How to Manage Precipitous Delivery and Complications
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Although infrequent, precipitous vaginal deliveries in the ED occur and are associated with higher rates of maternal and fetal complications. Here's how you can be prepared to manage these deliveries and common complications.
NSAIDs + OCPs = More VTEs?
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This Danish nationwide cohort study found that in reproductive-age women, NSAID use alone increased the risk of venous thromboembolism (VTE). The magnitude of risk was compounded by concomitant use of hormonal contraception.
Source
Venous thromboembolism with use of hormonal contraception and non-steroidal anti-inflammatory drugs: nationwide cohort study. BMJ 2023; 382 :e074450 doi:10.1136/bmj-2022-074450.
How to Improve STI Test Accuracy – Swab or Urine?
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Vaginal swabs are more accurate than urine samples in diagnosing Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. These results support CDC recommendations that vaginal swabs are the preferred sample modality when testing for STIs in women.
Source
Vaginal Swab vs Urine for Detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis: A Meta-Analysis. Ann Fam Med. 2023 Mar-Apr;21(2):172-179. doi: 10.1370/afm.2942.
PE Workup in Pregnancy – YEARS, Wells, Both, Neither?
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Pregnant patients who present with signs and symptoms concerning for PE can be safely evaluated using Wells criteria or the YEARS algorithm.
Source
Noninvasive diagnostic work-up for suspected acute pulmonary embolism during pregnancy: a systematic review and meta-analysis of individual patient data. J Thromb Haemost. 2023 Mar;21(3):606-615. doi: 10.1016/j.jtha.2022.11.025. Epub 2022 Dec 22.
Pregnancy and Residency – Laboring for Equity
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Though incremental progress has occurred over the last several decades, inequities loom for people that wish to become pregnant during medical training.
Source
Pregnancy and Residency - Overdue for Equity. N Engl J Med. 2023 Mar 16;388(11):966-967. doi: 10.1056/NEJMp2215288. Epub 2023 Mar 11.
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.
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.