Pregnancy

Endometriosis — what it is and what to do about it

by Shazah Khawaja, MD, FACOG

endometriosis pain in woman's abdoment

What is endometriosis?

Endometriosis is a chronic gynecologic disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus in other parts of the abdomen. As a condition that occurs in 6–10 percent of women of reproductive age, endometriosis represents a significant health problem for millions (maybe as high as 6.5M) of U.S. women.

If you’re still reading, you’re probably one of them, or you may know someone who has had to deal with these common endometriosis symptoms:

  • Painful periods (dysmenorrhea).
  • Pain during intercourse.
  • Pain with bowel movements or urination.
  • Excessive bleeding.
  • infertility.
  • Other symptoms, which may include fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

Clearly, this is not a fun list. The symptoms or clinical manifestations of endometriosis are variable and unpredictable in both presentation and course. It can vary greatly from woman to woman.

One thing to keep in mind is that the pain associated with endometriosis may not correlate with the stage of the disease. In other words, a woman experiencing significant endometrial pain may not necessarily be in a deep stage of the disease, and the opposite may also be true for someone else. There may be some association with the depth of infiltration of endometrial lesions. Painful defecation during menses and painful sexual intercourse are the most predictable symptoms of deeply infiltrating endometriosis.

According to U.S. Department of Health & Human Services’ Office on Women’s Health, other health problems women experience with endometriosis can include, allergies, asthma, chemical sensitivities, autoimmune diseases (these can include multiple sclerosis, lupus, and some types of hypothyroidism), chronic fatigue syndrome and fibromyalgia.

There is some good news: Endometriosis isn’t a fatal disease. In some cases, endometrial cells create cysts that can rupture and bleed. While this is serious and may sound a bit like cancer, endometriosis isn’t cancer. However, ovarian cancer does occur at higher than expected rates in women with endometriosis. Some studies suggest that endometriosis increases this risk, but it’s still relatively low, according to Mayo Clinic. Although rare, another type of cancer — endometriosis-associated adenocarcinoma — can develop later in life in women who have had endometriosis.

Who is likely to get endometriosis?

Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis often end temporarily with pregnancy and end permanently with menopause, unless you’re taking estrogen.

Endometriosis is especially common among women in their 30s and 40s, but I’ve also treated patients in their 20s that had the disorder. Statistically, it is racially neutral, meaning there appears to be no racial predisposition to endometriosis. Research suggests a familial association of endometriosis. Patients with an affected first-degree relationship have a seven- to ten-fold increased risk of developing the disorder.

How do we diagnose endometriosis?

A definitive endometriosis diagnosis can only be made by a diagnostic laparoscopy procedure. Your doctor will then order a histology (a study of the microscopic structure of tissues) of the lesions removed during the surgery.

Before recommending a diagnostic laparoscopic procedure, your doctor will talk to you about your symptoms and do or prescribe one or more of the following to find out if you have endometriosis:

  • Pelvic exam.
  • Imaging test (ultrasound or MRI).
  • Prescription medicine. If your doctor does not find signs of an ovarian cyst during an ultrasound, he or she may prescribe:
    • Hormonal birth control (which may help lessen pelvic pain during your period).
    • Gonadotropin-releasing hormone (GnRH) agonists, which block the menstrual cycle and lower the amount of estrogen your body makes. GnRH agonists also may help pelvic pain.

If your pain gets better with hormonal medicine, you probably have endometriosis. But, these medicines work only as long as you take them. Once you stop taking them, your pain may come back.

How do you treat endometriosis?

There is currently no cure for endometriosis, but several different treatment options can help manage symptoms and improve your chances of getting pregnant. Talk to your doctor about your treatment options.

It is important to note that the best course of action for you will be greatly informed by whether you are or wish to remain fertile. Other important factors include your age, how severe your symptoms are and how severe the disease is.

Endometriosis treatments will vary depending on whether the focus of your care is for pain or more for fertility concerns. For pain, there are three possible approaches:

  • Pain medications (NSAIDS, opioids).
  • Hormone therapy (birth control pills, progesterone, progestin, GnRH agonists).
  • Surgical treatment (laparoscopy, others).

Endometriosis is different for every woman. My colleagues and I at our practice, NCMA Women’s OB/GYN Center, first seek to treat the whole person, rather than address presenting symptoms only. In many cases, we will recommend laparoscopy to remove growths as a way to also improve fertility in women who have mild or minimal endometriosis.

Although studies show improved pregnancy rates following this type of surgery, the success rate is not clear. For some, we recommend in vitro fertilization (IVF) as the best option to improve fertility.

Even though the use of hormones in IVF is successful in treating infertility related to endometriosis, other forms of hormone therapy are not as successful. The American College of Obstetricians and Gynecologists does not recommend using oral contraceptive pills or GnRH agonists to treat endometriosis-related infertility. The use of these hormonal agents prevents ovulation and delays pregnancy, so this risk means you and your doctor must be on the same page about your risks and health goals.

The hormones used during IVF do not cure endometriosis lesions, which means that pain may recur after pregnancy and that not all women with endometriosis are able to become pregnant with IVF. The relationship between the extent of disease and the degree of symptoms, the effects on fertility, and choosing the best treatment, remains a challenge for many patients.

For more information, the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development offers excellent information on endometriosis treatment options.

Shazah Khawaja, MD, of NCMA Women’s OB/GYN Center

Shazah Khawaja, MD, FACOG, is a physician with NCMA Women’s OB/GYN Center in Santa Rosa, Calif.

Women’s health volunteerism: Delivering care around the globe, where it’s needed most

NCMA’s Suzi Saunders, CNM, on providing care to women in countries where access is challenging, like Haiti and the Philippines

NCMA’s Suzi Saunders, CNM, on providing care to women in countries where access is challenging, like Haiti and the Philippines

Photo by Suzanne Saunders, CNM

I have been a certified nurse midwife for 21 years. Having worked with NCMA Women’s OB/GYN Center for nearly 18 of those years, I’m very happy to continue my work both in Sonoma County and in sometimes faraway locales where adequate care is scarce.

I truly love women’s health. And let me tell you, there is nothing like holding a brand new baby in your hands!

I have long had an interest in providing care to women in countries where access is challenging. In addition to my master’s in nursing at Emory University, I also completed a master’s in public health, with a focus on international health concerns. My public health program emphasized the need for sustainable programs that had a lasting effect rather than “Band-Aid”-type efforts. Most programs rely heavily on donated supplies, and on volunteer labor to sustain them over time. I knew I wanted to make an impact, but wasn’t sure how to get started.

My first adventure became a family adventure

On the advice of a local colleague, I looked into two programs that had lengthy histories in their host countries, and had made significant impacts on local maternal health. The one I chose in 2011 was with Mercy in Action. It is located in Olongapo, Philippines, which was a nice coincidence, as my brother lived a few hours from there! I wanted my kids to be a part of my efforts. Although they were too young at the time to participate directly, by traveling there with me they could understand why it was important to me. In addition, I wanted them to realize how different life can be outside the U.S. By choosing this project, I could start my adventures as a volunteer, as well as get the kids involved.

I participated in a two-week intensive training on providing care in a low-resource environment, in addition to hiking to remote areas to provide needed prenatal and post-partum care to rural Filipina women. It was an amazing learning experience! My kids stayed with family, and while they were not with me, I did my work. They still had a lengthy trip in a developing nation. They were 5 and 10 at the time, and have never forgotten it.

On the ground in Haiti

Two years later, I went to Hinche, Haiti, with a group called Midwives for Haiti. It is a non-governmental organization (NGO) based in rural Haiti for the last 25 years. A midwife colleague had been there, and highly recommended the work they were doing.

After some vigorous fundraising, two labor nurses and I flew into the unknown. Haiti is the most dangerous country in the Western Hemisphere to have a baby, due to factors such as:

  • difficult access for rural women,
  • very few providers per thousand population,
  • a preference for home delivery due to costs, and
  • a high rate of risk factors such as preeclampsia and malnutrition.

In the U.S., midwives are often in a position of protecting normal pregnant women from having a disturbed or interventive birth. In Haiti, many, many births are high risk, and many more women need intervention than actually get it.

Midwives for Haiti has three main directives:

  1. To teach as many Haitians as possible the profession of midwifery. The more providers there are in the country, the more women have access to care.
  2. To support the mobile midwife service. These are a group of 5–6 midwives that go to a rural village every day, for a total of about 25 communities a month. This is typically the only way the women in those villages will ever get prenatal care.
  3. To train the “matwons,” which are traditional or “granny” midwives, working in remote areas but typically without much medical knowledge. The mobile midwives work closely with the matwons, to encourage them to give the best care they can, and to refer high risk women back to them.
Suzanne Saunders, CNM, Haiti, newborn baby and mother

Suzanne Saunders (L) loves her volunteer work.

The conditions in Haiti cannot be more different than here, and can be quite shocking if you have not traveled to truly desperate, developing nations. I saw and experienced things you might only see once, or never, in an entire career in the U.S. We had a patient die of pre-eclamptic complications the second day of our trip, which would have been fairly easily treated and dealt with here. It’s crushing to know that every woman you treat knows a friend or family member (often several) who has died of childbirth complications. The ambivalence toward newborn babies that might not even survive their first six months is heartbreaking.

Watching what Midwives for Haiti can do on a shoestring budget is a bright light in all of this! They train 20–30 midwives a year, who then go and serve their own communities for years and years. They send midwives out into the villages to give women much-needed prenatal care. And support the home-based Matwons in their quest to provide home birth. All of this has made a significant impact on maternal and infant mortality in their corner of Haiti. I am very satisfied that their program meets many criteria of sustainability in the NGO realm, and have seen with my own eyes the impact they are having.

Going back to Haiti

I went back to Haiti two years later and it was just as powerful. The supplies and medicines we brought were eagerly distributed as needed. Our work felt important, in a way that is hard to describe. It is incredibly hard work, under ridiculous conditions (think, rare running water—in the hospital!, think 90+ degrees with nary a fan, think riding in a rattle-trap jeep over washboard roads for two hours to reach the mobile clinic, think mosquitos that are trying to kill you!). But fulfilling in a way that first world health care isn’t.

I am hoping to go again in December after a bit of fundraising. If you are able to contribute, please visit our GoFundMe campaign. We will be so grateful.

Every dollar goes to teaching students, purchasing meds and supplies to bring along, and to the very small staff that keeps it all running. Believe me, they make every dollar work double time! Certain supplies are highly desirable, as are certain medications.

Most needs are simple, like

  • sutures,
  • Tylenol/ibuprofen,
  • cloth diapers,
  • blood pressure cuffs, and
  • other basics.

A basic kit of equipment is put together for each midwife student, to make sure they are prepared for their training and first months of work afterwards.

If any of you have donations of medical supplies, and/or funds to purchase said supplies, they are very warmly and happily accepted.

Suzi Saunders, CNM
NCMA Women’s OB/GYN Center

Focus on health risks for new mothers for Preeclampsia Awareness Month

May is Preeclampsia Awareness Month and NCMA Women’s OB/GYN Center joins with the Preeclampsia Foundation to help raise awareness. This year the foundation’s efforts are on postpartum preeclampsia as 97 percent of maternal deaths related to preeclampsia and other hypertensive disorders of pregnancy occur within just six weeks of delivery, a time when most new mothers might think the danger has passed.

A woman can develop preeclampsia after her baby is born, regardless of whether she experienced high blood pressure during her pregnancy. With such alarming statistics related to postpartum preeclampsia, it very important that a new mother remain vigilant and continue to monitor her heart health and blood pressure even after delivery.

Understanding preeclampsia

Postpartum preeclampsia is a serious condition related to high blood pressure. Women who have just delivered a baby are most at risk, although it has no effect on the baby. There is no known cause for preeclampsia to manifest in pregnant women. In many cases, women diagnosed with preeclampsia see symptoms abate following delivery, but the Preeclampsia Foundation emphasizes that ‘delivery is not a cure’. In some cases, symptoms begin during pregnancy, but some patients may not be symptomatic until after the baby is born. Postpartum preeclampsia most commonly occurs within the first seven days after delivery although new mothers remain at risk for up to six weeks following delivery.

Know the warning signs

Early diagnosis and being vigilant to symptoms followed by quick response is imperative to saving lives. Symptoms include (and can be complicated by lack of sleep, postpartum depression and/or simple lack of awareness about the signs):

  • nausea
  • swelling in hands/feet
  • severe headache
  • seeing spots or other vision changes
  • shortness of breath

When a patient thinks they are experiencing warning signs of postpartum preeclampsia, the first thing to do is go to the Emergency Department, request to be seen by an OB, and report that they have recently given birth. The first seven days after delivery is when women who experience preeclampsia are at highest risk. Effectively controlling high blood pressure is key to avoiding very serious health risks that include; seizures, stroke, organ damage and sometimes death.

About NCMA Women’s OBGYN Center

Our provider team of expert OB/GYN physicians, certified nurse midwives, family nurse practitioners, and medical assistants provides unmatched care to patients in our region. As women proudly serving women, we understand the needs and expectations of our patients. For more information, visit our website or call 707-579-1102.

Study reveals no increase in risks for women who eat and drink during labor

At most US maternity units, women in labor are put on nil per os (NPO) status -- they're not allowed to eat or drink anything, except ice chips. But new nursing research questions that policy, showing no increase in risks for women who are allowed to eat and drink during labor.

At most US maternity units, women in labor are put on nil per os (NPO) status — they’re not allowed to eat or drink anything, except ice chips. But new nursing research questions that policy, showing no increase in risks for women who are allowed to eat and drink during labor. The study appears in the March issue of the American Journal of Nursing, published by Wolters Kluwer.

“The findings of this study support relaxing the restrictions on oral intake in cases of uncomplicated labor,” write Anne Shea-Lewis, BSN, RN, of St. Charles Hospital, Port Jefferson, N.Y., and colleagues. Adding to the findings of previous reports, these results suggest that allowing laboring women to eat and drink “ad lib” doesn’t adversely affect maternal and neonatal outcomes.

No Increase in Complications with ‘Ad lib’ Oral Intake During Labor

The researchers analyzed the medical records of nearly 2,800 women in labor admitted to one hospital from 2008 through 2012. At the study hospital, one practice group of nurses and doctors had a policy of allowing laboring women to eat and drink ad lib (ad libitum, or “as they please”). Another four practice groups kept all patients NPO (nil per os, or “nothing by mouth”).

Recommendations to restrict oral intake during labor reflect concerns over the risk of vomiting and aspiration (inhalation) in case general anesthesia and surgery are needed. However, with advances in epidural and spinal anesthesia, the use of general anesthesia during labor has become rare (and, if needed, much safer than before).

The study compared maternal and child outcomes in about 1,600 women who were kept NPO (except for ice chips) with 1,200 who were allowed to eat and drink ad lib during labor. The two groups were “sufficiently equivalent” for comparison. The women’s average age was 31 years. Before delivery, a “preexisting medical condition” complicating pregnancy was identified in 14 percent of the NPO group compared with 20 percent of the ad lib group.

Even though the women in the NPO group started out with fewer medical problems, they had a significantly higher incidence of complications during labor and birth, compared with the ad lib group. The women in the NPO group were also significantly more likely to give birth via unplanned cesarean section.

Other outcomes — including requiring a higher level of care after delivery and the newborns’ condition as measured by Apgar score — were not significantly different between groups. Analysis using a technique called propensity score matching, comparing groups of women with similar risk factors, yielded similar results.

The findings add to those of previous studies suggesting that restrictions on eating and drinking during labor could be safely relaxed in uncomplicated cases. “Yet in keeping with current guidelines, most obstetricians and anesthesiologists in the United States continue to recommend restrictions on oral intake for laboring women,” Anne Shea-Lewis and colleagues write.

“Our findings support permitting women who are at low risk for an operative birth to self-regulate their intake of both solid food and liquids during labor,” the researchers add. They note some limitations of their study, especially the fact that the women weren’t randomly assigned to NPO or ad lib groups.

The authors hope their study will lead to reconsideration of current recommendations to keep women NPO during the “often long and grueling” process of labor and delivery. “Restricting oral intake to a laboring woman who is hungry or thirsty may intensify her stress,” Anne Shea-Lewis and colleagues conclude. “Conversely, allowing her to eat and drink ad lib during labor can contribute to both her comfort and her sense of autonomy.”

Story Source:

Read this article on Science Daily: Wolters Kluwer Health. “Ice chips only? Study questions restrictions on oral intake for women in labor.” ScienceDaily. ScienceDaily, 23 February 2018. www.sciencedaily.com/releases/2018/02/180223151852.htm.


The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. Call for an appointment today: (707) 579-1102. Visit our website: www.womensobgynmed.com

Mothers over 40 more at risk of preterm birth

Maternal age over 40 is associated with an increased risk of preterm birth Mothers aged 30-34 years old may have the lowest risk of preterm birth
Pregnant mothers aged 40 and over may have an increased risk for preterm birth, regardless of confounding factors, according to a new study.
Pregnant mothers aged 40 and over may have an increased risk for preterm birth, regardless of confounding factors, according to a study published January 31, 2018 in the open-access journal PLOS ONE by Florent Fuchs from CHU Sainte Justine, Canada and colleagues.

Maternal age at pregnancy has been increasing worldwide and so has the risk for preterm birth. However, the association between maternal age and preterm birth remains a topic of ongoing research.

Fuchs and colleagues sought to investigate the impact of maternal age on preterm birth in a large cohort. The researchers analyzed the previously-collected data from the QUARISMA randomized controlled trial, which had taken place in 32 hospitals in Quebec, Canada, from 2008 to 2011.

The researchers identified five different age groups among the 165,282 pregnancies included in the study, and compared them based on maternal characteristics, gestational and obstetric complications, and risk factors for prematurity. Some of the known risk factors identified more commonly in older mothers (40 and over) included placental praevia, gestational diabetes, medical history, use of assisted reproduction technologies and occurrence of an invasive procedure. On the other hand, nulliparity, past drug use and smoking were more prevalent in younger mothers (30 and under).

Even after adjusting for confounding factors, the researchers found that advanced maternal age (40 or over) was associated with preterm birth. Meanwhile, a maternal age of 30-34 years was associated with the lowest risk of prematurity.


Read this article on Science Daily:  “Maternal age over 40 is associated with an increased risk of preterm birth: Mothers aged 30-34 years old may have the lowest risk of preterm birth.” ScienceDaily. ScienceDaily, 31 January 2018. www.sciencedaily.com/releases/2018/01/180131160346.htm.


About Women’s OB/GYN Medical Group

The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. Call for an appointment today: (707) 579-1102. Visit our website: www.womensobgynmed.com

Researchers use MRI for the first time ever in effort to decode early labor

Scientists are using the latest imaging techniques usually used to map the brain to try and understand why some pregnant women miscarry or go into early labor.
Scientists are using the latest imaging techniques usually used to map the brain to try and understand why some pregnant women miscarry or go into early labor.

They have developed 3D images of the cervix, the load bearing organ which lies at the base of the womb and stops a developing baby from descending into the birth canal before the due date.

Around a quarter of miscarriages during the fourth to sixth month of pregnancy (mid-trimester) occur because of weaknesses in the cervix.

The researchers at the University of Leeds hope by developing a detailed image of its structure, they can develop ways of monitoring women for signs of potential problems before they become pregnant.

Mr Nigel Simpson, Associate Professor in Obstetrics and Gynaecology, said: “Ultrasound monitoring is used to identify women at risk — where their cervix is unable to support the pregnancy. But little is known about why that problem develops.

“This research is attempting to answer that question.”

MRI techniques were used to create 3D images of the cervix. This is the first time extremely high resolution imaging has been used to understand the detailed micro-structure of this organ.

The research is published in the international obstetrics and gynaecology journal, BJOG.

James Nott, from the Faculty of Medicine and Health and lead author, said: “A lot of our understanding of the biology of the cervix is rooted in research carried out 50 years ago.

“By applying the imaging techniques that have been used on the brain, we can get a much clearer understanding of the tissue architecture that gives the cervix its unique biomechanical properties.”

The images reveal a fibrous structure running along the upper part of the cervix. The fibres are much more pronounced near to where it joins the womb. The fibres are made of collagen and smooth muscle and form a ring around the upper aspect of the cervical canal.

During pregnancy, these fibres provide a strong supporting barrier — keeping the fetus and amniotic sac in place and preventing micro-organisms from entering the uterus.

The images reveal that these support tissues are less prominent further down the cervix as it joins the birth canal.

During labour, the body releases chemicals which result in the cervix opening and allowing the baby to enter the birth canal.

But there are medical conditions where earlier in the pregnancy, the cervix fails to support the baby, leading to a miscarriage or premature birth.

Mr Simpson said: “This study’s findings have encouraged us to explore new imaging techniques to check the integrity of these fibres before or during pregnancy in order to identify at-risk mums, intervene earlier, and so prevent late pregnancy loss and pre-term birth.”

The study was funded by Cerebra, the charity for children with brain conditions.

The scientists used diffusion tensor MRI, which is a technology that can remotely sense different types of tissue based on their water content.


Story Source:

Materials provided by University of Leeds. Note: Content may be edited for style and length.


Journal Reference:

  1. JP Nott, E Pervolaraki, AP Benson, EA Bonney, JD Pickering, N Wilkinson, NAB Simpson. Diffusion tensor imaging determines three-dimensional architecture of human cervix: a cross-sectional study. BJOG: An International Journal of Obstetrics & Gynaecology, 2017; DOI: 10.1111/1471-0528.15002

Read this article on ScienceDaily, 20 December 2017. www.sciencedaily.com/releases/2017/12/171220121758.htm.

Start the New Year Right: Quit the nicotine habit using the latest research model for success

In addition to lowering the effects of nicotine withdrawal, exercise is by far the best thing women can do to improve health.The Women’s OB/GYN Medical Group shares insight into how women who have a nicotine habit can take advantage of the latest research trends for quitting that might just guarantee success; starting an exercise routine.

Smoking is a bad habit for anyone and for women it poses very specific problems, particularly for pregnant women and women who are considering pregnancy. “Now is the perfect time for women of all ages to make a commitment to stop smoking,” says Dr. Lela Emad Obstetrician & Gynecologist. “In light of the latest research, we’re asking all of our patients who smoke or use nicotine products, to make the commitment to change this one lifestyle habit, and start the New Year on a better track toward health.”

The Study 

Experts at St George’s University of London set out to understand the underlying mechanism that seems to be exercise’s way of supporting the body against nicotine dependence and withdrawal. The study revealed that even moderate exercise noticeably reduces the severity of nicotine withdrawal symptoms. The findings help to validate the protective effect of exercise during smoking cessation; against the development of physical dependence, which may help smokers in giving up the habit by reducing the severity of withdrawal symptoms.

The Impact of Smoking

According to the Center of Disease Control and Prevention cigarette smoking remains the leading cause of preventable death and disability in the United States, despite a significant decline in the number of people who smoke. More than 16 million Americans have at least one disease caused by smoking.

“If exercise works to decrease the symptoms associated with nicotine withdrawal, then taking up an exercise routine and quitting the habit go hand in hand,” Dr. Emad says. “Statistics show that only 30 percent of women quit smoking when they find out they are pregnant, if we could make a dent in that number, it will have a positive impact on the well-being of both mothers and their children.”

Cigarette smoking alone kills more than 480,000 Americans each year. It causes direct damage to the body, which can lead to long-term health problems. We’ve all heard that smoking causes cancer, lung and heart disease, and stroke, but smoking also causes specific problems for women’s health including:

  • Decreased bone density
  • Rheumatoid arthritis
  • Cataracts
  • Gum disease
  • Ulcers
  • Depression
  • Menstrual problems
  • Low birth-weight
  • Pre-term delivery

In addition to lowering the effects of nicotine withdrawal, exercise is by far the best thing women can do to improve health. Exercise has been found to increase a person’s overall energy level and it releases endorphins—which in turn increases a person’s happiness quotient. Ongoing research suggests that as little as 2.5 hours weekly (about 20 minutes a day) of moderate aerobic exercise such as walking provides all the major health benefits a body needs to stay healthy.

“What a great resolution for women of all ages to make for this New Year; stop smoking, start exercising,” Dr. Emad said.

About Women’s OBGYN Medical Group

The provider team of expert OB/GYN physicians, certified nurse midwives, family nurse practitioners, and medical assistants provides unmatched care to patients in our region. As women proudly serving women, we understand the needs and expectations of our patients. For more information call (707) 579-1102 or visit the Women’s OB/GYN website.

Positive pregnancy test? What’s next?

I might be pregnant, what’s next?

Experiencing early signs of pregnancy or testing positive on a home pregnancy test means it is time to consult with a physician.

Early signs that you might be pregnant include spotting, vaginal discharge, cramps, breast changes (sensitivity, soreness, and color changes), and missing your period. Of course, noting the last time you had sex without using contraception properly can also help indicate whether or not you might be pregnant. When these signs occur, most women opt to use a home pregnancy test before starting care with an OB/GYN MD or certified nurse midwife. Pregnancy tests are easy to use and readily available for purchase over the counter at drug stores.

What to do following a Positive Pregnancy Test

If you think you are experiencing any early signs of pregnancy or have tested positive on a home pregnancy test, it is important to consult a physician in order to establish care with a medical professional as early as possible. Women’s OB/GYN Medical Group offers pregnancy test visits by appointment. At your appointment, our providers will confirm the positive pregnancy with a urine pregnancy test in our office. Once we have confirmed the positive result, we will establish your care regimen and will help you plan your health maintenance throughout your pregnancy.

If your in-office pregnancy result comes back negative but you are still experiencing symptoms, we will help you schedule another appointment if needed in order to provide treatment and advice moving forward.

What to expect at your first visit:

  • A thorough physical exam and review of your medical history.
  • An ultrasound to confirm your due date (when to expect you will go into labor).
  • Blood work and standard cultures for Chlamydia and gonorrhea.
  • A pap smear, unless you’ve had one recently.
  • Arrangement to consult with a specialist (if certain risk factors are present).
  • A request to see your old medical records (if needed).

Our experienced team of physicians, nurse midwives, and nurse practitioners deliver comprehensive, compassionate preconception, pregnancy, and post-partum care to our patients and their families in a comfortable environment close to home.

Malaria drug may prevent Zika virus from infecting fetus

Studying pregnant mice, researchers at Washington University School of Medicine in St. Louis found that Zika virus manipulates the body's normal barrier to infection, and that hydroxychloroquine, a malaria drug related to chloroquine, interferes with this process, protecting the fetus from viral infection.Zika virus infects the fetus by manipulating the body’s normal barrier to infection, according to a new study of pregnant mice. Moreover, the study showed that a drug that interferes with this process protects the fetus from viral infection. That drug is already approved for use in pregnant women for other medical purposes.
Devastating consequences of Zika virus infection are suffered in the womb, where the virus can cause brain damage and sometimes death.

Studying pregnant mice, researchers at Washington University School of Medicine in St. Louis have learned that the Zika virus infects the fetus by manipulating the body’s normal barrier to infection. Moreover, they showed that a malaria drug that interferes with this process protects the fetus from viral infection. That drug already is approved for use in pregnant women for other medical purposes.

“We found that the malaria drug hydroxychloroquine effectively blocks viral transmission to the fetus,” said senior author Indira Mysorekar, PhD, an associate professor of obstetrics and gynecology, and of pathology and immunology. “This drug already is used in pregnant women to treat malaria, and we suggest that it warrants evaluation in primates and women to diminish the risks of Zika infection and disease in developing fetuses.”

The findings are published July 10 in The Journal of Experimental Medicine.

In late 2015, doctors in Brazil began to notice a surge in the number of babies born with microcephaly, or unusually small heads, an indicator of neurological damage. The epidemic soon was linked to the mosquito-borne Zika virus, which was spreading through the tropical parts of the Americas. Doctors advised pregnant women to avoid mosquito bites by wearing bug spray and long-sleeved clothing, but had little other advice to offer. There were, and still are, no drugs or vaccines approved for use in pregnant women to protect them or their fetuses from Zika infection.

The developing fetus is uniquely vulnerable to damage from infection, so the body mobilizes robust defenses to keep microbes from ever reaching the fetus in the first place. The placenta is the last line of defense. Mysorekar and others have shown that a process known as autophagy — the cellular waste-disposal pathway by which cells grind up debris, unwanted organelles and invading microbes — is an important part of the formidable placental barrier to infection. However, previous studies by Mysorekar and others have shown that Zika not only can invade the placenta, but multiply there.

To learn more about how Zika breaches the placenta, Mysorekar, postdoctoral fellow Bin Cao, PhD, and colleagues infected human placental cells with Zika virus. They found that exposure to the virus activated genes related to autophagy.

However, when the researchers treated the cells with drugs to ramp up the autophagy pathway, the number of cells infected with Zika virus increased. Drugs that suppressed autophagy resulted in fewer placental cells infected with Zika virus. In other words, the virus multiplied and spread more effectively when the researchers dialed up the barrier response, and performed more sluggishly when they dialed it down. The virus seemed to be doing a form of microbial martial arts, turning the body’s weapons to its own advantage.

Mysorekar and colleagues verified these findings using mice whose autophagy response was hobbled by low levels of a key autophagy protein. They infected two groups of pregnant mice with Zika: one in which the autophagy process was disrupted and the other in which it worked normally.

Five days after infection, the mothers with a weak autophagy response had about the same amount of virus in their bloodstreams as the mice with a normal response. However, in mice with a weak autophagy response, the researchers found 10 times fewer viruses in the placenta and the heads of the fetuses and less damage to the placentas.

“It appears that Zika virus takes advantage of the autophagy process in the placenta to promote its survival and infection of placental cells,” Cao said.

Since hydroxychloroquine suppresses the autophagy response, the researchers questioned whether it also could protect fetuses against Zika.

To find out, they repeated the mouse experiment using only mice with a normal autophagy response. Female mice at day nine of pregnancy were infected with Zika and then dosed with hydroxychloroquine or placebo every day for the next five days.

Following treatment, the researchers found significantly less virus in the fetuses and placentas from the mice that had received hydroxychloroquine. In addition, these placentas showed less damage and the fetuses regained normal growth. Both the untreated and the treated mothers had about the same amount of Zika virus in their bloodstreams, indicating that hydroxychloroquine was able to protect fetuses even when the virus was circulating through the mother.

Although hydroxychloroquine has been used safely in pregnant women for short periods of time, the researchers caution that further studies are needed before it can be used in pregnant women to fend off Zika. Pregnant women living in areas where Zika circulates may need to take the drug for the duration of their pregnancies, and the safety of hydroxychloroquine for long-term use is unknown.

“We would urge caution but nevertheless feel our study provides new avenues for feasible therapeutic interventions,” said Mysorekar, who is also co-director of the university’s Center for Reproductive Health Sciences. “Our study suggests that an autophagy-based therapeutic intervention against Zika may be warranted in pregnant women infected with Zika virus.”

The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. Call for an appointment today: (707) 579-1102. Visit our website: www.womensobgynmed.com


Story Source:

Materials provided by Washington University School of Medicine. Original written by Tamara Bhandari. Note: Content may be edited for style and length.


Journal Reference:

  1. Indira Mysorekar et al. Inhibition of autophagy limits vertical transmission of Zika virus in pregnant mice. The Journal of Experimental Medicine, July 2017 DOI: 10.1084/jem.20170957

Read this article on ScienceDaily: Washington University School of Medicine. “Malaria drug protects fetuses from Zika infection: Treatment prevents virus from crossing placenta to infect fetus, mouse study shows.” ScienceDaily. ScienceDaily, 10 July 2017. www.sciencedaily.com/releases/2017/07/170710091702.htm.

Good outcomes for older women who give birth at home or in a birth center

Women with some characteristics commonly thought to increase pregnancy risks — being over age 35; being overweight; and in some cases, having a vaginal birth after a cesarean section — tend to have good outcomes when they give birth at home or in a birth center, a new assessment has found.

However, women with some other risk factors, a breech baby and some other cases of vaginal birth after cesarean or VBAC, may face an increased risk of poor outcomes for themselves or their babies, researchers at Oregon State University have found. The study is believed to be the first to examine these risks and the outcomes. About 2 percent of all births in the U.S., and about 4 percent in Oregon, occur at home or in a birth center, rather than in a hospital setting. Generally, women who are considered “low-risk” are good candidates for home or birth center births, also referred to as community births, if they are attended by a midwife or other trained provider and timely access to a hospital is available.

However, there is little agreement among health providers on what should be considered low- or high-risk, and some women choose to have a community birth despite potential risks, said Marit Bovbjerg, a clinical assistant professor of epidemiology at Oregon State University and lead author of the study.

Medical ethics and the tenets of maternal autonomy dictate that women be allowed to decide where and how they wish to give birth. That’s why it’s important to have as much information as possible about potential risks, said Bovbjerg, who works in the College of Public Health and Human Sciences at OSU.

There are also risks associated with hospital births, such as increased interventions, which means there aren’t always clear answers when it comes to determining the best and safest place to give birth, said Melissa Cheyney, a medical anthropologist and associate professor in OSU’s College of Liberal Arts.

The goal of the research was to better understand the outcomes for women and babies with some of the most common pregnancy risk factors, to see how those risk factors affected outcomes.

“There’s a middle or gray area, in terms of risk, where the risk associated with community birth is only slightly elevated relative to a completely low-risk sample,” Cheyney said. “We’re trying to get more information about births that fall in that middle zone so that clinicians and pregnant women can have the best evidence available when deciding where to give birth.”

The findings were published recently in the journal Birth. Other co-authors are Jennifer Brown of University of California, Davis; and Kim J. Cox and Lawrence Leeman of the University of New Mexico. Using birth outcome data collected by the Midwives Alliance of North America Statistics Project, commonly referred to as MANA Stats, the researchers analyzed more than 47,000 midwife-attended community births.

They looked specifically at the independent contributions to birth outcomes of 10 common risk factors: primiparity, or giving birth for the first time; advanced maternal age, or mother over age 35; obesity; gestational diabetes; preeclampsia; post-term pregnancy, or more than 42 weeks gestation; twins; breech presentation; history of both cesarean and vaginal birth; and history of only cesarean birth.

The last two groups are both considered VBACs and hospital policies and state regulations for midwifery practice usually make no distinction between the two types. However, the researchers found a clear distinction between the two groups in terms of community birth outcomes.

Women who delivered vaginally after a previous cesarean and also had a history of previous vaginal birth had better outcomes even than those women giving birth for the first time. On the other hand, women who had never given birth to a child vaginally had an increased risk of poor outcomes in community birth settings.

“That finding suggests that current policies that universally discourage VBAC should be revisited, as the evidence does not support them,” Bovbjerg said. “Women who in the past have successfully delivered vaginally seem to do just fine the next time around, even if they have also had a previous C-section. That’s really important because some medical groups totally oppose VBACs, even in hospital settings, and many hospitals don’t offer the option of a VBAC at all.”

Researchers also found that women whose babies were in breech position had the highest rate of adverse outcome when giving birth at home or in a birth center.

There was only a slight increase in poor outcomes for women over age 35, or women who were overweight or obese, compared to those without those risk factors. In some categories, there were not enough births in the data set to properly evaluate a risk’s impact, such as with gestational diabetes and preeclampsia.

“As is appropriate, women who face high complication risks such as preeclampsia tend to plan for and choose a hospital birth, rather than a community birth,” Bovbjerg said. “But even for these women, it’s important to remember that they can choose a community birth if their faith, culture or other considerations dictate that is the best choice for them.”

The researchers emphasized that the new information about risks and outcomes can serve as an important tool in decision-making for families making very personal choices about where to give birth. “These findings help us to put information and evidence, rather than fear, at the center of discussions around informed, shared decision-making between expectant families and their health care providers,” Cheyney said.

Researchers next plan to examine how the healthcare culture and standards of care in different locations within the U.S. affect outcomes of home and birthing center deliveries.


Story Source:

Materials provided by Oregon State University. Note: Content may be edited for style and length.


Journal Reference:

  1. Marit L. Bovbjerg, Melissa Cheyney, Jennifer Brown, Kim J. Cox, Lawrence Leeman. Perspectives on risk: Assessment of risk profiles and outcomes among women planning community birth in the United States. Birth, 2017; DOI: 10.1111/birt.12288

Read this article on Science Daily: www.sciencedaily.com/releases/2017/04/170413154439.htm.