Dr. Steven R. Goldstein MD - Best Obgyn in NYC for Early Pregnancy Monitoring

Dr. Steven R. Goldstein MD, is the Best Obgyn in NYC to monitor your pregnancy from its early stages, particularly if you are prone to miscarriages.  He is a Professor of Obstetrics and Gynecology at New York University School Of Medicine, a Past Chairman of the American College of Obstetrics and Gynecology, New York section, Past President American Institute of Ultrasound in Medicine and is currently the Director of Gynecologic Ultrasound at NYU Langone Medical Center.

At Dr. Goldstein’s practice, he works closely with pregnant patients or those considering a family to make sure all aspects of the pregnancy are covered. Dr. Goldstein ensures that the pregnancy meets established milestones, and one of the ways of doing this is by analyzing the Human Chorionic Gonadotropin (HCG) levels.

A developing pregnancy will produce detectable hormone of pregnancy by eight days post conception. That means it is there and present prior to being late for one’s menses. Home pregnancy tests turn positive at around the time of the expected menses (approximately fourteen days after conception). The rate of rise of hCG in normal healthy pregnancies is extremely well established.

Thus, if there is any concern for the health of a pregnancy, measuring the hCG rate of rise at 48 hour intervals will tell us a great deal about the health of the pregnancy (although, it does not tell us anything about the pregnancy’s location). Ectopic pregnancy can occasionally result in a relatively normal early development, which may follow normal doubling times of hCG. 

Ectopic pregnancy is when the developing embryo is located outside of the normal uterine cavity. 98% of these are in the fallopian tube. If they develop and rupture, they can cause hemorrhage requiring emergency surgery and transfusion.

Usually the hCG level doubles at 48 hours. However, there is a minimum rate of rise of approximately 35-45% in early pregnancy depending on the starting value of testing. Dr. Goldstein has published and lectures extensively on early pregnancy, both its detection by ultrasound and how to diagnose pregnancy failure before miscarriage, as well as, diagnosing ectopic pregnancy early enough to be treated non-surgically with medication.

Dr. Steven R. Goldstein MD is one of the Best Obgyn in NYC in practice for over 25 years. You may also visit his website at www.goldsteinmd.com for more information.

Dr. Steven R. Goldstein MD - Top Gynecologist in NYC comments on NY Times Article Re Bone Loss

Doctor Steven R. Goldstein MD, is a top Gynecologist in NYC in private practice for over 25 years. Dr. Goldstein had this to say regarding an April 9th NY Times article on Osteoporosis.

In yesterday‘s New York Times (April 9^th 2019), a teaser on the front page was entitled “Treatment for brittle bones”. The article itself was entitled “Osteoporosis drug deploys genetic tool to build bone”. On Tuesday the FDA approved a new drug known as Evenity (generic is romosozumab-aqqg). The article talks significantly about the fact that this is the first drug that restores bone without breaking it down. Understand that bone is a dynamic organ. It is constantly being laid down and taken away until the day you die. Estrogen is a potent inhibitor of taking bone away. This is why when women at menopause stop making estrogen they lose bone rapidly. Most of the commonly employed medications to prevent and treat osteoporosis are such “anti-resorptives” (they inhibit the taking away of bone like estrogen did yielding a net positive balance). There are some injectables that are anabolic bone drugs (like Forteo or Tymlos) that actually build bone but do not inhibit some of it’s taking away. Previously these have been reserved for the most severe cases and are limited to 18 months of use because of some bone cancers observed in rodents. This new drug, Evenity, actually uses genetically engineered blocking antibodies to restore bone without breaking it down.

 

To some of you who may have read the article, this may sound like a wonderful breakthrough and something you might in fact be interested in. Understand, this was a clinical trial of close to 8,000 women. All of them had osteoporosis and at least one pre-existing osteoporotic fracture of the vertebral column. In other words, all these women were extremely high risk. Bone health is increasingly one of the most important issues for my patients. As longevity has increased dramatically over the last generation or two, so many women are living into their early 90s. Suffering a hip fracture will result in 25% of women never living independently again and 20 to 30% will be dead within one year. My patients should be as concerned about their bone health as any other aspect of their lives as they pursue “healthy aging.” 

My take-home point, however, is that this drug is an excellent “arrow in the quiver” of clinicians who take care of women with severe osteoporosis and previous fracture. It is a monthly injectable. It is not for patients with average bone loss or early osteoporosis. It should be reserved for the most severely affected patients. It is not without potentially serious side effects. The most serious ones, as pointed out in the article, were a statistically significant increase in heart attacks, strokes, and even sudden death among women who used this medication. That is why, obviously, it should only be reserved for severely affected women with osteoporosis and pre-existing fracture.  

Dr. Steven R. Goldstein MD is a top Gynecologist in NYC.  Dr. Goldstein is a Professor of Obstetrics and Gynecology at New York University School Of Medicine. He is also a Past Chairman of the American College of Obstetrics and Gynecology, New York section, Past President American Institute of Ultrasound in Medicine and is currently the Director of Gynecologic Ultrasound at NYU Langone Medical Center. He is a Certified Menopause Practitioner and holds many other positions and accreditations. You may visit Dr. Goldstein’s website at www.goldsteinmd.com for more information on him and to make an appointment with a top Gynecologist in NYC.