Page 24 – Womens Health Polylang

An abnormally adherent placenta, although an uncommon condition, assumes considerable significance clinically because of morbidity and at times mortality from severe hemorrhage, uterine perforation, and infection. The incidence of placenta accreta, increta and percreta has increased because of the increased cesarean delivery rate. This document reflects emerging clinical and scientific advances on this subject. If the diagnosis or a strong suspicion is formed before delivery, the patient should be counseled about the likelihood of hysterectomy and blood transfusion.

Contraception Counseling & Compliance

September 23, 2009

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Contraception is a women’s health issue. It is about choices and human rights, not fear, guilt and shame. The negative images and concepts perceived regarding family planning and contraception in some religious and social arenas are the major factors for non-compliance and meager usage of birth control methods in many areas of the world. The purpose of this document is to help healthcare providers and women to identify their individual health care needs, and to make choices that will meet those needs. It also means that the patient has satisfied her personal preferences and arrived at the choice that best fits her life. A fundamental tenet in ethical, female-centered care is that women have a right to participate in their choice of contraceptive method. A woman who has actively chosen a method is more likely to use it consistently and correctly. Health benefits of hormonal contraception are also discussed. All contraception-methods offer health benefits in terms of reduced risk of unintended pregnancy, abortion, ectopic pregnancy, pregnancy complications, and pregnancy-related death. The help comes in focusing attention on the section of society with the most desperate needs.

Analgesia & Anesthesia

September 30, 2009

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The terms analgesia and anesthesia are sometimes confused in common usage. Obstetric analgesia is the loss or regulation of pain perception during labor. It may be local and affect only a small area of the body; regional and affect a larger portion; or systemic. Analgesia is achieved by the use of hypnosis (suggestion), systemic medication, regional agents, or inhalation agents. Anesthesia is the total loss of sensory perception, and may include loss of consciousness. It is induced by various agents and techniques. In obstetrics, regional anesthesia is accomplished with local anesthetic techniques (epidural, spinal) and general anesthesia with systemic medication and endotracheal intubation. It is helpful in decreasing maternal and neonatal mortality and morbidity. Labor results in severe pain for many women. Pain management should be provided whenever it is medically indicated. The use of techniques and medications to provide pain relief in obstetrics requires and expert understanding of their effects to ensure the safety of both mother and fetus.

Principles of Genetic Counseling and Prenatal Diagnosis

October 19, 2009

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The availability of prenatal diagnosis for a wide range of disorders has been a major advance in the area of reproductive genetics. Ultrasound has played a central role in the development of the various approaches to prenatal diagnosis. In addition, integration of a genetics-based prenatal diagnosis program with tertiary ultrasound has been shown to increase the accuracy of diagnosis when compared with ultrasound alone. The purpose of this document is to focus on the epidemiology of genetic defects and include a description of the various prenatal diagnostic procedures in use.

Pathologic Features of Uterine Cancer

December 2, 2009

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The purpose of this document is to enhance the understanding of endometrial hyperplasia and endometrial neoplasia (cancer). Most commonly, the prolonged unremitting estrogen stimulation results in endometrial hyperplasia. All gradations of this phenomenon occur, ranging from one distinguished only with difficulty from a normal exuberant proliferative endometrium (so-called disordered proliferative endometrium) to an atypical one that approaches the appearance of adenocarcinoma.

Vesico-Vaginal Fistula: The Need for Safe Motherhood Practices in India

January 16, 2013

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The social consequences of ostracism take an enormous toll on affected women; divorce is common, and depression and suicide may follow. Many women are unaware that the condition is treatable, and are prevented from learning about appropriate care by severe social isolation as a result of their incontinence. In the first half of the twentieth century, obstetricians in India considered Vesico-Vaginal Fistula (VVF) as a hopeless condition.

Newborn Care: Initial Assessment & Resuscitation

January 11, 2018

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Approximately 10% of term and late-preterm infants require some assistance to begin breathing that includes stimulation at birth; less than 1% will need extensive resuscitative measures. Although the vast majority do not require intervention to make the transition from intrauterine to extrauterine life, because of the large total number of births a sizable number of babies will require some degree of resuscitation. Recognition and immediate resuscitation of a distressed newborn infant requires an organized plan of action that includes the immediate availability of proper equipment and on-site qualified personnel. Anticipated newborn problems should be thoroughly communicated by the obstetric care provider to the responsible lead member of the resuscitation team. Assessment and resuscitation of the infant at delivery should be provided in accordance with the principles of guidelines for neonatal resuscitation. Most of the principles are applicable throughout the neonatal period and early infancy. Each hospital should have policies and procedures addressing the care and resuscitation of the newborn infant, including the qualifications of physicians and other health care practitioners who provide this care. The Women’s Health and Education Center (WHEC) with its partners has launched the series on Newborn Care to disseminate updated literature and guidelines to health care providers regarding newborn care and safety. Current guidelines are summarized in this section.

Dying With Dignity

August 16, 2018

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Every one of us will be confronted by our own death and that of the people we care about, yet it is difficult to name any other fact of life that is so fiercely resisted. In our culture denial of death is pervasive. In the past, death at home surrounded by relatives was perhaps easier to accept as a natural event. Now that more people die in hospitals, set apart from the living, death seems all the more mysterious, frightening and remote from our existence.

H1N1 Influenza in Pregnancy

October 8, 2009

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This document provides review of novel influenza A (H1N1) virus infection in pregnant women. Pregnant women with confirmed, probable, or suspected influenza A (H1N1) virus infection should receive antiviral treatment. Given the potential for rapidly worsening disease, close follow-up is recommended. The healthcare provider prescribing treatment should plan to contact patients on treatment within the first 24 hours of therapy to evaluate response. This review adds to a growing body of data that supports the notion that pregnant women may be both susceptible to and exhibit more severe symptoms with H1N1 influenza than is seen in non-pregnant patients.

End-of-Life Decision Making

April 19, 2012

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The population of the earth is aging, and as medical techniques, pharmaceuticals, and devices push the boundaries of human physiological capabilities, more humans will go on to live longer. However, this prolonged existence may involve incapacities, particularly at the end-of-life, and especially in the intensive care unit. This arena involves not only patients and families, but also care-givers. It involves topics from economics to existentialism and from surgery to spiritualism. It requires education, communication, acceptance of diversity, and an ultimate acquiescence to the inevitable. Advance directives can be a difficult topic because they deal with end-of-life and other serious medical situations. However, advance directives are valuable to patients and health care providers alike because they minimize conflict between family and health care providers by clarifying and respecting patients’ wishes. In a perfect world, every patient would have clear, concise documents that designate a proxy who communicates his or her end-of-life wishes. In the real world, however, this doesn’t always happen. This series on End-of-Life Care explores answers to some key questions to help physicians avoid legal liability in situations when the path is not entirely clear.