OB/GYN – JournalFeed

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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.

Apr 27 2023

PE Workup in Pregnancy – YEARS, Wells, Both, Neither?

Hematology/Oncology, OB/GYN, Venous Thromboembolism

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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.

Apr 24 2023

Pregnancy and Residency – Laboring for Equity

Education, Ethics, Health Policy, OB/GYN, Wellness

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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.

Nov 2 2022

Trauma in Pregnancy – New WEST Guideline and Algorithm

OB/GYN, Trauma

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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.

May 3 2022

How to Manage Ovarian Torsion – Spoon-Feed Version

OB/GYN

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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.

Nov 12 2021

Pregnancy-Adapted Geneva Score – Pre-test Probability of Acute PE in Pregnancy

OB/GYN, Venous Thromboembolism

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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.

Sep 9 2021

Impact of POCUS on Ectopic Pregnancy

OB/GYN, Ultrasound

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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.

Aug 20 2021

D-Dimer in Pregnancy – Can We Trust It?

OB/GYN, Venous Thromboembolism

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D-dimer can be safely used to rule out venous thromboembolism in pregnant adults with non-high pre-test probability.

Jun 29 2021

How to Manage Postpartum Hemorrhage

Hematology/Oncology, OB/GYN, Pharmacy/Pharmacology

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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).

May 10 2021

New Treatment for PID – Should We Add Metronidazole?

Infectious Disease, OB/GYN, Pharmacy/Pharmacology

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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.