Academic OB/GYN Cases: The House of Twins
This is a nice photo of a diamniotic/dichorionic placenta, part of a pregnancy involving two separate embryos in the same uterus.
Note the thick intervening membrane and lack of blood vessels traveling between the two placental discs, both characteristic of a di/di placenta.
Academic OB/GYN Podcast Episode 28 – Journals for December 2010
Journals for 2010 with Nicholas Fogelson and Paul Browne. Topics include NICHD Strip Classification, Oral vs Intrauterine Progestins for Hyperplasia, Fetal Lung Maturity Outcomes Less than 39 Weeks, Congenital Toxo and more!
Academic OB/GYN Podcast Episode 28 – Journals for December 2010
The Downside of Understanding
As I look back over my 10 year career in obstetrics and gynecology, I am sometimes struck at how many things have been discovered in this time period. When I started the origin of pre-eclampsia was unknown, and now we know that it likely originates in an overabundance of a molecule called Soluble FMS-Like Tyrosine Kinase, a competitive inhibitor to natural angiogenesis in the placenta. Ten years ago the origins of cervical dysplasia were still being developed, and now we know that the majority if not the entirety of cervical dysplasia and cancer is due to an infection of Human Papillomavirus, and for all intents and purposes cervical cancer is actually a sexually transmitted disease. We have developed this idea even further, allowing us to use HPV virus detection as part of a screening program for cervical dysplasia and cancer, and even to immunize for HPV infection in young women yet to be exposed.
All of these things amaze me. But to be honest, they also make the practice of obstetrics and gynecology more difficult. We have advanced our understanding to level that is impossible to explain to patients who lack a strong background in science, forcing us to accept simplistic explanations over explanations of how it really works. Let’s use HPV as an example.
Academic OB/GYN Cases: Another Day, Another Dermoid
First blonde one for me. Gotta catch ‘em all!
An Argument for Coverage of Lactation Consultation
A while back I published a bit about how to get insurance appeals approved. So here’s a specific example. This regards a young woman who delivered her first infant and was having trouble breastfeeding. After discharge, her physician recommended home lactation consultation services, which her insurer denied as not medically necessary. The patient’s policy did cover “skilled” medically necessary home health service , but not “custodial” care, defined as care meant for ongoing maintenance or assistance with daily living.
So here’s an answer to that (nonsense).
Academic OB/GYN Podcast Episode 27 – Articles for November 2010
Dr Paul Browne and I discuss articles from the Green and Grey of 2010, along with some interloping BMJ articles. Topics include The Big Homebirth Studies, The Goodness of Databases, Single Site Laparoscopy, and Reducing Induction before 39 weeks.
Academic OB/GYN Podcast Episode 27 – Journals for November 2010
5 Things I Learned From Netter
I recently had the opportunity to go to the anatomy lab and help the first years go through the pelvic anatomy. What a blast! There is nothing like dissecting a cadaver to tune up one’s surgical anatomy skills, and helping young eager medical students through it is a great experience.
Prior to going into the lab, I spent many hours going through Netter’s atlas to brush up on the anatomy so I could accurately help the medical students. Its amazing what one can learn reviewing what one used to know. Here’s a few examples:
1. The small vessels we like to cut at cesarean have names, and we can avoid them.
Everybody that does cesarean deliveries knows that there are small vessels in the path of entry that sometimes get cut, but not everyone knows what they are called. So for the record, the small vessels in the subcutaneous fat that get cut are superficial epigastrics (most people know this one) and the vessels that sometimes go during the lateral extension of the fascial incision are ascending branches of the deep circumflex iliac artery. One can see that these ascending branches lie between above the transversalis muscle but beneath the obliques, which explains why sometimes taking the fascial layers separately allows one to miss them. I’ve always felt that the routine sacrificing of these vessels was a surgical faux pas, and knowing this anatomy helps one to avoid it.
Academic OB/GYN Podcast Episode 26 – Journals for October 2010
Hosts Nicholas Fogelson and Paul Browne discuss articles from the Green and Grey journals for October 2010. Topics include – Two vessel cords, ablation techniques, tranexamic acid, high vs dose pitocin and more listener questions answered!
Academic OB/GYN Podcast Episode 26 – Journals for October 2010
The insurance appeals process – Part 2: Winning your appeals
In a previous post I talked about how the insurance appeals process works. In this post I’ll talk about the things every doctor can do to maximize the chance that insurance appeals will go in their favor. But first, a quick review.
Coverage requests get rejected when the requested service does not fit within an insurance company’s initial guidelines for approval. This happens for a number of reasons, but usually it comes down to poor documentation or inappropriate care, or in some cases care that is appropriate but can’t be supported in the literature. When a denial occurs, the physician or patient has several opportunities to appeal this decision. The first appeal is about proving that your case does meet the insurance guidelines and that it was incorrectly rejected. The second appeal is about proving that the request should be accepted outside of the coverage guidelines. Sometimes there is another level that looks at whether the care is experimental.
