Podcast #209: Rabbit Done Died

Author: Sam Killian, M.D.

Educational Pearls:

  • “The Rabbit Has Died” is a lesser used phrase to denote finding out one is pregnant.
  • During a test used in the 1930s, the “Rabbit’s Test,” a rabbit was injected with a potentially pregnant woman’s urine.  If the woman was pregnant, the rabbit would begin displaying signs of pregnancy itself.
  • This test required killing the rabbits to visualize the ovaries, hence the term “Rabbit Done Died”.

References: https://www.early-pregnancy-tests.com/history

 

Podcast #175: Preeclampsia

7a1391e6-193c-485f-817d-9c6f83332bc1Run Time:  6 minutes

Author: Samuel Killian M.D.

Educational Pearls:

  • The mechanism of preeclampsia is not well understood, but it is thought to be a widespread malfunction of vascular endothelium and inflammation.
  • Clinical features include hypertension – SBP >140 and DBP > 90, proteinuria, and potential pathologic edema.
  • Preeclampsia typically occurs after 20 weeks gestation up to 3-6 week postpartum. Preeclampsia occurs in 2-6% of pregnancies, and Eclampsia occurs in 1 out of 200 cases of Preeclampsia.
  • More severe symptoms include a blood pressure >160/110, renal dysfunction, thrombocytopenia, and elevated LFTs with or without HELLP syndrome.
  • A patient with a headache or focal neurologic deficits needs a CT scan because CVA and ICH are not uncommon.
  • Studies show that people who develop Preeclampsia have 2-4 fold increase in the probability of developing chronic hypertension and heart disease.
  • Some risk factors include: first pregnancy, higher BMI, family history, and African-American patients.

Link to Podcast: http://medicalminute.madewithopinion.com/preeclampsia-1/

References: http://emedicine.medscape.com/article/1476919-overview

Podcast #163: Pregnancy and Radiation

61126a09-45de-45b5-9a33-b18ea86908b6Run Time: 3 minutes

Author: Jared Scott M.D.

Educational Pearls:

  • Pregnancy is a hypercoagulable state and often PE is a concern. When we work up PE in pregnancy the main consideration for harm to the fetus is radiation exposure.
  • The amount of radiation to cause harm to the fetus during pregnancy is thought to be 0.1 Gray.
  • If 0.1 Gray is the same as $100 of radiation then an X-ray = 1/10 of a penny of radiation, a CT PE scan = 25-50 cents of radiation, a VQ scan = 50-75 cents of radiation, and background radiation during the full pregnancy = $5 of radiation.
  • It has been shown that the amount of radiation needed to increase the risk of cancer before age 20 by 1/100 = $10 of radiation – or many, many CT’s and imaging studies.
  • CT scans irradiate both the breast tissue and the thyroid of females, which increases the lifetime risk of breast cancer by 1.5%, which is not an insignificant amount.
  • The VQ scan is the ideal test for PE during pregnancy, but the downside to a VQ scan is that the radioisotope collects in the bladder directly over uterus before it is urinated out, therefore it is not recommended in the first trimester.

Link to Podcast: http://medicalminute.madewithopinion.com/pregnancy-and-radiation/

References: https://www.thoracic.org/statements/resources/pvd/evaluation-of-suspected-pulmonary-embolism-in-pregnancy.pdf

Podcast #127:  Nausea in Pregnancy

what20pregnant20women20should20avoid20when20catching20morning20sickness_1Run Time:  4 minutes

Author: Peter Bakes M.D.

Educational Pearls:

  • The American College of Obstetrics and Gynecology (ACOG) has new recommendations on the management of nausea and vomiting in pregnancy. This can present in any form along the spectrum from morning sickness to hyperemesis gravidarum.
  • Conventional management of any nausea in the ED is usually Zofran. Zofran has been linked to causing prolonged QT placing a pregnant woman at risk of developing Torsades, ventricular fibrillation, or cardiac arrest. There is good data from Sweden and Denmark that the relative risk of cardiac and septal defects in the fetus increases with administration of Zofran during the first trimester!
  • ACOG recommends the first line treatment against nausea in pregnancy is prescribing two pills at night of Diclegis. If that is not effective, another dose can be taken in the morning and the afternoon.
  • The second line treatment is Dramamine or Benadryl and the third line of is Reglan. If this does not work, Phenergan and Zofran are rescue medications that can be used! This marks a significant change in guidelines and should change our practice!

Link to Podcast: http://medicalminute.madewithopinion.com/nausea-in-pregnancy/

References: http://www.acog.org/Patients/FAQs/Morning-Sickness-Nausea-and-Vomiting-of-Pregnancy

Podcast #36: Pulmonary Embolism in Pregnancy

pregnancyRun Time: 4 minutes

Author: Dr. Nicholas Hatch

Educational Pearls:

  • Risk of DVT and PE does go up with pregnancy and increases in each trimester. 1 in 50,000 people develop blood clots in the first trimester with 1 in 10,000 people developing blood clots in the second trimester.
  • The risk for PE or DVT in pregnancy is about 3 in every 10,000 people. Comparatively, the risk for pre-eclampsia in pregnancy is 340 in every 10,000 people.
  • Two third of the blood clots found in pregnancy are DVTs.
  • The D-Dimer cut off in pregnancy is 0.75 in the first trimester, 1 in the second trimester, and 1.25 in the third trimester.
  • A perfusion-only VQ scan has the lowest radiation of imaging for PE.

Link to Podcast: http://medicalminute.madewithopinion.com/pulmonary-embolism-in-pregnancy-1/

References: http://www.uptodate.com/contents/deep-vein-thrombosis-and-pulmonary-embolism-in-pregnancy-treatment

http://atvb.ahajournals.org/content/29/3/326.full

 

Podcast #6: Trauma in Pregnancy/Perimortem C-section

Run Time: 15 minutesac07bd37-063f-4309-a0f3-5620b220935d

Author: Dr. Donald Stader

Educational Pearls:

  • Trauma ABCs change in pregnancy.
  • A: Progesterone dilates to blood vessels in the nose and the back of the throat changing the airway in pregnant women, causes intubation to be more difficult because of increased redundant tissue.
  • B: Pregnant women desaturate very quickly because of metabolic demands and diaphragm is pushed up. Supplemental oxygen should be used liberally.
  • C: Volume of fluids is increased during pregnancy. There is more blood flow to the uterus.
  • D: Starting in the 2nd trimester the uterus can push on the major blood vessels. Moving the uterus away from the Vena Ceva to the left will allow blood flow – either by left lateral decubitus or physically moving the uterus to the left.
  • E: Pregnant women need a complete head to toe exam and a manual vaginal exam.
  • Fibrinogen, rh, Kleihauer-betke tests are additional tests to consider adding to pregnant traumas.
  • The decision to perform a perimortem C-section should be made within 5 minutes of loss of pulses. Performing interestingly improves infant and mother’s chance of survival.

Link to Podcast:  http://medicalminute.madewithopinion.com/trauma-in-pregnancy-perimortem-c-section/

References:  http://www.aafp.org/afp/2014/1115/p717.html