Obstetric Services

Obstetrics is the field of medicine concerned with the care of women through pregnancy, childbirth and the postpartum period. We provide preconceptional counseling, prenatal care for low and high-risk pregnancies, delivery services including vaginal and cesarean deliveries and postpartum care. Dr. Agena provides obstetric services at both St. Tammany Parish Hospital and Lakeview Regional Medical Center.

Preconceptional Counseling

Whether you are just beginning to plan your family or have been trying to conceive for some time, preconceptional counseling can help answer many questions you may have. Preparing for your pregnancy with your ObGyn can help to ensure the best possible outcome from the very start. Many conditions can be addressed including infertility, pre-existing medical conditions such as diabetes or hypertension, or prior complications of pregnancy. Beginning your journey to parenthood with preconceptional care is the best way to get started.

Prenatal Care

Prenatal care is essential to the health of you and your baby. You should begin your prenatal care as early as possible. Women who receive adequate prenatal care consistently have better outcomes than those who do not. Pregnant women should see their doctor at least monthly until they reach 26-28 weeks of pregnancy, after which visits become more frequent. At your visit, your progress through the pregnancy will be monitored by listening to the baby’s heartbeat, measuring your stomach, and blood work and ultrasounds as needed. Our office provides the convenience of in-office laboratory testing and ultrasound.

Delivery

Nothing in a family’s life is more exciting than welcoming a new member. From creating a unique birth plan to the labor and delivery, we will provide you with an experience that is as safe and comfortable as possible. In today’s society, it isn’t common to have an Obstetrician who you see through your pregnancy be there for the delivery. This is often a very stressful situation for a family to meet a new doctor at the arrival of their child. Because we are a single physician practice, you know from the very start who you will see when you come to the office and who you will see when your little bundle arrives.

VBAC

VBAC, or vaginal birth after cesarean section, is an increasingly popular method of child birth. Because VBAC requires a doctor to be immediately available, many physicians do not provide this important service. According to ACOG, The American Congress of Obstetricians and Gynecologists, “Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery”. In keeping with the recommendations of the Congress and the ascribed best methods of practice, Dr. Agena does provide VBAC’s at St. Tammany Parish Hospital. We would be happy to discuss your obstetric history and determine if you could be a candidate for a vaginal delivery after cesarean section.

Cesarean delivery

Cesarean delivery is the delivery of a baby through an abdominal incision. While this is a more traumatic mode of delivery, many circumstances make this the preferred or necessary option. We utilize the most current technique of cesarean delivery to minimize the risk of complication to the patient. Also, through utilization of modern anesthetics, we strive to keep the mother as comfortable as possible throughout the process. Most people stay in the hospital for 2 to 4 days following cesarean section. Full recovery usually take 4 to 6 weeks.

High-risk Pregnancy

Certain conditions, such as diabetes or hypertension, may increase risk in pregnancy. Our staff is well versed in the care of high-risk pregnancies. We maintains a collaborative association with Woman’s Maternal Fetal Medicine to ensure the best care for women who have added risk in pregnancy. Some conditions which are considered high-risk include:

  • Hypertension
  • Diabetes
  • Prior preterm delivery
  • Recurrent pregnancy loss
  • Uterine abnormalities
  • Advanced maternal age
  • Bleeding disorders
  • Twin and triplet gestation
  • Postpartum care

Once you have delivered, it is important to follow up with your Obstetrician within the next 4-6 weeks. At your follow up, your doctor will ensure you have made the transition smoothly. A physical exam is performed to confirm you have healed well from your vaginal or cesarean delivery. You will discuss your long term family planning and determine which if any method of contraception is most appropriate. Also, we will determine when you should resume your routine health maintenance visits.

The information contained on this site is for educational purposes only and is not meant to diagnosis or treat any condition. Any information found on this site should be discussed with a health care professional. Use of this information should be done in accordance with the health care plan determined by you and your health care professional. For specific medical advice and treatment, consult your doctor.

Gynecologic services

Gynecology is the field of medicine dealing with the female reproductive system. We provide services for women of all ages from the first menstrual cycle to menopause and beyond. Our office staff strives to provide you with a private and serene environment in which to receive your care. Your health and comfort are the most important things to us. Surgical services, when required, are provided at the Covington Surgery Center, St. Tammany Parish Hospital, and Lakeview Regional Medical Center.

Annual Exam and Screening

The annual gynecologic exam and Pap smear are vital components of preventive medicine. Early detection is key in treating many conditions including sexual infections and cervical cancer. Annual exams are recommended for any women over the age of 21 or who is sexually active.

During the exam, the physician will talk to you about the medical history of you and your family. You will then have a comprehensive physical exam including breast and pelvic exam to screen for abnormalities such as malignancy. If you have a Pap smear, your doctor will use a soft brush to remove cells from the cervix. These cells will be sent to a lab to be screened for premalignant cells or cancer.

Contraceptive Counseling

Since its creation in the 1950’s, the birth control pill has been one of the most widely prescribed and used medications in the world. Currently, there are a multitude of both short term and long term methods available. For women who have completed having children, there are several outpatient surgical options available to achieve permanent sterilization.

For women who wish to maintain their fertility the following list includes some of the options available for reversible contraception:

  • Condoms
  • Vaginal sponges
  • Spermicides
  • Birth control pills
  • Vaginal ring
  • Contraceptive patch
  • Intrauterine device
  • Laboratory services

We offer the convenience of in office diagnostics. If you need blood work done, ultrasound, microscopic testing, or urodynamics, everything can be obtained within our office. Also, because we use an Electronic Medical Record (EMR), patients can receive their results much more quickly, often within 24 hours. Lab testing can either be scheduled or done as a walk-in service.

  • Commonly treated conditions
  • Abnormal uterine bleeding

Many women from all stages of life may experience changes in their menstrual cycle. Sometimes these changes are temporary and harmless. Other times, they may be a sign of an underlying problem. Your gynecologist can effectively diagnose and treat these conditions. Medical management is the cornerstone to therapy, but sometimes surgical intervention is needed. Some conditions which can cause abnormal uterine bleeding in non-pregnant women include:

  • Hormonal imbalance
  • Polyps
  • Fibroids or myomas
  • Adenomyosis
  • Endometriosis
  • Uterine cancer
  • Cervical cancer
  • Vaginal discharge and sexually transmitted diseases

A change in vaginal discharge can be a troubling finding for many women. While the vaginal secretions change given the time in one’s menstrual cycle, sometimes discharge can be a symptom of infection. Both sexually transmitted and non-sexually transmitted infections can result in discharge. Some examples of infection include:

  • Bacterial vaginosis (BV)
  • Yeast infection
  • Chlamydia
  • Gonorrhea
  • Trichomonas

While some of these infections are easily treated, many may cause long term damage and illness so a prompt evaluation by your gynecologist is always recommended. Here are some important facts to remember:

  • There are 15,300,000 new STD cases each year
  • 3,000,000 teenagers acquire an STD each year

Pelvic Pain

A sense of pressure, pain, or discomfort within the lower abdomen or pelvis may be an indication of a condition involving the female reproductive organs. Pain may be occasional, cyclic, or always present. Any time these symptoms persist, a thorough evaluation by your doctor is warranted. Our office is able to perform many tests including screening for infection and malignancy through laboratory testing, examination, and ultrasound. While there are numerous conditions which may cause these symptoms, some common conditions include:

  • Ovarian cyst
  • Infection
  • Uterine fibroid
  • Urinary tract infection
  • Endometriosis
  • Adenomyosis
  • Ectopic pregnancy
  • Infertility

Infertility is the inability for an individual or couple to achieve pregnancy. There are both male and female factors which may contribute to the condition. About one third of cases are caused by a male factor. One third of cases are caused by a female factor. Finally, one third of cases result from a combination of male and female factors.

Dealing with infertility can be a very stressful undertaking. While you may feel that others do not understand, you are not alone. More than 6 million women in the [COUNTY] alone suffer from infertility. Your gynecologist can diagnose and treat many of the common causes of infertility. Some conditions which may cause female factor infertility include:

  • Fallopian tube blockage
  • Endometriosis
  • Ovulation disorders
  • Fibroids
  • Early or premature menopause
  • PCOS (Polycystic ovarian syndrome)
  • PMS or PMDD

PMS stands for premenstrual syndrome. The changes in hormone levels prior to the start of menstruation can many people. PMS typically begin in the week prior to the onset of menses and stop 1-2 days after the start of your cycle. Symptoms are different for each individual. Some common symptoms include:

  • Bloating
  • Lower abdominal cramping
  • Breast tenderness
  • Clumsiness
  • Headache
  • Less tolerance for noises and lights
  • Confusion, difficulty concentrating, or forgetfulness
  • Fatigue and feeling slow or sluggish
  • Feelings of sadness or hopelessness
  • Feelings of tension, anxiety, or edginess
  • Loss of sex drive (may be increased in some women)
  • Mood swings

PMDD or Premenstrual Dysphoric Disorder has many of the same characteristics of PMS but the symptoms are more severe and debilitating. There is no laboratory test for PMDD, so a thorough history obtained by your doctor is needed to make the diagnosis. There are several behavioral techniques and medications your doctor may employ to alleviate symptoms.

Urinary Incontinence

Involuntary leakage of urine is among the most undertreated conditions among women. The exact prevalence is difficult to define due to underreporting. We estimate that between 10 and 20% of women suffer from incontinence. Our office provides in-house urodynamics, a test which can determine the cause and best treatment for each patient.

Treatment depends on the cause of leakage. Options for treatment include pessary (a plastic vaginal insert), medications to control spasm, and surgical correction. Dr. Agena has been performing surgical correction for urinary incontinence for over 10 years with over a 90% cure rate.

Menopause

Menopause is the time in a woman’s life in which menstruation stops and she is no longer able to get pregnant. While many women do not have other symptoms during this time, some have unpleasant side effects. Symptoms of menopause, or female climacteric, include mood swings, hot flashes, night sweats, irritability, and change in sex drive. There are many treatment options available depending on the symptoms you feel. Discussing your symptoms with your doctor can help him choose the best treatment option for you.

The information contained on this site is for educational purposes only and is not meant to diagnosis or treat any condition. Any information found on this site should be discussed with a health care professional. Use of this information should be done in accordance with the health care plan determined by you and your health care professional. For specific medical advice and treatment, consult your doctor.

Surgical Services

Hysterectomy

Hysterectomy is the removal of the uterus or womb. This can be accomplished by several different approaches. The approach used is determined by your personal history as well as the surgical skill of your doctor.

Abdominal hysterectomy

The removal of the uterus through a single incision in the abdominal wall. The incision is usually made in a fashion similar to cesarean delivery (The Pfannensteil Incision) or vertically between the umbilicus and pubic bone. The typical hospital stay is 2 days with a 6 week recovery.

Vaginal Hysterectomy

In this approach, no abdominal incisions are made. The uterus is removed entirely through the vagina. The hospital stay is usually 24 hours with a 4 week recovery.

Robotic Hysterectomy

Using a robotic surgical system, the procedure is performed through 4 incisions in the lower abdomen, each about as wide as a fingernail. Most people go home the same day or following morning. Recovery is from 3-5 weeks.

Myomectomy

Myomectomy is the removal of a uterine fibroid. This procedure is done to relieve symtpoms of heavy or painful menstruation and infertility. Dr. Agena has experience performing this procedure thorugh minimally invasive techniques. Using the DaVinci surgical system, recovery can be as little as 10 to 14 days. In the case of intrauterine fibroids, or fibroids inside the cavity of the uterus, the myomectomy can be performed with a small camera called a hysteroscope. Recovery is usually 3-5 days.

Ovarian Cystectomy

Ovarian cysts are a common cause of lower abdominal pain. Most cysts will resolve without surgical intervention. On occasion however, cysts may persist. In those cases, they can be removed while leaving the ovary intact. This option for treatment is especially important to those women who wish to maintain their fertility. This procedure can be done as an outpatient with recovery in 7 to 14 days.

Diagnostic Laparoscopy

Laparoscopy, or “Keyhole surgery” allows your surgeon to examine your pelvis through a small incision just below your belly button. This technique is useful in the evaluation of patients with abdominal symptoms or infertility of an unknown cause. Recovery varies from 3 days to a few weeks depending on the complexity of the case.

Robotics

The DaVinci surgical system was FDA approved in 2000. Since then, it has become widely implemented by Gynecologists around the world. Currently, over 60% of all hysterectomies performed nationwide are done robotically. This state of the art technology allows for improved precision in pelvic surgery. This in turn translates into fewer complications and a faster recovery. St. Tammany Parish Hospital was the first hospital on the Northshore to implement this technology. Dr. Agena is a skilled robotic surgeon with extensive experience. He not only performs cases locally, but also teaches other surgeons how to use the DaVinci robotic surgical system throughout the Gulf Coast from Lake Charles to Florida.

Pelvic Organ Prolapse Repair

Prolapse of the pelvic organs results from a loss of support from the ligaments which are meant to hold them in place. This can happen to the bladder, uterus and rectum. When the bladder support is lost, this results in what is called a cystocele. Symptoms include pelvic pressure and urinary leakage. Loss of support to the rectum results in a vaginal bulge called a rectocele. Symptoms may also include pelvic pressure and trouble completely evacuating with bowel movements. Finally, loss of support to the uterus can result in pelvic pain and pain with intercourse.

Correction of prolapse can be achieved through pelvic floor exercises, vaginal pressaries (plastic inserts) or surgical correction.

Hysteroscopy

Hysteroscopy involves placing a lit scope within the uterus through the cervical opening. This is performed to visualize the inner cavity of the uterus and the openings of the Fallopian tubes. Lesions such as polyps and fibroids can be removed through this technique. Because of the minimally invasive nature of this treatment, recovery is usually rapid, taking anywhere from 3-7 days.

Tubal Ligation

For families who have completed childbearing, laparoscopic tubal ligation allows for permanent contraception. The procedure is relatively quick, taking on average 15 minutes. Recovery is 7 to 14 days. The risk of getting pregnant after your tubes are tied is about 1 in 400, making the procedure over 99% effective.

Ablation

For women who have abnormal bleeding and have completed childbearing, an endometrial ablation provides a fast and safe method to treat their condition. This procedure involves removing the inner lining of the uterus while leaving the uterus itself intact. Endometrial ablation often takes less than 5 minutes and most people return to work within 2-3 days. Despite its relative speed and minimal downtime, the success rate exceeds 90%.

Da Vinci Robotics