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WHEC
WOMEN'S HEALTH AND EDUCATION CENTER

Neonatal Jaundice: Part II

June 17, 2019

The term kernicterus literally means “yellow kern,” with kern indicating the most commonly afflicted region of the brain (i.e. the nuclear region). Historically, the term refers to an anatomic diagnosis made at autopsy based on a characteristic pattern of staining found in babies who had marked hyperbilirubinemia before they died. This document discusses overview, clinical management and management of kernicterus. Despite the lack of a clear-cut cause-and-effect relationship between kernicterus and the degree of hyperbilirubinemia. Laboratory investigations have demonstrated that bilirubin is neurotoxic at a cellular level. Prevention of hyperbilirubinemia is the best way to minimize the incidence of kernicterus. However, because some babies develop kernicterus with relatively modest bilirubin levels, no known absolute level of bilirubin below which the infant is completely safe is recognized. Additionally, because other factors contribute to the ability of bilirubin to cross the blood-brain barrier, management of these components must be appropriately considered. Any infant at risk for significant hyperbilirubinemia and possible neurotoxicity should be cared for in a nursery capable of rendering appropriate care for the hyperbilirubinemia and any contributing diagnoses. Developmental potential can be maximized by early identification of and intervention for neurologic deficits.

Evaluation of Urinary Incontinence

February 9, 2009

Urinary incontinence can be a symptom of which patients complain, a sign demonstrated on examination, or a condition that can be confirmed by definitive studies. The history and physical examination are the first and most important steps in the evaluation. A preliminary diagnosis can be made with simple office and laboratory tests, with initial therapy based on these findings. For the vast majority of women presenting with complaints of urinary incontinence who have not had prior failed anti-incontinence operations or the history of neurologic disease, the simple evaluation may be all that is needed. With a detailed history, physical examination and the neurologic examination of the lower extremities and perineum, a diagnosis can usually be established accurately in approximately 90% of patients. If complex conditions are present or if surgery is being considered, definitive specialized studies are necessary.

Anxiety and Depression in Women in India

February 20, 2009

Anxiety and depressive disorders are among the most common psychiatric disorders in the community. Both disorders are more common in women according to literature available from developed countries. In this report we will evaluate whether such a trend is also seen in India, and if it is, what could be the possible factors behind it. Before evaluating prevalence figures for a given disorder, it may be necessary to establish that the referents for the disorder are similar to the prototype across cultures as it was widely believed earlier that depression was less common in non- western cultures.

Seizure Disorders and Pregnancy

June 8, 2009

Roughly one out of every 100 pregnancies occurs in a woman with epilepsy. These pregnancies present a unique challenge to obstetricians and neurologists due to the interrelationship of the effects of epilepsy and pregnancy, the variable effects of anti-convulsant medications on mother and fetus, and the changes in pharmacokinetics of these medications during pregnancy. The obstetricians and neurologist should work together prior to conception and throughout the patient’s pregnancy to determine the safest and most effective medical therapy. Furthermore, the pediatrician selected by the patient to care for her baby should be included in pre-pregnancy discussions to address the potential increase in congenital malformations, the potential for neonatal sedation with certain medications, and questions concerning breast-feeding. The purpose of this document is to provide the current information on this issue and to offer practical advice on managing patients.

Ovarian Cancer: Early Detection

June 24, 2009

Although ovarian cancer is the second most common female reproductive cancer, preceded by cancer of the uterus, more women die from ovarian cancer than from cervical and uterine cancers combined. Ovarian cancer remains the most lethal of the gynecologic malignancies. The role of the generalist obstetricians — gynecologists and primary care physicians in early detection of ovarian cancer is also defined in this article. Recommended cancer-screening protocols in women with high-risk is also discussed. Data suggest that currently available screening tests do not appear to be beneficial for screening low-risk, asymptomatic women. An annual gynecologic examination with an annual pelvic examination is recommended for preventive health care. Approximately one in 70 women will develop ovarian cancer in their lifetime. This increases to 4% to 6% if there is a family history in a first-degree relative.

An Overview & Forums On Obstetrical Fistulae

July 23, 2009

Obstetrical fistulae are the most devastating healthcare problem for women globally. In modern obstetrics its existence is negligible, yet each year over half a million women die of complications of pregnancy, childbirth or unsafe abortion. The vast majority of these deaths are in developing countries. For every woman who dies in childbirth, 30 to 50 women suffer injury, infection or disease. About 1 million women in the world suffer from obstetrical fistulae. Pregnancy related complications are among the leading causes of death and disability for women age 15-49 in developing countries. This is not a problem of developing countries only; it is about human beings in distress and pain. THE BEST TREATMENT & MANAGEMENT OF OBSTETRICAL FISTULAE IS PREVENTION.

Perinatal Viral Infections

August 5, 2009

Many viral infections are associated with significant maternal and fetal consequences if acquired during pregnancy. In the United States, some the most commonly encountered infections with subsequent perinatal effects include cytomegalovirus (CMV), parvovirus B19 (fifth disease), varicella zoster virus (VZV). The purpose of this document is to describe these infections, their mode of transmission, and their maternal and fetal effects. Guidelines for counseling about and management of these infections during pregnancy are also discussed. In general, perinatal infections have more severe fetal consequences when they occur early in gestation, because first-trimester infections may disrupt organogenesis. Second and third trimester infections can cause neurologic impairment or growth restriction.

Obesity In The United States

September 23, 2009

Obesity has in fact become so prevalent that the World Health Organization (WHO) has classified it as a global epidemic. The past two decades in particular have seen an explosion of the rates of obesity, especially in the United States. The economic, social and psychological burden of obesity on the individual and on society will continue to grow until the factors contributing to the increasing rates of obesity over the past two decades are identified and addressed. Though this article has focused on how an individual can approach obesity, society needs to develop a plan of action. Encouraging physical activity programs in schools and communities for children, developing cheap, healthful alternatives to fast food, providing better social and psychological support to those struggling with chaotic lifestyles, and redefining work load and the workplace so they are more compatible with maintaining healthy, balanced personal lives may be some strategies to consider.

Epidural Analgesia Failures: The Technique Review

September 30, 2009

The goal of epidural analgesia is to provide satisfactory pain control for labor with the lowest dose of analgesic drugs needed to minimize motor blockage and simultaneously reduce the potential side effects of epidural analgesia during the course of labor. Epidural analgesia offers the most effective form of pain relief and is used by most women in the United States. Uterine contractions and cervical dilatation result in visceral pain (T-10 through L-1). As labor progresses, the descent of the fetal head and subsequent pressure on the pelvic floor, vagina, and perineum generate somatic pain transmitted by the pudendal nerve (S2-S4). Ideally, methods of obstetric pain relief will ameliorate both sources of pain in the patient in labor. Patients with a history of back surgery, especially those who have had spinal instrumentation and fusion to correct scoliosis, have increased rates of epidural failure. Fortunately, in patients with a history of back surgery, epidural analgesia is often successful.