Department of Obstetrics, Gynecology & Women's Health

Department of Obstetrics, Gynecology & Women’s Health John A. Burns School of Medicine University of Hawai’i

2019-2020 Annual Report

Our Values Integrity Excellence (E Kulia Ika Nu’u)

Our Vision Advancing women's health care

Our Mission To advance women’s health by promoting excellence in education, research, clinical care and community service in a sustainable fashion

Contents Our Points of Pride ...... 1

Aloha from the Chair...... 2

Faculty Highlights ...... 4

Faculty Spotlight ...... 6

Family Planning Division ...... 8

General Obstetrics & Gynecology Specialists Division ...... 9

Gynecologic Oncology Division ...... 10

Maternal-Fetal Medicine Division ...... 10

Reproductive Endocrinology & Infertility Division ...... 11

Research Division...... 12

Urogynecology Division ...... 13

Undergraduate Medical Education ...... 14

Graduate Medical Education ...... 16

Ob-Gyn Residency Program ...... 16

Maternal-Fetal Medicine Fellowship Program ...... 18

Complex Family Planning Fellowship Program ...... 19

Research Day ...... 20

Awards ...... 22

Philanthropy ...... 24

Community Partnerships ...... 26

Faculty Listing ...... 27

Research Productivity ...... 30 Our Points of Pride 1. Lifelong learning • The best medical students matching in our OB/GYN residency program and nationally; OB/GYN clerkship continuously ranks the highest among all clinical departments at JABSOM • Nationally recognized OB/GYN residency program with long tradition since 1948 -among the best 5% programs in the country • Two nationally recognized fellowships: Maternal Fetal Medicine and Complex Family Planning 2. Discovery • This academic year: 35 peer reviewed publications • Current extramural funds: 12 grants (+2 collaborative): $1.5M • 2019 Roy Pitkin Award – among 4 best research papers in the USA 3. Healing • Hawai’i Best or Top Doctors: 9 in our department • Service to underserved: Wai’anae, Kalihi-Palama, Wahiawa, Waimanalo, L nai, Hilo • ā • PacificService Health to neighbor and Queen’s islands: Health Kauaʻi, Systems Maui, Lānaʻi, Hawaiʻi • ThePatient State safety/quality’s only clinical initiatives practice withwith aour whole major spectrum community of integrated partners: clinical Hawaiʻi care in women’s health (general OB/GYN, maternal fetal medicine, gynecologic oncology, urogynecology, reproductive endocrinology and infertility, family planning, critical care, addiction medicine, imaging) • First permanent JABSOM faculty practice on neighbor islands (Hilo) 4. Academic development • 21 faculty promoted since 2012 • American Board of OB/GYN: 3 examiners from our department • Leadership in major OB/GYN national and international organizations • Faculty on Editorial Boards or Associate Editors of major peer reviewed journals 5. Value to the community/ Philanthropy • Over $11 M since 2014 • 3 endowed chairs (>2 million) • 5 endowed professors (0.5-2 million) • Endowed programs/awards

Aloha from the Chair E Komo Mai (Welcome) to the Department of Obstetrics, Gynecology, and Women’s Health at the John A. Burns School of Medicine (JABSOM), University of Hawai‘i at Manoa. Our journey of lifelong learning, discovery, and healing has been filled with rewards and challenges this past year, as we embarked in new endeavors to promote excellence in education, research, clinical care, and community service in a sustainable fashion. We’ve recently made history as the first JABSOM Faculty Practice outside of Oahu and this academic year we started the first permanent OB/GYN resident rotation in that location. Our Hilo resident rotation offers our learners invaluable training in a low-resources setting to complement the training we currently offer in Honolulu. The support of Hilo Medical Center and Hawaii Health Systems Corporation, specially Dr. Linda Rosen and Dr. Kathleen Katt, has been key to realizing this milestone and a testament to our continuous commitment to promoting excellence in education while upholding outstanding quality of service to the women of Hawai‘i. We continue to foster an environment of academic excellence. Twenty-one faculty members have been promoted since 2012. Our faculty continues to hold leadership roles in major national and international organizations and peer reviewed journal Editorial Boards. Three of our faculty serve as examiners with ABOG. Our Family Planning Division was awarded the prestigious 2019 Roy Pitkin Award for publishing an outstanding article in Obstetrics and Gynecology. Only four academic departments in the country were honored with this extraordinary peer recognition. Philanthropy is a hallmark of a strong academic institution and a testament of its value creating greater good in perpetuity. This year we have been blessed with major investments from Drs. Santosh Sharma, Thomas Kosasa, Angela Pratt, Simon Chang, Don Tokairin, and many others. Dr. Bliss Kaneshiro was honored as Colin McCorriston Endowed Professor and Dr. Mark Hiraoka was named Lakskmi Devi and Devraj Sharma Endowed Chair. We currently have three endowed chairs, 5 endowed professors, and several endowed programs. This year’s internal giving campaign was also exceptional. Our department, faculty practice, and medical school are looking forward to redefining the academic clinical learning environment for our medical students, residents, fellows, and community. In the continuous quest for excellence in lifelong learning, the COVID19 pandemic reminded us of the true spirit of Ohana. The meaning of this Hawaiian concept is that family and friends are bound together, everyone must work together, and nobody is left out. Essential elements of professional Ohana as we learnedʻ dealing with COVID-19 pandemic are: rapid collaboration in implementing most current evidence-based medicine, assessing and improving the ever-changing healthcare environmentʻ by problem solving,

and a “how to” instead of a “should we” approach. In addition, as “the islands in the middle of nowhere” with very limited resources we have to rely heavily on internal expertise, ingenuity, and innovation. In order to sustain this positive energy in transforming healthcare, we have to invest in faculty and staff professional development, learners’ engagement, patient safety, and continuous quality improvement. We also need to address healthcare disparities and open wounds of racial injustice so deeply affecting the most vulnerable: women and children. Focused, funded, and well- designed research will help us to “push envelopes” to conquer the current pandemic. We need to be mindful of being a financially sustainable academic department and medical school as a whole, to continuously lead in healthcare innovation showing indispensable value to the local community that meets well-established national and international standards. As we navigate these shifting times in health care and the academic clinical learning environment, collaboration with deeply rooted Ohana spirit is key to moving forward in our mission. I want to thank each and every one of our clinicians, researchers, educators, staff, and community partners for their relentless commitmentʻ to advancing Women’s Health in Hawai‘i. Our leaners and patients are our inspiration to strive to the highest, or in the words of Hawaiian Queen Kapi’olani: E Kulia Ika Nu’u (in translation: Strive to reach the summit)!

Ivica Zalud, MD, PhD, FACOG, FAIUM Professor and Chair Kosasa Endowed Chair

Faculty Highlights

Lisa Bartholomew, MD was first Bliss Kaneshiro, MD, MPH, Family author on the publication Planning Division Chief was named “Obstetric challenges: Substance “Colin use in the breastfeeding woman” McCorriston Endowed Professor”. in Contemporary Ob/Gyn. She authored a chapter on Emergency Contraception in the Oxford Michael Carney, MD, MPH, Textbook of Endocrinology and Diabetes. Dr. Gynecologic Oncology Division Kaneshiro was awarded new funding from the Chief and Kosasa Endowed Hawaii State Department of Health for her Professor became a member of the research studies on Contraceptive Access in the National Cancer Institute State of Hawaii. Gynecologic Cancer Steering Committee. He was part of a team that Bruce Kessel, MD was an invited published “The Immune Landscape of Cancer” speaker at the 2019 National in Immunity. Dr. Carney continues to lead Medical Association Annual multiple research projects in gynecologic Convention and the 2019 Hawaii cancers. Academy of Family Physicians Meeting. He co-authored the article Ann Chang, MD, MPH, Generalist “Effects of 17b-Estradiol on the Plasminogen Division Chief and Associate Activator System in Vascular Smooth Muscle Residency Program Director co- Cells Treated with Lysophosphatidylcholine.” authored the article “Examining which was published in the Journal of the validity of a predictive model Menopausal Medicine. for vaginal birth after cesarean.” which was published in the Journal of Perinatal Medicine. Men-Jean Lee, MD, Maternal-Fetal She was part of the team that presented “A Medicine Division Chief qualitative study examining obstetricians’ and Kosasa Endowed Professor perspectives on delivery care for women from was accepted into the Executive Micronesia” at the American Public Health Leadership in Academic Medicine Association Annual Meeting. (ELAM) at Drexel University. She was a recipient of a $315,000 AlohaCare Wai Wai Ola grant to develop the Midwifery- Mark Hiraoka, MD, MS, Associate Integrated Home Program (MI-Home) for Chair of Academic Affairs and marginalized pregnant women. Dr. Lee spoke Residency Program Director was about health disparities at the National Medical named “Lakshmi Devi and Devraj Association Annual Convention in Hawaii. She Sharma Endowed Chair in hosted the first Maternal Telehealth Summit Obstetrics, Gynecology & Women's Health”. with sponsorship from the Hawaii State Department of Health and the Pacific Basin Telehealth Resource Center.

Richard McCartin, MD was appointed University Health Partners of Hawaii, Obstetrics and Gynecology Chief Medical Officer.

Melissa Natavio, MD, MPH joined Stacy Tsai, MD, MPH, MCR led our faculty. She authored a our Kapiolani Medical Center chapter on Emergency Labor and Delivery COVID-19 Contraception in the third edition response team. She was an invited of The Handbook of Contraception: speaker at the American College of Evidence Based Practice Obstetricians and Gynecologists Annual District Recommendations and Rationales. She was part Meeting. of a team that published “Effects of protease inhibitor use on combined oral contraceptive pharmacokinetics and pharmacodynamics in W. Steven Ward, PhD, Research HIV-positive women” in Contraception. Division Chief and Lakshmi Devi & Devraj Sharma Endowed Chair was awarded a program project Shandhini Raidoo, MD, MPH was grant from the NIH to support two first author on the publication core facilities and a pilot project program in the “Dual Method Contraception Institute for Biogenesis Research. Among Adolescents and Young People: Are LARC Users Different?” in the Journal of Pediatric and Adolescent Kelly Yamasato, MD, was first Gynecology. Dr. Raidoo was invited to plan and author on the publication lead VIA, Cryotherapy, and Family Planning “Complications of educational workshops in Yap, Federated States operative vaginal delivery and of Micronesia. provider volume and experience” in the Journal of Maternal-Fetal Reni Soon, MD, MPH assumed the Neonatal Medicine. She was an invited speaker role of Co-Program Director of our at the at American College of Obstetricians and Family Planning Fellowship. She Gynecologists Hawaii Section Annual Meeting. received research funding from the Hawaii State Department of Health for her study entitled: “SBIRT Ivica Zalud, MD, PhD, Kosasa – Screening Brief Intervention and Referral to Endowed Chair was an invited Treatment.” Dr. speaker at the 14th World Soon co-authored the article “Text message link Congress of Perinatal Medicine, to online survey: a new highly effective method the 5th World Congress on of longitudinal data collection” which was Ultrasound in OB/GYN, Maternofetal Medicine published on Contraception. and Human Reproduction, and the 2nd European Congress of Ian Donald School of Ultrasound in Obstetrics and Gynecology. He was named as Tracee Suetsugu, MD was Associate Editor and Reviews Editor of the promoted to Assistant Professor. Journal of Perinatal Medicine.

Faculty Spotlight

Scott Harvey, MD, MS Director, Obstetric Critical Care

During residency, Dr. Harvey recognized how quickly obstetric patients can clinically deteriorate and require provisions of critical care. To meet the need of the community, he elected to matriculate into a Surgical/Trauma Critical Care Fellowship, becoming Hawai‘i’s only practicing Obstetric Intensivist. Dual-board certified in OB/GYN and Critical Care Medicine, he is one of 24 people in the United States who practice the unique specialty of Obstetric Critical Care. Five years ago, he joined the University of Hawai‘i and University Health Partners to enter into an academic clinical practice. He is currently the Medical Director for the Adult Intensive Care Unit at Kapi‘olani Medical Center for Women and Children, and practice at four hospitals on O‘ahu, including The Queen’s Medical Center (Hawai’i’s only Level 1 Trauma Center). With this unique blend of specialties, he has been able to improve education, clinical care, and provide research for the vulnerable population of critically ill pregnant/postpartum women.

Dr. Harvey’s educational activities include teaching a myriad of professionals, from Nurse, Respiratory Therapists, Medical Students, Residents, Surgical Critical Care Fellows, and Maternal Fetal Medicine Fellows. He has developed curriculum that focuses on OBGYN Emergencies as well as aspects of critical care in pregnant and non-pregnant patients. Although educational curricula are important for increasing knowledge, it needs to translate to optimal treatment principles for patient care. As such, he has written many hospital protocols, order set panels, and algorithms that are augmented with team simulation. These simulations include high fidelity manikins and monitoring equipment and are performed in the same clinical areas that a normal patient would be seen. Simulation in this manner facilitates a safe learning environment for all participants, promotes teamwork, identifies system-related issues that can be improved by administrative processes, and puts education into action for rarely seen emergencies. As one example, the COVID-19 infection has threatened the population of Hawai‘i and there is significant ambiguity of how to treat these patients and manage a “surge” of multiple critically ill patients. First, he created several lectures observing current and emerging literature regarding COVID-19, foundational physiologic and pathophysiologic disease processes, and offered management principles. These lectures were video recorded and distributed widely to a range of audience participants. Second, along with a team of administrators, hospital staff, and other physicians, he was the director to write protocols, guidelines, and order sets for the entire Hawaii Pacific Health System. Lastly, they tested the clinical processes in patient areas, teaching staff how to “prone” patients, perform “Isolation Code Blue,” and emergently transfer infectious patients who require a Cesarean Delivery. In addition to having an excellent clinical process, these efforts reduced anxiety

amongst health care providers that there was a clinically tested protocol to protect them whilst providing optimal care for very ill patients.

OB/GYN has born the subspecialty fields of Urogynecology, Gynecology Oncology, Reproductive Endocrinology, and Maternal Fetal Medicine to support the specific needs of patients. As our obstetric patients are becoming more critically ill and have a higher mortality rate in the recent years, it has become important grow the new subspecialty of Obstetric Critical Care. As such, Dr. Harvey is honored to uniquely treat this population with the blended knowledge of two very diverse fields. Providing this clinical service line enhances care for all patients, allows mothers and babies to stay together in the same hospital (preventing maternal transfer to other hospitals with critical care services), and provides a safety net for medical providers in case of a medical complication. He is often called upon for consultation and management, but also for notification of patients at high risk for deterioration.

As an Obstetric Intensivist, building the research base is an equally important pillar to globally improve medical care to pregnant women. Having lobbied for the governmental provision of a Maternal Mortality Review, Dr. Harvey was appointed as the first chairperson of this statewide committee to collect and collate data on maternal deaths in the state. He has performed several other projects identifying risk factors for ICU admission as well as identifying race-ethnic disparities in Hawai‘i for maternal morbidity. He anticipates building a larger research base, as he was able to care for these patients and tabulate their outcomes.

Overall, the position of an Obstetric Intensivist has been overwhelmingly rewarding to Dr. Harvey. The ability to teach, research, and provide systematic improvements on patient care, even in the paucity of clinical information such as the COVID-19 pandemic has filled his vocation and provided a service for the community of Hawai‘i.

Family Planning Division

The physicians of the Division of Family Planning provide medical and surgical abortion services, miscarriage management and contraceptive consults to individuals throughout. Our work is embodied by the sentiment that all individuals in Hawai‘i should be able to make reproductive decisions that are consistent with their values. With multiple specialists trained in Complex Family Planning, we provide comprehensive contraceptive services and specialize in innovative contraceptive technologies. We are well-equipped to provide care to patients with complex medical issues. Our division receives referrals from across the state. We are pioneers in providing abortion and contraceptive care through telemedicine and were recently recognized for our work in the New York Times and The New Yorker.

We are committed to training the next generation of physicians and clinician researchers. In 2006, our division established the Ryan Residency Training Program, and in 2011, we were accredited for a Family Planning Fellowship. Our graduated fellows are considered experts in their field both in Hawai‘i and throughout the world. As leaders in family planning research, the Women’s Health Research Center bring in cutting-edge research to benefit Hawai‘I and train the next generation of clinical researchers. Because of the work of the Division of Family Planning and our dedicated Research Assistants, the American College of Obstetricians and Gynecologists awarded the University of Hawaii Department of Obstetrics and Gynecology the Roy M. Pitkin Award in 2020 which is awarded to four departments across the country who display excellence in research.

Bliss Kaneshiro, MD, MPH, Division Chief and Ivica Zalud, MD, PhD

General Obstetrics & Gynecology Specialists Division

The General Obstetrics and Gynecology Division is committed to providing exceptional care for all women. As hospitalists, we provide urgent and emergent obstetrical, gynecologic and critical care. We also work at many outpatient sites, including multiple faculty practices, hospital clinics, and the majority of federally qualified health centers in the state, to ensure that women of all socioeconomic backgrounds and of all ages can receive excellent medical and surgical services. In the past year, we have expanded our services in Hilo and Lanai and we will continue to focus on increasing access to women outside of Oahu.

We are also committed to advancing women’s health by educating health care teams and future physicians, creating a safer health care environment, and engaging in research. Our physicians are core educators in the department for the medical students, residents, and hospital nursing staff. We expanded simulation programs to enhance educational experiences, especially in surgery and hospital emergencies. Our division are leaders in the community in safety and quality. We continue to develop and implement safety programs and protocols in outpatient clinics, labor and delivery units, emergency departments, intensive care units, and operating room units across the state. With the COVID-19 crisis and the need to provide care during the stay-at- home period, we expanded on these safety and quality measures by increasing our telehealth services, developing additional protocols for antepartum care and inpatient care, and educating hospital staff and the community through simulations and other trainings.

4,079 surgical procedures

2,173 20,678 vaginal office visits deliveries

2019

277 900 emergency c-sections room visits

Gynecologic Oncology Division

Gynecologic oncology is a unique specialty as it is the only discipline in cancer medicine that is trained both in the surgical and medical treatment for the gynecologic cancer patient. This dual skill set allows our physicians to consider multiple options for treatment and arrive at the best therapy options for each individual cancer patient. Gynecologic oncology certification is achieved with an additional 3-4 years of intense oncology training after completion of the 4 years of OB/GYN training. The doubly board (L-R) Keith Terada, MD, Michael Carney, MD, and Robert certified physicians of the Division of Gynecologic Oncology care for women diagnosed with potentially malignant, pre-malignant and malignant gynecologic conditions. We are experts in the area of complicated pelvic and abdominal surgery for malignant conditions and are often called upon to perform surgery on non-cancerous conditions that could be difficult or complicated such as large benign gynecologic masses, endometriosis and multiple previous surgeries. In addition to open surgeries, we are experts in minimally invasive surgery such as laparoscopy or robotic surgery. In fact, almost half of our surgeries are minimally invasive allowing patients to have decreased pain, shorter hospital visits, fewer side effects, and less time recuperating so they can get back to normal life and work more quickly. As nationally and internationally involved academic physicians, we are always trying to bring the most advanced treatment options to the patients of Hawai‘i. Importantly, we work with the National Cancer Institute to bring the most cutting edge medicines to Hawai‘i so that patients have the option to enroll in clinical trials and hopefully benefit from these newest therapies. Involvement in clinical research often is the only way to have access to newer generations of potentially curative medicines. We are constantly working on research for our patients. Along with our amazing team of nurses, social workers, patient navigators, financial support experts, complementary therapy teams, pain and palliative care teams, emotional, psychological, and spiritual support experts, support groups, and collaborative physicians, our gynecologic oncology team strives to provide the best care for women with ovarian, uterine, cervical, vaginal, vulvar, gestational and other gynecologic cancers and complex gynecologic conditions. Our gynecologic oncology division cares for all the women of Hawai‘i and the Pacific. We travel to neighbor islands for patient visits and work with the local team to provide the best care, although most of our surgeries are done at the major centers in Honolulu.

Maternal-Fetal Medicine Division Maternal-Fetal Medicine is a subspecialty in the field of obstetrics with highly trained physicians who specialize in unexpected issues that arise in the mother or fetus during pregnancy. We specialize in providing prenatal diagnosis by ultrasound or genetic testing, prenatal care for women with complicated pregnancies, and developing care plans for medically complex pregnant patients in the delivery room and during the postpartum period. Besides caring for women with common obstetrical problems such as preterm labor, preeclampsia, and gestational diabetes; we thrive with the challenge of supporting pregnant women with terminal leukemia, COVID-19 10 infection, or brain hemorrhage. In addition to providing complex medical services, we provide prenatal fetal ultrasound, fetal echocardiogram, prenatal genetic testing with amniocentesis, chorionic villus sampling, as well as the latest advances in non-invasive prenatal screening. Over the past year, we have introduced novel services across the Hawaiian Islands including the MI-Home (Midwifery Initiated Home) Visitation Program with a generous grant from AlohaCare’s Wai Wai Ola Program which brings high risk pregnancy care to homeless and marginalized pregnant women as a bridge to accessing more mainstream health services by a local provider. We also hosted a State-Wide Maternal Telehealth Summit to perform a timely needs assessment for telehealth and telemedicine readiness with participation from the 6 major Hawaiian Islands. Our Division also played a large role in hosting the Hawaii State Maternal Mortality Review panels and took over the operations of the Hawaii Reproductive Biospecimen Repository (HRBR) that is housed at the John A. Burns School of Medicine.

Our prenatal diagnosis and consultative services are primarily based at the Kapi‘olani Medical Center Fetal Diagnostic Center in which pregnant women can be seen for ultrasound, genetic counseling, diabetes management, and high risk pregnancy consultation in one convenient location in the hospital’s Fetal Diagnostic Center. In addition, we also provide prenatal diagnostic services and Maternal-Fetal Medicine consultations at the Pali Momi Women’s Center on O‘ahu;

Health Center (FQHC) on Maui. Over the past year, our Division initiated Addiction Medicine servicesWilcox Memorial for pregnant Hospital women on atKaua‘i; the Waikiki and the Health’s Mālama PATH I Ke Clinic,Ola Health another Center, FQHC. a Federally During the Qualified COVID- 19 surge, we brought telemedicine consultations to women with high risk pregnancy issues across the Hawaiian Islands. We also continue to provide critical care obstetrics care in collaboration with the intensive care units at the Queens Medical Center and Straub Medical Center.

In addition to providing state-of-the-art perinatal care, our Division continues to host a highly competitive Fellowship in Maternal-Fetal Medicine; and develop multidisciplinary translational research collaborations with JABSOM scientists, University of Hawaii at Manoa, University of Hawaii Cancer Center, and other Mainland Institutions.

Reproductive Endocrinology & Infertility Division

The faculty of the Division of Reproductive Endocrinology and Infertility provide care for infertility and endocrinology patients and residents are exposed to surgical management of such patients, including minimally invasive surgery and robotic cases. They will attend conferences and seminars related to reproductive endocrinology as well as be exposed to a highly successful in vitro fertilization program. Collaboration with ongoing research is available and encouraged.

The Pacific in Vitro Fertilization Institute is Hawaii’s first IVF clinic. Since opening its doors in 1985, they have quietly built a history of successful pregnancies for people who previously had 11

no hope of bearing children on their own, with more than 6,700 babies born to couples in Hawaii, and around the world.

Today, Pacific in Vitro is led by two board certified physicians with decades of experience in IVF, reproductive endocrinology, fertility and OB/GYN, Dr. Thomas Kosasa and Dr. Celia Dominguez. Their team also consists of an on-site embryologist, Thomas Huang, Ph.D. who is a board certified laboratory director and leads the Certified Embryology Laboratory.

(L-R) Thomas Huang, PhD, Celia Dominguez, MD, and Thomas Kosasa, MD

Research Division

This year, the Research Division focused heavily on developing the interactions between the Institute for Biogenesis Research (IBR) and the Department of Obstetrics, Gynecology and Women’s Health (Ob-Gyn). As the economic impact from the COVID-19 pandemic for the department became clear, we modified our plans and operations accordingly. Finally, we established a protocol to work with Hawaii Pacific Health (HPH) to steer research applications through the HPH pathway much more efficiently.

IBR-COBRE Phase III Award Tied to Ob-Gyn: In August 13, 2019, the IBR was awarded a five year, $5,000,000 grant to support the center. This application was based on developing the relationship between the IBR and Ob-Gyn, and included up to $200,000 a year in pilot project funding. The central aim of the grant was to foster the development of translational research projects between the 12

IBR and Ob-Gyn. In March, 2020, we issued the first RFA for pilot project funding and received one application from Ob-Gyn. The IBR External Advisory Committee is now reviewing these applications. The IBR-COBRE Phase III award also made us eligible for an application for a supplemental award for and additional $200,000 for FY21 in response to NOT-GM-20-017 whose major purpose was “to expand research and research capability in the IDeA states to address important issues of women’s health with a special interest in maternal and infant mortality and morbidity.” The grant was submitted, and is currently being reviewed.

Research Expenses Shifted to the Sharma Endowment: The Research Division has worked to shift departmental expenses related to research to departmental endowment accounts. This year, the Lakshmi Devi and Devraj Sharma Endowment provided all the biostatistical support that had been paid by the department. The Endowment also paid for the research supplies for MFM faculty who operates a laboratory in Ob-Gyn.

Regular Meetings with HPH Research: In January, 2020, we established regular meetings with HPH Research Institute to develop protocols for following clinical research applications through the HPH approval pathway. We now regularly review the status of each protocol, and determine whose responsibility the next action would be. This effort established clear lines of communication for stewarding our proposals through HPH.

Urogynecology Division

The physicians of the Division of Urogynecology and Pelvic Reconstructive Surgery treat women with a full spectrum of conditions related to the bladder and reproductive organs such as urinary and fecal incontinence, pelvic organ prolapse, voiding and defecatory dysfunction, pelvic organ fistulas, and complex benign pelvic surgery. Our physicians are Board Certified in Obstetrics and Gynecology as well as Female Pelvic Medicine and Reconstructive Surgery. Our primary sites of service include Kapiolani Medical Center for Women and Children, Pali Momi Medical Center, and The Queen’s Medical Center. We also provide services at several surgicenters across the state, and we also see patients and perform surgery on Hawaii Island and the island of Maui.

The Covid-19 pandemic has allowed the Division to make tremendous use of telemedicine, as the conditions related to urogynecologic care are very suitable for remote evaluation and discussion of treatment options. Since many patients with urogynecologic complaints are in a high risk category for Covid-19, telemedicine has become a popular option for patients, and we hope to continue to offer these services for the foreseeable future. 13

Undergraduate Medical Education

The John A. Burns School of Medicine (JABSOM) is currently one of only a handful of schools in the nation to convert its curriculum to a problem-based learning format (PBL). PBL was adapted from McMaster University, Canada and introduced in 1989. The traditional system, which had an emphasis on teacher directed learning, passive student participation, and rote memorization of massive amounts of information, was seen as increasingly inefficient and outmoded. PBLs seek to solve the shortcomings of this conventional approach with a new mode of learning that is active, dynamic, self- motivational, and directed. For this system to work, it is essential that students be self-directed and take responsibility for their own learning. The primary objective of PBL is to accumulate the concepts of facts of medicine in a clinical context, basing the need to know on relevant problems at hand. Instead of being passive recipients of information, students can become actively involved in the learning process.

The Department of Obstetrics, Gynecology, and Women’s Health works with all levels of medical students. During the 1st year, students are able to work with faculty members who serve as their clinical preceptors. In addition to being clinical preceptors, faculty members serve as PBL tutors and give basic science lectures to 2nd year students.

JABSOM offers medical students two venues to completing their 3rd year clinical clerkships. Students may choose between a traditional block or longitudinal rotation. Block students spend 7- weeks on obstetrics and gynecology, while longitudinal students work 6 months in a rural outpatient setting and another 6 months in weekly inpatient block rotations. 2019 was spent planning for an innovative educational plan. Longitudinal Integrated Curriculum. Starting in June of 2020 all third year medical students will be assigned an OB/GYN preceptor. Students will report to this preceptor’s office for 6 months and follow patient conditions, including pregnancy throughout time. They will be able to follow their patients into the hospitals for admissions, surgeries or deliveries. All students will also complete a one-month rotation in the hospital. 2 weeks will be on Labor and Delivery and 2 weeks in the Operating Room.

The COVID-19 pandemic greatly affected how third year medical student training was offered. Students reported to the hospital once appropriate PPE was acquired. Students were asked to avoid any direct patient care with individuals with COVID-19 symptoms and each patient had only one learner involved in her care. As guidelines changed rapidly so did the Department’s response. We had weekly zoom, sometimes daily, meetings discussing student safety and learning. Obstetrical delivery simulations were offered at a acceptable social distancing recommendations. As the recommendations progressed and students were asked to no longer come into the hospital we adapted to a distance learning approach. Those residents and attendings that were not 14 physically in the hospital assisted students with case reports, testing and history gathering. Grading criteria for students on the OB/GYN rotation during the pandemic was discussed. Final grades were changed depending on percentage of time students had evaluating patients, if at all. The department is still developing alternative learning plans to as restrictions are being slowly lifted. The purpose of the department is to give the student a basic foundation in Obstetrics and Gynecology and the problems related to that field. The goals expected of the 3rd year medical student include, but are not limited to:

1. Perform directed history and physical examinations, including the pelvic exam 2. Diagnose and manage typical gynecologic conditions: • Understand the natural course of gynecologic diseases • Know about major types of family planning techniques • Understand the female life cycle beginning at puberty 3. Diagnose and manage typical obstetric conditions: • Apply knowledge of physiologic changes that occur during pregnancy to the pregnant patient • Understand prenatal and postpartum care • Recognize effects of surgical and medical problems on pregnancy • Manage normal labor and delivery • Know the management procedures for abnormal labor and delivery • Understand the management of pain/anesthesia in labor and delivery 4. Understand major psychosocial problems and know the resources available to women: • Appreciate psychosocial and sexual problems of the female patient and her family, including domestic violence • Be aware of the social and health services available to women

Students work 3 ½ weeks on gynecology surgery and 3 ½ weeks on labor and delivery, with assigned outpatient clinic day and night calls on labor and delivery. Student didactic sessions are scheduled for Friday mornings. These include faculty teaching sessions and department conferences.

Some faculty topics discussed are: • Antepartum Fetal Testing • Gestational Trophoblastic Disease • Vulvar Disease Vaginitis • Intrapartum Care Contraception/Sterilization • Preterm Labor/PPROM Family Planning • Induced Abortion & Vital Statistics Chronic Pelvic Pain • Isoimmunization Multiple Gestation, Diagnosis and Management • Puberty/Premenstrual Syndrome

We offer various types of electives to the 4th year medical students. Among them are Sub Internship in Labor & Delivery, Reproductive Endocrinology, High Risk Obstetrics, Gynecology Oncology, and Outpatient Clinic. Students are encouraged to work at the capacity level of an intern.

Graduate Medical Education Ob-Gyn Residency Program

PGY 1 PGY 2 Jinai Bharucha, MD - University of Minnesota Ingrid Chern, MD - Kaohsiung Medical University, Kelsi Chan, MD – Oregon Health and Science Taiwan University Reema Ghatnekar, MD - University of California, Katrina Chin, MD – St. Louis University Riverside Lauren Ing, MD – University of Hawaii Samantha Kaiser, MD - University of Southern Elizabeth Mercer, MD – Indiana University California, Keck School of Medicine Lucia Xiong, MD – University of New Mexico Wenhao “Cedric” Kuo, DO - Rocky Vista University College of Osteopathic Medicine Alyssa Malley, MD - University of Nebraska College of Medicine Theresa Myers, MD - University of Washington School of Medicine

PGY 3 Chiefs Christina Buchanan, MD - Georgetown University Jennifer Chin, MD - Tulane University Deena Elwan, MD - University of Arkansas Nikki Kumura, MD - University of Hawai‘i Vincent La, MD - University of California, LA Pamela Estrada, MD - University of California, Caroline Lau, MD - University of Hawai‘i Irvine Danielle Ogez, MD - University of California, LA Sharareh Firouzbakht, MD - University of Jennifer Wong, MD - University of Hawai‘i California, Irvine Kacie Fox, MD - University of Hawai‘i Jasmin Reyes Moncada, MD - University of California, Los Angeles

About our Program

The University of Hawai‘i John A. Burns School of Medicine Residency Training Program in Obstetrics & Gynecology is fully accredited by the Accreditation Council of Graduate Medical Education and approved for a total of 24 categorical resident positions, six at each level of the four-year program, and 1 one-year preliminary position.

The residency program is based at the Kapi‘olani Medical Center for Women & Children with additional rotations at the Queen’s Medical Center, Kaiser Medical Center and Pali Momi Medical Center.

Beginning this year, the program started a gynecologic rotation on the Island of Hawaii at the Hilo Medical Center, Bay Clinic and our faculty practice. Our residents spend one month during the 3rd and 4th years of training and participate in patient work ups and surgeries with three supervising faculty. Residents have been able to experience practice on a neighbor island as they participate in gynecologic surgeries. Resident response to this new rotation has been very positive.

Program Resilience and Resident Support

Nationwide, COVID-19 impacted hospitals, communities and training programs. Our residency program adjusted rotations as the state went into stay-at home mode and partner hospitals worked collaboratively to flatten the number of cases in Hawaii. Resident safety was of paramount concern as well as the need for learning to continue. Grand Rounds and resident education conferences became virtual and residents were assigned additional resources to study during the at-home weeks that alternated with team coverage weeks.

Instead of viewing 3rd year and fellow research projects at the traditional Waialae Country Club venue, the 25th Annual Research Day was held virtually using Zoom. A significantly higher number of faculty, community faculty physicians and researchers attended the proceedings, voting electronically for the Audience Choice Award and Fellow and resident presenters during the virtual celebrating the scholarly work of our learners. This th 25 Annual Research Day reflects the spirit of Ohana within our department and our island home.

Maternal-Fetal Medicine Fellowship Program

The fellowship in Maternal-Fetal Medicine at the University of Hawai’i was approved by the American Board of OB/GYN and enrolled the first fellow in 2009. A primary reason to develop the fellowship was to ensure the population of Hawai’i has adequate healthcare workers knowledgeable about the unique healthcare needs of the islands. Our first fellow remained in Hawai’i as have 44% of our gradates, thus fulfilling this goal.

Melanie Maykin, MD Nicole Kurata, MD Corrie Miller, DO Level 1 Fellow Level 2 Fellow Level 3 Fellow

The MFM fellowship combines exceptional training for future maternal-fetal medicine physicians in clinical practice and academic medicine. The fellows acquire knowledge of the basic and clinical facets of perinatal medicine and develop skills to conduct clinical and/or basic research related to our sub-specialty. Fellows will gain an extensive knowledge base and develop experiences in the management of common and unusual obstetrical and medical complications, including those conditions unique to Hawai’i and the Pacific Rim. This will enable them to manage such patients and to function as a consultant for obstetricians requesting input.

Fellows have the option to complete a Master of Science in Clinical Research Degree administered through the University of Hawai‘i at Manoa. Upon completion of the program, fellows will be able to effectively conduct and analyze new research and decide how to apply new knowledge. Of the nine fellows to complete the fellowship, four have completed this masters training.

The fellows are expected to be involved with obstetrical quality improvement processes with our hospital partners. Projects have included developing and implementing sepsis bundles, management of severe HTN, thrombosis prophylaxis, and C/S surgical site infection prevention to name a few. This year with the development of the COVID-19 pandemic, the fellows were instrumental in helping develop guidelines for safe obstetrical care for both outpatient and hospital based care in Hawai’i.

Fellows are encouraged to be advocates for the healthcare of women in Hawai’i through ACOG and programs specific to Hawai’i. Through this advocacy, Hawai’i now has a Maternal Morbidity review board. Maternal-Fetal Medicine specialists are seen in leadership roles, thus training in the program encourages the fellows to develop these skills as well as skills for becoming

academicians in teaching the future healthcare providers. We are proud that 78% of our graduates are in academic positions.

Fellows are expected to have hands on laboratory experience, which they receive in collaboration with the Institute for Biogenesis Research (https://www.ibr.hawaii.edu/), a Center of Biomedical Research Excellence (COBRE) that is focused on mammalian development and reproductive biology. Current projects involve evaluating the microbiome and the intrauterine environment in fetal development.

Complex Family Planning Fellowship Program

The U Fellowship in Complex Family Planning (CFP) was established in 2012. The two-year fellowship program follows the education, research, policy, and clinical competency requirementsniversity of Hawaiʻi outlined by the CFP Executive Council.

Fellows complete a master’s degree in either Public Health or Clinical Research, develop and complete a research project, serve in a domestic or international health care system where abortion access is limited, and gain skills to actively engage in physician advocacy on local and national policy levels. Graduates of the fellowship are experts in complex family planning clinical care, family planning clinical and translational research, family planning public health and public policy, and family planning education.

Clinical Training: • All methods of pregnancy termination • All diagnostic methods to confirm uterine extra-uterine pregnancy • Anesthesia and pain control for in-office gynecologic procedures • Ultrasonography related to contraception and abortion • Management of complications • All methods of contraception currently available and under investigation • Sterilization

Teaching: • Hands-on and didactic teaching for residents and medical students • Running journal club

Research: • Study design and structured clinical research • Statistical analysis • Obtain funding for research studies in contraception and abortion • Scientific writing for peer-reviewed journals and other academic publications • Presentation at national conferences • Development as an independent researcher/teacher • Grant writing

Advocacy: • Opportunities for public policy rotations • Participation in community health collaborative efforts, including Hawai i State Department of Health and other public health stakeholders • Gaining skills in physician advocacy through national workshops, engagingʻ local and national policymakers, and media communication

Courtney Kerestes, MD Paris Stowers, MD Level 1 Fellow Level 2 Fellow

Research Day Thursday, May 7, 2020

Dedicated to all of Hawaiʻi’s obstetrician-gynecologists who are on the COVID-19 frontlines of this pandemic, providing essential health care in our hospitals, offices, and community clinics.

Maternal-Fetal Medicine Fellow Abstract Presentation Corrie Beth Miller, DO “Diet Quality predicts Hypertensive Disorders of Pregnancy in Hawaii Cohort”

Family Planning Fellow Abstract Presentation Paris Stowers, MD “Abortion Patients’ Perspectives on Research Decision-making, Recruitment, and Participation”

Resident Presentations

Jasmin Reyes Moncada, MD “Racial disparities in Preeclampsia with severe features among women in Hawaii”

Pamela Estrada, MD “Racial and Ethnic Disparities in Intensive Care Admissions in a Pregnant and Postpartum Population”

Kacie Fox, MD “Patient Barriers to Discontinuing Long Acting Reversible Contraception”

Christina Buchanan, MD “Neonatal Hypoxic Ischemic Encephalopathy and Planned Home Birth”

Deena Elwan, MD “Reproductive Autonomy and Choice of Contraceptive Method”

Sharareh Firouzbakht, MD “Abortion Knowledge Affecting Abortion Provision after Obstetrics and Gynecology Residency”

Judging Panel

Elizabeth Kiefer, MD Yanyan Wu, PhD Ann Chang, MD, MPH Assistant Clinical Professor Associate Professor Epidemiology Associate Professor Internal Medicine Department Office of Public Health Studies Department of Obstetrics,

John A. Burns School of Medicine University of Hawaiʻi Gynecology & Women’s Health Clint Spencer Center John A. Burns School of Medicine University of Hawaiʻi University of Hawaiʻi

Presentation Awards

Most Outstanding Resident Research Project Award Sharareh Firouzbakht, MD

Audience Choice Award Christina Buchanan, MD

Santosh Sharma Resident Research Award Jennifer Chin MD, Nikki Kumura MD, Caroline Lau MD, and Jennifer Wong MD

(L-R) 3rd Year Residents: Jasmin Reyes Moncada MD, Christina Buchanan MD, Sharareh Firouzbakht MD, Deena Elwan MD, Pamela Estrada MD, Kacie Fox MD, and Fellows: Paris Stowers MD, Corrie Miller DO.

Awards

The Council on Resident Education in Obstetrics and Gynecology (CREOG) National Faculty Award Kareem Khozaim, MD

The Society for Academic Specialists in General Obstetrics and Gynecology 2019 Faculty Award Kimberly Nagamine, MD

Colin C. McCorriston, MD Master Teacher Award William Fong, MD

Excellence Teaching Award Lynne Saito-Tom, MD

The Association of Professors of Gynecology and Obstetrics (APGO) Excellence in Teaching Award Brittney Williams, MD

Fellow Excellence in Teaching Award Paris Stowers, MD

THE OUTSTANDING RESIDENT FOR EXCELLENCE IN MEDICAL STUDENT TEACHING AWARDS First Year: Kelsi Chan, MD Second Year: Reema Ghatnekar, MD Third Year: Sharareh Firouzbakht, MD Fourth Year: Jennifer Wong, MD Overall Winner: Jasmin Reyes-Mondaca, MD

The Society of Gynecologic Oncology: Outstanding Resident in Gynecologic Oncology Caroline Lau, MD

The American Urogynecologic Society: Resident Award for Excellence in Female Pelvic Medicine/Reconstructive Surgery Sharareh Firouzbakht, MD 22

The Society of Laparoendoscopic Surgeons: Outstanding MIS Resident Award Caroline Lau, MD

The American Association of Gynecologic Laparoscopists: Special Resident in Minimally Invasive Gynecology Award Jennifer Wong, MD

The American Association of Gynecologic Laparoscopists: Third Year Resident Excellence in Minimally Invasive Gynecology Award Kacie Fox, MD

The Ryan Program Resident Award for Excellence in Family Planning Sharareh Firouzbakht, MD

The Society of Academic Specialists in General Obstetrics and Gynecology Rising Star Award Kacie Fox, MD

American Society for Colposcopy and Cervical Pathology (ASCCP) Award Sharareh Firouzbakht, MD

The North American Society for Pediatric and Adolescent Gynecology: Best Resident Award Reema Ghatnekar MD

The Hawaii Section of the American College of Obstetricians and Gynecologists: Residency Advocacy Award Jennifer Chin, MD Danielle Ogez, MD

1st Year Residents Selected Recipient: Best PGY2 Teaching Resident Award Ingrid Chern, MD

The Philip I. McNamee, MD Award in Obstetrics and Gynecology Kacie Fox, MD

UH OB/GYN Department Academic Achievement Award Jennifer Chin, MD

Philanthropy

Philanthropy is a hallmark of an academic institution and since 2014, our department has been fortunate to receive over $11M in endowments via the University of Hawaii Foundation. Generous donors created 3 endowed chairs (donation over $2M), 5 endowed professors (donation in range of $0.5-2M) and 3 endowed programs. (donation in rage of $50-500k). Those endowments will serve our department and medical school for generations to come. This is a clear testament of the contributions made by the department and value we bring to our community.

This past year, private donations have benefited our department in the following ways: • Faculty development • Research endeavors • Neighbor island outreach • Disadvantaged communities’ clinical services • Maternal Fetal Medicine and Family Planning fellowship activities • Resident and medical student academic development • Clinical and administrative staff professional development • Global health initiatives • Visiting professorships • Departmental conference

Department faculty, staff, and special guests came together on Monday, February 3, 2020 to celebrate Dr. Thomas Kosasa’s and the McCorriston’s family gift to The Colin C. McCorriston, MD Endowed Professorship, which had been established in 2015. Dr. Bliss Kaneshiro was selected as the Colin McCorriston Endowed Professor. Dr. Kosasa's additional generous investment will contribute to the lasting success of our Department and the quality of health for women, unborn babies, infants, and families across Hawai'i and the Pacific Basin.

(L-R) Dr. Thomas Kosasa, Dean Jerris Hedges, Kitty Petersmeyer, Dr. Bliss Kaneshiro, Dr. Ivica Zalud, William McCorriston

On Monday, March 2, 2020 our department faculty, staff, and special guests gathered again to celebrate a new gift announcement: The Lakshmi Devi and Devraj Sharma Endowed Chair in Obstetrics, Gynecology & Women's Health. This is the second endowed chair given by Santosh D. Sharma, MD, Professor Emeritus, and is named in honor of her parents. Dr. Mark Hiraoka was named the new endowed Sharma Endowed Chair. Dr. Sharma's legacy and generosity will help to ensure the continued success of our Department for many generations to come.

(L-R) Ray Vara, Tim Dolan, Provost Michael Bruno, Dr. Mark Hiraoka, Dr. Santosh Sharma, Dean Jerris Hedges, Dr. Angela Pratt, Dr. Ivica Zalud, Barbara Pratt.

Department Endowments:

Kosasa Endowed Chair – Ivica Zalud, MD Lakshmi Devi and Devraj Sharma Endowed Chair I – Steven Ward, PhD Lakshmi Devi and Devraj Sharma Endowed Chair II – Mark Hiraoka, MD Kosasa Endowed Professor I – Men-Jean Lee, MD Kosasa Endowed Professor II – Keith Terada, MD Kosasa Endowed Professor in Gynecologic Oncology – Michael Carney, MD Endowed Professor in OB/GYN – Dena Towner, MD Colin McCorriston Endowed Professor – Bliss Kaneshiro Dr. Dena Towner Maternal Fetal Medicine (MFM) Endowment Dr. Angela M Pratt Endowment Dr. Phillip I McNamee Award

Community Partnerships

Volunteer Clinical Faculty in private practice or employed by healthcare systems More than 100 volunteer clinical faculty contribute to our lifelong learning activities. They participate in medical student and OB/GYN resident education. Many private practice physicians serve as preceptors and mentors to our medical students. In addition, they also serve as supervising attendings for deliveries and surgeries in hospital settings. This way, our residents are exposed to patient diversity that significantly contributes to the academic clinical learning environment. Many clinical faculty members serve on hospital medical staff committees, further mentoring our residents involved in those activities. Some clinical faculty are also involved in the Hawaii Section of the American College of Obstetricians and Gynecologist as leaders and serve as mentors to our learners in advocacy, community service, and engagement. Our learners have the opportunity to understand how to run a private practice. Clinical faculty regularly contribute in our medical school’s internal giving campaign, supporting our clinical academic environment via philanthropy. Community leaders serve the department on several committees related to resident education as well. Our department and medical school are deeply grateful to volunteer faculty, including Straub and Kaiser employed physicians, for their time and efforts. We congratulate Dr. Angela Pratt for her third term as KMCWC OB/GYN Department Chair! In addition, she serves as President-Elect of the Hawaii Medical Association. Congratulations to Dr. Robb Ohtani as elected QMC Chief of Staff and Dr. Christie Fujimoto as ACOG Hawaii Section Chair! Angela Pratt, MD

Community clinical service We serve disadvantaged, immigrant, and underserved communities by continuously addressing healthcare disparities. Our department has long standing partnerships in form of clinical service agreements with several federally qualified healthcare centers on Oahu, Maui, Lanai, and Hawaii. Our faculty provide outpatient clinical care at Waianae Coast Comprehensive Health Center with locations in Waianae, Kapolei and Waipahu. Similar arrangements are made with Kalihi- Palama Health Center (with locations on N. King Street and Downtown Honolulu), Waimanalo Health Center, Waikiki Health (PATH Clinic for addiction in pregnancy) and Wahiawa Health. We also provide telemedicine and on site healthcare on Lanai. One of our faculty serves the Bay Clinic on Hawaii and is part of our Hilo based faculty supervising our medical student and OB/GYN residents there. Our MFM faculty partnered with HPH/Wilcox Health on Kauai and on Maui to provide onsite and telemedicine services there. GynOncologists and UroGynecologistsMālama I Ke Ola Health provide Center subspecialty (MIKOHC) consultative services on islands of Maui and Hawaii. Family Planning faculty provide contracted services on Kauai and Maui. In order to address community needs on neighbor islands our department recently created a faculty practice in Hilo (continuing the legacy of Dr. John Uohara who retired from clinical practice) as a first and only permanent clinical faculty practice outside of Oahu. Our Hilo based faculty with strong partnerships with Hilo Medical Center and Chief Resident Jennifer Chin, MD Bay Clinic participate in medical student and OB/GYN resident 26

education. In addition, our faculty hold clinical faculty appointments with the Hawaii Island Family Medicine Residency Program based in Hilo Medical Center. They also serve on hospital committees.

Healthcare system partnerships Our department has longstanding partnerships to support medical student, resident and fellow education while providing inpatient and some outpatient clinical services (resident clinics, MFM and GynOncology services). Those partnerships are held via clinical service agreements with Hawaii Pacific Health (HPH) affiliates: Kapiolani Medical Center for Women and Children (KMCWC), Pali Momi Medical Center (PMMC), and Willox Health and Queen’s Health Systems (QHS) affiliates: The Queen’s Medical Center and Queen Emma Clinic. Kapiolani Medical Center for Women and Children also supports our MFM fellowship. Our residents gain a portion of their clinical experience at Kaiser Permanente Moanalua Medical Center in Honolulu. Most recently, our department established a clinical service agreement with Hilo Medical Center on the Big Island. We are honored and thankful that prestigious Hawaii healthcare systems have chosen us for partners to provide women’s healthcare. Our department congratulates Martha Smith for her recent promotion to HPH Executive Vice-president for Oahu Operations, Gidget Ruscetta to KMCWC COO, and Barbara Kraft to PMMC COO. We also congratulate Jill Hoggard Green for her appointment as QHS President and CEO and Jason Chang as president of The Queen’s Medical Center.

Other community partnerships and Global health Our Family planning faculty provide clinical services and mentor our learners at Planned Parenthood locations in Honolulu and Maui. We also partner with the State Department of Health to provide directorship for the Family Planning Division. As a global health initiative, our faculty provide clinical and teaching services in American Samoa, Federated States of Micronesia, Marshal Islands, and Guam, many times traveling with our residents and fellows.

Faculty Listing

Chair Ivica Zalud, MD, PhD, Associate Chair of Community Affairs Professor and Chair Ian Oyama, MD, MBA Kosasa Endowed Chair Associate Professor Urogyn Division Chief Vice Chair Keith Terada, MD Associate Chair of Clinical Affairs Professor Dena Towner, MD Kosasa Endowed Professor Professor Endowed Professor Associate Chair of Academic Affairs MFM Fellowship Program Director Mark Hiraoka, MD, MS Associate Professor Lakshmi Devi & Devraj Sharma Endowed Chair Residency Program Director

Family Planning Division

Bliss Kaneshiro, MD, MPH Professor Gary Kimoto, MD Colin McCorriston Endowed Professor Assistant Clinical Professor Family Planning Division Chief Complex FP Fellowship Program Co-director Richard McCartin, MD Assistant Professor Melissa Natavio, MD, MPH Chief Medical Officer Associate Professor Tamarin McCartin, DO Shandhini Raidoo, MD, MPH Clinical Instructor Assistant Professor Kimberly Nagamine, MD Reni Soon, MD, MPH Instructor Associate Professor Complex FP Fellowship Program Co-director Holly Olson, MD Assistant Professor General Obstetrics & Gynecology Deputy DIO

Division Michelle Pangilinan, MD Clinical Instructor Celeste Adrian, MD

Clinical Instructor Lynne Saito-Tom, MD, MS

Assistant Professor Ann Chang, MD, MPH Associate Director of Medical Student Associate Professor Education Generalist Division Chief Associate Residency Program Director Michael Savala, MD Assistant Professor James DiMarchi, MD Director of Medical Student Education Assistant Clinical Professor Emilie Stickley, MD Scott Harvey, MD, MS Assistant Clinical Professor Assistant Professor Tracee Suetsugu, MD Cori-Ann Hirai, MD Assistant Professor Instructor John Uohara, MD Mark Hiraoka, MD, MS Assistant Clinical Professor Associate Professor

Associate Chair of Academic Affairs Brittney Williams, MD Lakshmi Devi & Devraj Sharma Endowed Chair Instructor Residency Program Director

Gareth Yokochi, MD Kasey Kajiwara, MD Assistant Professor Clinical Instructor

Roxanne Kawelo, MD Gynecologic Oncology Division Assistant Clinical Professor Michael Carney, MD, MPH Kareem Khozaim, MD Professor Assistant Professor Gynecologic Oncology Division Chief Kosasa Endowed Professor 28

Robert Kim, MD Urogynecology Division Assistant Professor Steven Minaglia, MD, MBA Keith Terada, MD Associate Professor Professor Vice Chair Ian Oyama, MD, MBA Kosasa Endowed Professor Associate Professor Associate Chair of Community Affairs Maternal-Fetal Medicine Division Urogyn Division Chief

Lisa Bartholomew, MD Miriam Seitz, MD Associate Professor Assistant Professor

Men-Jean Lee, MD Emeritus Faculty Professor MFM Division Chief Thomas Kosasa, MD Kosasa Endowed Professor Professor Emeritus

Dena Towner, MD Roy Nakayama, MD Professor Professor Emeritus Endowed Professor Associate Chair of Clinical Affairs Santosh Sharma, MD MFM Fellowship Program Director Professor Emeritus

Stacy Tsai, MD, MPH Senior Staff Assistant Clinical Professor

Kelly Yamasato, MD Mattias Atterbom Assistant Professor IT Manager

Kristen Chun, RN, BSN, MBA/HCM Ivica Zalud, MD, PhD, Chief of Business Affairs Professor and Chair Kosasa Endowed Chair Genie Goo

Billing Office Manager Reproductive Endocrinology & Infertility Division Miyuki Hannemann Director of Faculty Practices Emily Goulet, MD Assistant Professor Ginny Kamikawa Residency Program Administrator Thomas Huang, PhD Associate Professor Krysten Kawamata HR Specialist & FP Fellowship Administrator Bruce Kessel, MD Professor Lisa Kellett Medical Student and MFM Fellowship Research Division Administrator

W. Steven Ward, PhD Thao Nguyen Professor Head of Financial Affairs Lakshmi Devi & Devraj Sharma Endowed Chair Research Division Chief 29

Research Productivity of UH OB/GYN Faculty, Fellows, Former Fellows, Residents, and Medical Students

Publications

1. Barcellos T, Natavio M, Stanczyk FZ, Luo D, Jusko WJ, Bender NM. Effects of ritonavir-boosted protease inhibitors on combined oral contraceptive pharmacokinetics and pharmacodynamics in HIV-positive women. Contraception. 2019 Oct;100(4):283-287. PMID: 31194965. 2. Benny P, Yamasato K, Yunits B, Zhu X, Ching T, Garmire LX, Berry MJ, Towner D. Maternal cardiovascular-related single nucleotide polymorphisms, genes, and pathways associated with early-onset preeclampsia. PLoS One. 2019 Sep 26;14(9):e0222672. doi: 10.1371/journal.pone.0222672. eCollection 2019. PMID: 31557190. PMCID: PMC6762142. DOI: 10.1371/journal.pone.0222672. 3. Chin J, Bartholomew ML. Methamphetamine Use in Pregnancy. Hawaii Journal of Health and Social Welfare. (Accepted January 2020) 4. Chin J, Salcedo J, Raidoo S. Over-The-Counter Availability of Levonorgestrel Emergency Contraception in Pharmacies on Oahu. Pharmacy (Basel). 2020 Feb 15;8(1). pii: E20. doi: 10.3390/pharmacy8010020. PMID: 32075212. 5. Devin KM, Stowers PN, Wasickanin ME, Chescheir NC. Connect the Dots-January 2020. Obstet Gynecol. 2020 Jan;135(1):215-216. doi: 10.1097/AOG.0000000000003629. No abstract available. PMID: 31809446. 6. Friedlander E, Soon R, Salcedo J, Tschann M, Fontanilla T, Kaneshiro B. (2020). Text message link to online survey: a highly effective method of longitudinal data collection. Contraception, 101, 244-248. PMID: 31884078. 7. Ha TK, Rao RR, Maykin MM, et al. Vaginal birth after cesarean: Does accuracy of predicted success change from prenatal intake to admission? Am J Obstet Gynecol MFM 2020. 8. Han MN, O'Donnell BE, Maykin MM, Gonzalez JM, Tabsh K, Gaw SL. The impact of cerclage in twin pregnancies on preterm birth rate before 32 weeks. J Matern Fetal Neonatal Med 2019;32:2143-51. 9. Kerestes C, Sheets K, Stockdale CK, Hardy-Fairbanks AJ. Prevalence, attitudes and knowledge of misoprostol for self-induction of abortion in women presenting for abortion at Midwestern reproductive health clinics. Sex Reprod Health Matters. 2019 Dec;27(1):1571311. doi: 10.1080/09688080.2019.1571311. PMID: 31533561. 10. Kumura NDS, Siarezi S. A Case of a Prolapsed Fibroid in a 12-Year-Old Girl. J Pediatr Adolesc Gynecol. 2020 Feb;33(1):96-97. doi: 10.1016/j.jpag.2019.08.013. Epub 2019 Sep 16. PMID: 31536802. 11. Lee AW, Wu AH, Wiensch A, Mukherjee B, Terry KL, Harris HR, Carney ME, Jensen A, Cramer DW, Berchuck A, Doherty JA, Modugno F, Goodman MT, Alimujiang A, Rossing MA, Cushing- Haugen KL, Bandera EV, Thompson PJ, Kjaer SK, Hogdall E, Webb PM, Huntsman DG, Moysich KB, Lurie G, Ness RB, Stram DO, Roman L, Pike MC, Pearce CL. Estrogen plus progestin hormone therapy and ovarian cancer: a complicated relationship explored. Ovarian Cancer Association Consortium. Epidemiology. 2020 Feb 4. doi: 10.1097/EDE.0000000000001175. [Epub ahead of print] PMID: 32028322. 12. Meagher NS, Wang L, Rambau PF, Intermaggio MP, Huntsman DG, Wilkens LR, El-Bahrawy MA,

30 Ness RB, Odunsi K, Steed H, Herpel E, Anglesio MS, Zhang B, Lambie N, Swerdlow AJ, Lubiński J, Vierkant RA, Goode EL, Menon U, Toloczko-Grabarek A, Oszurek O, Bilic S, Talhouk A, García- Closas M, Wang Q, Tan A, Farrell R, Kennedy CJ, Jimenez-Linan M, Sundfeldt K, Etter JL, Menkiszak J, Goodman MT, Klonowski P, Leung Y, Winham SJ, Moysich KB, Behrens S, Kluz T, Edwards RP, Gronwald J, Modugno F, Hernandez BY, Chow C, Kelemen LE, Keeney GL, Carney ME, Natanzon Y, Robertson G, Sharma R, Gayther SA, Alsop J, Luk H, Karpinskyj C, Campbell I, Sinn P, Gentry-Maharaj A, Coulson P, Chang-Claude J, Shah M, Widschwendter M, Tang K, Schoemaker MJ, Koziak JM, Cook LS, Brenton JD, Daley F, Kristjansdottir B, Mateoiu C, Larson MC, Harnett PR, Jung A, deFazio A, Gorringe KL, Pharoah PDP, Minoo P, Stewart C, Bathe OF, Gui X, Cohen P, Ramus SJ, Köbel M. A combination of the immunohistochemical markers CK7 and SATB2 is highly sensitive and specific for distinguishing primary ovarian mucinous tumors from colorectal and appendiceal metastases. Mod Pathol. 2019 Dec;32(12):1834-1846. PMID: 31239549. 13. Mei JY, Havard AL, Mularz AJ, Maykin MM, Gaw SL. Impact of Gestational Weight Gain on Trial of Labor after Cesarean Success. Am J Perinatol 2019;36:1023-30. 14. Mei JY, Havard AL, Mularz AJ, Maykin MM, Gaw SL. Impact of obesity class on trial of labor after cesarean success: does pre-pregnancy or at-delivery obesity status matter? J Perinatol 2019;39:1042-9. 15. Meurice ME, Goad LM, Barlow PB, Kerestes CA, Stockdale CK, Hardy-Fairbanks AJ. Efficacy- based Contraceptive Counseling for Women Experiencing Homelessness in Iowa City, Iowa. J Community Health Nurs. 2019 Oct-Dec;36(4):199-207. doi: 10.1080/07370016.2019.1665313. PMID: 31621431. 16. Pereira JP, Maykin MM, Vasconcelos Z, et al. The Role of Amniocentesis in the Diagnosis of Congenital Zika Syndrome. Clin Infect Dis 2019;69:713-6. 17. Perrigo JL, Nguyen BT, Hayes C, Nattell NA, Cortessis VK, Natavio M. Incarcerated Women’s Perceptions of a Reproductive Life-Planning Class: A Qualitative Study. Women & Criminal Justice. Epub 2019, Oct 10. 18. Raidoo S, Elia J, Tschann M, Kaneshiro B, Soon R. (2020). Dual method contraception among adolescents and young people: are LARC users different? A qualitative study. J Pediatr Adolesc Gynecol, 33, 45-52. PMID: 31585164. 19. Raidoo S, Tschann M, Kaneshiro B, Sentell T. Impact of Insurance Coverage for Abortion in Hawai'i on Gestational Age at Presentation and Type of Abortion, 2010-2013. Hawaii J Health Soc Welf. 2020 Apr 1;79(4):117-122. PMID: 32328583. 20. Schlueter RJ, Al-Akwaa FM, Benny PA, Gurary A, Xie G, Jia W, Chun SJ, Chern I, Garmire LX. Prepregnant Obesity of Mothers in a Multiethnic Cohort Is Associated with Cord Blood Metabolomic Changes in Offspring. J Proteome Res. 2020 Apr 3;19(4):1361-1374. doi: 10.1021/acs.jproteome.9b00319. Epub 2020 Feb 27. PMID: 31975597. 21. Stevens K, Elia J, Kaneshiro B, Salcedo J, Soon R, Tschann M. (2020). Updating fetal foot length to gestation age references: a chart review of abortion cases from 2012 to 2014. Contraception, 101, 10-13. PMID: 31302119. 22. Teoh D, Vogel RI, Langer A, Bharucha J, Geller MA, Harwood E, Kulasingam S, Melton GB. Effect of an Electronic Health Record Decision Support Alert to Decrease Excess Cervical Cancer Screening. J Low Genit Tract Dis. 2019 Oct;23(4):253-258. doi: 10.1097/LGT.0000000000000484. PMID: 31592972. 23. Thorsson V, Gibbs DL, Brown SD, Wolf D, Bortone DS, Ou Yang TH, Porta-Pardo E, Gao GF, Plaisier CL, Eddy JA, Ziv E, Culhane AC, Paull EO, Sivakumar IKA, Gentles AJ, Malhotra R, Farshidfar F, Colaprico A, Parker JS, Mose LE, Vo NS, Liu J, Liu Y, Rader J, Dhankani V, Reynolds

SM, Bowlby R, Califano A, Cherniack AD, Anastassiou D, Bedognetti D, Mokrab Y, Newman AM, Rao A, Chen K, Krasnitz A, Hu H, Malta TM, Noushmehr H, Pedamallu CS, Bullman S, Ojesina AI, Lamb A, Zhou W, Shen H, Choueiri TK, Weinstein JN, Guinney J, Saltz J, Holt RA, Rabkin CS; Cancer Genome Atlas Research Network, Lazar AJ, Serody JS, Demicco EG, Disis ML, Vincent BG, Shmulevich l Carney ME, et al. The Immune Landscape of Cancer. Immunity. 2019 Aug 20;51(2):411-412. 24. Timoteo-Liaina I, Khozaim K, Chen YA, Buenconsejo-Lum L, Arslan AA, Matthews R, Del Priore G. The rising relative and absolute incidence of uterine cancer in specific populations. Int J Gynaecol Obstet. 2020 Feb 29. doi: 10.1002/ijgo.13130. [Epub ahead of print] DOI: 10.1002/ijgo.13130. PMID: 32112712. 25. Tschann M, Wright T, Lusk H, Giorgio W, Colon A, Kaneshiro B. Understanding the Family Planning Needs of Female Participants in a Syringe Exchange Program: A Needs Assessment and Pilot Project. J Addict Med. 2019 Sep/Oct;13(5):366-371. doi: 10.1097/ADM.0000000000000508. PMID: 31589180. 26. Valencia K, Moayedi G, Raidoo S, Soon R, Kaneshiro B, Tschann M. (2020). Contraceptive method and abortions: a survival analysis. Hawaii J Health & Social Welfare. [accepted and in press]. 27. Vergote I, Scambia G, O'Malley DM, Van Calster B, Park SY, Del Campo JM, Meier W, Bamias A, Colombo N, Wenham RM, Covens A, Marth C, Raza Mirza M, Kroep JR, Ma H, Pickett CA, Carney ME, Monk BJ; TRINOVA-3/ENGOT-ov2/GOG-3001 investigators. Trebananib or placebo plus carboplatin and paclitaxel as first-line treatment for advanced ovarian cancer (TRINOVA- 3/ENGOT-ov2/GOG-3001): a randomised, double-blind, phase 3 trial. Lancet Oncol. 2019 Jul;20(6):862-876. 28. Wong JWH. A Case of Vaginal Birth after Cesarean Delivery in a Patient with Uterine Didelphys. Case Rep Obstet Gynecol. 2019 Dec 23;2019:3979581. doi: 10.1155/2019/3979581. eCollection 2019. PMID: 31934476. 29. Wong JWH, Killeen JL, Carney ME. Completeness of salpingectomy intended for ovarian cancer risk reduction. Gynecol Oncol. 2019 Nov;155(2):280-282. doi: 10.1016/j.ygyno.2019.09.005. Epub 2019 Sep 12. PMID: 31522838. 30. Wong JHW, La V, Lee S, Raidoo S. The ALOHA Study: Intimate Partner Violence in Hawaii’s LGBT Community. HJMPH. [pending publication] 31. Wong JWH, Sperling MM, Harvey SA, Killeen JL, Carney ME. A fight-and-flight for life: A rare case of advanced cervical cancer in pregnancy. Gynecol Oncol Rep. 2020 Apr 7;32:100565. PMID: 32300631. 32. Wong JWH, Ueno M, Harvey S, Killeen JL, Carney ME. A Fight-and-Flight for Life: A Rare Case of Advanced Cervical Cancer in Pregnancy. Gynecol Oncol Rep. [pending publication] 33. Wong JWH, Yoshino KDN, Ahn HJ, Choi SY, Chang AL. Examining the validity of a predictive model for vaginal birth after cesarean. J Perinat Med. 2019 Dec 18;48(1):11-15. doi: 10.1515/jpm-2019-0345. PMID: 31730535. 34. Yamasato K, Kimata C, Chern I, Clappier M, Burlingame J. Complications of operative vaginal delivery and provider volume and experience. J Matern Fetal Neonatal Med. 2019 Nov 19:1-6. doi: 10.1080/14767058.2019.1688293. [Epub ahead of print]. PMID: 31744361. 35. Yin C, Harvey S, Elia J, Kaneshiro B, Hayes D, Soon R. (2020). Highly effective contraception more likely among Native Hawaiian women than non-Native Hawaiian women at Title X clinics in Hawaii. Hawaii J Health & Social Welfare, 79, 16-22. PMID: 31967107.

Abstracts

1. Chern I, Bharucha J, Hiraoka, M (February 26-29, 2020) Utilizing Exam Prep Questions to Improve Resident CREOG In-training Examination Scores. Poster presentation, CREOG & APGO 2020 Annual Meeting, Orlando, FL. 2. Chin J, Salcedo J, Raidoo S (September 2019) Availability of Levonorgestrel Emergency Contraception in Pharmacies on Oahu. Oral presentation, Emergency Contraception Jamboree, Washington, DC. 3. Chin J, Kaneshiro B, Elia J, Raidoo S, Savala M, Soon R (October 2019) Buffered Lidocaine for Paracervical Blocks in First Trimester Outpatient Surgical Abortions. Poster presentation, Society of Family Planning Annual Meeting, Los Angeles, CA. 4. Chin J, Molero Bravo R, Wright T, Kiyokawa M, Chen E, Nakashima E, Karasaki K, Estrada P, Ghatnekar R, Bartholomew ML (February 2020) Urine Drug Screening on Labor and Delivery.Poster presentation, Humanism, Empathy, Social Justice and Global Health Symposium, Honolulu, HI. 5. Chin J, Bartholomew ML (April 2020) Aortic Aneurysm in Pregnancy. Poster Presentation, Biomedical Sciences and Health Disparities Symposium, Honolulu, HI [cancelled]. 6. Delafield R, Elia J, Chang A, Kaneshiro B, Sentell T, Pirkle CM A Qualitative Study Examining Obstetricians’ Perspectives on Labor and Delivery Care for Women from Micronesia. APHA Abstract Submission. 7. Estrada P, Yamasato K (February 7, 2020) Global Associations between Obesity, Access to Care, and Maternal Mortality. Poster presentation, Society of Maternal Fetal Medicine 40th Annual Meeting, Grapevine, Texas. 8. Kumura NDS, Siarezi S (April 2-3, 2020) A Case of a Prolapsed Fibroid in a 12-Year-Old Girl. Poster presentation, NASPAG, Grapevine, TX [cancelled]. 9. Kurata N, Benny P, Lesseur C, Miller C, Maykin M, Riel J, Yamasato K, Towner D, Marsit C, Chen J, Lee MJ (March 10-14, 2020) Methylation and Gene Expression of Cord Blood and Placental Cytokines in Pregnancies Complicated by Maternal Obesity. Poster Presentation, Society for Reproductive Investigation – 67th Annual Scientific Meeting, Vancouver, Canada. 10. Kurata N, Towner D (March 20-25, 2020) Evaluation of Estimated Fetal Weight, Interval Growth, and Neonatal Birthweight as Prognostic Tools for Expectant Management in Early-Onset Preeclampsia. Abstract, Annual Integrative Ultrasound Meeting, New York, NY. 11. Long J, Schreiber C, Creinin MD, Kaneshiro B, Dart C, Nanda K, Blithe D Menstrual Cup Use and Intrauterine Device Expulsion in a Copper Intrauterine Device Contraceptive Efficacy Trial. 12. Moayedi G, Stevens K, Tschann M, Salcedo J, Soon R, Kaneshiro B (2019) Intranasal Fentanyl for Pain Control During First-Trimester Uterine Aspiration: A Randomized Controlled Trial. Contraception, 100(4), 306 [abstract]. 13. Ogez D, Khozaim K (February 14, 2020) Obstetrics and Gynecology Rotation in American Samoa. Poster presentation, GlobalHealth Symposium, University of Hawai‘i John A. Burns School of Medicine, Honolulu, HI.

Book Chapters

1. Chang A, Aeby T. (2019) A 25-year-old woman reports midcycle spotting (evaluation and management when evaluation shows structural lesion:endometrial polyp or septum). In

Chelmow D, Isaacs C, Carrol A. Office Gynecology: A Case-Based Approach; Cambridge University Press, Shaftesbury Road, Cambridge CB2 8RU. 2. Harvey S, Zalud I (2020) Critical Care in Obstetrics. In Chervenak F, Kurjak A, Plavsic SK: The Fetus as a Patient. Yepee Brothers, New Delhi, London, Philadelphia pp. 143-162. 3. Harvey SA (2020) Management of Pregnancy. In: Society of Critical Care Medicine’s Fundamentals of Critical Care Support – Chapter 20: Resource–Limited Settings. 4. Kaneshiro B (2020) Chapter on Hormonal Contraception. In Wass, J and Wiebke A (Eds). Oxford Textbook of Endocrinology and Diabetes. 5. Natavio, MF (2020) Emergency contraception. In: The Handbook of Contraception: Evidence Based Practice Recommendations and Rationales (3rd edition; Donna Shoupe, [editor]). Springer Science and Business Media, Amherst, MA.

This report was created by Dr. Ian Oyama and Julieta Rajlevsky.

Department of Obstetrics, Gynecology & Women’s Health University of Hawai’i John A. Burns School of Medicine 2019-2020 Annual Report