Archive

Archive for December, 2009

A bit about Receiver Operator Curves and Cesarean Delivery

December 28, 2009 14 comments

In a few posts I have mentioned Reciever Operator Curves (ROC), and a few folks have asked what I mean, so I want to explain it.  This is an extremely important concept in medicine, and in decision making in general.  Unfortunately, it is also quite complex.  So complex in fact, that it is possible to explain an ROC in very high end mathematical speaking, such that few would understand (and yes, it can get over my head as well.)  To see this kind of explanation, check out the Wikipedia entry on the ROC.  But I want to try to make it a little simpler.

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Academic OB/GYN Podcast Episode 14 – Cardiovascular Disease Markers in Women

December 28, 2009 3 comments

In this episode I interview Dr Paul Ridker from Brigham and Women’s hospital about the JUPITER trial, a randomized trial of statins for prevention of cardiac events in people with elevated C-Reactive Protein who do not have hyperlipedemia.  Dr Ridker is hugely published as was on Time Magazine’s list of 100 Most Influential People.   We discuss not only his work, but academic medicine in general.  It was a great discussion that I hope you enjoy!

Academic OB/GYN Episode 14 – Cardiovascular Disease Markers in Women

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Academic OB/GYN Podcast Episode 13 – Green Journal November-December 2009

December 22, 2009 2 comments

Host Nicholas Fogelson discusses articles from The Green Journal from November and December of 2009.  Topics include Flu Vaccines and Antiretrovirals in Pregnancy, HPV Vaccine Safety in Pregnancy (yes), Moxibustion for Version (crazy), and Stupid Birth Control Comparisons (Pharma gone wild)

Academic OB/GYN Episode 13 – Green Journal November-December 2009

Ten Thoughts on VBAC

December 17, 2009 143 comments

There has been some discussion recently in the blogs and the twitterverse about VBAC.  Some have expressed a concern that not enough women are being offered VBAC, and that not enough doctors are supportive of it when the facilities are available.   I have a few thoughts on this.
VBAC, or Vaginal Birth after Cesarean, is something that gets a lot of discussion, because any discussion about VBAC is basically a discussion an inverse interplay between fetal and maternal well being.

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Categories: Obstetrics

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.

I Love John Hodgeman… in a nerdy way

December 4, 2009 1 comment

This is the best press dinner speech ever.   Even beats Colbert’s Bush smashing speech a few years ago.  Enjoy!

Categories: Fun Stuff

Delayed Cord Clamping Should Be Standard Practice in Obstetrics

December 3, 2009 302 comments

There are times in our medical careers where we see a shift in thought that leads to a completely different way of doing things.   This happened with episiotomy in the last few decades.  Most recently trained physicians cannot imagine doing routine episiotomy with every delivery, yet it was not so long ago that this was common practice.

Episiotomy was supported in Medline indexed publications as early as the 1920s(1), and many publications followed in support of this procedure.  But by as early as the 1940s, publications began to appear that argued that episiotomy was not such a good thing(2).  Over the years the mix of publications changed, now the vast majority of recent publications on episiotomy focus on the problems with the procedure, and lament why older physicians are still doing them (3) (4).  And over all this time, practice began to change.

It took a long time for this change to occur, and a lot of data had to accumulate and be absorbed by young inquisitive minds before we got to where we are today, with the majority of recently trained OBs and midwives now reserving episiotomy only for rare indicated situations.

Though this change in episiotomy seems behind us, there are many changes that are ahead of us.   One of these changes, I believe, is in the way obstetricians handle the timing of cord clamping.

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