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WHEC
WOMEN'S HEALTH AND EDUCATION CENTER

Postpartum Psychiatric Disorders

February 20, 2009

Despite societal expectations that having a baby should be a completely joyful experience, many women are ambivalent about the birth experience. Some women are not prepared for the postpartum blues, nor are they aware of the risk of postpartum depression or psychosis. Women who unexpectedly develop postpartum blues may find her experiencing guilt, concern, or fear that having the baby was a mistake. These fears may worsen if the women’s partner is not supportive and if there are no close relatives or friends to give emotional and physical assistance after delivery. The purpose of this document is to discuss the postpartum psychiatric disorders and to help primary care physicians to recognize and manage the emotional and psychiatric problems that can occur in the postpartum period.

Cancer, Sexual Health & Intimacy

June 24, 2009

Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. As patients move away from the acute phase of illness, healthy sexual functioning is an important step toward re-establishing their sense of well-being. Several physiologic and psychological factors specific to oncology patients (e.g. advanced disease, radical surgery, pelvic irradiation, symptoms related to menopause, pre-morbid sexual dysfunction, and negative self-concept) can promote sexual morbidity. These issues may place cancer survivors at increased risk for the development of sexual problems.

Antepartum Fetal Surveillance

August 6, 2009

The goal of antepartum fetal surveillance is to prevent fetal death. Several antepartum fetal surveillance techniques or tests are in use. These include fetal movement assessment, non-stress test (NST), contraction stress test (CST), biophysical profile (BPP), and umbilical artery Doppler velocimetry. Antepartum fetal surveillance techniques are now routinely used to assess the risk of fetal death in pregnancies complicated by preexisting maternal conditions, as well as those in which complications have developed. Identification of suspected fetal compromise provides the opportunity to intervene before progressive metabolic acidosis can lead to fetal death. Identification of suspected fetal compromise provides the opportunity to intervene before progressive metabolic acidosis can lead to fetal death. In both animals and humans, fetal heart rate pattern, level of activity, and degree of muscular tone are sensitive to hypoxemia and academia. Recent, normal antepartum fetal test results should not preclude the use of intrapartum fetal monitoring.

Renal Disorders and Pregnancy

September 10, 2009

Among the various physiologic alterations that occur in normal pregnancy, few are as striking as those affecting the urinary tract. Changes in the urinary tract during normal pregnancy are so marked that norms in the nonpregnant cannot be used for obstetric management. Awareness of all alterations is essential if kidney problems in pregnancy are to be suspected or detected and then handled correctly. Most women with mild to moderate renal disease tolerate pregnancy well and have a successful obstetric outcome without adverse effect on the natural history of the underlying renal lesion. Crucial determinants are renal functional status at conception, the presence or absence of hypertension, and the type of renal disease.

Dysfunctional Uterine Bleeding

September 23, 2009

Dysfunctional uterine bleeding (DUB) is abnormal bleeding from the uterine endometrium that is unrelated to an anatomic lesion of the uterus. The purpose of this document is to provide management guidelines for the treatment of patients with menstrual irregularities associated with anovulation based on the best available evidence. Dysfunctional uterine bleeding anovulatory type is the most common form of non-cyclic uterine bleeding and it is a condition for which women frequently seek gynecologic care and accounts for considerable patient anxiety and inconvenience. The choice of treatment for anovulatory bleeding depends on several factors, including the woman’s age, the severity of her bleeding, and her desire for fertility. Over the last decade, significant advances have been made in the evaluation and management of women with anovulatory bleeding.

Obesity and Anesthesia

September 30, 2009

The worldwide prevalence of obesity has increased substantially over the past few decades. Economic, technologic, and life style changes have created an abundance of cheap, high-calorie food coupled with decreased required physical activity. The purpose of this document is to review pathophysiology of obesity and challenges it poses for obstetrical anesthesia. The incidence of maternal obesity and its attendant comorbid conditions (diabetes, cardiovascular disease) continues to increase at an alarming rate, with major public health implications. Obese patients should be counseled before labor, advising them what intrapartum complications to anticipate. This also includes an anesthesia consult, especially to evaluate the airway.

United Nations: Commission on the Status of Women

October 14, 2009

Economic and Social Council One of its missions is, to achieve for women: gender equality, development and peace for the 20th century. Trafficking of women and girls for the purpose of prostitution is one of the fastest growing areas of international criminal activity. Over 1,200,000 persons (the number may as high as 4 million), especially […]

Migration of Physicians and Nurses: Trends & Policies

December 7, 2009

Migrant health workers are faced with a set of options that are a combination of economic, social and psychological factors and family choices. They trade decisions related to their career opportunities and to financial security for their families against the psychological and social costs of leaving their country, family and friends. In both the countries of origin and the receiving countries, consumers of health services have similar concerns. Continuing Medical Education (CME) Initiatives can be of benefit to donor, and recipient countries both.

Doppler Ultrasonography in Obstetrics

January 26, 2011

The advent of sonography has changed the practice of obstetrics by providing a window to the womb through which the anatomic structure of the fetus can be evaluated. The addition of Doppler flow studies of maternal and fetal vessels has provided a tool where the physiology of the maternal-fetal unit can be assessed. This information can provide the physician and the patient with vital information for a subsequent approach to the pregnancy. The use of fetal Doppler blood flow studies has become common in the evaluation and management of pregnancies complicated by conditions such as suspected fetal growth restriction and red blood cell isoimmunization to guide intrauterine therapy and delivery. The most commonly assessed Doppler flow studies of the fetus are the umbilical artery and middle cerebral artery (MCA). Doppler flow studies of MCA are used in the assessment of the fetus at risk of anemia and growth restricted fetus.

Preventing Mother-to-Child Human Immunodeficiency Virus Transmission

January 9, 2012

Human immunodeficiency virus (HIV) is a scourge which continues to fatally wound the physical, cultural, social, economic, political, and spiritual health achievements, hopes and aspirations of individuals, families, communities and nations. This review describes the utility of antenatal surveillance for monitoring and evaluating prevention of mother-to-child HIV transmission programs in resource limited countries and generalized HIV epidemics. Population-based data sources regarding the incidence and morbidity that are associated with perinatal HIV infection are improving and indicate that prevention efforts have been enormously successful. There have been major advances with the prevention of mother-to-child HIV transmission, and this review summarizes the successes and current challenges and provides suggestions for future directions. Viewing preventing the mother-to-child transmission as a gateway to family-based HIV care and treatment will help strengthen ties between these programs. Site-specific interventions to increase the uptake of prevention of mother-to-child transmission programs based on experiences in sub-Saharan Africa are discussed. Lessons learned can apply to many resource-constrained settings.