Health News Blog. Lots of resources and information

Worth mentioning is a rare condition called a molar pregnancy or, to give its full name, a hydatidiform mole.

This rather unpleasant sounding condition occurs in about one in 750 pregnancies in Australia. (It is more common in some other areas, like South-east Asia and Mexico.) What happens is that a fertilised egg may start off doing the right things, heading down to the uterus and implanting, but when it comes to dividing up into a placenta, sac and embryo, things go wrong. The embryo rarely develops, but what happens is that the chorionic villi, which usually go towards making up part of the placenta, overgrow. The overgrowing villi form cysts, creating a mass within the uterus, which enlarges more rapidly than a normal pregnancy would.

If a woman has a molar pregnancy, she may have exaggerated symptoms of pregnancy (such as marked morning sickness) and may have bleeding in early pregnancy. This is because the abnormal molar tissue produces increased levels of pregnancy hormones, and has a tendency to bleed. When she is examined, her uterus would generally be larger man it should be for the gestation of her pregnancy. An ultrasound would be performed, which would confirm the lack of a foetus, and the presence of this abnormal tissue. The treatment required is to remove the abnormal tissue, and this is done by a D and C.

Follow up is needed to ensure that all the molar tissue has been removed. Regular measurements of the level of HCG (the hormone measured in routine pregnancy tests) will monitor the regression of the condition. In most cases treatment will have been adequate. It is recommended that women wait eighteen months to two years before becoming pregnant again. There is usually no problem in subsequent pregnancies.

There is a tiny (3 to 5 per cent) chance of the molar pregnancy developing into a more serious condition, a form of cancer called choriocarcinoma (which fortunately usually responds well to treatment); another reason regular follow up is routine.

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Telling a woman with an unplanned pregnancy that she should have used contraception is not very useful. If she did use contraception, then it has obviously failed. If she didn’t then she has probably already told herself she should have. (Contraception is the responsibility of two people, not just one.) Making her feel worse about the situation is pretty mean.

If a couple want to have sex and avoid getting pregnant, then they should use reliable contraception. Unfortunately not everyone knows a lot about it, so getting reliable information is important. Many women, particularly younger women, do not actively associate pregnancy with having sex. Sometimes it takes a pregnancy, or a pregnancy scare to help them realize. It is a pretty dramatic way to learn.

Some women are probably very fertile. Just as we understand some women have problems getting pregnant, there are some who get pregnant more easily than the average woman.

Having been involved in the care of many women who have had unplanned pregnancies, my own feeling is that prevention is definitely better than cure. I am sure many women who have had abortions would agree. However, we are fortunate that if, despite our best efforts, we do become pregnant, and continuing the pregnancy is not a possibility, we have access to safe, legal abortion and support.

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The ultimate test for HIV infection and AIDS is a positive blood test. A sample of blood is sent to a laboratory where they test for evidence of HIV ‘antibody’. Antibody is the stuff that the body makes when it has tried to fight a particular bug. For example, if you have had chicken pox it would be possible to find antibody to the chicken pox virus in the blood stream. If there is HIV antibody in the blood it will prove that the body has been in contact with that particular virus, and that person is said to be ‘antibody positive’. We do not yet have a blood test which identifies the presence of the actual bug; we can only identify the antibodies to it. We know that with HIV this means that the person not only has antibodies to the virus, but also active, infective virus floating around the blood stream.

The problem with the blood test is that it will generally take up to three months after infection for the antibodies to show in the blood. This means that the infective virus particles may be in the blood, but the tell-tale antibody isn’t. It means that a person may feel well, be antibody negative on a test, but be infected and able to infect others. This period of being infective, and antibody negative is referred to as the ‘infective window’ or ‘window period’.

It is recommended that people have two tests, at least three months apart, with no ‘high-risk activity’ (doing things likely to put you at risk of catching the bug, outlined later) between tests if they want to be sure they are not infected. This makes sense, as it allows for the window period. Some researchers and clinicians have recommended allowing for a six-month window period, as it may take longer for some people to develop antibodies.

Actually having this blood test performed can be a very stressful event, not just because most people are afraid of needles, but because a positive result, no matter how unlikely, is for most people such a devastating prospect.

Contrary to the belief of some people, blood is not routinely tested for HIV whenever a blood test for anything else is taken. Guidelines for the handling of HIV testing have been suggested for Australian doctors, because the nature of the disease means that extra concerns about confidentiality and other ethical issues are raised. In Australia, doctors who order the test should do so at the request, or at least with the permission, of the patient. It should not be undertaken without a discussion of the test, its limitations, and what the consequences of a positive and negative result would be. The result should be given, in person, only to the person who was tested, and the result should remain confidential. Many insurance companies now request HIV results for insurance policies, and this is only done with written authorisation from the patient.

The stage of the disease (where along the line from ‘infected and well’ to ‘terminally ill’) in a particular person is worked out by a number of classifications doctors use. The stage of the disease is usually monitored by testing the numbers and function of certain white blood cells, and clinical findings.

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The condom. This useful little article is experiencing a renaissance. It fell out of favour when the more convenient, less obtrusive oral contraceptive pill took to the streets. However, recent events, such as the advent of AIDS (acquired immune deficiency syndrome), and the apparent explosion of PID (pelvic inflammatory disease), have bolstered the popularity of this strange little rubber thing.

The condom is a very thin, strong latex sheath. It is designed to fit over an erect penis, catch the ejaculate (the semen) in a little reservoir at the tip, and be removed and thrown away. Various success (or failure) rates have been reported. The failure rate of a contraceptive method is usually expressed as ‘per 100 women years’. This means how many women would be expected to get pregnant if 100 women were using the method for a year. The failure rate for condoms has been found to be between four and fifteen pregnancies pet 100 women years (about 85 to 96 per cent effective). There is an enormous variability depending on the users, so true failure rates are difficult to assess.

Problems can arise when the condom is not put on early enough. As mentioned previously, there are plenty of sperm hanging around eagerly prior to ejaculation, like barflies around opening time. Not everyone reads the instructions carefully before putting the condom on (admittedly, it can detract from the atmosphere a little). But if the condom breaks, a panicky trip to the doctor for the morning-after pill certainly doesn’t do heaps for the atmosphere either.

There is a little nipple-like bit on the tip of the condom. This is to catch the ejaculate. If the air is not fully squeezed out of the tip before the condom is rolled onto the penis, a pocket of air may be trapped inside, which heats up and expands during intercourse. Add to this a couple of millilitres of semen and the condom may burst, no matter how carefully it may have been tested.

Another trap for young players is removal of the condom. This should happen before the penis gets flaccid (floppy) again, and care should be taken not to spill semen. The condom should be held onto the base of the penis while the penis is being removed from the vagina so the condom doesn’t slip off. The effectiveness of the condom as a contraceptive is improved by the use of a spermicidal cream, jelly or foam. There are many on the market, but they should only be used in conjunction with a barrier method, not on their own, as they are NOT effective alone.

If using a lubricant, it is important to use a water-based one, such as K-Y Jelly, and not an oil-based product, such as Vaseline or baby oil, as these weaken the latex and make the condom less effective, and more likely to break. Putting on a condom does not necessarily need to be an inconvenience; imaginative couples can easily incorporate it into foreplay.

The benefits of the condom as a contraceptive are obvious. However, the function of the condom as a germ-catcher makes it an even more useful device. As well as stopping sperm, it can decrease your chances of catching viruses (like herpes and AIDS), bacteria (like gonorrhoea and chlamydia), and other miscellaneous bugs (like syphilis and trichomonads). There are many brands of condom on the market now, with a tantalizing selection of names and promotional promises. All Australian condoms must conform to Australian standards, but if used incorrectly, or not used EVERY TIME, you might as well be wearing it on your nose (not a recommended function).

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This is a muscular organ, which has a cavity. Its usual (non-pregnant) size in an adult woman is about as big as a large apricot, or a little peach. It may become bigger because of benign (non-cancerous) tumours of the muscle wall, called fibroids or polyps, or because it is housing a baby or, less commonly, because of cancerous growths.

The uterus has a lining, called the endometrium (endo = inside, metrium is to do with the uterus). This lining becomes thicker when the right hormones, mainly oestrogen and progesterone, are in the right levels in the blood stream, and is shed when the hormonal levels change. This shedding is called menstruation.

When you are pregnant the uterus grows to accommodate a foetus and a placenta. After delivery of the baby it returns to its pre-pregnancy size. This is called “involution” of the uterus. Involution may take about six weeks.

Other fascinating facts about the uterus include the fact that usually it is tilted forward (called “anteverted”), and in about 20 per cent of women it is tilted backward (called “retroverted”). If it is pointing upward it is called “axial”. All of these positions are normal variations. Usually the uterus is “mobile”, which means that it can be moved from one position to another; that it is not

tethered down to surrounding structures. An immobile uterus may result from scarring, or other structures blocking the way, like cysts. Whether or not your uterus is mobile or anteverted, etc., is usually of no significance in the day-to-day workings of the apparatus.

Some women have a uterus which is a different shape, not the typical peat shape. Some of them have two compartments (sometimes with a double cervix and even two vaginas). Some uteri are heart shaped. They have just developed this way, and usually function normally.

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