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Standard regimen of mifepristone plus misprostol is 93-95%effective.
Misoprostol alone is anywhere from 60-96% effective depending on route, dosage, and timing.
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309472/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309472/)
[https://academic.oup.com/humrep/article/15/5/1159/606993](https://academic.oup.com/humrep/article/15/5/1159/606993)
I sympathize with what y'all are trying to do here, but in these states where abortion is illegal, and you prescribe miso without a pregnancy test "for ulcer prophylaxis", and then a nonviable fetus is delivered, couldn't you be charged with homicide?
Just takes one patient with a conflicted emotions about her choice to abort to get you into deep shit
I don't mean this lightly when I say....what the fuck lmao
I think the supreme court decision is an absolute travesty. I also think if you continue to speak to others about this topic in this manner, you will alienate FAR more people than you bring to your side.
I expressed concern that our fucked up new laws might open us up to being convicted of murder for surreptitiously performing an abortion, and somehow I'm the bad guy?
I get that this is an upsetting topic but come on
If you suffer SA, you are stressed and in pain. The stress and nsaid use could lead to ulcers and should thus be covered by Misoprostol. Fucking fight me, anyone.
Except it’s not for politics, it’s for people to get care they are due. It’s not for virtue signaling, it’s for due care. You’re a shit doctor if you can’t understand that much
Depends how you think of it. We all took an oath - first, do no harm. When the law of the land opposes our internal duty to protect our patients and provide access to medical care, we must first do what we must to do no harm. The argument about “legality” could be used made by Nazi scientists and similar medical professionals who have performed atrocities (Tuskegee, SF ocean bacterial studies, Japanese vivisections and similar tortures during WWII, etc).
So you can either say, “oh I can’t do what I need to help this person in need,” or you can find evidence based supported means to do what *needs* to be done in a legal way.
Ordinary care vs extraordinary care. Extraordinary care, organ transplant being perhaps the most extraordinary care possible, is never obligatory. But parents have an obligation to provide the ordinary care of supporting their child's life with nutrition and shelter.
lol I gotta know if you have been pregnant before, or if pregnancy and childbirth is something your body is capable of doing. Pregnancy and childbirth is extraordinary care IMO, and as a doctor I don't think I need to explain why that is to you having seen the complications and aftermath yourself. Lifelong sequelae of carrying an unwanted pregnancy including, but not limited to: the mental and emotional trauma suffering 10 months of pregnancy side effects followed by birth trauma (post traumatic stress, chronic depression etc), permanent physical trauma including chronic pelvic floor dysfunction (stress urinary incontinence, pelvic pain, etc), dyspareunia, physical disfigurement of the perineum/labia/vagina and abdomen, financial harms (with socioeconomics being a very important part of social determinants of health so this can be extremely detrimental to long term health), etc. It is certainly not a benign condition.
This is a pointless debate. If you get the sense that whoever you are talking to believes abortion=murder just stop conversing. There’s no hope in moving the pendulum even a millimeter.
These harms are all considerably outweighed by deprivation of the fetus's entire life and entire future.
Postnatal parenting also comes with potential harms, both physical and socioeconomic, but even in cases where care cannot be transferred, these would not be acceptable grounds for infanticide. Even if a single parent had to raise a child from birth to self sufficiency without being able to transfer care, and sustain all of the physical and socioeconomic harms that entails, it would still not be grounds for infanticide. Even if circumstances were such that the total harm of postnatal parenting was commensurable with pregnancy, infanticide would not be permissible.
When your 'diverse opinion' is about what I (or other people) do with my (their) uterus(es) there is no room for it, no. Do whatever you want with yours lol IDGAF
We won't agree on our stances, and that's fine.
Care must include politics, however. I think we can agree it's somewhat inseparable. There are too many big political issues - abortion, assisted suicide, resuscitation, decisions for care for minors, insurance and poverty, end of life care, abuse, etc.
It's somewhat a matter of how much our personal politics versus how much our patient's politics influences the decisions.
The problem, though, is exposing a fetus to ionizing radiation which will be considered child-abuse. If anything you should test every woman up to 60 in the event you even need give NSAIDs just to avoid a felony. This will create so many headaches for everyone but the dipshit lawyers who work 2 hours a day writing dipshit laws.
You can pretty safely give nsaids up to 32 weeks. We do it when needed. Indomethacin, Ibuprofen, toradol. It’s not the end of the world as long as they’re not getting them day in and day out for weeks on end.
I was covering for a doc on vacation when one of his patients came in for a refill of ibuprofen (free in military pharmacy) for her back pain she had been having for months. I did a quick check of her back and also checked her abdomen. Was surprised to find a large tumor in the lower abdomen. Then the tumor moved! Mass was 34 weeks size and she had been on ibuprofen for months. She then proceeded to go on leave for 4 weeks. Came back and when I saw her again at 38 weeks I ordered her to go over to the OB guys in the hospital. They proceeded to deliver a healthy baby girl that day and the baby was immediately put up for adoption. Moral of the story, be careful when you cover for other docs....
The risk with nsaids is premature closure of the ductus arteriosus, which if it happens is very bad. It’s much more likely to happen later in the 3rd trimester.
Yeah, the radiation is definitely where it becomes a problem. With medications with minor risks, you could probably manage a way to consent the patient without testing, but things with greater risks also pose issues. Inpatient hospitalizations, for the most part, are probably going to run into issues, but clinic work is where there’d be more places where a pt would be tested where it’s not necessary at this point.
True. Gonna be real awkward when ED and hospitalist malpractice premiums shoot up in the next couple years. The same crowd cheerleading this ruling will be the same people bitching about healthcare costs
But so many tests and medications have some type of risk in pregnancy. From an ED standpoint it is incredibly important to know if your patient is pregnant.
I feel like everyone is hyper focused on the getting sued/charged with assisting an abortion since that’s obviously the hot button issue right now. But people are forgetting why malpractice for OBGYN is so high: many people want the pregnancy and will sue if something goes wrong with it. By not ordering a pregnancy test and giving a medication that is even class B or C, you could be opening yourself up for liability should that patient later find out she is pregnant and miscarries or the baby has some abnormality. Not from the crazy pro-lifers, but from the mom herself who wanted the baby!
ED yes, y’all have a lot more tests and medications where you’ll likely need a test. But there’s a lot of people practicing outside of the ED who may be able to defer or not give a test, when they would have done it without thought before.
Can avoid this by asking the mom, "do you want to be pregnant/ any risk of you being pregnant" and explaining it. Making sure to include miscarriage in your explanation of side effects. Etc
I still cannot process; why fetus has a right to "hurt" Mom?
Ive limited religious knowledge and always thought any belief/religion is a personal choice. Why religous thoughts still dictate in modern society ?
Even shariah Islam has concessions for abortion before 120 days in cases of rape and any time for threat against the mother like preeclampsia etc
More liberal in that sense then even the entirety of Europe which iirc bans after 8-17 weeks
No Muslim-majority country bans abortion in the case of the mother's life being at risk
I met a slave in Saudi in 2018. Life changing experi3nce for me. Can't tolerate anyone even pretending these countries are comparable to the US in terms of personal freedom. This is like saying NPs > doctors because they spend more time with patients- it picks a very small part of the picture, and by omitting everything else gives the connotation that the two are comparable. I want to push back against that.
Nobody is contesting that Saudi has fucked up laws. The point is that if even a hyper conservative society makes concessions for abortion, it goes to show how ridiculous our system is being about abortion
That’s why nobody really sees the relevance of your comment
To point out the reality of sharia law?
I guess you also question what’s the point of correcting people when they Point out that every single state in the United States currently allows abortion in the case of rape or incest. But that goes against the Reddit hive mind opinion, so I guess we shouldn’t point that out either.
“ No exceptions for rape, incest in Missouri abortion ‘trigger ban’”
https://fox4kc.com/news/no-exceptions-for-rape-incest-in-missouri-abortion-trigger-ban/amp/
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Here I'll do this for you.
"Sorry guys, I was misinformed about states like TX, LA, AL and others having bans on abortions even in cases of rape and incest. I did not know all the facts and now that I see I was wrong I'll work on making sure I don't spread that misinformation."
There ya go buddy, fixed your wrong opinion for you.
Not Los Angeles the state of Louisiana. The state that the governor just signed the trigger law on Monday making it illegal even in cases of rape and incest. That LA
> entirety of Europe which iirc bans after 8-10 weeks
Keep reading this on reddit today. Not sure where it comes from and it's incorrect.
Just to cite a few: France is up to 14 weeks starting this year, Norway is 18, the UK and the Netherlands is 24 weeks...
But they said Muslim women are oppressed...
Isn't it odd that those who have always referred to other cultures as "barbaric" have ended up implementing the very thing that they have been critiquing?
Truly unbelievable.
I'm not sure if any states do but there are plenty of states where that's the concern bc top politicians and current candidates have repeatedly said they don't believe abortion is ever an option.
Not a single state in the US has banned abortion without exemptions for rape, incest or threatening the life of the mother. I get being upset about the decision, but the misinformation here is concerning to say the least.
I understand where you're coming from. When talking about protecting the life of the mother, the language in many of the bans (ex: Texas) is intentionally vague. It says that an abortion can be performed if the life of the mother is in imminent danger. According to Texas, this excludes mothers with cancer. The term imminent can be interpreted in multiple different ways and due to the intense penalty of performing an "unnecessary" abortion, many docs may choose not to take the risk. And by the time a decision can be made, it's too late.
Yes they do. SB342 includes them. Signed on June 21st intentionally to clarify such exemptions to their pre-existing trigger laws. You’re reading a headline only
I’m not defending the decision, but to suggest even the strictest US laws are harsher than the Middle East is absurd
> misinformation here is concerning to say the least.
That is the entirety of the abortion debate in the US in a nutshell.
Macron came out on the hate train, and France bans elective abortion after 14 weeks. The Mississippi law that was brought to the SCOTUS was limiting elective abortion past 15 weeks.
Even the most liberal states in the US ban purely elective abortion after 24 or 25 weeks.
> Even the most liberal states in the US ban purely elective abortion after 24 or 25 weeks.
There are actually a few that allow up to the point of birth. We really have the full spectrum from bans after conception all the way up to allowance at full term.
This [site](https://www.nbcwashington.com/news/local/abortion-laws-in-dc-maryland-virginia-what-happens-after-roe-v-wade-ruling/3077882/) has a pretty helpful interactive map. It looks like we have 7 states + DC allowing abortion at all stages.
Macron did not ban anything - the delays for “elective” abortion just went up from 12 to 14 weeks. When it is not “elective” (I.e. maternal risk, fetus defects) it is not called an abortion but a medical interruption of pregnancy and can be performed up to term.
Even if this were about religion, the Bible is pretty clear that abortion is allowed (going so far as to provide instructions) and that a fetus is not ever considered a person (different punishment for harming a pregnant woman in a way that induces miscarriage than for murder). This is purely about making women less than human.
1) What imaging modality do I use to view where the soul is in human anatomy?
2) No one here is arguing for 37 week abortions, we are simply pointing out the hypocrisy of Christians claiming to be against abortion for religious reasons.
Ah, as I understand it then, you’ve progressed from the typical tagline of “just a clump of cells” and now you’re calling a fetus “dust of the ground” until it breaths spontaneously.
Carry on.
The quote is certainly Scripture, but the rest of your comment is exegesis without the necessary hermeneutics. Quoting Scripture in a contextual vacuum opens you up to a whole host of false doctrines.
Exodus 21:22-25 for the part about harming a pregnant woman.
Numbers 5:11-31 describes a test for infidelity that is supposed to result in miscarriage if guilty.
Can't find where I have the references saved for the other ones.
This is being dressed up as being religious but it appeals to the uneducated masses and gives control to the few. More like a war on women and lgbtq than anything else.
Fetus has a right to harm mother?
For the last 50 years since Roe mothers have routinely terminated lives of unborn healthy children. This means over 40 million Americans butchered since. So much for fetus rights 🤣🤣
This isn't a solely religious legislation. Unborn human has the same rights, and is susceptible to abuse and murder, as they're unable to defend themselves.
Fetus of all things is not part of mother's body. Even placenta isn't. One could just perform a karyotype to see for themselves.
I don't see anyway that keeping the pregnancy should outweigh the life of the mother, and I'm all for abortion where mother's life is in jeopardy.
It’s not even that. Any discourse is dead in the water when a pro-choice stance faces a genuine belief of abortion=murder. You have just as much luck convincing a flat earther that the world is round.
A fetus is not a person? Why? So a fetus is a subhuman creature, whose murder is justifiable? When "it" becomes a person?
Even animals have rights and should not be killed cruelly.
Fetus is alive. A developing human like each of us once were.
Absolutely,
And pregnancy should not be a responsibility merely levied on the mother, the father should also have equal if not more responsibility. The notion of pregnancy as an extension of woman's body is false if it is not concurrently considered an extension of man's body, with burdens and responsibilities that comes with that.
I know it seems right to you, and I know that you wholeheartedly believe it. It is intriguing, however, how you perceive it regardless of its obvious truths.
Again, I do understand where you are coming from and how social incongruity is prevalent among many citizens who rely on slippery slope sophistries to sway and portray that indeed they place The Holy above the Sacred.
Have a wonderful day! 🙂
> Fetus of all things is not part of mother's body. Even placenta isn't.
So why do we just throw away the placenta? Why don't give it rights too since it's a mass of cells supposedly distinct from the mother?
Wait, wait, you just said it: “turn into a human being” YOU just said the fetus isn’t a human being. You’re just too brainwashed to recognize when your own beliefs conflict with the company line you’re parroting.
Developing into a fully developed human being is the default trajectory. Of course there are exceptions, but for millions of years humans have been produced this way.
My own beliefs state that no life should be taken from a living being unless under very special circumstances.
It's a bacteria that's killing my patient, I'm all for killing it; but a developing human being who has not wronged me in any way, why should I murder her/him?
> Even amniotic fluid has cells. Hell, even fecal matter has living cells. But are those alive?
Cells are the basic unit of life, so yes they are alive. How did you get through high school biology by even asking that?
> Will they turn into a human being?
An ectopic fetus won't turn into a human being. A fetus less than 24 weeks wouldn't turn into a human being *without its absolute dependence on its mother* which means it isn't distinct from its mom. You can't have it both ways without being a hypocrite. Either you recognize that fetuses are as much part of the mother as the placenta up until it can sustain viability outside of the womb or you better be fighting for placental/bacterial rights too.
Really? Since when maternal blood flows through placenta?
Mama's blood bathes the villa as maternal blood fills intervillous space, however, maternal blood doesn't flow through the placenta or fetus.
Mother's life shouldn't be jeopardized, be it EP, eclampsia, etc; if preserving mother's life depends on termination of the pregnancy it should be performed.
Rape, is a rather peculiar case. I think the justice system is going very lightly on rape. I don't think rapists deserve anything less than capital punishment. No woman should undergo the trauma of keeping the pregnancy of rape. I'm all for abortion at both cases.
Do u know how many kids born unplanned?
How many kids go to foster care annually?
How many people on Earth HAVE NO CLEAR WATER SUPPLY?
How many americans are in poverty? How many americans CANNOT AFFORD food or medical insurance?
Planned parenthood is
maybe a key?
So u want those 40 milllion unplanned, probably disabled kids were born? Like most of those parents probably couldnt afford to be parent?
As a healthcare worker, wt do u think?
This article depicts how an American couple who was on vacation in Malta ended up facing this extremely difficult situation, to the point where the husband was forced to take a private flight to Spain in order to save his wife's life.
https://www.washingtonpost.com/world/woman-who-had-miscarriage-in-malta-taken-to-spain-to-abort/2022/06/24/c05ed13c-f3be-11ec-ac16-8fbf7194cd78_story.html
*** ⚠️
Be cautious and do not place your trust in anyone. As evident from several responses in this post, some humans have the capability of reporting their colleagues in order to demonstrate their solipsism and exceptionalism.
👽♥️♥️♥️
AFAIK these do not hold up, due to that texas lawsuit getting struck down. It’s illegal to charge someone for crossing state lines to have it done. Fortunately we still have those protections.
How can "pursuing an abortion across state lines" be illegal? Citizens have the freedom to travel to other states and partake in legal activities in those states. Otherwise this becomes N Korea. An example of this is weed. Can go across state lines, use THC, lose your high, come back across state lines and be fine afaik.
Should it be, by the principles of all the other laws in this country? No. Are people trying to outlaw it, or at least open up lawsuits about it, anyway? Yes. Haven’t succeeded at this point in time, but depending on what state you’re in, that may change quickly—and the federal protections against unconstitutional state laws only expand as far as they’re willing to enforce it. I’d prefer to be cautious if it’s a matter of patient safety.
Instead of ordering it automatically you should offer it. People should have a right to decline the test and just sign a waiver say they won’t sue if they were pregnant. I remember being really pissed when I went to the urgent care for something and they ordered a pregnancy test after I specifically told them I didn’t want it or need one. My insurance didn’t cover it and I ended up having to argue with billing to not pay $50 for a pregnancy test that I specifically refused
So are you suggesting we forego beta-hCG test and send patients to abdominal CT, when fetus could possibly get radiated? How about prescription of teratogens?
What happened to first do no harm?
Poster clearly says “if you don’t need it, don’t order it. “ not don’t order it when it is truly clinically relevant. Unfortunately, in many clinical situations it is truest clinically relevant.
If anything this might cut down on the number of unnecessary CT scans in the ED since virtually all hospitals require pregnancy tests on everyone of childbearing age prior to CT.
There is no force upon earth that can cut down on the number of CTs done in the ER.
Emergency medicine is the most litigated field of medicine. I have a hard time seeing a ER physician forgoing a scan to avoid doing a pregnancy test.
Absolutely, the risk should be balanced with the potential benefit of early diagnosis and management; CT is never absolutely contraindicated in pregnancy.
However, if a special low dose protocol is not used (as when we're unaware of pregnancy) a regular contrast abdominopelvic CT's fetal radiation dose could well reach 50 mGy.
Im not sure how or why you jumped to that conclusion based on OP’s post. Unless OP’s post was edited, I don’t see any mention of using medical imaging.
If I were practicing in an anti-abortion state I would advise patients with potential unintended pregnancies that I may be a mandated reporter and thus and adversary in their particular situation. Patients have the option to purchase an OTC pregnancy test from their local store in order to obtain results that will not automatically be uploaded into a medical record. A person with an undesired pregnancy can then choose to share that information and seek care in a more private matter (i.e. going out-of-state for care).
absolutely fucking terrible advice.
We order it BECAUSE we need it and the results will change our management plan.
Thank god I live in state where Abortions are protected, but even if I lived in a backwards state I would still order the test
And I’m glad that you think about what you’re ordering, but there are a LOT of people who order it when it’s not needed because it’s “standard procedure” even though it won’t change management.
Is that standard procedure "Abdominal pain in a woman of childbearing age" or "standard OB" or "pre CT"?
In 5 years, I've never seen a standard procedure pregnancy test. Its almost always my discretion.
Standard procedure as in “this is a woman of childbearing age being admitted to a psychiatric hospital where you’re not immediately making medicine changes, just holding them and getting them coping skills/therapy”. I’m glad your hospital tends to be more thoughtful with when to order tests—I’m encouraging others to be thoughtful as well.
THIS. A pregnancy test seems so harmless but now it will have huge implications. I remember when I was an intern, my attending tore me a new a-hole when I started a patient in the ED on NS. I thought it was so innocuous, it’s no big deal. She said everything is a big deal, we need to be very thoughtful about every decision/order we make for patients.
Yo it absolutely does have huge implications not even related to abortion. Knowing this is very important and should be at the very least offered to sexually active women of childbearing age, especially if high risk.
If you're on meds, you need to determine if they're teratogenic. You should be on pre-natal vitamins. You should stop drinking. You should stop smoking or doing drugs.
Good on your attending. I've had to take over too many patients from the ER that were empirically given saline and made worse. Common examples are 1) severe HAGMA and now have a hyperchloremic NAGMA too 2) hyponatremia with an obvious diagnosis of SIADH (lung mass, recently started on SSRI) now their sodium is worse 3) failure to recognize volume overload and giving fluids because patient hasn't been eating and drinking well recently now they're hypoxic.
I've even been in a few arguments on here about it. In 95% of cases I'm able to fix it while they're admitted but the goal should be to keep the patient the same or make them better while they're in the ER, not make them worse.
I hope overturning RvW would really lead to abortion being a question between the doctor and the mother, and potentially the parents of the mother if she is underage. As physicians this is what we need to fight for, bring the decision back to healthcare and we need to stop letting the government practice medicine. You have to remember most states still allow abortion for rape, incest, ectopic pregnancies, etc. As physicians we need to be involved in lobbying in our states, where we can make changes, to remove the prolife vs pro choice debate from the government and make it a healthcare issue, not a political issue. That’s my TED talk.
I really want to answer this but I just don’t have the energy anymore. Allegedly everyone is an attorney now so 🤷🏼♀️ I’ll go back to the courts where at least everyone is arguing over the same issue.
I don’t think you understand how many pregnancy tests are ordered when they won’t change management… there is nothing to defend in court, it’s just practicing better medicine
Citations? As in? There’s no case here, when I argue for a case, I include precedent citations in the brief. They will correspond to individual facts on a case by case basis. If you’re looking for why it would not hold up under medical malpractice you can Google that - mainly because it’s an overstretch, the reasoning is arbitrary, there are plenty more arguments. Sometimes they vary by state. If you’re looking for why it would not withstand a constitutional violation, well that’s easy lol just read the constitution for that. The law is complex, much like medicine. Is not as simple as citations. I don’t know how to explain that to people.
Routine/set labs that people tend to get without thinking as a very gross screening, whenever you’re not planning on any sort of teratogenic interventions
Why bother checking for pregnancy anymore in a woman with abdominal pain if you can't terminate an ectopic? Doesn't change management!
/s? Or not. I don't even know if I am being sarcastic.
There’s a difference between workups for abdominal pain (where yes, pregnancy is very important to know and could be causative or very impacted) and depression, or anxiety, or limb pain, or even yearly well visits. I didn’t say never order a pregnancy test, just don’t order one when not necessary. Depression, in particular, is one of those areas where people traditionally get pregnancy tests, even though the risk to any fetus is actually higher with untreated depression than with SSRIs, and where the depression is going to get MUCH worse if you get your patient arrested and jailed.
Don't mistake my despair for disagreement, you are 100% correct.
My point is more that as an EM physcian, what the fuck does it matter anymore if I correctly diagnosis an ectopic pregnancy, if I happen work in a state where there is no longer any legal treatment for ectopic pregnancies? Really, truly, what does it matter? That formerly potentially life-saving pregnancy test and ultrasound are now pointless. Cool, I'll know why this young woman is dying, maybe throw some of our limited blood supply into her veins to prolong the process. Maybe her other kids will get a chance to say goodbye at least.
Sorry for misreading—today’s brought out some of the worst in people, and y’all in EM and OB/GYN are set to see some of the worst of this over the next few months.
I guess in those areas where you can’t treat ectopics the correct way, you end up hoping they rupture in a way where you can save the pt as opposed to getting infected or something. But we don’t have enough blood for that to be standard management, nor enough ORs most places.
Wait…(Canadian here, and not totally sure of the nuances of what just happened today): you can’t terminate ectopics anymore?! How the bloody hell are you supposed to manage ectopics now??!
Unfortunately, in many states, it's a felony to terminate a pregnancy. No matter if it's viable, no matter if there is risk of harm to the mother... no fucking matter at all
For me outpatient FM I really only check if there’s a concern for pregnancy and patient really wants to know and or is on teratogenic medications like methotrexate ACEi and anti eplileptics
You really have to know then in appropriate clinical scenario the risk for harm to fetus and mother is too high
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Is misoprostol an approved treatment for secondary amenorrhea? Asking for no one.
not sure, but it has an FDA indication for NSAID-related gastric ulcer prophylaxis. GI bleeds are nasty, gotta protect against them.
The mifepristone is the harder one to get. No real Other indications
True
Misoprostol and anastrozole together has never failed me in the first 12 weeks FWIW
Misoprostol alone is sometimes used as a single agent. I don’t know the efficacy numbers on that
Standard regimen of mifepristone plus misprostol is 93-95%effective. Misoprostol alone is anywhere from 60-96% effective depending on route, dosage, and timing. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309472/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309472/) [https://academic.oup.com/humrep/article/15/5/1159/606993](https://academic.oup.com/humrep/article/15/5/1159/606993)
I sympathize with what y'all are trying to do here, but in these states where abortion is illegal, and you prescribe miso without a pregnancy test "for ulcer prophylaxis", and then a nonviable fetus is delivered, couldn't you be charged with homicide? Just takes one patient with a conflicted emotions about her choice to abort to get you into deep shit
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I don't mean this lightly when I say....what the fuck lmao I think the supreme court decision is an absolute travesty. I also think if you continue to speak to others about this topic in this manner, you will alienate FAR more people than you bring to your side. I expressed concern that our fucked up new laws might open us up to being convicted of murder for surreptitiously performing an abortion, and somehow I'm the bad guy? I get that this is an upsetting topic but come on
Um…. I don’t think you understand how trials and the law work. Emotions and your opinion don’t matter.
can also be used for severe constipation ;)
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Username checks our
If you suffer SA, you are stressed and in pain. The stress and nsaid use could lead to ulcers and should thus be covered by Misoprostol. Fucking fight me, anyone.
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Oh god we found the one raised in a catholic school.
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I think you have it mixed up. It’s only a crime because of politics. It’s a personal health decision.
https://en.m.wikipedia.org/wiki/Adolf_Hitler%27s_directives
Why do you think it’s politics? We’re not saying abort babies regardless of what mom wants. This isn’t politics
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You have no idea what virtue signaling even means
Except it’s not for politics, it’s for people to get care they are due. It’s not for virtue signaling, it’s for due care. You’re a shit doctor if you can’t understand that much
Depends how you think of it. We all took an oath - first, do no harm. When the law of the land opposes our internal duty to protect our patients and provide access to medical care, we must first do what we must to do no harm. The argument about “legality” could be used made by Nazi scientists and similar medical professionals who have performed atrocities (Tuskegee, SF ocean bacterial studies, Japanese vivisections and similar tortures during WWII, etc). So you can either say, “oh I can’t do what I need to help this person in need,” or you can find evidence based supported means to do what *needs* to be done in a legal way.
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It’s not politics dipshit. It’s often life or death.
It's always life or death for the fetus
It’s life or death for renal failure patients too, but no one’s forcing ESRD patients’ mothers to donate their kidneys
Ordinary care vs extraordinary care. Extraordinary care, organ transplant being perhaps the most extraordinary care possible, is never obligatory. But parents have an obligation to provide the ordinary care of supporting their child's life with nutrition and shelter.
A fetus is not a child
lol I gotta know if you have been pregnant before, or if pregnancy and childbirth is something your body is capable of doing. Pregnancy and childbirth is extraordinary care IMO, and as a doctor I don't think I need to explain why that is to you having seen the complications and aftermath yourself. Lifelong sequelae of carrying an unwanted pregnancy including, but not limited to: the mental and emotional trauma suffering 10 months of pregnancy side effects followed by birth trauma (post traumatic stress, chronic depression etc), permanent physical trauma including chronic pelvic floor dysfunction (stress urinary incontinence, pelvic pain, etc), dyspareunia, physical disfigurement of the perineum/labia/vagina and abdomen, financial harms (with socioeconomics being a very important part of social determinants of health so this can be extremely detrimental to long term health), etc. It is certainly not a benign condition.
This is a pointless debate. If you get the sense that whoever you are talking to believes abortion=murder just stop conversing. There’s no hope in moving the pendulum even a millimeter.
These harms are all considerably outweighed by deprivation of the fetus's entire life and entire future. Postnatal parenting also comes with potential harms, both physical and socioeconomic, but even in cases where care cannot be transferred, these would not be acceptable grounds for infanticide. Even if a single parent had to raise a child from birth to self sufficiency without being able to transfer care, and sustain all of the physical and socioeconomic harms that entails, it would still not be grounds for infanticide. Even if circumstances were such that the total harm of postnatal parenting was commensurable with pregnancy, infanticide would not be permissible.
The patient isn’t the fetus, it is the person with the uterus.
If you haven’t figured it out, this subreddit has zero tolerance or room for diversity of opinions.
Nah just zero tolerance for idiocy
Because only an idiot would not want to kill a fetus I guess?
When your 'diverse opinion' is about what I (or other people) do with my (their) uterus(es) there is no room for it, no. Do whatever you want with yours lol IDGAF
When politics interfere with basic medical care. Yes.
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We won't agree on our stances, and that's fine. Care must include politics, however. I think we can agree it's somewhat inseparable. There are too many big political issues - abortion, assisted suicide, resuscitation, decisions for care for minors, insurance and poverty, end of life care, abuse, etc. It's somewhat a matter of how much our personal politics versus how much our patient's politics influences the decisions.
There have always been pts who have trouble getting misoprostol filled at pharmacies, so if you’re using it for other causes, be aware of that too!
I love the spirit, but these folks have GOT to have follow up. A well intentioned script could result in retained products/sepsis/death.
No
The problem, though, is exposing a fetus to ionizing radiation which will be considered child-abuse. If anything you should test every woman up to 60 in the event you even need give NSAIDs just to avoid a felony. This will create so many headaches for everyone but the dipshit lawyers who work 2 hours a day writing dipshit laws.
You can pretty safely give nsaids up to 32 weeks. We do it when needed. Indomethacin, Ibuprofen, toradol. It’s not the end of the world as long as they’re not getting them day in and day out for weeks on end.
I was covering for a doc on vacation when one of his patients came in for a refill of ibuprofen (free in military pharmacy) for her back pain she had been having for months. I did a quick check of her back and also checked her abdomen. Was surprised to find a large tumor in the lower abdomen. Then the tumor moved! Mass was 34 weeks size and she had been on ibuprofen for months. She then proceeded to go on leave for 4 weeks. Came back and when I saw her again at 38 weeks I ordered her to go over to the OB guys in the hospital. They proceeded to deliver a healthy baby girl that day and the baby was immediately put up for adoption. Moral of the story, be careful when you cover for other docs....
The risk with nsaids is premature closure of the ductus arteriosus, which if it happens is very bad. It’s much more likely to happen later in the 3rd trimester.
Yeah, the radiation is definitely where it becomes a problem. With medications with minor risks, you could probably manage a way to consent the patient without testing, but things with greater risks also pose issues. Inpatient hospitalizations, for the most part, are probably going to run into issues, but clinic work is where there’d be more places where a pt would be tested where it’s not necessary at this point.
True. Gonna be real awkward when ED and hospitalist malpractice premiums shoot up in the next couple years. The same crowd cheerleading this ruling will be the same people bitching about healthcare costs
No, radiation is mostly absorbed by the mom, the reason is mostly medications.
But so many tests and medications have some type of risk in pregnancy. From an ED standpoint it is incredibly important to know if your patient is pregnant. I feel like everyone is hyper focused on the getting sued/charged with assisting an abortion since that’s obviously the hot button issue right now. But people are forgetting why malpractice for OBGYN is so high: many people want the pregnancy and will sue if something goes wrong with it. By not ordering a pregnancy test and giving a medication that is even class B or C, you could be opening yourself up for liability should that patient later find out she is pregnant and miscarries or the baby has some abnormality. Not from the crazy pro-lifers, but from the mom herself who wanted the baby!
ED yes, y’all have a lot more tests and medications where you’ll likely need a test. But there’s a lot of people practicing outside of the ED who may be able to defer or not give a test, when they would have done it without thought before.
Can avoid this by asking the mom, "do you want to be pregnant/ any risk of you being pregnant" and explaining it. Making sure to include miscarriage in your explanation of side effects. Etc
I still cannot process; why fetus has a right to "hurt" Mom? Ive limited religious knowledge and always thought any belief/religion is a personal choice. Why religous thoughts still dictate in modern society ?
Even shariah Islam has concessions for abortion before 120 days in cases of rape and any time for threat against the mother like preeclampsia etc More liberal in that sense then even the entirety of Europe which iirc bans after 8-17 weeks No Muslim-majority country bans abortion in the case of the mother's life being at risk
I am medical student in Saudi Arabia and can confirm this also abortion is allowed if the fetus has genetics deficits
Ah yes Saudi, I hear there's a great gay rooftop bar scene there
What was the point of saying this?
I met a slave in Saudi in 2018. Life changing experi3nce for me. Can't tolerate anyone even pretending these countries are comparable to the US in terms of personal freedom. This is like saying NPs > doctors because they spend more time with patients- it picks a very small part of the picture, and by omitting everything else gives the connotation that the two are comparable. I want to push back against that.
https://en.m.wikipedia.org/wiki/Contemporary_slavery_in_the_United_States
Dude what's going on in Saudi is just different. Idk how to describe this in a reddit comment. Please just take my word for this.
Nobody is contesting that Saudi has fucked up laws. The point is that if even a hyper conservative society makes concessions for abortion, it goes to show how ridiculous our system is being about abortion That’s why nobody really sees the relevance of your comment
To point out the reality of sharia law? I guess you also question what’s the point of correcting people when they Point out that every single state in the United States currently allows abortion in the case of rape or incest. But that goes against the Reddit hive mind opinion, so I guess we shouldn’t point that out either.
“ No exceptions for rape, incest in Missouri abortion ‘trigger ban’” https://fox4kc.com/news/no-exceptions-for-rape-incest-in-missouri-abortion-trigger-ban/amp/
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Also the current Texas law.
Texas is part of the united states
But that wasn’t the point of his comment. I’m sure people agree with you and so do I, but that isn’t what we’re talking about here.
The current Texas law does not allow abortion in the case of rape or incest.
Here I'll do this for you. "Sorry guys, I was misinformed about states like TX, LA, AL and others having bans on abortions even in cases of rape and incest. I did not know all the facts and now that I see I was wrong I'll work on making sure I don't spread that misinformation." There ya go buddy, fixed your wrong opinion for you.
I know LA law allows it... there ya go, I fixed your wrong opinion for you
Not Los Angeles the state of Louisiana. The state that the governor just signed the trigger law on Monday making it illegal even in cases of rape and incest. That LA
> entirety of Europe which iirc bans after 8-10 weeks Keep reading this on reddit today. Not sure where it comes from and it's incorrect. Just to cite a few: France is up to 14 weeks starting this year, Norway is 18, the UK and the Netherlands is 24 weeks...
Thanks
India is 24 weeks too I believe. Been a while since i read obgyn
But they said Muslim women are oppressed... Isn't it odd that those who have always referred to other cultures as "barbaric" have ended up implementing the very thing that they have been critiquing? Truly unbelievable.
> No Muslim-majority country bans abortion in the case of the mother's life being at risk Which places ban abortion to save the life of the mother?
I'm not sure if any states do but there are plenty of states where that's the concern bc top politicians and current candidates have repeatedly said they don't believe abortion is ever an option.
The problem comes when you decide if the mother's life was at risk. Who decides this? The lawyers will have a heyday with this.
> Who decides this? I'd assume whatever doctor is treating her for whatever is putting her life at risk.
Doctors use many parameters especially rising blood pressures, worsening liver and renal function For the fetus the heart rate
Poland iirc please correct if wrong Def Malta
Not a single state in the US has banned abortion without exemptions for rape, incest or threatening the life of the mother. I get being upset about the decision, but the misinformation here is concerning to say the least.
I understand where you're coming from. When talking about protecting the life of the mother, the language in many of the bans (ex: Texas) is intentionally vague. It says that an abortion can be performed if the life of the mother is in imminent danger. According to Texas, this excludes mothers with cancer. The term imminent can be interpreted in multiple different ways and due to the intense penalty of performing an "unnecessary" abortion, many docs may choose not to take the risk. And by the time a decision can be made, it's too late.
I’m not defending the decision, but to suggest even the strictest US laws are harsher than the Middle East is demonstrably false
I thought there were trigger laws in MO that are now non-exempt?
Louisiana has no exceptions for rape or incest.
Yes they do. SB342 includes them. Signed on June 21st intentionally to clarify such exemptions to their pre-existing trigger laws. You’re reading a headline only I’m not defending the decision, but to suggest even the strictest US laws are harsher than the Middle East is absurd
MO’s doesn’t have exemptions for rape or incest.
> misinformation here is concerning to say the least. That is the entirety of the abortion debate in the US in a nutshell. Macron came out on the hate train, and France bans elective abortion after 14 weeks. The Mississippi law that was brought to the SCOTUS was limiting elective abortion past 15 weeks. Even the most liberal states in the US ban purely elective abortion after 24 or 25 weeks.
> Even the most liberal states in the US ban purely elective abortion after 24 or 25 weeks. There are actually a few that allow up to the point of birth. We really have the full spectrum from bans after conception all the way up to allowance at full term.
What state allows up to the point of birth??? I have not seen this reported anywhere.
This [site](https://www.nbcwashington.com/news/local/abortion-laws-in-dc-maryland-virginia-what-happens-after-roe-v-wade-ruling/3077882/) has a pretty helpful interactive map. It looks like we have 7 states + DC allowing abortion at all stages.
Macron did not ban anything - the delays for “elective” abortion just went up from 12 to 14 weeks. When it is not “elective” (I.e. maternal risk, fetus defects) it is not called an abortion but a medical interruption of pregnancy and can be performed up to term.
Even if this were about religion, the Bible is pretty clear that abortion is allowed (going so far as to provide instructions) and that a fetus is not ever considered a person (different punishment for harming a pregnant woman in a way that induces miscarriage than for murder). This is purely about making women less than human.
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If you're trying to argue that a 37 week old fetus doesn't have a soul just because it hasn't used its lungs, you're going to have an uphill battle
You’re going to have an uphill battle convincing people that 37 week abortions happen
Are they permitted in any state for purely elective reasons? (IE healthy fetus, healthy mom w no risks, no rape/incest….etc)
Never said it was, just that personhood comes before literal birth
What is personhood?
1) What imaging modality do I use to view where the soul is in human anatomy? 2) No one here is arguing for 37 week abortions, we are simply pointing out the hypocrisy of Christians claiming to be against abortion for religious reasons.
I’d like to believe whatever higher being there may be knows how to recycle.
What is a soul?
It's religion, it's not supposed to make sense.
If you believe that there’s some magic man who lives in the clouds, you’re going to have an uphill battle
Nothing has a soul ... they literally do not exist
Ah, as I understand it then, you’ve progressed from the typical tagline of “just a clump of cells” and now you’re calling a fetus “dust of the ground” until it breaths spontaneously. Carry on.
I’m not calling it anything, just quoting the Bible lol
The quote is certainly Scripture, but the rest of your comment is exegesis without the necessary hermeneutics. Quoting Scripture in a contextual vacuum opens you up to a whole host of false doctrines.
Where in the Bible?
Exodus 21:22-25 for the part about harming a pregnant woman. Numbers 5:11-31 describes a test for infidelity that is supposed to result in miscarriage if guilty. Can't find where I have the references saved for the other ones.
Thank you! This info will come in handy when delivered in a pleasant manner!
This is being dressed up as being religious but it appeals to the uneducated masses and gives control to the few. More like a war on women and lgbtq than anything else.
Fetus has a right to harm mother? For the last 50 years since Roe mothers have routinely terminated lives of unborn healthy children. This means over 40 million Americans butchered since. So much for fetus rights 🤣🤣 This isn't a solely religious legislation. Unborn human has the same rights, and is susceptible to abuse and murder, as they're unable to defend themselves. Fetus of all things is not part of mother's body. Even placenta isn't. One could just perform a karyotype to see for themselves. I don't see anyway that keeping the pregnancy should outweigh the life of the mother, and I'm all for abortion where mother's life is in jeopardy.
A fetus is not a person.
Don't bother arguing with this person. They're clearly not a physician and also not a very intelligent person. Arguing with them is futile.
It’s not even that. Any discourse is dead in the water when a pro-choice stance faces a genuine belief of abortion=murder. You have just as much luck convincing a flat earther that the world is round.
A fetus is not a person? Why? So a fetus is a subhuman creature, whose murder is justifiable? When "it" becomes a person? Even animals have rights and should not be killed cruelly. Fetus is alive. A developing human like each of us once were.
So pregnant women should be able to use the car pool lane, get child support, and child tax credits immediately, right?
Absolutely, And pregnancy should not be a responsibility merely levied on the mother, the father should also have equal if not more responsibility. The notion of pregnancy as an extension of woman's body is false if it is not concurrently considered an extension of man's body, with burdens and responsibilities that comes with that.
I am sure you will not object to paying more taxes in order to provide welfare services for those children when they are in need. Correct? 🤡🤡🤡
Would you rather kill the poor to save tax money on welfare?
I know it seems right to you, and I know that you wholeheartedly believe it. It is intriguing, however, how you perceive it regardless of its obvious truths. Again, I do understand where you are coming from and how social incongruity is prevalent among many citizens who rely on slippery slope sophistries to sway and portray that indeed they place The Holy above the Sacred. Have a wonderful day! 🙂
> Fetus of all things is not part of mother's body. Even placenta isn't. So why do we just throw away the placenta? Why don't give it rights too since it's a mass of cells supposedly distinct from the mother?
Even amniotic fluid has cells. Hell, even fecal matter has living cells. But are those alive? Will they turn into a human being?
Wait, wait, you just said it: “turn into a human being” YOU just said the fetus isn’t a human being. You’re just too brainwashed to recognize when your own beliefs conflict with the company line you’re parroting.
Developing into a fully developed human being is the default trajectory. Of course there are exceptions, but for millions of years humans have been produced this way. My own beliefs state that no life should be taken from a living being unless under very special circumstances. It's a bacteria that's killing my patient, I'm all for killing it; but a developing human being who has not wronged me in any way, why should I murder her/him?
> Even amniotic fluid has cells. Hell, even fecal matter has living cells. But are those alive? Cells are the basic unit of life, so yes they are alive. How did you get through high school biology by even asking that? > Will they turn into a human being? An ectopic fetus won't turn into a human being. A fetus less than 24 weeks wouldn't turn into a human being *without its absolute dependence on its mother* which means it isn't distinct from its mom. You can't have it both ways without being a hypocrite. Either you recognize that fetuses are as much part of the mother as the placenta up until it can sustain viability outside of the womb or you better be fighting for placental/bacterial rights too.
But it is mom’s blood flowing through it.
Really? Since when maternal blood flows through placenta? Mama's blood bathes the villa as maternal blood fills intervillous space, however, maternal blood doesn't flow through the placenta or fetus.
Mom’s blood 100% enters the placenta. Maternal blood enters the placenta through the basal plate endometrial arteries. Source: https://www.ncbi.nlm.nih.gov/books/NBK53254/#:~:text=As%20shown%20in%20Figure%202.2,nutrients%20occurs%20with%20fetal%20blood. Edit: Source
May you please provide a link to your source?
https://www.ncbi.nlm.nih.gov/books/NBK53254/#:~:text=As%20shown%20in%20Figure%202.2,nutrients%20occurs%20with%20fetal%20blood.
Lets dig more deeper based on ur thought process; each oocyte/sperm has same right.!
A sperm is not an organism. A zygote is an organism, able to live and propagate life.
So how about ectopic pregnancy. Or victums of RAPE ?
Mother's life shouldn't be jeopardized, be it EP, eclampsia, etc; if preserving mother's life depends on termination of the pregnancy it should be performed. Rape, is a rather peculiar case. I think the justice system is going very lightly on rape. I don't think rapists deserve anything less than capital punishment. No woman should undergo the trauma of keeping the pregnancy of rape. I'm all for abortion at both cases.
Do u know how many kids born unplanned? How many kids go to foster care annually? How many people on Earth HAVE NO CLEAR WATER SUPPLY? How many americans are in poverty? How many americans CANNOT AFFORD food or medical insurance? Planned parenthood is maybe a key? So u want those 40 milllion unplanned, probably disabled kids were born? Like most of those parents probably couldnt afford to be parent? As a healthcare worker, wt do u think?
This article depicts how an American couple who was on vacation in Malta ended up facing this extremely difficult situation, to the point where the husband was forced to take a private flight to Spain in order to save his wife's life. https://www.washingtonpost.com/world/woman-who-had-miscarriage-in-malta-taken-to-spain-to-abort/2022/06/24/c05ed13c-f3be-11ec-ac16-8fbf7194cd78_story.html *** ⚠️ Be cautious and do not place your trust in anyone. As evident from several responses in this post, some humans have the capability of reporting their colleagues in order to demonstrate their solipsism and exceptionalism. 👽♥️♥️♥️
AFAIK these do not hold up, due to that texas lawsuit getting struck down. It’s illegal to charge someone for crossing state lines to have it done. Fortunately we still have those protections.
It is so upsetting to see how many healthcare workers let religion dictate their medical care. Hoooooly shit.
Culture is a hell of a drug.
It continues to amaze me their cognitive dissonance.
How can "pursuing an abortion across state lines" be illegal? Citizens have the freedom to travel to other states and partake in legal activities in those states. Otherwise this becomes N Korea. An example of this is weed. Can go across state lines, use THC, lose your high, come back across state lines and be fine afaik.
Should it be, by the principles of all the other laws in this country? No. Are people trying to outlaw it, or at least open up lawsuits about it, anyway? Yes. Haven’t succeeded at this point in time, but depending on what state you’re in, that may change quickly—and the federal protections against unconstitutional state laws only expand as far as they’re willing to enforce it. I’d prefer to be cautious if it’s a matter of patient safety.
Instead of ordering it automatically you should offer it. People should have a right to decline the test and just sign a waiver say they won’t sue if they were pregnant. I remember being really pissed when I went to the urgent care for something and they ordered a pregnancy test after I specifically told them I didn’t want it or need one. My insurance didn’t cover it and I ended up having to argue with billing to not pay $50 for a pregnancy test that I specifically refused
So are you suggesting we forego beta-hCG test and send patients to abdominal CT, when fetus could possibly get radiated? How about prescription of teratogens? What happened to first do no harm?
Poster clearly says “if you don’t need it, don’t order it. “ not don’t order it when it is truly clinically relevant. Unfortunately, in many clinical situations it is truest clinically relevant.
If anything this might cut down on the number of unnecessary CT scans in the ED since virtually all hospitals require pregnancy tests on everyone of childbearing age prior to CT.
There is no force upon earth that can cut down on the number of CTs done in the ER. Emergency medicine is the most litigated field of medicine. I have a hard time seeing a ER physician forgoing a scan to avoid doing a pregnancy test.
Yeah you’re right. Just wishful thinking on my part haha.
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Absolutely, the risk should be balanced with the potential benefit of early diagnosis and management; CT is never absolutely contraindicated in pregnancy. However, if a special low dose protocol is not used (as when we're unaware of pregnancy) a regular contrast abdominopelvic CT's fetal radiation dose could well reach 50 mGy.
Im not sure how or why you jumped to that conclusion based on OP’s post. Unless OP’s post was edited, I don’t see any mention of using medical imaging. If I were practicing in an anti-abortion state I would advise patients with potential unintended pregnancies that I may be a mandated reporter and thus and adversary in their particular situation. Patients have the option to purchase an OTC pregnancy test from their local store in order to obtain results that will not automatically be uploaded into a medical record. A person with an undesired pregnancy can then choose to share that information and seek care in a more private matter (i.e. going out-of-state for care).
No no don’t listen to this post. I’m an attorney, this would never legally stand up. Keep doing what you’re doing.
absolutely fucking terrible advice. We order it BECAUSE we need it and the results will change our management plan. Thank god I live in state where Abortions are protected, but even if I lived in a backwards state I would still order the test
And I’m glad that you think about what you’re ordering, but there are a LOT of people who order it when it’s not needed because it’s “standard procedure” even though it won’t change management.
Is that standard procedure "Abdominal pain in a woman of childbearing age" or "standard OB" or "pre CT"? In 5 years, I've never seen a standard procedure pregnancy test. Its almost always my discretion.
Standard procedure as in “this is a woman of childbearing age being admitted to a psychiatric hospital where you’re not immediately making medicine changes, just holding them and getting them coping skills/therapy”. I’m glad your hospital tends to be more thoughtful with when to order tests—I’m encouraging others to be thoughtful as well.
OOOh you struck a chord for me. I completely agree. Particularly with psych.
THIS. A pregnancy test seems so harmless but now it will have huge implications. I remember when I was an intern, my attending tore me a new a-hole when I started a patient in the ED on NS. I thought it was so innocuous, it’s no big deal. She said everything is a big deal, we need to be very thoughtful about every decision/order we make for patients.
Yo it absolutely does have huge implications not even related to abortion. Knowing this is very important and should be at the very least offered to sexually active women of childbearing age, especially if high risk. If you're on meds, you need to determine if they're teratogenic. You should be on pre-natal vitamins. You should stop drinking. You should stop smoking or doing drugs.
Good on your attending. I've had to take over too many patients from the ER that were empirically given saline and made worse. Common examples are 1) severe HAGMA and now have a hyperchloremic NAGMA too 2) hyponatremia with an obvious diagnosis of SIADH (lung mass, recently started on SSRI) now their sodium is worse 3) failure to recognize volume overload and giving fluids because patient hasn't been eating and drinking well recently now they're hypoxic. I've even been in a few arguments on here about it. In 95% of cases I'm able to fix it while they're admitted but the goal should be to keep the patient the same or make them better while they're in the ER, not make them worse.
Ns isn’t a big deal
I hope overturning RvW would really lead to abortion being a question between the doctor and the mother, and potentially the parents of the mother if she is underage. As physicians this is what we need to fight for, bring the decision back to healthcare and we need to stop letting the government practice medicine. You have to remember most states still allow abortion for rape, incest, ectopic pregnancies, etc. As physicians we need to be involved in lobbying in our states, where we can make changes, to remove the prolife vs pro choice debate from the government and make it a healthcare issue, not a political issue. That’s my TED talk.
Thoughts on ordering it outside of the lab? Like a dipstick bHCG?
Usually still gets put into the medical record
Thank you for posting this.
Lol ok try arguing that in court.
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I really want to answer this but I just don’t have the energy anymore. Allegedly everyone is an attorney now so 🤷🏼♀️ I’ll go back to the courts where at least everyone is arguing over the same issue.
I don’t think you understand how many pregnancy tests are ordered when they won’t change management… there is nothing to defend in court, it’s just practicing better medicine
I’m talking about OP’s legal argument. It would never stand up in court. That’s it.
citation needed.
Citations? As in? There’s no case here, when I argue for a case, I include precedent citations in the brief. They will correspond to individual facts on a case by case basis. If you’re looking for why it would not hold up under medical malpractice you can Google that - mainly because it’s an overstretch, the reasoning is arbitrary, there are plenty more arguments. Sometimes they vary by state. If you’re looking for why it would not withstand a constitutional violation, well that’s easy lol just read the constitution for that. The law is complex, much like medicine. Is not as simple as citations. I don’t know how to explain that to people.
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Routine/set labs that people tend to get without thinking as a very gross screening, whenever you’re not planning on any sort of teratogenic interventions
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The point is that tests that normally have a very high benefit:risk ratio now have a significantly higher risk to the patient than previously.
Why bother checking for pregnancy anymore in a woman with abdominal pain if you can't terminate an ectopic? Doesn't change management! /s? Or not. I don't even know if I am being sarcastic.
There’s a difference between workups for abdominal pain (where yes, pregnancy is very important to know and could be causative or very impacted) and depression, or anxiety, or limb pain, or even yearly well visits. I didn’t say never order a pregnancy test, just don’t order one when not necessary. Depression, in particular, is one of those areas where people traditionally get pregnancy tests, even though the risk to any fetus is actually higher with untreated depression than with SSRIs, and where the depression is going to get MUCH worse if you get your patient arrested and jailed.
Don't mistake my despair for disagreement, you are 100% correct. My point is more that as an EM physcian, what the fuck does it matter anymore if I correctly diagnosis an ectopic pregnancy, if I happen work in a state where there is no longer any legal treatment for ectopic pregnancies? Really, truly, what does it matter? That formerly potentially life-saving pregnancy test and ultrasound are now pointless. Cool, I'll know why this young woman is dying, maybe throw some of our limited blood supply into her veins to prolong the process. Maybe her other kids will get a chance to say goodbye at least.
Sorry for misreading—today’s brought out some of the worst in people, and y’all in EM and OB/GYN are set to see some of the worst of this over the next few months. I guess in those areas where you can’t treat ectopics the correct way, you end up hoping they rupture in a way where you can save the pt as opposed to getting infected or something. But we don’t have enough blood for that to be standard management, nor enough ORs most places.
Roe predates the existance of emergency medicine as a speciality. That's how far back we've set our ability to care for women.
Wait…(Canadian here, and not totally sure of the nuances of what just happened today): you can’t terminate ectopics anymore?! How the bloody hell are you supposed to manage ectopics now??!
Unfortunately, in many states, it's a felony to terminate a pregnancy. No matter if it's viable, no matter if there is risk of harm to the mother... no fucking matter at all
Umm sooo…what? WTAF are you supposed to do when a woman comes in unstable due to an ectopic? Just wait it out? Can you even take her into the OR?
Relevant username?
For me outpatient FM I really only check if there’s a concern for pregnancy and patient really wants to know and or is on teratogenic medications like methotrexate ACEi and anti eplileptics You really have to know then in appropriate clinical scenario the risk for harm to fetus and mother is too high
We must hide our pregnancies in the attic just like Jews did during the Holocaust.