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Archive for the ‘Family Planning’ Category

Why Pro-Choice is Losing

Lately I’ve been troubled by how badly the pro-choice movement has been doing.   Here in South Carolina we are continuously dealing with legislation to limit access to abortion.  This year a 24 hour waiting period law was passed, and the state legislature is almost ready to sign in a law that prevents state funding for any abortion, even in cases of maternal jeopardy, rape and incest.   Nationwide, abortion is under attack in many states, and in some cases progress is being made to limit access.

One of the things that bothers me is that I don’t see this trend improving, at least not until some major changes are made in the pro-choice movement.  Right now, anti-choice is wiping the floor with pro-choice.  Pro-choice is always on the defensive, and never on the offensive.  Prochoice is tending goal and Prolife is always taking shots.  This can only go on so long before one gets in the net, and we’ve been seeing that happen lately.
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Categories: Family Planning

D and C Workshop

January 26, 2010 3 comments

This is a rerecording of a recent workshop on D and C procedure that I did with my residents.  Enjoy!

If you would like to use this prezi for your residents, let me know and I can send you the file.  All I ask is a mention of the blog in your presentation!

Enjoy!

Ortho Evra and Venous Thromboembolism Risk – Why You Need to Read More Than Abstracts

January 5, 2010 71 comments

When Ortho Evra, the contraceptive patch came on the market, physicians were happy that women had a new and novel contraceptive method that significantly expanded options over what was already available.  Since that time, hundreds of thousands of women worldwide have safely used Ortho Evra for birth control.

As the transdermal patch was a new delivery method for birth control, several new pharmacokinetic studies were done postmarketing, in addition to those done prior to FDA approval.  One of these studies demonstrated that patients using Ortho Evra had on average 60% higher estrogen blood levels than patients on oral contraceptives, despite lower peak levels (1).  Given that estrogen somewhat increases the risk of venous thromboembolism(VTE), this data raised the concern that Ortho Evra might confer a greater attributable risk than traditional oral contraceptives.

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I got published this month! Yahoo!

December 15, 2009 1 comment

Nothing like getting in press.  This project started over two years ago and now has made it to press.  Man this stuff takes a long time.  Congrats to my wife who was primary investigator on this!

Bottom line – using a paracervical block during second trimester abortion done under general anesthesia does not affect postoperative pain scores.

Impact of paracervical block on postabortion pain in patients undergoing abortion under general anesthesia.  Lazenby GB, Fogelson NS, Aeby T.  Contraception. 2009 Dec; 80(6):578.82.  Epub 2009 Jul 10.

Evidence Based Use of Misoprostol in Second Trimester Induction

October 24, 2009 10 comments

I was recently on call and we had 2 patients on our board having second trimester inductions, one for ruptured membranes at 17 weeks and another for fetal anomaly.  Both patients were being treated with what seemed like a strange regimen of misoprostol, 400 mcg miso vaginally _and_ 400 mcg orally, every 4 hours.  I had never heard of this regimen, and was wondering where it came from. None of the residents seemed to know, only that it had been passed down through some route to them.

It struck me as odd that people are using misoprostol in all kinds of different ways,  despite the large amount of available evidence in the literature.  In fact, it may be one of the most thoroughly studied topics in obstetrics, having been the subject of many randomized trials, a standard of research rarely achieved in our field.  Studies have included both pharmacokinetic and clinical data.  For better or for worse, abortion is the single most common procedure performed for women worldwide, and the patient population tends to be appreciative and willing to participate in research.  Sadly, the mammoth amount of data available seems overlooked by the majority of practicing obstetricians, given the wide variation in practice I have observed.  As such, I want to review a few of the major articles here.

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