continue engagement approach in finding the best intervention our partnership that is less sensitive to pandemic to curtail the epidemic in this community. Accomplishments in AY 21/22 • Our Division was recognized by through a cooperation with the University of Minnesota • Our fellow, Sarrah Shahawy, MD, the new Senegalese Society of and others Gyn Laparoscopists (SOSEGYN) graduated and will join the at their meeting in July 2022 • Our faculty is helping organize academic faculty practice at as an essential partner due Beth Israel Deaconess Medical to its training activities with the next FIGO conference in 2023 Center (BIDMC) Senegalese gynecologists • Dr. Diouf is coPI in a PCORI • Dr. Shahawy was actively involved • Our faculty will actively funded HIV behavioral in a qualitative research study in participate in providing an intervention study in African Egypt to analyze reasons for the OB/GYN teaching curriculum immigrant women high cesarean section rates for medical students in Rwanda Clinical Divisions 33

Gynecologic Oncology Ross S. Berkowitz, MD, Director Michael G. Muto, MD William H. Baker Professor Associate Director, Gynecologic Oncology Harvard Medical School Fellowship Program Associate Professor, Harvard Medical School Division Members Yick Fu Wong, MD, PhD Michelle Davis, MD Visiting Scientist Instructor, Harvard Medical School Michael J. Worley, Jr., MD Assistant Professor, Harvard Medical School Kevin Elias, MD Assistant Professor, Harvard Medical School Stephanie Cham, MD (Fellow) Stephanie Alimena, MD (Fellow) Sarah Feldman, MD, MPH Jessica St. Laurent, MD (Fellow) Associate Professor, Harvard Medical School Olga Pagan, Administrative Support Colleen Feltmate, MD Hannah Marden, Practice Manager Director, Minimally Invasive Gynecologic Oncology Surgery Director, Gynecologic Oncology Fellowship Program Assistant Professor, Harvard Medical School Donald P. Goldstein, MD (Emeritus) Neil Horowitz, MD Director, Clinical Research in Gynecologic Oncology Associate Professor, Harvard Medical School Robert C. Knapp, MD (Emeritus) Mission In the AY2021/2022: The Division is committed to making the principles there were of diversity, equity, and inclusion as integral to our mission, recruitment of faculty and staff, research, 1,221 OR and esprit de corps. procedures performed 34 Department of Obstetrics and Gynecology

Our Voices Treatment of gestational trophoblastic neoplasia transformed by maintaining a high cure rate and minimizing drug toxicity Gestational trophoblastic neoplasia (GTN) develops Trophoblastic Center has the largest experience in from placental tissues and can spread to other areas treating this disease in Latin America. By combining of the body such as the lung, vaginal, and other more the experience of these three centers, we hoped to distant sites like the brain and liver. Patients who provide clear guidelines to manage the patients with develop these pregnancy-related tumors are maintaining a high cure rate and limiting drug toxicity. generally 20-30 years old. These tumors are highly and uniquely curable with chemotherapy. The tumors We found that 60% of these patients with a WHO are categorized as low-risk (World Health Organization score of 5 or 6 achieved remissions with single- Score < 7) of resistance to single-drug nontoxic drug therapy. We found that we could define three therapy or high-risk of resistance to single-drug distinct groups of these patients. If the patient did toxic therapy and needing multiple drugs. Low-risk not have spread and did not have choriocarcinoma GTN is less extensive in the extent of the disease (aggressive pathology), only 4% of these patients than high-risk GTN. Patients with the scores of 5 with a blood pregnancy test > 410,000 needed or 6 can have low levels of response to single-drug to start with combination chemotherapy. If the therapy and may be as low as 30%. For patients with patient had spread or choriocarcinoma, then a score of 5 or 6, we were unsure how they should 14% of these patients with a blood pregnancy be treated. Should they start with nontoxic single- test >150,000 needed initial combination drug treatment or start with toxic multiple-drug chemotherapy. All patients with spread and treatment? There was no dependable data to guide choriocarcinoma needed initial combination the selection of drug treatment for these patients. chemotherapy to be cured. All patients in the study with GTN and a WHO score of 5 or 6 were cured, The New England Trophoblastic Disease Center and we were able to reliably predict which patients at Brigham and Women’s Hospital has the largest will have a high likelihood of cure with non-toxic experience of treating GTN in North America. We single-drug therapy and which patients need initial have been collaborating for years in both clinical and toxic combination chemotherapy to be cured. laboratory research with the Charing Cross Hospital This collaborative study was published in Lancet in London and the Rio de Janeiro Trophoblastic Oncology in October of 2021 and has transformed Center. The Charing Cross Hospital has the largest the treatment of GTN by maintaining a high cure experience of treating GTN in Europe and Rio’s rate and minimizing drug toxicity. Accomplishments in AY 21/22 the New England Trophoblastic abnormal cervical screening results Disease Center under the support of the Society • The Gynecologic Oncology to Improve Diagnosis in Medicine • Drs. Muto and Davis continue to Program has increased clinical • Dr. Feltmate continues to activity at Dana Farber Cancer work to enhance the educational Institute both at the Longwood experience of residents through improve the education campus and at Chestnut Hill their roles as Associate Program experiences of the fellows in Director of the BWH OB/GYN her role of Fellowship Director • Five of the gynecologic oncology Residency and lead faculty for resident rotations, respectively • Dr. Horowitz has been appointed faculty have been named as Best in Boston (Drs. Berkowitz, • Dr. Feldman is a Co-Chair of editorial board member of Feldman, Feltmate, Horowitz Gynecologic Oncology and Muto), which is the greatest American Cancer Society representation of any hospital in Committee for HPV cervical cancer • Dr. Worley continues to advance metropolitan Boston screening and has initiated an important study to improve treatment of ovarian cancer • Drs. Elias and Horowitz are joining colposcopy follow-up after through his role as Director of Ovarian Cancer Surgery Research Dr. Berkowitz as Co-Director of Clinical Divisions 35

Maternal-Fetal Medicine and Reproductive Genetics Louise Wilkins-Haug, MD, PhD, Director William Lambert Richardson Distinguished Chair Professor, Harvard Medical School Division Members Margarita Ruiz, Administrative Support Beryl Benacerraf, MD, Professor, Harvard Medical School* Tandeka Hicks, Administrative Support Saba Berhie, MD, Instructor, Harvard Medical School Jennifer Cogan, Practice Manager Carolina Bibbo, MD, Assistant Professor, Harvard Medical School Daniela Carusi, MD, MSc, Associate Professor, Harvard Medical School Ann Marie Colletta, RN Karen Davidson, MD, Assistant Professor, Harvard Medical School Amy Demartino, RN Lisa Dunn-Albanese, MD, Assistant Professor, Harvard Medical School Barbara Devito, RN Sarah Rae Easter, MD, Assistant Professor, Harvard Medical School Cheryl Gerson, RN Katherine Economy, MD, MPH, Assistant Professor, Harvard Medical School Lucy Graves, RN Stephanie Guseh, MD, Instructor, Harvard Medical School Cheryl Hardy, RN Kathryn J. Gray, MD, PhD, Assistant Professor, Harvard Medical School Ashley Lewis, RN Yael Hoffman-Sage, MD, MPH, Instructor, Harvard Medical School Carol Luppi, RN Daniel Katz, MD, MS, Assistant Professor, Harvard Medical School Aisha Mailles, RN Sarah Lassey, MD, Instructor, Harvard Medical School Amy Reyes, RN Sarah Little, MD, MPH, Assistant Professor, Harvard Medical School Barbara Torrez, RN Thomas McElrath, MD, PhD, Professor, Harvard Medical School Miah Newman, RN Emily Reiff, MD, Instructor, Harvard Medical School Laurie Rapson, RN, Operations Lead Rosemary Reiss, MD, Assistant Professor, Harvard Medical School Thomas Shipp, MD, Associate Professor, Harvard Medical School Nicole Patton, PA-C Nicole Smith, MD, MPH, Assistant Professor, Harvard Medical School Kara Donati, PA-C Elizabeth Yoselevsky, MD, Instructor, Harvard Medical School Sara Villegas-Keech, PA-C Kristen Chase, PA-C Rebecca Reimers, MD, MPH (Fellow) Hope Yu, MD (Fellow) Research Core Rachel Wood, MD (Fellow) David Cantonwine, PhD, MPH Fahkra Khalid, MD (Fellow) Babatunde Akinwunmi, MD, MPH, MSc Tooba Anwer, MD (Fellow) Nicole Haas-Loomis, BS Anneli Merivaara, BS Elida Kocharian, BS *Dr. Benacerraf passed away on October 1, 2022. We thank her for her dedication to our department. 36 Department of Obstetrics and Gynecology

Mission The Maternal-Fetal Medicine Division endeavors to provide equitable obstetric care to high-risk persons, contribute to the broad base of knowledge underpinning the discipline, and train the next generation of diverse leaders. The MFM faculty is dedicated to advancing the care of women with high-risk pregnancies through innovative and equitable clinical program development, collaborative care throughout their communities, and a focus on the birthing persons’ reproductive health as an integral to long-term health. Accomplishments in AY 21/22 complex obstetric care. The last in 2022. The program provides year has seen significant growth in pregnancy and delivery care, • To meet the unique demands and our Multiples and Fetal Programs, consultations, and interpregnancy as well as ongoing successes in care to patients who anticipate concerns of mothers and families Surgical Obstetrics and Maternal or have faced highly complicated expecting twins, triplets, or higher- Health Subspecialty clinics. Our surgical deliveries. In addition order multiples, the Comprehensive nursing staff excels at patient to detailed delivery planning Care Center for Multiples, under education initiatives. We focus and provision of critical care, Dr. Carolina Bibbo’s leadership, on family-centered care, aiming its multidisciplinary team has launched December of 2020. It to redesign the postpartum incorporated mental health support is the first center of its kind in experience, with our virtual Post- as a routine part of practice to Massachusetts and one of only a Partum Connected groups and identify and support those with few in the United States. The goal specialty groups for women of traumatic birth experiences. Our is a center where everything we do color, parents of multiples, and current research examines risk is focused on multiple pregnancies, families expecting a baby that factor stratification into patient which are very different than will need special care. diagnosis, follows mental health singleton pregnancies. The team experiences of patients with accreta collaborates to offer a full range of • The Surgical Obstetrics and and postpartum hemorrhage, and clinical services, including prenatal has identified a novel biomarker care and diagnosis; assessment Abnormal Placentation Program for accreta spectrum in the and treatment of complications; led by Dr. Daniela Carusi, along with second trimester of pregnancy. obstetrical ultrasounds; and patient Dr. Sarah Rae Easter, recruited an education on delivery, lactation, and additional member, Dr. Hope Yu, newborn care. Dr. Bibbo and her team of nurses and social workers Total new MFM visits July 2021 – June 2022 host virtual meetings twice a month, which involve prenatal 160 and postpartum education. Topics 140 discussed include having a healthy 120 pregnancy, preparing for labor and 100 birth, breastfeeding, preparing for a possible NICU stay, and caring for 80 multiple newborns at home. The 60 team also hosts a support group 40 once a month for patients expecting 20 multiples. Since we started in December 2020, 271 birthing 0 persons have joined our program. Jul-21 Aug-21 Sep-21 Oct-21 Nov-21 Dec-21 Jan-22 Feb-22 Mar-22 Apr-22 May-22 Jun-22 • Under the leadership of Dr. Nicole Smith, the Maternal-Fetal Medicine practice continued to expand, now with 17 physicians and four experienced Physician Assistants seeing pregnant persons for Main Campus New OB FXB New OB Clinical Divisions 37

Our Voices Building research teams to improve maternal health and pregnancy outcomes 15 years of LIFECODES - a MFM division research into pregnancy health and social biorepository and research team disparities. Over 72% of authors and 100% of PhD recipients who have used LIFECODES data identify Since its inception in 2006, the LIFECODES as non-male. Hence, LIFECODES also represents an biorepository has become a nationally and important utility in promoting gender equality and internationally recognized resource for the opportunity in medical and public health research. advancement of both pregnancy and, in general, women’s health. Under Tom McElrath’s leadership, Research teams to address SARS-CoV-2 infection close to 200 peer reviewed publications have and COVID-19 vaccination in pregnancy utilized LIFECODES data and samples, including a recent research manuscript published in Nature. The Mass General Brigham COVID-19 pregnancy Additionally, LIFECODES has supplied data for biorepository is a highly productive joint BWH-MGH four PhD dissertations; four MFM fellowship scientific effort that began in April 2020 and is led by theses; five RO1 level grants; two NIH training two MFM physician-scientists, Kathryn Gray (BWH) grants; 12 corporate collaborations; four patents; and Andrea Edlow (MGH). This biorepository now and multiple, on-going intra-institutional, national, contains samples from more than 1000 pregnancies and international research collaborations. and has resulted in more than 13 high-impact publications to date. Work done within the LIFECODES biobank has made unique contributions to the investigation of The biorepositories were initiated early in the environmental exposures and pregnancy health pandemic in April 2020, first with recruitment of and ongoing work in identifying protein and RNA pregnant patients affected by SARS-CoV-2 infection based biomarkers of adverse pregnancy outcome. / COVID-19 and later expanding to include pregnant Presently the biobank contains biological samples and lactating individuals undergoing COVID-19 and data on over 7,000 pregnancies and continues vaccination. Research utilizing these samples has to recruit new participants at approximately eight (1) delineated that vertical transmission of SARS- per week. Over 43% of participants are self- CoV-2 is rare and identified mechanisms as to why identified as members of underrepresented minority this may be the case; (2) defined characteristics of groups, and based on geolocation data, LIFECODES maternal and fetal immunity following SARS-CoV-2 participants cover the entire metropolitan and infection and COVID-19 vaccination in pregnancy and commuter locations of Boston. Thus, LIFECODES lactation; (3) identified differences in maternal and represents an unparalleled resource for ongoing fetal humoral immunity by trimester of vaccination • The Diabetes in Pregnancy • Emily Reiff, MD, expanded the • The Maternal-Fetal Medicine Program continued to expand at quality and safety initiatives for fellowship under the direction Brigham and Women’s Hospital. MFM and assumed the co-lead of of Dr. Katherine Economy and Led by Dr. Sarah Lassey, the the Obstetric Quality Assurance associate director Dr. Sarah Little, program is a multidisciplinary care committee with monthly quality with assistance from coordinator clinic comprised of maternal- and safety review of cases to Margie Ruiz, also expanded training fetal medicine specialists, evaluate process and system opportunities with the addition of endocrinologists, nutritionists, improvement. She additionally a second combined fellowship nurses, and social workers. Our is Lead for the CRICO safety program. In addition to the existing, prenatal diabetes care includes program with a focus on with combined MFM-genetics four- type I, type II, and gestational obstetric debriefs. As part of this year program, a new combined diabetics from the preconception role, she is involved in the PNQIN/ fellowship was approved to start in visit through postpartum. Working Tufts study – implementation, 2023. This addition will be a four- as a team we aim to manage sustainability, and monitoring of year integrated program between diabetes with medication/insulin AIM obstetric bundles. maternal-fetal medicine and instruction, nutritional counseling, addiction medicine sponsored and management of pregnancy. by both divisions. 38 Department of Obstetrics and Gynecology

and COVID-19 vaccine type; (4) evaluated the effects Divisional research efforts and collaborations also of COVID-19 boosters on maternal and neonatal targeted on ways to improve shared decision-making immunity; and (5) described the duration of neonatal and the patient experience with labor induction. antibody titers in infants born to pregnant individuals Dr. Little was awarded a research grant from Hologic with COVID-19 vaccination in pregnancy compared to looking at improving the prediction of spontaneous SARS-CoV-2 infection. Ongoing efforts aim to define labor at term. Additionally, Dr. Little along with the maternal immune response more comprehensively Dr. Rachel Wood are leading a randomized controlled before and after maternal immunization across trial, supported by a research grant from Medicem, pregnancy and define the innate and adaptive on the optimal agent for outpatient cervical ripening. immune response across the maternal-fetal dyad. Drs. Little and Katherine Economy, along with Dr. Julianna Schantz-Dunn, have led a collaborative Our larger research team has included important task force to improve labor inductions at BWH. contributions from: Lydia Shook (MGH MFM); Khady Diouf (BWH OB/GYN); Mandy Belfort and Daniela Carusi, Hope Yu, Sarah Rae Easter, and the Laurie Foster (BWH Pediatric Newborn Medicine); surgical obstetrics team have led multiple research Babatunde Akinwunmi (BWH MFM); and all BWH efforts to improve the safety and care for patients and MGH obstetricians, nurses, residents, and staff. with accrete spectrum disorders. The Pan-American Society for the Placenta Accreta Spectrum (PAS2) is Research teams making delivery safer an international, multi-center research collaborative group of which Brigham and Women’s is a founding The MFM Division has worked this year to improve member. Multiple research projects have been safety on labor and delivery. Emily Reiff and Sarah published and are in the works on risk factors and Little were award a CRICO patient safety grant to surgical outcomes for placenta accreta spectrum. develop new ways to communicate with the care Dr. Carusi and her team collabroate across BWH team during the second stage of labor. The second with anesthesiologists, perinatal psychiatrists, and stage of labor, when a woman is fully dilated and infertility experts on accreta profiling and patient ready to start pushing, represents one of the most care. Drs. Yu, Carusi, McElrath, and Cantonwine vulnerable intrapartum periods for both mother presented at SMFM’s 2021 plenary session their and baby. Their work will focus on the management recent identification of a novel second trimester of the second stage of labor through centralized, biomarker predictive of accreta spectrum. remote, real-time review of the medical record. In addition, Dr. Reiff led our CRICO patient safety program this year, with multiple components focused on debriefing on labor and delivery. Division Awards/Honors/Promotions • Dr. McElrath was promoted to full professor in OB/GYN and in Epidemiology at SPH • Dr. Louise Wilkins-Haug was named the incumbent William Lambert Richardson Distinguished Chair in OBGYN, which will be renamed in her honor on her retirement • Drs. Carolina Bibbo and Sarah Rae Easter received the Brigham and Women’s Hospital 2022 Distinguished Clinician Award • Dr. Carusi was elected to the Executive Board of the Pan American Society for the Placenta Accreta Spectrum • Dr. Carusi received the BWH/MGH Combined Residency in OB/GYN Leonard E. Safon Award for Outstanding Teacher of Obstetrics Clinical Divisions 39

Midwifery Nicole Sczekan, MSN, CNM, CARN-AP, Director Division Members Tarcia Edmunds-Jehu, MPH, CNM Jocelyn Rinne, MSN, CNM Sundyna Beaven, MSN, CNM Sarah Enteen, DNP, MSN, CNM Lara Simondi, MPH, CNM Julia Bojanowski, MPH, CNM Glynnis Gracia, MSN, CNM Arianna Stein MSN, CNM Amanda Davis, MPH, CNM Matthew Medina, MSN, CNM Margot Stone-Condry, MSN, CNM Laura Detwiler, MSN, CNM Megan O’Keefe, MSN, CNM Erin Tullock, MPH, CNM Jill Doyle, MSN, CNM Julie Patel, MSN, CNM Raquel Vargas-Vila, MSN, CNM Mission Midwifery provides a holistic paradigm of care to meet the complex needs of vulnerable populations and improve the health of persons and their families regardless of race, language, social status, gender, or sexual orientation. The BWH Midwifery Group was established in 1977 and remains an integral part of the Obstetrics and Gynecology team within the Connors Center for Women and Newborns. The Group is committed to upholding the highest clinical, professional, and ethical standards. In a sustained commitment to decrease health disparities, the midwives provide care in nine Boston Community Health Centers and the BWH Adolescent Clinic. The BWH Midwives respect a person’s right to autonomy within a relationship of compassion, education, informed consent, and shared decision-making. We strive to teach patients using their primary language and with cultural sensitivity. We approach life events such as puberty, birth, and menopause as normal, physiologic transitions and support and educate persons, so they can make the best health choices throughout their lifespans. 40 Department of Obstetrics and Gynecology

Accomplishments in AY 21/22 Our Voices • Transitioned to a mixture of Midwives advocate for holistic care of patients amidst COVID-19 pandemic in-person and telehealth visits for prenatal and family planning needs The year has been challenging for patients and clinicians alike. As we emerge from the pandemic, we find people need • Provided ongoing support and selfcare and resources to move towards wellness. The midwives in the health centers work closely with social workers and education for the option of Trial case managers to meet the complex psychosocial needs of of Labor after Cesarean section pregnant persons. In addition to the increase in psychosocial (TOLAC) needs, we have found an increase in hypertension in pregnancy and collaborate closely with our Brigham and Women’s physician • Supported normal physiologic birth specialists. To provide the best care for each patient, we address needs through a holistic lens. A patient’s wellness to reduce the Nulliparous Term is contingent on their internal and external environment. It Singleton Vertex (NTSV) Cesarean encompasses physiology, mental health, mindset, social section rate supports, housing, transportation, food, safety, education, and resilience. The midwifery paradigm works across many • Created a new pathway to provide disciplines of care to address all aspects of a person’s health throughout pregnancy and across the lifespan. clinical education and mentorship to Georgetown and Yale midwifery students and clinical instruction for Harvard Medical School students In 2022, Midwifery: provided labor and birth care for 711 women Clinical Divisions 41

Minimally Invasive Accomplishments in AY 21/22 Gynecologic Surgery • Received the longest possible Mobolaji O. Ajao, MD, MPH, Interim Director; Director, Fellowship 4-year accreditation from FMIGS Assistant Professor, Harvard Medical School for our fellowship in Minimally Invasive Gynecologic Surgery Division Members Louise P. King, MD, JD • Dr. Gupta, MIGS fellow, won the Director, Research; Associate Director, Fellowship Instructor, Harvard Medical School Jay M. Cooper AAGL Foundation Jon Ivar Einarsson, MD, PhD, MPH Signature Award for the Best Associate Director, Fellowship paper on Minimally Invasive Professor, Harvard Medical School Gynecologic Surgery by a current Louisa Chatroux, MD (Fellow) or graduated FMIGS fellow at the 50th Annual Global Conference for Parmida Maghsoudlou, Research Assistant manuscript titled: “Very Low Rates Michelle Gittens, Administrative Support of Ureteral Injury in Laparoscopic Darlande Berry, Administrative Support Hysterectomy Performed by Hannah Marden, Practice Manager Fellowship-Trained Minimally Invasive Gynecologic Surgeons” Mission • In joint efforts between the MIGS Our mission is to offer minimally invasive surgical options to women who may have traditionally required and CIRS Division, the Department a more invasive surgical procedure. We strive to be at is launching two new Centers to the forefront of this rapidly evolving surgical field and advance expert patient-driven to translate progress into outstanding patient care. care for fibroids (Co-director, We are committed to resident and fellow education Dr. Ajao) and endometriosis as well as conducting clinical research and projects (Co-director, Dr. King) supporting innovation within our subspecialty. “Access to 42 Department of Obstetrics and Gynecology minimally invasive surgical options for complex benign disease processes should be available to all women. The MIGS Division will continue to advocate for this, both within BWH and beyond.” — Dr. Mobolaji Ajao

Our Voices Amidst several changes, division continues to thrive and lead in minimally invasive surgery It has been a bittersweet year for our division. The for our patients. Dr. King, a leader in Reproductive division founder, Dr. Einarsson, stepped down as Bioethics, adds an important dimension to our the division director and transitioned to a smaller, work. An example of this is her commentary in the focused practice here at BWH while continuing his Green Journal last year, looking at the pay gap in interests in surgical innovation and establishing a gynecologic surgery and how it potentially results in MIGS practice back home in Iceland. While we are lower quality care for women. Under the mentorship happy for him to continue to pursue his passions, of Dr. King, our new fellow, Dr. Chatroux, is exploring his contributions to BWH and the MIGS world disparity in gynecologic surgical care and the at large are immense and will be missed. Under concept of surgical deserts (i.e., access to his leadership, the MIGS Division developed into minimally invasive surgical care based on geography a national leader in minimally invasive surgery, and zip codes). The Division will continue to push offering thousands of women access to minimally the field of benign gynecologic surgery forward by invasive surgery. As the Division moves forward, leading with technical expertise in the operating we will build on this legacy of demanding the room, training future leaders in reproductive surgery, best, equitable, and least morbid interventions and performing practice-changing clinical research. MIGS completed new visits: July 2021 – July 2022 Number of completed visits 100 90 80 70 60 50 40 30 20 10 0 7-21-21 8-21-21 9-21-21 10-21-21 11-21-21 12-21-21 1-21-22 2-21-22 3-21-22 4-21-22 5-21-22 6-21-22 7-21-22 In person Virtual/Telemedicine FXB Division Awards/Honors/Promotions Jon Ivar Einarsson, MD, MPH, PhD • Distinguished Clinician Award, Brigham and Women’s Hospital Clinical Divisions 43

Nursing and Clinical Services Connors Center for Women and Newborns Margaret Higgins, MSN, RN, NEA-BC Interim Associate Chief Nursing Officer Women’s and Newborn Health Leadership Team Gynecology/Women’s Cancer Program (CWN 8N & TR 12C) Center for Labor, Birth and Recovery (CWN 5) Marykate Hegarty, MSN, RN, Nurse Director Antenatal Care (CWN 8S) Margaret Allaire, MSN, RN, Assistant Nurse Director Mother-Baby Care and OB Float Pool (CWN 9 & 10) Claire Zaya, MSN, RN, Nurse Director Neonatal Intensive Care Unit (CWN 6) Special Care Nursery Unit (CWN 6) Lactation Director Julie Cadogan, MSN, RN, Nurse Director Mimi Pomerleau, DNP, MPH, MSN, RN, Newborn Care Deborah Schlehuber, RN, Assistant Nurse Director Professional Development Manager Barbara Stabile, MSN, RN, Women’s Health/OB Care Mission The BWH Department of Nursing’s mission is to provide excellent care to patients and families with the best staff in the safest environment. We are committed to a healthy work environment that emphasizes mutual respect, productive discourse and collaborative relationships. These attributes enhance our patient care outcomes and our ability to advance nursing practice through research and innovation. The Department of Nursing updated our professional practice model in 2020, which guides the nursing care we provide to patients, families, and our community. Relationship-Based Care is at the center of this model, with guiding principals of compassion, knowledge, excellence, and collaboration. This professional practice model is set in the context of our Brigham and Women’s Hospital values: We Care, We Create Breakthroughs, We Pursue Excellence, and We’re Stronger Together. BWH obstetric, gynecologic, and newborn nursing is committed to patient and family- centered care. This commitment is based on providing relationship-based care and relies on excellent nursing practice and multidisciplinary team collaboration. 44 Department of Obstetrics and Gynecology

Our Voices Voalte communication system increases quality of communication and patient care CWN staff, along with our Nursing Information team for staff to come to the desk to answer a call. and Information Systems teams, were involved in the With the implementation of Voalte throughout all initial roll out of the Voalte communication system of CWN (the NICU started using Voalte almost five last fall and were finally able to experience a more years ago), all nurses now have a more efficient way efficient way to communicate with other disciplines. to stay connected to physicians, other providers, Nurses, patient care associates, attending physicians, and to each other, regardless of location in our residents, midwives, case managers, social workers, building. It has created such a positive change for lactation consultants, and unit coordinators can staff with shorter delays, ultimately allowing for use the application – which allows for secure and improved patient care with quicker responses to HIPAA-compliant texting and voice calls on an requests and a more satisfied patient when we iPhone – to quickly communicate without the need have timely communication. Voalte also allows for a page or waiting or a return call. Previously, with for direct communication between staff nurses the paging system, nurses would spend excess time on different units, allowing for conversations to waiting for return calls from providers, time that happen in real time and increase efficiencies in would take them away from the patient bedside, and patient flow or ensure coordination of care for providers would spend time waiting on the phone an individual patient and family. Accomplishments in AY 21/22 • Optimizing the lactation care we • This growth in volume means • #1 U.S. News and World Report provide to women and newborns having the optimal number of remains an important focus. We nurses with the ideal competencies ranking in OB/GYN have hired a nursing director to and expertise to care for our patient oversee the lactation program, population. We have continued • Onboarding many new and in late 2019, we opened to hire and crosstrain a number our outpatient lactation clinic at of nurses who are in our OB nurse leaders throughout 221 Longwood in collaboration Newborn Float Pool. They care our division, including ACNO, with the Department of Pediatric for postpartum women and well Labor & Delivery nursing director Newborn Medicine. This clinic is newborns on CWN 9 and 10, and assistant nursing director. has continued to grow under the and infants requiring Level II We also welcomed Julie Cadogan leadership of Sue Bryant, MSN, NICU care on CWN 6. In addition, to the NICU nursing director RN, IBCLC, who has provided some nurses with expertise in role, formerly a Professional lactation care to mothers and postpartum and well-newborn care Development Manager. infants. Both in-person and virtual are cross training to care for our care are offered. antepartum patients, allowing these • Development of strategies to nurses to expand their clinical skills • In all areas of nursing practice and care for a greater diversity of improve support for women and patients within our division. newborn’s discharge readiness, within the CWN, we have prioritized ensuring that all patients are building greater capacity into discharged home as soon as our nursing workforce. In 2022, they are ready. we anticipate >7000 births at BWH (nearly 1000 more than • Jennifer Riley, MSN, RN, IBCLC in 2019!) and have been hiring a large number of nurses who is a member of the lactation are interested in the women and services team and was the newborn health nursing specialty. recipient of the 2022 BWH We have hired staff RNs into Essence of Nursing award. educational roles to further This annual award recognizes support staff at the bedside. outstanding nursing practice of a member of the entire BWH community. Clinical Divisions 45

Obstetrics and Center Accomplishments in AY 21/22 for Labor and Birth • Documented a hemorrhage Robert L. Barbieri, MD risk assessment on all patients Interim Chief of Obstetrics admitted to labor and on transfer Kate Macy Ladd Professor from labor to postpartum (Dr. Reiff) Harvard Medical School • For cesarean birth, ensured the Division Members Margaret Higgins, MSN, RN, NEA-BC; Interim Associate Chief presence in the operating room Nursing Officer, Women’s and Newborn Health of the primary support person Emily Reiff, MD (Drs. Osterbur-Badhey, Onwuzurike, Nicole Patton, Chief PA and Bibbo) Co-Directors, Obstetric Quality Improvement Daniela Carusi, MD, MSC; Director, Surgical Obstetrics; Placenta • Standardized the diagnosis of Accreta Spectrum Disorders Carolina Bibbo, MD; Director, BWH Comprehensive Center acute kidney injury (Dr. Smith) for Multiples Sarah Rae Easter, MD; Director, BWH Obstetric Critical Care • Ensured the early detection of iron Adele Bertschy, Administrative Project Coordinator to the Chief deficiency by measuring ferritin Plus faculty, fellows, and house staff in the Department of Obstetrics in the first and third trimesters and Gynecology; independent obstetrician-gynecologists; BWH nurse (Dr. Carusi) midwives; and CWN nursing staff • Facilitated the provision of Mission postpartum sterilization and LARC Our mission is to provide a full range of innovative (Drs. Lagon and King) obstetric services, promote research and education, and facilitate equitable care in a safe and professional • Decreased the use of opioid environment, strengthened by a focus on diversity and inclusion. medications by patients having a vaginal or cesarean birth (Drs. Carusi and Farber) • Standardized antibiotic prophylaxis for the surgical repair of an anal sphincter injury (Dr. Diouf) In the AY2021/2022: there were 6,901 deliveries with a nulliparous, term, singleton, cephalic cesarean birth rate of 24.01% 46 Department of Obstetrics and Gynecology

Our Voices Improving clinical care for patients with limited English proficiency (LEP) Many healthcare team members are not fluent in then contact the hospital for the services that they our patients’ preferred language. Non-concordance need, such as contacting the on-call obstetrician or in language fluency between the healthcare team midwife. The second component is that clinicians and patient can adversely impact the patient’s care. can directly obtain interpreter services by calling a To enhance effective communication for patients phone number we have provided. The clinician and with LEP, we have developed a streamlined approach the interpreter can then call the patient to discuss to accessing interpreter services that has two the patient’s situation and needs. We believe that components. The first component is that patients by enhancing our patients’ ability to directly access with LEP can directly obtain interpreter services interpreter services, without first contacting a by calling a phone number we have provided. The healthcare team member, we will improve their care. patient, with the assistance of the interpreter, can Clinical Divisions 47

Pediatric and Adolescent Gynecology Marc R. Laufer, MD, Director Chief of Gynecology, Associate in Surgery, Boston Children’s Hospital Co-Director, Center for Young Women’s Health (CYWH) Founder and Director, Boston Center for Endometriosis (BCE) Professor, Harvard Medical School Division Members (Boston Children’s Hospital) Carol L. Cohen, NP Roxanne Gardner, MD Assistant Professor, Harvard Medical School Emily Haffner, BSN, RN, CPN Nurse Educator Frances Grimstad, MD Assistant Professor, Harvard Medical School Shaunna King, RN Maureen Lynch, MD Caitlin Roberts, MSN, RN Assistant Professor, Academic Part-time, Harvard Medical School Robyn M. Mars Jessica Shim, MD Administrative Support Instructor, Harvard Medical School Mission The Division, located at Boston Children’s Hospital, is a collaborative effort between the Department of OB/GYN at BWH and the Department of Surgery at BCH. Our mission is to be a leader in clinical care, teaching, and research on a local, national, and international level in the field of pediatric and adolescent gynecology. Our faculty provides critical training for residents in care for females from birth to age 26. Residents are exposed to a wide range of pediatric and adolescent gynecologic issues and procedures such as reconstructive surgery of the genital tract, examination of the prepubertal child under anesthesia, operative laparoscopy, management of pelvic pain, and endometriosis and ovarian masses. The Division promotes awareness of pediatric and adolescent gynecologic issues and supports community outreach programs through the following resources: THE BOSTON CENTER FOR ENDOMETRIOSIS (BCE), created in 2012 by Dr. Laufer, offers adolescent and adult women cutting edge treatment with the focus on short-term intervention and long-term management across the life span. Specialists from BCH and BWH focus on exceptional clinical care, research, and education. The research is made possible by grants from the J. Willard and Alice S. Marriott Foundation and the Marriott Daughters Foundation. (www.bostoncenterendometriosis.org) 48 Department of Obstetrics and Gynecology

THE CENTER FOR YOUNG WOMEN’S HEALTH (CYWH) was established in 1997 and it provides online health chats, conferences, and curriculum. The youngwomenshealth.org website, providing a wealth of clinician-back health education content, received almost 16 million visits in 2020. (www.youngwomenshealth.org) THE YOUTH ADVISORY PROGRAM recruits and trains students from Boston high schools to provide peer education and support in our clinic and at health fairs in the Greater Boston area. They also serve on the BCH Teen Advisory Committee. THE MEDICAL RESIDENT TRAINING PROGRAM holds mock interview sessions with youth advisors to develop best techniques for interviewing and providing care to teens. TEEN TALK NEWSLETTER written by the CYWH youth advisors promotes awareness of important health topics and youth friendly guidance and resources. INTERNET CHATS provide online support groups and education for girls (and their families) with PCOS, endometriosis, and MRKH. Accomplishments in AY 21/22 • CYWH Youth Advisors were In the AY2021/2022: • Continued high volume with finally able to attend a sexual 4,977 health education fair at nearby patients seen in the surgical and Emmanuel College for the first total clinic visits medical program by Drs. Laufer, time since early 2020 Grimstad, and Shim and in 383 the ambulatory program by • The CYWH expanded our virtual Drs. Gardner and Lynch surgical cases presence this year by launching total among • Developed a new two-year an Instagram account. This new platform allows us to reach our Drs. Laufer, Shim, fellowship which involves both teen audience via social media. By and Grimstad research and clinical training; putting visually engaging content Formal collaborations between front and center, we’re able to GYN and other services at BCH produce content that is rigorous, have also been added informative, and shareable • Developed a unique telehealth • o We expanded our health program for patients diagnosed guides and online features for with endometriosis and MRKH. the CYWH site with new guides: Patients diagnosed with COVID-19 Vaccine; Pelvic Floor endometriosis may have a virtual Physical Therapy; Taking Charge post-op visit to defer travel costs of Your Healthcare; Vaginoscopy; Vaginoscopy: A Guide for Parents; • The CYWH hosted the 16th Annual Self-Care during the School Year; Simone Biles, Me, and the Mayer-Rokitansky-Küster-Hauser Pressure of Perfection; Hybrid Syndrome Conference and 14th Learning: In Hindsight, Mindful Annual Endometriosis Conference, Movement; College Counseling; virtually, for the second time. This and Creating Change virtual format continues to allow patients and families from around • The CYWH has increased the world to meet our faculty, learn from keynote and guest speakers, sustainability efforts by and form connections with other leveraging virtual engagement patients and families and using QR codes Clinical Divisions 49