Dear Friends and Patients, As the COVID-19 scenario unfolds, we at WHSNT are putting extraordinary precautions in place to protect our patients. We continue to take all recommended CDC sterilization and disinfecting guidelines, as we always do. In light of the recent COVID-19 outbreak, we are also taking additional measures to ensure your health and safety. We have sinks and soap in every exam room and multiple hand sanitizer stations throughout the office for your use. We are asking that everyone come to your appointment alone, if at all possible. We understand some people need a driver or may be forced to bring a child given the school closures, but in order to minimize risk of exposure, we are asking that you please come to your visit alone. We also ask that you arrive on time to your appointment, rather than early, to avoid patients congregating in the waiting room. We will make every attempt to immediately escort you to your own exam room that has just been disinfected by our team. We are screening our patients on arrival for fever, chills, cough, congestion, breathing issues, and recent travel. If you are feeling the least bit under the weather, please call us to reschedule your appointment for a later date. Your health and safety are our top priority and minimizing the number of people you are in contact with is your best protection now. We take pride in our excellent sanitation practices, and will continue to go the extra mile as we navigate this together. We at WHSNT are essential workers and will continue to provide care during this time. We are putting every precaution in place to protect ourselves so we can continue to serve our patients and our community. This issue is rapidly evolving and we will keep you updated as we learn more. WHSNT supports the Centers for Disease Control and Prevention (CDC) patient care guidance issued on March 17 and the efforts of state and local authorities to combat the COVID-19 outbreak. Also, of critical importance are immediate efforts to assure access to essential health care, including urgent and emergent care provided by OB/GYNs, which can alleviate burdens on primary care clinics and emergency departments. Beginning Wednesday, 3/25/2020, the following change will be put in place in order to minimize the exposure of both the patients and staff while still providing the community with essential OB/GYN care. We will only see Gynecology patients with an urgent, emergent, or time sensitive problem and OB patients. All routine wellness/preventative visits will be cancelled. If you have medications that need to be refilled, or a problem that needs to be addressed sooner, please contact our office. We have Telehealth visits available and are seeing patients in the office that need care that cannot be provided remotely. As soon as the CDC announces it safe for routine office visits to resume, we will contact you to arrange WWE/preventative visit. With prayers for good health, WHSNT Management

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.