Toxicology test for pregnant women

A toxicology screen is a test used to determine if an individual has been exposed to certain legal or illegal drugs. Toxicology screens are usually ordered to see if a patient has taken drugs that could endanger his or her health. If a patient is suspected of taking illegal drugs, a screen for specific drugs that are commonly abused may be ordered.

Toxicology screens are often ordered by hospital emergency department personnel when a patient appears to be impaired or is unconscious. Testing is also done in patients who have a change in mental status, in cases of seizures, and onset of dementia. Toxicology testing can also be useful in cases of suspected sexual assault.

In some cases, a patient may have been exposed to a prescription drug accidentally or overdose may be suspected. Some employers require random drug screening. Employees who test positive for illegal drug abuse may be suspended or fired.

The test can be performed fairly quickly. Results can help doctors treat the patient effectively and safely.

 Types of Toxicology Screens

There are several types of toxicology screens. Most screening methods use a sample of urine to test for the presence of illegal narcotics or prescription drugs. Some, like the blood alcohol test, can determine the precise concentration of a particular drug. Others, like the urine screen, can indicate if a person has been exposed to drugs or poisons. Drug screens can also be performed on saliva.

One common type of toxicology test looks for evidence of alcohol abuse by a mother during pregnancy. Her newborn’s first stool is examined to predict a condition called fetal alcohol syndrome.

Most screens provide limited information about how much or how often a patient has taken a drug. Once the presence of a drug has been identified by screening, the doctor may order a more specific test, which will show exactly how much of the drug is present in the patient’s system.

The contents of the stomach may also be screened when doctors suspect a patient may have taken a drug orally.

How Samples for Toxicology Screens Are Obtained

Some toxicology screens are obtained by doing blood tests, which involve drawing one or more small tubes of blood. A medical professional inserts a needle into a vein and removes enough blood to perform the necessary tests.

If a urine sample is required, the patient may be asked to urinate into a small sample cup in the presence of law enforcement or medical personnel. This prevents the patient from tampering with the sample.

Types of Drugs Screened

Many types of drugs can be identified by toxicology screens. Depending on the drug, it may show up in the blood or urine hours or weeks after exposure to the drug. For example, alcohol is eliminated from the body relatively rapidly. It’s necessary to draw blood within about three hours of an automobile accident to accurately reflect a patient’s blood alcohol status at the time of the incident.

Other drugs, such as THC, a component of marijuana, may show up in urine for months after exposure. How long THC remains detectable depends on whether the patient is a heavy user.

Common classes of drugs that may be detected by toxicology screens include:

  •  alcohol (including ethanol and methanol)
  • amphetamines (such as Adderall)
  • barbiturates
  • benzodiazepines
  • methadone
  • cocaine
  • opiates (including codeine, oxycodone, heroin)
  • phencyclidine (PCP)
  • tetrahydrocannabinol (THC)

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acog org mortality

Chemicals taking a toll on reproductive health

Chemicals from a variety of sources are having an increasingly negative effect on human health—especially in children—so ob-gyns need to step up efforts to reverse this trend through advocacy and education, said Linda C. Giudice, MD, PhD, during the Donald F. Richardson Memorial Lecture on Monday, May 6, at the Annual Clinical Meeting.

Dr. Giudice presented “Environmental Chemical Effects on Reproductive Health Outcomes: Strength of the Evidence and What We Can Do for Our Patients, Learners, and Communities.” She is the Robert B. Jaffe, MD, Endowed Professor in the Reproductive Sciences at the University of California, San Francisco.

“Our scientists are taking a good look at the data and are finding trends that are disconcerting. We now have an opportunity to do something,” she said, pointing out that since lead was phased out of gasoline in 1973, blood lead levels have plummeted. “We can transform exposures.”

In the past 20 years, impaired fecundity in the US has increased from 8% to 12%, and 90% of that change has come in the 15–24 age group. In males, sperm counts and testosterone levels have declined about 1% per year in recent decades, Dr. Giudice said. At the same time, hypospadias and testicular germ cell tumors have increased.

“Malformations of the male reproductive system are among the most common birth defects today,” she said.

In adults, unhealthy trends have also developed. Prostate and breast cancers are increasing, and aggressive breast cancer has increased 36%.

Today, 80,000 chemical substances are registered for use in US commerce, and 700 new industrial chemicals are introduced into commerce each year. However, these chemicals are not monitored closely. “It is only when something happens and there are questions that this product or chemical is looked into in more depth,” Dr. Giudice said.

Evidence for adverse reproductive outcomes from exposure to endocrine-disrupting chemicals is strong, she said. “What can we as health professionals do? I think we can strengthen professional education in reproductive and environmental health at the undergraduate and medical education levels and at the graduate medical education level,” Dr. Giudice said. “I think we should share what we know with our patients. We should together advocate for chemical policy reform.”

Call to Action

Those who attend the Edith Louise Potter Memorial Lecture will be left with a challenge. Presenters Mary E. D’Alton, MD, New York, NY, and Sarah J. Kilpatrick, MD, PhD, Los Angeles, are hoping attendees are moved to action after hearing the lecture, “Maternal Morbidity and Mortality in the US: Time to Wake Up and Take the Lead,” from 11:15 am to 12:15 pm Tuesday in Skyline Ballroom (ABC).

“What I’m going to present is a plan that we believe every birthing center, hospital, and facility that delivers babies in the US should have within three years,” Dr. D’Alton said. “It’s going to focus on efforts that we believe will have a significant impact on reducing maternal mortality and morbidity.”

Dr. D’Alton said data suggest that maternal mortality has been increasing in the US during the last decade and serious maternal morbidity has increased even more so.

“We believe this is for several reasons, but some of it is related to the increased age of mothers as they become pregnant, so they have higher incidence of comorbidities such as diabetes and hypertension, and also the national epidemic of obesity,” she said.

As a result of these increases, ACOG is joining several other societies to form the National Partnership for Maternal Safety.

“We felt because of there being no minimal progress in this area that all societies that deliver care to women needed to come together to make a plan,” Dr. D’Alton said. “The energy behind this is palpable right now. … The challenge before us is implementation.”

Dr. D’Alton knows not all maternal mortalities and morbidities are preventable, but the partnership’s goal is to reduce those that are preventable by 50% in five years.

Future of Patient Safety

Today, Joanna M. Cain, MD, will take her ACM attendees on a journey six years into the future for a unique, forward-thinking look at patient safety.

Dr. Cain’s one-hour presentation is this year’s Morton and Diane Stenchever Lecture. “Keeping Our Patients Safe: Key Actions for Ob-Gyn for All Stages and Sites of Patient Care,” begins at 4 pm in Ballroom ABC. It will examine the direction patient safety is going—and what it could look like in the year 2020.

Dr. Cain’s presentation will cover actions that ob-gyns need to take to change how they educate students and residents and how they manage their own practice, taking into consideration the effects of all the new technology. How does that influence patient safety and how ob-gyns deliver care in the future?

Dr. Cain said present day is a tumultuous time in medicine because of technological innovations such as electronic medical records, and even Google Glass, the computerized eyewear. These technologies may affect students’ education and help train and evaluate ob-gyn surgical competence.

“How we teach is changing,” Dr. Cain said. “The cost of education is probably too high, so how we structure our future will make a difference in making sure we have a pipeline for the future.”

Dr. Cain will emphasize education that equips residents to be leaders in safety education and will discuss restructuring ambulatory practices. She’ll also look at what role ACOG’s Safety Certification in Outpatient Practice Excellence for Women’s Health Program (SCOPE) might play down the road.

The look ahead offers the chance for several intriguing “what-if” questions.

“What if, instead of seeing students as sort of a burden to practice, what if they came with skills that we could leverage to make practices safer?” Cain said. “What if they knew those skills from early on? What if medical schools worked together in the first years and shared a similar national curriculum with flipped classrooms?

“And what would it look like if there were students in almost every practice in the country and that’s how we educated students—and they were the front line of making sure we continue to improve safety and quality?”


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Fathers, to my postpartum wife

The art of fathering comes from experience and through modeling from the nurturing skills of mothers before us. When you and your partner work together from the moment of conception (i.e., attending childbirth classes together, interviewing care givers like doctors/midwives) till the baby is growing and needing both of your time, your mothering is easy and your marriage grows stronger. The father will also feel that joyful sacrifice that you feel. He will then understand why you behave in such way and how to be there at the right time for you and your baby. Fathers are also like expectant mothers, anxious of their new role as fathers. They are now serious in making more money for the new addition to the family. They view themselves as provider and giver of financial stability.

Frequently, because everyone is thinking As everyone thinks of the mother’s needs, the father is left on his own to fulfill his own emotional needs. He usually senses the need to be involved with own the birth of the baby and take part in the unfolding of this new life, but sometimes isn’t just just what he can and should do. He needs affirmation and praise for the work he does and the inovolvement he has.knows that he should also be patted on his back for he needs the reassurance that everything will work well. We should accept the many roles of our partner, the father of our babies, and learn to accept them where they are in their own parenting and fathering roles.

“I remember one father telling me how left out he felt of the breastfeeding experience, espeically in the baby’s first few months of life. As his child grew, he saw things he could do, and was a wonderful, nurturing father. It is a wonderful, joyous and challenging learning experience for all.” Pat Sonnenstuhl, CNM

The various roles a father takes in pregnancy,labor, birth and afterwards are: provider,birth assistant, massage therapist, health care giver at home, lover, nurturer, companion, friend and the list goes on and on.

Today’s fathers are more involved than ever in caring for their families and that the positive effect of their involvement touched all aspects of their lives. They were more likely to have successful careers, happy marriages, and to be leaders in the community. And their kids shared the success – sons and daughters of supportive fathers enjoyed more success in school and work.

An expectant father’s feelings should be validated in the same way we validate a mother’s feelings.After all, family-centered birth will drive the trend towards a more humane way of birthing, the real American way of birth.

To My Postpartum Wife

I am your partner, the father of our baby
I would like to care for our baby if not as much as you do
I wouldn’t like to see our baby given up to strange baby sitters
I wouldn’t like to see you cook, clean house, do the laundry or entertain
You will be given a helper, a doula, or an assistant
If not on our bed, you will be sitting on your rocking chair, wearing your nursing gown when resting
You shall honor me with my share of household chores
Take long walks in places with clean air, eat healthy food and drink much water and juice
Welcome with you friendly and helpful visitors with good baby advice.
Sleep when baby sleeps so that your nursing will go unimpeded.
I am your husband and I will give you the energy and environment conducive for both you and our baby.
Your partner in love, at your service

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The above article is taken from my ebook , Birthing Ways Healing Ways. I have been a childbirth educator in the past. Now I am helping new parents with college and retirement plans.  I provide information on tax free investing using index strategies with no market risks and funds that can be used during emergencies and health threats.

Connie Dello Buono

408-854-1883

CA Life Lic 0G60621

motherhealth@gmail.com

 

Cultural Differences on pregnancy and baby care by Connie

One way of sharing the nurturing practices that we give to mothers and babies is through our cultural lifestyles and practices. Please email me at motherhealth@gmail.com for other cultural practices that you know about concerning caring for women during their childbearing years.  Note that most of these cultural differences are present hundred years ago as the new century mothers are now delivering babies in the hospitals and families are spread in different parts of the globe.

In some rural places in the Philippines, a pregnant woman is a sign of  blessings. She brings in good fortune. Children are considered as wealth. Families filled their homes with display of certificates or    diplomas of their educated children. For poor families, children are    viewed as source of income later on when they can earn for a living.

The    mother of a pregnant mother is the doula or    the care giver after the baby is born. The father is viewed as always    the provider. A midwife called     “Komadrona” who attends to the birth. She or another person    massage the mother during pregnancy, labor,    and after delivering the baby.    The midwife only needs boiled water to attend to the laboring mother.

After    delivering the baby, the mother’s stomach is wrapped by a piece    of cloth and massaged every three days for two months to ensure that    the uterus goes back to its proper place. Rice when served to the    baby or red pepper applied to the nipples is used to wean the baby    after a few years of nursing. The average year of nursing    length is four years. The juice from a freshly cut young coconut is    used as a supplemental food for the baby. It is also used during the    last trimester of pregnancy to ease labor.

The    wish of a pregnant woman is always respected. She is not provoked or    argued with since her emotions affect the unborn child. Herbs    are used during pregnancy, labor, and postpartum.

The    liquid from boiled guava leaves is used for cleansing the mother    during postpartum. It serves as an antiseptic medication. Coconut oil    is the most popularly used massage    oil. Clams or any shell fish are served as soup to the mother during    the last trimester of pregnancy and during nursing to increase the    milk supply. The breast is also massaged during pregnancy to prepare    the breast for nursing.

When    in labor and the baby is breach    (baby’s head close to mom’s heart), a massage therapist can bring the    baby to its desired position, head first. Incense is used with the sitz    bath remedy while the mother is wrapped in a hot towel during    postpartum. A preparation with charcoal and herbs (indirectly applied    to the mother’s bottom) is used as the sitz bath itself. Boiled    rain water is also used.Sex    is resumed only after three months. In the cities of the    Philippines, the same practice applies depending upon the    availability of the lay midwife, massage therapist, and the environment.


In    Taiwan, a postpartum mother is placed in a communal place with the    care of doulas together with other postpartum mothers. For about two    months, they are cared for. This kind of service exist solely for    mothering the mother.

In    Ethiopia, the mother is also cared for the first three months during    postpartum by relatives or helpers. Though circumcision for girls is    still prevalent in some areas, educated women tend to do away with it.

In Russia, it is common to nurse more than one baby when supply is great.

A mother who is in the same hospital room with other new mothers who    also just delivered babies recalled how one mother volunteered to nurse her baby while her breast is still coping up with its supply of milk.

Advice from folks in the Philippines:

You should not nap in the afternoon that long since you might have    difficulty in delivering a bigger baby.

Drink the juice of a young coconut for easy labor.