The Eve Appeal’s Post

Adenomyosis is not as well-known as other conditions that affect women’s reproductive systems, though the pain women experience can be life-altering. If you’ve experienced symptoms like cramping or prolonged bleeding during menstruation, it’s a good idea to ask your OB-GYN—what is adenomyosis? Adenomyosis is a condition that causes the tissue from the lining of your uterus to grow into your uterine wall. Patient knowledge matters As an obstetrician and gynecologist, my goal is not just to treat but also to educate. In this article, I’ll explain adenomyosis and its diagnosis and treatment in simple terms, sharing what I’ve learned as a medical professional. Studies have consistently demonstrated that patient education improves health outcomes.¹ Today, I’d like to provide some clarity about this condition for women who have been diagnosed or are likely to be diagnosed with adenomyosis. Adenomyosis should be treated right away Adenomyosis occurs when the tissue inside the uterus starts growing into the muscular wall. It causes symptoms including heavy periods; bad cramps; and pelvic pain. These signs can be confusing because they overlap with other conditions. So, paying attention to your body and talking openly to your doctor about your symptoms is important. Adenomyosis can cause long-term issues Painful symptoms are reason enough to seek diagnosis and treatment, but there are also long-term health complications that the condition may cause in some women. 1. Chronic pelvic pain One of the primary symptoms of adenomyosis is chronic pelvic pain, which can significantly impact a person’s quality of life in the long term. 2. Anemia Adenomyosis often causes heavy and prolonged menstrual bleeding, leading to anemia over time due to iron loss. Anemia causes symptoms like fatigue, chest pain, and shortness of breath. 3. Infertility in severe cases While adenomyosis doesn’t always cause <a>infertility</a>, severe cases can lead to difficulty conceiving. That happens when adenomyosis interferes with embryo implantation and proper placenta development, increasing the risk of miscarriage.² Issues are preventable under the care of qualified OB-GYN I think it’s important to take these long-term issues seriously, which is why I strongly recommend anyone who thinks they may have adenomyosis to seek out the opinion of an OB-GYN. Don’t hesitate to contact your primary care physician for a referral or contact a reputable OB-GYN practice directly. How we diagnose adenomyosis If you visit your OB-GYN because you think you may have adenomyosis, we’ll use tests like ultrasounds and MRIs. Sometimes, a small tissue sample is needed. But one of the most important things is what you tell us. A full description of symptoms helps your OB-GYN put together a more accurate picture of what’s happening in your body and accelerates diagnosis and treatment. Adenomyosis is common, but we don’t know how common One study from 2010 found that about

🩸𝐀𝐩𝐩𝐫𝐨𝐚𝐜𝐡𝐢𝐧𝐠 𝐚 𝐏𝐚𝐭𝐢𝐞𝐧𝐭 𝐰𝐢𝐭𝐡 𝐇𝐞𝐚𝐯𝐲 𝐌𝐞𝐧𝐬𝐭𝐫𝐮𝐚𝐥 𝐁𝐥𝐞𝐞𝐝𝐢𝐧𝐠 (𝐇𝐌𝐁) - 𝐏𝐚𝐫𝐭 𝟏🩸 🧑⚕️👨⚕️Welcoming our first group of year 3 students for this new academic year to our O&G posting.🌷 This is their first clinical posting in their clinical years. Understandably, starting to take history from patients can be overwhelming. Not sure where to start, what to ask etc. So, I am sharing this as a guide. But remember! Do not use this guide like a checklist during the history taking – aim for a natural, compassionate conversation. Medical clerking is not an interrogation. Adjust your questions based on the patient’s responses. There will be 3 parts for this topic to keep it from being too lengthy for one post. 😅 So, follow through with my subsequent posts, please (𝑒𝑠𝑝 𝑚𝑦 𝑑𝑒𝑎𝑟 𝑠𝑡𝑢𝑑𝑒𝑛𝑡𝑠 𝑦𝑒) 🤓 🩸 𝐀 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 𝐩𝐫𝐞𝐬𝐞𝐧𝐭𝐬 𝐰𝐢𝐭𝐡 𝐡𝐞𝐚𝐯𝐲 𝐦𝐞𝐧𝐬𝐭𝐫𝐮𝐚𝐥 𝐛𝐥𝐞𝐞𝐝𝐢𝐧𝐠 (𝐇𝐌𝐁). 𝐖𝐡𝐞𝐫𝐞 𝐝𝐨 𝐰𝐞 𝐛𝐞𝐠𝐢𝐧? Start with having a list of differential diagnoses in your mind. You may use the 𝐅𝐈𝐆𝐎 𝐂𝐥𝐚𝐬𝐬𝐢𝐟𝐢𝐜𝐚𝐭𝐢𝐨𝐧 𝐨𝐟 𝐏𝐀𝐋𝐌- 𝐂𝐎𝐄𝐈𝐍 P - Polyp A- Adenomyosis L - Leiomyoma M - Malignancy and Hyperplasia C- Coagulopathy O - Ovulatory dysfunction E - Endometrium I - Iatrogenic N - Not otherwise specified 𝐑𝐞𝐦𝐞𝐦𝐛𝐞𝐫: This mnemonic to assist us in remembering easier, but the sequence of differential diagnoses you consider may differ in different age groups. Certain pathologies are more common in certain age groups. 𝐑𝐞𝐜𝐨𝐦𝐦𝐞𝐧𝐝𝐞𝐝 𝐫𝐞𝐚𝐝𝐢𝐧𝐠: Munro, M. G., Critchley, H. O., Broder, M. S., Fraser, I. S., & FIGO Working Group on Menstrual Disorders (2011). FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. International Journal of Gynaecology and Obstetrics 113(1), 3–13. https://lnkd.in/gSUyd7Vf #H𝐢𝐬𝐭𝐨𝐫𝐲𝐓𝐚𝐤𝐢𝐧𝐠 #𝐌𝐞𝐝𝐢𝐜𝐚𝐥𝐒𝐭𝐮𝐝𝐞𝐧𝐭𝐬 #𝐂𝐥𝐢𝐧𝐢𝐜𝐚𝐥𝐒𝐤𝐢𝐥𝐥𝐬 #𝐅𝐮𝐭𝐮𝐫𝐞𝐃𝐨𝐜𝐭𝐨𝐫𝐬 #𝐌𝐞𝐝𝐢𝐜𝐚𝐥𝐄𝐝𝐮𝐜𝐚𝐭𝐢𝐨𝐧 #𝐃𝐫𝐁

The International Gynaecological Awareness Day is all about empowering people to highlight gynaecological issues by celebrating the beauty of femininity, sharing knowledge and experiences within the community of women in an effort to remove cultural and sexual taboos surrounding feminine health. Obstetrics is a medical speciality evaluating, treating and monitoring women in pregnancy, childbirth, and the postpartum period while gynaecology is the medical practice dealing with the health of the female reproductive systems (vagina, uterus and ovaries) as well as the breasts and diagnoses. Types of conditions of gynaecological conditions treated are: ·      Menstrual disorders: Dysmenorrhea, abnormal uterine bleeding, and premenstrual syndrome. ·      Dysfunctional Uterine Bleeding ·      Urinary incontinence in women ·      Prolapse of Uterus ·      Gynaecological Malignancies: Cervical Cancer, Ovarian Cancer, Uterine Cancer (Cancer of the womb),Vaginal Cancer ·      Fibroid Uterus and ovarian cysts, ·      Management of infertility cases in gynaecology and obstetrics ·      Sexually transmitted disease and menopause, ·      Vaginitis and pelvic inflammatory diseases. ·      Menopause care #womenshealth #gynaecology #femininehealth

ICYMI, last week a new study published in the American Journal of Obstetrics & Gynecology found that maternal mortality rates in the U.S. could be lower than we thought. Since then, I have seen headlines either stating or implying that we don't have a maternal health crisis in our country, that it's simply a case of bad data. That's the wrong takeaway here. Here are some I urge you to consider instead (not a comprehensive list): ▶ Data matters. The study found that maternal mortality numbers previously shared by the CDC may be overstated due to flawed use of the pregnancy checkbox on death certificates. Our current maternal mortality surveillance efforts should be evaluated and modified to ensure we are gathering accurate data. ▶ Women are still dying as a result of pregnancy and associated complications. As Neel Shah pointed out on X, "There is little debate about how many pregnant people are dying. The debate is over what counts as 'pregnancy-related.'" The study estimates a rate of 10.4 deaths per 100,000 births from 2018 to 2021, and the study authors acknowledge that their methods may result in an undercount. According to 2022 data from the The Commonwealth Fund, even this conservative estimate is on the high end compared to other developed nations. (https://lnkd.in/ebt5PMb5) ▶ The study reaffirms that racial disparities exist. Even with the more conservative estimate, Black women are THREE times more likely to suffer a fatal complication associated with pregnancy. ▶ Maternal mortality is not the only relevant measure here. We should also look at measures like maternal morbidity, which affects more individuals. And measures that reflect what is happening locally with specific individuals, groups, and communities. ▶ And, most importantly, even one death is too many. As the interim CEO of American College of Obstetricians and Gynecologists (ACOG) said in response to this study, "It is important to remember that these are not just statistics. They represent actual lives." ▶ ▶ ▶ Bottom line, this study should not change our course. We must continue to act on every opportunity we have to improve maternal health in our country. #womenshealth #maternalhealth ________ Study: https://lnkd.in/e6-8ePSZ Summary: https://lnkd.in/e5a_bHQb ACOG News Release: https://lnkd.in/esA8zmzc

🔎 We are glad to share our latest publication in 𝘍𝘦𝘵𝘢𝘭 𝘋𝘪𝘢𝘨𝘯𝘰𝘴𝘪𝘴 𝘢𝘯𝘥 𝘛𝘩𝘦𝘳𝘢𝘱𝘺 explores the 𝐩𝐞𝐫𝐢𝐧𝐚𝐭𝐚𝐥 𝐨𝐮𝐭𝐜𝐨𝐦𝐞𝐬 𝐨𝐟 𝐩𝐫𝐞𝐠𝐧𝐚𝐧𝐜𝐢𝐞𝐬 𝐰𝐢𝐭𝐡 𝐛𝐨𝐫𝐝𝐞𝐫𝐥𝐢𝐧𝐞 𝐨𝐥𝐢𝐠𝐨𝐡𝐲𝐝𝐫𝐚𝐦𝐧𝐢𝐨𝐬 𝐚𝐭 𝐭𝐞𝐫𝐦. 🔎 This study provides valuable insights into a relatively underexplored area of obstetrics, revealing that even mildly reduced amniotic fluid levels can have significant impacts on perinatal outcomes. 🔎 Key findings include: ** Increased risk of delivering small-for-gestational-age neonates ** Higher rates of cesarean delivery due to fetal distress These results suggest that pregnancies with borderline oligohydramnios may benefit from closer antepartum surveillance, particularly to monitor fetal growth. Faculty of Medicine Bar-Ilan University Raya Strauss Wing of Obstetrics and Gynecology Galilee Medical Center Galilee Medical Center 📄 Read more: Fetal Diagn Ther, 2024 Aug 22. [DOI: 10.1159/000541008] #PerinatalOutcomes #Obstetrics #FetalHealth #Oligohydramnios #MedicalResearch #MaternalFetalMedicine

Understanding the Importance of Vaginal Birth After Cesarean (VBAC) in Modern Obstetrics 1. Significance of VBAC: - Empowerment: Provides a more natural and engaging birth experience for mothers. - Health Benefits: - Shorter recovery time compared to repeat cesarean. - Reduced risk of surgical complications. - Improved maternal satisfaction and bonding with the newborn. 2. Challenges in Implementation: - Provider Hesitance: Concerns regarding potential risks like uterine rupture cause reluctance among healthcare professionals. - Resource Availability:Not all medical facilities are equipped to manage emergencies during a VBAC attempt. - Access Issues: Women may struggle to find providers who support VBAC, leading to repeated cesareans. 3. The Need for Implementation: - Education and Training: - Ongoing training for healthcare providers on VBAC guidelines and safety. - Promoting understanding of VBAC benefits among providers and patients. - Informed Decision-Making: - Encourage open conversations between patients and providers about VBAC options. - Provide clear information on risks and benefits to facilitate informed choices. - Infrastructure Improvement: - Enhance facility readiness for VBAC procedures. - Ensure emergency protocols are in place to address potential complications. 4. Conclusion: - Promoting VBAC can greatly enhance maternal autonomy and improve health outcomes. - Overcoming barriers to VBAC implementation is essential for addressing rising rates of unnecessary cesarean deliveries and advancing maternal and fetal healthcare.

𝗢𝗯𝘀𝘁𝗲𝘁𝗿𝗶𝗰 𝗝𝗼𝘂𝗿𝗻𝗮𝗹 𝗖𝗹𝘂𝗯 – 𝗘𝗽𝗶𝘀𝗼𝗱𝗲 𝟭 𝙈𝙖𝙣𝙖𝙜𝙚𝙢𝙚𝙣𝙩 𝙤𝙛 𝙇𝙖𝙧𝙜𝙚 𝙛𝙤𝙧 𝙂𝙚𝙨𝙩𝙖𝙩𝙞𝙤𝙣𝙖𝙡 𝘼𝙜𝙚 𝙗𝙖𝙗𝙞𝙚𝙨 𝙞𝙣 𝙣𝙤𝙣-𝙙𝙞𝙖𝙗𝙚𝙩𝙞𝙘𝙨 𝗔𝗿𝘁𝗶𝗰𝗹𝗲: Information sharing and communication in management of LGA babies in non-diabetic mothers. Kahlon, G et al. 2023. The Obstetrician and Gynaecologist. 25:282-90 (2023) https://lnkd.in/eSh5Xmbz 𝗠𝗮𝗶𝗻 𝗳𝗶𝗻𝗱𝗶𝗻𝗴𝘀 ·       Inconsistent definitions of LGA and ‘macrosomia’. RCOG defines macrosomia as >4.5kg. NICE defines LGA as >95th centile. Many NHS trusts define LGA as >90th centile.  ·       Ultrasound has a 10% margin of error. ‘LGA’ babies may actually be born at a normal weight with potentially unnecessary intervention.  ·       Maternal risks of LGA: Emergency caesarean, instrumental delivery, PPH, 3rd/4th degree tears  ·       Fetal risks of LGA: Shoulder dystocia, bone fractures, NNU admission and hypoglycaemia 𝗖𝗼𝘂𝗻𝘀𝗲𝗹𝗹𝗶𝗻𝗴 𝗽𝗮𝘁𝗶𝗲𝗻𝘁𝘀 1.         Expectant management (vs IOL) - No difference in perinatal death, brachial plexus injury, caesarean section. - X3 higher risk of shoulder dystocia (7:1000 vs 20:1000). Absolute risk is low. 2.         Induction of Labour (IOL) (vs expectant management) - Reduction in shoulder dystocia and fetal fractures - Reduction in birthweight  - X 4.5 increase in 3rd/4th degree tears (29:1000 vs 6:1000). Absolute risk is low.  - No clear difference in brachial plexus injury, EMCS, neonatal asphyxia, perinatal death or low 5 min APGARS.   3.         Caesarean section - Surgical risks and risk to future pregnancies - Reduces (but does not eliminate) risk of shoulder dystocia and brachial plexus injury - Absolute indication if EFW >5kg 𝙏𝙝𝙚 𝙗𝙤𝙩𝙩𝙤𝙢 𝙡𝙞𝙣𝙚 ·       Counselling patients on management of non-diabetic LGA is a common dilemma for obstetricians ·      I have found very variable attitudes towards management and counselling of patients between (and amongst) different trusts. ·       There’s a potential for error with diagnosis.  ·       All options should be discussed - some confer higher risk to mother/baby, but absolute risks are low.  ·       Informed consent is crucial here. Document discussions carefully.  ·       Ensure a diagnosis of LGA is followed with a GDM screen: either OGTT or home glucose monitoring. Random blood glucose is not enough! 𝗔𝗱𝗱𝗶𝘁𝗶𝗼𝗻𝗮𝗹 𝗿𝗲𝗮𝗱𝗶𝗻𝗴 1.         Cochrane review - Induction of labour at or near term for suspected fetal macrosomia https://lnkd.in/e_tjvKjd 2.         LGA in Non-Diabetic Guidelines – 2022. Hywel Dda NHS Wales Guidelines. https://lnkd.in/e6CENSCm. (Very concise and well written). Does anyone else find this a difficult topic to counsel for? Thoughts? Let's discuss! 👇 #obstetrics #maternity #womenshealthresearch #research

🚨 Gynaecology Waiting Lists Double: Women Left in Pain 🚨 New BBC research reveals the stark reality: waiting lists for gynaecology appointments across the UK have more than doubled since February 2020, with 755,046 appointments pending. That's over 630,000 women waiting for care for conditions like #endometriosis and #menopause. This isn’t just about delays — it’s about lives being profoundly impacted. Take Anna Cooper, a 31-year-old with severe endometriosis. After 17 operations, organ loss, and living with two stomas, she reflects: "The delay in my care has cost me some of my major organs. Earlier diagnosis would have changed my life." The ripple effects are immense: 🩺 Women suffer unnecessary pain and worsening conditions. 💼 The UK economy loses £11 billion annually due to work absences tied to gynaecological conditions. Dr. Ranee Thakar of the Royal College of Obstetricians and Gynaecologists | RCOG says it best: "Gynaecology is the only elective specialty solely for women— and it has one of the worst waiting lists. This reflects the persistent lack of priority given to women’s health." While governments promise improvements, action is urgently needed. Women deserve timely, quality care — not to be sidelined! 💡 Let’s keep the conversation going. Women’s health must be a priority. #WomensHealth #EndometriosisAwareness #HealthCareInequality #CallToAction Andrew Horne endometriosis.org Organisationen af Lægevidenskabelige Selskaber (LVS) Danske Patienter (Danish Patients) Camilla Fabricius Monika Rubin Per Larsen Stine Bosse Caroline Stage Olsen Anette Steenberg

RSDP Committee Member, David Rahn, M.D., Professor of Obstetrics and Gynecology, and Sonia Bhandari Randhawa, M.D., a second-year Urogynecology fellow, explore the connection between postpartum urinary incontinence and mental health among women in Dallas County—often manageable yet overlooked symptoms. Learn how the eMCAP program and proper referrals for these treatable conditions can significantly improve patients' lives. https://bit.ly/4bquN0G

Is It Important for IVF Clinics to Pursue International Accreditation? In this insightful interview, led by Mr. Henning Kalwa, Regional Director of Temos Southeast Asia, Dr. Mara Simopoulou, a Temos Assessor specializing in fertility clinics, discusses the critical role of international accreditation in ensuring the highest standards of care in the field of fertility. Temos is the first and only international accreditation body to offer accreditation programs for Reproductive Care. We go beyond just evaluating laboratories; we assess all aspects of reproductive care, from the up-to-date technologies and qualified staff to the complete patient experience. But what does Temos Accreditation mean for patients? Why do we do what we do? 1. We want hospitals and clinics to achieve better clinical and non-clinical outcomes so every woman can maximize her chances of a successful IVF. 2. Improve the overall patient experience from the first contact to the follow-up for local and international patients. 3. Patients receive treatment in a safe, secure, trustworthy, and third-party-accredited environment. 4. To assure a continuum of care from first contact to follow-up. Gain recognition and trust by becoming Temos Accredited. To watch the full video, please use this link: https://lnkd.in/eW-64-23 Thank you ImagineHealth for the video. #Temos #accreditationstandards #healthcare #accreditation #qualityassurance #germanmade #medical #qualityexpert #clientcentered #healthcareindustry #international #germanquality #patientcare #reproductivehealth #ivf #fertilityclinic #network #obstetricsandgynecology #surgery#specialist #medicaltechnology #qualitymanagement #qualitycontrol #innovation #trust #interview