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Abnormal Pap Smear in Pregnancy

July 28, 2014/in Pregnancy Channel/by coastal

What is an Abnormal Pap Smear?

A Pap smear is a screening test that allows a doctor to look at the cells at the cervix (which is the lower part of the womb) and see if there are precancerous or cancerous cells. This test is usually performed using a speculum. Abnormal Pap smears are now known to be caused by infection with the human papilloma virus (HPV). This is a sexually transmitted virus. There are a number of different strains of HPV, and the strains that are associated with causing cervical cancer have been identified. If one has HPV, most people do not progress to cervical cancer. A similar analogy would be most people who have a cold to not develop pneumonia. Out of most women who get infected with HPV, only a small number of women develop abnormal Pap smears. Out of those, a much smaller number get progressively worse Pap smears that may develop into cervical cancer after 10-15 years. Abnormal

pap smears do not affect the

pregnancy or the baby. Rarely a procedure may be necessary (colposcopy, and/or cervical biopsy) however most procedures can be postponed until after the baby is born. If there is a history of the cervix being excised, frozen (cryotherapy) or a conization procedure then a transvaginal ultrasound is recommended at around 16-20wks to confirm there is no evidence of a short cervix (cervical insufficiency).

Pap smears are graded according to the degree of abnormality. There are three different degrees: Low Grade (LGSIL), High Grade (HGSIL), and Cancer (CIS). The progression from one stage to the other occurs over a number of years. Not all cases progress from one stage to the next; most cases of LGSIL regress to normal over time with no treatment. Management of abnormal Pap smears is dependent upon the patients’ age and degree of abnormality. Colposcopy is performed to rule out the presence of more abnormal cervical cells after an abnormal Pap smear. This procedure is performed using a specific magnifying apparatus, the cervix is carefully examined to ensure there is no evidence of cervical cancer. During this procedure cervical biopsies are often taken. In pregnancy, if necessary colposcopy and biopsies are safe.

LGSIL in a younger patient is managed expectantly with follow up pap smears and colposcopy as opposed to older patients.

Pap smears used to be reviewed by pathologist who based their diagnosis of the abnormal cells in the cervical smear, but with the knowledge that HPV is causative, most pap smears include testing to detect the presence of HPV. Newer tests can detect HPV from a urinalysis; these tests may ultimately replace the Pap smear as a screening test.

How do Abnormal Pap Smears Affect the Pregnancy and Baby?

HPV is not believed to harm the baby, or affect the pregnancy adversely. In rare cases of genital warts (also caused by HPV), a patient may have a large growth of warts called condyloma accuminata. This growth occurs in the vagina, the vuvla, or the rectum. These growths are very delicate, and during vaginal delivery can easily bleed because of the trauma of childbirth. There is a small chance the baby may be exposed to the virus. The baby has a small chance of developing a rare condition called laryngeal papillomatosis.

In some patients, the abnormal Pap smear may progress from LGSIL to HGSIL (slightly abnormal, to very abnormal). Depending upon the age of the patient, and the length of time the the abnormal Pap smear has been present, some patients may undergo a procedure called a LEEP (loop electrosurgical excisional procedure). This procedure is diagnostic, and curative. Using an “electric” knife, the abnormal portion of the cervix is removed. After this procedure usually Pap smears are performed every 4 months for one year to confirm no abnormal cervical cells were left behind. One risk of this procedure is that the amount of cervix removed may impact the ability to carry a baby to term and result in a insufficient (incompetent ) cervix. If you have had this procedure, you will need transvaginal ultrasounds around 16-20 weeks, and if your cervical length is less than 1.5cm, you may benefit from a cervical cerclage.

This procedure is rarely performed during pregnancy. If you are found to be at significant risk for cervical cancer and are pregnant, your doctor will send you to a Gyn-oncologist for their recommendations.
Website: http://www.acog.org/publications/patient_education/bp161.cfm

For more helpful pregnancy hints, instructional pregnancy videos, upcoming podcasts and to get more information about the world’s first non-toxic makeup exclusively for pregnant women, please go to www.VSACHARMD.com.

Chronic Hypertension in Pregnancy

July 20, 2014/in Pregnancy Channel/by coastal

What is it?

Chronic hypertension affects up to 5% of all pregnancies. If you have a blood pressure of 140/90 or greater AND you are before 20 weeks gestational age, then you may have chronic (pre-existing) hypertension. Because most women of childbearing age are young, they often do not go to their doctor for checkups because they feel “healthy”. Pregnancy involves multiple visits to your medical provider, and it may be here that elevated blood pressure is first noted. If you are noted to have elevated blood pressure (greater than 140/90) and you are past 20 weeks gestational age, then your diagnosis is gestational hypertension, or elevated blood pressure during pregnancy. In this case you will be evaluated 12 weeks after you deliver to determine if your hypertension persists; if it does, then you have chronic hypertension, if it resolves then you had transient hypertension.

Risk factors for developing hypertension include obesity, substance abuse, chronic exposure to toxins, advanced maternal age, pre-existing diabetes mellitus, other medical conditions such as lupus, renal disease, and genetics.

If you have chronic hypertension, you are probably on medication. If you are on angiotensin-converting enzyme inhibitors (ACE) or a similar class (ARB) these medications are teratogens associated with congenital malformations in the fetus and are NOT recommended during pregnancy. You should discuss your medications with your obstetric health care provider as early as possible. Classes of antihypertensives that safe in pregnancy include calcium channel blockers, and beta blockers.

Hypertension is a very dangerous disease both during pregnancy and outside of pregnancy. It is called the “silent killer” because the you, the patient don’t feel ill, or sick, however you may have blood pressure that is elevated. The elevated blood pressure causes damage to the placenta (affecting the baby), can injure your kidneys, brain, and your heart.

How it affects the Pregnancy?

I tell my patients that hypertension is like having really big waves on a beach. Eventually, the force of the big waves crashing on the soft sandy beach, will erode the beach. Similarly, elevated blood pressure damages the delicate placenta. If 50-70% of the placenta gets damaged, the placenta cannot function optimally. Accordingly the baby gets less nutrients, and oxygen. Subsequently the baby will stop growing appropriately, and if the placenta gets further damaged, it may eventually lead to fetal demise, or the placenta getting bruised (abruption). In this case there is bleeding inside the placenta, and there can be severe injury to both mother and baby; this is considered a pregnancy emergency.

Hypertension in pregnancy also places the mother at risk for worsening hypertension, pre-eclampsia and eclampsia. Pre-eclampsia is a condition in which the maternal blood pressure rises and this causes adverse maternal reactions in the maternal kidney, liver and brain. If this condition continues to evolve, a small percent of women may develop

a seizure with convulsions (eclampsia). The only way to treat pre-eclampsia and eclampsia is delivery. If pre-eclampsia occurs before 32 wks, there may be a role for expectant management, as the prematurity of fetal delivery places the baby at risk other sequelae of prematurity. When the pregnancy is complicated by a condition that necessitates delivery, women are given injections of Corticosteroids (Betamethasone/ Celestone), 2 injections 24 hours apart. This medication crosses the placenta and accelerates tissue maturity of the fetus therefore protecting the baby from some of the more severe sequelae of delivering prematurely.

Diagnosis and Treatment

The diagnosis of chronic hypertension is based on the finding of elevated blood pressure over 140/90 before 20 weeks gestational age. If elevated blood pressure is noted after 20 weeks gestation, then the diagnosis is called gestational hypertension. When the elevated blood pressure is accompanied by proteinuria, and elevated liver enzymes, the diagnosis is a variant called HELLP syndrome (Hemolysis, Elevated Liver Enzymes, Low Platelets). Generally this condition warrants immediate delivery, but gestational age always plays a role.

If you have this condition before or during pregnancy, your obstetrician will want to establish baseline values of your kidney function, platelet count, and liver tests. The kidney function is assessed by checking your urine for presence of protein. Both the platelet count and liver tests are blood tests.

Hypertension in pregnancy is treated with Beta Blockers, Calcium Channel Blockers, or diuretics. The goal of anti-hypertensive therapy is to keep the blood pressure below 140-150/90-100. In the past Methyldopa was used, however as the safety profile of the other beta blockers, diuretics and calcium channel blockers in pregnancy has been established, methyldopa is out of favor. One beta blocker in particular, atenolol, is NOT recommended in pregnancy as it is associated with growth restriction (impaired fetal growth).

After delivery, you may need to be reassessed by your primary care physician to see which medication is best for your hypertension. Often women with pre-eclampsia, eclampsia, and gestational hypertension may need treatment for up to 6 weeks postpartum. If they need treatment beyond this time period, the diagnosis of chronic hypertension should be considered.

Recently it has been found that women with pre-eclampsia, eclampsia and the disorders of hypertension in pregnancy are at higher risk for cardiovascular events later on in life. Careful followup with your primary care physician, and awareness of your blood pressure values is important to ensure that you do not become a victim to this “silent killer”.

Copyright 2014 V Sachar MD. All Rights Reserved.
No part of this post may be duplicated without expressed consent by author.

Anemia in Pregnancy

July 7, 2014/in Pregnancy Channel/by coastal

What is it?

Anemia is the most common nutritional problem affecting pregnant women. Anemia itself is not a diagnosis, but is a sign of a problem; there are multiple etiologies of anemia. In pregnancy one of the most common causes of anemia is that there is an increase in blood volume but less red blood cells are made. This results in a dilutional anemia; note however, your hemoglobin level should not go below 11. There are nutritional causes or anemia as well: the most common nutritional cause of anemia is iron deficiency. Iron is needed to carry oxygen in the blood, and this oxygen then supports the mom and the baby. Anemia in pregnancy is commonly attributed to the deficiency of iron, folate,and vitamin B12. Iron-deficiency anemia is the most commonly observed pregnancy-related anemia affecting about 15% to 25% of all pregnancies.

However, folic-acid deficiency anemia occurs in only about 1% to 5% pregnancies worldwide. Other common causes of anemia include folate and vitamin B12 deficiency, chronic liver disease, HIV, chronic renal disease etc. Symptoms associated with anemia may be maternal tachycardia, shortness of breath, being constantly tired, palpitations, lightheadedness ..unfortunately, these symptoms are also consistent with the normal symptoms experienced by women in pregnancy.

Some women with an underlying anemia during pregnancy, consume large amounts of nonnutritional substances: ice, chalk, corn starch, soil, matches, sand, hair, soap…and other similar textured substances. This is called Pica. The exact etiology why they eat these substances is unknown, however it makes the anemia more severe. I have had many patients who were sent to me with a diagnos i s of severe anemia (Hemoglobin around 6-7). Upon further questioning, i realized these women had pica,. They were consuming 20-30 large glasses of ice daily. Only after they stopped eating the substance did their hemoglobin levels rise, along with large amounts of iron replacement. In some situations, because the patient was so close to delivery, they needed blood transfusions.

Some anemias are due to a genetic error in the hemoglobin, these are called hemoglobinopathies. Examples include, sickle cell disease, thalassemia…etc. If you have anemia, your physician will order an iron level, folate level, vitamin b12 level, haptoglobin and a hemoglobin electrophoresis. These tests will help determine if you have a nutritional deficiency, or a genetic problem, or a problem with increased red blood cell destruction. This will guide your physician to the etiology of your anemia and best treatment for you.

How it affects Pregnancy & Baby?

In studies, severe anemia is associated with adverse fetal outcome, and possible preterm delivery. In these studies, the hemoglobin level was around 4-6. Note however, if your hemoglobin is below 11, you still should have the appropriate workup, and follow treatment if necessary. A low hemoglobin puts you at risk for medical consequences if you have severe bleeding in pregnancy (hemorrhage) or if you are at risk for hemorrhage (if you undergo a cesarean section). For instance you may need a blood transfusion. Genetic causes of anemia such as thalassemia, or sickle cell disease, may place the baby for risks of inheritance. If you have a genetic cause for your anemia, you should see a genetic counsellor during by your pregnancy to ensure you are aware of all potential risks to your baby.

Treatment

The treatment depends on the etiology of your anemia. This usually involves, iron, or vitamin B12, or folate. Iron supplementation is associated with some side effects, most notably constipation, nausea vomiting, and diarrhea. The most effective way to take iron supplements is with orange juice and food, not with milk.

If your etiology is pica, then stopping the offending action (through diet) will usually help, along with supplements. A followup hemoglobin level about 4-6 weeks after initiating treatment will demonstrate improvement. If the anemia is severe, and you
are going to deliver within 1-2 weeks, you may need a blood transfusion, or intravenous iron. Your practitioner will assess the severity of your anemia with the risk delivery.

Although extremely common in pregnancy, anemia is usually recognized early, and once an accurate etiology is determined, anemia can be treated without adversely affecting the pregnancy.

Can Your Makeup Cause Your Breakouts & Acne?

June 2, 2014/in Pregnancy Channel/by coastal

Yes it can! In this post, you will learn what causes makeup associated breakouts an acne, how to prevent it, and what your best makeup choices are.

The medical term for makeup associated acne is acne cosmetica. It generally appears like small, white bumps, but can also look like regular acne. Acne cosmetica usually occurs on the chin and cheek and occasionally the forehead too. This type of acne can take months to form, but once it starts it tends to last for years, as the person ends up using more makeup to cover the acne, which in turn leads to more breakouts. Acne can also be aggravated by applying makeup too aggressively, or using a harsh or dirty makeup brush.

Some women may experience allergic reactions to their cosmetics. The difference between acne cosmetica and an allergic reaction, is that the allergic reaction can occur very quickly, within minutes to hours of exposure. The reactions can range from an itching/burning to itching, swelling and even blister formation. These types of reactions are usually caused if you develop any kind of reaction soon after you begin using a new makeup product. If this occurs, it’s probably a good idea to stop using that particular product. Remember it’s not just what you put on your skin it’s what you put in your skin.

Recently the media is in a frenzy over gluten. Gluten is a protein found in wheat and related grains. Why is wheat in your makeup? It is often used as a filler, or bulking agent. Many people are unaware that they are gluten sensitive. Maybe you notice if you eat pizza, you get a little bloated and “uncomfortable” after. This may last the whole day and you may think this is a normal reaction to the food, however this may be a gluten sensitivity. If your makeup has gluten, then you may develop a mild reaction to the makeup. This may show up as puffy, red, sensitive skin, and maybe even mild forms of acne. It is difficult to diagnose this sensitivity

by a medical test; clinically the best way is avoidance; eliminate gluten from your diet (if you have those abdominal symptoms of bloating, pain and upset stomach), and use gluten free makeup. Because gluten sensitivity is quite often undiagnosed, we formulated all of the makeup at VSacharMD.com to be gluten free.

How to Prevent It?

If you think you have acne cosmetica, consider going bare when possible. This may alleviate the irritation on your skin, and give your skin a chance to heal. When applying makeup, use a gentle touch to minimize skin irritation. Use non-comedogenic (doesn’t cause your skin pores to clog), fragrance-free, powder based preparations as liquid based products have more oil, and can clog pores. Don’t sleep in your makeup at night and use a gentle cleanser to remove it. Consider using exfoliating wipes and pads, which are gentle but remove more dead skin than soap does. This will prevent clogged pores and acne.

Mineral makeup is a good choice as it uses natural minerals for color as opposed to artificial colors and dyes which are skin irritants. Some women may find a decrease in their acne just by changing their makeup brands to noncomedogenic brands. If you have skin irritation, and you also have symptoms of gluten sensitivity, consider using makeup that is gluten free.

At www.VSacharMD.com, we formulated our Loose Mineral Foundation and Cream Mineral Foundation with high levels of Zinc Oxide. Zinc Oxide protects against both UVA and UVB harmful rays, and is a proven natural antimicrobial which minimizes the breakout of adult acne. This makes our makeup an effective sunscreen with a natural sun protection factor (SPF) and an antimicrobial that prevents adult acne.

There are many Major Mineral Cosmetic companies that have Bismuth Chloride as one of their ingredients, however we know that this is a skin irritant, and is associated with acne, blemishes, inflammation and allergic reactions. Bismuth Chloride causes skin irritation in up to 80% of users because its molecular crystalline shape causes tiny micro tears in the skin, which are associated with itching, that is much worse with sweating. Bismuth Chloride is also associated with lead, which is a toxic metal.

At VSacharMD.com we complement our foundation with added topical botanicals that are anti-inflammatory, reparative and soothing to your skin. Our entire makeup line is non-toxic, and safe in pregnancy. All of our Mineral Foundations are Vegan, Gluten Free, are made without FD&C dyes, no nanoparticles, no carmine colorants, no BHT, no bismuth chloride, paraben free, free of petroleum-based oils, no alcohols, talc free, and preservative free.

Our cream foundation is hand crafted from the safest, highest quality botanicals, blended from premium crushed mineral pigments. It is specially formulated with topical botanicals such Bisabolol (the active component of Chamomile), Provitamin B5, Allanoitin and Golden jojoba oil, to protect, heal and nourish your skin. Meadowfoam seed oil provides a natural intrinsic sun protection factor (however we do not recommend using this as your only sunscreen). All of our Mineral Cream Foundations are Vegan, Gluten Free, are made without FD&C dyes, no carmine colorants, no BHT, no bismuth chloride, paraben free, free of petroleum-based oils, no alcohols, no nanoparticles, talc free, and preservative free.

One last possible source of acne is your makeup brushes!

There are 2 types of makeup brushes: those made from real animal hair (squirrel, weasel, sable, boar, horse,pony, goat, raccoon, squirrel, dog) and synthetic. At V Sachar MD, we use only synthetic brushes made from Taklon fibres. Taklon brushes are more hygienic than real hair brushes because real hair have an irregular surface which traps powders, dead skin cells, bacteria and chemicals. This can lead to “dirty” brushes which then get your makeup “dirty” as well, which leads to a recurrent cycle. Synthetic fibers\Taklon lack these surface irregularities, accordingly they cause less irritation and acne. Because Taklon is synthetic, animal cruelty is not an issue. At V Sachar MD, we do not support animal testing, and are PETA certified. The best way to clean your brushes, is soap and water, and isopropyl alcohol to disinfect them.

For makeup that is noncomedogenic, looks good and is good for you, go to www.VSacharMD.com.

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