2012, Vol. 83, No. 1 Women’s Health Northside Hospital Atlanta’s Leader in Women’s Health A trusted name in women’s health, Northside understands the unique health care needs of women. We’re committed to helping women make healthier choices through every stage of their lives. Our personalized care shows up in the details like dedicated breast care surgery suites and a specialty boutique just for women. Our board-certified physicians are leaders in their field, including oncology, cardiology, imaging and obstetrics and gynecology. A NATIONALLY RECOGNIZED CANCER INSTITUTE More cases of breast and gynecological cancer are diagnosed and treated at Northside Hospital’s Cancer Institute than any other hospital in Georgia. We believe this is because of our multidisciplinary approach and dedication to addressing all aspects of patient care. At Northside, patients can access the latest cancer treatments, close to home. COMPREHENSIVE CARDIOLOGY SERVICES Heart disease is the No. 1 threat to a woman’s health. A woman’s risk changes throughout her lifetime due to menopause, weight changes, and the normal process of aging. Our Cardiac Catheterization Laboratory, diagnostic tests and cardiac rehabilitation programs are all important tools in the fight against heart disease. HIGh-QUALITY IMAGING SERVICES Our subspecialized radiologists use the most advanced technology like 3D mammography to interpret images and provide accurate results fast. With convenient locations across the metro Atlanta area, Northside makes it easier for women to access high-quality imaging services. A LEADER IN MATERNITY CARE Northside is unsurpassed in maternity and newborn services, offering special expertise in nutrition, lactation and high risk pregnancy. Our team approach—utilizing the expertise of obstetricians and gynecologists, certified nurse midwives, pediatricians, nurses, lactation consultants, educators and other health care professionals—ensures that women get specialized care throughout their pregnancy. At Northside Hospital, women have the resources and services they need for a lifetime of care. www.northside.com Northside Hospital Atlanta’s Leader in Women’s Health A trusted name in women’s health, Northside understands the unique health care needs of women. We’re committed to helping women make healthier choices through every stage of their lives. Our personalized care shows up in the details like dedicated breast care surgery suites and a specialty boutique just for women. Our board-certified physicians are leaders in their field, including oncology, cardiology, imaging and obstetrics and gynecology. A NATIONALLY RECOGNIZED CANCER INSTITUTE More cases of breast and gynecological cancer are diagnosed and treated at Northside Hospital’s Cancer Institute than any other hospital in Georgia. We believe this is because of our multidisciplinary approach and dedication to addressing all aspects of patient care. At Northside, patients can access the latest cancer treatments, close to home. COMPREHENSIVE CARDIOLOGY SERVICES Heart disease is the No. 1 threat to a woman’s health. A woman’s risk changes throughout her lifetime due to menopause, weight changes, and the normal process of aging. Our Cardiac Catheterization Laboratory, diagnostic tests and cardiac rehabilitation programs are all important tools in the fight against heart disease. HIGh-QUALITY IMAGING SERVICES Our subspecialized radiologists use the most advanced technology like 3D mammography to interpret images and provide accurate results fast. With convenient locations across the metro Atlanta area, Northside makes it easier for women to access high-quality imaging services. A LEADER IN MATERNITY CARE Northside is unsurpassed in maternity and newborn services, offering special expertise in nutrition, lactation and high risk pregnancy. Our team approach—utilizing the expertise of obstetricians and gynecologists, certified nurse midwives, pediatricians, nurses, lactation consultants, educators and other health care professionals—ensures that women get specialized care throughout their pregnancy. At Northside Hospital, women have the resources and services they need for a lifetime of care. www.northside.com contentsVol. 83, No. 1, 2012 2012, Vol. 83, No. 1 16 Obesity in Pregnancy Atlanta Medicine A National Dilemma Editorial Board By Jeffrey H. Korotkin M.D., MBA, FACOG Genevieve Fairbrother, M.D., M.P.H., FACOG, is Chief of Medical Staff at Northside Hospital and past Chair of the 18 Heart Disease Obstetrics and Gynecology Department. She is a physician with Obstetrics and In Women Gynecology of Atlanta. Is Fifty Really The New Forty? Katherine Heilpern, M.D., is the Ada Lee Women’s By Kimberly P. Champney, and Pete Correll professor and Chair in the Department of Emergency Medicine M.D., MSCR Health at Emory University School of Medicine. She is the past president of the Society of 21 Intimate Partner Academic Emergency Medicine. Violence Michael C. Hilton, M.D., is in the Impacting Women’s Health private practice of general and forensic By Melissa Kottke, M.D., M.P.H., psychiatry in Atlanta, where he treats a FACOG wide range of adult psychiatric conditions. 4 Women’s Health He is the 2011-2012 president of the Looking Forward Medical Association of Atlanta. By Genevieve L. Fairbrother 24 Maternal-Fetal Rob Schreiner, M.D., is the executive M.D., M.P.H., FACOG Medicine medical director for The Southeast A Brief History Permanente Medical Group (TSPMG). 6 Cesarean Section By Larry C. Matsumoto, M.D., Dr. Schreiner joined TSPMG as a FACOG pulmonary and critical care medicine A Look Back… physician in 1994. and Forward By Kirsten Franklin M.D., FACOG 27 Breast Cancer Update Barry Silverman, M.D., has practiced car- diology in Sandy Springs for 36 years. He By Colleen Austin M.D. is the Mark Silverman Chair of Education and Dr. Lynn Baxter M.D. 9 Pelvic Organ Prolapse with the Piedmont Heart Institute. and Urinary Incontinence W. Hayes Wilson, M.D., is a physician By Joye Lowman M.D., M.P.H., FACOG 32 Advances in Birth with Piedmont Rheumatology Consultants, Control Options PC. He has served as Chair of the Medical 12 Low Libido By Joel S. Engel, M.D., FACOG & Scientific Committee of the Arthritis Foundation and Chair of the Division of Something To Talk About Rheumatology at Piedmont Hospital. By E.J. Aspuru, M.D., FACOG For information about ATLANTA Medicine Although every precaution is taken to ensure the accuracy of published magazine, contact the Medical Association materials, ATLANTA Medicine cannot be held responsible for the opinions of Atlanta. expressed or facts supplied by its authors. 1150 Lake Hearn Drive, STE 130, Atlanta, GA 30342, Phone: 404-881-1020 Copyright 2012, Medical Association of Atlanta. All rights reserved. FAX: 404-872-0601 or email: [email protected] Reproduction in whole or in part without written permission is prohibited. MEDICAL ASSOCIATION OF ATLANTA | 3 editor’s letter Women’s Health Looking Forward By Genevieve L. Fairbrother, M.D., M.P.H., FACOG hen I set to work on the Women’s Health edition clearly it is not a linear algorithm. This segues nicely into of Atlanta Medicine, the question was not Dr. Korotkin’s timely article on the obesity epidemic and its Wwhat topics to address but what topics to cull. effect on pregnancy and delivery. Finally, Dr. Matsumoto There are so many women’s health issues across multiple discusses the birth and evolution of maternal-fetal medicine medical disciplines that are on the forefront of the national and what the future holds for a specialty devoted to the consciousness; it was difficult to know where to begin. care of women and fetuses in high-risk pregnancies. Genetic With this issue of Atlanta Medicine, I have for you a group modification and interventions prior to fetal viability appear of authors who will address a sampling of the pressing issues to be this specialty’s next frontier. in women’s healthcare. Moving away from obstetrics but still intimately In specialties such as cardiology, the sex differences are connected, Dr. Joye Lowman discusses the advances in enough to render the classical studies less useful. In the United the evaluation of a patient with pelvic organ prolapse, its States, deaths due to cardiovascular disease are declining, etiology and repair, describing the benefits and cautioning but cardiovascular mortality in women now exceeds against the risks. Her discussion includes the firestorm that of men. Basic differences in the normal physiology surrounding mesh technologies. and pathophysiology between the sexes are still not well Dr. E.J. Aspuru bravely tackled the common problem of understood. Dr. Kim Champney, cardiologist, has chosen to low libido in women, describing the etiologies, evaluating address cardiology care particular to the female patient. In the effectiveness of various remedies and finally offering her article, she focuses on a women’s cardiovascular risk, proven solutions for our patients and their partners for this emphasizing an assessment of their reproductive history as troublesome situation. well as their hormone exposure. Dr. Champney reminds us Dr. Kottke raises awareness of intimate partner that women with a history of pre-eclampsia or Polycystic violence (IPV) in her article and covers the impact it ovary syndrome (PCOS) are at a heightened risk for coronary has on a victim’s health. She explores the demographics artery disease from endothelial dysfunction. and prevalence of IPV and offers concrete advice along Breast cancer is the leading cause of cancer death in with resources for our patients. Like Dr Kottke, Dr Engel women and has wormed its way into every race, age and addresses women’s health issues that have a broad impact social strata in this country. There is no one who has not on our society’s health. In his article he advocates for more been affected by this disease. A near herculean push from accessible, effective, and reliable birthcontrol in a country the research community has produced a 50 percent decline where the unintended pregnancy rate is 60%.