64-Year-Old Mom Stuns Doctors By Giving Birth To Healthy Twins

​ A 64-year-old woman in Spain shocked doctors when she gave birth to fraternal twins. Recoletas Hospital medical director Enrique Martin said the babies were “perfectly healthy” after being delivered via C-section. “This is an exceptional case not only in Castile and Leon, but also in Spain,” the hospital said. The mother had her first child at age 58. The Spanish woman traveled to the United States to receive IVF treatment. “She showed up four months pregnant at the gates of our hospital and all we could do was face the situation and react,” the doctor said. The Spanish Fertility Society discourages women from receiving IVF treatments after the age of 50. However, last year, a 62-year-old Spanish doctor gave birth thanks to IVF. Another 67-year-old woman received IVF in the United States and became pregnant with twins. Moreover, a 72-year-old woman in India conceived after an entire lifetime of infertility. While some believe it is “irresponsible” to have children at a later age because parents may not live to take care of them, with the growing life expectancy (some countries like Monaco have a life expectancy as high as 89.73), maybe the idea isn’t so crazy. What do you think of this 64-year-old’s decision to have children late in life? Let us know in the comments! 

64-Year-Old Mom Stuns Doctors By Giving Birth To Healthy Twins

​ A 64-year-old woman in Spain shocked doctors when she gave birth to fraternal twins. Recoletas Hospital medical director Enrique Martin said the babies were “perfectly healthy” after being delivered via C-section. “This is an exceptional case not only in Castile and Leon, but also in Spain,” the hospital said. The mother had her first child at age 58. The Spanish woman traveled to the United States to receive IVF treatment. “She showed up four months pregnant at the gates of our hospital and all we could do was face the situation and react,” the doctor said. The Spanish Fertility Society discourages women from receiving IVF treatments after the age of 50. However, last year, a 62-year-old Spanish doctor gave birth thanks to IVF. Another 67-year-old woman received IVF in the United States and became pregnant with twins. Moreover, a 72-year-old woman in India conceived after an entire lifetime of infertility. While some believe it is “irresponsible” to have children at a later age because parents may not live to take care of them, with the growing life expectancy (some countries like Monaco have a life expectancy as high as 89.73), maybe the idea isn’t so crazy. What do you think of this 64-year-old’s decision to have children late in life? Let us know in the comments! 

Long-acting reversible contraception, or LARC, methods provide reliable, long-term, highly effective prevention of pregnancy after one-time placement of a device. LARC methods are safe for use in almost all women, including young and nulliparous women. LARC methods include IUDs (hormonal IUDs and nonhormonal copper-containing IUDs) and the subdermal hormonal implant. Increasing access to these most effective, reversible methods of contraception is a key strategy to further decrease the rate of unintended pregnancy in the United States. A new Review Article explains. Clinical Pearl What pregnancy rates are associated with the use of IUDs? The copper-containing IUD, ParaGard, is a nonhormonal device and contains 380 mm2 of copper around the arms and stem. The four levonorgestrel-releasing IUDs (LNG-IUDs) include two devices that contain 52 mg of levonorgestrel (Mirena and Liletta), a device that contains 19.5 mg (Kyleena), and a slightly smaller device that contains 13.5 mg (Skyla). Less than 1% of women become pregnant during the first year of IUD use, with pregnancy rates with the LNG-IUD (0.1 to 0.2%) generally reported as lower than the rates with the copper-containing IUD (0.5 to 0.8%). ParaGard is approved by the FDA for 10 years of use, Mirena and Kyleena for 5 years, and Skyla for 3 years. As of November 2016, Liletta is approved for 3 years of use, but data are being collected to assess 5-year use. Clinical Pearl Is screening for STDs required before placement of an IUD? Women generally do not require screening for STDs at the time of IUD insertion if they have already been screened according to the STD Treatment Guidelines of the Centers for Disease Control and Prevention (e.g., annual screening for chlamydial infection for women younger than 25 years of age or for older women at increased risk for STDs). If a woman with risk factors for STDs has not been screened according to the guidelines, screening can be performed at the time of insertion of the IUD, and insertion should not be delayed. More research is needed to determine the most appropriate timing of IUD placement after a pelvic infection. Evidence is lacking to guide health care providers in determining when an infection has resolved sufficiently for IUD placement. In women who test positive for gonococcal infection or chlamydial infection at the time of IUD placement, the device should be left in place and treatment should be initiated. Morning Report Questions Q: How effective is a subdermal hormonal implant? A: Currently, Nexplanon is the only hormonal implant available in the United States. Nexplanon, which slowly releases the progestin etonogestrel, differs from a similar previous implant, Implanon, in that it has an improved inserter and contains barium to facilitate the radiologic detection of implants that cannot be palpated. The contraceptive effectiveness of the implant is high, with an estimated 0.1% of users becoming pregnant in the first year of use, and does not seem to vary with body-mass index. The etonogestrel-releasing implant is approved by the FDA for 3 years of use. The most common side effect of implants is unpredictable bleeding, and women should be counseled about this risk before implant placement. Q: Can IUDs and hormonal implants be placed immediately post partum or post abortion? A: Both IUDs and implants are safe for use in the postpartum and postabortion periods, including immediately post partum and post abortion; immediate placement has been associated with lower rates of repeat pregnancy and repeat abortions than the rates with other contraceptives. Insertion of an IUD immediately post partum is associated with low rates of adverse events such as perforation (0 in three studies of over 3000 women in total), infection (1% in one study of 554 women), and the need for removal of the IUD as a result of bleeding and pain (5 to 11% over 12 months in three studies of approximately 7500 women in total); these rates generally did not differ from those observed with IUD insertion at times other than the postpartum period. Although IUDs are generally safe for use in the postpartum period, the relative risk of expulsion of IUDs that are placed immediately post partum is higher than the risk with IUDs placed at 6 weeks post partum or later.

Long-acting reversible contraception, or LARC, methods provide reliable, long-term, highly effective prevention of pregnancy after one-time placement of a device. LARC methods are safe for use in almost all women, including young and nulliparous women. LARC methods include IUDs (hormonal IUDs and nonhormonal copper-containing IUDs) and the subdermal hormonal implant. Increasing access to these most effective, reversible methods of contraception is a key strategy to further decrease the rate of unintended pregnancy in the United States. A new Review Article explains. Clinical Pearl What pregnancy rates are associated with the use of IUDs? The copper-containing IUD, ParaGard, is a nonhormonal device and contains 380 mm2 of copper around the arms and stem. The four levonorgestrel-releasing IUDs (LNG-IUDs) include two devices that contain 52 mg of levonorgestrel (Mirena and Liletta), a device that contains 19.5 mg (Kyleena), and a slightly smaller device that contains 13.5 mg (Skyla). Less than 1% of women become pregnant during the first year of IUD use, with pregnancy rates with the LNG-IUD (0.1 to 0.2%) generally reported as lower than the rates with the copper-containing IUD (0.5 to 0.8%). ParaGard is approved by the FDA for 10 years of use, Mirena and Kyleena for 5 years, and Skyla for 3 years. As of November 2016, Liletta is approved for 3 years of use, but data are being collected to assess 5-year use. Clinical Pearl Is screening for STDs required before placement of an IUD? Women generally do not require screening for STDs at the time of IUD insertion if they have already been screened according to the STD Treatment Guidelines of the Centers for Disease Control and Prevention (e.g., annual screening for chlamydial infection for women younger than 25 years of age or for older women at increased risk for STDs). If a woman with risk factors for STDs has not been screened according to the guidelines, screening can be performed at the time of insertion of the IUD, and insertion should not be delayed. More research is needed to determine the most appropriate timing of IUD placement after a pelvic infection. Evidence is lacking to guide health care providers in determining when an infection has resolved sufficiently for IUD placement. In women who test positive for gonococcal infection or chlamydial infection at the time of IUD placement, the device should be left in place and treatment should be initiated. Morning Report Questions Q: How effective is a subdermal hormonal implant? A: Currently, Nexplanon is the only hormonal implant available in the United States. Nexplanon, which slowly releases the progestin etonogestrel, differs from a similar previous implant, Implanon, in that it has an improved inserter and contains barium to facilitate the radiologic detection of implants that cannot be palpated. The contraceptive effectiveness of the implant is high, with an estimated 0.1% of users becoming pregnant in the first year of use, and does not seem to vary with body-mass index. The etonogestrel-releasing implant is approved by the FDA for 3 years of use. The most common side effect of implants is unpredictable bleeding, and women should be counseled about this risk before implant placement. Q: Can IUDs and hormonal implants be placed immediately post partum or post abortion? A: Both IUDs and implants are safe for use in the postpartum and postabortion periods, including immediately post partum and post abortion; immediate placement has been associated with lower rates of repeat pregnancy and repeat abortions than the rates with other contraceptives. Insertion of an IUD immediately post partum is associated with low rates of adverse events such as perforation (0 in three studies of over 3000 women in total), infection (1% in one study of 554 women), and the need for removal of the IUD as a result of bleeding and pain (5 to 11% over 12 months in three studies of approximately 7500 women in total); these rates generally did not differ from those observed with IUD insertion at times other than the postpartum period. Although IUDs are generally safe for use in the postpartum period, the relative risk of expulsion of IUDs that are placed immediately post partum is higher than the risk with IUDs placed at 6 weeks post partum or later. 

10 Ways Pregnancy is Like a Terrifying Disease

How is it possible that the world population is over seven billion, yet most of what we think we know about pregnancy we either learned from played-out sitcoms or children’s books talking about how every life is a “miracle?” If you didn’t know that the subject was pregnancy and overheard a doctor describing all the things that can and do happen to a mother’s body over the course of her baby’s development, you would likely believe you had stumbled across a new Stephen King audiobook, or crashed a brainstorming session for some kind of body horror film. The details of human gestation and birth are grim to the point that, if they were more widely known and understood, it is likely that the prophylactic market would dry up overnight as celibacy became the new normal. The evolution of human female anatomy to require menstruation already put women in a rare and unfortunate club; other than primates, it’s just bats and the elephant shrew that have this contentious relationship with the moon. But it turns out that this is only the first of many Cronenberg-esque twists, just waiting to blindside mothers as they struggle through journey of pregnancy. Unlike so many other obliging diseases, you don’t develop immunity to pregnancy after your first exposure; you just go into remission, vulnerable to a new bout at any time. And if the gift of life is supposed to be the payoff for nine months of hardship, bad news: many of the effects of pregnancy never really go away. You’ll want to sit down before continuing, because the truth is, pregnancy is really less a beautiful miracle of life and more like a horrible plague, unmatched by almost any disease known to science. 10. Thinning of the Blood-Brain Barrier In humans, the brain is sort of like an impenetrable fortress. An intricate network of blood vessels insulates the brain from the rest of the body, ensuring that essential nutrients (like oxygen) are able to pass through, but that just about everything else gets blocked (to get an idea of what a breach of this system looks like, consult someone with multiple sclerosis; and that’s just from having extra white blood cells enter the brain). This zealous security system is known as the blood-brain barrier (BBB). Scientists have spent lifetimes trying to find ways to get medicine to penetrate this barrier to ensure life-saving treatments can be delivered to the whole body, preventing the return of cancer, as well as management of neurodegenerative disorders without having to perform literal brain surgery just to get medication where it is needed. Warning labels chiding expectant mothers to avoid eating, drinking, self-medicating, or generally putting anything into their bodies other than happy thoughts and classical music are usually focused on how the developing fetus does not yet have its own operational BBB to keep toxins out of its young brain. Considering how active this system is in healthy humans, it makes sense that almost everything that enters the bloodstream is potentially toxic to the unborn. This is also why the Zika virus is such a catastrophic threat to the population: it can appear quite mild in healthy adults, but cause permanent developmental harm in fetuses. We now know that this relationship is not one-way. During pregnancy, this system stops working normally in the mother’s brain as well. In order to help the developing fetus get all the materials it needs, it appears the mother’s body compromises its own BBB, making it more permeable and thus vulnerable to the intrusion of non-essential components in the blood. Most of the time, the BBB still manages to get the job done. But recent research has shown that fetal DNA can migrate into the mother’s brain, and then remain there indefinitely, even following birth. This phenomenon, known as microchimerism, may be harmless, but in other cases may be responsible for the development of any number of conditions and autoimmune diseases later on in the mother’s life. Given its name (literally: tiny chimera), scientists are clearly inclined to believe the latter. It does not appear to matter how long a pregnancy lasts, or whether it comes to term or is terminated early; since a fetus is really just a bundle of DNA and rapidly dividing cells, it is capable of infiltrating the mother’s BBB any old time and planting foreign DNA in her brain like a time bomb. Because these genetic sleeper agents can be activated at any time following pregnancy, it is difficult to screen for them or accurately predict what effect they might have later on. Of course, even if we could, the BBB’s return to normal operations following pregnancy means it would be all but impossible to treat the microchimera with anything less invasive than brain surgery. 9. Permanent Hormonal Disruption No self-respecting sitcom can resist the comedic goldmine that is the emotional pregnant woman. From the absent-minded bouts of “pregnancy brain” to wild fluctuations in temperament, the hormonal roller coaster of pregnancy is ripe for laugh tracks and bumbling, exasperated spouses. In real life, personality changes resulting from hormonal disruption during pregnancy last a little longer than 20 minutes plus commercial breaks. First, the upshot: studies suggest that women who have experienced pregnancy tend to possess superior memories and better overall mental organization than those who have not. This appears to be related to the boost in brain-developing stem cells from the developing fetus; as baby brains grow, they can lend a little extra neuroplasticity to the mother’s brain too. Neuroplasticity is the trainability of the brain, which makes it easier to change habits, learn skills, or adopt foreign languages, and normally peters out in adulthood. Unfortunately, they make up for this gentle surge in brain power with an increased predisposition to neurodegenerative conditions like Alzheimer’s. Even more confounding, this neurological restructuring can impact the mother’s entire nervous system, changing the way her body responds to medication and especially hormonal therapy. This is particularly relevant when women enter menopause, the girls-only, reverse-puberty spectacular, for which hormone therapy has become a popular compensatory method. Not only does hormone replacement during menopause make it a less taxing experience, it can help women mitigate bone loss and even uterine cancer. That is, if their bodies haven’t been too compromised by the hormonal fireworks that accompanied their pregnancy. It is really more of a Faustian bargain than a divine transformation that turns women into mothers: they gain some extra brain power in the short-term, sure; down the road, though, their ability to respond to medication or remember their own names can disappear. 8. Chronic Pain Modern society, with its endless variety of desk jobs, daily commutes, and binge-worthy television shows, has already given us plenty of ways to develop chronic back problems. Pregnancy takes all of these hazards and mechanisms for the slow degeneration of posture, and crams them into a crippling nine month window. Of course, it is hardly surprising that the sudden weight-gain and changing physique that accompanies the later weeks of pregnancy can put a bit of a strain on the spine. What is surprising to many new mothers is that all these bodily changes don’t immediately–or sometimes ever–fully correct following the pregnancy. Obviously, pregnant women are frequently identifiable by the round “bump” in their abdomens beneath which the fetus is growing. Less visible is the cascade of other physical changes taking place to accommodate this clump of new cells. A particular hormone, helpfully called relaxin, plays a major role in helping the mother’s body prepare to give birth. As the name suggests, relaxin works by getting ligaments and tissues in the body to loosen, stretch, and otherwise relax. In the correct doses, relaxin helps the pelvis and cervix gain some elasticity, so that the baby can pass through without getting stuck, causing damage, or being damaged on its way out. The effects of relaxin are seldom so concentrated and precise, however; this is why pregnant women also find their feet painfully swelling and contorting, making it hard to walk or wear shoes. This stretching and loosening can also cause the muscles and tissues of the back to slowly slip out of place and change shape. Expectant mothers compensate for all this by changing posture, adopting a new waddling gait, and training their bodies to accept this as the new normal. Once all this relaxin dissipates and the pregnancy is over, women’s bodies have a hard time going back to their original shape, and have developed a new muscular memory that prevents them from simply standing up straight and walking with their original stride. That is assuming, of course, that their bodies generated the ideal amount of relaxin in the first place. Too much, and all this sagging, slouching, and shuffling can be even more pronounced during pregnancy, and even longer lasting afterward. Too little, and the entire pregnancy will be accompanied by severe pain as the body struggles to maintain its original shape. 7. Skin Problems All that relaxin is still no match for the sudden abdominal swelling that makes pregnant women look pregnant. Naturally, that means stretch marks are all but guaranteed; they are difficult to prevent, and impossible to completely eliminate–no matter what the cosmetic company is trying to sell you. While this is a fairly well-known feature of pregnancy, it is far from the only ill-effect likely to show up in the skin. It is fun to say that pregnant women have a glow about them; it certainly fits the nonsensical narrative of the magic of maternity. In reality, they are more likely exhibiting chloasma, a sudden activation of melanin in the skin exposed to sunlight, making freckles and moles appear darker, and causing brownish blotches appear, especially on the face. It occurs in as many as three-quarters of all pregnancies, earning it the nickname, “the mask of pregnancy.” Although it is supposed to be temporary, it doesn’t always go away quickly. The beauty industry is happy to accommodate, of course, with all manner of chemical peels and laser treatments that do more harm than good in resolving chloasma. Absent this change of complexion, women can still look forward to a healthy crop of skin tags, pimply, rice-like growths of excess flesh that may or may not die off after the pregnancy, and will definitely bleed profusely and possibly scar should they be cut or shaved off once they emerge. Then there is always the chance of pruritic urticarial papules and plaques of pregnancy, also known as PUPPs and pregnancy rash. Unlike most of these side-effects, PUPPs doesn’t have many physical attributes other than itchiness, but routinely alarms women with its appearance. Of course, that fear may have to do with the fact that PUPPs can also disguise the incidence of other more serious skin conditions, ranging from a viral infection to scabies. PUPPs is such a common condition that doctors generally identify it by sight, rather than testing. This makes it a great instigator for hypochondria among pregnant women, as well as a solid crotch-punch to their self-esteem. 6. Metabolic Disruption Another hallmark of pregnancy is the double-threat of morning sickness and intense, spontaneous food cravings (or, in some cases, pseudo-food cravings). These only scratch the surface of the metabolic disruption that afflicts women over the course of their term, and beyond. While more than 90 percent of pregnant women will experience some degree of morning sickness, in some cases that persistent nausea is actually hyperemesis gravidarum: vomiting so intense and relentless that patients begin to lose weight, dehydrate, and potentially die. It is less common in the developing world, although it remains fatal elsewhere, and is often slow to be diagnosed because it is easy (at first, anyway) to mistake for routine morning sickness. Even among healthy women, it is possible to develop gestational diabetes, which is exactly what it sounds like: diabetes that develops during pregnancy, creating a cascade of health problems for the mother and her fetus, and putting both at a permanently elevated risk of developing Type II diabetes later on. Gestational diabetes typically diminishes after the pregnancy, but it frequently will lead to a chronic disruption in the woman’s glucose metabolism, not always to the point that it can be diagnosed as diabetes, but significant enough to require medical treatment and dietary management. Then there is preeclampsia. This condition seems simple on the surface: hypertension, or high blood-pressure, accompanying or following pregnancy. While doctors have been aware of it for nearly two centuries, they still can’t quite figure out what causes it. It seems to correlate with gestational diabetes, for example, but it has also been linked to insufficient vitamin D and sunlight exposure. Of course, too much exposure also tends to spur chloasma, but preeclampsia is more than a passing cosmetic concern. Hypertension is not particularly healthy for mother or infant to begin with, but along with the elevated blood pressure comes a concentration of proteins in the blood stream. The blood-brain barrier, you may recall, is meant to filter proteins out before blood reaches the brain, but given the hiccups in BBB function during pregnancy, this doesn’t alway work correctly. Preeclampsia can thus graduate to full eclampsia, which is characterized by violent seizures and is very often deadly. Alternatively, the telltale protein in the blood and hypertension may not manifest, and the preeclampsia will instead rear its head in the form of HELLP syndrome, which entails: Hemolysis (the red blood cells begin to break down), Elevated Liver enzymes, and Low Platelet count (the blood won’t clot properly). This all starts out like pretty much every other symptom of pregnancy: fatigue, nausea, aches and pains, which makes it hard to identify. It can escalate to a bleeding disorder–especially deadly when it isn’t caught before delivery–or else turn into full eclampsia. Perplexingly, risk factors for major metabolic complications include pretty much everything: it being the woman’s first pregnancy, as well as it being the woman’s second or greater pregnancy; a history of eating disorders like anorexia, as well as obesity. As with all things to with pregnancy, there is a precise happy medium that no one can quite pin down, and everything else falls into “extreme” territory and becomes a threat to the mother. 5. Sleep Cycles Destroyed People around the world are pretty sleep-deprived to begin with, but growing evidence indicates that women tend to get less sleep than men. Even without adding children or pregnancy to the picture, women’s elevated levels of estrogen, and the cyclical hormonal fluctuations that accompany their menstrual cycles mean that their circadian rhythms are under constant bombardment. All of the aforementioned complications and features of pregnancy–the metabolic changes, the constant pain, the hormonal fireworks (which make it harder for women to mitigate their urge to pee, especially when they are trying to sleep)–combine to put a good night’s rest on a nine-month hiatus. Finally having the child at home doesn’t help matters much, as the irregular feeding, pooping, and crying cycles of the newborn–along with some residual hormones tapdancing on the mother’s nerves–ensure that sleep, much like tomorrow, is always a day away. Pregnancy and motherhood constantly blur the line between insomnia and outright sleep-deprivation, and even for women in otherwise perfect health, this becomes a risk factor for every other pregnancy complication, as well as mood disorders, accidental injury, and death. 4. Potty Problems There is really no nice way to say it–which is probably why so much of the time, nobody says anything, and the new mother finds out the hard way: No matter how the mother delivers–naturally, or by C-section–she is going to have some poop issues. Caesarean surgery (C-section) is a procedure in which the baby is removed from the mother’s abdomen, rather than delivered naturally. It has become the most common form of major surgery in the world, due to the fact that more than a third of all births in the United States are via C-section. It is also completely unnecessary a great deal of the time, yet mothers frequently capitulate under the persistent pressure to elect to have the surgery. Although c-sections are meant to be a pathway to avoid high-risk pregnancies and deliveries, bypassing vaginal delivery entirely, they still often lead to some form of incontinence: that is, mom no longer has any choice in when or where her bladder evacuates. In the case of C-section deliveries, though, there is a risk of laceration of the internal organs, including various parts of the digestive tract, as well as the bladder, uterus, and all the reproductive organs (obviously, that’s what C-sections are for–as a complication, this type of laceration is unintentional beyond what is required for delivery). Doing it the old fashioned way, of course, involves a lot of straining and pelvic tension, which invariably results in the mother clearing out her bowels and uterus right at the same time. Precisely because almost all vaginal deliveries involve pooping, it generally gets no attention: the medical staff are ready to scoop the telltale turd right out of the way to clear the landing zone for the newborn, and the mother so preoccupied that she very likely won’t notice that it happened. She likely will notice in the weeks following delivery, however, when she finds herself strapping on a diaper to manage persistent incontinence. That’s right: it isn’t just babies who need diapers. Alternatively, all the straining and trauma (surgical as well as natural) that accompanies either type of delivery can also cause the sphincter to go on strike, and constipation to set in after childbirth. Depending on the severity, this can be remedied by something as innocuous as prune juice and high-fiber cereals, or the more sporting suppository laxative. But mother’s is not the only fecal event in the aptly named delivery room. Although still fed via umbilical cord and not able to “poop” in the full sense of the word, it is possible for the fetus to evacuate its own developing digestive system while still in the womb. These fetal feces–known as meconium–are released into the amniotic fluid suspended inside the uterus. Because the fetus does not take its first breath until after it has exited its mother, it can be at risk for meconium aspiration, literally choking on its own poop before it is even born. Stress experienced by the pregnant mother can stimulate a fetus to pass meconium–anything from excessive exertion to extreme shock. Since vaginal delivery pretty well meets both definitions, it is common for meconium to be discharged during birth, which while unpleasant, puts the fetus at lower risk of aspiration. 3. Emotional Trauma Clearly, pregnancy and childbirth is a pretty extreme experience–the impact of which is not aided in the least by the tendency for most cultures to “yada yada yada” their way from conception to the intangible, life-altering joy of parenthood. Besides glossing over the less attractive details of the whole process, it sets up some extremely misguided expectations in people going through pregnancy. As many as one out of every four known pregnancies ends in miscarriage, also known as spontaneous abortion. Causes range from obvious lifestyle issues (drug use, diet) to previously unknown problems with the mother’s reproductive system, to immune system responses terminating the gestation of the young embryo. If the emphasis on “known” pregnancies seems odd, try to appreciate that a small yet measurable proportion of women manage to carry a fetus all the way to delivery without recognizing that they are pregnant. Accounting for all of these unknown pregnancies, the rate of miscarriage is estimated to be as high as one in three. All these statistics distinguish miscarriages from stillbirths, which are essentially when the same problems terminate a pregnancy after 20 or more weeks of gestation. Measured separately, this accounts for another 26,000 births per year in the U.S. alone, a rate which has remained stable for more than a decade. The identities of women and girls around the world can be extremely caught up in maternity and the joy (or obligation) to bear children. As such, miscarriage can be a source of pronounced personal shame, trauma, and depression. Healthy mothers who successfully delivery live, resilient babies are still at risk for developing postpartum depression, a serious condition whose name is well know, but whose nature is poorly understood. Postpartum disorders can manifest as anxiety and obsessive compulsive behaviors, often revolving around the safety and welfare of the newborn. It can also take shape as a more typical form of depression, involving extreme sadness, a sense of isolation, hopelessness, and general despondency. Again, because an idealized expectation for maternity can dominate women’s identities, postpartum symptoms can involve extreme guilt, a sense of failure, or a fear that somehow, you are not fulfilling your role as a mother. Postpartum depression is not entirely the result of socialization. Ongoing research is exploring the role of genetic factors in causing the disorder, in the hopes of providing better treatment to suffering mothers. Roughly 10 percent of all women will experience post-traumatic stress disorder (PTSD) at some point in their lives, and research indicates that women who go through pregnancy are at an elevated, lifelong risk of experiencing or exacerbating symptoms of PTSD. This can result in all manner of complications during and after pregnancy, afflicting both mother and child. There is also strong evidence indicating that extreme trauma can be imprinted on DNA and passed from mother to child; survivors of the Holocaust and the 9/11 attacks have been shown to have transmitted a genetic imprint of their experiences to their children. 2. Obstetric Trauma Whatever your opinion of trigger warnings, consider this a final opportunity to avoid learning things you cannot unlearn. All scatalogic discourse aside, human childbirth is a messy process, equally as likely to traumatize mothers physically as emotionally. Although the physiological and historical reasons are unclear, the bottom line is that humans have evolved to have larger heads, without females evolving large enough pelvic bones to accommodate them. Put differently: babies’ heads are generally too big to fit through their mothers’ birth canals. In some cases, these relative differences are so extreme, there is truly no alternative to C-section delivery. For everyone else, that means a long, slow, painful delivery–more than nine hours on average–that will likely result in one of two typical forms of obstetric trauma. First: vaginal tearing. The sheer pressure of gigantic baby head against tiny vaginal opening can’t go on without one side giving way, and that side is almost always the strip of skin (perineal area) connecting the vagina with the anus. First-time mothers have a 95 percent chance of at least some tearing occurring during delivery. Sometimes, of course, the blunt force of the baby’s battering ram cranium isn’t enough to break through. That is when your friendly obstetrician-gynecologist will slice open your vagina manually, a procedure known as episiotomy, which surgically lacerates the perineal skin and lets the newborn slip through the tattered genital curtain. The alternative (or unavoidable side-effect, unfortunately) to all the heaving and hemorrhaging of natural delivery is injury to the mother’s coccyx. Although this is often described as a fracturing or bruising of the tailbone, it is effectively more like a dislocation caused by the infant on its way out. As might be expected, the subsequent recovery period frequently entails incontinence (and more diapers) as well as a loss of sexual desire. It only takes a few weeks for most perineal lacerations (incidental or manual) to heal, although some require stitching to hold them together until the skin can grow back together. Last but not least, there is pelvic organ prolapse. Imagine wearing a latex glove, then trying to remove it. About half the time, you will find the glove sticks to your hand and turns at least partially inside-out when you yank it off. Now imagine that your hand is a baby, and the glove is a vagina. That is, one finger of that glove is a vagina; the others are, potentially, the bladder, uterus, rectum, or intestines. And they may not all come flopping out right when you remove your hand/baby; any of them could emerge from the stretched out opening at any time, even 20 years after the initial delivery. As you might expect, historical records of this occurring are as old as humanity itself, yet general awareness of it is very low. Because it makes for such an uncomfortable subject of conversation, experts expect that the actual rate of occurrence is much higher than the rate of reporting–which is already more than 50 percent of all mothers. 1. Momnesia How many diseases have the ability to make you forget how terrible they were, so that you are driven to go out and get it again? Well, that is the genius and horror that is human reproduction: after it tears up mothers from the inside out, in ways both visible and invisible, it sets off one final coup de grace of hormonal chain reactions to cover its tracks. Actually, some evidence suggests that short-term memory loss is a feature of even the earlier stages of pregnancy–hence the phrase, “pregnancy brain” or “baby brain” in reference to lapses of memory associated with pregnancy. Other literature refers to a “halo effect,” which is when mothers over time begin to recall the pain of delivery less, and the joys of motherhood, thrill of seeing their newborn, or other positive features of childbirth more. It is debated whether this is a result of hormonal events following delivery, or simply a cognitive fallacy expressed in the context of maternity. This is part of the reason breast-feeding and other maternal bonding activities are encouraged, though: they can help trigger the release of hormones associated with happiness, socialization, and the formation of relationships. There is other evidence that memory problems can be a side effect of postpartum depression, although this is not strictly limited to memories of the pain of delivery. Whatever the specific cause, studies have repeatedly shown that for a majority of mothers, individual ratings of memories of the pain of childbirth go down over time. It is as though experiencing some sort of biological Stockholm Syndrome that makes them talk about how grateful they are to have given birth, rather than the more honest, “Yup, this melon-headed ankle-biter split me like firewood coming out.” 

New Male Contraceptive Pill Lasts 2 Years And Has 100 Percent Success Rate

Seemingly since time immemorial, the burden of long-term contraception has been predominantly lain on the fairer sex, and before any men start shouting “condom” from the rooftops, I did say “long-term”. The cornucopia of contraceptive choice for men is pretty slim pickings, and hasn’t really progressed for around 100 years; realistically limited to either the aforementioned condom, or a vasectomy, which, if we’re talking about long-term solutions, is just about as permanent as they come. An earlier attempt to create a jab suitable as a male contraceptive hit rocky ground when participants reported side effects such as depression and muscle pain, with 20 men dropping out of the year-long clinical trial. The new process involves injecting a gel, known as Vasalgel, into the tubes used by sperm to swim down the penis, which then acts as a physical barrier. Wincing? Well you shouldn’t be. The procedure is anticipated to be far less painful than getting “the snip”. Furthermore, experts are expecting the new approach to be far more easily reversible than a vasectomy. The injection of Vasalgel has already been trialled on Rhesus monkeys, in a study published on Basic and Clinical Andrology, including 10 who were already fathers. The study was conducted at the University of California and aimed to prove that the process could actually prevent pregnancy, rather than simply blocking sperm – which had already been proven in an earlier trial involving rabbits. Having been observed for a week, the monkeys under trial were released back into their co-ed habitat, rejoining their fertile female counterparts. Researchers found that, whilst the monkeys were still mating, over a period of more than a year, and up to two years in particular cases, there were no resultant pregnancies. What makes these results especially compelling is their comparison to the tradition pill, which has a typical success rate of 99 per in humans. Vasalgel has a 100 per cent success rate in the most recent trial on Rhesus monkeys. Additionally, the side effects reported by men from previous hormonal injection trials, of low moods, depression and muscle problems, did not appear to materialise in the Rhesus monkey trial for Vasalgel. An initial trial focused on rabbits found the process relatively simple to reverse; a second injection designed to flush out the gel using a simple solution was successful however, this is yet to be proven to work in monkeys or people. Current research into Vasalgel is being funded by not-for-profit outfit The Parsemus Foundation, who say they will look to undertake clinical trials on humans as soon as they gain the necessary funding. Catherine VandeVoort, the lead author of the research, is excited by the early results of the trials: “Men’s options for contraception have not changed much in decades. There’s vasectomy, which is poorly reversible, and condoms. If they knew they could get a reliable contraceptive that could also be reversed I think it would be appealing to them.” “One of the great things about the monkey model is that the male reproductive tract is very similar to humans and they have even more sperm than humans do.” “Chances are, it’s going to be effective in humans.” Professor Allan Pacey of the University of Sheffield thinks that there could be widespread interest in a reliable male contraceptive alternative: “The idea of trying to replace the traditional method of vasectomy by inserting a gel into the tube which carries sperm from the testicles to the penis at ejaculation is not a new one.” He continues: “However, we haven’t seen much progress in developing the idea in recent years, so this study is a useful step in the right direction.” It is worth noting that this method of contraception would not protect against sexually transmitted diseases. However, in terms of an effective method of pregnancy prevention, early signs are extremely positive. It is not yet clear how long it will be, or if indeed the procedure will get to the point of public availability however, clinical trials on humans seem set to take place sooner rather than later. 

Could Maternal Blood Pressure Be Predictive of the Baby's Sex?

An ultrasound done around 18-20 weeks of pregnancy can usually tell an expecting mother a key question she will having during her pregnancy: boy or girl? However, many people pursue predicting the sex of the baby into their own hands. Here are several old wive’s tales on how to tell if a woman is having a girl or a boy: If you prefer sleeping on your left side, you are having a boy. Extreme nausea means you are having a daughter. If your hands are dry during pregnancy, you are having a boy; soft, expect a girl. If you're craving citrus while pregnant, you're having a girl. If altering hormones makes your skin break out, expect a girl. There is no concrete scientific evidence proving any of these claims to be true, but a new study provides reason to believe that blood pressure before pregnancy could be predictive of a baby’s sex. Beginning in 2009 and led by Dr. Ravi Retnakaran, scientists from Mount Sinai Hospital in Toronto and the Lunendfeld-Tanenbaum Research Institute developed a unique “pre-conception cohort” including young females with immediate plans to become pregnant. Retnakaran and the team started out with over three thousand women, and around half were ultimately taken in for cardiometabolic characterization: a measurement of blood pressure, cholesterol, triglycerides, and glucose levels. A group of women were not included in the final cohort for the potential of already being pregnant at the time, so the final study group ended up being 1411 women, with cardiometabolic characterization conducted at a median time of 26.3 weeks before pregnancy. The model was designed to investigate the relationship between a woman’s health before and during pregnancy and the baby’s sex. Once the participants became pregnant, researchers followed up with them and continued to do so throughout the pregnancy to the day of delivery. The 1411 pregnancies resulted in the birth of 739 boys and 672 girls. Researchers zeroed in on the impact of pre-pregnancy blood pressure, and they adjusted their for age, education, BMI, waist, LDL cholesterol, HDL cholesterol, triglycerides, and glucose to get a clear reading of the independent effect of blood pressure. They found that the mean adjusted systolic blood pressure before pregnancy was found to be higher in women who ultimately gave birth to a boy than in those who had a girl. Additionally, the prevalence of mothers delivering a boy increased as pre-pregnancy systolic blood pressure levels increased. Compared to the other measurements made during cardiometabolic characterization, the researchers concluded that pre-pregnancy systolic blood pressure was the “only significant predictor of having a male baby.” “A woman's blood pressure before pregnancy is a previously unrecognized factor that is associated with her likelihood of delivering a boy or a girl,” Retnakaran said in summary of the study. “This novel insight may hold implications for both reproductive planning and our understanding of the fundamental mechanisms underlying the sex ratio in humans." Retnakaran’s study was recently published in the American Journal of Hypertension.

That Lactation Ice Cream You Heard About Isn’t Truly Going To Increase Your Milk Supply

You might have seen the rumor floating around the internet this week that a particular ice cream from Ben and Jerry’s (Oats of This Swirled) has the power to increase a breastfeeding mom’s milk supply. As much as I adore a nice pint of Ben and Jerry’s myself and would love to believe that something like this is true, I’m going to have to put my fancy lactation consultant hat (or bra?!) on to deliver the not-so-good news to you that this rumor just isn’t true — at least not according to the science of how milk production works. The claim that this particular ice cream would boost a mom’s milk supply is based on the fact that the ice cream has oats in it, and oats are thought to increase milk supply. (Though it should be noted that oats are the 13th ingredient in the ice cream, which means that even if oats did do wonders for milk supply, you’d have to eat a ton of this ice cream to get a good enough dosage). But it remains to be seen if oats really do much at all in terms of milk supply. As the evidence-based breastfeeding site KellyMom.com points out, eating oats has been recommended by lactation consultants and mothers for years as a milk-boosting agent. KellyMom.com surmises that this might be because oats are high in iron, and women who are anemic sometimes have lowered milk supplies as a result (most breastfeeding mothers are not anemic, however). Another possible explanation is that the warm, comforting association of oats and oatmeal relaxes women, thus aiding in the release of their milk. However, as KellyMom.com reports, and as many of us lactation consultants know, there is absolutely no scientific proof out there that oats do a anything to increase milk supply. All of the evidence is merely anecdotal, and in many instances, the increase that mothers see may very well be because of the placebo effect. Here’s how the placebo effect would work in term of oats or any other food that is supposed to increase supply: When it comes to the “milk ejection reflex” (i.e., your milk “letting down), relaxation and all those warm fuzzy feelings are proven to have a positive effect on releasing oxytocin, the hormone that causes the “letdown.” So perhaps just the mere thought that a mom is ingesting something that will boost her supply relaxes her enough to get her milk flowing. But even if it’s just a placebo — if the cozy comforts of oats, and probably also the creamy comforts of the ice cream itself, work their magic despite the lack of evidence — what’s the problem, and why am I even bothering to point something like this out? Well, first of all, most breastfeeding mothers don’t actually have milk supply issues, and the idea that a mom has to eat or drink anything special is a myth that perpetuates the idea that women are somehow unable to breastfeed their babies with the bodies (and boobs) they were born with. The fact is, the single most important way to ensure a good milk supply is to breastfeed your baby often, on demand (which does include the middle of the night, I’m sorry to say, at least for a while). Too often, we try to grab some quick-fix solution like a lactation cookie, tea, or tincture when most moms just need to go back to basics and breastfeed more regularly. Breastfeeding works by “supply and demand,” and while a mom has every right to demand delicious treats while she nurses, none of them are going to instantly boost her supply. The same goes for drinking gallons of water or milk; neither is proven to increase milk supply. Of course, some mothers truly DO have milk supply issues. But grabbing a package of Oreos or bottle of Gatorade off the shelf isn’t going to help (and yes, you read that right: Oreos and Gatorade have also been falsely purported to boost milk supply). True milk supply issues involve things like hormonal imbalances, breasts with insufficient milk-making tissue, and babies who have issues with how they suck. If you were dealing with a medical issue, you wouldn’t listen to something you read on the internet and then go to the grocery store to stock up on sugar-filled desserts to heal yourself, would you? I know it sounds much more pleasant to go snag a pint of ice cream than to call your doctor, lactation consultant, or breastfeeding counselor, but if you are concerned that you aren’t producing enough milk for your baby, please reach out for help. Chances are good that you actually are doing just fine and don’t need to do anything more than breastfeed and snuggle. My best advice for ensuring you have enough milk for your baby is to breastfeed often, and then sit back and trust your body and your baby. After that’s been established, go ahead and eat as much ice cream as you damn well please because breastfeeding makes you freaking starving. Just don’t rely on it to boost your milk supply because the truth is that it simply will not. 

Moms, Do Not Be Ashamed Of Your Postpartum Depression (From A Mother Of Four)

It is difficult to put into words who we turn into during those early months after not only our first baby, but also our second, third, and fourth too. I want to connect with those of you who have not felt connected before. I want you to know that even though everyone knows about postpartum depression, not everyone knows about what it’s like to be in the pit of it. To feel so out of control and regretful of the amazing baby you created that you are scared to reach out to anyone for fear that this amazing baby will be taken away from you. Taken away from you because you know you don’t deserve this little boy or girl who was supposed to light up your life, but has instead darkened it in a way you never thought possible. You find yourself thinking, What the hell is wrong with me? I should be handling motherhood better than this, like my mom did, like my friends do, and like everyone other than me does. Yes, it’s a ridiculous way to think, but there is absolutely no logic when we’re postpartum, and our hormones are going haywire, and our emotions are all over the place. I swear to god that the next person who said, “It will be okay,” or “Just relax. It gets better,” was in danger of getting boob-punched. To me, there was no way this was going to get better. There was no “snapping out of it.” How could I? My babies weren’t going anywhere, I wasn’t going anywhere (even though I sometimes thought about it), and I couldn’t afford to hire a nanny — so this was it. I felt like this is what life had come to. It wasn’t because I had no help. I had an amazing partner who was admittedly, at times, a better parent than I was. It was because I felt like I couldn’t handle something that I was supposedly made for. It was because apparently I was not cut out to do this if I couldn’t do it perfectly. It was because there were times when my new baby was crying, and my toddler was saying, “Watch this Mommy!” for the millionth time, and I just wanted to be anywhere but there, and I was ashamed. And shame can knock you on your ass. It can make you feel like not only less of a mother, but also less of a person. To the moms on social media who act like they all have their shit together, take an acting class because you aren’t fooling us. Stop judging and admit that you have been there. You have been ashamed of your parenting, and of yourself, before. Just like us, you were terrified someone would knock on the door and see the spaghetti sauce encrusted on the counter (because spaghetti was the closest thing to a home-cooked meal you could manage.) Just like us, you were ashamed that you questioned yourself: Why did I have a second baby? It’s harder than having the first. You have been ashamed in those ridiculously difficult moments when you were in the store with a crying baby and a toddler who chose that exact moment to throw a tantrum, and everyone was staring at you, and all you could think was, I wish I could close my eyes and fast-forward until they are 10 years old and a lot less bitchy, a lot easier. You have been ashamed by how lonely you feel even when you are surrounded by your awesome kids, husband, and family. You had so many ideas and thoughts about how you would handle parenting, about being a good mom — the kind of mom others would look up to. You expected to experience lots of emotions, but you are ashamed to say isolation wasn’t one of them. Anger wasn’t one of them. Loneliness wasn’t one of them. The hope for more purpose and meaning than getting your baby to latch on perfectly is always lurking somewhere in your mind, but you are ashamed to talk about it. This should be enough for you. We all have had those mommy-breakdown, lock-yourself-in-the-bathroom-and-cry moments that we are ashamed of. But we are still here. We actually did get better. We didn’t snap right out of it, but as time went on and we got better at this mommy thing, we came to be more at peace with it. And when we are more peaceful, we are better parents. When our hormones calmed down, and our lives started to regain some sense of order, we were able to see clearly what we had in our precious babies and truly feel lucky. We were able to embrace the hard part of parenting and come to the realization just how worth it motherhood really is. I hope anyone who has ever felt any of these things knows that they aren’t the only one, and that we should all be proud of each other, because parenting is not all sunny skies like we imagined it to be. It is a beautiful storm of emotions, complete with a flood of tears in the hard times and a rainbow of pure joy when things are good. 

Want To Have Smarter Children? Delay Giving Birth Until Your Late 30s

Want to have smarter children? Delay giving birth until your late 30s: Infants born to older mothers are more intelligent and successful Delayed pregnancies are often made by many women who focus on their career In previous research, it has been heavily linked to having less intelligent children But a new study has found the opposite - and provides another reason to delay Those born to older mothers performed better on tests, a new study has found Older mothers are more likely to give birth to clever children than those in their twenties, new research reveals. Delayed pregnancies are usually made by women who have instead decided to focus on establishing themselves a career. And this has a positive effect when it comes to start a family - giving their youngsters the best possible chance of going to university. The findings are a stark contrast to research from the 1970s which found the complete opposite. Delayed pregnancies are usually made by women who have instead decided to focus on establishing themselves a career Previously, the majority of women giving birth in their late 30s were having their third of fourth child. But this has now changed, as women are waiting until they reach the heights of their careers before choosing to start a family. The proportion of women over 40 giving birth in England and Wales has trebled in the last 30 years, from 4.9 per 1,000 in 1984 to 14.7 per 1,000 in 2014. And this allows them to give more resources and attention to children, perhaps explaining their raised levels of intelligence, experts claim. Researchers analysed data from three studies of children's development that were conducted in 1958, 1970 and 2001. Their ability to think, remember, pay attention and read were tested when they were 10/11 years old. And this has a positive effect when it comes to start a family - giving their youngsters the best possible chance of going to university with them being smarter In the two earlier studies, children born to mothers aged 25 to 29 had the highest cognitive ability, the researchers found. This was compared to women who were aged between 35 and 39 when they gave birth in the study published in the International Journal of Epidemiology. HEALTH DANGERS OF DELAYING CHILDREN Women who delay starting a family are more likely to have a stroke or heart attack later in life, a major study concluded last year. Scientists found women who give birth after the age of 40 are two-thirds more likely to die of cardiovascular disease when compared to those who become mothers earlier. Experts said their findings, based on a study of 72,000 women, showed the consequences of late motherhood could last for years. However, in 2001 the findings were reversed, the London School of Economics and Max Planck Institute for Demographic Research team found. But the researchers warned that the sample was smaller. The researchers said: 'Older mothers today tend to be more advantaged than younger mothers – for example, they are well educated, are less likely to smoke during pregnancy and are established in professional occupations. 'This was not necessarily true in the past.' Study author Dr Alice Goisis of the LSE, said: 'Our research is the first to look at how the cognitive abilities of children born to older mothers have changed over time and what might be responsible for this shift. 'It is essential to better understand how these children are doing given that, since the 1980s, there has been a significant increase in the average age of women having their first child in industrialised countries. 'Cognitive ability is important in and of itself but also because it is a strong predictor of how children fare in later life – in terms of their educational attainment, their occupation and their health.'

How Painful Are Periods Supposed to Be?

The experience of having periods varies between women. They can be light and completely painless for some, but completely debilitating for others. The majority of women experience some cramping for one to two days during their period, and this is normal. Teenage girls are also more likely to suffer from painful periods compared to adult women, particularly adult women who've had children. But painful periods in adolescence usually improve over time. However, some women have period pain that isn't easily managed and that requires them to take time off school or work. Pain to this extent is not normal, and needs to be investigated. Why periods cause pain A period is the shedding of the endometrium - the lining of the womb (uterus). Every month, the uterus prepares itself for pregnancy by growing a thick lining that has a rich blood supply, awaiting implanting of an embryo. When pregnancy does not ensue, the body produces a period, the by-product of the endometrium. During this time, the blood vessels open, the lining sheds off the uterine wall, and the uterine muscle contracts to expel the blood and tissue. During these mild contractions, it's common for women to feel a lower abdominal cramping sensation as blood products are expelled through the uterine body and out of the cervix before it makes it way out the vagina. The contractions are triggered by hormone-like compounds produced by the body called prostaglandins, which are the main source of pelvic pain associated with menstruation. Higher levels of prostaglandins have been associated with more severe menstrual cramps. Cramping is usually strongest in the first one to two days of the period, then settles for the remaining four to five days. Pain during periods is called dysmenorrhoea, and there are two types: primary and secondary. Primary dysmenorrhoea refers to pain with periods, that begins soon after girls start menstruating. This tends to get better as the teenager gets older. The cause of this pain is not known, but hormonal fluctuations are thought to be implicated. The main medications used to treat this pain are non steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Nurofen) or naproxen (Naprogesic). They work by blocking the action of prostaglandins. Secondary dysmenorrhoea generally refers to period pain resulting from a medical disorder in the reproductive system. Instead of period pain improving over time, it worsens. This can be due to several conditions, the most common of which is endometriosis. What is endometriosis? Endometriosis is a condition in which tissue similar to the lining the endometrium (womb), grows outside of the womb. It can grow on the ovaries, bowel, and in some rare cases has even been found outside of the pelvis such as the lungs. The hormones that trigger a period cause bleeding at these sites of implanted endometrial tissue, and this causes pain. Endometriosis usually causes period pain to start earlier and last longer than what is commonly experienced with menstruation. Sometimes the pain doesn't go away when the period ends. Women with endometriosis can describe pain at the the time of ovulation, or pain with sex. Another problem associated with endometriosis is infertility. It is a common condition affecting 16 to 61 percent of women of reproductive age experiencing symptoms. An estimated 100 million women worldwide suffer from endometriosis. Women themselves may be unaware of endometriosis, or think their pain is normal. Many tend to tolerate the pain, which is can also occur in teenagers and young adults. Although the exact cause of endometriosis is unknown, there are a number of theories such as retrograde (opposite to the intended direction) flow of endometrial tissue out of the womb through the fallopian tubes, and this tissue can implant in the pelvic cavity in locations outside of the womb. The way nerves interpret pain in the pelvis also plays a role. It is an unusual disease in that some women can have a lot of endometriosis and have very few symptoms, whereas others can have only a small amount of disease and suffer from quite severe symptoms. Affected girls and women often face negative impacts on their education or careers. There may be reduced productiveness at work or study as a result of the pain and discomfort caused by endometriosis. Treatment includes hormonal tablets such as the oral contraceptive pill. The progestogen implant or intrauterine device, are also helpful for some in reduction of pain with periods. But these treatments don't work for everyone. How will I know if I have endometriosis? Diagnosis of endometriosis can only be made via keyhole surgery. If it is seen surgically, and removed, women often have an improvement in their symptoms. But symptoms can return. Although it is not a deadly disease, the disruption it causes to women and society can be distressing – and as it is chronic, persisting throughout the woman's menstrual life. One study found an average delay of nearly four years before women with endometriosis sought medical help for their symptoms, and this delay brings about much anxiety and distress over the uncertainty of their own condition and how it can be resolved. Many women are told their period pain is normal, but at keyhole surgery a number of these women with pelvic pain actually have endometriosis. However, making a decision to pursue surgery is a difficult one, as this carries minor risks such as bladder, bowel and vessel injury as well as anaesthetic risks. Care for women needs to be individualised in terms of whether the risks of surgery outweigh the symptoms experienced. There are a number of different conditions which contribute to period pain. These include pain from the intestines, bladder and kidney, muscles and bones (including hip and back pain). There are also conditions that cause pain from the nerves in the pelvis and back. Psychological conditions can also be responsible for or contribute to pelvic and period pain. If you have severe period pain affecting your school, work, or quality of life then you should seek help, by first consulting your GP.

Dad Records Baby Kicking. But Look Closely At Mom's Belly Button ... Incredible!

We’ve all seen a pregnant mom’s baby bump before and the tiny impressions a baby can leave on a mommy’s belly when in the womb ... but this video shows that and then some. What this dad captured when he began recording his wife’s belly is amazing. This 39-week baby is moving so aggressively inside the womb, you would think it is trying to get out. And yes, the video is real. See for yourself what all the fuss is about. 

What Not to Do While Pregnant

There is a lot of advice that will be coming your way about what to do and what not to do while pregnant. It can be a little overwhelming and even unsettling at times. That being said, there are certain things and activities that need to be avoided for the sake of your own and your child’s health. What Not to Do While Pregnant 1.Don’t Eat These Foods The primary reason to avoid certain kind of food is to reduce any possible risk of contracting an infection. This list of food includes sushi, clams, mussels or any other kind of uncooked seafood. Even other kinds of meat that are eaten raw or rare should be avoided during this time. Meat that is uncooked or undercooked carries the risk of harboring toxoplasmosis or salmonella infection. Similarly, deli meat should be avoided because it can contain listeria, a bacteria that can life-threatening to the fetus. Raw eggs, unpasteurized milk, soft cheeses or refrigerated seafood should also be avoided during pregnancy because of similar risks of infection. 2.Don’t Overdo It on the Caffeine Caffeine is a stimulant that crosses the placenta and so even if you need it to function properly, remember to keep a tight check on the amount you are ingesting to avoid causing your baby harm. Coffee can increase the blood pressure and increase your trips to the bathroom as well. Doctors allow around 150-300 mg of caffeine per day from all sources combined but advise against anything more. Having too much of caffeine is high on the list of what not to do while pregnant. 3.Don’t Take Certain Medications One of the first things that your doctor will tell you during your pregnancy is not to self-medicate or listen to any advice from friends or family. The intentions of such actions may be well-intentioned but can cause real and permanent damage to your baby. No over the counter medication unless cleared by your physician or explicitly prescribed by your doctor should be taken during pregnancy. Even seemingly harmless medicines such as Ibuprofen, Naproxen or Aspirin should not be taken without your doctor’s consent. 4.Don’t Wear Stilettos Those lovely stilettos that you love wearing on night’s out should be wrapped up and kept in storage until you have delivered your child. It may not seem obvious but the center of balance changes as your belly grows and you put on weight all over. This can make you unsteady especially if you add swollen ankles into the mix as well. Wear heels less than 3 inches if you must or not at all. There is also a good chance that your feet don’t really fit into the slinky footwear like they once did and so the decision might be taken out of your hand completely. 5.Don’t Hang out in the Hot Tub or Sauna This is one of the lesser known things about what not to do while pregnant. Being pregnant is tiring and a relaxing time in the hot tub can sound ideal. Unfortunately, though, this prolonged period of time in the hot tub has been found to be very damaging for the developing fetus. Doctors recommend taking a warm shower instead of a hot tub to help you wash away those aches and pains. Keep the temperature of the shower to warm as well rather than too hot. 6.Don’t Change the Kitty Litter This is important for all the cat owners out there because they may have to change up something that has been routine for them all throughout. Have someone else change out the kitty litter once you are pregnant or wear gloves while doing it yourselves. Pregnant women run the risk of contracting toxoplasmosis from cat feces and even though the chances are slim, doctors recommend they avoid doing so. 7.Don’t Breathe Secondhand Smoke The harmful effects of smoking while pregnant and otherwise are pretty well documented. Most people are aware of the risks that it carries but not all of them are aware that second-hand smoke is almost as dangerous to them as smoking itself. There are an estimated 4000 chemicals that are released in second-hand smoke, including some that are linked to the occurrence of cancer. Smoking around a pregnant woman is an absolute no-no and breathing in second-hand smoke is non-negotiable what not to do while pregnant rule. 8.Don’t Drink Drinking during pregnancy is one of the things that can sometimes be looked upon with a little leeway by some people. It is important to understand that there is no amount of alcohol that can be safely ingested during pregnancy. The alcohol passes through the placenta and umbilical cord to the baby and can cause long lasting damage even in seemingly small amounts. Drinking during pregnancy has been associated with the occurrence of premature births, brain damage, stillbirths, miscarriages as well certain birth defects. Think long and hard about the effects that drink can have before deciding if it's actually worth it. 9.Don’t Sit or Stand for Too Long Sitting in position or standing for a prolonged period of time is to be avoided during pregnancy unless specifically advised by the doctor. There are well known adverse effects of continuous pressure on one part of the body as that can affect the circulation, cause swollen ankles, legs and exacerbate deep vein problems. Take short breaks and continue moving about during your pregnancy. 10. Don’t Do Extreme Exercises A moderate amount of exercise is encouraged during pregnancy but anything that requires extreme exertion or contorting in difficult positions comes in the what not do while pregnant list. Try and ensure that your heart rate does not go above 160 beats per minute since it can have an adverse effect on the amount of oxygen being transported to the fetus and possible cause brain damage. 11. Avoid X-Rays X-ray radiation can cause a lot of damage to the developing fetus, especially in the first trimester when the process of organogenesis is going on. If exposure to X-rays is a must and has been advised by your doctor then the belly should be protected by a lead apron so that the least amount of exposure occurs. X ray exposure can cause malignancies, birth defects and mortality in the fetus of care is not taken.

Is Nipple Hair Normal? What You Need To Know About Sprouting Hair ‘On There’

Nipple hair. It’s the nemesis of many a woman, and another entry on the long list of body hair woes. Human beings are mammals, and you don’t qualify as a mammal without a certain necessary amount of body hair. It’s just how we’re built. That said, there are some kinds of body hair that just make us feel icky. Why couldn’t we just have hair on our heads, and skip unwanted chin hair entirely? We all have some unwanted body hair, though you may have more than others depending on a few situations. Genetics play a major role in how much body hair you grow, while certain hormone imbalances could also mean you grow a little bit more hair than average. Still, at the end of the day, it’s all normal. Nipple hair, like all other body hair, is just part of the messy, beautiful spectrum of being a human. That said, there’s no reason you can’t pluck the heck out of it if you really want to. Human beings are mammals, which means we’re covered in hair. Some areas have more hair than others, but even “bare” skin has a light coat of peach fuzz. That includes you breasts and, yes, your nipples. Technically, hair grows from the areola, the ring around your actual nipple. Most of it is light and downy, but some hairs will grow darker, longer, and coarser. When we talk about nipple hair, we’re usually referring to these more distinctive hairs. Is Nipple Hair Normal? Yes, nipple hair is totally normal. Humans are hairy creatures! Most women don’t have a ton of body hair compared with our male counterparts, but it still crops in a few major locations: our underarms, groins, and legs are all sources of body hair. Nipple hairs are also very, very common. According to Cosmopolitan and Dr. Mary Jane Minkin, 30 percent of all women report that they have nipple hair, though the numbers could be even higher. When Is Nipple Hair Not Normal? There are some situations where nipple hair may not be normal. If it crops up suddenly, it might be a symptom or side effect worth paying attention to. If your nipple hair suddenly changes (maybe it grows much longer, or there’s more of it) or if nipple hair appears when you’ve never had it before, it usually indicates a hormonal shift. Excess nipple hair might be a warning sign that you are having a hormonal reaction to medication, or that you have a hormonal imbalance due to polycystic ovary syndrome, or another similar condition. No More Nipple Hair #1: Tweeze It For most women, tweezing is the go-to route for getting rid of small amounts of unwanted hair. When our eyebrows get unruly, or a whisker develops on the chin, we reach right for the tweezers. They’re an equally effective remedy for small amounts of nipple hair. Plucking can banish a hair for a solid month or two, though be careful to clean the site to prevent infections and in-grown hair. No More Nipple Hair #2: Shave It There’s a common myth that shaving your body hair makes it grow back thicker and darker. In fact, shaving just makes new hair appear thicker because the shorter strands are less flexible and tapered than long strands. In other words, shaving off your nipple hair won’t give you more nipple hair down the road. That said, it might leave you at risk for itchy stubble in a sensitive area. It’s also worth noting that using a razor on such delicate skin might be a little bit perilous. No More Nipple Hair #3: Trim It If your nipple hair is growing wild and free, there’s no reason you can’t get in there with a pair of nail scissors to trim it down. Trimming your nipple hair is a great way to make it a bit less noticeable, especially if you have a few long, fine hairs growing. It might not get as close a trim as shaving or plucking, but trimming also means you’re less likely to develop in-growns. No More Nipple Hair #4: Wax It Every woman has a love-hate relationship with waxing. It hurts like a son of a gun, but it’s very effective. If you’re used to getting your lips, brows, and even your downstairs region waxed, there’s no reason you can’t add your nips to the list. However, be warned: If you aren’t a frequent waxer, you might find it very painful to have the sensitive skin around your nipples waxed. No More Nipple Hair #5: Laser It If you really can’t stand your nipple hair, laser hair removal might be the route for you. Laser hair removal can be very painful for some people, and it’s often pretty expensive. The big benefit of laser hair removal is that it zaps your unwanted hair for months at a time, and it helps get rid of it for good. This is the ideal option for anyone who wants to remove their nipple hair long term and then forget they ever had it. No More Nipple Hair #6: Leave It! Just leave it there! Your body is beautiful, right down to the three silky hairs sprouting from your nips. If you want to remove your hair, that’s totally fine. But it’s just as wonderful to simply embrace the growth as a natural (and womanly!) part of being you! Having nipple hair is no different than being left-handed or having a widow’s peak — it’s just another physical feature that makes you you! 

Discharge: 8 Types You May Find ‘Down There’ And What They Reveal About Your Health

Just about every woman has a keen understanding of what’s normal for her body. We’re attuned to everything, from hormonal fluctuations to lumps and bumps in our breasts that might signal that we need a doctor’s opinion. The one area that tends to be a little more, shall we say mysterious, is, well, our most private area. Women know more about their bodies now than ever before, but we can still get a little bit shy when it comes to our vaginas. It’s not that we don’t care about their health — far from it! — it’s just that investigating under the hood can be a little awkward. Even going to the gynecologist and getting an expert opinion makes plenty of us uncomfortable, even though we should all go at least once a year. That’s part of the reason it’s so important that we pay attention to the signs our bodies send us. Often, vaginal discharge is our body’s first warning that something might be amiss, so we should all know what different kinds of discharge mean! Discharge Type #1: Clear And Slippery One of the major signs of ovulation is clear and slippery discharge, which is your body’s way of saying, “Hey, I’m trying to get pregnant over here!” Not coincidentally, this is also the natural lubricant your body releases when it’s aroused; even if you aren’t looking to be pregnant right now, your body definitely is. In other words, if you notice this kind of fluid in a totally non-sexy situation, it’s a good indicator that it’s your other time of the month, and you should be extra careful about using protecting. Discharge Type #2: Thick And Foamy Yeast infections are one of the most common — and irritating — ailments that can afflict your undercarriage. Yeast infections, caused by the candida organism, can affect men too, and can also be found in the throat and mouth, but they’re at their worst when they affect your vagina. Fortunately, even if you do spot the tell-tale thick, “cottage cheese” discharge, it’s easy to treat with an over-the-counter antifungal like Monistat or a prescription from your doctor. Discharge Type #3: Yellowish-Green If you notice that your discharge seems to be turning a yellow-green color, it’s time to schedule an appointment with your doctor. Greenish discharge is a sign of infection in your vagina, just like green mucus is a sign of infection in your sinuses — your body is building up white blood cells to fight off an attacker, which give it a greenish tint. A lot of the infections that cause this tint are caused by treatable STI’s, like gonorrhea and trichomoniasis, so it’s a good idea to go to the doctor and get treatment, and to tell any sex partners. Discharge Type #4: Bloody Or Brown Finding blood anywhere when you aren’t expecting it is alarming, and it’s especially unnerving when it’s coming from your private area. Fortunately, most of the time these stains are just menstrual spotting, and might be brownish because it’s older blood that wasn’t flushed out during your last period. However, if you no longer get a period, or don’t normally spot, you should have this checked out immediately — bloody discharge can be a sign of cervical or ovarian cancer. Discharge Type #5: Bad-Smelling To be perfectly frank, we all know the downstairs can get a bit musty from time to time. Most bad smells are related to sweat getting trapped in the groin and developing body odor, much like your armpits, but pay attention if it’s your discharge itself that smells funky. Smelly discharge might be linked to a yeast infection, or it could be related to bacterial vaginosis, a bacterial infection that happens when the acidic balance of your vagina is thrown off. Discharge Type #6: Cloudy White Normal vaginal discharge colors can range from clear to milky white, so this is usually nothing to be overly concerned about. The exception? If your discharge normally looks different and the cloudy discharge comes with additional changes, like itching or sores, which could mean infection. On the other hand, cloudy discharge is also one of the earliest signs of pregnancy, so if you’ve been “trying” it might be time to take a home test! Discharge Type #7: Gray-Black Gray or black discharge is almost always cause for alarm, so if you’re seeing this pattern, call your doctor straight away. There are some exceptions: Sometimes old menstrual blood can look black, or your body might be picking up color from something like a new pair of underpants. The most common reason for black discharge is that you have a foreign object — like a forgotten tampon — in your body, and you need immediate medical attention to avoid toxic shock syndrome. Discharge Type #8: Pinkish Tint Pinkish discharge usually means that you’re bleeding, but only a little bit. Pink discharge usually indicates a small amount of fresh blood, rather than the heavier, darker flow of menstrual blood. If you get pregnant, you might experience pink discharge from implantation. You might also see this coloration after sex, because the friction of sexual activity can sometimes cause minor injuries to the vaginal walls.

Daily Low-Dose Aspirin Can Boost Chances of Successful Pregnancy

For some women who are trying to get pregnant, taking a low dose of aspirin daily may boost their chances of having a baby, according to a new analysis. The analysis, which looked at women who'd had a prior pregnancy loss and taken part in an earlier study, found that women who benefited from the aspirin regimen had high blood levels of C-reactive protein (CRP), a marker of inflammation in the body. Among these women, those who took a daily aspirin were 31 percent more likely to become pregnant, and 35 percent more likely to carry a pregnancy to term, than those who took a placebo. However, it's too soon to officially recommend daily aspirin to prevent pregnancy loss, the researchers said. Prior to this report, researchers knew that inflammation in the body could contribute to reproductive problems. For example, women with pelvic inflammatory disease or polycystic ovary syndrome — two conditions that involve inflammation — are at increased risk for infertility. But few studies have examined whether lowering levels of inflammation in a woman's body would affect her chances of successfully becoming pregnant and giving birth. In the new analysis, the researchers analyzed information from more than 1,200 U.S. women ages 18 to 40 who had previously experienced a miscarriage or stillbirth. The women were randomly assigned to take either a low dose of daily aspirin (81 milligrams) — which is thought to counteract inflammation — or a placebo, for six menstrual cycles while they were trying to become pregnant. If the women became pregnant, they continued taking the pills until 36 weeks of pregnancy. (A full-term pregnancy is 39 to 40 weeks.) Then, the researchers divided the women into three groups: those with low, medium and high CRP levels. Overall, 55 percent of the women in the study became pregnant and gave birth. Among the women with high CRP levels, those who took a daily aspirin had a birth rate of 59 percent, compared with just 44 percent among those who took the placebo. Taking daily aspirin also lowered CRP levels in the women with the highest CRP levels. Women with low or medium CRP levels had about the same birth rate, regardless of whether they took aspirin or a placebo, the researchers found. In an earlier analysis of this same study, published in 2014, researchers did not find a link between taking aspirin and a reduced risk of pregnancy loss. But for that analysis, the researchers did not look at the level of inflammation in the women's bodies. The new findings suggest that "inflammation may significantly harm women's ability to become pregnant," and that taking aspirin prior to conception may reduce this risk, the researchers said. In the future, doctors might consider using a screening test for CRP levels to determine whether a woman may benefit from aspirin treatment before and during pregnancy, the researchers said. However, future studies would be needed to examine this, and to determine exactly what the cutoff would be for "high" CRP levels, they said. Taking high doses of aspirin (more than 100 milligrams a day) during pregnancy may increase the risk of pregnancy loss, congenital defects and complications with the fetuses' heart, according to the Mayo Clinic. Women should speak with their doctor about taking pain medication during pregnancy. The anaysis, conducted by researchers at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, was published online Feb. 3 in the Journal of Clinical Endocrinology and Metabolism. 

Quick And Accurate Way Of Diagnosing Endometriosis (Not By Laparoscopy)

A quick and accurate test for endometriosis that does not require surgery has been developed by researchers from Australia, Jordan and Belgium, according to new research published online in Europe's leading reproductive medicine journal Human Reproduction. Until now there has been no way of accurately diagnosing endometriosis apart from laparoscopy – an invasive surgical procedure – and this often leads to women waiting for years in pain and discomfort before their condition is identified correctly and treated. Now researchers at the University of Sydney and Mu'tah University in Karak, Jordan, have discovered that if they take a small sample of the endometrium (the lining of the uterus), which can be done by inserting the device for taking the biopsy via the vagina, and then test for the presence of nerve fibres in the sample, they can diagnose whether or not endometriosis is present with nearly 100% accuracy. Endometriosis, which has been estimated to affect 10-15% of women of reproductive age, is a chronic gynaecological disease in which cells from the endometrium establish themselves outside the uterus, within a woman's pelvic area. Symptoms associated with it include infertility, painful periods, pelvic pain and pain during sexual intercourse. Once laparoscopy has identified endometriosis as the cause of these symptoms, treatment involves surgical removal (usually via laparoscopy) of the abnormally sited endometrial cells. However, laparoscopy itself can be associated with complications and can adversely affect fertility in women who do not have endometriosis. In a separate study also published online in Human Reproduction, another research group from Belgium and Hungary has found that the density of nerve fibres in the endometrium was about 14 times higher in women with endometriosis than in healthy women, and that using specific markers to identify the presence of nerve fibres could predict with nearly 100% accuracy the presence of minimal to mild endometriosis/ In the first study, led by Professor Ian S. Fraser, head of the Queen Elizabeth II Research Institute for Mothers and Infants at the University of Sydney and Dr Moamar Al-Jefout, assistant professor in reproductive medicine at Mu'tah University, researchers took endometrial biopsies from 99 women who had consulted doctors about pelvic pain, infertility or both and who were undergoing laparoscopy for the condition. The results from the endometrial biopsies were compared with the results of the laparoscopies, and the researchers found that in 64 women who had endometriosis confirmed by laparoscopy, all but one tested positive for the presence of nerve fibres in the endometrial biopsy. In the 35 women who were found not to have endometriosis by laparoscopy, no nerve fibres were found in 29 of the endometrial biopsies. In the other six cases, the biopsy found there were nerve fibres present; three of these women had severely painful periods and painful sex, and also a history of infertility, and of the other three, one had adhesions that were considered too slight to be endometriosis, while the other had a previous history of endometriosis. Women with endometriosis and painful symptoms had significantly higher nerve fibre density in comparison with women with infertility but no pain (2.3 nerve fibres per mm2 compared to 0.8 per mm2 respectively). The mean average of nerve fibre density in the women with a laparoscopic diagnosis of endometriosis was 2.7 per mm2. The study showed that testing endometrial biopsies for the presence of nerve fibres was able to diagnose endometriosis with 83% specificity (the proportion of negative cases of endometriosis correctly identified) and 98% sensitivity (proportion of positive cases correctly identified). This double blind study confirmed the results of a pilot study published in 2007 by the same group. Dr Al-Jefout said: "This study has shown that testing for nerve fibres in endometrial biopsies is a valid and highly accurate diagnostic test for endometriosis. This test is probably as accurate as assessment via laparoscopy, the current gold standard, especially as it is unclear how often endometriosis is overlooked, even by experienced gynaecologists. Endometrial biopsy is clearly less invasive than laparoscopy, and this test could help to reduce the current lengthy delay in diagnosis of the condition, as well as allowing more effective planning for formal surgical or long-term medical management. It may be particularly helpful in cases of infertility." Currently, diagnosing endometriosis via laparoscopy involves the woman being booked into hospital for the surgical procedure, an anaesthetic, and the presence of doctors, nurses and expensive equipment. In some countries there are long waiting lists for operations. In contrast, taking an endometrial biopsy is relatively quick and easy to organise and perform, and results are available within about three days. However, Dr Al-Jefout said: "It needs to be emphasised that this test requires a carefully collected endometrial biopsy and an experienced immunohistochemical pathology laboratory to confirm or exclude the presence of nerve fibres." He continued: "Our results indicate that a negative endometrial biopsy result would miss endometriosis in only one percent of women. Performing a planned laparoscopy only on a woman with a positive endometrial biopsy result would result in endometriosis being confirmed in eighty to ninety percent of these women. Thus, using this diagnostic test in an infertility workup would significantly reduce the number of laparoscopies performed without reducing the number of women whose endometriosis is diagnosed and surgically treated." In addition, he said it could be particularly useful in teenagers with spasmodic symptoms but a family history of endometriosis. "The usual diagnostic delay in this special group is greater than in older women. An endometrial biopsy to confirm or exclude the diagnosis of endometriosis will help initiating earlier treatment and possibly preventing the progress of endometriosis, thus improving life style and protecting their future fertility." The researchers plan to continue using the test in patients and to search for other markers to help refine the test further. "Ideally, we would like to develop a blood test as an even simpler means of providing early information on the presence or absence of endometriosis in order to assist doctors in early diagnosis. However, this endometrial biopsy test has proven so effective that it is currently the only test which appears to have equivalent efficacy to a diagnostic laparoscopy carried out by an experienced gynaecologist," he concluded. In the second study, led by Professor Thomas D'Hooghe, coordinator of the University of Leuven Fertility Centre (Belgium), researchers looked at 40 endometrial samples, half taken from women with minimal to mild endometriosis diagnosed by laparoscopy and histology (microscopic examination of tissue), and half from women without the condition. They analysed the tissues for several markers indicating the presence of four types of nerve fibres (sensory C, A∂, adrenergic and cholinergic nerve fibres). Dr Attila Bokor, a doctoral fellow at the University of Leuven, who did the study as part of his PhD project said: "We observed nerve fibres in the endometrial samples of ninety percent (18 out of 20) of the women with endometriosis. The density varied throughout the samples, with few specimens showing counts above 30 per mm2, and with most between 0 and 10 per mm2. None, or very few, nerve fibres, were detected in any of the samples from women without endometriosis. The density of the small nerve fibres was about 14 times higher in endometrium from patients with minimal to mild endometriosis when compared with women with a normal pelvis." Prof D'Hooghe said: "Our data show that the combination of three different neural markers increases the sensitivity, specificity and diagnostic accuracy of this method of testing for endometriosis. The test diagnosed endometriosis with 95% sensitivity and 100% specificity." Dr Bokor and the team of Prof D'Hooghe will do a blinded validation study in September 2009 to confirm the results of their research. "If this confirms our findings, we believe our research can be a solid base for a simple, reliable and relatively cheap method for non-invasive diagnosis of minimal and mild endometriosis, since trans-cervical endometrium sampling and immunohistochemical analysis are routine gynaecological and pathological procedures. Our research programme is also aimed at discovering new biomarkers that can enable a blood test for endometriosis to be developed," said Prof D'Hooghe.

New FDA Pregnancy Categories Explained

FDA Pregnancy Categories FDA Pregnancy Risk Information: An Update In 2015 the FDA replaced the former pregnancy risk letter categories on prescription and biological drug labeling with new information to make them more meaningful to both patients and healthcare providers. The FDA received comments that the old five-letter system left patients and providers ill-informed and resulted in false assumptions about the actual meaning of the letters. The new labeling system allows better patient-specific counseling and informed decision making for pregnant women seeking medication therapies. While the new labeling improves the old format, it still does not provide a definitive “yes” or “no” answer in most cases. Clinical interpretation is still required on a case-by-case basis. The Pregnancy and Lactation Labeling Final Rule (PLLR) went into effect on June 30, 2015; however, the timelines for implementing this new information on drug labels (also known as the package insert) is variable. Prescription drugs submitted for FDA approval after June 30, 2015 will use the new format immediately, while labeling for prescription drugs approved on or after June 30, 2001 will be phased in gradually. Medications approved prior to June 29, 2001 are not subject to the PLLR rule; however, the pregnancy letter category must be removed by June 29, 2018. For generic drugs, if the labeling of a reference listed drug is updated as a result of the final rule, the abbreviated new drug application (ANDA) labeling must also be revised. Labeling for over-the-counter (OTC) medicines will not change, as OTC drug products are not affected by the new FDA pregnancy labeling. The A, B, C, D and X risk categories, in use since 1979, are now replaced with narrative sections and subsections to include: Pregnancy (includes Labor and Delivery): Pregnancy Exposure Registry Risk Summary Clinical Considerations Data Lactation (includes Nursing Mothers) Risk Summary Clinical Considerations Data Females and Males of Reproductive Potential Pregnancy Testing Contraception Infertility The Pregnancy subsection will provide information about dosing and potential risks to the developing fetus and registry information that collects and maintains data on how pregnant women are affected when they use the drug or biological product. Information in drug labeling about the existence of any pregnancy registries has been previously recommended but not required until now. Contact information for the registries will also be included, and pregnant women are encouraged to enroll to help provide data on the effects of drug use or biologics in pregnancy. If information for the subsections of Pregnancy Exposure Registry, Clinical Considerations, and Data is not available, these subsections will be excluded. The Risk Summary subheadings are always required, even if no data is available. The Lactation subsection will replace the “Nursing Mothers” subsection of the old label. Information will include drugs that should not be used during breastfeeding, known human or animal data regarding active metabolites in milk, as well as clinical effects on the infant. Other information may include pharmacokinetic data like metabolism or excretion, a risk and benefit section, as well as timing of breastfeeding to minimize infant exposure. In the subsection entitled Females and Males of Reproductive Potential, relevant information on pregnancy testing or birth control before, during or after drug therapy, and a medication’s effect on fertility or pregnancy loss will be provided when available. Why Did the FDA Make This Change? Clinically, many women require drug treatment during pregnancy due to chronic conditions such as epilepsy, diabetes, hypertension (high blood pressure), or asthma. To withhold drug treatment would be dangerous for both mother and baby. In addition, women are having babies at a later age, which can boost the number of women with chronic conditions. Accessible and understandable pregnancy and lactation information is important for women and their health care provider’s to assess risk versus benefit. The FDA has received requests to improve the decades-old content and format of pregnancy prescription drug labeling since 1992. According to the Drug Information Division at the FDA, they obtained input from many affected groups and held public hearings, advisory committee meetings, and focus groups to assess the changes. In 2008, the FDA issued the proposed rule and then opened a docket for public comments. Clinicians and patients were often confused by the meaning of the pregnancy risk categories because, according to the FDA, it was overly simplistic, led to misinformation, and did not adequately address the available information. Examples of drugs approved since June 30th, 2015 showing various new pregnancy and lactation subsections in their labels: Addyi (flibanserin) - indicated for generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. Descovy (emtricitabine and tenofovir alafenamide fumarate) - indicated for HIV-1 infection. Entresto (sacubitril and valsartan) - indicated for heart failure. Harvoni (ledipasvir and sofosbuvir) - indicated for chronic viral hepatitis C infection (HCV). Praluent (alirocumab) - indicated for heterozygous familial hypercholesterolemia, or patients with atherosclerotic heart disease who require additional lowering of LDL-cholesterol. FDA Pregnancy Risk Categories Prior to 2015 In 1979, the FDA established five letter risk categories - A, B, C, D or X - to indicate the potential of a drug to cause birth defects if used during pregnancy. The categories were determined by assessing the reliability of documentation and the risk to benefit ratio. These categories did not take into account any risks from pharmaceutical agents or their metabolites in breast milk. In the drug product label, this information was found in the section “Use in Specific Populations”. The former pregnancy categories, which still may be found in some package inserts, were as follows: Category A Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters). Example drugs or substances: levothyroxine, folic acid, liothyronine Category B Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. Example drugs: metformin, hydrochlorothiazide, cyclobenzaprine, amoxicillin, pantoprazole Category C Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Example drugs: tramadol, gabapentin, amlodipine, trazodone Category D There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Example drugs: lisinopril, alprazolam, losartan, clonazepam, lorazepam Category X Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits. Example drugs: atorvastatin, simvastatin, warfarin, methotrexate, finasteride

This Baby's Legs Are Poking Through A Tear In Its Mother's Uterus Wall

If you're not familiar with what goes on inside a woman's body during pregnancy, the above image might not look particularly unusual to you – but it's something the doctors at Angers University Hospital in France had never seen before. In what is only the 26th documented episode of this extremely unusual pregnancy complication, a woman had developed a tear in the wall of her uterus, through which her baby's legs and a large amount of protective amniotic fluid escaped. The case began when a 33-year-old woman went to hospital for what was supposed to be a regular, scheduled ultrasound during the 22nd week of her pregnancy. At the time, she had detected no unusual symptoms, and presumably thought the check-up would be simply routine. But when doctors examined her, they found a large herniation of the amniotic sac – the protective membranes that envelop the foetus during gestation. In this case, the ultrasound showed that the sac had slipped through a rupture in the left wall of her uterus. Additional scans via magnetic resonance imaging (MRI) showed that the tear in the uterine wall extended for 2.5 centimetres (1 inch), indicated by the arrows in the image below: A portion of the amniotic sac measuring 19 by 12 by 9 cm (7.5 by 4.7 by 3.5 inches) had slipped through this hole, along with the baby's legs up to a little above the knees. Obstetrician and gynaecologist Pierre-Emmanuel Bouet told Sara G. Miller at Live Science that this "extremely rare" condition was something the medical staff at the hospital had never encountered. The doctors advised the patient that the herniated sac could lead to potentially dangerous complications as the pregnancy developed – including a complete uterine rupture, or the possibility of pre-term birth. But the woman and her partner decided to proceed with the pregnancy as well as they could, and monitor the situation closely. According to Bouet, the most likely cause for the rupture was the woman's earlier history with caesarean sections (C-sections). This pregnancy was the patient's sixth, with her five previous children all being delivered by C-section. While the tissue where these C-section incisions were made had healed over and strengthened, areas around the uterus incisions had become weakened, leading to the rupture. According to doctor Yvonne Bohn from Providence Saint John's Health Centre in Santa Monica, repeated C-sections are known to carry risks, but they don't usually present like this. "It is extremely rare. Usually the risk of rupture [occurs] during labour, but in this case the uterine wall was very weak from prior C-sections," she told Melissa Willets at Parents. "The risk of uterine rupture increases exponentially with each C-section," Bohn added, explaining that the situation can become an issue after three or four C-sections. Fortunately in this case, the issue didn't result in the loss of the baby. Two months after the MRI, with the pregnancy now in its 30th week, another ultrasound showed that the tear had doubled in length to 5 centimetres (2 inches). As a result, more of the amniotic sac had slipped through the gap, along with more of the foetus's body – with the abdomen now popping through too. A decision was made to attempt an early C-section, and at 30 weeks, a healthy baby boy weighing 1.385 kilograms (3 lbs.) was delivered. After the birth, the woman's uterine wall and herniated amniotic sac were treated, and the patient was discharged after only five days in hospital. Six months later, both the mother and her baby were healthy and doing well, so despite the potentially dangerous situation, it all worked out okay. And now that the doctors have written up the circumstances of this unusual case, hopefully it'll help other medical staff to be more aware of this rare condition in the future. Source   Monday at 6:39 AM LikeReply Nada El Garhy Golden Member it's very unusual that she was symptom-less. I mean haven't she complained of spotting at least? Or were the fetus' legs just plugging the rupture?   Monday at 7:25 PM LikeReply Write your reply... Popular Threads How To Study Once and Remember... Nada El Garhy posted Jan 16, 2017 The Top 19 Most Narcissistic... Ghada Ali youssef posted Jan 6, 2017 Lowest Paid Doctors In The World Nada El Garhy posted Jan 4, 2017 Sutures Materials - What ,Why... Ghada Ali youssef posted Jan 12, 2017 Meet The World’s Oldest Surgeon... Ghada Ali youssef posted Feb 4, 2017 Recent Threads 4 Reasons Why Being A Doctor Is... Nada El Garhy posted Friday at 4:16 PM Researcher Investigates Why... Ghada Ali youssef posted Today at 6:00 AM Acid Reflux And Coughing:... Ghada Ali youssef posted Today at 5:56 AM Cholesterol Test: Uses, What To... Ghada Ali youssef posted Today at 5:50 AM What Increases The Chance Of... 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