Podcasts about obstet gynecol

NeuroEdge with Hunter Williams

Play Episode Listen Later Aug 20, 2024 55:29

Women's health has a history of being underfunded in the United States, leading many women to receive suboptimal care. In this episode of the BackTable OBGYN podcast, hosts Dr. Mark Hoffman and Dr. Amy Park engage in a detailed discussion with Dr. Louise P. King, a minimally invasive gynecologic surgeon, and Christopher Robertson, a law professor at Boston University, regarding the inequitable reimbursement structures that persist within the field of OBGYN. --- SYNPOSIS The guests emphasize the systemic discrepancies between gynecologic and other surgical disciplines. The conversation delves into the origins of these disparities, the complexities of revising current codes and creating new codes, and potential legislative and legal remedies to address gender-based inequities. The guests also stress the importance of patient care outcomes and the role of proper reimbursement in enhancing healthcare delivery. --- TIMESTAMPS 00:00 - Introduction 06:28 - Background on RVUs and Disparities in OBGYN 12:39 - Gender Disparities in Medical Billing 18:00 - Efforts to Address Inequities 31:22 - RUC Structure and Surgical Specialties 32:42 - Billing and Reimbursement Inequities 35:15 - Diagnosis Related Groups 36:42 - Turnover Times and Gender Disparities 40:21 - Advocacy and Legislative Solutions 48:23 - Legal Approaches for Change 52:44 - Conclusion --- RESOURCES Watson KL, King LP. Double Discrimination, the Pay Gap in Gynecologic Surgery, and Its Association With Quality of Care. Obstet Gynecol. 2021 Apr 1;137(4):657-661. doi: 10.1097/AOG.0000000000004309. PMID: 33706362. Robertson, Christopher T. and Kupke, Annabel and King, Louise P., Structural Sex Discrimination: Why Gynecology Patients Suffer Avoidable Injuries and What the Law Can Do About It (May 9, 2024). Emory Law Journal, Forthcoming, Boston Univ. School of Law Research Paper Forthcoming, Available at SSRN: https://ssrn.com/abstract=4800783 or http://dx.doi.org/10.2139/ssrn.4800783

Soil. ft. Terinney Haley (Medical Student at Howard U)

Stranger Fruit Podcast

Play Episode Listen Later Jul 22, 2024 71:14

Kennedy Dunn and Terinney Haley, 3rd year medical students at Howard U, explore soil and how we nourish those around us and what it means to be human in the fourth episode of Stranger Fruit Vol I. Chapters: 0:00 Understanding Soil and Self-Care: Foundations for Growth 11:39 The Journey of Medical Education and Personal Development 40:36 Authenticity and Growth: Embracing Heritage and Personal Identity 51:37 Navigating Adversity: Cultivating Resilience and Authenticity 58:15 Mental Health and Motivation: Harnessing Anxiety for Success Guest Host Socials! TikTok: goldendocther Instagram: goldendocther Works Cited: Prevalence of Incontinence Among Older Americans. Vital & Health Statistics, Series 3, Number 36, US Department of Health And Human Services. June, 2014 : https://www.cdc.gov/nchs/data/series/sr_03/sr03_036.pdf Nygaard I et al. Urinary incontinence and depression in middle-aged United States women. Obstet Gynecol 2003; 101: 149-156 Bogner HR et al. Anxiety disorders and disability secondary to urinary incontinence among adults over age 50. Int J Psychiatry Med 2002; 32: 141-154. Sutherst J, Brown M: Sexual dysfunction associated with urinary incontinence. Urol Int 35: 414, 1980 Intro Music: Bosch's Garden - by Kjartan Abel. This work is licensed under the following: CC BY-SA 4.0 Attribution-ShareAlike 4.0 International.

united states mental health anxiety international gardens series authenticity chapters vital soil us department medical education medical students cc by sa urinary health and human services health statistics howard u obstet gynecol kjartan abel

Desiccated Thyroid for Women Post Childbirth

Play Episode Listen Later Jul 19, 2024 18:56

Download The Peptide Cheat Sheet: https://peptidecheatsheet.carrd.co/

S3 Ep133: Best Breast Advice When it comes to Hormone Therapy With Dr. Corinne Menn

Dr. Streicherâ€™s Inside Information: THE Menopause Podcast

Play Episode Listen Later Jun 20, 2024 57:07

There continues to be great confusion regarding the impact of hormone therapy on the breast. And despite the known benefits of hormone therapy, and reassuring data regarding the impact of hormone therapy on breast cancer, most clinicians are still reluctant to prescribe it, and most women are reluctant to take it. Even more so if a woman is high risk for breast cancer or has a breast cancer diagnosis. In this episode, I am joined by Dr. Corinne Menn, a board-certified Ob GYN and menopause expert who herself had a breast cancer diagnosis when she was in her 20s. We will be reviewing the latest research on the impact of estrogen on the breast in several different scenarios. PREGNANCY post breast cancer Women who have a BREAST CANCER diagnosis Women with a FAMILY HISTORY of breast cancer Women with a BRCA MUTATION after prophylactic ovary removal The approach to therapy for women with a NEW BREAST CANCER DIAGNOSIS The use of local vaginal estrogen in women with a breast cancer diagnosis that are taking TAMOXIFEN or using an AROMOTASE INHIBITOR If a LOCAL VAGINAL ESTROGEN needs to be used at the lowest dose What to do if your DOCTOR NOT WILLING to prescribe local or systemic estrogen (list of articles to share is below) If a woman with a breast cancer diagnosis can use TESTOSTERONE for libido and other possible benefits Dr. Corrine Menn https://drmenn.com/ @drmennobgyn For more information: Episode 124 All Hormones Are Not Created Equal with Dr. James Simon Episode 65- The Dilemma of Menopause and Breast Cancer Episode 31 The TRUTH About Hormone Therapy: Does it CAUSE or Does it PREVENT Breast Cancer? Episode 28: The BEST approach for BREAST Cancer Screening and Risk Reduction with Dr. Lisa Larkin Dr. Streicher's Inside Information podcast is not intended to replace medical advice and should be used to supplement, not replace, care by your personal health care clinician. Dr. Streicher disclaims liability for any medical outcomes that may occur because of applying methods suggested or discussed in this podcast. Scientific Articles Hormone Therapy and Risk of Breast Cancer Bluming AZ, Hodis HN, Langer RD. 'Tis but a scratch: a critical review of the Women's Health Initiative evidence associating menopausal hormone therapy with the risk of breast cancer. Menopause. 2023 Dec 1;30(12):1241-1245. Bluming AZ. Introduction: Estrogen Reconsidered: Exploring the Evidence for Estrogen's Benefits and Risks. Cancer J. 2022 May-Jun 01;28(3):157-162. Hodis HN, Sarrel PM. Menopausal hormone therapy and breast cancer: what is the evidence from randomized trials? Climacteric 2018;21:521–8. Levy B, Simon JA. A Contemporary View of Menopausal Hormone Therapy. Obstet Gynecol. 2024 Mar 14. Chlebowski RT, Aragaki AK, Pan K, Mortimer JE, Johnson KC, Wactawski-Wende J, LeBoff MS, Lavasani S, Lane D, Nelson RA, Manson JE. Randomized trials of estrogen-alone and breast cancer incidence: a meta-analysis. Breast Cancer Res Treat. 2024 Apr 23. doi: 10.1007/s10549-024-07307-9. Pan K, Lavasani S, Aragaki AK, Chlebowski RT. Estrogen therapy and breast cancer in randomized clinical trials: a narrative review. Menopause. 2022 Sep 1;29(9):1086-1092. Use of Hormone Therapy in Women with a Breast Cancer Diagnosis Bluming A. Hormone replacement therapy after breast cancer: it is time. Cancer J 2022;28:183–90. Bluming AZ. Safety of systemic hormone replacement therapy in breast cancer survivors. Breast Cancer Res Treat. 2022 Feb;191(3):685-686. doi: 10.1007/s10549-021-06479-y. Fahlén M, Fornander T, Johansson H, Johansson U, Rutqvist LE, Wilking N, von Schoultz E. Hormone replacement therapy after breast cancer: 10 year follow up of the Stockholm randomised trial. Eur J Cancer. 2013 Jan;49(1):52-9. Mikkola TS, Savolainen-Peltonen H, Tuomikoski P, Hoti F, Vattulainen P, Gissler M, et al. Reduced risk of breast cancer mortality in women using postmenopausal hormone therapy: a Finnish nationwide comparative study. Menopause 2016;23:1199–203 Hormone Therapy in Women with BRCA Mutation Kotsopoulos J, Gronwald J, Karlan BY, Huzarski T, Tung N, Moller P, Armel S, Lynch HT, Senter L, Eisen A, Singer CF, Foulkes WD, Jacobson MR, Sun P, Lubinski J, Narod SA; Hereditary Breast Cancer Clinical Study Group. Hormone Replacement Therapy After Oophorectomy and Breast Cancer Risk Among BRCA1 Mutation Carriers. JAMA Oncol. 2018 Aug 1;4(8):1059-1065.. Lauren Streicher, MD is a clinical professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine, and the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause. She is a certified menopause practitioner of the North American Menopause Society. Sign up to receive DR. STREICHER'S FREE NEWSLETTER Dr. Streicher is the medical correspondent for Chicago's top-rated news program, the WGN Morning News, and has been seen on The Today Show, Good Morning America, The Oprah Winfrey Show, CNN, NPR, Dr. Radio, Nightline, Fox and Friends, The Steve Harvey Show, CBS This Morning, ABC News Now, NBCNightlyNews,20/20, and World News Tonight. She is an expert source for many magazines and serves on the medical advisory board of The Kinsey Institute, Self Magazine, and Prevention Magazine. She writes a regular column for The Ethel by AARP and Prevention Magazine. Subscribe and Follow Dr. Streicher on DrStreicher.com Instagram @DrStreich Facebook @DrStreicher YouTube DrStreicherTV Books by Lauren Streicher, MD Slip Sliding Away: Turning Back the Clock on Your Vagina-A gynecologist's guide to eliminating post-menopause dryness and pain Hot Flash Hell: A Gynecologist's Guide to Turning Down the Heat Sex Rx- Hormones, Health, and Your Best Sex Ever The Essential Guide to Hysterectomy

Navigating Breastfeeding As An EM Physician

EM Pulse Podcast™

Play Episode Listen Later May 6, 2024

Navigating breastfeeding as an EM physician In the previous two episodes, we explored some of the challenges related to fertility and pregnancy for EM physicians. In the final episode of our three part series, we take it one step further to discuss yet another challenge: breastfeeding. Of course, fed is always best, and there are many reasons to formula feed, but providing breastmilk is very important to many families. For EM physicians, choosing to breastfeed usually means figuring out how to pump and store milk while you're on shift. This can be daunting, especially for residents and junior physicians. How do you find time to sneak away? Is there an easily accessible pumping room close by? Will you feel supported by colleagues and your department? We cover these questions and much more with experts, Dr. Claire Abramoff, and Dr. Shada Rouhani. Does your ED have policies to support breastfeeding and pumping? Share your experience with us on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guests: Dr. Claire Abramoff, Assistant professor at Jefferson, Sidney Kimmel Medical Center College and Assistant Residency Program Director, Department of Emergency Medicine, Einstein Medical Center in Philadelphia, PA Dr. Shada Rouhani, Assistant Professor of Emergency Medicine at Harvard Medical School and Emergency Physician at Brigham and Women's Hospital in Boston, MA Resources: Practice Management Breastfeeding Disasters and Solutions for EPs, by Claire Abramoff, MD, for Emergency Medicine News, March 14, 2023. Cleveland Manchanda EC, Vogel LD, Kass D, Rouhani SA. Best Practices for Lactation Support at Conferences and Standardized Testing Centers. Obstet Gynecol. 2020 Feb;135(2):475-478. doi: 10.1097/AOG.0000000000003661. PMID: 31923075. McDonald L, Illg Z, Dow A, Gunaga S. Maternity Experiences and Perceptions of Emergency Medicine Physicians. Spartan Med Res J. 2021 Apr 13;6(1):22009. doi: 10.51894/001c.22009. PMID: 33870004; PMCID: PMC8043905. ***** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

S3 Ep124: All Hormones Are Not Created Equal With Dr. James Simon

Dr. Streicherâ€™s Inside Information: THE Menopause Podcast

Play Episode Listen Later Apr 18, 2024 45:34

Every available type of hormone therapy will effectively eliminate hot flashes and other menopause symptoms. However, all hormone therapy is not the same. Individual formulations impact bone health, breast health, and cardiovascular health differently. In episode 123, Dr. James Simon and I discussed starting hormone therapy after the age of 60. In this episode, we discuss the nuances between different hormones and their impact on breast cancer and bone health. Why it is important to individualize hormone therapy Why there is the perception that estrogen causes breast cancer There is a difference between causing breast cancer and making breast cancer grow The differences between conjugated equine estrogen (Provera) and a plant-derived bioidentical beta-estradiol in terms of breast cancer impact The differences between the different estrogens and progestogens as far as bone health Transdermal vs oral estrogen Dr. Simon's Article : Levy B, Simon JA. A Contemporary View of Menopausal Hormone Therapy. Obstet Gynecol. 2024 Mar 14. Ms Magazine article with Lancet Rebuttal https://msmagazine.com/2024/04/15/menopause-treatment-the-lancet/ List of doctors who signed rebuttal James A. Simon, MD Clinical Professor George Washington University www.IntimMedicine.com The Menopause Society Find a menopause practitioner page Midi Health https://www.joinmidi.com/ For more information on this topic: Episode 51- Transdermal versus Oral Estrogen- What's the Difference? Episode 67- How Long Can you Safely Take Hormone Therapy? Episode 114- Is Duovee the Ideal Hormone Therapy? Episode 123 Is Starting Hormone Therapy After Age 60 an Option? Slip Sliding Away: Turning Back the Clock on Your Vagina-A gynecologist's guide to eliminating post-menopause dryness and pain Hot Flash Hell: A Gynecologist's Guide to Turning Down the Heat Dr. Streicher's Inside Information podcast is not intended to replace medical advice and should be used to supplement, not replace, care by your personal health care clinician. Dr. Streicher disclaims liability for any medical outcomes that may occur because of applying methods suggested or discussed in this podcast. Lauren Streicher, MD is a clinical professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine, and the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause. She is a certified menopause practitioner of the North American Menopause Society. Sign up to receive DR. STREICHER'S FREE NEWSLETTER Dr. Streicher is the medical correspondent for Chicago's top-rated news program, the WGN Morning News, and has been seen on The Today Show, Good Morning America, The Oprah Winfrey Show, CNN, NPR, Dr. Radio, Nightline, Fox and Friends, The Steve Harvey Show, CBS This Morning, ABC News Now, NBCNightlyNews,20/20, and World News Tonight. She is an expert source for many magazines and serves on the medical advisory board of The Kinsey Institute, Self Magazine, and Prevention Magazine. She writes a regular column for The Ethel by AARP and Prevention Magazine. Subscribe and Follow Dr. Streicher on DrStreicher.com Instagram @DrStreich Facebook @DrStreicher YouTube DrStreicherTV Books by Lauren Streicher, MD Slip Sliding Away: Turning Back the Clock on Your Vagina-A gynecologist's guide to eliminating post-menopause dryness and pain Hot Flash Hell: A Gynecologist's Guide to Turning Down the Heat Sex Rx- Hormones, Health, and Your Best Sex Ever The Essential Guide to Hysterectomy

Ep. 50 Decoding Isthmocele: Causes and Considerations with Dr. Chuck Miller

Behind The Knife: The Surgery Podcast

Play Episode Listen Later Apr 2, 2024 53:52

In this episode of BackTable OBGYN, renowned reproductive endocrinologist and minimally invasive gynecologic surgeon Dr. Charles (Chuck) Miller delves into the topic of isthmoceles, a common yet often overlooked complication of C-sections, and shares his best practices for repair. Dr. Miller shares his extensive experience in diagnosing and treating isthmoceles, discussing various surgical techniques including hysteroscopic, laparoscopic, and robotic-assisted resection. He emphasizes the importance of an aggressive surgical approach for achieving higher success rates in terms of future fertility and resolving symptoms such as abnormal bleeding. Moreover, Dr. Miller highlights the need for standardized treatment protocols and reflects on the mentorship, the ongoing journey of learning and adapting in medicine, and the noble profession of healthcare. The episode offers insightful perspectives on a lesser-known gynecologic issue, underscores the value of experience and mentorship in medicine, and advocates for concerted efforts toward establishing best practices in surgical procedures. --- SHOW NOTES 00:00 - Introduction 07:18 - Defining Isthmocele and the History of Isthmocele 10:00 - The Diagnosis of Isthmocele and Its Impact on Fertility 19:31 - Exploring Surgical Techniques for Isthmocele Repair 27:54 - Understanding Hysteroscopic Resection 30:12 - Addressing C-Section Ectopics and Isthmocele Repairs 36:46 - Adapting the Surgical Approach to Different Patient Scenarios 39:35 - Postoperative Complications and Safety Measures 40:55 - The Future of Isthmocele: Surgical Standardization 50:51 - Closing Thoughts and Acknowledgements --- RESOURCES Ban Y, Shen J, Wang X, Zhang T, Lu X, Qu W, Hao Y, Mao Z, Li S, Tao G, Wang F, Zhao Y, Zhang X, Zhang Y, Zhang G, Cui B. Cesarean Scar Ectopic Pregnancy Clinical Classification System With Recommended Surgical Strategy. Obstet Gynecol. 2023 May 1;141(5):927-936. doi: 10.1097/AOG.0000000000005113. Epub 2023 Apr 5. PMID: 37023450; PMCID: PMC10108840.

history future adapting diagnosis considerations decoding closing thoughts epub its impact pmid aog chuck miller obstet gynecol zhang y zhang x

Laboring Under Pressure Episode 2: Postpartum Hemorrhage with Dr. Kiersten Williams

Emergency Medical Minute

Play Episode Listen Later Jan 8, 2024 25:23

Contributor: Kiersten Williams MD, Travis Barlock MD, Jeffrey Olson MS2 Summary: In this episode, Dr. Travis Barlock and Jeffrey Olson meet in the studio to discuss a clip from Dr. Williams' talk at the “Laboring Under Pressure, Managing Obstetric Emergencies in a Global Setting” event from May 2023. This event was hosted at the University of Denver and was organized with the help of Joe Parker as a fundraiser for the organization Health Outreach Latin America (HOLA). Dr. Kiersten Williams completed her OBGYN residency at Bay State Medical Center and practices as an Obstetric Hospitalist at Presbyterian/St. Luke's Medical Center in Denver, Colorado. During her talk, Dr. Williams walks the audience through the common causes and treatments for post-partum hemorrhage (PPH). Some important take-away points from this talk are: The most common causes of PPH can be remembered by the 4 T's. Tone (atony), Trauma, Tissue (retained placenta), and Thrombin (coagulopathies). AV malformations of the uterus are probably underdiagnosed. Quantitative blood loss is much more accurate than estimated blood loss (EBL). The ideal fibrinogen for an obstetric patient about to deliver is above 400 mg/dl - under 200 is certain to cause bleeding. Do not deliver oxytocin via IV push dose, it can cause significant hypotension. Tranexamic Acid is available in both IV and PO and can be administered in the field. The dose is 1 gram and can be run over 10 minutes if administered via IV. It is best if used within 3 hours of delivery. When performing a uterine massage, place one hand inside the vagina and one hand on the lower abdomen. Then rub the lower abdomen like mad. A new option for treating PPH is called the JADA System which is slimmer than a Bakri Balloon and uses vacuum suction to help the uterus clamp down.* Another option for a small uterus is to insert a 60 cc Foley catheter. In an operating room, a B-Lynch suture can be put in place, uterine artery ligation can be performed, and as a last resort, a hysterectomy can be done. *EMM is not sponsored by JADA system or the Bakri balloon. References Andrikopoulou M, D'Alton ME. Postpartum hemorrhage: early identification challenges. Semin Perinatol. 2019 Feb;43(1):11-17. doi: 10.1053/j.semperi.2018.11.003. Epub 2018 Nov 14. PMID: 30503400. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. 2017 Oct;130(4):e168-e186. doi: 10.1097/AOG.0000000000002351. PMID: 28937571. Federspiel JJ, Eke AC, Eppes CS. Postpartum hemorrhage protocols and benchmarks: improving care through standardization. Am J Obstet Gynecol MFM. 2023 Feb;5(2S):100740. doi: 10.1016/j.ajogmf.2022.100740. Epub 2022 Sep 2. PMID: 36058518; PMCID: PMC9941009. Health Outreach for Latin America Foundation - HOLA Foundation. (n.d.). http://www.hola-foundation.org/ Kumaraswami S, Butwick A. Latest advances in postpartum hemorrhage management. Best Pract Res Clin Anaesthesiol. 2022 May;36(1):123-134. doi: 10.1016/j.bpa.2022.02.004. Epub 2022 Feb 24. PMID: 35659949. Pacheco LD, Saade GR, Hankins GDV. Medical management of postpartum hemorrhage: An update. Semin Perinatol. 2019 Feb;43(1):22-26. doi: 10.1053/j.semperi.2018.11.005. Epub 2018 Nov 14. PMID: 30503399. Produced by Jeffrey Olson, MS2 | Edited by Jeffrey Olson and Jorge Chalit, OMSII

Clinical Challenges in Minimally Invasive Surgery: MIS in the Pregnant Patient

Play Episode Listen Later Nov 16, 2023 39:45

If you operate for long enough, chances are you will come across the unique, and potentially daunting scenario of operating on a pregnant patient. If, and when, you do, would you know what to do? Join University of Washington and MIS faculty Drs. Andrew Wright, Nicole White, and Nick Cetrulo, and residents Drs. Ben Vierra and Paul Herman as they discuss non-obstetric surgery in the pregnant patient so that you will be better informed when the challenge arises. Hosts: 1. Andrew Wright, UW Medical Center—Montlake and Northwest, @andrewswright 2. Nick Cetrulo, UW Medical Center—Northwest, @Trules25 3. Nicole White, UW Medical Center—Northwest, @NicoleWhiteTho1 4. Paul Herman, UW General Surgery Resident PGY-3, @paul_herm 5. Ben Vierra, UW General Surgery Resident PGY-2 Learning Objectives 1. Describe important physiologic changes in pregnancy that are relevant for the surgeon to know. 2. Review the epidemiology of non-obstetric general surgery in the pregnant patient. 3. Discuss specific imaging considerations in the pregnant patient. 4. Become more familiar with the technical aspects of approaching a typical surgical case in a pregnant patient. References 1. Pearl, J.P., Price, R.R., Tonkin, A.E. et al. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc 31, 3767–3782 (2017). https://doi.org/10.1007/s00464-017-5637-3 2. Vasileiou G, Eid AI, Qian S, Pust GD, Rattan R, Namias N, Larentzakis A, Kaafarani HMA, Yeh DD; EAST Appendicitis Study Group. Appendicitis in Pregnancy: A Post-Hoc Analysis of an EAST Multicenter Study. Surg Infect (Larchmt). 2020 Apr;21(3):205-211. https://pubmed.ncbi.nlm.nih.gov/31687887/ 3. Dongarwar D, Taylor J, Ajewole V, Anene N, Omoyele O, Ogba C, Oluwatoba A, Giger D, Thuy A, Argueta E, Naik E, Salemi JL, Spooner K, Olaleye O, Salihu HM. Trends in Appendicitis Among Pregnant Women, the Risk for Cardiac Arrest, and Maternal-Fetal Mortality. World J Surg. 2020 Dec;44(12):3999-4005. https://pubmed.ncbi.nlm.nih.gov/32737556/ 4. Fong ZV, Pitt HA, Strasberg SM, Molina RL, Perez NP, Kelleher CM, Loehrer AP, Sicklick JK, Talamini MA, Lillemoe KD, Chang DC; California Cholecystectomy Group. Cholecystectomy During the Third Trimester of Pregnancy: Proceed or Delay? J Am Coll Surg. 2019 Apr;228(4):494-502.e1. https://pubmed.ncbi.nlm.nih.gov/30769111/ 5. Hong J, Yang J, Zhang X, Su J, Tumati A, Garry D, Docimo S, Bates AT, Spaniolas K, Talamini MA, Pryor AD. Considering delay of cholecystectomy in the third trimester of pregnancy. Surg Endosc. 2021 Aug;35(8):4673-4680. https://pubmed.ncbi.nlm.nih.gov/32875420/ 6. ACOG Committee Opinion No. 775: Nonobstetric Surgery During Pregnancy. Obstet Gynecol. 2019 Apr;133(4):e285-e286. https://pubmed.ncbi.nlm.nih.gov/30913200/ 7. Ashbrook M, Cheng V, Sandhu K, Matsuo K, Schellenberg M, Inaba K, Matsushima K. Management of Complicated Appendicitis During Pregnancy in the US. JAMA Netw Open. 2022 Apr 1;5(4):e227555. https://pubmed.ncbi.nlm.nih.gov/35426921/ 8. Capella CE, Godovchik J, Chandrasekar T, Al-Kouatly HB. Nonobstetrical Robotic-Assisted Laparoscopic Surgery in Pregnancy: A Systematic Literature Review. Urology. 2021 May;151:58-66. https://pubmed.ncbi.nlm.nih.gov/32445766/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out other Behind the Knife minimally invasive surgery episodes: https://behindtheknife.org/podcast-category/minimally-invasive/

[coup de ❤️] soutenons les AVAC

Sage-Femme Authentique

Play Episode Listen Later Aug 13, 2023 33:17

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168 - Beyond the Controversy: Exploring Efficacy and Safety of Medication Abortion

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

Play Episode Listen Later Jul 18, 2023 45:57

There has been a lot of news about abortion (abortifacient) medications recently. Since the overturn of Roe v. Wade in 2022, individual states passed their own laws restricting access to abortion, this includes access to abortion medications. This clearly impacts the way pharmacists practice. In this episode, we summarize the science behind the two main abortive drugs, mifepristone and misoprostol, and provide a picture of how the access to these medications stand in the United States. Key Concepts Among other modalities to terminate pregnancies, medication abortion is a safe and alternative option that is picking up popularity given recent changes post-Dobbs vs. Jackson WHO decision. The FDA-approved use of combination mifepristone and misoprostol regimen to terminate pregnancy up to 70 days (10 weeks of gestation) is based on strong evidence for its efficacy and safety. Since the overturning of Roe vs. Wade in 2022, states have taken their own action to further restrict or increase access to abortion services including access to medication abortion. These legal changes further impact dispensing of mifepristone and misoprostol by pharmacists across the country adding to more confusion. Legal councils, state boards of pharmacies, or state pharmacy associations may serve as suitable resources to consult regarding these fast-changing laws. References American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology, Society of Family Planning. Medication Abortion Up to 70 Days of Gestation: ACOG Practice Bulletin, Number 225. Obstet Gynecol. 2020 Oct;136(4):e31-e47. doi: 10.1097/AOG.0000000000004082. PMID: 32804884. Kaiser Family Foundation. https://www.kff.org/womens-health-policy/fact-sheet/the-availability-and-use-of-medication-abortion Guttmacher Institute. https://www.guttmacher.org/state-policy/explore/overview-abortion-laws

E228: MDCast w/ Dr. Michael Lauria - Severe Postpartum Hemorrhage

The FlightBridgeED Podcast

Play Episode Listen Later Jul 3, 2023 48:33

This is the first of a special podcast series on obstetric critical care. I am joined on this series by Dr. Elizabeth Garchar, MD, FACOG. She is an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a special interest in obstetric critical care. She is also unique in that she flies regularly with our critical care transport teams and acts as one of our Assistant Medical Directors for the flight program. So, Dr. Garchar has unique insight into managing this population in transport. This podcast focuses on severe postpartum hemorrhage. We discuss the epidemiology and risk factors as well as the nuances of diagnosis, specifically how blood loss is actually quantified in this setting. We also go through the importance of point-of-care ultrasound to help identify and manage the causes of postpartum hemorrhage. Then, we transition to the discussion of management, focusing on the medical management of uterine atony, and also go over advanced interventions such as uterine packing, balloon tamponade devices, and REBOA. Finally, Dr. Garchar discusses the indication and procedure for emergent hysterectomy as well as the post-procedure management critical care transport crews may have to perform. References Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. Oct 2017;130(4):e168-e186. doi:10.1097/aog.0000000000002351 Abdel-Aleem H, Singata M, Abdel-Aleem M, Mshweshwe N, Williams X, Hofmeyr GJ. Uterine massage to reduce postpartum hemorrhage after vaginal delivery. Int J Gynaecol Obstet. Oct 2010;111(1):32-6. doi:10.1016/j.ijgo.2010.04.036 Abul A, Al-Naseem A, Althuwaini A, Al-Muhanna A, Clement NS. Safety and efficacy of intrauterine balloon tamponade vs uterine gauze packing in managing postpartum hemorrhage: A systematic review and meta-analysis. AJOG Glob Rep. Feb 2023;3(1):100135. doi:10.1016/j.xagr.2022.100135 Aibar L, Aguilar MT, Puertas A, Valverde M. Bakri balloon for the management of postpartum hemorrhage. Acta Obstet Gynecol Scand. Apr 2013;92(4):465-7. doi:10.1111/j.1600-0412.2012.01497.x Bagga R, Jain V, Kalra J, Chopra S, Gopalan S. Uterovaginal packing with rolled gauze in postpartum hemorrhage. MedGenMed. Feb 13 2004;6(1):50. Borger van der Burg BLS, van Dongen T, Morrison JJ, et al. A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination. Eur J Trauma Emerg Surg. Aug 2018;44(4):535-550. doi:10.1007/s00068-018-0959-y Castellini G, Gianola S, Biffi A, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysis. World J Emerg Surg. Aug 12 2021;16(1):41. doi:10.1186/s13017-021-00386-9 Collaborators WT. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. May 27 2017;389(10084):2105-2116. doi:10.1016/S0140-6736(17)30638-4 Cunningham FG, Nelson DB. Disseminated Intravascular Coagulation Syndromes in Obstetrics. Obstet Gynecol. Nov 2015;126(5):999-1011. doi:10.1097/AOG.0000000000001110 D'Alton M, Rood K, Simhan H, Goffman D. Profile of the Jada(R) System: the vacuum-induced hemorrhage control device for treating abnormal postpartum uterine bleeding and postpartum hemorrhage. Expert Rev Med Devices. Sep 2021;18(9):849-853. doi:10.1080/17434440.2021.1962288 Dildy GA, 3rd. Postpartum hemorrhage: new management options. Clin Obstet Gynecol. Jun 2002;45(2):330-44. doi:10.1097/00003081-200206000-00005 Dueckelmann AM, Hinkson L, Nonnenmacher A, et al. Uterine packing with chitosan-covered gauze compared to balloon tamponade for managing postpartum hemorrhage. Eur J Obstet Gynecol Reprod Biol. Sep 2019;240:151-155. doi:10.1016/j.ejogrb.2019.06.003 Erez O. Disseminated intravascular coagulation in pregnancy: New insights. Thrombosis Update. 2022;6doi:10.1016/j.tru.2021.100083 Erez O, Mastrolia SA, Thachil J. Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management. Am J Obstet Gynecol. Oct 2015;213(4):452-63. doi:10.1016/j.ajog.2015.03.054 Erez O, Othman M, Rabinovich A, Leron E, Gotsch F, Thachil J. DIC in Pregnancy - Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments. J Blood Med. 2022;13:21-44. doi:10.2147/JBM.S273047 Feng S, Liao Z, Huang H. Effect of prophylactic placement of internal iliac artery balloon catheters on outcomes of women with placenta accreta: an impact study. Anaesthesia. Jul 2017;72(7):853-858. doi:10.1111/anae.13895 Higgins N, Patel SK, Toledo P. Postpartum hemorrhage revisited: new challenges and solutions. Curr Opin Anaesthesiol. Jun 2019;32(3):278-284. doi:10.1097/ACO.0000000000000717 Ji SM, Cho C, Choi G, et al. Successful management of uncontrolled postpartum hemorrhage due to morbidly adherent placenta with Resuscitative endovascular balloon occlusion of the aorta during emergency cesarean section - A case report. Anesth Pain Med (Seoul). Jul 31 2020;15(3):314-318. doi:10.17085/apm.19051 Kellie FJ, Wandabwa JN, Mousa HA, Weeks AD. Mechanical and surgical interventions for treating primary postpartum haemorrhage. Cochrane Database Syst Rev. Jul 1 2020;7(7):CD013663. doi:10.1002/14651858.CD013663 Kogutt BK, Vaught AJ. Postpartum hemorrhage: Blood product management and massive transfusion. Semin Perinatol. Feb 2019;43(1):44-50. doi:10.1053/j.semperi.2018.11.008 Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. Apr 2009;145(1):24-33. doi:10.1111/j.1365-2141.2009.07600.x Liu C, Gao J, Liu J, et al. Predictors of Failed Intrauterine Balloon Tamponade in the Management of Severe Postpartum Hemorrhage. Front Med (Lausanne). 2021;8:656422. doi:10.3389/fmed.2021.656422 Lohano R, Haq G, Kazi S, Sheikh S. Intrauterine balloon tamponade for the control of postpartum haemorrhage. J Pak Med Assoc. Jan 2016;66(1):22-6. Maier RC. Control of postpartum hemorrhage with uterine packing. Am J Obstet Gynecol. Aug 1993;169(2 Pt 1):317-21; discussion 321-3. doi:10.1016/0002-9378(93)90082-t Makin J, Suarez-Rebling DI, Varma Shivkumar P, Tarimo V, Burke TF. Innovative Uses of Condom Uterine Balloon Tamponade for Postpartum Hemorrhage in India and Tanzania. Case Rep Obstet Gynecol. 2018;2018:4952048. doi:10.1155/2018/4952048 Natarajan A, Alaska Pendleton A, Nelson BD, et al. Provider experiences with improvised uterine balloon tamponade for the management of uncontrolled postpartum hemorrhage in Kenya. Int J Gynaecol Obstet. Nov 2016;135(2):210-213. doi:10.1016/j.ijgo.2016.05.006 Natarajan A, Kamara J, Ahn R, et al. Provider experience of uterine balloon tamponade for the management of postpartum hemorrhage in Sierra Leone. Int J Gynaecol Obstet. Jul 2016;134(1):83-6. doi:10.1016/j.ijgo.2015.10.026 Okoye HC, Nwagha TU, Ugwu AO, et al. Diagnosis and treatment of bbstetrics disseminated intravascular coagulation in resource limited settings. Afr Health Sci. Mar 2022;22(1):183-190. doi:10.4314/ahs.v22i1.24 Ordonez CA, Manzano-Nunez R, Parra MW, et al. Prophylactic use of resuscitative endovascular balloon occlusion of the aorta in women with abnormal placentation: A systematic review, meta-analysis, and case series. J Trauma Acute Care Surg. May 2018;84(5):809-818. doi:10.1097/TA.0000000000001821 Papageorgiou C, Jourdi G, Adjambri E, et al. Disseminated Intravascular Coagulation: An Update on Pathogenesis, Diagnosis, and Therapeutic Strategies. Clin Appl Thromb Hemost. Dec 2018;24(9_suppl):8S-28S. doi:10.1177/1076029618806424 Pingray V, Widmer M, Ciapponi A, et al. Effectiveness of uterine tamponade devices for refractory postpartum haemorrhage after vaginal birth: a systematic review. BJOG. Oct 2021;128(11):1732-1743. doi:10.1111/1471-0528.16819 Quandalle A, Ghesquiere L, Kyheng M, et al. Impact of intrauterine balloon tamponade on emergency peripartum hysterectomy following vaginal delivery. Eur J Obstet Gynecol Reprod Biol. Jan 2021;256:125-129. doi:10.1016/j.ejogrb.2020.10.064 Rattray DD, O'Connell CM, Baskett TF. Acute disseminated intravascular coagulation in obstetrics: a tertiary centre population review (1980 to 2009). J Obstet Gynaecol Can. Apr 2012;34(4):341-347. doi:10.1016/S1701-2163(16)35214-8 Revert M, Rozenberg P, Cottenet J, Quantin C. Intrauterine Balloon Tamponade for Severe Postpartum Hemorrhage. Obstet Gynecol. Jan 2018;131(1):143-149. doi:10.1097/AOG.0000000000002405 Sadek S, Lockey DJ, Lendrum RA, Perkins Z, Price J, Davies GE. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the pre-hospital setting: An additional resuscitation option for uncontrolled catastrophic haemorrhage. Resuscitation. Oct 2016;107:135-8. doi:10.1016/j.resuscitation.2016.06.029 Schmid BC, Rezniczek GA, Rolf N, Saade G, Gebauer G, Maul H. Uterine packing with chitosan-covered gauze for control of postpartum hemorrhage. Am J Obstet Gynecol. Sep 2013;209(3):225 e1-5. doi:10.1016/j.ajog.2013.05.055 Shimada K, Taniguchi H, Enomoto K, Umeda S, Abe T, Takeuchi I. Hospital transfer for patients with postpartum hemorrhage in Yokohama, Japan: a single-center descriptive study. Acute Med Surg. Jan-Dec 2021;8(1):e716. doi:10.1002/ams2.716 Simpson KR. Update on Evaluation, Prevention, and Management of Postpartum Hemorrhage. MCN Am J Matern Child Nurs. Mar/Apr 2018;43(2):120. doi:10.1097/NMC.0000000000000406 Singer KE, Morris MC, Blakeman C, et al. Can Resuscitative Endovascular Balloon Occlusion of the Aorta Fly? Assessing Aortic Balloon Performance for Aeromedical Evacuation. J Surg Res. Oct 2020;254:390-397. doi:10.1016/j.jss.2020.05.021 Snyder JA, Schuerer DJE, Bochicchio GV, Hoofnagle MH. When REBOA grows wings: Resuscitative endovascular balloon occlusion of the aorta to facilitate aeromedical transport. Trauma Case Rep. Apr 2022;38:100622. doi:10.1016/j.tcr.2022.100622 Soued M, Vivanti AJ, Smiljkovski D, et al. Efficacy of Intra-Uterine Tamponade Balloon in Post-Partum Hemorrhage after Cesarean Delivery: An Impact Study. J Clin Med. Dec 28 2020;10(1)doi:10.3390/jcm10010081 Stensaeth KH, Sovik E, Haig IN, Skomedal E, Jorgensen A. Fluoroscopy-free Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for controlling life threatening postpartum hemorrhage. PLoS One. 2017;12(3):e0174520. doi:10.1371/journal.pone.0174520 Suarez S, Conde-Agudelo A, Borovac-Pinheiro A, et al. Uterine balloon tamponade for the treatment of postpartum hemorrhage: a systematic review and meta-analysis. Am J Obstet Gynecol. Apr 2020;222(4):293 e1-293 e52. doi:10.1016/j.ajog.2019.11.1287 Theron GB, Mpumlwana V. A case series of post-partum haemorrhage managed using Ellavi uterine balloon tamponade in a rural regional hospital. S Afr Fam Pract (2004). May 11 2021;63(1):e1-e4. doi:10.4102/safp.v63i1.5266 Tran QK, Hollis G, Beher R, et al. Transport of Peripartum Patients for Medical Management: Predictors of Any Intervention During Transport. Cureus. Nov 2022;14(11):e31102. doi:10.7759/cureus.31102 Weir R, Lee J, Almroth S, Taylor J. Flying with a Safety Net: Use of REBOA to Enable Safe Transfer to a Level 1 Trauma Center. Journal of Endovascular Resuscitation and Trauma Management. 2022;5(3)doi:10.26676/jevtm.v5i3.214 Wu Q, Liu Z, Zhao X, et al. Outcome of Pregnancies After Balloon Occlusion of the Infrarenal Abdominal Aorta During Caesarean in 230 Patients With Placenta Praevia Accreta. Cardiovasc Intervent Radiol. Nov 2016;39(11):1573-1579. doi:10.1007/s00270-016-1418-y Zeng KW, Ovenell KJ, Alholm Z, Foley MR. Postpartum Hemorrhage Management and Blood Component Therapy. Obstet Gynecol Clin North Am. Sep 2022;49(3):397-421. doi:10.1016/j.ogc.2022.02.001 See omnystudio.com/listener for privacy information.

Healthcast 635 - Ovarian Cysts: Diagnosis and Treatment After Menopause

biobalancehealth's podcast

Play Episode Listen Later Jun 19, 2023 0:09

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog At Biobalance® Health we often find cysts or masses on the ovaries of women who are menopausal quite by accident. We order an ultrasound before we treat a menopausal woman with estradiol to see if there is a thickened lining that might cause bleeding under the influence of estrogen replacement, or to make sure there is no uterine cancer before we treat a new patient. We also incidentally find ovarian masses or cysts when we are investigating pelvic pain or postmenopausal bleeding on our patients who are already on estrogen replacement. In general, since BioBalance's female patients have their own GYN we don't do pelvic exams in the office, therefore we don't find a mass by palpating (feeling) the pelvic structures, however ovarian cysts and masses can be found by ultrasound as well as by physical exam. We generally find ours by vaginal ultrasound. Why do we get ovarian cysts? Before menopause we make an egg every month (if we are not on birth control) that grows within a fluid filled sack. This egg will grow to about 18 mm, or 1.8 cm before it ruptures and releases the egg. That is the miracle of ovulation. It is normal to see one or two of these small cysts on the ovaries of ovulating, fertile women. These small sacks are not cysts because of their size. Ovarian cysts are fluid filled sacks attached to the ovary that are over 2.5 cm. They often occur secondary to a trapped egg that won't ovulate for some reason, and the cyst will remain until the next period. If the cyst doesn't dissolve before the next cycle, it can grow larger with the surges of hormones and it can prevent future ovulation, or it can cause pain from the stretching of the outer covering of the ovary. If a cyst is less than 2.5 mg. we don't re-ultrasound in cycling women. If it is larger or continues to cause pain, we follow up an ultrasound in 6 weeks to see if it is growing. If it is growing but is still clear, depending on the size and the pain involved, we might do a laparoscopy to remove the cyst from the ovary. If it is growing and looks unusual in shape or density, we order 2 blood tumor markers for ovarian cancer. If those are negative, we follow up with another ultrasound in 3 more months. In some patients, multiple ovarian cysts are the norm. Those patients with polycystic ovaries create multiple cysts each month and rarely ovulate. It helps to use the drug Metformin ER to improve ovulation in PCO patients (and the rupture of cysts). Some patients require laparoscopy to punch holes in all the cysts especially if she is trying to get pregnant. What does a postmenopausal ovarian mass or cyst mean indicate? Now for postmenopausal patient's ovarian cysts and masses are much more worrisome but much rarer. Because the ovary is not metabolically active, and therefore not ovulating the menopausal ovary should look small without cystic structures, however there are some exceptions! The menopausal ovary that has a fluid filled cyst 2.5 cm or less can have been there since the patient stopped ovulating and it never deflated, or ovulated. This type of cyst doesn't grow and is not malignant. Ovarian cysts in postmenopausal women that are fluid filled and larger than 2.5 cm, or solid, or partially fluid filled and partially solid are suspicious for malignancy. In this case your doctor may order an MRI, a CT scan of the pelvis, and order cancer tumor markers. In most cases these masses are benign, or early in a malignancy and can be treated with surgery. Sometimes we find a suspicious mass that needs confirmatory ultrasound or MRI by a GYN Oncologist, tumor markers, and surgery would be scheduled to take the uterus tubes and ovaries and sometimes the omentum and lymph nodes. When will a patient know that her mass if not malignant and if she needs surgery? The surgeon may do a frozen section in the operating room to see if more than the ovary itself must be removed or your GYN may wait for the final pathology report to determine if it is malignant. That takes several days to a week. How common is ovarian cancer? Ovarian cancer is very rare and tends to run in families. If you have not had a relative with ovarian cancer, then you are not likely to have ovarian cancer if you have a suspicious mass. That does not mean you won't' need surgery, it just means the outcome has a high chance of being benign. What can be mistaken for an ovarian mass on ultrasound? There are several pelvic structures that might be confused with an ovarian cyst/mass. The most common is a pedunculated fibroid that hangs down from the uterus and looks like it is coming from the ovary. These muscle masses from the ovary are generally benign, but they can grow under the influence of estrogens. There are cysts called para-ovarian cysts that can originate from the fallopian tube. They are fluid filled and can actually grow, looking like an ovarian mass, but they are benign, and most are sedentary and don't grow or become a problem. In my 25 years of operating on women I only had one of the next types of cysts that was thought to be a malignancy at first. It was a very large cyst, 12x 12 inches in diameter and I asked a general surgeon to come in and work with me to help with the surgery if it was a malignancy. In the end, it was a cyst in the retroperitoneal space, called a peritoneal cyst, that was totally benign, and the patient did not require any further treatment after the surgery. Postmenopausal women who have had an ovarian cyst or ovarian mass you know that it can be an anxiety producing situation, however the great majority of the simple ovarian cysts in postmenopausal women are benign and surgery is not necessary. Most ovarian cysts are likely to remain unchanged or disappear during the follow-up period. The malignancy rate of these cysts is about 1 in 10,000, so worry is usually unnecessary. In my 25 years of private practice, I only operated on 5 patients with an ovarian cyst or mass that turned out to be malignant. As gynecologic surgeons we are trained to investigate any ovarian cysts that are suspicious through ultrasound, or surgically even if there is a very slight chance that they might be malignant. We are expected to remove any ovary that is suspected to be cancer, even if the chance is minimal that the cyst is malignant. In our practice we send all our patients with suspicious ovarian masses to their gynecologist for evaluation and treatment. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. Practice Bulletin No. 174: evaluation and management of adnexal masses. Obstet Gynecol 2016;128:e210–e226. doi: 10.1097/AOG.0000000000001768

treatments committee diagnosis menopause mri american colleges obstetricians gynecologists ovarian cancer gyn ovarian pco aog ovarian cysts postmenopausal obstet gynecol healthcast

Episode 139: What is PCOS

Rio Bravo qWeek

Play Episode Listen Later May 22, 2023 22:00

Episode 139: What is PCOS Future Dr. Salimi explains the pathophysiology, signs, and symptoms of PCOS. Diagnostic criteria and the basics of treatment are also discussed. Dr. Arreaza adds some comments about the treatment of obesity. Written by Elika Salimi, MS3, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Hello there! My name is Elika and I am a third-year medical student at Western University of Health Sciences. Today I will be talking to you about polycystic ovary syndrome AKA PCOS.Do you have a female patient in her reproductive years with irregular menstrual cycles, or no menstrual cycles at all? Is she unable to conceive a child? Did she have an unexpected diagnosis of diabetes? Does she have more acne than she would like, or has hair in unwanted or unexpected areas such as her chin?Does she have a hard time losing weight? If you answered YES to many of these questions, it is possible that your patient is suffering from polycystic ovary syndrome also known as PCOS, which is one of the most common endocrine disorders in women. Pathophysiology:The exact pathophysiology behind this syndrome is unknown; however, per the American College of Obstetricians and Gynecologists committee, some studies have shown a strong association between PCOS and obesity. In a woman with obesity disorder, the excess adipose tissue ends up increasing peripheral estrogen synthesis and as a result, there is a decrease in peripheral sensitivity to insulin which means many of these women tend to have hyperinsulinemia. To be more detailed, it is important to mention that during these anovulatory cycles, the increase in estrogen, which is also unopposed estrogen with a lack of progesterone, can lead to endometrial hyperplasia and consequently increase the risk of endometrial carcinoma.Clinical Features: Unless there is a clear history and physical or if perhaps there was an incidental ultrasound finding of polycystic ovaries, the diagnosis of PCOS is not exactly black-and-white. That is why it is important to increase awareness so that women can put the pieces of the puzzle together and come in to get evaluated. Multiple cysts in ovaries can present in patients without PCOS, and they are common in teenagers. To use the multiple cysts as part of the diagnosis, the patient has to be 2 years after menarche (AAFP). Some of these clinical symptoms typically start during adolescence displaying menstrual irregularities such as she could've had her period and then stopped getting it or she has a very delayed onset of her menstrual cycle. It is also possible to have spotty menstrual cycles also known as breakthrough bleeding or menorrhagia. And very important to many women, she could be infertile or have difficulties conceiving.She could also have diabetes because of insulin resistance that comes with the metabolic syndrome that develops with PCOS, which is also increased if she has obesity. This obesity disorder going hand in hand with the metabolic syndrome, can also increase the risk of having sleep apnea, which could affect the quality of her sleep, finding herself more fatigued than she should be after adequate hours of rest. Other symptoms include skin conditions such as hirsutism which is basically male pattern hair growth in women in areas such as the upper lip, chin, around the umbilicus, back, or even buttocks. She could also have male pattern hair loss on the head or too much acne or oily skin or acanthosis nigricans which are these brown/velvety hyperpigmented streaks on the neck or axilla, or groin. She could also find herself more depressed or anxious.Diagnosis:The diagnostic criteria and treatments are mainly addressed in the Journal of Clinical Endocrinology & Metabolism, an evidence-based guideline for the assessment and management of polycystic ovary syndrome, and the American Family Physician Journal:The diagnosis of PCOS requires the presence of at least two criteria that are not due to any other endocrine disorder such as thyroid disease or hyperprolactinemia, or other. 1) Periods of oligo-ovulation and or anovulation which means she's either having very low ovulatory cycles or she's not ovulating at all. 2) hyperandrogenism and this could be based on her clinical features or laboratory studies showing elevated testosterone levels or LH to FSH ratio and 3) Seeing enlarged and/or polycystic ovaries on a pelvic ultrasound. This means that the pelvic ultrasound shows an ovarian volume of equal to or greater than 10 mL and/or there's multiple cystic follicles that are about 2 to 9 mm in one or both of her ovaries which also usually tend to have a string of pearls appearance.So, if you have 2 out of the 3, you have PCOS. There are ways to confirm that there is in fact hyperandrogenism by doing lab studies and this could mean that her testosterone levels are elevated, or her androstenedione is elevated as well as elevated dehydro-epi-androsterone sulfate (DHEAS) and of course we need to rule out pregnancy and other endocrine disorders as I mentioned earlier. However, if the clinical picture of hyperandrogenism is there then that fulfills the diagnostic criteria for PCOS even if the serum antigen levels are normal. This also applies to an elevated LH:FSH ratio of typically greater than 2 to 1 which is also a characteristic finding of most patients with PCOS but this is not exactly necessary for diagnosis. We also don't need to find cystic follicles in order to diagnose PCOS. Treatment: In family medicine practices and even OB/GYN practice for PCOS the most common recommendation for all patients is to encourage them to increase their physical activity (exercise) and eat healthy and try to consider behavioral modifications to have a target BMI of ideally less than 25 kg/m² because this can reduce estrone production in adipose tissue.Then we are thinking about ways to treat patients who are not planning to conceive versus those that are. For those patients that are not planning to conceive the goal is to regulate their menstrual cycles and irregularities as well as their hyperandrogenism and to treat the comorbidities as well to overall improve their quality of life.The first line treatment for hyperandrogenism to try to regulate menstrual cycle abnormalities is combined oral contraceptives also known as birth control pills. This also reduces endometrial hyperplasia which in turn can decrease the risk of endometrial carcinoma as mentioned earlier and it can reduce menstrual bleeding and you can reduce acne and try to assist with the hirsutism as well. As mentioned earlier, PCOS can also go hand-in-hand with insulin resistance or hyperinsulinemia and therefore we can also use metformin that can improve menstrual irregularities but also address the metabolic side of this as well. Summary: Diet, exercise, combined oral contraceptives, and metformin.Some other more controversial medications to treat hyperandrogenism could be potassium-sparing diuretics such as spironolactone that also inhibits 17-a-hydroxylase or finasteride which is a 5-alpha-reductase inhibitor and flutamide which is an androgen receptor blocker. The mentioned examples are typically for those people that can't really tolerate combined oral contraceptives. Other things to consider for those that are suffering from obesity syndrome are to possibly consider bariatric surgery if of course the criteria are met, and this is on a case-by-case basis. Bariatric surgery may be an answer to many of our metabolic problems that's why it is now called metabolic surgery. For patients who are planning to conceive the goal is to manage their comorbidities such as weight loss but also to try to induce ovulation.Now the first-line therapy for inducing ovulation is a medication called letrozole which is an aromatase inhibitor that in turn reduces estrogen production stimulating FSH secretion and ultimately inducing ovulation, not to get too heavily into the weeds of how these medications work, but basically it improves pregnancy and live birth rate outcomes in patients who are infertile because of the fact that they have anovulatory cycles or a.k.a. they are not ovulating.Then we also have clomiphene which is just an alternative to letrozole and has a different mechanism of action but it also stimulates ovulation by more particularly causing a pulsatile secretion of GnRH and in turn increasing FSH and LH as well, and this medication might be actually preferred over metformin monotherapy in women that are suffering from obesity syndrome who also have anovulatory infertility. However, apparently, clomiphene can cause more chance of multiple gestations versus letrozole.Also, letrozole is preferred over clomiphene to induce ovulation because of a higher rate of live births, but we have the risk of multiple pregnancies with both these methods. Let's talk about the second-line therapies.As mentioned earlier we have this 2 to 1 ratio of FSH to LH in women with PCOS or at least a good amount of them. We said that that is not required to diagnose this disorder but we can also give women exogenous FSH plus human menopausal gonadotropin, but this is really a second-line treatment for ovulation induction and typically we go for second-line treatments if first-line therapies aren't successful. But I will mention that using this exogenous gonadotropin is very expensive and it requires you to have access to specialized healthcare facilities and constant ultrasound monitoring so this may just not be feasible for many people but if you have the resources and it's affordable for you then exogenous gonadotropins are actually preferred over clomiphene and metformin therapy.Metformin can also use as a second-line monotherapy for fertility treatments and this in combination with clomiphene can increase pregnancy rates, especially in women who are suffering from obesity disorder, and of course, this is first-line therapy for insulin resistance.Now if we're talking about an invasive type of procedure for infertility it would be laparoscopic ovarian drilling which basically, we use a laser beam or surgical needle to reduce ovarian tissue to decrease its volume and try to reduce androgen production. Doing this can cause a hormone shift that can induce FSH secretion and ultimately improve ovarian function as well. This is also a second-line treatment for ovulation induction, but it can be performed as a first line if other indications for laparoscopy are present. Third-line therapy would be in vitro fertilization which means that basically we take mature eggs from ovaries and then we fertilize them with sperm in a lab and then the fertilized egg or the embryo is transferred to a uterus to be implanted.For the management of hirsutism, the first-line therapy is usually non-pharmacological and that's electrolysis or light-based hair removal with laser or photo-epilation. For acne, we can consider benzoyl peroxide or topical antibiotics if necessary.Final thoughts: Now I know that was a ton of information but ultimately, we are trying to make women more aware of PCOS and let them know that they are not alone, also we are trying to reduce complications such as cardiovascular problems, diabetes, endometrial cancer, infertility or even pregnancy loss. The best we can do is try to educate more women because many are suffering from this condition and they have no idea. Again, my name is Elika Salimi, and I am a third-year medical student. If you have any questions, you can reach me at elika.salimi@westernu.edu.___________________________Conclusion: Now we conclude episode number 139, “What is PCOS.” Future Dr. Salimi explained that patients with Polycystic Ovary Syndrome present with: Hyperandrogenism, Oligo-ovulation or anovulation, and multiple cysts in ovaries. If your patient meets 2 out of the 3 criteria, then you can confidently give the diagnosis of PCOS. Dr. Arreaza reminded us that by treating obesity you are also treating PCOS. This week we thank Hector Arreaza and Elika Salimi. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology..ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome..Obstet Gynecol.2018; 131(6): p.e157-e171.doi:10.1097/AOG.0000000000002656Hoeger KM, Dokras A, Piltonen T.Update on PCOS: Consequences, Challenges, and Guiding Treatment.The Journal of Clinical Endocrinology & Metabolism.2020; 106(3): p.e1071-e1083.doi:10.1210/clinem/dgaa839Williams T, Mortada R, Porter S.Diagnosis and Treatment of Polycystic Ovary Syndrome..Am Fam Physician.2016; 94(2): p.106-13.pmid: 27419327.Legro RS, Arslanian SA, Ehrmann DA, et al.Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline.J Clin Endocrinol Metab.2013; 98(12): p.4565-4592.doi:10.1210/jc.2013-2350.International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018.https://www.monash.edu/__data/assets/pdf_file/0004/1412644/PCOS_Evidence-Based-Guidelines_20181009.pdf

Normal Labor

philadelphia normal labor approaches american colleges obstetricians gynecologists elsevier obstet gynecol gabbe

Play Episode Listen Later Mar 27, 2023 32:22

Sarena and Theresa discuss normal labor with Dr. David Marzano. 00:34 Dr. Marzano Biography 02:44 Case 1: 26yo G2P1 at 39w3d presenting to triage with contractions 09:20 Case 2: 32yo G3P2 at 39w6d is admitted to L&D in spontaneous labor 17:52 Case 3: 38yo G2P1 at 40w5d delivers a healthy baby boy Transcript: https://bit.ly/Ultrasounds_Labor Resources: Mark B., Landon et al. 2021. Gabbe's Obstetrics: Normal and Problem Pregnancies. Philadelphia, PA, Elsevier. Approaches to limit intervention during labor and birth. ACOG Committee Opinion No. 766. American College of Obstetricians and Gynecologists. Obstet Gynecol 2019;133:e164–73.

Colorado Wants to GAG Pregnancy Centers and BAN Abortion Pill Reversal!

Christian Podcast Community

Play Episode Listen Later Mar 20, 2023 79:59

We found out last Monday evening that the Colorado legislature is ramming through a package of three radical pro-abortion bills: SB23-188, SB23-189, and SB23-190.The most dangerous and impacting to pregnancy resource centers is SB23-190: Deceptive Trade Practice Pregnancy-related Service. The language of this bill could penalize pregnancy centers for trying to advertise their services to help pregnant women in crisis. Even more devastating is a clear ban on any means of offering anything intending to reverse an abortion pill.Chelsea and I spent this last week engaged in this battle. Tuesday evening we were working on Chelsea's testimony for the judiciary committee on Wednesday. Thursday and Friday we worked on information to send out to legislators about this bill.In this episode we play Chelsea's testimony in the bill committee. We also play some salient points from other testimonies. In particular, we respond to some of the testimony of Dr. Mitchell Creinin, who conducted the world-renowned "inconclusive" clinical trial on abortion pill reversal. Dr. Creinin concludes that the practice is unproven and "medical fraud."We also played clips from other medical professionals who disputed Dr. Creinin's claims.If you are listening to this episode the day it is released, March 19, 2023, the bill is at the Colorado Senate floor and will voted on today. Prayers for this situation are very much appreciated.Update: Senate floor debate for these bills has been moved to the next day, Tuesday, March 21.Scriptures Referenced:Proverbs 14:27Sources Consulted:Colorado Senate Judiciary [March 15, 2023 - Upon Adjournment] [Recording]Delgado G, Condly SJ, Davenport M, Tinnakornsrisuphap T, Mack J, Khauv V, Zhou PS. A case series detailing the successful reversal of the effects of mifepristone using progesterone. Issues Law Med. 2018 Spring;33(1):21-31. PMID: 30831017. [Full study PDF]Creinin MD, Hou MY, Dalton L, Steward R, Chen MJ. Mifepristone Antagonization With Progesterone to Prevent Medical Abortion: A Randomized Controlled Trial. Obstet Gynecol. 2020 Jan;135(1):158-165. doi: 10.1097/AOG.0000000000003620. PMID: 31809439. [Full study PDF]Wahabi HA, Fayed AA, Esmaeil SA, Bahkali KH. Progestogen for treating threatened miscarriage. Cochrane Database Syst Rev. 2018 Aug 6;8(8):CD005943. doi: 10.1002/14651858.CD005943.pub5. PMID: 30081430; PMCID: PMC6513446. [Full study PDF]Kooistra B, Dijkman B, Einhorn TA, Bhandari M. How...

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Colorado Wants to GAG Pregnancy Centers and BAN Abortion Pill Reversal!

Christian Podcast Community

Play Episode Listen Later Mar 20, 2023 79:59

We found out last Monday evening that the Colorado legislature is ramming through a package of three radical pro-abortion bills: SB23-188, SB23-189, and SB23-190. The most dangerous and impacting to pregnancy resource centers is SB23-190: Deceptive Trade Practice Pregnancy-related Service. The language of this bill could penalize pregnancy centers for trying to advertise their services to help pregnant women in crisis. Even more devastating is a clear ban on any means of offering anything intending to reverse an abortion pill. Chelsea and I spent this last week engaged in this battle. Tuesday evening we working on Chelsea's testimony for the judiciary committee on Wednesday. Thursday and Friday we worked on information to send out to legislators about this bill. In this episode we play Chelsea's testimony in the bill committee. We also play some salient points from other testimonies. In particular, we respond to some of the testimony of Dr. Mitchell Creinin, who conducted the world-renowned "inconclusive" clinical trial on abortion pill reversal. Dr. Creinin concludes that the practice is unproven and "medical fraud." We also played clips from other medical professionals who disputed Dr. Creinin's claims. If you are listening to this episode the day it is released, March 19, 2023, the bill is at the Colorado Senate floor and will voted on today. Prayers for this situation are very much appreciated. Update: Senate floor debate for these bills has been moved to the next day, Tuesday, March 21. Scriptures Referenced: Proverbs 14:27 Sources Consulted: Colorado Senate Judiciary [March 15, 2023 - Upon Adjournment] [Recording] Delgado G, Condly SJ, Davenport M, Tinnakornsrisuphap T, Mack J, Khauv V, Zhou PS. A case series detailing the successful reversal of the effects of mifepristone using progesterone. Issues Law Med. 2018 Spring;33(1):21-31. PMID: 30831017. [Full study PDF] Creinin MD, Hou MY, Dalton L, Steward R, Chen MJ. Mifepristone Antagonization With Progesterone to Prevent Medical Abortion: A Randomized Controlled Trial. Obstet Gynecol. 2020 Jan;135(1):158-165. doi: 10.1097/AOG.0000000000003620. PMID: 31809439. [Full study PDF] Wahabi HA, Fayed AA, Esmaeil SA, Bahkali KH. Progestogen for treating threatened miscarriage. Cochrane Database Syst Rev. 2018 Aug 6;8(8):CD005943. doi: 10.1002/14651858.CD005943.pub5. PMID: 30081430; PMCID: PMC6513446. [Full study PDF] Kooistra B, Dijkman B, Einhorn TA, Bhandari M. How to design a good case series. J Bone Joint Surg Am. 2009 May;91 Suppl 3:21-6. doi: 10.2106/JBJS.H.01573. PMID: 19411496. Dalziel K, Round A, Stein K, Garside R, Castelnuovo E, Payne L. Do the findings of case series studies vary significantly according to methodological characteristics? Health Technol Assess. 2005 Jan;9(2):iii-iv, 1-146. doi: 10.3310/hta9020. PMID: 15588556. Abortion Pill Reversal Helpline Heartbeat International

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Colorado Wants to GAG Pregnancy Centers and BAN Abortion Pill Reversal!

Truthspresso

Play Episode Listen Later Mar 20, 2023 79:59

We found out last Monday evening that the Colorado legislature is ramming through a package of three radical pro-abortion bills: SB23-188, SB23-189, and SB23-190.The most dangerous and impacting to pregnancy resource centers is SB23-190: Deceptive Trade Practice Pregnancy-related Service. The language of this bill could penalize pregnancy centers for trying to advertise their services to help pregnant women in crisis. Even more devastating is a clear ban on any means of offering anything intending to reverse an abortion pill.Chelsea and I spent this last week engaged in this battle. Tuesday evening we were working on Chelsea's testimony for the judiciary committee on Wednesday. Thursday and Friday we worked on information to send out to legislators about this bill.In this episode we play Chelsea's testimony in the bill committee. We also play some salient points from other testimonies. In particular, we respond to some of the testimony of Dr. Mitchell Creinin, who conducted the world-renowned "inconclusive" clinical trial on abortion pill reversal. Dr. Creinin concludes that the practice is unproven and "medical fraud."We also played clips from other medical professionals who disputed Dr. Creinin's claims.If you are listening to this episode the day it is released, March 19, 2023, the bill is at the Colorado Senate floor and will voted on today. Prayers for this situation are very much appreciated.Update: Senate floor debate for these bills has been moved to the next day, Tuesday, March 21.Scriptures Referenced:Proverbs 14:27Sources Consulted:Colorado Senate Judiciary [March 15, 2023 - Upon Adjournment] [Recording]Delgado G, Condly SJ, Davenport M, Tinnakornsrisuphap T, Mack J, Khauv V, Zhou PS. A case series detailing the successful reversal of the effects of mifepristone using progesterone. Issues Law Med. 2018 Spring;33(1):21-31. PMID: 30831017. [Full study PDF]Creinin MD, Hou MY, Dalton L, Steward R, Chen MJ. Mifepristone Antagonization With Progesterone to Prevent Medical Abortion: A Randomized Controlled Trial. Obstet Gynecol. 2020 Jan;135(1):158-165. doi: 10.1097/AOG.0000000000003620. PMID: 31809439. [Full study PDF]Wahabi HA, Fayed AA, Esmaeil SA, Bahkali KH. Progestogen for treating threatened miscarriage. Cochrane Database Syst Rev. 2018 Aug 6;8(8):CD005943. doi: 10.1002/14651858.CD005943.pub5. PMID: 30081430; PMCID: PMC6513446. [Full study PDF]Kooistra B, Dijkman B, Einhorn TA, Bhandari M. How...

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Perinatal Mental Health Part 2

Play Episode Listen Later Mar 14, 2023 18:53

Brittany and Jordan continue their discussion with Dr. Mahela Ashraf on perinatal mood disorders. 00:46 Case 1: A 31 year old G2P2 comes in to clinic for her 6 week postpartum visit. 08:50 Case 2: The patient in the previous vignette is interested in starting an SSRI to treat her anxiety. Transcript: https://tinyurl.com/UltrasoundsPerinatalMH2 Berens, Pamela. “Overview of the Postpartum Period: Disorders and Complications.” Edited by Charles Lockwood and Vanessa Barss, UpToDate, 6 Sept. 2022, https://www.uptodate.com/contents/overview-of-the-postpartum-period-disorders-and-complications?search=postpartum+anxiety&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H352546182. Lanza di Scalea T, Wisner KL. Antidepressant medication use during breastfeeding. Clin Obstet Gynecol. 2009 Sep;52(3):483-97. doi: 10.1097/GRF.0b013e3181b52bd6. PMID: 19661763; PMCID: PMC2902256. Use of psychiatric medications during pregnancy and lactation. ACOG Practice Bulletin No. 92. American College of Obstetricians and Gynecologists. Obstet Gynecol 2008;111:1001–20.

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EBB 258 - A Hospital Waterbirth Story with Cord Avulsion featuring EBB Childbirth Class Graduate, Samantha Reisz, PhD.

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Play Episode Listen Later Mar 8, 2023 44:49

In this episode we talk with Samantha Reisz, EBB Childbirth Class graduate about her experiences taking the class and preparing for a waterbirth in a hospital with her “Golden Ticket” birth team, who were skilled and prepared to manage a placental cord avulsion also known as cord snapping. Samantha Reisz, she/her, is a Scholarly Assistant Professor of Human Development at Washington State University in Vancouver, Washington, just outside of the Portland, Oregon area. She completed her bachelor's in Psychology and master's in Infant Mental Health from Mills College in Oakland, California when she first began studying childbirth. Samantha then earned her PhD in Human Development and Family Sciences from the University of Texas at Austin, where she studied infant parent relationships and the transition to parenthood. Samantha is a passionate scholar and educator. After years of studying these topics academically, she finally was able to live her own research with the birth of her first child. Samantha lives in Vancouver, Washington with her baby, partner, and two dogs. Samantha shares how she prepared to give birth for the first time with the use of a doula who recommended the EBB Childbirth Course. Samantha and her partner planned for a waterbirth in a hospital with an OBGYN attending the birth. After experiencing the beautiful waterbirth she had desired, complications arose in the 3rd stage with a placental cord avulsion. Her “Golden Ticket Birth Team” was skilled and prepared to support her through this experience. Content & Trigger warning: complications in the third stage of labor, active management of the third phase, umbilical cord snapping or avulsion, excessive blood loss Resources: Find out more about Samantha's work and research here. Find out about Scarlett Lynsky's EBB Childbirth Education class here and listen to her EBB Podcast interview here. Read the EBB Sigature Article on The Evidence on Waterbirth here Read the EBB Signature Article on Eating & Drinking here Listen to the EBB Natural Induction series here Find out more about the Evidence on Nitrous Oxide in EBB Episode 15 here Listen to all the EBB Podcast Episodes on Waterbirth and Cord Avulsion: Find EBB 4 – Waterbirth and the Newborn Microbiome here Find EBB 11 – Evidence on: Waterbirth here Find EBB 202 - A Fast First Time Birth Expereince with Childbirth Class Graduate, Haley Grachico here Find EBB 223 – An Empowering Hospital Water Birth Story with Samantha Parker and Justin Fontaine here Find EBB 230 – An Inspirational Home Waterbirth Story with EBB Childbirth Class Parent Shelitha Owens here Go to our YouTube channel to see video versions of the episode listed above!! References: Bovbjerg, M.L., Cheyney, M., Caughey, A. B. (2022). “Maternal and neonatal outcomes following waterbirth: a cohort study of 17,530 waterbirths and 17,530 propensity score-matched land births.” BJOG 129 (6): 950-958. Access the article here Burns, E. E., Boulton, M.G., Cluett, E., et al. (2012). “Characteristics, interventions, and outcomes of women who used a birthing pool: a prospective observational study.” Birth 39(3): 192-202. Access the article here Schafer, R. (2014). “Umbilical cord avulsion in waterbirth.” J Midwifery Womens Health 59(1): 91-94. Access the article here Sidebottom, A.C., Vacquier, M., Simon, K., et al. (2020). “Maternal and neonatal outcomes in hospital-based deliveries with water immersion.” Obstet GYnecol 136(4): 707-715. Access the article here For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on: TikTok Instagram Pinterest Ready to get involved? Check out our Professional membership (including scholarship options) here Find an EBB Instructor here Click here to learn more about the Evidence Based Birth® Childbirth Class.

EP004 Soutenons les AVAC

Sage-Femme Authentique

Play Episode Listen Later Mar 5, 2023 30:50

Un AVAC c'est un Accouchement Vaginal Après Cesarienne. Quel sont les enjeux de ces naissances? Le besoin des femmes d'enfanter dans leur pleine puissante et de vivre pleinement une naissance après une césarienne. aujourd'hui je vous donne des informations concrête sur comment mettre toutes les chances du côté des femmes qui souhaitent vivre une naissance voie basse après avoir eu une césarienne. voici quelques pistes de lecture: Cesarienne: questions, effets et enjeux. Michel ODENT Une autre césarienne ou un AVAC?: s'informer pour mieux décider Hélène VADEBONCOEUR site internet: https://www.cesarine.org https://naitreetgrandir.com liens des études: PubMed 15516382Lieberman E, Ernst EK, Rooks JP, Stapleton S, Flamm B. Results of the national study of vaginal birth after cesarean in birth centers. Obstet Gynecol. 2004 Nov;104(5 Pt 1):933-42. PubMed 11958242Diaz SD, Jones JE, Seryakov M, Mann WJ. South Med J. Uterine rupture and dehiscence: ten-year review and case-control study. 2002 Apr;95(4):431-5. CNGOF RPC utérus cicatriciel, 2012 - texte completCollège National des Gynécologues et Obstétriciens Français. Recommandations pour la pratique clinique : Accouchement en cas d'utérus cicatriciel (2012) Si ce sujet vous a parlé et que vous souhaitez encore en discuter, je vous invite à échanger que ce soit sur nos réseaux ou par e-mail. De même si vous souhaitez témoigner, partager ou me partager des sujets que vous aimeriez que je développe: Melyssa.chambard@gmail.com Pour suivre la Bulle Maison de naissance sur les réseaux : https://www.facebook.com/labulle.mdn https://www.instagram.com/labulle.mdn/?hl=fr www.la-bulle.be pour le salon naitre et grandir en douceur voici le lien de l'évènement: https://www.facebook.com/events/1123502041656628 Hébergé par Ausha. Visitez ausha.co/politique-de-confidentialite pour plus d'informations.

Perinatal Mental Health Part 1

Play Episode Listen Later Feb 27, 2023 15:28

Survey: https://bit.ly/feedback_UltraSounds Brittany and Jordan discuss perinatal mood disorders with Dr. Mahela Ashraf. 00:43 Dr. Ashraf Biography 02:16 Case: 23 year old G1P1 comes into clinic for her 6 week postpartum visit Transcript: https://tinyurl.com/UltrasoundsPerinatalMH Berens, Pamela. “Overview of the Postpartum Period: Disorders and Complications.” Edited by Charles Lockwood and Vanessa Barss, UpToDate, 6 Sept. 2022, https://www.uptodate.com/contents/overview-of-the-postpartum-period-disorders-and-complications?search=postpartum+anxiety&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H352546182. Lanza di Scalea T, Wisner KL. Antidepressant medication use during breastfeeding. Clin Obstet Gynecol. 2009 Sep;52(3):483-97. doi: 10.1097/GRF.0b013e3181b52bd6. PMID: 19661763; PMCID: PMC2902256. Use of psychiatric medications during pregnancy and lactation. ACOG Practice Bulletin No. 92. American College of Obstetricians and Gynecologists. Obstet Gynecol 2008;111:1001–20.

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Ep. 14 Cosmetic Gynecology with Dr. Cheryl Iglesia

Play Episode Listen Later Feb 16, 2023 48:26

In this episode, Dr. Mark Hoffman invites Dr. Cheryl Iglesia to shed light on the topic of cosmetic gynecology. --- SHOW NOTES Dr. Iglesia is the Director of the Section of Female Pelvic Medicine and Reconstructive Surgery at MedStar Washington Hospital Center, as well the current President of the Society of Gynecologic Surgeons. In addition to being involved with a consensus document regarding cosmetic gynecology, Dr. Iglesia has contributed numerous studies to the growing field and hopes to educate other providers on the topic. The episode begins with Dr. Iglesia sharing how she became passionate about cosmetic gynecology. Her experience initially began with a weekend course in California learning about topics such as “laser vaginal rejuvenation” and “designer laser vaginoplasty,” which were early marketing terms used for the field. After multiple years of training and education within a field filled with gray areas and limited evidence-based medicine, she later helped develop a consensus document about cosmetic gynecology procedures, which provides clarification for patients and opportunity for future research studies. Dr. Iglesia then describes the field of cosmetic gynecology, which includes the elective intervention to alter the aesthetic appearance of the external genitalia or modify the genital organs. These elective, functional procedures may be performed in the absence of any pathology (e.g., no incontinence, prolapse, etc.) with the goal of improving a person's quality of life (e.g., sexual function). She describes two pillars of the field, including cosmetic (e.g., labiaplasty) versus functional (e.g., surgical tightening of the vagina for vaginal laxity) procedures. The physicians then address the concerns of societal pressure, agreeing that the goal is to help patients make well-informed, ethical decisions, which requires discussing goals with patients. After discussing the field as a whole, Dr. Iglesia then highlights different procedures and technologies. For example, a fractionated laser may be used to stimulate tissue growth and may be utilized for diagnosis such as genitourinary syndrome (GSM) of menopause or lichen sclerosis. In addition, she briefly mentions aesthetic procedures, including a clitoral frenulum reduction (frenulectomy) or clitoral amplification with platelet rich plasma or the O-Shot. She addresses that a lot of the procedures and technologies are proprietary, have limited evidence, and are not risk-free. Ultimately, Dr. Iglesia states that there is a need for more data, urging the need for future level I trials. --- RESOURCES Developed by the Joint Writing Group of the International Urogynecological Association and the American Urogynecologic Society. Joint Report on Terminology for Cosmetic Gynecology. Int Urogynecol J. 2022 Jun;33(6):1367-1386. Li FG, Maheux-Lacroix S, Deans R, Nesbitt-Hawes E, Budden A, Nguyen K, Lim CY, Song S, McCormack L, Lyons SD, Segelov E, Abbott JA. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Symptom Severity in Women With Postmenopausal Vaginal Symptoms: A Randomized Clinical Trial. JAMA. 2021 Oct 12;326(14):1381-1389. Paraiso MFR, Ferrando CA, Sokol ER, Rardin CR, Matthews CA, Karram MM, Iglesia CB. A randomized clinical trial comparing vaginal laser therapy to vaginal estrogen therapy in women with genitourinary syndrome of menopause: The VeLVET Trial. Menopause. 2020 Jan;27(1):50-56. Burkett LS, Siddique M, Zeymo A, Brunn EA, Gutman RE, Park AJ, Iglesia CB. Clobetasol Compared With Fractionated Carbon Dioxide Laser for Lichen Sclerosus: A Randomized Controlled Trial. Obstet Gynecol. 2021 Jun 1;137(6):968-978. Cosmetic Gynecology and the Elusive Quest for the “Perfect” Vagina: https://journals.lww.com/greenjournal/Citation/2012/10000/Cosmetic_Gynecology_and_the_Elusive_Quest_for_the.34.aspx

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Multifetal Pregnancies

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Play Episode Listen Later Feb 13, 2023 32:18

Survey: https://bit.ly/feedback_UltraSounds Sarena and Theresa discuss multifetal pregnancies and potential complications with Dr. Alissa Carver. 0:33 Dr. Carver Bio 2:54 25 year old G1P0 at 27 weeks with a risk of cord entanglement 10:38 36 year old G2P1 at 8 weeks with twins at first ultrasounds 21:34 28 year old G1P0 at 9 weeks with di-di twins Transcript: bit.ly/Ultrasounds_multiples American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics, Society for Maternal-Fetal Medicine. Multifetal Gestations: Twin, Triplet, and Higher-Order Multifetal Pregnancies: ACOG Practice Bulletin, Number 231. Obstet Gynecol. 2021 Jun 1;137(6):e145-e162. American Society for Reproductive Medicine, Multiple Pregnancy and Birth: Twins, Triplets, and High Order Multiples Borse V, Shanks AL. Twin-To-Twin Transfusion Syndrome. 2022 Oct 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.

BrainWaves #129 Neurologic complications of pregnancy

MedLink Neurology Podcast

Play Episode Listen Later Feb 2, 2023 30:20

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: January 17, 2019 For such a thrilling time in a woman's life, pregnancy can be a frightening experience for some. As a physician, I'm always a little more on edge when dealing with these patients. This week on BrainWaves, Dr. Jonathan Edlow (Emergency Medicine) of Beth Israel Deaconness Medical Center shares his experience in treating neuromedical complications in this unique patient population. Produced by Jonathan Edlow and James E Siegler. Music by Daniel Birch, Ian Southerland, Kevin McLeod, and John Bartmann. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @BrainWavesaudio for the latest updates to the podcast. REFERENCES Chen MM, Coakley FV, Kaimal A, Laros RK Jr. Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol 2008;112(2 Pt 1):333-40. PMID 18669732Edlow AG, Edlow BL, Edlow JA. Diagnosis of acute neurologic emergencies in pregnant and postpartum women. Emerg Med Clin North Am 2016;34(4):943-65. PMID 27741996Edlow JA, Caplan LR, O'Brien K, Tibbles CD. Diagnosis of acute neurological emergencies in pregnant and post-partum women. Lancet Neurol 2013;12(2):175-85. PMID 23332362Kranick SM, Mowry EM, Colcher A, Horn S, Golbe LI. Movement disorders and pregnancy: a review of the literature. Mov Disord 2010;25(6):665-71. PMID 20437535Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA 2016;316(9):952-61. PMID 27599330We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

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Friday Night Thoughts

The World’s Okayest Medic Podcast

Play Episode Listen Later Jan 28, 2023

REFERENCES: August, P., Siabi, B. (2022). Preeclampsia: Clinical Features and Diagnosis. Up-to-Date. Judy AE, McCain CL, Lawton ES, Morton CH, Main EK, Druzin ML. Systolic Hypertension, Preeclampsia-Related Mortality, and Stroke in California. Obstet Gynecol. 2019 Jun;133(6):1151-1159. doi: 10.1097/AOG.0000000000003290. PMID: 31135728.

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The ABCs of IUDs...And is P for Pain?

Let's Talk About Down There

Play Episode Listen Later Dec 26, 2022 50:28

What's going down: All about IUD insertions: what to know prior, how to mentally prepare, and the best ways to treat the pain if need be The many uses of an IUD beyond preventing pregnancy The 2 different types of IUDs: Hormonal vs. Copper, and what to expect from each Discussing anxiety surrounding IUDs: uterine perforation, string placement, and hormonal concerns The importance of doing your own research, speaking with your healthcare provider, and avoiding misinformation on social media Clitorally, we can't believe how confused (some) men are about IUDs. Watch full TikTok here! Thank you for continuing the conversation and calling into the Viva la Vulva Voicemail at (503) 893-2016! Please be sure to rate, follow, review, and remember that nothing is considered TMI around here. Social & Website Tiktok: @drjenniferlincoln Instagram: @drjenniferlincoln YouTube: @drjenniferlincoln Website: www.drjenniferlincoln.com Resources Grab a copy of my book HERE! Obstetricians For Reproductive Justice References 1. Whitworth K, Neher J, Safranek S. Effective analgesic options for intrauterine device placement pain. Can Fam Physician. 2020;66(8):580 581. 2. Gemzell-Danielsson K, Mansour D, Fiala C, Kaunitz AM, Bahamondes L. Management of pain associated with the insertion of intrauterine contraceptives. Hum Reprod Update. 2013;19(4):419-427. doi:10.1093/humupd/dmt022. 3. Laura Nguyen, Larkin Lamarche, Robin Lennox, Amanda Ramdyal, Tejal Patel, Morgan Black, Dee Mangin. Strategies to Mitigate Anxiety and Pain in Intrauterine Device Insertion: A Systematic Review. Journal of Obstetrics and Gynaecology Canada, Volume 42, Issue 9, 2020, Pages 1138-1146.e2, ISSN 1701-2163. 4. Lopez LM, Bernholc A, Zeng Y, Allen RH, Bartz D, O'Brien PA, Hubacher D. Interventions for pain with intrauterine device insertion. Cochrane Database Syst Rev. 2015 Jul 29;(7):CD007373. doi: 10.1002/14651858.CD007373.pub3. PMID: 26222246. 5. Karabayirli S, Ayrim AA, Muslu B. Comparison of the analgesic effects of oral tramadol and naproxen sodium on pain relief during IUD insertion. J Minim Invasive Gynecol. 2012 Sep-Oct;19(5):581-4. doi: 10.1016/j.jmig.2012.04.004. Epub 2012 Jul 4. PMID: 22766124. 6. Ngo LL, Ward KK, Mody SK. Ketorolac for Pain Control With Intrauterine Device Placement: A Randomized Controlled Trial. Obstet Gynecol. 2015 Jul;126(1):29-36. doi: 10.1097/AOG.0000000000000912. PMID: 26241253; PMCID: PMC4527080. 7. Mody SK, Farala JP, Jimenez B, Nishikawa M, Ngo LL. Paracervical Block for Intrauterine Device Placement Among Nulliparous Women: A Randomized Controlled Trial. Obstet Gynecol. 2018 Sep;132(3):575-582. doi: 10.1097/AOG.0000000000002790. PMID: 30095776; PMCID: PMC6438819. Learn more about your ad choices. Visit megaphone.fm/adchoices

Opioid Use Disorder in Pregnancy, Part 1

Play Episode Listen Later Dec 12, 2022 12:04

Survey: https://bit.ly/feedback_UltraSounds Sanaya and Regina discuss the management of opioid use disorder in pregnancy with Dr. Townsel. 0:44 Dr. Townsel Bio 1:25 Case 1: 29 year old at 6 weeks pregnant inquiring about oxycodone use 4:12 Case 2: 29 year old on buprenorphine treatment during pregnancy 6:24 Case 3: Neonate with tremors, fever after delivery Transcript: bit.ly/Ultrasounds_OUD1 Jansson, L. M., & Wilkie, L. (2022, April 29). Neonatal Abstinence Syndrome. UpToDate. Retrieved November 14, 2022. Opioid use and opioid use disorder in pregnancy. Committee Opinion No. 711. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;130:e81–94. Centers for Disease Control and Prevention. (2021, July 21). Treatment for opioid use disorder before, during, and after pregnancy. Centers for Disease Control and Prevention. Seligman, N. S., Rosenthal, E., & Berghella, V. (2021, November 10). Overview of management of opioid use disorder during pregnancy. UpToDate. Whelan PJ, Remski K. Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds. J Neurosci Rural Pract. 2012 Jan;3(1):45-50. Inspira Health. “The EAT, Sleep, Console Method for Infants with Neonatal Abstinence Syndrome.” Inspira Health, 20 Apr. 2022.

Nix RhoGAM® Under 12 weeks?

historic rh obstet gynecol rhogam

Play Episode Listen Later Dec 3, 2022 20:40

Anti-D immune globulin has been advocated for use in appropriate patients since the 1970s. Historic data showed that 0.1ml of fetal D+ blood was all that was required to potentially sensitize an Rh negative mother. New data is questioning whether this prophylaxis is required in all cases of threatened miscarriage/abortion in early pregnancy, or if a more selective approach is appropriate. In this episode, we will highlight a soon to be released “Questioning Clinical Practice” commentary from Obstet Gynecol (the Green Journal) tackling this issue. Is it time to change our current and standard practice?

Postpartum Hemorrhage

Play Episode Listen Later Nov 28, 2022 33:24

Survey: https://bit.ly/feedback_UltraSounds Theresa and Rachel discuss postpartum hemorrhage with Dr. Luke Burns. 00:30 Dr. Burns Biography 01:50 Case 1: 35 year old G4P4 with polyhydramnios, boggy uterus 09:17 Case 2: 35 year old G4P4 with postpartum hemorrhage and chronic hypertension 16:53 Case 3: hemodynamically unstable 35 year old G4P4 with postpartum hemorrhage 23:59 Case 4: 35 year old G4P4 with no return of menstruation Transcript: https://bit.ly/Ultrasounds_PPH Trends in maternal mortality: 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2019. ACOG Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol 2017, 30(4). Wormer KC, Jamil RT, Bryant SB. Acute Postpartum Hemorrhage. StatPearls Publishing; 2022 Jan. ACOG Committee Opinion No. 794: Quantitative blood loss in obstetric hemorrhage. American College of Obstetricians and Gynecologists. Obstet Gynecol 2019;134. Bell, S. F., et al (2020). Incidence of postpartum haemorrhage defined by quantitative blood loss measurement: a national cohort. BMC pregnancy and childbirth, 20(1), 271. Parry Smith WR, et al. Uterotonic agents for first‐line treatment of postpartum haemorrhage: a network meta‐analysis. Cochrane Database of Systematic Reviews 2020, Issue 11. Vogel JP, et al. WHO recommendations on uterotonics for postpartum haemorrhage prevention: what works, and which one? BMJ Global Health 2019. A. Borovac-Pinheiro, et al. (2018). Postpartum hemorrhage: new insights for definition and diagnosis. American Journal of Obstetrics and Gynecology, 219(2):162-8. A. Leleu, et al. (2021). Intrauterine balloon tamponade in the management of severe postpartum haemorrhage after vaginal delivery: Is the failure early predictable?. European Journal of Obstetrics & Gynecology and Reproductive Biology, 258:317-323. Schury MP, Adigun R. Sheehan Syndrome. StatPearls Publishing; 2022 Jan.

Ep. 4 IR/OB Collaboration in Treating Postpartum Hemorrhage with Dr. Roxane Rampersad and Dr. Anthony Shanks

Play Episode Listen Later Nov 17, 2022 49:38

On this episode, BackTable VI host Dr. Christopher Beck shares the mic with two Maternal Fetal Medicine (MFM) specialists, Drs. Roxane Rampersad at Washington University and Tony Shanks at Indiana University, to discuss cross-specialty management of postpartum hemorrhage (PPH) between OBGYN and interventional radiology (IR). --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/ASxPdP --- SHOW NOTES To set the stage, Drs. Rampersad and Shanks explain the definition of PPH based on the American College of Obstetricians and Gynecologists (ACOG) guidelines. They further describe the differences between early / acute versus late blood loss, in addition to the most common etiologies using the “Four T's” pneumonic: tone, trauma, tissue, thrombin. Drs. Rampersad and Shanks then describe their approach to the workup and management of PPH. The group discusses topics such as uterine massage, oxytocin, hemabate / methergine, tamponade (e.g. Bakri balloon, the JADA System), embolization, and hysterectomy. The physicians then describe the role of cross-specialty collaboration between OBGYN and IR, specifically in the management of PPH. When highlighting the role of IR, Dr. Beck describes how he counsels patients for uterine artery embolization (UAE), and he provides an anecdote regarding a repeat UAE. He also shares his perspective with utilization of gel foam versus coils. The group then transitions to describe diagnosis and management of placenta accreta spectrum (PAS), its association with PPH, and the role of radiology in this disease process. Lastly, Drs. Rampersad and Shanks allude to what the future may hold for PPH, including more personalized medicine and potential technologies to prevent PAS. The group ends the episode by providing IR colleagues with insight to what may strengthen the collaboration between OBGYN and IR in order to provide optimal care for patients with PPH. --- RESOURCES Silver RM, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006 Jun;107(6):1226-32. doi: 10.1097/01.AOG.0000219750.79480.84. PMID: 16738145. Bienstock RM, Eke AC and Hueppchen NA; Postpartum Hemorrhage. New England Journal of Medicine 2021 Vol. 384 Issue 17 Pages 1635-1645. Accession Number: 33913640 DOI: 10.1056/NEJMra1513247. https://www.nejm.org/doi/full/10.1056/NEJMra1513247 ACOG Postpartum Hemorrhage: https://www.acog.org/en/clinical/clinical-guidance/practice-bulletin/articles/2017/10/postpartum-hemorrhage

EBB 243 - Importance of Kick Counting for Preventing Stillbirth with Stephaney Moody, Health Equity Ambassador of Count the Kicks

Play Episode Listen Later Oct 26, 2022 38:42

On today's podcast, we're going to talk with Stephaney Moody, a Health Equity Ambassador and an advocate for Healthy Birthday and Count the Kicks about the importance of kick counting to prevent stillbirth. Stephaney Moody's passion for stillbirth prevention came after her family experienced loss, when her sister lost her daughter. Upon learning about the inequities that persist in stillbirth outcomes in the African-American Community, she felt led to join the fight against preventable stillbirth and strive for equity. Stephaney is also the Founder of Black Women's Health and Wellness Webcast which addresses issues that impact the health and wellbeing of African-American women. She also serves in her community as a Pastor at New Beginnings Discipleship Ministries and as a Chaplain to the Des Moines Police Department. We will talk about the importance of kick counting in the third trimester to prevent stillbirth. Stephaney shares how her family has been affected by stillbirth and how she became involved in Kick the Counts, an evidence-based stillbirth prevention public health awareness campaign for expectant parents in the 3rd trimester. We will discuss the evidence on kick counting and how Count the Kicks and Healthy Birthday's public health and awareness campaigns are having a direct impact on stillbirth rates in the United States and abroad. A video with this episode will also come out later today at our YouTube channel here. **Content warning: pregnancy loss, stillbirth, racial inequities in healthcare, maternal mortality, maternal morbidity infant mortality** Resources: Count the Kicks Evidence and Resources here. Download the Count the Kicks App here Healthy Birthday Resources here Find Count the Kick on Social Media: Instragam Youtube Twitter Facebook Stephaney moderates the Black Women's Health and Wellness group here. Research discussed: Tveit, J.V., et al. (2009). "Reduction of late stillbirth with the introduction of fetal movement information and guidelines - a clinical quality improvement." BMC Pregnancy Childbirth 9:32: http://europepmc.org/article/PMC/2734741 Sadovsky, E. and Yaffe, H. (1973). "Daily fetal movement recording and fetal prognosis." Obstet Gynecol 41(6): 845-850. https://journals.lww.com/greenjournal/Abstract/1973/06000/Daily_Fetal_Movement_Recording_and_Fetal_Prognosis.8.aspx Leader, L. R., Baillie, P. and Van Schalwyk, D. J. (1981). “Fetal movement and fetal outcome: A prospective study.” Obstet Gynecol 57(4): 431-436. https://pubmed.ncbi.nlm.nih.gov/7243088/ For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on: TikTok Instagram Pinterest Ready to get involved? Check out our Professional membership (including scholarship options) here Find an EBB Instructor here Click here to learn more about the Evidence Based Birth® Childbirth Class.

Pediatric and Adolescent Gynecology, Part 1 (Patients with Disabilities)

Just US: Before, Birth, and Beyond

Play Episode Listen Later Sep 19, 2022 20:14

SURVEY LINK: https://bit.ly/feedback_UltraSounds SUMMARY: Theresa and Rachel discuss 3 clinical vignettes regarding gyn care for adolescents and girls with disabilities. TIMESTAMPS: 00:53 Dr. Monica Rosen Biography 02:06 Case 1: 13 year old girl with a history of cerebral palsy presenting with concerns about menstruation 08:57 Case 2: 21 year old woman with a history of spina bifida presenting for gynecologic exam 12:08 Case 3: 8 year old girl with a history of trisomy 21 presenting with concerns about menarche and puberty 18:52 Wrap-up LINKS: Reimers, Arne, et al. “Ethinyl Estradiol, Not Progestogens, Reduces Lamotrigine Serum Concentrations.” Epilepsia. 2005;46(9):1414–1417. Curtis, Tepper, Jatlaoui, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016.; 2016. Daunov M et al. Prevalence of VTE in Ambulatory and Non-Ambulatory Patients with Cerebral Palsy. Pathophysiology of Thrombosis. 2019;134(1):2428. ACOG Committee Opinion, No. 651. Menstruation in girls and Adolescents: Using the Menstrual Cycle as a Vital Sign. Obstet Gynecol. 2015;126(6). Cutler G. The role of estrogen in bone growth and maturation during childhood and adolescence. J Steroid Biochem Mol Biol. 1997;61(3-6):141-144. Frances YF et al. Satisfaction With Hormonal Treatment for Menstrual Suppression in Adolescents and Young Women With Disabilities. J Adolesc Health. 2021;69(3):482-488. Quint, EH. Adolescents with Special Needs: Clinical Challenges in Reproductive Health Care. J Pediatr Adolesc Gynecol. 2016;21(1):2-6. Fei YF, Ernst SD, Dendrinos ML, Quint EH. Preparing for Puberty in Girls With Special Needs: A Cohort Study of Caregiver Concerns and Patient Outcomes. J Pediatr Adolesc Gynecol. 2021;34(4):471-476. Enujioke SC, Leland B, Munson E, et al. Sexuality Among Adolescents With Intellectual Disability: Balancing Autonomy and Protection. Pediatrics. 2021;148(5). TRANSCRIPT: https://bit.ly/ultrasounds_PAGs_disabilities DISCLOSURES/DISCLAIMERS: The OBGYN Delivered student team has no relevant financial disclosures. The Ultrasounds podcast is for educational and informational purposes only and should not be considered medical advice. Please do not use any of the information presented to treat, diagnose, or prevent real life medical concerns. The statements made on this podcast are solely those of the OB/GYN Delivered hosts and guests and do not reflect the views of any specific institution or organization.

Épisode 101 – Un premier club de lecture à trois chiffres

Pharmascope

Play Episode Listen Later Sep 2, 2022 38:00

Un nouvel épisode du pharmascope est maintenant disponible! Dans de ce 101ème épisode, Nicolas et Sébastien traiteront de différents sujets: la contraception orale d'urgence chez les patientes obèses, l'ézétimibe en dyslipidémie, les effets (ou pas) de la vitamine D et la restriction du temps d'écran sur le dodo. Les objectifs pour cet épisode sont les suivants: Discuter de l'efficacité d'une double dose de lévonorgestrel en contraception orale d'urgence chez des patientes obèsesExpliquer les avantages et les inconvénients de l'ajout de l'ézétimibe à une statine dans le traitement de la dyslipidémieExpliquer le rôle de la vitamine D dans la prévention des fracturesDiscuter de l'effet de la réduction du temps d'écran sur le sommeil et l'activité physique Ressources pertinentes en lien avec l'épisode Double dose de lévonorgestrel en contraception orale d'urgenceEdelman AB et coll. Double Dosing Levonorgestrel-Based Emergency Contraception for Individuals With Obesity: A Randomized Controlled Trial. Obstet Gynecol. 2022;140:48-54. Étude RACINGKim BK et coll; RACING investigators. Long-term efficacy and safety of moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (RACING): a randomised, open-label, non-inferiority trial. Lancet. 2022;400:380-390. Étude VITALLeBoff MS et coll. Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults. N Engl J Med. 2022;387:299-309. Éditorial de l'étude VITALCummings SR, Rosen C. VITAL Findings - A Decisive Verdict on Vitamin D Supplementation. N Engl J Med. 2022;387:368-370. Étude SCREENSPedersen J et coll. Effects of Limiting Recreational Screen Media Use on Physical Activity and Sleep in Families With Children: A Cluster Randomized Clinical Trial. JAMA Pediatr. 2022;176:741-749. Revue systématique des traitements pharmacologiques en insomnieDe Crescenzo F et coll. Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis. Lancet. 2022;400:170-184.

A conversation about how doctors can join the fight for reproductive health equity

Play Episode Listen Later Aug 30, 2022 22:39

Speaker: Jasmine Johnson, MD, FACOGDescription: In this episode of Just Us, join Cindy McMillan CD(DONA), CBPC, CBE, DBD, NCPSS as she delves into an insightful conversation with Dr. Jazmin Johnson, a self-described maternal health disparities crusader. She is a wife, mom, blogger, MFM Physician with a mission to eliminate inequities. Learn more about how to do so, here with us.Instagram: http://instagram.com/mrsmommymd Twitter: http://twitter.com/JasminRJohnsonIf you liked what you heard please share with your network!We would appreciate if you can provide feedback by filling out the following survey:https://redcap.mahec.net/redcap/surveys/?s=XTM8T3RPNK Show notes:For some extra reading, please check out Dr. Johnson's research:Traylor CS, Johnson JD, Kimmel MC, Manuck TA. Effects of psychological stress on adverse pregnancy outcomes and nonpharmacologic approaches for reduction: an expert review. Am J Obstet Gynecol MFM. 2020 Nov;2(4):100229. doi: 10.1016/j.ajogmf.2020.100229. Epub 2020 Sep 24. PMID: 32995736; PMCID: PMC7513755.Johnson JD, Louis JM. Does race or ethnicity play a role in the origin, pathophysiology, and outcomes of preeclampsia? An expert review of the literature. Am J Obstet Gynecol. 2022 Feb;226(2S):S876-S885. doi: 10.1016/j.ajog.2020.07.038. Epub 2020 Jul 24. PMID: 32717255.Johnson JD, Green CA, Vladutiu CJ, Manuck TA. Racial Disparities in Prematurity Persist among Women of High Socioeconomic Status. Am J Obstet Gynecol MFM. 2020 Aug;2(3):100104. doi: 10.1016/j.ajogmf.2020.100104. Epub 2020 Mar 23. PMID: 33179010; PMCID: PMC7654959.Green CA, Johnson JD, Vladutiu CJ, Manuck TA. The association between maternal and paternal race and preterm birth. Am J Obstet Gynecol MFM. 2021 Jul;3(4):100353. doi: 10.1016/j.ajogmf.2021.100353. Epub 2021 Mar 20. PMID: 33757934; PMCID: PMC8555705.Johnson JD, Asiodu IV, McKenzie CP, Tucker C, Tully KP, Bryant K, Verbiest S, Stuebe AM. Racial and Ethnic Inequities in Postpartum Pain Evaluation and Management. Obstet Gynecol. 2019 Dec;134(6):1155-1162. doi: 10.1097/AOG.0000000000003505. PMID: 31764724.

women conversations doctors management md effects racial health equity reproductive health epub pmid racial disparities cbe just us dbd aog obstet gynecol am j obstet gynecol

S3E7 - Hemostasis results interpretation along pregnancy.

Ask Stago

Play Episode Listen Later Jul 5, 2022 16:05

Welcome to Ask Stago, the Podcast dedicated to provide expert answers to your expert questions in coagulation. In today's episode, our guest François Depasse will help us to understand the hemostasis results obtained along pregnancy, what are the related difficulties for the lab and Link to previous podcasts: S1E15 Disseminated Intravascular Coagulation (DIC) and fibrin related markers: S2E1 Whole Blood Viscoelastic Testing (VET) Literature sources: Szecsi PB, Jørgensen M, Klajnbard A, Andresen MR, Colov NP, Stender S, Haemostatic reference intervals in pregnancy. Thromb Haemost 2010; 2013: 718-27 Kristoffersen AH, Peters PH, Bjørge L, Røraas T and Sandberg S. Concentration of fibrin monomer in pregnancy and during the postpartum period. Annals of Clinical Biochemistry 2019; 56(6): 692-700. Hellgren H. Hemostasis during normal prgenancy and puerperium. Semin Thromb Hemost. 2003; 29(2): 125-30. Leduc L, Wheeler JM, Kirshon B, Mitchell P, Cotton DB, Coagulation profile in severe preeclampsia, Obstet Gynecol 1992 79(1); 14-8 Gillissen A, van den Akker T, Caram-Deelder C, Henriquez DDCA, Bloemenkamp KWM, de Maat MPM, van Roosmalen JJM, Zwart JJ, Eikenboom J, van der Bom JG. Coagulation parameter during the course of severe postpartum hemorrhage: a nationwide retrospective cohort study. Blood Adv 2018; 2(19): 2433-42 Ducloy-Bouthors AS, Mercier FJ, Grouin JM, Bayoumey F, Corouge I, Le Goueze A, Rackelboom T, Broisin F, Vial F, Luzi A, Capronnier O, Huissoud C, Mignon A, Early and systematic administration of fibrinogen concentrate in post-partum haemorrhage following vaginal delivery: the FIDEL randomized controlled trial. BJOG 2021. 128:1814-23. Brenner A, Ker K, Shakur-Still H, Roberts I. Tranexamic acid for post-partum haemorrhage: what, who and when. Best Pract Res Clin Obstet Gynaecol. 2019; 1:66-74 Content is scientific and technical in nature. It is intended as an educational tool for laboratory professionals and topics discussed are not intended as recommendations or as commentary on appropriate clinical practice.

pregnancy bj postpartum interpretation concentration laboratory fidel annals coagulation hemostasis tranexamic obstet gynecol clinical biochemistry

Episódio 118: Caso Clínico de Sangramento

Ta de Clinicagem

Play Episode Listen Later Dec 8, 2021 53:51

João e Kaue discutem um caso clínico do Pedro, trazendo os principais pontos na abordagem diagnóstico do paciente sangrando. O que é relevante na anamnese? Hereditário ou adquirido? Como interpretar o coagulograma? Tudo isso nesse episódio! Referências: 1. Dilley A, Drews C, Miller C, et al. von Willebrand disease and other inherited bleeding disorders in women with diagnosed menorrhagia. Obstet Gynecol. 2001;97(4):630–636. 2. Knol HM, Mulder AB, Bogchelman DH, Kluin-Nelemans HC, van der Zee AG, Meijer K. The prevalence of underlying bleeding disorders in patients with heavy menstrual bleeding with and without gynecologic abnormalities. Am J Obstet Gynecol. 2013;209(3):202.e1–202.e7. 3. Neutze D, Roque J. Clinical Evaluation of Bleeding and Bruising in Primary Care. Am Fam Physician. 2016;93(4):279-286. 4. Girolami A, Luzzatto G, Varvarikis C, et al. Main clinical manifestations of a bleeding diathesis: an often disregarded aspect of medical and surgical history taking. Haemophilia 2005; 11:193. 5. Schulman S, Kearon C, Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 2005; 3:692.

definition tudo epis caso scientific refer bleeding international society primary care subcommittee bruising thrombosis heredit anticoagulation haemophilia willebrand kaue obstet gynecol haemostasis am fam physician am j obstet gynecol clinical evaluation

Detecting Partner Violence in Fertility Clinics

Your Fertility Pharmacist

Play Episode Listen Later Sep 27, 2021 10:20

ResourcesBarishansky SJ, Shapiro P, Meyman G, Pavone ME, Lawson AK. Reproductive endocrinologists' knowledge and attitudes in the identification of intimate partner violence [published online ahead of print, 2021 Sep 16]. Fertil Steril. 2021;S0015-0282(21)01934-8. doi:10.1016/j.fertnstert.2021.08.011https://stacks.cdc.gov/view/cdc/60893Cheng D, Horon IL. Intimate-partner homicide among pregnant and postpartum women. Obstet Gynecol. 2010;115(6):1181-1186. doi:10.1097/AOG.0b013e3181de0194National Domestic Violence Hotline www.thehotline.org or 1-800-799-SAFE (7233) Sharifi, F., J. Jamali, M. Larki, and R. L. Roudsari. “Domestic Violence Against Infertile Women : A Systematic Review and Meta-Analysis”. Sultan Qaboos University Medical Journal [SQUMJ], vol. 1, no. 1, June 2021, doi:10.18295/squmj.5.2021.075.

partner safe violence fertility intimate clinics reproductive detecting meta analysis aog jamali obstet gynecol

Multidisciplinary Approach to Pelvic Pain

Mayo Clinic Talks

Play Episode Listen Later Jul 20, 2021 29:26

Guest: Isabel C. Green, M.D. Host: Darryl S. Chutka, M.D. (@ChutkaMD) Pelvic pain can be challenging. It can have a variety of presenting symptoms since it can originate from a variety of organ systems. When pelvic pain becomes chronic, it becomes even more challenging. It's associated with significant direct medical costs as well as indirect costs as it frequently results in work absenteeism. Patients with chronic pelvic pain are often initially evaluated by primary care providers, but referral to specialists is quite common. Due to the variety of symptoms associated with chronic pelvic pain, multiple specialties often are asked to evaluate these patients. This frequently results in patients being passed back and forth between various medical specialties. It therefore becomes important for primary care providers to become comfortable evaluating and managing patients with pelvic pain. Our guest for this podcast is Dr. Isabel Green, a physician from the Department of Obstetrics and Gynecology at the Mayo Clinic. We'll discuss how to effectively evaluate patients with pelvic pain, “red flag symptoms” to watch for, useful laboratory tests to order, and common imaging studies which can be helpful in establishing a cause for the pain. We'll also discuss the benefits of a multi-disciplinary approach to pelvic pain. Specific topics: Categorization of pelvic pain Appropriate evaluation of pelvic pain including the clinical history, physical exam, laboratory tests and imaging studies Relationship of chronic pelvic pain with other symptoms such as anxiety, depression, insomnia, and work/relationship issues Chronic pelvic pain representing a form of centralized pain Advantages of a multi-disciplinary approach to evaluating and managing chronic pelvic pain Additional resources: Chronic pelvic pain: ACOG practice bulletin, number 218. Obstet Gynecol. 2020 Mar; 135(3):e98-e109. doi: 1097/AOG.0000000000003716. Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

school patients chronic mayo clinic obstetrics gynecology multidisciplinary pelvic pain acog categorization aog multidisciplinary approach obstet gynecol continuous professional development

Trisomy 13 & 18 Ethical Considerations with Dr. Paul Mann

The MCG Pediatric Podcast

Play Episode Listen Later Jun 1, 2021 20:01

Trisomy 13 & 18 Ethical Considerations with Dr. Paul Mann PARTICIPANTS: Paul Mann, MD Zachary Hodges, MD About Our Guest: Dr. Paul Mann is an Associate Professor of Pediatrics, Chief of the Division of Neonatology and practicing neonatologist at the Medical College of Georgia. He also is the Director of Clinical Ethics for the Augusta University Center for Bioethics and Health Policy. Free CME Credit: https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=7772 Learning Objectives: By the end of listening to this episode, learners should be able to: Recognize aneuploidies as a common cause of genetic abnormalities in pregnancy. Recognize the historically pessimistic counseling given to families of children with trisomy 13 and 18 and how this might continue to influence our counseling today. Recall how most babies are prenatally diagnosed with trisomy 13 and 18. Describe the life-limiting malformations associated with trisomy 13 and 18. Recognize the recent improvement in prognosis of children with trisomy 13 and 18 as they are being selectively offered more intensive and surgical care. Sensitively counsel families about the general prognosis of newborns with trisomy 13 and 18 while avoiding inaccurate and problematic language such as “lethal and incompatible with life.” Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu. Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. We look forward to speaking to you on our next episode of the MCG Pediatric Podcast. Peer Reviewers: Amy Thompson, MD & MCG Pediatric Podcast Committee References: Kett JC. Who Is the Next "Baby Doe?" From Trisomy 21 to Trisomy 13 and 18 and Beyond. Pediatrics. 2020;146(Suppl 1):S9-S12. doi:10.1542/peds.2020-0818D American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics; Committee on Genetics; Society for Maternal–Fetal Medicine. Practice Bulletin No. 162: Prenatal Diagnostic Testing for Genetic Disorders. Obstet Gynecol. 2016;127(5):e108-e122. doi:10.1097/AOG.0000000000001405 Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs. Stamford, Conn: Appleton & Lange, 1999. Print. McCaffrey MJ. Trisomy 13 and 18: Selecting the road previously not taken. Am J Med Genet C Semin Med Genet. 2016;172(3):251-256. doi:10.1002/ajmg.c.31512 Bajinting A, Munoz-Abraham AS, Osei H, Kirby AJ, Greenspon J, Villalona GA. To operate or not to operate? Assessing NSQIP surgical outcomes in trisomy 18 patients [published online ahead of print, 2020 Jun 5]. J Pediatr Surg. 2020;S0022-3468(20)30369-9. doi:10.1016/j.jpedsurg.2020.05.037 Neubauer K, Boss RD. Ethical considerations for cardiac surgical interventions in children with trisomy 13 and trisomy 18. Am J Med Genet C Semin Med Genet. 2020;184(1):187-191. doi:10.1002/ajmg.c.31767 Wightman A, Kett J, Campelia G, Wilfond BS. The Relational Potential Standard: Rethinking the Ethical Justification for Life-Sustaining Treatment for Children with Profound Cognitive Disabilities. Hastings Cent Rep. 2019;49(3):18-25. doi:10.1002/hast.1003 Nelson KE, Rosella LC, Mahant S, Guttmann A. Survival and Surgical Interventions for Children With Trisomy 13 and 18 [published correction appears in JAMA. 2017 May 2;317(17 ):1803]. JAMA. 2016;316(4):420-428. doi:10.1001/jama.2016.9819

Journal Club 妇产乳腺星期四 Episode 29

Play Episode Listen Later Dec 10, 2020 20:51

FDA 批准一种新型的单抗-药物偶联物治疗乳腺癌JAMA 乳腺癌筛查时，简易乳房MRI与数字乳房合成技术哪一种好？Science子刊能快速诊断癌症的便携式细胞分析仪-CytoPAN曲妥珠单抗-德鲁替康（trastuzumab deruxtecan）曲妥珠单抗-德鲁替康（trastuzumab deruxtecan）是一种HER-2单抗、偶联拓扑异构酶1抑制剂的药物。2019年12月，曲妥珠单抗-德鲁替康（trastuzumab deruxtecan）被FDA批准用于治疗HER2阳性的、经治疗的乳腺癌。《DESTINY-Breast01研究：曲妥珠单抗-德鲁替康经治疗的HER2阳性乳腺癌的2期临床研究》New England Journal of Medicine，2020年2月 (1)这项2部分的、开放标签、单组、多中心、2期研究，评估了184名、HER2阳性的、转移性乳腺癌患者，使用曲妥珠单抗德鲁替康的疗效。研究第一部分，使用了3种不同剂量，以确定推荐剂量；在第二部分中，评估了推荐剂量的有效性和安全性。曲妥珠单抗德鲁替康的推荐剂量为5.4mg/kg。随访11.1个月后，患者的中位缓解时间为14.8个月，中位无进展生存时间为16.4个月。在研究中，最常见的严重不良事件是中性粒细胞计数减少、贫血和恶心。结论：曲妥珠单抗-德鲁替康在HER2阳性的、转移性乳腺癌患者中，显示出持久的抗肿瘤活性。除了恶心和骨髓抑制，治疗组还观察到间质性肺病，因此用药过程中需监测肺部情况。避孕法避孕法主要包括激素避孕和非激素避孕。激素避孕药包括雌-孕激素避孕药和单纯孕激素避孕药；可采用口服、注射、皮下植入剂、透皮贴剂、子宫避孕器或阴道避孕器等方式给药。非激素避孕法主要包括：输卵管阻断、含铜宫内避孕器、避孕套。《回顾性研究：避孕法类型是否影响痤疮的发病率和严重程度》Obstetrics and Gynecology，2020年5月 (2)皮肤科医生常开出复方口服避孕药用于治疗痤疮，这项回顾性队列研究，目的是比较各种避孕法使用1年内，对痤疮的发病率和严重程度的影响。研究共大约337,000名避孕法的新使用者（年龄12～40岁），2%～8%出现新发痤疮，年轻女性的发病率较高。研究发现复方口服避孕药相比，含铜宫内节育器的痤疮发生风险比为1.14，含孕酮的宫内节育器的痤疮风险比1.09，这些女性新发痤疮后的就诊率略高。21,000名患有痤疮病史的女性，使用含铜宫内节育器和含孕酮的节育器后，从外用药转换成口服四环素类抗生素的可能性更高（风险比分别为1.44和1.34）。结论：复方口服避孕药似乎痤疮风险相对较小，各种避孕法之间绝对差异也很小。《回顾性研究：产后即刻行皮下植入依托孕烯植入剂避孕，与静脉血栓栓塞的关系》Obstetrics and Gynecology，2020年6月 (3)来自贝勒大学医学院的研究人员，对分娩后30天内皮下植入依托孕烯植入剂的妇女与未植入的妇女的再入院率进行了比较，旨在明确这种避孕方法是否增加静脉血栓的风险。在338万余名产妇中，排除有静脉血栓栓塞史或抗凝治疗史的产妇，共8369名产妇在分娩住院期间接受了皮下植入避孕。研究发现，依托孕烯避孕的产妇和没有避孕的产妇的静脉血栓栓塞再入院率没有差异；而且糖尿病、血栓性血友病、系统性红斑狼疮和剖宫产的发生率在组间无差异。统计发现，接受避孕植入的产妇更年轻、收入更低、吸烟者更多、高血压、围产期感染或产后出血发生率也较高；在对这些混杂因素进行调整后，静脉血栓栓塞发生率的风险比为1.81，没有统计学差异（95%可信区间0.44 - -7.45）。结论：分娩后立即接受依托孕烯避孕植入物避孕，没有增加静脉血栓发生率。《对照研究：依托孕烯避孕植入物使用者不良出血模式的治疗》Obstetrics and Gynecology，2020年8月 (4)依托孕烯避孕植入物的主要副作用是阴道不规则出血，该研究的目的是评价短程使用他莫西芬是否有效。这个研究的前90天，这是一个双盲、随机、对照试验中，研究纳入112名植入依托孕烯避孕植入物后反复阴道出血的女性，随机双盲入组他莫昔芬10mg bid组或安慰剂组，连续治疗7天。然后，参与者进入下一个90天的开放标签研究，如果需要每30天可以接受最多3个疗程的他莫西芬，在此期间，参与者使用短信记录每天的流血情况。双盲对照期间，他莫西芬组报告在最初90天内阴道连续不出血的天数比安慰剂组少9.8天（P=0.001)；在开放标签阶段，服用他莫西芬的女性得到了类似的疗效。在随机对照期，他莫西芬组参与者的满意度也更高。结论：短疗程的他莫昔芬减少了问题性出血，提高了使用者的满意度。《随机对照研究：新型的宫内节育器的2期临床研究》Obsteteric & Gynecology，2020年4月 (5)这种新型的宫内节育器，支架含有镍钛合金，铜仅位于靠近子宫角和子宫颈内口的位置，含有的铜和镍钛合金的剂量都很小；而且设计时为了方便放置，自带细线。因此，这种宫内节育器可能减少与铜相关的子宫痉挛和出血。在这项为期36个月2期研究中，纳入了286名女性，评价了总共5,640个月经周期的妊娠情况。宫内节育器的平均使用时间为2.7年；37.8%的女性使用该宫内节育器的时间达到36个月。在使用宫内节育器的第1年，每个月经周期的平均出血天数从7.6天（第1个月经周期）减少至5.2天（第13个月经周期）。主要不良反应是出血、疼痛。结论：这种新型的宫内节育器有效性高，且耐受性好。《系统回顾：延长宫内节育器使用时间的有效性和安全性》American Journal of Obstetrics and Gynecology，2020年7月 (6)文章系统地回顾了关于宫内节育器超过批准的有效时间后，是否仍能有效和安全的避孕。研究纳入了2篇关于含铜宫内节育器（批准有效期10年）和4篇关于左炔诺孕酮宫内节育器（批准有效期为5年）的研究。研究发现，左炔诺孕酮宫内节育器在第6和第7年合并妊娠率为0.02/100人年(95%置信区间，0.00-0.29)。超期使用后，每年不良事件发生率、或因不良事件取环的比率为0- 3.7/100。对于含铜宫内节育器，11年和12年的合并妊娠率为0.0/100人年(95%可信区间为0-0.8)；在此期间，不良事件年发生率为0-4.6/100人。结论：左炔诺孕酮宫内节育器和含铜宫内节育器，延长使用的前两年的妊娠率、不良事件率、因副作用取出率都是很低的；但这些数据在数量和质量上都是有限的，不建议推广。乳腺癌的筛查乳腺癌的筛查首先需要对风险进行分层。没有卵巢癌、腹膜癌、乳腺癌个人史或家族史，没有遗传基因突变，10-30岁之间没有接受过胸部放疗的女性属于低危人群；有以上病史的女性属于高危。美国癌症协会建议女性45岁开始接受每年一次的钼靶筛查，55岁以后每两年一次。筛查方式：钼靶是首选，高危女性可使用MRI联合钼靶。《横向研究：简易乳房MRI与数字乳房合成技术在筛查致密乳房女性中乳腺癌的比较》JAMA，2020年2月 (7)乳腺密度高的女性患乳腺癌的风险增加，研究旨在比较简易乳房MRI和数字乳房合成技术对致密乳腺患者的筛查效果。共1516名女性参与了研究，平均年龄54岁。队列中，有17名浸润性乳腺癌和6名原位导管癌。MRI检测出全部17名浸润性乳腺癌和5名原位导管癌；数字合成技术仅检测出7例浸润性乳腺癌和2例原位癌。MRI敏感度为95.7%、特异性为86.7%；数字合成技术灵敏度为39.1%，特异性为97.4%（P=0.001，P

Journal Club 妇产乳腺星期四 Episode 29

Let's Talk Space Medicine

Play Episode Listen Later Dec 10, 2020 20:51

FDA 批准一种新型的单抗-药物偶联物治疗乳腺癌JAMA 乳腺癌筛查时，简易乳房MRI与数字乳房合成技术哪一种好？Science子刊能快速诊断癌症的便携式细胞分析仪-CytoPAN曲妥珠单抗-德鲁替康（trastuzumab deruxtecan）曲妥珠单抗-德鲁替康（trastuzumab deruxtecan）是一种HER-2单抗、偶联拓扑异构酶1抑制剂的药物。2019年12月，曲妥珠单抗-德鲁替康（trastuzumab deruxtecan）被FDA批准用于治疗HER2阳性的、经治疗的乳腺癌。《DESTINY-Breast01研究：曲妥珠单抗-德鲁替康经治疗的HER2阳性乳腺癌的2期临床研究》New England Journal of Medicine，2020年2月 (1)这项2部分的、开放标签、单组、多中心、2期研究，评估了184名、HER2阳性的、转移性乳腺癌患者，使用曲妥珠单抗德鲁替康的疗效。研究第一部分，使用了3种不同剂量，以确定推荐剂量；在第二部分中，评估了推荐剂量的有效性和安全性。曲妥珠单抗德鲁替康的推荐剂量为5.4mg/kg。随访11.1个月后，患者的中位缓解时间为14.8个月，中位无进展生存时间为16.4个月。在研究中，最常见的严重不良事件是中性粒细胞计数减少、贫血和恶心。结论：曲妥珠单抗-德鲁替康在HER2阳性的、转移性乳腺癌患者中，显示出持久的抗肿瘤活性。除了恶心和骨髓抑制，治疗组还观察到间质性肺病，因此用药过程中需监测肺部情况。避孕法避孕法主要包括激素避孕和非激素避孕。激素避孕药包括雌-孕激素避孕药和单纯孕激素避孕药；可采用口服、注射、皮下植入剂、透皮贴剂、子宫避孕器或阴道避孕器等方式给药。非激素避孕法主要包括：输卵管阻断、含铜宫内避孕器、避孕套。《回顾性研究：避孕法类型是否影响痤疮的发病率和严重程度》Obstetrics and Gynecology，2020年5月 (2)皮肤科医生常开出复方口服避孕药用于治疗痤疮，这项回顾性队列研究，目的是比较各种避孕法使用1年内，对痤疮的发病率和严重程度的影响。研究共大约337,000名避孕法的新使用者（年龄12～40岁），2%～8%出现新发痤疮，年轻女性的发病率较高。研究发现复方口服避孕药相比，含铜宫内节育器的痤疮发生风险比为1.14，含孕酮的宫内节育器的痤疮风险比1.09，这些女性新发痤疮后的就诊率略高。21,000名患有痤疮病史的女性，使用含铜宫内节育器和含孕酮的节育器后，从外用药转换成口服四环素类抗生素的可能性更高（风险比分别为1.44和1.34）。结论：复方口服避孕药似乎痤疮风险相对较小，各种避孕法之间绝对差异也很小。《回顾性研究：产后即刻行皮下植入依托孕烯植入剂避孕，与静脉血栓栓塞的关系》Obstetrics and Gynecology，2020年6月 (3)来自贝勒大学医学院的研究人员，对分娩后30天内皮下植入依托孕烯植入剂的妇女与未植入的妇女的再入院率进行了比较，旨在明确这种避孕方法是否增加静脉血栓的风险。在338万余名产妇中，排除有静脉血栓栓塞史或抗凝治疗史的产妇，共8369名产妇在分娩住院期间接受了皮下植入避孕。研究发现，依托孕烯避孕的产妇和没有避孕的产妇的静脉血栓栓塞再入院率没有差异；而且糖尿病、血栓性血友病、系统性红斑狼疮和剖宫产的发生率在组间无差异。统计发现，接受避孕植入的产妇更年轻、收入更低、吸烟者更多、高血压、围产期感染或产后出血发生率也较高；在对这些混杂因素进行调整后，静脉血栓栓塞发生率的风险比为1.81，没有统计学差异（95%可信区间0.44 - -7.45）。结论：分娩后立即接受依托孕烯避孕植入物避孕，没有增加静脉血栓发生率。《对照研究：依托孕烯避孕植入物使用者不良出血模式的治疗》Obstetrics and Gynecology，2020年8月 (4)依托孕烯避孕植入物的主要副作用是阴道不规则出血，该研究的目的是评价短程使用他莫西芬是否有效。这个研究的前90天，这是一个双盲、随机、对照试验中，研究纳入112名植入依托孕烯避孕植入物后反复阴道出血的女性，随机双盲入组他莫昔芬10mg bid组或安慰剂组，连续治疗7天。然后，参与者进入下一个90天的开放标签研究，如果需要每30天可以接受最多3个疗程的他莫西芬，在此期间，参与者使用短信记录每天的流血情况。双盲对照期间，他莫西芬组报告在最初90天内阴道连续不出血的天数比安慰剂组少9.8天（P=0.001)；在开放标签阶段，服用他莫西芬的女性得到了类似的疗效。在随机对照期，他莫西芬组参与者的满意度也更高。结论：短疗程的他莫昔芬减少了问题性出血，提高了使用者的满意度。《随机对照研究：新型的宫内节育器的2期临床研究》Obsteteric & Gynecology，2020年4月 (5)这种新型的宫内节育器，支架含有镍钛合金，铜仅位于靠近子宫角和子宫颈内口的位置，含有的铜和镍钛合金的剂量都很小；而且设计时为了方便放置，自带细线。因此，这种宫内节育器可能减少与铜相关的子宫痉挛和出血。在这项为期36个月2期研究中，纳入了286名女性，评价了总共5,640个月经周期的妊娠情况。宫内节育器的平均使用时间为2.7年；37.8%的女性使用该宫内节育器的时间达到36个月。在使用宫内节育器的第1年，每个月经周期的平均出血天数从7.6天（第1个月经周期）减少至5.2天（第13个月经周期）。主要不良反应是出血、疼痛。结论：这种新型的宫内节育器有效性高，且耐受性好。《系统回顾：延长宫内节育器使用时间的有效性和安全性》American Journal of Obstetrics and Gynecology，2020年7月 (6)文章系统地回顾了关于宫内节育器超过批准的有效时间后，是否仍能有效和安全的避孕。研究纳入了2篇关于含铜宫内节育器（批准有效期10年）和4篇关于左炔诺孕酮宫内节育器（批准有效期为5年）的研究。研究发现，左炔诺孕酮宫内节育器在第6和第7年合并妊娠率为0.02/100人年(95%置信区间，0.00-0.29)。超期使用后，每年不良事件发生率、或因不良事件取环的比率为0- 3.7/100。对于含铜宫内节育器，11年和12年的合并妊娠率为0.0/100人年(95%可信区间为0-0.8)；在此期间，不良事件年发生率为0-4.6/100人。结论：左炔诺孕酮宫内节育器和含铜宫内节育器，延长使用的前两年的妊娠率、不良事件率、因副作用取出率都是很低的；但这些数据在数量和质量上都是有限的，不建议推广。乳腺癌的筛查乳腺癌的筛查首先需要对风险进行分层。没有卵巢癌、腹膜癌、乳腺癌个人史或家族史，没有遗传基因突变，10-30岁之间没有接受过胸部放疗的女性属于低危人群；有以上病史的女性属于高危。美国癌症协会建议女性45岁开始接受每年一次的钼靶筛查，55岁以后每两年一次。筛查方式：钼靶是首选，高危女性可使用MRI联合钼靶。《横向研究：简易乳房MRI与数字乳房合成技术在筛查致密乳房女性中乳腺癌的比较》JAMA，2020年2月 (7)乳腺密度高的女性患乳腺癌的风险增加，研究旨在比较简易乳房MRI和数字乳房合成技术对致密乳腺患者的筛查效果。共1516名女性参与了研究，平均年龄54岁。队列中，有17名浸润性乳腺癌和6名原位导管癌。MRI检测出全部17名浸润性乳腺癌和5名原位导管癌；数字合成技术仅检测出7例浸润性乳腺癌和2例原位癌。MRI敏感度为95.7%、特异性为86.7%；数字合成技术灵敏度为39.1%，特异性为97.4%（P=0.001，P

Episode 2 - Contraceptive Pill & Bone Health: Two Birds with One Stone?

Play Episode Listen Later Dec 1, 2020 9:21

During this episode I worked with my space-nerd-friends aurora, avinash, and ben from the nexus aurora discord community to try and answer the question, can the oral contraception pill serve a multifunctional role in both inducing amenorrhea while preserving bone health in female astronauts? Follow us on twitter! https://twitter.com/TalkSpaceMed Join our discord! https://www.google.com/url?q=https%3A%2F%2Fdiscord.gg%2FWtUcKYyH3b&sa=D&sntz=1&usg=AFQjCNFWSYEMvPusokT0AL50JKsRt2cg8g Credit: Everyday Astronaut for intro music! (Listen here) https://www.youtube.com/watch?v=LQMq4YEMvH8&list=PL-ptSDHlAdQNZ4LxFv_c5MEsmQ6i8bQUN&pbjreload=101&ab_channel=EverydayAstronaut (Buy here) https://www.amazon.com/Maximum-Aerodynamic-Pressure-Everyday-Astronaut/dp/B07KPVRG67/ref=sr_1_1?dchild=1&keywords=maximum+aerodynamic+pressure&qid=1612331710&sr=8-1 References [1] Jain V, Wotring VE. Medically induced amenorrhea in female astronauts. npj Microgravity. Published online December 21, 2016:6. doi:10.1038/npjmgrav.2016.8 [2] Berenson AB, Breitkopf CR, Grady JJ, Rickert VI, Thomas A. Effects of hormonal contraception on bone mineral density after 24 months of use. Obstet Gynecol. 2004;103(5 Pt 1):899-906. doi:10.1097/01.AOG.0000117082.49490.d5 [3] Wei S, Winzenberg T, Laslett LL, Venn A, Jones G. Oral contraceptive use and bone. Curr Osteoporos Rep. 2011;9(1):6-11. doi:10.1007/s11914-010-0037-9 [4] Cauley JA, Robbins J, Chen Z, et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women's Health Initiative randomized trial. JAMA. 2003;290(13):1729-1738. doi:10.1001/jama.290.13.1729 [5] Yang KY, Kim YS, Ji YI, Jung MH. Changes in bone mineral density of users of the levonorgestrel-releasing intrauterine system. J Nippon Med Sch. 2012;79(3):190-194. doi:10.1272/jnms.79.190

women effects published jama medically contraceptives bone health two birds health initiative one stone microgravity aog contraceptive pill obstet gynecol

EBB 153 – Pros and Cons of the Foley and Dilapan-S® for Cervical Ripening During an Induction

Play Episode Listen Later Nov 18, 2020 28:13

In this episode, I will talk about cervical ripening, the Bishop score, and some "mechanical" ways to ripen the cervix. More specifically, we'll talk about the advantages and disadvantages of cervical osmotic dilators (including Dilapan-S®), and using the Foley balloon for cervical ripening. Get on the wait list for the Pocket Guide here: https://evidencebasedbirth.com/pocket-guide-wait-list/ References on Cervical Ripening: Curran, M. (2020). Bishop Score Calculator. Click here. Kolkman, D. G. E., Verhoeven, C. J. M., Brinkhorst, S. J., et al. (2013). Bishop score as a predictor of labor induction success: a systematic review. American Journal of Perinatology, 30(8), 625-30. Click here. Ivars, J., Garabedian, C., Devos, P., et al. (2016). Simplified Bishop score including parity predicts successful induction of labor. Eur J Obstet Gynecol Reprod Biol., 203, 309-314. Click here. References on the Foley: Abdelhakim, A. M. Shareef, M .A., AlAmodi, A. A., et al. (2020). Outpatient versus inpatient balloon catheter insertion for labor induction: A systematic review and meta-analysis of randomized controlled trials. Journal of Gynecology Obstetrics and Human Reproduction, In Press. Click here. Alfirevic, Z., Keeney, E., Dowswell, T., et al. (2016). Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis. BJOG., 123(9), 1462-1470. Click here. American College of Obstetricians and Gynecologists (2009, Reaffirmed 2019). ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol.,114(2 Pt 1), 386-397. Click here. de Vaan, M. D. T., ten Eikelder, M. L. G., Jozwiak, M., et al. (2019). Mechanical methods for induction of labour. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD001233. Click here. Dong, S., Khan, M., Hashimi, F., et al. (2020). Inpatient versus outpatient induction of labour: a systematic review and meta-analysis. BMC pregnancy and childbirth, 20(1), 382. Click here. Leduc, D., Biringer, A., Lee, L., et al. (2013). Induction of Labor: SOGC Clinical Practice Guideline. No. 296, 35(9), 840-857. Click here. Liu, X., Wang, Y., Zhang, F., et al. (2019). Double- versus single-balloon catheters for labour induction and cervical ripening: a meta-analysis. BMC pregnancy and childbirth, 19(1), 358. Click here. Simpson, K. R. (2020). Cervical Ripening and Labor Induction and Augmentation, 5th Edition. AWHONN Practice Monograph, 24(4), PS1-S41. Click here. References on Dilapan-S: American College of Obstetricians and Gynecologists (2009, Reaffirmed 2019). ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol.,114(2 Pt 1), 386-397. Click here. Levine, L. D., Valencia, C. M. and Tolosa, J. E. (2020). Induction of labor in continuing pregnancies. Best Pract Res Clin Obstet Gynaecol., S1521-6934(20), 30079-1. Click here. Gupta, J., Chodankar, R., Baev, O., et al. (2018). Synthetic osmotic dilators in the induction of labour-An international multicentre observational study. Eur J Obstet Gynecol Reprod Biol., 229, 70-75. Click here. Saad, A. F., Villarreal, J., Eid, J., et al. (2019). A randomized controlled trial of Dilapan-S vs Foley balloon for preinduction cervical ripening (DILAFOL trial). Am J Obstet Gynecol., 220(3), 275.e1-275.e9. Click here. For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on Facebook (https://www.facebook.com/EvidenceBasedBirth/), Instagram (https://www.instagram.com/ebbirth/), and Pinterest (https://www.pinterest.com/ebbirth/). Ready to get involved? Check out our Professional membership (including scholarship options) (https://evidencebasedbirth.com/become-pro-member/). Find an EBB Instructor here (https://evidencebasedbirth.com/find-an-instructor-parents/), and click here (https://evidencebasedbirth.com/childbirth-class/) to learn more about the Evidence Based Birth® Childbirth Class.

Journal Club 妇产科星期四 Episode 9

Play Episode Listen Later Nov 13, 2020 25:08

FDA 批准促性腺激素释放激素（GnRH）拮抗剂治疗子宫肌瘤导致的大量子宫出血NEJM 比较子宫动脉栓塞术与子宫肌瘤切除术治疗子宫肌瘤的疗效Cell 在孕妇中利用代谢动力学预测孕周和分娩时间恶拉戈利（elagolix）恶拉戈利（elagolix）是一种口服促性腺激素释放激素（GnRH）拮抗剂，既往用于治疗子宫内膜异位症引起的盆腔疼痛。2020年5月，美国FDA批准恶拉戈利用于治疗绝经前期、子宫肌瘤导致的大量子宫出血。《UF-1和UF-2研究：恶拉戈利治疗子宫肌瘤所致月经过多的治疗方案》New England Journal of Medicine，2020年1月 (1)研究旨在比较恶拉戈利300mg bid（单药治疗或联合雌激素-孕激素反加疗法）对子宫肌瘤的疗效。在两项相同的试验（UF-1和UF-2）中，月经过多（月经失血量＞80 mL）且经超声诊断为子宫肌瘤的总共790名女性（平均年龄42岁）被随机分组，分别接受6个月的恶拉戈利联合反加疗法、恶拉戈利单药治疗或安慰剂治疗。研究者通过收集生理用品的方式量化月经失血量。两项研究6个月后，84%和77%的单药治疗、68.5%和76.5%的恶拉戈利联合反加疗法和9%的安慰剂组达到主要终点（月经量50%）。主要不良反应是潮热和子宫出血，恶拉戈利联合反加治疗组的发生率显著高于安慰剂组。反加治疗法减轻了恶拉戈利的低雌激素效应，腰椎骨密度减少0.76%，低于恶拉戈利单药治疗组2.95%。结论：恶拉戈利单药治疗或联合雌-孕激素反加疗法均有效减轻子宫肌瘤相关的月经过多。恶拉戈利单药治疗与骨密度显著降低相关，反加治疗可以减少这种副作用。子宫肌瘤子宫肌瘤，是女性最常见的盆腔肿瘤，是起源于子宫平滑肌细胞和成纤维细胞的单克隆非癌性肿瘤。主要发生在育龄期妇女，可表现为异常子宫出血、盆腔疼痛/压迫感、生殖功能障碍（不孕或产科并发症）。大多数的子宫肌瘤会在生产后或绝经后自行萎缩；如果子宫肌瘤引起严重症状，则需治疗。对没有生育要求的患者，可行宫腔镜下切除粘膜下肌瘤；雌-孕激素避孕药；释放孕激素的宫内节育器；氨甲环酸；促性腺激素释放激素（GnRH）的激动剂和拮抗剂等。对于有生育要求的患者，药物大多会妨碍受孕，因此治疗首选微创手术切除。《行子宫动脉栓塞术与子宫肌瘤切除术治疗子宫肌瘤的比较》New England Journal of Medicine，2020年7月 (2)对于希望保留子宫、且药物治疗无效的女性，子宫肌瘤切除术和子宫动脉栓塞术是可选治疗方案。这项多中心、随机、开放标签试验，旨在评估症状性子宫肌瘤患者中使用子宫肌瘤切除术和子宫动脉栓塞术的疗效的比较。子宫肌瘤切除术的可选术式包括开腹、腹腔镜或宫腔镜手术。研究共招募了254名女性随机分组：子宫肌瘤切除术组和子宫动脉栓塞术。随访2年时，两组的生活质量评分分别为84.6分和80.0分（P=0.01）。在所有初次手术中，子宫肌瘤切除术组29%的女性和子宫动脉栓塞术组24%的女性发生了围手术期和术后并发症。结论：在有症状的子宫肌瘤患者中，接受子宫肌瘤切除术的女性在2年时的子宫肌瘤相关生活质量优于接受子宫动脉栓塞术的女性。《随机双盲对照试验：术前氨甲环酸减少子宫肌瘤切除术失血》American Journal of Obstetrics and Gynecology，2020年9月(3)氨甲环酸是一种合成赖氨酸衍生物，具有抗纤溶活性，用于其他外科学科，以减少手术期间的失血。本研究旨在探讨早期静脉注射氨甲环酸对子宫肌瘤切除术妇女围手术期出血和输血需求的影响。这项双盲、随机、安慰剂对照试验中，纳入有大出血风险的、症状性子宫肌瘤的女性共60人，随机分入干预组（手术前20分钟静脉注射氨甲环酸15 mg/kg）和安慰剂组（手术前静脉注射生理盐水）。这里有大出血风险定义为：（1）至少1个肌瘤≥10cm，（2）任何1个肌壁内或阔韧带肌瘤≥6cm，和/或（3）手术前影像学检查提示至少有5个肌瘤。患者中53%接受腹腔镜子宫肌瘤切除术，40%接受机器人子宫肌瘤切除术，7%接受采用剖腹手术。氨甲环酸组和安慰剂组中，中位估计失血量分别为200ml和240ml（P=0.88）；中位手术时间没有差异（165min 和 164min），围手术期血红蛋白改变也没有差异（1.00 和 1.1 g/dL）。氨甲环酸组的患者均不需要输血，但安慰剂组有4例需要输血。结论：术前静脉给予氨甲环酸在腹腔镜或机器人肌瘤切除过程中，与减少出血量无关。《术前肠道准备并不能减少子宫切除术后的感染》American Journal of Obstetrics and Gynecology，2020年8月 (4)关于妇科手术前肠道准备的文献很少，在子宫切除术前进行肠道准备主要是借鉴结直肠手术的经验。因此本研究的目的是比较子宫切除术前，与无肠道准备相比，单纯机械性肠准备、单纯口服抗生素或联合使用抗生素是否与手术部位感染或吻合口漏发生率降低有关。研究回顾性的分析了10余年间、共224,687例子宫切除术手术患者的数据。其中良性疾病186,148例、平均45岁，恶性肿瘤38,539例，平均54岁。其中包括腹腔镜/机器人手术、剖腹手术和经阴道手术等不同术式。术前准备包括肠道准备、口服抗生素、两者联合等不同策略。研究人员发现，肠道准备并没有降低手术部位感染、吻合口漏或其他并发症的发病率。在恶性肿瘤、开腹子宫切除术中，肠道准备、口服抗生素或肠道准备联合抗生素等几种策略，与不进行抗生素预防治疗的患者相比，感染发病率没有差异。结论：无论手术方式如何，肠道准备都不能预防手术部位感染或并发症，可以安全省略此步骤。妊娠期高血压妊娠>20周的女性新发高血压，但没有蛋白尿或新发靶器官功能障碍，则诊断为妊娠期高血压。根据2019年美国妇产科医师学会的建议，无论是否有其他表现，收缩压≥ 160mmHg和/或舒张压≥110mmHg，应直接诊断为“重度子痫前期”，即以前所说的“重度妊娠高血压”。更名的原因是，即使没有蛋白尿，妊娠诱发的重度血压升高也可能导致严重的不良事件。若产后≥12周后，血压仍高于正常，诊断为慢性高血压。妊娠期高血压最常用的降压药物包括：甲基多巴、拉贝洛尔、硝苯地平。尚有争议的药物包括：噻嗪类利尿剂、肼屈嗪、可乐定、硝普钠。妊娠期应避免使用的药物包括：ACEI、ARB、直接肾素抑制剂、盐皮质激素。《综述：他汀类药物在预防子痫前期中的作用》American Journal of Obstetrics and Gynecology，2020年8月 (5)子痫前期的确切原因尚不清楚，但普遍认为与胎盘异常释放可溶性抗血管生成因子有关，加之氧化应激和炎症反应的增加，导致母体全身内皮功能障碍。他汀类药物已被证明可以纠正类似的病理生理过程。普伐他汀，在各种临床前期和临床研究中显示，它可以逆转妊娠特异性的血管功能失衡，恢复内皮健康，防止氧化和炎症损伤。人类研究表明普伐他汀具有良好的安全性，而最近的证据不支持他汀类药物致畸的担忧。结论：他汀类药物在子痫前期预防性的使用，仍需大型随机对照研究支持。《荟萃分析：口服降压药对慢性高血压孕妇的疗效和安全性的比较》American Journal of Obstetrics and Gynecology，2020年10月 (6)此荟萃分析的目的是同时比较降压药对患有慢性高血压的孕妇的疗效和安全性。共纳入了22项研究，包括4464名女性。随机对照试验的分析表明，没有任何药物会显著影响先兆子痫的发生率。与安慰剂相比，阿替洛尔与小于胎龄儿（small for gestational age，SGA）的风险增加显著相关（风险比 26.00），而且被列为疗效最差的降压药。严重高血压的发生率在以下药物的干预下显著降低：硝苯地平风险比0.27，甲基多巴风险比0.31，吲哚洛尔风险比0.29，酮舍林风险比0.17。相比而言，严重高血压发生的概率最高的药物包括：速尿、氨氯地平和安慰剂。硝苯地平和甲基多巴能显著降低胎盘早剥率的风险（风险比 0.29和0.23）。各类降压药在剖宫产、围产期死亡、早产和分娩时胎龄方面无显著差异。结论：阿替洛尔与小于胎龄儿的风险显著增加有关。当使用硝苯地平和甲基多巴时，严重高血压的发生率显著降低。尽管在降压药中先兆子痫的风险是相似的，但未来仍需大规模研究为妊娠期降压药的选择和目标血压提供指导。《前瞻性观察队列研究：慢性高血压患者妊娠并发症与妊娠前母体心脏功能和结构有关》American Journal of Obstetrics and Gynecology，2020年9月 (7)约3%的妊娠合并为慢性高血压，这些产妇的分娩并发症发生率可高达25 - 28%。本研究的目的是通过超声心动图，评估妊娠前孕妇的心脏结构和功能，寻找其与分娩并发症以及妊娠前治疗的相关性。这项前瞻性观察队列研究，纳入192名长期接受降压治疗的孕妇，妊娠前改用甲基多巴，并随访至分娩。在192例患者中，出现24例早期并发症（

Journal Club 儿科星期五 Episode 10

Play Episode Listen Later Nov 13, 2020 23:13

FDA 批准2种治疗儿童遗传性癫痫综合征的药物NEJM 早产儿Apgar评分与新生儿死亡风险的关系Science Translational Medicine 基因治疗可逆转Danon病的代谢和多器官功能障碍司替戊醇（Stiripentol）Dravet综合征，以前称为婴儿严重肌阵挛性癫痫，是一种罕见的儿童遗传性癫痫综合征。其典型的特征是药物难治性癫痫发作，抗癫痫药物治疗是主要手段，但总体疗效有限，初始药物选择包括丙戊酸盐、苯二氮卓类药物氯巴占；一线药物治疗失败，也有选择生酮饮食疗法和神经调控技术治疗的。司替戊醇（Stiripentol，CYP450抑制剂，2018年FDA批准用于Dravet综合征的二线治疗，需与丙戊酸盐和氯巴占合用）。《STICLO-France和STICLO-Italy研究：司替戊醇治疗Dravet综合征》Drugs，2019年11月 (1)司替戊醇可以用于氯巴占和丙戊酸盐无法控制的Dravet综合征患者。佐证其疗效的最重要的两个随机对照研究分别为STICLO-France和STICLO-Italy，这两个小型的、随机对照试验，2个月的司替戊醇辅助疗法与明显优于安慰剂，两个研究数据放在一起分析，司替戊醇的缓解率是安慰剂组的10倍（70%比7%）。随后，这些短期结果被扩展为开放标签、观察性研究，当时3-21岁的参与者，长期使用该药物直至中青年，最长服药24年，疗效维持。乏力、食欲减退、体重减轻、共济失调和震颤是最常见的不良事件。结论：根据现有证据，司替戊醇作为Dravet综合征的辅助药物，疗效和安全性均较可靠。芬氟拉明（fenfluramine）2020年6月，芬氟拉明（fenfluramine），是一种安非他明的衍生物，被FDA批准用于治疗≥2岁的Dravet综合征患儿。《FAiRE DS研究：芬氟拉明剂量滴定治疗Dravet综合征的剂量滴定的3期研究》JAMA Neurology，2019年12月 (2)研究旨在评估芬氟拉明治疗司替戊醇治疗效果不佳的、Dravet综合征患者是否可以减少每月惊厥发作频率。这项双盲、安慰剂对照、平行组随机、剂量滴定的3期临床试验，纳入确诊为Dravet综合征的、2岁-18岁的、正在接受稳定剂量司替戊醇治疗的、115名儿童。他们被随机分配到芬氟拉明组和或安慰剂，经过3周的药物滴定后，进入12周的维持治疗。患儿平均年龄9.1岁，惊厥性癫痫发作平均每月25次。12周后，芬氟拉明组的患儿发作频率较安慰剂组下降54.0%；同时，芬氟拉明组54%的患者发作频率下降≥50%，而安慰剂组仅5% (P

Journal Club 妇产科星期四 Episode 9

Play Episode Listen Later Nov 13, 2020 25:08

FDA 批准促性腺激素释放激素（GnRH）拮抗剂治疗子宫肌瘤导致的大量子宫出血NEJM 比较子宫动脉栓塞术与子宫肌瘤切除术治疗子宫肌瘤的疗效Cell 在孕妇中利用代谢动力学预测孕周和分娩时间恶拉戈利（elagolix）恶拉戈利（elagolix）是一种口服促性腺激素释放激素（GnRH）拮抗剂，既往用于治疗子宫内膜异位症引起的盆腔疼痛。2020年5月，美国FDA批准恶拉戈利用于治疗绝经前期、子宫肌瘤导致的大量子宫出血。《UF-1和UF-2研究：恶拉戈利治疗子宫肌瘤所致月经过多的治疗方案》New England Journal of Medicine，2020年1月 (1)研究旨在比较恶拉戈利300mg bid（单药治疗或联合雌激素-孕激素反加疗法）对子宫肌瘤的疗效。在两项相同的试验（UF-1和UF-2）中，月经过多（月经失血量＞80 mL）且经超声诊断为子宫肌瘤的总共790名女性（平均年龄42岁）被随机分组，分别接受6个月的恶拉戈利联合反加疗法、恶拉戈利单药治疗或安慰剂治疗。研究者通过收集生理用品的方式量化月经失血量。两项研究6个月后，84%和77%的单药治疗、68.5%和76.5%的恶拉戈利联合反加疗法和9%的安慰剂组达到主要终点（月经量50%）。主要不良反应是潮热和子宫出血，恶拉戈利联合反加治疗组的发生率显著高于安慰剂组。反加治疗法减轻了恶拉戈利的低雌激素效应，腰椎骨密度减少0.76%，低于恶拉戈利单药治疗组2.95%。结论：恶拉戈利单药治疗或联合雌-孕激素反加疗法均有效减轻子宫肌瘤相关的月经过多。恶拉戈利单药治疗与骨密度显著降低相关，反加治疗可以减少这种副作用。子宫肌瘤子宫肌瘤，是女性最常见的盆腔肿瘤，是起源于子宫平滑肌细胞和成纤维细胞的单克隆非癌性肿瘤。主要发生在育龄期妇女，可表现为异常子宫出血、盆腔疼痛/压迫感、生殖功能障碍（不孕或产科并发症）。大多数的子宫肌瘤会在生产后或绝经后自行萎缩；如果子宫肌瘤引起严重症状，则需治疗。对没有生育要求的患者，可行宫腔镜下切除粘膜下肌瘤；雌-孕激素避孕药；释放孕激素的宫内节育器；氨甲环酸；促性腺激素释放激素（GnRH）的激动剂和拮抗剂等。对于有生育要求的患者，药物大多会妨碍受孕，因此治疗首选微创手术切除。《行子宫动脉栓塞术与子宫肌瘤切除术治疗子宫肌瘤的比较》New England Journal of Medicine，2020年7月 (2)对于希望保留子宫、且药物治疗无效的女性，子宫肌瘤切除术和子宫动脉栓塞术是可选治疗方案。这项多中心、随机、开放标签试验，旨在评估症状性子宫肌瘤患者中使用子宫肌瘤切除术和子宫动脉栓塞术的疗效的比较。子宫肌瘤切除术的可选术式包括开腹、腹腔镜或宫腔镜手术。研究共招募了254名女性随机分组：子宫肌瘤切除术组和子宫动脉栓塞术。随访2年时，两组的生活质量评分分别为84.6分和80.0分（P=0.01）。在所有初次手术中，子宫肌瘤切除术组29%的女性和子宫动脉栓塞术组24%的女性发生了围手术期和术后并发症。结论：在有症状的子宫肌瘤患者中，接受子宫肌瘤切除术的女性在2年时的子宫肌瘤相关生活质量优于接受子宫动脉栓塞术的女性。《随机双盲对照试验：术前氨甲环酸减少子宫肌瘤切除术失血》American Journal of Obstetrics and Gynecology，2020年9月(3)氨甲环酸是一种合成赖氨酸衍生物，具有抗纤溶活性，用于其他外科学科，以减少手术期间的失血。本研究旨在探讨早期静脉注射氨甲环酸对子宫肌瘤切除术妇女围手术期出血和输血需求的影响。这项双盲、随机、安慰剂对照试验中，纳入有大出血风险的、症状性子宫肌瘤的女性共60人，随机分入干预组（手术前20分钟静脉注射氨甲环酸15 mg/kg）和安慰剂组（手术前静脉注射生理盐水）。这里有大出血风险定义为：（1）至少1个肌瘤≥10cm，（2）任何1个肌壁内或阔韧带肌瘤≥6cm，和/或（3）手术前影像学检查提示至少有5个肌瘤。患者中53%接受腹腔镜子宫肌瘤切除术，40%接受机器人子宫肌瘤切除术，7%接受采用剖腹手术。氨甲环酸组和安慰剂组中，中位估计失血量分别为200ml和240ml（P=0.88）；中位手术时间没有差异（165min 和 164min），围手术期血红蛋白改变也没有差异（1.00 和 1.1 g/dL）。氨甲环酸组的患者均不需要输血，但安慰剂组有4例需要输血。结论：术前静脉给予氨甲环酸在腹腔镜或机器人肌瘤切除过程中，与减少出血量无关。《术前肠道准备并不能减少子宫切除术后的感染》American Journal of Obstetrics and Gynecology，2020年8月 (4)关于妇科手术前肠道准备的文献很少，在子宫切除术前进行肠道准备主要是借鉴结直肠手术的经验。因此本研究的目的是比较子宫切除术前，与无肠道准备相比，单纯机械性肠准备、单纯口服抗生素或联合使用抗生素是否与手术部位感染或吻合口漏发生率降低有关。研究回顾性的分析了10余年间、共224,687例子宫切除术手术患者的数据。其中良性疾病186,148例、平均45岁，恶性肿瘤38,539例，平均54岁。其中包括腹腔镜/机器人手术、剖腹手术和经阴道手术等不同术式。术前准备包括肠道准备、口服抗生素、两者联合等不同策略。研究人员发现，肠道准备并没有降低手术部位感染、吻合口漏或其他并发症的发病率。在恶性肿瘤、开腹子宫切除术中，肠道准备、口服抗生素或肠道准备联合抗生素等几种策略，与不进行抗生素预防治疗的患者相比，感染发病率没有差异。结论：无论手术方式如何，肠道准备都不能预防手术部位感染或并发症，可以安全省略此步骤。妊娠期高血压妊娠>20周的女性新发高血压，但没有蛋白尿或新发靶器官功能障碍，则诊断为妊娠期高血压。根据2019年美国妇产科医师学会的建议，无论是否有其他表现，收缩压≥ 160mmHg和/或舒张压≥110mmHg，应直接诊断为“重度子痫前期”，即以前所说的“重度妊娠高血压”。更名的原因是，即使没有蛋白尿，妊娠诱发的重度血压升高也可能导致严重的不良事件。若产后≥12周后，血压仍高于正常，诊断为慢性高血压。妊娠期高血压最常用的降压药物包括：甲基多巴、拉贝洛尔、硝苯地平。尚有争议的药物包括：噻嗪类利尿剂、肼屈嗪、可乐定、硝普钠。妊娠期应避免使用的药物包括：ACEI、ARB、直接肾素抑制剂、盐皮质激素。《综述：他汀类药物在预防子痫前期中的作用》American Journal of Obstetrics and Gynecology，2020年8月 (5)子痫前期的确切原因尚不清楚，但普遍认为与胎盘异常释放可溶性抗血管生成因子有关，加之氧化应激和炎症反应的增加，导致母体全身内皮功能障碍。他汀类药物已被证明可以纠正类似的病理生理过程。普伐他汀，在各种临床前期和临床研究中显示，它可以逆转妊娠特异性的血管功能失衡，恢复内皮健康，防止氧化和炎症损伤。人类研究表明普伐他汀具有良好的安全性，而最近的证据不支持他汀类药物致畸的担忧。结论：他汀类药物在子痫前期预防性的使用，仍需大型随机对照研究支持。《荟萃分析：口服降压药对慢性高血压孕妇的疗效和安全性的比较》American Journal of Obstetrics and Gynecology，2020年10月 (6)此荟萃分析的目的是同时比较降压药对患有慢性高血压的孕妇的疗效和安全性。共纳入了22项研究，包括4464名女性。随机对照试验的分析表明，没有任何药物会显著影响先兆子痫的发生率。与安慰剂相比，阿替洛尔与小于胎龄儿（small for gestational age，SGA）的风险增加显著相关（风险比 26.00），而且被列为疗效最差的降压药。严重高血压的发生率在以下药物的干预下显著降低：硝苯地平风险比0.27，甲基多巴风险比0.31，吲哚洛尔风险比0.29，酮舍林风险比0.17。相比而言，严重高血压发生的概率最高的药物包括：速尿、氨氯地平和安慰剂。硝苯地平和甲基多巴能显著降低胎盘早剥率的风险（风险比 0.29和0.23）。各类降压药在剖宫产、围产期死亡、早产和分娩时胎龄方面无显著差异。结论：阿替洛尔与小于胎龄儿的风险显著增加有关。当使用硝苯地平和甲基多巴时，严重高血压的发生率显著降低。尽管在降压药中先兆子痫的风险是相似的，但未来仍需大规模研究为妊娠期降压药的选择和目标血压提供指导。《前瞻性观察队列研究：慢性高血压患者妊娠并发症与妊娠前母体心脏功能和结构有关》American Journal of Obstetrics and Gynecology，2020年9月 (7)约3%的妊娠合并为慢性高血压，这些产妇的分娩并发症发生率可高达25 - 28%。本研究的目的是通过超声心动图，评估妊娠前孕妇的心脏结构和功能，寻找其与分娩并发症以及妊娠前治疗的相关性。这项前瞻性观察队列研究，纳入192名长期接受降压治疗的孕妇，妊娠前改用甲基多巴，并随访至分娩。在192例患者中，出现24例早期并发症（

Journal Club 儿科星期五 Episode 10

Play Episode Listen Later Nov 13, 2020 23:13

FDA 批准2种治疗儿童遗传性癫痫综合征的药物NEJM 早产儿Apgar评分与新生儿死亡风险的关系Science Translational Medicine 基因治疗可逆转Danon病的代谢和多器官功能障碍司替戊醇（Stiripentol）Dravet综合征，以前称为婴儿严重肌阵挛性癫痫，是一种罕见的儿童遗传性癫痫综合征。其典型的特征是药物难治性癫痫发作，抗癫痫药物治疗是主要手段，但总体疗效有限，初始药物选择包括丙戊酸盐、苯二氮卓类药物氯巴占；一线药物治疗失败，也有选择生酮饮食疗法和神经调控技术治疗的。司替戊醇（Stiripentol，CYP450抑制剂，2018年FDA批准用于Dravet综合征的二线治疗，需与丙戊酸盐和氯巴占合用）。《STICLO-France和STICLO-Italy研究：司替戊醇治疗Dravet综合征》Drugs，2019年11月 (1)司替戊醇可以用于氯巴占和丙戊酸盐无法控制的Dravet综合征患者。佐证其疗效的最重要的两个随机对照研究分别为STICLO-France和STICLO-Italy，这两个小型的、随机对照试验，2个月的司替戊醇辅助疗法与明显优于安慰剂，两个研究数据放在一起分析，司替戊醇的缓解率是安慰剂组的10倍（70%比7%）。随后，这些短期结果被扩展为开放标签、观察性研究，当时3-21岁的参与者，长期使用该药物直至中青年，最长服药24年，疗效维持。乏力、食欲减退、体重减轻、共济失调和震颤是最常见的不良事件。结论：根据现有证据，司替戊醇作为Dravet综合征的辅助药物，疗效和安全性均较可靠。芬氟拉明（fenfluramine）2020年6月，芬氟拉明（fenfluramine），是一种安非他明的衍生物，被FDA批准用于治疗≥2岁的Dravet综合征患儿。《FAiRE DS研究：芬氟拉明剂量滴定治疗Dravet综合征的剂量滴定的3期研究》JAMA Neurology，2019年12月 (2)研究旨在评估芬氟拉明治疗司替戊醇治疗效果不佳的、Dravet综合征患者是否可以减少每月惊厥发作频率。这项双盲、安慰剂对照、平行组随机、剂量滴定的3期临床试验，纳入确诊为Dravet综合征的、2岁-18岁的、正在接受稳定剂量司替戊醇治疗的、115名儿童。他们被随机分配到芬氟拉明组和或安慰剂，经过3周的药物滴定后，进入12周的维持治疗。患儿平均年龄9.1岁，惊厥性癫痫发作平均每月25次。12周后，芬氟拉明组的患儿发作频率较安慰剂组下降54.0%；同时，芬氟拉明组54%的患者发作频率下降≥50%，而安慰剂组仅5% (P

Episode 2: Meredith Tries Yoga

Rescue Page

Play Episode Listen Later Nov 11, 2020 16:56

Meredith tries yoga! Did she survive? Is Monee secretly a guru of the ancient art? Find out on this episode of Rescue Page! And as always, there are midnight ICEEs to go around.Articles referenced in this episode:https://pubmed.ncbi.nlm.nih.gov/30969208/Babbar S, Renner K, Williams K. Addressing Obstetrics and Gynecology Trainee Burnout Using a Yoga-Based Wellness Initiative During Dedicated Education Time. Obstet Gynecol. 2019 May;133(5):994-1001. doi: 10.1097/AOG.0000000000003229. PMID: 30969208.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230658/La Torre G, Raffone A, Peruzzo M, et al. Yoga and Mindfulness as a Tool for Influencing Affectivity, Anxiety, Mental Health, and Stress among Healthcare Workers: Results of a Single-Arm Clinical Trial. J Clin Med. 2020;9(4):1037. Published 2020 Apr 7. doi:10.3390/jcm9041037Meredith's yoga recsI pretty much just searched youtube videos for yoga when I started and found her videos to be the most down to earth, so I did her 30 day intro to yoga challenge. She's also from ATX which gave me a taste of home during quarantine which was very welcome as well. https://www.youtube.com/user/yogawithadrieneThen, I switched to the Peloton app, which is not free. It's 12.99 a month, but I liked the app because it was not just yoga. It included strength, outdoor running, indoor cardio, etc. I felt like during quarantine where everyday is the same, it was nice to have some options outside of yoga. Last resource I will say (which I have not tried), is that some studios are offering virtual class options. If yoga is something that you think you might like, but are overwhelmed by the number of studios and which one might be a good fit, then quarantine is the time to try. You don't have to leave your home, and it is pretty easy/judgement free to try different places, until you find one you like! When we all feel safe to return, you will have a good idea of the place that you would like to go to, which is a huge step in the process!

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Épisode 55 – Spécial COVID-19 #6

Pharmascope

Play Episode Listen Later Jun 26, 2020 35:18

Et oui, comme le dit le diction: jamais cinq sans six! Alors voici le sixième épisode spécial sur la COVID-19. Dans ce 55ème épisode du Pharmascope, Nicolas, Sébastien et Isabelle discutent possiblement pour la dernière fois d’hydroxychloroquine, mais font aussi une mise à jour sur les corticostéroïdes, le plasma convalescent et sur l’effet de la COVID-19 durant la grossesse. Les objectifs pour cet épisode sont : Comprendre les données cliniques associées à l’hydroxychloroquine dans le traitement ou la prévention de la COVID-19Comprendre les données cliniques associées aux corticostéroïdes et au plasma convalescent dans le traitement de la COVID-19Discuter des issues obstétricales et néonatales chez la femme enceinte atteinte de COVID-19 Ressources pertinentes en lien avec l’épisode Études portant sur l’hydroxychloroquineRETRACTED: Mehra MR et coll. Hydroxychloroquine or Chloroquine With or Without a Macrolide for Treatment of COVID-19: A Multinational Registry Analysis. Lancet.2020;May 22; S0140-6736(20)31180-6. Boulware DR et coll. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxie for Covid-19. N Engl J Med. 2020 Jun 3. Statement from the Chief Investigators of the Randomised Evaluation of COVid-19 thERapY (RECOVERY) Trial on hydroxychloroquine, 5 June 2020. No clinical benefit from use of hydroxychloroquine in hospitalised patients with COVID-19. Étude portant sur la dexaméthasoneOxford University News Release. Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID-19. 16 June 2020. Études portant sur le plasma convalescentLi L et coll. Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19: A Randomized Clinical Trial. JAMA. 2020 Jun 3. Lien pour s’inscrire comme donneur de plasma convalescent auprès d’Héma-Québec. Arnold DM et coll. CONvalescent Plasma for Hospitalized Adults With COVID-19 Respiratory Illness (CONCOR-1). ClinicalTrials.gov NCT identifier: NCT04348656. Impact sur la grossesse et les issues néonatalesHuntley BJF et coll. Rates of Maternal and Perinatal Mortality and Vertical Transmission in Pregnancies Complicated by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Co-V-2) Infection: A Systematic Review. Obstet Gynecol. 2020 Jun 9. Ressources générales sur la COVID-19 Guides de l’INESSSGouvernement du Québec. Institut national d’excellence en santé et en services sociaux (INESSS). University of Oxford. Center for Evidence-Based MedicineOxford COVID-19 Evidence Service. Organisation mondiale de la santéLignes directrices pour le nouveau coronavirus (2019-nCoV). Evidence AlertsMcMaster University. Health Information Research Unit. Evidence Alerts. UpToDate® Clinical Effectiveness COVID-19 Resources Available to All.

Universal HCV Screening (Obstet Gynecol EPub).

universal screenings obstetrics gynecology epub hepatitis c acog obstet gynecol

Play Episode Listen Later Mar 16, 2020 9:30

Even though we have covered this topic in a prior podcast, the urgent need for Hepatitis C screening in pregnant women still leads the medical literature. In the journal Obstetrics and Gynecology, a new current commentary will soon be released titled, “A call to action: the urgent need for hepatitis C screening in pregnant women“. In this podcast, we will summarize the key aspects of this current commentary, proving that despite the ACOG recommendation of using a risk-based model, that ACOG recommendation is now outdated.

EBB 113 - The Evidence on VBAC

tips preparing wrap birth pregnancy stitcher misconceptions hundreds pelvic floor bk kegels beyond podcast aog obstet gynecol

Play Episode Listen Later Jan 29, 2020 44:04

In this episode, I am excited to share the evidence on vaginal birth after Cesarean, or VBAC. We have received many requests at Evidence Based Birth to cover this topic, so I want to share with you the information on VBAC that I present in a class we teach in the EBB Higher Ed program. In this podcast, I define some common terms related to VBAC and talk about the history of the procedure. By the end, you will have the facts on the prevalence and risk factors for uterine rupture, and you’ll understand some of the maternal, fetal, and newborn risks of VBAC, elective repeat Cesarean, and Cesarean birth after Cesarean. For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on Facebook, Instagram, and Pinterest. Ready to get involved? Check out our Professional membership (including scholarship options) and our Instructor program. Find an EBB Instructor here, and click here to learn more about the Evidence Based Birth® Childbirth Class. RESOURCES: American College of Obstetricians and Gynecologists/ Society for Maternal-Fetal Medicine (2018). Placenta accreta spectrum. Obstetric Care Consensus No. 7. Obstet Gynecol, 132, e259-275. Click here. Free full text! Bujold, E., Goyet, M., Marcoux, S., et al. (2010). The role of uterine closure in the risk of uterine rupture. Obstet Gynecol, 116(1), 43-50. Carlton Fagerberg, M. and Källén, K. (2019). Third trimester prediction of successful vaginal birth after one cesarean delivery - a Swedish model. Acts Obstet Gynecol Scand. (Epub ahead of print.] Click here. Grobman, W. A., Lai, Y., Landon, M. B., et al. (2007). Development of a nomogram for prediction of vaginal birth after cesarean delivery. Obstet Gynecol, 109, 806. Click here. VBAC calculator for use at first prenatal visit: https://mfmunetwork.bsc.gwu.edu/PublicBSC/MFMU/VGBirthCalc/vagbirth.html Guise, J.-M., Eden, K., Emeis, C., et al. (2010). Vaginal Birth After Cesarean: New Insights. Evidence Report/Technology Assessment No.191. (Prepared by the Oregon Health & Science University Evidence-based Practice Center under Contract No. 290-2007-10057-I). AHRQ Publication No. 10-E003. Rockville, MD: Agency for Healthcare Research and Quality. Click here. Free full text! Landon, M. B., Hauth, J. C., Leveno, K. J. et al. (2004). Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery. N Engl J Med, 351, 258-2589. Click here. Free full text! Landon, M. B., Grobman, W. A. and Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network (2016). What We Have Learned About Trial of Labor After Cesarean Delivery from the Maternal-Fetal Medicine Units Cesarean Registry. Seminars in perinatology, 40(5), 281–286. Click here. Free full text! Metz, T. D., Stoddard, G. J., Henry, E., et al. (2013). Simple, validated vaginal birth after cesarean delivery prediction model for use at the time of admission. Obstet Gynecol, 122, 571. Click here. Free full text! VBAC calculator for use at time of admission for birth: https://mfmunetwork.bsc.gwu.edu/PublicBSC/MFMU/VGBirthCalc/vagbrth2.html Sandall, J., Tribe, R. M., Avery, L., et al. (2018). Short-term and long-term effects of caesarean section on the health of women and children. Lancet, 392(10155), 1349-1357. Click here. Silver, R. M., Landon, M. B., Rouse, D. J., et al. (2006). Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol, 107(6), 1226-1232. Click here. Smith, G. C. S., Pell, J. P., Cameron, A. D., et al. (2002). Risk of Perinatal Death Associated With Labor After Previous Cesarean Delivery in Uncomplicated Term Pregnancies. JAMA, 287(20), 2684–2690. Click here. Free full text! Vlemminx, M. W., de Lau, H. and Oei, S. G. (2017). Tocogram characteristics of uterine rupture: a systematic review. Archives of gynecology and obstetrics, 295(1), 17–26. Click here. Free full text! Access the International Cesarean Awareness Network’s "Terminology: What is a CBAC?” here. Visit VBAC Facts here. Visit The VBAC Link here. Visit ICAN here. See the Association of Ontario Midwives Clinical Guidelines Statement on Vaginal Birth After Previous Low-Segment Cesarean Section here. Get the Association of Ontario Midwives handout, Thinking About VBAC: What’s Right for Me, here. Get information on VBAC from Power to Push here (http://www.powertopush.ca/birth-options/types-of-birth/vaginal-birth-after-cesarean/). Click here (https://evidencebasedbirth.com/the-evidence-for-skin-to-skin-care-after-a-cesarean/) for the Evidence Based Birth® Signature Article, The Evidence on: Skin to Skin Care After Cesarean.

Episode 102: 3 Misconceptions When Preparing Your Pelvic Floor for Birth

To Birth and Beyond

Play Episode Listen Later Jan 14, 2020 19:08

In today's episode, Anita outlines the 3 most common misconceptions around the preparation of your pelvic floor for birth - along with some tips and tricks to correct them!- - - -If you liked this episode of To Birth and Beyond, tell your friends! Find us on iTunes and Stitcher to rate/review/subscribe to the show. Want more? Visit www.ToBirthAndBeyond.com, join our Facebook group (To Birth and Beyond Podcast), and follow us on Instagram @tobirthandbeyondpodcast! Thanks for listening and joining the conversation! Resources and References Anita's free guide: 3 Tips to Help Pelvic Floor Connection in Pregnancy to Prepare for Birth Without Doing 100s of Kegels a Day Du Y, Xu L, Ding L, Wang Y, Wang Z. (2015) The effect of antenatal pelvic floor muscle training on labor and delivery outcomes: a systematic review with meta-analysis. International Urogynecology Journal, Volume 26 (10):1415-27. doi: 10.1007/s00192-015-2654-4 Bø K, Fleten C, Nystad W. Effect of antenatal pelvic floor muscle training on labor and birth. Obstet Gynecol. 2009 Jun;113(6):1279-84. doi:10.1097/AOG.0b013e3181a66f40 TBAB episode 31: Top 5 exercise tips for pregnancy TBAB episode 15: Pregnancy and postpartum athleticism with Brianna Battles TBAB episode 5: Prenatal Exercise Time Stamps2:20 - What we are talking about today! 3:59 - Misconception #1: You must do HUNDREDS of kegels per day during pregnancy. 10:42 - Misconception #2: Only focus on squeezing and tightening your pelvic floor. 15:14 - Misconception #3: You should only use relaxation breathing or birth breathing in labor. 16:35 - Wrap up and run down!

Episode 102: 3 Misconceptions When Preparing Your Pelvic Floor for Birth

To Birth and Beyond

Play Episode Listen Later Jan 13, 2020 19:08

In today’s episode, Anita outlines the 3 most common misconceptions around the preparation of your pelvic floor for birth - along with some tips and tricks to correct them!- - - -If you liked this episode of To Birth and Beyond, tell your friends! Find us on iTunes and Stitcher to rate/review/subscribe to the show. Want more? Visit www.ToBirthAndBeyond.com, join our Facebook group (To Birth and Beyond Podcast), and follow us on Instagram @tobirthandbeyondpodcast! Thanks for listening and joining the conversation! Resources and References Free guide: 3 Misconceptions when Preparing your Pelvic Floor for Birth (and what to do instead) includes waitlist for Bump to Birth online program Du Y, Xu L, Ding L, Wang Y, Wang Z. (2015) The effect of antenatal pelvic floor muscle training on labor and delivery outcomes: a systematic review with meta-analysis. International Urogynecology Journal, Volume 26 (10):1415-27. doi: 10.1007/s00192-015-2654-4 Bø K, Fleten C, Nystad W. Effect of antenatal pelvic floor muscle training on labor and birth. Obstet Gynecol. 2009 Jun;113(6):1279-84. doi:10.1097/AOG.0b013e3181a66f40 TBAB episode 31: Top 5 exercise tips for pregnancy TBAB episode 15: Pregnancy and postpartum athleticism with Brianna Battles TBAB episode 5: Prenatal Exercise Time Stamps2:20 - What we are talking about today! 3:59 - Misconception #1: You must do HUNDREDS of kegels per day during pregnancy. 10:42 - Misconception #2: Only focus on squeezing and tightening your pelvic floor. 15:14 - Misconception #3: You should only use relaxation breathing or birth breathing in labor. 16:35 - Wrap up and run down!

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HCV in Pregnancy: IDSA Update

Play Episode Listen Later Jan 12, 2020 12:01

Currently, the ACOG and SMFM recommend a “risk-based” approach to HCV screening in pregnancy. HOWEVER, a soon to be published original article (February 2020) in Obstet Gynecol confirms that “The reported prevalence of maternal HCV infection has increased 161% from 2009 to 2017”. The IDSA has called for UNIVERSAL screening of HCV. In the session, we will review the Nov 2019 IDSA HCV screening recommendations and provide key points from the Rossi et al Feb 2020 Green Journal publication.

universal pregnancy rossi acog hcv idsa obstet gynecol smfm

EBB 110 - Inside an Unplanned, Unassisted Home Birth with Parent Sabrina Tran

Play Episode Listen Later Jan 8, 2020 34:06

In this episode, I am joined by Sabrina Tran of Alabama, who recently had a daughter, and took the Evidence Based Birth Childbirth Class with Instructor Traci Weafer. Sabrina, a therapist, is now a stay at home mom. Sabrina had a precipitous - or, extremely fast labor and delivery. She describes it as exciting! Hear her tell her story of how her baby was born before the midwife could make it to her home. I also share the evidence on perineal tearing, and the relationships between tearing, provider experience, and home birth. For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on Facebook, Instagram, and Pinterest. Ready to get involved? Check out our Professional membership (including scholarship options) and our Instructor program. Find an EBB Instructor here, and click here to learn more about the Evidence Based Birth® Childbirth Class. RESOURCES: Click here for great images explaining perineal tears on the Mayo Clinic website. More references: Albers, L. L., Sedler, K. D., Bedrisk, E. J., et al. (2005). Midwifery care measures in the second stage of labor and reduction of genital tract trauma at birth: a randomized trial. J Midwifery Womens Health. 50(5): 365-372. Mizrachi, Y., Leytes, S., Levy, M., et al. (2017). Does midwife experience affect the rate of severe perineal tears? Birth. 44(2): 161-166. Begley, C., Guilliland, K., Dixon, L., et al. (2018). A qualitative exploration of techniques used by expert midwives to preserve the perineum intact. Women Birth. Kopas, M. L. (2014). A review of evidence-based practices for management of the second stage of labor. J Midwifery Womens Health. 59(3):264-76. Shorten, A., Donsante, J. and Shorten, B. (2002). Birth position, accoucheur, and perineal outcomes: informing women about choices for vaginal birth. Birth. 29(1): 18-27. Sandall, J., Soltani, H., Shennan, A., et al. (2013). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. (8): CD004667. Hutton, E. K., Cappelletti, A., Reitsma, A. H., et al. (2016). Outcomes associated with planned place of birth among women with low-risk pregnancies. CMAJ. 188(5): E80-E90. Hastings-Tolsma, M., Vincent, D., Emeis, C., et al. (2007). Getting through birth in one piece: protecting the perineum. MCN AM J Matern Child Nurs. 32: 158-64. Landy H. J., Laughon, S. K., Bailit, J. L., et al. (2011). Characteristics associated with severe perineal and cervical lacerations during vaginal delivery. Obstet Gynecol. 117(3): 627-35 Klein, M. C., Gauthier, R. J., Jorgensen, S. H., et al. (1992). Does episiotomy prevent perineal trauma and pelvic floor relaxation? Online J Curr Clin Trials. 10. Klein, M. C., Gauthier, R. J., Robbins, J. M., et al. (1994). Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. Am J Obstet Gynecol. 171(3): 591-8. Aasheim, V., Nilsen, A. B. V., Reinar, L. M., et al. (2017). Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database of Sys Rev. 6: CD006672 Alliman, J. and Phillippi, J. C. (2016). Maternal Outcomes in Birth Centers: An integrative review of the literature. J Midwifery Womens Health. 61(1): 21-51. Cheyney, M., Bovbjerg, M., Everson, C., et al. (2014). Outcomes of care for 16,924 planned home births in the U.S.: the Midwives Alliance of North America Statistics Project, 2004 to 2009. J Midwifery Womens Health. 59(1): 17-27. Hutton, E. K., Cappelletti, A., Reitsma, A. H., et al. (2016). Outcomes associated with planned place of birth among women with low-risk pregnancies. CMAJ. 188(5): E80-E90. Click here to access the EBB Signature Article, The Evidence on: Waterbirth.

Uric Acid for Preeclampsia Eval? No.

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Play Episode Listen Later Aug 23, 2019 7:47

Serum uric acid levels are often ordered for the evaluation of hypertensive disorders of pregnancy. But why is this done? Is this test able to guide clinical management? A staple of PIH evaluation in the 1970s and 1980s, uric acid levels are still around. In this session, we will review why uric acid determinations for hypertensive disorders of pregnancy is not clinically useful – in general. Reference: Sept 2019 ACOG publication, “Questioning Clinical Practice”; Obstet Gynecol.

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Podcast # 470: Zofran and Pregnancy

Emergency Medical Minute

Play Episode Listen Later May 17, 2019 3:33

Author: Jared Scott, MD Educational Pearls: Ondansetron (Zofran) is one of the latest drugs that has had concerns raised about side effects, particularly in pregnancy 2018 study probed two birth defect databases to assess increases in 51 major birth defects with increased exposure to ondansetron Only two of the 51 had even a modest increase, which is unclear in causation (cleft palate and renal agenesis) When administering ondansetron (or any drug) to pregnant women, be able to discuss any potential risks for an informed decision by the patient Editor's note: in this study, adjusted odds ratios for risk of birth defects from exposure to ondansetron were: cleft palate 1.6 (95% CI 1.1-2.3) and renal agenesis 1.8 (95% CI 1.1-3.0) References Parker SE, Van Bennekom C, Anderka M, Mitchell AA. Ondansetron for Treatment of Nausea and Vomiting of Pregnancy and the Risk of Specific Birth Defects. Obstet Gynecol. 2018 Aug;132(2):385-394. doi: 10.1097/AOG.0000000000002679. PubMed PMID: 29995744. Summarized by Will Dewispelaere, MS3 | Edited by Erik Verzemnieks, MD

55: Post-Delivery IUDs

The Ob/Gyn Podcast

Play Episode Listen Later Apr 11, 2019 23:32

Dr. Gina Milone takes us through the pros and cons of post-delivery IUD placement. feedback@obgyn.fm Blumenthal, P. D., et al. (2018). "Comparative safety and efficacy of a dedicated postpartum IUD inserter versus forceps for immediate postpartum IUD insertion: a randomized trial." Contraception98(3): 215-219. Center for Disease Control, U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC), 2016. Eser, A., et al. (2018). "Clinical experience with a novel anchored, frameless copper-releasing contraceptive device for intra-caesarean insertion." Eur J Contracept Reprod Health Care23(4): 255-259. Immediate postpartum long-acting reversible contraception. Committee Opinion No. 670. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;128:e32-7. Jatlaoui, T. C., et al. (2018). "Intrauterine Device Expulsion After Postpartum Placement: A Systematic Review and Meta-analysis." Obstet Gynecol132(4): 895-905. Kapp, N. and K. M. Curtis (2009). "Intrauterine device insertion during the postpartum period: a systematic review." Contraception80(4): 327-336. Long-acting reversible contraception: implants and intrauterine devices. Practice Bulletin No 186. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;130:e251-69. Optimizing postpartum care. ACOG Committee Opinion No. 736. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e140-50. Singh, S., et al. (2016). "A Dedicated Postpartum Intrauterine Device Inserter: Pilot Experience and Proof of Concept." Glob Health Sci Pract4(1): 132-140. Unal, C., et al. (2018). "Comparison of expulsions following intracesarean placement of an innovative frameless copper-releasing IUD (Gyn-CS(R)) versus the TCu380A: A randomized trial." Contraception.

Peripartum Cardiomyopathy (Part 1)

Play Episode Listen Later Jan 2, 2019 9:03

(Part 1): Peripartum cardiomyopathy occurs in about 1 in 2,000 births in the United States. Although relatively rare, it can be devastating to the mother. In this session we will summarize the January 2019 clinical expert series on peripartum cardiomyopathy from Dr. Gary Cunningham, et al (Obstet Gynecol. Jan 2019).

united states cardiomyopathy peripartum obstet gynecol gary cunningham

Vulvar Lichen Sclerosus (2018 Update)