DailyDx


Daily Dx: Dysmenorrhea and Pelvic Discomfort
Joe Antony, MD , May 21, 2013

This middle-aged woman has severe dysmenorrhea and pelvic discomfort. Ultrasound images of the uterus are shown. What is your diagnosis?


EventCalendar

  • The 5th IVI International Congress: Reproductive Medicine and Beyond by ComtecMed
    04-Apr-13 to 06-Apr-13 Seville , SPAIN (GYN - Contraception & Reproductive Health)
     
  • 2013 AIUM Annual Convention by American Institute of Ultrasound in Medicine
    06-Apr-13 to 10-Apr-13 New York (New York Marriott Marquis Hotel) , NY USA (CME - Medical Education)
     
  • Manejo clínico y terapéutico de la esterilidad. Segundo curso online by Fundacio Dexeus Salud de la Mujer
    09-Apr-13 to 31-May-13 online , SPAIN(gynecology)
     
  • Pediatric Nursing: Care of the Hospitalized Child by Continuing Education Inc.
    10-Apr-13 to 13-Apr-13 Anaheim (Hyatt Regency Orange County) , CA USA (CME - Obstetrics, Gynecology & Women's Health)
     
  • Medicina fetal Curso-Taller. Curso de Nivel I y II de la SESEGO by Fundacio Dexeus Salud de la Mujer
    15-Apr-13 to 17-Apr-13 Barcelona (Auditorio Salud de la Mujer Dexeus) , SPAIN (OB - Maternal Fetal Medicine)
     
  • Female Urology & Urogynecology Symposium (FUUS) by Quadrant HealthCom, Inc
    18-Apr-13 to 20-Apr-13 Las Vegas (ARIA) , NV USA (CME - Obstetrics, Gynecology & Women's Health)
     
  • Female Urology and Urogynecology Symposium (FUUS) 2013 by Quadrant HealthCom, Inc
    18-Apr-13 to 20-Apr-13 Las Vegas (ARIA) , NV USA (CME - Obstetrics, Gynecology & Women's Health)

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LatestFeatures


Postmenopausal Breast Cancer Survivors at Greater Risk for Metabolic Syndrome
Jamie Habib , May 22, 2013

Metabolic syndrome is more likely to develop in postmenopausal survivors of breast cancer than in postmenopausal women who never had the disease.

Daily Dx: Dysmenorrhea and Pelvic Discomfort
Joe Antony, MD , May 21, 2013

This middle-aged woman has severe dysmenorrhea and pelvic discomfort. Ultrasound images of the uterus are shown. What is your diagnosis?

History of Cesarean Delivery Does Not Preclude LESS-H
Jamie Habib , May 20, 2013

Laparoendoscopic single-site surgery with hysterectomy (LESS-H) for benign disease with either a lateral or vaginal approach is a feasible procedure regardless of cesarean section history.

Which Contraceptive Is Best for Women With Diabetes Mellitus?
Jamie Habib , May 15, 2013

There is insufficient evidence to determine that hormonal contraceptives do not influence glucose and lipid metabolism in women with diabetes mellitus, concluded a systematic review conducted by the Cochrane Fertility Regulation Group.

Daily Dx: Polymenorrhea and Pelvic Pain
Joe Antony, MD , May 14, 2013

there is a clearly defined rounded mass just below the endometrial stripe of the uterus. The endometrium itself appears normal in thickness ruling out hyperplasia. The mass is within the uterine fundus and body ruling out a cervical mass.

Menopausal Medicine Is Overlooked in US Residency Programs
Jamie Habib , May 13, 2013

Fewer than 20% of obstetrics and gynecology residents receive formal training in menopause medicine. With an expected 50 million menopausal women in the US by 2020, how will we address the knowledge gap?

Does Controlled Cord Traction Reduce Postpartum Blood Loss?
Jamie Habib , May 10, 2013

In high-resource settings, the practice of controlled cord traction for the management of placenta expulsion is not associated with a decreased incidence of postpartum hemorrhage.

Improved Methods of Egg Preservation and Counseling Patients Seeking to Delay Conception
Mary Harpin , May 9, 2013

In October 2012, the American Society of Reproductive Medicine announced it no longer considers oocyte freezing experimental. This raises complex questions about how to counsel patients who wish to preserve eggs for social indications.

Improving Uterine Artery Embolization Outcomes in Infertility Patients
Mary Harpin , May 9, 2013

Uterine artery embolization for fibroids results in a tremendous reduction in menorrhagia. But while complication rates are low, up to 15% of patients are readmitted for indications like pain, bleeding and infection.

Ob/Gyns Should Offer Long Acting Reversible Contraception First to Lower Unintended Pregnancy Rates
Mary Harpin , May 9, 2013

The Contraceptive CHOICE Project, a research study at Washington University in St. Louis, found that offering long-acting, reversible contraception (LARC) to women first, citing its low-failure rates, reduced rates of unintended pregnancy and abortion and increased continuation rates.

Early Surgically-Induced Menopause Linked with Cognitive Decline
Becky Ellis, Editorial Director, ObGyn.net , May 9, 2013

Women with early, surgically-induced menopause had greater incidence of neurological problems, including declining cognitive function and early indicators of Alzheimer’s disease in a study reported at the American Academy of Neurology meeting.

FDA Contraindicates Migraine Treatments for Pregnant Women
Rachel Warren , May 8, 2013

The US Food and Drug Administration has announced that the children of mothers who took medications including or related to valproate sodium during pregnancy show decreased IQ scores, and that these drugs are now contraindicated for pregnant women.

Are You Ready for Noninvasive Prenatal Testing?
Becky Ellis, Editorial Director, ObGyn.net , May 8, 2013

Diana Bianchi discusses noninvasive prenatal testing, including false positives and testing average-risk women, at ACOG's Annual Meeting.

Prophylactic Progesterone May Be Harmful in Twin Pregnancies
Jamie Habib , May 8, 2013

The use of prophylactic 17 alpha-hydroxyprogesterone caproate (17P) is not effective for the prevention of preterm delivery, and may even be harmful in women with an asymptomatic twin pregnancy and short cervix.

Use of a Prophylactic Sling in Prolapse Repair Prevents Stress Incontinence
Mary Harpin , May 8, 2013

“Using a prophylactic sling during prolapse repair significantly reduces postoperative stress incontinence,” said Anthony Visco, a representative of the American Urogynecologic Society at the 61st annual American Congress of Obstetricians and Gynecologists meeting.

MedicalProfessionalForum

Medica Forums - 5/23/13
Hello,

Has anyone tried FetalGrowth app (App Store for iPhone/iPad) ? I'm interested in using a simple and handy tool to calculate fetal percentiles, and I came across this app, which seems it does the job (plots growth charts, as well). I haven't seen anything else, besides this app, so I was wondering if there are people who have already tried it.

Thanks !
Medica Forums - 5/19/13
Had a case the other day with the above finding on a pap. She was age 36 and had a Mirena in place. How do people feel about the idea of trying to do an EMB with an IUD in place? If not, how do we proceed?
Medica Forums - 5/12/13
Welcome to the new ObGyn.net Forum!

To all the members of OB-GYN-L… Thank you for coming! I’m thrilled that you’ve decided to check out the new Forum site, and look forward to reading about what’s on your mind.

If you’re new to the ObGyn.net community... welcome aboard! You’ve just joined an outstanding group of physicians and health care professionals who have been sharing information, answering questions, and building professional relationships via the site’s listserv for nearly 20 years.

Feel free to poke around on the site to get a feel for things, or take a look at the Help Topics page for instructions on how to use the different features of the site.

A few quick tips:
For those of you who like getting new Forum messages delivered directly to your inbox, the first thing you’ll want to do is click on the ‘Follow this forum’ button on the main page. You’ll have the option of getting notifications immediately, as a daily digest, a weekly digest, or only when you’re not online (which is to say, if you’re on the site when someone posts a message, you won’t be notified of it). You won’t be able to post on the site just by replying to the email, but the message will contain a link that takes you directly to the message you’d like to reply to.

You can also follow individual conversations without following the whole list by going into the topic and clicking the ‘Follow this topic’ button next to the title.

Also, in ‘My Profile’ you can:
  • Enter your professional information, including specialty, subspecialty, and education (by clicking ‘Edit my profile’)
  • See your activity on the Forum, such as what discussions you have initiated or replied to, content you’ve ‘liked,’ and activity of people you’ve made your friends
In ‘My Settings’ you can:
  • Add or change your photo
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  • Change the types of content you get notifications for, or change the way you receive notifications
If you have questions, feel free to respond to this post or send me a direct message by clicking on the envelope icon.

Happy posting!
Medica Forums - 5/11/13
I helped another physician with removal of a retained placenta last night, we were unsuccessful in removing it vaginally, her cervix was too closed to allow manual removal and we could only get a few pieces out with ring forceps and a large curette, so we did a laparotomy/hysterotomy and were able to preserve the uterus. The placenta turned out not to be an accreta and it was easily removed via that route through a low vertical incision on the uterus. Any thoughts on the appropriate CPT code would be appreciated. The patient came in through the ER five days after home delivery by her husband. She was severely anemic, rcvd 7 units of blood and is still quite ill and in the ICU but improving.

Ronald E. Ainsworth, MD, FACOG
Medica Forums - 4/15/13
Recently, I had the occasion to review a case of a term primigravida with PROM in a private hospital (no housestaff or in house obstetricians). She was seen by an obstetrician soon after arrival, evaluated, and pitocin induction begun.

She did not deliver for around 29 hours after admission, and the delivering obstetrician (a different physician) was physically present during the last 2 hours of labor prior to delivery.

Simply put, while the two involved obstetricians were in communication by phone with the nursing staff throughout labor (separately as their "shifts" did not overlap), no one actually came to the bedside and wrote a note) from admission until around 2 hours before delivery.

Medical staff bylaws call for a daily progress note; this bylaw was easily met.

In reviewing the case, it did not "feel good" that no one came to the bedside.

My questions:

1. Does anyone have or know of any guidelines to mandate such bedside attendance? Of course, we all hope that the involved physicians would not need said guidelines.
2. Does anyone have a suggestion of hospital/nursing protocols? Simply, in this case I would like to have had a charge nurse or bedside nurse simply say, "Hey, no one has been by for a while. What's up?"

Garry
Medica Forums - 4/12/13
Hey, what textbooks would you advise for my son who is beginning residency this summer?

Post here or email privately if better.

Thanks,

Garry
Medica Forums - 4/8/13
<p>Hello  friends ,

           I want to know how much does a facelift cost on average? Do you know anyone what is facelift cost ? please help me .........
Medica Forums - 4/7/13
Hello,

I really need help from OB/GYNs and I'm having a hard time getting it. I find your opinions really valuable. I'm researching recommendations for cosleeping. This is for my dissertation, so your time is truly appreciated! Please complete the full survey. It will help me tremendously.

The study takes about 5 to 10 minutes to complete. Please don't hesitate to contact me at bhamel@pacificu.edu with any questions.

If you are interested in participating, please follow the link provided below:

https://www.surveymonkey.com/s/Cosleeping

Thank you in advance for your time. If possible, please forward this to other OB/GYNs you know.

Sorry if this an innappropriate use of the forum. But it seems like the right place to find the participants I need.
Medica Forums - 4/7/13
.

Our hospital bought an electronic medical record (EMR) system for the clinics. There is a large hosptial group practice including pediatrics, medicine, FP, OB/GYN, and other specialities and sub-specialities. Furthermore, the hospitalists and the ER doctors are also employed in the same hosptial group practice.

The hospital spent millions of dollars on an EMR. As best I can tell there are only two useful things that the EMR does. One is to automatically calcualte the BMI, which it does very well. THe other is to make records available on any patient to any doctor anywhere in the practice. It does not do this well -- it requires lots of mouse movements and clicks and different documents come up in different formats, making it labor intenisve. But, with enough time, effort, and frustration, one can obtain copies of every document in the sustem, either on a computer screen or on paper.

Swith to the ER now. A paitnet whom I had seen the previous week in consultatio comes into the ER for a non-pregnancy problem. They call me on the telephone in the evening. "No problem", I say. I did a torough evaluation and wrote a detailed note on the patient and her OB and non-OB problems only a few days ago. "Just go to the EMR and you can print out my note with all the details."

Seems, however, that for some reason the EMR is not available in the ER (or on the wards for that matter). When I asked the hosptial administrator about it the next morning, he said that he and the hosptial lawyers were working on the problem.

Apparently the government thinks that the ER doctors and hospitalists have nothing better to do with their time than to print out copies of patients' medical records from the EMR and sell them on the black market. Therefore, we cannot let those nasty doctors have access to the EMR records. Nevermind that the ER doctors are in the same group practice as all the other doctors. Never mind that the patient is willing to sign a release so that the doctor who is taking care of her can see the records of the practice. We have to protect the patient even if it means that vital information is rendered unavailable and that things are made more difficult, complicated, and expensive. It reminds me of the Army in Viet Nam where they would have to "destroy a village in order to save it!" Apparently the EMR makes us destroy a patient in order to save her.

Thank GOD for the EMR. Three million dollars and the only benefit is that we can get a BMI 10 seconds faster.

I think the NEJM got it correct last month when they said in an atricle that the only ones who truly benefit from electronic medical record systems are the people who make and sell them.



Dean Huffman
Medica Forums - 4/7/13
Decline in Semen Concentration and Morphology in a Sample of 26,609 Men Close to General Population Between 1989 and 2005 in France


http://www.medscape....22498EV&spon=16

Women'sHealthBlog


New Medical Guidelines for Cervical Cancer Screening: Is there a role for new molecular diagnostics?
Daniel M. Jones, MD, PhD , January 31, 2013

Some may argue that the new ACOG, ACS and other cervical cancer screening guidelines will detect the majority of at-risk women. We should not be content with settling for identifying a majority of at risk women; rather, we should constantly reassess the availability of useful tests to see if we can improve reliability.

Using RVUs to Improve Your Practice’s Performance
Sara Larch, MSHA, FACMPE, Principal, Business of Medicine , May 21, 2012

In the early years, medical practices only utilized Relative Value Units (RVUs) to understand the Medicare fee schedule. Now the role of RVU analysis has expanded. RVUs have become the standard measurement in analysis of reimbursement and payer contracts, physician compensation and productivity, and practice staffing and operating costs.

2012 Geographic Practice Cost Indices
May 21, 2012

A geographic practice cost index (GPCI) accounts for geographic differences in the cost of practice around the country.

Can You Give Your Patients Too Much Information?
Sonja Kristiansen, MD , April 24, 2012

Like many of my patients, my life revolves around information. Personally, I use the same technology as most of you to keep track of obligations and loved ones. Professionally, the Houston Fertility Center team uses technology and constant communication to manage our patients' treatment plans.

The Fertility Preservation Pipeline Is Clogged for Women with Cancer
Sonja Kristiansen, MD , April 3, 2012

Here's a situation that illustrates how fantastic medical advances don't always translate to patients benefiting in the clinic. For that to happen, the science needs to be carried along a pipeline of practitioner communication, all the way to the patient.



EducationalTutorials


Educational Tutorial: Complications of Laparoscopy
February 7, 2012

There are a variety of complications that can occur during laparoscopic surgery. In this tutorial learn some of the complications and tips to avoid them.

Educational Tutorial: Low Molecular Weight Heparin in Recurrent Abortions
January 17, 2012

Review information on low molecular weight heparin in recurrent miscarriages in this educational tutorial.

CaseStudies


Fetal Abdomen with Gallbladder Calculi
September 27, 2011

B mode and 3D Ultrasound images of a fetal abdomen (35wks) revealing gallbladder calculi

Sacrococcygeal Teratoma?
September 14, 2011

This case study shows a 26 week gestation with a cystic mass close to the sacrum.

Fetal Cardiac Anomalies
July 19, 2011

CC is a 31 year old primigravida who was referred for ultrasound at a community hospital due to suspected cardiac anomalies noted on a screening sonogram at her doctor's office. Due to concern about a probable cardiac abnormality an amniocentesis was performed at the local hospital.

Single Umbilical Artery Color Doppler
June 15, 2011

Single umbilical artery color doppler, transverse scan of urinary bladder shows single umbilical artery (left), transverse section of umbilical cord showing only two vessels: one vein and one artery (right).

Ductus Venosus Spectral Waveform
June 15, 2011

Normal 35 week pregnancy

FromPhysiciansPractice

Five Steps to Improving Patient Access
Judy Capko,  May 21, 2013
Patient access is getting increased attention through reform initiatives. Here are five steps you can take to make sure patients get appropriate access to care in your office.
Growing HIPAA Threat – Ignore Windows XP at Your Own Peril
Marion K. Jenkins,  May 21, 2013
Chances are good that you have some major ticking software time bombs lurking in your medical practice's computer environment, namely Windows XP and Server 2003.
Finding Physician Work-Life Balance in the Small Moments
Jennifer Frank, MD,  May 21, 2013
At my practice and at home, things are always busy. There's laundry or homework, or a patient with needs.
Three Areas to Reduce Costs at Your Medical Practice
Greg Mertz,  May 19, 2013
By taking a hard look at reducing costs for staffing, overhead, and technology at your medical practice, you may see increased physician compensation.
Dos and Don’ts for Starting a Physician Blog
Michael Woo-Ming, MD,  May 18, 2013
Starting a physician blog can provide your medical practice with marketing benefits, but it's important to do it right.