June Cosmetic Specials

I just tested positive for COVID-19 and I’m pregnant! Now WHAT?!?!

With rising COVID19 cases in New Hampshire, we are getting calls daily from our patients reporting a positive COVID-19 test.  We are here to support you with the latest information about pregnancy and COVID19.  We know that you are worried and have lot’s of questions.  We are updating this information as new guidance becomes available.

If you think you may have symptoms of COVID19, you should be tested.  Symptoms include: cough, fever, shortness of breath, headache, cold-like symptoms, sore throat, or loss or change to your sense of smell or taste.  There are many options for testing including at-home test kits (only should be done if you are symptomatic), state test sites, and pharmacies.  For a full list of testing sites, click here.  New Hampshire is also offering free COVID19 test kits.  To get your test kit, follow this link.

If you test positive for COVID-19, please call us during office hours at 603-668-8400 to let us know.  For the safety of our patients and team members, your next visit will be scheduled at least 10 days from the date of your positive test.  We are also happy to convert your scheduled visit to a telehealth visit to check-in with you.  You should isolate from others and stay at home for 10 days.  If you live with unvaccinated family members, try to isolate yourself from them.  If you are unable to isolate yourself, those family members also need to quarantine – they will need to quarantine for 20 days.  If you do need to leave your house for medical care, please be sure to wear a mask and call your healthcare provider before you arrive to notify them of your positive COVID-19 test result.

Most cases of COVID-19 are mild and can be managed at home with getting plenty of fluids and rest, as well as using medication to reduce a fever.  It is safe to treat a fever in pregnancy with Tylenol (Acetaminophen) 1000mg every eight hours.  In addition, make sure you’re staying hydrated by drinking a lot of water.  If you are fully vaccinated for COVID-19, your risk of severe illness is significantly less than those who are not vaccinated.

Primary care providers are well versed in the symptoms of COVID-19 and recommendations for treatment.  We would encourage you to reach out to your primary care provider for additional recommendations.  Because pregnancy is considered to be a high risk condition for COVID-19, your primary care provider may recommend that you receive monoclonal antibodies.  Monoclonal antibody treatments are recommended by the Centers for Disease Control (CDC) and the American College of Obstetricians and Gynecologists (ACOG) for treatment of pregnant people with mild to moderate COVID-19 who are at risk for complications from COVID-19.  There is a limited supply of monoclonal antibodies so we are relying on insight from your primary care provider as to whether you should receive monoclonal antibodies based on your symptoms.  Although monoclonal antibodies have not been specifically evaluated in pregnancy, preliminary data suggests that monoclonal antibody treatment is safe in pregnancy.  Orders for monoclonal antibodies need to come from your primary care provider.

If you feel like your symptoms are worsening, please reach out to your primary care provider for additional recommendations.  Watch for emergency warning signs for COVID-19 which may indicate more severe illness including difficulty breathing, confusion, persistent pain or pressure in the chest, or pale, gray, or blue-colored skin, lips or nail beds.  If you have any of these signs, seek emergency medical care immediately.

According to the data available from the CDC and ACOG, people with COVID-19 during pregnancy are more likely to experience preterm birth (delivering the baby earlier than 37 weeks) and stillbirth and might be more likely to have other pregnancy complications compared to people without COVID-19 during pregnancy.  Unfortunately, there are not any specific ways to prevent these risks once someone tests positive for COVID-19 other than monitoring for symptoms.  Due to a risk of pre-eclampsia (high blood pressures in pregnancy), if you are less than 28 weeks pregnant, you should begin taking low dose aspirin (81mg) daily starting at 12 weeks of pregnancy, if you have not already been instructed to take aspirin.  If you’re more than 28 weeks pregnant, you do not need to start aspirin.  If you’ve already been on it, continue taking your aspirin until you deliver.

If you were hospitalized with COVID-19, we will schedule non-stress tests to monitor your baby’s well-being twice weekly starting at 32 weeks (and at least 14 days after you were diagnosed with COVID-19) and an ultrasound to check your baby’s growth.  Please reach out to our office with any symptoms of preterm labor which include: Regular, frequent contractions or tightening of your belly, leaking fluid like your water might have broke, worsening lower back pain, and a sensation of significant lower pelvic pressure.

If you have not already received your COVID-19 vaccine or booster, once you are feeling better and it’s been at least 14 days since you were diagnosed with COVID-19, please get vaccinated.  Even if you have already had COVID-19, vaccination is still the best way to protect you and your baby.  

We hope you feel better soon.  Again, please be sure to seek emergency medical help if you are having any severe symptoms of COVID-19.

For more information, please visit: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnant-people.html

Travel in Pregnancy

Travel During Pregnancy
In most cases, pregnant women can travel safely until close to their due dates. Please discuss your travel plans with your OB-GYN for specific recommendations. Some considerations:

COVID
Delay travel until you are fully vaccinated. If you are not fully vaccinated and must travel, follow the CDC guidelines at www.cdc.gov.

Risk of Blood Clots
DVT (deep venous thrombosis) is a condition in which a blood clot forms in the veins, usually in the leg. DVT can lead to a dangerous condition called pulmonary embolism. This is when a blood clot travels to the lungs. Research shows that any type of travel lasting 4 hours or more—whether by car, train, bus, or plane—doubles the risk of DVT. Being pregnant is an extra risk factor for DVT. If you are planning a long trip, take the following steps to reduce your risk of DVT:

  • Drink lots of fluids without caffeine.
  • Wear loose-fitting clothing.
  • Walk and stretch at regular intervals.
  • Special stockings that compress the legs, either below the knee or full length, also can be worn to help prevent blood clots from forming.
  • Take 81mg of aspirin (also called low-dose aspirin) once prior to travel if you are not already taking daily aspirin for other indications.


Travel by Plane

  • Generally safe during pregnancy. Most airlines allow travel until 36 weeks.
  • Consider international travel plans in the third trimester of pregnancy. Depending on where you are planning to go, you may want to delay travel until after delivery based on the healthcare resources available where you are traveling.

Zika

  • Can be found throughout the world and is transmitted by a mosquito
  • Babies born to women infected with Zika are at increased risk for birth defects, especially microcephaly (small head and brain)
  • There is no vaccine or treatment for Zika. Avoidance of mosquito bites in active areas is the best protection. Discuss with your doctor if you will be traveling out of the country.
  • Visit www.cdc.gov/zika for the most updated guidelines.

 

Breast Density – What does it mean?!?

Mammogram reports now frequently include a notation of breast density and a disclaimer that this may reduce the ability of the mammogram to detect cancer.  Naturally this is a bit alarming

First of all, it is important to realize that dense breast tissue is not abnormal.  Almost half of women have dense breast tissue and women with dense breasts do NOT have an increased risk of dying from breast cancer. The term itself is a term that describes how your mammogram image looks, not how the breast tissue feels on exam.  It is the relative amount of black (fat tissue) on the image to white (glandular tissue) on the image.

Increased density is more common in women who are younger, on hormones, have a higher weight,  with history of previous pregnancies and those who have used tamoxifen or have family history of dense breasts. There is also subjective differences in assigning breast density, meaning different radiologists may interpret the image differently.

The scale that defines the breast density is called Bi-Rads and categorizes women into 4 groups:

  • A – Almost entirely fatty
  • B – Scattered areas of fibroglandular density
  • C – Heterogeneously dense (may obscure small masses)
  • D – Extremely dense (lowers the sensitivity of mammography)

For most purposes, the term “dense breasts” refers to either heterogeneously dense or extremely dense breasts (categories C or D).

Denser breasts have a few implications.  First, it may obscure the detection of a mass in the breast.  Second, it does slightly increase the risk of developing breast cancer. For these reasons it is important not to ignore the classification, but it is equally important not to over inflate the significance of it.

While studies have shown that breast ultrasound and MRI can help find some breast cancers that can’t be seen on mammograms, they can also show more findings that are not cancer. This can lead to more tests and unnecessary biopsies. Additionally, the cost of an ultrasound or MRI may not be covered by insurance.   So really the trick is figuring out who needs additional imaging because they have increased breast cancer risk and who “just has normal dense breasts”.

There are several online tools that can help estimate your risk of breast cancer such as https://bcrisktool.cancer.gov/.  In general, these models do not take breast density into account, but can still guide the decision how to follow up after a mammogram with this finding.

  • A woman with <15% risk of breast cancer, then no additional screening is recommended regardless of breast density.
  • A risk of 15-20% is a gray zone, with most organizations recommending a shared decision with your provider. Additional imaging with MRI or ultrasound may be an option, but neither modality is routinely covered by insurance for this risk category in most states.
  • With a risk >20% most groups recommend supplemental testing. Frequently women with higher cancer risks will be referred to a specialty breast care center to determine the best management options.

Regardless of risk, there are lifestyle factors which can decrease your chances of developing breast cancer.  Exercise and limiting weight gain, especially in the postmenopausal years, a low-fat diet, limiting alcohol intake and not smoking have all been shown a lower breast cancer rate. Screening modalities can be different as well.  Digital tomosynthesis, or 3D mammography, may be more sensitive for women with dense breasts and pick up more cancers than traditional 2D mammograms.  Most women who have had 3D imaging do not need further imaging because of dense breasts.

COVID-19 Visitor Policy Update

We are pleased to share that due to low community transmission rates in our area, we are no longer restricting visitors to our office.  Like always, children accompanying you to your visits need to be supervised at all times.  We look forward to seeing you!

We continue to follow CDC and NH state guidance regarding COVID-19 precautions.  Bedford Commons OBGYN continues to require masks for all patients and team members.  If you have any questions or concerns, please reach out to our office.

Special request from Bedford Commons OB-GYN – Please get vaccinated!

As you probably are aware, we are seeing a dramatic surge in COVID-19 cases.  After two years of providing healthcare in this new environment, many of us are exhausted; we are sure you are exhausted too.

This is our special request – please get vaccinated. 

With the rising COVID-19 cases in New Hampshire, we unfortunately have seen some of the sad outcomes that can occur with COVID-19.  We have witnessed firsthand the devastating effects of severe COVID-19 in pregnancy, seeing our patients hospitalized, some required ICU care, long term oxygen supplementation, and all of whom were in fear of harm to their baby.  Compared to those who aren’t pregnant, pregnant women infected by COVID-19 with symptoms are 3 times more likely to need ICU care, 2 to 3 times more likely to need advanced life support and have a 70% increased risk of death.  Severe COVID-19 can also cause issues for babies including a 60% increased risk of very premature birth, extended stays in the neonatal ICU, and risk of stillbirth.  All major medical organizations and we, your doctors, feel that COVID-19 vaccination in pregnancy is very safe and critically important because pregnancy is considered a high-risk condition for severe illness with COVID-19.

If you’re pregnant, get vaccinated as soon as possible.  We get calls daily from unvaccinated pregnant women who recently tested positive for COVID-19, asking us how they can prevent complications from COVID-19.  Unfortunately, there really isn’t anything that can be done once someone has COVID-19 other than monitor symptoms and treat a fever.  The only way to prevent complications from COVID-19 is vaccination.

If you’re not pregnant, make sure you get a COVID-19 vaccine and talk to friends and family members who are pregnant and encourage them to get vaccinated.  If you’re already vaccinated, thank you.  Be sure to also get your booster dose.

We know that everyone is really tired of this.  Please do your part and get vaccinated.

We care deeply about you so please, let’s work together to keep each other safe.

COVID19 Vaccine Considerations for Pregnant or Breastfeeding Women

Many of our patients have been asking about the safety and effectiveness of the COVID19 vaccine in pregnancy and breastfeeding.  Vaccination is the best way to reduce the risks of COVID-19 infection and COVID-related complications for both you and your baby.  Now that the vaccine has been out since December 2020, we have a lot more information about the vaccine for pregnant and breastfeeding women.

Both the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) recommend that pregnant and breastfeeding people be vaccinated against COVID19.  The Society for Maternal-Fetal Medicine has issued a statement with some guidance to women who are currently pregnant, planning pregnancy, or breastfeeding who are considering the COVID19 vaccine.  Click here to read the article.

Although pregnant or lactating women were not included in the COVID19 vaccine clinical trials, at this time more than 177,000 pregnant people have been vaccinated and no unexpected pregnancy or fetal problems have occurred.  There have been no reports of any increased risk of pregnancy loss, growth problems, or birth defects.

We know that about 1 to 3 in 1,000 pregnant women with COVID19 will develop severe illness.  Compared to those who aren’t pregnant, pregnant women infected by COVID19 with symptoms are 3 times more likely to need ICU care, 2 to 3 times more likely to need advanced life support, and have a 70% increased risk of death.  According to a September 29, 2021 urgent health advisory from the Centers for Disease Control (CDC), there have been more than 125,000 confirmed cases of COVID19 in pregnant people including more than 22,000 hospitalizations and 161 deaths.  To reduce these risk, the COVID19 vaccine is recommended.  See the full CDC health advisory here.  

With the rising COVID-19 cases in New Hampshire, we unfortunately have seen some of the sad outcomes that can occur with COVID-19 in pregnancy.  We get calls daily from unvaccinated pregnant women who recently tested positive for COVID-19, asking us how they can prevent complications from COVID-19.  Unfortunately, there really isn’t anything that can be done once someone has COVID-19 other than monitor symptoms and treat a fever.  The best way to prevent complications from COVID-19 is vaccination.

We strongly recommend that our pregnant and breastfeeding patients get the COVID19 vaccinationPregnancy is not an indication for a COVID19 vaccine waiver.  

If you have questions about the vaccine, please talk to your provider at your next visit.

COVID Vaccine Boosters – Do I need one?

The short answer is YES.  As of November 29th, 2021, the U.S. Centers for Disease Control and Prevention (CDC) recommends that everyone ages 18 and older should get a booster dose.  

If you received Pfizer-BioNTech or Moderna vaccines: You should get a booster at least 6 months after completing your primary COVID-19 vaccination series.
If you received the Janssen (J&J) vaccine: You should get a booster 2 months after completing your primary COVID-19 vaccination.

Which booster should you get?
You may choose which COVID-19 vaccine you receive as a booster shot.  Some people may prefer the vaccine type that they originally received, and others may prefer to get a different booster.  CDC’s recommendations now allow for this type of mix and max dosing for booster shots.

For any adults 18 years old or older who completed their primary Pfizer-BioNTech or Moderna vaccine series at least 6 months ago OR received the Janssen (J&J) vaccine at least 2 months ago, a booster dose of the COVID-19 vaccine is recommened.

Where can I get a booster?  Although we are not giving COVID19 boosters at Bedford Commons OBGYN, if you are eligible for a booster dose, you can schedule an appointment at any retail pharmacy or can inquire about an additional dose through your primary care provider office.  Find a vaccine location by clicking here: https://www.vaccines.gov/.  If you haven’t gotten a flu shot this year, consider getting the flu vaccination along with your COVID19 booster.  Both can be given on the same day.

What about boosters in pregnancy?  We strongly recommend that our pregnant patients receive the COVID-19 vaccine and also strongly recommend the COVID-19 booster for our pregnant patients who qualify.  For more information about the COVID19 vaccine and pregnancy, click here.