Pregnancy and Birth

Chronic hypertension plagues as many as 5% of pregnancies and can result in such adverse perinatal outcomes as preterm birth and fetal death. Further complications can present among women with chronic hypertension who develop superimposed preeclampsia, yet data on perinatal outcomes for such women are sparse.

Spontaneous preterm birth, the most common cause of premature birth, results from a multifactorial process. Its etiology is unknown, which makes it difficult to treat. In addition, there are few proven preventive measures.

Increases in the prevalence of asthma, especially in children, have raised concern in the medical community, resulting in research to find possible causes and to explore potential means of prevention. Recently there has been some evidence linking acetaminophen (known as paracetamol in New Zealand) use in pregnant women and subsequent increased risk for asthma in their offspring.

A 37 year old woman came to me in July, 2009 with a prolapsing 8 cm. fibroid. She had been seen by her HMO doctors multiple times for heavy bleeding, had 15 ultrasounds, but nothing was done.

Infertility is the inability to conceive despite frequent and unprotected intercourse between a man and his female partner for at least 1 year.

I believe epidurals are overused in obstetrics because not enough women receive hands-on labor support, and the side effects and risks are not well described to women.

With more than 7 million infertile women in the United States, the need and demand for effective IVF treatment remains high. Unfortunately for these women/couples, the cost for such treatment is also relatively high.

Untreated sexually transmitted infections (STIs) in pregnancy can lead to such negative outcomes as spontaneous abortion, preterm birth, low birth weight, congenital infections, and other abnormalities.

One in 10 pregnant women experience depression with severe risks, and depression during pregnancy is associated with higher risks for complications as well as postpartum depression. Yet treating depression during pregnancy raises concerns for maternal well-being and fetus well-being alike, requiring clinicians to constantly balance the benefits of psychopharmacological agents for women while minimizing risks to their fetuses.

Children whose mothers used paracetamol during their pregnancy may have a slightly increased risk of childhood wheeze, according to a meta-analysis published in the April issue of Clinical & Experimental Allergy.

Incorrectly positioned intrauterine devices (IUDs) make intrauterine pregnancy (IUP) more likely, with more than half of IUDs identified during the first trimester of pregnancy malpositioned, according to a study published online Feb. 24 in the American Journal of Obstetrics & Gynecology.

The duration of breast-feeding is associated with higher maternal ghrelin and pancreatic peptide YY (PYY) levels at three years postpartum, independent of other risk factors for metabolic disease, according to a study published in the April issue of Diabetes.

Young women who are subject to controlling behaviors from a partner and suffering from physical and sexual relationship violence (RV) are more reticent about screening for RV, according to a study published in the April issue of the Archives of Pediatrics & Adolescent Medicine.

Intrauterine devices (IUDs) can be a safe, effective, and relatively easy birth control option. However, pregnancy can occur if the IUD dislodges or is not placed properly. Dr Elysia Moschos, associate professor of obstetrics and gynecology, and Dr Diane M. Twickler, professor of radiology, at the University of Texas Southwestern Medical Center in Dallas, studied ultrasound findings, clinical symptoms, and outcomes for women with first-trimester pregnancies despite having intrauterine devices to better understand this issue.

A recent video segment on ABC News (see embedded video) addresses the growing rate of placenta accreta. The accompanying article with the jarring headline, "Placenta Accreta: Multiple C-Sections Can Kill Mother," reports that doctors are attributing the rise in this condition (from 1 in 30,000 pregnancies in the 1950s and 1960s to 1 in 2500 pregnancies in 2007, according to a report in AJOG) to the increased number of cesarean births. The article goes on to describe more reasons for the growing incidence of cesarean delivery, including diabetes, preeclampsia, and advanced maternal age, under the heading "More Women Demand Caesarians."Not surprisingly, the article has readers in a tizzy over when, exactly, a cesarean delivery is needed . . . and has them pointing fingers regarding who is to blame for the increased rate of this surgery.

March 9, 2010 a 46 year old woman came to me having been told that she needs a hysterectomy because of heavy bleeding from her fibroid. She wanted to know her options. Ultrasound showed a tennis ball size fibroid that was 2/3 in the uterine wall and 1/3 in the cavity of the uterus.

Teen birth rates in the United States have declined over the last two decades, but they remain high, according a Vital Signs report in the April 5 early-release issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

An individualized screen evaluating epithelial cells from women's breast milk may provide insight into breast cancer risk, according to research presented at the annual meeting of the American Association for Cancer Research, held April 2 to 6 in Orlando, Fla.

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

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

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

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

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

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

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

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

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

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

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

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