A Lifetime of Women’s Health at UT Medicine

By: Tiffany Parnell
Tuesday, June 7, 2016

Providing adolescent and general gynecology, infertility solutions, cancer treatment, urogynecologic services, and care for healthy and high-risk pregnancies, the UT Medicine Obstetrics and Gynecology practice is equipped to meet women’s health needs at all stages of life.

Staffed by physicians representing the faculty of The UT Health Science Center San Antonio School of Medicine, the UT Medicine Obstetrics and Gynecology practice is the regional referral resource for physicians looking to partner with specialists who can offer consultation or, if needed, temporarily assume care. Genetic testing, as well as advanced imaging and surgical modalities, are among the state-of-the-art services provided by the practice’s subspecialists.

A Lifetime of Care

Through a grant from the Office of Adolescent Health, Kristen Plastino, MD, gynecologist at UT Medicine, is able to offer a full spectrum of adolescent gynecology services. Dr. Plastino recommends teens begin seeing a gynecologist between ages 13 and 15, though teens don’t usually need pelvic exams at this age. However, these appointments ensure they receive human papillomavirus vaccination and information about sexual health, as well as care for irregular or painful menses and conditions such as polycystic ovary syndrome.

“Pediatricians and family physicians aren’t always comfortable managing gynecologic health needs,” Dr. Plastino says. “We can fill that void by co-managing or assuming gynecologic care of adolescent patients.”

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Kristen A. Plastino, MD, UT Medicine Gynecology
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UT Medicine Reproductive Health providers Robert S. Schenken, MD; Randal D. Robinson, MD; Jennifer F. Knudtson, MD; and Arthur Chang, PhD

As women enter reproductive age, family planning, general gynecologic services, and permanent and temporary birth control options are available. Dr. Plastino continues to follow women through menopause and beyond, utilizing best practices for screening based on age and risk stratification. In accordance with U.S. Preventive Services Task Force guidelines, women older than age 30 who are in her care receive Pap tests and HPV screening every five years until age 65, when cervical cancer screening is no longer recommended.

Cost-effective Assistance for Infertility

The UT Medicine Fertility Center provides infertility evaluation and management of common conditions such as tubal factor infertility. The team also collaborates with other specialists to co-manage male factor infertility.

The American Congress of Obstetricians and Gynecologists recommends women see an infertility specialist if they are younger than age 35 and have been trying to conceive unsuccessfully for one year or are 35 or older and have been trying to conceive for six months. Irregular menses, as well as diagnosis of a known fertility issue or a condition such as endometriosis that can impact fertility, may also warrant referral.

For women who wish to delay childbearing or have been diagnosed with cancer, cryopreservation of eggs can help preserve fertility. Sperm cryopreservation is also available for men facing cancer treatment. Part of the LIVESTRONG Fertility Discount Program — a program that allows adults who have been diagnosed with cancer to access fertility services at a reduced cost — the center’s goal is to make fertility treatments as affordable as possible.

One of the distinguishing factors of the UT Medicine Fertility Center is the availability of preimplantation genetic screening, which physicians use to evaluate embryos for genetic and chromosomal anomalies prior to in vitro fertilization.

“Preimplantation genetic screening may be indicated for women who have a history of miscarriage or multiple failed implantations,” says Randal Robinson, MD, infertility specialist at UT Medicine. “We can also screen for single-gene disorders, such as cystic fibrosis and Tay-Sachs disease; chromosomal abnormalities, including trisomy 21; and BRCA1 or BRCA2 gene mutations. This helps ensure the embryos we transfer are healthy.”

Caring for Routine and High-risk Pregnancies

The UT Medicine Department of Obstetrics and Gynecology offers all-inclusive care for women looking to expand their families. Care may begin with preconception counseling and end with delivery at University Hospital, which features private labor-and-delivery rooms, a Level IV NICU and an operating suite with three operating rooms and one procedure room.

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Elly M-J. Xenakis, MD, Chief of Maternal-Fetal Medicine, provides counseling, screening and advanced care for high-risk pregnancies.

In addition to a large team of OB/GYNs, UT Medicine has an extensive staff of maternal-fetal medicine specialists and 24/7 access to anesthesiologists. Because of this breadth of expertise, UT Medicine can provide services unavailable at many regional institutions, including vaginal birth following Caesarean section and management of placenta accreta and percreta.

“Placenta accreta and percreta are dangerous conditions that occur when the placenta erodes into the wall of the uterus following a prior C-section,” says Patrick Ramsey, MD, maternal-fetal medicine specialist at UT Medicine. “We have the capabilities to diagnose these conditions and manage them from the beginning of a woman’s pregnancy through delivery.”

UT Medicine maternal-fetal medicine specialists also accept referrals for preconception counseling, in addition to prenatal care. Women who have a medical condition or take medication that might impact fetal development are advised to meet with a maternal-fetal medicine specialist prior to conception. During pregnancy, referral may be indicated if there are changes in maternal or fetal health, such as diagnosis of gestational diabetes, poor fetal growth, or the suspected presence of a genetic disorder or other developmental concern.

To examine fetal anatomy in greater detail, maternal-fetal medicine specialists at UT Medicine use high-resolution ultrasound. These ultrasounds may be recommended for women over age 35 and women who have an increased risk of delivering a baby with a structural abnormality. If the detailed ultrasound shows cause for concern, women are counseled about their diagnostic and screening options, which may include a genetic test that extracts fetal DNA from the mother’s blood to screen for chromosomal abnormalities, such as trisomy 21.

“When patients have complications and require a higher level of care, we utilize a team approach,” says Rochelle David, MD, OB/GYN at UT Medicine. “If pediatric and neonatal specialists need to be involved in delivery, there is consultation with those services during pregnancy and the postpartum period. We also hold multidisciplinary conferences where we discuss patients so everyone involved in care understands and is on board with the plan.”

If a patient is referred to UT Medicine because of complications, such as premature rupture of membranes or preterm labor, referring physicians also receive frequent follow-up communication. As soon as the mother is stable or has delivered, care is transferred back to the referring OB/GYNs.

Multidisciplinary Management of Gynecologic Malignancy

Endometrial carcinoma, ovarian cancer and cervical cancer are among the most common malignancies treated through UT Medicine’s gynecologic oncology program, which is closely partnered with the renowned Cancer Therapy & Research Center, South Texas’ only NCI-designated cancer center. Three gynecologic oncologists staff the collaborative program.

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Georgia McCann, MD, cares for patients with gynecologic cancers, large pelvic masses and complicated surgical needs.

“We meet weekly for tumor board sessions dedicated to these specific cancers,” says Kevin Hall, MD, Chief of Gynecologic Oncology and Gynecology at UT Medicine. “These tumor boards include gynecologic, surgical and medical oncologists, pathologists, and a case manager. Together, we create a detailed management plan for each patient.”

Treatment may include advanced chemotherapeutic modalities, including biologic therapies, participation in clinical research trials or robotic surgery using the da Vinci Surgical System. All three gynecologic oncologists utilize robotic surgery to remove endometrial, cervical and ovarian malignancies and perform salvage surgery as needed for recurrent disease. The minimally invasive, robotic approach allows for less pain, less scarring and shorter recoveries. In addition, it allows physicians to treat higher-risk patients, including women who are obese or who have had prior abdominal surgery.

For women who have extensive personal or family histories of breast, ovarian or colorectal cancers — especially those diagnosed early in life — genetic counseling and testing are available to screen for Lynch syndrome, a BRCA1 or BRCA2 gene mutation, or other abnormalities.

Advanced Urogynecologic Services

More than 33 percent of women in the United States have a pelvic floor disorder, such as incontinence and prolapse of the uterus or vaginal walls, according to the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Primary care physicians play critical roles in identifying women in need of evaluation because women are often reluctant to discuss these symptoms.

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Elizabeth Casiano-Evans, MD, urogynecology, creates personalized treatment plans offering relief to women with pelvic floor disorders.

“Getting a complete medical history is crucial to helping women find relief,” says Elizabeth Casiano Evans, MD, urogynecologist at UT Medicine. “Physicians shouldn’t be afraid to ask women questions about incontinence or prolapse. Women often admit to having these symptoms for 20 years or more by the time of referral.”

Often a consequence of childbirth or menopause, pelvic floor disorders typically affect women in their 50s and 60s. Many women fear surgery is the only available treatment option, but UT Medicine’s Obstetrics and Gynecology practice offers a full range of surgical and conservative treatments.

Most pelvic floor disorders are diagnosed based on medical history and a pelvic examination. However, advanced studies, including cystoscopy and urodynamics testing, may be indicated. Medication, physical therapy and in-office placement of pessaries — devices that are placed in the vagina to support the bladder and reproductive organs — are available in addition to surgical care.

A Complete Resource Practice

The subspecialties representing the UT Medicine Department of Obstetrics and Gynecology practice share clinical space, as well as electronic medical records. This atmosphere of collegiality can be a great source of comfort for patients — and referring providers.

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“Physicians in all of our specialties collaborate closely and share the same values,” says Deborah Conway, MD, Interim Chair of the Department of Obstetrics and Gynecology at UT Medicine. “Referring physicians from both within and outside the UT Medicine System can rest assured that their patients will receive the best possible care.”

To learn more about UT Medicine Obstetrics and Gynecology, visit utmedicine.org. For referral information, visit utmedicine.org and select “Healthcare Professionals” or call 210-450-9002. For information on the Women’s Comprehensive Health Institute, visit utmedicine.org/wchi or call 210-450-6400.