Safe Vaccinations in Pregnancy - MacArthur Medical Center

Are Vaccinations Safe in Pregnancy?

Keeping your baby safe during pregnancy is likely the most important concern on your mind if you are pregnant, and it depends on many factors. Just like taking your prenatal vitamins and keeping your doctor’s appointments, one of the best things you can do for the health of your baby is to protect him or her from getting sick, and many women go through pregnancy without realizing that they can prevent certain diseases simply by keeping up with all recommended vaccinations.

What are vaccines?

Vaccines contain substances that prepare your body’s immune, or defense, system so that it can fight off certain infections when exposed to a particular virus or bacteria in the future. In this way, your body is trained to resist a disease, and you become immune to it. Vaccines can help prevent certain infections and serious complications during your pregnancy and in the first few months of your baby’s life.

Are vaccines safe in pregnancy?

Certain vaccines are safe in pregnancy and certain ones are not. In general, vaccines that contain inactivated or killed viruses are considered safe, while those that contain live viruses may be harmful to an unborn baby, and are therefore not given during pregnancy.

Which vaccines should I get during pregnancy?

Two vaccines are routinely recommended for all pregnant women and will be offered to you during your prenatal visits. They are the influenza vaccine and Tdap.

Influenza –  You may think of  having “the flu” as having a fever, runny nose, and muscle aches, however this infection can actually be especially dangerous in pregnant and post-partum women and can lead to serious complications including hospital stays and even ICU admissions. The influenza vaccine, or flu shot, can help prevent these serious complications. And by delivering protective antibodies to your baby through the placenta during pregnancy and through breastfeeding post-partum, the flu shot also helps protect your baby during his or her first few months of life, as babies cannot receive the flu shot before they are six months old and can also get very sick from an infection. The flu shot is recommended for all women who are pregnant or who might be pregnant during the flu season (typically October through March). It can be safely given at any week of pregnancy (even in the first trimester), and is in fact recommended as soon as it becomes available during a season and ideally before the outbreak of the flu in the community. While the inactivated influenza vaccine, which is given in an intramuscular injection, is safe in pregnancy, the nasal spray influenza vaccine is made from a live virus and is therefore avoided during pregnancy.

Tdap – The tetanus toxoid, reduced diptheria toxoid, and acellular pertussis, or Tdap vaccine is safe in pregnancy and is recommended to be given to all pregnant women between 27 and 36 weeks. It most importantly protects against Pertussis, or the “whooping cough,” a bacterial disease that can spread through air droplets by coughing or sneezing. This disease has the most severe consequences in infants less than three months of age, and in the 1900s before the vaccine was available, it was a major cause of sickness and death in babies and children. After the vaccine was developed, the number of cases significantly decreased, however in recent years we are again seeing a rise in the disease and it is important for everyone to get vaccinated. You likely received DTaP, another form of the vaccine that is given in five doses during childhood, however Tdap is a booster you need to get in every pregnancy (even if you just got it during your last pregnancy) in order to protect you from getting sick and allowing for transfer of protective antibodies through the placenta to protect your baby during the first few months of life when he or she is too young to get vaccinated. If TDap is missed during pregnancy, it should be given immediately postpartum so that your baby can receive the protective antibodies through your breast milk. The TDap booster is also recommended for all teenagers and adults who have not previously received it and especially for household members who will be having close contact with an infant.

Should I receive any other vaccines during pregnancy?

You may need a certain vaccine to be given during pregnancy if you are at risk for a particular infection due to travel, a certain job, or other risk factors. These may include Hepatitis A or B, meningococcus, Yellow fever, or others. Don’t forget to tell your doctor if you plan on international travel, especially to tropical areas of South America and sub-Saharan Africa, although travel to such places should be avoided during pregnancy if possible.

What if I’m not pregnant yet but planning for pregnancy?

It is important to be up to date on all your vaccines and boosters prior to pregnancy. This can help prevent certain serious complications when you do become pregnant. Besides routine vaccines that you should have received as a child or teen, it is also important to receive immunity against measles, mumps, and rubella (MMR) and varicella (chicken pox) if you are not already immune. The reason is that these vaccines cannot be given during pregnancy as they contain live virus, and getting one of these infections during pregnancy can have serious consequences such as miscarriage or birth defects. If you do receive one of these vaccines, it is recommended to wait at least one month (or 3 months with varicella) prior to conceiving. You should see your doctor for a “preconception counseling visit” during which your doctor will review your vaccine history (bring your immunization record if you have one) and possibly draw some blood tests to help identify what vaccines if any you should receive in order to prepare for a healthy pregnancy.

Influenza vaccination during pregnancy. Committee Opinion No. 608. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;124:648–51.

Update on immunization and pregnancy: tetanus, diphtheria, and tetanus vaccination. Committee Opinion No. 566. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013; 121:1411-4.

Labor 101 - MacArthur Medical Center

Labor 101: When Am I in Labor and What Do I Do?

A lot of my time in the office is spent on educating patients about their bodies and the changes that occur during pregnancy. As women get closer to their due date, many questions come up about pelvic pressure, belly pain, and contractions. Pregnancy is a time of great physical stress on a woman’s body and changes do occur that are foreign to most women. These physical changes can be unusual and even scary for some patients. There is a lot of confusion surrounding the following questions: “When exactly does my labor begin?  When will my baby be born? When should I go to the hospital? What can I do about labor pain?” We doctors are responsible for educating all patients early and often on these topics so that they feel prepared and comfortable with the labor process.

“My doctor gave me a due date. Is that when my baby is going to be born?”

Finding out a “due date” is very exciting for mothers and fathers to be. Once a due date is given, patients often mark it down on their iPhone calendar or due date app or immediately text it to family members and close friends. However, I always caution them about this and tell them that a “due date” is NOT THE EXACT DATE when the baby will be born. It’s actually a calculated date that tells us when you are exactly 40 weeks and is based on your last menstrual period and first ultrasound of your pregnancy. Your baby could come a little earlier or a little later than that date depending on when your body is ready for labor. Labor is defined as when a woman experiences regular contractions with progressive cervical dilation (opening). Dilation from 0 to 4 centimeters takes days to weeks, however dilation from 4 or 5 centimeters to 10 centimeters (when a woman is ready to push) only takes hours! For this reason, you are not considered “in labor” and not required to stay in the hospital until you have reached 4 or 5 centimeters. Consequently, you may be allowed to go home if your cervical dilation is less than 4 cm although you may be feeling contractions.

“How do I know if I am in labor?”

The natural follow up questions that patients have are “How do I know when I am 4 centimeters? Can I tell by my contractions? How do I know when to go to the hospital?” Great questions. The answer is there is no way to know for sure unless you get checked by your doctor or at the hospital. My recommendation is to time your contractions. Look at the clock to see how often your contractions are coming and for how long they have been lasting. If they are irregular, on and off, or coming every 15 to 30 minutes apart, just wait. These are Braxton-Hicks contractions (false labor). They are not associated with labor but can be uncomfortable. Once your contractions start coming every 3-5 minutes for more than 30-45 minutes then you should go to the hospital.

“Should I go to the hospital for anything else other than contractions?”

Yes. You should go to the hospital if you are experiencing leakage of fluid or vaginal bleeding. The “bag of water” is the amniotic sac. It holds the amniotic fluid that bathes the baby. The bag of water can rupture on its own at any point during labor or even prior to labor. Once the bag has ruptured there is no longer a protective layer around the baby, and infection can potentially set in. For this reason, you should go to the hospital immediately when your water “breaks”, and if you are found to be less than 4 centimeters, your labor will be induced. Regarding bleeding, it is never normal to have bleeding, however bleeding isn’t always an ominous sign. Sometimes, bleeding can occur after a cervical check in the office or just from cervical dilation during labor. However, bleeding can also be a sign of fetal distress so my recommendation is that vaginal bleeding should always be evaluated by your doctor at the hospital.

“What things can I do to relieve labor pain from contractions?”

Labor is appropriately named because having a baby is very hard work! Whether false labor, early labor, or real labor, pain from contractions can be very uncomfortable and at times, downright intense. Contractions can affect your ability to sleep, your appetite, can make you feel nauseated, or your ability to move around like normal. The first thing to remember is that contractions are a normal part of late pregnancy as you approach your due date. Don’t be scared. Being of sound mind and not panicking is key when contractions start. There are also several things that you can do to help relieve some of the pain from your contractions. First, you can perform breathing exercises in order to relax your body. Controlling your breathing and establishing a regular breathing pattern will help alleviate some of the pain and the anxiety that comes along with labor. Next, taking a warm bath can help relieve pain as immersing your belly in water will have a soothing effect. Just ensure that the water is warm and not too hot. Massages are another helpful option. Involve your significant other with this. Gentle rubbing of the lower back, shoulders, or sides can provide a lot of relief. Other things that can relieve the pain from contractions are applying warm or cool compresses to your belly, putting yourself in a low stress/quiet environment, and continuous movement to get to a comfortable position (on your right or left side, on your back, leaning against pillows to optimize back/front support).

“What about an epidural?”

Labor pain is intense, and I always feel bad for patients who are experiencing a great deal of pain. Standing at the bedside and watching an expecting mother go through labor pain is not an easy sight to see. Luckily, we now have epidurals and medications that weren’t around in the past to help us alleviate the pain you feel from contractions. An epidural is a small catheter that is placed in your back, whereby medications can be administered that will numb the areas from the top of your belly to the vaginal area to decrease the pain sensation from contractions. Epidurals are safe for the baby and are the most effective way of relieving pain from contractions. Epidurals are only given to women who are in labor (4 centimeters or more) or who have already ruptured their bag of water (regardless of cervical dilation). With an epidural, you will be much more relaxed, your baby will tolerate labor better, and you can enjoy the childbirth experience much more. As always, I leave the decision up to the patient as to if and when she wants an epidural, but I believe that epidurals are a great way to take your mind off labor pain so that you can better focus your attention to what’s really important, which is having your baby.

LARCs - MacArthur Medical Center

LARCs – Be Pregnant When You Want To Be

Are you ready to be a mom? If you are sexually active and are not ready to be a parent then it is important to choose an effective form of contraception. If you are a parent and your child has become sexually active it is important she start birth control before you become a grandparent. Almost half of pregnancies in the United States are unplanned. Don’t be a statistic. Choose an effective form of birth control that puts you in control. The most effective forms of non-permanent birth control are called LARCs – Long Acting Reversible Contraception. These methods allow you to be pregnant when you want to be and help you take control.

LARCs  – Long Acting Reversible Contraception

Long acting reversible contraception are important birth control methods to understand. These are birth control methods that work for an extended period of time without you having to do anything. Examples of  LARCs  are IUDs (Intratuterine Device) and subdermal implants (Nexplanon). An IUD is a small device that is inserted into the cavity of the uterus. There are currently currently 4 IUDs available in the US – Skyla, Mirena, Paragard and Liletta. There is only one subdermal implant available. It is called Nexplanon and is inserted just under the skin of the arm.

Of all the birth control options LARCs are the most convenient for the user. You have to come in for insertion and can leave with the confidence of having years of protection. When you are ready to parent you simply come in for removal. The return to fertility is almost immediate with pregnancies seen as early as 7 days after removal. They also have the highest continuation rates, excellent safety profiles, few side effects and few medical contraindications.

Although these methods are not right for everyone, they are considered to be the first line treatment choice for all women regardless of age including adolescents. It is not true that you have to have had a baby before you can get an IUD. Studies show that Progesterone IUDs actually decrease the risk of pelvic inflammatory disease.

If you are not ready to be a parent then choose a LARC and only be pregnant when you want to be.

Clinical Trial: Suffering from Recurring Yeast Infections?

Vaginal yeast infection, also known as vaginal thrush or vulvovaginal candidiasis, is a common fungal infection of the vagina. This infection occurs when there is an overgrowth of yeast in the vagina.

Up to 75% of women will experience this infection at some point in their lives, and approximately 5 – 8% will have recurring episodes. Common symptoms include: itching, burning, inflammation, abnormal vaginal discharge, discomfort and pain. Women who suffer recurring infections may have Recurrent VulvoVaginal Candidiasis also known as RVVC.

Each study has specific inclusion and exclusion criteria. Patients generally receive the study medications for free and are compensated for their time. In order to participate, a patient may be identified by one of our doctors as being potentially eligible, or a patient can contact our office and express an interest in participating; in which case they would be scheduled to see one of the doctors who is either the Principle Investigator or Sub-investigator for the particular study.

If you have Recurring Yeast Infections contact Veronica Almanza, CRC at 214-367-8400 ext. 402. She can explain the study to you in more detail and arrange a visit with one of our physicians. We are here to help.

If you would like more information, you may also go to yeastinfectionstudy.com.

Condoms - MacArthur Medical Center

Condoms: Are They Still Needed?

As an OBGYN, I discuss birth control and STD prevention on a regular basis, sometimes multiple times a day, and sometimes even multiple times with a single patient.  With all the different types of birth control out there we often forget about condoms as an option. While it is true that condoms are not as effective at preventing pregnancy as other birth control methods like IUDs, implants, pills, patches, and injections, there are still benefits to using condoms including their practicality and effectiveness in protecting against sexually transmitted diseases (STDs).

Condoms are the oldest form of protection whose origin dates back many centuries. In ancient Egypt and Rome, people would actually use linen sheaths to protect themselves from venereal diseases. Nowadays with advances in manufacturing and mass production, condom production has evolved greatly and continues to this day.  Condom use and demand has also been a result of the changing times with several major world events including World War I and the free spirit of the 1960s and 70s and with the social awareness of new diseases like HIV in the 1980s and human papillomavirus (HPV) more recently. Condom companies have made millions of dollars producing and selling condoms. For example, Trojan, who makes over 70% of all U.S. condoms, brings in revenues of approximately $270 million annually.

Condoms are a type of barrier contraception that physically blocks sperm, semen, and other genital lesions from making contact with one’s partner. Condoms serve two main purposes. They can prevent pregnancy, although not as reliably as other birth control options (condoms are 85% effective with typical use as compared with >95% with other forms), and more importantly, protect against STDs including HIV, Gonorrhea, Chlamydia, Trichomonas, Syphilis, Hepatitis B, and even HPV. In fact, the U.S. has the highest rate of STDs of any nation in the industrialized world with our youngest adults (ages 15-24) being hit the hardest. These teens and young adults account for only 25% of the sexually active individuals in our country but amount to just under 50% of all STD cases in the U.S.! Condoms are made of various materials including latex, polyurethane, and natural animal skin with latex being the most effective against STDs and therefore the most commonly used condom (over 80%).

Here are some benefits unique to condoms.

  1. Condoms prevent STDs. I can’t say this enough times as this is their greatest utility. There is overwhelming evidence that condoms drastically decrease the transmission rates of STDs. In fact, there is only one way that is more effective at preventing STDs and that is abstinence (not having sex).
  2. Condoms are inexpensive. Condoms do not cost much if anything. Most come in packs which usually cost less than $20. Some programs or clinics supply them at no cost at all.
  3. Condoms are readily accessible. They do not require any doctor appointments or prescriptions and can be purchased over the counter at any grocery store, pharmacy, or even gas stations.
  4. Condoms are convenient. Condoms are small in size, easily concealed, and ready for immediate use. They require no preparation prior to use.
  5. There is no delay in fertility after their use. Condoms are a good option for those couples who are not wanting to get pregnant right away but may want a family very soon. They are a highly reversible birth control option.

Again, am I saying that condoms are a better alternative to other forms of birth control? Absolutely not. But they do carry some added benefits, most importantly STD prevention. In fact, I encourage all of my patients using contraception to use one form of reliable birth control (implant, IUD, pills, etc.) and to also use condoms concurrently to prevent STDs.

Miscarriages: Tough Questions and Tough Answers

I chose to become an OBGYN because I love delivering babies and bringing joy to expectant parents. It is by far the MOST REWARDING part of my job. Seeing the sense of pride on a new dad’s face, the joyful tears in a happy mother’s eyes, or the inquisitive look of a young big brother or sister is priceless and makes my “job” feel more like a privilege. Bringing a new life into the world is an opportunity that all of us OBGYNs keep sacred and is the main reason why many of us chose the field. But like all things in life there’s a downside to everything, and my job is no different.

Miscarriage is a topic that no one likes to discuss, myself included. It’s something that no expectant mother even wants to think about. Similarly, no athlete wants to discuss the possibility of a career ending injury, no pilot wants to talk about plane crashes, and no CEO wants to discuss the possibility of his or her company going bankrupt. Women who have miscarried are usually reluctant to discuss their experiences or share their feelings about it, which is totally understandable. It’s a private and personal matter for most that can often bring back painful memories and feelings of uneasiness. It can make women feel isolated, fearful, heartbroken, and at times, even guilty. In addition, it raises many questions like “Did I do something wrong?” “Is there something wrong with my body?” “Can I get pregnant again, and if so, when is the best time to try?” But the most important question for women and couples is “Why did this happen?” Unfortunately, the answer is one of the most challenging and elusive to provide.

Why?

Studies have shown that people are often misinformed when it comes to understanding the causes of miscarriages. In a recent survey of the general public, people were asked what they thought was the most common reason for a miscarriage. The top 7 answers were:

  1. A traumatic event
  2. Stress
  3. Lifting a heavy object
  4. An STD
  5. A previous miscarriage
  6. An IUD
  7. Woman not wanting to be pregnant

The answer to the question of “Why?” is very important for women who have experienced a miscarriage. Finding an answer or cause can lead to a sense of closure, the possibility of a solution, and a plan moving forward as most couples will want to get pregnant in the near future. The truth is that there are many causes of miscarriages none of which include the above. Various causes do include uterine or cervical anatomic problems, immunologic disorders, diabetes, thyroid disease, advanced age, smoking, alcohol, drugs, or environmental toxins. However, the vast majority of miscarriages are from chromosomal abnormalities (problems with the genetic makeup of a fetus), which cause over 50% of all miscarriages. When a genetic abnormality occurs, a woman’s body recognizes that the embryo’s genetic integrity is faulty and aborts or rejects the pregnancy. In a sense, nature is able to tell when development is abnormal and triggers a response to “start over”.

The important thing for women to understand is that while some of the above mentioned factors can be controlled such as smoking, alcohol, or environmental exposures, most of them cannot. For instance, many women are born with anatomical abnormalities or are diagnosed with chronic diseases during their childhood or adult life. Due to social reasons, some women may not be able to start a family until later in life when they are older. Because these causes cannot always be controlled, I tell my patients that they should never feel like it’s “their fault” and understand that sometimes unfortunate things just happen. I always reiterate to patients that they did nothing wrong and there was nothing that they could have done to prevent the miscarriage from happening.

Is there anything I can do?

Unfortunately, preventing a miscarriage from happening is impossible. My main advice to women who are considering conceiving is to optimize their health and body in preparation for a healthy pregnancy. These are some recommendations that I give to my patients.

  1. Eat a balanced diet that includes fruits, vegetables, meats, and carbohydrates. This will provide your body with essential nutrients, minerals, and vitamins for a healthy pregnancy.
  2. Maintain a healthy body weight. Being overweight or underweight can affect the health and the outcome of your pregnancy. It can also lead to complications later in life.
  3. Optimize your well-being if you have chronic medical diseases such as diabetes or thyroid disorders. For diabetics, your hemoglobin A1c level should be low and you should keep a daily log of your sugars and review them with your doctor. If you have a thyroid disorder, remain compliant with your thyroid medications and check with your doctor to make sure that your thyroid levels are within the normal limits.
  4. Stop bad habits. Quitting smoking and alcohol are some of the most important things you can do for a healthy pregnancy.
  5. Eliminate environmental exposures (lead, arsenic, radiation). No amount of exposure is considered “safe” especially if you have a very early pregnancy.
  6. Ensure sufficient folic acid intake. You should start taking prenatal vitamins with adequate amounts of folic acid (at least 400 micrograms daily) ideally 1 month prior to conceiving. Prenatal vitamins can be purchased over the counter at any local pharmacy or grocery store.

What now?

As vital as it is to take appropriate time for grieving and questions, most women will want to find closure and move forward. You should discuss with your doctor what the next steps are, your future plans for children, and how soon you wish to get pregnant if you so desire. You should also discuss the chances of a successful pregnancy and any interventions that may be needed for the next pregnancy. Some women may need laboratory testing or imaging procedures for some of the previously stated causes while others may not. Birth control is also an option as some women do not want to get pregnant for a certain period of time after a miscarriage. Lastly, it’s important for you to understand that while this was a tragic and disappointing time, you should not be afraid to get pregnant again. Even after a miscarriage, the vast majority of women will have no issues conceiving and will go on to have completely normal, healthy pregnancies. With my patients I strive to provide a sense of support, hope, and optimism through this process.

Air Travel During Pregnancy: Is It Safe To Fly While I’m Pregnant?

A common question I often hear is “Can I fly while I’m pregnant?” Air travel brings a whole new set of concerns and stress to an expectant mother, and rightfully so. Nowadays air travel is much more common with most Americans traveling at least twice a year if not more often than that! With every pregnancy lasting about 9 months, it’s almost impossible to put off flying during pregnancy. Plus, you’d hate to miss a special graduation, a family member’s wedding, or Christmas with loved ones just because of pregnancy, right? This topic always brings up questions for patients but hopefully I can provide some tips that will make the answer a little more simple.

In general, occasional air travel while pregnant is considered safe for healthy, uncomplicated pregnancies. Fetal heart rate is unaffected by flying if the mother and fetus are healthy. During flight, the body adapts to accommodate the higher altitude and small changes in cabin pressure. This is seen by an increase in the mother’s heart rate and blood pressure as well as a significant decrease in aerobic capacity.

Most commercial airlines allow pregnant women to fly up to around 35 weeks. Beyond this time, they fear that you will be approaching your due date and therefore deliver on the airplane without a doctor. However, each airline is different so the best thing to do is to check with the airline regarding their individual policy. Some airlines even want you to provide documentation of gestational age for them. Check with your OB doctor as well as some doctors do not recommend flying after 32-34 weeks.

There is no optimal time to fly during pregnancy. Women should be made aware that the most common OB emergencies occur in the first and third trimesters. In addition, during the second trimester, women are usually beyond morning sickness and the risks of miscarriage that occur in the first trimester as well as avoiding the physical discomforts and demands of the third trimester at which time the uterus is largest.

While flying is considered “safe” there are some special considerations that pregnant women should take note of. Here is my list of tips/advice if you are planning on flying while pregnant.

  • First and foremost, clots can develop from prolonged periods of sitting in the same position. Long periods of sitting in one position is not healthy for anyone but especially for pregnant women. All pregnant women are in a “hypercoagulable” state or a propensity to develop clots (especially in your legs). This is dangerous as these clots in your extremities can dislodge and travel to your heart and lungs. To prevent this, you should walk the aisles and stretch your legs periodically. Taking quick, frequent bathroom breaks to prevent any blood stasis can go a long way. In addition, compression stockings or hose can be placed on your legs to prevent any pooling of blood.
  • Second, stay hydrated! The airplane cabins usually have slightly lower humidity making it easy to get dehydrated. Dehydration can lead to contractions, preterm labor, and sometimes even problems with blood circulation to your baby. Periodic sips of water will help you stay hydrated especially during longer flights.
  • Third, pregnant women should wear seatbelts continuously throughout the flight as unexpected turbulence can lead to falls and trauma to the belly, which can cause problems for the unborn baby. The seatbelt should be worn low on the hipbones below the abdomen and not directly on the pregnant belly.
  • Fourth, air travel is not recommended at any time during pregnancy for women who have complicated medical or obstetric conditions that may be exacerbated or worsened by flight. Inform your doctor anytime that you are planning on flying. He or she will let you know of any risks of flying with your specific medical condition.
  • Lastly, arrangements and planning should be made regarding your destination. Knowledge of the closest hospital and ER should be sought prior to travel. You should ensure that these facilities have the capability of managing pregnancy complications, performing C-sections, and caring for preterm or ill babies. In addition, general health insurance policies may or may not provide coverage for pregnancy-related problems if traveling overseas. You should inquire about your individual health insurance policy and assess the need for a possible supplemental plan or temporary coverage while out of the country.

Air travel during pregnancy can be a tricky and daunting task. It brings new medical issues to the forefront for both mom and baby. But with a good understanding of the risks, effective communication with your doctor, and early planning and preparation, you can ensure safe travels for both you and your baby.

Got fibroids? Got polyps?… Get Symphion!

What is Symphion?

It is a hysteroscopic (very small camera/telescope that goes into the uterus) tool used to remove fibroids and/or polyps without having to cut or remove any part of the uterus. Also, it’s an outpatient procedure, so you can go home the same day.

So, what are fibroids?

wud_myosure02These are very common non-cancerous tissue growths in the uterus. The size and number of these fibroids is variable… can be a single fibroid or multiple fibroids, and can range from very small to the size of a cantaloupe. They can be found on a stalk inside or outside the uterus. They can also be found in any layer of the uterus: in the muscle wall (intramural), under the outer layer (subserosal), or just below the inner lining of the uterus (submucosal).

 

So, what are polyps?

wud_myosure03These are small protrusions of the uterine lining (endometrium) that grow, become fragile, and start to bleed. Here is a picture of two polyps and the Symphion device.

 

 

 

So, are polypectomies and myomectomies safe? Effective?

With a hysteroscopic approach or with Symphion, the complication rate is less than 1%. The procedure is 90% effective in reducing heavy bleeding and recurrence rates at 2 years are less than 10% for fibroids and less than 3% for polyps.

What are the steps of the procedure?

  1. Your doctor will gently open your cervix and insert a very slender camera into your uterus.
  2. After visualizing the polyp or fibroid, a slender wand-like device is passed through the camera/telescope into your uterus. This wand suctions and cuts the fibroid or polyp into very small pieces and removes the tissue.
  3. Once the polyp/fibroid is completely removed, the wand and camera are removed. Nothing is left in your body after the procedure.

What’s the recovery like and what can I expect after the Symphion procedure?

Some women have mild cramping, for which most only need over the counter pain medicine. Most women are back to normal activities within a day or two. You are unlikely to have any complications, but call your doctor immediately if you have any of the following:

  • Fever > 100.4°F
  • Increasing pain not relieved by pain meds
  • Nausea, vomiting, dizziness, shortness of breath
  • Bowel or bladder problems
  • Greenish vaginal discharge

When will I know how well the procedure worked?

This varies for every woman, but plan to give your body approximately 3 months to fully heal. By then you and your doctor should be able to tell what your cycles are going to be like.

Contraception Counseling Impacts Unplanned Pregnancy

Of the 6.7 million pregnancies in the US each year 48% are unplanned. Disturbingly,  about half occur in women who were using contraception at the time of conception. That statistic haunts me. As health care providers we must take that to heart and change the way we think about birth control counseling. Is there more that we can do to help prevent unplanned pregnancy in those who are actively using birth control?

When we break down the statistics and focus on young people the numbers are even more striking.  Shows like TeenMom and 16 and Pregnant draw media attention to teen pregnancy. Ironically, young women ages 15-19, are the most likely group to have used birth control the last time they had sex. The problem is this age group typically chooses methods with higher failure rates such as cycle timing, condoms, withdrawal method and birth control pills. The result is unsurprising — unplanned pregnancies.

Young patients often ask me, “what is the best birth control?” My answer is always the same – “The one that YOU will use.” There is no “right” answer. Effective contraceptive counseling involves not only providing information and options,  but also matching the right method to the right person.

Research shows that pregnancies occur less often when one chooses a contraception option that requires the least amount of effort. This is not a surprise.  Condoms work great unless you never take them out of your pocket. Birth control pills also are effective but not if you forget to swallow them. Despite the many contraception options available many patients are unaware of the choices. Linguistically speaking the phrase “birth control” is synonymous with oral contraceptives for many people. Birth control refers to many more methods than just birth control pills. Health care providers should never assume patients know all of the alternatives. Pregnancy can be prevented with a variety of nondaily options that are safe and easy to use.

When discussing  contraception with young patients, start with methods that require the LEAST amount of effort and then work backwards to the methods that require the Most effort. Direct patients to the options that have the best track record. Keep in mind that efficacy has a direct correlation with compliance. The more effort the birth control method demands from the patient the less effective it will be long term.

At Macarthur Ob/Gyn we always start with Mirena IUD, Paragard IUD and Nexplanon. We discuss the risks, benefits and potential side effects. These methods involve one visit for insertion and one for removal providing coverage for 5 years, 10 years and 3 years respectively. These methods have the highest efficacy rates and excellent continuation rates. They have excellent safety profiles, few side effects and few medical contraindications. Despite that, nationwide less than 10% of adolescents are using these methods collectively referred to as LARCS (Long Acting Reversible Contraception.) We focus on LARCS because they have the highest success rate at preventing unplanned pregnancy. We spend time addressing fears, misconceptions and myths. We make sure our patients are aware of these options. We use technology in the office via an on screen waiting room power point presentation highlighting the birth control options. We use social media platforms to educate our patients on their birth control choices. As a result a much higher percent of our young patients are choosing LARCs as their preferred method of contraception.

While the patient should ultimately choose the best for her, the health provider should be guiding her to the methods that can best meet her goal of preventing pregnancy. By increasing the use of LARCs we can dramatically impact the number of young women struggling with unplanned pregnancy while using contraception.

Adolescents and long-acting reversible contraception: implants and intrauterine devices. Committee Opinion No. 539. American College of Obstetricians and Gynecologists. Obstet Gynecol 2012;120:983–8.

Chromosomal Screening - MacArthur Medical Center

Abnormal Chromosomal Screening: Will My Baby Have Down Syndrome?

With so many technological breakthroughs recently, the field of prenatal diagnosis has undergone major advances. Over the last 30 years, detection rates for Down syndrome and other chromosomal abnormalities (Trisomy 18 and 13) have increased from a mere 60% to well over 95%. Chromosomal abnormalities were once thought of as being an issue primarily for “older” women (pregnant women over the age of 35), but now with the ability to detect these problems so accurately, ACOG (American Congress of Obstetrics and Gynecology) now recommends that ALL pregnant women who present for prenatal care at less than 20 weeks be offered some form of prenatal screening for chromosome problems such as Down syndrome.

Discussing the topic of chromosome screening with patients can cause confusion and anxiety. Many patients wonder why this testing is needed, how testing is done, at what gestational age can testing be done, and of course, the big question: WHAT HAPPENS IF MY SCREENING TEST IS ABNORMAL? These are all great questions that are difficult to explain during one quick office visit. The following questions/answers will hopefully clear up any myths or rumors that you might be hearing about chromosomal screening.

What is aneuploidy?

Aneuploidy means abnormal chromosome number (either missing or extra chromosomes). Aneuploidy results from a problem very early in pregnancy when chromosomes fail to separate properly and therefore an “extra” chromosome is obtained.  Most commonly this occurs on chromosome numbers 21 (Down syndrome), 18 (Edwards syndrome), and 13 (Patau syndrome). When a fetus has an extra chromosome at one of these positions, the outcome can have varying degrees of abnormalities. These range from learning difficulties, short stature, or distinct facial features to even more serious problems such as structural birth defects (heart, kidney, GI tract) or a baby who will be unlikely to survive after birth.

What is a screening test?

A screening test is a test that is performed to give information about a patient’s risk of having a baby with certain birth defects/chromosomal problems. It DOES NOT have the ability to diagnose a chromosomal problem. Instead, it simply indicates that a patient is at higher risk and needs more invasive testing to confirm the screening test results. The higher the detection rate, the better its ability to pick up the abnormality, and therefore the better the screening test.  Unfortunately, screening tests cannot detect 100% of all abnormalities and rarely even give false positive results.

How is a chromosomal screening test performed?

Levels of certain hormones/proteins are often abnormally high or low with certain chromosomal problems. These levels can be measured by simply analyzing a mother’s blood during specific times in pregnancy.

What specific tests are involved with chromosomal screening?

There are many different tests available to screen for aneuploidy. It’s more important that testing IS BEING DONE rather than WHICH test is being performed. With that said, different tests have different detection rates and which test you receive will depend on your doctor’s office’s resources and laboratory. At MacArthur OBGYN, you will have your blood tested on two separate occasions and an ultrasound to evaluate the neck of your baby (nuchal translucency) as babies with thicker neck measurements on ultrasound are at higher risk for having chromosome problems.

When will I be screened for chromosomal problems?

Typically, we at MacArthur OB/GYN use an “integrated” screening test. This involves combining the results of a test from 11-14 weeks with another test after 15 weeks. During your visit between 11 and 14 weeks, your blood will be drawn and an ultrasound will be done to measure the neck of your baby. These tests are combined with another blood test after 15 weeks to calculate a combined risk. The result of the test does not come back until after the second blood test is performed after 15 weeks. The combination of both of these tests (as opposed to only one test) leads to a higher detection rate and more accurate results. If for some reason a pregnant woman misses her first screening test from 11-14 weeks, but is still less than 23 weeks, a single blood test called the Penta screen can be performed to determine her risk. The Penta screen has a lower detection rate than traditional integrated screening but is still effective.

How accurate are chromosomal screening tests?

The detection rate of the integrated screening test is approximately 94-96%, while the Penta screen (the testing that occurs only in the second trimester after 15 weeks) has a detection rate of approximately 85%.

What happens if I have a positive screening test result?

If you have a positive screening test, first of all, DO NOT PANIC. You simply are deemed higher risk. It DOES NOT mean that your baby has a chromosome defect. A positive screening test will typically be followed by a referral to a Maternal-Fetal Medicine specialist (high risk pregnancy doctor), where he or she will offer the following:

  1. A targeted ultrasound to look closely at the other parts of the baby (heart, stomach, face, spine, kidneys) to see if there are any obvious birth defects that suggest chromosomal problems or other genetic syndromes.
  2. A confirmatory test to diagnose what type, if any, chromosome abnormality is present.

Confirmation of aneuploidy can be done in several different ways depending on the doctor.  Some will offer you an amniocentesis. This is a procedure in which amniotic fluid (which has fetal cells) is drawn from within the amniotic sac and sent for chromosomal analysis. Others will offer a chorionic villus sampling (CVS), in which a small sample of cells from the placenta is tested. Other testing that can be done are maternal blood tests such as the Panorama, Harmony, or Materni21 tests, which detect cell free fetal DNA in the maternal circulation. This testing involves new technology and is indicated for pregnant women over 35 years old or for women who have an abnormal standard screening test or ultrasound findings suggestive of aneuploidy. These tests are not confirmatory tests but do have detection rates up to 99% and are therefore very helpful to patients who either decline amniocentesis or where amniocentesis is not feasible.

With new technologies we now know even more about the health of babies before they are born. Improved ultrasound quality and more accurate blood testing has given us more insight into a baby’s genetic makeup, specific syndromes, or any structural problems that he or she may have. Chromosomal screening is an integral part of prenatal care and hopefully the information above has helped make it a less intimidating and confusing topic.

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