Amniocentesis involves the withdrawal of amniotic fluid through a fine needle which has been inserted through the mother's abdomen into the amniotic sac (bag of water) surrounding the baby. This fluid contains cells shed from the baby's skin, lungs, and urinary tract. These cells and fluid can be analyzed for certain types of problems with the baby.
The most common study performed on the fluid is a chromosomal analysis, which not only identifies Down's Syndrome, but other chromosomal abnormalities as well. Neural tube defects, or open areas of the skull or spine, can also be detected by amniocentesis. Later in pregnancy, amniocentesis can be used to check whether or not the baby's lungs are mature. Amniocentesis is also done for several other less common reasons, such as too much amniotic fluid or to check a baby's well-being if a problem is suspected.
The amniocentesis procedure is done under ultrasound guidance to avoid critical structures of the baby and mother. It is not unusual to delay the amniocentesis if an adequately safe insertion site is not found. Local anesthetic is usually injected to numb the skin's surface. After the needle is inserted, about 2 tablespoons of fluid are withdrawn through a syringe. After the procedure, heavy lifting and strenuous activity is discouraged for about 24 hours. Usually patients feel more comfortable if someone drives them home.
The decision to have an amniocentesis should not be taken lightly. The risk of losing the pregnancy from an amniocentesis done in the fourth to sixth month of pregnancy is about 1 in 200. The usefulness of the information gained from the amniocentesis and how that information will be used should be considered carefully. Later in pregnancy, pregnancy loss from amniocentesis is minimal, but premature labor and delivery occasionally occur.
Women who are 21 (younger, if sexually active) and over should have annual gynecological examinations. You should also see your gynecologist more often if you are planning pregnancy, have a sexually transmitted infection or have a partner who has STI, have a history of sexually related illness, or have a mother or sister who developed breast cancer before menopause.
To achieve the most accurate results from your gynecological examination and annual Pap smear, the best time for your appointment is one week after your period, while the least advisable time is the week prior to your menstrual cycle. During your visit, your doctor will do a Pap smear – a routine screening test that evaluates the presence of premalignant or cancerous conditions of the cervix.
Until you decide to start a family – or when your family is complete – you may want to use birth control to prevent pregnancy. There are many different methods of birth control. Talk to your doctor about the options and decide which method is right for you and your partner.
A bone density test uses special X-rays to measure how many grams of calcium and other bone minerals – collectively known as bone mineral content – are packed into a segment of bone. The higher your mineral content, the denser your bones are. The denser your bones, the stronger they are and the less likely they are to break. Doctors use a bone density test to determine if you have - or are at risk of - osteoporosis.
Endometrial ablation is an alternative to hysterectomy for patients suffering from heavy or prolonged menstrual bleeding. The procedure involves removing the source of the bleeding, which is the lining of the uterus. Removing the uterine lining will decrease your menstrual flow or even stop it completely.
Endometriosis is a condition where endometrial tissue, the tissue that lines the uterus and is shed during menstruation, grows outside the uterus – on the ovaries, fallopian tubes, other pelvic organs and less commonly anywhere in the body.
Endometriosis occurs in about 30-40% of women, and in most women it does not cause a problem. The cells can sometimes trigger an inflammatory reaction and cause scarring, adhesions, or pain. Unfortunately, these misplaced cells can block the fallopian tubes or inhibit the normal sweeping movements of the tubes, making pregnancy difficult.
The cause of endometriosis is unknown. It tends to run in families. It is also more common in women who have a blocked cervix that promotes menstruation into the pelvis (retrograde menstruation). Research toward finding a cure continues.
Diagnosis of endometriosis is made through a laparoscopy, although signs and symptoms sometimes make the diagnosis highly suspected. During laparoscopy, a slender fiberoptic tube is inserted into the abdomen to allow the doctor to look closely for endometrial growths.
Treatment for endometriosis is divided into medical and surgical components. Because endometrial cells respond to hormones of the menstrual cycle, medical management includes birth control pills and medications such as Danazol, Depo-Provera or Lupron. Lupron is most effective, but also has the most noticeable side effects – primarily hot flushes. This is because Lupron interrupts normal menstruation by essentially "shutting off" the ovaries and placing the patient in a menopausal state while on the medication. Without estrogen, the implants shrink.
Surgical management of endometriosis depends on the reason for treatment. If pregnancy is desired, laser laparoscopic ablation is sometimes helpful. If treatment is for pain, laser laparoscopic ablation may also be helpful. However, the most consistently effective treatment for pain from endometriosis is removal of the ovaries. This is not appropriate for women who desire children in the future, but when childbearing is complete, this approach often gives remarkable relief of symptoms.
Obstetricians and gynecologists spend a significant portion of their training in High-Risk Obstetrics (Perinatology). This includes training in common as well as unusual complications of pregnancy. Our physicians have experience managing diabetes in pregnancy (including gestational diabetes and insulin-dependent diabetes). Other common high-risk pregnancies managed include multiple gestations (such as twins or triplets), toxemia (Pregnancy Induced Hypertension), fetal growth restriction, low or high fluid, and many others.
High-risk pregnancies, also known as Maternal-Fetal Medicine, or MFM, may include: advanced maternal age, previous pregnancy history, current or history of various medial conditions including diabetes, genetic disorders, drug use, alcoholism, and various complications that may arise during pregnancy. Sometimes it is in the patient's best interest to be evaluated further or receive care for the duration of the pregnancy at a high-risk facility. Some situations can be “co-managed” between our office and a high-risk clinic. The facility at which delivery takes place will be determined with safety considerations in mind.
An HSG (hysterosalpingogram) is an X-ray of the inside of the fallopian tubes and uterus. This test is sometimes used to help find out why a woman is not becoming pregnant. An OB-GYN and a radiologist generally work together to do this test in a hospital's radiology department.
An HSG can pick up several problems that may prevent pregnancy. The most common is blocked fallopian tubes from old or current pelvic infection. Other problems identified by an HSG include uterine fibroids, a septum or division inside the uterus, or adhesions in the uterus.
An HSG is usually done just after the patient's menstrual period. To help with cramping during the test, pain medication such as Ibuprofen or Tylenol may be used 1-2 hours before the test. Your doctor may prescribe an antibiotic just before or after the test to help prevent infection.
The actual test involves being positioned as you would be during a Pap test. A speculum is used to see the cervix. A thin tube is placed just inside the cervix while dye is pushed into the uterus through the tube. X-rays are taken as the dye is pushed through the tube. You may be able to watch the progress of the dye on the X-ray monitor. The test usually takes about 10-20 minutes.
Most women can return to work right after the HSG. Cramping and discharge for a few hours is common and pads (not tampons) can be used for this discharge. You should call your doctor if you have a fever greater than 100 degrees F or have increasing lower abdominal pain after the test.
HSG is also used to confirm that an ESSURE has successfully blocked both fallopian tubes for desired sterilization. In this case, HSG is done three months after the procedure.
To diagnosis certain problems, your doctor may need to look directly into the abdomen at your reproductive organs. A laparoscope is a small fiber-optic telescope with a light that allows the physician to look into the abdomen through a small cut in the skin.
There are many reasons a laparoscopy might be performed. These include looking for and treating endometriosis, adhesions, fibroids, ovarian cysts or ectopic pregnancy. Laparoscopy can also be used to assist in a vaginal hysterectomy or removal of ovaries. Laparoscopy is also used for sterilization by cutting, clipping or burning the fallopian tubes.
The procedure itself involves having an IV placed, going to sleep with general anesthesia and then having the laparoscope inserted into the abdomen through a small incision-usually just below the navel (belly button).
Usually carbon dioxide gas is placed into the abdomen so the pelvic organs can be seen more clearly. One to three small cuts are made just above the pubic bone. Instruments can be placed through the skin at these sites to move organs into view or perform procedures such as taking biopsies, cutting adhesions, or removing something like an ovary or tumor.
Laparoscopy is usually an outpatient procedure. You may have some nausea, scratchy throat, abdominal cramping and vaginal discharge immediately after the surgery. Pain around the small incisions is usually minimal, since a long-acting numbing medication is injected at the time of surgery. Often, the most bothersome problem is discomfort that occurs when small carbon dioxide bubbles get trapped under the diaphragm and refer pain to the shoulder. This usually resolves within about two days.
Recovery from a laparoscopy is shorter than from regular surgery. We generally suggest to patients that they plan to be off work for 1-2 weeks, but many are able to return within 2-3 days.
Mammograms are probably the most important tool doctors have to help them diagnose, evaluate and follow women who have had breast cancer. Safe and highly accurate, a mammogram is an X-ray photograph of the breast. The technique has been in use for about thirty years.
Like many OB-GYN's, we recommend patients have their first mammogram at age 40. For women at high risk for breast cancer, who have a strong family history of breast or ovarian cancer, or who have had radiation treatment to the chest in the past, the first mammogram might be done at a younger age at the advice of your doctor.
Your mother or grandmother may have referred to menopause as “the change,” but it isn’t really a single event. Menopause is a transition that can begin in a woman’s 30s or 40s and last into her 50s or 60s. Some women experience signs and symptoms of menopause before their periods stop permanently.
Estrogen therapy is still a safe, short-term option for some women, but numerous other therapies are available to help patients manage menopausal symptoms and stay healthy during this important phase of life.
Menstruation is the release of blood and endometrial tissue through the vagina that occurs as part of the normal menstrual cycle. Menstrual disorders may involve the absence of menses (amenorrhea), abnormal vaginal bleeding, or other conditions related to menstruation.
A woman's menstrual history begins with her first period (menarche) and continues until menopause. It includes average cycle length and commonly associated symptoms, such as menstrual cramps, ovulation pain, and premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). If you have irregular periods, heavy bleeding, or painful cramping, we may be able to help you by prescribing an oral contraceptive.
The most common type of obstetrical surgery is the Cesarean Section, or "C-section." During a C-Section, an incision is made below the belly button to deliver a baby (or babies). There are many reasons a physician may perform a C-section, but some of the most common include labor failing to proceed normally, the baby having difficulty tolerating labor, the baby coming out backwards, or the mother having had a prior C-section. About 20-25% of all babies in the U.S. are born by C-section. Our goal is to minimize the number of C-sections in our practice while providing the safest care possible.
An uncommon type of obstetrical surgery is a Cervical Cerclage. This is when thick thread or suture is sewed around the cervix (the opening where the baby will eventually come through). The cervix may be weak from previous surgeries, and some women are born with a weaker cervix that cannot hold the baby inside for the whole pregnancy. Cerclages are generally placed after the first third of pregnancy when forces on the cervix become more intense.
A more uncommon type of obstetrical surgery is a Cesarean Hysterectomy. This is when the uterus is removed at or near the time of delivery. The usual reason is massive and life-threatening bleeding from the mother which can only be corrected with this dramatic step.
A Non-Stress Test, or "NST", is a procedure where a heart monitor is used to listen to and record a baby's heartbeat. The "tracing" that is recorded can then be examined by an obstetrician for reassurance of the unborn baby's good health. Patterns of the tracing can give clues as to how much fluid is around the baby, whether the baby is getting enough oxygen and nutrition, or if the baby is growing adequately. Many lives have been saved by this simple test.
A biophysical profile incorporates NST and ultrasound technology to provide a clearer picture of an unborn baby's health. Biophysical profiling is usually performed when the results of an NST are unclear. The procedure involves using ultrasound to view the baby's movements and fluid levels. Combined with NST results, these observations can help the physician determine whether the baby needs to be delivered earlier than planned.
During an ultrasound, high frequency sound waves are transmitted through the skin and bounce back as pictures on a monitor screen. Most women will have two ultrasounds during a pregnancy, one in the first trimester and another at around 20 weeks. At the 20 week ultrasound, the sex of the baby might be seen. The 20-week ultrasound is also a very important screening tool. Measurements of organs, limbs and cardiac evaluation are done. We want this to be a pleasant experience, but please understand this is a crucial evaluation of your baby. Please limit observers and be understanding if impatient siblings are asked to be removed from the ultrasound room.
The vaginal “ecosystem” can be easily disturbed. Vaginal infections can be triggered by dozens of daily things, such as sexual behavior, hormones (including hormonal contraceptives and changes in menstrual cycle), vaginal blood (from your period, irregular bleeding, etc.), anything inserted into the vagina (diaphragm, tampons, strings from an IUD) or medications (antibiotics, douching agents, antifungal agents, spermicides).