Infertility

First, Plan B was only available OTC to women age 17 and up. In April, a judge ordered that it be made available to women of all ages. Now, an appeals court judge has stayed an order that would make a one-dose version of the emergency contraception available to all ages, while allowing the two-dose drug to be sold OTC without restriction. What do you make of all this?

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For the past few months, I have not received any posts on the listserv OB-GYN-L. I would get daily posts in my e-mail. Where has it gone, what has happened to it? What can I do to get back on the list?

If anybody has any information, send me a note at:

dean@thehuffpeople.net


Dean Huffman

Pregnant woman and the newborn infant in breast feeding both of them need safety. So, caution in use of drugs in pregnancy and during lactation is mandatory. The knowledge of risk-benefit ratio of different drugs should be in mind of the doctor while prescribing a pregnant or lactating lady.Definitions of Pregnancy categories of drugs and a table showing pregnancy categories of drugs and safety of drugs in lactation are given here.

Definitions of Pregnancy categories of drugs:

On the basis of the potentiality for producing birth defects drugs in pregnancy are grouped into 1 of 5 categories which are A,B, C, D and X. Drugs of class A and B are considered safe and can be used routinely.

Pregnancy Category A : Controlled studies in pregnant women fail to detect risk to the fetus in the first trimester and no evidence of risk in later trimesters. The possibility of harm to the fetus appears remote by using the drugs of pregnancy category A.

Pregnancy Category B : Presumed safety on the basis of animal studies, with no controlled study in pregnant women, or animal studies have shown an adverse effect which was not confirmed in controlled studies in women in the first trimester and there is no evidence of risk to the fetus in later trimesters.

Pregnancy Category C : Studies in women and animals are not available or studies in animals have shown adverse effects on the fetus and there is no controlled study in women. Drugs should be given in pregnancy only if the potential benefits justify the potential risk to the fetus.

Pregnancy Category D : There is positive evidence of risk to the human fetus (unsafe), however in a life-threatening illness the potential risk may be justified if there are no other alternatives.

Pregnancy Category X : Highly unsafe: risk of use outweighs any potential benefit. Drugs in this category are contraindicated in pregnant women or in a woman who may become pregnant. To get more please visit -
http://medicalforall.net/drugs-pregnancy-lactation/

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

Reviews Of Progress is a weekly peer-reviewed scientific journal that covers original research and reviews. It publishes all articles under the guidance of the editorial team. The current Editor-in-Chief is Pindipol S.I, the editorial office is in Solapur.

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

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 !

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?

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