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WHEC
WOMEN'S HEALTH AND EDUCATION CENTER

Immunization During Pregnancy

August 6, 2009

The purpose of this document is to understand immunization during pregnancy. Immunization saves lives and prevents disease. There are many national resources available to help you fine-tune your vaccination practices. If you have not yet incorporated vaccination into your practices, now would be a great time to start. Immunizations are considered one of the major medical achievements of the 20th century. However, inadequate vaccination remains an important public health problem. This document reflects emerging clinical and scientific advances and current information on the safety of vaccines given during pregnancy. The benefits of immunization to the pregnant woman and her neonate usually outweigh the theoretic risk of adverse effects. The theoretic risks of the vaccination of pregnant women with killed virus vaccines have not been identified. Preconceptional immunization of women to prevent disease in the offspring, when practical, is preferred to vaccination of pregnant women with certain vaccines.

Endometriosis

September 23, 2009

Endometriosis is the presence of tissue that resembles normal endometrium at site outside of the uterus. The anatomical areas most commonly affected by endometriosis are the ovaries, the pelvic peritoneum, the uterosacral ligaments, the fallopian tubes, the appendix and the bowel serosa. Endometriomas, or “chocolate cysts” are cysts of endometriosis within the ovary. The “gold standard” for diagnosing endometriosis is laparoscopy, with visual recognition of endometriosis lesions. The severity of endometriosis is defined by the American Society for Reproductive Medicine using a surgical staging system based on the size and location of endometriosis implants and the severity of pelvic scarring. The stages are: Stage I-minimal, Stage II-mild, Stage III-moderate and Stage IV-severe.

Thyroid Storm: Critical Care In Obstetrics

June 2, 2010

The review evidence-based research and approaches for diagnosis and management of thyroid storm during pregnancy. Especially relevant is the intimate relationship between maternal and fetal thyroid function, particularly during the first half of pregnancy. Significant fetal brain development continues considerably beyond the first trimester, making thyroid hormone also important later in gestation. Importantly, although overt maternal thyroid failure during the first half of pregnancy has been associated with several pregnancy complications and intellectual impairment in offspring, it is currently less clear whether milder forms of thyroid dysfunction have similar effects on pregnancy and infant outcomes

Sexual Violence

October 17, 2012

Physicians who make screening for a history of sexual assault a routine part of clinical practice provide tertiary prevention of long-term and persistent physical and mental consequences of sexual assault. Healthcare providers should be aware of the existence of local protocols, including the use of specially trained sexual assault examiners or sexual assault forensic examiners. Long-term effects of childhood sexual abuse are varied, complex, and often devastating. Survivors come from all cultural, racial, and economic groups. Traumatized patients generally benefit from mental health care. The healthcare provider can be a powerful ally in the patient’s healing by offering support and referral. Efforts should be made to refer survivors to professionals with significant experience in abuse-related issues.

Improving Maternal Health through Education (PDF)

June 20, 2018

Education improves health, while health improves learning potential. Education and health complement, enhance and support each other; together, they serve as the foundation for a better world. Gender equality, including in education, is a condition for development. In so doing, we can make healthier choices and lay the foundations for true social and economic development. If we consider what it takes to create health, the school becomes an ideal setting for action. Schools can help young people acquire the basic skills needed to create health. Adolescents find themselves under strong peer pressure to engage in highly risky behavior, which can have serious implications on theirlives. Lack of access to and use of essential obstetric services is a crucial factor that contributes to high maternal mortality. Continuing medical education in women’s health and health care is beneficial to both donor and recipient countries and can engage public and private stakeholders towards common goals.

Contraception and Mental Health

September 21, 2015

This review highlights for healthcare providers evidence and principles for practice, affecting women with the common mental health conditions, who want to avoid an unplanned pregnancy. Among the most prevalent and disabling chronic diseases affecting reproductive-aged women worldwide, depression and anxiety can contribute to adverse reproductive health outcomes, including an increased risk of unintended pregnancy and its health and social consequences. Effective contraception can be an important strategy to maintain and even improve mental health and well-being. Reproductive health clinicians play a critical role in providing and managing contraception to help women with mental health considerations achieve their desired fertility. This discussion reviews the literature on relationships between mental health and contraception and describes considerations for the clinical management of contraception among women with depression and anxiety. The issues related to contraceptive method effectiveness, adherence concerns, and mental health – specific contraceptive method safety and drug interaction considerations, clinical counseling and management strategies are also discussed. Given important gaps in current scientific knowledge of mental health and contraception, the Women’s Health and Education Center (WHEC) highlights areas for future research. Ultimately, mental health promotion may reduce adverse pregnancy-related outcomes, improve family-planning experiences, and help achieve reproductive goals for women, their families, and society.

Urodynamic Assessment: Cystometry

February 9, 2009

A discussion of basic principles of cystometry, indications, normal and abnormal cystometric parameters. A basic principle of cystometry is the coupling of a manometer to the bladder lumen. A filling medium is instilled into the bladder and, as it fills, intravesical pressure is measured against volume. Testing apparatuses range from simple single-channel methods, which are performed manually or electronically, to complex methods combining electronic measurements of bladder, abdominal, and urethral pressure, together with electromyography and fluoroscopy. A cystometrogram has two phases: a filling/storage phase and an emptying (voiding) phase. The filling phase is subdivided into a brief initial rise in pressure to achieve resting bladder pressure, followed by a tonus limb that reflects vesicoelastic properties of accommodation of the smooth muscle and collagen of the bladder wall. There may be a third increase in pressure, which is attributed to stretching of detrusor muscle and collagenous elements of the bladder wall beyond their limits at bladder capacity. During this third stage, the patient is still able to suppress voiding. A detrusor contraction then is initiated voluntarily and the patient voids.

Pregnancy and Nutrition

August 6, 2009

There have always been differing approaches, even controversies with regard to the role of food intake during pregnancy. Traditional beliefs from a wide variety of cultures present divergent approaches. At present, nutritional care during pregnancy is based on the following general premises: women are encouraged to eat a variety of foods “to appetite”, to achieve adequate weight gain as determined by their pre-pregnancy body mass index, and to breast-feed their infants after birth. Nutritional problems can be found in women of every socioeconomic status and range from an inability to acquire and prepare food to eating disorders. If the women cannot afford a sufficient supply of food, she should be referred to food pantries and soup kitchens in her area. All low-income women should receive information about the Special Supplemental Food Program for Women, Infants and Children (WIC) and food stamp program. All WIC programs have nutritionists who are required to counsel patients on these matters. Poor weight gain also may reflect substance abuse, domestic violence, or depression.

Uterine Myomas: A Comprehensive Review

September 23, 2009

Uterine leiomyomata are among the most frequent entities encountered in the practice of gynecology. It occurs in 20-40% of women during their reproductive years. Approximately 600,000 hysterectomies are performed per year in the United States for uterine myomas. Many surgical procedures other than hysterectomy are also commonly performed to deal with myomas. The purpose of this document is to review the literature and medical and surgical advances in the management of uterine myomas. Authors hope this helps healthcare providers the decision-making process as logical as possible.

Poverty and Maternal Mortality

December 7, 2009

The wide acceptance of the Millennium Development Goals (MDGs) by the international community confirms the central role of human development, including health and nutrition, in combating poverty. As countries develop and implement their Poverty Reduction Strategies (PRS), one of the key challenges is to identify actions that will have the greatest impact on poverty and improve the lives of poor. The challenge is compounded by the fact that poverty has many dimensions, cuts across many sectors, and is experienced differently by women and by men. In no region of the developing world are women equal to men in legal, social and economic rights. Gender gaps are widespread in access to and control of resources, in economic opportunities, in power and political voice. Gender equality is a development objective on its own — it also makes good business sense as it is central to economic growth and sustainable development. Safe Motherhood is back at the top of the global health agenda. Today the interventions already exist to transform the lives of millions of mothers and children and to prevent millions of tragically premature deaths and disabilities.