Category: Obstetrics & Gynecology
Keywords: postpartum depression (PubMed Search)
Posted: 5/2/2024 by Michele Callahan, MD
(Updated: 5/16/2024)
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Perinatal mental health problems are unfortunately quite common: according to the World Health Organization, approximately 10% of women in high-income countries and approximately 30% in low- or middle-income countries are affected.
It's important to be able to distinguish “baby blues” from more significant mental health issues. Typical symptoms of the “baby blues” include mild and short-lived changes in mood, as well as feelings of exhaustion, worry, and unhappiness in the weeks that follow giving birth.
Symptoms that are more severe or lasting >2 weeks post-partum should prompt further investigation and discussion with a mental health professional. Symptoms of perinatal depression may include: feeling persistently sad, feelings of hopelessness, loss of interest or pleasure in hobbies/activities, trouble bonding with the infant, appetite changes, and can even become as severe as wanting to harm onself or one's child. There are specific DSM-5 Criteria used to diagnose postpartum depression.
Universal screening for all pregnant and postpartum patients is highly recommended, and can be life-saving.
Bauman BL, Ko JY, Cox S, et al. Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression — United States, 2018. MMWR Morb Mortal Wkly Rep 2020;69:575–581. DOI: http://dx.doi.org/10.15585/mmwr.mm6919a2
Category: Obstetrics & Gynecology
Keywords: postpartum, hemorrhage, pregnancy, maternal (PubMed Search)
Posted: 4/4/2024 by Michele Callahan, MD
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Postpartum hemorrhage (defined as >500 mL blood loss after birth by the WHO and >1000 mL blood loss within 24 hours of birth by ACOG), accounts for 27% of maternal deaths worldwide. It is the leading cause of maternal complications and death worldwide, with approximately 70,000 deaths globally.
In a randomized trial published in the NEJM in 2023, they implemented a bundle of first-response treatments including uterine massage, uterotonic medications, and tranexamic acid and compared this intervention group with a control group providing "usual care". They concluded that early detection of PPH and use of bundled treatment led to a lower risk of postpartum hemorrhage, lower need for laparotomy for bleeding, or lower risk of death from bleeding compared with usual care amongst patients having a vaginal delivery.
This study confirms the already widely-published recommendations for prevention of PPH with active management of the third stage of labor using prophylactic uterotonic medication (most commonly Oxytocin), uterine massage for atony, early cord clamping, and controlled cord traction for delivery of the placenta. Prompt escalation to more aggressive management (including blood transfusion, TXA, and more invasive treatments such as uterine tamponade or surgical intervention) should occur when initial treatments fail.
Gallos I, Devall A, Martin J, et al. Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage. The New England Journal of Medicine. 2023 Jul;389(1):11-21. DOI: 10.1056/nejmoa2303966. PMID: 37158447.
Category: Obstetrics & Gynecology
Keywords: POCUS, OB, Ectopic Pregnancy (PubMed Search)
Posted: 7/31/2023 by Alexis Salerno, MD
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Ectopic pregnancy ranges from 3 to 13% in symptomatic first-trimester ED patients.
The discriminatory zone is defined as the level of Bhcg above which an intrauterine pregnancy can be reliably detected using ultrasound. (1,500 mIU/mL for transvaginal ultrasound and 3,000 mIU/mL for transabdominal ultrasound)
One study found that an intrauterine pregnancy was visualized with as low as 1,440 mIU/mL and patients with an interdeterminate pelvic ultrasound who were found to have an ectopic pregnancy had a Bhcg greater than 3,000 mIU/mL only 35% of the time.
Bottom Line: If you have a symptomatic patient with an empty uterus and a bhcg above the discriminatory zone, they have a higher risk for ectopic pregnancy. However, if your patient is symptomatic, they should still have further evaluation for ectopic pregnancy even if they have a bhcg lower than the discriminatory zone.
Wang R, Reynolds TA, West HH, Ravikumar D, Martinez C, McAlpine I, Jacoby VL, Stein JC. Use of a β-hCG discriminatory zone with bedside pelvic ultrasonography. Ann Emerg Med. 2011 Jul;58(1):12-20. doi: 10.1016/j.annemergmed.2010.12.023. Epub 2011 Feb 18. PMID: 21310509.
Category: Obstetrics & Gynecology
Keywords: Morning Sickness, Pregnancy (PubMed Search)
Posted: 9/21/2013 by Michael Bond, MD
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Treatment:
Consider these therapies the next time you see a pregnant with persistent nausea and vomiting in her 1st
--Yemi
Niebyl, Jennifer MD. Nausea and Vomiting in Pregnancy. The New England Journal of Medicine. Oct 2010. 363:16.
Category: Obstetrics & Gynecology
Keywords: Rhogam, Pregnancy (PubMed Search)
Posted: 8/22/2009 by Michael Bond, MD
(Updated: 5/16/2024)
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Rhogam Dosing:
Though most textbooks recommend Micro-Rhogram (50mcg) for woman that have miscarried and are less than 12 weeks gestation, you might find it a real challenge to get that dose from your pharmacy or blood bank.
The cost difference between microRhogram and Rhogam is minimal so most hospitals have decided to only stock full dose (300 mcg) Rhogam. The full dose can be given to woman in their 1st trimester without any deleterious effects.
Just remember if you are giving it as a result of a delivery you should order a Kleihauer-Betke test to determine if additional doses of Rhogam are needed.
Category: Obstetrics & Gynecology
Keywords: postpartum, headache (PubMed Search)
Posted: 7/25/2009 by Michael Bond, MD
(Updated: 7/26/2009)
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Postpartum Headaches:
Category: Obstetrics & Gynecology
Keywords: metronidazole, pregnancy, safety (PubMed Search)
Posted: 12/14/2008 by Michael Bond, MD
(Updated: 5/16/2024)
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It seems to come up about once or twice a month about the safety of metronidazole in pregnancy. This has been very controversial over the years, but the current stance is that it is safe in pregnancy. In fact, untreated vaginal infections, bacterial vaginosis and trichomonas, have been associated with miscarriages and preterm labor, so the benefits outweigh the risks.
Below are two good references to add to your file in case you get into a debate with somebody quoting old data.
Organization of Teratology Information Specialists Information on Flagyl and Pregnancy
Safety of metronidazole during pregnancy: a cohort study of risk of congenital abnormalities, preterm delivery and low birth weight in 124 women. J Antimicrob Chemother 1999; 44: 854-855 http://jac.oxfordjournals.org/cgi/content/full/44/6/854
Category: Obstetrics & Gynecology
Posted: 11/23/2008 by Michael Bond, MD
(Updated: 5/16/2024)
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Third Trimester Bleeding:
Category: Obstetrics & Gynecology
Keywords: Bacterial Vaginosis, Treatment, Pregnancy (PubMed Search)
Posted: 4/5/2008 by Michael Bond, MD
(Updated: 5/16/2024)
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Bacterial Vaginosis
Category: Obstetrics & Gynecology
Keywords: Ultrasound, ectopic, pregnancy (PubMed Search)
Posted: 2/24/2008 by Michael Bond, MD
(Updated: 5/16/2024)
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Ultrasound in Pregnancy
Category: Obstetrics & Gynecology
Keywords: Rhogam, Pregnancy (PubMed Search)
Posted: 2/9/2008 by Michael Bond, MD
(Updated: 5/16/2024)
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Rhogam
Dosing:
Trivial Fact: Rhogam is Pregnancy Class C
Category: Obstetrics & Gynecology
Keywords: Migraines, Pregnancy (PubMed Search)
Posted: 1/27/2008 by Michael Bond, MD
(Updated: 5/16/2024)
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Migraines and Pregnancy
Category: Obstetrics & Gynecology
Keywords: Placenta, Abruption, Vaginal Bleed, Third Trimester (PubMed Search)
Posted: 10/20/2007 by Michael Bond, MD
(Updated: 5/16/2024)
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Placental Abruption
Category: Obstetrics & Gynecology
Keywords: Delivery, Imminent, Dystocia (PubMed Search)
Posted: 7/10/2007 by Michael Bond, MD
(Emailed: 7/8/2007)
(Updated: 5/16/2024)
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Category: Obstetrics & Gynecology
Keywords: Pre-eclampsia, eclampsia, HELLP (PubMed Search)
Posted: 7/12/2007 by Michael Bond, MD
(Emailed: 7/8/2007)
(Updated: 5/16/2024)
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Category: Obstetrics & Gynecology
Keywords: Erb's Palsy, Dystocia, Legal (PubMed Search)
Posted: 7/14/2007 by Michael Bond, MD
(Emailed: 7/8/2007)
(Updated: 5/16/2024)
Click here to contact Michael Bond, MD
In follow up to my Shoulder Dystocia Pearl
Dr. DePriest Whye has some legal pearls for us:
Erbs Palsy( Brachial Plexus Injury) is a known complication of shoulder dystocia and is due to traction on the arm that causes stretching of the brachial plexus.
Erb's Palsy cases are difficult to defend. They are impossible to defend with improper documentation.