Of all the normally formed infants who die, most of them, sixty to eighty percent die simply because they were born too early.  A normal pregnancy lasts 40 weeks and prematurity is defined as birth at less than 37 weeks.  For those pregnancies that make it to 23 weeks, only about one third will survive; of those babies delivered at 25 weeks, half of them will survive; and, of those babies delivered at 29 weeks, about 90% will live.

Unfortunately, depending on how early they are born, premature babies can have :

*poorly formed lungs (bronchopulmonary dysplasia),

*lungs that don’t inflate (respiratory distress syndrome),

*damaged bowels (necrotizing enterocolitis),

*bleeding in the brain (intraventricular hemorrhage),

*cerebral palsy

*and underdeveloped eyes (retinopathy of prematurity).

Given the seriousness of prematurity, researchers have tried to identify those women who are most at risk. Women who have had a previous preterm delivery are more than twice as like to delivery the next baby early.  Infection in the amniotic sack (the sack where babies grow and develop) has been shown to be a major reason why women deliver early, especial those who deliver at less than 25 weeks.  Black women are twice as likely than white women to experience a preterm birth.  And, since one third of births occur after the spontaneous rupture of the amniotic sack, it is important to mention that smoking is a big culprit because nicotine weakens the amniotic membranes.  Also, women who get infections in other parts of the body like appendicitis, pneumonia, cholecystitis (infection of the gallbladder), or pyelonephritis (infection in the kidneys) also have an increase risk of delivering early.  Certainly, women who are carrying twins or triplets are more likely to deliver early.

Because many pregnant women have pelvic pain, cramping and occasional contractions, it is difficult to determine who is really at risk for preterm delivery.  (I had contractions but I assumed that I just needed more hydration and rest.)  Physicians can check for fetal fibronectin; if the test is negative, it provides significant reassurance that birth will not happen for at least seven days.  Also, the length of the cervix as measured by an ultrasound helps to determine who is at risk—the shorter the cervix, the higher the chances of preterm delivery.

With this information, doctors can take steps to prolong pregnancy and reduce the severity of lung disease in premature babies.  For women who have had a preterm birth or those whose cervix has measured short, a cerclage—a stitch around the cervix—can be placed.  In recent years, a hormone called progesterone has shown to help prevent preterm labor.  Once contractions start and if the patient is at least 24 weeks, medication is given to delay delivery for at least 48hrs.  Steroids are given to the mom during this critical time to help the baby’s lungs mature faster, so that they are better able to breath on their own if born early. If labor starts before 24 weeks, before the baby can survive outside the mother, many doctors will try to stop contractions with medication as long as there is no evidence of infection.

So, I was put on bed rest, given antibiotics and started on weekly progesterone injections.  My doctors decided not to place a cerclage.  Every three weeks I had the length of my cervix measured by ultrasound.  I was relieved each time I was told the cervix was not getting worse but fell apart when my fetal fibronectin was positive (a positive result only predicts delivery 23% of the time).  I received steroids in preparation for a premature birth.  At the end of the most intense emotional roller coaster ride of my life, I delivered the most beautiful baby I had ever seen, my son Cole, at 38 weeks.

To my doctors, a heart felt thank you.  To friends/family who shoveled snow, sat with me, brought me food and movies, who drove hours to go with me to the doctor, who called daily, who packed/unpacked for the move to New York, I will never forget your kindness and I appreciate you more than words can express.  To my son, I thank you for renewing my faith in God.

There you have it.  Now spread the word.

The simplest description of this disorder: tissue that lines the inside of the uterus attach to the outside of the uterus and ovaries.  The most commonly accepted theory of how this happens is, when we have a period, although most of the blood and tissue comes out of the vagina, some of it backs up into the fallopian tubes, spilling onto the outside of the uterus and onto the ovaries.  This process happens in all  women and the body’s immune system usually clears away the blood and tissue.  For reasons that are not quite clear, instead of being cleared, the tissue implants on the surface of the uterus, the ovary, the bowel or bladder and the surfaces between these organs.  Implants that are deep or that are close to nerve ending cause more pain.  I’ve done laparoscopic surgeries on women where the pelvis looks as if someone poured dark honey inside.

Women who start having periods before age eleven, whose periods come more often than every 27 days and who have heavy periods are more likely to develop endometriosis.  Those who have family members with this disorder, i.e. sister or mother, also have a tendency to develop endometriosis.  Having children, breast feeding and exercising may be “protective”.

The only way to definitely diagnose endometriosis is to biopsy the implant. A biopsy is important because implants can be varied in appearance and not always obvious to the surgeon.  Undergoing surgery, whether laparoscopic (using a small camera to look inside) or by making a larger incision, means accepting the risk of bleeding, infection, injury to the bowel, injury to the bladder as well as the potential complications of general anesthesia.  Ultrasounds, Cat Scans and MRIs cannot detect endometriosis.  These tests can only reveal if an endometrioma (a cyst filled with endometriosis) has formed.

In women who have symptoms that suggest endometriosis, starting medical treatment without surgery may be the best way to proceed.  The first line of treatment is a birth control pill, along with anti-inflammatory drugs like Naproxen or Ibuprofen.  If the birth control pill fails to control pain, there are three other FDA approved drugs (androgens, GnRH agonists, progestins) that have been shown to be very effective in the treatment of endometriosis.  All of these medications, including the pill, work by suppressing the amount of estrogen being produced by the body; this “cools” the implants, helping them to degenerate and thereby reducing pain.  Medications used to treat endometriosis can have unpleasant side effects, like hot flashes and unwanted hair growth. Hormones are prescribed to treat bothersome side effects.  Some of these medications, the GnRH agonist for example, can only be used for up to one year.  Unfortunately, pain usually returns after women are off treatment.  Birth control pills, however, can be used for years, is the least expensive and has the least side effects of all the medicines used to treat endometriosis.  If they work don’t stop taking them, even if you’re feeling better!

Surgery to laser or burn the implants is effective but, again, after a few months most women report the return of pain.  In those whom the implants have damaged the fallopian tubes or for women who are infertile because of endometriosis, Invitro fertilization (IVF) is the best way around this problem.  Surgery is definitely needed if one has an endometrioma.  Endometriomas can get very big, can cause the ovary to twist and cut off its blood supply and can rupture (pop open) in the pelvis.  Removing them will reduce pain and in some cases, help with infertility.

Of course, there is always the option of a hysterectomy to remove the uterus and ovaries.  One study showed that women whose ovaries were removed were least likely to have a recurrence of pain.  But, another study showed that if the ovaries were free of implants and otherwise normal, leaving the ovaries in place was also an alternative.  Removing the ovaries means instant menopause! Each woman has to weigh the benefits of ridding herself of pain verses living with hot flashes, vaginal dryness and other changes that come with menopause.  Keep in mind that there are treatments for the symptoms of menopause but nothing will equal the benefits of hormones from the ovaries.

There you have it!  Now spread the word!

The most frequent cause of PID is an initial infection with Gonorrhea (gon-o-ri-a) or Chlamydia (Cla-mid-e-a).  Basically, PID occurs when infection passes the cervix (the opening to the uterus or womb), ascends into the uterus and further, up into the fallopian tubes.  Most physicians will diagnose PID when a woman presents with lower abdominal pain and the cervix, uterus and tubes are tender on the gynecological exam.  Pain is often accompanied by fever or vaginal discharge.  Some women will only have mild pain while others will have unusual signs like bleeding between periods, bleeding with sex, frequent need to urinate or nausea and vomiting. 1

PID can be treated with antibiotics even though some women, those with severe infections, will need hospitalization.  If the infection involves just the cervix or just the cervix and the uterus, there are no long term damages.  However, once the infection reaches the fallopian tubes, permanent damage can occur, even with treatment.  Once the inside of the tubes are scarred, infertility can result.  And, even if a woman is able to become pregnant, a fertilized egg may not be able to slide into the uterus because the pathway is scarred;  this is how ectopic pregnancies are formed.  Lastly, scarring can occur outside, as well as inside the tubes, causing constant pain that does not respond to antibiotics.

I’m often surprised that some women take great offense when I offer testing for Gonorrhea and Chlamydia.  Finding and treating these infections early is the best way to protect one’s ability to have children in the future.  It is also important to limit the number of sexual partners and to practice the consistent use of condoms.  Also important, Bacterial Vaginosis (Read my blog: The Fishy Vaginal Odor) weakens the vagina’s natural ability to keep bacteria from moving up into the uterus and into the fallopian tubes; BV should be treated when present.

Each episode of PID causes more damage and waiting days before seeking medical attention only allows the infection time to reek havoc.

There you have it! Now spread the word!!

1. Obstetrics & Gynecology vol. 116. num 2, part 1, August 2010

Women request the surgery for a many reasons including a previous painful or traumatic birth experience or tales about the “horrors” of a vaginal delivery. Often though, when asked why they want a c-section, the answer is some variation of…“I don’t want to go through all that…I just want a c-section.”

There is no such thing as just a c-section. Although, the rate of complication from this surgery is extremely low, it’s still considered a major abdominal operation and patients have become overly nonchalant about it.

Delivery by surgery can benefit the baby in that they have fewer birth injuries and infections. However, babies born by c-section have the highest rate of breathing problems and often need assistance from neonatologists. They also have higher rates of hypoglycemia (low blood sugar) at birth. The passage through the birth canal helps clear the lungs and allows the baby time to correct glucose abnormalities.

For the mother, there’s a lower for hemorrhage risk with a c-section. And, women who have c-sections have fewer problems with urinary incontinence (leaking of urine), but only for the first year after delivery.

On the flip side, it’s important to consider the total number of c-sections that a woman undergoes. A bikini cut may look better, but it still extends into the abdomen and significant scarring can occur underneath the skin. Scar tissue also forms on the uterus and can cause the placenta to attach abnormally in subsequent pregnancies. These patients often end up needing a c-section and a hysterectomy. In addition, if the scar on the uterus separates, the baby will have to be delivered—sometimes prematurely—by an emergent c-section, which further increases the injury risk for the mother.

Consider also that c-sections do not always “save” the vagina. Studies have shown that c-sections do not necessarily keep the uterus from dropping into the vagina (known as uterine prolapse). However, to decrease this risk, I would advise women to limit weight gain. This limits the size of the baby and reduces trauma to the vagina.

I will admit, if a woman experienced a vaginal delivery where she had a horrendous tear down into the rectum, I would advise her to have a c-section for the next delivery. Urinary incontinence is one thing to worry about, but fecal incontinence is quite another, and no woman should have to face that.

Overall, women who leave the hospital with healthy babies are happy, regardless of how they were delivered.

But before you elect to just have a c-section, think carefully about the consequences. If you are planning to have more than one or two babies, the drawbacks of having a multiple surgeries start to outweigh the benefits.

Spread the word

Another point to be made here is that there are people who have been given the diagnoses of herpes and make a conscience choice not to tell their partners, usually because they are afraid of losing someone they love or really like.  Here are some reasons that I’ve heard: “It’s not like it’s life threatening”,  ”I’ve never had an outbreak and don’t think that I will” or “I just can’t tell him (or her)”.  Before you weigh in, here are a few facts from the CDC that you should know:

*Eighty one percent (8 out of 10!) of people who have herpes DO NOT KNOW.

*Of blacks between the ages of 40-49, fifty six percent, that’s more than half, of this population have herpes!  For whites in the same age range, 20% have herpes and for Mexicans, 20% have herpes.

The number of sex partners matter.  Yesterday, I met an 18 year woman who had already slept with eight men.

* One third of blacks who have had sex with 2 to 4 partners have herpes.  How many does it take before you are considered a “playa” or a “diva”?  For whites and Mexicans who have had sex with more than two to four partners, only 9% and 13% will have herpes, respectively.

*By the time you get to 10 partners, 49% of blacks will have herpes; for whites who have slept with more than 10 partners, 22% will have herpes and for Mexicans who have slept with more than 10 partners, 13% will have herpes.

I could go on, but I think you get the picture.  Herpes is prevalent.  Hooking up is ‘in’ and asking direct questions about another’s sexual exposure and history of sexually transmitted diseases has gone out of style.  More women than men have herpes because it’s easier for men to transmit the virus to women.  And if you are a black woman, what should you do, rinse the penis with bleach before you have your fun?  Not that this would help.  And, as a side note, infection with Herpes type-2 makes you more susceptible to acquiring HIV.

Herpes is such an emotional issue, more than a physical one, for many.  But, getting tested, both you and your intended partner, and being open to full disclosure is one reasonable approach, in my humble opinion. At least with knowledge of the infection you can try to avoid spreading it to others, especially if that other is someone you really care about. If you have herpes, use of a condom can provide moderate, not complete, protection for your partner.  Also, talk to you doctor about suppressive therapy, drugs like Valtrex, Acyclovir and Famvir are used to reduce the chances that you will transmit the virus to someone who does not have it and reduce the number of painful outbreaks you have to suffer through.  Lastly, avoid having sex if a lesion is present or if you feel and outbreak coming on.

There it is.  Spread the word!  I’d love to hear what you guys think about this topic.  Please comment or click on Forums (top right hand corner) and start a discussion.

Over 200,000 people were diagnosed with lung cancer in 2008.  Ninety percent of them were smokers.  About 35% of men and 22% of women who live in the United States are smokers.  And, one in ten lifelong smokers will develop lung cancer.  This is bad.  People who continue to smoke after they have been diagnosed with lung cancer do not respond to treatment as well as those who quit.  Bad.  And, unfortunately, 4 out of 25 cases of lung cancer are due to second hand smoke.  Really bad.  Even worse, children of smokers tend to become smokers and are twice as likely to develop lung cancer as adults.

Stop smoking and one can reduce the risk of getting lung cancer by up to 50%.  The best!  Diets rich in fruits and vegetables, i.e. lots of antioxidants, may help to protect the lungs.  Good. Cigarette for cigarette, the Harvard Alumni Health Study showed that exercise could reduce the risk of lung cancer, a drop of 39% for the men who did strenuous exercise on a regular basis. Great!

Ladies, you, and the men in your lives, should stop smoking.  I’ll admit, I’ve puffed on a couple of Marlboro lights while I sipped cocktails.  Think Sarah Jessica Parker in “Sex in the City”, when she was still a smoker.  Then I noticed tiny wrinkles around my eyes—the damage to small blood vessels leads to premature aging–I was all too happy to pay for facials instead.  Shear panic was my antidote.  Dig deep and find yours.  My father had friends who were always bumming cigarettes. So he stopped, cold turkey, out of spite.

Spread the word! Happy Father’s Day.

For those who prefer the au natural approach, here is some information on one of the most popular alternative supplements: black cohosh.

Black cohosh is an herb.  For the budding botanists, it is also called Actaea racemosa or Cimicifuga racemosa.  The Native American Indians called it something else altogether but, the most common formulation is Remifemin.  Remifemin is available over the counter and is usually taken twice daily.  It is regulated as a dietary supplement, not a drug; therefore it is not subject to the same stringent testing as your Tylenol, for example.  Does it work?  Not all the studies agree, but most reported a definite reduction in hot flashes, night sweats and irritability.  It absolutely will not help with vaginal dryness.  The American College of Obstetricians and Gynecologists states that black cohosh may be helpful if used for up to six months.  The University of Pennsylvania School of Medicine, sponsored by the National Institute of Health, studied women in the Philadelphia area with breast cancer who used black cohosh.  They found that black cohosh had a protective effect against breast cancer!  More studies have to be done but this was exciting.

Side effects: stomach cramps and a few reports of liver damage.  One should definitely stop using this supplement if these symptoms develop.  Keep in mind, there are no long-term studies (at least five years) on black cohosh.  Given what we know about black cohosh, when my patients ask for advice about what they can do besides take hormones or antidepressants, I answer, “Eat right, exercise, throw out the cigarettes and try black cohosh.”

There you have it.  Now spread the word!

Stay tuned.  Don’t miss!  More to come on The Big M…..

Now that we have clearer understanding of how HPV (human papillomavirus) affects the cervix at different points in women’s lives, we can now target certain women while reducing the number of procedures that we do on others.

Every year, millions of women are infected with HPV in the United States — but relatively VERY FEW actually develop cervical cancer.

HPV is the most common sexually transmitted virus. It’s spread through sexual intercourse.  But know that it is easily spread through skin-to-skin contact, so penetration during sex is not required to get HPV.  Infection with HPV peaks between ages 16 and 24.  This is the time when most women are exposed to HPV, which is often when they become sexually active.

Young women who are sexually active are very likely to have HPV. A study done on a college campus documented that 60 to70% of the young women tested had HPV. But, nearly 90% of all young women who have HPV will clear the virus within two years without any additional tests or procedures.

This is why women younger than 21 do not need a Pap or HPV test, even if they are sexually active.  This is not a free ticket to get out of going to your gynecologist.  Preventing unwanted pregnancy and screening for sexually transmitted diseases, like chlamydia (cla-mid-i-a) is essential at this age.

Also, consider getting immunized against the most common types of HPV.  Gardasil, a vaccine approved for females ages 9 to 26, has been shown to reduce the occurrence of moderate and severe abnormal changes in the cervix caused by HPV.

For those of us who are not so young anymore, here is another scenario: “I’ve been in a stable relationship for many years and my paps have been normal.  How did I get HPV? Is my partner cheating?”

What’s not commonly known is that some women get HPV in their younger years but never completely eradicate the virus from the body.  HPV peaks again in the 30s; women in this age group are the best candidates for the HPV test.

Testing for HPV, in addition to Pap tests, has improved the ability to pick up abnormal cells 8 to 12 years before they become cancerous.

An HPV test is usually done every 6 to 12 months for women:

1. who have had an abnormal Pap smear,

2. who have had a LEEP or Cone biopsy (two procedures that remove abnormal cells from the cervix)

3. or in women 30 and over who wish to have less frequent smears.

Also:

4. It’s possible to have HPV and have a normal Pap smear. In this situation, it’s important to have a Pap             smear and HPV test done at least once each year.

5. If you are a healthy women over age 30 who have a negative HPV test and a normal Pap smear do not           need another Pap smear for two to three years.

Remember, however, that annual gynecological exams are still necessary since they examine overall breast and gyn health. Talk with your doctor about how often you should have Pap smears.

We can live healthfully with HPV, as long as it doesn’t cause worrisome changes in the cervix.

There you have it. Now spread the word!

AIDS (Acquired Immunodeficiency Syndrome) was first reported in 1981.  Two years later, scientists were able to find the cause of this disease: HIV  (Human Immunodeficiency Virus).  The infection has touched lives in every part of the world.  Countries in regions of the world with little resource: Sub-Saharan African, the Caribbean and Asia, have seen millions of their citizens die from this disease.  HIV in contracted by contact with infected blood and body fluids.  The virus then attacks the immune system, leaving the body unable to defend itself against infections that might otherwise be effectively eliminated.

Recently, there has been a flurry of discussions about the number of single professional black women, of whom, 45% will never marry.  With so many women spending an extended amount of time “out there”, I thought it prudent to bring up the topic of safer sex.  Nice guys, guys with good hygiene, hard workers, men who love children, professional men and men who always smell nice, can be infected with HIV.  While you’re looking for Mr. Right, take steps to protect yourself: use condoms, ask about their sexual history, limit the number of sexual partners and get tested.  The very act of getting an HIV test is a reminder to be vigilant about protecting yourself.  It’s amazing how many women chose not use condoms based on how they feel instead of acting on facts.

Since the isolation of the virus, scientists have worked hard to discover ways to treat people with HIV/AIDS.  There is no cure and a vaccine is far in the horizon.  Prevention should be the goal but early discovery of one’s infection, will lend itself to early treatment and to a longer and better quality of life. Women who are HIV positive should take steps to prevent pregnancy or at least seek early prenatal care to reduce the risk of passing the virus to the child.  Without treatment, one in every four (25%) of babies born to HIV positive mothers will become HIV positive.  With early detection and treatment, the risk of passing the virus to the child can be reduced to less than 2%.  Mothers who are HIV positive should not breastfeed.

There it is!  Now spread the word.

I chose this topic because recently I had several patients who were diagnosed with this syndrome and most of them had no idea of what this disease meant for them or for their unborn child.

Simply, Preeclampsia is a type of high blood pressure that affects pregnancy.  It is diagnosed when there is both an increase in the mother’s blood pressure and when a certain amount of protein is found in the urine.

We don’t know what causes preeclampsia and we have not found a way to prevent it.  But, we do know that certain women are more prone to developing this disorder. Here are some of the top risk factors: women having their first baby, those who have had preeclampsia in a previous pregnancy and those with a family history of preeclampsia.  Some other really important risk factors include: women who are obese, those who were diagnosed with high blood pressure before they became pregnant (or who were diagnosed in the beginning of the pregnancy), women who have kidney disease, those carrying two or more babies and those who are genetically prone to develop blood clots.

Preclampsia can damage the placenta which in turn results in a baby who does not grow well in the uterus.  It can also cause low amniotic fluid levels.  More devastating is when the placenta pulls away from its attachment (abruptio placenta) leading to bleeding, the need for an emergency Caesarean section or worse, fetal death.  For the mother, the most serious outcomes are bleeding, liver damage, stroke and seizures.

If the baby is premature and the condition is mild, obstetricians can elect to monitor the baby and mother with weekly tests to insure the safety of both.  This management will allow more time so that the baby’s lungs will mature and at birth, the infant can breathe on its own without assistance.  Nevertheless, once there is evidence that the mother or baby is in danger, delivery–either by the vaginal route or by a Caesarean section–is the next step.  In this situation and if there is time, the mother may be given steroids to help strengthen the lungs of a premature baby before he/she is brought into the world.  During this brief period, medication to prevent seizures and to control blood pressure may be given to the mother.  Sometimes babies have to be delivered early in order to save their lives and that of the mother.

I bring this topic to you because many women forgo their prenatal appointments.  The only way to spot preeclampsia is by monitoring your blood pressure and urine each time you go to the doctor.  So make the time ladies (and dads-to-be), keep your appointments!

There it is, now spread the word!