I gave up obstetrics last year and have moved to the head end (GP-anaesthetics). To be honest I have not seen a huge amount of new FOAMed material relevant to GP-obstetrics, but this may reflect my own cognitive bias.
Asking the question of a practicing obstetric colleague “what’s new in obstetrics?” was met with a wry smile and the comment “babies still get made in the same way and come out the same hole(s)”
If you have any relevant FOAMed for sharing amongst rural brethren, please let me know so can be posted here.
Two topics that I think still cause some controversy are those of timing of antibiotics pre-LSCS and dose of oxytocin to give at delivery.
Timing of antibiotic dosing for LSCS
Standard teaching used to be to wait until baby was delivered before giving maternal antibiotics during LSCS “in case of anaphylaxis”. Certainly this was still being promulgated when I was doing an anaesthetic refresher back in 2011. Yet this is surly muddled thinking – if we are giving antibiotics to prevent maternal infection post-op, it needs to be given before knife-to-skin. The concern has been not just anaphylaxis, but also neonatal necrotising enterocolitis. This does not appear to be borne out in studies and indeed perinatal guidelines indicate that antibiotics be given 30 mins before knife-to-skin. See this link for details.
Do you do this? Or does it depend on the obstetrician/anaesthetist/day of the week/whether you remember?
Use of a LSCS checklist may help.
Cephalosporins safe with penicillin allergy? Depends on side-chain
Leading on from this, would you give a cephalosporin to a patient noted to be ‘allergic to penicillin’? Some recent evidence that the oft-cited 10% cross-reactivity between pencillins and cephalosporins is a fallacy. Cephalosporins with a different side chain to beta-lactams appear safe (ceftriaxone OK, cefazolin/cephalothin/cephalexin maybe not). Read the evidence in this article and decide for yourself.
What dose of oxytocin?
“Is the synto in yet?” asks the obstetrician. “What dose do you want?” replies the obstetrician. Surely this could be decided beforehand, with an agreed escalation if there is abnormal bleeding…
The BJA suggests that TWO units of oxytocin is optimal. That’s from the anaesthetic end. What do the obstetrician’s think?
Of course if there is an ongoing PPH, follow accepted guidelines, backed up by evidence eg: BestBETS - a synto infusion is way to go…
Dr Jo Deverill blogged this lovely piece on obstetric nightmares for the ED doc – relevant to GP-obstetricians as well!
Managing First Trimester Bleeding
Excellent podcast from BroomeDocs
Managing late pregnancy bleeding
Another great case from Dr Casey Parker and colleagues at BroomeDocs.com
Management of PCOS
Check out this useful presentation from Penny Wilson (@nomadicgp) on PCOS
Management of Dysmenorrhoea
Another useful presentation from Penny Wilson as part of the BroomeDocs podcast
The Pap Smear Podcast
BroomeDocs admits he is not much of a dab hand with the speculum – so goes in search of some top tips n tricks from colleagues – listen to “the Pap Smear Podcast“