Tranexamic Acid (TXA) in Obstetric Hemorrhage

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Image Credit: Wikimedia

Authors: Patrick Wallace, DO, MS
Emergency Medicine Resident, PGY-2
University Nevada Las Vegas
AAEM/RSA Publications and Social Media Committee, and AAEM/RSA Education Committee

Laurie Bezjian Wallace, DO
Family Medicine Resident, PGY-2
Mike O’Callaghan Military Medical Center

Bottom Line Up Front: Tranexamic Acid (TXA) reduces postpartum hemorrhage with no major adverse events. There is some evidence to suggest routine use of TXA in all vaginal deliveries.

Introduction: Postpartum hemorrhage (PPH) is the leading cause of maternal deaths with over 100,000 deaths per year. It occurs in 3-15% of deliveries, making up about 25% of all maternal deaths worldwide.[1-5] The three most common causes of PPH can be remembered as the three T’s: tone, tissue, and trauma. Tone refers to uterine atony, tissue referrers to retained placental tissue, and trauma refers to cervical or perineal lacerations. Uterine atony is the most common cause of PPH and can be treated with bimanual massage and uterotonics such as oxytocin, methergine, or misoprostol.[2,5] American College of Obstetrics and Gynecology (ACOG) and World Health Organization (WHO) currently recommend routine prophylaxis with the administration of oxytocin during the third stage of labor.[2,5]

Interstitial versus Cornual Pregnancies: There is a Difference

Image Credit: Pixabay

Author: Megan Litzau, MD
Indiana University
Originally Published: Modern Resident April/May 2016

Commonly the terms interstitial and cornual pregnancies are used interchangeably. However, these are two distinct entities, and are managed differently.[1] An interstitial pregnancy occurs when there is implantation in the proximal intramural portion of the fallopian tube. A cornual pregnancy is when there is implantation in the lateral portion of the uterus.

There’s a First for Everything: Surviving and Thriving Through Internship and Pregnancy

Author: Faith Quenzer, DO PGY-1
Originally Published: Common Sense November/December 2016

July was a whirlwind. Fresh out of medical school, I moved to the desert in California to a brand new emergency medicine residency. I was one of five interns and the only female in our inaugural class. Five weeks into the program, I felt strangely tired and nauseated every day. The positive pregnancy test confirmed my suspicion. I knew, without a doubt, that being an emergency physician was exactly what I wanted to do — a stroke in one bed, major trauma in another, appendicitis next to that patient, etc. But now I had the internal turmoil of figuring out how to balance working hard and taking advantage of all the learning opportunities presented to me with proper self-care — which really means baby care. Additionally, the anxiety of having to reveal my pregnancy to my program director, coordinator, fellow residents, and the hospital was a heavy burden. I feared this news might be detrimental to the newly minted EM program and to me as a new physician.

The number of women in the physician workforce has increased substantially over the last couple decades. According to a recent survey by the American Medical Association, approximately 48% of those enrolled in medical school are women. The average age of a graduating medical student is 28.[1-2] For those already in their 30s, the pressure to have children increases as advanced maternal age looms. And complications are a reality for pregnant physicians. According to surveys conducted in surgical specialties, high stress levels and long hours increase the risk of preterm labor, pre-eclampsia, and other obstetrical complications.[3]

Medical and Surgical Emergencies in the Pregnant Patient

Originally Published: Modern Resident, Dec/Jan 2012 

Original Author: McKaila Allcorn, DO Kent Hospital

Submitted by: Rachel Engle, DO Communications Committee Chair

For most of us, pregnant patients can be intimidating (and not just because of their hormones). While it would be nice to think that our obstetric colleagues can handle all emergencies that occur in pregnancy, it is important to remember that not all baby-bump wielding women present with a purely obstetric complaint. Here are just a few things to keep in mind!

Appendicitis is still the most common surgical emergency in pregnant patients. Incidence is the same in pregnant patients as it is in non-pregnant patients (7%). During the first 20 weeks, clinical findings are usually similar to that of the non-pregnant patient. The