After several groups say Pap smears aren't needed every year, ob/gyns recommend an annual 'well-woman' visit

Though several groups have said women don't need a Pap smear every year, obstetricians and gynecologists still recommend an annual "well-woman" visit and annual pelvic exams for all females over 21.

These new recommendations by the American College of Obstetricians and Gynecologists were published Monday. They come a few months after the American Cancer Society, the U.S. Preventive Services Task Force and other groups said most women only need a Pap smear every three years starting at age 21. After the age of 30, they can get them less often if they also get tests for the human papillomavirus, known to cause cervical and other cancers.

The visit "can be used to check blood pressure and weight, update immunizations, counsel patients on healthy lifestyles, screen for sexually transmitted infections and other health problems, perform breast exams and build relationships between doctors and patients," reports Kim Painter for USA Today.

But some critics question if these visits are just a way to make money. "We estimate that about $8 billion a year is spent on preventive yearly physicals of all kinds," said Ateev Mehrotra, a professor at the University of Pittsburgh School of Medicine. "The question is whether we could spend those $8 billion more wisely." (Read more)

Mothers should try to go to full term in their pregnancies, but many are unaware of the risks of early delivery, UK study finds

Illustration by Michelle Kumata via KRT

Babies who are born before the full term of 40 weeks may have health problems later in life, since important brain development takes place in the very last stages of pregnancy. As such, mothers should try to avoid being induced early or having elective C-sections.

A study conducted at the University of Kentucky College of Communication and Information found women often don't realize the important development that takes place at the end of pregnancy, write UK doctoral student Sarah Vos and H. Dan O'Hair, dean of the college, for the Lexington Herald-Leader.

Evidence shows that early, elective births are expensive. One study found reducing the number of elective births before 39 weeks of gestation to less than 2 percent of all U.S. births would save $1 billion each year.

But many women are uncomfortable at the end of their pregnancy, are anxious to know their children are healthy, and may even ask for early induction of labor because employers aren't flexible about time off. Sometimes doctors and other providers induce women early for their convenience.

Encouraging women to go full term and telling them the disadvantages of early labor — problems feeding and a higher incidence of Sudden Infant Death Syndrome — can influence their decision. As Vos and O'Hair conclude, "Babies are worth the wait." (Read more)

Critics, proponents debate Louisville hospital merger

Questions regarding ectopic pregnancy, end-of-life care and funding for indigent care were addressed Wednesday by proponents and critics of a proposed merger between University Hospital, Jewish Hospital & St. Mary's HealthCare and St. Joseph Health System. The issues were discussed at a meeting of the Louisville Forum.

The merger, which still needs approval by Gov. Steve Beshear, would give St. Joseph majority control over the three systems. Because St. Joseph is owned by Catholic Health Initiatives, University Hospital and Jewish and St. Mary's would have to adhere to Catholic health directives.

As such, "The other merger partners have agreed not to perform certain services forbidden by those directives: elective abortions; sterilizations; contraceptive dispensing for the purpose of contraception only (except in cases of sexual assault when the victim isn't already pregnant); artificial insemination and in-vitro fertilizations; and euthanasia," reports Laura Ungar of The Courier-Journal.

Altogether, there are 72 Catholic health directives, but David Laird, president and chief executive officer of Jewish and St. Mary's, said his organization and University Hospital have not agreed to abide by all of them. "We are not a Catholic hospital," said Laird, left. "University will not become a Catholic hospital," he said. (Photo by Frankie Steele)

Merger critic Beverly Glascock, a Louisville attorney and former nurse, broached the issue of ectopic pregnancies, which occur in the fallopian tube rather than in the womb. In all cases, the fetus cannot survive and there is danger to the mother if the tube bursts.

But, in a merger document released earlier this week, one of the banned procedures includes "elective (direct) abortions." "In the case of extra-uterine pregnancy, no direct abortion will be performed," the document reads.

Dr. Dan Varga, chief medical officer for St. Joseph Health System, addressed the issue, saying "a direct abortion is the termination of a viable pregnancy, and ectopic pregnancies are, by definition, not viable," Ungar reports.

The issue of indigent care was also discussed. Since CHI has said it will invest $320 million in the deal and commit $200 million to improve University and Jewish hospitals, one audience member asked how much of that would be used for indigent care. Laird said a combined $270 million in indigent care is already being spent. As for whether the CHI funds will increase that sum, Laird said he could not say. "How much will these hundreds of millions of dollars will go to help the indigent?" Glasscock asked. "Not one dollar, not a cent."

As for end-of-life care, merger partners said they have "agreed only not to perform euthanasia, which they do now," Ungar said. Continuing to provide food to someone in a vegetative state and honoring living wills should not be a concern. (Read more) To view a video of part of the hospital merger discussion, click here.

The Lancet: Commonest cause of maternal death is post-partum haemorrhage - one woman dies every 7 minutes

99% of all deaths in childbirth are in the least developed countries - 45 million women deliver without a skilled birth attendant every year, a situation in which the greatest number of maternal deaths occur.

The commonest single cause of maternal death is from post-partum haemorrhage, from which one woman dies every 7 minutes.


Health Technologies to Save Mothers. PATH.org video.

References:
Maternal mortality: one death every 7 min. The Lancet, Volume 375, Issue 9728, Pages 1762 - 1763, 22 May 2010.