Four Tips for Using A Quantitative HCG Test

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Pregnancy tests come in three varieties: a urine qualitative test (it’s either positive or negative), a serum qualitative test (again, either positive or negative), and a serum quantitative test (with a specific numeric result). I see far too many serum quantitative hCGs ordered in clinical practice (by OBs, ER docs, etc.) and this implies that […]

Four Tips for Performing a Hysterosalpingogram (HSG)

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Hysterosalpingogram (HSG) is performed less commonly in modern gynecology than in the past, but it is still a valuable tool for some patients. A well performed HSG should be relatively painless and its results need to be correctly interpreted in context of what is already known about the patient. Here are four tips for performing […]

Four Tips to Reduce Pain After Laparoscopy

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One of the obvious benefits of a laparoscopic surgical approach compared to an open approach is less pain and morbidity related to smaller incisions and less wound morbidity. Postoperative pain in general is reduced with laparoscopic surgeries, but a unique type of pain is found in up to 80% of surgeries: post-laparoscopic shoulder pain (PLSP), […]

Four Tips for Correctly Diagnosing Uterine Anomalies

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Unfortunately, I’ve recently seen a rash of patients who have been told by other  gynecologists that they suffer from a significant congenital uterine malformation that will require extensive workup, probable surgery, and will significantly hinder their ability to reproduce.  Yet, in each case, the women either had no uterine abnormality at all or a mild […]

Four Tips for Correctly Diagnosing Vaginitis

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Complaints of vaginal irritation and/or vaginal discharge are very common in ambulatory settings, particularly in gynecology offices. Bacterial vaginosis, candidiasis, and trichomoniasis account for about 70% of these complaints. Patients who present with these symptoms are frequently over-treated and misdiagnosed. Those with recurrent symptoms are especially challenging.  Here are four tips for correctly diagnosing women with […]

Four Tips for Initial Laparoscopic Entry

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The initial trocar placement at the time of laparoscopic surgery is the most important step: 50% of complications that occur during laparoscopic surgery occur with the initial laparoscopic puncture. Here are four tips to reduce the risk of injury when making the initial entry. 1. Use a direct entry optical trocar, preferably one that insufflates […]

Four Tips for Easy Postpartum Tubal Ligation

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Postpartum sterilization is a relatively low-cost and convenient option for many women, but it is too often under-utilized because many obstetricians struggle with the technique. A postpartum tubal ligation should take about ten minutes, but for many surgeons it turns into an unnecessarily longer procedure as they struggle to locate the fallopian tubes. Here are […]

Four Tips to Avoid Air Knots

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Ever get an air knot? I bet you do, especially if you are a resident or early in surgical training. Air knots can cause major complications, particularly bleeding. They are sign of looser knots in general, and looser knots are more prone to delayed bleeding and knot failure, resulting sometimes in catastrophes like fascial dehiscence or even […]

Four Tips for A Non-Descending Uterus

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“If you do only routine cases eventually even they will become difficult.” A limiting factor for many during vaginal hysterectomy is the non-descending uterus. Women who have not given birth, for example, often pose a challenge to the vaginal hysterectomist, particularly when there is another complicating factor, like obesity or a large uterus. In general, […]