An HSG (hystersalpingogram) is an X-ray of the inside of the fallopian tubes and uterus. This test is sometimes used to help find out why a woman is not becoming pregnant. An OB-GYN and a radiologist generally work together to do this test in a hospital's Radiology Department.
An HSG can pick up several problems that may prevent pregnancy. The most common is blocked fallopian tubes from old or current pelvic infection.
Other problems identified by an HSG include uterine fibroids, a septum or division inside the uterus, or adhesions in the uterus.
An HSG is usually done just after your menstrual period. To help with cramping during the test, pain medication such as Ibuprophen or Tylenol may be used 1-2 hours before the test. Your doctor may also prescribe an antibiotic just before or after the test to help prevent an infection from the test.
The actual test involves being in a position as during a Pap test. A speculum is used to see the cervix. A thin tube is placed just inside the cervix while dye is pushed into the uterus through the tube. X-rays are taken as the dye is pushed through the tube. You may be able to watch the progress of the dye on the X-ray monitor. The test usually takes about 10-20 minutes.
Most women can return to work right after the HSG. Cramping and discharge for a few hours are common and pads (not tampons) can be used for this discharge. You need to call your doctor if you have a fever greater than 100 degrees F or have increasing lower abdominal pain after the test.
Back to topTo diagnosis certain problems, your doctor may need to look directly into the abdomen at your reproductive organs. A laparoscope is a small fiberoptic telescope with a light that allows looking into the abdomen through a small cut in the skin.
There are many reasons laparoscopy is done. These include looking for and treating endometriosis, adhesions, fibroids, ovarian cysts or ectopic pregnancy. It can also be used to assist in a vaginal hysterectomy or remove ovaries. Laparoscopy is also used for sterilization by cutting, clippping or burning the fallopian tubes.
The procedure itself involves having an IV placed, going to sleep with general anesthesia and then having the laparoscope inserted into the abdomen through a small incision usually just below the navel (belly button). Usually carbon dioxide gas is placed into the abdomen so the pelvic organs can be seen more clearly. One to three small cuts are made just above the pubic bone. Instruments can be placed through the skin at these sites to move organs into view or perform procedures such as taking biopsies, cutting adhesions or removing something like an ovary or tumor.
Laparoscopy is usually an outpatient procedure. You may have some nausea, scratchy throat, abdoninal cramping and discharge immediately after the surgery. Pain around the small incisions is usually minimal as a long-acting numbing medication is injected at the time of surgery. The most bothersome problem is shoulder pain that occurs because small carbon dioxide bubbles get trapped under the diaphragm and refer pain to the shoulder. This slowly resolves in hours to about two days.
Recovery from a laparoscopy is shorter than from regular surgery. We generally suggest to patients that they plan to be off work for 1-2 weeks but many are able to return in 2-3 days.
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Endometriosis is a condition where endometrial tissue, the tissue that lines the uterus and is shed during menstruation, grows outside the uterus – on the ovaries, fallopian tubes, other pelvic organs and less commonly anywhere in the body.
Endometriosis occurs in about 30-40% of women and in most women it does not cause a problem. The cells can sometimes trigger an inflammatory reaction and cause scarring, adhesions or pain. Unfortunately, these misplaced cells can block the fallopian tubes or inhibit the normal sweeping movements of the tubes, making pregnancy difficult.
The cause of endometriosis is unknown. It tends to run in families. It is also more common in women who have a blocked cervix that promotes menstruation into the pelvis (retrograde menstruation). Research continues to find a cure.
Diagnosis is made through a laparoscopy, although signs and symptoms sometimes make the diagnosis highly suspected. During laparoscopy, a slender fiberoptic tube is inserted into the abdomen to allow the doctor to look closely for endometrial growths.
Treatment for endometriosis is divided into medical and surgical. Because endometrial cells respond to hormones of the menstrual cycle, medical management includes birth control pills and medications such as Dannazol, DepoProvera or Lupron. Lupron (or similar drugs used for 6 months) is most effective but also has the most noticeable side effects – primarily hot flushes. This is because Lupron interrupts normal menstruation by essentially "shutting off" the ovaries and placing the woman in a menopausal state while on the medication. Without estrogen, the implants shrink away. Remission of endometriosis can then occur from a couple months to years.
Surgical management depends on the reason for treatment. If pregnancy is desired, laser laparoscopic ablation is sometimes helpful. If treatment is for pain, laser laparoscopic ablation may also be helpful. However, the most consistently effective treatment for pain from endometriosis is removal of the ovaries. This is obviously not appropriate for women who desire children in the future, but when childbearing is complete, this often gives remarkable relief of symptoms.
Back to topObstetricians and gynecologists spend a significant portion of their training in High Risk Obstetrics (Perinatology). This includes training in common as well as unusual complications of pregnancy. Our physicians have experience managing diabetes in pregnancy (including gestational diabetes and insulin dependent diabetes). Other common high-risk pregnancies managed include multiple gestations (such as twins or triplets), toxemia (Pregnancy Induced Hypertension), fetal growth restriction, low or high fluid and many others.
Some patients require co-management or transfer to High Risk Perinatologists in a larger city (usually Akron or Canton). Our goal is to make our patient and their baby's care convenient but as safe as possible.
Back to topThe most common type of obstetrical surgery is the Caesarean Section or C-section. This is when an incision is made below the belly button to deliver a baby (or babies). There are many reasons to perform a C-section but some of the most common include labor failing to proceed normally, the baby having difficulty tolerating labor, the baby coming out backwards or having had a prior C-section. About 20-25% of all babies in the U.S. are presently born by C-section. Our goal is to minimize the number of C-sections in our practice while providing the safest care possible.
An uncommon type of obstetrical surgery is a Cervical Cerclage. This is when thick thread or suture is sewed around the cervix or opening where the baby will eventually come through. The cervix may be weak from previous surgeries, and some women are born with a weaker cervix that cannot hold the baby inside for the whole pregnancy. Cerclages are generally placed after the first third of pregnancy when forces on the cervix become more intense.
An even more uncommon type of obstetrical surgery is a Caesarean Hysterectomy. This is when the uterus is removed at or near the time of delivery. The usual reason is massive and life threatening bleeding from the mother which can only be corrected with this dramatic step.
Back to topUltrasound is when high frequency sound waves are transmitted through the skin and the sound waves that a computer assembles “bounce back” into pictures on a monitor screen.
Ultrasound has been proven to be completely safe to babies before birth. It is widely used in obstetrics to obtain measurements of babies and check for normal structures in and around babies – all of this is done while the baby is still inside the mother!
Back to topAmniocentesis involves the withdrawal of amniotic fluid through a fine needle, which has been inserted through the mother's abdomen into the amniotic sac (bag of water) surrounding the baby. This fluid contains cells shed from the baby's skin, lungs, and urinary tract. These cells and fluid can be analyzed for certain types of problems with the baby.
The most common study on the fluid is chromosomal analysis which not only identifies Down's Syndrome but other chromosomal abnormalities as well. Neural tube defects, or open areas of the skull or spine, can also be detected by amniocentesis. Later in pregnancy amniocentesis can be used to check whether or not the baby's lungs are mature. Amniocentesis is also done for several other less common reasons such as too much fluid or to check a baby's well-being if he or she is attacking its own blood cells.
The actual procedure is done under ultrasound guidance to avoid critical structures of the baby and mother. It is not unusual to delay the amniocentesis if an adequately safe insertion site is not found. Local anesthetic is usually injected to numb the skin's surface. After the needle is inserted about 2 tablespoons of fluid are withdrawn through a syringe. Support people are usually present for the procedure. Afterward, heavy lifting and strenuous activity is discouraged for about 24 hours and usually patients feel more comfortable if someone drives them home.
The decision to have an amniocentesis should not be taken lightly. The risk of losing the pregnancy from an amniocentesis done in the fourth to sixth month of pregnancy is about 1 in 200. The usefulness of the information gained from the amniocentesis and how that information will be used should be considered carefully. Later in pregnancy, pregnancy loss is minimal from amniocentesis but premature labor and delivery occasionally occur.
Back to topA Non-Stress Test or NST is when a heart monitor is used to listen and record a baby's heartbeat for about 20 minutes. The "tracing" that is recorded can then be examined by an obstetrician for reassurance of the unborn baby's good health. Patterns of the tracing can give clues to how much fluid is around the baby, if the baby is getting enough oxygen and nutrition or if the baby is growing adequately. Many lives have been saved by this simple test.
Biophysical profiles incorporate NST and ultrasound together to help determine if an unborn baby is in good health. It is usually done when an NST result is unclear. It involves using ultrasound to look at big movements, tiny movements, breathing movements, and fluid level along with NST to get a score. Each of these categories gets 2 points if reassurance of the unborn baby's health is seen. A perfect BPP is 10. When a BPP is in the 4-6 range, strong consideration is given to delivering the baby immediately.
Back to topWomen who are 18 ( younger, if sexually active) and over, should have annual gynecological examinations. You should also see your gynecologist more often if you are planning pregnancy, have a sexually transmitted infection or have a partner who has STI, have a history of sexually related illness or have a mother or sister who developed breast cancer before menopause.
To achieve the most accurate results from your gynecological examination and annual Pap smear, the best time for your appointment is one week after your period, while the worst time is the week prior to your menstrual cycle. During your visit, your doctor will do a Pap smear – a routine screening test that evaluates the presence of premalignant or cancerous conditions of the cervix.
Back to topCervical dysplasia is a term used to describe the appearance of abnormal cells on the surface of the cervix, the lowest part of the uterus. These changes in cervical tissue are classified as mild, moderate or severe. While dysplasia itself does not cause health problems, it is considered to be a precancerous condition. Left untreated, dysplasia sometimes progresses to an early form of cancer known as cervical carcinoma in situ, and eventually to invasive cervical cancer.
Back to topMenstruation is the release of blood and endometrial tissue through the vagina that occurs as part of the normal menstrual cycle. Menstrual disorders may involve the absence of menses (amenorrhea), abnormal vaginal bleeding or other conditions related to menstruation (e.g., toxic shock syndrome).
A woman's menstrual history begins with her first period (menarche) and continues until menopause. It includes average cycle length, and common associated symptoms, such as menstrual cramps, ovulation pain, premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). If you have irregular periods, heavy bleeding or painful cramping, we may be able to help you by prescribing an oral contraceptive.
Back to topThe vaginal “ecosystem” can be easily disturbed. Vaginal infections can be triggered by dozens of daily things, such as sexual behavior, hormones (including hormonal contraceptives, changes in menstrual cycle), vaginal blood (from your period, irregular bleeding, etc.), anything inserted into the vagina (diaphragm, tampons, strings from an IUD) or medications (antibiotics, douching agents, antifungal agents, spermicides). Studies have even found that women from different races have different vaginal ecosystems, predisposing some groups of women to more vaginal infections than others.
Back to topMammograms are probably the most important tool doctors have to help them diagnose, evaluate and follow women who have had breast cancer. Safe and highly accurate, a mammogram is an X-ray photograph of the breast. The technique has been in use for about thirty years.
Like many OB-GYNs, we recommend patients have their first mammogram at age 40. Women at high risk for breast cancer, with a strong family history of breast or ovarian cancer or have had radiation treatment to the chest in the past, the first mammogram should be done at a younger age, at the advice of your doctor.
Back to topA bone density test uses special X-rays to measure how many grams of calcium and other bone minerals – collectively known as bone mineral content – are packed into a segment of bone. The higher your mineral content, the denser your bones are. And the denser your bones, the stronger they are and the less likely they are to break. Doctors use a bone density test to determine if you have, or are at risk of, osteoporosis.
Back to topUntil you decide to start a family – or when your family is complete – you may want to use birth control to prevent pregnancy. There are many different methods of birth control. Talk to your doctor about the options and to decide which method is right for you and your partner.
Back to topYour mother or grandmother may have referred to menopause as “the change,” but it isn’t really a single event. It’s a transition that can begin in a woman’s 30s or 40s and last into her 50s or 60s. some women experience signs and symptoms of menopause before their periods stop permanently.
Menopause is a natural biological process, not a medical illness. Hormone therapy (HT) has been widely used in recent decades to relieve the signs and symptoms of menopause. However, new long-term evidence has demonstrated that HT may actually increase your risk of serious health conditions, such as heart disease, breast cancer and stroke.
Estrogen therapy is still a safe, short-term option for some women, but numerous other therapies are available to help you manage menopausal symptoms and stay healthy during this important phase of your life.
Back to topEndometrial ablation is an alternative to hysterectomy for patients suffering from heavy or prolonged menstrual bleeding. The procedure involves removing the lining of the uterus, which is the source of the bleeding. Removing the uterine lining will decrease your menstrual flow or even stop it completely.
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