Whilly Bermudez for WOMEN'S HEALTH NOW - Online Health Topics for Women

High-risk pregnancies in obstetrics today

2015-09-12T07:56:00.001-07:00

Managing high-risk pregnancies in obstetrics today

By Dr Harini Narayan

Every year, across the world 287,000 women die in pregnancy and childbirth along with at least 2.6 million stillbirths, of which about 50% are intrapartum deaths. Among 133 million babies born alive each year, 2.8 million die in the first week of life. The latest MBRRACE reports of the UK show a maternal mortality rate of 10 per 100,000 women giving birth (December 2014) and an extended perinatal mortality rate of 6.0 per 1,000 total births, comprising 4.2 stillbirths per 1,000 total births and 1.8 neonatal deaths per 1,000 live births (June 2015).

While there have been significant clinical and technical advances in the care of high-risk pregnancies in the last few decades in economically advantaged countries, the complexity of patients has also changed quite dramatically. The challenges are numerous and varied with rising rates of obesity, diabetes, a host of co-morbidities, older mothers, immigration patterns, and social deprivation. Increasing numbers of women who were once unable to become pregnant or were advised not to due to underlying health problems are now able to have children. High-risk pregnancies form a significant and increasing proportion of any pregnant population. Improved outcomes also mean that patient expectations are at an all-time high.

Several generations of Confidential Enquiries into Maternal and Perinatal Mortality in the UK have focused on improvements needed in intrapartum care. The most recent MBRRACE report (2014) has, for the first time, highlighted the vital role of high standard pre-conceptual and antenatal care for women with underlying co-morbidities. Three quarters of all women who died had coexisting medical complications. Pre-existing medical or mental health problems were the main contributors to both direct and indirect causes of maternal death. Timely recognition and diagnosis of a high-risk condition complicating pregnancy, the involvement of appropriate senior staff from multiple disciplines, and prompt treatment or action can make the difference between life and death.

Most high-risk pregnancies belong to one or more of three categories:

Where there is a pre-existent medical/mental condition that could have a serious impact on the maternal/fetal outcome of any pregnancy and where specific management plans with multi-speciality input are essential.
Where the pregnancy itself could cause worsening of a pre-existent medical/mental disorder which had hitherto remained stable or in remission.
Where complications experienced during a previous pregnancy/ies are likely to recur or those that develop de novo in the present pregnancy could adversely affect maternal/fetal outcomes.

There is often much misunderstanding about the label “high-risk pregnancy” amongst health care professionals as well as in pregnant women and their families. It can result in patient anxiety to unwarranted, unnecessary, and sometimes potentially risky interventions undertaken without valid obstetric indications. It often leads to community midwives disengaging almost entirely from the ongoing routine antenatal care with the mistaken impression that their own input is unnecessary. This denies the normality that exists even in the most complex of pregnancies.

F.W. Peabody, a US physician (1881-1927), stated “The treatment of a disease may be entirely impersonal; the care of a patient must be entirely personal.” The corollary is equally true. Once deemed ‘high risk,’ there is often unnecessary duplication of appointments, sometimes within the same week or even the same day between the hospital antenatal clinics and primary care, creating significant disruption and inconvenience for patients. A lack of coordinated and integrated care planning in a patchy service wastes valuable resources. All maternity units are working under serious financial and manpower constraints in an increasingly litigious environment. There is more pressure than ever on the NHS to ensure every penny is spent in the most effective way for patients to improve standards of care while reducing costs. Every antenatal appointment needs a valid purpose, every investigation must be clinically justifiable, and every intervention must be medically indicated.

Challenging the status quo is bound to be difficult. The day-to day reality is that in most maternity units the antenatal care for women with high-risk pregnancy is of variable quality, often laced with conflicting advice. Trainees often find themselves in the dilemma of managing such patients depending on the consultant’s antenatal clinic in which they work. Individualized care pathways grounded in best practice, national guidelines, and centred on the woman with a specific high-risk condition are uncommon. Such care pathways should be designed to enable integrated and seamless care across primary, secondary, and, if indicated, in tertiary settings. Transforming structural and organisational norms is at the core of delivering a truly patient-centred service that starts from pre-pregnancy and continues to post-childbirth.

The crucial role of pre-pregnancy assessment and counselling services for women with pre-existing high-risk conditions is one that is often overlooked by commissioners and providers, quite apart from the woman herself. Does the obstetrician’s role end when the patient is discharged from the hospital? What about ‘after-sales customer care’? Does this extend to discussions about the most appropriate contraception suitable to her underlying medical condition? What about further multidisciplinary disease management and optimisation of health before the next pregnancy ‘just happens’?

An informed patient who actively participates in the management of her pregnancy is one to be cherished. The keystone for this lies in providing clear and comprehensive information, thus starting the process of shared decision-making throughout pregnancy.

Dr. Harini Narayan has worked in the NHS for more than three decades, 21 years of which have been as Consultant Obstetrician and Gynaecologist and Lead Obstetrician. She is Lead Obstetrician at the Great Western Hospitals Foundation Trust in Swindon, UK (1997-to date), heading maternal medicine, high risk obstetrics and clinical risk management. She is also a preceptor/supervisor for the RCOG ATSMs in Maternal Medicine, Advanced antenatal and labour ward practice and Honorary Consultant in Feto-Maternal Medicine in Oxford. She is the author of Compendium for the Antenatal Care of High-Risk Pregnancies.

Woman sues Marshall Obstetrics & Gynecology for HIPAA violations

2013-08-02T14:57:00.001-07:00

Woman sues Marshall Obstetrics & Gynecology for HIPAA violations

July 19, 2013 9:10 AM
By KYLA ASBURY

HUNTINGTON – A woman is suing Marshall Obstetrics & Gynecology for violating the Health Insurance Portability and Accountability Act and causing her damages.

Marshall Obstetrics & Gynecology is doing business as Marshall University-Joan C. Edwards School of Medicine.

Jane Doe was also named as a defendant in the suit.

During the summer and fall of 2012, Savannah Murphy was pregnant and receiving medical treatment and monitoring from two physicians of the defendants, according to a complaint filed June 28 in Cabell Circuit Court.

Murphy claims during her pregnancy, she was going through a divorce from her husband, Jonathan Broce.

Broce had Doe, who was a relative and/or friend, provide him with protected health information during the divorce, according to the suit.

Murphy claims the defendants violated HIPAA and were negligent in allowing her protected health information to be disseminated to Broce without the authority to do so.

The defendants breached Murphy’s confidentiality by allowing Doe, an agent, servant and/or employee, to access and disseminate her protected health information without authority and in violation of HIPAA, according to the suit.

Murphy claims the defendants’ actions caused her damages.

As a direct and proximate result of the defendants’ actions, Murphy’s protected health information was compromised, resulting in an invasion of privacy, according to the suit.

Murphy is seeking damages against the defendants for negligently disseminating the plaintiff’s protected health information. She is being represented by Robert B. Kuenzel and Eric R. Bias of Kuenzel & Associates PLLC.

The case has been assigned to Circuit Judge F. Jane Hustead.

Cabell Circuit Court case number: 13-C-450

When cancer isn't cancer at all

2013-07-30T18:43:00.001-07:00

Overtested Americans: When cancer isn't cancer at all

By Jacque Wilson and Amanda Enayati

The patient slammed his fist on the table in Dr. Otis Brawley's office.

"Dammit, I'm American," Brawley remembers him saying. "You can't tell me I have prostate cancer and that we're just going to 'watch it.'"

Brawley is the chief medical officer for the American Cancer Society, a world-renowned cancer expert and practicing oncologist. If you're going to get someone's opinion on a cancer diagnosis or course of treatment, he's a good choice. And in this case, he was recommending no treatment.

It's a scenario that may happen more as science reveals cancer's secrets, the biggest one being that what we now call cancer maybe shouldn't be called cancer at all.

"The word 'cancer' often invokes the specter of an inexorably lethal process," a working group for the National Cancer Institute wrote in a recent recommendation. "However, cancers are heterogeneous and can follow multiple paths, not all of which progress to metastases and death."

Basically, cancer is scary, but some kinds may be more boogeyman-in-the-closet scary than serial killer scary.

To understand fully, you have to look at the history of cancer diagnosis, Brawley says. In the 1850s, a group of German pathologists did some of the first biopsies on people who had clearly died of cancer. They took samples of their tumors and decided what breast cancer looks like, what lung cancer looks like, etc.

Today, Brawley says, there is a patient who has a lesion that's approximately 5 millimeters in diameter -- smaller than a pea. There's a doctor taking a biopsy of that lesion and a pathologist who's analyzing the sample using 21st-century technology. The problem, Brawley says, is that they're still comparing the samples to the cancer definition that was created more than 150 years ago.

"He's going, 'This looks just like what those Germans said is breast cancer,' " Brawley said of the pathologist. "But it's 5 millimeters in size. What killed the woman 160 years ago had spread all throughout her body."

We all harbor abnormalities, says H. Gilbert Welch, Dartmouth professor of medicine and author of the book "Overdiagnosed: Making People Sick in the Pursuit of Health." And new technology is increasingly able to find these abnormalities. When we do, our inclination is to act, even when the remedy turns out to be far more harmful than the disease would have been, had it run its course.

There is a growing consensus, backed by mounting scientific evidence, that Americans tend to be overtested, overdiagnosed and overtreated across a variety of conditions. Some experts estimate that unnecessary interventions account for 10% to 30% of U.S. health care spending.

Part of the problem is our medical culture, Welch says. The physician may be engaging in what is known as "defensive medicine," which entails ordering tests to guard against malpractice suits, should something go awry. There may also be perverse economic incentives at play -- that is, in a fee-for-service system, doctors are compensated for the quantity of tests and procedures they order.

But a recent study of physicians with the U.S. Department of Veterans Affairs found that salaried physicians who received no income from an increased volume of services and who had limited liability concerns ordered as many heart stress tests deemed "unnecessary" as doctors in more traditional settings.

The researchers theorized that the doctors had "an exaggerated perception of benefit" of the tests. In an editor's note on the study, Dr. Deborah Grady observed that while the study sample was small, "neverthless, it suggests that the culture of overdoing is ingrained."

Simply put, physicians are trained to think that the way you take care of people is to "find stuff and to take care of that stuff," Welch says.

Patients aren't exactly helping the issue, either. Energized by public awareness cancer campaigns, many patients have been empowered to find cancer early through screening and to intervene as soon as possible, Welch observes.

"To raise awareness and to get people to participate in screening, we have to whip up fear; we must introduce a bit of 'dis-ease' into the population," he said. "In a way, we have to make them feel as if the world may be a more dangerous place and that they ought to be worried about their future."

Brawley's patient, the one he refused to treat, eventually found another doctor who would treat his prostate cancer. "Patients will doctor-shop until they get what they want," Brawley said.

It's an issue many people have difficulty wrapping their heads around: Some patients who are diagnosed with cancer do not need to be treated, because that cancer is never going to bother them. The problem is that we don't know who those people are.

"There is a lot of work and research in this area in trying to better characterize which tumors will matter," Welch said.

The National Cancer Institute working group made several recommendations for the medical community in addressing cancer overdiagnosis and overtreatment. One was a change in the terminology doctors use to talk about cancer, especially when the cells they've found may not be dangerous.

"Use of the term 'cancer' should be reserved for describing lesions with a reasonable likelihood of lethal progression if left untreated," they wrote.

They also noted that the public should be made aware that overdiagnosis is common in cancer screening.

Doctors know that approximately 10% of localized lung cancer tumors and 20% to 30% of localized breast cancer tumors that are found through screening would never cause harm, Brawley says. "That tumor would just stay there: never grow, never spread." The rate is even higher for prostate cancer at 60%.

But isn't screening used to catch some aggressive cancers in people that we would otherwise see too late to treat?

Some overdiagnosis is acceptable, Brawley says. "We cure and treat some people who don't need to be treated. And in return, we save some lives." But screening has its own dangers.

Whenever you test a population, you will have some false positives. For example, if a woman is told that her mammogram is abnormal, that diagnosis might be straightened out days or weeks later, and she might find out that she does not have cancer. The diagnosis will create anxiety and lead to additional unnecessary testing.

Good health is more than absence of physical abnormality; it's also a state of mind, experts say.

"In my experience, it's not the diagnosis of cancer which really kills people," said Ezekiel Emanuel, a former oncologist, vice provost for global initiatives and chairman of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. "It's the uncertainty."

The National Cancer Institute group recommended reducing the frequency of some screening examinations, focusing that screening on high-risk groups (e.g. screening smokers for lung cancer) and raising the requirements that would lead to a biopsy or other follow up care.

"We've been taught that cancer is a terrible thing and the way to deal with it always is to find it early and cut it out," Brawley said. "We're starting to realize that that is not true in all cases."

Weird facts about Sex and Childbirth

2013-07-24T06:52:00.000-07:00

5 questions you'd never think to ask about childbirth

By Robert Martin

The evolutionary background of human reproduction can shed much-needed light on some of life's most intimate mysteries.

In my book, I trace our reproductive lifeline back to its earliest roots, revealing the hard science -- and the primate origins -- behind sex cells, mating behavior, gestation and the way we care for our young.

My main aim is to deal with issues that are of practical importance in everyday life. In that light, here are some of the questions that I tackle.

1. Why are a man's testes located outside the body?

In most mammals, including all primates, the testes descend from their initial position next to the kidneys into a pouch-like scrotum outside the body cavity.

Descent of the testes has been explained in various ways.

The most widely accepted explanation is that descent of testes is connected with the raised body temperature that is typical of mammals. It has often been baldly stated that sperm production cannot take place at body temperature. We know, for instance, that infertility results if a man's testes remain in the body cavity. Yet sperm production clearly can take place inside the body, because some mammals -- such as dolphins, rhinoceroses and elephants -- produce sperm with testes that do not descend.

Instead, it seems that a lower temperature is better for sperm storage. Mammals with undescended testes have various special adaptations to store sperm at sites where the temperature is lower.

2. How many sperm are needed to ensure fertilization?

The short answer is that only one sperm is needed to fertilize an egg. Indeed, it is disastrous if an egg is fertilized by more than one sperm as only one set of paternal chromosomes should be provided.

There are special mechanisms to prevent more than one sperm from fertilizing an egg. Yet the average human ejaculate contains a quarter of a billion (250 million) sperm.

Why so many? Several surveys have shown that men who have ejaculates containing fewer than 60 million sperm tend to have fertility problems. Moreover, fertility improves as sperm counts increase from 60 million to about 200 million sperm. But any further increase seems to have no effect on fertility.

We do know that the large number of sperm initially ejaculated is whittled down and that only a few hundred end up close to the egg. Part of that reduction in numbers clearly serves to remove unsuitable sperm. For instance, deformed sperm are filtered out by the mucus in the neck of the womb (cervix), and it seems likely that further filtering occurs in the oviduct (a tube allowing for the passage of eggs from an ovary). So large numbers of sperm are presumably needed to ensure that one high-quality sperm reaches the target.

3. Is it true that human sperm counts are declining?

Since 1974, various surveys have indicated that human sperm counts have been reduced by about half in several industrialized populations over the past 60 years or so.

But that conclusion has been challenged for various reasons, notably because some studies found no evidence for a decline in sperm counts. It has turned out that this is because there are marked differences in occurrence and timing between regions. It was also suggested that reductions in sperm numbers were an artifact arising from changes in counting methods.

However, the same methods have been used to assess sperm counts in farm animals such as cattle, sheep and pigs, and no decline in numbers has occurred. Human sperm counts have not yet declined to levels where fertility is severely threatened, and decreases may be leveling off.

More worryingly at this point, declining sperm counts are accompanied by a marked rise in abnormalities of the male reproductive system -- undescended testes and abnormal development of the penis -- in tandem with higher rates of testicular and prostate cancer. The evidence suggests an environmental effect of some kind that is only affecting humans. Several factors have been implicated, but prominent candidates are environmental toxins that mimic the action of steroid hormones.

4. Is there a distinct fertile window in a woman's cycle?

The "egg-timer" model of the human menstrual cycle, with ovulation and conception regularly occurring close to midcycle, has formed the basis for medical thinking and intervention since the 1930s. This model needs radical revision.

The notion of regular midcycle ovulation is itself just a statistical abstraction. Menstrual cycles show considerable variation both in length, routinely ranging between three and five weeks, and in timing of ovulation relative to menstruation.

More important, however, several lines of evidence lead to the revolutionary conclusion that sperm are stored in the human womb, probably in crypts in the cervix. This means that intercourse leading to conception can occur up to 10 days or more before ovulation takes place.

This raises major problems for the "rhythm method" of contraception, which relies on the accepted wisdom that sperm and eggs have strictly limited maximum life-spans, surviving for only two days and one day, respectively. In practice, the rhythm method (even with refinements) is very unreliable.

Worse yet, deliberate avoidance of intercourse around the time of ovulation can be confidently expected to increase the risk of fertilization with a time-worn sperm or egg and hence the probability of fetal abnormality. Various studies have indicated that this is, indeed, what happens.

5. Why is human birth such a long and painful process?

Human birth is a challenging process usually lasting several hours, rather than just an hour or two as in monkeys and apes. This is because our newborns are unusually large -- twice as big as babies of great apes -- and have particularly large brains.

During birth, the human baby rotates in a complex manner, with the result that its head normally ends up facing toward the mother's back rather than to the front, as in other primates. Measurement reveals that the size of the newborn's head is pushed to the limit. Biological dimensions generally fit a standard bell curve, which statisticians call a normal distribution. But the curves are truncated at the upper end for the newborn's head and at the lower end the size of the pelvic canal.

In a process called "genetic pruning," natural selection has acted against over-large heads and small pelvic canals. The fit is still so tight that the human brain also has to grow an unusual amount after birth. In other primates, the newborn's brain is about half its adult size, but in humans it is only a quarter of adult size.

So, despite the large size of human newborns and their brains, additional rapid brain growth after birth is needed.

Union to meet midwives amid obstetrics closure

2013-07-18T18:44:00.002-07:00

The Nursing and Midwifery Federation will today meet midwives at the Millicent Hospital to discuss their futures.

Country Health SA last week announced plans to close obstetric services at the hospital because of a lack of doctors with obstetric and anaesthetic skills and a drop in births.

The decision has caused a community backlash, with the local mayor saying it goes against assurances that the service would remain intact.

The federation's Rob Bonner says he wants to meet Country Health SA before it finalises the plan.

"We would hope that Country Health SA will listen to our members, will listen to the local community and local government and revisit this kneejerk decision it's announced last week," he said.

He says about six midwives at the hospital stand to lose their jobs.

"Those midwives now are being asked ... to make decisions about where they see their personal and professional futures," he said.

"At least one midwife has already moved her employment to Mount Gambier so she can remain actively practising in the area.

"Others are considering whether they want to do the same."

Study shows US women get too many Pap tests

2011-08-22T08:45:00.000-07:00

Study shows US women get too many Pap tests
A new study from America's Centers for Disease Control and Prevention (CDC) reveals that many American women are getting too many unnecessary Pap tests, the screening for cervical cancer.

A study published August 18 in the American Journal of Obstetrics and Gynecology found that many doctors are recommending annual Pap tests, even though guidelines in both the US and UK suggest that women over 30 years old and at average risk for cervical cancer wait at least three years between negative tests.

Researchers noted that over-screening adds up to extra costs, more hassle for women (arranging child care and/or taking time off work for doctor's appointments), and an increased risk of unnecessary treatment for false-positive test results, with no benefit to women in detecting more cancers.

Mark H. Einstein, MD, a gynecologic oncologist in New York City told WebMD News that "there is quite a bit of over-screening in women in the US, which ultimately leads to over-management and over-treatment."

Also the researchers stated that about 51 percent of doctors in their study ordered a recommended co-test for the human papilloma virus (HPV), which is a common cause of cervical cancer, in addition to a Pap test.

"If only half are using the co-test, there is a lack of understanding about the guidelines," says study researcher Katherine Roland, a behavioral scientist at the CDC in a statement. "Women should discuss with their provider whether they are eligible for extended intervals between testing or not based on the type of test that is ordered and their results."

The new findings appear in the American Journal of Obstetrics & Gynecology

Pharmacist Reveals 5 Trade Secrets You Don't Get 'Over-The-Counter'

2011-08-15T08:07:00.000-07:00

Pharmacist Reveals 5 Trade Secrets You Don't Get 'Over-The-Counter'

By Alan Okpechi

Behind the glass at your national chain pharmacy exists a world of long periods of boredom punctuated by extremely busy periods of stress, angry and illogical patients in Xanax withdrawal, and screaming babies with fevers. The typicalpharmacist has grown accustomed to a mostly sedentary life of sitting in chairs and occasionally helping patients with problems of the insurance variety.

While we may think our job is to make time go by as quickly as possible, there are constantly issues that go unresolved and leave patients without medication. Placing too much trust in your local pharmacy can also be dangerous for your health and, though rare, errors are made that can compromise your health.

There are, however, simple steps that patients can take to ensure everything is done correctly every time you fill a prescription. Whether it's the pharmacy's fault or not, there are also ways to resolve insurance denials with little effort.

1. Do not trust the expiration date on your prescription bottle.

Unless you are given the exact bottle delivered to us by the manufacturer, you may as well be guessing as to when your medication actually expires. While expired medication may not be worrisome, the effectiveness of your medication decreases with each passing day that the tablet or capsule is expired. With hundreds of bottles of medication being delivered to pharmacies every week, it is easy to overlook the expiration date of medication.

Safety is our first priority for patients, but some things do slip through the cracks. If you have a condition which requires a precise medication and strength, ask the pharmacist to show you the bottle from which the medication originated. Self-verifying the expiration date only takes a few seconds, and gives you the confirmation that you need to trust the effectiveness of your prescription.

2. Do not pay full price for an insurance denial.

If an expensive medication is denied by your health insurance company, ask your pharmacist to perform aprior authorization while you wait. Waiting in the pharmacy is crucial for this process to be successful. A prior authorization is simply a form that is sent to your insurance company and doctor's office that can force your insurance company to pay for your medication. This process usually takes up to 10 days depending on the pharmacy. However, I have personally pushed this process to be completed in under 10 minutes. Make sure that your doctor or his/her staff is prepared to answer the call from your insurance company. Once your doctor or staff says the magic words, "medically necessary," you are on your way to paying your regular co-pay for your medication.

The alternative is waiting 10 days for a rejection from your insurance company for a prior authorization that may or may not have been done in a correct and timely manner. Some pharmacist may try to brush off this request, but the fact is we are legally required to assist you in getting your medication. Anything else can be considered unprofessional, irresponsible, and possibly grounds for malpractice. Do not get pushed around by anyone when it comes to your health.

3. All generics are not created equal.

Insurance companies push generics due to their low cost, but every person reacts differently to medication. There are some medications for conditions like epilepsy and thyroid issues that, for some patients, work differently than their brand-named counterparts. Even the same generic medication made by different manufactures can have a different effect on the same person. While the chemical structure of the medication may be the same, the way it is synthesized and concentrated differs from company to company.

Small differences between medications can make all the difference for a patient. If one generic does not work for you, ask for a different malefactor. If no generics work, you always have the option (under federal law) to substitute for the brand name version. Many patients experience a change in their health when a generic becomes available for their medication, but are unaware that they do not have to take the generic medication.

4. Ask for a loaner when needed.

If you for some reason run out of medication (that is a non-controlled medication such as Xanax or Hydrocodone) your pharmacist has the option to give you up to a three-day loaner supply to hold you over until your doctor is contacted for a refill. This loaner supply also goes for when you are out of town and forgot to pack your medication -- if you do have a refill somewhere in the United States -- though you may have to pay for the three-day supply in this circumstance. Many pharmacist do not extend the offer because they fear taking a loss for the pharmacy, but simply asking is often all a patient needs to do.

5. Take advantage of transfer gift cards!

We will give you a gift card for a transfer in almost any situation. If you are in a large national chain pharmacy, at least. When gift cards were popular for transfer prescriptions in 2005, there were many restrictions placed as to how they were to be given out. These restrictions no longer exist since we have been notified not to argue with customers in this situation. Instead of a pharmacy district manager personally replying to complaints on transfer gift cards, most pharmacies simply give them out. There may be nice pharmacy staff who will give you a gift card automatically, but most hope you don't ask. Ask for the card: Issuing $30 gift cards brings returns to the pharmacy that exceed their cost. The pharmacy makes a fortune from insurance companies, you shouldn't feel guilty or timid for taking advantage of a program created for the patient.

Asthma, preterm birth and preeclampsia

2011-08-10T10:02:00.001-07:00

Asthma, preterm birth and preeclampsia
By Crocker Stephenson

An extensive review of pregnancies over the course of more than three decades shows that women with poorly managed asthma are at an increased risk of having a low-birth weight baby, a premature baby and other pregnancy complications, such as preeclampsia.

The new study was recently published in the British Journal of Obstetrics and Gynecology.

Christina Chambers, a professor of pediatrics at the University of California, San Diego was part of the team of seven researchers who reviewed data involving more than 1 million women between 1975 and 2009.

“The findings are significant and call for women with asthma to be more closely monitored during pregnancy,” Chambers said.

“It would be advisable for women on regular medications for asthma or having frequent symptoms to be monitored at least monthly during the course of their pregnancies,” she said.

The study found that the infants of women with asthma were likely to weigh an average of 0.2 lbs. less at birth compared to babies of mothers without asthma. Mothers with poorly controlled asthma were also at a 25% increased risk of preterm birth and 50% increased risk of developing preeclampsia, a condition in which high blood pressure develops during pregnancy.

Click here to read more about the study.

Menopause Treatment Not Effective

2011-08-09T10:15:00.000-07:00

Soy Supplements Don't Ease Bone Loss, Menopausal Symptoms

Women taking high-dose soy isoflavone pills for 2 years even had more hot flashes.

By Kathleen Doheny, HealthDay News

Soy supplements, sometimes promoted as a healthier alternative to estrogen for maintaining bone and relieving menopausal symptoms, don't appear to do so, according to a new study.

"Our study shows that contrary to popular belief, soy isoflavone supplements do not prevent bone loss or alleviate menopausal symptoms," said lead author Dr. Silvina Levis, professor of medicine and director of the Osteoporosis Center at the University of Miami Miller School of Medicine.

In fact, a greater percent of women taking the supplements hadhot flashes after the study than those taking the placebo.

The study, funded by the U.S. National Institutes of Health, is published Aug.8 in the Archives of Internal Medicine. The researchers reported no conflicts of interest.

Levis and her colleagues evaluated 248 women between the ages of 45 to 60, all of whom were menopausal. At the study start, they had bone density levels considered healthy.

In a study in which neither the participants nor the researchers knew which women were getting what, the team randomly assigned 126 volunteers to the placebo group and 122 to the soy group. The latter group took 200 milligrams of soy isoflavones a day for two years.

After two years, the researchers measured the hip and spine — standard areas to screen for bone loss — to determine whether the soy had made a difference in bone density. It had not.

They also looked at the women's reports of menopausal symptoms. At the beginning, 176 of the women reported one or more symptoms such as hot flashes, night sweats, insomnia, loss of libido or vaginal dryness.

The two groups showed no differences in any of the symptoms at the end of the study, except hot flashes: Those taking soy isoflavone supplements actually had more. Of those taking soy supplements, more than 48 percent had hot flashes, compared to about 32 percent of those on placebo.

More women taking soy isoflavone tablets reported constipation, too, although the differences were not significant from a statistical point of view.

The researchers did find that spinal bone loss was smaller in a subgroup of women taking the soy isoflavone tablets: women whose vitamin D levels were less than 20 nanograms per milliliter.

Interest in soy supplements increased after the Women's Health Initiative study, halted in 2002, found increased risk of strokes and heart attacks in women who took combination hormone therapy using estrogen and progesterone. Soy has been promoted as an alternative to estrogen, providing comparable benefits of bone preservation and symptom relief without the risks.

Levis said that if a patient were to ask her now about taking soy for menopausal symptoms or bone health, "I would not suggest they start for hot flash [relief] or bone loss prevention."

Dr. Deborah Grady, professor of medicine and epidemiology at the University of California San Francisco, co-wrote a commentary to accompany the study. In an interview, she said that, "I personally would say we have spent enough time and effort on this. And to do more trials on soy doesn't seem to be an efficient way to spend money if we want to come up with better treatments for menopausal women."

Many studies have looked at soy, she said. Every time one has had negative results, it seems, people say perhaps the dose was wrong or perhaps the study was not long enough, she noted.

But the results of the new study are definitive, Grady said. "This one is important because it was funded by the NIH, was long-term and they gave a huge dose of soy."

The bottom line: "Paying money to buy soy supplements doesn't make sense," she said.

Costs vary, but soy isoflavone supplements are widely sold on the internet. A month's supply can be bought for about $7.

Grady points out that the study was on soy supplements only; in addition, the study found the soy supplements to be benign. "It probably is not going to hurt anyone to eat soy in their diets," she said.

In her commentary, Grady also noted that the search for a safe alternative to hormone replacement therapy continues, with some menopausal women finding their symptoms are relieved by the class of antidepressants known as SSRIs. Other researchers have recommended yoga and other relaxation techniques as complementary therapies.

"Perhaps effort should be directed away from the hope of a one-size-fits all therapy for menopausal symptoms toward using existing treatments to target the symptoms that disturb patients most," Grady and her co-author concluded in the journal.

Learn more in the Everyday Health Menopause Center.

Bladder inflammation may be cause of sex difficulties

2011-08-08T07:30:00.000-07:00

Bladder inflammation may be cause of sex difficulties

The China Post--A urogynecology group identified two potential physiological hindrances against smooth sexual intercourse and named potential solutions, yesterday, in Taipei.

The Foundation for Women's Health and Urogynecology of Taiwan (FWHUT) announced yesterday that interstitial cystitis (IC), a kind of inflammation of the bladder, has long been the culprit of pain during sexual intercourse for women; an epidemiological research has indicated that about 52 to 67 out of every 100,000 Taiwanese women in Taiwan suffer from IC.

According to FWHUT, IC involves complex syndromes that result from autoimmunal, endocrinal, and neuronal dysfunctions, which often leads to inflammation in the bladder independent of foreign pathogens.

Common warning signs of the disease include bladder pain that can only be relieved after urination, frequent urination and enuresis that interrupt one's daily functions and interferes with one's sleep, with no infection or germs detected in one's urine.

In addition to causing patients physical pain, the chronic disease often sacrifices patients' sex lives; while their day jobs are disrupted by having to frequently use the bathroom, the quality of their sexual intercourses is also reduced - patients not only have to endure additional pain, but also fear that they would fail at holding back the urge to urinate.

Many disrupted marital lives result from the disease, the FWHUT noted.

Recent research has shown that hyaluronic acid infusions could relieve the discomfort resulting from bladder inflammation by protecting the endometrial of the bladder, the FWHUT said, while how much it alleviates the discomfort during sexual intercourse is still being investigated.

Other research on "the ideal sex life," taken from polling of 3,282 people from ten Asian countries, indicated that the hardness of erection, in addition to being the indication of men's cardiovascular health, also reflects men's self-confidence and dignity.

This research indicated that many males who face erection-related problems care about the process of sexual intercourse as a means only of reaching orgasm themselves; in other words, they focus on their own rather than on mutual feelings. About 30 per cent of this category of men feel uncomfortable discussing sex-related issues with their partners.

Jiaan Ban-pin (???), head of the Taiwanese Association of Andrology, pointed out that sexual intercourse is an important means of interaction between the two genders; without enough communication, one could neglect a partner's feelings, which would lead to chronic sexual dysfunction. Asking for help from professionals could be a good solution, Jiaan added.

Osteopenia: Know Your Fracture Risk

2011-08-05T07:14:00.000-07:00

Osteopenia: Know Your Fracture Risk

Osteopenia, an early stage of bone loss, isn't as serious as osteoporosis, but it can still cause your bones to break. Are you at risk?

By Diana Rodriguez

Medically reviewed by Lindsey Marcellin, MD, MPH

Do you know your T-score? This magic little number is calculated from bone density tests such as dual absorption absorptiometry (DEXA) — and it can tell you a lot about yourbone health. If your score shows low bone density (but not yet low enough to be osteoporosis), you could have osteopenia.

But to get a full picture of your bone health, you and your doctor need to take several additional factors into account.

Bone Density Tests: Your T-Score

Your T-score is a number on a scale that measures bone density. The ideal score is 0, which means that your bones are as dense as those of a healthy young adult. Negative numbers indicate less-dense bone. The lower the number, the more severe the bone loss; for example, -3 is worse than -2.

A T-score between +1 and -1 is considered normal. Osteoporosis is defined as a T-score lower than -2.5, which indicates substantial bone loss and significant risk of fractures. A T-score between -1 and -2.5 indicates less-severe bone loss, a condition called osteopenia.

However, even with a T-score in the osteopenia range, you can still be at risk of fracturing a bone. In fact, more than 50 percent of fractures due to weakened bones occur in women with T-scores in this range.

Assessing Other Fracture Risk Factors

Your T-score is only one piece of the puzzle. Determining your fracture risk requires also looking at your current health, medical history, and other factors. Your risk of breaking a bone is higher if you:

Are 65 years old or older
Have a thin, small frame
Smoke tobacco
Experienced early menopause
Have a family history of osteoporosis
Have used steroids for a long time or used certain anti-seizure medications
Are undergoing treatment for prostate cancer or breast cancer
Have an overactive thyroid or are taking high doses of thyroid hormone for an underactive thyroid
Are female — men also experience bone loss as they age but are less likely to develop osteoporosis or experience fractures
Don’t get enough calcium and vitamin D
Consume more than three alcoholic drinks per day
Have a disease that can cause bone loss, such as rheumatoid arthritis or anorexia nervosa

Evaluating Your Risk

One way to calculate your fracture risk based on the above factors is to use the WHO Fracture Risk Assessment Tool, or FRAX, according to Nelson Watts, MD, a nationally recognized bone health and osteoporosis expert and the director of the Osteoporosis and Bone Health Program at the University of Cincinnati in Ohio.

Available for free online, the FRAX calculator, which was developed by the World Health Organization (WHO), uses a range of criteria to determine your likelihood of having a fracture in the next 10 years. FRAX is an effective assessment of risk because it incorporates so many factors, says Dr. Watts.

Guidelines from the National Osteoporosis Foundation encourage the use of FRAX for patients with T-scores between -1 and -2.5, says Watts. For people with scores in this range, the foundation recommends osteoporosis medication for those who also have a FRAX 10-year probability of a hip fracture of 3 percent or higher or a FRAX 10-year probability of a major osteoporosis-related fracture of 20 percent or higher.

Having a bone density test to learn your T-score is important for those concerned about bone health and fracture risk. But remember that your T-score alone doesn't give you a complete appraisal of your risk of breaking a bone. For a more realistic assessment, take a look at the bigger picture.

Common vein problem raises clot risk on the Pill

2011-08-04T10:58:00.000-07:00

Common vein problem raises clot risk on the Pill

Women who use the standard form of birth control pill may have a much higher than average risk of dangerous blood clots if they also have a vein malformation seen in a quarter of the population, California researchers say.

Up to 25 percent of the healthy population has a narrowing, known as stenosis, in the left common iliac vein (one of two major veins deep in the pelvis that return blood from the lower body to the heart), according to Dr. Lawrence Hofmann and his colleagues at Stanford University School of Medicine.

In their study, published in the American Journal of Obstetrics and Gynecology, having a "left common iliac vein stenosis" and taking so-called combined oral contraceptives - the kind containing both the hormones estrogen and progestin - multiplied a woman's risk of deep vein thrombosis nearly 18 times compared to women with neither risk factor.

Sometimes known as "economy class syndrome," a deep vein thrombosis is a blood clot - often formed in veins of the lower legs -- which is potentially dangerous because it can travel to the heart and lungs and cause serious harm.

Some 12 million women in the U.S. use the "combined" form of birth control pill, which is already known to increase a woman's risk of blood clots.

In general, the researchers note, among every 10,000 young women who are not taking oral contraceptives, about 1 to 3 will have a deep vein thrombosis every year. For young women who've been taking the Pill for a year, that risk goes up six-fold.

In the study, Hofmann's group looked at 35 women with deep vein thrombosis and 35 women without the condition for comparison. They found that left-side common iliac vein stenosis raised a woman's clot risk 3.5 times. Combined oral contraceptives raised clot risk nearly 5 times. And the combination of the two raised the risk 17.7 times.

For the study, the Stanford group used CT or MRI scans to evaluate women with deep vein thrombosis. They compared them to an equal number of women of the same age who came to the emergency room with abdominal pain.

In total, 37 percent of the women with deep vein thrombosis and 11 percent of the control subjects used the combined type of birth control pills. Among thrombosis cases, 63 percent also had other clot risk factors, such as pregnancy or a clot-prone condition called thrombophilia, compared to 23 percent of the controls.

Among women with deep vein thrombosis and left common iliac vein stenosis, the degree of narrowing of the vein was, on average, 70 percent, compared to 56 percent blockage in controls.

For the women in general, every one percent increase in iliac vein stenosis above 70 percent boosted the risk of thrombosis by five percent. But for women using the Pill, every one percent increase in stenosis raised the risk of thrombosis about 500 percent.

Given the risks, the authors caution doctors that, "If a young woman using combined oral contraceptives develops left-sided deep vein thrombosis in the absence of other risk factors, the possibility of common iliac vein stenosis should be considered."

SOURCE: bit.ly/oxHUeK American Journal of Obstetrics and Gynecology, online July 11, 2011.

Endoscopic Instrumentation Linked to Insulation Failures

2011-08-03T08:29:00.000-07:00

Endoscopic Instrumentation Linked to Insulation Failures
Robotic and laparoscopic endoscopic instrumentations -- particularly robotic -- are associated with high incidence and prevalence of insulation failure after 10 procedures, according to a study published in the August issue of the American Journal of Obstetrics & Gynecology.

TUESDAY, Aug. 2 (HealthDay News) -- Robotic and laparoscopic endoscopic instrumentations -- particularly robotic -- are associated with high incidence and prevalence of insulation failure (IF) after 10 procedures, according to a study published in the August issue of theAmerican Journal of Obstetrics & Gynecology.

Mercedes Espada, M.D., from the Hospital Quirón Madrid in Spain, and colleagues investigated the incidence, prevalence, and location of IF in laparoscopic and robotic instruments. A total of 78 robotic and 298 laparoscopic instruments were tested at 20 W and 2.64 kV in phase A, and 60 robotic and 308 laparoscopic instruments were tested at 20 W/1 kV and 20 W/4.2 kV, respectively, in phase B.

The investigators found that the robotic group had a significantly higher prevalence (32 versus 13 percent) and incidence (80 versus 36 percent) of IF after 10 uses in phase A compared to the laparoscopy group. In phase B, 81.7 percent of robotic, and 19.5 percent of laparoscopic instruments demonstrated IF.

"There is a high incidence and prevalence of IF in robotic and laparoscopic electrosurgical instruments, even when tested according to manufacturer specifications of voltage," the authors write.

FDA warns of counterfeit 'morning-after' pill

2011-08-02T06:07:00.000-07:00

FDA warns of counterfeit 'morning-after' pill

The Food and Drug Administration says the emergency "morning after" birth control pill Evital could be counterfeit and may not be safe or prevent pregnancy. The agency is asking women not to use the medication.

Evital is not approved for use in the United States. But the FDA says, while it doesn't have evidence of "pattern targeting" of a specific ethnic group, the drug may have been distributed in Hispanic communities under the label "Evital Anticonceptivo de emergencia, 1.5mg, 1 tablet by Fluter Domull."

"Evital was discovered through routine imports entry review and we are currently working to find out more about this apparently illegal U.S. distribution of what FDA suspects is a counterfeit product," said FDA spokeswoman Shelly Burgess.

The FDA is asking consumers to contact their doctor if they've taken the pills and had any side effects. It also is asking anyone with information about the pills to contact their Center for Drug Evaluation and Research/Ingredient Adulteration (CDER). Any information gathered will be used to get Evital off the market.

Emergency contraception can be used to prevent pregnancy up to five days after unprotected sex. Common brands are Plan B One-Step, Next Choice and ella. The drug can cost from $10 to $70 depending on the brand.

FDA-approved emergency birth control is available with a prescription and over-the-counter if you are at least 17 years old.

Labiaplasty complications may result from cookie-cutter approach

2011-08-01T08:41:00.000-07:00

Labiaplasty complications may result from cookie-cutter approach

-In consultation, surgeon must determine whether patient's anatomic goal is achievable
-Be cautious regarding aggressiveness of reduction
-Careful technique critical for avoiding complications when performing linear resection

ATLANTA — Success in labiaplasty requires understanding of the patient's motivations and outcome goals along with good surgical technique. While these principles seem obvious, the frequency of women presenting for revision labiaplasty suggests they are too often being overlooked, says John R. Miklos, M.D.

"Avoiding complications in any surgery involves choosing the right procedure and performing it correctly. However, the first step depends on obtaining a good history to determine the patient's indication for seeking surgery and postoperative expectations, and then one must have proper training and skills," says Dr. Miklos, a private practitioner in Atlanta with fellowship training in urogynecology and laparoscopic reconstructive vaginal surgery. "Considering the number of women I see who are devastated by the results of their labiaplasty, not all surgeons are following these basic rules."

PATIENT MOTIVATIONS

Almost universally, women seeking labial reduction surgery present with protrusion of the labia minora beyond the edge of the labia majora, Dr. Miklos says. Results of a study undertaken by Dr. Miklos and his partner, Robert D. Moore, D.O., to identify patient expectations determined that 98 percent of more than 500 women having labiaplasty wanted the labia minora to be at or below the level of the labia majora. It may be surprising to some surgeons, however, that findings from a previous study (Miklos JR, Moore RD. J Sex Med. 2008;5(6):1492-1495) showed that for two-thirds of women, relief of pain, discomfort or irritation was at least part of the underlying reason why labiaplasty was being pursued, Dr. Miklos says.

"Only about one one-third of women wanted labiaplasty solely for cosmesis. For the majority, there was a functional quality of life issue involved," he says.

With the patient's anatomic goal in mind, surgeons must first determine whether it is achievable and inform the patient of their determination. In some women, the labia majora are so flat because of changes in weight and/or age-related fat atrophy that it is not possible to get the labia minora below the level of the labia majora, Dr. Miklos says.

"However, lowering of the labia minora will still relieve discomfort because the tissue will be less pedunculated. Therefore, the outcome may be acceptable to women seeking surgery for functional reasons," he says.

Dr. Miklos says it is important to be cautious about the aggressiveness of the reduction performed, taking into account whether the patient wants or is willing to have the tissue completely removed.

"One recurring problem among women who come to me for postlabiaplasty revision is a desire to have the labia minora rebuilt because the tissue was totally amputated by their previous surgeon," Dr. Miklos says.

COLORING COUNTS

Another misconception about labiaplasty surgery that leads to patient dissatisfaction is the idea that the procedure should maintain the current skin color of the labia edges. Rather, Dr. Miklos's research also shows that 98 percent of women don't want what is "natural" for their age but rather desire restoration of the pinker skin color present when they were younger.

"It is widely written throughout the literature that labiaplasty should maintain the natural skin color and border, and for that reason, the procedure is usually performed with a V-wedge resection," Dr. Miklos says. "However, to meet the expectations of the majority of patients, a linear-contouring resection should be done instead. Even then, depending on the anatomy, it is sometimes not possible to provide the desired skin color, and patients need to be told that preoperatively."

Careful technique is also critical for avoiding complications when performing a linear resection. Cutting the labia while pulling the tissue with excessive tension is one mistake that results in over-shortening to the point of near complete amputation, Dr. Miklos says.

"Though all cosmetic surgeries have their potential financial incentive, the ultimate physician reward is an elated patient with an improved quality of life. Therefore, I would caution surgeons to be slow to adapt new surgical procedures and techniques and to address patients' cosmetic labia requests with the same intensity and concern as he/she would for themselves or a family member," he says.

Pregnancy and the Flu

2011-07-29T09:02:00.000-07:00

Pregnancy and the Flu

One simple step Ð which takes seconds to do Ð can help pregnant women keep their babies safe from the flu after they're born.

Hi, I'm Dr. Cindy Haines, host of HealthDay TV.

The flu poses special health threats to pregnant women. Babies are also at high risk of flu-related complications, but they can't be vaccinated against the disease until they're 6 months old.

New research supports the later benefits when pregnant women get a flu shot. The study, published in the American Journal of Obstetrics & Gynecology, included 1,510 babies who were hospitalized with flu-like symptoms before the age of 6 months. Testing found that most didn't actually have the flu, however.

The researchers found that when the mothers had a flu vaccination during pregnancy, their babies were about 48 percent less likely to need to be hospitalized for the flu

According to the CDC, pregnant women can have a flu shot at any point during any trimester. The organization also points out that millions of pregnant women have had the flu vaccine, which has not been found to be harmful to the mom or the baby.

I'm Dr. Cindy Haines of HealthDay TV, with the news that doctors are reading; health news that matters to you.

Study: IUD Users Have Fewer Repeat Abortions

2011-07-28T11:37:00.000-07:00

Study: IUD Users Have Fewer Repeat Abortions

Giving women free access to long-term birth control after they've had an abortion may help them avoid a second one, New Zealand researchers suggest.

Of 510 women who'd been offered contraceptives free of charge at an abortion clinic, less than six percent of those who went on to use an intrauterine device, or IUD, ended up having another abortion within two years.

Among those women who said they were taking birth control pills, 13 percent had a repeat abortion. For condom users, the number was 17 percent.

The results suggest long-acting birth control methods should be promoted to women following an abortion, according to the researchers.

"In the United States, widespread access to IUDs has been hampered by barriers including costs, lack of provider training, and misconceptions held by both patients and providers," Sally Rose and Dr. Beverley Lawton of the University of Otago in Wellington write in the American Journal of Obstetrics and Gynecology.

Their study comes on the heels of a new proposal from the U.S.-based Institute of Medicine calling on insurers to cover all birth control methods.

The Institute also recommends that birth control should be available without co-pays in order to reduce upfront costs and encourage its use.

Currently, two types of IUDs are available: a plastic model that releases hormones (sold as Mirena) and a copper model (Paraguard).

The devices, which cost between $500 and $1,000, prevent pregnancy more than 99 percent of the time, according to Planned Parenthood. They have to be inserted and removed by a health care provider, but can last as long as 12 years.

In the New Zealand study, women who'd had an abortion were offered a choice between different contraceptives. After six months, they were contacted and asked what kind of birth control they used, if any.

Nearly one in 10 women had a repeat abortion at the clinic within two years. Those who'd said they used an IUD had a 64-percent lower chance of ending up at the clinic again compared to women on the pill.

IUDs and similar devices "can go a long way to reducing unintended pregnancies, and as a consequence, abortions," said Adam Sonfield of the Guttmacher Institute in Washington DC, an organization that researches sexual and reproductive health.

Even though IUDs are considered the most effective type of birth control, the high cost of inserting the device often prevents people opting for it, Sonfield told Reuters Health.

"If you can take away those up-front costs as a barrier and allow women to choose among the different options ...most women end up choosing IUDs" or similar devices, he said.

Over time, the device may end up being less costly than birth control pills because it lasts for many years.

According to Dr. Joseph Speidel, who heads the Bixby Center for Global Reproductive Health at the University of California, San Francisco, unintended pregnancies rack up a bill of over $10 billion a year.

So curbing abortions with increased access to long-acting birth control might also cut U.S. healthcare spending, he told Reuters Health.

Inserting an IUD can carry some risk of side effects, including moderate pain and cramps shortly after it's put in, and changes in menstrual bleeding. Over the long term, there is a small risk of infection, and the IUD can become dislodged in rare instances.

Although less than one in 100 women become pregnant when using an IUD, those who do become pregnant are at a higher risk for miscarriage or early delivery.

An alternative to the IUD is a matchstick-sized rod (sold as Implanon), which releases hormones and is implanted into the patient's arm. It can last for three years and costs between $400 and $800.

Dr. Suzan Goodman, who teaches family and community medicine at the University of California, San Francisco, said offering birth control immediately after an abortion has several advantages.

Those include "high motivation, less discomfort, assurance a woman is not pregnant and reduced burden on both the patient and the healthcare system," she said in an e-mail to Reuters Health.

Menopause Does Not Boost Diabetes Risk, Study Finds

2011-07-27T10:03:00.000-07:00

Menopause Does Not Boost Diabetes Risk, Study Finds
Exercise and weight control can cut the odds for older women even further, researchers say
Menopause does not raise a woman's odds of developing diabetes, according to a new study.

Researchers from the University of Michigan Health System found this was true for both women who underwent natural menopause and those who had their ovaries removed.

"In our study, menopause had no additional effect on risk for diabetes," the study's lead author, Dr. Catherine Kim, associate professor of internal medicine and obstetrics and gynecology at the University of Michigan Health System, said in a universitynews release. "Menopause is one of many small steps in aging and it doesn't mean women's health will be worse after going through this transition."

In conducting the study, published in the August issue of Menopause, researchers examined more than 1,200 women between the ages of 40 and 65 with what's known as glucose intolerance (a pre-stage to diabetes characterized by high blood sugar levels).

The study found that for every year 100 women were observed, 11.8 premenopausal women developed diabetes, compared to 10.5 among women in natural menopause and 12.9 cases among women who had their ovaries removed.

Meanwhile, women who had their ovaries removed but also lost 7 percent of their body weight and exercised for at least 150 minutes per week actually saw a decline in their risk for diabetes. The researchers found that for every year 100 of these women were followed, only 1.1 of them developed the disease.

The results among this group, the study authors pointed out, were surprising considering that nearly all of the women who had their ovaries removed were on hormone replacement therapy -- a treatment that may put them at risk for an array of health problems. They added that additional research is needed on the role of hormone therapy and diabetes risk.

"Physicians can be empowered to tell women that lifestyle changes can be very effective, and that menopause does not mean that they have a higher risk of diabetes," concluded Kim.

More information

The U.S. National Library of Medicine provides more information on menopause.

Doctors group contradicts U.S. mammogram advice

2011-07-26T10:38:00.000-07:00

Doctors group contradicts U.S. mammogram advice
Victoria Colliver

Less than two years after a key government task force recommended that most women in their 40s may not need mammograms, the nation's largest group representing obstetricians and gynecologists has advised women in that age group to have annual mammograms.
The American College of Obstetricians and Gynecologists on Wednesday issued the new guidelines, which recommend that woman get annual mammograms starting at age 40. Previously, the group recommended mammograms every one to two years starting at age 40, and annually beginning at age 50.
"We know mammography saves lives. If you can find cancer earlier, we know we're doing some good," said Dr. Mary Gemignani, an associate attending physician in breast surgery at Memorial Sloan-Kettering Cancer Center in New York City who helped write the new screening guidelines.
"We know from a cancer perspective that women in their 40s often have more aggressive tumors and by shortening the interval (between screenings), the cancer may be detected earlier," she said.
The new guidelines put the group in line with other organizations, including the American Cancer Society, the American College of Radiology and the Society of Breast Imaging.
But in November 2009, the U.S. Preventive Services Task Force, a government-sponsored group that provides guidance to doctors, insurance companies and policymakers, came out with controversial guidelines that suggested women in their 40s may not need regular mammograms and that women 50 and older should get them every other year instead of annually.

The risks for women

Women have a lifetime risk of about 12 percent of developing breast cancer, but less than 2 percent of women in their 40s develop the disease.
The 2009 recommendations acknowledged that mammograms were found to reduce breast cancer deaths in women aged 40-49 by 15 percent, but determined that wasn't enough to warrant routine mammography at age 40. The risks include radiation exposure and unnecessary biopsies. The group also found insufficient evidence to support screening after age 74.
Dr. George Sawaya, a UCSF professor in obstetrics, gynecology and reproductive sciences who served on the U.S. task force and voted for its new guidelines, said the two recommendations are not as different as they appear.
Sawaya, who is also a member of the American College of Obstetricians and Gynecologists, said the task force did not discourage women in their 40s from having mammograms but, instead, suggested they discuss the potential risks of screenings with their doctors.
"The task force said for women in their 40s and older, it's an individual decision based on their values and the benefits and harms," he said.
Nancy Brinker, founder and chief executive officer of Susan G. Komen for the Cure, lauded the new guidelines issued Wednesday and called the task force's 2009 recommendations "confusing and clumsy."
"The more confused the public is, the less screenings that will occur," Brinker said. "Every time we have one of these debates, more people are confused. These guidelines go a long way at clearing up some of those issues."

Anger over confusion

Another breast cancer advocacy group, Breast Cancer Action in San Francisco, agreed that the dueling guidelines create confusion. The organization supports the task force's 2009 approach, contending scientific evidence does not warrant mammography in younger women at low risk.
"We are incensed about this confusion. Our concern is that putting out new recommendations without any supporting evidence puts women in an impossible situation," said Karuna Jaggar, executive director of the group.
Jaggar said the focus needs to shift to preventing breast cancer in the first place. "Mammography works in some situations, but there are limits and there are risks," she said. "Screening is always going to be a tool. It will never be the answer. We need to get at the root of this problem."

New guidelines

The American College of Obstetricians and Gynecologists on Wednesday issued screening guidelines for breast cancer that recommend:
-- Women 40 and older be offered mammography every year rather than every other year, as previously recommended.
-- Women 50 and older be offered annual mammograms, as previously recommended.
-- Clinical breast exams be conducted annually for all women 40 and older.
-- Women ages 20 to 29 receive clinical breast examinations every one to three years.
-- Women be informed about the potential for false negative and false positive results, and that additional imaging or biopsies may be needed.
-- Women at high risk of breast cancer receive enhanced screening opportunities.
Source: American College of Obstetricians and Gynecologists

Low Newborn Apgar Score Linked To Lower Academic Achievement At Age 16

2011-07-25T08:46:00.000-07:00

Low Newborn Apgar Score Linked To Lower Academic Achievement At Age 16

Babies with low Apgar scores at birth have a higher risk of having special education needs during adolescence, Swedish researchers reported in Obstetrics & Gynecology.

Apgar is a way of evaluating the health of a newborn shortly after birth. The Apgar score is a number which is added up by scoring respiratory effort, heart rate, skin color, response to a catheter in the nostril, and muscle tone. Each objective sign can receive a score from 0 to 2 points. The highest total Apgar score is ten - a baby with a score between 0 and 3 needs to be resuscitated immediately.

Dr. Andrea Stuart of Central Hospital in Helsingborg, Sweden, and team set out to estimate what the link might be between low Apgar score and long-term cognitive function. The scores are taken within five minutes of the baby being born. They were specifically looking at scores below 7.

The researchers gathered Apgar score data from the Swedish Medical Birth Registry and academic performance from the Swedish School Grade Registry. They were specifically trying to link low Apgar scores with the likelihood of a child having to go to a special-education school. The database included information on 877,618 babies from 1973 to 1986. 23,000 kids were attending a special-education school.

The vast majority of the newborns had Apgar scores of 9 or ten, and 1% had a score below 7. Of those with a score below 7, one third had a score below 4.

The team calculated that a newborn with an Apgar score below 7 within five minutes of being born had twice the risk of subsequently going to a special school, compared to those with high scores. The risk was three times greater for those whose Apgar scores were 2 or 3.

Those with an Apgar score of less than seven had a much higher chance of never receiving graduation grades.

Dr. Andrea Stuart said:

"It is not the Apgar score in itself that leads to lower cognitive abilities. It is the reasons leading to a low Apgar score (including asphyxiation, preterm delivery, maternal drug use, infections) that might have an impact on future brain function."

Even though the risk is higher, the authors stressed that it is still low. A newborn with a score below seven has only a 2.27% chance of needing to go to a special-education school as a teenager.

The authors concluded:

"An Apgar score of less than 7 at 5 minutes after birth is associated with subtle cognitive impairment, as measured by academic achievement at 16 years of age."

"Apgar Scores at 5 Minutes After Birth in Relation to School Performance at 16 Years of Age"
Stuart, Andrea MD; Otterblad Olausson, Petra PhD; Källen, Karin PhD
Obstetrics & Gynecology: August 2011 - Volume 118 - Issue 2, Part 1 - pp 201-208 doi: 10.1097/AOG.0b013e31822200eb

Written by Christian Nordqvist

This Test Given Moments After Birth May Tell How Well Your Kids Do In School

2011-07-22T09:53:00.000-07:00

This Test Given Moments After Birth May Tell How Well Your Kids Do In School
By Robert Johnson

A test given to all newborns moments after they're born may reveal how well they'll do in high school.

According to LiveScience, a new study in the journal of Obstetrics & Gynecology looked at 877,000 Swedish children given the Apgar test used to determine an infants health, and compared those scores with graduation rates.

The lower the scores when they were born, the greater the likelihood the children would have learning difficulties later in life.

"It is not the Apgar score in itself that leads to lower cognitive abilities," said study author Dr. Andrea Stuart, an obstetrician at Central Hospital in Helsingborg, Sweden. "It is the reasons leading to a low Apgar score [including asphyxiation, preterm delivery, maternal drug use, infections] that might have an impact on future brain function."

The Apgar is given between one and five minutes after birth and evaluate an baby's heart rate, muscle tone, breathing, skin color, and reflex irritability -- each on a two-point scale.

The study found that kids with scores below 7 have twice the odds of attending special schools for the learning impaired.

Screen All Women for Alcohol Use, ACOG Says

2011-07-21T09:50:00.000-07:00

Screen All Women for Alcohol Use, ACOG Says

By Todd Neale

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

Pregnant or not, all women seeing their ob/gyn should be screened for alcohol use to identify at-risk drinking and alcohol dependence, according to the American College of Obstetricians & Gynecologists (ACOG).

The screenings should take place at least every year and within the first trimester of pregnancy, stated an opinion from ACOG's committee on healthcare for underserved women, which was published in the August issue of Obstetrics & Gynecology.

"It should be noted that women who drink at risk levels are less likely to maintain routine annual visits, and screening should be considered for episodic visits if not completed within the past 12 months," the authors wrote.

The National Institute on Alcohol Abuse and Alcoholism defines at-risk alcohol use as more than three drinks per occasion (binge drinking) or seven drinks per week for healthy women, and any amount of drinking for women who are pregnant or who are at risk of becoming pregnant.

According to the authors of the ACOG opinion paper, at-risk alcohol use is a greater risk to women than men, with wide-ranging health effects.

Those include negative effects on reproductive function and pregnancy outcomes and greater risks of various cancers, sexually transmitted diseases, menstrual disorders, altered fertility, injuries, and a host of psychosocial problems, such as relationship loss, sexual assault, loss of income, altered judgment, depression, and suicide.

In addition, women who drink during pregnancy place their unborn children at risk of birth defects.

According to ACOG, ob-gyns play an integral part in mitigating the health effects of problem drinking in three main areas -- screening, intervention and education, and treatment referral.

Various screening tools can be used, and the opinion highlighted TACE (Tolerance, Annoyed, Cut down, Eye-opener), which asks about a woman's tolerance to alcohol, annoyance with being criticized for her drinking, feelings about the need to decrease her amount of drinking, and drinking first thing in the morning.

The authors noted that "although the CAGE mnemonic screening tool has been taught in most medical schools and residency programs, it has not proved to be sensitive for women and minorities."

They also noted that women with alcohol use problems are often more likely than men to deny the existence of a problem and often do not have any signs on physical examination.

In terms of intervention, a brief educational session and motivational interviewing by the ob-gyn can be effective in women who are not addicted to alcohol.

The provision of clear advice on avoiding alcohol and achieving abstinence should be used for pregnant women and those at risk for getting pregnant, the authors wrote.

"Women who have already consumed alcohol during a current pregnancy should stop in order to minimize further risk, and those who are considering becoming pregnant should abstain from drinking alcohol," they wrote.

They added that "healthcare providers should advise women that low-level consumption of alcohol in early pregnancy is not an indication for pregnancy termination."

If intervention and education fail to get a woman who is drinking at risky levels to curtail her drinking, the ob-gyn should refer her to a substance abuse specialist, according to the opinion. The appointment should be made with the woman still in the ob-gyn's office.

"It may take a number of offers before the patient is ready to accept a treatment referral," the authors wrote. "The patient's trust in her medical provider may be key in taking the step toward treatment."

Breastfeeding Problems Associated with Depression

2011-07-20T08:37:00.000-07:00

Breastfeeding Problems Associated with Depression
By RICK NAUERT PHD

Postpartum depression is more common among women who had breastfeeding issues in the first two weeks after giving birth.

Accordingly, researchers say women with breastfeeding difficulties should be screened for depressive symptoms.

“We found that women who said they disliked breastfeeding were 42 percent more likely to experience postpartum depression at two months compared to women who liked breastfeeding,” said Stephanie Watkins, a doctoral student in epidemiology at University of North Carolina at Chapel Hill.

“We also found that women with severe breast pain at day one and also at two weeks postpartum were twice as likely to be depressed compared to women that did not experience pain with nursing.”

The idea for the study, published online ahead of print by the journalObstetrics & Gynecology, grew from the clinical experience of senior author Alison Stuebe, M.D.

“We found that very commonly the same moms who were struggling with breastfeeding were also depressed,” she said. “There was a tremendous clinical overlap.”

In the study, researchers worked to determine if this anecdotal association would be backed up by statistical analysis of relevant data. They used data collected as part of the Infant Feeding and Practices Study II, and assessed the postpartum depression status of the 2,586 women in that study with the Edinburgh Postnatal Depression Scale.

Of those women, 8.6 percent met the criteria for major depression two months after giving birth.

Women who reported disliking breastfeeding during the first week were 1.42 times as likely to be depressed at two months. Women who reported severe breastfeeding pain on their first day were 1.96 times as likely to be depressed at two months.

The finding indicated that mothers with breastfeeding difficulties should be screened for depression and referred to counseling when depression is confirmed.

Further, the study also provides a message for mothers, Stuebe said.

“If they’re struggling with breastfeeding, they should seek help and tell their provider. If they don’t have joy in their life, if they wake up in the morning and think, ‘I just can’t do this another day’ – that’s a medical emergency.

“They shouldn’t just say, ‘I’m going to power through this and snap out of it.’ They should call their provider and say, ‘I just don’t feel right, I’m wondering if I could be depressed, can I come in and talk to you about it?’ ”

Birth Control May Become Free After Panel’s Recommendation

2011-07-19T11:46:00.000-07:00

Birth Control May Become Free After Panel’s Recommendation

WASHINGTON (CBSMiami.com) – Health experts advising the federal government have recommended that health insurance companiesbe required to cover birth control for women as preventive service, with no copayment.

The Institute of Medicine recommendations also included diabetes tests during pregnancy and screening for the virus that causes cervical as recommended preventive services for women.

The findings were issued as the government begins to implement parts of the federal health care reform law. The law requires most health plans to cover preventive care for both sexes, but the women’s health recommendations were sent to a nonpartisan institute for review.

The final decision from Health and Human Services Secretary Kathleen Sebelius is expected to be issued soon.

More studies show drugs block HIV

2011-07-19T07:59:00.000-07:00

More studies show PrEP prevents HIV infection

The evidence is mounting. Another study has found that PrEP - pre-exposure prophylaxis – is relatively safe and can prevent HIV transmission in couples where one partner is already infected with the virus.

The data from the study, called the HPTN 052 trial, released Monday in the New England Journal of Medicine at the International AIDS Society Conference in Rome. Researchers enrolled nearly 1,800 couples in Botswana, Kenya, Malawi, South Africa, Zimbabwe, Brazil, India, Thailand and the United States.

Fifty-four percent of the couples were from Africa; half of the infected partners were men. Those infected, with CD4 counts between 350 and 550, were randomly broken into two groups. In one group, the infected partner received antiretroviral drugs when they were enrolled. In the other, therapy was delayed until after their CD4 count fell below 250, or they suffered an AIDS related illness.

CD4, or T-Cells are a type of white blood cell that helps the body fight infections like viruses and bacteria. The higher your count, the stronger your immune system which helps reduce complications of HIV. When the CD4 count falls below 200 a person has AIDS.

Researchers found for those who got antiretroviral therapy (ART) early, the rate of transmission dropped by 96% compared with those who were treated later. HIV transmission occurred in just 39 people. Twenty-eight of those were directly linked to the HIV-infected partner. Of that 28, only one was from the group that got early treatment. HIV patients that got early therapy also had less HIV-related illness.

"HPTN 052 demonstrated that early initiation of ART by the infected partner in heterosexual couples, where one partner is HIV-infected and the other not, is highly effective in decreasing transmission of HIV to the uninfected partner," said Dr. Anthony Fauci, director, National Institute of Allergy and Infectious Diseases at the National Institutes of Health. "With these recent advances, we now have an unprecedented opportunity, based on solid scientific data, to control and ultimately end the AIDS pandemic. Of course, global implementation of HIV interventions, including the scale-up of the delivery of ART, must be accelerated, and this will be costly. A truly global commitment is essential. In this regard, major investments in implementation now will save even greater expenditures in the future; and in the meantime, countless lives will be saved."

The drugs used included Combivir, a combination of zidovudine and lamivudine; lopinavir and ritonavir or Kaletra–also known as Aluvia; and the combination tenofovir and emitricitabine whose brand name is Truvada. Last week, two different African studies, one of uninfected heterosexual men and women in Botswana, and the other of heterosexual couples in Kenya and Uganda, found Truvada significantly reduced the risk of transmission in study participants.

In the HPTN study, 82% of the transmissions occurred in Africa. Researchers say more frequent sexual activity and less condom use could be a reason for increased transmission there. Study investigators also saw higher viral loads in HIV patients in sub-Saharan Africa versus patients from developed countries.

Adverse events most often reported included infections, gastrointestinal problems, nervous system disorders and psychiatric issues. Some patients were found to have pulmonary tuberculosis; the majority of those cases were seen in India. More adverse events were seen in patients that got the drugs early. Study authors say the reason is unclear and more follow-up is necessary.

Researchers admit the study, funded by NIAID, is not without limitations. They say the couples were "stable" and possibly not representative of the general population. They were also counseled and given condoms, which authors say could have contributed to the low rate of infection.

New data from the iPrEx study is also being released this week at international AIDS meeting. In iPrEx, a trial that spanned four continents, daily PrEP with Truvada reduced HIV infections in men who have sex with men, or MSM. It was one of the largest studies ever conducted and the first in Asia or Africa that focused on MSM. Eleven new analyses will be presented.

"These new analyses confirm the safety and efficacy of PrEP in MSM and strengthen our belief that PrEP is an important HIV prevention tool with the potential to prevent significant number s of new HIV infections," said iPrEx Protocol Chair Dr. Robert Grant, Gladstone Institutes and the University of California at San Francisco. "When we viewed along with the Partners PrEP and TD2 data in heterosexual men and women, these findings make a compelling case that providing broad access to PrEP could reduce the human and financial cost of the epidemic significantly."