“Please be aware that are office visit cancellation policy has changed. Effective immediately, there will be a $50 cancellation fee for any appointment that is canceled less than 24 hours or if you do not show up for your appointment.”

Postpartum Care: Taking “You” Home from the Hospital

Posted on Tuesday, September 27th, 2022 at 12:15 am    

The big moment is finally here! You have waited nine months (by the way, it’s actually 10 months) for this big event! Your baby is about to enter the world. You have prepared diligently and meticulously for this exact moment. And, then it happens. The baby is here!

You’re ready to slay this thing called motherhood. Once your home, you start cramping. “Wait. Is that normal?” you think. Your significant other asks you if you want ketchup for your fries and you burst into tears. Is this normal?

“Is this normal?” is probably one of the most frequently asked questions by both new moms and seasoned moms alike. Women spend countless hours preparing to bring home the baby, but what about preparing for YOU? It is just as important to prepare for YOUR arrival home. In this 3-part series, we are going to focus on Postpartum Care for mom. That’s right! This is your ultimate guide to Bringing YOU Home. In today’s discussion, we are going to talk about what’s normal. But first, let’s talk about what the postpartum period is.

What is the Postpartum Period?

The postpartum period is defined as the time from delivery of the infant to the first six to eight weeks afterwards. Just as your body experienced all these miraculous changes during your pregnancy, your body will continue to go through changes after delivery in order to get back to its normal state; or more likely its “new” normal state. Remember, your body is recovering from 10 months of growing and nurturing another human being; not to mention the stress of that Iron Man triathlon you just completed, otherwise known as delivering a baby. So, this is an important time that you should be ready for.

So, what is normal?

This topic here could take up one of those ginormous 1000-page college textbooks you use to have. But let’s try to briefly summarize this.

  • Cramping – Your uterus is a muscle. When the baby is full term, your uterus is about the size of a watermelon. After the baby is delivered, your uterus shrinks by approximately 50%. Even after its initial downsizing, it still has a long way to go before it is back to its normal size – around the size of a pear. Part of that shrinking process involves cramping. This can be normal for the first couple of weeks.

Typically, acetaminophen (Tylenol) and/or ibuprofen (Motrin), which are both available over-the -counter, can help. Be sure to check your discharge instructions from the hospital to see what your doctor recommends. A heating pad can also be soothing.

What to consider having at home: Acetaminophen, ibuprofen, a heating pad.

  • Bleeding – The blood and discharge expelled from the uterus after delivery is called lochia. In the first 24 hours after delivery, the lochia may be heavier than a period. After that, the bleeding will gradually decrease to a flow similar to a period, then to spotting, and finally it will stop. This process can take anywhere from two to six weeks. Be sure to have both pads and panty liners at home to use. Avoid using tampons during this time.

What to have at home: Maxi pads and panty liners

  • Emotional Changes – A wide range of emotions can occur after having a baby. Of course, there can be plenty of bliss and joy, but there are many other emotions women experience such as anxiety, exhaustion, and frustration. Feeling overwhelmed in general or irritated by unsolicited advice from EVERYONE can also be normal emotions for moms. Typically, these changes in emotions can start around two to three days after delivery but last no longer than two weeks.

Why does this happen? After delivery, there is a sudden withdraw of the increased levels of hormones that were circulating in your body to support the pregnancy. With this withdraw, many women experience changes in emotions. All these things can be a part of what is called the “Baby Blues”. According to the March of Dimes, up to 80% of women can experience the “Baby Blues” after delivery.

If your symptoms are not getting better after two weeks OR your symptoms are getting worse, PLEASE speak with your provider. Sometimes there can be something more, such as Postpartum Depression. More on this in Part 3 of this series.

What to have at home:A support network, be it friends or family, that can lend a helping hand when needed. It is even better if they are also willing to give you a little space when needed but are honest enough to speak up if there is a concern. If there are certain ways you want things done, let them know that in advance BEFORE you and baby come home.

  • Breast changes – Whether you breastfeed, bottle feed, or a little bit of both, your breasts will go through changes.
  • If you are breastfeeding, you may get discomfort as your milk comes in and when your breasts get engorged. A nice warm shower can help to ease this discomfort. If you are engorged, breastfeeding your baby or pumping your breasts can help.

Nipple discomfort is also something women can face. Things that you can do for nipple discomfort are applying lanolin cream and cool compresses to the nipple. They sell creams and nipple cooling pads at your local store, or they are available online. You can also use a soaked tea bag that you put in the refrigerator. Another helpful tip that is quick and easy is expressing some of the milk after nursing, rubbing the milk into the nipple, and allowing the nipple to air dry.  Finally, avoid using soap on the nipple as this can be drying. If it is not getting better after a week, you may want to speak with a lactation consultant to help you with the baby latching on.

What to have at home: Lanolin cream, nipple cooling pads, nursing bra

  • If you are bottle feeding, you can still get some breast discomfort. If your mom or grandmother tells you to bind your breasts, DON’T DO IT. Back in the day, that was a recommendation, but times have changed. Instead, experts recommend that you simply wear a good supporting bra. Cool compresses can also be comforting. Heat is not recommended as this stimulates the milk and that defeats the purpose if you don’t want to breastfeed.

What to have at home: Good supporting bra, ice pack

Other normal changes:

  • Swelling of the hands and feet – Your body is starting to mobilize and get rid of the fluid it retained during pregnancy. Elevating your feet can help with this. If more support is needed, you can purchase compression stockings at your local pharmacy or online.
  • Pain in the vaginal area – Even if you don’t have any tears, you can still get pain in the vaginal area. Ice packs to that area or cold maxi pads can help to relieve some of the discomfort. They do sell ice pack pads as well. Perineal bottles, which are often given to you at the hospital, can help flush water over the perineum – the area between the vagina and rectum – during and after urination, as urinating can be irritating. There are also numbing sprays with benzocaine in them, such as Dermoplast, that are available over-the-counter.
  • Hemorrhoids  – Having hemorrhoid cream and witch hazel wipes, such as Tucks wipes, is always good to have on hand.
  • Hair loss – It is normal to have thicker hair DURING pregnancy, but it is also normal to lose more hair than normal after you give birth. But don’t panic. It all evens out after a few months.

To sum it up, your “Bringing You Home” care package should include:

  • Pads
  • Maxi pads

You might also consider these items as well:

  • Acetaminophen
  • Ibuprofen
  • Heating Pad
  • Ice packs
  • Lanolin cream
  • Nipple cooling pads
  • Nursing bra
  • Good supporting bra
  • Compression stockings
  • Hemorrhoid cream
  • Witch hazel wipes
  • Benzocaine spray

These are some of the normal things that you may experience in the postpartum period. Of course, there are other things that you may notice that are completely normal as well. If ever in doubt, reach out to your doctor.

Next time, we will talk about some of the abnormal changes you want to watch out for.

Until then, be well and be sure to show yourself grace and love.

Dr. Kristin Williams

Medical Director of Women’s Health Specialists of North Texas

About the author: Dr. Kristin Williams is a board-certified Ob/Gyn. She graduated from Wayne State University School of Medicine in Detroit, Michigan. After completing one year of training at Tulane University in New Orleans, Louisiana, Dr. Williams moved to Dallas, Texas to complete her residency at Parkland Hospital. She worked in private practice with Women’s Health Specialists of North Texas for 16 years and now works with the office as the office Medical Director.

This blog provides general information and discussions about health and related topics. The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice. This information is not a substitute for professional medical expertise or treatment.

If you or any other person has a medical concern, please consult with your healthcare provider, or seek other professional medical treatment. Never disregard professional medical advice or delay seeking care based on the information you have read on this blog or in any linked materials. If you think you may have a medical emergency, call or go to the Emergency Room or dial 9-1-1.


Do I Need a Pap Smear?

Posted on Tuesday, August 9th, 2022 at 6:41 pm    

Can you guess one of the most frequently asked questions I received when I was in private practice? No matter their age, nationality, or education level, women wanted to know – Do I need a pap smear?

Who can blame them? Recommendations have changed throughout the years, and once you think you’ve got it all figured out, it changes again. So, what’s the answer?  In this blog, you will finally know the answer to a question that has bewildered women for ages. But first, let’s talk about what a pap smear is.

What is a pap smear?

A Papanicolaou test, affectionately known as the pap smear, is a test that looks for abnormal cells on the cervix that can lead to cervical cancer. But did you know that now experts say that looking for abnormal cells of the cervix is not the only way to screen for cervical cancer? Let’s take a closer look at this.

What are the tests for cervical cancer screening?

There are three basic types of tests for cervical cancer screening – Cytology, HPV testing, and Cytology with HPV testing. While all these tests are performed the same way in the doctor’s office, they are tested differently in the lab.

  • Cytology only (also known as the Pap smear) – Looks for abnormal cells on the cervix but does not screen for HPV. This type of cervical cancer screening is recommended for women 21-29 y/o.
  • HPV testing only – Looks for high-risk strains of the Human Papilloma Virus (HPV). There are well over 100 different strains of HPV. But not all strains of HPV cause abnormalities that could potentially lead to cervical cancer. Therefore, screening only for high-risk strains of HPV, not for abnormal cells of the cervix itself, is one option for cervical cancer screening. This test can be performed on women 30–64 years old.
  • Cytology with HPV testing (also known as the Pap smear with co-testing) – Combines the two methods described above. This test can be performed on women 30–64 years old as well. It basically combines the two methods mentioned above.

Therefore, in this blog, we will not use the term pap smear but instead cervical cancer screening. Now, let’s debunk five of the most common myths about cervical cancer screening.

Does age matter?

Myth #1:  You should have cervical cancer screening when you turn 18 years old.

Fact:  Women should start having cervical cancer screening at 21 years old. Even if someone becomes sexually active before then, screening for cervical cancer is not necessary until age 21.

How often do I really need to be screened for cervical cancer?

Myth #2:  Even if your cervical cancer screening is normal, you should still have to repeat your screening every single year.

Fact:  Women who have normal screenings of their cervix do not need to have yearly cervical cancer screening. I know some of you are saying, “Are you sure about that? Is that safe?” Yes, I am and yes it is!

Women who have normal screenings of their cervix may space out their screenings between 3 -5 years, depending on your age and what type of screening you had. I continue to stress normal because these guidelines do not necessarily apply to women who have had an abnormal result on their cervical cancer screening.

Let’s break this down further

  • Cytology only (the pap smear) – This type of cervical cancer screening is recommended for women 21-29 y/o and is performed every 3 years if normal.
  • HPV testing only – This type of cervical cancer screening only looks for high-risk strains of HPV, not abnormal cells from the cervix. It can be performed on women 30–64-year-old and is performed every 3 years if normal.
  • Cytology with HPV testing (the pap smear with co-testing) – This test screens for both abnormal cells of the cervix and high-risk strains of HPV. It can be performed on women 30–64-year-old and can be performed every 5 years, instead of every 3 years.

The good thing is that you do not have to remember all of this. Your doctor will keep track of when you are due for your cervical cancer screening. The takeaway from this myth is that not every person needs a cervical cancer screening every year. This takes us into Myth #3.

How often should I see my Gynecologist?

Myth #3:  My doctor says that I do not need to have cervical cancer screening every year. Therefore, I do not need to see my gynecologist every year.

Fact:  You need to see your gynecologist every year. YOU NEED TO SEE YOUR GYNECOLOGIST EVERY YEAR. One more time for the people in the backYOU NEED TO SEE YOUR GYNECOLOGIST EVERY YEAR. Ok. I think I have made my point.

You need to see your gynecologist every year for your annual exam even if cervical cancer screening is not needed. At an annual exam, other important things occur such as:

  • Blood pressure check
  • Weight check (Yeah, I hate it too.)
  • Breast exam
  • Pelvic Exam
  • Birth control options
  • Risk factor screening for medical illnesses and cancers
  • Menopause discussion
  • Blood work
  • Ordering mammograms
  • Options for colon cancer screening (colonoscopy, Cologard)
  • And more!

Yearly visits help to maintain the doctor-patient relationship. This is important for many reasons. But one huge perk of being seen each year is that if you develop health concerns between your yearly visits, you won’t be considered a new patient and won’t have to wait as long to be seen. Just remember, it is important to see your doctor every year even if you don’t have cervical cancer screening performed.

I’m on my period. Now what?

Myth #4:  If you are on your period, you should cancel your yearly exam.

Fact:  If you are having CERVICAL CANCER SCREENING, it is best to reschedule your appointment. The blood obtained on the specimen can make it difficult for the pathologist to interpret the results. This means that we would need to repeat your cervical cancer screening when you are not on your period.

If you are having your ANNUAL EXAM without cervical cancer screening, you can still keep your appointment. I know it may feel embarrassing being examined while you are on your period. But let me assure you, it is ok. However, if you feel uncomfortable, you can always call to reschedule your appointment.

It is understandable that it can be confusing trying to keep up with when you are due for your cervical cancer screening. If you aren’t sure and need to know before your appointment, just call. We can let you know if your cervical cancer screening is “to be, or not to be” (thank you, Shakespeare). But whatever you do, don’t just not show up for your appointment with your doctor. Always call if you need to cancel, reschedule, or have questions about your appointment.

Can cervical cancer screening look for cancers other than cervical cancer?

Myth #5:  Cervical cancer screening lets you know if you have cervical cancer, uterine cancer, and ovarian cancer.

Fact:  Cervical cancer screening only screens for cancer of the cervix. It does not screen for any other cancers. Here are how other cancers are screened for.

  • Ovarian cancer – Yearly pelvic exams can help your doctor determine if there are concerns for ovarian cancer. A pelvic exam can look for any physical signs concerning for ovarian cancer. But it is also important for you to listen to your body and report any persistent swelling/bloating and or abdominal/pelvic pain. Your family history is also an important consideration.
  • Uterine cancer – If you have not gone through menopause, look for significant, persistent changes in your period such as them being heavier, longer, or more frequent. If you have already gone through menopause and have not had a period for at least one year, you should report any vaginal spotting or bleeding.
  • Vulvar cancer – Once again, yearly pelvic exams with your doctor are key. Also, you should report any itching on the outside of the vaginal area that is persistent.

So, back to the original question –Do I need a pap smear?  Well let’s change that question to – Do I need cervical cancer screening? The answer is… maybe. There are a few factors that go into the correct answer for each individual woman. The takeaway message is not everyone needs to have cervical cancer screening every year, but you should still see your gynecologist every year. But do not worry if you can’t remember all the ins and outs of cervical cancer screening. That’s what we are here for!

I hope that the information shared in this blog helped to shed some light on what may be right for you. Now, you can walk with your head held up high, knowing what to do, and confidently tell your girlfriends and family what they need to do as well.

Keep in mind that recommendations could very well change again in the future. But for now, you’ve got it! Plus, you’ll be going to see your gynecologist every year anyways, right?

Dr. Kristin Williams

Medical Director of Women’s Health Specialists of North Texas

About the author: Dr. Kristin Williams is a board-certified Ob/Gyn. She graduated from Wayne State University School of Medicine in Detroit, Michigan. After completing one year of training at Tulane University in New Orleans, Louisiana, Dr. Williams moved to Dallas, Texas to complete her residency at Parkland Hospital. She worked in private practice with Women’s Health Specialists of North Texas for 16 years and now works with the office as the office Medical Director.

This blog provides general information and discussions about health and related topics. The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice. This information is not a substitute for professional medical expertise or treatment.

If you or any other person has a medical concern, please consult with your healthcare provider, or seek other professional medical treatment. Never disregard professional medical advice or delay seeking care based on the information you have read on this blog or in any linked materials. If you think you may have a medical emergency, call or go to the Emergency Room or dial 9-1-1.


Coronavirus Disease 2019

Posted on Wednesday, March 25th, 2020 at 5:01 am    

Pregnant Women

What is the risk to pregnant women of getting COVID-19? Is it easier for pregnant women to become ill with the disease? If they become infected, will they be more sick than other people?

We do not currently know if pregnant women have a greater chance of getting sick from COVID-19 than the general public nor whether they are more likely to have serious illness as a result. Pregnant women experience changes in their bodies that may increase their risk of some infections. With viruses from the same family as COVID-19, and other viral respiratory infections, such as influenza, women have had a higher risk of developing severe illness. It is always important for pregnant women to protect themselves from illnesses.

How can pregnant women protect themselves from getting COVID-19?

Pregnant women should do the same things as the general public to avoid infection. You can help stop the spread of COVID-19 by taking these actions:

  • Cover your cough (using your elbow is a good technique)
  • Avoid people who are sick
  • Clean your hands often using soap and water or alcohol-based hand sanitizer

You can find additional information on preventing COVID-19 disease at CDC’s (Prevention for 2019 Novel Coronavirus).

Can COVID-19 cause problems for a pregnancy?

We do not know at this time if COVID-19 would cause problems during pregnancy or affect the health of the baby after birth.

During Pregnancy or Delivery

Can COVID-19 be passed from a pregnant woman to the fetus or newborn?

We still do not know if a pregnant woman with COVID-19 can pass the virus that causes COVID-19 to her fetus or baby during pregnancy or delivery. No infants born to mothers with COVID-19 have tested positive for the COVID-19 virus. In these cases, which are a small number, the virus was not found in samples of amniotic fluid or breastmilk.

Infants

If a pregnant woman has COVID-19 during pregnancy, will it hurt the baby?

We do not know at this time what if any risk is posed to infants of a pregnant woman who has COVID-19. There have been a small number of reported problems with pregnancy or delivery (e.g. preterm birth) in babies born to mothers who tested positive for COVID-19 during their pregnancy. However, it is not clear that these outcomes were related to maternal infection.

Breastfeeding

Interim Guidance on Breastfeeding for a Mother Confirmed or Under Investigation For COVID-19

This interim guidance is intended for women who are confirmed to have COVID-19 or are persons-under-investigation (PUI) for COVID-19 and are currently breastfeeding. This interim guidance is based on what is currently known about COVID-19 and the transmission of other viral respiratory infections. CDC will update this interim guidance as needed as additional information becomes available. For breastfeeding guidance in the immediate postpartum setting, refer to Interim Considerations for Infection Prevention and Control of 2019 Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings.

Transmission of COVID-19 through breast milk

Much is unknown about how COVID-19 is spread. Person-to-person spread is thought to occur mainly via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza (flu) and other respiratory pathogens spread. In limited studies on women with COVID-19 and another coronavirus infection, Severe Acute Respiratory Syndrome (SARS-CoV), the virus has not been detected in breast milk; however we do not know whether mothers with COVID-19 can transmit the virus via breast milk.

CDC breastfeeding guidance for other infectious illnesses

Breast milk provides protection against many illnesses. There are rare exceptions when breastfeeding or  feeding expressed breast milk is not recommended. CDC has no specific guidance for breastfeeding during infection with similar viruses like SARS-CoV or Middle Eastern Respiratory Syndrome (MERS-CoV).

Outside of the immediate postpartum setting, CDC recommends that a mother with flu continue breastfeeding or feeding expressed breast milk to her infant while taking precautions to avoid spreading the virus to her infant.

Guidance on breastfeeding for mothers with confirmed COVID-19 or under investigation for COVID-19

Breast milk is the best source of nutrition for most infants. However, much is unknown about COVID-19. Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and healthcare providers.  A mother with confirmed COVID-19 or who is a symptomatic PUI should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast.  If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well feed the expressed breast milk to the infant.

Source: https://www.cdc.gov/coronavirus/2019-ncov/prepare/pregnancy-breastfeeding.html


What is a LARC?

Posted on Tuesday, December 1st, 2015 at 7:38 pm    

image1image2
  • LARC stands for long acting reversible contraception. This category includes intrauterine contraception (IUCs/ IUDs) which can last for 3-10 years, and implanted devices (Nexplanon®) which are effective for up to three years.
  • LARCs are >99% effective at preventing pregnancy. That is as effective as permanent sterilization procedures!
  • All LARCs are completely reversible. After removal, resumption in fertility is almost immediate.
  • LARCs are safe for most women and teens, even if you’ve never had a baby.
  • If you are not a candidate for hormonal birth control like birth control pills, a LARC may be appropriate for you.
  • The ParaGard® device may also be used as emergency contraception within 120 hours of unprotected intercourse.
  • Some LARCs may also provide non-contraceptive benefits like shorter, lighter periods.
How long does it last? How does it work? Size
Nexplanon® 3 years Progestin – ENG 4cm x 2mm
SkylaTM 3 years Progestin – LNG 29mm x 30mm
Liletta® 3 years Progestin – LNG 32mm x 32mm
Mirena® 5 years Progestin – LNG 32mm x 32mm
ParaGard® 10 years Copper 32mm x 36mm
  • If you know you don’t want a pregnancy within the next few years, a LARC may be a great option for you.

Prenatal Screening for Birth Defects

Posted on Tuesday, November 10th, 2015 at 4:05 pm    

A pregnant woman can undergo fetal screening for certain birth defects during her pregnancy. Birth defects may be caused by problems with genes, chromosomes, or exposure to certain agents. However, 70% of birth defects have no known cause.

Prenatal screening tests can show whether you are at high risk or low risk of having a baby with a particular disorder.

If the screening test shows that you are high risk for a birth defect, a diagnostic test will have to be done to determine if your baby actually has the disorder.

Here are some screening tests which can help determine your baby’s risk of having a birth defect.

Prenatal Screening Tests

Screening Test Test Type What Does It Screen For? Detection Rate
Combined first trimester screening (11-13 weeks gestational age) Blood test plus an ultrasound exam Trisomy 21
Trisomy 13
Trisomy 18
82–87%
Second trimester single screen for neural tube defects (14-16 wga) Blood test Neural tube defects 85%
Second trimester quad screen (15-20 wga) Blood test Trisomy 21
Trisomy 18
Neural tube defects
81%
Integrated screening Blood and an ultrasound exam in the first trimester, followed by quad screen in the second trimester Trisomy 21
Trisomy 18
Neural tube defects
94–96%
Panorama Screen also known as cell free fetal DNA test (>10 wga) Blood test that looks at fetal DNA in mother’s blood Trisomy 21
Trisomy 13
Trisomy 18
Neural tube defects
Sex chromosome abnormalities
Microdeletions
>99%

Glossary

Trisomy:
a condition in which there is an extra chromosome.
Monosomy:
a condition in which there is a missing chromosome.
Trisomy 13:
Patau syndrome is a genetic disorder characterized by heart defects and other developmental problems. Most affected infants die within the first year of life.
Trisomy 18:
Edwards Syndrome is a genetic disorder that causes serious mental and developmental problems. Most affected infants die within the first year of life.
Trisomy 21:
Down Syndrome is a genetic disorder in which abnormal features of the face and body, medical problems such as heart defects, and intellectual disability occur.
Monosomy X:
Turner Syndrome is a condition affecting females in which there is a missing or damaged X chromosome. It causes a webbed neck, short height, and heart problems.
Neural Tube Defect:
Birth defects of the brain, spine, or spinal cord. The most common neural tube defects are spina bifida and anencephaly. In spina bifida, the fetal spinal column doesn’t close completely. In anencephaly, most of the brain and skull do not develop.

Information adapted from ACOG Patient Information FAQ 165


Medical Apps

Posted on Tuesday, November 10th, 2015 at 3:20 pm    

Smart phones are an inescapable part of modern life. They are convenient and increase efficiency in many areas. Here are some apps that we here at Women’s Healthcare Specialists of North Texas may help improve your health and quality of life.*

My Pregnancy Today App and Contraction Timer
iOS | Android

My Pregnancy Today

Period Tracker
iOS | Android

Period Tracker

Pill Reminder by Drugs.com
iOS | Android

Pill Reminder

Red Cross First Aid App
iOS | Android

Red Cross First Aid App

Omvana Meditation App
iOS | Android

Omvana Meditation App

MyFitnessPal – Calorie and Fitness Tracker App
iOS | Android

MyFitnessPal

* Medical health and lifestyle apps are no substitute for personalized medical advice. If you have medical questions or concerns, please contact your healthcare provider.


Oh no! My pap smear is abnormal!

Posted on Monday, November 9th, 2015 at 11:03 pm    

Don’t panic.  A pap smear is a screening test for cervical cancer and pre-cancer.  The pap test is usually done in conjunction with an HPV test. There are many causes of abnormal pap smears, and most can be managed in the office.  Once your test comes back abnormal, your provider reviews the test results and decides on a plan of action.

What are the different types of abnormal pap test results?

  • Atypical squamous cells of undetermined significance (ASC-US)—ASC-US means that changes in the cervical cells have been found. The changes are almost always a sign of an HPV infection. The changes may also be a result of infection or inflammation. ASC-US is the most common abnormal Pap test result.
  • Low-grade squamous intraepithelial lesion (LSIL)—LSIL means that the cervical cells show changes that are mildly abnormal. LSIL usually is caused by an HPV infection that often goes away on its own.
  • High-grade squamous intraepithelial lesion (HSIL)—HSIL suggests more serious changes in the cervix than LSIL. It is more likely than LSIL to be associated with pre-cancer and cancer.
  • Atypical squamous cells, cannot exclude HSIL (ASC-H)—ASC-H means that changes in the cervical cells have been found that raise concern for the presence of HSIL.
  • Atypical glandular cells (AGC)—Glandular cells are another type of cell that make up the thin layer of tissue that covers the inner canal of the cervix. Glandular cells also are present inside the uterus. An AGC result means that changes have been found in glandular cells that raise concern for the presence of pre-cancer or cancer.

What testing is done after an abnormal result?

  • Colposcopy with or without cervical biopsy—Colposcopy is an in office exam of the cervix with a magnifying device. If an area of abnormal cells is seen, your health care provider may decide that a cervical biopsy is needed. For a biopsy, the health care provider removes a small sample of tissue and sends it to a lab for testing. The lab tests can determine whether abnormal cells are present and, if so, how severe.
  • Endocervical sampling – A small brush or other instrument is used to take a tissue sample from the cervical canal.
  • Endometrial sampling— In the case of an AGC result, a sample of the endometrium (the lining of the uterus) may be collected for study using an instrument which looks like a small straw.

What are the potential results of the biopsy?

  • Cervical intraepithelial lesion (CIN) is used to report cervical biopsy results. CIN is graded as 1, 2, or 3.
  • CIN 1 is used for mild (low-grade) changes in the cells that usually go away on their own without treatment.
  • CIN 2 is used for moderate changes.
  • CIN 3 is used for more severe (high-grade) changes.
  • Moderate and high-grade changes can progress to cancer. For this reason, they may be described as “pre-cancer,” and are usually treated.

How are abnormal cervical cells treated?

  • Loop electrosurgical excision procedure (LEEP)—A thin wire loop that carries an electric current is used to remove abnormal areas of the cervix. This procedure can be done in the office or in the operating room.
  • Conization—A cone-shaped piece of the cervix that contains the abnormal cells is removed. This procedure must be done in the operating room.

These procedures are usually curative.  Once complete, patients are asked to come in for a follow up visit two weeks after the procedure to review pathology results and to form a plan for future testing.

 

Information adapted from ACOG Patient Information FAQ 187


What is the Zika virus?

Posted on Saturday, October 10th, 2015 at 5:59 pm    

What is the Zika virus?

  • Zika virus is transmitted to humans through the bite of an infected Aedes species mosquito. Aedes mosquitoes are aggressive daytime biters and feed both indoors and outdoors. They can also bite at night.
  • Only one in five people who are infected with the virus will show any symptoms. Symptoms are usually mild and include mild fever, rash, muscle and joint pain.

Why should I be concerned?

  • Zika virus can be transmitted from a pregnant mother to her fetus during pregnancy or around the time of birth.
  • There have been reports of poor pregnancy outcomes and congenital microcephaly in babies of mothers who were infected with Zika virus while pregnant.

Is there a vaccine or medicine to treat Zika?

  • No. There is no vaccine to prevent infection. There is no medicine to treat Zika.

I am pregnant. Can I travel to a country where cases of Zika have been reported?

  • Until more is known, the CDC recommends that pregnant women in any trimester consider postponing travel to the areas where Zika virus transmission is ongoing.
  • Pregnant women who do travel to one of these areas should talk to their doctor or other healthcare provider first and strictly follow steps to avoid mosquito bites during the trip.
  • Women trying to become pregnant or who are thinking about becoming pregnant should consult with their healthcare provider before traveling to these areas and strictly follow steps to prevent mosquito bites during the trip.

What should I do if I have been in an area where Zika virus is transmitted?

  • Zika virus usually remains in the blood of an infected person for up to a week. 
  • The virus will not cause infections in an infant that is conceived after the virus is cleared from the blood.
  • There is currently no evidence that Zika virus infection poses a risk of birth defects in future pregnancies.

I am pregnant and I have been to an area of active transmission. What should I do?

  • Please alert your OB of any travel to an affected region during your pregnancy.
  • If you have two or more symptoms consistent with Zika virus infection within 2 weeks of travel, a blood test can be performed to determine if you have recently been infected with the virus.
  • If you do not have symptoms, detailed ultrasounds will be performed to look for any abnormalities associated with Zika virus.

Locations of active Zika virus transmission

zika-active-transmission

CDC has issued a travel notice (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing.

Americas

  • Barbados
  • Bolivia
  • Brazil
  • Colombia
  • Commonwealth of Puerto Rico, US territory
  • Costa Rica
  • Curacao
  • Dominican Republic
  • Ecuador
  • El Salvador
  • French Guiana
  • Guadeloupe
  • Guatemala
  • Guyana
  • Haiti
  • Honduras
  • Martinique
  • Mexico
  • Nicaragua
  • Panama
  • Paraguay
  • Saint Martin
  • Suriname
  • U.S. Virgin Islands
  • Venezuela

Oceania/Pacific Islands

  • American Samoa
  • Samoa

Africa

  • Cape Verde

Petersen EE, Staples JE, Meaney-Delman, D, et al. Interim Guidelines for Pregnant Women During a Zika Virus Outbreak — United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:30–33. DOI: http://dx.doi.org/10.15585/mmwr.mm6502e1.