Health News

There’s a myth going about that women who’ve ever had genital herpes must have their babies delivered by caesarean section. This isn’t true. However, if you’re pregnant and you or your partner have been infected with HSV, tell your doctor or midwife. You’ll be checked when you come into labour: if a recurrence is suspected, caesarean delivery will be considered. However, even if a baby is delivered to a woman with an undiscovered recurrence, the chance that the baby will be infected is low because it gets some immunity from the mother.

If you get a first attack of herpes during the early months of pregnancy, you will be advised to take antiviral drugs. If you get a first attack towards the end of pregnancy, antiviral treatment will reduce the risk of the baby becoming infected during birth. Severe infections in newborns are extremely rare, and are likely only if the mother has an undiagnosed first attack near delivery.

Some women who’ve had herpes ask whether they should take antiviral drugs during pregnancy to prevent recurrences. This is something you should discuss with your doctor. So far we don’t know whether these drugs are safe if taken during pregnancy. Records have been collected since 1985 from all pregnant women who have used them. To date there have been no problems.

Radiation therapy

Radioactivity can damage all living cells, but it is more destructive to cells that are multiplying rapidly (as cancer cells do) than to normal, slow-growing cells. Radiotherapy, which focuses a measured amount of radioactivity on an area affected by cancer, may be used to shrink a tumour before surgery, as a follow-up to surgery, and in some forms of spread. Your radiotherapist will discuss possible side-effects with you before treatment.

Radiation following lumpectomy doesn’t often cause troublesome side-effects: many women manage to drop in for their treatment before or after work. There may be mild nausea and tiredness that disappear when the treatment is finished. Changes such as skin discolouration, altered skin texture and tightening of the breast may persist in the area treated, though the focusing of the rays has become so accurate that these side-effects are now much less common.

Systemic therapy

This is treatment given by mouth or injection so that it circulates to all parts of the body. It is used to prevent further growth of any cancer cells that may have spread beyond the breast. There is increasing evidence that systemic therapy can reduce the risk of relapse of breast cancer.

There are two types of systemic therapy.

Tamoxifen, an anti-oestrogen drug, prevents the growth of cancer cells that are stimulated by oestrogen. It has few serious side-effects. Some patients experience nausea, hot flushes, headaches and vaginal dryness.

Anticancer drugs (chemotherapy) are toxic to all cells but, like radiotherapy, are much more destructive to the rapidly growing cancer cells. Chemotherapy usually causes some side-effects, mostly on the day of treatment and for a day or so after. Some patients have persistent problems that need treatment, including nausea and vomiting, mouth ulcers, tiredness and anaemia. Temporary hair loss is common, but complete regrowth is usual within six months.

Your doctor will tell you the reason for advising any systemic therapy, what side-effects to expect, how long they may last, and what can be done to relieve them.

Whatever surgery and other treatment you have, you will probably be more shocked than you expected by the reality. Many patients become depressed after treatment for breast cancer. The more you know about your condition and the reactions you may have to its treatment, the better you will be able to cope with your feelings afterwards. Don’t be afraid to admit that you need some help. Speak to your doctor about how you feel. Be honest with your family and friends – don’t tell them you’re ‘fine’ when you’re miserable. You’ll need their support, but they can only give it if they know how you really feel. During recovery from surgery, Breast Cancer Support Service volunteers will visit you in hospital or at home if requested, so do make use of this service.

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Treatment isn’t always necessary. If it is, it consists of removing the abnormal area. Five types of treatment are used.

Laser destroys the abnormal cells with the heat produced by high-frequency light beams. This can be done as an outpatient procedure with local anaesthetic in a clinic or gynaecologist’s rooms, or with general anaesthetic in a day surgery or hospital, whichever you prefer.

Diathermy destroys abnormal cells with the heat produced by an electric current. This is usually done under general anaesthetic in a day surgery or hospital.

Cryosurgery is a method of destroying abnormal cells by freezing. Usually no anaesthetic is needed, so it can be done in your doctor’s rooms or an outpatient clinic.

Loop biopsy a loop of wire that carries a diathermy current is used to remove the abnormal epithelium and some underlying tissue from the cervix. Local or general anaesthetic may be used. This treatment is usually done in a day surgery or hospital.

Cone biopsy is the surgical removal of a cone-shaped section of the cervix. This needs general anaesthetic and usually a few days in hospital after the procedure.

All forms of treatment are effective. Your doctor will advise which treatment is most
suitable for the type and extent of your abnormality. In a small number of women the abnormal cells reappear after treatment. When this happens, treatment is repeated.

After treatment

There is usually some bloodstained discharge, often increasing three or four days after treatment when the destroyed tissue separates and is shed. Spotting may continue for several weeks after the procedure. Sex can be resumed when bleeding stops.

You will be advised to have a smear test and colposcopy six months after treatment, followed by another smear at 12 months and then annual smears for die next five years. If all remains normal, you can then go back to routine Paps every two years.

What about pregnancy?

Having an abnormal Pap smear test result doesn’t affect your ability to have children, but there are two points you should consider.

1 If you’ve had an abnormal smear, it is wise to have the abnormality assessed by colposcopy and treated if necessary before becoming pregnant.

2 If an abnormal Pap smear is found when you are already pregnant, your doctor ill probably recommend colposcopy, which won’t affect the pregnancy. Almost always any treatment that might be needed can wait until after your baby is born.

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The reproductive organs don’t always develop properly. Many defects are minor and may never cause problems or can be easily corrected. Others may have a profound effect on sexual development and the ability to have children. To understand the congenital abnormalities that are possible, we must know something of reproductive development before birth.

Beginning around the sixth week of pregnancy, the female foetus’s XX sex genes stimulate the development of its ovaries. Two pairs of foetal structures – the Wolffian ducts and the genital ridges on each side – contribute tissue to the ovaries. The ova and ovarian stroma come from the genital ridge. The Wolffian duct makes only a small contribution to each ovary. Its lower part regresses.

It is the Y chromosome in the male foetus that leads to the development of the testis. The tissues that produce sperm and hormones come from the genital ridge, and the Wolffian duct contributes the collecting tubules of the testis, the epididymis, the vas deferens and the seminal vesicles.

In both sexes, the Wolffian ducts make a large contribution to the development of the kidneys.

The tubes, uterus and upper vagina develop from another pair of structures in the foetus – the Müllerian ducts – which run the length of the developing abdominal cavity near the Wolffian ducts. This development begins around the eighth week of pregnancy. The upper ends of the Müllerian ducts remain separate, forming the fallopian tubes. The remainder fuses in the middle to form the uterus, cervix and upper vagina. The development of the Müllerian ducts in female foetuses is independent of ovarian hormones. In male foetuses, this development is suppressed by the Mullerian inhibitory hormone (MIH) produced by the foetal testis.

The external genitals and lower vagina develop from the foetal structure that also forms the lower urinary system. The difference between female and male genital development is determined mainly by the effect of male hormones from the foetal testis.

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Can miscarriage be dangerous?

Sometimes miscarriage can be dangerous. The main risks are haemorrhage and infection as complications of incomplete abortion. When the uterus can’t contract properly because all or part of the placenta is still attached to its wall, haemorrhage can be severe. The uterus must be emptied (by suction or curettage) as quickly as possible. Rarely, transfusion may be needed if blood loss has been great.

When dead or dying products of conception remain in the uterus and the cervical canal is open, conditions are ideal for infection. Incomplete miscarriage complicated by infection is septic abortion. The infection can spread rapidly beyond the uterus to the tubes and other pelvic organs. Infection can also enter the mother’s bloodstream, resulting in septicaemia. Before the advent of antibiotics, septicaemia from septic abortion was one of the most common causes of maternal death. Happily for us, prompt treatment with curettage and today’s antibiotics can prevent or rapidly resolve the risks of infection from incomplete miscarriage.

What to do if you bleed

If you have any bleeding at any time during pregnancy, don’t wait to see what happens. Contact your doctor and remain within easy reach of medical care, as heavy bleeding sometimes develops very quickly. Camping trips to remote places are definitely unwise. Try not to worry too much: remember that half of those who have bleeding won’t miscarry. An important reason for reporting all bleeding in early pregnancy is that it may be the first sign of ectopic pregnancy.

What are the consequences of miscarriage?

There are usually no physical consequences from complete spontaneous miscarriage. The uterus returns to normal and the next menstrual cycle starts a few days after the pregnancy has been expelled.

Blood transfusion, though rarely needed, now prevents the prolonged illness and anaemia previously common after haemorrhage from incomplete miscarriage. Prompt use of antibiotics to prevent or treat septic abortion has reduced the chances of the tubes being damaged -with subsequent risk of subfertility – by spread of infection.