About

Anne Nichols Flynn, M.D., M.S.H.P., is an Assistant Clinical Professor in the Department of Obstetrics and Gynecology at UC Davis Health. She is a family planning specialist committed to providing comprehensive and compassionate reproductive healthcare to people of all ages and backgrounds. Dr. Flynn has a particular interest in early pregnancy loss and patient-centered care, emphasizing shared decision-making to foster effective patient-physician partnerships and practicing evidence-based medicine. Her research focuses on early pregnancy loss and pregnancy of unknown location, with an emphasis on improving the quality of care delivered to patients. She has contributed to the understanding of the burden of the Risk Evaluation and Mitigation Strategy (REMS) on providers and patients experiencing early pregnancy loss, as well as the timing and efficacy of medical management strategies such as mifepristone pretreatment. Dr. Flynn's work aims to enhance patient-centered approaches and optimize clinical outcomes in reproductive health.

Research topics

• Medicine
• Obstetrics
• Gynecology
• Family medicine
• Intensive care medicine
• Emergency medicine
• Surgery
• Pediatrics

Selected publications

• Improving Follow-up Utilizing Plan-Do-Study-Act Cycles and a Texting Intervention for Patients with Pregnancy of Unknown Location

  SSRN Electronic Journal · 2026-01-01

  preprintOpen access1st authorCorresponding
  PublisherDOI

• P167 Enhanced clinical validation: cost and time savings for routine dermatology waiting lists

  British Journal of Dermatology · 2025-06-27

  articleOpen access

  Abstract The COVID-19 pandemic had a detrimental effect on dermatology outpatient waiting times across the UK, with Northern Ireland having the worst waiting-list figures. In December 2019, 219 489 patients in Northern Ireland awaited a first outpatient dermatology appointment, of whom 14% had waited > 2 years. By September 2023, this increased by 64% to 359 763, with 29% waiting > 2 years. With growing pressures to prioritize timely assessment of suspected cancers, routine waiting lists are not seen as a priority. We sought to explore novel ways of addressing this via a multifaceted enhanced validation programme, to increase efficiency by ensuring the right patients were seen at the right time. Between October 2020 and February 2022, 5140 patients on the waiting list were contacted via post and text to confirm whether an appointment was still required. This resulted in 33% (n = 1710) being discharged, yielding potential savings of £427 500, as the average appointment cost was £250. Duplicate referrals were reviewed, revealing that long-waiting patients were more likely to have duplicate entries due to multiple referrals or secondary diagnoses. Of 481 duplicates reviewed, 50% (n = 239) were merged into single appointments, saving an additional £59 750. Enhanced clinical validation included the addition of dermatology nursing staff using standardized flowcharts and scripts to contact patients. Patient contact details were cross-checked between databases and electronic healthcare records (EHRs) to correct discrepancies. EHR reviews determined whether the referring conditions had already been addressed. Patients were contacted to confirm whether they still required dermatology input, without providing clinical advice. Those no longer requiring dermatology input were discharged, allowing patients warranting review to be prioritized. Of 600 patients validated, 25% (n = 150) were discharged, saving £37 500, primarily because their conditions had resolved. Feedback received from staff and patients was positive. Staff felt valued and team morale was enhanced by contributing to improving patient waiting times, while patients appreciated being kept informed via communication with clinical teams. Overall, this initiative showed a clear positive impact of enhanced validation in reducing waiting-list numbers, thereby providing significant cost savings. The process required minimal technological input and consultant oversight. Staff who were unable to work in patient-facing roles felt they were making a difference, thereby improving productivity of the service. Updating patient contact details as part of validation also meant correspondence could be sent to correct addresses, reducing the likelihood of patients not attending scheduled appointments due to miscommunication. Moving forwards, enhanced validation could be expanded to other outpatient services, although dedicated resources are required to ensure the sustainability of the service.

  PublisherOA PDFDOI

• Examination of Referrals to Address Social Needs Among Health Home Patients

  Journal of General Internal Medicine · 2025-04-24

  letter
  PublisherDOI

• Errors in the Society of Family Planning medication management for early pregnancy loss clinical recommendations

  Contraception · 2025-11-07

  letter
  PublisherDOI

• Exploring Reasons for Loss to Follow-up in Pregnancy of Unknown Location: A Mixed-Methods Study

  Journal of Women s Health · 2024-01-09 · 3 citations

  article1st authorCorresponding

  Objective: To quantify proportions of loss to follow-up in patients presenting with a pregnancy of unknown location and explore patients’ perspectives on follow-up for pregnancy of unknown location. A pregnancy of unknown location is a scenario in which a patient has a positive pregnancy test but the pregnancy is not visualized on transvaginal ultrasound. Study Design: We conducted a retrospective cohort study of patients with pregnancy of unknown location who presented to an urban academic emergency department or complex family planning outpatient office. We sought to calculate the proportion of patients lost to follow-up, defined as inability to contact the patient within 2 weeks. We then conducted focus groups of patients diagnosed with a pregnancy of unknown location. We used thematic analysis to identify themes related to follow-up. Results: We reviewed 464 charts of patients diagnosed with pregnancy of unknown location. The median age in this cohort was 27 with most patients identifying as Black (80%, n = 370) and using public insurance (67%, n = 315). When looking at loss to follow-up rates, Black patients experienced loss to follow-up (20%, n = 72) more often than White patients (4%, n = 2; p = 0.003). Focus group participants had a mean age of 31.8+/−4.8, and the majority were of Black race ( n = 16, 72.7%). Participants identified barriers to follow-up including the long duration of management, general inconvenience, and poor communication with their health care team. Participants felt a burden of responsibility to learn about their condition and to self-advocate for their follow-up and communication of results. Conclusions: These data indicate that Black patients are more likely to experience loss to follow-up compared with White patients during monitoring for pregnancy of unknown location. Patients identified many barriers to follow-up and felt that successful follow-up required substantial self-efficacy.

  PublisherDOI

• OP86 A qualitative study: exploring the perceived support needs of those food insecure during and after pregnancy in South East England

  SSM Annual Scientific Meeting · 2024-08-01

  articleSenior author

  <h3>Background</h3> During the first 1,001 days women and their infants are distinctively vulnerable in terms of their susceptibility to food insecurity, and its impact. Food insecurity during this period can have an adverse impact on maternal and foetal health and child development. However, we have a poor understanding of the experiences of this group. Therefore, this research aimed to explore the experiences of food insecurity both during and after pregnancy in relation to the support services they find useful and need. <h3>Methods</h3> This study was ethically approved (Ref No: LRS/DP-23/24-39437) and pre-registered on OSF Registries (https://osf.io/9hn6r). Semi-structured mixed format individual interviews were conducted between November 2023 and February 2024. Pregnant individuals, those who had given birth &lt;12 months ago, &gt;18 years old, food insecure, residing in Lambeth, South London with recourse to public funds were recruited through purposive sampling. The topic guide was informed by food insecurity, pregnancy and postpartum related literature and piloted with a nutrition expert and mother. Interviews were audio-recorded and professionally transcribed verbatim. Demographic data was summarised using SPSS. Inductive Thematic Analysis was completed using NVivo. <h3>Results</h3> Eleven food insecure participants (2 pregnant, 9 new mothers) participated in this research. Findings are part of ongoing analysis and represented by three themes: 1) Beyond food: Push and Pull, 2) System Soothers, and 3) Creating Coordinated Care. Theme one illustrates how food insecurity sits within societal systems beyond the food system which work against participants to drain and block their household income, thus is conducive to food insecurity around the pregnancy period. Theme two relates to informal and formal support services ‘soothing’ the experience of food insecurity. This theme also provides insight into what’s working well locally whilst revealing an inconsistency in coordination of care across the first 1,001 days. Theme three discusses future solutions to improve the experience of food insecurity during and after pregnancy. <h3>Conclusion</h3> This is the first research to provide in-depth qualitative insights into the systematic barriers faced by this vulnerable group experiencing food insecurity. Participants provided policy recommendations to enhance support during the first 1,001 days, including early identification of food insecurity during pregnancy. Further highlighted was the preference of healthcare professional as a route of access to these support services. Future research should consider exploring the experiences of those without recourse to public fund who may have a more severe form of food insecurity, and thus have additional barriers/needs.

  PublisherDOI

• Levonorgestrel 52 mg intrauterine device placement without uterine sounding: A feasibility study

  Contraception · 2024-10-04 · 1 citations

  articleOpen access

  OBJECTIVES: To evaluate feasibility of levonorgestrel 52 mg intrauterine device (IUD) placement without uterine sounding. STUDY DESIGN: We performed a three-phase feasibility study from February 2023-May 2024. In phase one, participants had levonorgestrel 52 mg IUD placement with sounding. In the experimental phases, placement occurred without sounding and with (phase two) or without (phase three) concurrent transabdominal sonography and participants had 3-month follow-up. We defined feasibility as successful IUD placement without uterine sounding based on ultrasound confirmation. We measured total instrumentation time from the sound or inserter touching the cervix to inserter removal. Participants reported maximal pain experienced using a 100-mm Visual Analog Scale when the inserter was removed. We calculated a sample size of 30 per phase so that if there was one failed placement, the lower 95% confidence interval of the successful placement rate would be no less than 90.0%. RESULTS: Successful placement without sounding occurred in 30(100%) participants in phase two and 28(93.3%) in phase three. Median instrumentation was longest in phase one (49.5 [interquartile range (IQR) 42.3-55.0] seconds) compared to phases two (16.0 [IQR12.0-28.0] seconds, p < 0.0001) and three (25.0 [IQR 18.5-32.2] seconds, p < 0.0001). Participants' median placement pain was 21.0 (IQR 10.3-32.8) mm in phase one with no difference in phase two (25.5 [IQR 14.3-47.0] mm, p = 0.35), but was higher in phase three (36.0 [IQR 22.8, 61.0] mm, p = 0.01). CONCLUSIONS: Levonorgestrel 52 mg IUD placement without sounding is feasible with concurrent sonography. Placement without sounding results in shorter instrumentation time but does not decrease maximum placement pain.

  PublisherDOI

• 24-Hour Compared With 48-Hour β-hCG Follow-up for Patients With Pregnancy of Unknown Location [ID 2683407]

  Obstetrics and Gynecology · 2024-05-01

  article

  INTRODUCTION: Patients who are followed with a pregnancy of unknown location (PUL) are generally advised to return for repeat β-hCG level after 48 hours. This study compares the time to final diagnosis for patients who had repeat β-hCG levels 24 versus 48 hours after diagnosis of PUL. METHODS: This was a retrospective cohort study of patients diagnosed with PUL who were recommended to return at 24 versus 48 hours at a single site from 2021 to 2022. We reviewed charts for time to final diagnosis, demographic characteristics, pregnancy history, β-hCG levels, interventions, and whether the patient was lost to follow-up. We compared the time to final diagnosis using Kaplan–Meier curves and log-rank tests between the two cohorts. RESULTS: Over the two-year time period, 61 patients were eligible for inclusion, 18 of whom followed up at 24 hours and 43 of whom followed up at 48 hours. Most patients completed the recommended follow-up (94.4% 24-hour versus 83.7% 48-hour). The median time to final diagnosis was 2 days (interquartile range [IQR] 1–5 days) for the 24-hour cohort compared to 6 days (IQR 3–13) for the 48-hour cohort ( P =.03). None of the 24-hour group was lost to follow-up compared to 11.6% (n=5) in the 48-hour group. CONCLUSION: We found the time to final diagnosis was shorter in the 24-hour group compared to the 48-hour group. Clinicians may consider 24-hour follow-up for patients at higher risk for ectopic pregnancy or to expedite the time to a final diagnosis.

  PublisherDOI

• Telemedicine Follow-up After Medication Management of Early Pregnancy Loss

  Journal of Women s Health · 2024-07-03 · 3 citations

  article

  Objective: Our objective was to evaluate the feasibility of a new protocol for telemedicine follow-up after medication management of early pregnancy loss. Study Design: The study was designed to assess the feasibility of planned telemedicine follow-up after medication management of early pregnancy loss. We compared these follow-up rates with those after planned in-person follow-up of medication management of early pregnancy loss and planned telemedicine follow-up after medication abortion. We conducted a retrospective cohort study, including patients initiating medication management of early pregnancy loss &lt;13w0d gestation and medication abortion ≤10w0d with a combination of mifepristone and misoprostol between April 1, 2020, and March 28, 2021. As part of a new clinical protocol, patients could opt for telemedicine follow-up one week after treatment and a home urine pregnancy test 4 weeks after treatment. Our primary outcome was completed follow-up as per clinical protocol. We also examined outcomes related to complications across telemedicine and in-person follow-up groups. Results: Of patients reviewed, 181 were eligible for inclusion; 75 had medication management of early pregnancy loss, and 106 had medication abortion. Thirty-six out of 75 patients elected for telemedicine follow-up after early pregnancy loss. Of patients scheduled for telemedicine follow-up, 29/36 (81%, 95% CI: 64–92) with early pregnancy loss and 64/69 (93%, 95% CI: 84–98) undergoing medication abortion completed follow-up as per protocol ( p = 0.06). Completed follow-up was also similar among patients undergoing medication management of early pregnancy loss who planned for in-person follow-up ( p = 0.135). Complications were rare and did not differ across early pregnancy loss and medication abortion groups. Conclusions: Telemedicine follow-up is a feasible alternative to in-person assessment after medication management of early pregnancy loss.

  PublisherDOI

• LEVONORGESTREL 52 MG INTRAUTERINE DEVICE PLACEMENT WITHOUT SOUNDING: A FEASIBILITY STUDY

  Contraception · 2024-10-07

  article
  PublisherDOI

Frequent coauthors

• Sarita Sonalkar

  University of Pennsylvania

  20 shared

• Courtney A. Schreiber

  University of Pennsylvania

  16 shared

• Andrea H. Roe

  University of Pennsylvania

  15 shared

• Nathanael Koelper

  Hospital of the University of Pennsylvania

  10 shared

• Arden McAllister

  Hospital of the University of Pennsylvania

  10 shared

• Jill M. Krapf

  The Centers

  6 shared

• Kurt T. Barnhart

  University of Pennsylvania

  5 shared

• Sarah Gutman

  University of Pennsylvania

  5 shared

Labs

• Family Planning Center/ProgramPI

Awards & honors

• Alpha Omega Honor Society, Kane-King-Dodek Obstetrical Georg…