Category Archives: Pregnancy

An ancient imaging system proves to be an amazing cure for infertility!

Towards the end of the work week, Medical News Today revealed a story that looks like a miracle and something out of science fiction simultaneously. Infertility is a huge problem, with expensive, whose treatments are temperamental to say the least, fraught with emotional travails for families and other complicating issues.

And now, a single study appears to upend the problems and probably offer a simple, cost effective solution that will beat infertility right out of the cliched ball park! It is probably imprudent to get so excited, but it is hardly resistible.

Old techniques have gotten a second look in the past. Some of these techniques were trial and error prone, and many times the underlying science has not been understood. Renal Denervation is one such technique. With a surprising and incredible purchase of Ardian by Medtronic, it caused a frenzy, only to be let down by a poorly designed clinical trials. I have seen similar comebacks on old studies that controlled the Over Active Bladder condition. Therefore, one should look at any revivals of old techniques with ample caution.

Interesting Coincidences

Dr. Ben Mol, a Professor at Australia who spearheaded the study into an age old imaging technique as a possible treatment, appears to have been conceived as a result of this imaging treatment and has a younger brother! It seems remarkable that he started research intot his technique even before being made aware of his own history and relationship with the technique. Please refer to the MNT link below for more on this.

The Technique – Hysterosalpingography (HSG)

The technique, whose name is a mouthful, simply refers to imaging of the hystero, the uterus and salpingo, the fallopian tube. It was first carried out exactly 100 years ago, in 2017, just a few years after X-rays came into existence.

The procedure itself is a dye test, performed under X-ray. Water or oil are used to flush the Fallopian tubes. It is the flushing that appears to have aided fertility. In view of this notion, Dr. Ben Mol and others led a study with 1119 women, that produced interesting results.

The Study

The study, titled H2Oil was held in Netherlands, and as mentioned before, recruiting 1119 women, approximately half received HSG with oil, and as MNT put it, Lipidoil Ultra-Fluid, an iodized solution of fatty acids derived from poppy seeds.

The other half received HSG with water.

The Results

Nearly 40% of the women in the oil group, and 29% in the water group all conceived within 6 months. This is an amazing result. It shows immense promise.

Of course, more needs to be known, as I mentioned before. An underlying understanding of science, safety of flushing fallopian tubes and other important, fundamental considerations remain. However, for women and families struggling with infertility, this study shows great promise.

References: 

  1. The MNT Article: http://www.medicalnewstoday.com/articles/317532.php
  2. The NEJM Publication: http://www.nejm.org/doi/10.1056/NEJMoa1612337
  3. Image Courtesy, Pexels: https://www.pexels.com/photo/close-up-of-hands-holding-baby-feet-325690/

Obesity is a risk factor for IUD Expulsions

This is National Women’s Health Week. I am trying to highlight key health-related news all week. This night’s post also comes from the latest ACOG 2017 meeting from last week.

Obesity

Obesity is already a risk factor for various health conditions, such as diabetes, cardiovascular diseases and so on. For long term, reversible contraception, it is recommended that obese women opt for IUD over oral pills or patches, as the chances of venous thromboembolism is higher in obese and overweight women, than in women of normal weight. Please see referenced link below. It is an earlier paper by the same lead author/group as the current one, coming from Hawaii.

Weight classification, takes women and men from underweight to normal weight, overweight and obese. Within obesity, depending on waist size, the classification goes from Class I to Class III, representing extreme obesity. I have attached an NIH reference for your convenience.

It appears that in women with Class III obesity, IUDs can shift inside the uterus, also commonly termed IUD expulsion, at a higher rate than in women of other weight classes. This was the focus of the presentation at ACOG last week.

The current study

A retrospective cohort study, in Hawaii, with access to a diverse population including approximately a third each of Asian women and Native Pacific Islanders, has shown that obese women with Class III obesity have a risk, that is 3.06 times other women. Read other details in the paper summary and the article linked below.

Theories

The study itself was only performed, retrospectively to titrate risks. Some theories have been presented by the authors.

Placement itself might pose difficulties because of obesity.

Another risk of obesity is heavy menstrual bleeding, and therefore, IUD expulsions might be encouraged.

The authors however continue to encourage the use of IUDs in all women, regardless of body weight, as the benefits outweigh risks.

Conclusion

While on one end, further studies are needed, and will likelihood indicate why IUD expulsions occur at a higher rate in obese women, women should not stop opting for IUDs.

Additional studies that describe the causes for IUD expulsion might indicate that it is solely not a function of obesity, and it has already been shown that obesity is but one risk factor for expulsion.

Knowing why IUDs dislodge or move would make for better IUD design! 

Until the reasons are known and designs could be potentially improved, for the long term, women should focus on efforts that help them lose weight, in a healthy and practical manner.

References:

  1. ACOG Presentation Summary: http://mobile.journals.lww.com/greenjournal/Abstract/2017/05001/Levonorgestrel_Intrauterine_Device_Complications.235.aspx
  2. A previous article by the same group: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642497/
  3. The mdedge article http://www.mdedge.com/clinicalendocrinologynews/article/137744/gynecology/beware-hormonal-iud-expulsion-obese-women?channel=261&utm_source=News_CEN_eNL_051317_F&utm_medium=email&utm_content=Are%20some%20obese%20women%20having%20issues%20with%20IUDs?
  4. NIH Weight Classification: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi_dis.htm
  5. Some information on IUD Expulsion and what to do: http://www.healthline.com/health/birth-control/iud-fell-out#5
  6. Retrospective Cohort Studies: https://en.wikipedia.org/wiki/Retrospective_cohort_study
  7. Image Courtesy, Pexels: https://www.pexels.com/photo/backlit-beach-dawn-dusk-227674/

Some shocking revelations on violence and trauma during pregnancy!

The American College of Obstetrics and Gynecologists (ACOG) has its annual meeting this week, and how I wish I could be there! Maybe next year. Meanwhile, some shocking new findings are being presented at the meeting!

The results are from researchers at the Perelman School of Medicine at the University of Pennsylvania, who analyze a statewide analysis, for pregnancy related hospital trauma cases over a decade, for the State of Pennsylvania.

Please read the key findings in the link below. You may also refer to the proceedings poster.

A Couple of Shockers

The data itself is shocking, about 1 in 12 women have trauma during pregnancy, that may be due to accidents or assaults. This is also the leading non-obstetric  reason for death among pregnant women. There are the usual caveats about how pregnancy complicates everything. But, I found a couple of things really shocking! Here is one from Neha Deshpande MD, the clinical resident, who is also the lead author of the study:

“Despite the severity of the issue, little is known about how trauma actually impacts pregnant women since accidental and incidental causes of death are excluded in many statewide and national maternal mortality reviews. The striking results of our study suggest that widespread screening for violence and trauma during pregnancy may provide an opportunity to identify women at risk for death during pregnancy.”

  1. The “little is known” gave me pause and I had to re-read it twice! And, apparently not much screening of trauma and pregnancy occurs!
  2. The second thing that shocks me is that “accidental and incidental causes of death” are excluded from many state and national maternity mortality reviews! Well, there is something in need of fixing! If we don’t even do a good job of counting the causes and cases carefully, how would we proactively fight pregnancy related trauma?

Other Findings

  1. Some of the other findings were disturbing as well. The study found that injuries in pregnant women were fewer than in women who weren’t, but even with the reduced severity, pregnant women were nearly twice as likely to die! Clearly, resource availability and planning have to be increased to give immediate special care and attention to pregnant women.
  2. The next one, mental health, ignored for long, seems to be particularly troublesome when it comes to pregnant women. Nearly 1 in 5 pregnant women reported some form of psychiatric illness. What little attention has been provided to pregnancy related mental health issues, usually focuses (not that it should be reduced) on postpartum depression. Well, it appears, this attention should be increased and should span the entire pregnancy timeline!
  3. In more disturbing news, minority and uninsured women were reported be significantly more likely to experience assault. It is already reported through many channels that minority women and uninsured women have the most problems, and this makes things worse. Given the recent proposed changes to healthcare laws in the US, and the debate surrounding affordable care, and access to care, these findings are the most disturbing and alarming!

The Future?

Results from a single state, spanning a decade are commendable, as much as their findings give much cause for concern. But, what of the future? I think alongside making more resources available, and creating more awareness, a few changes are in order:

  1. Change how pregnancy related morbidity and mortality data are collected, specifically to highlight accidents and violence.
  2. As I mentioned before, make maternal mental health a central issue through the pregnancy cycle. Is there any reason to believe (and this is in no way in defense of) that both parents face mental health issues during pregnancy, and perhaps, sometimes, violence is a result? This might be important to know.
  3. Do pregnant women know how to approach for help when abused? Where to go? What treatment options are available?
  4. How would this data about pregnancy look like, if collected and analyzed globally?

This study, from U.Penn is truly an eye opener, but if anything, it tells us not enough is being done.

Reference:

  1. The MedicalXpress Article: https://medicalxpress.com/news/2017-05-pregnancy-linked-higher-death-traumatic.html
  2. Image courtesy, Pexels: https://www.pexels.com/photo/motherhood-parenthood-pregnancny-mother-59894/