Trauma in Pregnancy – New WEST Guideline and Algorithm
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The primary survey and standard initial interventions are the same. Here is how a viable pregnancy changes the algorithm beyond that.
OB/GYN
How to Manage Ovarian Torsion – Spoon-Feed Version
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Ovarian torsion is a rare condition that is difficult to diagnose and associated with significant morbidity. Key points are summarized here, but reading the entire article is highly recommended. It’s short and packed with important information.
Source
High risk and low prevalence diseases: Ovarian torsion. Am J Emerg Med. 2022 Mar 31;56:145-150. doi: 10.1016/j.ajem.2022.03.046. Online ahead of print.
Pregnancy-Adapted Geneva Score – Pre-test Probability of Acute PE in Pregnancy
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In this prospective cohort, a pregnancy-adapted Geneva Score demonstrated better diagnostic accuracy than the original Geneva Score in identifying pregnant patients as low, intermediate, and high risk for acute pulmonary embolism.
Impact of POCUS on Ectopic Pregnancy
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Using point of care ultrasound (POCUS) to assess for ectopic pregnancy is associated with shorter ED length of stay for all ectopic pregnancies and faster time to the OR for ruptured ectopics, when compared to radiology-based US alone.
D-Dimer in Pregnancy – Can We Trust It?
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D-dimer can be safely used to rule out venous thromboembolism in pregnant adults with non-high pre-test probability.
How to Manage Postpartum Hemorrhage
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Postpartum hemorrhage is defined as ≥1000mL of blood loss irrespective of the delivery route, with associated shock. Remember the four “T’s”: tone (uterine atony), trauma (lacerations, uterine rupture), tissue (retained placenta, clots) and thrombin (coagulopathies). Manage the ABCs (especially two large bore IV’s for massive transfusion) and tailor treatment to the specific cause. Recommendations for balanced transfusion are derived from the trauma literature, but it is important to administer cryoprecipitate earlier to maintain a higher fibrinogen level (at term the normal level is >350mg/dL).
New Treatment for PID – Should We Add Metronidazole?
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Adding metronidazole to the current IDSA regimen of ceftriaxone (CTX) and doxycycline for outpatient pelvic inflammatory disease treatment is generally well tolerated and associated with less-frequent recovery of anaerobic organisms and improved clinical response compared to CTX and doxy.
New Regimen for Gonorrhea and Chlamydia
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The new regimen for treating gonorrhea is ceftriaxone 500mg IM, and in patients with unknown chlamydia status, add doxycycline 100mg po bid x 7 days.
Fluconazole During Pregnancy – Is It Safe?
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Even at the usual low dose for vulvovaginal candidiasis, fluconazole was associated with an increased risk of musculoskeletal malformations when given in the first trimester. Higher doses were associated with an even greater risk.
Should We Rethink Pregnancy-Adapted YEARS Criteria?
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Had the pregnancy-adapted YEARS algorithm been applied in the DiPEP population, it would have missed a significant number of PEs. But there are several limitations to this study.