Medical Monday: Breaking News from the World of Obstetrics and Gynecology 

The White House and the Centers for Disease Control plan a Summit to “ develop a Zika attack plan”. Interest in such a summit has intensified since it has become clear that Zika spreads not only by mosquitos but also readily by sexual contact. This makes the potential for spread in a much larger area much greater. It has been determined that 75% of semen from men recovering from Zika infection contains the virus. 

Two new research studies from two different countries have been published this week further solidifying the link between Zika and prenatal brain damage. Insight has been gained that Zika interferes with the cells “ human embryonic cortical neural progenitors “. These are the cells that affect the outer part of the brain, the cortex. While the deep parts of the brain govern things like breathing, balance, and some feelings, the cortex is what enables us to think. So far about 29 % of women who deliver after Zika infection in pregnancy have a a baby affected with microcephaly. 

As of March 8th there were 153 cases of Zika in the United States. However at there same time there were 156 on the island of Puerto Rico. Case numbers in Puerto Rico are doubling weekly. The US is sending Zika free blood to Puerto Rico to help them through the crisis. 

In grave news, Zika carrying mosquitos Aedes Aegypti in Mexico and Puerto Rico have developed resistance to the common insecticide Permethrin. 

The Los Angeles Times reports that in the wake of the Zika crisis, there is an increase demand for abortion. This is most acute in Latin American Countries where there are few legal avenues to get one. 

Zika notwithstanding, infant mortality has fallen 13 % in the last ten year in the US. However, there is still a significant gap between those black and non black Americans, and in fact, between the Southern and the Northern parts of the country in general. It is interesting to note that home vistas by nurses are an effective way to reduce infant mortality. The Affordable Care Act includes this service, but it is still underutilzed. 

In the sad news department, the first uterine transplant has failed. Complications ensued nd the uterus was removed.This was the first of ten such planned procedures. 

In policy news, there are many states who are introducing or passing bills banning abortion facilities which are not staffed by physicians with hospital privileges. Most abortion facilities are staffed by midlevel providers such as nurse practitioners. What is surprising to me is that the Indiana legislature has passed a bill banning abortions for genetic abnormalities. In my experience, people most generally chose abortion for babies who carry LETHAL genetic abnormalities. The same bill also requires parents to arrange for cremation or burial of aborted or miscarried fetuses. I can imagine difficulties in the practical execution of this with a poor cramping woman in the bathroom trying to retrieve tissue lest she be branded a criminal. 


Let us hope next week brings some better news.