Gyno Gab

Tampon Health: 'There is a Catch'

2012-01-25T06:38:00.000-06:00

For women who have used tampons for years they insert their favorite one, it pops right in, and you are off to deal iwth your day without a care or a thought. But if you didn't have a mom or a girlfried or a sister to show you the ropes, that first time, well, many of us have a story! And for some, no matter how expert the advice, there is still a catch and it won't go in! So what could be the problem? Tense muscles and technique aside, some of us have anatomic conditions that prevent successful tampon use! A vaginal septum, or simple wall, is one of the more common causes. Double vaginas and vaginas that really don't have openings are the other causes. It's important that check with your gyno if you just cannot manage that tampon! Many conditions are not harmful and just a part of your body you need to learn to negotiate, other conditions actually require treatment.

Tampon Health

2012-01-24T06:26:00.001-06:00

Tampons are designed to catch menstrual flow. They are easy to use, affordable, and preferable in many cases. Simplistically speaking choosing the right tampon shouldn't be difficult for most women and fairly quidkly we learn that both the fit and the absorbancy have to match your anatomy and physiology to be comfortable and safe. Tampons that contained certain types of fibers in the 1970s and 1980s that were too absorbant encouraged the overgrowth of bacteria that caused Toxic Shock Syndrome. Once these polyacrylate rayon-containing tampons were removed from the market very few of these cases are ever reported. Tampons are packaged to be sterile from production, but most are not sterile, and rarely there have been recalls of sanitary products that have been determined to carry bacteria from the manufacturing point. Tampons are not a typical source of infection. Tampons come in many sizes, and larger ones will retain more menstrual blood, for the most part. Most physicians will encourage relatively frequent change of your tampon to decrease total wearing time of any one tampon, and pad use at night will prevent a woman from wearing any individual tampon for too many hours. Night use for the most part is not harmful, but discouraged as a general rule. While tampons come in a variety of sizes and there are some variations in fiber content many have cotton as their primary fiber. The way the tampons are designed few fibers are ever shed during use, but some women will notice some.Tampons used when you do not have flow at all, or when the flow is extermely light could cause drying and even 'catch' the lining of the vagina so that some flakes of tissue are passed. The shedding of a body part is medically called desquamation, and there are vaginal infections that cause this producing a discharge that under the microscope would look like many cells. Actually yeast infections can do this as can a disorder called inflammetory vaginitis. Toxic Shock doesn't produce vaginal desquamation. Actually with Toxic Shock a rash develops, and many days later if desquamation occurs it's usually of the hands or the feet one to two weeks after the infection started. Fibers from cloth or sanitary pads can work their way into the vagina, so it's not only tampons that cause cause the presence of fibers. It is not known if stray fibers can be a chronic source of infection, but when women have chronic vaginal infections an source of contamination should probably try to be eliminated, including tampon use until cured.

Treating Cervical Pre-Cancer With Cream Not Knives

2012-01-21T20:21:00.000-06:00

When a woman gets an early pre-cancer of the cervix, called mild dysplasia, or CIN I, she is likely to resolve her infection, or at least keep it in check so that it doesn't progress, and it's only likely to progress to overt invasive cancer in about 1/100 cases. Even if she has severe dysplasia, or CIN III, she only has a 1/10 chance of progressing to invasive cancer. The reason that so many women clear or control their disease is related to an inate immune response that some women can ount. The cervical pre-cancer is caused by the Human Papilloma Virus (HPV). Various types of HPV viruses cause other diseases rather than just cervical cancer, including genital warts. It has been shown that the warts too can be cleared by an immune response. To aid the ability of the body's immune response to clear the HPV Virus a novel wart treatment called imiquimod was developed and approved for use in 1997. In 1999 a small group of women (56 women) were given the opportunity to have treatment of their dysplasia either by medication with imiquimod or by a surgical treatment. Theresults were reported in the January 2012 issue of the American Journal of Obstetrics and Gynecology, the imiquimod treatment of the cervix was tolerated well and helped to clear HPV types, but it did not reliably clear the pre-cancer (dysplasi). So we cannot yet prescribe creams, but surgery, weather performed with knives, lasers, freezing or burning is still the treatment of choice when you do need to be treated.

If you are Infertile, What Tests Do YOu Need?

2012-01-19T06:48:00.002-06:00

Infertility is defined as a couple trying to conceive for more than a year. Your gyno is likely going to tell you that if you are over the age of 35 and have been trying for over 6 months then it is time to get talking to your gyno about beginning the testing. An initial interview will tarket your individual gynecologic and health history and direct some testing. The National Institute of Health has also come up with recommened infetility testing. Most testing will be focused on the female, but there is recommended testing for her partner. At the NIH infertility site you can find guidelines from many organizations, such as ACOG which over sees recommendations from all Board Certified Obstetricians and Gynecologists, and other organizations, such as the one that oversees recommendations on in vitro fertilization. Many of these tests can be costly, and it is prudent to ask your physician what is cost effective with regards to testing as well. Shopping around for instance can help you save hundreds of dollars, and for an initial evaluation that is often what gynos recommend.

News Flashes on Menopausal Hot Flushes

2012-01-17T17:02:00.000-06:00

Hot flashes have remained a persistent problem for women, when a woman transitions through menopause she's likely to experience hot flashes which persist in a bothersome way for up to 2 years. For others it is much longer. It does not help to use flaxseed to treat them, although many women have looked for a non-hormonal plant based alternative, research has not backed up that this would work. A cancer treatment group, in conjunction with Mayo Clinic has shown that in addition to possibly causeing some flatulence and diarrhea, flaxseed when given in supplemental form won't relieve hot flashes. Physicians continue to explore the nature of these hot lashes and their consequences for women who have them. Whether they are a cause of heart disease, or a result of poor fitness is still debated. We do know that some links exist between hormone levels in menopause, general heath and the hot flashes. Elevated male hormone levels have been associated with increased of heart disease for menopausal women. This was shown to be true even for women who have hormone levels within the normal range, but are higher than some women their own age, and may be worse for women with hot flashes regardless of their hormone levels. Why this should be true is not completely understood.

Back To Your Favorite PIll

2012-01-07T17:01:00.001-06:00

You just had a baby and are ready for contraception, but your gyno hasn't given you the same prescription of pills you've found as the best for you. Why? Because it has been a belief that progesterone only pills help improve breast feeding by improving milk supply. But the progestetrone only pills have never been quite as desireable as the typical combination pill as without the estrogen component they tend to have slightly higher breakthrough bleeding and slightly greater failure rates. After delivery, about 85% of moms are trying breast feeding, but only 60% are still breastfeeding after two weeks! So trying to figure out how as your gyno we can make this process more successful, and helping you pick the right birth control pill is important. With a grant funded by the American Congress of Obstetrics and Gynecology researchers at the University of New Mexico have specifically looked at the first 8 weeks, and the first 6 months of breast feeding and whether the mom's stopped breastfeeding sooner or baby's growth was any different based on the type of birth control pill. They did not compare these women to women who were breastfeeding and not on hormonal contraception, and they didn't exclude people that began to supplement early in the addition to breastfeeding, so the study doesn't answer all the questions you might think of regarding the best type of contraception, but none the less a very informative study. At 8 weeks each group, those on progesterone only pills, and those on the regular pills were virtually identical with each group having over 60% of moms breastfeeding, and about half of each group reportted stoping breastfeeding because of a perception of low milk supply. Interestingly many organizations do discourage combined birth control pill us in the first 3-6 weeks after pregnancy because of the risk of getting a deep vein blood clot. But , after the three weeks pass, this study says don't worry regarding milk production with or without various types of pills, and pick the pill you and your gyno have decided is best for you! And remember is milk production is an issue, there are other things to consider rather than jsut the type of pill you are taking.

Matzoon and Kumyss on the Prego Menu

2012-01-07T08:11:00.000-06:00

You are pregnant, and happy, but some of the minor side effects of pregnancy, like vomiting, may become such a nuisance that once it hits, we reach for the medication bottle. How about the treatment of constipation in pregnancy? Have you tried kumyss and matzoon? That's what they recommended in the Progressive Era! Matzoon is essentially Armenian yogurt, and kumyss is a fermented dairy product traditionally made from mare's milk favored by the Mongolian war lords. The Japanese believed their version of matzoon, also called matzoni, which is yogurt from the Caspian Sea area is best. If you aren't a vegan, then these products milk might just help keep you regulated in pregnancy, but given that are pretty hard to find, but I just recommend bran and Greek yogurt, and try to stay way from the drops of cascara sagrada, as that might turn into too much laxative.

Vaginal Itching in Young Girls: If Not Yeast, What is Wrong?

2012-01-03T03:51:00.000-06:00

Vaginal itching is very common in young girls. Both yeast infections and bacterial infections are known to both produce vaginal itching and vaginal discharge.And in posts on both ewe have discussed some of the causes and cures. But if your young kido is complaining of itching or has a vaginal rash, it could be yeast, it's not likely to be bacterial, and they also are more likely to pick up other bugs. If there is a bloody or actively painful discharge in a young girl before puberty, it's more likely to be something that she's stuck into the vagina, and that does have to be checked. If she's had recent diarrhea, some of those same organisms can cause infections. They also are more likely to get an obvious rash from scratching as the skin is so sensitive, even normal sexual exploration can cause enough irritation to be mistaken for an infection. And pinworms are occasionally seen as well. Those are a bit harder to detect in a regular exam, but pediatricians recommend putting some tape over the anus before bed and then taking it off first thing in the morning and bringing it to the doctor to look at under the microscope. This is literally known as the tape test, and rarely it's positive in teens as well. Although there are other causes of the itching or irritation, these are some of the most common causes.

Hysterectomy Stories: A woman and her decision about her cervix

2012-01-02T15:27:00.003-06:00

We have discussed sexuality after a hysterectomy before, but some women feel that part of a discussion on sex after a hysterectomy should include a decision regarding whether to keep your cervix. Interestingly keeping the cervix was a normal part of the hysterectomy operations in the early part of the 20th century, but by 1960, as a way to control cervical cancer, and other reasons, gynecologists began to recommend that the cervix be routinely removed at the time of a hysterectomy. Although under the microscope the cervix and uterus have different tissue compositions, the fact is that the cervix and the top portion called the uterine fundus, actually make up a single organ, and the surgery is usually more effective and in some ways more straightforward if both the cervix and the uterus are removed together. So as for the pros and cons of taking the cervix: on the pro side: fewer cases of cervical cancer and the con side: removing the cervix disrupts some pelvic support and the surgery in that region is near both the bladder and the bowel. But in the 1980s Scandinavian researchers put forth the idea that sexual function is preserved better if the cervix was left. This early proclamation was not backed up by study, but by patient reports. When the studies of sexual function were done not all the work looked at all aspects of sexuality. Most women who had a good sex life after their hysterectomy, had a good sex life before their hysterectomy. So if you are having gynecologic problems, and sexuality problems, if you need a hysterectomy to fix the gynecological problems, you likely will need other treatments to treat your sexual function. Leaving the cervix will not really change the way you approach sex.

Predicting Rain Or Predicting Ectopic Pregnancy, The Statistics Are the Same

2011-12-31T13:04:00.001-06:00

In our office we joke about the accuracy of rain prediction: I usually say it is correct about 50% of the time, what's your take? In medicine we have improved the diagnosis of tubal pregnancy greatly, but unfortunately the initial diagnosis of ectopic pregnancy may be incorrect up to 40 percent of the time! In a new study that looked at the medical consequences of missing this diagnosis they discuss that the medications used to treat tubal pregnancy, in the cases that can be treated with medicine, can be harmful to a pregnancy that is actually developing in the uterus and may go on to term. They also have cautioned that several tests over a period of days are needed to confirm the diagnosis of a tubal (ectopic) pregnancy, and that women need to understand that patience is often important. Pregnancies develop at a different pace in different women and the levels of hormone and when and how rapidly the different structures are visualized on ultrasound can also vary.

Ovarian Cysts Still: In Menopause

2011-12-30T20:01:00.001-06:00

Ovaries of women in menopause do still have some eggs, do still have some hormone production, and can still get ovarian cysts. One study showed that almost 1/5 women in menopause will be found to have an ovarian cyst. And its also important to note that while the worry of ovarian cancer is high in the women who do have cysts in menopause, the likelihood of a simple cyst in menopause being cancerous is very low. Your gyno will likely look at the size of the cyst and decide if it is something that is serious and needs surgery or needs to be just watched. Blood tests, other symptoms, sometimes other imagining tests, like CAT scans can help determine this as well, although hands down the ultrasound is the most efficient and accurate and actually the least expensive way to determine what the significance of the cyst is.

In the Aftermath of a Cesarean Section: What to Watch For

2011-12-29T13:20:00.000-06:00

If you have had a Cesarean Section chances are you healed quickly and feel well, but you may want to be generally aware of what the newest studies are saying about your longer term risks of medical complications from the surgery. Cesarean Births have become the most frequent operation performed in the US today, so based on sheer numbers gynos are beginning to see more complications that are directly related to that operation. The surgical technique used in the United States always enters the abdominal cavity, although there is a way to actually perform this surgery without doing so. It was always thought that the incidence of causing scar tissue in the abdomen was very low because the Cesarean operation cuts into the cervix which is located very low so the place where the cut is into the cervix is actually a fairly confined space between the abdominal wall and the uterus in the lower part of the abdomen itself. While scaring internally in the pelvis and the abdomen after the C-section is now found to be more common than we thought, it is not universal by any means. Dr. Michael Diamond in an editorial about the post C-section scarring explains that perhaps the shrinking of the uterus itself as well as the expanding and contraction of the nearest structure which is the bladder, as we fill it during the day, are two of the reasons that scar tissue isn't always formed. Other problems from the scar tissue may occur including chronic pelvic pain, and even tubal pregnancies. Gynos have started to investigate the health of having your second, third, or even more babies by C-section and they have found there are more cases of premature birth and smaller babies and even greater numbers of stillbirths.We also worry about a rare medical condition of the placenta growing within the wall of the uterus which can happen a bit more commonly if that part of the uterus has a scar from a prior C-section. So if you have had this operation, have a discussion with your gyno on what tests you may need to have to investigate any longer term problems.

Fight Fat and Prevent Uterine Cancer

2011-12-28T18:57:00.000-06:00

Uterine lining cancer, called endometrial cancer by gynos, has obesity as an established cause. Not only are you more likely to get uterine cancer if you are obese, you are more likely to die of that cancer. as researchers form MD Anderson Cancer Center explain in a recent article in the American Journal of Obstetrics & Gynecology. Obese women have more estrogen. Their estrogen doesn't just come from their ovaries, but their estrogen comes from their fat, and the levels of estrogen in the fat are highly concentrated and greater than the levels we see in the blood stream! Obese women also have different hormones all together. They have less of the hormone binding substance called SHBG (serum hormone binding globulin) and with less of this substance the estrogen that they do have circulates free, thus is an effectively higher concentration. Estrogen promotes the growth of the uterine cancer cells itself. If you are a diabetic you are more prone to this uterine cancer, but if you are an obese diabetic, you are significantly more likely to get this cancer, as obesity promotes the production of insulin which in tern also signals cancer promoting cells growth. One of the fat regulating hormones, adiponectin changes when a woman is prediabetic or diabetic or what we call insulin resistant. We don't understand all the ways that hormones produced in our body fat affect conditions like lining cancer of the uterus, but current research supports that they do. So what specifically can women do: 1. use potent progesterone to counterbalance the effects of estrogen in the uterus, 2. take medicines that will improve your ability to respond to insulin, like the diabetic medicine glucophage, 3. loose weight, and 4. exercise which will change the amount of fat you have and the response to estrogen as well! So no one needs a better reason than these to get the fat off this new year!

Menoapsue and Polycystic Ovaries

2011-12-20T01:55:00.004-06:00

Polycystic ovaries have many effects on the rest of our boidies. For some women they lead to the medical conditions of diabetes, hypertension and gall bladder disease. For some they lead to unwanted acne or hair growth. They may make weight increase and polycystic ovaries may make it more difficult to loose weight. But when it comes to menopause: There is actually improvement! There are fewer eggs surviving in our ovaries as we get older, so as a women gets older the contribution of each little cyst begins to diminish!Polycystic patients who may have never had regular cycles, unlike their friends who are reportting more period problems, may actually see their cycles normalize for the first time. Of course a bit of weight loss, adherence to nutritional recommendations overall, and more exercise may also be the reason some women are 'cured' of their polycystic ovaries as they age, so there is much we need to know about!

HPV Testing Updated

2011-12-18T12:34:00.000-06:00

The more you read about HPV testing the more you will here these words: Primary Screening and Co-testing. A new study published in the Dec 15th issue of Lancet says that women should not get a pap test first, but they should just get an HPV test! This study looked at a specific set of women: ages 29 to 59 and the performance of HPV testing verses pap testing when done twice in 5 years.Scientists from our National Cancer Institute have said that this study, like many that are publishing their results, back up the fact that adding HPV testing to your cervical cancer screening does add value. What will be important is for women to discuss with their own gyno which test to do, when to do the tests, and then what sort of on going testing you need based on the results. Let us know if you have had HPV testing and if so , was it helpful?

UTI Symptoms That Wasn't a Bladder Infection: Suburethral Diverticula

2011-12-17T12:31:00.000-06:00

Suburethral Diverticula

This patient came to the office with what she thought was a bladder infection. The examination revealed a cyst that was sitting near the opening of the urethra. This condition is called a suburethral diverticula. It's possible this cyst is a Skene's gland infection, or a cyst of the wall of the vagina itself, but usually they are pouches off the urethra that can become infected. They also can just be the site of old infection and now the cyst is not active and doesn't need to be treated.But as with all lumps, it is important to get them evaluated by your gyno so that your medical management can be individualized.

Ovulation Treatments and Breast Tumors

2011-12-16T01:13:00.002-06:00

When women are pregnant, or breast feeding, or taking birth control pills, they are not ovulating, and they are therefore at reduced risk of ovarian cancer. When women are given ovulation inducing medications they may be slightly increasing their risk. Studies have varied, and most women don't ovulate too many 'extra' times with just a few short months of treatment, so ovarian cancer not regarded as an actual consequence of fertility enhancing ovulation treatments. But we have paid less attention to what the breast tissue response of ovulation treatments have been. One of the most common kinds of breast lump is a fibroadenoma. Not only are fibroadenomas of the breast not thought to be cancerous, but they are not thought to be able to turn cancerous. A single case has now been reported in Fertility and Sterility of a fibroadenoma breast lump turning into a cancerous tumor during fertility treatment. Fertility treatments increase estrogen blood levels and this is theorized to be the way a noncancerous breast lump could turn cancerous when stimulated with enough estrogen. Currently there are no specific recommendations for fertility patients who have non-cancerous breast lumps to be treated any differently than your gyno would normally. But this case calls attention to an important development in breast care that we will have to follow. Although we do not uniformly encourage women to do self breast exams, it may be that an infertilty patient undergoing ovulation treatments should be more attentive to them.

Fertility Failure Fix?

2011-12-15T07:00:00.002-06:00

When fertility treatments fail patients and their gynos look for what new strategies can help them conceive. In the broad sense we explain fertility to our patients fairly simply: we have to ovulate, the egg has to meet up with the sperm, it has to implant. And the ovulation treatments aim to make this happen, and literally dozens of medications and perhaps hundreds of dosing and timing strategies have been tried. We say that these three 'simple' steps is all it takes, but of course there are many delicate steps in the ovulation process, and some women will just not respond to the treatments we give. One newer treatment that is fairly controversial is the use of Growth Hormone (GH) to improve ovulation. Growth Hormone is a lesser known hormone of the pituitary gland that also makes the ovulation stimulating hormones FSH and LH. It's been more commonly abused by athletes and body builders than by physicians who have only ever used it to treat rare disorders of children. It's use in fertility has been in small research settings. But as we have discovered GH deficiencies in women who are aging and fatigued, we have now begun to suspect that some women who are infertile have this deficiency as well. It may be a test for you to discuss with your gyno if you have not been able to fix your fertility.

Painful Breasts: Top 10 Questions

2011-12-14T14:27:00.000-06:00

1. Do Painful breasts mean I am pregnant?
---Not typically although early pregnant patients do have breast discomfort, but if you suspect, run a home test.
2. If I have painful breasts am I drinking too much caffeine?
---Many studies say this is true, moderate and see how your symptoms are.
3. Will breast pain be resolved by taking the birth control pill?
---For new start pill patients new breast pain could be caused, but for most over time the steady hormone levels prevent that pre-menstrual breast pain.
4. Can my Mirena IUD cause breast pain?
---The low levels of progesterone could cause symptoms, but not very likely.
5. What should I take for breast pain?
---It is important to talk to your gyno, but ibuprofen, tylenol and heat are what most women will try first.
6. Should I get a mammogram if I have breast pain?
--If you are over 40 and have other indications, yes you need one, if you have had yours for the year, then you need to discuss with your gyno first.
7. Does it mean something different if only one breast hurts?
---Bilateral pain is more likely hormonal or a generalized condition. Pain that is localized to one breast might be more likely to be a symptom of something that needs a gyno exam.
8. Can breast touching during sex cause breast pain?
----Rough sex can cause discomfort but actual pain or bruising is abnormal, if either occurred consider an examination.
9. If I have breast pain should I do a breast self exam?
--Yes
10. Can an infection cause breast pain?
--Yes, if your skin is warm or red, you need to see your gyno promptly.

HPV Transmission

2011-12-11T00:57:00.001-06:00

It's been assumed that HPV can only be transmitted by contact with the surfaces that the virus lives on, such as the skin or membrane layers known as epithelium. Many gynos will translate epithelium for the patients to be "skin like" because it has many flat layers. Knowing that the virus likes these surfaces, it's the genital tract surface is where we think the virus lives. The location of the virus can explain then the way transmission has most likely occurred. But recently it has come to light that HPV is one of the most common infections in semen. In Italy, and reported in the Andrology section of the November 20011 issue of Fertility and Sterility a group has now reported, that 1/10 young men, who have no symptoms at all, will have HPV detectable in their semen. Exactly what this new information means is confusing. For instance will this be a risk for women getting donor insemination, and how would it affect the quality of the sperm themselves, and can the processing techniques for donor insemination eliminate this infection. Currently it is thought that HPV infection of semen is not a problem for fertilization, but more of a risk of transmission to an uninfected partner. Currently there are still no HPV tests for men. So the strategy has to be to vigilantly screen female partners. So as we move to doing less frequent routine pap smears, it would be important to perhaps continue to screen those getting donor insemination on a yearly basis.

Fibroid Risk: Caucasians vs African American Women

2011-12-10T13:13:00.000-06:00

Fibroid risk is almost ubiquitous, but in fact it is more common for some groups of patients to have uterine fibroids. According to a recent study of gynecologic population trends from the Mayo Clinic and reported in the November 2011 American Journal of Obstetric and Gynecology, by age 50 about 70% of Caucasian women and 80% of African American women have fibroids. But by the age of 35 over a third of Caucasian women and over half of black women will already have them, and be symptomatic. These numbers are so large that the numbers of women getting treatments is constantly increasing.So if you think you have them, see your gyno, it may be time for an ultrasound as well as a pap.

Dad Can Also Insure The Baby is Healthy

2011-12-09T10:01:00.002-06:00

Gynos spend a lot of time speaking to their mom's about what to do and what not to do, what to eat and what not to eat, what medicine to take and what not to take, and what the effects of various exposures may be in pregnancy. But we don't regularly speak about what the dads can do. Interestingly, we have always thought that the "winning sperm" would take care of any problems. And this has some truth: healthy sperm can fertilize an egg, and unhealthy sperm rarely win the race through the fallopian tube to the egg. So nature has solved much of the problem for us. Which is probably why neither Agent Orange, atomic radiation nor recreational drug use in the dad has ever been associated with a higher than normal rate of birth defects in their children. Interestingly pesticide exposure has been associated with birth defects, showing that there must be something fundamentally different about the way the body is effected. So when planning that healthy baby, bring the baby daddy along to your gyno visits, you gyno may just need to have a chat with him!

Dust off the Obstetrical Forceps?

2011-12-08T07:29:00.003-06:00

When I think of obstetrical forceps I can’t help but also think of the saying by Werner Karl Heisenberg: ‘Every tool caries with it the spirit by which it has been created.” And The clan of brilliant and skilled obstetricians, the Chamberlains, who invented forceps and hid them from the world to preserve their secret. The recent experts in obstetrics hid forceps from the patients because of perceived harm. Is it time to re-evaluate forceps? There was a collaborative study just published in the Green Journal: Obstetrics and Gynecology by a group of Eastern seaboard physicians: Johns Hopkins, Yale, Brown, that has showed that the use of forceps, not the vacuum can reduce the risk of adverse neonatal neurologic outcomes. The physicians noted that in 1990 about 1/20 babies was delivered by forceps, and by the year 2007 less than 1% were. If an operative vaginal delivery is selected, and so often a C-section is selected instead, they note that physicians will select a cesarean. This group looked at the three choices: c-section, vacuum delivery or forceps. The c-section group of babies had lower Apgar scores and higher rates of seizures. Rates of other serious complications tended to be worse as well Vacuum deliveries tended to have more scalp cuts, fractures and bruising. Forceps babies had more nerve injuries: face and arm. But when the total numbers of cases of neurologic complications was looked at: forceps were the safest. The data can be confusing because a forceps delivery has to be performed when mom is almost ready to deliver. In many cases with stress on their fetal heart rate tracing mom is not that far along in labor and only a c-section can intervene, and perhaps these babies are indeed sicker. This is also a study from the baby perspective, not mom’s and mom may sustain a tear to get the baby delivered vaginally. The article doesn’t go into the subtleties of the types of forceps, and they were once evolving into a very wide range of designs for each situation the obstetrician encountered: like the Karl Marx saying in 1867: (machines) are ‘knowledge objectified,’ and the obstetricians of antiquity made tools that would fit different pelvic shapes as well as different baby sizes. But we also have to remember, forceps are a tool that has to be taught, and they have been mostly in the closet, so the young physicians have not used them as much. No matter what your choices are, you have to discuss individually with your gyno.

C-section and the Risk of Post-Endometrial Ablation Syndrome

2011-12-08T06:01:00.001-06:00

In a new study at the Mayo clinic they looked at the patients that underwent enedometrial ablation and also had a prior C-section to see if there was any greater risk of post endometrial ablation surgery. About 23% of their patient population had had a C-section before, which is a bit less than the national C-section overall rate of closer to 30%, but likely fairly close to their overall C-section rate. So just from the rate of C-section in this population we would have to say that a C-section would not protect against or cause a patient to need endometrial ablation! No additional complications were seen in these women, and two patients in each group: with a prior C-section, and without a prior C-section had a hole made in the uterine wall during the surgery so that it was concluded that statistically it was about the same risk although there were fewer women in the group that had had C-section, so a slight trend towards risk. In their study population there was no reduced effectiveness, or change in the overall success rates whether a woman had had a C-section or not. The study was very powerful as they followed women for a full 5 years. And we conclude that your risk of post endometrial ablation syndrome is no greater if you have had one or more Cesarean delivery.

Ovarian Cancer Screening of The Future

2011-12-06T06:32:00.000-06:00

A new study from the University of Kentucky Ovarian Cancer Screening Trial Which has been underway since 1987 studied women over 25 with history, BUT ALSO women over the age of 50 who had NO SYMPTOMS. They had a plan to check out any cysts that persisted for over 6 weeks with blood tests, more sophisticated color flow ultrasound and they had a definite plan on doing surgery if there was suspicion of cancer. With just testing patients that have symptoms or risk we only find about 15% of the cancers in stage I, but the good news is that with their plan, almost half (47%) of all tumors were found to be in stage I. Not only that, but in this Kentucky trial women were much more likely to survive if they had been screened with the ultrasound test. So it is beginning to look like this may indeed develop into a good strategy for women. Now the authors are still worried that they have too healthy of a group of patients, and that in fact their statistics may not really support wide spread screening. Currently their work is being additionally validated by the UK Collaborative Trial of Ovarian Cancer Screening. Their results won’t be ready until 2015 and we think, therefore, that there will be reasons to change how we care for women in the next few years.