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WHEC
WOMEN'S HEALTH AND EDUCATION CENTER

Premenstrual Disorders

September 23, 2009

Premenstrual physical and mood symptoms are common among reproductive-age women, but diagnostic criteria and treatment strategies to recognize premenstrual disorders are not always clearly understood. The purpose of this document to examine the evidence for commonly used approaches in the treatment of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Until recently, the difficulty in managing PMS / PMDD was largely attributed to imprecise diagnostic criteria, poorly designed clinical trials, and promotion of treatment options for which there was no scientific support. In the mid-1980s, however, rigorous criteria for the diagnosis of PMS / PMDD were defined. Since then, most studies of pathophysiology and treatment have met recognized standards of scientific design. Selective serotonin reuptake inhibitors (SSRIs) are found to be effective in treating PMS / PMDD symptoms and many other treatment options are discussed.

Overview of Obstetric Anesthesia Professional Liability

September 30, 2009

Nearly in two decades, a review of liability associated with obstetric anesthesia using the American Society of Anesthesiologists (ASA) Closed Claim database found that, although awards to plaintiffs were higher in obstetric claims from the 1970s and 1980s, there were more claims for minor complications in obstetric compared to non-obstetric claims. The most common complications in obstetric claims were newborn death or brain damage (29%) and maternal death (22%). Over the past three decades, there have been numerous changes in the practice of anesthesiology in general and in the practice of obstetric anesthesia specifically. Specifically explored are the contribution of newborn death and brain damage compared to maternal death and brain damage to obstetric anesthesia liability in 1990 or later claims. This review should spur us to examine and change our practices to minimize both patient harm and our liability when we are not at fault. Only closed claim analyses can help us understand the conditions under which fatal and non-fatal injuries lead to litigation.

Ultrasound Screening of Neural Tube Defects

October 19, 2009

The prevalence of congenital anomalies of the central nervous system varies in different epidemiologic studies, mostly as a consequence of the type of ascertainment and the length of follow up. The clinical role of sonographic biometry of the fetal cranium is well established. Biparietal diameter, head circumference, and transverse cerebellar diameter are currently used for assessing gestational age and fetal growth and identifying cranial abnormalities. Anencephaly and spina bifida comprise the majority of neural tube defects. In the 20 plus years since maternal serum alpha-fetoprotein (MSAFP) was recommended in United States for the general population, significant changes in the use of ultrasound and better understanding of the factors that place a woman at increased risk of bearing a child with spina bifida (and thus a candidate for diagnostic testing and not screening) have changed the utility of MSAFP screening. Amniotic fluid evaluation of alpha-fetoprotein and the role of fetal surgery for neural tube defects (NTDs) are also discussed.

Pathogenesis of Cervical Adenocarcinoma

December 2, 2009

The purpose of this document is to review cytological screening, DNA testing procedures and pathological features of glandular cells abnormalities. Consensus guidelines are available for the management of women with cervical cytological abnormalities and cervical cancer precursors. These evidence-based guidelines were developed in 2001 by an expert consensus conference sponsored by the American Society for Colposcopy and Cervical Pathology. Vaccines are currently being developed to reduce susceptibility to HPV infection and persistent infection. Widespread acceptance of these vaccines should significantly reduce the incidence of HPV-associated disease, thereby alleviating a significant fraction of morbidity associated with HPV infections.

Domestic Violence Programs: Understanding the Restraining Order Process

November 14, 2017

Domestic violence is one of the most serious public health problems in the United States (U.S.). More than 27.3% of women and 11.5% of men 18 years of age and older have a lifetime history of spousal abuse, battering, or intimate partner violence. In many states in the U.S., the weighted lifetime prevalence of domestic violence (including rape, physical violence, and/or stalking) is 34.2% among women and 24% among men. Although many of these incidents are relatively minor and consist of pushing, grabbing, and hitting, domestic violence resulted approximately 1,200 deaths in the United States in 2014. One of the difficulties in addressing the problem is that abuse is prevalent in all demographics, regardless of age, ethnicity, race, religious denomination, education, or socioeconomic status and most of the time either unreported or under-reported. This document provides helpful information illustrating the steps necessary to obtain a restraining order, improve your safety, abused person’s rights and domestic violence law enforcement guidelines 2017. High-risk teams build upon the work of risk assessment by providing systematic responses to monitor offenders and enhance safety for victims. Violence can be prevented and should be prevented. Governments, communities and individuals can make a difference. Laws against violence send a clear message to society about unacceptable behavior and legitimize the actions needed to ensure people’s safety at all times. The presence of a gun in a domestic violence situation increases the risk of homicide by 500%. The Women’s Health and Education Center (WHEC) works with its partners to better understand the problem of violence and to prevent it before it begins.

Neonatal Jaundice: Part I

September 17, 2019

Jaundice (hyperbilirubinemia) occurs in most newborns. Jaundice is benign in most newborns, but because of potential toxicity of bilirubin, newborns must be monitored to identify those who might develop severe hyperbilirubinemia, and in rare cases, acute bilirubin encephalopathy or kernicterus. Based on a consensus of expert opinion and review of available evidence, universal pre-discharge bilirubin screening is recommended. This can be accomplished by measuring the total serum bilirubin level (ideally at the time of routine metabolic screening) or transcutaneous bilirubin level and plotting the result on an hour-specific nomogram to determine the risk of subsequent hyperbilirubinemia that will require treatment. If an infant is discharged before 24 hours postnatal age, the bilirubin should be rechecked within 48 hours. These guidelines provide a framework for the prevention and management of hyperbilirubinemia in newborn infants of 35 or more weeks of gestation. Kernicterus in detail is discussed in Neonatal Jaundice: Part II. In every infant, the Women’s Health and Education Center (WHEC) recommends that clinicians: 1) Promote and support successful breastfeeding; 2) Perform a systematic assessment before discharge for the risk of severe bilirubinemia; 3) Provide early and focused follow-up based on the risk assessment; and when indicated 4)Treat newborns with phototherapy or exchange transfusion to prevent the development of severe hyperbilirubinemia, and possibly bilirubin encephalopathy (kernicterus).

Lower Urinary Tract Infections

February 9, 2009

Women are prone to urinary infections, especially before puberty and after the menopause. The main effect of infection on vesicourethral function is that 25% of the patients have uninhibited detrusor contractions with associated urethral relaxation. E. coli endotoxin causes these findings in many patients. In many patients urethral striated sphincteric spasm results, creating a vicious cycle of retention, obstructed voiding and repeated infection. The treatment is elimination of the infection by antimicrobial agents. Prevention of recurrent urinary tract infections is vital.

Eating Disorders

March 3, 2009

It has been estimated that the prevalence of anorexia nervosa is 0.5% in high school and college-aged women and that 1% to 3% of young women meet criteria for the diagnosis of bulimia nervosa. In addition, many more women display evidence of milder forms of eating disorder behaviors. The first step in detecting the onset of an eating disorder is to be familiar with the diagnostic criteria for the major types of eating disorders, including: anorexia nervosa — identified most simply by significant weight loss and a decrease in nutritional input; bulimia nervosa — marked by binge and purge behavior with or without weight loss; and eating disorder not otherwise specified — which is a category that includes patients with eating disorder behaviors and thoughts who do not meet all of the official criteria of anorexia nervosa or bulimia nervosa. Early detection and management of eating disorders are key factors in improving the course and outcome of the illness. The roles of the individual practitioner in the initial stages of management are to detect the presence of the eating disorder, to perform the initial evaluation, and to refer the patient to appropriate level of care. Coordination with the patient’s family, primary care physician, nutritionist, and / or mental health provider is often necessary.

Thyroid Disease in Pregnancy

June 8, 2009

Thyroid disease is the second most common endocrine disease affecting women of reproductive age; obstetricians often care for patients who have been previously diagnosed with alterations in thyroid gland function. In addition both hyperthyroidism and hypothyroidism may initially manifest during pregnancy. The interactions between pregnancy and the thyroid gland are fascinating from at least three aspects: pregnancy induces increased thyroid-binding globulin, intimate relationship between maternal and fetal thyroid function, and a number of related abnormal pregnancy and thyroid conditions that at least appear to interact. The purpose of this document is to review the thyroid-related patho-physiologic changes created by pregnancy, and the maternal-fetal impact of thyroid disease.