Newer ultrasounds are now available that show a three- dimensional view of the fetus. This is similar in clarity to a photograph and can be useful in detecting birth defects when performed in a medical center. Some facilities are providing this scan at the parents request without a specific medical indication. A moving picture interpretation is referred to as a 4-D ultrasound.

We recommend that this ultrasound be scheduled anywhere between 28- 32 weeks. Keep in mind this is not a covered benefit.

Preterm labor is the start of labor between 20 and 37 weeks of pregnancy. A full-term pregnancy lasts 37 to 42 weeks. In labor, the uterus contracts to open the cervix. This is the first stage of childbirth. Preterm labor is also called premature labor.

If you are in preterm labor, your doctor must weigh the risks of early delivery against the risks of waiting to deliver. Depending on your situation, your doctor may:

The placenta is the organ created during pregnancy to nourish the fetus, remove its waste, and produce hormones to sustain the pregnancy. The placenta is attached to the wall of the uterus by blood vessels that supply the fetus with oxygen and nutrition, and which remove waste from the fetus and transfer it to the mother. The placenta is usually attached to the upper part of the uterus, away from the cervix, the opening which the baby passes through during delivery. On rare occasions, the placenta lies low in the uterus, partly or completely blocking the cervix -- called a placenta previa Placenta previa is classified according to the placement of the placenta:

Pregnancy-induced hypertension (PIH) is a form of high blood pressure in pregnancy. It occurs in about 5 percent to 8 percent of all pregnancies. Another type of high blood pressure is chronic hypertension - high blood pressure that is present before pregnancy begins. Usually, there are three primary characteristics of this condition, including the following: · high blood pressure (a blood pressure reading higher than 140/90 mm Hg, or a significant increase in one or both pressures) · protein in the urine · edema (swelling Recurrent Miscarriage Miscarriage is defined as the loss of a pregnancy before 20 weeks of gestation. Nearly 20% of pregnancies end in miscarriage, most often within the first 12 weeks. Recurrent miscarriage, or habitual pregnancy loss, is defined as three or more consecutive, spontaneous pregnancy losses Often no cause for miscarriages is found but possible causes include genetic defect, abnormally shaped uterus, uterine fibroids, scar tissue, hormonal imbalances and illness such as diabetes. Increased age, habits such as smoking, caffeine and alcohol, and the use of certain medications increase a woman's risk for miscarriage.

Cord blood is the blood that remains in your newborn's umbilical cord after the cord has been cut. Doctors have identified that cord blood, like bone marrow, is a rich source of stem cells, which can be used in medical treatments. A variety of cell types exist in cord blood including hematopoietic stem cells (HSC), mesenchymal stem cells (MSC) and embryonic-like stem cells (ESC). Cord blood is routinely discarded after birth, but a process known as cord blood banking allows families to save this valuable resource for potential future medical use.

The collection process is easy and painless, and does not interfere with the delivery or subsequent care for your newborn or yourself. After your baby is born, but before the placenta is delivered, your obstetrician cleans a 4-to 8-inch area of umbilical cord with antiseptic solution and inserts the blood bag needle into the umbilical vein draining the cord of the blood by gravity. The blood bag is clamped, sealed and labeled. The collection typically takes 3-minutes. Additionally there are three tubes of blood drawn from the mother that will be used for diagnostic testing required by law CBR link

Dysfunctional uterine bleeding is irregular vaginal bleeding that is not caused by a serious medical problem, such as miscarriage or cancer. In most cases, dysfunctional uterine bleeding is related to changes in hormone levels. Dysfunctional uterine bleeding is:

Treatment options include:

Women with dysfunctional uterine bleeding should be examined for other causes of symptoms and tested for anemia (low red blood cell count).

Endometrial ablation is the removal or destruction of the endometrium (lining of the uterus). It does not require hospitalization, and most women return to normal activities in a day or two. Ablation is an alternative to hysterectomy for many women with heavy uterine bleeding who wish to avoid major surgery. After a successful endometrial ablation, most women will have little or no menstrual bleeding. Patient selection and physician experience is essential to a good outcome. (Links to her option and therma choice)

Many women experience abnormal vaginal bleeding or spotting between periods sometime in their lives. Vaginal bleeding is considered to be abnormal if it occurs:

Treatments

The neurostimulator is placed in the upper buttock

Neurostimulation was FDA-approved in 1997 for urge incontinence and in 1999 for urinary retention and significant symptoms of urgency-frequency

Neurostimulation is a reversible treatment that can be discontinued at any time by turning off or removing the device. It sends mild electrical pulses to the sacral nerves.

Located near the tailbone, the sacral nerves control the bladder and the muscles related to urinary function. If the brain and sacral nerves don’t communicate correctly, the nerves can’t tell the bladder to function properly. This communication problem can lead to symptoms of overactive bladder. Neurostimulation targets these symptoms by stimulating the sacral nerves with mild electrical pulses.

Neurostimulation may help you resume normal activities, and help you avoid frustrating experiences associated with overactive bladder. (Medtronic link)

Hormone Imbalance Hormones! From PMS to menopause, these messengers of womanhood can affect your mood, your weight, your food cravings - even your desire for sex. For many women, it's smooth sailing, but for others, it's a shipwreck at every turn of the hormonal bend

-Bioidentical hormones

Sexual desire is a normal and natural feeling for women and men. However, sexual desire can change over time, and can increase or decrease depending on the situation... To understand changes in sex drive, which is called libido in medical terminology, one must understand that every person, and every couple, has a different level of desire. Sexual desire often changes in response to outside forces, like stress. Plus, libido can decrease with certain medical conditions and by many medications.

Localized estrogen therapy. Placing estrogen directly into the vagina soothes vaginal tissue, and allows the secretions necessary for comfortable sex and possibly even an increase in sexual desire.

Compounded testosterone cream. Many compounding pharmacies offer testosterone creams and gels, but you'll need a doctor's prescription.

Vitamin E. When used locally in the vagina it can help rehydrate tissue and may possibly increase sensation. No need for a prescription here.

Troubling physical and emotional symptoms that occur between the time of ovulation and the first days of the menstrual period are called premenstrual symptoms. Premenstrual symptoms that interfere with relationships or responsibilities are called premenstrual syndrome (PMS).

PMS has a wide variety of physical, emotional, and behavioral symptoms that vary greatly from woman to woman and from cycle to cycle. Symptoms may range from mild to severe. The most common physical symptoms of PMS are water retention, breast tenderness, and weight gain. Common emotional and behavioral symptoms include depression, irritability, and mood swings.

While there is no cure for PMS, many women can improve their symptoms by getting regular exercise, eating a healthy diet, limiting alcohol and caffeine intake, and reducing stress. Nonprescription pain relievers can help reduce some symptoms. Prescription medications may be necessary for women who have severe PMS that significantly interferes with their lives on a regular basis.

Premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome (PMS), causes physical and mood-related symptoms that seriously disrupt a woman's life and relationships. PMDD symptoms develop during the latter half of each menstrual cycle, after ovulation, and go away during the first few days of each menstrual period.

PMDD symptoms are related to hormone changes during the menstrual cycle. Emotional symptoms include feelings of sadness, hopelessness, anxiety, irritability and sensitivity, anger, being overwhelmed, and the need to withdraw from others. Physical and behavioral symptoms include lack of energy, problems with concentrating, sleep problems, food cravings or binge eating, breast tenderness, bloating and weight gain, headaches, and joint or muscle pain.

Women diagnosed with PMDD are typically encouraged to use healthy lifestyle choices and prescription medication to manage their symptoms.

Sexually transmitted diseases, commonly called STDs, are diseases that are spread by having sex with someone who has an STD. You can get a sexually transmitted disease from sexual activity that involves the mouth, anus, vagina, or penis. Sexual conditions, such as STDs and sexual problems, need a medical evaluation and treatment. Frequently, there are no STD symptoms, although there’s sometimes a discharge from the vagina or the penis and burning or pain during urination. Doctors use STD tests to diagnose sexually transmitted diseases such as Chlamydia, gonorrhea, syphilis, and trichomoniasis. Whereas STD treatment can help resolve these sexual conditions, practicing safe sex can prevent STDs.

There are many STDs out there, and the types of STD treatment are as varied as their symptoms. Remember, however, if you are diagnosed with an STD, that the only person who can tell you the appropriate STD treatment is your healthcare provider. Treatment is decided on between you and your doctor on an individual basis in order to adjust for any other issues that may be affecting your overall physical health.

HPV vaccines protect against a very common sexually transmitted virus called HPV or human papillomavirus. HPV infects at least 80% of sexually active people at some point in their lives. The virus often clears on its own. If it persists, it can lead to cervical and other cancers and to genital warts.

One HPV vaccine, Gardasil, was licensed for use by the FDA in 2006. In September 2008, the FDA announced it may also be used to prevent some cancers of the vulva and vagina when given to females aged 9-26. (Gardasil link)

Birth control is any method used to prevent pregnancy. There are many different methods of birth control including condoms, IUDs, birth control pills, the rhythm method, surgical sterilization, and tubal ligation.

Essure is a new form of permanent sterilization for women that can be performed without general anesthesia (being put to sleep).

Essure is a tiny birth control device that looks like a spring. Doctors use a thin tube to thread an Essure device through the vagina, into the uterus, and then into the fallopian tubes. Thus, each woman receives two Essure devices to achieve sterilization.

A mesh-like substance that's embedded in the Essure device irritates the lining of the fallopian tubes, causing scarring that over time permanently blocks the tube. (Essure link)

Osteoporosis is a common disease that weakens bones. As it does, your risk of sudden and unexpected fractures goes up. Osteopenia is the forerunner of osteoporosis. It is a silent but destructive condition that robs bones during a woman's -- even a young woman's -- most productive time.

No matter what your age or sex, osteoporosis and osteopenia can affect you. Your bones might seem sturdy now. You may be very active and doing the things you want to do. But osteoporosis and osteopenia are quiet, accomplished thieves. In fact, there are usually no visible signs. You may notice a loss of height or a Dowager's hump over time. But chances are good the first sign that you have one of these conditions will be a painful fracture.

Osteoporosis treatments include the “basic CDE’s” -- calcium(C), vitamin D (D), weight-bearing exercise (E), prevention of Falls (F), and bone-friendly medicines.

Since the mid- 1990’s, techniques based around placing the sample into a vial containing a liquid medium which preserves the cells have been increasingly used. The media are primarily ethanol based. Two of the types are Sure-Path(TriPath Imaging) and Thin- Prep (Cytic Corp). Once placed into a vial, the sample is processed at the laboratory into a cell thin-layer, stained, and examined by a light microscopy. The liquid sample has the advantage of being suitable for low and high risk HPV testing and reduced unsatisfactory specimens. Proper sample acquisition is crucial to the accuracy of the test; clearly, a cell that is not in sample cannot be evaluated.

Cervical Cryotherapy

Colposcopy is a procedure that gives your healthcare provider a magnified view of the cervix. It is done using a lighted microscope called a colposcope. In most cases, a sample of cervical cells is taken during a biopsy. The sample can then be studied in a lab. If any problems are found, you and your healthcare provider will discuss treatment options. Problems with the cervix can be best when detected early.

The loop electrosurgical excision procedure (LEEP) uses a thin, low-voltage electrified wire loop to cut out abnormal tissue. LEEP can:

-Cut away abnormal cervical tissue that can be seen during colposcopy.
-Remove abnormal tissue high in the cervical canal that cannot be seen during colposcopy. In this situation, LEEP may be done instead of a cone biopsy. (For more information, see cone biopsy.)

LEEP is also known as large loop excision of the transformation zone (LLETZ).

A vinegar (acetic acid) or iodine solution, which makes abnormal cells more visible, may be applied to the cervix before the procedure is done.

Prolapse (or falling) of any pelvic floor organ (vagina, uterus, bladder, or rectum) occurs when the connective tissues or muscles within the body cavity are weak and unable to hold the pelvis in its natural orientation. The weakening of connective tissues accelerates with age, after child birth, with weight gain and strenuous physical labor. Women experiencing pelvic organ prolapsed typically have problems with urinary incontinence, vaginal ulceration, sexual dysfunction and/or having a bowel movement.

Anterior Repair (colporrhaphy)

This procedure is used to treat prolapse of the bladder (cystocele), urethra (urethrocele) or both the bladder and urethra (cystourethrocele).

The operation is done through the vagina and you will be given a general anaesthetic. It involves making a cut in the front (anterior) wall of the vagina so the bladder and/or urethra can be pushed back into place. Once this is done, the surgeon stitches together existing tissues to provide a new support for the bladder and urethra. A small portion of the vaginal wall is removed to give the vagina more strength.

The main complications of anterior repair are painful sex (dyspareunia) and incontinence. Your surgeon may be able to reduce the risk of painful sex by making sure the vagina is not narrowed too much or pulled out of place during the repair. Incontinence can usually be prevented when diagnosed before surgery (see Before Surgery, above).

Posterior Repair (colporrhaphy/colpoperineorraphy)

Posterior repair is used to treat prolapse of the rectum (rectocele) and small bowel (enterocele). The operation is done through the vagina and you will be given a general anaesthetic. The procedure is similar to an anterior repair (above) but the doctor may first make a small cut from the base of the vagina towards the anus (similar to an episiotomy during childbirth). This makes it easier for the repair to be done. A cut is then made in the back (posterior) wall of the vagina and the rectum and/or small bowel is pushed back into place. The doctor stitches together the existing tissues to create a new support for the prolapsed organ(s) and then removes some of the tissue from the vaginal wall to make it stronger. If a cut was made at the base of your vagina, it will also be stitched back together.

Suspending the Uterus

Treatments that suspend rather than remove the uterus are recommended for women who want to keep their uterus or have children in the future. Procedures can be done either vaginally or abdominally, and there is some evidence to suggest that abdominal repairs tend to have better long-term results.

It’s a simple ultrasound procedure that may be used to evaluate the endometrium. The technique involves placement of a catheter into the endometrial canal with subsequent instillation of sterile saline under US guidance. The sonohysterogram is completed after menstruation has ended and before ovulation occurs. The timing of the procedure allows for optimal viewing of the uterine walls, since they are at their thinnest at this point in a woman’s cycle.