REPOST: Facing a tough choice: Should i have surgery while i'm pregnant?

Pregnancy is certainly not the best time to have a surgical procedure. This Health.com article shares how a woman faced the hardest decision in her life.

Ever since my first child was born, my wrists have been in pain. When my daughter was just three months old, I was diagnosed with de Quervain's disease, a kind of tendinitis that can be severely aggravated by motherhood. With this, my third pregnancy, the pain has become unbearable, and I've just been told that my only option of finding relief is surgery during pregnancy.

Apparently, the wrist actions required for breast-feeding and carrying an infant can be incompatible with a woman's wrist structure (which seems antievolution), causing tendons in the wrist to swell and become painful to use. Pregnancy can also aggravate tendinitis, and many women experience their first symptoms of carpal tunnel syndrome while pregnant.

When I was first diagnosed, I didn't even want to take the anti-inflammatory drugs my doctor prescribed, because I was breast-feeding.

I wore hand splints and did special hand exercises and yoga in order to heal the tendon, but nothing worked. Even when my daughter began to wean herself, the problem only got worse. I could barely grasp a diaper, let alone fasten one to my child.

I finally found relief with corticosteroid injections. Within two days of my first shots, my wrists felt as though I'd never had any pain at all.

Thereafter, when the de Quervain's would flare up, I'd report to the orthopedic surgeon for another set of shots. He would freeze the skin over my aching tendons, then inject the corticosteriod, almost painlessly "solving" the problem for another six months or so.

But this latest swelling of my wrist tendons has been 10 times more painful than any before. In tears, I went to the emergency room on Sunday morning, where the radiologist draped my pregnant belly with two lead aprons and X-rayed the offending appendages; then a nurse affixed a plaster cast to my most painful wrist.

Once my orthopedic surgeon studied those X-rays, he told me that the only solution to my advanced condition is surgery. He then replaced the cast with a fiberglass splint on each hand.

The pain has continued, and the splints have prevented me from taking care of my children. I've had to hire a nanny despite being a stay-at-home mother. So I really want this surgery. I want the problem solved before the new baby is born, so I can snuggle up to this child and not whack its little head on hard fiberglass splints. But everyone, including me, is nervous at the prospect of surgery during pregnancy.

My surgeon suspects that I will require general anesthesia for the work needed on my left hand, and he doesn't feel comfortable doing the surgery until I am six months pregnant—waiting until the baby is bigger and somehow more capable of withstanding general anesthesia, but still allowing my wrists enough time to recuperate before the birth. Although there are no studies to indicate that general anesthesia is harmful after twelve weeks of pregnancy, it simply seems wrong and scary.

So I called Joshua Copel, MD, a professor of obstetrics, gynecology, reproductive sciences, and pediatrics at Yale University School of Medicine, and asked him whether a woman with such a debilitating condition should undergo or avoid the curative surgery.

He suggested that it may be possible to perform the surgery with a brachial plexus block instead of general anesthesia, exciting in me the possibility of having the surgery sooner than March. I look forward to suggesting this to my surgeon this week.

"We generally try to avoid the first trimester, although there is little evidence of teratogenicity [the production of fetal abnormalities] from current inhalational agents," says Dr. Copel. "For all women undergoing nonobstetric surgery during pregnancy, we also require that there be an obstetrician who is identified as the responsible provider for the patient and who is part of a team approach including the surgeon and anesthesiologist to determine the best course of action."

The American College of Obstetricians and Gynecologists' "Guidelines for Perinatal Care" could give me no statistics on the safety of the procedure: "There are no data to support specific recommendations...Pregnant patients who undergo nonobstetric surgery are best managed with communication between involved services, including obstetrics, anesthesia, surgery, and nursing." In other words, my doctors and I are on our own.

Diedre Lyell, MD, an assistant professor of obstetrics and gynecology at Stanford School of Medicine, also tells me that, "General anesthesia can be used (during pregnancy), but a local block may be better if it allows the surgeon to perform the surgery adequately."

Now I pray that such a local block will be possible for the more intense surgery of my left hand. A brachial plexus block would involve a needle inserted into the tender tissue under my arm, but if I can break free of these clunky fiberglass casts before June, with minimal risk to the new baby, I will jump at the chance. And, if not, well I'm going to need your help making a very tough decision.

Cristian Andronic specializes in advanced gynecologic and robotic pelvic reconstructive surgery. Follow this Twitter page for more updates on the industry.

Plan B: New York's emergency contraceptive for teens

Teen pregnancy and teen birth rates have steadily declined since 2008, but the Centers for Disease Control and Prevention says that the number of teen pregnancy cases in the US is still nine times higher than in other developed countries. This lays the ground for the government to initiate concrete actions to contain teenage pregnancy rate at a standstill.

Image Source: at-risk.org

In January 2011, New York City launched a program dispensing free prescription contraceptives, including the emergency contraceptive pill called Plan B, to students in a number of public high schools.

The Department of Health and Human Services restricted the over-the-counter distribution of the morning-after pill to girls younger than 17. However, the FDA’s Center for Drug Evaluation and Research (CDER) ascertained that the drug is safe and effective for younger girls, and that they’re also capable of using Plan B properly, without the help of doctors. Consequently, following a judge’s decision to rule out age restrictions for those purchasing Plan B, pharmacies are now free to dispense the pill to “all females of child-bearing potential,” even without a prescription.

Image Source: plannedparenthood.tumblr.com

While some experts disagree with the judge’s ruling, others see it as an opportunity to increase awareness on safe sex, teen pregnancy, and health. Dr. Daniel Grossman, vice president of research at Ibis Reproductive Health, hopes that the judge’s ruling will “increase access to all modes of contraceptives, including an eventual over-the-counter availability for daily birth control.”

Image Source: drugwatch.com

Dr. Cristian Andronic is a board-certified ob-gyn. This Facebook page shares more helpful resources about pregnancy.

The use of robotic hysterectomy among women

Hysterectomy is the removal of the uterus through surgery to treat certain uterine problems. A woman undergoes this procedure due to any of the following reasons: unusual menstrual bleeding, fibroids, endometriosis, or cancer. A hysterectomy may be performed through an abdominal or vaginal incision.

Image Source: direct-healthcare.com

Approved by the US FDA in 2005, robotic hysterectomy, has gained popularity in doing hysterectomies. Over the past couple of years, the use of this operation has been significantly increasing. This can mostly be attributed to the faster healing period as compared with the traditional approach. As the makers of the da Vinci® robotic systems put it, a robotic hysterectomy involves “only a few small incisions, so you can get back to life faster - within days rather than the usual weeks required with traditional surgery.”

Image Source: usatoday.com

Patients can enjoy the other benefits of robotic hysterectomy, including the following:

• Less pain than conventional types of surgery

• Less risk of a blood transfusion

• Fewer complications than the traditional surgeries

• Faster recuperation and shorter hospital stay

• Immediate return to normal activities

• Less chances of scarring

With the use of robotic surgery, gynecologists are now able to perform with precision and timing, giving patients improved outcomes and satisfaction. However, there is no compulsion as to whether or not robotic hysterectomy is recommended for all patients. Studies show that this may be beneficial to some women but not to others. In this light, it’s really the patients’ prerogative whether to undergo treatment through robotic or traditional means.

Image Source: brighamandwomens.org

Dr. Cristian Andronic is among the medical practitioners that specialize in robotic surgery. Visit this Twitter page for more updates related to Obstetrics and Gynecology.

REPOST: Study clarifies link between fertility treatments and neurological problems in kids

Low birth weight, premature birth, and brain development issues have all been linked to fertility treatments, including IVF.  Read the details from this Time article:  

Children born from in vitro fertilization (IVF) treatments have shown a higher risk of developmental problems, but what is responsible for the heightened risk?

Low birth weight, premature birth and minor problems with brain development have all been correlated with fertility treatments, which include IVF as well as sophisticated insemination techniques. While it’s possible that the treatments themselves, which require manipulation of the egg, sperm and embryo outside of the woman’s body, could be contributing to changes in development, it’s also logical that the infertility that required the procedures in the first place might also be playing a role. And in the latest study investigating the association, published online in the journal Archives of Disease in Childhood, researchers report that the latter may be largely responsible for the neurological differences documented among children born via fertility treatments.

The new study is very small, involving just 209 children who were born to parents who struggled to get pregnant. The findings, however, support previous data that found that techniques associated with IVF were not lniked with increased risk of neurological issues among children at age two who were born using these treatments.

In the current study, the researchers focused on a group of couples enrolled in a study of assisted reproductive techniques who were considered subfertile, or unable to conceive after 12 months of unprotected intercourse. The parents took anywhere from 1.6 years to a little over 13 years to get pregnant, producing 209 children. When they reached age two, the children were evaluated for mild neurological and developmental problems, including movement issues, posture, muscle tone and hand-eye coordination. Seventeen of the toddlers showed minor neurological problems, and these children were more likely to be born of parents who took the longest to conceive. The median time to pregnancy for couples whose children did not show neurological issues was 2.8 years, while it those whose children did show minor problems took 4.1 years to conceive. Taking a longer time to get pregnant was associated with a 30% greater risk of having a child with mild neurological issues — even when the researchers accounted for other factors like parents’ age and education, which can also affect risk of such developmental abnormalities.

The results imply that factors linked to poor fertility, which can contribute to taking longer to conceive, were playing a larger role in the children’s poor development than the fertility treatments themselves. The authors also stress that the development issues noted in the study are not debilitating, but minor abnormalities that probably don’t affect overall behavior or development.

“Suboptimal neurological condition does not imply overt problems in daily life. It does, however, indicate an increased vulnerability for developmental problems such as learning and behavior problems. This means that our findings do not have significance on the level of the individual child, but that they do have significance for the population at large,” says study author Mijna Hadders-Algra, a professor of developmental neurology at the Beatrix Children’s Hospital at the University of Groningen Medical Center in The Netherlands.

Hadders-Algra hopes the results raise awareness that prolonged time to pregnancy is associated with a less optimal brain condition in the baby, and that researchers and fertility specialists keep this in mind as they help parents to conceive. “Prolonged time to pregnancy may be prevented by reduction of maternal age at child conception. This is an issue with strong political and social consequences,” she says. “For instance, in the Netherlands, the age at which women get their first child steadily increases. One could say: a smart woman gets her pregnancy in time.”

Results from studies such as the current one should inform reproductive health policy, she says. In the United Kingdom, for example, the National Health Service revised its guidelines in February to allow women to start IVF treatments earlier, after two years of failed attempts to get pregnant, rather than three, but extended the upper age limit for women from 39 years to 42 years. As more studies such as Hadders-Algra’s become available to better inform doctors and policy makers, such guidelines can become better suited to reflect the risks and benefits of the latest assisted reproductive techniques, for both the parents and the child.

Obstetrician-gynecologist Cristian Andronic is well versed in fertility and other related matters. This Facebook page links to more sources.

Myomectomy: An alternative to hysterectomy

If a woman who has undergone hysterectomy due to fibroids knew the truth behind myomectomy, then she could have saved her uterus and bore children.

Image Source: orlandohealthdocs.com

The University of California San Francisco Medical Center defines myomectomy as the removal of fibroids while preserving the uterus. This operation is one of the most effective treatment solutions for women who have fibroids and still want to bear children in the future.

Dr. William Parker, an obstetrician-gynecologist from Saint John’s Hospital and Health Center, affirms that patients should treat fibroids by determining their effects with regard to pain, mood, and energy levels, and other determining factors, such as menstrual bleeding. Dr. Parker disputes the notion that fibroids can often be cancerous, saying that there is less than 1 in 1,000 incidences of cancer cases in women with fibroids.

Image Source: endofibroid.com

Many doctors, like Cristian Andronic and Jodi Abbott, would agree that hysterectomy is not the answer to treating fibroids. There are alternatives, like myomectomy.

Depending on the size, number, and location of the fibroids, a myomectomy is performed in several different methods:

• Abdominal myomectomy (also known as open myomectomy)

• Laparoscopic myomectomy (only certain fibroids can be removed)

• Hysteroscopic myomectomy (only women with submucosal fibroids are candidates for this procedure)

Most women want to see their offspring in the future. However, with complications in health, many will find it difficult. Thus, they should get all necessary information and know their options to have a viable pregnancy.

Image Source: fibroids-and-endometriosis-help.com

This Twitter page provides more information about women’s reproductive health.

Pregnant at 40: Coping with the challenges

News of Hollywood actress Kelly Preston getting pregnant at 47 sent shockwaves among fans, moms, and even medical professionals. Preston is just among the many celebrities who became pregnant later in life, with Madonna, Geena Davis, and Jane Seymour included in the list.

Image Source: dailymail.co.uk

While these successful pregnancies are great news for older women who are looking to conceive, getting pregnant at 40 is never a smooth journey, and majority of women trying to get pregnant at this age are not going to be successful.



The National Institute of Child Health and Human Development attests that old maternal age is one of the well-recognized risk factors for a high-risk pregnancy. Other factors include:

• Being overweight or underweight

• Pre-existing health conditions, like high blood pressure, autoimmune disorders, cancer, and other infectious diseases

Image Source: reuters.com

• Irregular prenatal care visits

• Multiple births

What to do?

No matter what age a woman is in, there are basics to having a healthy pregnancy. Mayo Clinic suggests scheduling a preconception appointment and being extra cautious when using assisted reproductive technology or ART when trying to conceive. Before and during pregnancy, intake of folic acid, calcium, iron and other nutrients is vital. Also, gaining the right amount of weight sustains the baby's health — a weight gain of 25 to 35 pounds is recommended for women with a healthy weight before gestation. Reasonably, smoking, alcohol drinking, and taking illegal drugs are off-limits during this delicate time.

Image Source: sciencedaily.com

Dr. Cristian Andronic is a board-certified ob-gyn who specializes in high-risk pregnancies. Follow this Twitter page to receive timely updates related to obstetrics and gynecology.

REPOST: Am I having a boy or girl? Fun ways to tell!

Thinking about the new baby inside you is very exciting.This Parenting.com shares exciting ways to give you clues about your baby's gender.

Image Source: parenting.com

Our super-cool gender predictor gives you just-for-fun ways to guess the gender of your baby, from Chinese birth calendars to morning sickness to Drano. Plus, try our fun Chinese Gender Predictor tool!

The suspense is torturous: am I having a boy or a girl? An ultrasound technician can tell you, but they can be wrong. Until the Big Reveal, here are some entertaining, sometimes weird ways to predict your baby's sex.

Highs and Lows

This one you can do just by looking south: if you're carrying high, break out the pink. If your bump is low, you're carrying a boy.

Be Still My Beating Heart

Next time your OB pulls out the Doppler to listen to baby's heartbeat, ask her to tell you what the heart rate is. According to legend, 140+ beats per minute indicates a girl, and below 140 a boy.

Sweet and Sour

Craving ice cream every single day? Some people believe this means it's a girl. If you have to have salty or sour stuff, then it's a boy.

Chinese Birth Chart

This ancient method uses your age at conception and the month you did the deed to determine gender.

Potty Time

This one's a little out there. Pee in a cup (you've been doing it at all your prenatal appointments anyway, haven't you?), mix a tablespoon of Drano in, and watch to see if it changes color. Green = girl, and blue = boy.

Even and Odd

Legend has it that the Mayans determined a baby's sex by looking at the mother's age at conception and the year of conception. If both are even or odd, it's a girl. If one's even and one's odd, it's a boy.

Unlocking the Mystery

This is one for a friend to try. Place a key in front of your preggo friend and ask her to pick it up. If she grabs it by the narrow part, she's in for sugar and spice and all that. If she picks it up by the round part, it's snips and snails.

Spot On

If you're breaking out like crazy, blame it on your girl babe. The belief goes that girls steal their mother's beauty, hence, those annoying zits.

Nice Ring to It

Pop off your wedding ring -- if you still can! -- and tie it to a string. Hang it over your belly. If it swings in a circle, a little guy's in your future. If it goes back and forth, you've got a girl.

Queasy Does It

Sick as a dog during the first trimester -- or still? Signs indicate you're having a girl. Little or no morning sickness points to a boy.

Get the latest updates in pregnancy care by followong this Cristian Andronic Twitter page.