Screening for cervical cancer starts at a young age- 21 for most women- which often occurs before childbearing and pregnancy. When we screen women for cervical dysplasia and subsequently treat it, it's easy to get caught up in the primary objective (prevent or stop cancer) and to forget about considerations for long term health, such as the implications for future pregnancy. Since the cervix plays a key role in pregnancy (keeping the fetus safely in the uterus!), it follows that treating cervical dysplasia could affect pregnancy in the future. Read on to learn four ways treatment of cervical dysplasia can affect pregnancy outcomes.
Early pregnancy is one of the most exciting- and nerve-wracking- times for a new mother. Amidst the joy of expecting a new baby are usually worries about whether the pregnancy is healthy and normal. Early pregnancy loss occurs when there is an intrauterine pregnancy either with no embryo or with an embryo without a heartbeat, before 13 weeks. Early pregnancy loss occurs in 15% of clinically recognized pregnancies. Doctors can use levels of the pregnancy hormone hCG and ultrasound to assist in this diagnosis. But how certain is the diagnosis of a healthy versus nonviable early pregnancy? How can we be sure that we do not misdiagnose a viable pregnancy as an early pregnancy loss and intervene inappropriately? Read on to learn about the new ultrasound guidelines meant to increase certainty in diagnosing early pregnancy loss.
There are few bigger surprises than learning that you are pregnant with twins. We can all picture the shocked mother and father looking at an ultrasound of two growing babies with wide eyes. The incidence of twins is on the rise, mostly due to the increased utilization of ART. With this increase, researchers have taken another look at the mechanisms that lead to twins, both "typical" and "atypical." This week, we cover the traditional and some new models for how twins form.
Delivery, like all things in life, is a balancing act, especially in the case of pregnancies with complications. Depending on the complication, be it high blood pressure or diabetes, scheduled delivery earlier than labor starts naturally can be in everyone's best interest- if the risks & benefits balance. In the case of chronic hypertension, timing of delivery must balance the risks to the infant of being born too early with the risk of stillbirth as pregnancy continues. ACOG recommendations for timing of delivery for pregnancies complicated by chronic hypertension are broad (anywhere from 36 to 39 weeks), so a new study examined the risks and benefits of delivery at each week of gestation.
Endometriosis is the number 1 cause of infertility in the US. Endometriosis occurs when the endometrial tissue that makes up the inner lining of the uterus migrates to other places, like the ovary or pelvic wall. Endometriosis affects up to 10% of US reproductive-aged women, and, of women with endometriosis, about 35% experience infertility. So, what can we do to help women with endometriosis achieve pregnancy? Unfortunately, the number of medical treatments to increase fertility in the face of endometriosis are limited. Read on to learn about a promising new study of a new treatment, plasma energy ablation.
The obesity epidemic is a popular topic in the media. Our news feeds are flush with articles about the dangers of obesity: hypertension, sleep apnea, cancer, dyslipidemia, and cardiovascular disease. In the OBGYN world, every month brings new journal articles about the dangers of obesity during pregnancy, everything from birth defects to obstetric complications to a higher risk of obesity in offspring. Recently, the American Society for Reproductive Medicine issued a committee opinion on the ways in which obesity affects fertility. So, how, exactly, does obesity affect fertility?
"Individually we are one drop, but together we are an ocean." -Ryunosuke Satoro. The wisdom underlying the power of teamwork has never been so true as when it is applied to delivering medical care. From restructuring care teams to center around patients and their families to encouraging collaboration between medical centers, improvements in medicine rely on increasing teamwork. A collaborative in Ohio has recently shown the tremendous benefits that can be achieved in the field of obstetrics when groups team up to prevent preterm birth through better access to progesterone treatments.
Everyone who has ever overdosed on entire pint of Ben & Jerry's knows: you can have too much of a good thing. Modern medicine has brought about miracles, increasing our health and lifespans. However, sometimes, medicine can be too much of a good thing. Too many procedures lead to more complications. Too many medications lead to more side effects. Too many hospitalizations lead to more infections. The list goes on and on. So how can we find a balance between too much and too little in OBGYN?
Every January, the Society for Maternal Fetal Medicine hosts their annual conference, "The Pregnancy Meeting." I was honored to be able to join the party this year in Las Vegas, where hundreds of brilliant OBGYNs and MFM specialists came together to summit on the latest research pertaining to pregnancy. Naturally, I dutifully collected the most interesting factoids for my blog and Twitter friends. Below are the five most popular findings, as voted by the awesome @Elmtreemedical Twitter community.
We'd all love to be able to predict the future, especially when it comes to how a baby will be born: by vaginal, operative, or cesarean delivery. A cesarean delivery after labor is significantly more likely to lead to complications like hemorrhage or infection than a scheduled cesarean delivery. However, for the average low-risk woman, a spontaneous vaginal delivery is safer than any cesarean delivery. Obstructed (or stalled) labor is one of the largest contributors to our rising cesarean delivery rate. Therefore, predicting which women will ultimately need a cesarean delivery for obstructed labor could potentially lead to more effective care and possibly fewer complications. One approach to predicting mode of delivery is by analyzing the pelvic muscles as viewed through ultrasound.