Maria Manriquez

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• Worly, B., Woodland, M. B., Stagg, A., Ogburn, T., Manriquez, M., Carson, S. A., & Blanchard, M. H. (2021). Sexual Health Education in Obstetrics and Gynecology (Ob-Gyn) Residencies-A Resident Physician Survey.. The journal of sexual medicine, 18(6), 1042-1052. doi:10.1016/j.jsxm.2021.03.005
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  Many women will experience a sexual health concern and present to their Obstetrics and Gynecology (Ob-Gyn) care provider, yet a large portion of graduating Ob-Gyn resident physicians in the United States may not feel comfortable helping patients with some sexual health issues..To perform a cross-sectional study of U.S. Ob-Gyn resident physicians that assesses sexual health education didactic sessions and comfort level with sexual health clinical vignettes..A 32-item anonymous survey was sent to all 4,065 Ob-Gyn residents on June 7, 2016. Respondents voluntarily completed the survey electronically..The primary outcome measures are the comfort level of Ob-Gyn resident physicians in taking a sexual history and providing counseling to patients represented in clinical vignettes, which were based on sexual health learning objectives from the Council on Resident Education in Obstetrics and Gynecology (CREOG)..Of the 4,065 eligible U.S. examinees, 968 (23.8%) agreed to participate in the study, and 802 (19.7%) completed the survey and were included in the final analysis. Nearly two-thirds of the residents indicated that sexual health training was a priority in residency. However, more than half were not able to describe the disorders of sexual function or list common medications that effect sexual function. When posed with clinical vignettes, residents felt very comfortable obtaining a sexual history (98.5%) and providing counseling (97.0%) for a 16-year-old seeking contraception, yet fewer felt very comfortable obtaining a history and providing counseling for a 26-year-old who is a refugee from Somalia (77.2% and 73.8%). Smaller cohorts felt prepared to take a sexual history and provide counseling for a 17-year-old who discloses that she is a victim of sex trafficking (61.2% and 57.7%), and for a 58-year-old transgender patient planning hormone therapy and surgery (49.9% and 37.9%). In logistic regression analysis, the factors that were influential in an Ob-Gyn resident physician's program to prepare them to describe the disorders of sexual function were post-graduate year (OR 1.387, 95% CI 1.189, 1.618; P = .0001), those that rated the importance of a sexual health curriculum highly (OR 0.701, 95% CI 0.569, 0.864; P = .0012), and a greater number of didactic sessions on sexual health in the residency curriculum (OR 0.685, 95% CI 0.626, 0.750; P < .0001)..These findings highlight strengths in the comfort of Ob-Gyn resident physicians about sexual health and illustrate areas of opportunity to engage resident learners by improving the sexual health curriculum. Worly B, Manriquez M, Stagg A, et al. Sexual Health Education in Obstetrics and Gynecology (Ob-Gyn) Residencies-A Resident Physician Survey. J Sex Med 2021;18:1042-1052.
• Manriquez, M., Starer, J., Parisi, V., Tracy, E., McFadden, T., & Penney, L. (2019). Fetal alcohol spectrum disorder prevention program: SBIRT's role in averting fetal alcohol spectrum disorders. Birth defects research, 111(12), 829-834.
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  Empowering obstetricians to assess and improve their own practices of screening brief intervention and referral to treatment (SBIRT) in treating alcohol use disorders (AUDs) and preventing fetal alcohol spectrum disorder (FASD) is the goal of the American College of Obstetricians and Gynecologist (ACOG) FASD Prevention Program. The FASD Prevention Program is a CDC funded initiative of the ACOG which is the largest specialty professional membership organization in the United States. Obstetrics and gynecology as a specialty is dedicated to the broad, integrated medical and surgical care of women's health throughout their lifespan. Understanding of reproductive physiology, including the physiologic, social, cultural, environmental, and genetic factors that influence disease in women, is a major priority for ACOG. Preventive counseling and health education are essential and integral parts of the practice of obstetricians and gynecologists as they advance the individual and community-based health of women of all ages. The FASD Prevention Program aims to provide obstetrician-gynecologists with the resources and tools needed to communicate with patients and the communities they serve about alcohol use during pregnancy. This review describes activities to empower and educate providers to address alcohol use disorder in pregnancy and the effect of FASD.
• Wolfenden, E., Manriquez, M., Santiago, R., & Kang, P. (2019). Strong Start for Mothers and Newborns: Impact on OB Triage Visits [20D]. Obstetrics & Gynecology, 133(1), 48S-46S. doi:10.1097/01.aog.0000558976.38806.91
• Mercer, L., Ludwig, A., Smith, J., Erickson, L., & Manriquez, M. (2018). The Use of Standardized Patients to Increase Medical Student Awareness of and Confidence in Screening for Human Trafficking. Obstetrics & Gynecology, 132(1), 49S. doi:10.1097/01.aog.0000546646.85990.78
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  Local Mentor:Laurie Erickson, MDAPGO Advisor:Jody Steinauer, MD, MASPROBLEM:Human trafficking is a growing problem, but is often unrecognized. Victims are frequently kept in isolation with little freedom and autonomy, limiting their access to resources and recovery. Skilled health care providers can
• Worly, B., Manriquez, M., Stagg, A., Ogburn, T., Woodland, M. B., Carson, S. A., & Blanchard, M. H. (2018). Sexual Health Education in OB-Gyn Residencies—The Program Directors’ Survey. International Journal of Sexual Health, 30(4), 390-397. doi:10.1080/19317611.2018.1527425
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  Objective: To evaluate U.S. obstetrics-gynecology (OB-Gyn) program Director appraisal of resident physician female sexual health training. Methods: An OB-Gyn resident sexual health curriculum surve...
• Barkley, J., Manriquez, M., Chambliss, L. R., Connell, M., Wu, T. S., & Coonrod, D. V. (2016). Development of an Advanced Women's Imaging Fellowship in Obstetrics and Gynecology [21E]. Obstetrics & Gynecology, 127, 43S. doi:10.1097/aog.0000000000001381
• Manriquez, M., Ayutyanont, N., & Habak, P. J. (2016). A Quality Improvement Curriculum in Ambulatory Obstetrics and Gynecology: Development and Implementation With OBGYN Residents. Obstetrics & Gynecology, 128, 51S-52S. doi:10.1097/01.aog.0000502705.59137.94
• Manriquez, M., Cookingham, L. M., & Coonrod, D. V. (2012). Reentry into clinical practice in obstetrics and gynecology.. Obstetrics and gynecology, 120(2 Pt 1), 365-9. doi:10.1097/aog.0b013e318257ffba
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  The American College of Obstetricians and Gynecologists selected "Reentry Into Practice" as the subject for the 2012 Issue of the Year. Physician reentry programs in obstetrics and gynecology are driven by the fact that there is a projected physician shortage, and there are physicians who voluntarily leave clinical practice for a period of time. In planning formal reentry programs, evidence-based practice and highest regard for patient safety must be considered. Our department initiated a reentry fellowship program in 2010. This article describes the process of how we developed our program, the challenges encountered, and the solutions used to overcome these challenges. The formal instruction, evaluation, and documentation of competency are presented. Process improvement has been based on feedback and evaluation from the reentry fellows and from staff and residents. Bringing physicians back into the clinical realm will depend on the success of new programs implementing the guidelines recommended by national regulatory bodies. The guidelines recommend that the programs are accessible, collaborative, comprehensive, ethical, flexible, individualized, innovative, accountable, stable, and responsive. Our reentry program has been successful in helping fellows reestablish clinical practice and is a way to incorporate hands-on competency-based experiences for the reentering obstetrician-gynecologist (ob-gyn).
• Manriquez, M., Srinivas, G., Bollepalli, S., Britt, L., & Drachman, D. (2010). Is computed tomography a reliable diagnostic modality in detecting placental injuries in the setting of acute trauma?. American journal of obstetrics and gynecology, 202(6), 611.e1-5. doi:10.1016/j.ajog.2010.01.027
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  The objective of this study was to determine whether computed tomography (CT) is a reliable method of imaging to assess placental injury after acute trauma during pregnancy..This study was a retrospective review of digital CT images and electronically scanned charts of pregnant trauma patients identified from the hospital trauma registry list..Using delivery within 36 hours of trauma as the clinical marker for the occurrence of placental abruption, positive radiologic readings showed 86% sensitivity and 98% specificity. The overall accuracy was 96%..Given that defined patterns on CT can be identified and those can be correlated to actual abruption, CT may be a reliable method for evaluation of placental abruption after maternal trauma, especially in the face of abdominal trauma. Our results show that CT has both good sensitivity and specificity identifying abruption and should be considered for use in the management in the pregnant patient after trauma.
• Coonrod, D. V., Drachman, D., Hobson, P., & Manriquez, M. (2008). Nulliparous term singleton vertex cesarean delivery rates: institutional and individual level predictors.. American journal of obstetrics and gynecology, 198(6), 694.e1-11; discussion 694.e11. doi:10.1016/j.ajog.2008.03.026
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  This study was undertaken to determine individual and institutional level variables predictive of variations in nulliparous term singleton vertex cesarean delivery rates..Retrospective cohort study of 28,863 nulliparous term singleton vertex births at 40 Arizona hospitals..The average nulliparous term singleton vertex cesarean delivery rate was 22.0%, the lowest hospital rate was 10.3%, high, 34.2%. The following individual level variables increased the nulliparous term singleton vertex cesarean delivery rate in a multivariable model: increased mother's age, African American race, increased birthweight, labor induction, and the presence of medical conditions such as diabetes and hypertension. Of the institutional variables, after adjustment, the highest level of nursery or a higher percentage of government-paid births was associated with lower risks, whereas delivery at a hospital with the lowest level of care or with an obstetric and gynecology residency was associated with an increased risk of cesarean delivery..Substantial variations in nulliparous term singleton vertex cesarean delivery rates were seen in this comparative analysis of 40 hospitals.