Full Transcript Intro and guest introduction 0:00 Is my lighting okay? 0:01 Yeah, it's good. 0:02 It's because I have like an added light just because the light in this room is not that great, so. 0:06 Okay, no, that's fine. 0:07 Should be alright. 0:08 I don't think people are looking at me, honestly, I'm just saying. 0:11 Nobody listens to this anyway. 0:13 No one's looking, someone's listening to us so it doesn't matter. 0:25 Hello again, and welcome everybody to this episode of the Jaffercast. 0:28 I am your host, Dr. 0:29 Mark Papadakis. 0:30 Nobody particularly special, just another frickin' ER doctor. 0:33 This episode, we're going to be talking about vaginal bleeding specifically, first trimester vaginobleeding. 0:37 Pregnancy loss, abortion, miscarriage, all those terms that you've heard a lot about in the news recently, but may have a little bit of misconceptions 0:45 about and also questions about too. 0:46 So, one of my colleagues, I went to medical school with Dr T. 0:49 Beezer, she's going be joining us. 0:50 She's OB-GYN, so we are going have good conversation, So let's bring her in here. 0:55 Alright, I'm here with Dr. 0:56 Teague Beezer-Teague. 0:58 Hello, how you doing? 0:59 Hi, it's good to see you. 1:01 Good to you too. 1:02 I think it has been quite a few years since we talked to each other. 1:05 You graduated from my alma mater, Toro, in 2017. How you doin'? 1:09 You know. 1:14 You're living the dream, I'm living The Waking Nightmare. 1:16 It's fine. 1:19 After Toro, you went to Cooper, actually, for residency in New Jersey, and I'd forgotten about that. 1:28 Okay, and then you did a fellowship at University of Rochester Medical Center. 1:31 Now, what was your fellowship in? 1:32 Maternal fetal medicine, so high-risk pregnancies. 1:36 Gotcha. 1:36 All right, walk me through because maternal fetus medicine I did not realize is actually its own separate fellowship and high risk pregnacies. 1:45 Yes, so a lot of ultrasound. 1:48 So we're the ones who traditionally read your ultrasounds when a person finds out they're pregnant, date their pregnancy, 1:56 look at their anatomic ultrasound.
Maternal-fetal medicine and OB training 1:59 If there are any fetal concerns, we'll read the ultrasound, send mom. 2:04 or the caring parent to the appropriate specialist. 2:07 We also do consultations for women with complex medical problems in pregnancy, make recommendations. 2:14 Some people refer to us as like the IM of pregnancy. 2:19 you know, take care of all the chronic medical conditions. 2:21 Did you want to do OB-GYN like the entire time you're in medical school? 2:24 Like how did that kind of come about? 2:26 I actually really wanted to be ENT, which is so weird because now that is weird. 2:31 How'd you go from here down to... 2:32 I know. 2:34 I had a reality check with step one and I was like, Oh, I don't think that's for me. 2:38 And also then when I went on my rotation, loved my OB rotation. 2:44 It was at Trinitas in Elizabeth, New Jersey. 2:46 Oh yes. 2:50 I liked that there was a little bit of primary care, a bit surgery. 2:55 You can follow patients throughout the course of their lives. 2:59 Um, you have two patients at once. 3:02 And it's interesting that you mentioned that because in emergency medicine training, we consider, two patient at one, the mother being the primary patient 3:09 and the fetus, child being secondary. 3:13 You know, there's a lot of push, um, lately in the news and politics, whatever, you know with the abortion legislations and all that, 3:21 how do we reconcile the health of the mother versus health with child? 3:24 And for emergency medicine, it is fairly straightforward in a sense that we prioritize the Health of The Mother. 3:29 If you don't have a healthy mother, You don' have healthy child. 3:33 Um, so our focus is kind of on that. 3:36 Is that also kind your, your world as well, Yes, I want to say that it is not that we ignore the baby, of course not. 3:46 No, that's a good point. 3:47 That's good. 3:47 We don't ignore the babies. 3:48 Definitely not. 3:49 Babies are very important to us. 3:51 But yes, maternal health is primary, because if you don' have a healthy mother, you do not have healthy baby. 3:57 And there are also instances in where the health of the baby actually truly compromises the help of mom. 4:05 Not to get into the nitty gritty, but the age of viability is incredibly important, which varies by institution, But overall is somewhere between 22 to 24 weeks. 4:15 usually in the ED majority of the time you are seeing patients when they're not even viable, usually. 4:23 that's a factor that is incredibly important and gets overlooked more than we would like in legislature by people who are not physicians, 4:35 not obstetricians. 4:36 Yep. 4:37 Nobody has ever had laid a hands on an actual patient before writing some of these laws. 4:42 So before we get into the The popular stuff that's in the news right now, we got to talk about the one thing I want to mention on your resume.
Pregnancy, COVID vaccine, and public trust 4:51 It says that you were the face of the New York state COVID vaccine and pregnancy campaign. 4:55 You partnered with the new York city department of health. 4:58 So when you say that I took your face on flyers, like, can I actually Google you and you're, you know, smiling on a brochure somewhere, 5:04 what was that like? 5:05 And Google me, I was on the subway, buses. 5:07 Alright. 5:08 Actually where I got my eyebrow threaded in Rochester, they actually had a sign. 5:13 I don't know why, but it was even there. 5:15 Yes. 5:16 Do your patients recognize you? 5:17 No, some have given me weird looks. 5:21 Okay, like I had that in the when it was first out. 5:25 I have people like look and I also did a verbal ad and my voice unfortunately is unique. 5:33 So I think people recognize my boys but they couldn't put their finger on where so I got a lot of that like. 5:40 That's awesome. 5:41 And you actually, so you worked on a congenital syphilis project for the New York City Department of Health as well. 5:45 For almost, for like two and a half years, two years. 5:50 Yes. 5:50 Okay. 5:50 So what was that like? 5:51 How did you get involved in something like this? 5:54 Infectious disease and pregnancy, do they seek you out? 5:57 Do you just kind of, are you in the same room and this is discussed and they just, you know, get picked on randomly? 6:03 So I actually had a lovely mentor and somebody who is on staff at the University of Rochester who works on the maternal mortality board, 6:11 Dr. 6:11 Christopher Glantz, amazing human being, taught me many things that I know or don't know when I ask him on below. 6:18 Now, he's wonderful. 6:20 He actually has suggested me because in 2021 slash 2022, I was pregnant with my first child. 6:29 And I had received the COVID vaccine and pregnancy in 2020 or sorry, I have received it in pregnancy during my 2021 pregnancy. 6:39 And i had also received that when it first came out like all of us as a physician on the front line. 6:44 So we're looking for your pregnant so because I got December 2020. Yes. 6:50 And I had mine, I think like end of December, 2020 as well. 6:53 Then I got pregnant 2021, got it again when I was 20 weeks pregnant. 6:59 They were looking for somebody to be the face of this campaign to try to encourage moms to get the COVID vaccine in pregnancy. 7:08 Did you have reservations about the vaccine at all? 7:10 Was that something that you were cautious about? 7:13 Did look at something? 7:15 How did your decision-making process evolve to get the vaccines while you're pregnant? 7:19 So, fortunately, in between the time that I had got it, the first time, December 2020, and by the I got while I was pregnant, 7:28 a study had come out showing that getting the COVID vaccine did not affect fertility. 7:34 which I think was monumental in my decision making going forward. 7:38 I wanted the vaccine so that I could pass on antibodies to my baby. 7:43 And I was also working during Omicron to mass on delivering women in the ICU who were incredibly sick with COVID. 7:54 Faces I will never forget were also incredibly paramount in reason why I got the COVID vaccine. 8:00 So I'd seen the worst of the for worse. 8:03 I was reading the literature about its safety profile in women trying to conceive and women who were pregnant. 8:10 And I wanted to give my newborn protection who wouldn't be able to get the Covid vaccine until they were six months. 8:16 And like a lot of healthcare workers too at the time, you know, we wanted to be the face of the vaccination campaign in general. 8:22 So that's why a lots of us lined up to kind of say, hey, this is safe. 8:26 It's really important that you actually did that to show pregnant women it was safe too. 8:29 Cause I remember that was a concern that we had and data was coming out slowly, but surely. 8:34 That's great. 8:36 And also as a woman of color too, to try to the faced of attempting to gain trust within the community was really to me as well. 8:45 Yeah, 100%. The patient population that I treat, very unfortunately poor, low socioeconomic status, is a huge underserved community. 8:55 And I remember at the time we were getting out a campaign to try and push for that vaccination because there was a lot of mistrust in that community that 9:02 even I see with regards to vaccination and medical treatments. 9:05 I'm never having more than one conversation with my patients, young, healthy patients whatever, about the vaccine. 9:11 concerns about either efficacy or side effects. 9:15 I remember that was a big, still is in many ways, a major step to try and get the word out about mass vaccination. 9:22 And really quickly, I do want to put this in, even though you're like, nobody has been listening to this, but I have to say this. 9:28 I know that recently the recommendation for pregnant women has been walked back by the government. 9:33 I don't agree with that. 9:34 Women are still at a higher, pregnant patients particularly, are at higher risk to get severe disease. 9:42 They stand by their recommendation to the COVID vaccine while you're pregnant. 9:46 There is a robust amount of data proving that it is safe. 9:51 and effective and decreases your chances of morbidity and even mortality within your pregnancy. 9:58 We don't think about this, but pregnancy is considered an immunocompromised state. 10:02 Yes, it is. 10:03 And something that we have to understand is your bodies, women's bodies are primed from puberty really to carry a child in the sense that when now a childhood 10:14 is developing inside of them, What prevents your own body from attacking this baby? 10:21 It is a parasite that is leeching nutrients from you and the body needs to go and say, this is bad thing for our own self. 10:28 And it's because the immune system is tapered down. 10:31 It's not as robust as it usually is. 10:34 It's actually one of the theories why women are more prone to autoimmune diseases, because if you have an immune system that is basically overcompensating 10:43 for the times when they are not pregnant, that's when you can see auto immune issues. 10:47 So now you an immunocompromised individual dealing with a virus that can cause, like you said, significant morbidity and mortality. 10:54 Yeah, you guys are prime candidates for this vaccine, even though others really don't think that and you, well, your work is funny because you work in 11:03 infectious disease and pregnancy kind of lends your own unique voice to this too. 11:06 You see a lot of congenital stuff coming about. 11:09 you see other issues that people don't think about during pregnancy, namely syphilis. 11:14 And then all of a sudden a woman gets sick with COVID, you know, what do you do? 11:16 Also, just physiologically, you have a fetus and a growing uterus sitting on your diaphragm, decreasing literally the amount of space your lungs have to 11:29 expand and deflate. 11:30 So that makes ventilating you incredibly difficult when you severe COVID. 11:37 Yes, people are nuts because I have had the privilege of seeing the worst of the worse of It's a no-brainer, you need this vaccination. 11:48 You don't want this to be you. 11:49 But it's hard to tell people. 11:52 People want to experience it for themselves. 11:54 That's right. 11:55 Yeah, exactly. 11:56 They want see what life is on the other side is like, and it is not pretty. 11:59 It is good. 12:00 Now, have you seen pregnancy lost due to COVID?
COVID, flu, and pregnancy risks 12:04 Yes. 12:08 Yes, while I myself was pregnant. 12:11 Yes. 12:11 I will never forget I was in fellowship and before that too, but in Fellowship, a woman, I want to say she was like in their 30-ish weeks. 12:20 So late term. 12:21 We're talking third trimester. 12:22 Yeah. 12:26 I remember her face. 12:27 She had very bad COVID and had a demise. 12:31 And we had to delay management of the demise, meaning delivery, because she was so sick. 12:38 It was horrible. 12:39 So she had pregnancy loss because of how sick she, was not because the virus was at home. 12:45 Yeah, we believe. 12:46 Please don't come at me. 12:47 I don' have the autopsy. 12:51 Yeah, no, she was hypoxic and we believe that that had led to the demise. 12:55 She was satting 78% when she came in. 12:58 Yeah. 12:58 I've seen that a lot of times, especially in the first two waves where patients come in, they're saturating 60, 70%. They're talking to you, 13:06 but their auction level is still so incredibly low. 13:13 immunocompromised, more at risk of severe disease, especially women. 13:16 That fetus, that baby, takes up a lot of the oxygen. 13:20 So in a normal pregnancy, in normal pregnancies, we normally see heart rates rise just because the body is trying to get blood to the baby in addition 13:28 to you. 13:29 Can you imagine the strain that's undergoing the bodies trying get oxygenated blood into both you and the babies in that situation? 13:37 It's not good and I can see how it can lead to some pretty bad outcomes. 13:41 Now, that being said, the virus itself, have you seen a lot of that recently? 13:46 No. 13:46 It's been five, you know, four or five years since really two deadliest waves kind of came through. 13:50 Omnicron obviously caused another spike, but we didn't see nearly as much morbidity and mortality, death and destruction compared to the first two waves. 13:59 What about these subsequent waves? 14:01 Are we seeing a lots of still now in in pregnant women, you know, babies, whatever. 14:06 So I will put a disclaimer out that I was not practicing for half of the winter. 14:14 I started my attending job in December, and I'm mostly outpatient now. 14:19 December of what year? 14:20 December 2024. Okay. 14:22 My, I graduated July, had time off my contract, started December. 14:26 so I wasn't really in the mix, mix mix. 14:28 i will say flu was tough this year. 14:32 Yes. 14:34 Yes, 100%. We saw more flu, I would say, more morbidity from flu than COVID. 14:39 I'd say last year when I was in the mix and also pregnant, so 2023 to 2024, a lot of flu. 14:49 Not great. 14:50 We a little COVID, but I say flu was dominant the last two seasons, if it were from my clinical experience. 14:57 Yeah, and you're primarily now outpatient, correct? 15:00 You're no longer really in the hospital setting. 15:02 And that's been my experience in ER too, is really a bad flu season. 15:06 RSV has been bad for the last two years as well. 15:09 Flu has outpaced COVID in terms of the severity of disease, largely for a combination of reasons. 15:15 You can talk about mutated strains, vaccination campaigns, whatever the case is. 15:19 But, you know, the risk factor for pregnant women is still the same when it comes to a lot of these viruses. 15:24 It can devastate the person, which can therefore devastates the baby. 15:29 And that's how a lots of this stuff comes about. 15:33 I want to switch gears a little bit and we need to talk about vaginal bleeding, the main topic for obviously this show. 15:40 Vaginal Bleeding does correlate with pregnancy loss in many ways. 15:44 So people think now, okay, I'm bleeding. 15:46 I vaginally bleeding I am pregnant. 15:48 Therefore, this is likely a miscarriage. 15:51 Not all the time. 15:53 Yeah, yeah. 15:55 It's distressing. 15:56 Absolutely. 15:57 Yes. 15:57 So, when is vaginal bleeding a miscarriage? 16:00 When is it normal? 16:02 Are there signs that we can look at? 16:04 Is there something that women can say, okay, this is likely not a mismarriage, but what should we do here? 16:10 You are at home having vagina bleeding and you know you're pregnant. 16:14 You need to seek some sort of medical attention. 16:16 Please never ignore vagin bleeding in pregnancy, whether it's you love the Oh, it's only when I wiped. 16:23 Don't care. 16:25 I'm bleeding through a pad. 16:26 Please see somebody. 16:28 Whether you're wiping and spotting, bleeding a through pad, you need evaluation for a myriad of reasons. 16:34 It is never normal in pregnancy. 16:36 Yeah. 16:36 And that's one of the biggest things that, you know, women come in and they say, I wasn't sure.
First-trimester vaginal bleeding basics 16:41 I don't know. 16:41 It was only a little bit. 16:42 Then I'm like, well, it doesn't matter. 16:44 If you're getting ultrasound, if you getting blood work, then you are getting the whole nine yards. 16:46 This is what it is. 16:48 That's exactly what I would recommend. 16:50 Yes, there are times where we can't find a cause and everything looks okay, and that is fine. 16:57 But I never want a person to ignore vaginal bleeding in pregnancy. 17:01 You need some sort of evaluation. 17:03 What? 17:03 What is a common cause? 17:05 Let's say that I have a patient who comes in and they've been spotting a little bit, maybe a lot of blood, a bit of cramping, 17:12 but okay, we see a baby in there. 17:15 Let say there are seven or eight weeks we've seen a heartbeat. 17:18 Now what can I tell my patients that it could be this or it's most likely this? 17:24 It could be one, threatened miscarriage, so threatened abortion. 17:29 So your pregnancy looks okay right now, but we should follow up in a couple of weeks, especially in first trimester. 17:36 Not sure what this could lead to. 17:37 That's number one. 17:38 Cervical friability. 17:40 We see that a lot because the cervix is very soft. 17:44 and sensitive in the beginning of pregnancy, so it's not uncommon to have intercourse and your cervix starts to bleed because it is very sensitive. 17:53 So that could be a cause. 17:54 Also, infection. 17:56 It could chlamydia, gonorrhea, some sort of STI irritating the cervx. 18:02 So should I be swabbing these patients out for STIs? 18:04 Does every vaginal bleeder get swabbed for an STI? 18:07 So that's tough for me to determine for you because then you guys are the ones receiving the results, right? 18:13 And I'm sure you want that, correct? 18:15 I want you to say yes, and then, you're going to get the hate of every single emergency medicine physician in the country. 18:20 I already do, I really do. 18:22 Don't come for me, don't do it. 18:24 I do that. 18:24 But I personally, when I would see a patient in OB triage when i was a resident, if they had bleeding, i would absolutely swab them. 18:33 If I saw that they have a swab within the last week or two and no new partners and it was negative, then I wouldn't probably re-swab them I'd look incredibly 18:44 closely as well to what I'm seeing on the cervix. 18:47 STIs can look really nasty. 18:49 There could be a polyp to a cervical poly, a growth on the cervix causing bleeding. 18:55 Other things that can fool us are hemorrhoids. 18:58 People think they're bleeding from their vagina, but actually it's a hemorhoid that is incredibly engorged and painful and causing the bleeding Yeah, 19:05 and that's a very common issue that women have when they're pregnant because all of a sudden, now there's increased pressure to your abdomen, 19:12 there is pressure on your bladder, you can get constipated more easily now and all the sudden you get external hemorrhoids and this happens obviously much 19:20 more frequently after and during childbirth and child delivery but yeah, it's problem in pregnancy though. 19:25 Yeah. 19:26 And then like later on out of the first trimester, probably mid-trimester so second trimest or third trimestre, bleeding is concerning. 19:35 Are we missing a previa? 19:36 Meaning the placenta is covering the cervix. 19:39 You have to be very careful when you're examining a pregnant patient saying that they're bleeding. 19:44 Do you know where their placent is? 19:46 Have we ruled out a preview? 19:48 Just things to Be mindful. 19:50 Yeah, and if you think about it logically, right, your placenta is a thing that gives your baby blood, oxygen, nutrients, 19:56 all that stuff. 19:57 And usually it's sitting somewhere up higher away from the cervix, but now it is covering the cervical. 20:05 How is the baby supposed to even get through the Cervix if there's something blocking the way that has a lot of blood vessels in it? 20:11 And so you have leaking going on there that also has to be diagnosed ideally before the patient goes to deliver as well because then they need a C-section. 20:19 They can't just go right through there. 20:21 So how is that even diagnosed? 20:23 What is the usual method for that? 20:24 By ultrasound, by ultrasound at your anatomic ultrasounds, we are always looking at the relationship of the placenta to the cervix. 20:31 Now, can you see that early on like the first trimester? 20:34 Yes, but many people had Previas in the first trimester and it doesn't mean anything because as the uterus, it's, sorry, 20:41 It's not that it does mean it anything. 20:42 It is not as clinically significant because that's probably the case for everybody. 20:48 As the Uterus expands, the placenta kind of shifts backwards. 20:52 Doesn't literally walk and move. 20:54 That would be cool if it did. 20:56 A neat trick. 20:59 I wonder if we would have more rights if it did, right? 21:03 No, probably not. 21:04 Probably not, honestly. 21:05 So yeah, it wouldn't be uncommon at least 12, 14, 16 weeks to see the placenta coming down pretty low towards the cervix.
Placenta previa and C-section considerations 21:14 We become more worried about it when you're in your mid-second trimester. 21:21 And we still look again in third trimesters too, sorry. 21:24 And if somebody has a previa in the past, are they more at risk for a preview later on? 21:28 Yes, they are. 21:29 So that usually means that they're going to be getting multiple C-sections. 21:32 If you've had one C section, chances are good you're gonna need a Csection for the rest of your pregnancies, correct? 21:38 Not all the time. 21:38 You can try for vaginal birth after cesarean section after one c-section depending on the indications for your original c section. 21:47 So, breach, non-reassuring fetal heart tracing, like baby's heart rate drops. 21:51 Yes, you could try for vaginal birth after cesarean. 21:56 Times when you cannot tolac, trial of labor after caesareans. 22:00 So times you can not to lack is if you've had a... 22:03 It's a new one for me too. 22:05 Oh, really? 22:05 Oh my god. 22:06 Yeah, I've never heard of that one before. 22:08 I'm just a dumb ass emergency medicine doctor, okay? 22:10 All these fancy terms you're throwing at me I don't know about. 22:14 All right, that wraps up another episode of the Jaffer Gas. 22:16 We had to cut this one short because we have a lot more to cover. 22:18 Dr. 22:18 Teague Beezer, thank you for coming on and we're going to get her back in here to talk more about first trimester vaginal bleeding along with miscarriage, 22:25 ectopic pregnancy, things like that. 22:27 So we are going split it up into two separate episodes. 22:29 Already, we talked about getting the COVID vaccine during pregnancy. 22:32 Women are especially at higher risk during the pregnancy period, their immunocompromised and therefore should consider getting a COVID booster when it 22:39 becomes available, if it become available. 22:41 And of course, vaginal bleeding in the first trimester can be normal, however, it should never be blown off and should always be evaluated by a doctor, 22:49 either in OB-GYN or in an emergency department. 22:51 As always, I encourage constructive thoughts, comments, and suggestions. 22:54 You can leave them in comment section for those on YouTube or email them to me at jeffordcast at gmail.com. 23:00 If you're in the healthcare field and interested in being in a show to discuss topics in healthcare, or if you have a passing interest in health care topics, 23:06 please feel free to reach out to me as well.
Closing remarks 23:08 Like with anything though, don't take my word for it. 23:10 Do your own research, talk to your doctor, because at the end of the day, like I keep getting reminded at work, I'm just another friggin' ER doctor. 23:16 Make good choices, everybody.
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