Posts Tagged ‘Pregnancy’

Chemotherapy safe in pregnancy! العلاج الكيميائي أثناء الحمل لا يؤثر على الجنين

Posted: February 20, 2012 in Health, عربي
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This post is about a recent study released online on Feb. 10th 2012 in The Lancet Oncology as an early publication.  In brief the study assessed “children who were prenatally exposed to maternal cancer staging and treatment, including chemotherapy.” They examined 68 pregnancies who were exposed to 236 cycles of different kinds of chemotherapies. 70 children were assessed at age 18 months, 5—6, 8—9, 11—12, 14—15, and 18 years. Assessment included examining neurological and cognitive functioning or IQ, heart functioning, general health and development, hearing, memory, attention and behaviour.

The study concluded that “fetal exposure to chemotherapy was not associated with increased CNS, cardiac or auditory morbidity, or with impairments to general health and growth compared with the general population.”

The importance of this study lies in providing a perspective on long-term outcomes of newborns after exposure to chemotherapy during pregnancy. With such reassuring findings, we should consider avoiding early deliveries that subjects those newborns to risks of prematurity.

It is important to realize that not all chemotherapies are safe and the ones included in this study are those that are know to be tolerated during pregnancy.

Below is an Arabic version:

أثبتت دراسة أوروبية حديثة أن إخضاع السيدة الحامل للعلاج الكيميائي لا يؤثر على صحة الجنين، خاصة إذا حدث ذلك في الفترة الممتدة ما بين الشهر الرابع والسادس من الحمل.حيث قام أخصائيون أوروبيون تابعون لـLeuven Catholic University في علاج السرطان بمراجعة حالة 68 سيدة حامل أنجبن 70 طفلا بعد أن خضعن لعلاج الكيميائي ضد السرطان، وفحصوا صحة الأطفال عند مولدهم كما عند بلوغهم 18 شهرا، ثم بعد ذلك عند بلوغهم سن الخامسة وحتى بلوغهم 18 عاما.وقد شمل الفحص الحالة الصحية العامة للأطفال، كما تم تفحص ما إذا كان لديهم قصور في الجهاز العصبي المركزي أو القلب أو السمع وتم اختبار مهاراتهم المعرفية والعقلية كذلك.

وقد تبين للباحثين عدم وجود أي دليل على تضرر صحة الأطفال من جراء العلاج الكيميائي الذي خضعت له والداتهن أثناء الحمل بهم، إلا أن الأطفال الذين ولدوا قبل الميعاد الطبيعي أظهروا مهارات معرفية أقل من الباقين، ولكن هذه مشكلة عادة ما تصيب كل الأطفال الذين يولدون قبل الميعاد، حتى دون تعرضهم لعلاج كيميائي.

وقد أوصت الدراسة بعدم القلق في إخضاع الأم الحامل للعلاج الكيميائي، ونصحت الأطباء بألا يحثوا المرأة الحامل المصابة بالسرطان بالولادة قبل ميعادها لإخضاعها لاحقاً للعلاج.

وأشارت الدراسة إلى أنه “يمكن إخضاع السيدة الحامل للعلاج الكيميائي بدءاً من الأسبوع الرابع عشر من الحمل، ولكن كي يستعيد النخاع العظمي قوته ولتقليل مخاطر تسمم الأم والجنين أو حدوث نزيف يجب أن يتم التخطيط للولادة على الأقل بعد ثلاثة أسابيع من آخر جرعة كيماوية تعطى للحامل، كما يجب أن تتوقف الجرعات عند الأسبوع الـ35 وذلك تلافيا لحدوث ولادة تلقائية في ذلك الوقت”.

ولكن يقر فريق الباحثين بوجود حاجة لعمل المزيد من الدراسات لمعرفة ما إذا كان للعلاج الكيميائي تأثير على هؤلاء الأولاد في الأمد البعيد. المصدر

من المهم أن نتذكر أن هذا الحديث لا ينطبق على كل علاج كيميائي انما على بعض الأدوية التي كنا نعتقد أنها أمنة، فتأتي هذه الدراسة الآن لتؤكد ذلك.

Abortion safer than delivery!

Posted: February 10, 2012 in Health, Human Rights
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A new study by Dr. Elizabeth Raynmond and Dr. David Grimes published in the Green Journal (Obstetrics & Gynecology) in Feb. 2012 concluded that:

Legal induced abortion is markedly safer than childbirth. The risk of death associated with childbirth is approximately 14 times higher than that with abortion. Similarly, the overall morbidity associated with childbirth exceeds that with abortion.

This sounds common sense to an Obstetrician & Gynecologist regardless of their political or moral position on abortion. Now, we have it in print. In the golden era of evidence based medicine, this piece of common sense information is now supported by evidence.

Raymond & Grimes reviewed data from the CDC’s Pregnancy Mortality Surveillance System, birth certificates and Guttmacher Institute surveys to estimate mortality rates associated with live births and legal induced abortions in USA from 1998 to 2005. They also searched population-based data comparing the morbidity of abortion and childbirth.

Here are the figures they found:

  • With delivery, 8.8 womyn died per 100,000 live births
  • With legal abortion, only 0.6 womyn died per 100,000 live births

Legal abortion has been found to be safe in multiple studies. Allegations that abortion can lead to breast cancer or mental illness have been refuted.

It is true that abortion might be regretted, but so could delivery of an unwanted pregnancy. It is true that depression can be diagnosed after an abortion, but it can more so be diagnosed after a delivery.

I am not pro-choice. I am not pro-life. Actually those two terms are relatively new to me. Having studied medicine in Lebanon, the issue of abortion does not even come up in the curriculum, not even in residency training. Apparently, unwanted pregnancies do not occur in Lebanon; neither does pre-marital sex! Rape and incest in some magical way do not get womyn pregnant in the Sin City of the Middle East. Abortion is illegal in Lebanon. A woman can spend up to 5 years in prison for getting one. Abortions are being performed in Lebanon. It costs 500 to 2000 USD per abortion in a country where minimum wage is 448 USD. RU486 or mefiprostone is illegal in Lebanon but can still be found in Black Market. Read more about Lebanon’s abortion question.

After 4 years in USA, I learned all about the choice vs. life controversy. I still could not identify with either. When asked, I say I am pro-patient. As a physician, I can not and should not impose my set of moral rules on my patients. Regardless of what my personal feelings about abortion are, I am obliged to provide my patients with facts. I owe it to them. The facts as I know it stated simple and clear: Abortion is not riskier than continuing with an unwanted pregnancy, it actually appears to be safer.

So the controversy is political and not medical. I did not spend 13 years of my life studying as much as I did to allow politics to influence my medical decisions. Patient’s safety and well being should remain the focus of any health advocate. There are more serious risks to which womyn are exposed and to which governments pay less attention. Poverty should be illegal, it is a great health risk. Smoking claims 3.1 million deaths over 7-years in USA (Pregnancy claims 2856 and abortion 64 deaths).

Dr. Mitchell Creinin stated in an editorial for the Green Journal this month that:

Abortion is safer than delivery. Regardless of personal views, every woman deserves factual medical information whenever she is faced with a decision of whether or not to terminate her pregnancy. Government should be concerned about important issues that create public health hazards. With pregnancy and abortion, more laws are promoted to limit access to a safe procedure when the alternative  is riskier.

The ethical controversy will continue. We will always agree to disagree. In the meantime facts should be provided to womyn to empower them in making well-informed decisions.

Blood clot prevention now recommended for all Cesarean deliveries.

Posted: August 25, 2011 in Health
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On Aug. 22 2011, the American College of Obstetricians and Gynecologists (The College) announced new recommendations to prevent blood clots during Cesarean Deliveries.

"Wearing the Inside Out ..." by Lebanese graphic designer Rasha Rahal

The new guidelines will be published in Sept. 2011 issue of the Green Journal. Blood clots, medically known as venous thromboembolic events (VTEs), are a leading cause of maternal mortality in USA and Canada. The College now recommends that all women having a cesarean delivery receive preventive intervention at the time of delivery. The most cost effective method would be sequential compressive devices (SCDs) to be placed on the lower extremities of a patient before a Cesarean and removed after surgery only when adequate ambulation is attained.

The risk of developing blood clots is increased four folds during pregnancy and two folds during and after a Cesarean delivery. Blood clots can block blood flow and cause damage to certain organs. The most common site of a blood clot in a pregnant patient is the left lower leg but other sites are commonly affected. Symptoms include swelling and pain in affected limb. If a clot gets dislodged, it can travel to the lungs causing a life-threatening condition known as pulmonary embolism (PE). Symptoms include sudden shortness of breath, chest pain, and coughing.

The recommendations explain how to monitor women for these events, address certain risk factors, and treat suspected or acute cases of VTE. “It’s important for ob-gyns to adopt these recommendations to help reduce maternal deaths.” said Dr. Andra H. James who helped develop the guidelines.

The Society of Obstetricians and Gynecologists of Canada (SOGC) has no clear recommendations on using VTE prevention during a Cesarean delivery for patients who are at low risk. Regardless of the plethora of new research on this topic, the SOGC guidelines were last updated in 2000. (See Prevention and Treatment of Venous Thromboembolism (VTE) in Obstetrics).

If you or someone you know are undergoing a Cesarean delivery ask the doctor about methods of VTE prevention she/he are implementing.

Should drinking during pregnancy be punishable by law?

Posted: January 13, 2011 in Health
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If a patient admits to drinking while pregnant, shall her doctor report this to authorities? Shall the hospital lock the patient until she is handed in to police? Shall her newborn be taken away by child protective services?

Photo from The Guardian's article: Light drinking during pregnancy 'does children no harm' on Oct. 6, 2010

If you were her health care provider, what would you do? Would you:

  1. Admit her (involuntarily) to the hospital
  2. Call the police or child protective services/ social workers
  3. Admit her (involuntarily) to a mental health facility
  4. Force her to undergo rehab
  5. Counseling her about risks and let her go?

 

What are your thoughts ? Share your comments below.

In the USA, fifteen states consider substance abuse during pregnancy to be child abuse under civil child-abuse statutes, and three states consider it grounds for involuntary commitment to a mental health or substance abuse treatment facility.

Canada promotes alcohol-free pregnancy but has no law against consuming alcohol while pregnant. In 2005, Bill 43 (Sandy’s Law) came into effect in Ontario requiring warning signs where alcohol is served or sold. It is worth noting that in the Criminal Code of Canada” a fetus is not a person” and thus has no protective rights until delivered.

In the UK, the Department of health warns that pregnant womyn “should avoid alcohol altogether, never more than 1 -2 units once or twice a week”

In a recent press release by ACOG, the American College of Obstetricians and Gynecologists urges health care providers to “Help Retract Punitive State Legislation”. In Committee Opinion #473, “Substance Abuse Reporting in Pregnancy,” published in the January 2011 issue of Obstetrics & Gynecology, ACOG states:

Drug enforcement policies that deter women from seeking prenatal care are contrary to the welfare of the mother and fetus. Incarceration and the threat of incarceration have proved to be ineffective in reducing the incidence of alcohol or drug abuse… They are encouraged to work with state legislators to retract legislation that punishes women for substance abuse during pregnancy.

The argument is not whether a woman has the right to drink or use drugs while pregnant, whether drug or alcohol use cause harm to the woman and her fetus. The question is: are we improving the health outcome of this pregnancy by enforcing such laws? There is no evidence to support that. Based on the most recent evidence, we now know that placing a pregnant womyn with substance abuse in jail or mental institution against their will is futile.

What do you think? Is alcohol use by pregnant womyn a form of child neglect that needs punishment or an addiction that needs medical attention? Do pregnant womyn with addictions need medical help or incarceration? What is safer for the fetus and pregnancy? Who decides how much alcohol during pregnancy is too much?

Medical literature is unclear on this issue. In August 2010, the Journal of Obstetrics and Gynaecology Canada (JOGC) published ”Alcohol use and Pregnancy Consensus Clinical Guidelines” that states:

There is insufficient evidence regarding fetal safety or harm at low levels of alcohol consumption in pregnancy. There is insufficient evidence to define any threshold for low-level drinking in pregnancy.

In the light of these guidelines, shall alcohol drinking during pregnancy be a personal well-informed choice or shall it be the responsibility of our authoritarian governments to punish competent womyn who after adequate counseling still choose to drink during pregnancy?

To heat up the debate, a 2009 study from the UK found that light drinking during pregnancy did not cause any harm in babies, on the contrary, boys born to mothers who drank lightly during pregnancy were “better behaved and score more highly in tests at the age of three” than the sons of womyn who abstained. This study was recently featured in The Guardian.

Pregnancy checklist: (√) Baby shower. (√) Ultrasound photo. (√) Flu Vaccine!?

Posted: October 27, 2010 in Health
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I just got my Flu Shot today. You should too, especially if pregnant.

It is NOT “just the flu”. When you are pregnant influenza virus can have serious implications on your health and the health of your baby. The best treatment is prevention.

If you are pregnant or recently delivered a baby, I strongly advise you to get vaccinated against seasonal influenza.

The flu vaccine was proven to be safe and effective. It has been given to millions of pregnant women over the past decade and has NOT been shown to cause serious harm to women or their babies.

As an added bonus, vaccination during pregnancy will pass on immunity, protecting your baby until she/he is old enough to receive her/his own vaccinations. Remember, your newborn baby can not receive the flu vaccine before she/he is 6 months old.

You can receive the flu vaccine in any trimester and after you deliver even if you are breast feeding.

You should NOT receive the vaccine if you are sick with a fever or if you are allergic to eggs.

If your care provider does not offer the vaccine, make sure she or he refers you to someone who does.

I understand you took it last year. You do need it again:

Influenza virus has many types. Each year the flu vaccine is designed to prevent the most commonly circulating types. The vaccine changes every year. So even if you received the vaccine last year, you still need to be vaccinated with this year’s vaccine for best protection.

DO NOT take the nasal spray vaccine during pregnancy:

There are two forms of the vaccine. One is given as a shot in your muscles (flu shot: contains inactivated virus) and the other as spray in your nose (nasal spray: contains live virus). After you deliver either form of the vaccine is appropriate.

5 Reasons why you should receive the vaccine:

  1. To protect yourself. Influenza is more likely to cause severe illness, even death, when you are pregnant as compared to when you are not.
  2. To decrease your chances of having preterm labor or delivering a premature baby if you catch the flu
  3. To offer protection to your new born baby during the first 6 months of her/his life. During this period, your newborn baby is 10 times more likely to be hospitalized if she/he catches the flu.
  4. Severe illness in postpartum women was also documented. Last year’s H1N1 (Swine flu) is expected to circulate this influenza season so it is included in the seasonal trivalent influenza vaccine this year.
  5. By not catching the flu you help avoid communicating the infection to other people and family around you

 

“But isn’t it controversial?”

No, it is not controversial. It is strongly recommended by all of the following medical organizations in a joint statement released on Sept. 15th 2010:

 

“Wanna learn more?” Click here for free patient education resources by CDC.

Have a safe, flu-free pregnancy.