Obstetrics & Gynecology Archives - Mayo Clinic News Network

Mayo Clinic expert discusses how COVID-19 vaccination during pregnancy may protect babies after birth

DeeDee Stiepan — Fri, 25 Feb 2022 14:17:55 +0000

Getting vaccinated for COVID-19 during pregnancy might protect not only the pregnant woman, but also the baby after birth. That's what a recent Center for Disease Control and Prevention (CDC) study suggests.

Data show that being vaccinated, even before pregnancy, can prevent COVID-19 hospitalizations among infants 6 months and younger.

Dr. Myra Wick, a Mayo Clinic OB-GYN, explains why the findings are significant.

Watch: Dr. Myra Wick discusses COVID-19 vaccination during pregnancy.

Journalists: Broadcast-quality video is available in the downloads at the end of the post. Please "Courtesy: Mayo Clinic News Network." Name super/CG: Myra Wick, M.D., Ph.D., Obstetrics and Gynecology.

The study looked at two groups of infants 6 months and younger who had been admitted to the hospital. One group was admitted for COVID-19 infection. The second was admitted for various other reasons.

Researchers then looked at the vaccination statuses of the mothers during pregnancy to see if being vaccinated provided some protection after delivery for the infants. The babies whose mothers were vaccinated during pregnancy were found to be protected for up to six months after birth.

How do babies gain this protection?

"When the mom is vaccinated, she produces antibodies, and these antibodies can be transferred through the cord blood to the baby and provide what we call 'passive immunization.' The antibodies transferred from the mom protect the infant against COVID infection."

Dr. Wick says one of the best examples of this, prior to COVID, is the tetanus diphtheria and acellular pertussis booster, or Tdap.

"We vaccinate all women who are pregnant with Tdap, regardless of when they were vaccinated previously," says Dr. Wick. "Mom produces an increased number of antibodies in response to the vaccination. These are transferred to the fetus and provide protection against pertussis (whooping cough)."

Why are these findings significant?

"It just gives us another reason to encourage moms to vaccinate during pregnancy. We know that moms who are pregnant and get COVID-19 are at increased risk for needing hospitalization, ICU care, ventilation, even death. And that data has been pretty well established. Those are all reasons to be vaccinated, and now knowing that there could be protection for the baby, as well, is very exciting. And seeing that protection up to six months ― that's wonderful."

Guidance for those who have not been vaccinated for COVID-19, and are pregnant or plan to become pregnant

"Vaccinate. We know that there aren't any adverse effects. There are over 185,000 women enrolled in the V-Safe Program, which is a tracking program through the CDC after COVID vaccination, who have reported that they were pregnant at the time of receiving the COVID vaccine. There haven't been any increased number of adverse events or effects in women who have received the vaccine. We also know that there aren't any issues with fertility. There aren't any issues with miscarriage associated with the vaccine."

COVID-19 vaccination during pregnancy is recommended to prevent severe illness and death in women who are pregnant. Infants are also at risk for COVID-19 associated complications, including respiratory failure and other life-threatening complications.

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Information in this post was accurate at the time of its posting. Due to the fluid nature of the COVID-19 pandemic, scientific understanding, along with guidelines and recommendations, may have changed since the original publication date.

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Women’s Wellness: Uterine fibroids are common noncancerous growths

Dana Sparks — Fri, 16 Oct 2020 16:00:00 +0000

Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.

Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. You can have a single fibroid or multiple ones. In extreme cases, multiple fibroids can expand the uterus so much that it reaches the rib cage and can add weight.

Many women have uterine fibroids sometime during their lives. But you might not know you have uterine fibroids because they often cause no symptoms. Your doctor may discover fibroids incidentally during a pelvic exam or prenatal ultrasound.

Symptoms

Many women who have fibroids don't have any symptoms. In those that do, symptoms can be influenced by the location, size and number of fibroids.

In women who have symptoms, the most common signs and symptoms of uterine fibroids include:

Heavy menstrual bleeding
Menstrual periods lasting more than a week
Pelvic pressure or pain
Frequent urination
Difficulty emptying the bladder
Constipation
Backache or leg pains

Rarely, a fibroid can cause acute pain when it outgrows its blood supply, and begins to die.

Fibroids are generally classified by their location. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus.

When to see a health care provider

See your health care provider if you have:

Pelvic pain that doesn't go away
Overly heavy, prolonged or painful periods
Spotting or bleeding between periods
Difficulty emptying your bladder
Unexplained low red blood cell count (anemia)

Seek prompt medical care if you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.

This article is written by Mayo Clinic Staff. Find more health and medical information on mayoclinic.org.

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Mayo Clinic Q and A: Pregnancy and prolapse concerns

DeeDee Stiepan — Fri, 18 Sep 2020 16:30:05 +0000

DEAR MAYO CLINIC: I am seven months pregnant with my first child. My obstetrician said I have ureterocele. He also mentioned bladder prolapse. I am not having incontinence at the moment, but I have a lot of pain and always feel like I’m on the verge of an accident. I am trying to understand the condition, how I may prevent it from worsening, and if there is any treatment.

ANSWER: Congratulations on your pregnancy. I am sure it is a very exciting and anxious time.

Pelvic organ prolapse is the general term that is applied to any relaxation of the supportive tissues around organs in the pelvis and vaginal area. The condition occurs as a result of changes to your body.

There are three areas that often are affected:

Uterus – known as uterine prolapse
Back wall of the vagina – known as rectocele
Bladder – known as cystocele

There are several factors that can increase a woman’s risk of prolapse. Pregnancy is a commonly known risk factor that predisposes women to development of prolapse, although it typically occurs after delivery. Chronic constipation and genetics can elevate a woman’s risk.

In your case, diagnosed during your first pregnancy, I would venture that the pressure from your uterus and pregnancy are contributing most of your prolapse.

While women who give birth via vaginal delivery also may have a slight increased risk, I do not think there is any reason for you to consider a cesarean section because you are experiencing symptoms of prolapse. It is likely that many of your symptoms will improve after delivery.

It is estimated that 40–50% percent of women who are postmenopausal have some degree of prolapse, although many are asymptomatic. Other women report bulging in the vaginal area, a feeling of pelvic pressure or heaviness. For some, if the prolapse is severe, they may see something hanging if the tissue has broken through the plane of the vaginal area. Pain is not usually a symptom.

Discussing prolapse may be uncomfortable, but it is important to talk with your health care provider because an accurate diagnosis can help with respect to treatment.

A visit with a specialist, such as a urogynecologist, is a great place to start. A thorough physical examination of the pelvis can confirm the relaxation of the tissues and identify the affected areas. There is usually no need for additional imaging or tests.

Treatments for prolapse vary based on the severity and the patient's wishes. If a woman does not have any discomfort, we may simply do “watchful waiting.” Unfortunately, we have no way of knowing if a woman’s prolapse will worsen over time.

The most common nonsurgical treatment is to insert a silicone rubber device called a "pessary" into the vagina. Similar to a diaphragm, a pessary sits in the vagina to essentially hold things up. It is relatively easy for a woman to put in and remove on her own.

Surgery is also an option to correct prolapse. There are various proceedures based on the severity and individual woman’s situation. More information can be found on credible resources such as Voices for PFD.

Many women inquire about physical therapy for prolapse. Pelvic floor physical therapy can provide a benefit to relieve symptoms, but it is unlikely to substantially improve the prolapse itself. As your pregnancy continues, you may want to talk to your doctor about a pessary, as that may provide you some relief until delivery. If your discomfort continues after delivery, you might consider surgery once you are done with childbearing. – Dr. John Occhino, Urogynecology, Mayo Clinic, Rochester, Minnesota

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Related Article

Mayo Clinic Q and A: Treatment for vaginal prolapse depends on severity, symptoms published 12/10/19

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Women’s Wellness: Infertility causes, tests and treatments

Dana Sparks — Thu, 15 Mar 2018 20:02:50 +0000

Infertility is defined as trying to get pregnant (with frequent intercourse) for at least a year with no success. Female infertility, male infertility or a combination of the two affects millions of couples in the United States. An estimated 10 to 18 percent of couples have trouble getting pregnant or having a successful delivery.

Infertility results from female factors about one-third of the time and male factors about one-third of the time. The cause is either unknown or a combination of male and female factors in the remaining cases.

Female infertility causes can be difficult to diagnose. There are many available treatments, which will depend on the cause of infertility. Many infertile couples will go on to conceive a child without treatment. After trying to get pregnant for two years, about 95 percent of couples successfully conceive.

Symptoms

The main symptom of infertility is the inability to get pregnant. A menstrual cycle that's too long (35 days or more), too short (less than 21 days), irregular or absent can mean that you're not ovulating. There may be no other outward signs or symptoms.

Each of these factors is essential to become pregnant:

You need to ovulate. To get pregnant, your ovaries must produce and release an egg, a process known as ovulation. Your doctor can help evaluate your menstrual cycles and confirm ovulation.
Your partner needs sperm. For most couples, this isn't a problem unless your partner has a history of illness or surgery. Your doctor can run some simple tests to evaluate the health of your partner's sperm.
You need to have regular intercourse. You need to have regular sexual intercourse during your fertile time. Your doctor can help you better understand when you're most fertile.
You need to have open fallopian tubes and a normal uterus. The egg and sperm meet in the fallopian tubes, and the embryo needs a healthy uterus in which to grow.

Watch: Female fertility animation.

Journalists: Broadcast quality video is in the downloads.

For pregnancy to occur, every step of the human reproduction process has to happen correctly. The steps in this process are:

One of the two ovaries releases a mature egg.
The egg is picked up by the fallopian tube.
Sperm swim up the cervix, through the uterus and into the fallopian tube to reach the egg for fertilization.
The fertilized egg travels down the fallopian tube to the uterus.
The fertilized egg implants and grows in the uterus.

In women, a number of factors can disrupt this process at any step. Female infertility is caused by one or more of the factors below.

Ovulation disorders

Ovulation disorders, meaning you ovulate infrequently or not at all, account for infertility in about 1 in 4 infertile couples. Problems with the regulation of reproductive hormones by the hypothalamus or the pituitary gland, or problems in the ovary, can cause ovulation disorders.

Polycystic ovary syndrome (PCOS).PCOS causes a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It's the most common cause of female infertility.
Hypothalamic dysfunction. Two hormones produced by the pituitary gland are responsible for stimulating ovulation each month — (FSH) and luteinizing hormone (LH). Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt production of these hormones and affect ovulation. Irregular or absent periods are the most common signs.
Premature ovarian failure. Also called primary ovarian insufficiency, this disorder is usually caused by an autoimmune response or by premature loss of eggs from your ovary (possibly from genetics or chemotherapy). The ovary no longer produces eggs, and it lowers estrogen production in women under the age of 40.
Too much prolactin. The pituitary gland may cause excess production of prolactin (hyperprolactinemia), which reduces estrogen production and may cause infertility. Usually related to a pituitary gland problem, this can also be caused by medications you're taking for another disease.

Female reproductive system

Damage to fallopian tubes (tubal infertility)

Damaged or blocked fallopian tubes keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:

Pelvic inflammatory disease, an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea or other sexually transmitted infections
Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy, in which a fertilized egg implants and develops in a fallopian tube instead of the uterus
Pelvic tuberculosis, a major cause of tubal infertility worldwide, although uncommon in the United States

Endometriosis

Endometriosis occurs when tissue that normally grows in the uterus implants and grows in other locations. This extra tissue growth — and the surgical removal of it — can cause scarring, which may block fallopian tubes and keep an egg and sperm from uniting.

Endometriosis can also affect the lining of the uterus, disrupting implantation of the fertilized egg. The condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.

Uterine or cervical causes

Several uterine or cervical causes can impact fertility by interfering with implantation or increasing the likelihood of a miscarriage:

Benign polyps or tumors (fibroids or myomas) are common in the uterus. Some can block fallopian tubes or interfere with implantation, affecting fertility. However, many women who have fibroids or polyps do become pregnant.
Endometriosis scarring or inflammation within the uterus can disrupt implantation.
Uterine abnormalities present from birth, such as an abnormally shaped uterus, can cause problems becoming or remaining pregnant.
Cervical stenosis, a narrowing of the cervix, can be caused by an inherited malformation or damage to the cervix.
Sometimes the cervix can't produce the best type of mucus to allow the sperm to travel through the cervix into the uterus.

Unexplained infertility

Sometimes, the cause of infertility is never found. A combination of several minor factors in both partners could cause unexplained fertility problems. Although it's frustrating to get no specific answer, this problem may correct itself with time. But, you shouldn't delay treatment for infertility.

Fertilization and implantation

Risk factors

Certain factors may put you at higher risk of infertility, including:

Age. The quality and quantity of a woman's eggs begin to decline with increasing age. In the mid-30s, the rate of follicle loss speeds, resulting in fewer and poorer quality eggs. This makes conception more difficult, and increases the risk of miscarriage.
Smoking. Besides damaging your cervix and fallopian tubes, smoking increases your risk of miscarriage and ectopic pregnancy. It's also thought to age your ovaries and deplete your eggs prematurely. Stop smoking before beginning fertility treatment.
Weight. Being overweight or significantly underweight may affect normal ovulation. Getting to a healthy body mass index (BMI) may increase the frequency of ovulation and likelihood of pregnancy.
Sexual history. Sexually transmitted infections such as chlamydia and gonorrhea can damage the fallopian tubes. Having unprotected intercourse with multiple partners increases your risk of a sexually transmitted infection that may cause fertility problems later.
Alcohol. Stick to moderate alcohol consumption of no more than one alcoholic drink per day.

Prevention

If you're a woman thinking about getting pregnant soon or in the future, you may improve your chances of having normal fertility if you:

Maintain a normal weight. Overweight and underweight women are at increased risk of ovulation disorders. If you need to lose weight, exercise moderately. Strenuous, intense exercise of more than five hours a week has been associated with decreased ovulation.
Quit smoking. Tobacco has multiple negative effects on fertility, not to mention your general health and the health of a fetus. If you smoke and are considering pregnancy, quit now.
Avoid alcohol. Heavy alcohol use may lead to decreased fertility. And any alcohol use can affect the health of a developing fetus. If you're planning to become pregnant, avoid alcohol, and don't drink alcohol while you're pregnant.
Reduce stress. Some studies have shown that couples experiencing psychological stress had poorer results with infertility treatment. If you can, find a way to reduce stress in your life before trying to become pregnant.
Limit caffeine. Research suggests that limiting caffeine intake to less than 200 milligrams a day shouldn't affect your ability to get pregnant. That's about one to two cups of 6 to 8 ounces of coffee per day.

When to see a doctor sometimes depends on your age:

Up to age 35, most doctors recommend trying to get pregnant for at least a year before testing or treatment.
If you're between 35 and 40, discuss your concerns with your doctor after six months of trying.
If you're older than 40, your doctor may want to begin testing or treatment right away.

Your doctor may also want to begin testing or treatment right away if you or your partner has known fertility problems, or if you have a history of irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, prior cancer treatment, or endometriosis.

This article is written by Mayo Clinic Staff and can be found with other health and medical information on mayoclinic.org.

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Mayo Clinic Study: Enhanced Recovery Pathway for Gynecologic Surgery Gets Patients Back To Health Faster

Kelley Luckstein — Mon, 26 Aug 2013 15:48:35 +0000

ROCHESTER, Minn. — Aug 26, 2013 — Patients who had complex gynecologic surgery managed by an enhanced recovery pathway (ERP) resulted in decreased narcotic use, earlier discharge, stable readmission rates, excellent patient satisfaction and cost savings, according to a Mayo Clinic study. The findings are published in the journal Obstetrics & Gynecology.

MULTIMEDIA ALERT: Video and audio of Dr. Dowdy are available for download on the Mayo Clinic News Network.

A team of gynecologic oncologists, urogynecologists and anesthesiologists developed an enhanced recovery pathway for patients undergoing gynecologic surgery to recover more quickly. Prior to the ERP for gynecologic surgery, patients had extensive bowel preparations, caloric restriction, received more intravenous fluids, bed rest, high rates of intravenous opioid use, and drains and catheters were used liberally. The ERP standardized postoperative management to avoid prolonged preoperative fasting and eliminated bowel cleansing. Patients are eating, drinking and ambulating shortly after surgery. In addition, drains and nasogastric tubes are not routinely used and urinary catheters are promptly removed after 24 hours. Patients receive limited IV narcotics and their fluid is restricted to avoid fluid overload.

"Patients are much happier when we are able to eliminate the use of unproven and unpleasant interventions such as bowel preparations, caloric restriction, sedating medications and the use of surgical drains," says Sean Dowdy, M.D., a Mayo Clinic gynecologic surgeon and lead study author. "We show that patients undergoing the most complex and invasive operations have the most to gain from this recovery pathway."

In a retrospective study, the researchers studied the outcomes of 241 women who followed the ERP during a six-month period and compared them to 235 women who did not follow the ERP during a nine-month period. The patients were divided into three cohorts: patients with complicated vaginal surgeries due to pelvic floor dysfunction; surgery through the abdomen for hysterectomy and lymph node dissection for ovarian or endometrial cancer; and extensive, complex surgeries for patients with ovarian cancer.

Though all three groups had dramatic improvements, the researchers found that patients who underwent surgery for ovarian cancer had the most significant improvement in recovery. These patients need extensive surgery that can last 4 to 8 hours and their average hospital stay is about 10 days. For this group, intravenous narcotic use decreased from 98.7 percent to 33.3 percent; overall narcotic use decreased by 80 percent within the first 48 hours after surgery; patients had a four-day reduction in hospital stay and cost of care was reduced 18.8 percent due to the shorter hospital stay.

"Our goal after surgery is for patients to recover as quickly as possible in order for them to return home to their families and get back to normal activities as soon as possible," Dr. Dowdy says.

The use of the ERP allows patients to have a more rapid recovery with faster return of bowel function, stable pain scores despite reduced narcotic use, excellent patient satisfaction and stable complication and readmission rates.

"There is accumulating evidence that patients who receive chemotherapy sooner rather than later for example, patients with ovarian cancer, have improved outcomes," Dr. Dowdy says. "Thus, the quicker recovery made possible by this pathway may allow patients to receive other recommended therapies, such as chemotherapy, sooner." The researchers conclude that the enhanced recovery pathway substantially improves the outcome and the quality of care for patients undergoing complex and extensive gynecologic surgeries.

Other study co-authors are Eleftheria Kalogera, M.D.; Jamie Bakkum-Gamez, M.D.; Christopher Jankowski, M.D.; Emanuel Trabuco, M.D.; Jenna Lovely; Pamela Grubbs; Amy Weaver; Lindsey Haas; Bijan Borah, Ph.D.; April Bursiek; Michael Walsh, M.D.; and William Cliby, M.D., all of Mayo Clinic.

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About Mayo Clinic
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MEDIA CONTACT:
Kelley Luckstein, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

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In Vitro Fertilization

Mon, 29 Oct 2012 18:03:01 +0000

Dr. Dean Morbeck and Dr. Jani Jensen joined us to talk about In Vitro Fertilization. How and why is IVF carried out? What are the drawbacks of IVF?

Click here for Full Medical edge Radio show - 11/3/12 44min - mp3

We also spoke with Co-Director of the Mayo Nicotine Dependence Center, Dr. Richard Hurt about second hand smoke. Since 2007 when "The Freedom to Breathe Act" was passed in Minnesota, there has been a 33% decrease in heart attacks in Olmsted County! If you would like help to quit smoking, call 800-Quit-Now or 507-266-1930.

You can listen to our show on I Heart Radio on our flagship station KROC AM.

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