Pregnancy and Birth

Uterine fibroids that are completely or partially inside the cavity of the uterus (submucous myomas) can often be removed through the cervix by using an instrument called a resectoscope.

The American College of Obstetricians and Gynecologists recommends that women begin Pap test screening at 21 years, but are there certain circumstances in which Pap tests are warranted at younger ages? Dr Amy M. Johnson of Hartford Hospital in Connecticut and colleagues hypothesized that teenage girls who engage in risky behaviors would benefit from early initiation of cervical screening.

Intrauterine devices (IUDs) represent a safe and effective option for preventing unwanted pregnancies. Yet studies have shown that gynecologists still have concerns over its safety and do not utilize evidence-based criteria to assist in the selection of IUD candidates. In order to overcome this obstacle, it is imperative that current obstetric and gynecology residents are receiving correct information on this treatment modality-but are they?

Advances in successful assisted reproductive technologies have enabled clinicians to further aid their patients who would otherwise be unable to conceive. However, little is known about this trend and its continued future growth.

Despite great advances in maternity care, the number of women who give birth to infants requiring special care is still high. The Centers for Disease Control and Prevention’s National Preconception Health Plan has called for care to ameliorate health problems, support pregnancy spacing, and improve future birth outcomes in those women with a previous adverse pregnancy outcome

Should I have my fibroids removed before I try to get pregnant? That is one of the most difficult questions I have to answer! Here is what we know.

A recent study found that women with gestational hypertension are not receiving appropriate follow-up care and prevention. Specifically, the researchers found that women with gestational hypertension were less likely to have their blood pressure checked within the previous 2 years and were less likely to have their blood cholesterol checked within the previous 4 years.

As clinicians and patients strive to find oral contraceptives that are safe and effective, newer varieties have emerged on the market. Venous thromboembolism, an adverse event that has been associated with third-generation oral contraceptives, is a serious concern, especially with the growing popularity of these newer contraceptives.

Emergency care in obstetric practice is fraught with medico-legal risk. This is especially true when the practitioner has no established relationship with the parturient and either mother or child sustains serious or permanent injury during the birth process. Although reform efforts have been proposed expanding limits to liability in certain settings where emergency care is provided, currently, obstetricians often must rely on the protection afforded by their respective state’s Good Samaritan statute.

Hypertension affects as many as 8% of all pregnancies. Not only does it pose complications during pregnancy, but even if it resolves after delivery, it places women at increased risk for cardiovascular disease. As such, these women should receive cardiovascular disease counseling and screening, including the monitoring of their blood pressure and cholesterol levels, implementation of lifestyle modifications, and awareness of heart attack symptoms.

Insulin resistance in pregnancy poses risks for the mother, including preeclampsia and many other pregnancy-related complications. In this editor’s choice article-fast-tracked for publication in the American Journal of Obstetrics and Gynecology due to its clinical importance-researchers explored the association between increased maternal midtrimester insulin resistance and subsequent preeclampsia.

This young adult female (22 years age) had no significant complaints and was referred for a routine ultrasound scan of the abdomen to rule out any pathology. She complained of minor thyroid complaints, and ultrasonography suggested presence of Hashimoto’s thyroiditis in this lady.

Chronic hypertension plagues as many as 5% of pregnancies and can result in such adverse perinatal outcomes as preterm birth and fetal death. Further complications can present among women with chronic hypertension who develop superimposed preeclampsia, yet data on perinatal outcomes for such women are sparse.

Spontaneous preterm birth, the most common cause of premature birth, results from a multifactorial process. Its etiology is unknown, which makes it difficult to treat. In addition, there are few proven preventive measures.

Increases in the prevalence of asthma, especially in children, have raised concern in the medical community, resulting in research to find possible causes and to explore potential means of prevention. Recently there has been some evidence linking acetaminophen (known as paracetamol in New Zealand) use in pregnant women and subsequent increased risk for asthma in their offspring.

A 37 year old woman came to me in July, 2009 with a prolapsing 8 cm. fibroid. She had been seen by her HMO doctors multiple times for heavy bleeding, had 15 ultrasounds, but nothing was done.

Infertility is the inability to conceive despite frequent and unprotected intercourse between a man and his female partner for at least 1 year.

I believe epidurals are overused in obstetrics because not enough women receive hands-on labor support, and the side effects and risks are not well described to women.

With more than 7 million infertile women in the United States, the need and demand for effective IVF treatment remains high. Unfortunately for these women/couples, the cost for such treatment is also relatively high.

Untreated sexually transmitted infections (STIs) in pregnancy can lead to such negative outcomes as spontaneous abortion, preterm birth, low birth weight, congenital infections, and other abnormalities.

One in 10 pregnant women experience depression with severe risks, and depression during pregnancy is associated with higher risks for complications as well as postpartum depression. Yet treating depression during pregnancy raises concerns for maternal well-being and fetus well-being alike, requiring clinicians to constantly balance the benefits of psychopharmacological agents for women while minimizing risks to their fetuses.

Children whose mothers used paracetamol during their pregnancy may have a slightly increased risk of childhood wheeze, according to a meta-analysis published in the April issue of Clinical & Experimental Allergy.

Incorrectly positioned intrauterine devices (IUDs) make intrauterine pregnancy (IUP) more likely, with more than half of IUDs identified during the first trimester of pregnancy malpositioned, according to a study published online Feb. 24 in the American Journal of Obstetrics & Gynecology.

The duration of breast-feeding is associated with higher maternal ghrelin and pancreatic peptide YY (PYY) levels at three years postpartum, independent of other risk factors for metabolic disease, according to a study published in the April issue of Diabetes.

Young women who are subject to controlling behaviors from a partner and suffering from physical and sexual relationship violence (RV) are more reticent about screening for RV, according to a study published in the April issue of the Archives of Pediatrics & Adolescent Medicine.

Intrauterine devices (IUDs) can be a safe, effective, and relatively easy birth control option. However, pregnancy can occur if the IUD dislodges or is not placed properly. Dr Elysia Moschos, associate professor of obstetrics and gynecology, and Dr Diane M. Twickler, professor of radiology, at the University of Texas Southwestern Medical Center in Dallas, studied ultrasound findings, clinical symptoms, and outcomes for women with first-trimester pregnancies despite having intrauterine devices to better understand this issue.

A recent video segment on ABC News (see embedded video) addresses the growing rate of placenta accreta. The accompanying article with the jarring headline, "Placenta Accreta: Multiple C-Sections Can Kill Mother," reports that doctors are attributing the rise in this condition (from 1 in 30,000 pregnancies in the 1950s and 1960s to 1 in 2500 pregnancies in 2007, according to a report in AJOG) to the increased number of cesarean births. The article goes on to describe more reasons for the growing incidence of cesarean delivery, including diabetes, preeclampsia, and advanced maternal age, under the heading "More Women Demand Caesarians."Not surprisingly, the article has readers in a tizzy over when, exactly, a cesarean delivery is needed . . . and has them pointing fingers regarding who is to blame for the increased rate of this surgery.

March 9, 2010 a 46 year old woman came to me having been told that she needs a hysterectomy because of heavy bleeding from her fibroid. She wanted to know her options. Ultrasound showed a tennis ball size fibroid that was 2/3 in the uterine wall and 1/3 in the cavity of the uterus.

Teen birth rates in the United States have declined over the last two decades, but they remain high, according a Vital Signs report in the April 5 early-release issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

An individualized screen evaluating epithelial cells from women's breast milk may provide insight into breast cancer risk, according to research presented at the annual meeting of the American Association for Cancer Research, held April 2 to 6 in Orlando, Fla.