Congenital malformations of the female reproductive tract and their treatment

Congenital malformations of the female reproductive tract and their treatment

compounded by past tendencres of relevant to sexu~i abuse The focus many medical professionalsto avoid should be on the ~rosr anatomy of Iwk;ng do&at ...

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compounded by past tendencres of relevant to sexu~i abuse The focus many medical professionalsto avoid should be on the ~rosr anatomy of Iwk;ng do&at prepubescent genthe anus and genitals, and the chapitals. This lack of traininq. combined ter should be much earlier in the with the apparent reluc&ce to ex~ book. Including a chapter on testify amine the genitals and anus of chilinq a* a” expert witness is a” exceldren during routine &ice UiSts, his lentidea. b;t at tunes terms are de. left most medical professionals ignofined in legalese. making it difficult rant of what exactly constitlltes norfor the non-attorney to be enlightmal anal and genital anatomy at varened. The chaoter should be exious stagesof development. Diagnopanded to in&e more relevant examples and more pratical advice on sis of child abuse has been further hindered by the hesitation of many what to expect from the legal system medical professionalsto interact with at each step of the pro&and how the leqal system. to avoid pitf& and problems. Four Thi; text is designed to help ovadifferent &ual abuse protocols. es come some of these problems. The wen as a preappointment questioneditors assertthat it is “the first mednaire, are included in the appendix. ical book to combme a step-by-step but there is no annotation as to what discussion of how to inte~iew and their strengths and weaknesses are. “or how they differ from one anevaluate sexually abused children other with a complete photowwhic atlas.” There are 10 contributors, including Despite the noted weaknesses in the teutura! matar;al. rhs book would the editors: eight MDs, one attorney. be a valuable resource for physicians, and one PhD osvcholwist. The text consistsof 10 fhi;pten c&ring such nurses. and nurse-practitioners who deal with children topics es genital anatomy. the physical examination. the interview. the forensic examination, sexually bansCongenital Mallormations of the Female Reproductive Tract and mitted diseases,psychological effects of sexual abuse, and a&ice on testiTheir Treatment. Edited bv Barn, 5. Verkaub. Norwalk. Con&cut: kpfying as a” expert witness. A lengthy appendix includes sample sexual pkzton & Lange. 199% 240 pages. $62.50, hardcover. abuse protocols that have been used in various areas of the country. There Reviewed by: Shirley White-Walker, is also a &say. e,” annotated blbEd& CNM, Director. Nurse-Midwifery liography, and an index. Services. Plainfield Women’s Center. llw 120 color photographs of norPlainfield. New Jersey. mal and abnormal genital and anal Conqenital malfonations of the fe. anatomy are the stmngpoint of this r”al~reprodwti”e had represent apbook. In contrast, the text is someproximatelv 2.5% to 3% of all bIrtha what weak in parts. for example, a ~owwzr. -the end result of these brief chapter on the child protection anomalies finds their expression in systemmakes the valid point that the infertility, increased pregnancy loss. system is fragmented, understaffed. endomehioses. and other disorders. underkained. and crisis-driven. but This book is a” excellent reference provides little advice on either imfor understanding female genital tract proving the system or on how the disorders, their diagnosis. and beatmedical professional can best under“lent. stand and interact with the system The introductoy chapter provides that is now in place. Chapter seven. a historical overview of the incidence on anatomy, primarily deals with a of female genihl tract anomalies datdiscussionof embryology. However, ing back to 460 BC.The entire text of this topic does not seem particularly

the book is well illustiated. with both drawings and photugraphs. The section on embryology is clearlv “resented and relativeiv easv to co&;rehend given the corn&xi& of the sub,ect. The book is divided into 13 &pters. each ilddresS”g a particular organ or structure and the anomalies that affect it. It is well worth noting that the chapter discussing breast anomalies of congenital origin is very complete. The accompanying photographs give the reader a gmphic understanding of these rare conditions. The chapter that coverx the effects of diethyL&wxrol IDES) on female genital tract anomalies is especially well done. It is interesting that as early as 1953, the lack of efficacy of DES in preventing pregnancy loss was well confirmed and documented, yet the drug was still in wide use until 1971. Nurse-midwives and other providers of women’s health care need to be aware that many of the young women see” today could have been exposed to DES in utero. with all its attendant problems. The dixovey of female genital abnomlalities is frequently cause for great psychological and emotional duress for patients and their families. Although most anomalies MCUT only spradkally, some are given to familial clustering. A detailed family histoy isex?remely important becauseit can assistin making the diagnosis. as many anomalies are characterized by this familiel tendency. This book was both inta~esti”g and informative. What could have bee” a cumbersome and boring subject was a” easy. pleasant read. The text provides the right balance of depth and clarity to make it useful as a reference tool. AlthcJgh only a small Percentage of patients till present with these anomalies, the incidence is best appreciated when taken in the context of reproductive and sexual dysfuw tion. This book is ideally suited for the CNM in practice as well as strrdent ieamen. However, because of

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the complexity of the diagnosis and management, care af these patients would undoubtedly fall under the category of MD management. Elizabeth Bins’s Guide to Moving Through Pregnancy. By Elizabeth Bing. New York: Farrar, Sbaus. & Girow The Noonday Press. 1991. 117 pages. $12.00, paperback. Reviewed by: Roxann Mitchell, RNC, SNM. Nurse Midwifery Program, School of Health Related Pmfessicns, University of Medicine and Dentistry of New Jersey, Newark, New Jersey. Elizabeth Bing, one of America’s best-known childbirth educators. presents an illush-ated narration of “Mary” and her family moving through a day in her eighth month of pregnancy. The tide is a doubleentendre: the book addresses the physical challenges of navigation at home, at work, and out in public during the third trimester of geslation. Even/&y activities. increasing tiredness, and the awkwardness of pregnancy are discussedwith simple insimctions for achieving comfort. The activities of May’s day are set out I” a large, clear typeface. Responsive movements and exercises incorporated mto May’s daily mutines are simply and precisely described. Clear, depIctwe photos accompany the text. May is in maternity wear rather than exercise gear. This realistic photo approach lends a feeling of accessibilityto the book. II is oractical rather than damorous. &ions include exercisesto use at home. with and without the helo of fail; members, exercises at tbi office, a daily exercise routine. exercisesfor the postpartum period in the hospital, and a daily postpartum exercise routine. An easily readable script with beautiful black and white oictures moves sequentially thrash tie exercises,making this an ideal educational book for any pregnant woman to

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USBthroughout her pregnancy Bing offers encouragement and reassurance for the pregnant woman who wank to manage normal discomforts of pregnancy through good body mechanics, simple exercises. and proper rest. Postpattum exercisesare cornprehensive. describing when and how to begin. It progresses from day one postpartum to a full postpartum exercise routine. This reviewer finds valuable information for all pregnant women in Bing’s book. It is fun and quick reading with advice that can be incmporated into any life-style to hnprcwe ramfolt and fi.mersin-pregnancy and after childbitih. The author doer an excellem job of providing fnformation for pregnant women. She addressesthe common d&comforts encamtered in everyday living and working situations. Bing teaches women how to mwe more comfortably throughout the day. The concise, complete definition of dincomforts and comfort measuresused to allav them are awxomiate for the busy -life-styles m&t pregnant women lead. Elizabeth Bin& Guide to Mouing Through Pregnancy IS a text to be used and recommended often by nurse-midwives. Mother Well Maternity Health and Rtness. Color, sound, 90 minutes. Produced by Bonnie Berk. RN, BS. C&S, 1992. Available in half-inch VHS format from Mother Well, 1106 Stratford Drive, Carlisle, PA 17013. 1.lSOO)-MOM-WELL, Price: $34.95 plus shipping and handling Reviewed by: Kathleen Raney, RNC. BUN.SNM,Nurse-Midwifery Prcgmm. lJCSF/UCSD Intercampus Graduate Studies. La Jolla, California. This 90.minute color fitness video 1s visually clear and wonderfully directed. Nan&d and led bv Cetitied Education Specialist, B&n& Berk, RN, BS, this video instantly communicates to the viewer a sincere interest

in the physical support of the expectant and new mother as well as the social support needed during this time. Bonnie Berk clearly and simply leads four expectan: mothers at var. ions stages oi pregnancy through a variety of cardiovascular. stretching. and relaxation exercises.The viewers are encouraged to participate at individual comfort and tolerance levels, maintaining a safe pulse rate while focusing on breathing techniques and specific muscle groups. Along with 55 minutes of easy-to-follow exercise routines, the video also includes an 18.minute relaxation segment with visual imagery and stretching, a 5-minute nuhilional questionand-answer segment with a registered dietitian, and a 7minute set of abdominal strenghening exercisesfor after delivety. During the exercise and relaxaiio~segments, Bonnie Berk makes heart-warming references to the unborn child and encourages her pariiclpants to send loving thoughts to their babies to encourage perinatal bonding. Included with this video is a practical and very informative exercise booklet that contains exercise guidelines for pregnancy, nuhitional information, and an a&ion scale. In addition, she rates the advantages and disadvantage of the top 20 spoports and exercisesduring p’q9nancy. The booklet allow women to read wine of the content of the video as well as other pertinent information at their leisure. This video clearly follows the exercise safety guidelines of the American College of Obstetriclsns and Gmcalwjsb and also incmPurates selfpacing guidelines to personalif and modify each exercise program. The consumer receives much more than just lnstmctlon on prenatal exercises when purchasing this video. For example, the information cm relaxation can be used throughout one’s life span. Postpatum exercisesand professional responses to frequently

Journal of Nuae.MidwUery . Vol. 39. No. 3. May/June lQ%l