OB Potpourri 4.0

Stop the tilt I haven’t used a left lateral tilt during Cesarean delivery in years. There has never been any robust scientific data that tilting the table or tilting the mother with a rolled blanket or pillow to approximately 15° has any effect on fetal outcomes. Still, the practice is widespread and most practitioners believe…

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Four Tips for Correctly Diagnosing Vaginitis

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…

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Four Tips for Initial Laparoscopic Entry

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…

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Four Tips for Easy Postpartum Tubal Ligation

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…

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Four Tips to Avoid Air Knots

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…

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Fact Checkers

I’ve been thinking about making a fact-checking page that lists common medical-related myths and fact-checks them. There are tons of resources around the Internet that already do this type of thing. People like to read about information that most other people get wrong. I think it makes them feel special that they know something that no…

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Antenatal Testing

A patient of mine moved out of state after her last pregnancy. She’s pregnant again and doing fine at about 12 weeks. Yes, I’m sad that she left me. But she e-mailed me recently wondering why I didn’t do a bunch of antenatal testing that her new doc says she must have. Specifically, the new doctor…

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Prophylactic Salpingectomy?

Should we perform prophylactic salpingectomy whenever possible to reduce the risk of ovarian cancer? Over the last five years, many gynecologists have made it routine practice to perform bilateral salpingectomies at the time of hysterectomy whenever possible to reduce the risk of ovarian cancer, and some have extended this to making bilateral salpingectomies their method…

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The Hippocratic Oath

NB: This is not normal howardisms fare, but I needed to put it somewhere for reference by others. Don’t feel obligated to read it unless you’re interested in the topic. The Hippocratic Oath: A Commentary and Translation Introduction The Hippocratic Oath is one of the most popular selections of ancient literature, even though the original…

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