Full Transcript Introduction to Pregnancy Loss 0:00 Miscarriage and abortion remain a hotly debated topic with lawmakers, passing questionable legislation at best, dangerous at worst, 0:06 and the general public not only having a vague understanding of what happens during pregnancy loss, but misconstruing it often altogether. 0:12 Today on the Jaffercast, we're talking about pregnancy lost, healthcare deserts, And what happened when a pregnancy is not exactly in the location it should be. 0:19 I'm your host, Dr. 0:19 Mark Papadakis, no one particularly special, just another frickin' ER doctor. 0:24 Subscribe to the show if you liked what you hear and want to support us, and if have questions or comments or want tell me how bad I am doing, 0:29 Just reach out at jeffordcast at gmail.com. 0:32 Let's do this. 0:42 Here with us again, Dr. 0:43 Beezer. 0:43 Hello again. 0:44 Deke, how are you doing? 0:45 Mark, thank you for having me back. 0:46 It's been a while. 0:47 Yeah, it has been quite a wild, unfortunately. 0:51 Life has gotten the best of us and I'm also slacking on my uploads too. 0:55 So you can totally blame me for this. 0:57 For those of who are new, who don't recall Dr Beeser, OB-GYN, MFM, maternal fetal medicine, working in New York. 1:05 She has dealt with a lot of our topic, as I am sure that you've seen a lots of this stuff. 1:11 Missed abortion, miscarriage is a very big part of our specialty, unfortunately. 1:17 Um, because we read a lot of ultrasounds. 1:19 So we're sometimes the ones determining the ability of a pregnancy. 1:24 And a love women come into the ER for vaginal bleeding in pregnancy because I think, oh my God, I've lost a baby. 1:29 I'm losing the baby and there's nuance there because sometimes, sometimes yes, we have to deliver the bad news. 1:36 Other times, no, there are other conditions that cause this, but you know, people think of, in my experience, at least people, 1:42 think they miscarriage as bleeding, cramping, pregnancy loss. 1:47 And that's it. 1:48 But there's definitely a spectrum for sure about all this. 1:51 Yes. 1:52 Unfortunately, not all miscarriages are perceived by the patient, meaning they can be completely asymptomatic. 1:59 Sometimes referred to what we call a missed abortion, A miscarriage, but is not aware, doesn't necessarily have symptoms like vaginal bleeding or cramping. 2:11 One point might have had a viable heartbeat and then at the next revisit, unfortunately, or show up into the emergency room. 2:19 And there is no longer a heartbeat. 2:21 Yeah. 2:22 And it's important to also talk about terminology because abortion is a very hot button topic in society.
Bleeding, Cramping, and Early Warning Signs 2:27 So when we say abortion, we're not talking about, you know, an abortion clinic or somebody going to have an abortions. 2:33 This is the medical term that we refer to any type of pregnancy loss. 2:38 Yes. 2:39 If we are talking, if you hear the word abortion don't get triggered. 2:42 Don't at me, don' at Dr. 2:43 Beezer. 2:44 this is literally just a medical terms that use to refer a miscarriage or just pregnancy in general. 2:49 So I do want to talk about going back to vaginal bleeding. 2:53 First of all, you say that pregnancy loss can be asymptomatic and then it's not found until later, empty sac, all of these things can happen. 3:03 But I recall you saying last time we talked, any bleeding in the setting of pregnancy is abnormal. 3:09 Like that's just, we start there. 3:11 If you have bleeding and you're pregnant, that is not normal. 3:13 You can have cramping during your pregnancy. 3:17 in pregnancy anytime during your pregnancy, which can be a symptom of early pregnancy. 3:23 However, if you are finding that the cramping is persistent, you were doubled over in pain, and you feel as though you cannot carry on normal daily activities, 3:33 you should be seen. 3:34 Absolutely. 3:35 So as far as cramping goes, You talk about the quality of pain. 3:38 What about. 3:39 The timing of the cramming in the pregnancy? 3:42 When is it, when is cramps being considered not normal at all during any stage of pregnancy. 3:47 Is it just only in first trimester? 3:49 Yeah. 3:49 You can have some and then it's gone. 3:50 It's so hard to say the threshold of normal to abnormal. 3:56 Everyone is different. 3:58 You are uncomfortable. 3:59 I do suggest that you get checked out. 4:02 But I want patients to know that there's not always necessarily something wrong if you are experiencing some cramping. 4:10 There is the phenomenon called like implantation bleeding or beginning of pregnancy. 4:16 As the pregnancy is forming, your uterus is slowly timing itself for pregnancy and expanding. 4:23 patients can experience cramping and discomfort. 4:27 There are times where it's truly like a physiologic part of early pregnancy. 4:32 Again, if you're feeling uncomfortable, you can't carry on daily activities as normal you are doubled over in pain, is associated bleeding, 4:43 nausea, vomiting, just not feeling well, you should be evaluated. 4:48 Yeah, and that kind of leads us into a little bit of ectopic pregnancy because when somebody comes to me, And they say, Hey, 4:56 I'm having some bleeding. 4:58 And by the way, having pain, but not cramping pain. 5:01 It could be having a sharp pain but that pain is now associated on the side of the abdomen. 5:05 That raises our suspicions for, is this an ectopic pregnancy? 5:08 In the first trimester, second, third trimesters, a whole different ballgame. 5:11 First trimesters specifically, what is going on in that side your abdomen that where you're having bleeding, you know, or we now know you are pregnant. 5:20 Is this in eectopic pregnant? 5:21 And for people who are unaware, ectopic pregnancy means a pregnancy that has started not in the uterus, but actually now off to the side. 5:28 So your ovaries are over here, now suddenly you have a pregnant here but the ureters is here. 5:34 Something happened in transit where now the baby is no longer in. 5:38 The uterus is actually to side here and it's growing. 5:40 It's implanted, it is growing and that's a problem because now we get concerned that it could have ruptured eectopic pregnant meaning it grows so big,
Ectopic Pregnancy and Dangerous Locations 5:48 you've now rupture the fallopian tube and you're bleeding now. 5:51 And there are other sites of topics as well. 5:54 The most common is tubal in the fallopian tube, can have less commonly an ovarian ectopic, cervical eectopic from the cervix. 6:03 Can have a cesarean scar eptopic pregnancy if you have history of C-sections. 6:09 Abdominal ectopics, which I have not seen, but it's most commonly in the tubes. 6:15 So that's why we're talking about side pain, your fallopian tubes are hanging off the sides of your uterus. 6:20 Yeah. 6:21 And cervical eectopic seems to me very scary and weird at the same time, because that means there's a baby that is developing right where the exit point 6:31 of the uterus is. 6:33 How the heck did that happen physiologically? 6:35 Rhetorical question, just more out of curiosity than anything else. 6:38 And also cesarean scar atopic pregnancies are very scary too. 6:43 Can leave it. 6:46 Yes. 6:46 So speaking in terms of cesarians, speaking terms, of C-sections, I'm seeing a rise in women getting C sections, which to me growing up, 6:55 it used to be a, not a rare procedure, but something that it happened only if it needed to happen. 7:01 And now I feel like I see more people getting C-sections, you know, routinely in a way. 7:06 I don't know how to really say it. 7:08 When I was doing my rotations, we had one or two C sections a day. 7:13 And I dunno if that's common, I know what it is, but are we seeing rise in these types of ectopic pregnancies? 7:19 Well, a couple of things. 7:20 It's complicated. 7:22 As is everything, trust me. 7:23 So as our population becomes more high risk in general, there becomes risk factors for eating a C-section. 7:31 In some respects, yes, higher rate of cesarean sections for those reasons. 7:37 But overall, the American College of Obstetrics and Gynecology for maternal fetal medicine, many hospitals around the country particularly the one I currently 7:47 work out that was featured in the New York Times recently, Rochester Regional Health, has taken many steps to reduce the number of cesarean sections performed. 7:57 Where I did residency at Cooper University Hospital in New Jersey and where I am currently, we were fortunate enough to really work on our cesarian section 8:09 levels to get it below the national rate, which I believe the low 30%. Um, over a fact, when I was at Cooper, we were in the 25th ish percent for MRC sections. 8:24 There are many efforts to decrease the rate of C-sections. 8:28 However, like I said, our population unfortunately is getting sicker. 8:32 We in states is not best at maternal healthcare. 8:35 So we will have a high rate. 8:37 Of caesarian section in comparison to many. 8:40 or developed countries. 8:41 That being said, with more C-sections come more caesarean genic topic pregnancies. 8:47 There's nuance to that statistic as well with, you know, maternal health, and maternal death, those statistics. 8:53 Because we have a disparity of care across the country, so you can go to, let's say, Germany, it's relatively uniform as far as the care goes, 9:03 but you go from a place like New York City versus a places like rural somewhere, I don't know I'm not going to call names, 9:09 obviously, but the number of doctors available per resident drops. 9:15 That said, the poverty rate also has something to do with it too. 9:18 There are people who can't afford to seek prenatal care, that leads to a higher complication rate later in pregnancy, which can lead to more C-sections 9:26 or things like that. 9:27 So, you know, people like to talk about doctors and, oh, well, Bills are so high, but we have so many complications. 9:35 And we've talked about this before, you know, it's not just about C-section and or not, It's also about preeclampsia. 9:42 It is about, help syndrome, liver dysfunction during pregnancy. 9:46 Is that caught early? 9:47 Is it caught late? 9:48 All these things factor into the health of the mother at the time of delivery and even after the care too. 9:53 But that's a soapbox. 9:55 Also the creation of maternal care deserts. 9:58 If we're unable to offer 24 hour anesthesiology, somebody in-house are readily available. 10:04 We cannot offer what's called a trial of labor after a cesarean section or VBAC. 10:10 So there are certain things that have to be in place in order to. 10:14 Offer people who have had cesarian sections, the opportunity for vaginal delivery and with increase in maternal care of deserts, 10:22 that's going to be less and less of an opportunity. 10:25 an increase in repeat C-sections. 10:28 And that's something that we don't talk about often enough too, healthcare deserts, maternal care desert, things like that. 10:33 A topic for next time. 10:35 Yeah, sorry. 10:37 No, don' apologize. 10:38 Because this is something the general public, I don''t feel understands enough about, unless until it affects them directly. 10:44 But then they're asking questions, well, why can't this happen? 10:47 Why can'''t I do this? 10:48 Well, Why Can't My Doctors See Me? 10:50 All of these reasons are part of it, and it's not talked enough, or It's talked about in different contexts, namely, why do doctors kill people?
C-Sections, Maternal Care Deserts, and Access Issues 11:00 You know, it's more the humor. 11:04 That headline plays a lot better than maternal care desert. 11:08 Like that's way too technical for the New York times or something like that. 11:11 I don't know. 11:13 So as far as ectopic pregnancy goes, we have very limited options because that pregnancy is not viable. 11:18 Right away we determined that the pregnancy was growing in a spot it shouldn't be. 11:22 Wait, say it louder for people who think that they're viable or not. 11:27 So technically speaking, when we give somebody in the ER or you in office medication to terminate a pregnancy, because it's non-violence growing in a location 11:38 that one cannot go to term and two will kill the mother. 11:40 It is technically an abortion. 11:43 That's just, that is what it is, you know? 11:45 And this is one prime example of where state laws over the last now couple of years have run into sound medical practice. 11:55 Now that too is a discussion for another time. 11:58 But ultimately we have to give the mother an abortion because if we don't, that baby grows inside to the point where it ruptures something. 12:05 The fallopian tube, the uterus comes out, cervix, who knows? 12:10 But I've cared for a couple of rupture topics. 12:13 My colleagues have called, have cared a for couple rupertic topics and all of them have gone emergently to OR because there's bleeding inside the belly 12:21 and that is not a good situation. 12:22 So the challenge for us in the ER and for you guys is. 12:27 had a diagnosis and how are we sure that this is ectopic versus not? 12:31 Oh, a couple of things. 12:33 The thing that is popularly drawn, the emergency room besides a urine pregnancy test is a beta-HCG. 12:39 It is at the pregnancy hormone level. 12:42 We can track and follow. 12:44 it does not definitively tell us it's an eectopic pregnancy, but it can tell There, this is more likely a normal abnormal pregnancy when we should start 12:55 to see a pregnancy in the uterus. 12:58 And there is a nice diagram that you guys go out of that I didn't know existed until approximately 20 minutes ago. 13:06 Oh, that diagram is really for diagnosing early pregnancy loss. 13:11 So miscarriage takes us step-by-step. 13:16 We're starting to say something in uterine. 13:19 takes a step-by-step by one gestational sack. 13:23 The gestation sack contain a yolk sack, great. 13:34 Fetal pole, the heartbeat, so fetal poles, very early stages of a little tiny fetus developing. 13:40 Till we get to that, I guess, those four things within the uterus, we're not clear where this pregnancy is going. 13:48 So this lovely chart we'll share. 13:50 Yeah. 13:51 And for those of you who are listening to this in your car, unlike my wife, probably, rather than YouTube, sorry, tough luck, 13:57 but I will put the link to the description for the episode if you want to bring it up later by yourself. 14:03 So this is the guidelines for ultrasound diagnosis of pregnancy failure or loss, where we can apply very conservative findings and not, 14:17 in an effort to not call a pregnancy a failure too early. 14:22 So on the right side are findings that are suspicious, but not diagnostic of a pregnant failure. 14:28 Whereas on left side, it's definitely pregnancy. 14:33 It tells us when a patient should follow up with us based off of what we're seeing as well. 14:39 Yeah. 14:39 And this is something that we, in general, know about in the ER. 14:45 Obviously, if we have obvious ultrasound findings of pregnancy failure, which is what you see here on the left, we are done. 14:51 I go to the patient, I give them the sad news that this pregnancy is a failure. 14:57 It's a miscarriage. 14:58 And then here's what to expect. 15:01 The tricky part comes in stuff on the right, because usually what happens, at least for us in the ER, women comes with spotting, 15:10 maybe a little bit of cramping, and let's say they're at their five week marks, six week mark, since, you know, their period ended, 15:17 four weeks ago, right? 15:19 And now I say, okay, well, just like we talked about in the first episode, I'm getting a blood test, the serum HCG. 15:26 I was checking all your other blood pounds as well. 15:28 And I get a urine test and I am also getting an ultrasound. 15:32 Let's say you have an elevated serum HDG level, a pregnancy hormone level that's elevated. 15:38 Good. 15:40 But without context, it's a number. 15:43 You know, I need to put that number into greater context, which is usually when I say at least come back in two days to see if that numbers goes up or 15:52 if it goes down. 15:53 And then we get ultrasound findings like what you're seeing here on the right where it's like, what do I do with this? 15:58 What's going on? 15:59 And something that we have to tell our patients is that the heartbeat may not kick in until about week seven to week eight. 16:05 So it could just be an early pregnancy. 16:07 And oftentimes you will see the ultrasound technician or the radiologist, whoever's reading these ultrasounds put in the comments, 16:13 hey, it Could be in early IOP. 16:15 It could be pregnancy failure. 16:17 Could it be a pregnancy of unknown location. 16:19 We don't know based on this imaging. 16:21 This is what they're going by. 16:22 this is why they don' know. 16:24 There's this criteria here. 16:25 It also clearly outlines when the patient should come back for a repeat ultrasound, because if a patient thinks they should be eight weeks, 16:35 sometimes that's not always accurate. 16:37 Even if they are tracking their period, things can happen. 16:40 So we need to look a little bit beyond last menstrual period sometimes, or even beta HCGs. 16:48 Like they don't offer as a whole list of criteria for those who are appropriate candidates for medical management of an ectopic pregnancy versus surgical candidates. 17:02 For a topic pregnancy, hemoperitoneum, blood in the abdomen, excruciating pain, certain beta HCG levels we're actually seeing on ultrasound.
Diagnosing Pregnancy Failure on Ultrasound 17:13 So it's a medical history and rule you in or out or call management, meaning methotrexate. 17:22 is an injection that dissolves the pregnancy. 17:26 This is going to the emergency room to remove the ectopic pregnancy And when we discover that there is an ectopic break in a non-vibral location, 17:37 you talk about giving abort, they're called abortificants. 17:40 That's the general term for them. 17:42 Methotrexate being the most common one. 17:44 Let's say we give that. 17:46 What can a woman expect? 17:47 So they've gotten the injection in the ER, the go home, now what? 17:50 After receiving methotrexy, You can experience a little bit of pain. 17:54 And what I don't want is you doubled over in pain, excruciating pain or nausea, vomiting. 18:00 Don't want that to occur, but a little bit of pain is normal. 18:03 Can continue to see a bit vaginal bleeding, again, excessive vagina bleeding is not normal, do have to follow your beta HCG levels very closely. 18:14 That's how we will know did the methotrexate work, how much your Beta HCD decreases for the next week. 18:23 So you're getting it drawn the day you receive it and then I believe 48 hours to four days after. 18:34 And then again, seven days, after we're looking at that trend. 18:38 much your beta HCG is dropping. 18:40 So what about a person who comes in, they received an abortifacant from either you or let's say they've gone to Planned Parenthood now. 18:47 Yeah. 18:48 And that's a different context. 18:49 That's somebody who wants to terminate their pregnancy that we assume is a, was a viable pregnancy. 18:54 and they come in with increased bleeding and cramping. 18:57 Is it just, this is the pregnancy passing and everything is passing through me now, or is it, just that there is another complication going on? 19:04 And it's like, what's that complicate? 19:06 I guess would be my question. 19:07 person undergoing. 19:09 Let's say they, they underwent methotrexate for the ectopic. 19:12 You say it dissolves the pregnancy. 19:14 Yeah. 19:15 Are they expected to have increased bleeding at all to pass the remnants of that pregnancy at any point in time? 19:20 Or is this kind of just go away on its own? 19:22 You can have a little bit of bleeding and you can't have little a bit a pain, but it's important to pay attention to threshold. 19:29 Same thing applies. 19:30 If you're soaking through pads, you are doubled over in pain. 19:33 That's not normal. 19:34 And you need to seek reevaluation. 19:37 Or sometimes where bethotrexate doesn't work. 19:40 Sometimes people need either surgical management or a second dose. 19:44 The way that we are figuring out that it doesn' work is one beta HCG level is actually going up, kind of plateauing and not falling appropriately. 19:54 Or if plain and simple, we're doing an ultrasound, it's not changing appearance and you are still in a lot of pain and discomfort. 20:04 And what about the person who now has a viable IUP, who terminates the pregnancy, what can they expect after getting, you know, 20:11 an abortifacant from there? 20:12 Can they except increased pain and bleeding compared to the personal who got methotrexate or are they now going to get almost like period cramping and 20:20 period levels of bleeding with clots? 20:21 Patients who receive all depression or just side attack, You absolutely can accept increasing cramps and increase in vaginal bleeding. 20:33 Again, it's all about amount. 20:36 You are heavily bleeding, which you can go through for a period of time. 20:42 So an hour or two of where you just have very heavy pain can happen. 20:47 If it is not stopping, you feel lightheaded, dizzy, who are doubled over in pain, uncomfortable. 20:54 You need to seek evaluation. 20:55 And let's say they come into the ER and that that's happening for whatever reason, either methotrexate or any other border weekends now. 21:02 So they're having heavy persistent bleeding, worsening, cramping. 21:06 What's. 21:06 Happening. 21:07 what are you concerned about at this point? 21:09 Concerned about the pregnancy might have difficulty passing on its own. 21:14 so for those who were undergoing either termination. 21:19 already had a miscarriage and were undergoing medical management of their mis carriage, I'm concerned that the patient is not fully passing the pregnancy 21:28 and has what we call incomplete abortion, or we might have to assist them with a surgical procedure to really remove the pregnant to stop the bleeding. 21:37 The body is actively trying to get rid of the Instead, the patient's just bleeding and nothing's actually being removed.
Treatment, Complications, and Types of Abortion 21:45 Yeah, and that's a problem because in our situation in the ER, we not only get concerned for just obviously blood loss and anemia, 21:54 but we're also thinking this can be a source of a possible infection. 21:57 So I see a woman who, I actually saw a person, not too long ago, they had a miscarriage, natural, quote unquote natural mis-carriages. 22:07 It was just a pregnancy loss, their body was passing it, it stopped. 22:11 They still continued to have some pain though, the pain never fully went away. 22:14 And then they started to spike a fever. 22:16 And they started to notice a discharge. 22:18 And so you have now a recent pregnancy loss for whatever reason, fever and a foul discharge, and now we're concerned that there is actually basically an 22:29 infection in the uterus that's now caused them to become septic. 22:32 That's a much greater problem because now it just doesn't become, the procedure you're talking about is called dilation and cure. 22:38 You go in and basically, for lack of a better term, Roto-Rooter the Uterus and clean everything out. 22:44 And it actually sucks. 22:46 Pregnancy, tissue, clot, et cetera, out of the uterus. 22:49 Yeah. 22:50 So it not only becomes just from that, but now becomes there's now pus, there is something else going on here that you can just easily extract. 22:58 You know, we're admitting you for IV antibiotics, probably going to the OR potentially, depending on how bad off you are, 23:03 how septic you were. 23:05 And these people come in, you know pretty sick too. 23:07 This isn't just a benign thing here. 23:09 very sick and ultimately, yes, start them on antibiotics. 23:13 They have to go to the OR. 23:15 And that's infected. 23:16 Is it, what's the term for it? 23:17 Infected? 23:18 I'm blanking on it now. 23:19 In fact, is it endometritis? 23:21 No. 23:21 That's after pregnancy. 23:22 I mean, this sounds like a septic abortion. 23:24 You're correct. 23:25 Yeah. 23:26 Thank you. 23:26 All right. 23:27 But then thankfully, to be fair, it doesn't happen often. 23:32 Even in people who I've seen have trouble passing the pregnancy, they go for the DNC, They don't obviously get sick. 23:38 It's something that has been in there for a while. 23:40 They may not realize they've had an abortion, but there's remnants there, things like that. 23:45 So it's not common, thankfully. 23:47 I would agree, especially where we live. 23:49 Thankfully, yes. 23:50 And for the record, you know, urban, suburban level areas with access to care doesn't happen often. 23:56 We're talking about, health care desert, like we were just talking earlier, healthcare deserts, lack of access care, things like that. 24:04 That is one of those things that unfortunately looks bad for us in terms of how we care for our moms. 24:10 So something to think about. 24:12 Definitely. 24:12 But anyway. 24:13 Cat, of course, can happen. 24:16 We've, we've seen them. 24:19 So it's not impossible. 24:21 Not necessarily where we live. 24:23 We have seen that. 24:25 And not necessarily related to somebody who did not get care or was undergoing an abortion. 24:32 That did that occur in a hospital or a clinic or something like that? 24:36 Like sometimes these things unfortunately can just happen. 24:40 Yeah. 24:41 I mean, complications arise from every single thing that we do. 24:43 You know, you have the best healthcare in the world and the most insurance and best doctors and still things can go wrong. 24:50 That is the reality of our physiology, unfortunately. 24:55 And so before we head off, there's technically four types of abortion. 25:01 We just, we just said it actually off camera. 25:04 Incomplete, missed, complete. 25:06 And what was the other one? 25:08 See, this is what? 25:09 Threatened. 25:09 Thank you. 25:10 Yeah. 25:10 Yes. 25:11 Threaded. 25:12 Missed, incomplete, and complete, yes. 25:14 Complete. 25:14 All right. 25:14 So let's run through those. 25:16 Complete is obviously self-evident, right? 25:18 It's a miscarriage that happened. 25:20 By the time you discover it, it's done. 25:22 You know, nothing else really to do. 25:23 were not seeing anything in the uterus anymore and have had a positive pregnancy test, might've had an ultrasound that actually showed either the beginnings 25:32 of a pregnancy, even unfortunately, a fetal pull with a heartbeat. 25:37 But then the patient undergoes significant bleeding, cramping. 25:41 Now there's no longer anything on the Uterus. 25:44 Yeah. 25:45 So that's complete. 25:45 And then missed is actually what happened to a colleague of mine where they went to their OBGYN and they saw an empty gestational sac. 25:53 That was just all sudden. 25:55 Yeah, or again, you are, I think we touched on it earlier. 25:59 Um, we're seeing the beginnings in early pregnancy with a heartbeat. 26:03 Unfortunately you come back and is no longer a heart beat and be in the presence of vaginal bleeding or some abdominal pain or not have to occur at all. 26:15 Yeah. 26:16 And then we have the other two now. 26:17 So you have threatened and incomplete. 26:19 I guess incomplete, we already kind of talked about. 26:21 We do the DNC. 26:22 There's still remnants left over. 26:23 Is that pretty much accurate? 26:25 And incomplete something that's a little bit different is the fact that the cervix is then dilated. 26:32 Pregnancy is trying to come out of the uterus. 26:35 The cervic is open preparation for that, whereas Threatened and missed, the cervix is often closed. 26:42 The body has not caught up to the fact that there could be a miscarriage or has been a mismarriage. 26:48 Now, is there a situation where a threatened abortion can be no longer a threated abortion? 26:55 Like is a threaten abortion reversible? 26:57 People can stop having their symptoms. 26:59 So for example, if you're having vaginal bleeding, we do the ultrasound. 27:04 We're seeing a heartbeat, that pregnancy is carrying. 27:08 as normal, you have a follow-up ultrasound one or two weeks just to see how's your bleeding doing? 27:13 How, what's going on? 27:15 Is the pregnancy still viable? 27:17 Everything is okay. 27:18 And your vaginal bleeding has stopped. 27:20 We are still seeing pregnancy with heartbeat that would not consider that a threatened abortion anymore. 27:27 Okay. 27:28 So that's fair. 27:28 That's good news. 27:29 All right. 27:30 Is there anything else you can think of that you personally want, you know, people to know or think about as far as this topic goes? 27:37 Anything we may have missed? 27:38 I think, in general, I just want to encourage patients, if something doesn't feel right, please reach out to your OBGYN. 27:45 Seek medical care. 27:47 Don't sit at home.
Closing Advice and Episode Wrap-Up 27:48 Please don't go on the internet. 27:50 And, well, found this one thread on Reddit where this patient had YZ. 27:56 You can always find that. 27:58 Seeking medical care, speaking to your provider, contacting us through the portal. 28:04 Always a good idea. 28:06 The internet is very helpful. 28:08 At some point, you probably want to hear a medical provider. 28:13 Yeah, for sure. 28:14 You don't want assume things that may or may not be true. 28:17 you can hear anecdotal stories all the time about anything. 28:20 Yes. 28:21 It's all about the care that we give you personally. 28:25 So good. 28:26 I just want empower people to utilize the wonderful technology we have. 28:31 That's what we're here for, to answer questions. 28:34 Yeah. 28:34 All right. 28:35 Well, Dr. 28:35 Deezer, thank you so much for coming back on here. 28:37 It was a good talk as always. 28:39 Thank you for having me. 28:40 We'll get you back. 28:41 There's a lot more to talk about in the realm of MFMOB and I'm sure as things progress in healthcare landscape, we'll guess you're back sooner probably 28:49 rather than later at this point. 28:50 Sounds great. 28:51 Take care. 28:54 All right, and that does it for another episode. 28:55 My thanks again to Dr. 28:56 Teague Beezer for coming on to talk about ectopic pregnancy, miscarriage, maternal healthcare deserts, all things OB-GYN related. 29:02 These topics are not only important for the women in our lives, but also for general public. 29:06 As we face increasing scrutiny from lawmakers and politicians and those with varied interests in the healthcare sector, we're going to have issues come 29:14 up with maternal health care that are always not well understood. 29:17 It's important to get the message out, understand what's going on, approach every topic with a level head, if possible. 29:23 As always, these topics are often very, very nuanced. 29:26 When it comes to your own health, talk to YOUR doctor, find recommendations that are pertinent to YOU, and make solid choices that you feel comfortable with. 29:34 Don't take on these choices alone, either. 29:36 Talk to somebody that's supportive of you, that YOU care about, you KNOW cares about you. 29:41 And as always... 29:42 make good choices. 29:43 I'll see you next time.
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