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WHEC
WOMEN'S HEALTH AND EDUCATION CENTER

Ultrasound Evaluation of Fetal Growth

October 19, 2009

A number of interventions are available to reduce morbidity and mortality in fetuses with intrauterine growth restriction (IUGR); but these can only be implemented appropriately with timely diagnosis and monitoring. Prenatal diagnosis of these conditions can aid in decision making concerning the timing and route of delivery, thereby reducing perinatal risk. Regulation of fetal growth is multifactorial and complex. Optimal fetal development depends on genetically predetermined growth potential, and is modulated by fetal, maternal, placental, and environmental factors. The role of Doppler ultrasonography is also discussed. Abnormally small fetuses as a group have a relatively poor prognosis because some of the causes of subnormal size, such as inadequate supply of oxygen and nutrients through the placenta, chromosomal anomalies, and infections, adversely affect fetal outcome. Disturbances of fetal growth — intrauterine growth restriction (IUGR) and macrosomia — are associated with increased risk of perinatal morbidity and mortality. Prenatal diagnosis of these conditions can aid in decision making concerning the timing and route of delivery, thereby reducing perinatal risk.

Value of Cervical Cytology: Cervical Dysplasia & HPV

December 2, 2009

Dysplasia or cervical intraepithelial neoplasia (CIN) means disordered growth and development of the epithelial lining of the cervix. Although cervical cancer was the leading cause of cancer death in USA in 1930s, both the incidence and mortality from cervical cancer have decreased by almost one half since the early 1970s, largely as a result of widespread screening with the Pap-test. New technology for performing cervical cytology is evolving rapidly, as are recommendations for classifying and interpreting the results. In USA cervical cancer is the third most common gynecologic malignancy and in countries where cytologic screening is not widely available, cervical cancer remains common. Cervical cytology screening programs have markedly reduced the cervical cancer incidence in the communities. The purpose of this document is to provide a review of the best available evidence on screening of cervical cancer.

Newborn Male Circumcision

June 4, 2019

Newborn male circumcision is a surgical procedure to remove the foreskin, the skin that covers the tip of the penis. In the United States, a large percentage of male newborns are circumcised. Although circumcision has known medical benefits, the procedure generally is performed for family, religious, or cultural reasons. Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision. However, these data are not sufficient to recommend routine neonatal circumcision. Circumcision is a safe and straightforward procedure but has its risks and potential complications. In the United States, it is often done before a new baby leaves the hospital. Possible benefits include a lower risk of urinary tract infections, penile cancer, and sexually transmitted diseases. There is a low risk of bleeding or infection. The baby might also feel some pain. The Women’s Health and Education Center (WHEC) recommends that parents should discuss circumcision with their baby’s healthcare provider. The World Health Organization’s (WHO’s) program for male circumcision and HIV prevention is also discussed. Parents should make their decision based on the benefits and risks, as well as their own religious, cultural, and personal preferences. As with most surgeries, the best outcomes are achieved by practitioners who are well trained, who perform the procedure under supervision until their experience is sufficient, and who follow correct protocol during the entire operation.

Medical Management of Voiding Dysfunctions

February 9, 2009

Recent advances in the understanding of the neurology and neuro-pharmacology of the lower urinary tract indicate that a multiplicity of different types of drugs influence the physiological activity of the bladder and urethra. Although behavior modification improves or cures most patients with detrusor instability, pharmacologic therapy remains the most popular mode of treatment. In women between the ages of 15 to 60 years, the prevalence of voiding dysfunction is about 5-25%. 12 to 38% of women are over the age of 60. 69% of women are over the age of 18 with the symptoms of urinary incontinence, and the incidence of urge incontinence among this group is about 46%. Because the cause of detrusor instability is unknown, the response to treatment is often unpredictable and the side effects are common with effective doses. In general, drugs improve detrusor instability by inhibiting the contractile activity of the bladder.

Mental Health Promotion in Schools

February 20, 2009

When people think of mental health, a negative picture of madness or depression tends to come to mind. However, just as physical health creates an image of strength and vitality, mental health should be associated with strength of mind and vitality in the way that individuals interact with others and as they deal with the challenges of everyday life. Life skills education in schools enables children to protect and promote their own health and well-being. They must have the opportunity to practice such skills in the classroom as well as in homework assignments. Teaching methods therefore need to be interactive for learning such skills, rather than just acquiring knowledge.

Fetal Alcohol Syndrome: Recognition & Prevention

June 8, 2009

Maternal alcohol abuse is associated with impaired fetal growth; virtually all neonates with fetal alcohol syndrome (FAS) will exhibit significant growth restriction. The physicians should counsel patients presenting with drug or alcohol problems and refer them to an appropriate treatment resource when available. Physicians who detect the serious medical condition of addiction (drugs and/or alcohol) are obligated to intervene during pregnancy or Preconceptional counseling. On the one hand, no person has a right to use illegal drugs, and a pregnant woman has a moral obligation to avoid use of both illicit drugs and alcohol in order to safeguard the welfare of her fetus. On the other hand, effective intervention with respect to substance and alcohol abuse by a pregnant or a non-pregnant woman requires that a climate of respect and trust exist within the physician-patient relationship. Patients who begin to disclose behaviors that are stigmatized by society may be harmed if they feel that their trust is met with disrespect.

Staging & Surgical Management of Ovarian Cancer

June 24, 2009

Ovarian cancer remains the most lethal of gynecologic malignancies, and its mortality exceeds the combined mortality from both cervical and endometrial cancer in the United States. Ovarian malignancy is the fourth most common cause of cancer death in American women and accounts for 5% of all cancer deaths. Insightful overview of the current understanding of the ovarian malignancy as well as the areas of continuing challenges are also discussed in this series of the articles exploring different aspects of ovarian cancer. While therapy for ovarian malignancy has undergone important progress, there is growing concern about the quality of life of these patients. The contributors to this symposium include many of the experts who have advanced the management of this disease, and their articles thoughtfully describe the progress and point to future areas of reproductive research.

Genital Herpes Simplex Virus Infection during Pregnancy

August 5, 2009

Herpes simplex virus (HSV) infection of the genital tract is one of the most common viral sexually transmitted diseases (STDs). Approximately 45 million adolescent and adult Americans have been infected with genital herpes based on positive serology test results for HSV-2 and estimates of genital HSV-1 infection. About 30% of the female population in the United States has antibodies to HSV-2. The purpose of this document is to define the stages of herpetic infection, outline the spectrum of maternal and neonatal infection and provide the management guidelines.

Guidelines for Performance of the Obstetric Ultrasound

August 5, 2009

The purpose of this document is to present evidence regarding methodology, indications, benefits, and risks of obstetric ultrasonography in specific clinical situations. Sections of the document addressing physician qualifications and responsibilities, documentation, quality control, infection control and patient education are the recommendations of Women’s Health and Education Center (WHEC). We are hopeful that this text will serve two purposes: to educate and to intrigue. Through the education process of the healthcare providers will help alleviate errors in diagnosis. Casual use of ultrasonography, especially during pregnancy, should be avoided. Before an ultrasound examination is performed, patients should be counseled about the limitations of ultrasonography for diagnosis.