Gynecology (and Medicine in General) Continues to Evolve Robert C. Rankin, MD
I enrolled in medical school in September 1971 when expected to rest quietly or pace nervously, all the while smoking I was 20 years old, and finished my residency in obstetrics and cigarettes. In fact, I remember opening the waiting room door to gynecology in July 1978. I was in the full-time private practice announce the birth (and sex) of the child, and had to first brace of obstetrics and gynecology from then until August 2018, when myself to cope with the thick cigarette smoke escaping into the I chose to electively stop delivering babies and devote all of my hallway. Some older obstetricians would say that the appropriate professional time to providing gynecological care for my patients. amount of time to wait for a patient about to push the baby out I have been asked to reflect on the changes that have occurred in was the time it took to smoke a cigar at the nurses’ station. Today, medicine over that period of time. the father of the baby is usually in the delivery room (some still To put things into perspective, in 1971 the Pittsburgh Pirates faint), and smoking is prohibited inside the hospital and within won the World Series. Life expectancy in the United States was ten feet of the building. 68 years for a male and 75 for a female. Today, life expectancy for In 2003, the human genome project was completed, detailing males is 76 and 81 for females. In 1971, Richard Nixon was presi- the 6.7 billion base pairs of human DNA, which revolutionized dent, Watergate had not yet happened, gasoline was $.40/gallon, genetic testing and counseling. A simple blood test from the and the United States had 500,000 soldiers fighting in Vietnam. mother can now determine whether the baby has too many or Two things that have happened in medicine that have, in too few chromosomes and can also test for up to 200 potential general, improved the quality of lives are the improvement of genetic mutations in the baby. Simple genetic screening can be cataract surgery in ophthalmology and the use of joint replace- done on the mother and father before pregnancy to determine ment surgery in orthopedic surgery. In 1971, cataract surgery was whether or not there are any genetic mutations in the parents. a major three-hour procedure that was done infrequently. It was In the ’70s and early ’80s, the care of the diabetic mother was believed that joint replacement might only last for five years, so it extremely difficult and resulted in many poor outcomes. Babies SOUTH OBGYN was not performed on the very old. Now cataract surgery takesHILLS a who were delivered tooASSOCIATES early had trouble breathing and babies ocmere 15 minutes, and joint replacement surgery is often done as casionally died in utero at the end of pregnancy. It was found in the with Robert C. Rankin, MD, FACOG an out-patient procedure. Both are done on patients of any age, early ’80s that pregnancies did remarkably better if the blood sugar and these procedures are among the most commonly 412-572-6127 performed was well •controlled. Home glucose monitoring with finger sticks www.shobgyn.com procedures in America. became available, allowing for the precise control of blood sugars. I am, of course, more aware of the changes that have occurred Today, if the blood sugar of a diabetic pregnancy is well controlled, in obstetrics and gynecology since 1971. The cesarean section rate it is at no greater risk than that of a non-diabetic pregnancy. in 1971 was six percent. It is now 32%. Most of that increase is In the ’70s, the treatment for premature labor was IV alcohol. attributable to an increase in the diagnosis of the baby being too In my opinion, that treatment never worked very well, but it did large to “fit out,” the belief that all breech babies should be deliv- lead to some very inebriated patients. Today, we can accurately ered by cesarean section, and an increase in the diagnosis of the diagnose premature labor with a lab test and effectively treat it baby’s heart rate decelerating during labor. The ubiquitous use of with medicine. the ultrasound today makes the diagnosis of these potential birthWhen I went into private practice, there were very few large ing issues easy. In 2018, almost every pregnant patient receives groups of obstetricians and gynecologists; almost all were in priat least one ultrasound examination. That technology was just vate practice. Most doctors were in solo practice or had, at most, becoming available in the ’70s. In fact, looking at an ultrasound in one partner. In fact, Magee-Womens Hosptial had the largest numthe ’70s was similar to watching babies on your television in 2018 ber of private practice deliveries of babies in the country. Today, when turned to channel 3 without cable. The technology today you would be hard pressed to is so good that it is now easy to see details such as the valves in find an obstetrician at Magee the baby’s heart and the fingers on the baby’s hands. who is in private practice. In 1971, epidural anesthesia was rarely used and only adminisUntil the mid to late ’70s, tered under special circumstances. Today, the vast most insurance companies majority of patients delivering vaginally are given considered pregnancy to be an epidural anesthetic during labor and made to elective medical care and, feel quite comfortable. therefore, would not pay for Delivery in 1979 When I first started practicing medicine, a obstetrical care. That changed patient would arrive at the hospital to have a baby at the end of the decade with and be placed in a delivery room. Her husband the passage of a well-conceived federal law. would be directed to a waiting room where he was Today, insurance companies pay for obstetrical
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UPPER ST. CLAIR TODAY
Winter 2018
