Lessons From Our Ob-Gyn Colleagues in Mexico

Last week, I had the wonderful opportunity to take part in The Federacion Mexicano de Colegios de Obstetricia y Ginegologia (FEMECOG) meeting in Mexico City. The outstanding program provided the most up-to-date discussions on all aspects of women’s health to about 4,000 of Mexico’s 14,000 ob-gyns. Imagine if ACOG was able to share cutting-edge information with 30 percent of our Fellows at one meeting.

Our own Dr. James Martin, former ACOG President, was a bit of a ‘rock star’ as he delivered seven different lectures on preeclampsia. He was surrounded by physicians afterward asking for photographs with him! The variety of lectures at this meeting was impressive—and certainly challenged my understanding of Spanish. Our hosts—from outgoing FEMECOG President, Dr. Jose Montoya, to the newly elected FEMECOG President Ernesto Castelazo, and his spouse, Gabriela—made every moment enjoyable. ACOG Mexico Section Chair, Dr. Francisco Ruiloba, and his spouse, Gabriela, attended to every detail during our stay in Mexico City.

One of the best discussions we had was about medical student and residency training in image (2)Mexico. Students there have four years of medical school, followed by a one-year internship that is required before medical school completion. Every student from each of the almost 80 medical schools must complete one year of public service to underserved populations in Mexico City or in the deepest jungles of Mexico.

Our hosts, Felipe Gonzalez and Maru Morales, discussed their concern when their eldest daughter, Sofia, accepted her public service assignment in Santa Cruz, Huamuxtitlan, in Guerrero, one of Mexico’s most remote locations. No one was willing to serve there the year before. I can only imagine leaving my daughter in a remote valley for a year of service.

Sofia says her time in Santa Cruz was one of the best and most important years of her life. In fact, Sofia thrived as she provided primary care to the 1,000 local inhabitants of the surrounding countryside. She said she learned self-reliance and independence. She saw 40 patients a day because she was one of only a handful of physicians in the surrounding towns. About 45 minutes away from her was a support clinic to handle deliveries and advanced emergency care.

image_7Sofia treated patients with diabetes and hypertension, but she also gave hope to so many in other ways. She started exercise classes in the town square (Zumba in the plaza!) to emphasize healthy lifestyle choices for everyone. She talked friends, colleagues, and a university into donating computers because there were none in town. The computer center near the town kiosk is now named the ‘Dr. Sophia Gonzalez Center.’ At her graduation, Sophia was the first recipient of her university’s newly established “Best Social Service Award.”

I also had an opportunity to discuss the desire of ob-gyn residents in Mexico to work with ACOG through our Junior Fellow programs. ACOG’s programs are inspiring the many ob-gyn residents throughout Mexico to want to exchange skills and interests with ob-gyn residents here in the US. What better opportunity than to develop exchange programs so that we can foster mutual respect, understanding, and knowledge from our diverse programs.

As we look closely at our health care system, it’s clear that we have much to learn from other countries. Most of us enter medicine with an interest in serving others, but we have never had a system dedicated to achieving such lofty goals. Although many academic programs have a global presence, often we can achieve more by collaborating closely with our ob-gyn colleagues in other countries.

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Fighting Preeclampsia in May and Beyond

This is my last blog post as ACOG president (I continue as immediate past president for another year), so I’d like to finish where it all began, with my Issue of the Year: preeclampsia. It’s a condition that affects up to 7% of pregnant women, and in my opinion, it’s the most important medical complication of pregnancy. It’s potentially life-threatening to mother and baby during pregnancy and can signal health problems for the mother later in life. Unfortunately, this serious and common condition is understudied and largely misunderstood.

As part of my President’s Program on Monday, May 7, at The College’s Annual Clinical Meeting, I invited three of my esteemed colleagues at the forefront of preeclampsia research to share what we know, what’s new, and the advances that may be coming soon in preventing and treating preeclampsia. This session will help educate ob-gyns about the condition. It’s imperative that physicians appreciate a patient’s experience of preeclampsia. It’s also extremely important to raise awareness of the signs and symptoms of preeclampsia among women.

High blood pressure and protein in the urine can both signal preeclampsia. Because these changes are hard—if not impossible—for women to spot, blood pressure and urine tests are routinely checked at each prenatal visit. Other symptoms may arise, especially in the last three months of pregnancy, including sudden weight gain, headaches, swelling of the face or hands, blurred or altered vision, chest pain or shortness of breath, pain in the upper right abdomen area, and nausea and vomiting. These symptoms may seem normal, but because preeclampsia can worsen quickly, it’s important that pregnant women alert their doctor immediately if they occur.

Preeclampsia Awareness Month (PAM) in May is an excellent time to educate women and spread the word about this condition. The Preeclampsia Foundation’s website has a page devoted to the signs and symptoms of preeclampsia and what women can do to monitor themselves for preeclampsia-related changes. The foundation also has great news and information about risk factors, resources, and local PAM events. The more we know, the safer we can make pregnancy for women and their families.

Meetings Matter—The Importance of Our Annual Clinical Meeting

The ob-gyn community is abuzz in anticipation of our 60th Annual Clinical Meeting (ACM), just over two weeks away in San Diego. You read that right. We’re excited over an annual meeting. I’ve been an ob-gyn since the 1970s and I’ve had many reasons for attending the ACM over the years. In my opinion, each meeting gets better and more relevant to my daily practice.

The ACM is the best place to gather with other ob-gyns to learn about and discuss a wide array of new findings in research and in clinical practice. The phenomenal poster sessions—where more than 260 research abstracts will be presented—help physicians get a pulse on emerging areas in ob-gyn research and of the breakthroughs that may be coming soon. The ACM also provides an excellent opportunity to meet up with colleagues, collaborators, and friends from the US and abroad. It has been the birthplace of countless projects and initiatives that support our mission of providing the highest quality women’s health care and eliminating obstacles and health disparities our patients may face.

Of all the times I’ve attended, this particular ACM holds special significance. It marks the sunset of my tenure as president of ACOG. It has been an amazing and transformational year for our organization. One of the highlights of my presidency has been shining a national spotlight on preeclampsia, a leading cause of maternal and infant sickness and death in the US that is both understudied and misunderstood. Unfortunately it is also an area of reproductive research that is woefully underfunded especially with regard to clinical trial undertakings. The 2012 ACM will kick off with my President’s Program on preeclampsia. I’m very excited to have James M. Roberts, MD, giving the historical and current perspective on the condition; John Barton, MD, reporting on the findings of ACOG’s Preeclampsia Task Force and some of the implications for our clinical practice; and Eleni Z. Tsigas of the Preeclampsia Foundation discussing how it affects women and families.

So for the next few weeks, I’ll be looking forward to all that awaits me at the ACM. There’s still time to register for what promises to be an informative, fun, and comprehensive meeting. Hope to see you in San Diego!

Support Preeclampsia Awareness Month Today

In an effort to increase public awareness and research funding, ACOG is pleased to support the Preeclampsia Foundation’s petition to Congress to have the month of May officially designated as national “Preeclampsia Awareness Month.” Please take a moment to show your support by signing the petition today—the deadline is December 31, 2011.

The main focus of my ACOG presidential initiative is something that has consumed my professional career for more than 30 years: preeclampsia and hypertensive disorders during pregnancy. Over the past two decades, preeclampsia in particular has been a growing problem in the US, and it is a leading cause of maternal and infant death and illness. Yet despite decades of research, we still don’t know what causes it or how to prevent it. 

What we do know is that certain women are at increased risk of developing preeclampsia, including women who are obese, carrying two or more babies, pregnant for the first time, older than 35 years, African American, or who have diabetes, lupus, or kidney disease, among a few factors.

Preeclampsia is high blood pressure that occurs only during pregnancy and usually starts sometime after the 20th week of gestation. Some of the warning signs include headaches, vision problems, rapid weight gain, and upper abdominal pain. Hypertensive disorders during pregnancy, including preeclampsia, often require very preterm delivery to protect the health of both mothers and infants and are a major contributor to the high prematurity rate.

Even though preeclampsia causes so many preterm births and related deaths, it is among the most poorly understood, understudied, and underfunded conditions compared with other diseases. More research is critically needed so that we can develop evidence-based guidelines for prevention and treatment.

Increased Health Risks for DES-exposed Women

Back in the 1940s and until 1971, women took a synthetic estrogen called diethylstilbestrol (DES) to prevent miscarriages and other pregnancy complications. As a result, millions of babies were exposed to DES in utero with profound health consequences.

Now, a new study in the New England Journal of Medicine quantifies the magnitude of that impact. Government researchers analyzed data from three studies that began in the 1970s, looking at 12 health risks in 4,600 women who were exposed to DES in utero and compared them to 1,900 women who were not.

Investigators found that exposed women had higher rates of infertility (33% vs. 16%), miscarriage (50% vs. 39%) and premature delivery (53% vs. 18%) than unexposed women. In addition, they were more likely to develop preeclampsia (26% vs. 14%), miscarry in the second trimester (16% vs. 2%), and experience early menopause (5% vs. 2%). DES daughters also had a slightly higher risk for breast cancer after age 40 (4% vs. 2%).

Little can be done now to undo this public health disaster. Researchers plan to follow these women through menopause and study their daughters to see whether the impact will affect future generations.