enruarzh-hansfres en
enruarzh-hansfres en
WHEC
WOMEN'S HEALTH AND EDUCATION CENTER

Update on Colposcopic Terminology

September 19, 2012

The purpose of this document is review new colposcopy terminology and its implementation for diagnosis, treatment, and research. This document has been expanded to include terminology of both cervix and vagina. The current nomenclature committee is the first that presents and International Federation of Cervical Pathology and Colposcopy (IFCPC) terminology dedicated to colposcopy of the vagina. Various human papillomas virus (HPV) lesions and intraepithelial neoplasia may occur in the vagina as a primary lesion or in continuum with cervical intraepithelial neoplasia. The popular terms “satisfactory colposcopy” and “unsatisfactory colposcopy” have been replaced. The colposcopic examination should be assessed for three variables: 1) adequate or inadequate, with the reason given; 2) squamo-columnar junction visibility; 3) transformation zone type. Other additions were the localization of the lesion to either inside or outside the transformation zone and determinants of size as well as location of cervical lesions. Two new signs are included in the terminology – the “inner border sign” and “ridge sign”.

The Obstetric Fistula in the Developing World

January 16, 2013

Worldwide obstructed labor occurs in an estimated 5% of live births and accounts for 8% of maternal deaths. Obstetric fistula are predominately caused by a very long, or obstructed, labor which can last several days or even sometimes, over a week before the women receives obstetric care or dies. Globally, over 300 million women currently suffer from short- or long-term complications arising from pregnancy or childbirth, with around 20 million new cases arising every year. This review provides essential, factual background information along with guiding principles for clinical management and program development. We hope to contribute to the development of more effective services for women under treatment for fistula repair. We hope our efforts advance effective programs for eliminating obstetric fistula. Most of all, however, we hope that the contents will motivate future research that will further enhance the understanding of reproductive health.

Sudden Infant Death Syndrome

September 23, 2019

Significant new information has been forthcoming in recent decades on sudden infant death and apnea during early infancy. Sudden Infant Death Syndrome (SIDS) also known as Sudden Unexpected Infant Death (SUID) and Sudden Unexpected Death in Infancy (SUDI), are the terms used to describe unexpected death of an infant less than 12 months of age. The cause of death that cannot be explained after thorough investigation, death scene examination, and review of clinical history. Back-to-Sleep position for every sleep time campaign, has helped educate millions of caregivers, parents, grandparents, aunts, uncles, babysitters, childcare providers, health care providers, and others, about ways to reduce the risk to reduce SIDS and other sleep-related causes of infant death. Tummy Time describes the times when you place your baby on his or her stomach while your baby is awake and while someone is watching. Tummy Time is important. Newborn safety should be routinely taught in obstetrics curricula, and the Women’s Health and Education Center (WHEC) has partnered with the United Nations (UN) and the World Health Organization (WHO), to disseminate updated literature and guidelines to health care providers regarding newborn safety.

Pelvic Floor Muscle Rehabilitation

February 9, 2009

Pregnancy and vaginal delivery have been considered main risk factors in the development of pelvic floor disorders and in the development of stress urinary incontinence. Urinary incontinence alone represents a $ 26 billion economic burden. There appears to be an increase in demand for care of these disorders that is disproportionate to the net growth of the population. In order to restore function of the pelvic floor muscles after childbirth, women in most industrialized countries have been encouraged to perform pelvic floor muscle exercises. Postpartum pelvic floor muscle training has been demonstrated to be effective in the prevention and treatment of stress urinary incontinence in the immediate postpartum period. Many education techniques have been described, and physiotherapists skilled in uro-gynecology frequently use pelvic floor exercises, biofeedback, and electrostimulation techniques.

Crisis Intervention In Office Practice

February 20, 2009

Crisis intervention provides a theory and treatment model that can be readily applied to helping patients with their psycho-social problems. Patients entering crisis treatment should expect that they will be treated immediately and recover from crisis. Patients can be treated while living in their natural environment, and should be able to return to normal life as soon as possible.  Mental health is a low priority in most countries around the world. Minimal research and resources have been invested in mental health at the national level. The document encourages mental health policy-makers to shift the responsibility to the primary care sector. Although professional training in mental health for primary care workers exists in many countries, it is not rigorously evaluated.

Group B Streptococci Perinatal Infections: A Comprehensive Review

March 12, 2009

Group B streptococci (GBS) emerged dramatically in the 1970s as the leading cause of neonatal infection and as an important cause of maternal uterine infection. In 2002, new national guidelines were released recommending: 1) solely a screen-based prevention strategy, 2) a new algorithm for patients with penicillin allergy, and 3) more specific practices in certain clinical scenarios. In the pre-prevention era, active surveillance for invasive neonatal GBS disease estimated that approximately 6,100 early-onset cases and 1,400 late-onset cases occurred annually in the United States.  The purpose of this document is to address clinical issues of group B streptococci (GBS) perinatal infection, implementation of new diagnostic techniques, management of preterm rupture of membranes, use of alternative antibiotic approaches, improvement of compliance, prevention of low birth-weight infants, emergence of resistant organisms and vaccine development.

Uterine Cancer: Early Detection

June 24, 2009

Each year approximately 36,000 women in the United States are diagnosed with endometrial cancer. There are currently no routine screening techniques for endometrial cancer in the general population. It is predominantly a disease of affluent, obese, postmenopausal women of low parity. Over the last few decades, age-standardized incidence rates have risen in most countries and in urban populations. Developing countries and Japan have incidence rates four to five times lower than western industrialized nations, with the lowest rates being in India and south Asia. There are currently no routine screening techniques for endometrial cancer in the general population. The vast majority of women have early-stage disease at diagnosis owing to postmenopausal bleeding. The American Cancer Society (ACS) has recommended that at the time of menopause, the average-risk woman should be informed about the risks for symptoms of endometrial cancer and be strongly encouraged to report any unexpected bleeding or spotting to her gynecologist. When appropriate, genetic counseling and testing should be offered.

Rectovaginal Fistula and Fecal Incontinence

July 23, 2009

Childbirth is increasingly being recognized as commonly injuring the mother’s anal sphincter complex. Fecal incontinence also appears to be associated with urinary incontinence and pelvic organ prolapse. Anal continence does not completely depend on intact sphincters; also important are intact neuromuscular function, including a functioning puborectalis muscle and pudendal nerve. This is supported by the fact that some women with sphincter lacerations remain continent. Anatomical knowledge of the anorectal canal is essential. Complications of anal sphincter laceration include anal incontinence, fecal urgency, perineal pain, and sexual dysfunction. Diagnostic studies, non-invasive therapies, and surgical management have all evolved in recent years. This has resulted in an improving outlook for women with this stigmatizing condition.

Cardiovascular Diseases and Pregnancy

July 30, 2009

The current guidelines to manage cardiovascular diseases affecting pregnancy, and preconception counseling are discussed. The new guidelines for antibiotic prophylaxis for infective endocarditis are also discussed. There is some controversy over the optimal approaches to clinical assessment and treatment of women with cardiac diseases. Management hinges on the severity of cardiac diseases, gestational age and evaluation of relative risks. Additional guidelines on the basis of consensus and expert opinion also are presented. Without accurate diagnosis and appropriate care, heart disease in pregnancy can be a significant cause of maternal mortality and morbidity.

Shoulder Dystocia

August 6, 2009

Shoulder dystocia is most often defined as a delivery that requires additional obstetric maneuvers following failure of gentle downward traction on the fetal head to effect delivery of the shoulders. It is most often an unpredictable and unpreventable obstetric emergency. Failure of the shoulders to deliver spontaneously places both the pregnant woman and fetus at risk for injury. Shoulder dystocia is caused by the impaction of the anterior fetal shoulder behind the maternal pubis symphysis. It also can occur from impaction of the posterior fetal shoulder on the sacral promontory. Several maneuvers to release impacted shoulders have been developed, and they are described below. The purpose of this chapter is to provide clinicians with information regarding management of deliveries at risk for or complicated by shoulder dystocia.