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WHEC
WOMEN'S HEALTH AND EDUCATION CENTER

Thromboembolism in Pregnancy

August 6, 2009

The risk of symptomatic venous thrombosis during pregnancy is between 0.5 and 3.0 per 1,000 women. Pulmonary embolism (PE) is a leading cause of maternal deaths in the United States. During pregnancy women have a five-fold increased risk of venous thromboembolism (VTE), compared to non-pregnant women. The prevalence and severity of this condition warrants consideration of anticoagulant therapy in pregnancy for women at risk for VTE. The purpose of this document is to review the current literature on the prevention and management of thromboembolism in obstetric patients. It offers evidence-based recommendations to address the most clinically relevant issues in the management of these patients.

Pain Relief During Childbirth: A Comprehensive Review

September 30, 2009

The methods of pain relief offered to expectant mothers have increased significantly since the first half of the 20th century. It is fortunate that in this era, pain relief during labor and delivery is an accepted part of the birthing process. The first pain-free childbirth using regional anesthesia was reported in July of 1900. Since then, a firm and dedicated commitment of anesthesiologists and professional societies such as the Society of Obstetric Anesthesia and Perinatology (SOAP) in the last century have led to tremendous advances in regional anesthesia. This has led to the availability of safe pain-free delivery to requesting expectant mothers. More than 2 million mothers used epidural analgesia to deliver their babies in the year 2000. Over 70% of pregnant women at Brigham & Women’s Hospital, Boston choose epidural analgesia for childbirth. In the United States, national average use of epidural analgesia in the year 1992 was about 51%. The American College of Obstetricians and Gynecologists (ACOG) also believes that “of the various pharmacological methods used for pain relief during labor and delivery, the lumbar epidural block is the most effective and least depressant, allowing for an alert, participating mother.”

Profiling Domestic Violence

October 14, 2009

Scientific investigation of the problem of domestic violence is a relatively recent endeavor. It is only within the past 30 years that violence against women has been acknowledged nationally and internationally as a threat to the health and rights of women as well as to national development. This chapter illuminates the different faces of violence, from the “invisible” suffering of society’s most vulnerable individuals to the all-too-visible tragedy of societies.

Polycystic Ovary Syndrome

November 19, 2009

Polycystic ovary syndrome (PCOS) is a condition of unexplained chronic anovulation state. The purpose of this document is to enhance understanding of the best available evidence on the diagnosis and clinical management of polycystic ovary syndrome (PCOS). A question which has puzzled gynecologists and endocrinologists for many years is what causes polycystic ovaries. The characteristic polycystic ovary emerges when a state of anovulation persists for any length of time. Whether diagnosis is by ultrasound or by the traditional clinical and biochemical criteria, a cross-section of anovulatory women at any one point of time will reveal that approximately 75% will have polycystic ovaries. Variety of treatments of PCOS is also discussed in this chapter and the healthcare providers must appreciate the clinical impact of anovulation and should undertake appropriate managements.

The Bethesda System – An Overview

December 2, 2009

By the 1980s, DNA determination by flow cytometry and cell image analysis began to enhance the diagnostic accuracy of cytopathology. The first Bethesda Conference met on December 12-13, 1988 in Maryland (USA) at the National Institutes of Health (NIH) to consider methods of reporting gynecologic cytology in meaningful diagnostic terminology. Between 1988 and 1991, The Bethesda System (TBS) nomenclature materialized on cytology reports in the United State, Europe, Asia and Latin America. Today both exfoliative and aspiration biopsy cytology have gained widespread acceptance. The TBS format and their appropriate usage are the main focus of this document. Specimen adequacy and the terminology and its clarification are discussed in detail.

Obstetrical Fistulae & Efforts Of The United Nations

January 16, 2013

The United Nations is an organization of sovereign States and not a world government. It is an international organization comprising 192 Member States. As the “town hall of global affairs”, its work affects our life every day. Clearly no single organization can solve crisis of maternal mortality and morbidity worldwide. Its causes are incredibly complex, and its solution requires more than good obstetrical care alone. The United Nations is irreplaceable as a forum for international dialogue. Global issues require global action and global initiatives involving both from industrialized and developing countries. Building strategic and coordinated responses to this tragedy is the way forward. The need to take a fresh look at development aid is vital. This manual is intended to be a practical guide to be read and used at many different levels by many different people, especially health-care professionals and planners, policy-makers and community leaders.

Newborn Nutrition

June 20, 2018

The landscape of breastfeeding has changed over the past several decades as more women initiate breastfeeding in the postpartum period and more hospitals are designated as Baby-Friendly Hospitals by following the evidence-based Ten Steps to Successful Breastfeeding. Human milk feeding supports optimal growth and development of the infant while decreasing the risk of a variety of acute and chronic diseases. The use of donor human milk is increasing for high-risk infants, primarily for infants born weighing <1,500 g or those who have severe intestinal disorders. Pasteurized donor milk may be considered in situations in which the supply of maternal milk is insufficient. Intramuscular vitamin K1 (phytonadione) at a dose of 0.5 to 1.0 mg should routinely be administered to all infants on the first day to reduce the risk of hemorrhagic disease of newborn. Vitamin D deficiency/insufficiency and rickets has increased in all infants because of decreased sunlight exposure secondary to changes in lifestyle, dress habits, and use of topical sunscreen preparations. Supplementary fluoride should not be provided during the first 6 months. From age 6 months to 3 years, fluoride supplementation should be limited to infants residing in communities where the fluoride concentration in water is <0.3 ppm. The Women's Health and Education Center (WHEC) strongly supports the national and international associations in endorsing the consumption of only pasteurized milk and milk products for pregnant women, infants and children.

Understanding Overactive Bladder (OAB) In Women

February 9, 2009

Overactive bladder (OAB) is a common medical condition that can erode a woman’s psychological and social well-being, and may have serious health consequences if left untreated. Therapy may include non-pharmacologic techniques, medication or a combination. Usefulness of pharmacotherapy may be limited by adverse reactions such as dry mouth, although newer medications such as ER oxybutynin and tolterodine tartrate may have slightly fewer side effects. Appropriate early intervention, which includes identifying the disorder, is a key factor in slowing the progression of detrimental changes in the lower urinary tract.

Sonographic Screening for Down Syndrome

March 12, 2009

Screening for Down syndrome is an important part of routine antenatal care. Significant advances have been made in antenatal screening for Down syndrome over the past few decades. The most common screening method in the United States involves the assessment of a combination of factors: maternal age, multiple second-trimester serum markers, and second-trimester ultrasonography. More recently there has been significant interest in first-trimester methods of screening, including screening for first-trimester markers and the sonographic measurement of fetal nuchal translucency. Invasive prenatal diagnosis for Down syndrome with amniocentesis or chorionic villus sample (CVS) is offered only to women of advanced maternal age (older than 35 years at delivery) or those who previously had an affected child or to women who has abnormal multiple-marker serum screening. The most efficient multiple-marker screening test in the second trimester is the “quad” screen, comprising alpha-fetoprotein (AFP), human chorionic Gonadotropin (hCG), unconjugated estriol (E3), and Inhibin-A. This approach yields sensitivities for Down syndrome of 67-76%. The purpose of the document is to summarize the current data and shift toward first-trimester screening for Down syndrome