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UWOMJ Volume 74, No. 1 Western University Western University Scholarship@Western University of Western Ontario Medical Journal Digitized Special Collections 2005 UWOMJ Volume 74, No. 1 Western University Follow this and additional works at: https://ir.lib.uwo.ca/uwomj Part of the Medicine and Health Sciences Commons Recommended Citation Western University, "UWOMJ Volume 74, No. 1" (2005). University of Western Ontario Medical Journal. 5. https://ir.lib.uwo.ca/uwomj/5 This Book is brought to you for free and open access by the Digitized Special Collections at Scholarship@Western. It has been accepted for inclusion in University of Western Ontario Medical Journal by an authorized administrator of Scholarship@Western. For more information, please contact [email protected], [email protected]. Paediatrics London Health Sciences Centre 800 Cmnmissioners Road East London, ON N6A 405 v Canada's Trusted Choice Adverse Reactions Advene Drug Reection Overview MoA Common Adotetu Eft.cts I lodJ Syrtem I Clmetldlne (--.) ~D ('Mt) I<NS 1hood•"'• r-z.1-' ·' !Endocrtne end Het.bollsm - I I GJnecomerti• r- 0.3-4,0 I N/A [CedTolnt .. cttn•l - Wffi. Current drug information <•• ~~~~ at your fingertips! • Instant access to approximately 3000 Health-Canada-approved product monographs Updated and always current Search products by brand name, generic name and/or therapeutic class CANADLAN PHARMACISTS Search directories for Canada's poison control centres, various health organizations, ASSOCIATION manufacturers and distributors of pharmaceutical products ASSOCIATION DES PHARMACIENS DUCANADA • Printable, easy-to-read "Information for the Patient" leaflets - now the only resource offering these customer-friendly pages Subscribe online at www.e-cps.ca OMJ Volume 74 Number 1 Contents EDITORIAL Health Promotion Changes A Review of Current Literature on NuvaRing , Leanne Tran, Editor-in-Chief 3 a Contraceptive Vaginal Ring DEPARTMENT ARTICLES Michelle Ngo, B.Sc. B.Ed., Meds 2007 23 Ethics Medicine and the Law Prenatal Testing & Disability Rights: The Role of A New Plan for Plan B Healthcare Professionals Daren Lin, Meds 2007 and Andrea Guerin, Meds 2008 25 Tanya Raha, Meds 2006 4 FEATURE ARTICLES Diagnostic Review "Born to be a Burden":A dramatic way to educate medical Ultrasound's Role in Obstetrics and Gynecology: students about the ethics of prenatal screening Fetal Assessment and Pelvic Bleeding Tim Heerema, Kevin Kuo, Patricia Lee, Ray mond Lim, Nooreen Popat, Meds 2008, Janet Malowany, Meds 2008, Jeff Rade1; Harry Wu, Meds 2005 28 and Jeremy Keller, Meds 2007 7 Non-Directive Counselling: Rhetoric Or Reality? Proftles David Silver, M eds 2006 30 A Conversation with Dr. Paul Bernstein, The Experience of Infertility For Women From a Obstetrician/Gynecologist Psychological and Social Perspective Betty Lee, B.Sc., Medicine 2006 10 Shirley Chow, Meds 2006 33 Clinical Procedures Perinatal Care for Adult Survivors of Child Sexual Abuse The Pap Smear Nelvia Van Dorp, B.Sc., Meds 2006 36 Christopher Gillis, Meds 2008 12 The Motherisk Program - Now at UWO Medicine and the Internet Gideon Koren, MD, FRCPC, Telemedicine in Ontario l vey Chair in Molecular Toxicology, UWO 39 Deric Morrison, Meds 2005 13 Ocular Manifestations of Pre-eclampsia Thinking on Your Feet Chetna Tail01; Meds 2004 40 An Approach to Postpartum Hemorrhage Maternal Hypothyroidism in Pregnancy: Jay Banerjee, Meds 2005 and Sujiva Heyn, Meds 2006 15 The Neurodevelopmental Manifestations in the Offspring Joint Replacement: Past, Present, and Future Natalie Kotowycz, Meds 2005 42 Sujiva Heyn, Meds 2006 and Jay Banerjee, Meds 2005 17 Fetal Surgery: A Review Zebra Files Sandeep K. Aggarwal, Meds 2006 45 Amniotic Fluid Embolism - An Unpredictable and Often The Next Wave - Medical Education Without Borders Catastrophic Obstetrical Emergency Sherryn Rambihar, Meds 2005 Stephen Chihrin, Meds 2008 and Leslie Wong, Meds 2007 20 47 ©2005 UWOMJ UWOMJ is published every 6 months. Editorial Staff Upcoming Issue: EDITORIAL BOARD PEDIATRICS COVER ART Cover art: "Bloodroot", by Emily Kelly. Emily is in third year medicine at the Schulich School of Medicine and Dentistry. She paints in acrylic and oil media to fi ll her wall space with pic­ tures more interesting than textbook illustrations. Emily can be contacted at [email protected] Editor-in-Chief (right} Leanne Tran Med 2005 Senior Associate Editor (not pictured) Mohammed Loubani Med 2006 Junior Associate Editor (left) Eisar Al-Sukhni Meds 2007 DEPARTMENTAL EDITORS Ethics Medicine and the Internet Sr: Tarek Loubani, Meds 2007 Sr: Patricia Lee, Med 2007 Jr: Sankalp Bhavsar, Med 2008 Jr: Joanna Zuraw ka, Med 2008 UWOMJ Clinical Procedures Profiles Room MS-175 Sr: John Omura, Meds 2007 Sr: Sheldon Lyn, Med 2007 Medical Sciences Building Jr: Christopher Gi ll is, Meds 2008 Jr: Aaron Mocon, Meds 2008 The University ofWestern Ontario London, ON Diagnostic Review Thinking on Your Feet 6A 5C l Sr: Jeremy Kell er, Meds 2007 Sr: Alan Gob, Meds 2007 Jr: Janet Malowany, Meds 2008 Jr: Melani e Sproule, Meds 2008 Jr: Nooreen Popat, Meds 2008 Phone/Fax: (519) 661-4238 Zebra Files Email : [email protected] Health Promotion Sr: Le lie Wong, Med 2007 URL: www. med.uwo.ca/medjrnl Sr: Michell e Ngo, Med 2007 Jr: Stephen hihrin, Meds 2008 Jr: Luke Harris, Meds 2008 For info rmation about writing fo r the Histo ry of Medicine UWOMJ, please follow the guidelines out­ Sr: Jacqueline Joza, Med 2007 lined on the website. Jr: Urszu la Zuraw ka, Meds 2008 Medicine and the Law The UWOMJ is a peer-reviewed publica­ Sr: Daren Lin, Meds 2007 tion. All editorial matter in the UWOMJ Jr: Andrea Guerin, Med 2008 represents the opinions of the authors and not necessarily those of the edi torial staff and advisory council. The edi torial staff UWOMJ ADVISORY COUNCIL and advisory council asswne no responsi­ Dr. Colby, Microbiology Dr. Silcox, Obstetrics I Gynecology bili ty or li ability for damage arising from Dr. Wexler, Anesthesiology Dr. Nisker, Obstetrics I Gynecology any error or omission or from use of any Dr. Ri eder, Paediatrics information or advice contained in UWOMJ. ADVERTISING PRINTER Kenmara Inc. Willow Printing Group Ltd. Canada Post - Publication Mai l Agreement Number 17201 98 POSTMASTER: Undeliverable copie , please return to the address above. 2 UWOMJ 74( 1) 2005 Editorial Changes Leanne Tran, Editor-in-Chief If we look at the field of obstetrics and gynecology, the fea­ inception at the Hospital for Sick Children in Toronto and is now ture topic of this issue, and compare it to even ten years ago, we also operating at UWO. In addition to the start of the Motherisk would find that in terms of the practice structure, technology and Program here at UWO, I am pleased to inform you that there have lifestyle, there have been significant changes. These changes are been major developments to UWO's Global Health curriculum indicative of the way that medicine in general is progressing. As since the publication of the last issue of the journal. The Joint stated by Dr. Paul Bernstein, an obstetrician and gynecologist at issue editorial entitled Physicians and Peace: Promoting Peace by Mount Sinai Hospital in Toronto, "I personally think that [obstet­ Pursuing Health spoke about a new academic discipline, "Peace rics and gynecology] will evolve into more sub-specialization, Through Health". Research has shown that health initiatives can perhaps into surgical and non-surgical aspects. It would be prac­ not only foster health in a region of conflict but peace as well. tical to have streaming, as that would provide focus and improve Given the increasing awareness of the importance of global resources for new clinicians". Upon reading this Profiles health, it is only appropriate that the journal give an update on Interview, I noted that this trend is not isolated to obstetrics and UWO's contributions to this area. I believe that the piece The gynecology but holds true for all of medicine. There is a notice­ Next Wave: Medical Education Without Borders is particularly able shift of medicine towards greater specialization and focus on timely given the recent tsunami and the changes currently under­ individual interests whether one is a family physician, an internist way in academic and clinical medicine. The article emphasizes or a surgeon. This is inevitable; as we progress through medical the unique opportunity that we as health care workers have in school, postgraduate training, independent practice and yes, life, affecting the economic, political, legal and social network around we are exposed to different ideas and people that shape our inter­ us and in the process, promote peace by pursuing health. Above ests. Similarly, this issue of the UWOMJ is filled with a range of all, it reminds us to take a patient-centered, culturally sensitive, exciting topics that include pregnancy complications, technologi­ and globally conscious approach to medicine. With this in mind, cal developments, ethical debates, and psychosocial perspectives. I hope you enjoy reading this Obstetrics and Gynecology issue as In particular, I would like to draw your attention to an article much as we, at the medical journal, have enjoyed putting it written by Dr. Gideon Koren, the Ivey Chair in Molecular together for you. Toxicology at UWO. I encourage all of you to read this as it serves as an introduction to the Motherisk Program that had its UWOMJ 74(1) 2005 3 Ethics Prenatal Testing & Disability Rights: The Role of Healthcare Professionals Tanya Raha, Meds 2006 Prenatal genetic diagnosis (PND) and pre-implantation genetic diagnosis (PGD) are becoming increasingly avaiJable as options for parents-to-be. Despite the benefits of both procedures, several ethically troublesome issues remain. In particular, disability rights advocates have expressed a number of concerns: the "expres­ sivist" argument that such practices deem disabled individuals on a whole as unfit for living, that it accepts and encourages parental attitudes of selectivity and intolerance, that PND-related decisions are often based on misinformation or misconceptions, that it threatens the fair & equitable integration of disabled individu­ als as a part of our society and that it foretells a tendency towards eugenics.
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