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Are you pregnant and considering, or undecided, about having prenatal chromosomal testing done? Here’s some thoughtful advice that may help in your decision making.
1. What is the advantage of prenatal testing?
- Early detection of Down's Syndrome is the primary advantage of prenatal testing, as it is the most common chromosomal abnormality among live births.
2. What factors increase my risks for chromosomal abnormalities?
- Certain family history/medical history of chromosomal abnormalities, and advance maternal age, may put a patient at a higher risk for a chromosomal abnormalities. Nonetheless, all pregnant women, despite a known family/medical history of chromosomal abnormalities, or advanced maternal age, should be offered chromosomal aneuploidy screening before 20 weeks gestation.
The flu season is definitely among us, with January being the peak season for influenza outbreaks. The CDC has predicted a more severe 2014-2015 flu season this year, with 91% of influenza infections thus far being due to the H3N2 virus. Unfortunately, because of the guesswork involved in manufacturer’s development of the upcoming year’s vaccine strains, this year’s flu vaccine has only a 48% match to the H3N2 viral strain. Nonetheless, flu illness does appear to be less severe in those having received the vaccine. Of particularly grave significance, is the prevention of the flu in pregnant women. Pregnancy infers particularly high risks for the development of severe illness in mothers to be. Pregnancy related changes in our immune systems make pregnant women at higher risk for developing severe complications of the flu, such as pneumonia, respiratory distress and even death. In the 2009 pandemic of the H1N1 influenza virus, 5% of deaths occurred in pregnant women, though pregnant women accounted for only 1% of the U.S. population. The CDC and ACOG strongly advise pregnant women to receive the flu vaccine, noting its safety in all trimesters of pregnancy.
If you’re pregnant, be sure to get your flu vaccine. The most common symptoms of the flu are fever, cough, nasal congestion, sore throat, headache, shortness of breath and muscle aches. Be sure to contact your health care provider if you’re experiencing any symptoms of the flu.
Suzanne Hall, MD Ob/Gyn (@drsuzyyhall)
Eastside Gynecology Obstetrics, PC
Macomb, Roseville, Grosse Pointe, Rochester, MI
In modern obstetrics, there is a growing trend in expecting mothers’ request for ‘elective’ Cesarean section (‘Cesarean Section on Maternal Request’.) This ‘elective’ cesarean delivery, is a maternal request for Cesarean section delivery, in the absence of any maternal or fetal need (nor medical indication) for Cesarean section birth. (This particular ‘request’ for Cesarean section refers to a maternal request for a first-time Cesarean delivery… not a request for a repeat Cesarean birth, as in the case of a mother with previous Cesarean Section deliveries.) In the U.S. 2.5% of births are performed by Cesarean section for this request. In my experience, concern and anxiety regarding pain in labor seem to represent the most common reason for this request.
Understandably, for many persons, a new diagnosis of genital herpes may lead to feelings of shock, shame, guilt or embarrassment. Often times, patients are unaware of how common this virus is among the general population. Some studies have shown up to 1 in 5 of sexually active people have been infected with the Herpes virus, whether they’re aware of it or not.
Genital herpes is a treatable condition. Aside from being sexually transmitted, much of the negative stigma around this infection seems to come from the fact that you don’t ‘get rid of’ it, and that recurrences can happen. Herpes is a viral infection (like HPV,) and though the symptoms (a cold sore in the case of oral herpes, or a genital sore in the case of genital herpes) can be treated, the virus itself remains present in our blood stream indefinitely. Even in its dormant state (no symptoms present,) the virus remains detectable by blood test, and can lead to partner-to-partner spread of infection (from asymptomatic shedding of the virus) when no detectable ‘sore’ is present. Gonorrhea and chlamydia, different from the Herpes virus and HPV, are bacteria or bacterial-like infections that are cured with treatment, with no detectable bacteria remaining after adequate therapy (unless the individual is ‘re-infected’.)
Though a diagnosis of genital herpes can be an embarrassing nuisance, it’s actually a newborn baby who’s at the most serious risks from a genital herpes infection. A newborn baby infected with genital herpes is at risk for multi-organ infection, that can be fatal if left untreated. If you are pregnant, with a known history of genital herpes, it’s important to let your healthcare providers know that information. Certain measures (anti-viral medications in the last month of your pregnancy, and performing a Cesarean section if active lesions are present at the time of labor) should be taken, to decrease the risk of spread of infection to your newborn baby.
Is this Depression or PMS? According to ACOG, "Depression and anxiety disorders are the most common conditions that overlap with PMS. About one half of women seeking treatment for PMS have one of these disorders. The symptoms of depression and anxiety are much like the emotional symptoms of PMS. Women with depression, however, often have symptoms that are present all month long. These symptoms may worsen before or during their periods. Your health care provider will want to find out whether you have one of these conditions if you are having PMS symptoms." (posted 7/9/13 by @drsuzyyhall)
Breast/Nipple Discharge? Though most cases of nipple discharge (especially occurring with stimulation or expression of the breast) are benign (non-cancerous), an evaluation/exam by your doctor is usually warranted. (posted 5/28/13 by @drsuzyyhall)
Low Libido? Studies have shown Testosterone supplementation to be effective in treating low libido in menopausal women. While Estrogen Therapy may not directly effect libido, it does promote increased vaginal lubrication, improving vaginal pain with sex. Testosterone supplements are not approved by the FDA for treatment in women. Speak with your healthcare provider regarding safety concerns. (posted 4/3/13 by @drsuzyyhall.)
As an Ob/Gyn physician, it’s not uncommon for me to hear the question from patients, “Am I actually ABLE to conceive?” For some women who are planning pregnancy, as well as for some others who’ve never had a pregnancy (intended or not)…the question, “Can I get pregnant?” may be a looming concern.
Other than actually attaining a ‘positive’ pregnancy test, there really is no other specific test allowing us to know IF a woman CAN actually achieve pregnancy. What we do know is, that for the normal couple (those without risk factors/or a history of infertility, regularly sexually active,) the chances of conception are actually stacked in our favor. In fact, for regularly sexually active couples, there is a 15-25% probability of pregnancy with each menstrual cycle!
It is expected that nearly 90% of sexually active couples, without contraception, would become pregnant (intentionally or not) within one year. The one year mark is typically used in defining those couples with ‘infertility’…the inability to become pregnant, despite frequent, unprotected sex within one year. An infertility evaluation by your health care provider may be initiated at this time, and even earlier (at 6 months) for those women over 35.
Suzanne Hall, MD (@drsuzyyhall)
Eastside Gynecology Obstetrics
An exciting time for expecting parents is the first sensation of fetal movement, medically termed ‘quickening’. Though fetal movement can be seen by ultrasound as early as the first trimester, the perceived, physical sensation of fetal movement generally occurs by around the 20th week of the pregnancy. This sensation of fetal movement may vary among women, and among different pregnancies. Some first-time moms may not perceive this movement until up to 22nd-24th week of pregnancy, while others may recognize the sensation of movement as early as 16-18 weeks.
This sensation of early fetal movement has been described as feeling like the fluttering of a butterfly, a tickling, or a light tap. The differences in the timing of your perception of fetal movement may be based fetal/placental location, or the anatomy of your abdominal wall. Initially, it may be hard to distinguish these movements from a feeling of gas or a hunger pang. But once you recognize the sensation as fetal movement, you’ll most likely be reassured and happy with your baby’s activity!
What is a Certified Nurse-Midwife?
More and more women in the US are choosing a certified nurse-midwife (CNM) for their pregnancy, birth, postpartum, and well-woman care. Certified Nurse Midwives are licensed health care providers educated in nursing and midwifery. They have master’s degrees in nursing, certified by the American Midwifery Certification Board, and are licensed to practice midwifery in the state of Michigan. National statistics show that in 2009 CNMs attended 11.9% of vaginal births, an all time-high. This trend has been discussed in newspapers such as the New York Times and in movies such as The Business of Being Born. As a leader and innovator in women’s health care, Eastside Gynecology and Obstetrics has committed to bring midwifery services to their clients, the only practice that does so in the area.
The midwives at Eastside Gyn/OB provide personalized, individualized care. We nurture each mother and her family with sensitive, holistic care. Our clients love that they get to know the person who will be taking care of them for their birth. We also have a commitment to promoting physiologic labor and birth, believing that labor works best when allowed to begin in its own time and progress at its own pace. At the same time, we are trained to recognize those situations where intervention is warranted and have the benefit of a close and supportive working relationship with the physicians in the practice when referral or consultation is needed. As midwives, we aspire for you to have the birth experience that you desire. We promote mother-infant bonding immediately after birth, delayed cord clamping, breastfeeding, and childbirth classes such as hypnobirthing. We also desire for each birth to be a family experience for all who wish to be involved.
Did you know that up to 10-15% of pregnancies are affected by hypertension? About 5% of those cases are in women previously known to have hypertension (termed ‘chronic hypertension’), prior to pregnancy. Another 5-8%, develop hypertension within the pregnancy (termed ‘gestational hypertension’ or ‘pregnancy-induced hypertension’.)
Hypertensive disorders are characterized by blood pressures consistently ranging 140/90 or greater. Women with chronic hypertension (existing before pregnancy, or diagnosed before 20 weeks of gestation) may require blood pressure medications to control their blood pressure, even throughout the pregnancy. Those medications should be reviewed with your healthcare provider, to assess their safety in pregnancy, even before conception.
If anyone should know the concerns of choosing pregnancy and childbirth later in life, as an Ob-Gyn physician, having given birth to my first child at 39 yo, I should think I’d be one of them. With my training and experience as an Ob-Gyn physician, I was fully aware of my risks in deciding on childbirth…as a woman of ‘advanced maternal age’. I counsel women on their risks nearly every day.
I already knew that at my age, it may take longer for me to get pregnant. I knew that advancing age is associated with subfertility (prolongation in time to achieve conception,) and I knew this to be related to altered/changing hormonal patterns as we age, leading to suboptimal ovulation. I already knew that there is decreased ovarian reserve (fewer fertilizable eggs remaining in our ovaries) as we age. I also knew that advancing age was associated with a higher risk of miscarriage, most likely related to the poorer quality of aging eggs, and the increased chances of fertilizing an egg containing abnormal chromosomal material...
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Suzanne Hall, MD (@drsuzyyhall)