Menstruation
and Your Daughter: A Parent’s Guide
Doreen DeGraaff, M.D., Obstetrics
and Gynecology
Attending physician at Saint Barnabas Medical Center
with offices in Verona and Livingston
Adolescence is a time of intense physical, social,
cognitive and sexual development. It is divided into
early, middle and late phases. The goal of adolescence
is for young women to achieve reproductive maturity,
develop operational thought and form a capacity to
engage in intimate relationships. The success of a
young woman’s adolescent experience depends greatly
on her interaction with her peers, parents and healthcare
providers. Most of the health problems in the adolescent
population arise from risk-taking behavior, such as
drinking, smoking, and other drug use, various sexual
practices and involvement in violent relationships.
The physical part of adolescence begins with breast
development, which typically occurs at age 11, though
some girls are younger and some are older. It progresses
over a two-year period, beginning with the appearance
of pubic and axilary hair and an obvious growth spurt,
and ending with menarche, the beginning of menstruation.
A "normal" menstrual cycle is between 21 and 35 days
apart and the menses itself may last up to 8 days.
It is important for both the adolescent girl and her
mother to understand that menstrual irregularities
are very common during the years immediately following
menarche, and are not necessarily cause for alarm.
In fact, regulation of the menstrual cycle can take
between two and four years in 80% of young women. Many
mothers will not riiber having such difficulties in
the early years of menstruation, but chances are they
did. Even if a mother did not experience an irregular
cycle, it is comforting for her to know that her daughter’s
problems are not unusual, and usually do not require
medical attention. Medical intervention becomes necessary,
however, if aniia or quality of life problems (e.g.
school absenteeism) arise. Menstrual dysfunction is
the most common cause of short-term absenteeism in
adolescent girls, but only approximately 15-20% of
them will seek medical attention. The treatment frequently
used for cycle regulation for girls with heavy, lengthy,
and/or frequent periods that lead to aniia is hormonal,
especially oral contraceptive use. Open mother- daughter
communication is a must if an adolescent is to receive
the appropriate medical care.
On occasion, the menstrual problem is very infrequent
or non-existent periods (amenorrhea). This irregularity
is usually seen in adolescent girls who are either
very thin and/or athletic, or in the obese girl. Amenorrhea
is also seen frequently with eating disorders, especially
anorexia nervosa. Because eating disorders can be life
threatening, medical intervention is a must if they
are suspected. If an eating disorder is not the problem,
then an over or underproduction of estrogen is usually
the cause. Again, treatment is usually hormonal, with
oral contraceptives or progestational agents.
Dysmenorrhea is a term that encompasses not only menstrual
cramping, but also the nausea and diarrhea that may
accompany menses. Menstrual cramps usually do not affect
a young woman until she is ovulating regularly and
having a monthly period. This is because the substances
in the body responsible for dysmenorrhea, prostaglandins,
are only produced in high enough amounts to cause symptoms
in cycles in which ovulation has occurred. Medications
which can relieve symptoms of dysmenorrhea are called
anti-prostaglandins or non-steroidal anti-inflammatory
drugs (NSAIDs). One of the most effective of these
is ibuprofen (Motrin or Advil). Antiprostaglandins
also have the side benefit of reducing menstrual flow
and duration. These medications can have the side effect
of nausea and indigestion (and stomach ulcers). They
should be taken with meals whenever possible. Oral
contraceptive pills are also used alone and in conjunction
with NSAIDs to treat dysmenorrhea.
Physical development and maturation may be the most
obvious change in the adolescent females, but other
changes are occurring as well. Importantly, her sexual
identity is forming. In early adolescence, sexual interest
usually exceeds activity, but soon experimentation
and consolidation of sexual identity follow. A healthy,
open communication will allow a mother to help her
daughter realize that her virginity is a gift that
can only be given once, and that there can be far-reaching
consequences to early and/or inappropriate sexual relationships.
More than 50% of females are sexually active by age
17. Most of these teens do not request, or inquire
about, contraception for six to twelve months following
the initial act of intercourse. Unfortunately, the
majority of teen pregnancies occur in the first six
months of intercourse. In addition, 25% of reported
sexually transmitted diseases occur in adolescents.
These diseases can have long term consequences, ranging
from recurrences, to infertility, to death. It is imperative
that the adolescent has access to appropriate counseling
and a physical exam from a health care provider, as
well as an effective form of contraception when needed.
Adolescence can be a confusing, troubling and frightening
time for both mother and daughter. A communicative
relationship, as well as the knowledge that medical
help and advice is available, can make this important
transition an easier one.
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Assisted
Vaginal Deliveries: A Question and Answer Forum
A discussion with CATHERINE SLADOWSKI,
M.D., Obstetrics and Gynecology, Attending physician
at Saint Barnabas Medical Center with offices in
Verona and Livingston
Interviewed by Susan Weinstein, R.N., Director, Women’s
Health Education
Q. What are the technical
procedures available if a woman needs assistance
during a vaginal delivery?
A. When the normal forces of labor
do not result in the baby progressing in a downward
direction through the birth canal, the application
of either forceps or the use of vacuum extraction may
be necessary.
Q. What are some of the indications during
delivery that vacuum extraction would be used?
A. Maternal fatigue is one indication.
A woman who has had an extended pushing stage or a
long labor may be too physically tired to push with
the effort that may be required.
Another reason would be a narrow vaginal opening where
the elasticity of the perineum muscles are too tight
in relation to the size of the baby's head.
In situations where the emphasis on shortening the
pushing stage of labor (for example, if there was concern
about the baby’s heart rate) one choice for delivering
the baby would be by using vacuum extraction.
Q. How is a vacuum extraction procedure done?
A. The procedure involves the placement
of a small, soft rubber cap-like instrument, which
is applied to the baby’s head. The cup is attached
to a hand-held suction applicator calibrated to a gentle
pressure which is needed to enhance the downward movement
of the baby without causing any permanent damage. The
pressure apparatus is controlled by the assisting nurse
while the movement of the suction cup is monitored
and controlled by the physician.
Q. Does the mother feel any discomfort?
A. She could feel a vaginal pressure
which closely resembles the pressure experienced by
women in a non-assisted birth. We encourage the patient
to assist us by continuing to push under the direction
of the obstetrical team.
Q. Are their any side effects to the baby?
A. After the vacuum cup is removed,
there is a small swelling on the baby’s scalp
which usually completely resolves within 48 hours.
Q. What are forceps? How are they used?
A. Forceps are a pair of metal instruments
which are carefully applied to the baby’s head
when a downward movement through the birth canal is
needed.
Q. When would forceps be used?
A. The indications for use are the
same as for vacuum extraction.
Q. What would a woman feel if the forcep technique
was used?
A. Since epidermal anesthesia is
used prior to applying forceps, she would only experience
vaginal pressure.
Q. Is an episiotomy done if forceps are applied?
A. Usually an episiotomy is necessary
to allow more room for the forceps to be applied. Occasionally
some small vaginal tears may occur. These tears are
repaired at the same time that episiotomy repair is
done. The mother does not generally feel this repair
because she has epidural anesthesia.
Q. Are there any marks on the baby?
A. You may notice some pressure marks
on the baby’s face which usually disappear in
a few days.
Q. Why would one technique be used over the
other?
A. The use of the vacuum extraction
versus forceps to facilitate a birth when needed is
a decision that is made at the time of delivery by
the obstetrician. The technique used depends on the
obstetrician’s experience and preference with
either of the procedures and what he or she does appropriate
for the particular patient and situation. Patients
sign an informed consent upon admission to the Maternity
Department and if the patient has questions regarding
their own attending obstetrician’s use of either
technique, I would encourage them to ask at their next
visit.
To learn more about Saint Barnabas’ Maternity
Center, call the Women’s Health Department at
(973) 322-5360.
[ top ]
No Bones
About It... Calcium Counts!
Marjorie M. Luckey, M.D., Medical
Director, Osteoporosis and Metabolic Bone Disease
Center at the Saint Barnabas Ambulatory Care Center
Once thought of as an inevitable part of aging, osteoporosis
is now considered a condition that is preventable and
treatable. Osteoporosis is a disease characterized
by a severe decrease in bone mass and dramatic structural
deterioration of bone tissue. This condition leads
to increased bone fragility and high levels of susceptibility
to bone fractures.
Currently there are 10 million people in the United
States with osteoporosis and an additional 18 million
people with low bone density who are at a high risk
for developing the disease. Over 80% of these cases
are women.
Osteoporosis is a silent disease, one that takes a
number of years to develop. For many individuals, the
first sign of the disease comes in the form of a fractured
bone. The most common are hip, spine and wrist fractures.
Any sudden strain, bump or fall may cause a fracture
when the bones become too weak. As spinal bones begin
to collapse, height is lost and a stooped or a hunched-over
posture may appear. As time goes on, osteoporosis often
becomes more painful and crippling.
Women of all ages should be concerned about the disease.
Those who are premenopausal should be especially concerned
because they can take active steps to prevent a dramatic
decrease in bone density and the onset of the disease
later on in life. Those who have children should teach
them about the important role calcium plays in their
diet. Additionally, make sure your children are getting
as much calcium as they can throughout childhood and
especially during their adolescent years. Maximizing
their peak bone mass at the time of bone maturity could
be the best protection for them later on in life.
There are many ways to keep bone mass at an ideal
level and to continue to grow new bone: Consume adequate
amounts of Calcium.
Calcium plays a big role in the prevention of osteoporosis.
However, calcium is one of the major nutrients most
likely to be lacking in the American diet. How much
calcium should you be consuming?
The Institute of Medicine and National Academy of
Sciences released new calcium recommendations in 1997
which updated and expanded the Recommended Dietary
Allowances (RDA) first published in 1941.
- 1 to 3 years old 500 mg per day
- 4 to 8 years old 800 mg per day
- 9 to 18 years old 1300 mg per day
- 19 to 50 years old 1000 mg per day
- 51 years old and above 1200 mg per day
Pregnant/Lactating women:
- Less than 18 years old 1300 mg per day
- 19 to 50 years old 1000 mg per day
Calcium is found in water and in many foods in varying
amounts. Dairy products and dark green vegetables are
some of the best natural sources of calcium. Low or
non-fat dairy foods such as milk, yogurt, cheese and
ice cream; green, leafy vegetables such as broccoli,
turnip or collard greens; salmon and sardines- but
only with bones; tofu and foods fortified with calcium
such as orange juice, are great sources of calcium.
Calcium supplements are also available for those who
do not get enough calcium in their daily diets.
Take adequate amounts of Vitamin D. Vitamin D helps
the body to absorb calcium. The vitamin is naturally
absorbed through the skin through exposure to the sun.
While most people do produce enough vitamin D naturally,
many elder individuals and those who are housebound
may not be getting enough. Milk and most multi- vitamins
contain Vitamin D. If you are not getting enough Vitamin
D naturally, you may need to take supplements of 400
to 800 IU daily.
Exercise Regularly. Bone is living tissue that can
be greatly strengthened with exercise. Weight-bearing
exercises such as walking, jogging, racquet sports,
stair-climbing and low-impact aerobics help to increase
bone strength. In growing children, exercise can actually
build more bone if it is continued throughout adolescence.
Quit Smoking. Everyone knows that smoking is bad for
the heart and the lungs.
It is also a major cause of osteoporosis, even in
younger women. Smoking poisons the cells that make
bone and also decreases the amount of estrogen in the
body. If you are smoking, quit.
Stop excessive Alcohol Consumption. The intake of
large amounts of alcohol is toxic to bone and may interfere
with calcium absorption. It is recommended that alcohol
be limited to no more than 1 to 2 alcoholic drinks
daily.
Note Medications that may cause Bone Loss. Some medications
that are used over a long period of time can lead to
a decrease in bone density. Glucocorticoids, anti-seizure
medications, excessive use of aluminum-containing antacids,
certain cancer treatments, and excessive thyroid hormones
are a few examples. Make sure to ask your physician
about the possibility of bone loss if you ever need
long-term medications of any kind.
You can detect osteoporosis by asking your physician
for a bone density scan. The best technology available
for this is called Dual Energy X-ray Absorptiometry
(DEXA) scan, because it can measure two important areas
of the skeleton, the hip and the spine. This test is
painless, noninvasive and very safe.
Osteoporosis should be treated with a comprehensive
program involving nutrition, exercise, a healthy lifestyle
and possibly medication, if osteoporosis is present.
Additionally, your treatment plan should include safety
tips or assisting devices, in order to prevent falls
that may result in fractures.
It is critical to maintain and enhance quality of
life for those with osteoporosis. Today people are
living longer, and they want to be able to live independently.
With the latest advances and technologies available
today, the crippling effects of osteoporosis can be
treated and even prevented. It is never too early or
too late to start.
Marjorie M. Luckey, M.D., is the Medical Director
of the Osteoporosis and Metabolic Bone Disease Center
at the Saint Barnabas Ambulatory Care Center in Livingston,
NJ.
For further information about osteoporosis,
please
call (973) 322-7400.
[ top ]
Postpartum
Mood Disorders
Hilda B. Tipleton, M.D., Chairperson,
Department of Psychiatry, Saint Barnabas Medical
Center
There have been many advances in women’s healthcare
in the past decade that have raised awareness of such
issues as premenstrual syndrome, heart disease, osteoporosis,
and Alzheimer’s Disease, as well as breast cancer.
However, what most women of childbearing age do not
realize is that during the postpartum period, they
are at the highest risk for the onset of mental illness
and a possible pattern of life-long recurrent bouts
of depression.
It is estimated that anywhere from 10-15% of postpartum
women develop a mental illness called Postpartum Depression.
Another significant group of women develop new onset
of Obsessive Compulsive Disorder or Panic Disorder.
In our hospital alone, where there are almost 7,000
deliveries a year, this statistic indicates that 600
to 700 women will develop a postpartum psychiatric
disorder within the first year after delivery. In fact,
the highest incidence of psychiatric hospitalization
for women occurs immediately postpartum and particularly
in the first four months after delivery. This would
make postpartum psychiatric illness the most common
complication of pregnancy and childbirth.
For most women, pregnancy is one of the happiest times
of their lives. For many others, it is a time of ambivalent
feelings. For some women, the postpartum period dissolves
into sadness and anxiety after the baby is born.
SPECTRUM OF MOOD DISORDERS
A wide spectrum of psychiatric disorders can follow
childbirth. It is estimated that up to 80% of women
suffer from a transient mood disorder called Postpartum
Blues or Baby Blues. This is characterized by mood
swings, crying spells; irritability, obsessive thinking
and feelings of being overwhelmed and just plain exhausted.
Postpartum Blues are very transient and usually last
no more than hours to a few days and iit by the end
of the second week. The Baby Blues are thought to be
a normal consequence of the physical trauma of childbirth,
the hormonal changes experienced by the mother and
the additional stress of new motherhood. Education
about Baby Blues and good family support are all that
is needed to support the new mother.
In Postpartum Depression, symptoms are more severe
and persist after a two-week period. Postpartum Depression
is known to be a biochemical imbalance, i.e. a deficiency
of neurotransmitters in the brain that are responsible
for controlling mood. Postpartum Depression may also
develop at any time during pregnancy and continue after
delivery. Women who suffer from Postpartum Depression
are persistently depressed for more than two weeks
and some of the following symptoms present all or most
of the time:
• Feelings of sadness or low mood, feeling "down"
• Loss of interest or pleasure in usual activities
• Difficulty concentrating
• Loss of energy, fatigue
• Either an inability to sleep or an increased
need for sleep
• Either weight loss or weight gain
• Excessive or inappropriate guilt
• Feelings of worthlessness
• Feelings of hopelessness
• Unexplained anxiety
• Panicky feelings or actual panic attacks
• Anger or ambivalence about the baby
• Feelings of guilt or shame that you are not
a good mother
• Irritability or explosive temper
• Feeling "out of control"
• Serious inability to concentrate, the feeling
of your mind "racing" or memory loss
• Obsessive thoughts about hurting the baby or
not being able to care for the baby
Postpartum Depression may be short-lived and riit
spontaneously within weeks. However, the most common
pattern is for the symptom, left untreated, to last
for several months or a year. A good number of women
continue to cope and remain functional even though
they feel awful, while others are virtually bedridden.
A small number of women require psychiatric hospitalization.
It is sometimes difficult to make a diagnosis of Postpartum
Depression since lack of sleep, little time for meals,
and increased stress with the new baby are common.
Most women who have had good coping mechanisms throughout
their lifetimes should be able to cope well in the
postpartum period even with disturbed sleep and little
time for themselves. If an otherwise healthy woman
is noted not to be coping well after the delivery of
a child, then one must question "what" is undermining
her ability to cope. Most often the diagnosis would
be depression.
Postpartum Psychosis is seen in approximately 1-2%
percent of childbearing women. This syndrome is much
more severe and is characterized by a loss of reality
and by delusions and hallucinations. The psychosis
usually begins shortly after childbirth from day three
to day 14, with rapidly changing symptoms. The symptoms
tend to intensify and may lead to agitation or delirium.
Thoughts of suicide and infanticide are common. Postpartum
Psychosis is treated as a medical urgency requiring
immediate hospitalization. It is not uncommon for women
with Postpartum Psychosis to develop Postpartum Depression
within three to five months following delivery.
TREATMENT
It is thought that the Baby Blues are a normal part
of the postpartum period. This would account for the
spontaneous resolution of these symptoms within a matter
of days. Postpartum Depression is a more serious illness,
understood to be a "biochemical imbalance" requiring
the intervention of antidepressant medication. Postpartum
Psychosis is biochemical in nature and also requires
the intervention of psychotropic medications, including
antidepressants and antipsychotics.
There is a genetic predisposition for these more serious
disorders. A past history of depression or a family
history of depression are among the risk factors that
would allow us to predict who might be at risk for
postpartum psychiatric disorders. It is very important
to attempt to identify women at risk early on so that
the proper intervention can be made during the pregnancy
and immediately postpartum. Psychiatrists are now routinely
placing mothers at risk for Postpartum Depression on
antidepressant medication the day of the delivery.
The prophylaxis reduces the risk for a recurrent episode
of illness.
Antidepressant medications such as Zoloft, Prozac
and Paxil (SSRI’s) and Effexor are non addictive
medications that correct the chemical imbalance responsible
for the mood, behavior and psychological changes of
Postpartum Depression. Transient nausea and diarrhea
are the most common side effects, and last hours to
days. There are no known long-term side effects from
any of these antidepressants. Antidepressant medications
need to be started as quickly as possible once the
symptoms are recognized and a diagnosis is confirmed.
Antidepressants take time to work and the symptoms
may not begin to resolve for approximately two to four
weeks.
Most women can expect to fully recover from Postpartum
Depression. Only a small number of women do not achieve
complete remission of symptoms. Short term, supportive
psychotherapy is indicated along with antidepressant
medication. Women and their families need much education
and support during this difficult time.
Patients who suffer from Postpartum Psychosis benefit
from the use of short term antipsychotics along with
antidepressant medication. Symptoms resolve quickly
and patients can be stabilized without any harm to
them or to their children as a consequence of their
delusions and hallucinations. Suicide and infanticide
may be consequences of untreated Postpartum Psychosis.
COMMUNITY SUPPORT
There are support groups in the community for women
with Postpartum Depression or Psychosis. Saint Barnabas
Medical Center, for example, has a very active Postpartum
Depression Support Group that meets on a weekly basis
at the Ambulatory Care Center on South Orange Avenue
in Livingston. The group meets each Tuesday from 10:30
am to 12:30 pm and is facilitated by a member of the
Psychiatric support staff from our inpatient psychiatric
unit. The Postpartum Depression Support Group was started
with a $10,000 grant from the State of New Jersey given
to us by Governor Christine Whitman in response to
a request from Senator Richard Codey, whose wife MaryJo
has suffered from Postpartum Depression. MaryJo remains
an ardent supporter of the group and has become a national
figure in helping others to develop an awareness of
these disorders.
The idea of seeking mental health counseling or treatment
may seem frightening, particularly if you have always
viewed yourself as a confident, independent woman.
Although it may be difficult to ask for help, it is
necessary to do so to confirm a diagnosis so treatment
can begin. The longer the illness is left untreated,
the greater the risk of long-term repercussions to
you, your baby, and the bonds that link your family
together.
Postpartum Depression Support Group at Saint
Barnabas Medical Center, Call 1-800-300-0628.
[ top ]
BRCA
1 and BRCA 2 Breast and Ovarian Cancer Genes
Robert R. Taylor, M.D., Associate
Director of Gynecologic Oncology, Saint Barnabas
Medical Center
In the United States, malignancies of the breast and
ovary represent 29% and 4% of the total cancers diagnosed
in women. These two cancers are the second and fifth
leading cause of female cancer death. The vast majority
of breast and ovarian cancers can be attributed to
the natural development of critical mutations in our
genetic material or DNA. Current research suggests
that several critical gene mutations are necessary
for the development of these and other cancers.
Recent evidence indicates that 5-10% of breast and
ovarian malignancies are found in cancer-prone families,
and this finding suggests a hereditary transmission
of cancer-associated gene mutations. Hereditary breast
and ovarian cancer has been linked to two genes, namely
BRCA 1 and BRCA 2. These two very large genes are located
on chromosomes 17 and 13 respectively and, to date,
over 200 mutations have been described. Individuals
carrying one of these mutations may transmit this abnormal
gene to their offspring, resulting in an increased
risk of developing breast and/or ovarian cancer.
Scientific interest in the hereditary nature of cancers
has concluded that cancer is a genetic disease, or
more simply, a disease caused by mutations in an individual’s
genes. In hereditary cancers, the abnormal gene transmitted
has been characterized and is called a tumor suppressor
gene. Tumor suppressor genes act to regulate cell growth.
Given the unbridled growth associated with cancer,
it is easy to consider the loss of tumor suppressor
genes as very important in cancer development. Current
evidence suggests that the breast and ovarian cancer
genes BRCA 1 and BRCA 2 are tumor suppressor genes.
Because humans have small families and a long life
expectancy, conclusive assessment of hereditary cancer
is difficult and requires the assistance of a genetic
counselor or clinician with oncology interests. These
providers can calculate relative risks of developing
breast and/or ovarian cancer by describing a person
as coming from a hereditary cancer family, or a family
with a predisposition for developing cancer. An individual
from a hereditary cancer family is defined as having
2 or 3 first-degree relatives with certain cancers
and has affected family members in each generation.
Patients from hereditary cancers families have a high
risk (often greater than 50%) of developing cancer
during their lifetime and this often occurs 10-20 years
earlier than expected.
This increased cancer risk appears to be linked to
the transmission of a mutation in a critical tumor
suppressor gene, like BRCA 1 or BRCA 2. In contrast
to individuals from hereditary cancer families, patients
from families with a predisposition to cancer are defined
as having one first-degree relative or distant relatives
with certain cancers. Members of these families have
2 to 3 times the cancer risk of the general population.
The mechanism of this increased risk is most likely
a combination of an undefined genetic predisposition
and environmental causes.
During genetic counseling and prior to undergoing
genetic analysis, patients should be advised about
the inheritance, diagnosis and treatment of the cancers
in question. They must be aware of the potential emotional
risks associated with finding that they carry a cancer
gene mutation. These risks include developing low self-esteem
or feeling defective, experiencing conflicts within
families between mutation carriers and non-carriers,
and feeling guilt associated with transmitting a defective
gene to offspring. Support groups must be in place
as a safety net for these individuals. In addition,
there should be strict confidentiality to guard against
the inappropriate use of one’s genetic information.
Lastly, patients should understand the highly charged
and emotional conflicts arising between those individuals
who do and do not want to know if they carry an abnormal
gene.
After being assigned to the high risk category, a
patient should receive detailed counseling and education
about cancer screening. A complete physical exam should
be performed with careful attention to the breasts
and pelvis. Breast self-exam should be taught and performed
at the same time during each menstrual cycle. Self-exam
timing will reduce confusion associated with the normal
changes the breast has during the menstrual cycle.
A mammography every two years can be considered in
the mid to late twenties for high-risk patients, and
converted to an annual screening in the mid to late
thirties.
Ovarian cancer screening utilizes semiannual endovaginal
ultrasound and CA-125 tumor marker analysis. To date,
despite laudable efforts, screening for early stage
ovarian cancer has not proven successful. Patients
at high risk may still elect screening and should be
advised that ultrasound screening often finds enlarged
ovaries and thus increases the chance of surgery for
benign ovarian masses.
Some clinicians recommend the prophylactic removal
of the breasts and/or ovaries in patients having a
high cancer risk. Such an aggressive therapy should
not be taken lightly. Based on current studies, these
procedures appear to decrease but, most importantly,
do not guarantee freedom from the development of breast
or an ovarian like cancer. Prophylactic surgery, if
contemplated, is probably best reserved for the ovary
given the lack of adequate and proven ovarian cancer
screening in contrast to the excellent screening results
for mammography of the breast.
[ top ]
Breastfeeding
Services at Saint Barnabas Medical Center
Educational and Clinical Support by Certified Lactation
Consultants & Lactation Nurse Specialists
Services include:
• Breastfeeding classes and individualized instruction
before and after your baby is born
• Special breastfeeding classes and individualized
instruction for moms with preiies and multiples, including
pump techniques
• Help in hospital before discharge
• Telephone counseling (973-322-5554)
• Electronic breast pump rentals
• In room NEWBORN CHANNEL breastfeeding program
• Complimentary individual "drop-in" breastfeeding
support services
• Complimentary four-session breastfeeding and
parenting support group
[ top ]
Ask
An Expert
Stephen Crane, M.D., Obstetrics
and Gynecology, Attending physician at Saint Barnabas
Medical Center with offices in Livingston and Verona
Q. What is ablation and when is it indicated
or not needed?
A. Endometrial ablation (EA) is destruction
of the lining of the uterus. The endometrial lining
is what is shed each month as menstrual flow in women
of reproductive age. When the bleeding is excessive,
it can lead to aniia and painful menses in up to 20%
of women. There are many different causes including
fibroids, polyps, infection, cancer, hormone imbalance,
medications or clotting disorders. It is important
to determine the reason for the abnormal bleeding prior
to proceeding with treatment and this can be accomplished
by endometrial biopsy or D&C and ultrasound.
If child bearing is no longer desired and medical
therapy fails, the choices for treatment are either
hysterectomy or endometrial ablation (EA). Patients
with large fibroids or cancer are not candidates for
ablation. The advantages of EA over hysterectomy are
avoidance of major surgery, quick return to normal
functioning and a short hospital stay. EA is usually
carried out as a same day surgical procedure with full
recovery anticipated within 72 hours. EA can be performed
with a laser or electrocautery through a hysteroscope
or a newer method using a thermal balloon. In all cases
the goal is to destroy the endometrium and prevent
excessive bleeding. Post operatively, 20% of patients
will have no further bleeding and 60% will have normal
or less than normal menses. The remaining 20% of patients
will continue to have excessive bleeding and usually
undergo hysterectomy. Side effects to the procedure
are:
• Cramping and vaginal discharge lasting up to
two weeks.
• Serious complications, although rare, include
uterine perforation and infection.
Pregnancy after this procedure is unlikely but this
should not be considered a method of birth control
and some form of contraception needs to be used. EA
is a simple, safe and effective therapy for the treatment
of heavy menstrual periods. Discuss with your physician
if you feel you would be a candidate for this procedure.
Leon Smith, Jr., M.D., Perinatologist
Director, Division of Maternal-Fetal Medicine,
Saint Barnabas Medical Center
Q: I will be thirty-five at the time of my
baby’s birth. What type of genetic testing
should I receive during the pregnancy?
A. A woman age 35 or older is at
an increased risk for delivering an infant with chromosomal
abnormalities. We generally recommend genetic counseling
for such patients and they should also be offered Chorionic
Villus Sampling (CVS) or amniocentesis. Recent non-invasive
alternatives such as blood serum screening and detailed
ultrasound monitoring (genetic ultrasound) for conditions
such as Down’s Syndrome may be offered.
The American College of Obstetrics and Gynecology
mandates obstetricians to offer CVS or amniocentesis
to any woman 35 years of age or older since they are
still the only definitive tests for abnormal fetal
chromosomes. |
