While summer is thought of as a time for relaxation and vacations, it is also the most deadly time for children 0-14, as nearly 3 million children will be rushed to emergency rooms during May through August for unintentional injuries.  To keep your children safe this summer you need to keep these safety tips in mind:

• Actively supervise your child when engaging in summertime activities, such as swimming and playing on playgrounds and backyards.
• Use the appropriate safety gear when your child is participating in summer activities.  Such as helmets when biking, a car seat when traveling in a motor vehicle, and life jackets when in or near open bodies of water.
• If you have a pool or a spa, it should be surrounded on all four sides by a fence at least four feet high with self-closing, self-latching gates, and it should be equipped with an anti-entrapment drain cover and safety vacuum release system. An inflatable pool needs to be surrounded by a fence, just like any other pool, and parents need to empty these pools when not in use.
• Make sure your home playground is safe. Keep 12 inches safe surfacing, such as mulch, shredded rubber or fine sand, extending at least six feet in all directions around the equipment. Remove hood and neck drawstrings from your child’s clothing.
• Keep children away from the grill area while preheating and cooking, and while the grill is cooling.
• Remove potential poisons from your yard, including poisonous plants, pesticides and pool chemicals.
• Walk all the way around a parked vehicle to check for children before entering a car and starting the motor.  Don’t let children play in driveways, streets, parking lots or unfenced yards adjacent to busy streets.
• Apply sunscreen rated SPF 15 or higher to your child’s exposed skin 15 to 30 minutes before going out, and reapply frequently.
• Make sure your child drinks plenty of water. A child who seems tired or achy should rest in the shade or go inside for a while. Get immediate medical help any time a child’s skin is hot to the touch (with or without perspiration), if a child has a seizure, or if they become disoriented in hot weather.

Following these simple tips will keep your kids away from danger this summer, which means more time for fun for the entire family!

by:  Kristin Wedding, Safe Kids Coordinator

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Many of you reading this health blog may be pregnant so let’s talk about the father of this baby for just a moment with Father’s Day just around the corner. 

Having a baby is a family affair. The more informed and involved the father is during the pregnancy, the better the experience will be for you, your partner, and your new baby.

Fathers-to-be often need much of the same support and encouragement that you are receiving. 

•  Upon learning that they are going to have a baby, many men will immediately wonder or worry about whether they will be able to support a family – both financially and emotionally.
•  They will also worry about whether they too will be able to tolerate labor – meaning will they get queasy? Or will they faint? In actuality and thank goodness, very few fathers have ever done either.
•  Finally, many men know very little about what happens when you visit the OBGYN, not to mention a hospital or labor and delivery suite.

Tell him things you’ve read or learned about being pregnant. Explain what you are feeling – what it’s like to feel the baby kicking and rolling. If he doesn’t go to your prenatal visits with you, fill him in on all the details when you see him the next time. Enroll in a childbirth class together, so that both of you can get an idea of what the delivery will be like.

And then, when you are in the 3rd trimester, schedule a time to visit Labor and Delivery together. I bet it will put you both at ease.

Happy Father’s Day!

What is a Prenatal Ultrasound?

A prenatal ultrasound transmits high-frequency sound waves through the abdomen. The echoes are then transformed into photographic images of your baby. During pregnancy, ultrasound will be used to evaluate the baby, the placenta, the uterine wall, and even your ovaries. Most major birth defects can be seen on ultrasound.

How is an Ultrasound performed?

The majority of prenatal ultrasounds are performed by scanning through your abdomen.  On occasion, a transvaginal ultrasound is necessary to improve the image quality or to assess different parts of your anatomy or of the baby’s anatomy. Very early in pregnancy, transvaginal ultrasound is the preferred method of evaluating pregnancies because the transducer can get so much closer to the image needing to be studied.

Ultrasounds are typically performed on all pregnant women at 20 weeks gestation. During that ultrasound, it will be confirmed that your baby appears normal and is growing properly. You will be able to see the baby’s heartbeat and see the body, arms and legs move. Gender can usually be determined at 20 weeks. Be sure to tell the sonographer performing the ultrasound whether or not you want to know the gender of your baby!

Is it Safe?

Studies have not found obstetrical ultrasounds to be harmful or hazardous in any way. Remember, ultrasounds do not use radiation – such as X-rays and CT scans. They use sound waves.

How Should I Prepare?

You should drink 4 to 6 glasses of water before your ultrasound, so that your bladder is full. A full bladder will help the doctor view the baby better on the ultrasound.  If you are having a transvaginal ultrasound however, you will probably be asked to empty your bladder before the exam starts.

What Happens?

You will lie on a padded examining table during the test and a small amount of water-soluble gel is applied to the skin over your abdomen. The gel does not harm your skin or stain your clothes.

A small device, called a transducer, is gently applied against the skin on your abdomen. The transducer sends high-frequency sound waves into the body, which reflect off internal structures, including your baby. The sound waves or echoes that reflect back are received by the transducer and transformed into a picture on a screen.

There is virtually no discomfort during the test. Because a full bladder is required for the test, you may feel some discomfort when the probe is applied over the bladder. You may be asked to hold your breath briefly several times.

An ultrasound takes 30-45 minutes to complete.

Will Insurance Pay?

Insurance will pay for the ultrasound if it is deemed medically necessary. If you have an ultrasound that is not medically necessary (for example, to simply see the baby or find out the baby's sex), your insurance company may not pay for the ultrasound.

What is a 3-D and 4-D Ultrasound?

3-D ultrasound is a picture of the outside surface of the baby. A moving picture interpretation is referred to as a 4-D ultrasound. It’s important for patients to remember that the 3D pictures are fun to have, but they typically tell us very little about the actual structures inside the baby. For that reason, 2D ultrasound is the most accurate method to evaluate the baby for birth defects.

AIUM Certified

In an increasingly competitive health care climate with limited resources, it is imperative that ultrasound practitioners demonstrate excellence in their practices. The American Institute of Ultrasound in Medicine (AIUM) Ultrasound Practice Accreditation Council has developed standards for the accreditation of ultrasound practices. MUSC Women’s Health is proud to say that the Prenatal Wellness Center has been accredited since 2001.

Why MUSC?

- We’ve demonstrated and maintained excellence with AIUM Certification.
- One of 7 registered sonographers will perform your ultrasound.
- A Maternal Fetal Medicine Specialist will review your ultrasound and you will be informed of any birth defects or problems on the day of your visit.
- As a keepsake, you will receive a CD of ultrasound images of your baby and several paper prints as well.
- We make every attempt to remain on schedule and our goal is to have your visit completed within 75 minutes of your appointment time. However, unforeseen circumstances can arise which delay our progression. We will make every attempt to notify you if there is a significant delay. Most importantly, we guarantee that you will receive the time attention necessary to meet your needs.

by:  Jill Mauldin, M.D.

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Fibroid Facts for Females
Fibroids are the most common benign smooth muscle tumor of the uterus and the most common indication for hysterectomy in the United States.  Fibroids are found in over three-quarters of all hysterectomy specimens, even when the indication for surgery was not fibroids.  Fibroids are discovered in 40% of all women by age 35 and 70% by age 50, and are more common in black women.

Symptoms
The presence of fibroids within the uterus may produce no symptoms at all or may lead to excessive and irregular menstrual bleeding and/or pelvic and abdominal pain.  For some women, these symptoms can be debilitating.

You can’t make an asymptomatic woman with fibroids feel better by treating her; so, unless there is a rapid change in fibroid size, a woman with no symptoms needs no treatment.

Treatment
There are many treatment options for fibroids, and which is chosen depends upon a woman’s desire for pregnancy, her desire to keep her uterus, her symptom severity, and the location and size of the fibroids within her uterus.  The appropriate type of procedure: should be discussed with a woman by a gynecologist who is skilled in all these procedures. 

Medication options:  Medical therapy can, and should, always be the first approach to the management of fibroids symptoms. Oral contraceptive pills and progestin-type drugs will almost always control abnormal bleeding from fibroids, but will do nothing to reduce their size. A medication that will reduce fibroid size works only while the medication is taken, and fibroids will re-grow after the medication is stopped.  So, this latter medication is used to reduce fibroid size or stop uterine bleeding in preparation for surgical removal.   A new class of medications called selected progesterone receptor modulators are in development and should be a source for treatment in the future.

Uterine Fibroid Embolization (UFE):  This is a procedure that can permanently reduce fibroid size without surgery.  A woman’s appropriateness for this procedure will depend upon her symptoms, fibroid size and location, and her desire for future pregnancy, since this procedure is not recommended if future pregnancy is desired.  This procedure is done by a specially trained radiologist and involves injecting material which will cut off blood supply to the fibroid.  Over the course of a few months the fibroid will decrease to about one-half of its original size.  Women are usually kept in the hospital overnight in case they feel pain while the fibroid degenerates.  This procedure does not eliminate the fibroids, but most women will have a decrease in their symptoms.  A woman’s gynecologist or an Interventional Radiologist can determine her appropriateness for uterine fibroid embolization.

Magnetic Resonance Imaging Guided Focused Ultrasound:  This procedure can also reduce fibroid size, and therefore a woman’s symptoms, without surgery.  It is relatively new and is only available in approximately 30 center in the United States.  Its appropriateness is also determined by fibroid size and location and involves focusing high-frequency ultrasound waves into the fibroids to produce heat and to destroy them.  This procedure, like UFE, can only reduce fibroid size without removing them, and studies to-date indicate that the size-reduction is less than that achieved with UFE.

Myomectomy:  This less invasive type of surgery removes the fibroids themselves and can be performed, depending upon fibroid size and location, with minimally-invasive techniques such as hysteroscopy and laparoscopy, or, if necessary, an open abdominal procedure.  Myomectomies are the preferred procedure for those women wishing to preserve their ability to get pregnant.  After myomectomy, fibroids can recur, because each fibroid comes from a single individual uterine muscle cell. 

Hysterectomy:  This is the only procedure that completely removes all fibroids with no chance for recurrence, and with the permanent relief of symptoms.  The entire uterus is removed during this procedure.  Fortunately, those gynecologists skilled in vaginal and laparoscopic procedures can remove even very large uteri without making a large incision.  These minimally invasive vaginal and laparoscopic procedures markedly shorten hospital stay and post-operative recovery time and can even be done in the out-patient setting.  Many women can resume normal activity within a week of so after vaginal and laparoscopic hysterectomy.

Summary
Patient choice should play a significant role in deciding a treatment option for uterine fibroids.  Medication therapy will almost always relieve abnormal bleeding   Imaging studies such as ultrasound and magnetic resonance imaging (MRI) can be used to guide surgical and non-surgical treatment strategies.   Non-surgical options, like UFE, can greatly decrease symptoms.  Myomectomy is the treatment of choice for symptomatic fibroids in a woman wishing to retain her uterus for child-bearing.  Women should be well informed and question their healthcare provider if hysterectomy is the first and only option offered. 

MUSC has developed a Virtual Fibroid Center.  With the exception of MRI focused ultrasound, all other treatment options are available through MUSC Women’s Services.  Call 843-792-5300 for information or for an appointment with one of MUSC’s GYN physicians.

by:  Donald L. Fylstra, M.D.

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PMS is common – 80% of women report symptoms that occur during their cycle that “forecast” the start of their period and 40% of women seek medical assistance for their symptoms. These symptoms include: depression, angry outbursts, irritability, anxiety, social withdrawal, breast tenderness, bloating, headaches, and swelling.  Sound familiar?

When these symptoms happen most months but go away within the first few days of bleeding, you probably fit the diagnosis of mild to moderate premenstrual syndrome. However a small percentage of women do experience symptoms that impact their daily lives.  These women experience fatigue or sometimes, insomnia, extreme changes in appetite, severe anxiety, difficulty concentrating, and/or a marked decreased interest in normal home and work activities. This may be a more serious condition called Pre-menstrual Dysphoric Disorder or PMDD.

What causes this?
As with many complicated disorders, researchers don’t really know what causes premenstrual syndromes.  The current consensus among researchers is that PMS and PMDD are probably caused by normal hormone functions in a woman and are not hormonal imbalances. There may be some link between the sex hormones (estrogen and progesterone) and neurotransmitters like serotonin, but the research continues.

How do I know if I have PMS or PMDD?
There is no specific blood test to diagnose PMS or PMDD. Your provider will do a routine exam to check for any abnormalities that may be causing your symptoms, such as a thyroid disorder or depression.

The best thing that you can do to help your provider is to keep a diary of your symptoms. There are several tools available (i.e. Calendar of Premenstrual Experiences ) to help you keep a daily record and to help you and your provider develop a treatment plan.

Is there anything that will help my symptoms?
There are several changes that you can make on your own to try and improve your PMS symptoms, including dietary changes and vitamin supplements. Dietary changes include: decreasing or avoiding caffeine intake, eating a balanced diet, adequate water intake, and decreased high-salt foods. There are some vitamin and mineral supplements that have been researched and are thought to help as well.

Alternative therapies that help many women include relaxation techniques, guided imagery, yoga, aerobic exercise, and massage/reflexology. These activities all help in stress reduction which may improve PMS symptoms. Your provider may also recommend a psychiatric professional in certain cases, which has proven very helpful in teaching coping skills to deal with the cyclic changes that are happening.

There are also several prescription drug options that you and your provider may consider.

You are not ALONE!
It is okay to ask for help with your PMS symptoms. There is no magic pill to fix PMS, but you and your provider can work together to stop PMS from interfering with your life.

By:  Allison Nissen, CNM

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Breast pumps

Many mothers return to work after having their baby and desire to continue providing breastmilk for their infants.  Using a breast pump while at work is an efficient and convenient method of expressing milk and maintaining your milk supply when you and your infant are apart.

There are many types of breast pumps on the market, the most reputable brands are Medela and Avent-Hollister.  Prices range from $30 to $400 and depend on the type of breast pump you purchase: manual, single electric, or double electric.

Plan ahead

I suggest that mothers introduce a bottle of pumped milk to their infants around 4 weeks of age, once latch and milk supply are well-established.  This can be continued at least once a day or every other day so the infant learns how to suck the bottle nipple which is quite different from your nipple, both in shape and milk flow.  The mother may need to be out of the room when introducing a bottle so that the infant cannot see or hear her, as many infants prefer the breast over the bottle and will not take it if they know their mother is near.

A woman can start pumping once her milk has come in to start storing milk for when she returns to work.  It is important to remember that your body makes milk in response to breast stimulation, whether that is a breast pump or your infant sucking at the breast.  Therefore, if you begin to pump before you return to work, be consistent and pump the same time every day.  If your infant only takes one breast for a particular feeding, or all feedings, you can pump the other breast to empty it of milk.

Work and Pump

When separated from her baby, a woman should pump at least every 3-4 hours to maintain her milk supply.  She should completely drain her breasts of milk at each pumping session.

Milk can be stored safely in the refrigerator for up to 5 days and then can be transferred to a freezer and stored for up to 6 months.  Milk can be stored in bottles or bags specifically made for breastmilk storage.  It should be stored in 2-3 oz portions; the infant can always be given more if needed but you cannot store milk once it has been reheated.  If using breastmilk bags, place them flat in the freezer, this will save space.

As the milk sits, the cream will naturally separate and rise to the top.  When reheating the milk, gently swirl the cream back into the watery portion of the milk.  Reheat breastmilk by placing warm water into a cup, do not microwave or heat the breastmilk in a container on the stove, hot spots can develop and burn the infant’s mouth.

by:  Pamela K. Murphy, PhD, CNM, IBCLC
Lactation Consultant
MUSC Lactation Center