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WHEC
WOMEN'S HEALTH AND EDUCATION CENTER

Obstetric Anesthesia in High-Risk Situations

September 30, 2009

Pregnancy and delivery are considered “high-risk” when accompanied by conditions unfavorable to the well-being of the mother or unborn baby or both. Analgesia management in acute and chronic fetal distress and in maternal complications such as preeclampsia, eclampsia, hypertension, heart disease, renal disease, neurologic disorder, obesity, substance abuse and diabetes are affected by it. The analgesic management of obstetric complications such as placenta previa, cord prolapse, abruptio placentae, prematurity, multiple gestation, and breech presentation may increase the risk to the mother or the fetus. There is less room for error because many of these functions may be compromised before the induction of anesthesia. Significant acidosis is prone to develop in fetuses of diabetic mothers when delivered by cesarean section with spinal anesthesia complicated by even brief maternal hypotension. Because the high-risk pregnant patients may have received a variety of drugs, anesthesiologists must be familiar with potential interactions between these drugs and the anesthetic drugs they plan to administer.

Viral Hepatitis in Pregnancy

October 22, 2009

Viral hepatitis complicates 0.2% of all pregnancies. It is one of the most serious infections that can occur in pregnant women. Six different forms of viral hepatitis have now been defined. The most common viral agents causing hepatitis in pregnancy are hepatitis A virus, hepatitis B virus, hepatitis C (non-A, non-B hepatitis virus), and Epstein-Barr virus. Delta agent hepatitis has also received increasing attention as a cause of hepatitis. This chapter addresses various types of hepatitis, their implications during pregnancy, the risk of perinatal transmission and treatment. The immunization recommendations of the Centers for Disease Control and Prevention (CDC) are also discussed with special focus on health care workers.

Pathology Of Breast Cancer

December 2, 2009

Understanding the histopathologic features of breast cancer has been recognized as a necessary element for appropriate management of breast carcinoma. There have been two general approaches to prognostication via histopathologic analysis. The first categorizes carcinomas based on specific features, recognizing the so-called special-type carcinomas. The second approach evaluates individual characteristics of the carcinoma, such as nuclear pleomorphism or gland formation (grading). The purpose of this document is to review the histopathology of invasive breast carcinoma, emphasizing the proven and potential settings in which it provides prognostic information. In-situ carcinomas of the breast were first recognized in the early 20th century and were identified morphologically as cells cytologically similar to those of invasive carcinomas but confined to duct structures. Short- and long-term risks associated with specific histologic variants or types of in-situ carcinomas are also discussed in this chapter.

The Apgar Score

February 19, 2018

The purpose of this document is to place the Apgar score in its proper perspective. The Apgar score describes the condition of newborn infant immediately after birth, and when properly applied, it is a tool for standardized assessment. It also provides a mechanism to record fetal-to-neonatal transition. Apgar scores do not predict individual mortality or adverse neurologic outcome. However, based on population studies, Apgar scores of less than 5 at 5-minutes and 10-minutes clearly confer an increased relative risk of cerebral palsy, and the degree of abnormality correlates with the risk of cerebral palsy. Most infants with low Apgar score, however, will not develop cerebral palsy. The Apgar score is affected by many factors, including gestational age, maternal medications, resuscitation, and cardiorespiratory and neurologic conditions. If the Apgar score at 5- minutes is 7 or greater, it is unlikely that peripartum hypoxia-ischemia caused neonatal encephalopathy. The Neonatal Resuscitation Program (NRP) guidelines, Apgar score and subsequent neurological dysfunctions are also discussed. The review also examines the occurrence of 5-minute Apgar score of 0 and seizures or serious neurologic dysfunctions. Perinatal asphyxia is a major cause of neurologic sequelae in term newborns. Apgar score is useful for conveying information about the newborn’s overall status and response to resuscitation. However, resuscitation must be initiated, if needed, before the 1-minute score is assigned. Therefore, Apgar score is not used to determine whether the need for initial resuscitation steps are necessary, or when to use them.

Pelvic Organ Prolapse: An Overview

February 9, 2009

Pelvic organ prolapse is a very common gynecological condition – it is estimated that 50% of women who have had even one childbirth, lose pelvic floor strength and about 10 to 38% of these women, between 15 to 60 years of age suffer from full blown prolapse. The incidence increases with advancing age. Unfortunately, only 1 in 5 patients are able to access medical care for their symptoms. Every year nearly 2.04 women per thousand year’s risk are hospitalized for prolapse and almost 338,000 undergo surgical interventions for the disorder. This high incidence places a severe social and economic burden on the society.

Psychological Impact of Infertility

February 23, 2009

The psychological stress of infertility and its managements is widely acknowledged; and it actually affects pregnancy rates. The relationship between stress and infertility has been recognized since biblical times. Recent research indicates that distress may indeed influence the outcome of infertility treatments, and that psychological interventions are associated with increased pregnancy rates. Infertility affects every aspect of women’s lives. With infertility treatment, some women become pregnant after one or two tries, but others need many attempts before they are successful. A few never be able to become pregnant or have live and healthy baby. This chapter reviews the psychological impacts of infertility and helps to guide the various coping mechanism. Many institutions have developed mind/body program for infertility, and helps many to reduce the distress of coping with infertility. Although attending the sessions is no guarantee of pregnancy, women who have participated generally feel better.

Ovarian Cancer: Neo-Adjuvant Chemotherapy & Other Treatment Modalities

June 24, 2009

Epithelial ovarian cancer is the most lethal gynecologic malignancy in adult women. Exploratory laparotomy is required for histologic confirmation, staging and tumor debulking and should be performed by a surgeon trained in these aspects of ovarian cancer management. Because of the propensity of epithelial ovarian cancer to spread beyond the confines of the ovary, the majority of patients will require postoperative chemotherapy in an attempt to eradicate residual tissue. With advanced-stage disease (stages III and IV), postoperative combination chemotherapy with a taxane and platinum combination is the standard of care. Such treatment is capable of inducing responses in >70% of patients with residual epithelial ovarian cancer and is also capable of prolonging both disease-free and overall survival. Ongoing efforts to identify anti-angiogenesis compound to incorporate agents with novel mechanisms of action are also discussed. Role of radiotherapy and other modalities are explored. Ultimately, it is hoped, a combination of these approaches will result in an improvement in the survival of patients with this devastating disease.

Isoimmunization (Rh Disease) in Pregnancy

July 27, 2009

When any fetal group factor inherited from the father is not possessed by the mother, antepartum or intrapartum fetal-maternal bleeding may stimulate an immune reaction by the mother. The term hemolytic disease of the fetus/newborn, for instance has replaced hemolytic disease of the newborn because modern diagnostic techniques now allows us to detect the disorder much earlier. To prevent the disease, routine postpartum use of Rhesus immune globulin (Rh I G) in Rh-negative patients was introduced in the United States over 40 years ago. A subsequent recommendation for routine antenatal use at 28 weeks’ gestation was introduced 20 years later. Despite these efforts, a recent review of the 2001 birth certificates in the US by the Centers for Disease Control and Prevention indicates that Rh sensitization still affects 6.7 out of every 1,000 live births. Maternal immune reactions can also occur from blood product transfusion.

HIV in Pregnancy: A Comprehensive Review

August 5, 2009

The transformation of the human immunodeficiency virus (HIV) epidemic over the last 20 years has been remarkable. With access to appropriate therapies, clinicians can now offer infected women a much improved prognosis as well as a very high likelihood of birthing children who will be HIV uninfected. Prevention of transmission of HIV from mother to fetus or newborn (vertical transmission) is a major goal in the care of pregnant women infected with HIV. In this article, the most recent developments in the field are summarized in a fashion that should allow the integration into the practice of obstetrics and thereby assure the HIV-infected women the best possible prognosis for themselves and for their children. The focus of this work is on the dual responsibilities of obstetricians, assuring the health of women and minimizing the risks of transmission.