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ACOG Exercise Guidelines

I read with much interest Dr. Lawrence D. DeVoe's guest editorial "Exercise in Pregnancy" (Sept. 1, 2001, p. 7).

I share Dr. DeVoe's enthusiasm on advising pregnant women to engage in physical activities in pregnancy, and I strongly believe that pregnancy should not be a state of confinement. However, Dr. DeVoe's comments and those expressed in the Journal of Obstetric, Gynecologic, and Neonatal Nursing (22[4]:329-35, 1993), which he cited, relate to outdated guidelines that are 16 years old and were part of a video home exercise package marketed by the American College of Obstetricians and Gynecologists in 1985.

The ACOG guidelines on exercise in pregnancy have since been amended and updated to reflect current state of knowledge.

However, despite the enthusiasm Dr. Devoe and I share for advocating an active lifestyle, there are limitations and risks associated with certain physical activities.

Raul Artal, M.D.

vice chair

ACOG Committee on Obstetric Practice

St. Louis

Proper Endometriosis Tx

The article "Endometriosis Surgery May Warrant Referral" did not mention the proper treatment of endometriosis that has invaded the cul-de-sac and rectosigmoid colon (Oct. 15, 2001, p. 16). If one has such an extensive endometriosis, the treatment of choice would be a bilateral oophorectomy.

A complete resection of the disease, as was mentioned in the article, will not cure the disease. There is microimplantation of the endometriosis in other areas of the culde-sac and abdomen, regardless of how well you clean up the lesion of the rectosigmoid, etc. These patients will have recurrence of endometriosis even if they are followed with medical treatment.

Palliation therapy may be achieved by resecting the rectosigmoid lesions or any other lesions in the pelvis, followed by medical treatment, if the patient is of childbearing age. For a patient who has passed the childbearing stage, however, the correct treatment is the bilateral salpingooophorectomy, with or without hysterectomy I would rather do a hysterectomy and bilateral salpingo-oophorectomy.

Firooz Banooni, M.D.

Southfield, Mich.

The Liver's Perspective

Liver changes that occur during pregnancy are incompletely studied. The impairment of sulfobromophthalein sodium excretion, especially in multiple pregnancy, is taken placidly. The accumulation of fat in the liver is prevented by lipolytic factors such as choline, betaine, inositol, casein, and some other proteins. Many antilipotropic factors exist in pregnancy: Elevated serum cholesterol, pituitary hormones, sex steroids, and insulin are all lipogenic, especially if associated with a low-protein diet.

We need to pay more attention to nutrition from the liver's perspective. Choline and casein content must be adequate, especially in diabetic and preedamptic patients. Attention to nutrition may eliminate the enigmatic, though rare, acute yellow atrophy in pregnancy as well as the hepatic complications of preeclampsia.

N.G. Mussalli, M.D.

New York


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Publication:OB GYN News
Date:Mar 15, 2002
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