Latest news with #gynecology
CBC
3 days ago
- General
- CBC
Kelowna General Hospital doctors warn of 'collapse' of primary maternity care coverage
Doctors in the department of obstetrics and gynecology at Kelowna General Hospital (KGH) are warning that the maternity ward is on the verge of collapse amid a shortage of family physicians. A joint statement from all nine members of the department issued Thursday said that "without immediate action from health authorities and government decision-makers, the safety of patients and newborns is at serious risk." "Due to a critical shortage of family physicians willing or able to provide this care— worsened by a failure to recruit replacements—our hospital is facing a collapse of its primary maternity care coverage as early as June 1, 2025. "This means that many pregnant patients may arrive at the hospital in labour with no doctor available to provide safe, continuous care during delivery." The doctors said their concerns about staffing and support have gone largely unanswered and they're demanding immediate action from Interior Health. The doctor representing the group declined an interview request from CBC News. Dr. Hussam Azzam, executive medical director for Interior Health South, acknowledged the physicians' concerns, saying KGH leadership is in regular contact with with the ob-gyns to address a complex issue with "multiple pillars to it that we need to address." "We are open to listen and we're open to work with them collaboratively to meet their needs and to deliver the best quality care that they've trained to do," Azzam said. Dr. Charlene Lui, president of the professional association Doctors of B.C., said family doctors often handle low-risk patients with obstetricians focused on cases that are high risk and more complex. "When we have fewer low-risk maternity providers that are family physicians, then that puts additional pressure on our obstetricians to sometimes need to be in several places at the same time when an emergency arises," Lui said. The statement followed last week's announcement of an extended closure of the pediatric unit at KGH. The health authority said it temporarily closed the pediatric care unit at the hospital to address scheduling gaps due to limited physician availability. "We are very alarmed to hear that the issues at Kelowna General continue to escalate without solutions from the health authority," Lui said Friday. KGH is a regional referral centre with over 1,800 deliveries each year and a Tier 4 neonatal intensive care unit (NICU) caring for babies born at 30 weeks gestation or later, according to the doctors' letter. Dr. Jeff Eppler, an emergency department physician at KGH, told CBC News on Friday that he was heading into a weekend shift amid staff shortages, including no pediatricians and a limited number of ob-gyns. "Our staff is burning out. All of these service disruptions just make the job so much harder for all of us in the emergency department," Eppler said. "And even though we are all starting to burn out, we are going to have to pick up extra shifts this summer to make up for all the shortcomings in the system." In a statement, B.C. Health Minister Josie Osborne said parents can be assured that all of the hospital's critical care services for children remain open, including the emergency department and NICU. Gavin Dew, the B.C. Conservative MLA for Kelowna-Mission, described the situation at the hospital as a "crisis of government neglect." "We have multiple departments of the hospital who clearly feel as if they are not being heard by the folks who should be listening to them and are resorting to making public the crisis-level conditions at the hospital," Dew said. The hospital ob-gyns said they have warned administrators of the risks, and have tried to offer solutions. "We have submitted multiple letters, proposals, and formal communications urging action," reads the statement. "Our concerns have gone largely unanswered." They are calling on Interior Health and B.C.'s health ministry to create a contingency plan to ensure patients are cared for and to support the transfer of maternity patients if care can't be provided locally. Osborne acknowledged the hard work of pediatricians at KGH, saying they have been dealing with staffing shortages and are "understandably experiencing burnout." She went on to say the province's efforts to recruit health-care workers are starting to pay off. Two new pediatricians have accepted offers to work at KGH, she said, with the first set to arrive in July.
CTV News
4 days ago
- General
- CTV News
OB/GYNs warn of looming crisis in maternity ward at Kelowna General Hospital
Nine doctors who work in the department of obstetrics and gynecology at Kelowna General Hospital are warning because of a lack of family physicians who can deliver babies, the region faces the collapse of primary maternity care coverage as early as June 1. In a news release, the nine OB/GYNs, who provide specialized care for high-risk pregnancies and emergency services at the hospital, say they're also being asked to cover low-risk labour deliveries, which are normally covered by family doctors and midwives. 'If a low-risk patient is delivering and something high-risk or emergency comes along where the obstetrician is urgently needed, they can't be in two places at once. So it causes some serious concerns around delivering quality patient care and safety,' said Dr. Charlene Lui, the president of Doctors of B.C. The news release says it puts the OB/GYNs in a position where they will have to choose which patient to care for first, which could result in permanent harm to mother or baby. 'These doctors are sounding the alarm because somebody is going to get hurt, somebody is going to die,' said Gavin Dew, the B.C. Conservative MLA for Kelowna-Mission. 'It has gone on for far too long. These smart, talented and trained frontline professionals have not been heard.' The warning about a looming crisis in the maternity ward at Kelowna General comes on the heels of the pediatric unit announcing it will close for six weeks because of a shortage of pediatricians. 'Kelowna at the moment is really seeing some enhanced challenges compared to other regions of the province and the country,' said Lui. 'This is in every parent WhatsApp group in Kelowna and in the Okanagan. Everyone is talking about this, everyone is scared by this, everyone is angry about this,' said Dew. 'We obviously need appropriate staffing levels. We obviously need operational changes. But the most important thing that needs to happen is that government needs to start listening to the frontline medical professionals who are the boots on the ground dealing with this crisis,' he added. 'We do have concerns that Interior Health is downplaying how serious these issues are and how they can negatively affect patients in the community and the physicians working in the hospital,' said Lui. CTV News reached out to Interior Health for comment but did not hear back by deadline. This article will be updated if a response is received.
Medscape
5 days ago
- General
- Medscape
ACOG Issues Pain Management Guidelines for Procedures
Clinicians need to discuss and offer all patients a variety of pain management options for in-office gynecologic procedures ranging from intrauterine device (IUD) insertion to biopsies, according to new guidance published by the American College of Obstetricians and Gynecologists (ACOG). The guidelines, published on May 15, are the first formal ones from ACOG to not only acknowledge the range of pain experiences that can be associated with different procedures but also to explicitly lay out recommendations for the conversations providers should have with their patients about what pain management options are available. 'This guidance speaks to more than just Ob/Gyns,' Co-Author Genevieve Hofmann, DNP, women's health nurse practitioner and assistant professor of Ob/Gyn at the University of Colorado School of Medicine in Aurora, Colorado, said during a discussion with the press on May 17 at American College of Obstetricians and Gynecologists (ACOG) Annual Meeting in Minneapolis. 'It speaks to any physician who's providing these types of services and certainly to advanced practice registered nurses who work in women's health and provide these services.' The types of procedures addressed in the guidelines include IUD insertion, endometrial and cervical biopsies, hysteroscopy, intrauterine imaging, endometrial ablation, uterine aspiration, and loop electrosurgical excision procedures (LEEP). The specific pain management options advised for each of these, however, differ according to what evidence was available to inform the guidance. 'It's really important to equip clinicians with these tools to be able to have these conversations with patients,' not only about what pain to expect during the procedure but also about what pain management options there are and what the experience of receiving those pain management options is like, Jayme Trevino, MD, MPH, Ob/Gyn and complex family planning subspecialist, said during the press meeting at ACOG. Not everybody needs pain management for procedures such as an IUD insertion or an endometrial biopsy, Hofmann said, 'but they should be given the information to then make that decision, and as providers, we should be able to provide them with at least something that has some evidence behind it.' According to Uchenna Acholonu, MD, MBA, chief of minimally invasive gynecologic surgery at Northwell Health's Long Island Jewish Medical Center in New Hyde Park, New York, the guidance is very welcome for both patients and providers. 'ACOG made a big step in actually putting this out,' he said. 'They try to come up with guidelines that are inclusive so that they don't alienate providers or make it difficult for providers to help out. This guideline is helpful in that it's not absolute, but it's giving providers an opportunity to choose what they do to help patients.' Even 'more importantly,' he added, 'it's finally acknowledging that it's not 'just a little pinch' or it's not 'just a little cramp,'' when it comes to the pain associated with many procedures. That sentiment was echoed in comments that Nisha Verma, MD, MPH, Ob/Gyn and complex family planning subspecialist and assistant professor at Emory University in Atlanta, said at the ACOG press meeting. 'Patients have very reasonable mistrust of the medical system and have had their pain dismissed in a lot of cases by the medical system,' Verma said. 'Women and people of color are, in many cases, offered less pain management or their pain is taken less seriously, and I think it's important for us as clinicians to be aware that our patients are coming in with this reasonable mistrust.' Verma emphasized that pain is a very individual experience as well. 'My 10 out of 10 might be different from your 10 out of 10,' she said. 'This is grounded in principles of shared decision-making, like so much of the other care we provide.' The guidelines are particularly helpful and important for those just coming out of training. They are entering the profession with the understanding that pain is significant and something potentially worth an intervention. 'I don't think all providers will see this as something to add to their practice right away,' Acholonu said. 'I think it might take a little bit of a push from the patients. That's not ideal,' he said, but the reality is that it may require a patient asking for something to help with the pain or discomfort for a doctor to think about offering it. 'Self-advocacy has come a long way, and I think it'll continue to improve,' he said. At the same time, he added, 'I think providers are going to take a step, as a result of this, to offer [pain management], even if it doesn't seem like it's necessary by their training, now that there is some sort of framework to help guide them.' Acknowledging that the evidence base in gynecological pain management is still thin, Acholonu expects that this guidance may prompt new studies to look at head-to-head comparisons between pain options for different procedures. The Pain Management Guidelines The guidelines address gaps in the literature and the risks associated with different pain options. The section on hysteroscopy, ablation, and polypectomy, for example, notes that there isn't enough evidence to recommend local injected anesthesia for these procedures, but that misoprostol can reduce pain during the procedure, albeit with an added risk for adverse effects such as abdominal pain or gastrointestinal symptoms. Imaging such as hysterosalpingography or sonohysterography similarly lacks evidence for specific interventions, but enough data exist to suggest that applying 5% lidocaine-prilocaine could help reduce pain with these procedures. Local anesthetics are recommended for LEEP, and paracervical blocks are among the options for uterine aspiration. But while preprocedural nonsteroidal anti-inflammatory drugs can effectively reduce pain after uterine aspiration, oral opioids, and oral anxiolytics have not been found to effectively decrease pain, although the latter may reduce anxiety related to the procedure. Verma highlighted the importance of recognizing that the anxiety associated with the perceived anticipation of pain is an important part of the experience for patients too. 'We don't have any way to predict who is going to do fine with an IUD insertion and someone who's going to just have a really miserable experience,' Hofmann said. She said they worked to ensure the document was not prescriptive in terms of what pain management patients receive, especially if lack of availability of certain options would make the procedures less accessible. But clinicians need to at least be having a conversation about the options that do exist, she said. In addition to recognizing the variety of pain experiences that patients may have with these procedures, the guidelines also highlight historical failures to take many patients' pain seriously and acknowledge marginalized groups and special populations whose needs have been neglected or whose history may interact with their experience of pain. 'The way pain is understood and managed by healthcare professionals is also affected by systemic racism and bias of how pain is experienced,' the guidelines stated. 'Specific populations, such as adolescents and those with a history of chronic pelvic pain, sexual violence or abuse, and other pain conditions, may also have increased or decreased tolerance of pain and resistance to pain medications.' 'We have to recognize and acknowledge that [the field of gynecology] has probably not historically done a very good job at managing some of this, and I think the only thing that I can do as a clinician now is do better,' Hofmann said. 'Hopefully, establishing trust with people and having good relationships and being open to the conversation is a good starting place.' No external funding was noted in developing the guidelines and any disclosures were managed according to ACOG policy without specific mention in the guidance document. Shah, Verma, and Acholonu had no relevant financial disclosures.
Yahoo
27-05-2025
- Health
- Yahoo
How soon do pregnancy symptoms start? Here's what experts say.
Corrections & Clarifications: An earlier version of this story misstated how to calculate pregnancy duration. It has since been updated. If you think there's a chance you might be pregnant, you want to know as soon as possible. But how soon can symptoms be attributed to a new pregnancy, rather than other ailments or conditions? It's helpful first to know how to actually measure pregnancy duration: It's calculated from the first day of your last period, not the actual day of conception, says Dr. Karen Tang, author of "It's Not Hysteria: Everything You Need to Know About Your Reproductive Health (But Were Never Told)." And symptoms could begin to arise sooner than you might think. Here's what gynecological experts want you to know about early pregnancy symptoms and detection. How does IVF work? Plus what the process is like and how much it costs. Pregnancy (or "morning sickness") symptoms can begin to show within four to eight weeks, experts say. Symptoms including nausea, fatigue, moodiness, breast tenderness, light bleeding and mild pelvic cramping. Food cravings or aversions are common. But not everyone experiences those symptoms in that timeframe – and not everyone who experiences those symptoms is pregnant. It's rare, but in some cases, false negative tests occur. "Some people never notice symptoms, which is why pregnancies are detected at all different gestational ages, even sometimes in the third trimester," Tang says. "Some of the symptoms of pregnancy can be the same as what people experience in PMS, because they're also caused by a hormone called progesterone that rises in both the luteal phase before your period, and as the placenta develops. You could also think you have a virus because of feeling nauseated, tired and achy." Noted: Can you actually get pregnant during your period? What an OB/GYN needs you to know. The "most sensitive" drugstore tests can detect pregnancy as early as three or four weeks after your period date, Tang says. In those first few weeks, pregnancy hormones are on the rise every day. If you take a test early on that turns up negative but you still believe you may be pregnant, Johns Hopkins Medicine recommends testing again in a week. Getting a blood test done by a medical professional also may be helpful, as blood tests are able to detect pregnancy before urine tests and ultrasounds. "You should take a test as soon as you are worried you might be pregnant, but most over-the-counter tests may not turn positive until around the time that you'd be due for or missing your period," she adds. "Pregnancy hormone (HCG) is most concentrated in the first morning urine, so that may have the best chance of showing a positive, but obviously take the test whenever in the day you're able to." This article originally appeared on USA TODAY: When do pregnancy symptoms start? Expert thoughts on morning sickness
Health Line
22-05-2025
- Health
- Health Line
Everything You Need to Know About Your Vaginal pH Balance
Your vaginal pH is a key indication of your overall vaginal health. A balanced pH is usually between 3.8 and 4.2, but it can vary with age and where you are in your menstrual cycle. pH is a measurement of how acidic or alkaline (basic) a substance is. The scale runs from 0 to 14. A pH of less than 7 is considered acidic, a pH of 7 is neutral, and a pH of more than 7 is basic. A 'normal' vaginal pH level is between 3.8 and 4.2, which is moderately acidic. However, what constitutes a 'normal' pH level can vary slightly based on your stage of life. For example, during your reproductive years (ages 15–49), your vaginal pH should be below or equal to 4.5. But before menstruation and after menopause, a healthy pH tends to be higher than 4.5. An acidic vaginal environment is protective. It creates a barrier that prevents unhealthy bacteria and yeast from multiplying too quickly. How do you know if your vaginal pH is imbalanced? Usually, a sign of an underlying pH imbalance is when you experience an unexpected change in odor that lingers after bathing or an odor that occurs alongside other unusual symptoms. A healthy vulva and vagina can smell somewhat salty, sweet, or musky. You might notice a more metallic smell around your menstrual period. But if your vaginal area smells fishy or otherwise foul, it's usually an indicator of BV. Other symptoms that can indicate an underlying pH imbalance include: an uptick in vaginal discharge itching in or around the vagina pain during or after penetrative sex pain or burning during urination a change in texture a change in color What can happen if your vaginal pH is off or unbalanced? Disrupting the natural acidity of your vagina can cause discomfort and may even lead to infection. Bacterial vaginosis (BV), for example, can develop in response to an overgrowth of certain bacteria. This can increase vaginal pH levels, making the vagina more alkaline. BV is the most common vaginal infection in the United States. BV isn't necessarily harmful in itself, but people who have this condition have an increased risk of developing more serious infections, such as: chlamydia gonorrhea herpes simplex virus type 2, which can cause both oral and genital herpes HIV HPV Yeast infections, also known as candidiasis, are the one of the most common vaginal infection in the United States. They can cause vaginal pH levels to decrease, making the vagina more acidic. An acidic environment typically doesn't increase the risk of infection or disease. But it can affect your ability to become pregnant during penis-in-vagina sex. Sperm thrive in an alkaline environment. The optimal pH for sperm to swim is between 7 and 8.5. Sustained acidity can make it difficult for sperm to reach or fertilize an egg. What can cause a pH imbalance in your vagina? Some pH fluctuations are expected. Menstrual blood, for example, is slightly alkaline. When blood flows through the vaginal canal, it increases the overall pH. Antibiotics significantly reduce both harmful and helpful bacteria. This includes the bacteria that cause illness and the bacteria you need to maintain a healthy, more acidic vaginal pH level. Other disruptions are more unpredictable. Solo or partnered sexual activity can affect your vaginal pH with or without vaginal penetration, regardless of whether you use a condom or other barrier method. Exchanging bodily fluids through genital-to-genital and oral-genital contact can encourage the growth of certain bacteria. Fingering can introduce bacteria, as can shared or improperly cleaned sex toys. So-called 'feminine' hygiene products, including scented sprays and suppositories, and practices like douching and steaming can also alter the vagina's natural microbiome (the helpful bacteria that live inside the vagina). What can you do to fix or restore your vaginal pH balance? Certain lifestyle changes can help manage mild irritation. These can include: limiting time spent in damp or wet underwear and clothes washing more frequently staying hydrated If you suspect BV could be to blame, you can use an at-home test to check for infection or make an appointment with a healthcare professional to discuss your symptoms. Although some over-the-counter (OTC) products are marketed as effective BV treatments, the Food and Drug Administration (FDA) has not approved any OTC method. Antibiotics aren't always necessary (BV may resolve on its own), but they can help relieve your symptoms and speed up recovery. Your clinician will likely prescribe one of the following: metronidazole, which can be applied topically or taken as a pill clindamycin, which can be applied topically, inserted as a suppository, or taken as a pill tinidazole, which is taken as a pill secnidazole, which is taken as a powder mixed with food You can also use an at-home test to check your overall pH balance. These tests don't check for infection specifically, but the results can help narrow down the potential cause. If you suspect a yeast infection, you may be able to self-treat with OTC products like: antifungal cream antifungal ointment an antifungal suppository More severe cases may benefit from prescription medication like fluconazole (Diflucan). If this is your first yeast infection, it's best to make an appointment with a doctor. What can you do to maintain a healthy vaginal pH balance? Wash your vulva, not your vagina: Your vagina is self-cleaning, but your vulva can use a little help. Wet a washcloth with warm water and gently clean each fold of your external genitalia. Avoid douches and other internal 'cleansers.' Stay dry: Avoid spending extended time in damp underwear or swimsuit bottoms. Wash up, pat yourself dry, and change into something clean and dry as soon as possible. Let your vulva and vagina breathe: Stick to cotton and other breathable materials when selecting underwear. You might also size up on pants, shorts, and other bottoms, or choose clothes with an airy silhouette for a looser fit. Pay attention to how you wipe: Always wipe from front to back to prevent fecal bacteria from spreading to your vagina. Consider your probiotic intake: Probiotics, or helpful bacteria, may help reduce symptoms of BV and prevent recurrent BV infections. Lactobacillus strains, in particular, can help speed up recovery. Practice safer sex: Using a condom or barrier method can help reduce the risk of STIs, and regular STI testing can help you stay on top of your status. When should you consult with a doctor or other healthcare professional? If you're uncomfortable with at-home testing or unsure of your symptoms, it's important to consult with a healthcare professional. The following symptoms typically require medical intervention: burning, itching, or pain fishy or foul vaginal odor foamy, frothy, or increased vaginal discharge gray, yellow, or green vaginal discharge Your clinician will ask about your symptoms, your medical history, and recent sexual activity to help identify the underlying cause. They may perform a pelvic exam and swab inside the vagina to take a fluid sample for lab testing. They may also ask for a urine sample. Frequently asked questions Can you fix your pH balance overnight? It is not possible to balance your vaginal pH overnight. It is not possible to balance your vaginal pH overnight. How do you check your vaginal pH level? You can purchase an OTC test kit to measure the pH of your vaginal secretions, but this typically isn't necessary to detect a yeast infection or BV. Remember, your vaginal pH can fluctuate for a number of reasons. A lower or higher-than-expected pH isn't an automatic indication of infection or that something is wrong. You can purchase an OTC test kit to measure the pH of your vaginal secretions, but this typically isn't necessary to detect a yeast infection or BV. Remember, your vaginal pH can fluctuate for a number of reasons. A lower or higher-than-expected pH isn't an automatic indication of infection or that something is wrong. Is there a natural way to balance your vaginal pH? Eating fermented foods with live probiotics can help increase the amount of healthy bacteria in your body. Probiotic supplements with Lactobacilli may be especially beneficial.
