Emergency Contraception

Today we spend some time with Dr. Leanne Free, who is one of Fei and Nick’s co-residents. As a rising PGY-4 at Brown, Leanne is interested in family planning fellowship and shares some of that interest with us today by talking emergency contraception!

Leanne breaks down for us the main types of emergency contraceptives — the copper IUD and pills. Much of the information Leanne shares is really nicely prepared in graphical format on the BedSider website:

One crazy thing we learned: many levonorgestrel EC formulations are available on Amazon! Though buyer beware, as there have been some news stories regarding these to be potentially expired medicines. Additionally, as Leanne states, EC is most effective immediately after unprotected intercourse, rather than the 48 hours it takes for Prime delivery. All levonorgestrel EC should be available over-the-counter without restrictions for purchase based on age, gender, or parental consent.

Additionally, patients can follow the Yuzpe method by taking birth control pills that they may already have at home. This can be useful for patients who for some reason do not have access to the emergency contraceptives we refer to in the podcast — though an annual visit is a great time to review and prescribe these options!

Espresso: Treatment of Acute Hypertension in Pregnancy and Postpartum

Our second espresso episode focuses on the acute treatment of severe-range BPs in the pregnant and postpartum patient. More or less, we let the freshly released ACOG CO 767 speak for itself.

Below you’ll find the algorithms we describe in the podcast, which are present in ACOG CO 767. In addition to the below, always remember:

-Obtain IV access and labs (CBC, Creatinine, AST, ALT, urine protein:creatinine ratio) for any newly diagnosed patient with severe-range pressures.
-Avoid labetalol in patients with known asthma, as the beta-blockade effect can trigger respiratory issues, as well as those with CHF or pre-existing cardiac disease. Labetalol may also cause neonatal bradycardia due to beta-blockade.
-Immediate-release nifedipine should not be administered sublingually due to possibility of developing precipitous hypotension. Similarly, parenteral hydralazine may also cause precipitous maternal hypotension.
-IV magnesium sulfate should be given at a 4g or 6g bolus initially, followed by 2g/hr drip for the prevention of eclamptic seizures, if not previously given. Adjusted dosing may be required if renal insufficiency is noted on laboratories. Magnesium sulfate is not an antihypertensive agent.

Espresso: Medical Management of Postpartum Hemorrhage

Welcome to our first Espresso Episode! Just like an espresso, this should be a short, sweet, but highly caffeinated review of more familiar topics. These are intended for rapid-fire review — perfect for while you’re running up to that postpartum hemorrhage!

In today’s episode, we really just stick to the medication management for postpartum hemorrhage, though as anyone with experience with these might remember, there are a lot more components than just these medicines to make hemorrhage management successful. That said, an exam, bimanual massage, and uterotonic agents will resolve many of the cases you’ll see on the floor. More important for CREOGs are likely the dosing and side effects of these medicines, which we also review today. The ACOG PB 183 table on these medicines is also below for visual learners.

For when you have a bit more time to sit and breathe after the run up the stairs, check out ACOG PB 183 to review postpartum hemorrhage in full (ACOG membership required).