Women’s Health Blog

It seems we have always talked of ‘the flu’ and ‘the flu shot’, but over the last several years we have been inundated with stories of new forms of the influenza virus that sound as if they would have greater importance to veterinarians than to medical physicians. First we were warned of avian or bird flu and more recently, of course, swine flu or H1N1. Not surprisingly, both of these viral forms have many looking at our avian and mammalian friends with a more suspicious eye. But these critters are actually reservoirs for these viruses. What is influenza? How is it spread? How is infection treated and who should be vaccinated? And what if I am pregnant? All of these are important questions.

The influenza virus causes an acute upper respiratory illness accompanied by fever. This highly contagious infection is spread by respiratory droplets and usually occurs as an epidemic, or in the case of the ‘swine’ flu, a pandemic, during the winter months. ‘The flu’ or an influenza viral infection is characterized by the abrupt onset of fever, chills, headache, achy, sore muscles and general malaise accompanied by respiratory symptoms such as a dry cough and runny nose. Complications of influenza infection include pneumonia, which occurs in up to 12 percent of influenza-infected pregnant women.

Treatment of influenza infection includes supportive care with rest and hydration and, in non-pregnant women, anti-viral medications. Because the effect of antiviral therapy on the fetus is not known, its use in pregnancy is limited to cases of severe infection where the benefits outweigh the risks.

Who should receive the seasonal influenza vaccine? According to the Centers for Disease Control it is recommended that the following individuals receive the seasonal influenza vaccine:

1) Children aged 6 months to age 19 years
2) Pregnant women
3) Persons aged 50 years and older
4) People of any age with certain chronic medical conditions
5) People who live in nursing homes or other long-term care facilities
6) Those persons who live with or care for individuals at high risk for complications of flu including healthcare workers and household contacts of those at high risk for complications from the flu and household contacts of those less than 6 months of age.

A question I receive almost daily is whether or not one should receive the influenza vaccine if they are pregnant. Not only may pregnant individuals receive the flu vaccine when they are pregnant, but it is recommended. Both the American College of Obstetrics and Gynecology and The Centers for Disease Control recommend vaccination of all pregnant women during the influenza season. Vaccination can be performed at any time and at any gestational age using the intramuscular, inactivated vaccine and this vaccine is safe in breastfeeding women. The intranasal vaccine uses live virus and should not be used in pregnancy.

In terms of the H1N1 vaccine (swine-flu vaccine) due to be released in October, similar recommendations for who should receive the vaccine have been expressed by the CDC and the healthcare community including the vaccination of pregnant women. Much apprehension surrounds this recommendation because many feel this vaccine has been rushed to market and, because it is a new vaccine, there exists a fear that little is known about its safety profile.

In at-risk individuals, the benefits are thought to greatly outweigh the risks. In pregnant individuals specifically the likelihood of hospitalization from severe symptoms is four times greater than in the general population and six percent of confirmed deaths from H1N1 infection have occurred in pregnant women. It is important to remember that pregnant individuals are in an immunocompromised state and they, therefore, have greater difficulty fighting these infections.

As for concerns regarding the preparation of this new H1N1 vaccine, each year a new seasonal influenza vaccine is formulated with the intention of protecting people against the three strains that are predicted to be the greatest threat. Although the H1N1 virus poses unique health risks, the process through which the vaccine has been developed is largely the same as for the seasonal influenza vaccine.

There are currently studies on H1N1 vaccination in pregnancy ongoing at Baylor and the University of St. Louis. We hope to gain more detailed information about this vaccine in pregnancy through these studies. In the meantime, it is recommended that at-risk individuals, including those who are pregnant, receive the vaccine.

I hope you have found this brief summary to be both useful and informative and remember, if you have questions or concerns, there is no substitute for direct consultation with your healthcare provider.

One of the most important and often difficult decisions a woman must make is whether or not permanent contraception or sterilization is the right choice for her. Frankly, I have never cared for the word ‘sterilization. It has always sounded so cold and austere, so permanent. It is, of course, permanent and that really is the point. In order for a woman or couple to consider permanent contraception they really must be 100% sure they have completed their family and that their desire for future fertility is gone for good.

In one study, anywhere from 2 to 2.7% of women in the United States expressed regret following tubal ligation at 1 and 2 years post-operatively and approximately 2 per 1000 will undergo tubal reanastomosis. The main factors associated with regret 2 years after tubal sterilization were age less than 30 and sterilization performed at the time of cesarean section. It is also important to note that rates of success following reanastomosis vary greatly depending upon the method used for sterilization. It is, therefore, extremely important that a couple undergo counseling about the permanence of the procedure. Proper counseling should include a complete discussion which includes information about all available methods of contraception both permanent and temporary.

Once a patient decides that permanent contraception is right for her she must then decide on the method she finds most desirable. Options include vasectomy for the male partner and tubal ligation or interruption for the female partner. There exists a seemingly never-ending list of procedures available all of which are provided through one of three approaches: open, laparoscopic and, now, incision-free. Open procedures include tubal interruption performed at the time of cesarean section as well as post-partum tubal ligations performed following vaginal delivery. These procedures require an umbilical incision through which the tubes are accessed and include methods with sometimes ‘catchy’ names like the Pomeroy or the Uchida.

Numerous procedures are available through the laparoscopic approach, as well. The laparoscopic approach generally requires 1 to 3 small incisions in the abdomen depending upon the surgeon’s skill and technique as well as the procedure chosen. The methods utilized with this approach include various forms of cautery or ‘burning’ as well as a variety of methods utilizing clips, bands or rings. Some of these methods sport equally ‘catchy’ names like the Hulka clip or the Filshie clip.

Of all of the current methods of tubal interruption, however, the one which most would consider most desirable would utilize an incision-free approach, for obvious reasons. The Essure method provides just such an approach.

The Essure tubal sterilization technique is an incision-free method of sterilization that utilizes a hysteroscopic approach. Hysteroscopy is a surgical technique which utilizes a camera placed through the cervix thus providing visualization of and surgical access to the uterine cavity without the need for a surgical incision. Specifically, with the Essure technique, the hysteroscope is used to access the tubal ostia where the fallopian tubes enter the uterine cavity. Then, under direct visualization, an extremely small, soft and flexible micro-insert is placed at each tubal ostia thus causing a tissue in-growth reaction resulting in tubal occlusion and thus, sterilization.

The Essure technique provides many advantages over other more traditional techniques. Essure can be performed in-office with minimal anesthesia and has virtually no down-time. Because it is incision-free there is usually no discomfort and patients can easily return to work or to caring for their families the following day. And because the Essure procedure can be performed in-office, a hospital stay or visit is unnecessary, saving the patient both time and money as well as being a more cost-effective option for our healthcare system as a whole.

If you are considering permanent contraception please consult with your healthcare provider to learn if Essure is right for you.