Obstetrics Counseling - ECAB

Book excerpt: Informed choice is the right of an individual. Gynecologists have immense responsibility and a unique opportunity to guide their patients through the various milestones/changes in their life by good counseling—menarche, sexuality, pregnancy, pelvic operations, and menopause. Adolescents should be taught about safe sex practices, premarital counseling, and contraception. Preconception counseling is also important in the identification of risk factors, disease states, and potential teratogens in the pregnancy. The availability of first-trimester prenatal diagnosis and the advent of presymptomatic diagnosis by DNA analysis have created increasing opportunities to avoid disorders characterized by early death, severe disease, or irreparable mental retardation, for example, periconceptional maternal folic acid supplementation has now been shown to provide high protective effect against neural tube defects. Similarly, certain maternal diseases, including diabetes, lupus, and myotonic muscular dystrophy, impose potential maternal, fetal, neonatal, and other complications. The preconception visits provide important opportunities for intervention, avoidance, or prevention in these cases. The patients’ ethnicity and medical and genetic family history are key elements in their evaluation, whereas patients with prolonged infertility of unknown cause or recurrent spontaneous abortion may have a 3–10% risk of a parental chromosome abnormality, which may also require chromosome analysis, as do their spouses.