Pregnancy and Birth

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.

Endometrial cancer remains the most commonly diagnosed gynecologic cancer in the United States. In fact, the number of women affected by the disease continues to rise despite a slight decline in annual incidence rates in the past 30 years.

Using a combination of magnetic resonance (MR) imaging and mammography increases sensitivity of cancer detection in women with a history of chest irradiation compared to using either modality on its own, according to a study published in the April issue of Radiology.n

After peaking at 4,316,233 births in 2007, the birth rate in the United States fell 4 percent by 2009, and a provisional count in 2010 indicates the number is continuing to decline, according to a March data brief released by the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics.

Black and Asian/Pacific Islander women are more likely to experience antenatal depression than non-Hispanic whites, according to a study published online Jan. 31 in General Hospital Psychiatry.

One in 8 women and men are diagnosed with infertility. In honor of National Infertility Awareness Week, RESOLVE is busting myths and misconceptions about infertility. Click through the slideshow to learn more about these misconceptions and share some myths you've heard in our comments section.

Medical abortions by mid-level providers (MLPs), up to nine weeks gestation, are as safe and effective as those provided by doctors, according to a study published online March 31 in The Lancet.

About two-thirds of the U.S. population takes in sufficient amounts of vitamin D, but 8 percent may be at risk for vitamin D deficiency, according to a March data brief published by the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics.

Pacifier use in healthy, full-term newborns, introduced before or after breast-feeding is established, has little impact on the prevalence or duration of breast-feeding up to four months, according to a review published online in the Cochrane Database of Systematic Reviews.

After practicing medicine in Antarctica and the western Pacific, it was time to come back to the US. Where would I practice? What size practice should I look for? What quality-of-life factors should I consider?

Lots of citalopram, an antidepressant, and finasteride, used to treat benign prostatic hyperplasia, are being recalled by Greenstone LLC due to possible mislabeling of the bottles, the U.S. Food and Drug Administration has announced.

Ambulatory blood pressure monitoring is a useful prognosis tool to differentiate between true and white coat resistant hypertension, according to a study published online March 28 in Hypertension.

Maternal anemia during pregnancy is linked with wheezing and asthma in early childhood, according to a study published in the February issue of the Annals of Allergy, Asthma & Immunology.

Amid the media frenzy regarding KV Pharmaceutical's decision to sell the FDA-approved drug Makena (hydroxyprogesterone caproate injection) at up to $1500 per injection, the pharmaceutical company as well as the FDA took steps last week to ensure that the medication, which is recommended for women at high risk for premature birth, is more accessible to patients.

Group B streptococci (GBS) is still the dominant cause of neonatal bacterial meningitis, whereas Escherichia coli (E. coli) is the most common cause among preterm infants, according to a study published in the March issue of The Pediatric Infectious Disease Journal.

The use of progestin-estrogen oral contraceptive pills (OCPs) in women prior to becoming pregnant does not appear to increase the risk of adverse respiratory outcomes in offspring, according to a study presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology, held from March 18 to 22 in San Francisco.

There's an important subtext that undergirds defensive medicine that often goes unrecognized and therefore unanalyzed. Defensive medicine is driven by the fact that we live in a "risk society," a society that is organized around a new understanding of risk.

A 43 year old woman came to me with irregular bleeding despite being on birth control pills. Her OB/GYN had inserted a Mirena® IUD 7 months ago, which failed to stop her irregular bleeding.

Obesity is a worldwide public health concern that affects many pregnant women. According to new research published in British Journal of Obstetrics and Gynaecology, pregnancy is an ideal time to initiate healthy weight and lifestyle discussions with patients.

Answering the Institute of Medicine’s call to improve patient safety, the New York Presbyterian Hospital-Weill Cornell Medical Center undertook a step-wise, comprehensive, and ongoing safety program. The program was conceived in 2002 and began with a review by independent consultants.

Prophylactic treatment with 17-alpha-hydroxyprogesterone caproate (17Pc) in twin pregnancy does not reduce neonatal morbidity or prolong gestation, according to a study published in the March issue of the American Journal of Obstetrics & Gynecology.

Between 1965 and 2007, the prevalence of high-intensity smoking declined in California and in the remaining states, according to a study published in the March 16 issue of the Journal of the American Medical Association.

Higher serum polychlorinated biphenyl (PCB) concentration levels that are within the normal range for women in the general U.S. population are associated with failed implantation in women undergoing in vitro fertilization (IVF), according to a study published online Feb. 24 in Environmental Health Perspectives.

Low-level lead exposure, measured by umbilical blood lead levels, suggests a significant association with elevations in maternal blood pressure during labor and delivery, according to a study published online Feb. 3 in Environmental Health Perspectives.

The incidence and severity of cerebral palsy (CP) among preterm survivors decreased significantly from 1990 to 1993 onward, possibly because of a reduction in severe cystic periventricular leukomalacia (c-PVL), according to a study published online March 3 in The Journal of Pediatrics.

A recent article in the Wall Street Journal describes some of the ways health care professionals are collaborating to improve obstetrics care, thanks in part to grants from the federal Agency for Healthcare Research and Quality.

The 2009 H1N1 pandemic caused anxiety and concern, especially for pregnant women and their physicians. The Centers for Disease Control (CDC) recognized this special patient population and the increased risk for serious problems and negative outcomes-both for the women and their unborn babies. As such, the CDC advised doctors to provide antiviral medicines to those with symptoms of the flu and vaccines to those pregnant women who were eligible. They further partnered with the American College of Obstetricians and Gynecology, the American Medical Association, and the American Academy of Family Physicians to educate clinicians and urge their participation in the 2009 H1N1 vaccination programs.