Obstetrics & Gynaecology Dr Adel Abdulhafid

Subtitle

Happy New Year 2019

Happy new year


I had moved to another Hospital and two new clinic the address below;

Dr Adel Abdulhafid
Fort Saskatchewan Community Hospital
9401 86 Avenue, Fort Saskatchewan, Alberta
Call 780-998-2256
============================================
Albany Medical Center
12916 - 167th Ave NW
Edmonton, AB T6V 1J6
Phone: 780-244-2696
Fax; 780-2440692
Web site: drabdulhafid.wbs.com
My facebook page:
Facebook/pages: dr adel abdulhafid

============================================
Ross Greek Medical Clinic
206, 10101 - 86 Ave
Fort Saskatchewan, AB T8L 0T6
Phone; 780-589-3989
Fax; 780-998-036
Web site: drabdulhafid.wbs.com
My facebook page:
Facebook/pages: dr adel abdulhafid

Obstetrics & Gynaecology 

Advanced laparoscopic surgery 

minimally invasive surgery 

Dr Adel Abdulhafid

Laparoscopy-assisted vaginal hysterectomy (Hysterectomy done by Laparoscopy)

Laparoscopic surgery:
Laparoscopic surgery, whose development has been so impressive in the last decade, was initially introduced at the beginning of this century where Gynecologist have look at abdominal cavity of a pregnant women in 1901 with acute abdominal pain.
Operative laparoscopy has advanced surprisingly in the last ten years. Several operative procedures have been performed by this new approach.
The most known laparoscopic surgery is:
Laparoscopy-assisted vaginal hysterectomy (Hysterectomy done by Laparoscopy)

Laparoscopic hysterectomy was first performed in 1989. The impetus for trying a new approach to a common gynecologic procedure was to reduce the morbidity and mortality of abdominal hysterectomy.
Professional societies encourage the use of minimally invasive techniques for hysterectomy for benign diseases when appropriate

LAPAROSCOPIC VERSUS TRADITIONAL HYSTERECTOMY
A Cochrane review evaluated 27 randomized controlled trials with a total of 3643 participants to determine the most appropriate approach to hysterectomy

Laparoscopic hysterectomy compared to abdominal hysterectomy
  1. Less blood loss
  2. Shorter hospital stay
  3. Speedier return to normal activities
  4. Fewer wound infections or fevers
  5. Longer operating time
  6. More urinary tract injuries..





******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


***************************************************************** 

Myths


Total hysterectomy

False = in this procedure both uterus and ovary removed
Truth = only uterus and cervix remove, the ovary not included

Partial hysterectomy
False = uterus with out ovary
Truth = uterus only with out cervix

Total hysterectomy with both ovary ( bilateral salpingo-oophorectomy )
Truth = uterus + cervix + tube + both ovary









******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************


Endometrial ablation = Burning the uterine lining
NovaSure
How does NovaSure work to treat heavy periods?
The one-time, 5-minute procedure trusted by over 1 million women.
NovaSure® is an endometrial ablation (EA) procedure that can reduce or stop menstrual bleeding.
It works by removing the endometrium (Burning the uterine lining), or the lining of the uterus (the part that causes the bleeding), with a quick delivery of radiofrequency energy.

Benefits and consideration of NovaSure for heavy periods
It’s Safe
No pills. No hormonal side effects.
It’s Effective
For 90% of women, menstrual bleeding is dramatically reduced or stopped.
It’s Quick
NovaSure® is a one-time, five-minute procedure.

NovaSure can do more than just stop the bleeding. Many women who’ve had the NovaSure procedure say they are now able to spend more time at work and daily activities, participating in more social and athletic outings now that they no longer suffer from heavy bleeding. They also report improved energy levels, better moods, and a boost in self-confidence. And many also had a significant reduction in painful periods and PMS symptoms like irritability.*

Not all women are candidates for NovaSure Endometrial Ablation.
Your doctor will explain the risks of all treatment options. NovaSure is for premenopausal women with heavy periods due to benign causes who are finished childbearing. Pregnancy following NovaSure can be dangerous.
NovaSure is not for those who have or suspect uterine cancer, have an active genital, urinary or pelvic infection, an IUD or a metal uterine implant.
NovaSure is not a sterilization procedure.
Rare but serious risks include but are not limited to thermal injury, perforation and infection. Temporary side effects may include cramping, nausea, vomiting, discharge and spotting.

What to expect from the NovaSure procedure
What is the NovaSure procedure like?
NovaSure® Endometrial Ablation is the simple, one-time, 5 minute procedure trusted by over one million women - without hormones or hysterectomy.
The entire procedure typically takes less than 5 minutes
It is performed without any incisions
Most women report little or no pain, and return to their regular activities within a day

Here's what you can expect before, during, and after the NovaSure procedure:

Before the NovaSure® procedure
The procedure can be scheduled any time during your menstrual cycle, even if you are bleeding at the time. Your doctor will give you a pregnancy test before the procedure to confirm you are not pregnant.
You may be given an anti-inflammatory medicine, to take an hour or two before the procedure, to reduce discomfort.

During the NovaSure procedure
Your doctor slightly opens your cervix (the opening to the uterus), inserts a slender wand, and extends a triangular mesh device into the uterus.
The mesh gently expands, fitting to the size and shape of your uterus.
Precisely measured radio frequency energy is delivered through the mesh for about 90 seconds.
The mesh device is pulled back into the wand, and both are removed from the uterus.
The entire procedure usually takes less than 5 minutes.

Right after the NovaSure procedure
The instructions after procedure include the following information:
Have someone drive you home.
Do not drive, operate potentially dangerous machinery, sign legal documents or make critical decisions the day of the procedure. You may resume regular activities the next day.
A heating pad placed on your lower abdomen can help to reduce cramping.
Consult your physician about medication to help reduce cramping.
You may shower the same day but refrain from swimming and baths.
Please refrain from anything in the vagina for 4 weeks. This includes tampons and intercourse.
Call your doctor if you have...
...increased abnormal discharge.
...increased post-procedural pain.
...increased bleeding.
...fever above 100.4F.
Be sure to check with your own doctor to find out what your specific discharge instructions are.
Most women report little or no pain, and return to their regular activities within a day.

Permanent contraception with NovaSure
When you have the NovaSure procedure, you’ll need long-term birth control, since it’s still possible to become pregnant and a pregnancy after any ablation procedure is unsafe for both mother and fetus.

******************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid

******************************************************

Polycystic ovary syndrome – (PCOS)

Polycystic ovarian syndrome (PCOS) is a very common condition affecting at least 1 in 7 women of reproductive age.

Symptoms of polycystic ovarian syndrome
Most women have never even heard of PCOS, yet it causes a wide variety of symptoms that often affect female reproductive health in ways that can be truly devastating. Although PCOS often affects the reproductive system, it's important to understand that it is an endocrine system disor
der. 
Polycystic ovarian syndrome can present with a variety of symptoms which include:
  1. Irregular periods (cycle greater than 35 days or lack of periods)
  2. Infertility; difficulty in becoming pregnant
  3. Recurrent miscarriages
  4. Unwanted facial and or body hair (hirsutism)
  5. Oily skin, acne
  6. Being overweight, rapid weight gain especially around the waist and abdomen (known as central      obesity)
  7. Difficulty in losing weight

What causes polycystic ovarian syndrome?
The cause of PCOS is not known exactly but probably results from a combination of several related factors.
Women with PCOS frequently have a mother or sister with PCOS. But there is not enough evidence yet to say there is a genetic link to this disorder.
There may be an imbalance between a hormone produced by the brain (pituitary) called luteinizing hormone (LH) and follicle-stimulating hormone (FSH), resulting in a lack of ovulation and an increased testosterone production, a male sex hormone.
Many women with PCOS have a weight problem. So researchers are looking at a relationship between PCOS and the body's ability to make insulin. Insulin is a hormone that regulates the change of sugar, starches and other food into energy for the body's use or for storage. Many women with PCOS have insulin resistance, in which the body cannot use insulin efficiently. Since some women with PCOS make too much insulin, this leads to high circulating blood levels of insulin, called hyperinsulinemia. It is believed that hyperinsulinemia is related to increased levels of male hormones and it is possible that the ovaries react by making too many male hormones, androgens. This can lead to acne, excessive hair growth, weight gain (obesity), and ovulation problems as well as type 2 diabetes. In turn, obesity can increase insulin levels, causing worsening of PCOS. If there is evidence of being overweight a blood test to assess whether there is a tendency to develop diabetes (Oral glucose tolerance test) is sometimes recommended.

Treatment of polycystic ovarian syndrome
Lifestyle change and change in diet are absolutely paramount. The long-term consequences of PCOS should also be highlighted. Prophylactic use of a drug call Metformin in women with impaired glucose tolerance to prevent progression of diabetes may be useful in selected cases but this has to be decided by the doctors on a case by case basis at present. The effectiveness of Metformin in relation to ovulation induction has been evaluated and the most recent studies concluded that clomiphene citrate (Clomid) (CC) should still be the first choice therapy for women with therapy naïve PCOS (no previous treatments). In women who do not respond to clomiphene, a combination therapy with Metformin may be considered.

Take home messages for polycystic ovarian syndrome
  1. The condition never presents itself in exactly the same way in every woman - symptoms are highly variable. 
  2. Not all women with PCOS are infertile
  3. Treatment of PCOS is highly individualised
  4. Lifestyle changes and exercise are extremely important to manage the condition
  5. Metformin is a drug which may have a role in treatment of PCOS and a six month trial is worthwhile especially in women with PCOS who are overweight
  6. For women requesting cycle control oral contraceptive pill with anti-androgen activity may be useful
  7. Clomiphene is the initial treatment of choice in women who are trying to conceive

Conclusion
PCOS is a very common problem that has both short-term effects upon reproductive function and longer term effects upon the risk of diabetes and cardiovascular disease. Treatment of this condition should not only include drug therapy but also lifestyle changes.

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


****************************************************************** 

Pap smear is it important and how important is the HPV vaccine?

What is a Pap test?
This is a simple test that can help prevent cervical cancer.
The Pap test detects cell changes on your cervix that, if left untreated for several years, could eventually turn into cervical cancer. 
When changes in cervical cells are found early, they can often be treated effectively before they become dangerous.
Regular Pap testing can reduce cervical cancer deaths by 70%.

How can I get a Pap test?
You can get a Pap test from your health-care professional, such as a family physician, midwife, nurse practitioner or gynaecologist..

How often should I have a Pap test?
In the past, national guidelines have recommended that you begin having Pap tests within 3 years of becoming sexually active or by age 21.
You should have a Pap test once per year until you have had two normal test results in a row, and then you only need one every 3 years.
You should continue having tests until you are at least 70 years old..

Further testing
To examine the cervix better after an abnormal Pap test, you may need a colposcopy.
Your health-care provider, usually send you to see a gynaecologist , will use a special solution on your cervix which causes abnormal cells to turn white. He or she will then use a colposcope to look at your cervix. This is a special instrument that shines a light on your cervix and magnifies it, like looking through binoculars.
He or she may take a tissue sample from your cervix for further testing in a laboratory..

How are abnormal cells treated?
If testing shows that you have some changes on your cervix that could lead to cancer, your doctor may recommend cryosurgery, laser surgery or a LEEP procedure to remove the affected cells.
Rarely, women may have to have treatment more than once, because the treatments don't always reach all of the affected cells the first time.
You will need more frequent (every 4-6 moths)Pap tests after treatment to see if it has worked and to keep an eye out for any more changes of your cervix..

HPV (human papillomavirus)vaccine
Women 16 to 26 Years of Age
Why Is Vaccination Recommended for Those ages?
Ideally the vaccine should be given before sexual debut and thereby before exposure to HPV.
Vaccination of younger girls is important, as 20% of girls in grade 9 and 46% of those in grade 11 have had sexual intercourse.
Even if you have been vaccinated against the HPV, which is the root cause of many cervical cancer cases, it is still important to get regular Pap tests..

What is HPV?
The Human papillomavirus, or HPV, is the most common family of viruses. HPV is also the most common sexually transmitted infection in the world today. 
But you need to know that some types of the HPV virus are considered "low risk" and can cause genital and anal warts. Other types are considered "high risk" and can cause pre-cancerous lesions and cancer in the cervix, anus and other genital areas.

How is HPV spread?
The HPV virus can infect anyone who has ever had a sexual encounter even without penetration. The most common transmission is by skin-to-skin contact with the penis, scrotum, vagina, vulva, or anus of an infected person. Kissing or touching a partner's genitals with the mouth can also transmit the HPV virus.
Having HPV does not mean you have a disease. Most people who get HPV don't even have any signs or symptoms.

HPV test
There is an HPV test that can detect high-risk HPV strains in DNA from the body’s cells. But it is not included in the regular STI testing because it is not widely accessible. Currently, the test is usually only used in rare circumstances, either when a physician recommends it or when a woman has abnormal results on her Pap test. Many parts of Canada do not have the test, and since it may not be covered by your health plan, you may have to pay about $90 for it.

Can you prevent HPV?
Because the HPV virus is so contagious, total prevention of the HPV virus is not easy.
Abstinence of all sexual contact, even skin-to-skin sexual activity without penetration, is the only way to avoid contracting the HPV virus.
Limiting the number of partners – the more sexual partners you have, the higher your risk of contracting HPV.

Can HPV be cured?
Most people with HPV have no signs or symptoms and HPV will clear up by itself.
Unlike other sexually transmitted infections, HPV is caused by a virus and viruses cannot be cured with antibiotics. There is currently no medical cure to eliminate the HPV virus. Four types of HPV cause the majority of genital warts (types 6 and 11) and most cases of cervical cancer (types 16 and 18). Two vaccines are now available in Canada; one protects against types 16 and 18 and the other against all four types. You should speak to your physician about this option.

Cone biopsy or LEEP ( teatment for abnormal pap )

If you are considering having a cone biopsy or have one planned, it is important to know all you can about it.

What is the problem?
You have unhealthy tissue on the lower part of your uterus. This lower part of your uterus is called ‘the neck of the uterus’ or the cervix.

What is the cervix?

The cervix is the lowest part of your uterus. It juts into the upper end of your vagina, like an upside down cone. Your cervix has a central hole, or canal, which runs up into the centre of your uterus. The tissue on the outside of your cervix and inside your cervical canal is called epithelium. It is different from the tissue that lines the rest of your uterus, which is called the endometrium.

Cone biopsyWhat has gone wrong?
You have probably had a pap smear test, where cells are taken from the epithelium tissue that covers your cervix. Under the microscope these cells look like they are starting to become abnormal.
The unhealthy cells are probably intra-epithelial. This means they are still only in the skin and have probably not spread into the deeper parts of your cervix yet. Over years these cells may change to become an invasive cancer. The condition at this stage is called abnormal cell. A pathologist identifies this in the laboratory. We know that these changes will develop into cancer if left untreated. The cancerous changes usually happen over many years.

What is a cone biopsy?
To prevent cancer it is sensible to remove the area with the diseased cells. A biopsy means removal of some tissue. We usually only remove small areas on the outside of the cervix to test under the microscope. If we find pre-malignant changes in the inner canal of the cervix we need to remove a bigger, cone shaped piece of tissue. This is called a cone biopsy. We remove the tissue using a knife, a special electric current or a laser.

The aims
We aim to remove all of the unhealthy tissue before it changes into invasive cancer. We send the removed tissue to the laboratory for examination under the microscope. Sometimes, the laboratory results suggest that some diseased tissue has been left behind after a cone biopsy. A further biopsy may be needed. Very rarely, the laboratory results show that the disease is beyond the pre-cancer stage. Further treatment is then necessary.

The benefits
Complete removal of unhealthy tissue from your cervix gives a high chance of a permanent cure. You would have less risk of developing an invasive cancer.
Destroying the abnormal tissue using a laser, cold coagulation and cryotherapy treats just the part of the cervix that contains abnormal cells. This allows normal cells to grow back in their place.

Are there any alternatives?
If you are past the menopause or have had all the children you want, your doctor may suggest a hysterectomy, where the whole of your uterus is removed. This is more likely if you have had abnormal cells found on your cervix more than once or if severe abnormality was found.

What if you do nothing?
The lower levels of abnormal pap may sometimes get better without treatment. You may decide to wait and see if this happens for you. You would need frequent smear tests and examinations of your cervix over several years to see if the tissue is returning to normal. The tissue is less likely to recover if you smoke.
If you do not have treatment for a higher level of abnormal pap , there is high chance of cancer developing in your cervix in the future. If you develop cancer the treatment will involve extensive surgery. Curing a cancer is much more difficult. Removing the pre-cancerous changes before they get to this stage is a much simpler operation.


******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************



Pregnancy

Congratulations! If you are pregnant or just thinking about conception, we are pleased to have you as an obstetrical patient and look forward to helping you make this a wonderful pregnancy.

The upcoming birth of a child is a time of excitement, joy, and at times - anxiety. 

If you are having a normal pregnancy, you will visit our office monthly until you reach the last 3 months of your pregnancy, at which time, you will come every two weeks until the last month, when you will come weekly until delivery, so that you can meet and discuss any concerns or questions you may have.

Obstetrical Calendar: Weeks Gestation: Discussion & Testing

1) First Visit:
  • Pre-natal blood work drawn
  • Obtain medical history from mother and father
  • Pregnancy education
  • Discuss testing options: 1st Trimester Screen (provides a more accurate assessment of a woman's risk for carrying a baby with Down syndrome, than age alone) and AFP (Alpha-fetoprotein - screens for Down syndrome, Trisomy 18 and neural tube defects).
  • Schedule ultrasound if if indicated

2) Second Visit:
  • Review results of Pre-natal blood work
  • Discuss 1st Trimester Screen if you wish to pursue
  • Discuss Dating Ultrasound if done
  • Discuss indication or need for if High Risk or 35 and older for amniocentesis or CVS (Chorionic villus sampling) tests used to diagnose chromosomal abnormalities.
  • Full pelvic exam includes Pap smear and cultures. Please note, there is a possibility of spotting after the exam.
  • At each visit
    • Check Blood pressure (BP)
    • Check Urine
    • Check Weight

3) 12 weeks
  • Discuss AFP Testing with provider. AFP to be done between 15-22 weeks if you wish to do it.
  • Check Fetal heart beat at each visit
  • Check weight, BP, and urine

4) 16 weeks
  • Discuss AFP results if they are back
  • Discuss results of 1st Trimester Screen
  • Listen to fetal heart beat and check uterine size

5) 18-20 weeks
  • Detailed Anatomic Screening Ultrasound: during this Ultrasound, we take a detailed look at the anatomy of the baby.
6) 20 weeks
  • Check weight, BP, and urine
  • Listen to fetal heart beat and check uterine size
  • Review results of 19-20 week ultrasound if done
  • Review results of AFP if done later than 16 weeks

7) 24 weeks
  • Check weight, BP, and urine
  • Listen to fetal heart beat and check uterine size
  • Discuss 1-hour Glucose Test to be done to check for Gestational Diabetes
  • Antibody screen to be checked only if Rh negative

8) 28 weeks
  • Check weight, BP, and urine
  • Listen to fetal heart beat and check uterine size
  • Review results of 1-hour Glucose Test and blood work to check anemia.
  • Discuss Rhogam injection Only if Rh negative

9) 30 weeks - Starting every 2 weeks visits
  • Check weight, BP, and urine
  • Listen to fetal heart beat and check uterine size

10) 32 weeks
  • Check weight, BP, and urine
  • Listen to fetal heart beat and check uterine size
11) 34 weeks
  • Check weight, BP, and urine
  • Listen to fetal heart beat and check uterine size
  • Address any additional questions or concerns you may have regarding labor and delivery.

12) 36 weeks - Starting Weekly Visits
  • Check weight, BP, and urine
  • Listen to fetal heart beat and check uterine size
  • We will obtain a Cervical Culture to check for Group B-Strep
  • Please note, there is a possibility of spotting after the exam
  • Repeat Chlamydia culture if indicated
  • Repeat RPR and HIV if indicated

13) 37 weeks
  • Check weight, BP, and urine
  • Listen to fetal heart beat and check uterine size

14) 38 weeks
  • Check weight, BP, and urine
  • Listen to fetal heart beat and check uterine size
  • Discuss GBS culture results

15) 39 weeks
  • Check weight, BP, and urine
  • Listen to fetal heart beat and check uterine size
  • Cervical Exam if indicated

16) 40 weeks
  • Check weight, BP, and urine
  • Listen to fetal heart beat and check uterine size
  • You may have a non stress test (NST) and/or ultrasound to check the status of your babyProvider may discuss and schedule induction prior to 42 weeks.Cervical Exam


******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************


Ultrasound in Pregnancy

What is an ultrasound?
Ultrasound comes from a machine that creates an image of the inside of your body. It shows what your baby looks like while still inside your womb (uterus).
Ultrasound can tell you—and your health-care provider—many things about your baby, such as:
• the size of the baby
• how well the baby’s heart works
• how well other organs (such as the spine, brain and kidneys) are growing
• the anticipated date of birth
The moving pictures from the ultrasound machine are like a movie. The pictures appear on a computer screen.

How does ultrasound work?
Ultrasound pictures are made from sound waves which are too high pitched to be heard by the human ear. The sound waves travel through your skin and are focused on a certain part of your body by a scanning device called a “transducer.” It picks up the sound waves as they bounce back from organs inside the body.
Ultrasound is different from x-rays because it does not use radiation. This makes it safer for you and your baby. Ultrasound is used in many areas of medicine.

Why is an ultrasound done?
An ultrasound can help to check on many aspects of a healthy pregnancy, such as:
• the number of babies
• whether the baby ’s size is right for his/her age
• how the baby’s internal organs are growing
• whether the placenta (afterbirth) is in the correct place
• whether there are problems with the mother's uterus, fallopian tubes or ovaries

Experts in Canada recommend that all women have an ultrasound when they are pregnant. 
The best time to do this is between 18 and 22 weeks of pregnancy.

You might be asked to have ultrasound at other times during your pregnancy. Your health-care provider may suggest this:
• to see what position the baby is in
• to check the placenta (afterbirth)
• to view how much fluid is around the baby
• to check the baby’s growth and well-being
• to check for signs of a possible genetic problem

What will happen during the ultrasound?
Before you go for an ultrasound, you will get information on how to prepare and where to go. Sometimes, women are told to arrive with a full bladder, but not so full it causes pain. This helps the sound waves travel better through the skin and tissues. You may be asked to change from your own clothing into a medical gown.

The person who does the ultrasound is called an ultrasonographer. Once you are lying down on the examining table, clear gel will be put on your skin. The gel allows the transducer to move easily on your skin and helps the sound waves to transmit into your body. You may feel light pressure on your tummy but no pain. An ultrasound exam takes about 30 minutes. If more tests are needed, it could take longer.

Sometimes, the ultrasound must be done through the vagina (birth passage). A special kind of transducer is placed into your vagina. Most women feel no pain during this type of ultrasound.
What can an ultrasound find?

You should make sure you are fully informed about why you are having an ultrasound. It is an important way to learn about problems. The results of an ultrasound may mean you will need to have more tests. Talk to your health-care provider before you have an ultrasound to make an informed decision.

For most pregnant women, ultrasound assures them that their baby is healthy and all is well. Sadly, for a few, the ultrasound will find signs that all is not normal. Remember that the screening test only indicates an increased chance for concern and cannot tell you for sure if the baby does have a specific condition.

Your health- care provider will be told if the ultrasound shows any signs of abnormality. They will discuss this with you. You may be referred to a centre that has expert doctors with experience in the field of fetal abnormalities.

Does a normal ultrasound mean I will have a healthy baby?
Ultrasound can detect many, but not all, abnormalities. Finding an abnormality depends on many factors, including the age and position of the baby, as well as the size and type of abnormality.

The clarity of the pictures depends on the ultrasound equipment and how well the ultrasound can pass through the mother’s abdomen. For example, ultrasound will be less clear when the mother’s abdomen is thick or scarred.

Is ultrasound safe?
Ultrasound has been used on pregnant women for more than 30 years. Studies continue to make sure ultrasound is safe. So far, there is no reason to think that it harms mothers or babies. As with all medical tests, the benefits must always be greater than the risks.

Health Canada regulates ultrasounds in Canada through two laws: the Medical Devices Regulations of the Food and Drugs Act and the Radiation Emitting D evices Act. This helps to ensure that ultrasounds are safe when used for medical reasons.

The Society of Obstetricians and Gynaecologists of Canada and Health Canada have produced guidelines on diagnostic ultrasound. They state that ultrasound should not be used for any of these reasons:
• to have a picture of the baby, solely for non-medical reasons
• to learn the sex of the baby, solely for non-medical reasons
• for commercial use, such as trade shows or making videos of a baby
What are the benefits of ultrasound?
Ultrasounds provide pregnant women with important medical information. It helps Canadian women have healthy babies.
Ultrasound must be used carefully to ensure that mothers and their babies benefit from what it offers.
If your health-care provider recommends that you have an ultrasound, make sure you know:
• why it is needed
• the risks that may be involved
• how it will be done







******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Ovarian Cysts
(Also Called 'Cysts - Ovarian')

What is an ovarian cyst?
An ovarian cyst is a sac filled with fluid or a semisolid material that forms on or within one of the ovaries, the small organs in the pelvis that make female hormones and hold egg cells.

There are different types of cysts, many of which are normal and harmless (benign). Functional cysts, which are not disease related, occur as a result of ovulation (the release of an egg from the ovary). Functional cysts generally shrink over time, usually within 60 days, without specific treatment.

Functional ovarian cysts, which are relatively common, should not be confused with other types of cysts that are disease-related. Conditions such as polycystic ovary syndrome and ovarian cancer also involve growths on the ovaries. Tell your health care provider if you have any of the symptoms listed below. He or she can determine the type of cyst you have.

What are the symptoms of an ovarian cyst?
Some smaller cysts cause no symptoms; you may not even know you have a cyst. Larger cysts may cause the following symptoms:
  1. A change in your normal menstrual bleeding (abnormal bleeding)
  2. Pelvic pain or a dull ache in your back
  3. A feeling of fullness (bloating) in your lower belly
  4. Pain during intercourse
  5. Painful periods

Some prolonged symptoms may be associated with a condition called polycystic ovary syndrome, a hormonal imbalance that causes irregular periods and other hormone-related problems, including obesity and infertility. Other symptoms of polycystic ovary syndrome include hirsutism (increased growth of body hair) and obesity.
What causes an ovarian cyst?
The exact cause of ovarian cysts is not known, but they tend to form when the ovary produces t
How is an ovarian cyst diagnosed?
Your health care provider will first rule out pregnancy as the cause of your symptoms. He or she then may use the following tests to diagnose an ovarian cyst:

  1. A pelvic exam — During this exam, the doctor uses an instrument to widen the      vagina, which allows the doctor to examine the vagina, cervix and uterus. The doctor also feels the reproductive organs for any lumps or changes.
  2. Blood tests — These tests are used to measure the levels of certain hormones in the blood. 
  3.  Ultrasound — This test uses sound waves to create images of the body’s internal organs. It can be used to detect cysts on the ovaries. 
  4.  Laparoscopy — This is a procedure, performed in an operating room, in which the doctor inserts a small device through an incision (cut) in the abdomen. He or she views the reproductive organs and pelvic cavity using the device. During a laparoscopy, small cysts or samples of tissue for testing may be removed. 

How is an ovarian cyst treated? 
  1. Functional ovarian cysts generally go away without treatment. Your health care provider may give you medications containing hormones (such as birth control pills) to stop ovulation. If you do not ovulate, you will not form functional cysts. 
  2. In some cases, surgery may be necessary to remove a cyst. 

Types of surgery 
The type of surgery used depends on the size of the cyst and how it appears on the ultrasound. The different procedures used include: 
  1. Laparoscopy — This is a procedure in which the doctor inserts a small device through an incision in the abdomen. He or she views the reproductive organs and pelvic cavity using the device. If the cyst is small, the doctor can remove it through tiny incisions made in the pubic hairline. 
  2. Laparotomy — This procedure uses a bigger incision to remove the cyst. The cyst will be tested for cancer. If it is cancer, the doctor may need to remove one or both ovaries, the uterus, a fold of fatty tissue called the omentum and some lymph nodes. Lymph nodes are small, bean-shaped structures found throughout the body that produce and store infection-fighting cells, but may contain cancer cells. 

What are the complications of an ovarian cyst? 
If a cyst breaks open, it can cause severe pain and swelling in the abdomen. 

Can ovarian cysts be prevented? 
Taking medications that contain hormones (such as birth control pills) will stop ovulation. However, many women taking low-dose oral contraceptives may still ovulate. Although there has been no study that shows that oral contraceptive pills reduce the formation of the ovarian cysts, many physicians still do prescribe this regimen. 

When should I call my health care provider? 
Call your health care provider if any of the following occur: 
  1. Your menstrual periods are late, irregular, or painful 
  2.  Your abdominal pain doesn’t go away 
  3.  Your abdomen becomes enlarged or swollen 
  4.  You have trouble urinating or emptying your bladder completely 
  5.  You have pain during intercourse 
  6.  You have feelings of fullness (bloating), pressure, or discomfort in your abdomen 
  7.  You lose weight for no apparent reason 
  8.  You feel generally ill


******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************


Endometriosis

The inner lining of the uterus is called the endometrium. During a menstrual period, the lining of the endometrium is shed through the vagina. 

In endometriosis, fragments of endometrium develop in places other than the inner lining of the uterus. These fragments may develop on the ovaries, or sometimes on the fallopian tubes, the vagina, the peritoneum, or the intestine.

Mild forms of endometriosis are common and may not require treatment. Endometriosis can make it difficult for a woman to become pregnant.

Who can get endometriosis?
Any woman who has menstrual periods can get endometriosis. Endometriosis occurs most often between the ages of 25 and 40, but it also can occur in younger women. This condition may also persist after menopause in some women, but such an occurrence is very uncommon.

What causes endometriosis?
The cause of endometriosis is unknown. Some experts believe that pieces of endometrium travel back through the fallopian tubes and pass out into the pelvic cavity (space inside the pelvis that holds the reproductive organs). Tiny pieces of tissue may lodge on surfaces of the reproductive organs. 

During menstruation, the tissue bleeds, just like the endometrium inside the uterus. Surrounding tissue may become inflamed. Over time, scar tissue and cysts can form.

What are the symptoms of endometriosis?
Many times, endometriosis has no symptoms. When symptoms are present, they may include:
  1. Very painful menstrual cramps
  2. Painful sex
  3. Difficulty becoming pregnant
  4. Abnormal or heavy bleeding during periods
  5. Abdominal cramps or back pain during menstruation
  6. Painful bowel movements

There is no connection between the symptoms and severity or extent of endometriosis. In other words, patients with very mild disease may have very severe symptoms while those with significant disease may not experience significant symptoms.

How do you find out if you have endometriosis?
If you have any of the symptoms mentioned previously, see your physician. You may need to undergo a surgical procedure called a laparoscopy to confirm the diagnosis. In this procedure, a small scope is inserted through a small incision in the abdomen so the physician can look for endometrial implants. Many times, the physician will biopsy these implants in order to confirm the diagnosis. Once the diagnosis is clear, he or she will attempt to remove the implants during this surgery.

What is the treatment for endometriosis?
Treatment for endometriosis symptoms may include:
  1. Birth control pills
  2. Non-steroidal anti-inflammatory drugs (NSAIDs)
  3. Mirena®
  4. Danazol® (Danocrine)
  5. Gonadotropin-releasing hormone (GnRH agonist)
  6. Progestins
  7. surgical treatment of endometriosis:laparoscopic cauterization of endometriosis. Although medical therapy will relieve pain, it will not increase fertility rates. On the other hand, surgery may improve the pregnancy rate as well as relieve pain.  
  8. For severe cases, both medical and surgical treatment will improve the symptoms of pain. 
  9. As with mild disease, surgery will improve pregnancy rates. In cases of mild and severe endometriosis, infertility treatment options like artificial insemination and/or in vitro fertilization (IVF) may be considered if pain is not a primary concern.


******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Pelvic Organ Prolapse
(dropped bladder, dropped rectum, Uterine prolapse)

Pelvic organ prolapse is a downward descent of female pelvic organs, including the bladder, uterus and the small or large bowel, resulting in protrusion of the vagina, uterus, or both. 

Risk Factors: prolapse development can be attributed to several factors, including:

  • Vaginal child birth 
  • Advancing age 
  • Obesity. 
  • Chronic straining
  • Normal aging 
  • Forceps delivery
  • Young age at first delivery
  • Prolonged second stage of labor (pushing)
  • Infant birthweight > 4,500 g
  • Shape or orientation of bony pelvis
  • Family history of pelvic organ prolapse
  • Race or ethnic origin
  • Occupations entailing heavy lifting
  • Constipation
  • Selective estrogen-receptor modulators
  • Abnormalities of connective tissue or connective-tissue repair predispose some women to disruption, 
stretching or dysfunction of the connective-tissue attachments of the vagina, resulting in prolapse.

Four main types of pelvic organ prolapse can occur:
1- Cystocele or "dropped bladder: When the protrusion involves the front (anterior wall) of the vagina and bladder, the condition is called a cystocele or "dropped bladder."
2- Rectocele or dropped rectum: When the back (posterior wall) of the vagina and rectum are involved, the condition is called a rectocele.
3- Enterocele: When the upper portion of the vaginal wall and small bowel are involved the condition is called an enterocele.
4- Uterine prolapse: When the uterus descends downward, the presentation is called uterine prolapse.

Symptoms:
1- Vaginal: Sensation of a bulge or protrusion. Seeing or feeling a bulge or protrusion
2- Pressure
3- Heaviness
4-Urinary: Incontinence. Frequency. Urgency. Weak or prolonged urinary stream. Hesitancy. Feeling of incomplete emptying. Manual reduction of prolapse to start or complete voiding. Position change to start or complete voiding
4-Bowel: Incontinence of flatus, or liquid or solid stool. Feeling of incomplete emptying. Straining during defecation. Urgency to defecate. Digital evacuation to complete defecation. Splinting, or pushing on or around the vagina or perineum, to start of complete defecation
5-Sexual: Dyspareunia (painful sexual intercourse). Decreased sexual desire due to decreased body image associated with prolapse

Treatment
Women have several options to treating pelvic organ prolapse.
A-Non-surgical
1- Kegel exercises or Pelvic floor physical therapy is offered by specially trained physical therapists to strengthen the pelvic floor muscles.

2- Pessary use is the only currently available, non-surgical intervention for women with pelvic organ prolapse. These devices are inserted into the vagina to reduce prolapse inside the vagina, to provide support to related pelvic structures, and to relieve pressure on the bladder and bowel. Approximately 20 different types of pessaries are available, made either of silicone or plastic. Use of these devices has been reserved for patients with symptomatic pelvic organ prolapse who decline surgery, are poor surgical candidates because of medical conditions or who need temporary relief of pregnancy-related prolapse or incontinence.
Gynecologists fit a patient's pessary based on the nature and extent of the prolapse and the patient's cognitive status, manual dexterity and level of sexual activity. The size of the vagina is estimated and the appropriate size and shape of pessary is inserted such that the prolapse is effectively reduced and the woman is comfortable with the device in place. Follow-up visits are necessary to ensure the pessary is functioning effectively. The most common side effects are vaginal discharge and odor.

B- Surgical
1- Anterior (bladder lift) and posterior (bowel lift)
Reconstructive surgery for prolapse aims to correct the prolapsed vagina while maintaining (or improving) vaginal sexual function and relieving any associated pelvic symptoms.

2- Sacrocolpopexy
The abdominal sacrocolpopexy can be done through an abdominal incision, laparoscopically, and robotically and suspends the upper vagina with synthetic mesh.

3- Vaginal Approach
For prolapse repairs that are performed vaginally, the surgeon attaches either the upper vagina or cervix to the ligament between the ischial spine and the sacrum (sacrospinous ligament) or to the ligaments between the sacrum and uterus (uterosacral ligaments).

4- An alternative to reconstructive surgery is obliterative surgery, which closes off the vaginal canal either partially or totally. This procedure is typically reserved for women who are no longer sexually active.


******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Urinary Incontinence in Women

Question :
1.Do you feel embarrassed to go out because you get wet when you Laugh, sneeze or cough?
Or
2.Do you have to go to washroom every 30 min or first thing to do when you go to shopping center, looking for all washroom locations in that center?..

Is incontinence common in women?
Yes

As many as 20 to 50 % of adult women will experience urinary incontinence at some point in their lives.
However, many women are too embarrassed to speak about this problem. Are you one of those women?
If you are experiencing incontinence, it is important to discuss this with your health-care professional.
In many cases, this condition can be greatly improved with treatment..

Stress Incontinence = leaking when coughing or laughing

This occurs during activities requiring effort or physical exertion.
Actions such as coughing, sneezing, laughing or exercising can lead to urine loss.
Pregnancy and childbirth are the most common causes of pelvic floor weakening.
Other contributing factors include menopause, aging, chronic coughing and obesity..

How is stress incontinence treated?
1.Pelvic floor retraining
The first step in treating stress incontinence is to strengthen the muscles used in bladder control by pelvic exercises ( Kegels)
It is important to maintain proper technique and be persistent.

2.Pessary:
A thick rubber device, often ring shaped, is inserted into your vagina. This pessary presses against the vaginal wall to provide support to the urethra..

3.Surgery
Tape or mesh materials are surgically attached to your internal organs, to support the bladder and urethra in their proper positions..
Tension-Free Vaginal Tape for Stress Incontinence = TVT or TVTO:
procedure is designed to provide support for a sagging urethra. so that when you cough or move vigorously or suddenly, the urethra can remain closed with no accidental release of urine.
The tape is inserted through tiny incisions in your vaginal wall. No sutures are required to hold the tape in place. TVT or TVTO surgery takes about 30 minutes .

What To Expect After Surgery
You may be released to go home the same day as your surgery, or you may remain in the hospital overnight. It may be necessary to have a thin, flexible tube (catheter) placed into your bladder through your urethra to allow urine to drain while you recover .
TVT or TVTO surgery usually causes minimal pain and discomfort. Although you may resume most normal activities within 1 to 2 weeks, you will be advised to donot left more than 20Ib and from sexual intercourse or strenuous activities for 6 weeks.

How Well It Works
Tension-free vaginal tape surgery works to cure stress incontinence. About 8 out of 10 women are cured ("dry") in the year after TVT or TVTO surgery.
Surgery time, hospital stay, and recovery time are all shorter for women who have TVT or TVTO.

Risks
The most common risks of TVT or TVTO surgery are:
Injury to the bladder or urethra (perforation).
Difficulty urinating after surgery.
Groin pain after surgery.
Numbness or weakness in the groin or legs.
All surgeries carry some risk of infection or other complications.

What To Think About
Is there anything you can do to increase the likelihood of a successful surgery? Losing weight, quitting smoking, or doing pelvic floor (Kegel) exercises prior to surgery may increase the likelihood of regaining continence after surgery.

Urge incontinence = Over active bladder
Urge incontinence, which is sometimes called Overactive Bladder Syndrome (OAB), is the frequent, sudden or urgent need to pee, followed by urine loss.
Coffee and tea make it worse because of the caffeine which irritate the balder (make it crazy)
orange juice or lemon juice because of acidity which irritate the balder (make it crazy)..

How is urge incontinence treated?
1.Pelvic floor retraining
Many women with urge incontinence are also affected by stress incontinence. If this is the case for you, pelvic floor retraining

2.Controlling your fluid intake
It is recommend to watch what you are drinking
•Coffee and tea have caffeine which is irritate the bladder.
•Orange and lemon juice is acidic and irritate the bladder..

3. Bladder training (bladder drill)
Bladder training can be effective in decreasing how often you feel the need to pee, and decreasing the sense of urgency you feel.
•If you get a strong urge to go to the bathroom before your scheduled time: Stop, don't run to the bathroom! Stand still or sit down if you can.
•RELAX. Take a deep breath and let it out slowly. Concentrate on making the urge decrease or even go away, anyway you can for 5 min
•When you feel IN CONTROL OF YOUR BLADDER, walk slowly to the bathroom, and then go. Then, increase the time 10 min.
•When you can go two days without urine leakage, extend the time between trips again 15min. This may take several weeks.
•DON'T GET DISCOURAGED! Bladder training takes time and effort, but it is an effective way to get rid of incontinence without medication or surgery..

4. Medications

If you have an infection, your health care provider will prescribe antibiotics.


Medications used to treat urge incontinence relax bladder contractions and help improve bladder function. There are several types of medications that may be used alone or together:

  • Anticholinergic medicines help relax the muscles of the bladder. They include oxybutynin (Oxytrol, Ditropan), tolterodine (Detrol), darifenacin (Enablex), trospium (Sanctura), and solifenacin (Vesicare).
    • These are the most commonly used medications for urge incontinence. They are available in a once-a-day formula that makes dosing easy and effective.
    • The most common side effects of these medicines are dry mouth and constipation. People with narrow-angle glaucoma cannot use these medications.
  • Flavoxate (Urispas) is a drug that calms muscle spasms. However, studies have shown that it is not always effective at controlling symptoms of urge incontinence.
  • Tricyclic antidepressants (imipramine, doxepin) have also been used to treat urge incontinence because of their ability to "paralyze" the smooth muscle of the bladder. Possible side effects include:
    • Blurred vision
    • Dizziness
    • Dry mouth
    • Fatigue
    • Insomnia
    • Nausea

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

D & C - dilatation and curettage

If you are considering having a D & C or have one planned, it is important to know all you can about it.

What is the problem?
You are having troublesome periods. They may be heavy, prolonged or irregular. You may be having bleeding in-between your periods, after sexual intercourse or even after the menopause. The bleeding seems to be coming from your uterus.

What is the uterus?

To explain where the uterus is, and what it does, the best place to start is at the vagina. The vagina is a tube about 5 inches long. It runs from just in front of the rectum up into the pelvis. The vagina is just behind the bladder. 

The uterus is at the top of the vagina. It is about the size of your clenched fist. It is made of thick muscle and it is hollow. Inside the uterus there is a special lining called the endometrium. The lowest part of the uterus, called the neck, juts down into the vagina. The neck of the uterus is called the cervix. Cervical smears are taken from the cervix.The main part of the uterus is called the body.

What does the uterus do?
The uterus is where a baby develops during pregnancy. At the same time, hormones make the endometrium thicker so that if the egg is fertilised by a sperm it can lodge in the uterus. The hormones change and the endometrium also dies and is shed. There is some bleeding from the raw endometrium for a few days. This is a typical period. The cycle then starts again for the next month. 
After the age of about 45 years the ovaries stop making some of the female hormones. Eggs are not released each month. The endometrium is no longer shed. The periods stop. This is called the change or the menopause. Sometimes the periods become very heavy during this time.

What has gone wrong?
There are several possible causes of your heavy bleeding.
  1. Fibroids - These are swellings in the walls of the uterus. They are a very common reason for heavy or painful periods. They are benign tumours made of muscle and fibres. They make the surface area of the endometrium larger. This, in turn, makes the periods heavier and more painful. 
  2. Dysfunctional uterine bleeding - This is where we cannot find a clear cause for the problem. In some way the shedding mechanism of the endometrium is not working properly.
  3. Malignancy (cancer of the endometrium) - This is something that needs to be ruled out, especially if there is bleeding after the menopause. 

What is the aims of the D&C:
The sample removed during the D&C will be sent to the laboratory for examination under the microscope.The aimsThe main aim of the operation is to take scrapings of the endometrium to send for examination under the microscope to find the cause of your bleeding. Sometimes we can also treat the cause. For instance, if the cause of the bleeding is an overgrowth of the lining, called a polyp, we can remove it at the same time as the D&C; this is called a polypectomy.The benefitsWe should be able find out whether the endometrium is responsible for your bleeding. If the endometrium is not the cause, we can use other tests to find out what the problem is. You should then be able to start the correct treatment.Are there any alternatives?X-rays and scans, such as ultrasound, CT and MRI scans, can be of some help in finding the cause for the bleeding. None of these tests produce samples of tissue. 
A D&C is the simplest way of doing this but nowadays it is usually combined with a hysteroscopy which is diagnostically more accurate.

What if you do nothing?
If you do nothing, the cause of your problem will remain in doubt. You may miss out on important treatment. Any period problem is likely to continue until you reach the menopause.


******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Kegel exercises

Kegel exercises can help you prevent or control urinary incontinence and other pelvic floor problems (uterus, bladder or rectum prolapse) . 

Here's a step-by-step guide to doing Kegel exercises correctly.

Kegel exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum. You can do Kegel exercises, also known as pelvic floor muscle training, discreetly just about anytime.

Many factors can weaken your pelvic floor muscles, including: 

  1. pregnancy, 
  2. childbirth, 
  3. surgery, 
  4. aging and 
  5. being overweight.

You might benefit from doing Kegel exercises if you:

  • Leak a few drops of urine while sneezing, laughing or coughing
  • Have a strong, sudden urge to urinate just before losing a large amount of urine (urinary incontinence)
  • Leak stool (fecal incontinence)

Kegel exercises can be done during pregnancy or after childbirth to try to prevent urinary incontinence. Kegel exercises might also be helpful for women who have persistent difficulty reaching orgasm.

Keep in mind that Kegel exercises are less helpful for women who have severe urine leakage when they sneeze, cough or laugh. Also, Kegel exercises aren't helpful for women who unexpectedly leak small amounts of urine due to a full bladder (overflow incontinence).

How to do Kegel exercises

It takes diligence to identify your pelvic floor muscles and learn how to contract and relax them. Here are some pointers:

Find the right muscles. 
  • To identify your pelvic floor muscles, stop urination in midstream. If you succeed, you've got the right muscles.
  • another way to identify your pelvic floor muscles, by inserting two finger in the vagina and squeeze your finger, If you succeed, you've got the right muscles.
Perfect your technique. 
Once you've identified your pelvic floor muscles, empty your bladder and lie on your back. Tighten your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.
  • Maintain your focus. For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.
  • Repeat 10 times a day. Aim for at least 10 sets of 10 repetitions a day.
  • Then you can do your Kegel exercises anywhere, driving, shopping, cooking, talking or watching TV...etc

Don't make a habit of using Kegel exercises to start and stop your urine stream. Doing Kegel exercises while emptying your bladder can actually weaken the muscles, as well as lead to incomplete emptying of the bladder — which increases the risk of a urinary tract infection.


******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Hysterosalpingogram
Test used in = Infertility 


A hysterosalpingogram (HSG) is an X-ray test that looks at the inside of the uterus and fallopian tubes and the area around them. It often is done for women who are having a hard time becoming pregnant (infertile).
During a hysterosalpingogram, a dye (contrast material) is put through a thin tube that is put through the vagina and into the uterus. Because the uterus and the fallopian tubes are hooked together, the dye will flow into the fallopian tubes. Pictures are taken using a steady beam of X-ray (fluoroscopy) as the dye passes through the uterus and fallopian tubes. The pictures can show problems such as an injury or abnormal structure of the uterus or fallopian tubes, or a blockage that would prevent an egg moving through a fallopian tube to the uterus. A blockage also could prevent sperm from moving into a fallopian tube and joining (fertilizing) an egg. A hysterosalpingogram also may find problems on the inside of the uterus that prevent a fertilized egg from attaching (implanting) to the uterine wall.

Why It Is Done
A hysterosalpingogram is done to:
Find a blocked fallopian tube. The test often is done for a woman who is having a hard time becoming pregnant. An infection may cause severe scarring of the fallopian tubes and block the tubes, preventing pregnancy. Occasionally the dye used during a hysterosalpingogram will push through and open a blocked tube.
Find problems in the uterus, such as an abnormal shape or structure, an injury, polyps, fibroids, adhesions, or a foreign object in the uterus. These types of problems may cause painful menstrual periods or repeated miscarriages.

How To Prepare
Before a hysterosalpingogram, tell your doctor if you:
Are or might be pregnant.
Currently have a pelvic infection (pelvic inflammatory disease) or sexually transmitted disease (such as gonorrhea or chlamydia).
Are allergic to the iodine dye used or any other substance that has iodine. Also tell your doctor if you have asthma, are allergic to any medicines, or have had a serious allergic reaction (anaphylaxis) from any substance (such as the venom from a bee sting or from eating shellfish).
Have any bleeding problems or are taking any blood-thinning medicines, such as aspirin or warfarin (such as Coumadin).
Have a history of kidney problems or diabetes, especially if you take metformin (such as Glucophage) to control your diabetes. The dye used during a hysterosalpingogram can cause kidney damage in people with poor kidney function. If you have a history of kidney problems, blood tests (creatinine, blood urea nitrogen) may be done before the hysterosalpingogram to check that your kidneys are working well.

This test should be done 2 to 5 days after your menstrual period has ended to be sure you are not pregnant. It should also be done before you ovulate the next month (unless you are using contraception) to avoid using X-rays during an early pregnancy. You may want to bring along a sanitary napkin to wear after the test because some leakage of the X-ray dye may occur along with slight bleeding.

You may need to sign a consent form that says you understand the risks of a hysterosalpingogram and agree to have the test done. Talk to your doctor about any concerns you have about the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form.

How It Is Done
A hysterosalpingogram usually is done by a radiologist or Gynecologist in the X-ray room of a hospital or clinic. A radiology technologist and a nurse may help the doctor. A gynecologist or a doctor who specializes in infertility (reproductive endocrinologist) also may help with the test.
Before the test begins, you may get a sedative or ibuprofen (such as Advil) to help you relax and to relax your uterus so it will not cramp during the test. You will need to take off your clothes below the waist and drape a gown around your waist. You will empty your bladder and then lie on your back on an examination table with your feet raised and supported by stirrups. This allows your doctor to look at your genital area.
An X-ray may be taken to make sure that there is nothing in the large intestine (colon) that could block the view of the uterus and fallopian tubes. Sometimes a laxative or enema is given a few hours before the test to empty the large intestine.

Your doctor will put a smooth, curved speculum into your vagina. The speculum gently spreads apart the vaginal walls, allowing him or her to see the inside of the vagina and the cervix. The cervix may be held in place with a clamp called a tenaculum. The cervix is washed with a special soap and a stiff tube (cannula) or a flexible tube (catheter) is put through the cervix into the uterus. The X-ray dye is put through the tube. If the fallopian tubes are open, the dye will flow through them and spill into the belly where it will be absorbed naturally by the body. If a fallopian tube is blocked, the dye will not pass through. The X-ray pictures are shown on a TV monitor during the test. If another view is needed, the examination table may be tilted or you may be asked to change position.
After the test, the cannula or catheter and speculum are removed. This test usually takes 15 to 30 minutes.

How It Feels
You probably will feel some cramping like menstrual cramps during the test. The amount of pain you have depends on what problems the doctor finds and treats during the test.

Risks
  1. There is always a small chance of damage to cells or tissue from being exposed to any radiation, including the low levels of radiation used for this test. The chance of damage from the X-rays is generally very low compared with the potential benefits of the test.
  2. There is a small chance (less than 1 in 100) of a pelvic infection, endometritis, or salpingitis after the test. The chance may be higher for women who have had pelvic infections before. Your doctor may give you antibiotics if he or she thinks you might develop a pelvic infection.
  3. There is a small chance of damaging or puncturing the uterus or fallopian tubes during the test.
  4. There is a small chance of an allergic reaction to the iodine X-ray dye, especially if you are allergic to any shellfish.
  5. In rare cases, if an oil-based dye is used, the oil can leak into the blood. This can cause blockage of blood flow to a section of the lung (pulmonary embolism). Most hysterosalpingogram tests use water-based dyes.

After the test
After the test, some of the dye will leak out of the vagina. You also may have some vaginal bleeding for several days after the test. 
Call your doctor immediately if you have:
  1. Heavy vaginal bleeding (soak more than one tampon or pad in one hour).
  2. A fever. 
  3.  Severe belly pain. 
  4.  Vaginal bleeding that lasts for more than 3 to 4 days. 

What Affects the Test, Reasons you may not be able to have the test or why the results may not be helpful include: 
  1.  If your fallopian tube has a spasm. This may make a normal fallopian tube look blocked. 
  2.  If the doctor cannot put a catheter in the uterus. 
  3. This test is not done on women who are having their period, are pregnant, or have a pelvic infection. 


******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Laparoscopy and dye test (hydrotubation)

Infertility test = Checking your tubes

"You are having problems with becoming pregnant. This may be because your Fallopian tubes are blocked".

If you are considering having a laparoscopy and dye test or have a test planned, it is important to know all you can about it. This includes:

What is the problem?
You are having problems with becoming pregnant. This may be because your Fallopian tubes are blocked. During this test we inject dye through your cervix and into your uterus. If we see dye passing through the ends of your Fallopian tubes we know they are not blocked.

What has gone wrong?
Your Fallopian tubes may be blocked because of a past infection or by scarring, called adhesions, inside your pelvis. You may have a different condition inside your pelvis that is making it difficult for you to become pregnant.

The aims?
We use this test to find out if your Fallopian tubes are blocked and, if so, why. As part of the test we do a diagnostic operation with keyhole instruments, called a laparoscopy. This lets us examine inside your pelvis with a telescope, called a laparoscope. We pass this through a small cut in your abdomen. This may reveal a different cause for your pregnancy difficulties. The dye test part of the operation is called hydrotubation.

The benefits?
If we find a clear cause for your pregnancy difficulties, such as blocked tubes, you can start the best treatment. If there are other causes, a laparoscopy is a very good way of detecting them.

Are there any alternatives?
Ultrasound scans or x-rays may also give us some information about your tubes, but they are not usually as informative as a laparoscopy. A laparoscopy is usually better for finding the cause of any blockage and for seeing the condition of your pelvic organs.

What if you do nothing?
If you do nothing, your difficulties in becoming pregnant will probably continue. If we do not know the cause of your problems we cannot treat you.


******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Working during Pregnancy

For most women with healthy pregnancies, it is safe to work until just before childbirth

Can you work during pregnancy? How long you can work for?
The answer depends on your health, the health of your baby and the type of work that you do. Talk to your doctor, nurse or midwife — he or she can help you plan for when you will stop working.

Is it safe for me to work during pregnancy?
For most women with uncomplicated pregnancies, the type of work they do does not usually pose any health risks for them or their babies.
However, if your work is hard on your body, your doctor, nurse or midwife may suggest you make changes until after your pregnancy.
You might also be at risk if you work with certain chemicals, solvents, fumes or radiation. To find out more about this type of hazard, at work and at home, go to www.motherisk.org. Women planning a pregnancy should be careful and follow all safety guidelines. If you are already pregnant, your care provider may advise you to avoid contact with some of these workplace hazards. Your employer may also have policies in place to protect pregnant women.

Work activities to discuss with your care provider
Your doctor, nurse or midwife may recommend changes if your work involves the following:
  1. Stooping or bending over more than ten times each hour
  2. Climbing a ladder more than three times during an eight-hour shift
  3. Standing for more than four hours at one time
  4. Climbing stairs more than three times per shift
  5. Working more than 40 hours per week Shift work
  6. Lifting more than 23 kg (50 lbs) after the 20th week of pregnancy
  7. Lifting more than 11 kg (24 lbs) after the 24th week
  8. Stooping, bending or climbing ladders after the 28th week
  9. Needing to lift any heavy items after the 30th week
  10. Needing to stand still for more than 30 minutes of every hour after the 32nd week
  11. Working with chemicals, solvents, fumes or radiation

What about Fifth disease? 
Some women who work with young children may be at higher risk of being exposed to this common virus which, in very rare cases, could harm your unborn baby. However, there is usually no need for a woman to cease work because of this risk.

I have an uncomplicated pregnancy. When should I stop working?
A woman who is having a normal, healthy pregnancy is considered ‘fit to work’ until the start of labour. However, the choice of when to stop working is yours, and should be discussed with your health-care provider, who is there to support you in making decisions that are right for you. Many women choose to stop working two to six weeks before their expected delivery dates, although others may need more or less time than that.

Will I receive maternity benefits when I stop working?
For a woman in Canada with a healthy pregnancy, stopping work before the onset of labour is considered to be a voluntary leave. In this situation, Canada’s federal Employment Insurance (EI) program will provide maternity benefits for a woman who is within eight weeks of her expected due date (see the next panel for information on how many hours you must have worked to be eligible).

This type of voluntary, health-related maternity leave to prepare for delivery is different from a sickness leave, which a health-care provider might advise for a pregnant woman who is experiencing complications that make her unable to continue working as long as she had expected.

Employment Insurance benefits
In Canada, federal Employment Insurance (EI) provides temporary financial assistance to Canadians who are sick, pregnant or caring for a newborn or adopted child. In order to qualify for these maternity, parental or sickness benefits, you must have worked 600 hours within the past 52 weeks. For more detailed information on eligibility and benefits, visit www.servicescanada.gc.ca.

Maternity benefits: 
The EI program provides maternity benefits of up to 15 weeks to a mother for the birth of a child. These benefits can be collected any time during a period which begins eight weeks before your expected due date and ends 17 weeks after the birth. However, if you stop work earlier than eight weeks before the due date, you would not receive EI maternity benefits until the eligibility period begins.

Parental benefits: 
In addition to the15 weeks of maternity benefits, the EI program provides parental benefits to either parent for up to 35 weeks. These benefits can be claimed by either parent, concurrently or consecutively, as long as the total maternity and parental benefits add up to no more than 50 weeks for a pregnancy.

Sickness benefits: 
The EI program provides sickness benefits to individuals who are unable to work because of sickness.

Other information: 
Some employers may also supplement EI benefits so that parents receive up to 95 per cent of their salary while on maternity or parental leave. The province of Quebec is the only province that
has a program to provide financial benefits to women with uncomplicated pregnancies whose work or work environment may pose a threat to them or their unborn child, if they cannot be temporarily reassigned by their employers to jobs that are not hazardous.

What if I have complications in pregnancy?
Pregnant women who experience complications or other illness-related problems during pregnancy may be deemed unable to continue working by their health-care professional. If this is the case for you, you may be eligible to receive sickness benefits from the EI program until your health problem resolves or until you qualify for maternity benefits.

However, a health-care provider cannot advocate for a sickness leave, which would qualify you for sickness benefits through the EI program, without justification. Issues such as discomfort, poor sleep, fatigue, and musculoskeletal pain are unfortunate but are a normal part of a healthy pregnancy.

How can my health-care provider help me make the right choices?
The role of obstetrical care providers in Canada is to promote and apply best practices in caring for pregnant women, in order to minimize risk and maximize positive outcomes for both mother and infant. Pregnant women often seek input from their caregivers on the topic of maternity leave, and to plan for stopping work before delivery.


******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Bartholin’s cyst and the treatment (marsupialisation)

If you want to find out about bartholin's cyst symptoms and diagnosis, and bartholin's cyst treatment, you will find the following information of interest.

What is the problem?

You have a swelling near the back of the opening of your vagina. This may just be a cyst with liquid in it or it may be a painful abscess full of pus. This is the swelling of a gland, called the Bartholin’s gland.

What is a Bartholin’s gland?
There are several glands with openings close to the entrance of your vagina. A gland here means a group of cells under the skin. The cells make a liquid called mucus. This passes into your vagina through tiny openings. The liquid lubricates your vagina during sexual intercourse. If the openings become blocked, the liquid builds up to make a cyst. An infection of the cyst will cause a Bartholin’s abscess. An abscess may burst through the skin releasing pus.

The aims
The aim of the operation is to get rid of your swelling. Removing the swollen gland could damage your vagina. Instead, we enlarge the opening to the gland, creating a tiny pouch. The liquid and pus can then drain out and the swelling should not return. The operation is called marsupialisation.

The benefits
Having the operation will relieve your pain or discomfort from the swelling. The new opening will allow mucus from the gland to reach your vagina.

Are there any alternatives?
If infection is causing your symptoms antibiotics may help, but the cyst often remains troublesome. Drawing off the liquid or pus with a needle can reduce the swelling but it will usually return.

What if you do nothing?
If you do nothing, the swelling is likely to continue causing pain and could burst. You would suffer unnecessarily and the problem often returns.





******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************



Vaginal Vault Prolapse

Vaginal vault prolapse occurs when the upper portion of the vagina loses its normal shape and sags or drops down into the vaginal canal or outside of the vagina. It may occur alone or along
with prolapse of the bladder (cystocele), urethra (urethrocele), rectum (rectocele), or small bowel (enterocele).

Vaginal vault prolapse is usually caused by weakness of the pelvic and vaginal tissues and muscles.

Symptoms of vaginal vault prolapse include:

  1. Pelvic heaviness.
  2. Backache.
  3. A mass bulging into the vaginal canal or out of the vagina that may make standing and walking difficult.
  4. Involuntary release of urine (incontinence). 
  5. Vaginal bleeding.
During surgery, the top of the vagina is attached to the lower back (lumbar) spine, or the ligaments (Please see Abdominal Sacrocolpopexy).



Abdominal Sacrocolpopexy ( Vaginal Vault Prolapse )

What is an abdominal sacrocolpopexy?

It is an operation performed through an incision (cut) in the abdomen to cure a vaginal vault prolapse (sacrocolpopexy) or a prolapse of the uterus (sacrohysteropexy). It lifts the vagina or uterus back into its normal position by attaching a piece of synthetic mesh between the top of the vagina and a bone of the pelvis (the sacrum).

Laparoscopic Sacrocolpopexy for Vaginal Vault Prolapse


The same above surgery can be done by laparoscopy. Can be done in our hospital.






******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Preterm Labour

Not everyone understands how important it is to carry a baby to full term. Some women hope for a premature baby, thinking a small baby may be easier to deliver.

In fact, premature labour is one of the most common problems in pregnancy and it is the cause of 75 percent of all newborn deaths in babies born without birth defects. Premature babies are more delicate and can have lifelong problems related to their prematurity. In general, the more premature a baby is, the more severe the problems. Babies born before the 25th week usually do not survive without problems.

It is important to know early whether premature labour is occurring, as it sometimes can be stopped or delayed. This can provide time to give medicine that can help the baby, and to treat conditions causing premature labour.


What causes premature labour?
Why some women develop premature labour, and others don’t, is not well known. What we do know is that about half of all premature labours begin for unknown reasons to women whose pregnancies were otherwise normal. However, certain things seem to increase a woman’s chances of going into early labour.
What you do during your pregnancy can help you carry your baby longer, and give him a better start. Research has shown that the more women know about the signs and risks of premature labour, the lower the rate of premature births.

These are some of the risk factors for premature labour, and how the risk can be reduced:

  1. Smoking - It is best not to smoke during pregnancy. You can still benefit your baby if you quit smoking before you reach 32 weeks.
  2. Working too hard - Working long hours, doing strenuous kinds of work and being tired all the time can lead to a preterm birth. 
  3. Physical and emotional abuse - When someone hurts you, they can also hurt your unborn baby. Even emotional abuse can lead to a preterm birth by significantly raising your stress levels. Please seek the help you need by calling a family crisis centre in your area. 
  4. Incompetent cervix – a rare condition in which the cervix dilates (opens) early and is associated with premature labour. This can sometimes be diagnosed during a vaginal examination or by measuring the size of the cervix during an ultrasound. Sometimes this can be treated by sewing the cervix closed with a “drawstring” stitch and removing the sutures when the baby is full term. 
  5. Fibroids in and/or on your uterus can cause it to be misshapen. If fibroids large enough to deform the uterus are detected before pregnancy, they may be removed. Small fibroids usually don’t cause problems during pregnancy. 
  6. Bleeding during second trimester - A small amount of bleeding can occur if the placenta begins to separate a bit from the lining of the uterus before labour starts. Each case of bleeding should be treated separately and may be treated differently depending on the cause. Always notify your health care provider about bleeding. 
  7. Abdominal surgery during pregnancy - Sometimes abdominal surgery is needed when a woman is pregnant (for example, for appendicitis). Surgery that is wanted but not essential (elective) should be avoided until after the baby is born. 
  8. Common infections in the mother are vaginal, cervical, kidney or bladder infections. You may have a bladder or kidney infection if you have pain when you urinate, if you have to go often, and when you do only a small amount of urine comes out. You may have an infection in your vagina or cervix if you notice an unusual vaginal discharge, have pain in your pelvis or groin area, or a fever. Notify your doctor. 
  9. An underweight mother - Treatment depends on the cause of the problem. Sometimes this problem is helped by eating healthy, good food on a regular basis. Talk to your health care provider if you are underweight and having problems. 
  10. Placenta previa – a condition in which the placenta implanted and grew over the opening of the cervix (where the baby must come out). This can lead to hemorrhaging during labour. This problem is usually found during routine ultrasound testing. The mother is often confined to bed for the last few weeks of pregnancy and the baby is usually delivered by caesarean section before labour has a chance to begin. 
  11. Premature rupture of membranes – the sac of amniotic fluid breaks or leaks before your baby reaches full term. Some studies link this to infections in the uterus, but further research needs to be done. If your membranes rupture early, treatment depends on how much amniotic fluid is lost and how close to your due date you are. Notify your doctor, or health care provider. 
  12. Gestational hypertension (high blood pressure caused by pregnancy) – is treatable in various ways depending on the severity. 
  13. Chronic illness in the mother. Some illnesses (diabetes, high blood pressure) may become out of control during the pregnancy, and in some situations the only way to stop the worsening condition is to deliver the baby. Sometimes the labour will begin too early on its own, and in other cases, the labour needs to be brought on (induced). 


What you can do to prevent premature labour 
  1. Quit smoking: Try to understand why you smoke, and seek help to learn other ways of dealing with these issues. Ask around in your community about “Quit Smoking” programs. Ask your doctor about programs to help you quit. 
  2. Eat properly: Talk to a registered dietitian about your eating habits. Plan your meals around the basic food groups and avoid junk food. Drink plenty of milk. 
  3. Get help if you need it: You have a right to feel safe. If you are being abused, call your local women's shelter and ask where you can go for help. 
  4. Get plenty of rest: Plan ahead to be sure a certain part of your day will be set aside for you to rest. Don't feel guilty for resting. It is very important during pregnancy. 
  5. Learn ways to reduce stress: Talk to people you trust about how you feel. Learn relaxation techniques such as meditation and self-massage to reduce your stress. Consider yoga. 
  6. Avoid strenuous work 
  7. Avoid overexertion when exercising during pregnancy: Even though you are physically fit, it is important not to increase your workout intensity during certain times of your pregnancy.

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Lichen sclerosus

Definition
Lichen sclerosus (LIE-kun skluh-ROW-sus) is an uncommon condition that creates patchy, white skin that's thinner than normal. Lichen sclerosus may affect skin on any part of your body, but most often involves skin of the vulva, foreskin of the penis or skin around the anus.
Anyone can get lichen sclerosus, but postmenopausal women are at highest risk. Left untreated, lichen sclerosus may lead to other complications. If you do need treatment, your doctor can suggest options to return a more normal appearance to your skin and decrease the tendency for scarring.

Symptoms
Lichen sclerosus can affect the skin on any part of your body. Sometimes, no symptoms are present.
When they do occur, lichen sclerosus symptoms may include:

  1. Itching (pruritus), which can be severe
  2. Discomfort, which is generally greater if lichen sclerosus appears on or around your genital or anal areas
  3. Smooth white spots on your skin that may grow into blotchy, wrinkled patches
  4. Tenderness of the affected areas of your skin
  5. Easy bruising or tearing
  6. In severe cases, bleeding, blistering or ulcerated lesions
  7. Painful intercourse

When to see a doctor
See your doctor if you have signs and symptoms common to lichen sclerosus. Effective treatments are available to help manage your discomfort and prevent complications.
If you've already been diagnosed with lichen sclerosus, see your doctor every six to 12 months to be checked for any skin changes or treatment side effects.

Causes
The exact cause of lichen sclerosus isn't known. However, the condition may be related to a lack of sex hormones in the affected skin or to an overactive immune system. Previous skin damage at a particular site on your skin may increase the likelihood of lichen sclerosus at that location.
Although lichen sclerosus may involve skin around your genitals, it isn't contagious and cannot spread through sexual intercourse.
Lichen sclerosus occurs most often in postmenopausal women, but it also occurs in men and children. In women, lichen sclerosus usually involves the vulva.

Complications
Persistent lichen sclerosus in one location may slightly increase your risk of skin cancer, although this has not yet been definitively proved. For this reason, make sure that you have follow-up examinations every six to 12 months.

Other potential complications:
In women, the uncomfortable itching and scarring that accompanies severe lichen sclerosus may narrow the vaginal opening and affect the ability or desire to have sexual intercourse. In some cases, the blistering may create extremely sensitive skin to the point that any pressure on the area is unbearable.

Preparing for your appointment
If you have signs and symptoms common to lichen sclerosus, make an appointment with your family doctor or general practitioner. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of skin conditions.
Here's some information to help you get ready for your appointment, and what to expect from your doctor.

Information to gather in advance
Write down your symptoms and how long you've had them.
Write down your key medical information, such as other conditions with which you've been diagnosed and any prescription or over-the-counter medications you're taking, including vitamins and supplements.
Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

Tests and diagnosis
Your doctor may diagnose lichen sclerosus based on:
A physical examination
Removal of a small piece of affected tissue (biopsy) for examination under a microscope

Treatments and drugs
If you have lichen sclerosus on or around your genitals or anus, or have a more advanced case on other parts of your body, your doctor will recommend treatment.

  1. Corticosteroids
The most commonly prescribed treatment for lichen sclerosus is corticosteroid ointments or creams. These medications are usually quite effective and help stop the itching right away. Doctors generally recommend putting cortisone creams or ointments on the affected patches of skin every day for several weeks. After that, you'll likely need to continue applying corticosteroids a couple of times a week to prevent a recurrence of lichen sclerosus. Your doctor will monitor you for side effects associated with prolonged use of topical corticosteroids, such as thinning of the skin. Treatments cause your skin to assume a more normal appearance and decrease its tendency for further scarring. 

Surgery generally isn't recommended for women with lichen sclerosus because the condition may just come back after surgery.

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Post menopausal hormone replacement therapy

Menopause, Hormones & More

What is menopause
Menopause is a normal stage in a woman’s life. The term menopause is commonly used to describe any of the changes a woman experiences either before or after she stops menstruating. As menopause nears, the ovaries gradually produce less estrogen (a female hormone), causing changes in the menstrual cycle and other physical changes. 
The most common symptoms of menopause are
  1. hot flashes, 
  2. night sweats, 
  3. emotional changes and 
  4.  changes in the vagina (dryness and atrophy or thinning of the vaginal walls).

Female Reproductive organs
Technically, menopause is the end of a woman’s reproductive cycle, when the ovaries no longer produce eggs and she has her last menstrual cycle. The diagnosis of menopause is not confirmed until a woman has not had her period for six to twelve consecutive months.
Menopause usually occurs naturally in women between ages 45 and 55 ( in north America the average 50-52 year old) . However, loss of estrogen can also occur if the ovaries are removed during surgery or if a woman goes through early menopause.

What exactly is HRT?
Hormone replacement therapy (HRT) is a treatment program in which a woman takes estrogen with or without progestin (a synthetic form of progesterone). To decrease the risk of uterine cancer in women who have a uterus, progestin is usually prescribed with estrogen.

What are the benefits of HRT?
Benefits of hormone replacement therapy for post-menopausal women, include:
1- Increased elasticity of the blood vessels, allowing them to dilate (widen) and let the blood flow more freely throughout the body
2- Improved short-term symptoms of menopause such as hot flashes and mood swings, as well as vaginal dryness, dry skin, sleeplessness and irritable bladder symptoms
3- Decreased risk of osteoporosis and fractures (broken bones)
4- Decreased incidence of colon cancer
5- Possible decreased incidence of Alzheimer’s disease
6- Possible improvement of glucose levels

Is HRT safe?
Short-term hormone replacement therapy is safe for most menopausal women who take HRT for symptom control. However, before HRT is prescribed, make sure you review your medical history with your health care provider. Together, you and your health care provider can decide if you have conditions or inherited health risks that would make HRT unsafe for you.

HRT is not recommended for women who have:
  1. History of prior heart attack or stroke and/or increased risk for vascular disease
  2. Unexplained vaginal bleeding
  3. Active or past breast cancer
  4. Fibrocystic breast disease
  5. Active liver disease
  6. Endometrial cancer
  7. Gall bladder disease
  8. High risk for blood clots or a history of blood clots

What are the risks of HRT?
The health risks of HRT include:
  1. Increased risk of endometrial cancer (only when estrogen is taken without progestin) For women who have had a hysterectomy (removal of the uterus), this is not a problem.
  2. Increased risk of breast cancer with long-term use
  3. Increased risk of cardiovascular disease (including heart attack)
  4. Increase in inflammatory markers (such as C-reactive protein)
  5. Increased risk of blood clots and stroke, especially during the first year of use in susceptible women

All women taking hormone replacement therapy should have regular gynecological exams (including a PAP smear). 
The American Cancer Society also recommends that women over age 50 should:
  1. Perform breast self-examination once a month;
  2. Have a breast physical examination by her health care provider once a year; and
  3. Have a mammogram once a year.

What are the side effects of HRT?
About 5 to 10 percent of women treated with HRT have side effects which may include 
  1. breast tenderness, 
  2. fluid retention and 
  3. mood swings. 
In most cases, these side effects are mild and do not require the woman to stop HRT therapy.

If you have bothersome side effects from HRT, talk to your doctor. He or she can often reduce these side effects by changing the type and dosage of estrogen and/or progestin.
If you have a uterus and take progestin, monthly vaginal bleeding is likely to occur. If it will bother you to have your monthly menstrual cycle, discuss this with your health care provider.

Is HRT the same as birth control?
No. Although women who take birth control pills are also taking estrogen and progestin, the effect is not the same. Women who take birth control pills have not been through menopause and need higher levels of hormones to prevent ovulation. HRT is not a high enough strength to stop ovulation.
After menopause, estrogen levels are low and HRT is used at a low dose to restore hormone levels to a more normal level.

How do I decide if HRT is right for me?
Even the best candidates for HRT need to periodically evaluate if HRT is the right treatment for them. You and your health care provider should discuss your medical history and risk factors, as well as how HRT can be tailored to your needs.

Here are some questions you can ask yourself and discuss with your physician:
  1. Am I experiencing difficult menopause symptoms?
  2. Do I have any medical conditions or a family history of certain conditions that might make HRT beneficial for me?
  3. Do I have any medical conditions or a family history of certain conditions that might make HRT riskier for me?
  4. Have I considered alternatives to HRT?

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Endometrial ablation = Burning the uterine lining


Therapy System is a thermal balloon ablation device intended to ablate the endometrial lining of the uterus in premenopausal women with menorrhagia (excessive uterine bleeding).


Indicated 

1-menorrhagia AND 

2-shown to reduce dysmenorrhea (painful cycle).


At 1 year outcome data from a pivotal studyI:

    1- 81% of patients returned to normal levels of menstrual bleeding or lower

    2- 37% of patients experienced amenorrhea

    3- 89% of patients experienced a reduction in menstrual pain and cramping


CONTRAINDICATIONS: 

1- The device is contraindicated for use in a patient who is pregnant or who wants to become pregnant in the future (pregnancies following ablation can be dangerous for both mother and fetus); 

2- known or suspected endometrial carcinoma (uterine cancer) or premalignant change of the endometrium, such as unresolved adenomatous hyperplasia

3- active genital or urinary tract infection at the time of procedure (eg, cervicitis, vaginitis, endometritis, salpingitis, or cystitis) or with active pelvic inflammatory disease (PID); with an intrauterine device (IUD) currently in place.


ADVERSE EVENTS: include 

1- cramping/pelvic pain; 

2- nausea and vomiting; 

3- complications with pregnancy

4- post-procedure symptoms such as pain, fever, nausea, vomiting ; hemorrhage; infection or sepsis; perforation




******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************



Vaginitis

(Also Called 'Vaginal Infections', 'Vulvovaginitis')

What is vaginitis?
"Vaginitis" is a medical term used to describe various disorders that cause infection or inflammation of the vagina. Vulvovaginitis refers to inflammation of both the vagina and vulva (the external female genitals). These conditions can result from an infection caused by organisms such as bacteria, yeast or viruses. In addition, irritations from chemicals in creams, sprays, or even clothing that are in contact with this area can result in vaginitis. In some cases, vaginitis results from organisms that are passed between sexual partners and from vaginal dryness and lack of estrogen.

What are the symptoms of vaginitis?
The symptoms of vaginitis can vary depending on what is causing the infection or inflammation. Some women have no symptoms at all. Some of the more common symptoms of vaginitis include:

  1. Abnormal vaginal discharge with an unpleasant odor
  2. Burning during urination
  3. Itching around the outside of the vagina
  4. Discomfort during intercourse

Is vaginal discharge normal?
A women's vagina normally produces a discharge that usually is described as clear or slightly cloudy, non-irritating and odor-free. 
During the normal menstrual cycle, the amount and consistency of discharge vary. 
          At one time of the month there may be a small amount of a very thin or watery discharge. 
          At another time, (usually the latter part of the menstrual cycle) a more extensive thicker 
          discharge may appear. 
All of these descriptions could be considered normal.

A vaginal discharge that has an odor or that is irritating usually is considered an abnormal discharge. The irritation might be itching or burning, or both. The burning could feel like a bladder infection. The itching may be present at any time of the day, but it often is most bothersome at night. These symptoms often are made worse by sexual intercourse. It is important to see your health care professional if there has been a change in the amount, color or smell of the discharge.

What are the most common types of vaginitis?
The six most common types of vaginitis are:
  1. Candida or "yeast" vaginitis
  2. Bacterial vaginosis
  3. Trichomoniasis vaginitis (a sexually transmitted infection)
  4. Chlamydia vaginitis
  5. Viral vaginitis
  6. Non-infectious vaginitis
  7. Atrophic vaginitis

Each of these vaginal infections can have different symptoms, or no symptoms at all. In fact, diagnosis can even be tricky for an experienced clinician. Sometimes more than one type of vaginitis can be present at the same time

To better understand these seven major causes of vaginitis, let's look briefly at each one of them and how they are treated.

What are candida or yest infections?
Yeast infections of the vagina are what most women think of when they hear the term "vaginitis." Yeast infections are caused by one of the many species of fungus called candida. Candida normally live in small numbers in the vagina, as well as in the mouth and digestive tract of both men and women.

Yeast infections produce a thick, white vaginal discharge with the consistency of cottage cheese. Although the discharge can be somewhat watery, it is odorless. Yeast infections usually cause the vagina and the vulva to be very itchy and red, even before the onset of discharge.

If yeast is normal in a woman's vagina, what makes it cause an infection? Usually, infection occurs when a change in the delicate balance in a woman's system takes place. For example, a woman may take an antibiotic to treat a urinary tract infection, and the antibiotic kills "friendly" bacteria that normally keep the yeast in balance. As a result, the yeast overgrows and causes the infection. Other factors that can upset the delicate balance include pregnancy, which changes hormone levels, and diabetes, which allows too much sugar in the urine and vagina.

What are the risk factors for vaginal candida infections? 
  1. Recent treatment with antibiotics
  2. Uncontrolled diabetes
  3. Pregnancy
  4. High-estrogen contraceptives
  5. Disorders affecting the immune system (such as HIV and organ transplantation)
  6. Thyroid or endocrine disorders
  7. Corticosteroid therapy
  8. Vaginal douching

What is bacterial vaginosis?
Although "yeast" is the name most women know, bacterial vaginosis (BV) actually is the most common vaginal infection in women of reproductive age. Bacterial vaginosis often will cause a vaginal discharge. The discharge usually is thin and milky, and is described as having a "fishy" odor. This odor may become more noticeable after intercourse.

Redness or itching of the vagina are not common symptoms of bacterial vaginosis. Some women with BV have no symptoms at all, and the vaginitis is only discovered during a routine gynecologic exam. Bacterial vaginosis is caused by a combination of several bacteria. These bacteria seem to overgrow in much the same way as do candida when the vaginal pH balance is upset.

Because bacterial vaginosis is caused by bacteria and not by yeast, medicine that is appropriate for yeast is not effective against the bacteria that cause bacterial vaginosis.
BV is treated in asymptomatic females of child bearing age to decrease their risk of preterm delivery.

Risk factors for BV include:
  1. New or multiple sexual partners
  2. Douching
  3. Cigarette smoking

What are trichomoniasis, chlamydia and viral vaginitis?
Trichomoniasis — Trichomoniasis is caused by a tiny single-celled organism known as a "protozoa." When this organism infects the vagina, it can cause a frothy, greenish-yellow discharge. Often this discharge will have a foul smell. Women with trichomonal vaginitis may complain of itching and soreness of the vagina and vulva, as well as burning during urination. In addition, there can be discomfort in the lower abdomen and vaginal pain with intercourse. These symptoms may be worse after the menstrual period. Many women, however, do not develop any symptoms. It is important to understand that this type of vaginitis can be transmitted through sexual intercourse. For treatment to be effective, the sexual partner must be treated at the same time as the patient.

Chlamydia — Is the most common sexually transmitted infection (STI). Unfortunately, most women with chlamydia infection do not have symptoms, making diagnosis difficult. A vaginal discharge is sometimes present with this infection but not always. More often, a woman might experience light bleeding, especially after intercourse, and she may have pain in the lower abdomen and pelvis. Chlamydial vaginitis is most common in young women (18 to 35 years) who have multiple sexual partners. Routine chlamydia screening is done annually for sexually active females age 15-26 years and older if you have multiple sexual partners.
While chlamydia infections are treatable with antibiotic medications, the best "treatment" for chlamydia is prevention. Use of a condom will decrease your risk of contracting not only chlamydia, but other sexually transmitted diseases as well. Gonorrhea, another STI can rarely cause vaginitis symptoms.

Viral vaginitis — Viruses are a common cause of vaginitis. One form caused by the herpes simplex virus (HSV) is often just called "herpes" infection. These infections also are spread by sexual contact. The primary symptom of herpes vaginitis is pain associated with lesions or "sores." These sores usually are visible on the vulva or the vagina but occasionally are inside the vagina and can only be seen during a gynecologic exam.
Another source of viral vaginal infection is the human papillomavirus (HPV). HPV, sometime referred to as genital warts, also can be transmitted by sexual intercourse. This virus can cause painful warts to grow in the vagina, rectum, vulva or groin. These warts usually are white to gray in color, but they may be pink or purple. However, visible warts are not always present, and the virus may only be detected when a Pap smear is abnormal. Outbreaks of HPV often are associated with stress or emotional distress.

Many of the infections that cause vaginitis can be spread between men and women during sexual intercourse. Use of a barrier contraceptive, such as a condom, can help reduce your risk (but does not offer 100% protection against) contracting these and more serious infections, such as the human immunodeficiency virus (HIV), which can lead to AIDS.

What is non-infectious vaginitis?
Occasionally, a woman can have itching, burning and even a vaginal discharge without having an infection. The most common cause is an allergic reaction or irritation from vaginal sprays, douches or spermicidal products. The skin around the vagina also can be sensitive to perfumed soaps, lotions, sexual lubricants detergents, and fabric softeners.

What is atrophic vaginitis?
Atrophic vaginitis, or vulvovaginal atrophy, is another non-infectious form of vaginitis that results from a decrease in hormones. The vagina becomes dry or "atrophic." This occurs primarily during perimenopause and postmenopause, either natural or surgical (removal of ovaries). Postlactation and postpartum states can also contribute to atrophy. Medications such as aromatase inhibitors (used in breast cancer) or depo lupron (used in endometriosis) can drastically lower estrogen levels and cause atrophy. The woman may notice pain (especially with sexual intercourse), vaginal itching and burning, or symptoms of urinary urgency and frequency.

How is vaginitis treated?
The key to proper treatment of vaginitis is proper diagnosis. This is not always easy since the same symptoms can exist in different forms of vaginitis. You can greatly assist your health care provider by paying close attention to exactly which symptoms you have and when they occur, along with a description of the color, consistency, amount and smell of any abnormal discharge. We never recommend douching. Some providers ask that you abstain from sex for 24 hours before your appointment.

Because different types of vaginitis have different causes, the treatment needs to be specific to the type of vaginitis present. When a woman has had a yeast infection diagnosed by her doctor, she usually is treated with a prescription for a vaginal cream, suppositories or oral medication. If the infection clears up for some period of time but then the exact same symptoms occur again, a woman can obtain, with her doctor or pharmacist's consent, a vaginal cream or suppository without a prescription that can completely treat the infection.

The important thing to understand is that this medication may only cure the most common types of candida associated with vaginal yeast infections and will not cure other yeast infections or any other type of vaginitis. If you are not absolutely sure, see your doctor. You may save the expense of buying the wrong medication and avoid delay in treating your type of vaginitis.

When buying an over-the-counter medicine, be sure to read all of the instructions completely before using the product. Be sure to use all of the medicine and don't stop just because your symptoms have gone away.

Be sure to see your health care practitioner if:
  1. All of the symptoms do not go away completely.
  2. The symptoms return immediately or shortly after you finish treatment.
  3. You have any other serious medical problems such as diabetes.
  4. You might be pregnant.
  5. You have a new sexual partner and are concerned for STI’s.

It is important to follow your doctor's instructions, as well as the instructions that come with the medication. Do not stop taking the medicine when your symptoms go away. Do not be embarrassed to ask your doctor or health care practitioner questions. 

Good questions to ask include:
  1. Should I abstain from sexual intercourse during treatment?
  2. Should my sexual partner(s) be treated at the same time?
  3. Will the medication for this vaginitis interact with my other medication(s)?
  4. Should I continue the vaginal cream or suppositories during my period?
  5. Do I need to be re-examined and if so, when?

"Non-infectious" vaginitis is treated by changing the probable cause. If you recently changed your soap or laundry detergent or have added a fabric softener, you might consider stopping the new product to see if the symptoms remain. The same instruction would apply to a new vaginal spray, douche, sanitary napkin or tampon. If the vaginitis is due to hormonal changes, estrogen (either used locally in the vagina or systemically) may be prescribed to help reduce symptoms.

How can I prevent vaginitis?
There are certain things that you can do to decrease the chance of getting vaginitis. If you suffer from yeast infections, it usually is helpful to avoid garments that hold in heat and moisture. The wearing of nylon panties, pantyhose without a cotton panel and tight spandex or jeans can lead to yeast infections. Good hygiene also is important.
There is little scientific evidence that yogurt and probiotics containing lactobacillus will reduce vaginitis infections.
Because they can cause vaginal irritation, most doctors do not recommend vaginal sprays or heavily perfumed soaps for cleansing this area. Likewise, repeated douching may cause irritation or, more importantly, may hide a vaginal infection.

Safe sexual practices can help prevent the passing of diseases between partners. The use of condoms is particularly important.

If you are approaching menopause, have had your ovaries removed or have low levels of estrogen for any reason, discuss with your doctor the use of hormone pills or creams to keep the vagina lubricated and healthy.

Good health habits are important. Have a complete gynecologic exam, including a Pap smear and or HPV testing at intervals discussed with your doctor. If you have multiple sexual partners, you should request screening for sexually transmitted diseases

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Pregnancy   Key Resources & Services

Most people have some questions about their pregnancy and developing baby. Here is a selection of key resources and services about health before and during pregnancy, and in the first few weeks following delivery. A range of supports is provided, including helpful websites, documents, programs and phone lines. Finding answers to your questions is important, for your health, and the health of your baby.

Aboriginal CAPC/CPNP
Phone: 1-800-361-0563 or 1-807-684-1920
Web: www.kanen.on.ca

Adoption
Web: www.children.gov.on.ca/CS/en/programs/Adoption/default.htm

Assaulted Women's Helpline
Phone: 1-866-863-0511 or 1-416-863-0511

Association of Ontario Midwives
Phone: 1-866-418-3773 or 1-416-425-9974
Web: www.aom.on.ca

Association of Ontario Translators and Interpreters of Ontario
Phone: 1-800-234-5030 or 1-613-241-2846

Best Start Resource Centre
Phone: 1-800-397-9567 or 1-416-408-2249
Web: www.beststart.org
Alcohol: www.alcoholfreepregnancy.ca
Health Before Pregnancy: www.healthbeforepregnancy.ca

Canada Prenatal Nutrition Program
Web: www.phac-aspc.gc.ca/dca-dea/programs-mes/index_e.html

Canadian Cancer Society Smokers' Helpline
Phone: 1-877-513-5333
Web: www.smokershelpline.ca

Canadian Centre for Occupational Health and Safety
Tel: 1-800-668-4284 or 1-905-570-8094
Web: www.ccohs.ca

Canadian Child Care Federation
Web: www.cccf-fcsge.ca

Canadian Coalition for Immunization Awareness and Promotion
Web: www.immunize.cpha.ca

Canadian Foundation for the Study of Infant Deaths
Phone: 1-800-363-7437 or 1-416-488-3260
Web: www.sidscanada.org

Canadian Health Network
Web: www.canadian-health-network.ca
Children's Affiliate: www.canadian-health-network.ca/1children.html

Canadian Mental Health Association - Postpartum Depression
Web: www.cmha.ca/bins/content_page.asp?cid=3-86-87-88&lang=1

Canadian Paediatric Society - Caring for Kids
Web: www.caringforkids.cps.ca

Centre of Excellence for Early Childhood Development
Web: www.excellence-earlychildhood.ca

Child and Family Canada
Web: www.cfc-efc.ca

Children with Special Needs
Web: www.children.gov.on.ca/CS/en/programs/SpecialNeeds/default.htm

Community Action Programs for Children
Web: www.phac-aspc.gc.ca/dca-dea/programs-mes/index_e.html

Dads Can
Phone: 1-888-323-7226
Web: www.dadscan.ca

Diabetes
Web: www.diabetesontario.org

DisAbled Women's Network Canada
Web: www.dawncanada.net

Doulas
Web: www.canadiandoulas.com

Family Pride Canada
Web: familypride.uwo.ca

Family Resource Programs
Phone: 1-866-637-7226 or 1-613-237-7667
Web: www.frp.ca

Family Service Canada
Phone: 1-800-668-7808 or 1-613-722-9006
Web: www.familyservicecanada.org

Father Involvement Initiative
Web: www.cfii.ca/fiion

FITMOM
Web: www.fitmomcanada.com

Growing Healthy Canadians - A Guide to Positive Child Development
Web: www.growinghealthykids.com

Healthy Babies, Healthy Children
Web: www.children.gov.on.ca/CS/en/programs/BestStart/Healthy/default.htm

Healthy Ontario
Web: www.healthyontario.com

Infant Development Program
Web: www.children.gov.on.ca/CS/en/programs/SpecialNeeds/
infDevelopment.htm

Infant Hearing Program
Web: www.children.gov.on.ca/CS/en/programs/BestStart/
InfantHearing/default.htm

Invest In Kids
Web: www.investinkids.ca

La Leche League Canada
Phone: 1-800-665-4324
Web: www.lalecheleaguecanada.ca

Lamaze International
Web: www.lamaze.org/

Maternity and Parenting Leave
Web: www.labour.gov.on.ca/english/es/factsheets/fs_preg.html

Ministry of Health and Long-Term Care INFOline
Phone: 1-800-268-1154 or 1-416-314-5518
TTY: 1-800-387-5559

Mother Goose Program
Phone: 1-416-588-5234 Web: www.nald.ca/mothergooseprogram

Motherisk
Phone: 1-416-813-6780
Alcohol and Substance Use in Pregnancy: 1-877-327-4636
Nausea and Vomiting in Pregnancy: 1-800-436-8477
HIV in Pregnancy: 1-888-246-5840
Web: www.motherisk.org

Multiple Births Canada
Web: www.multiplebirthscanada.org

National Clearinghouse on Family Violence
Web: www.phac-aspc.gc.ca/ncfv-cnivf

Nobody's Perfect Parenting Program
Phone: 1-705-567-5926
Web: www.phac-aspc.gc.ca/dca-dea/family_famille/nobody_e.html

Ontario Association of Children's Rehabilitation Services
Web: www.oacrs.com

Ontario Association of Speech Language Pathologists and Audiologists
Phone: 1-800-718-6752 or 1-416-920-3676
Web: www.osla.on.ca

Ontario College of Family Physicians
Web: www.ocfp.on.ca

Ontario Early Years Centres
Web: www.ontarioearlyyears.ca

Ontario Federation of Indian Friendship Centres
Phone: 1-416-956-7575
Web: www.ofifc.org

Ontario Human Rights Commission - Pregnancy and Breastfeeding Rights
Phone: 1-800-387-9080 or 1-416-326-9511
TTY: 1-800-308-5561
Web: www.ohrc.on.ca

Ontario Ministry of Transportation - Car Seat Information
Web: www.mto.gov.on.ca/english/safety/carseat/choose.htm

Ontario Poison Centre
Phone: 1-800-268-9017 or 1-416-813-5900
Web: www.sickkids.on.ca/Poison/default.asp

Ottawa Coalition for the Prevention of Low Birth Weight
Web: www.lbwinfo.ca

Our Sisters' Place - Postpartum Depression
Web: www.oursistersplace.ca

Parent Help Line
Phone: 1-888-603-9100
Web: www.parentsinfo.sympatico.ca

Perinatal Bereavement Service Ontario
Phone: 1-888-301-7276 or 1-905-472-1807
Web: www.pbso.ca

Planned Parenthood Federation of Canada
Phone: 1-613-241-4474
Web: www.ppfc.ca

Pacific Post Partum Support Society - Support Groups in Ontario
Web: www.postpartum.org/supportgroups.html

Pregnancy Library
Web: www.pregnancylibrary.com

Pregnets - Smoking and Pregnancy
Web: www.pregnets.org

Prenatal HIV Testing
Web: www.health.gov.on.ca/english/public/pub/aids/prenatalhiv.html

Preschool Speech and Language Program
Web: www.children.gov.on.ca/CS/en/programs/BestStart/
PreschoolSpeechLanguage/default.htm

Public Health Agency of Canada
Healthy Pregnancy: www.phac-aspc.gc.ca/hp-gs/index.html
Infant Care: www.phac-aspc.gc.ca/dca-dea/prenatal/index_e.html

Public Health Units
Phone: 1-800-268-1154
Web: www.health.gov.on.ca/english/public/contact/phu/phu_mn.html

Safe Kids Canada
Web: www.safekidscanada.org

Shelternet - Shelters for Abused Women
Web: www.shelternet.ca

Single Parents
Web: www.singleparents.about.com

SportCARE - Exercise and Pregnancy Question Hotline
Phone: 1-416-323-7524

Telehealth Ontario
Phone: 1-866-797-0000
TTY: 1-866-797-0007
Web: www.health.gov.on.ca/english/public/program/telehealth/
telehealth_mn.html

Transport Canada - Car Seat Safety
Web: www.tc.gc.ca/roadsafety/childsafety/menu.htm

Women's Health Concerns Clinic - Postpartum Depression Information
Web: http://www.stjosham.on.ca/default.asp?action=article&ID=348

Women's Health Matters Pregnancy Health Centre
Web: www.womenshealthmatters.ca/centres/pregnancy/index.html

Last Updated November 20, 2007
SOGC

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Umbilical Cord Blood
Stem cells 

When a baby is born, his or her umbilical cord is filled with a small amount of blood. This blood contains high numbers of special cells called stem cells. If you choose, this blood can be stored. It will then be used in the future to treat children or their family members with deadly diseases including Leukemia and Lymphoma. Often, this blood can be used to treat children when a donor cannot be found for a bone marrow transplant.

Put simply, the blood from your child’s umbilical cord could save a human life. Until recently, this blood with the potential to save lives was simply discarded as medical waste.

What are Umbilical Cord Blood Stem Cells?
Each adult human body is made up of about 100 trillion cells. There are 100 different types of cells. Most types of cells perform a certain function. Nerve cells, for example, are very long and carry signals to and from your brain quickly.
babyMost cells can also make copies of themselves, but only of the same type. In this respect, stem cells are special. Unlike other cells, they don’t have one specific job. They are like a “blank” cell. They don’t die and can split to form several different types of cells.
It is for this reason that umbilical cord blood is collected. The blood is rich in a special type of stem cell (called hematopoietic stem cells). They can produce red blood cells, white blood cells and blood clotting cells. These stem cells can be saved and transplanted into other people to treat deadly diseases. And this is just a start.
One day scientists hope to use stem cells to cure or treat heart disease, diabetes, spinal cord injuries, Parkinson’s, Alzheimer’s, burn victims and even HIV and AIDS. This makes it even more important to begin collecting and preserving stem cells.

Is it Ethical to Use Umbilical Cord Blood Stem Cells?
The collection and storage of umbilical cord blood stem cells is completely ethical.
Recently, there has been a lot of public debate on the collection of other types of stem cells. These cells come from aborted fetuses or human embryos grown in a lab called embryonic stem cells. This debate does not include stem cells taken from umbilical cord blood which are Adult or Non-Embryonic Stem Cells.

What are the Umbilical Cord Blood Stem Cells Used For?
Stem cells from umbilical cord blood can be used to treat a wide variety of blood, bone, genetic, and immune system diseases in children, including:

  1. Lymphoma
  2. Leukemia
  3. Adrenoleukodystrophy (a degenerative brain disease)
  4. Krabbe’s Disease (genetic brain disease)
  5. Sickle Cell Anemia
  6. Osteopetrosis

Many are considered life-saving procedures. Some of these diseases, such as Krabbe’s Disease, were deadly before the development of stem cell transplants. On rare occasions these procedures can be used to treat adults. The small amount of stem cells collected from each cord allows for transplants mostly in children. Research continues to increase the use of stem cells in adults and to treat many other diseases.

What are the Options for Umbilical Cord Blood Collection?
baby on a blanketIf you choose to collect your child’s umbilical cord blood, there are a number of options available. There is absolutely no health risk associated with collection, and the process does not interfere with childbirth in any way. Usually, collection takes less than ten minutes. You will be asked to provide some health information, similar to what would be required when donating regular blood.

Donation for General Public Use
Most healthy women, 18 years of age or older, who undergo a complication-free pregnancy can donate their child’s umbilical cord blood. 

Exceptions to donation of umbilical cord blood include:

  1. Parents who have a family history of blood, immune system or genetic disorders.
  2. Women who were prescribed certain medications during pregnancy.
  3. Parents who have tested positive for sexually transmitted infections.

It is your decision whether to donate your child’s umbilical cord blood. Remember, by donating your child’s umbilical cord blood you could save another child’s life.
The umbilical cord blood that is not donated is merely thrown out as medical waste. The donated cord blood is processed and stored in a public (not-for-profit) cord blood bank. The aim of a public cord blood bank is to make umbilical cord blood stem cells a public resource and provide a supply for medical treatments.

There is no fee to donate your child’s cord blood.

Directed Donation for High-Risk Families
The cord blood may be stored at a public or with some private cord blood banks for specific use by the child or family member when:
  1. An immediate family member of a newborn has an existing disease
  2. The newborn is at high-risk for a disease that may be treated with umbilical cord blood stem cells

A physician consultation and approval is needed for this type of donation.
There is no fee required from you for this service.

Private Storage for Family Banking
You can also choose to store your child’s umbilical cord blood in a private cord blood bank. If you or your children ever need access to the cord blood, it will be there for your use only. It is not available to the general public.
This service costs money and has a yearly storage fee.

What are the Important Differences to Remember with Each Option?

Donated stem cells for general public use may not be available to you or a family member.
The chance you will use the stem cells in private storage is very low.
----------------------------------------------------
Alberta Cord Blood Bank
Alternate names: ACBB
Additionally, Alberta Cord Blood Bank is the only public cord blood bank in Canada and it is a not-for-profit service dedicated to the provisions of stem cells for transplantation uses in treatment centres across Canada.

Details:
Cord blood is the blood present in the umbilical cord of newborn babies.
Ordinarily, the remnant blood is discarded after the birth of the baby.
Cord blood contains stem cells that are used for transplantation and research.

In order to register to donate with the ACBB, participants will need to:
Read our brochure through completely
Fill out our registration form and
Mail it in before the end of the 34th week of your pregnancy.

Please see website for additional registration information.
http://www.albertahealthservices.ca/services.asp?pid=service&rid=6955
Available to
All Mother's in Canada with a healthy full-term pregnancy and a normal vaginal delivery.

Service locations
Please visit the links above for more details about this service at various locations.
College Plaza
Suite 408
8215 112 Street, Edmonton, Alberta T6G 2C8; 780-492-2673, [email protected] (medical enqui)

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Genetic Counseling
Prenatal Testing and Diagnosis

Prenatal, or intrauterine, diagnosis is a process that can identify some birth defects and genetic disorders in your child before birth.

Depending on your age, family health history and other risk factors, you may undergo a blood draw, an ultrasound examination of your pregnancy, or more invasive forms of testing such as chorionic villus sampling or amniocentesis.

More than 300 disorders can be detected in unborn infants. Some of the birth defects and genetic disorders for which Medical Genetics provides testing include:

  1. Down's syndrome (Trisomy 21)
  2. Cystic fibrosis
  3. Sickle cell disease
  4. Tay-Sachs disease
  5. Fragile X syndrome (a leading cause of mental retardation)
  6. Spina bifida
  7. Heart defects

These disorders can have different forms of inheritance, and a genetic counselor may be able to give you a better idea of the chance that your baby will be affected. The first step in the process is to obtain a detailed family history to determine the conditions for which your baby is at risk. Then, information from blood testing and/or ultrasound can be used to provide an assessment of risk, and you may have to make a decision regarding a more invasive procedure for diagnosis. For example, a baby's sex can be determined before birth with ultrasound. This is important in assessing the risk for certain diseases such as muscular dystrophy or hemophilia, which are typically passed from unaffected mothers (carriers) to their sons. For a mother who is known to be a carrier for one of these conditions, there is a 50 percent chance that male offspring will be affected by the disorder.

Not all disorders present at birth can be detected through the tests that are currently available, and some babies who have normal test results are born with birth defects or genetic disorders. A normal ultrasound, maternal blood test, amniocentesis or chorionic villus sample does not guarantee that a baby will not have a problem, but normal test results usually indicate that chances for having a baby without genetic disorders are high.
Reasons For Having Prenatal Testing

The decision to undergo prenatal testing and diagnosis is a personal one. Your doctor can make recommendations, but you must make the decision. Prenatal testing can lead to early detection of certain birth defects or other problems that may require special care. This testing offers parents the opportunity to learn about these conditions and make decisions and plans long before the baby is delivered. Prenatal testing helps parents and doctors work together for the best management of a pregnancy known to be at risk.

Who Should Have Prenatal Testing
Your obstetrician may recommend prenatal testing and diagnosis if you have a higher-than-normal risk of giving birth to a baby with a birth defect or genetic disorder. Women who meet any of the follow criteria have an increased risk and should consider prenatal testing:
  1. A previous child with a chromosomal abnormality, birth defect or other inherited condition.
  2. Family history or an inherited disorder.
  3. Those who are carriers of X-linked diseases such as hemophilia or muscular dystrophy.
  4. Those who are carriers, or whose partners are carriers, of a known genetic disorder.
  5. Belonging to a certain ethnic group or race among which certain inherited disorders are prevalent (e.g., Ashkenazi Jew, French Canadian or Cajun ancestry)
  6. Abnormal findings on a fetal ultrasound.

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Adolescent pregnancy

Adolescent pregnancy is pregnancy in girls age 19 or younger.


Causes

Adolescent pregnancy and babies born to adolescents have dropped since reaching an all-time high in 1990. This is mostly due to the increased use of condoms.

Adolescent pregnancy is a complex issue with many reasons for concern. Kids age 12 - 14 years old are more likely than other adolescents to have unplanned sexual intercourse . They are more likely to be talked into having into sex.

Up to two-thirds of adolescent pregnancies occur in teens age 18 - 19 years old.


Risk factors for adolescent pregnancy include:

  • Younger age
  • Poor school performance
  • Economic disadvantage
  • Older male partner
  • Single or teen parents

Symptoms

Pregnancy symptoms include:


Exams and Tests

The adolescent may or may not admit to being involved sexually. If the teen is pregnant, there are usually weight changes (usually a gain, but there may be a loss if nausea and vomiting are significant). Examination may show increased abdominal girth, and the health care provider may be able to feel the fundus (the top of the enlarged uterus).

Pelvic examination may reveal bluish or purple coloration of vaginal walls, bluish or purple coloration and softening of the cervix, and softening and enlargement of the uterus.


Treatment

All options made available to the pregnant teen should be considered carefully, including abortion, adoption, and raising the child with community or family support. 

Discussion with the teen may require several visits with a health care provider to explain all options in a non-judgmental manner and involve the parents or the father of the baby as appropriate.

Early and adequate prenatal care, preferably through a program that specializes in teenage pregnancies, ensures a healthier baby. 

Pregnant teens need to be assessed for smoking, alcohol use, and drug use, and they should be offered support to help them quit.

Adequate nutrition can be encouraged through education and community resources. Appropriate exercise and adequate sleep should also be emphasized. Contraceptive information and services are important after delivery to prevent teens from becoming pregnant again.

Pregnant teens and those who have recently given birth should be encouraged and helped to remain in school or reenter educational programs that give them the skills to be better parents, and provide for their child financially and emotionally. Accessible and affordable child care is an important factor in teen mothers continuing school or entering the work force.


Outlook (Prognosis)

Having her first child during adolescence makes a woman more likely to have more children overall. Teen mothers are about 2 years behind their age group in completing their education. Women who have a baby during their teen years are more likely to live in poverty.

Teen mothers with a history of substance abuse are more likely to start abusing by about 6 months after delivery.

Teen mothers are more likely than older mothers to have a second child within 2 years of their first child.

Infants born to teenage mothers are at greater risk for developmental problems. Girls born to teen mothers are more likely to become teen mothers themselves, and boys born to teen mothers have a higher than average rate of being arrested and jailed.


Possible Complications

Adolescent pregnancy is associated with higher rates of illness and death for both the mother and infant. Death from violence is the second leading cause of death during pregnancy for teens, and is higher in teens than in any other group.

Pregnant teens are at much higher risk of having serious medical complications such as:

Teen mothers are more likely to have unhealthy habits that place the infant at greater risk for inadequate growth, infection, or chemical dependence. The younger a mother is below age 20, the greater the risk of her infant dying during the first year of life.

It is very important for pregnant teens to have early and adequate prenatal care.


When to Contact a Medical Professional

Make an appointment with your health care provider if you have symptoms of pregnancy.

Your health care provider can also provide counseling regarding birth control methods, sexually transmitted disease (STD) prevention, or pregnancy risk.


Prevention

There are many different kinds of teen pregnancy prevention programs.

  • Abstinence education programs encourage young people to wait to have sex until marriage, or until they are mature enough to handle sexual activity and a potential pregnancy in a responsible manner.
  • Knowledge-based programs focus on teaching kids about their bodies. It also provides detailed information about birth control and how to prevent sexually transmitted infections (STIs). Research shows knowledge-based programs help decrease teen pregnancy rates. Abstinence-only education without information about birth control does not.
  • Clinic-focused programs give kids easier access to information, counseling by health care providers, and birth control services. Many of these programs are offered through school-based clinics.
  • Peer counseling programs typically involve older teens, who encourage other kids to resist peer and social pressures to have sex. For teens who are already sexually active, peer counseling programs teach them relationship skills and give them information on how to get and successfully use birth control.

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Ectopic Pregnancy

(Also Called 'Tubal Pregnancy')

What is an ectopic pregnancy?
An ectopic pregnancy occurs when the embryo does not implant in the uterus. In many cases of ectopic pregnancy, the embryo implants in one of the fallopian tubes. In rare cases, the embryo attaches to an ovary or other abdominal organs.
Ectopic pregnancy is a potentially life-threatening condition and requires prompt treatment. It usually is discovered by the eighth week of pregnancy.

What causes an ectopic pregnancy?
In most cases, an ectopic pregnancy is caused by conditions that slow down or block the movement of the egg down the fallopian tube and into the uterus. Certain risk factors exist for ectopic pregnancy. A risk factor is a trait or behavior that increases a person’s chance of developing a disease or predisposes a person to a certain condition. 

Risk factors for ectopic pregnancy include:
  1. Use of an intrauterine device (IUD), a form of birth control, at the time of conception
  2. History of pelvic inflammatory disease (PID)
  3. Sexually-transmitted diseases such as chlamydia and gonorrhea
  4. Congenital abnormality of the fallopian tube
  5. History of pelvic surgery — Scarring might block the fertilized egg from leaving the fallopian tube.
  6. History of ectopic pregnancy
  7. Tubal ligation (surgical sterilization), unsuccessful tubal ligation, or reversal of tubal ligation
  8. Use of fertility drugs
  9. Infertility treatments such as in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT)

What are the symptoms of an ectopic pregnancy?
  1. Vaginal bleeding
  2. Signs of early pregnancy
  3. Lower abdominal or pelvic pain
  4. Dizziness or weakness
If the fallopian tube ruptures, the pain and bleeding could be severe enough to cause fainting. Contact your health care provider if you are experiencing any of the above symptoms.

How is an ectopic pregnancy diagnosed?
A health care provider will perform a pregnancy test, a pelvic exam, and an ultrasound test to view the condition of the uterus and fallopian tubes.

How is an ectopic pregnancy treated?
  1. Medical: In some cases, medicine might be used to stop the growth of pregnancy tissue. 
  2. Surgical: If there is a ruptured fallopian tube, emergency surgery might be necessary to stop the bleeding. 
    1. A laparotomy (a procedure during which an incision is made in the abdomen and the embryonic tissue is removed) might be needed if the embryo is large or blood loss is considered life-threatening. 
    2. Laparoscopic surgery (minimally invasive surgery) might be appropriate if the fallopian tube is not ruptured and the pregnancy has not progressed very far. In some cases, the fallopian tube and ovary might be damaged and have to be removed, depending on the progression of the pregnancy. 
Most women who have had an ectopic pregnancy can go on to have subsequent normal pregnancies and births. Discuss the timing of your next pregnancy with your health care provider.

Can an ectopic pregnancy be prevented? 
Ectopic pregnancy cannot be prevented. However, treatment of any risk factors the mother might have can improve the chances for a successful pregnancy.

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Female Reproductive System


The female reproductive system is designed to carry out several functions. 

  1. It produces the female egg cells necessary for reproduction, called the ova or oocytes. 
  2. The system is designed to transport the ova to the site of fertilization. Conception, the fertilization of an egg by a sperm, normally occurs in the fallopian tubes. 
  3. The next step for the fertilized egg is to implant into the walls of the uterus, beginning the initial stages of pregnancy
  4.  If fertilization and/or implantation does not take place, the system is designed to menstruate (the monthly shedding of the uterine lining). 
  5. In addition, the female reproductive system produces female sex hormones that maintain the reproductive cycle.

What Parts Make up the Female Anatomy?

The female reproductive anatomy includes parts inside and outside the body.

The function of the external female reproductive structures (the genitals) is twofold: To enable sperm to enter the body and to protect the internal genital organs from infectious organisms. 


The main external structures of the female reproductive system include:

  • Labia majora: The labia majora enclose and protect the other external reproductive organs. Literally translated as "large lips," the labia majora are relatively large and fleshy, and are comparable to the scrotum in males. The labia majora contain sweat and oil-secreting glands. After puberty, the labia majora are covered with hair.
  • Labia minora: Literally translated as "small lips," the labia minora can be very small or up to 2 inches wide. They lie just inside the labia majora, and surround the openings to the vagina (the canal that joins the lower part of the uterus to the outside of the body) and urethra (the tube that carries urine from the bladder to the outside of the body).
  • Bartholin's glands: These glands are located beside the vaginal opening and produce a fluid (mucus) secretion.
  • Clitoris: The two labia minora meet at the clitoris, a small, sensitive protrusion that is comparable to the penis in males. The clitoris is covered by a fold of skin, called the prepuce, which is similar to the foreskin at the end of the penis. Like the penis, the clitoris is very sensitive to stimulation and can become erect.


The internal reproductive organs in the female include:

  • Vagina: The vagina is a canal that joins the cervix (the lower part of uterus) to the outside of the body. It also is known as the birth canal.
  • Uterus (womb): The uterus is a hollow, pear-shaped organ that is the home to a developing fetus. The uterus is divided into two parts: the cervix, which is the lower part that opens into the vagina, and the main body of the uterus, called the corpus. The corpus can easily expand to hold a developing baby. A channel through the cervix allows sperm to enter and menstrual blood to exit.
  • Ovaries: The ovaries are small, oval-shaped glands that are located on either side of the uterus. The ovaries produce eggs and hormones.
  • Fallopian tubes: These are narrow tubes that are attached to the upper part of the uterus and serve as tunnels for the ova (egg cells) to travel from the ovaries to the uterus. Conception, the fertilization of an egg by a sperm, normally occurs in the fallopian tubes. The fertilized egg then moves to the uterus, where it implants into the lining of the uterine wall.

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Pregnancy and Substance Abuse


When you are pregnant, you are not just "eating for two." You also breathe and drink for two, so it is important to carefully consider what you give to your baby. If you smoke, use alcohol or take illegal drugs, so does your unborn baby.

First, don't smoke:

Smoking during pregnancy passes nicotine and cancer-causing drugs to your baby. Smoke also keeps your baby from getting nourishment and raises the risk of stillbirth or premature birth. 

Second Don't drink alcohol: 

There is no known safe amount of alcohol a woman can drink while pregnant. Alcohol can cause life-long physical and behavioral problems in children, including fetal alcohol syndrome

Third Don't use illegal drugs: 

Using illegal drugs may cause underweight babies, birth defects or withdrawal symptoms after birth.


Smoking

Also called: Cigar smoking, Cigarette smoking, Pipe smoking, Tobacco smoking 

There's no way around it. Smoking is bad for your health. Smoking harms nearly every organ of the body. Cigarette smoking causes 87 percent of lung cancer deaths. It is also responsible for many other cancers and health problems. These include lung disease, heart and blood vessel disease, stroke and cataracts. 

Women who smoke have a greater chance of certain pregnancy problems or having a baby die from sudden infant death syndrome (SIDS). Your smoke is also bad for other people - they breathe in your smoke secondhand and can get many of the same problems as smokers do.

Quitting smoking can reduce your risk of these problems. The earlier you quit, the greater the health benefit.


If you are pregnant and you smoke, drink alcohol or do drugs, get help. 

Your health care provider can recommend programs to help you quit. 

You and your baby will be better off.


Alcohol and pregnancy

Pregnant women are strongly urged not to drink alcohol during pregnancy.  

Drinking alcohol while you are pregnant has been shown to cause harm to a baby inside the womb and may lead to long-term medical problems in the child after birth. 


When a pregnant woman drinks alcohol, the alcohol travels through her blood and into the baby's blood, tissues, and organs. That means when a pregnant mom has a glass of wine, her baby has a glass of wine, too.

Drinking alcohol can harm the baby's development. Alcohol breaks down much more slowly in the baby's body than in an adult. That means the baby's blood alcohol level remains increased longer than the mother's. This is very dangerous, and can sometimes lead to lifelong damage.


Dangers of Alcohol During Pregnancy

Drinking a lot of alcohol during pregnancy can lead to fetal alcohol syndrome in the baby. Fetal alcohol syndrome refers to a group of birth defects found in children born to mothers who drink too much alcohol. Symptoms can include:

  • Behavior and attention problems
  • Heart defects
  • Changes in the shape of the face
  • Poor growth before and after birth
  • Poor muscle tone and problems with movement and balance
  • Problems with thinking and speech
  • Learning problems


These medical problems are lifelong and can range from mild to severe.

Complications seen in the infant may include:

  • Cerebral palsy
  • Premature delivery
  • Miscarriage or stillbirth


How Much Alcohol is Dangerous?

There is no known "safe" amount of alcohol use during pregnancy. Alcohol use appears to be the most harmful during the first 3 months of pregnancy; however, drinking alcohol anytime during pregnancy can be harmful.

Alcohol includes beer, wine, wine coolers, and liquor.

One drink is defined as:

  • 12 oz of beer
  • 5 oz of wine
  • 1.5 oz of liquor

How much you drink is just as important as how often you drink.

  • Even if you don't drink often, drinking a large amount at one time can be quite harmful to the baby.
  • Binge drinking (5 or more drinks on one occasion) greatly increases a baby's risk of alcohol-related damage.
  • Drinking moderate amounts of alcohol when pregnant may lead to miscarriage.
  • Heavy drinkers (those who drink more than 2 alcoholic beverages a day) are at greater risk of giving birth to a child with fetal alcohol syndrome.
  • The more you drink, the more you raise your baby's risk for harm.


Do Not Drink During Pregnancy

Women who are pregnant or who are trying to get pregnant should avoid drinking any amount of alcohol. The only way to prevent fetal alcohol syndrome is to not drink alcohol during pregnancy.

If you did not know you were pregnant and drank alcohol, stop drinking as soon as you find out. While it is unlikely that the occasional drink you took before finding out you were pregnant will harm your baby, the sooner you stop drinking alcohol, the healthier your baby will be.

Try replacing alcoholic drinks with their nonalcoholic counterparts: for example, you might opt for a nonalcoholic pina colada instead of the real thing.

If you cannot control your drinking, avoid eating or drinking around people who are drinking alcohol.

Pregnant women with alcoholism should join an alcohol abuse rehabilitation program and be checked closely by a health care provider throughout pregnancy.

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

General anesthesia

General anesthesia is a treatment that puts you into a deep sleep so you do not feel pain during surgery. When you receive these medications, you will not be aware of what is happening around you.

Description

You will receive general anesthesia in a hospital or outpatient office. Most times, a doctor called an anesthesiologist will put you to sleep. 

The doctor will give you medication into your vein. You may be asked to breathe in (inhale) a special gas through a mask. Once you are asleep, the doctor may insert a tube into your windpipe (trachea) to help you breathe and protect your lungs.

You will be watched very closely while you are asleep. Your blood pressure, pulse, and breathing will be monitored. The doctor taking care of you can change how deeply asleep you are during the surgery.

You will not move, feel any pain, or have any memories of the procedure because of this medicine.


Why the Procedure is Performed

General anesthesia is a safe way to stay asleep and pain-free during procedures that would:

  • Be too painful
  • Take a long time
  • Affect your ability to breathe
  • Make you uncomfortable
  • Cause too much anxiety

You may also be able to have conscious sedation for your procedure, but sometimes it is not enough to make you comfortable. Children may need general anesthesia for a medical or dental procedure to handle any pain or anxiety they may feel.


Risks

General anesthesia is usually safe for healthy people. The following people may have a higher risk of problems with general anesthesia:

  • People who abuse alcohol or medications
  • People with allergies or a family history of being allergic to medicine
  • People with heart, lung, or kidney problems
  • Smokers

Ask your doctor about these complications:

  • Death (rare)
  • Harm to your vocal cords
  • Heart attack
  • Lung infection
  • Mental confusion (temporary)
  • Stroke
  • Trauma to the teeth or tongue
  • Waking during anesthesia (rare)

Before the Procedure

Always tell your doctor:

  • If you could be pregnant
  • What drugs you are taking, even drugs or herbs you bought without a prescription

During the days before the surgery:

  • An anesthesiologist will take a complete medical history to determine the type and amount of anesthesia you need. This includes asking you about any allergies, health conditions, medications, and history of anesthesia.
  • Several days before surgery, you may be asked to stop taking aspirin, ibuprofen, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
  • Ask your doctor which drugs you should still take on the day of your surgery.
  • Always try to stop smoking.

On the day of your surgery:

  • You will usually be asked not to drink or eat anything after midnight the night before the surgery. This is to prevent you from vomiting while you are under anesthesia. Vomiting during anesthesia can be dangerous.
  • Take the drugs your doctor told you to take with a small sip of water.
  • Your doctor or nurse will tell you when to arrive.
After the Procedure

You will wake up tired and groggy in the recovery or operating room. You may also feel sick to your stomach, and have a dry mouth, sore throat, or feel cold or restless until the anesthesia wears off. Your nurse will monitor these side effects. They will wear off, but it may take a few hours. Sometimes nausea and vomiting can be treated with other medicines.

Follow your doctor's recommendations while you recover and care for your surgical wound.


General anesthesia is generally safe because of modern equipment, medications, and safety standards. Most people recover completely and do not have any complications.

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Miscarriage
(Also Called 'Spontaneous Abortion')

  • A miscarriage, also called spontaneous abortion, is the spontaneous ending of a pregnancy before the fetus is mature enough to survive outside the uterus. 
  • About one-third of all pregnancies end in miscarriage, most often before a woman misses a menstrual period or even knows she is pregnant. 
  • One out of five recognized pregnancies will miscarry.
  • A miscarriage is most likely to occur within the first three months of pregnancy, before 12 weeks gestation.
  • Only 1 percent of miscarriages occur after 20 weeks gestation; these are termed late miscarriages.


What are the symptoms of a miscarriage?

  1. Bleeding which progresses from light to heavy
  2. Cramps
  3. Abdominal pain
  4. Fever
  5. Weakness
  6. Vomiting
  7. Back pain

If you are experiencing the symptoms listed above, contact your obstetric health care provider right away. He or she will tell you to come in to the office or go to the emergency room.

What causes miscarriage?
About half of all miscarriages that occur in the first trimester are caused by chromosomal abnormalities which may be hereditary or spontaneous. Chromosomes are tiny structures inside the cells of the body which carry many genes, the basic units of heredity.
Genes determine all of a person’s physical attributes, such as sex, hair and eye color, and blood type. Most chromosomal problems occur by chance and are not related to the mother’s or father’s health.

Miscarriages are also caused by a variety of unknown and known factors, such as:
  1. Infection
  2. Exposure to environmental and workplace hazards such as high levels of 
  3. radiation or toxic agents
  4. Hormonal irregularities
  5. Uterine abnormalities
  6. Incompetent cervix (The cervix begins to widen and open too early, in the middle of pregnancy, without signs of pain or labor.)
  7. Lifestyle factors such as smoking, drinking alcohol, or using illegal drugs
  8. Disorders of the immune system including lupus, an autoimmune disease
  9. Severe kidney disease
  10. Congenital heart disease
  11. Diabetes that is not controlled
  12. Thyroid disease
  13. Certain medications, such as the acne drug Accutane®
  14. Severe malnutrition
Note: There is no proof that stress or physical or sexual activity causes miscarriage.
Sometimes, treatment of a mother’s medical condition can improve the chances for a successful pregnancy.

What are the risk factors for a miscarriage?
A risk factor is a trait or behavior that increases a person’s chance of developing a disease or predisposes a person to a certain condition. 

 Risk factors for miscarriage include:

  1. Previous miscarriage—One does not increase the risk, but two or more does. 
  2. Maternal age—Studies show that the risk of miscarriage is about 15 percent for women in their 20s and rises to about 40 percent for women at age 40. Paternal age is not thought to affect the risk. 
  3. Certain health conditions in the mother as listed above in the section, 


How is a miscarriage diagnosed and treated? 

 1) Your health care provider will perform a pelvic exam and an ultrasound test to confirm the miscarriage. If the miscarriage is complete and the uterus is clear, then no further treatment is usually required. 

2) Occasionally, the uterus is not completely emptied, so a dilation and curettage (D&C) or dilation and extraction (D&E) procedure is performed. During these procedures, the cervix is dilated, and any remaining fetal or placental tissue is gently scraped or suctioned out of the uterus. Usually this is performed in an operating room under anesthesia. 

3) A third option (besides waiting for the tissue to pass or having a D&C, is to take an oral medication to hasten the process along. In this case, the tissue will pass at home. A repeat visit to the office is needed to make sure that the uterus is completely empty. 

4) If the pregnancy looks healthy despite the bleeding, bed rest is often prescribed for several days. When the bleeding stops, usually you will be able to continue with your normal activities. This is called "a threatened abortion." 

5)Blood tests, genetic tests or medication may be necessary if a woman has more than two miscarriages in a row (called repeated miscarriage). 

Some diagnostic tests may include: 

 Special blood testing Endometrial biopsy 

 Hysterosalpingogram (an X-ray of the uterus and fallopian tubes) 

 Hysteroscopy (a test in which the doctor views the inside of the uterus with a thin, telescope-like device) 

 Laparoscopy (a procedure in which the doctor views the pelvic organs with a lighted device) 

Referral to a specialist 


What are some of the symptoms after a miscarriage? 

 Spotting and mild discomfort are common symptoms after a miscarriage. If you have heavy bleeding, fever, chills, or pain, contact your health care provider right away. These may be signs of an infection.


Can I get pregnant after I’ve had a miscarriage? 

 Yes. Most women (87 percent) who have miscarriages have subsequent normal pregnancies and births. Having a miscarriage does not necessarily mean you have a fertility problem. 

But about 1 percent of women may have repeated miscarriages (three or more). 

Some researchers believe this is related to an autoimmune response. 


Timing of next pregnancy:

Discuss the timing of your next pregnancy with your health care provider: Some health care providers recommend waiting a certain amount of time (from one menstrual cycle to 3 months) before trying to conceive again. 


To prevent another miscarriage:

To prevent another miscarriage, your health care provider may recommend treatment with progesterone, a hormone needed for implantation in the uterus. 

Taking time to heal both physically and emotionally after a miscarriage is important. 

Above all, don’t blame yourself for the miscarriage. 

Counseling is available to help you cope with your loss. Pregnancy loss support groups may also be a valuable resource to you and your partner. Ask your health care provider for more information about counseling and support groups. 

If you’ve had two miscarriages in a row, you should stop trying to conceive, use a form of birth control, and ask your health care provider to perform diagnostic tests to determine the cause of the miscarriages. 


Can a miscarriage be prevented? 

Usually a miscarriage can not be prevented and often occurs because the pregnancy is not normal. Sometimes, treatment of a mother’s medical condition can improve the chances for a successful pregnancy.

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

 The reason for a woman's vaginal bleeding 


Possible causes include:

  1. Uterine fibroids Uterine fibroids (see below)
    Formed of muscle and tissue from the uterine wall, fibroids are the most common benign tumors in women of childbearing age.
  2.  Cancer
    When vaginal bleeding occurs after menopause, it may be a sign of gynecologic cancer, although younger women can develop these cancers too.
  3. Sexually transmitted infections (STIs)
    Gonorrhea and Chlamydia are two sexually transmitted infections that can cause bleeding between periods.Chlamydia can also produce painful menstrual periods.
  4. Polycystic ovary syndrome (PCOS)
  5. Inherited susceptibility to bleeding
    A tendency to bleed excessively can be passed down through families via faulty genes. Hemophilia and von Willebrand's disease are two examples; in both cases, women may hemorrhage when they have periods.

    Evaluation & Diagnosis
    An extensive "workup" can pinpoint the cause, location and/or extent of fibroids or menstrual difficulties. We begin with a detailed menstrual and health history, and a gynecologic exam. 
Then we use one of the following imaging techniques to determine the health of your uterus before proceeding with treatment:
  1.  Ultr
  2. MRI
  3. Hysteroscopy

    Customized Treatment
    Following your evaluation, we will openly discuss all treatment options available to you. Treatments may involve medical management, non-surgical solutions, or minimally invasive or standard surgery.
1. Non-surgical therapy Current medications typically treat only the symptoms of fibroids. 
2. Surgical options For women who hope to have children To treat menstrual problems in women who want babies, we can preserve the uterus. 

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Uterine fibroids

What is Uterine Fibroid

Formed of muscle and tissue from the uterine wall, fibroids are the most common benign tumors in women of childbearing age.
African-American are two to three times more likely to develop fibroids than Caucasian women, and Hispanic women are also at increased risk. Asian women have the lowest risk of fibroids.

Cause

The cause of fibroids is unknown.  One of the strongest risk factors for fibroids is obesity; extra fat cells produce too much male hormone and store too much female hormone. Being African-American.


Symptoms:

Fibroids only require treatment when they cause problems – such as heavy bleeding, pain, or "pressure symptoms" – constipation or frequent urination. This occurs in about half the cases

Many women with uterine fibroids have no symptoms. If you have symptoms, they may include

  • Heavy or painful periods or bleeding between periods
  • Feeling "full" in the lower abdomen
  • Urinating often
  • Pain during sex
  • Lower back pain
  • Reproductive problems, such as infertility, multiple miscarriages or early labor

Most women with fibroids can get pregnant naturally. For those who cannot, infertility treatments may help. 


Evaluation & Diagnosis
Careful preoperative evaluation is a must. An extensive "workup" can pinpoint the cause, location and/or extent of fibroids or menstrual difficulties. We begin with a detailed menstrual and health history, and a gynecologic exam. Then we use one of the following imaging techniques to determine the health of your uterus before proceeding with treatment:

  1. Ultrasound: sending sound waves through the abdomen to see detailed pictures of the inside of the uterus.
  2. MRI: combining a powerful magnet, radio signals and a computer to obtain intricate pictures of the uterus and surrounding organs.
  3. Hysteroscopy: use of a lighted tube, or endoscope, inserted through the vagina to examine the uterus.


Treatment

Treatment for uterine fibroids includes medicines that can slow or stop their growth, or surgery. If you have no symptoms, you may not even need treatment.

Customized Treatment
Following your evaluation, we will openly discuss all treatment options available to you. Treatments may involve medical management, non-surgical solutions, or minimally invasive or standard surgery.
  1. Non-surgical therapy
Current medications typically treat only the symptoms of fibroids. However, medications won't help when fibroids are too large or numerous. Medications being developed to permanently shrink fibroids are not yet approved.  
a. OCP: may reduce the bleeding.
b. IUD Mirena: This Hormone IUD-like device, implanted in the lining of the uterus, sends out small amounts of hormone that can stop periods for up to five years. 
2. Surgical options 
a. For women who hope to have children. To treat menstrual problems in women who want babies, we can preserve the uterus. 
Fibroid removal is known as myomectomy. Abdominal myomectomy When fibroids are too numerous or large, sometimes they must be removed in an open surgical procedure, through a bikini-line incision. The advantage is that the uterus can be repaired in layers, making it as strong as possible for subsequent pregnancies. 
b. Uterine fibroid embolization (UFE) Clinic interventional radiologists on uterine fibroid embolization. This procedure is not for women who wish to conceive because its effects on the strength of the uterus are unknown. The radiologist guides a catheter to arteries that supply the fibroids, then inserts tiny plastic particles to block blood flow. 
c. Hysterectomy for large fibroid or women don't want to have babies. by laproscopy or open surgery.

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Genital Warts

(Also Called 'Condyloma', 'Warts - Genital')

What are genital warts?
Genital warts are growths or bumps on the penis, vagina, vulva (vaginal lips), cervix (the opening between the vagina and the womb), rectum, or groin. Genital warts are a sexually transmitted infection, or STI, which means that they are caught by having sex with an infected person. Genital warts are also called “condyloma.”
After a person has been infected, it may take one to three months for warts to appear. Some people who have been infected never get warts. If you think you have been infected, you should be tested, even if you cannot see any warts.

What do genital warts look like?
Genital warts look like small pink or red growths in or around the sex organs. The warts may look similar to small parts of a cauliflower, or may be very tiny and difficult to see. They often appear in clusters of three or four, and may grow and spread rapidly. They are usually not painful, although they may cause mild pain, bleeding, and itching.

How does a person get genital warts?
Genital warts spread by direct, skin-to-skin contact with the warts of an infected person. Contact most often occurs during sexual activity that involves the penis, vagina, anus, or mouth.

How can I know if I have genital warts?
If you think that you have genital warts, or any STI, visit your health care provider. He or she can examine you and perform tests, if necessary, to see if you have an STI. 

The following tests for genital warts are performed:
Men
Examines visible growths to see if they look like genital warts
Takes a sample of fluid to test for gonorrhea and chlamydia
Takes a sample of blood to test for syphilis
Takes a sample of blood to test for HIV (the virus that causes AIDS)
Women
Examines visible growths to see if they look like genital warts
Performs a complete pelvic exam and Pap smear
Examines the rectum
Takes a sample of fluid to test for gonorrhea and chlamydia
Takes a sample of blood to test for syphilis
Takes a sample of blood to test for HIV

Tests for gonorrhea, chlamydia, and syphilis are taken because STIs often occur together and share similar symptoms. Sometimes patients are referred to a gynecologist for further testing and biopsy.

What causes genital warts?
Genital warts are caused by a number of different viruses. These viruses are among a group of more than 60 viruses that are called HPV. HPV can cause genital infections other than genital warts. HPV also causes warts on the hands and feet, though these viruses are not as easily spread.

Why are Pap smears and biopsies performed?
The Pap smear looks for changes in the cervix that could be caused by an HPV infection. It also looks for cervical cancer. With early treatment, cancer of the cervix can be cured. Therefore, it's important to get a yearly Pap smear, even when HPV infection is not suspected.
A biopsy is used to take a close look at tissue cells under a microscope. The test looks for cells that show early signs of genital cancers. There is an association between HPV infection and cervical cancer, so women with HPV must be watched carefully for cancer.

How are genital warts treated?
You cannot treat genital warts yourself. If you think you have them, don't delay getting examined and treated. The longer genital warts go untreated, the more difficult they are to cure. With the help of a health care provider, genital warts are removed with the following methods:

  1. Chemicals that dissolve the warts (applied by the health care provider or by the patient)
  2. Laser lights or electric current
  3. Freezing with a special device
  4. Surgery (for warts that are large or difficult to treat)

Genital warts can come back, so you may need to return to the doctor for more treatment.

What should I do while I have the warts?
Keep the area as dry as possible.
Wear all-cotton underwear. Man-made fabrics can irritate the area and trap moisture.

How can I prevent genital warts?

  1. Don't have sex with someone who has genital warts or is being treated for genital warts.
  2. Use latex condoms, even if you are using another form of birth control.
  3. Get vaccinated with the HPV vaccine. One vaccine, called Gardasil, is approved for girls and women ages 9 to 26 and protects against the development of cervical cancer. It is best to get the shot before the start of sexual activity. The vaccine consists of a series of three shots, with shot two coming 2 months after the first, and shot three coming 6 months after the first. If you already have HPV, the vaccine does not treat or cure but can still help protect against other types of HPV infections (other than those that cause cervical cancer; for example, the vaccine can help protect against the HPV that causes genital warts).

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Vaginal Birth after Cesarean Section (VBAC)

Can I still have a traditional delivery?
Many women who have previously given birth through Cesarean section (C-section) can still safely give birth to a child through a normal vaginal delivery. Attempts at vaginal birth after cesarean (VBAC) have a high success rate and have many benefits.
In cases where a vaginal birth attempt is unsuccessful, a repeat cesarean section is performed.
Occasionally, medical history or circumstance can make VBAC a poor choice for women – a repeat cesarean section would be recommended in this case. Ask your health care professional if VBAC is right for you.

Background of Vaginal Birth after Cesarean (VBAC)
Cesarean section deliveries are becoming more frequent. They account for 15 to 25 percent of all births in North America. They are performed for a variety of reasons:

  1. a slow or difficult labour (referred to as Dystocia);
  2. the mother has already had a cesarean section for a previous birth;
  3. a breech birth.

Because a Cesarean section leaves a scar on the wall of the uterus, doctors will sometimes recommend a repeat cesarean section for pregnant women instead of a trying a VBAC delivery. However, a vaginal birth is still a safe option for the majority of women who have had a C-section.

Benefits of a Vaginal Delivery
There are several benefits to having a vaginal birth instead of a repeat cesarean:
  1. reduces blood loss;
  2. reduces injury and risk of infection;
  3. eliminates complications associated with surgery;
  4. require a shorter hospital stay;
  5. more rapid recovery;
  6. less painful.

Risks of VBAC
A C-Section leaves a scar on the uterus. This is a weak area and can tear during labour. This is called a uterine rupture. If this occurs you would require an emergency C-section. You could need a blood transfusion or a hysterectomy and the baby could be harmed.

What if You Have Had 2 or More C-Sections?
VBAC is still an option if you have had more than one previous birth by cesarean, though the risk of complication is slightly higher.

What you need to know
To reduce risks, spontaneous labour is preferred over induced labour for VBAC.
Your doctor will review your surgery record and discuss whether a trial of VBAC is right for you.
Make sure your doctor has your previous surgery records.

Can I have my delivery at home?
A VBAC should occur in a hospital for the safety of the baby and mother.

Is an epidural still an option?
Yes, an epidural is frequently used during a VBAC.

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Immunization before and during pregnancy
You are having a baby or planning a pregnancy. Learn what you need to know about immunization.

What is immunization?
Immunization is the process through which your body becomes protected from disease. When your immune system is exposed to something unfamiliar – such as bacteria or viruses – it produces antibodies to fight those potential threats. These antibodies can also help your body recognize and fight those threats if you are ever exposed again. Vaccines are a safe way to develop the immunity which will keep you safe from disease.

How do vaccines work?
Active vaccines
In active immunization, vaccines contain agents which mimic bacteria or viruses and cause your immune system to produce antibodies.
Some active vaccines, called live-attenuated vaccines, contain weakened forms of bacteria or viruses: the agents are alive, but their harmful parts have been removed.
Passive vaccines
In passive immunization, vaccines contain the antibodies that fight bacteria or viruses. Passive immunization doesn’t last very long, but can be useful for someone who has recently been exposed to a disease or who may be exposed to a disease for only a short time (for example, while travelling).

Why is immunization important before and during pregnancy?
Some diseases are particularly harmful for pregnant women and their babies. Many of these can be prevented through immunization. A mother’s immunity can protect her baby during pregnancy and often for the baby’s first six to 12 months of life.
When planning and experiencing pregnancies, women often have more contact with health-care professionals than at other times in their lives. This makes it a good opportunity for you to have your immunization status evaluated and to consider which vaccines might be beneficial to you and your baby.
In the last century, immunization programs have saved more lives than any other health intervention. Many diseases that could affect you or your baby are preventable through immunization. This keeps you and your baby safe, and also protects the rest of the population — particularly people who cannot receive vaccines or who do not develop full immunity.

Are vaccines safe?
The most common side effects of vaccines are tenderness and swelling where the injection was given. Rarely, vaccines result in a minor fever. These effects are usually mild and have no long-term consequences. Serious adverse reactions to vaccines are very rare. The Public Health Agency of Canada closely monitors vaccine safety, and has a reporting system to track serious side effects that may be related to vaccines.
For every 100,000 doses of vaccines given, only one to two will result in serious adverse reactions. The dangers of vaccine-preventable diseases are many times greater than the risks of a serious adverse reaction to vaccines.

Immunization safety in pregnancy
Scientific evidence shows that most types of vaccines are safe during pregnancy. These include passive vaccines and some active vaccines. Live-attenuated vaccines are not given if a patient knows she is pregnant, because there is a potential risk to her baby. However, in cases where live-attenuated vaccines have been given to women who did not know they were pregnant, there has been no evidence of adverse outcomes.
It is safe for a person who lives with a pregnant woman to be vaccinated with any type of vaccine.

What about vaccination during breastfeeding?
All types of vaccines are safe for women who are breastfeeding.

Common vaccines to consider before and during pregnancy
If you are planning to or could become pregnant, it’s important to speak with your health-care professional to ensure that your immunizations are up to date. If you are already pregnant, immunization with some vaccines, or planning for immunization with live-attenuated vaccines after your baby is born, is still possible.

Rubella
Rubella (German measles) can be very dangerous for your unborn baby, and is most dangerous early in your pregnancy. If you are infected in your first trimester, there is an 85 per cent chance that your baby will also be infected. Infection in an unborn baby can lead to deafness, cataracts, cardiac defects, mental retardation, bone damage, and enlargement of the liver and spleen.
Before you conceive, your health-care professional should test your immunity to rubella. You may have received a rubella vaccine in childhood, but you may no longer have immunity and may need to get it again. It is often given as a combined measles-mumps-rubella (MMR) vaccine. Because this is a live-attenuated vaccine, it is not given during pregnancy and you should wait at least four weeks after getting the vaccine before trying to conceive.

Hepatitis B
Your job, lifestyle or health history may put you at increased risk to become infected with hepatitis B. In this case, your health-care professional may recommend that you be immunized against hepatitis B, if you have not been before. Not only does the hepatitis B virus pose a risk for you, but you could pass the virus on to your baby. Carriers of the hepatitis B virus are at risk for cirrhosis of the liver and liver cancer. The hepatitis B vaccine is safe for use in pregnancy.

Seasonal and H1N1 influenza vaccines
Influenza, or flu, is a highly-contagious acute respiratory infection. The seasonal flu vaccine is safe for pregnant women and is recommended for those who will be pregnant during flu season. Being immunized will also help protect your baby through his or her first few months of life.
Pregnant women are at increased risk of hospitalization and serious complications from H1N1 influenza. This increased risk is believed to be related to the changes that occur during pregnancy in the cardiovascular, respiratory and immune systems, and is greatest in the second and third trimesters. The H1N1 influenza vaccine is safe for pregnant women, and you should get it if you will be pregnant during flu season.

Tetanus, diphtheria and pertussis
Tetanus and tetanus-diphtheria (Td) vaccines are well-established as being safe for pregnant women. Recently, the Td vaccine has been combined with a pertussis vaccine, known as the Tdap vaccine. Administration of the Tdap vaccine during pregnancy has not yet been studied, so the decision to use Tdap during pregnancy should be made on a case-by-case basis, depending on your risk of getting pertussis while you are pregnant.

Other vaccines
Special circumstances might arise during pregnancy where you should speak to your health-care professional to discuss additional vaccines that may be necessary. For example, if you need to travel abroad during pregnancy, you may need to consider other vaccines. In some parts of the world, vaccine-preventable diseases such as polio and tuberculosis are a serious concern.
You may have an immunization record from childhood. If possible, find this card or booklet and have it with you when you see your health-care professional.

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Hysteroscopy

A hysteroscopy is a procedure used to look inside the uterus. A thin instrument called a hysteroscope is passed through your vagina and cervix and into your uterus to help your doctor find the cause of a possible problem, to look for cancer in the lining of the uterus or to operate.

When is it used?
Your doctor might suggest a hysteroscopy if you have:

  1. heavy and/or long menstrual periods
  2. bleeding between your periods
  3. bleeding after menopause
  4. irregular cycles
  5. severe cramping
  6. frequent miscarriages (lost pregnancies)
  7. a displaced intrauterine device (IUD)
  8. difficulty getting pregnant (infertility)

How do I prepare for a hysteroscopy?
If you are having the operation done while you are under general anaesthetic:
  1. You may need to have some blood work done, usually within one week of your operation.
  2. Most hospitals will ask to check with their admitting department to find out at what time you should come to the hospital on the day of your operation.
  3. Shower or bathe the night or morning before the operation.
  4. Do not eat or drink (even water) after midnight on the night before the operation.

What happens during the operation?
At first, you will be given a general anaesthetic will make you unconscious during the operation. A tube or breathing mask may be used to help you breathe. 
Before the hysteroscopy, it is possible that your cervix be gentlywidened with another instrument to allow the hysteroscope to enter your uterus. Once inside, a gas or a liquid is usually inserted through the hysteroscope to expand the uterus, making it easier for the doctor to see.
The doctor will then carefully look at the inside of the uterus, searching for the source of your problem. If there are any abnormal findings, the doctor may remove a small sample for further examination.
If surgery is required to treat a problem, small instruments will be passed through the hysteroscope. Doctors may then repair a septum, remove fibroids or polyps, or use an electric current, extreme heat or cold to destroy the lining of the womb.
At the end of the operation, the doctor will remove the instruments and the gas or liquid if it was used.

What happens after the procedure?
You may be able to leave shortly after the procedure, but most patients need to stay at the hospital for 1-2 hours until they recover. If you had an anaesthetic, you should have someone drive you home since it can make you feel sore, drowsy and "washed out".
You may experience nausea, sore throat (if a tube was placed in your throat during general anaesthetic) and some shoulder pain if gas was used. It is also possible that you have cramps, spotting and light bleeding similar to what you would experience during your period. These symptoms are normal and may last up to a few days after the operation.
Your doctor may give you a prescription for painkillers when you leave the hospital. You can also try some pain relievers like Acetaminophen or Ibuprofen that you can buy without a prescription. Depending on your progress, the nature of your work and your own pain tolerance, you might need to take a few days off work to fully recover.
Your doctor will let you know when you should return for a check-up or report usuall after 6 weeks.

What are the risks?
Although hysteroscopy is a safe procedure, there still remains a small risk as with all operations. Safety measures are taken and you are monitored throughout the operation to reduce the risks.
Problems can arise with the medications and anaesthetic given.

  1. Bleeding 1/100
  2. Organs close to the uterus like the ovaries, bladder or bowel could be damaged 1/1000. 
  3. Infections can occur 1/100. Sometimes this is severe enough to require the patient to stay in the hospital for several days. Return to top Call the doctor or return to the hospital immediately if you develop: a fever severe abdominal pain heavy vaginal discharge excessive bleeding. Return to top Call the doctor during office hours if you: have abnormal bleeding or pain that continues more than 2 or 3 days want to make another appointment experience increasing pain over the next few days.

******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

BRCA and Breast cancer and Ovarian cancer


What are the BRCA1 (and BRCA2) gene mutations?

BRCA1 and BRCA2 are genes that have been linked to hereditary breast and ovarian cancer. Women who inherit one of these faulty genes are at an increased risk of breast or ovarian cancer. Men who inherit a faulty gene may be at increased risk of prostate cancer. Breast cancer in men carrying BRCA2 has also been described in the medical literature.

These genes are important in helping repair breaks in the DNA in our cells, so a faulty gene can mean that DNA repair is less than optimal. In some people this can lead to the development of cancer.


Should I be getting tested for them?

Not routinely. In general terms, genetic testing should be carried out following counselling in a familial cancer centre after a proper assessment of risk.

Testing is offered to people who have developed breast or ovarian cancer where there are features that might suggest a mutation is present.

These can include an early age of onset of cancer, or cancer in both breasts, multiple cancers in the family, male breast cancer, ovarian cancer, certain ancestry (such eastern European Jewish ancestry), or where there is a known mutation in the family.

Sometimes the appearance of a tumour, reported by the pathologist can help make a decision regarding whether testing is necessary.


How are they tested for?

This is generally done through a blood sample.


What is the cost of the test/s and why?

At present testing for these genes is expensive – about A$2,000 to A$3,000 – but costs are coming down.

Once a mutation has been identified in a family member, other members can be tested and this is much cheaper.


How many people are affected?

About 5% of all breast cancers are hereditary, and can involve the BRCA1 or BRCA2 gene. That is why it is important to look for special features that suggest risk.


Say I have the gene/s, what is the likelihood that I will develop (a) breast cancer and (b) ovarian cancer?

Having the gene does not mean that a woman will definitely develop either of the cancers.

The risk is believed to be on average somewhere between 40% and 65% for breast and 15% to 40% for ovary, depending on the gene.


What are the treatment options?

If a cancer develops, it is often treated in a very similar fashion to other breast or ovarian cancers.

For breast cancer, sometimes women might consider more extensive surgery (such as mastectomies). There are new drugs called PARP inhibitors that are being developed tested for BRCA-associated cancers.


What are the prevention options?

There are a number of options. For breast cancer, this includes close monitoring which includes MRI scans and mammograms starting at a suitable age.

Breast cancer prevention drugs such as Tamoxifen are likely to be helpful and may even halve the risk of getting breast cancer.

Some women may consider mastectomy with breast reconstruction. The uptake of this option differs; on average about 20% of women carrying the genes take this option.

Importantly, due to the potential risk of ovarian cancer some women will be advised to have their fallopian tubes and ovaries removed at a suitable age (and after they have had children).

If this is carried out at age 40, it can halve breast cancer risk. It is known to be safe to give women hormone replacement therapy in most cases, so that they don’t experience menopausal symptoms.


What are the side-effects of mastectomies, if any?

These are generally minimal. In the short term, there can be surgical risks of infection and bleeding and, of course, cosmetic results (breast reconstruction) may differ.


What are the chances of survival for preventative measures vs treatment options?

The chances of survival for preventative measures are excellent and the risk of breast cancer is very substantially reduced. Since screening can detect cancer early, this helps improve outcomes.

Treatment for breast cancer has substantially improved over the last two decades, including for BRCA1 and BRCA2-associated cancers, so with proper treatment of early cancers, the outlook can be very good.


******************************************************************

Obstetrics & Gynaecology

Dr Adel Abdulhafid


******************************************************************

Medications and drugs while breastfeeding

When you are breastfeeding, speak with a health-care professional before taking any prescription or non-prescription medication, natural or herbal remedy, or drug.

Evidence shows that breastfeeding is the healthiest and most natural way to feed your baby and also has beneficial effects for mothers. Today, 85 per cent of Canadian mothers breastfeed following the birth of their children. When you are breastfeeding, most products that go into your body will also enter your breast milk. You need to consider how any medication, drug or herbal remedy you take could affect your baby or your ability to produce milk.
Although many medications are safe to take while breastfeeding, you should always consult your health-care professional before taking any medication, drug or herbal remedy. Something which is safe for use during pregnancy may not necessarily be safe for a nursing baby.

Can I breastfeed while I’m on medication?
When deciding whether to take a medication or herbal remedy, you should always consider why you require it and what the risks might be for your baby. We make similar types of risk-benefit decisions every day as we go about our normal activities. You should only take medication if you really need it and should take the lowest effective dose for the shortest possible time, while always following the instructions of your health-care provider.
In general, most medications that are applied to the skin, inhaled (for example, asthma treatments), or applied to the eyes or nose are safe for breastfeeding women. Most vaccines are safe, as well as medications that are commonly prescribed to infants.

Some medications which can be used while breastfeeding may require close monitoring. For example, you and your baby’s blood levels may need to be evaluated regularly. If, after assessment of the risks and benefits, the decision is made to breastfeed while you are using a medication, you should closely monitor your infant for any potential adverse effects that your doctor tells you are associated with the medication you are taking.
Other medications can pose a higher risk and are usually not used in conjunction with breastfeeding: anti-cancer drugs, some immune suppressants, ergot alkaloids, gold, some radioactive medications and some anticonvulsants. If taking a higher-risk medication is unavoidable, you and your health-care professional may need to discuss whether to breastfeed or not.

Will my baby be affected by the medication I am taking?
Nearly all medications transfer into breast milk to some extent. The amount of medication to which an infant is exposed depends on several factors, such as the dosage of medication, when and how often it is taken, and how quickly the mother metabolizes the medication.

Although a mother’s use of topical preparations such as creams, nasal sprays or inhalers generally carries less risk to a breastfed infant than medications administered orally, it is important to remember that medication or products applied directly to the nipples before or after breastfeeding may be harmful for your baby.

The safety of certain medications also depends on the age of the infant. Nearly all reported adverse effects in nursing infants have occurred in infants less than six months old. Newborns and premature infants are most at risk.

Will taking medication affect my ability to produce milk?
Breastfeeding mothers should always watch for changes in their milk production, even for subtle differences. Some medications can decrease milk production:
- Antihistamines
- Sedating medications
- Some decongestants
- Some weight loss medications
- Diuretics
- Very high doses of vitamin B6
- Hormonal contraceptives containing estrogen
- Nicotine
- Ergot alkaloids

Infant weight gain and development are directly associated with milk production: modest changes in milk supply can lead to major growth complications. The most sensitive time for production suppression is shortly after birth, before a mother’s milk supply is established.

Should I take medication before or after breastfeeding?
The frequency and timing of feedings can influence the amount of medication that an infant is exposed to. By breastfeeding either shortly before or immediately after taking your medication, your baby’s exposure may be reduced. However, this approach may not be practical for newborns, who typically feed every two to three hours, or with drugs that last a long time in your system. It is important that breastfeeding mothers consider the schedule of administration when making a decision about taking a medication.

Often, a health-care professional will recommend that a breastfeeding mother take a single dailydose medication just before the longest sleep interval of her baby, usually after the bedtime feeding. To minimize an infant’s exposure when multiple daily doses are needed, you should breastfeed your baby immediately before the next dose of the medication.

What about alcohol, caffeine, nicotine and street drugs?
Caffeine in moderate amounts (no more than two cups of coffee per day) is not likely to be harmful to your nursing infant.

Alcohol freely distributes into milk and will be ingested by nursing infants. Low-level, occasional alcohol consumption is not likely to pose a problem to the infant, but heavy alcohol consumption or binge drinking is to be avoided. Ideally, nursing should be withheld temporarily after alcohol consumption; at least two hours per drink to avoid unnecessary infant exposure. Side effects reported in infants include sedation and impairment of motor skills.

Cigarette smoking is not recommended in nursing mothers. Nicotine and its major byproducts are detectable in milk. Smoking while breastfeeding has been associated with infantile colic and lowered maternal prolactin levels, which lead to earlier weaning. Additionally, caution should be used to avoid infant exposure to second-hand smoke.

Street drugs can be very potent, so even very small amounts can be very dangerous for an infant. It is suggested that breastfeeding be at least temporarily delayed after maternal use of these products and caution should be used to avoid infant exposure to smoke fumes. Infants may experience toxicity after maternal cocaine use and marijuana use has been associated with slower motor development.

Are over-the-counter products safer than prescriptions?
No. Over-the-counter products, including natural or herbal remedies, are not necessarily safer than prescription products.

What if I can’t breastfeed because of my medications?
Not every woman will be able to breastfeed; speak with your healthcare provider to ensure that your baby still gets all the nutrients he or she needs.