Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old woman is evaluated for anticoagulation management after an uncomplicated vaginal delivery of a healthy newborn. She was diagnosed with a bilateral pulmonary embolism at 25 weeks' gestation and was treated with therapeutic low-molecular-weight heparin (LMWH). The LMWH was discontinued at the onset of labor and was restarted 6 hours after ...

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The debate over the safety of giving birth at home, both for the mother and for the infant, has been debated for years. I’ve written about the issue myself. From time immemorial until about 75 years ago or so most babies were born at home. Now it’s around 1 percent in the U.S., although it’s much higher than that in many Western European countries. The shift to hospital births ...

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There have been many times when I have struggled to empathize with the patient. There are certain health care issues, and certain patients, that I have found consistently frustrating over the years. I've written about this, and been pretty well chastised by readers. I don't mind, because I know that 99 percent of physicians have their kryptonite issues, and just don't talk about it. I'll take the heat for being honest. My ...

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Though I am two years into my residency, I still experience flashbacks to my time as a medical student on the wards. The adrenaline of arriving at the hospital 2 hours before rounds, scrambling to see my patients, constructing a note that no one would ever look at, and preparing a hastily-constructed presentation to deliver in a half-performance, half-examination outside of our patient’s room. I remember being the object of a ...

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Foria wants you to know they are selling vaginal suppositories of THC (tetrahydrocannabinol) and CBD (cannabidiol) called Fiora Relief for menstrual cramps. Each suppository contains 60 mg of THC and 10 mg of CBD. Foria claims they can treat the pain of menstrual cramps and endometriosis. Is this possible? THC and cannabidiol (CBD) are compounds found in marijuana. The psychoactive (i.e., high) from marijuana is believed to be due to the ...

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Quick: Which U.S. state has the highest rate of unintended pregnancy? I’ll reveal below, but I learned the answer and several other surprising facts in an interview with Mark Edwards, the co-founder of Upstream USA, a non-profit advocacy organization that provides technical assistance to health enterprises (medical practices, clinics, public health departments) in the use of long-acting, reversible contraceptives (known in the trade as LARC). LARC consists of two options: ...

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I know we all bemoan the chief complaint of vaginal bleeding when it pops up on the board. Your heart sinks even more when it is followed by the dreaded home pregnancy test. No ED provider is going to love seeing patients with first trimester bleeding. More than anything, I loathe the drag it takes on my time and productivity. Labs, urine, moving them to the appropriate room for the ...

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Ohio is attempting to introduce legislation that would require abortion clinics to incinerate or bury products of conception from abortion. This legislation is already in place in Arkansas and Indiana. These laws are supposed to afford human tissue a “respectful and proper” end as lawmakers were apparently horrified that products of conception were disposed of as medical waste. Medical waste is not an offensive term. When ...

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I woke up to someone forwarding this tweet. Yes, some company is selling tiny bags of herbs (they call them pearls) to stuff in the vagina for three days to cleanse your uterus or shrink your fibroids or treat bacterial vaginosis or tighten your vagina. This is not only pointless it could be very dangerous. Here’s why. Your uterus and vagina want you to leave them alone. Your uterus isn’t tired or ...

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My son Acton is truly a miracle baby because he was not even supposed to be here. I had gone through four years of infertility with three miscarriages and an ectopic pregnancy (pregnancy in my fallopian tube), causing my left tube to be removed. After my last miscarriage, I was told I was in perimenopause and had less than 1 percent chance of ever getting pregnant again, let alone carrying ...

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