The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
|
Orgasmic Birth -- the documentary! ABC's 20/20 will be airing a segment about Orgasmic Birth on May
16th for their special Mother's Day show.
Interviews with Christiane Northrup, MD, Ina May Gaskin, MA, CPM, Sarah J Buckley, MD, Marsden Wagner, MD Joyous, sensuous and revolutionary, this pioneering film will compel many to reexamine their perceptions about childbirth. Viewers will understand how the use of normal, undisturbed birthing methods can aid the health and well-being of future generations. |
Manual of Laboratory,
X-Ray and Special Procedures (from the New York Hospital - Cornell
Medical Center)
Canterbury Health Laboratories
- Handbook of Tests
Content of Prenatal Tests - OB opinions
Timing of Prenatal Tests - OB opinions
Laboratory Testing
During Pregnancy
The state tells us (since we are licensed midwives) what labs to do, and this is what we get on all women:
CBC, Rubella titer, ABO and RH, antibody screen, UA, urine culture, HBSag, RPR. Though not required by the state we also do HIV and Hep C antibody. Our price from the lab is less than $40. We negotiated this.
State requires pap and GC, so we do the pap, (cost $12.) and a GC/Ch
DNA probe (less than $25.)
Maternal
urine albumin excretion and pregnancy outcome.
Franceschini N, Savitz DA, Kaufman JS, Thorp JM.
Am J Kidney Dis. 2005 Jun;45(6):1010-8.
CONCLUSION: Low levels of albuminuria are associated with preterm birth.
The mechanism underlying this association warrants additional exploration.
Wouldn't 10s be more useful in screening for UTI, assessing hydration
status in hyperemesis etc.
Ok, so here is why I spend the extra bucks for the 10sSG. First of all, I just love the SG. My clients check their own urine and many times will have a concentrated specimen. No matter how much I tell them to increase their fluid intake they never listen 'till they see it on the stick :-) They come out of the bathroom saying "oops, I guess I need more water huh?" Worth every penny to me.
I also don't do routine blood sugars. If a mom spills sugar on the stick then we review the diet. If she does it twice then we do the 1hour pp. I tell them that many moms just spill sugar but it will also pick up diabetes if blood sugars are >175-180.
We basically ignore leukocytes unless they are associated with proteinuria and/or blood. We try to rule out vag infections. We tend to be pretty aggressive with nitrites.
We like to see ph at ~7. Urine that is too alkaline provides a perfect environment for bacteria to grow.
Bilirubin and Urobilinogen can show that the liver is starting to get compromised. If one of these shows up we will put the moms on herbs to help strengthen the liver.
Some moms will spill a trace of protein at every visit. We basically ignore them unless they go 1+ or higher, or they are associated with leukocytes or nitrites.
I rarely see ketones but when I do I usually will jump all over the
mom about her diet. The presence of ketones means that the mom is burning
into her fat reserves. Ketones can also indicate dehydration. Either way,
ketones are not a good sign during pregnancy.
A rather 'progressive' hospital here (Brisbane) has basically dropped
weighing the mum, routine urine testing, and fundal/ girth measurement.
I believe this has been a research-based decision.
I am thrilled to see this. As midwives, especially OOH or DEM's, we
are really risking ourselves and our clients if we go out of community
standards. But if the hospitals, and thus the docs do it, then we can follow
suit swiftly. Even if just one hospital in your area does it, it disrupts
the community standard enough to CYA. Hurrah....
I think this is very interesting -- i wrote my master's thesis
on the origins of prenatal care (mostly looking at what the Maternity Center
did in the early days -- and they pretty much spread the gospel not only
around the country but around the world) and how it was developed almost
entirely to screen for pre-eclampsia. (Except that there was sort of a
sideline of prenatal care as primarily a social event, getting pregnant
immigrant women together in singing groups, etc. which seemed at one point
to be just as important but got completely dropped once docs instead of
nurses were running the show) The thing is, as we all know, that treatments
for pre-eclampsia were for the most part pretty horrific -- so how to explain
(in retrospect) the great improvements that getting prenatal care seemed
to show in terms of maternal/infant morbidity/mortality? I'm hoping, some
day, to try to research this stuff more seriously because a)i find it fascinating
but b)it has SO MUCH to do with what we're doing with prenatal care right
now!! It's so hard to evaluate rigorously the particulars of what we do
in prenatal visits, and you're right -- the studies that have been done
don't show much benefit for any of the above measures -- so what
are you doing during visits now?? Talking and bonding?? and someone will
actually pay for it?? [Very Big Grin]
There is no danger to alkaline urine, it simply means there is not a
lot of acid in her urine. That's it. Usually this is seen with vegetarians,
especially vegans, cause the acids are formed with animal protein breakdown.
An interesting note about elevated leukocytes. One of my clients
was seeing a nutritionist who told her that insufficient stomach acid allows
larger food molecules into the bloodstream and that then the immune system
has to take over the work of "digesting" the nutrients in the blood.
This causes an elevated leukocytes reading. Her nutritionist put
her on digestive enzymes, and we'll see if the leukocytes disappear from
her urine! I found some references to digestive
leukocytosis but I can't tell if this is just marketing.
Leukocytes in the urine with repeat negative cultures may be a sign
of interstitial
cystitis, especially when accompanied by protein.
[from ob-gyn-l]
Would be interested to hear input on the use of routine urinalysis during
pregnancy. Seemed pretty useful when you could simply have the nurse dipstick
in the clinic. However, give that CLIA has pushed the study into the lab
and hence inflated the cost, seems questionable whether to justify the
test in asymptomatic population throughout pregnancy. I'd like to hear
others perspective and their clinical practices.
The latest version of Williams states that unless you are following
a pt for diabetes or hypertension then routine UA's do not help with the
management of a routine pregnancy. We have 4 docs in our Ob dept. and as
chair I typically try everything first (the Mikey syndrome). For the last
year I haven't done routine UA's and pts don't mind trying to hit the cup.
we also do "routine urine dipstix", but with a scaled -down version;
only test for glucose and protein. Testing for leukocytes is a waste -
vaginal contamination is usually responsible for positive tests. if you
are really worried about +leukocytes on dipstix, repeat test with midstream
before requesting lab analysis.
"Initial care shall be provided as follows:
1.the following tests shall be scheduled or ordered during the first
visit:
a Blood type, including ABO and Rh, with antibody screen,
b urinalysis
c Hematocrit, hemoglobin, or CBC, initially and rechecked at 28-36
weeks.
d syphilis and gonorrhea and chlamydia, unless written refusal for
gonorrhea or chlamydia is obtained from the client.
e rubella titre; and
f One hour blood glucose screening test for diabetes, between 24 to
28 weeks of the pregnancy.
So they can refuse the chlamydia or GC testing. Also may refuse eye
ointment , metabolic screen, IM vit k, but need to attach written refusal.
Well, I guess none of these tests would hurt anyone, though they would sure get pretty spendy if a client had no insurance.. and a number of them are mostly unnecessary. I would question how many of these are truly needed.
A. Will blood-type change? If she is A-pos then she will always be A-pos
B. Why a urinalysis on a non-symptomatic woman?
C. Hematocrit & Hemoglobin, or CBC --- well, OK, but if a client is really strapped and on WIC, then WIC can do the Hemoglobin.
D. Syphilis Chlamydia, Gonorrhea -- - Sounds like syphilis can't be refused..
E. Rubella titre -- if she has already had rubella or is immunised then what is the point of retesting? It wont change from one pregnancy to the next. (I can see the point of testing postpartum perhaps, to give her the chance to get MMR immunization. Makes more sense...)
F. GGT screen is REQUIRED! Heaven's sakes! One could make a good case that the GGT screen is best used for women with risk factors, and is a waste of time and money for others, and has too many false-positives to be reliable for any worthwhile management decisions.
How agreeable is your board to changes? Can they be persuaded with evidence
(how about a copy of Guide To Effective Care..[Grin]?)
UA with asymptomatic woman : no point what so ever, but the routine checks for protein at each visit could help diagnose pre-eclampsia.
CBC : again, overkill when anemia status is needed, do a hematocrit
VD : I think the point here is to cure the illness to prevent sequelae to patient and baby
Rubella titer : many women have been immunized by vaccination not exposure to illness and the titer might not protect from disease. Hence, if mom has low rubella titer, keep her away from small kids and exposure to the virus if possible, then inoculate her after pregnancy.
GGT : IMHO, a real crock! Seems as though GD is the illness of the century.
A decade ago, it was barely mentioned and now everybody must be tested.
A better way would be a post prandial glucose test after lunch. Or a fasting
sugar which is high but, knowing how late our local OBs are with appointments,
I wouldn't want a pregnant lady fasting until noon :-) ! Both of these
alternatives are much cheaper than a tolerance or a carbohydrate load test.
I'm so glad you brought up the subject of leukocytes in the urine because I was going to do it today. It has become almost ludicrous how many of my women have leukocytes in their urine. Sometimes they have other s/s that lead me to suspect and treat UTI, other times, it's there by itself. Rarely, does it remain a trace. Typically, it becomes "++" on the strip, even if it appears there is no UTI.
Now, I am better than familiar with asymptomatic UTI (AUTI), however, I'm talking about a case where the woman has had a culture and come back negative. Please, if any of you ladies who use these strips have any wisdom, pour it on.
By the way, I'm using 10SG strips.
One suggestion to get more valid results on the test strips........
MAKE CERTAIN THE WOMAN COLLECTS A "CLEAN CATCH" URINE SPECIMEN.
A "clean catch" is a specimen uncontaminated by vaginal secretions or anything which might be on the external tissues.
Leukocytes without nitrites might be a contaminant from the vagina.
I have also had a rash of these, but in non-pregnant women (many peri-menopausal).
Many of them have been coming in with S/S of UTI, urine dip + leukocytes,
so start ABX presumptively and cultures come back clean. I don't get it!
Saw one today whose provider (MD) had started her Friday on ABX, still
symptomatic, clean culture, but something she said made me wonder if maybe
giardia? Camping a month ago, diarrhea resolved spontaneously, but had
had suprapubic and bladder pain ever since. Ran it by the on-call doc,
who suggested treating for giardia presumptively, there's apparently been
a lot around here.
I remember reading about it a few years ago, (can't remember where)
and that it was due to increased discharge of pregnancy. I also have this
happen with my pregnant moms. What I do is have them do a clean catch,
even for my dip-stick, and if it doesn't resolve with that I suggest mild
treatment for AUTI, like increasing fluids, add lemon to their water to
aid pH balance and maybe a few gtt. of uva ursi tincture and check again.
If not resolved then I send them to the lab or a U/A (clean catch of course)
and go from there. Over all I think it is really from the increased discharge.
For moms w/HepB, once infected, the baby has an 80-90% risk of becoming
a carrier which puts them at higher risk of cirrhosis and liver CA later
in life. This can be prevented by giving HBIg at birth and vaccinating
against Hep B. Minimize exposure by keeping membranes intact
I had a lady last year with a positive Hep B (actually after about 4-6
tests she was negative) but I consulted with a doctor who said we would
just need to bring the baby in after birth and they would test and give
the baby the Hep B shot. Of course, if she has an active case you should
transfer care.
I just attended a birth last week to a hep B+ mom. We had to make arrangements
for the baby to get a HBIg shot within 12 hours and also a HepB vaccination.
Home health at the Arkansas Department of Health took care of this for
us. There was no problem with me being a licensed midwife and attending
the birth of a hep B+ woman. I certainly was very careful with universal
precautions as we always should be. But I was EXTRA careful this time.
I wore two pairs of gloves at all times in case I ever needed to pull off
a pair. We made sure no bodily fluids got any place they shouldn't. And
thank God her membranes ruptured while on the toilet and she bled very
little.
Just my two cents worth here since I'm not an expert on this: Lately,
we've had a couple of women turn up with one Hep B screen positive after
several negatives in the OB unit where I work. The pediatricians in both
cases ordered the Heptavax but also HBIg. I haven't a clue if this is standard
operating procedure or not.
I don't think there is any reason for a woman with a history of Hep B to necessarily deliver in hospital. What are the reasons for +HepB? If current IV drug exposure, probably not a great home birth candidate. If occupational exposure, no reason to suspect additional risk. I do think the midwife needs to know if the woman is HepBsAg positive at the time of birth....if so, baby needs to get HBIg immediately following birth, and also start a Heptavax series. Any protocols for home birth of HepBsAg+ moms needs to include appropriate treatment of the neonate.
And of course the midwife will follow universal precautions to protect
herself from infection!
At all the hospitals where I have worked Hepatitis B Immunoglobulin
(HBIg) was given to all babies born to Hepatitis B surface antigen positive
mothers within 2 hours of age along with the first of the Hepatitis B vaccine
series.
My friendly online ped told me that he follows CDC guidelines in taking care of infants of HBsAg positive moms.
Case Management to Prevent Perinatal Hepatitis B (Aug. 15, 1996) NS.-Perinatal transmission of hepatitis B virus is largely preventable -- immunoprophylaxis of exposed infants is about 90 percent effective. Vaccine advisory groups currently recommend screening all pregnant women for hepatitis B surface antigen (HBsAg), treating infants born to HBsAg- positive women with hepatitis B immune globulin at birth, and vaccinating them with hepatitis B vaccine at birth, one month, and six months of age. However, a 1988 survey in New York City found that only 59 percent of eligible infants had received appropriate prophylaxis by 18 months of age.
This article reports a successful case-management program for HBsAg-positive women in Connecticut and evaluates 58 federally funded perinatal hepatitis B prevention programs in the U.S. in 1994. The Connecticut program extended educational outreach to HBsAg-positive pregnant women prior to delivery, notified pediatricians and delivering hospitals about their HBsAg status, and monitored follow-up prophylaxis with a computerized tracking system. The program achieved complete vaccination in 91 percent of enrolled infants, compared with 48 percent of those not enrolled. In other states, less comprehensive approaches without case management produced less impressive results (about 67 percent completion of vaccination).
Comment: This report shows the potential benefit of a comprehensive case-management system, as opposed to single, "silver bullet" interventions, to assure complete immunoprophylaxis. --DM Berwick.
TI.-Prevention of perinatal hepatitis B through enhanced case management
-- Connecticut, 1994-95, and United States, 1994.
SO.-MMWR 1996 Jul 12; 45:584-7.
[from ob-gyn-l]
In a similar vein, how many of you are doing preconception Varicella
titers? How many are recommending vaccination prior to pregnancy?
In our high-risk clinic and office we ask all patients at initial prenatal visit if they are positive or if their parents know whether they had chickenpox. IF there is no history, we perform a Varicella IgG (about 20% of our patients) . If it is negative, we advise patients on the risks of Varicella and recommend avoidance of infected individuals if possible.
If a patient becomes exposed and has a negative IgG, we recommend Zoster immune globulin (VZIG). If a patient breaks out with a rash anytime after the first trimester, we recommend Zovirax 1g tid (I would look up the recommended dose...Valtrex can be used as an alternative) Varicella pneumonias are treated with antiviral agents even in the first trimester.
Our lab will run a stat Varicella IgG to see if a patient needs VZIG. Still, only under the best circumstances (weekday, patient readily available) can we get results fast enough to decide during the period of effectiveness of VZIG (2-3 days). That is why we screen all patients with a negative history.
I have no experience with routine immunization. I speculate that preconceptional immunization might, at first, be reserved for susceptible patients at high risk of exposure (teachers, health care workers, etc.)
Cost effectiveness? I don't worry, after all, the population will be
rid of most HMO's soon because they will realize those that don't support
research and education are freeloaders.
Toxoplasmosis
Fact Sheet from the March of Dimes
In Portugal, Toxoplasmosis titers is part of the standard routine pregnancy
control (also rubella, AgHBs, HIV - after consent - and syphilis. It's
recommended IgG titers once per trimester and IgM if IgG is positive. But,
if you want really control gestational toxoplasmosis, it should be done
the first titer before pregnancy and then, once a month, otherwise one
can miss the beginning of the infection and so, the right time to start
therapy in a way that could have some efficacy in preventing the transmission
to the fetus. The parasitemis period occurs during the first month. There
are lots of problems with these approach:
But I think that for infections in general, it would be very helpful
to have a serum sample stored until the end of pregnancy for every pregnant
patients. In the event of fetal conditions in which infections can have
a etiologic role, one could test the patient for those infections in an
actual sample and a previous one to compare the Immunoglobulin titers.
The actual incidence of fetal complications in most of gestational infections
is low. Thus, I think that there is more interest in finding an infectious
etiology for an abnormality in the fetus that to find an abnormality in
the fetus when we have a theoretic possibility of an infection in the mother.
Sure, there are exceptions to this rule as in almost all rules (rubella
in first trimester is not the same thing). Furthermore, it is still possible
to decrease the probability of an infected fetus, in the event of a diagnosis
of infection in the mother, if one has available the technical possibility
of PUBS. A bunch of tests can be done in fetal blood that, if negative,
can decrease more and more that probability. Unfortunately, none of them
is 100% accurate.
When IgM for toxoplasmosis is measured by ISAgA, usually, the curve
of the titer rises and then decrease, reaching a plateau that can stay
measurable for years, sometimes with titers considered high. That plateau
phase usually is reach in about 7 months after the acute infection. Thus
if, in two simultaneous measurements of two serum samples taken two weeks
apart, there is the same result it's possible to conclude, with a certain
amount of certainty, that the parasitemia occurred ~7 months before. Sorry,
I have no references for this; I was informed by the parasitologist of
our reference lab in Lisbon.
If we're going to check toxo at all, it should be PRECONCEPTION. If
the woman is negative, then she can be counseled to avoid cat litter, undercooked
meat and dirt that may be used as a feline toilet. Once she's pregnant,
testing causes nothing but headaches.
In a similar vein, how many of you are doing preconception Varicella
titers? How many are recommending vaccination prior to pregnancy?
After toxoplasmosis, How long should a woman wait before being pregnant
?
A therapeutic abortion was practiced in December 96. IgM are still positive
but IgG are falling.
"Acquired immunity to T.gondii requires time to develop, and the precise
time at which it is safe for a woman to conceive after she has been acutely
infected has not been clarified. Although relevant data for large numbers
of women are not available, congenital transmission has, on rare occasion,
been documented in women who have acquired the infection > 1 month before
conception. For this reason, it is recommended that a recently infected
woman postpone becoming pregnant for at least 6 months".
Extracted from: Wong SY, Remington JS. Toxoplasmosis in Pregnancy. Clinical
Infectious Diseases 1994; 18:853-62.
The
Thyroid in Pregnancy by Tricia Westhoff, M.D., and Eli Ipp, M.D.
[Cyberounds registration is free]
Maternal
Thyroid Deficiency during Pregnancy and Subsequent Neuropsychological Development
of the Child [PubMed
Citation]
Thyroid Disease,
Pregnancy and Fertility
Thyroid Disorders
and Pregnancy (Thyroid Foundation)
The Facts About
Thyroid Problems and Pregnancy (JONES PHARMA INCORPORATED)
Thyroid Problems
and Pregnancy - Headaches, anxiety, nervousness, and hypertension (EndocrineWeb.com)
Normally in pregnancy, there is an increase in thyroxine-binding globulin
which results in increased levels of T4 and T3. The levels of free T4,
free T3 and TSH are not affected, while T3 uptake will be normally be reduced.
T4 does not cross the placenta, while T3 does, to some extent. Therefore,
if this patient is truly hypothyroid, I would definitely use Armour rather
than Synthroid, since it contains a mixture of T3 and T4. (Synthroid is
just synthetic T4.)
By monitoring free T4 and TSH, you can safely use Armour thyroid and
adjust the dosage pretty much as you would in a non-pregnant patient. Just
be sure not to rely on T4 or T3 uptake values.
Although it seems unlikely that a low dose of thyroxine would cause
the "hyperthyroid" side effects you observed in this pregnant patient,
it is possible that even a small amount could do this transiently. Pregnancy
itself is a natural "hyperthyroid" state, i.e., serum thyroxine demands
are higher than in the non-pregnant state. Therefore it is possible that
what was ordinarily a "euthyroid" individual before pregnancy, becomes
slightly hypothyroid during pregnancy owing to the greater demand on the
gland. If carefully followed with frequent TSH determinations, standard
thyroxine should suffice for this person. Notwithstanding the "curb appeal"
of a natural form of thyroid extract (usually porcine), it is wiser to
go with the more titratable human hormone--with care to avoid cheap generics.
You are correct that it is wise to err on the generous side as a little
too much is safer than too little during gestation.
My comment regarding Armour was in the context of the expressed concern
regarding cretinism in the fetus. In general, of course, the fetus produces
it's own T4, but this production increases slowly during gestation, normally
approaching adult levels only at term. If Armour is used only as true replacement
therapy, I would argue that the levels of circulating T3 & T4 are no
different than a normal euthyroid patient.
I don't prescribe Armour based on "curb appeal." My clinical experience
is that levothyroxine works better than Armour about 15% of the time, Armour
works better than levothyroxine about 50% of the time, and in the balance
of patients, either one produces satisfactory results. Therefore, my initial
therapeutic approach is usually to use Armour, and to switch if I'm not
pleased with the results.
TB
Blood Test, Forget TB Skin Tests by Randall Neustaedter OMD - a great
explanation of how the skin test is ineffective and potentially harmful.
TB TESTS (Mantoux/PPD
(Purified Protein Derivative) ) - The Skin Test or Skin Prick Test
for TB
The package insert claims that "Tubersol is prepared from a large batch
Master Batch, Connaught Tuberculin (CT68) and is a cell-free purified protein
fraction obtained from a human strain of Mycobacterium tuberculosis grown
on a protein-free synthetic medium, and inactivated. Tubersol is a sterile
isotonic solution of Tuberculin in phosphate buffered saline containing
Tween 80 as a stabilizer. 0.28 percent phenol is added as a preservative."
(read more at the webpage)
The 1972 edition of Encyclopedia and Dictionary of Medicine and Nursing
defines phenol as "an extremely poisonous antiseptic, germicidal and disinfectant."
The Oxford Universal Dictionary (1955) defines phenol as "A hydroxyl derivative
of benzene, commonly known as carbolic acid."
QuantiFERON-TB
Test - Blood test as alternative to skin prick test. Here's some
additional
information.
This section has been moved to another
page.
[from ob-gyn-l]
Do you really do an internal, speculum and swabs on every woman you
book in early pregnancy? (We don't here, in fact its the exception - i.e.
if they are symptomatic of infection or are 'due' for a smear).
In our practice the newly pregnant patients all see the nurse practitioners.
Every woman has a pelvic exam complete with PAP (unless one has been done
within the past 6 months), cervical evaluation for gonorrhea, chlamydia,
and bacterial vaginosis (the method depends upon which laboratory their
insurance carrier uses). Also vaginal and rectal swabs for GBS are done
at the same time. These evaluations are usually done around the 8-12 th
week of pregnancy, but occasionally much later.
Our obstetrical population has a large component of teenage welfare
mothers, and we've experienced what we feel to be a significant number
of patients with all combinations of these pathogens.
As far as GBS goes, any patients we find with GBS early in pregnancy
are treated once, labeled as high risk, then cultured again at 36 weeks
and treated in labor if positive. But we've felt that early identification
and treatment has definitely prevented some early GBS complications.
Without reculturing everyone at 36 weeks, we realize we may be missing
some GBS problems at term. We'll certainly take another look at CDC and
ACOG guidelines, but ultimately it will be helpful to know more about why
people get GBS colonization in the first place.
Central Medical Lab
Smith-Kline labs comes to mind for blood tests and such.
The lab I use is Pathology Labs in Spokane, Washington. They send you
the centrifuge and all the eqipt free.
As long as humans are involved in the testing, human error will be a
factor. This applies to cultures as well as to rapid tests.
In one of my excursions out on the web I came across a
page of notes from a community college course for lab technicians -
cultures are fraught with peril and vulnerable to both false negatives
and false positives. After reading this, I was even more amazed that
practitioners could have a policy that a history of a single positive GBS
culture would leave a woman "branded for life" despite a trail of subsequent
negative cultures.
I know I have naively assumed that "reputable" labs are 100% reliable.
This spring, the large lab I use reported that one of their phlebotomists
had been re-using needles to draw blood. Yes, as in using the same needle
from one client to the next. It leaves me wondering what kinds of technicians
are handling the cultures. I wonder if this is why some protocols
have recommended repeat cultures during pregnancy, hoping that if the lab
messes up on one of the cultures, at least the repeat is likely to detect
a heavy colonization. Maybe this is why they also discount subsequent
negatives, figuring that if one of them was false, they're safer assuming
it was the negative that was false.
I almost feel more comfortable doing the GBS test myself with a rapid
test that is theoretically less reliable but possibly much more reliable
in practice. If money weren't an issue, I'd happily use both for
clients who want prenatal testing.
Many years ago I was reviewing labs I had just received with a mom.
I told her she was O pos (?) so wouldn't need to worry about titres or
RhoGAM. She told me she was sure she was O neg (?). We redid
her labs and sure enough she was O neg. I'm really glad she knew
her blood type and called me on it.
This news item l0 June l999 on a local (Vancouver, B.C. Canada) radio
station:
Woman Sues St. Paul's VANCOUVER (CKNW/98) -- A Vancouver
woman is suing St. Paul's Hospital and several doctors because she was
diagnosed as carrying the Aids virus, when in fact she wasn't. In a BC
Supreme Court writ, Lisa Lebed claims when she was admitted to the hospital
in late 1995 to give birth to a daughter, a blood sample was taken without
her consent. It revealed she was HIV positive, so she gave up the baby
girl for adoption and decided to have a tubal ligation. A year and-a-half
later, while undergoing aids treatment, she found out she was not HIV positive.
The explanation she was given was a lab error. She says because of the
negligence of the hospital, she's now sterile and has lost a daughter.
About Varicella, if there is risk of exposure, I agree that if, by history,
is not possible to confirm a previous infection, then it's worthwhile to
have a IgG titer; in the event of an exposure, one should give VZIG to
a non-immune patient. If there is no titer before an exposure, there is
no time to wait for the result, so we've to give VZIG. However, the embriotoxic
effects are very rare and, most of the time is possible to rule out most
of the malformations trough ultrasound. The problem is the very small risk
of mental retardation without malformations.
Thyroid in Pregnancy
Hypothyroid Lowers Baby's IQ
Pregnant women with underactive thyroids are four times more likely to
have
children with low IQs if the disorder is left untreated, a study found.
James E. Haddow, Glenn E. Palomaki, Walter C. Allan, Josephine R. Williams,
George J. Knight, June Gagnon, Cheryl E. O'Heir, Marvin L. Mitchell, Rosalie
J. Hermos, Susan E. Waisbren, James D. Faix, Robert Z. Klein
The New England Journal of Medicine -- August 19, 1999 -- Vol. 341,
No. 8
Tuberculosis
Prenatal Vaginal Exams
Routine Cultures
Where to get Lab Work Done
Lab for Pap Smears
have a good one, only $5.90 for each test
5552 Cerritos Ave. suite D
Cypress, CA 90630
Lab Errors
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