Breast pain is a common and concerning symptom in women. Breast pain can either be cyclical and associated with hormonal changes or noncyclical and constant. Cylical breast pain associated with hormonal changes tends to be bilaterally (both breasts) and tends to feel heavy, achy, and full. Noncyclical breast pain tends to be one sided and can be more sharp or stinging. Causes of noncyclical, one sided breast pain can be a cyst, infection, trauma, pain in the underlying ribs, or nerve disease. In women being evaluated for breast pain, cancer is the cause in only 1-6% of the patients.
If a women has breast pain that is cyclical or noncylical, clinical evaluation by her physician is recommended. The physician will determine if the pain is associated with hormonal changes. The physician will determine if the pain is one sided or not, is associated with a specific mass, and if there is any associated causes of the pain. After determing the answers to these question, the physician will perform a careful exam to evaluate for any nodule or cyst in the breast that could be the cause of breast pain.
If a woman has a normal breast exam and pain that is cyclical in nature, a physician can reassure the patient that the pain is most likely hormonal in nature. However, if the pain persists for longer than 3-6 months or if the patient notices any masses, it is important to follow up with one's physician for an additional examination.
If a woman has noncyclical breast pain, an examination by one's physician and an imaging study is recommended. If a woman is under the age of 35, an ultrasound may be the best choice because the density of women's breasts under the age of 35 which make mammograms less useful. If she is over 35, a mammogram would be recommend. If there are any abnormalities found on the imaging studies, biopsy is recommend either by a breast surgeon or radiologist.
If the imaging studies or breast biopsies turn out normal, treatment for breast pain include wearing a well supported and fitted bra, and pain reliever medication such as ibuprofen or acetominophen. Some studies suggest that caffeine avoidance and use of vitamin E or evening primrose oil is helpful. Other studies suggest these things do not help.
It is important to discuss any breast pain or concerns with your physician.
Please look at the following link for more info:
http://www.uptodate.com/contents/patient-information-common-breast-problems?source=see_link
Wednesday, January 25, 2012
Wednesday, January 11, 2012
Placenta previa
Abnormal placenta locations during pregnancy can be a serious complication during pregnancy. Placenta previa is associated with bleeding during pregnancy and can cause significant and life threatening bleeding. There are three types of placenta previa-total, partial, or marginal. In total placenta previa, the placenta completely covers the cervical os (opening), whereas in partial placenta previa, only a portion of the cervix is covered. In a marginal placenta, the placenta does not cover the cervix but is nearby the opening and may cause bleeding during contractions.
Placenta previa occurs in about 1 in 200 pregnancies and occurrs more often in women greater than 35 years, African American women, women who have been previously pregnant, women who smoke, women who live at higher altitude, or in women with a previous cesarean section.
Approximately 5-15% of women will be diagnosed with a placenta previa at their 20 week anatomy scan. 90% of these women will have a normal placental location at term. This is due to the lower aspect of the uterus growing during pregnancy which will then cause the edge of the placenta to move farther away from the cervix.
The clinical symptoms of placenta previa are painless bleeding. This bleeding can range from spotting to hemorrhage requiring emergent surgery and delivery, although this is rare. One third of women with a previa experience bleeding before 30 weeks gestation, 1/3 experience bleeding between 30-35 weeks gestation, and 1/3 experience bleeding after 35 weeks gestation. If a women does experience bleeding, it is imperative for them to contact their physician for examination. If a women is remote from term (37 weeks), their bleeding is stabilized and they may receive a blood transfusion. If a women is at term, delivery is recommended.
Conditions associated with placenta previa that adversely affect the pregnancy include poor fetal growth, preterm contraction or rupture of membranes, abnormal presentation of the fetus (ie breech), and placenta accreta. Placenta accreta is a serious complication of pregnancy in which the placenta invades the uterus. Approximately 2/3 of women with a placenta accreta will need a hysterectomy at the time of delivery secondary to the significant bleeding associated with an accreta.
Depending on a woman's amount of bleeding due to the previa, she may be placed on activity restrictions including no heavy lifting, no intercourse, or even modified bed rest.
Placenta previa is a serious complication in pregnancy but most women can be safely managed by their obstetrician to result in a term or near term delivery.
Placenta previa occurs in about 1 in 200 pregnancies and occurrs more often in women greater than 35 years, African American women, women who have been previously pregnant, women who smoke, women who live at higher altitude, or in women with a previous cesarean section.
Approximately 5-15% of women will be diagnosed with a placenta previa at their 20 week anatomy scan. 90% of these women will have a normal placental location at term. This is due to the lower aspect of the uterus growing during pregnancy which will then cause the edge of the placenta to move farther away from the cervix.
The clinical symptoms of placenta previa are painless bleeding. This bleeding can range from spotting to hemorrhage requiring emergent surgery and delivery, although this is rare. One third of women with a previa experience bleeding before 30 weeks gestation, 1/3 experience bleeding between 30-35 weeks gestation, and 1/3 experience bleeding after 35 weeks gestation. If a women does experience bleeding, it is imperative for them to contact their physician for examination. If a women is remote from term (37 weeks), their bleeding is stabilized and they may receive a blood transfusion. If a women is at term, delivery is recommended.
Conditions associated with placenta previa that adversely affect the pregnancy include poor fetal growth, preterm contraction or rupture of membranes, abnormal presentation of the fetus (ie breech), and placenta accreta. Placenta accreta is a serious complication of pregnancy in which the placenta invades the uterus. Approximately 2/3 of women with a placenta accreta will need a hysterectomy at the time of delivery secondary to the significant bleeding associated with an accreta.
Depending on a woman's amount of bleeding due to the previa, she may be placed on activity restrictions including no heavy lifting, no intercourse, or even modified bed rest.
Placenta previa is a serious complication in pregnancy but most women can be safely managed by their obstetrician to result in a term or near term delivery.
Tuesday, January 3, 2012
Breech presentation in pregnancy
Breech presentation at term (fetus is bottom first or feet first) occurs in less than 5% of pregnancies. There are numerous causes of breech presention such as an abnormally shaped uterus (ie heart shaped), low amniotic fluid, high amniotic fluid, abnormal placenta placement, uterine fibroids, uterine scarring, fetal malformations, and decreased fetal mobility. Random chance plays a signficant factor as well.
Most fetuses settle into their final position in the uterus around 34 weeks although certainly fetuses may switch positions even at 40 weeks or beyond. If one is diagnosed with a breech fetus after 34 weeks, management options include trying to turn the fetus to cephalic or head down position, scheduling a planned cesarean section, or attempting a vaginal breech delivery.
External cephalic version is a procedure that an obstetrician will perform in the labor suite to attempt a change in the fetus's position. A fetus is monitored via fetal heart rate monitoring usually for one half hour. An ultrasound is performed to verify that adequate amniotic fluid is present. An obstetrician will then push on the fetus through the maternal abdominal wall to attempt the fetus to "somersault" into position. The success rate is variable and depends again on the factors that caused the breech position in the first place. Risks associated with the procedure are infrequent (less than 5% of the time) but including fetal heart rate deceleration, placental abruption, rupture of amniotic membranes and stillbirth. A fetus is monitored via fetal heart rate monitoring after the procedure as well.
Recent clinical trials have shown that fetuses born via cesarean delivery due to breech presentation instead of vaginal delivery tend to have decreased morbidity (illness or injury) or mortality (death). This is because when a fetus is born via vaginal delivery in the breech presentation, the umbilical cord is more likely to get compressed, thereby decreasing the blood flow to the fetus. The fetal head is also more likely to become stuck in the birth canal. Most fetuses in breech presentation that do not convert to cephalic presentation after an attempted external cephalic version are born via cesarean section.
Some women choose to have a vaginal breech delivery which may be acceptable as long as they understand the above risks and are at a hospital where obstetricians are skilled in breech deliveries. For more information, please look at the following links:
http://www.ncbi.nlm.nih.gov/pubmed?term=11052579
http://www.acog.org/~/media/F65E95C3644349F1AEFABBB8B560CBE5.ashx
Most fetuses settle into their final position in the uterus around 34 weeks although certainly fetuses may switch positions even at 40 weeks or beyond. If one is diagnosed with a breech fetus after 34 weeks, management options include trying to turn the fetus to cephalic or head down position, scheduling a planned cesarean section, or attempting a vaginal breech delivery.
External cephalic version is a procedure that an obstetrician will perform in the labor suite to attempt a change in the fetus's position. A fetus is monitored via fetal heart rate monitoring usually for one half hour. An ultrasound is performed to verify that adequate amniotic fluid is present. An obstetrician will then push on the fetus through the maternal abdominal wall to attempt the fetus to "somersault" into position. The success rate is variable and depends again on the factors that caused the breech position in the first place. Risks associated with the procedure are infrequent (less than 5% of the time) but including fetal heart rate deceleration, placental abruption, rupture of amniotic membranes and stillbirth. A fetus is monitored via fetal heart rate monitoring after the procedure as well.
Recent clinical trials have shown that fetuses born via cesarean delivery due to breech presentation instead of vaginal delivery tend to have decreased morbidity (illness or injury) or mortality (death). This is because when a fetus is born via vaginal delivery in the breech presentation, the umbilical cord is more likely to get compressed, thereby decreasing the blood flow to the fetus. The fetal head is also more likely to become stuck in the birth canal. Most fetuses in breech presentation that do not convert to cephalic presentation after an attempted external cephalic version are born via cesarean section.
Some women choose to have a vaginal breech delivery which may be acceptable as long as they understand the above risks and are at a hospital where obstetricians are skilled in breech deliveries. For more information, please look at the following links:
http://www.ncbi.nlm.nih.gov/pubmed?term=11052579
http://www.acog.org/~/media/F65E95C3644349F1AEFABBB8B560CBE5.ashx
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