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Preventive Care is
one of the most important job functions of a #gynecologist. The doctor carries out regular examinations on the body in order to detect any reproductive organ illnesses or disease early enough. As soon as a lady becomes sexually active, it is necessary for her to visit a gynecologist near you at least once a year.
There are some misconceptions as
regards the functions of a gynecologist, with many individuals believing their
only duty is to help #pregnantwomen
have safe deliveries. A #gynecologist
is a medical doctor who specializes in the #generalhealth of women's
reproductive system. Their functions are not restricted to only pregnancy, but
also other aspects of reproductive health. These are the functions of a
gynecologist at a glance.
Seeking abortion medications
online can be a response to clinic access barriers in states with and without
restrictive abortion laws and can occur when self-managed abortion is preferred
over clinical care, according to new research from the LBJ School of Public
Affairs at The University of Texas at Austin. Researchers also found that
online options offer either information or medications, but not both, and lack
of trusted online options can delay care and lead to consideration of
ineffective or unsafe alternatives.
Abigail Aiken, an assistant professor of public affairs and a fellow of
the Richter Chair in Global Health Policy at the LBJ School, conducted
anonymous in-depth interviews with 32 people from 20 states who sought abortion
medications online. Results, which were peer-reviewed and published in
Perspectives on Sexual and Reproductive Health, provide insight into the
clinical and public health implications of the internet as a pathway to care.
"Though it may be surprising to consider, people in the United
States are looking for ways to end their pregnancies at home using abortionpills they can get online," Aiken said. "Someone might decide to
self-manage their own abortion either because of barriers to clinic access or
because it's a better fit for their circumstances."
The sample was composed of 30 women and two men, who sought abortion
medications online on behalf of their female partners. Participants' states of
residence were categorized in their policies toward abortion as "extremely
hostile," "hostile," "middle ground" or "supportive"
following the state abortion policy classifications developed by Elizabeth Nash
and colleagues at the Guttmacher Institute.
A major barrier for participants living in states with restrictive laws
was the high cost of clinical care. Other participants described major
logistical challenges resulting from state abortion laws, such as waiting
periods and ultrasound requirements. Logistical and financial difficulties
often intersected with concerns about harassment posed by clinic protesters.
Those living in states with middle-ground and supportive laws also experienced
access barriers, including long distances to clinics, lack of transportation
and difficulty finding information.
Whereas many participants cited access barriers as the reason they
considered ordering medications online, others explicitly preferred
self-managing their abortion to seeking care within the formal health care
setting. Underlying these preferences were the perceived advantages of
convenience, privacy and the comfort and familiarity of one's own home.
A key theme, regardless of participants' motivations for seeking
medication abortion online, was that the current options did not meet their
needs. Upon realizing telemedicine resources such as Women on the Web (WoW) and
safe2choose (s2c) do not serve the United States, almost all of the
participants also searched other sites. Most participants expressed concerns
about the legitimacy of online pharmacy sites.
"We know that medication abortion is extremely safe and effective
when carried out with the correct doses of medications, clear instructions and
information about what to expect, and a reliable source of support and
aftercare," Aiken said. "Unfortunately, most current online options
leave these needs unmet."
The lack of availability of trusted sources of abortion medications
online led some participants to research and consider options without strong
evidence of efficacy. These options included various supplements and
botanicals, as well as unsafe methods such as strenuous exercise, physical
trauma, use of sharp objects or ingestion of alcohol or household cleaning
"Our study shows that there is a public health justification to
ensure that people who do self-manage can do so safely," Aiken said.
The study was supported by a grant from the Society of Family Planning
and was supported in part by the Eunice Kennedy Shriver National Institute of
Child Health and Human Development.
Improvements in imaging technology, endoscopic equipment, drug treatment, and scientific innovation have all contributed to recent advances in gynaecology. Advances have also resulted from a change in the attitudes and practice of gynaecologists themselves, in response to the greater expectations and knowledge of their patients, who frequently seek new and innovative procedures on the basis of media publicity and access to non-peer reviewed information including the world wide web. It is increasingly recognised that gynaecological problems affect the quality of life of women in different ways, highlighting the value and importance of patient assessed health status measures to evaluate the subjective severity and treatment efficacy of common gynaecological conditions. Laparoscopic and hysteroscopic surgery, medical treatment, and expectant management are replacing major gynaecological surgery for many common gynaecological complaints. For example, ectopic pregnancy is being diagnosed earlier by the use of transvaginal ultrasonography and quantitative measurements of human chorionic gonadotrophin concentrations. Thus women can be treated either medically as outpatients with methotrexate injections3 4 or by laparoscopic surgery, reducing stay in hospital and preserving tubal function in most cases.4–6 Minor procedure units for gynaecology, with one stop investigation and treatment (including ultrasonography and hysteroscopy), and early pregnancy assessment units, where bleeding in early pregnancy can be dealt with rapidly and sympathetically, are becoming more commonplace. The prolonged life expectancy of menopausal women and their higher expectations for health have encouraged new developments in hormone replacement therapy. The increased use of such therapy has also increased surveillance and thus recognition of other common problems affecting older women. Delaying childbearing has resulted in a greater demand for effective fertility treatments and for surgical procedures that preserve fertility.
We asked consultant gynaecological staff at a London teaching hospital for their views on important recent advances in gynaecological practice. Overlap occurred in topics believed to be important, and these are detailed here. To supplement our knowledge of the relevant recent literature, we electronically searched Medline, hand searched the major British and US gynaecological journals published over the past 2 years, and read presentations and abstracts from the 1998 British congress of obstetrics and gynaecology.
Treatment of menorrhagia
Heavy menstrual loss is a common complaint and accounts for about 12% of referrals to gynaecology outpatient departments. Many of these women will undergo hysterectomy—a woman’s lifetime risk of hysterectomy is estimated at 20%. Despite the success of the procedure compared with other treatments for menorrhagia, the morbidity and complication rates (before and after discharge from hospital) are high. The frequency of the operation and its complications have provided incentives to re-evaluate simple medical treatment and to explore new conservative and surgical treatments for dysfunctional uterine bleeding.
Medical treatment Randomised controlled trials of commonly prescribed medical treatments for menorrhagia have confirmed the efficacy of tranexamic acid and have shown that norethisterone, the most commonly prescribed drug in the United Kingdom for the treatment of ovulatory menorrhagia, is ineffective at its recommended dosage. Despite this evidence, a recent survey of 206 general practitioners showed that 69% would still consider prescribing cyclical norethisterone for this condition. Even when used appropriately simple medical treatment may not relieve the symptoms of menorrhagia. Although this may result from inappropriate prescribing, evidence from studies of patient satisfaction and quality of life have shown that women with severe self assessed symptoms are unlikely to experience improvement with drugs.
Hysteroscopic ablative surgery:
If medical treatment fails to treat menorrhagia, an alternative treatment is hysteroscopic ablation of the endometrium. Several techniques are available, and despite initial concerns about safety a recent survey of more than 10 000 operations (MISTLETOE; miminally invasive surgical techniques, laser, endothermal or endoresection) showed that the techniques are safe even in inexperienced hands. At the start of the survey in 1993, 83% of NHS hospitals in the United Kingdom offered ablative surgery. Although randomised trials have shown ablative surgery to be more effective than medical management, the technique is invasive, requires general anaesthesia, is not without complications, and has reduced long term efficacy in women under 45 years of age.Recently introduced balloon devices for ablative treatment may prove to be equally efficacious, simpler, and even safer to use than ablative surgery, although further evaluation is awaited.
The hysteroscopic resection of small submucous fibroids distorting the endometrial cavity is now standard practice , but not all fibroids are amenable to this surgical option because of their position and size. In the presence of large symptomatic fibroids, hysterectomy or myomectomy has remained the major treatment option. Recent advances in the long term interventional radiological and medical treatment of large symptomatic myomas offer an important alternative approach.
Although the gonadotrophin releasing hormone agonists are more frequently used in assisted conception, in the management of endometriosis, for the premenstrual syndrome, and to prepare the endometrium before hysteroscopic surgery, they have also been shown to reduce the size of fibroids by up to 50% with short term treatment (3-6 months). This has made them an ideal adjunct to surgery for large symptomatic fibroids. The main disadvantages of gonadotrophin releasing hormone agonists are secondary to the induced hypooestrogenic state, affecting the cardiovascular, skeletal, and urogenital systems and producing vasomotor symptoms. This has limited their use to short term treatment, the cessation of which leads to a rapid increase of fibroids to their previous dimensions. Thus the short term treatment of fibroids with gonadotrophin releasing hormone agonists alone is a costly and ineffective treatment option.
Overcoming male factor infertility:
It is now 21 years since the first live birth after fertilisation in vitro to alleviate female tubal infertility. Despite only moderate success (between 9% and 26% live births per cycle started), influenced mainly by maternal age, duration of infertility, and previous parity, in vitro fertilisation is now accepted as an alternative to tubal surgery and for protracted unexplained infertility. In a similar way, the recent ability to achieve fertilisation of eggs in vitro by the injection of a single spermatozoon (intracytoplasmic sperm injection; ICSI) has overturned the poor prognosis for men with low sperm counts or azoospermia. Adequate spermatozoal samples for intracytoplasmic sperm injection can be obtained from very poor ejaculates, including semen samples frozen for patients undergoing chemotherapy or radiotherapy but too poor to be used for artificial insemination. In men with obstructive azoospermia of infective origin or after failed reversal of vasectomy, sperm for intracytoplasmic sperm injection can be obtained by percutaneous aspiration from the epidydimis (PESA) or from a small testicular biopsy (testicular sperm extraction; TESE), performed under local anaesthesia. This latter technique may be used in men with small testes and a high follicle stimulating hormone concentration who have testicular failure, as multiple small biopsies will show adequate sperm for intracytoplasmic sperm injection in half the cases. Pregnancy success with intracytoplasmic sperm injection is as good as or even better than with in vitro fertilisation, and the outcome seems to be independent of the source of the sperm.
(HealthDay)—Offering cell-free DNA (cfDNA) screening followed by invasive testing in the case of positive results does not result in a significant reduction in miscarriage among women with pregnancies at high risk of trisomy 21, according to a study.
Valérie Malan, M.D., Ph.D., from the Hôpital Necker-Enfants Malades in Paris, and colleagues compared the rates of miscarriage following invasive procedures only in the case of positive cfDNA test results versus immediate invasive testing procedures among 2,111 women with pregnancies at high risk of trisomy 21 as identified in combined screening in the first trimester. Patients were randomized to receive cfDNA testing followed by invasive procedures when test results were positive or to receive immediate invasive testing (1,034 and 1,017 women, respectively).
A total of 1,997 of the 2,051 women who were randomized completed the trial. The researchers observed no significant difference in the miscarriage rate between the groups (0.8 versus 0.8 percent; risk difference, −0.03 percent). For trisomy 21, the cfDNA detection rate was 100 percent.
"Among women with pregnancies at high risk of trisomy 21, offering cfDNA screening, followed by invasive testing if cfDNA test results were positive, compared with invasive testing procedures alone, did not result in a significant reduction in miscarriage before 24 weeks