Capital Women's Care

At Capital Women’s Care, our mission is to provide exceptional care and personalized attention for all stages of your life. From adolescence until beyond menopause, you will receive expert medical care through a direct partnership with your provider and our exceptional staff. Our group of all female physicians provides comprehensive gynecologic care to women throughout Germantown and Silver Spring, Maryland. Call (301) 681-3400 to schedule an appointment at one of our offices today! Well Woman Care Contraceptive Counseling / Family Planning / Birth Control Mammography Endometriosis Polycystic Ovary Syndrome (PCOS) Evaluation and Treatment – Abnormal Pap Smears Female Cancer Screening Genital Herpes Gynecologic Ultrasound HPV Vaccines Irregular / Abnormal Uterine Bleeding Menopausal Evaluation and Treatment Osteoporosis Bone Density Screening Pelvic Pain – Evaluation and Treatment Pelvic Prolapse Sexual Transmitted Infections Uterine Fibroids – Evaluation and Treatment Urinary Incontinence Vaginal Infections and Discharge Domestic Violence A Lifetime of Care At our office you will receive the finest care available throughout your entire life. We are here to be partners with you in helping you lead a healthier life, to listen to your concerns, to share our knowledge and expertise, all in an environment that is focused on you.

Our philosophy is very simple: “Healthy Baby…Healthy Mother” …always emphasizing a very personal, individualized approach to your Obstetrical Care. Note: Please be advised, all deliveries at Holy Cross Silver Spring. You can still be seen in our Germantown office for routine ob visits and sonograms as well as well woman exams and all gynecologic visits. First Trimester Once you have determined you are pregnant, you will be scheduled for “an initial obstetrical visit” as soon as possible. At this visit a sonogram will be performed in our office to help determine a “due date” and confirm the pregnancy is developing normally. You will also meet with one of our doctors for an extended consultation to review your medical, gynecologic and family history to help outline the individualized care you will receive during your pregnancy. Routine and special blood tests will be performed, along with the offering of early, non-invasive genetic screening to evaluate your baby’s risk of having a condition that may impact his/her health. You can see a copy of the information that will be given to you at your initial visit in the collection of documents titled PATIENT PACK. Second Trimester This generally is an easier time during the pregnancy. Patients usually feel well and maintain their normal activity. You will be seen every month at this time in your pregnancy. At 20 weeks, we perform a comprehensive sonogram in our office to evaluate the baby’s entire anatomy to ensure that is developing normally. If the baby is in the correct position we can see the gender of the baby, if you desire to know. Other tests, such as screening for diabetes and spina bifida, a spinal defect, may be performed. You will also be given information of Stem Cell Cord Banking and guidance on what will happen as you enter the last trimester of your pregnancy. EVERY WOMAN IS DIFFERENT – We listen to your concerns and will work together for a successful pregnancy and healthy baby. Third Trimester At 28 weeks of your pregnancy, a blood test is performed to screen for anemia and diabetes. You are seen every 2 weeks until 36 weeks, when you will be seen weekly. During this time, another sonogram is performed to determine the exact position, growth and general overall health of your baby. A vaginal culture will be taken to screen for a bacteria called Group B Strep which could effect your baby in labor. During these visits we are happy to discuss YOUR delivery plan. Resources for New Mothers The expertly trained obstetricians at Captial Women’s Care have provided this list of resources to help new mothers and parents address common questions and concerns. Now Available Childbirth Education Classes Baby and Infant Care and Infant CPR Breastfeeding Stork Childbirth Education Obstetrical Care Services and Education Birth Control Options After Pregnancy Breastfeeding Lactation Consultant Circumcision Cord Blood Banking Diabetes Diet and Nutrition Exercise During Pregnancy Genital Herpes High Blood Pressure / Hypertension: Preeclampsia in Pregnancy High-Risk Pregnancy Care High-Risk Pregnancy Assessment Labor and Delivery Postpartum Guidelines for New Mothers Preconception Counseling Prenatal Visits Pregnancy Nutrition Routine Testing Timeline and Overview Safety Thyroid Disorders Travel During Pregnancy Twins Ultrasound Uncomplicated Prenatal Care Vaccines

As gynecologists we are trained to evaluate all female problems and concerns. Some women may require medications to improve their symptoms, while others may need simple procedures or even surgery. We will offer all alternative treatments, fully explaining them to you and guiding you through the process. We will be your partner in your health care decisions and continue to care for you after your recovery. As Board-Certified Obstetrician Gynecologists, we are trained as abdominal surgeons and also perform minimally invasive surgery using the latest advances and techniques including laporoscopic, hysteroscopic and vaginal surgery for the treatment of abnormal bleeding, endometriosis, fibroids, pelvic pain, incontinence and prolapse. Using these minimally invasive techniques most patients are able to go home the same day of their surgery and are able to return to their normal daily activities faster when compared to conventional open surgical techniques. If you have symptoms or questions about symptoms that are concerning to you, please call to schedule a consultation so that we can discuss all possible options. Some of our surgical services are listed below: da Vinci® Hysterectomy da Vinci® Myomectomy da Vinci® Endometriosis Resection Minimally Invasive Surgery: Endometrial Ablation by Hysteroscopy Operative Hysteroscopy (removal of Polyps and/or Fibroids) Laparoscopic Hysterectomy Operative Laporoscopy Permanent Contraception by Tubal Ligation using Laporoscopy Procedures: Colposcopy Hysteroscopy Endometrial Ablation LEEP Procedure To further evaluate abnormal biopsies found during colposcopy (PDF) Sonohysterography Sonohysterography – To evaluate irregular menopausal bleeding (PDF) Dilation and Curettage (D&C)

Minimally Invasive Surgery is defined as surgery using the laparoscope or the hysteroscope which enables the surgeon to avoid intra-abdominal incisions or open surgery. This speeds your recovery and we select this option whenever it is medically possible to use these techniques. Laparoscopy is a surgery or procedure that uses a thin, lighted tube (the laparoscope) put through a cut (incision) in the belly to look at the abdominal organs or the female pelvic organs. Additional small incisions are made for other devices to complete the procedure. Laparoscopy is used to find problems such as cysts, adhesions, fibroids , and infection. Hysteroscopy is a surgery or procedure that uses a thin, lighted tube that is inserted into the vagina and gently moved through the cervix into the uterus to examine the cervix and inside of the uterus. Hysteroscopy is used uterus in order to diagnose and treat causes of abnormal bleeding. Hysteroscopic Endometrial Ablation / Novasure Operative Hysteroscopy (removal of Polyps and/or Fibroids) Laparoscopic Hysterectomy Operative Laporoscopy Permanent Contraception by Tubal Ligation using Laporoscopy

Breastfeeding Your Infant Breastfeeding is widely regarded as having many benefits and advantages for both mothers and their newborns. While it is a natural way to provide the healthiest nutrition to a child during its first year of life, it is a process which has to be learned to in order to obtain all of its advantages. The expertly trained OBGYNs at Capital Women’s Care have extensive experience advising mothers on common breastfeeding concerns. If you have questions about breastfeeding or are experiencing difficulties, call (301) 681-3400 to request an appointment at our OBGYN office in Silver Spring or Germantown, MD. The American Academy of Pediatrics’ policy on breastfeeding states that “breastfeeding insures the best possible health as well as the best developmental and psychosocial outcomes for the infant”. How Breastfeeding Works The breastfeeding process works on the principal of positive feedback. As an infant suckles at a mother’s breast, a message is sent to the mother’s brain that results in the production of a chemical that stimulates the production of milk. The ability for a mother to continuously produce milk depends upon this feedback cycle not being interrupted. Interruptions in the cycle can occur when the message to the mother’s brain is disrupted by: Advantages of Breastfeeding and Breast Milk The important aspect of breastfeeding is that a mother’s breast milk is intended exclusively for infants. It provides not only all the protein, sugar, fat and vitamins an infant requires, but special and unique benefits that artificial formulas cannot match. These include: easily digested no preparation is needed continuously available and costs nothing environmentally safe since it produces no waste stimulation of the uterus return to its regular size more quickly faster return to pre-pregnancy weight reduced risk of ovarian and breast cancer stimulation of building of bone strength in mothers enhanced infant and mother bonding and development promotion of infant eye and jaw muscle development Additionally, substances in human breast milk provide an infant with protective antibodies so that they are less likely to experience: ear infections allergies vomiting diarrhea respiratory infections such as pneumonia and bronchiolitis meningitis SIDS (Sudden Infant Death Syndrome) obesity Who Can Breastfeed Generally women without health conditions are encouraged to breastfeed for at least the first six months of their infant’s life. Conditions where breastfeeding should not be done include the presence of HIV or tuberculosis since these infections can be passed on to the infant. Additionally, certain medicines, illegal drugs and alcohol can also cause harm to the baby. How to Begin Breastfeeding Infants are born with the instinct to nurse and will naturally turn towards a mother’s nipple and open his or her mouth and begin sucking. When a mother is ready to begin nursing, she should find a comfortable position that permits her to cup her breast in her hand and stroke the baby’s lower lip with her nipple. The baby will open his or her mouth and the mother should quickly center her nipple in the baby’s mouth, making sure that the tongue is down while pulling the baby close to her. A mother should always bring her baby to her breast – not her breast to her baby. It is important to note that the first two weeks of nursing can be more difficult than bottle feeding because of the time it takes for the baby and mother to become accustom to the breastfeeding process. Resources for Breastfeeding Women expecting to breastfeed should consult with their pediatrician to find out what local resources, are available to them. In many cases they will be able to recommend Lactation Educators who can provide one-on-one support on how to achieve the best results. Additionally the La Leche League, (www.llli.org) an international non-profit, non-sectarian organization can provide education, information, support and encouragement to women who would like to breastfeed.

Having a professional and licensed sonographer on site in our office allows us to evaluate and treat common female problems such as: Obstetrical Evaluation Gender Determination GYN Evaluation Pain Fibroids Ovarian cysts Abnormal bleeding Sonohystergraphy -To evaluate irregular menopausal bleeding We utilize the latest,high definition ultrasound technology, along with 3-D capability and a large screen monitor for you to view the findings as they are being evaluated. How Ultrasound Imaging Works Ultrasound, also called sonography, uses sound waves to develop images of what’s going on inside the body. An instrument called a transducer emits high-frequency sound, inaudible to human ears, and then records the echoes as the sound waves bounce back to determine the size, shape, and consistency of soft tissues and organs. This information is relayed to produce images on a computer screen. Ultrasound technicians, or sonographers, have special training in how to perform the test. Uses of Ultrasound Tests Ultrasound imaging has many uses in medicine, from confirming and dating a pregnancy to diagnosing certain conditions and guiding doctors through precise medical procedures. As an Obstetric patient, a sonogram can be performed in our office at the time of your regularly scheduled appointment so the doctors can go over the results with you immediately Pregnancy. Ultrasound images have many uses during pregnancy. Early on, they may be used to determine due dates reveal the presence of twins or other multiples rule out ectopic pregnancies. They also are valuable screening tools in helping to detect potential problems, including Monitoring the growth of your baby Birth defects and placental issues Evaluating anatomical structures Breech positioning, and others. Many expectant parents look forward to learning the gender of their babies via ultrasound midway through a pregnancy. As a Gynecology patient, a sonogram can be performed in our office at the time of your appointment to assist the doctors in making a diagnosis. The doctors can go over the results with you immediately. GYN Diagnostics. Doctors employ ultrasound imaging in diagnosing a wide variety of conditions affecting the organs and soft tissues of the body, including the uterus and ovaries, such a: Pain Fibroids Ovarian cysts Irregular bleeding Possible endometriosis Ultrasounds do have some diagnostic limitations, however; sound waves do not transmit well through dense bone or parts of the body that may hold air or gas, such as the bowel. Types of Ultrasound in OB GYN Most ultrasounds are done using a transducer on the surface of the skin. Sometimes, however, doctors and technicians can get a better diagnostic image by inserting a special transducer into the vagina: In a transvaginal ultrasound, a transducer wand is placed in a woman’s vagina to get images of her uterus and ovaries. Additionally, ultrasound technology has advanced to allow for different types of imaging: Doppler is a special type of ultrasound that creates images of blood flow through vessels. 3 D adds another to the ultrasound image, creating three-dimensional interpretations rather than the flat two-dimensional images that are made with traditional ultrasound. 4D ultrasounds show 3D images in motion. Benefits of Ultrasound Ultrasounds offer many advantages: They are generally painless and do not require needles, injections, or incisions. Patients aren’t exposed to ionizing radiation, making the procedure safer than diagnostic techniques such as X-rays and CT scans. In fact, there are no known harmful effects when used as directed by your health care provider. Ultrasound captures images of soft tissues that don’t show up well on X-rays. An Ultrasound For Gender Determination The Ultrasound to view all the skeletal and anatomical structure of your baby is usually done at 20 weeks. If the baby cooperates by being in the correct position to view the genitals, the sonographer can see the gender of your baby. If you cannot wait until 20 weeks (because you just want to know !) you can choose to have an earlier ultrasound, between 15 and 16 weeks, to find out the gender. Insurance will not pay for this sonogram. We can attempt to determine gender for a small, courtesy fee of $60.00. Again, not all babies will cooperate, depending on angle of his or her movements. We request that you schedule this in advance so it can be conveniently done at your appointment. Is there another opportunity to see my baby? Your 20 week ultrasound exam is the best time to view all of the anatomy of the baby.

Contraception is any method used to prevent pregnancy. Making the right decision regarding contraception is an important consideration in many women’s lives. Every woman has different needs, concerns, medical issues and lifestyles which contribute to this decision. Once we have discussed your individual priorities, we can add our medical knowledge to partner with you to make the best possible decision. Commonly used forms of contraception include: Newer, low dosage birth control pills Intra uterine devices (IUD) Nuvaring Nexplanon (implant) Long acting injectables (Depo Provera) Hormonal Contraception Hormonal Birth Control Birth Control Pills Hormonal IUD: Mirena – visit www.mirena-us.com Kyleena – Visit www.kyleena-us.com Skyla – visit www.skyla-us.com Nuvaring – visit www.nuvaring.com Nexplanon – visit www.nexplanon.com Depo Provera Non Hormonal Contraception Non-Hormonal IUD Paragard – www.paragard.com If you have any further questions or concerns regarding Contraception and Family Planning , please call us today to schedule a consultation. 301-681-3400

About da Vinci Systems Surgical robotics for minimally invasive surgery Your surgeon in control The da Vinci® surgical system gives your surgeon an advanced set of instruments to use in performing robotic-assisted minimally invasive surgery. The term “robotic” often misleads people. Robots don’t perform surgery. Your surgeon performs surgery with da Vinci by using instruments that he or she guides via a console. The da Vinci system translates your surgeon’s hand movements at the console in real time, bending and rotating the instruments while performing the procedure. The tiny wristed instruments move like a human hand, but with a greater range of motion. The da Vinci vision system also delivers highly magnified, 3D high-definition views of the surgical area. The instrument size makes it possible for surgeons to operate through one or a few small incisions. A dedicated care team The da Vinci system is one part of a much bigger picture. As the company that makes da Vinci, Intuitive’s services extend far beyond the surgical system. These include comprehensive and ongoing education, training, and support for surgeons, operating room staff, and hospital care teams. As a patient, you are at the center of a network of dedicated professionals working together to help you get back to what matters most. Three components of the da Vinci system Surgeon Console Your surgeon sits at the console, controlling the instruments while viewing your anatomy in high-definition 3D. Patient Cart Positioned alongside the bed, the patient cart holds the camera and instruments that the surgeon controls from the console. Vision Cart The vision cart makes communication between components possible and supports the 3D high-definition vision system. A family of technologies Hospitals may have one or multiple versions of the da Vinci available. These systems all work to enable your surgeon to perform minimally invasive surgery. The different models include: The da Vinci Si surgical system The da Vinci X surgical system The da Vinci Xi surgical system The da Vinci SP1 surgical system 1. In the U.S., the da Vinci SP® system is only cleared for use in single-port urological procedures, lateral oropharyngectomy procedures (commonly referred to as radical tonsillectomy) and tongue base resection. Disclosures and Important Safety Information Important Safety Information Patients should talk to their doctors to decide if da Vinci® surgery is right for them. Patients and doctors should review all available information on nonsurgical and surgical options and associated risks in order to make an informed decision. Serious complications may occur in any surgery, including da Vinci surgery, up to and including death. Serious risks include, but are not limited to, injury to tissues and organs and conversion to other surgical techniques, which could result in a longer operative time and/or increased complications. For Important Safety Information, including surgical risks, indications, and considerations and contraindications for use, please also refer to www.intuitive.com/safety. Individuals' outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics, and/or surgeon experience. Da Vinci Xi® System Precaution Statement The demonstration of safety and effectiveness for the specific procedure(s) discussed in this material was based on evaluation of the device as a surgical tool and did not include evaluation of outcomes related to the treatment of cancer (overall survival, disease-free survival, local recurrence) or treatment of the patient’s underlying disease/condition. Device usage in all surgical procedures should be guided by the clinical judgment of an adequately trained surgeon. Da Vinci SP® System Precaution Statement The safety and effectiveness of this device for use in the performance of general laparoscopic surgery procedures have not been established. This device is only intended to be used for single port urological procedures with the da Vinci EndoWrist® SP Instruments and the da Vinci SP Surgical System (SP1098). Patients should talk to their doctor to decide if da Vinci surgery is right for them. Other options may be available and appropriate. Only a doctor can determine whether da Vinci surgery is appropriate for a patient’s situation. Patients and doctors should review all available information on both nonsurgical and surgical options in order to make an informed decision. Surgeons experienced with the da Vinci system can be found using the Surgeon Locator. Intuitive Surgical provides surgeons training on the use of the da Vinci system but does not certify, credential or qualify the surgeons listed in the Surgeon Locator.