68 percent of women in America who are having unprotected sex say that they would be able to get birth control if they didn't have to first obtain a doctor's prescription.  While hormonal birth control pills are substantially safer than many types of over the counter medication, obstetricians and gynecologists have tended to lobby for it to remain presciption-only, for both economic and safety reasons.

However, that may all be changing in the near future.  The American College of Obstetricians and Gynecologists (ACOG), the biggest organization in the U.S. for doctors involved in women's reproductive healthcare, now says that it approves over the counter access for some types of hormonal birth control.

Safety concerns have always been the primary reason that doctors and health departments in the past have shied away from letting any woman purchase the Pill at her local pharmacy.  Of particular concern to many physicians is the possibility of pulmonary embolism, which can be deadly. 

However, the ACOG Committee Opinion about OTC birth control access shows some startling figures: while there is indeed a risk involved with taking birth control pills, the risk of pulmonary embolism is much higher during labor and the post-partum period.  ACOG notes that several other very commonly ingested over the counter medications, like acetaminophen (Tylenol), have substantially worse side effect profiles including permanent liver damage.  These side effects are a much more common than significant side effects from birth control pills.

One of the advantages that the ACOG sees in allowing over the counter access to birth control pills is that this allows women to buy several packs at once.  It's much more likely for women, especially young women, to continue using birth control when they have access to several packs at once.  ACOG reports that their trials show significantly higher continuation rates for women who receive 7 pill packs than those who receive three.

Until recently, one of the biggest reasons that obstetricians were reluctant to throw their support behind over the counter birth control was that birth control prescriptions brought women to the doctor for preventative care like Pap smears when they otherwise may not have done so.  However, ACOG says that this is not a sufficient reason to withhold oral contraceptives, because this examination is in no way relevant to starting a regimen of birth control pills.

With Obamacare now helping women to obtain free birth control from their insurance providers, the new recommendations may actually cost insured women more, while costing uninsured women substantially less, if they are enacted.  However, the greater ease of access to birth control may make it so that many more women can use reliable contraceptive methods without worrying about the cost of a doctor visit or the embarrassment of invasive examinations simply to get contraception.

In order for birth control to be made over the counter in the United States, a drug company would have to propose making a particular birth control formulation available for OTC sales.  The FDA would then have to review all the evidence about that formulation before making a final determination on whether to allow over the counter sales.

Source: acog.org

On September 21, 2012, the National Institutes of Health reported that infants delivered head-first in standard deliveries before the 32^nd term are just as likely to survive as infants delivered by a planned cesarean. 

Infants born before the 32^nd week face an increased risk of “death, cerebral palsy, developmental delays, infections and vision and hearing problems.”  Many studies have argued that infants delivered vaginally before the 32^nd week face an increased risk of injury or other health risks once passing through the birth canal, and many of the same studies have promoted cesarean deliveries in such situations. 

However, the NIH argues otherwise.  In the recent study, the NIH compared results between about 3,000 women who underwent a head-first, standard delivery and those who chose a planned cesarean delivery. 

The NIH reports, “Nearly 80 percent of the women with a fetus positioned head-first attempted a vaginal delivery, and 84 percent of them were successful.  The remainder ultimately delivered by cesarean.”  The success rate was the same for planned cesareans. 

The survival rate for breached infants under 32 weeks is significantly higher during a planned cesarean.  Uma M. Reddy, M.D., M.P.H., of the Eunice Kennedy Shriver National Institute of Child Health and Human Development states, “The decision to deliver vaginally or by cesarean is an individual one, and must be made carefully by the woman, in close consultation with her physician” 

The NICHD conducted the study, and their next goal is to understand the results from “extremely preterm” deliveries and the neurological and physical disabilities associated with such deliveries. 

The study presents several challenges in medical malpractice law.  A doctor is now less liable if they suggest a head-first, standard delivery before the 32^nd week.  Still, the link between preterm deliveries and neurological disabilities needs studied further. 

Source: National Institutes of Health

On October 19, 2012, the Food and Drug Administration approved the expanded use of the Sapien Transcatheter Heart Valve (THV).  Patients with aortic valve stenosis who can receive surgery but appear at risk of serious complications during surgery are now approved for the heart valve.  

The Sapien THV was first approved in 2011 for patients who could not undergo surgery for aortic valve stenosis.  The condition occurs when calcium deposits occur on the aortic valve and cause it to narrow.  The heart will eventually work harder to push blood through the reduced opening, and aortic valve stenosis can eventually lead to fainting, chest pain, heart failure, arrhythmias, or even cardiac arrest.  

The Sapien THV does not require a surgeon to open the chest or heart.  Instead, the THV is compressed into a small tube referred to as a delivery catheter.  The delivery catheter and the THV are then placed in the femoral artery in the leg and threaded to the bad valve.  Lastly, the THV is released from the delivery catheter and then increased to normal size with a balloon.  The inserted THV begins working right away.  

The use of the Sapien THV was expanded after a clinical study compared results between 348 patients who received the THV through the delivery catheter and 351 patients who received a valve replacement during open-heart surgery.  The groups experienced similar death rates during the first month, first year, and first two years.  THV recipients are at an increased risk of artery dissection or perforation, and the same patients are at risk of stroke during the first month after the procedure.  

Christy Foreman, the director at the FDA’s Center for Devices and Radiological Health, stated, “Any procedure to replace the aortic valve carries the risk for serious complications, but for some patients with coexisting conditions or diseases that risk may be especially high.  The THV serves as an alternative for some very high-risk patients.”

Source: U.S. Food and Drug Administration
 

Pediatricians should consider giving teenage girls a prescription for emergency contraception before they need it, according to a recent report released by the American Academy of Pediatrics.  The recommendation represents a significant shift in how the medication has been treated by pediatricians in the United States.

Although the popular emergency contraceptive, consisting of a combination of synthetic estrogens and progesterones, was made over the counter for women 17 years of age and older,  women under 17 still require a prescription to obtain the pills.

This presents a problem for girls under 16, who often have difficulty scheduling a doctor's appointment and obtaining a prescription within the 72 hour effective window for emergency contraceptives.  Making matters even worse for teenagers trying to get EC, the pill is at its most effective when it's taken as early as possible.

In repeated studies, physicians have found that emergency contraceptive drugs are safe for occasional use in adolescents.  Most of the objection to allowing girls under the age of 17 obtain the pills on their own came from people who had issues with the ways in which over the counter Plan B would diminish parental control over a child's medical treatment.

According to the American Academy of Pediatrics, giving girls pre-emptive prescriptions would solve several of the current issues with prescribing Plan B to teenagers.  For one, the pre-emptive prescription could be filled nearly immediately after an incident of unprotected sex or of a birth control method being compromised.  This makes the Plan B medications very likely to be effective. 

Another reason is that the doctor can evaluate any girls who are given a pre emptive Plan B prescription to ensure that they do not have any medical conditions that might make Plan B less safe for them to take.  Doctors can also go over side effect information with patients and help them understand that Plan B is not for use as a primary birth control method.

Anti abortion groups are likely to decry the statement by the American Academy of Pediatrics.  These groups also fought the approval of Plan B, as well as the recent change that made it over the counter for girls and women over 17 years of age.  According to these anti-abortion groups, because Plan B may be responsible for causing fertilized eggs not to implant in the uterus, they are tantamount to abortion.

However, according to the CDC and other government sources, these pills work primarily by blocking ovulation and are considered very safe.  There have been no major lawsuits as a result of Plan B being made available to consumers, either behind the pharmacy counter or over the counter.

It remains to be seen how many pediatricians will actually act in accordance with the new recommendations from the AAP.  Parental objections may make it difficult for some pediatricians, especially those in conservative or rural areas, to give pre-emptive Plan B prescriptions to younger female patients.

Sources: cdc.gov, aap.org

What is Fetal Abduction?

Fetal abduction occurs when a pregnant mother is forced to undergo a cesarean.  The abductor will then kidnap the fetus, and the mother is usually murdered or killed during the cesarean.  The type of abduction is somewhat of a phenomenon, for recorded cases have only occurred since the 1980s. 

Psychology of the Abductor

A fetal abduction is much rarer than an infant abduction, but the abductor usually has the same frame of mind and thoughts before the abduction.  The abductor is usually a woman, and she will usually have fantasies of becoming pregnant or being a mother.  In some cases, the abductor will fake a pregnancy and abduct the fetus when it would appear the abductor is ready to have a child.

The Most Recent Case of Fetal Abduction

Warning: the details of the following crimes are graphic and may offend some readers.  On September 20, 2012, Annette Morales-Rodriguez was convicted of first-degree homicide after she killed a woman and her unborn child.  The woman was Maritza Ramirez-Cruz, and she died as a result of asphyxiation, head trauma, and blood loss along with the involuntary caesarean performed Morales. 

A witness stated that Morales lured the victim to her house and attacked her with a baseball bat.  Ramirez was then bound with duct tape, and the tape covered her nose and mouth as well.  Morales proceeded to place a plastic bag over Ramirez and then cut the unborn fetus from the womb.  Morales will spend the rest of her life in prison. 

Other Cases of Fetal Abduction

Recorded fetal abductions have occurred in the United States since 1987.  Some of the cases are described below:

1987, Albuquerque, New Mexico

The first recorded fetal abduction occurred in Albuquerque when Darci Pierce murdered Cindy Ray and stole her unborn child.  Cindy Ray was attacked after she left the Kirkland Air Force Base in New Mexico, and Peirce strangled her.  She then used a car key to remove the unborn child, who survived and is still living. 

1996, Tuscaloosa, Alabama

Felicia Scott and Carenthia Curry were friends before the crime occurred.  Scott cut open Curry to steal her child, shot Curry in the head, and placed her body in a plastic bag.  The family eventually reported Curry as missing, and authorities found Curry’s body three months later.  The baby survived the abduction. 

2006, St. Louis, Illinois

Tiffany Hall killed Jimella Tunstall and cut the unborn fetus out of her womb.  She then proceeded to drown three of the pregnant woman’s children and left the drowned children in a washing machine and dryer.  It was another case where the defendant knew the victim.  Sadly, the baby did not survive the attack. 

2008, Kennewick, Washington

In this case, Phiengchai Sisouvanh Synhavong killed Araceli Camacho Gomez by stabbing her in the chest numerous times.  Gomez’s feet and hands were found with yarn, and Synhavong cut the fetus out of the womb.  Bloody gloves, a box cutter, and other bloody items were found in Synhavong’s purse, and the child miraculously survived. 

Stem cell controversy

"Stem cell controversy" refers to the ethical debate over the use of embryonic stem cells in medical research. Embryonic stem cells can be harvested from fetuses, which has caused controversy and objections from some people over this type of research, frequently on religious grounds. In the United States, stem cell controversy has led to a number of laws and court challenges.

In 1995, the United States Congress passed the Dickey Amendment. This legislation prohibited the federal Department of Health and Human Services from funding any research involving the destruction of human embryos. This legislation also prohibited this department from funding the development of embryos for research purposes.

This legislation remained in effect but was amended by several other laws addressing the stem cell controversy. In 1998, the discovery of human embryonic stem cells led the Clinton administration to reconsider its stance on funding of research involving stem cells. After reviewing the issue, the administration decided that the Dickey Amendment did not prohibit research involving human embryonic stem cells provided that obtaining them did not require destroying a fetus first. After George W. Bush assumed the presidency in 2001, his administration reviewed the stem cell controversy and decided to allow federal funding involving stem cells harvested from fetuses that had already been destroyed.

In 2005, Congress passed legislation designed to permit the harvesting of stem cells from frozen embryos in the custody of in vitro fertilization clinics, provided that the donors responsible for the embryos approved. However, this legislation was vetoed by president George W. Bush. During his presidency, George W. Bush's position on the stem cell controversy led to several other bills attempting to allow more public funds for this type of research being vetoed.

In March of 2009, president Barack Obama issued an executive order removing the restrictions in the Dickey Amendment concerning federal funding using newly created human embryos. In response, a group of scientists filed a lawsuit challenging the executive order's application. The suit was led by two scientists whose work only involved the use of adult stem cells. In their lawsuit, the scientists claimed that such funding would be in direct competition with the funding they required, making it impossible for them to complete their research. In 2010, they appeared in district court before Judge Lamberth, who issued a temporary injunction prohibiting such funding on the grounds that the scientists had a strong probability of winning their lawsuit.

The stem cell controversy continued when the ruling issued by Judge Lamberth was reversed on appeal by the federal government. The government argued since since federal funding is not applied to the destruction of embryos, the executive order was not in violation of the Dickey Amendment. The appellate court ruled in favor of the Obama administration and ordered Judge Lamberth to reverse his ruling. In July of 2011, Judge Lamberth did so despite his personal objection to the finding.

On November 5, 2012, the National Institutes of Health announced that patients who receive stem cells from their own bone marrow three to seven days after a heart attack do not show greater heart function within six months.

The medical trial that looked into the treatment was called the Transplantation in Myocardial Infarction Evaluation (TIME).  The trial had similar results to a previous study performed by TIME.  The study looked into the effects of autologous stem cells, which are produced in bone marrow.  

Sonia Karlatos, Ph.D., the deputy director of NHLBI’s Division of Cardiovascular Sciences, stated: “Heart stem cell therapy research is still in its infancy, and results from early trials have varied greatly due to differences in the numbers of stem cells injected, the delivery methods used, and the compositions of the study populations.”  With the results from both of the TIME studies, Karlatos mentioned, “This standard will inform the next steps in research on the use of stem cells to repair damaged hearts.”

Researchers with TIME enrolled 120 volunteers between July 2008 and February 2011.  The average age of the participants was 57, and 87.5 percent of the participants were male.  All of the volunteers had moderate or severe blockage of the left ventricles and has received stents after heart attacks.  The volunteers were assigned to four groups:

•    group 1: injection of stem cells three days after heart attack
•    group 2: injection of placebo three days after heart attack
•    group 3: injection of stem cells seven days after heart attack
•    group 4: injection of placebo seven days after heart attack

The participants that received stem cells were injected with 150 million stem cells 8 hours after the cells were taken from the marrow.  

Even though the results were unsuccessful, CCTRN member Jay Travese, M.D., stated: “With this baseline now set, we can start to adjust some of the components of the protocol to grow and administer stem cells to find cases where the procedure may improve function.”

Source: National Institutes of Health