In this episode, episode 62, I discuss problems that can occur during pregnancy with Dr. Jacqueline Galvan. We discuss a wide range of high yield topics from gestational diabetes to molar pregnancies to maternal heart disease.
References are here: References
Outline by April Liu
6 thoughts on “Episode 62: Problems during pregnancy with Jacqueline Galvan part 1”
I am a GP obstetrician/anaesthetist with extensive experience in remote Australia. Enjoying the episodes on obstetric anaesthesia however I must point out to the listeners that much of the commentary on obstetrics rather than obstetric anaesthesia is factually not very accurate/lacks perspective-unsurprising in view of the guest being an anaesthetist rather than an obstetrician or obstetric physician. This comment applies equally to previous obstetric anaesthesia episodes.
I would suggest the involvement of an experienced obstetrician in any future obstetric themed episodes- listeners are missing out on a great learning opportunity.
Keep up the good work .
Thanks for the comment. One of the advantages of this forum is that people like you, with different expertise, can leave comments that everyone else can learn from. In that spirit I would love to hear more specifics about what was inaccurate so that we can all learn! Thanks so much.
Thanks for your response.
If I may first clarify my comments.
The topics covered in this, and previous obstetric themed episodes, included discussions on obstetric and gynaecologic and general medical conditions. It is a matter of judgement to present these topics in a manner that provides a good general framework for rational decision making. It is not realistic to expect an obstetric anaesthetist to have the knowledge and perspective of a specialist working in these areas and my opinion is that this perspective which was lacking rather than numerous errors of fact. Errors were however present. I felt that listeners would had been better served by the involvement of an obstetrician/ gynaecologist.
Regarding the podcast itself I have made a few corrections/ comments.
Re ectopic- Cervical, abdominal and scar ectopics are rare and unlikely to be encountered. Cornual ectopic though not common is more likely to be encountered, is associated with the potential for catastrophic bleeding and was not mentioned.
Re IUFD -One point not mentioned is hysterotomy for delivery of a dead fetus in not in the lower segment, which develops in the third trimester. This procedure therefore represents an upper uterine segment incision and mandates early repeat CS in any subsequent preganancy due to the perceived significant increased risk of uterine rupture- this is a significant issue.
Re Gestational Trophoblastic Disease (GTD)-This is a complex area with complex terminology and the discussion around this classification was incorrect. This correct terminology includes but is not limited to
-gestational trophoblastic disease (GTD) which includes complete and partial moles, invasive moles, gestational choriocarcinoma and other placental disorders.
-persistent GTD with persisiting hCG.
-gestational trophoblastic neoplasia (GTN)
Re thyroid disease- TSH not T4 is the usual diagnostic test and laboratory parameter for monitoring thyroid function and treatment.
Re diabetes in pregnancy- The classification of diabetes in the discussion was not correct.
Type 1 and 2 diabetes are pre exiting conditions. Gestational diabetes a condition of pregnancy. There are other types of diabetes.
Of interest and not mentioned is the current thinking of the role of epigenetic mechanisms upon the fetal DNA of maternal hyperglycaemia. This is thought to be associated with an increased risk of obesity and and chronic disease in the offspring of these infants of diabetic mothers.
Re cardiac disease-It is my opinion only, however I felt the discussion lacked perspective rather than containing factual errors (aside from the statement that the maternal mortality in pulmonary hypertension is 30% which I presume to be an unintentional). I personally would like to had seen Grown Up CHD, aging maternal population with multiple comorbidities given more prominence than they were. Other conditions, common and uncommon but important, affecting pregnant women including valvular heart disease (very common where I work), cardiomyopathies including HCM, peripartum and takesubo cardiomyopathy were not discussed at all.
In the interests of brevity and other considerations I have not gone through the whole podcast.
I appreciate putting these podcasts together must be a lot of work.
All the best. Russell
Hi Russell, thanks for sharing your perspective and providing some important insights. I’ll see if any of my OB anesthesia guests have any thoughts on what you’ve shared and will post them if they do.
First of all thank you for the fantastic work. I was introduced to ACCRAC by a medical student who rotated through the OR with me. I have to say the content, tone and flow of the productions is the best ive come accross yet. Thank you!
My comment here is unrelated to the OBS podcast. I was reading through for the references and thought id ask a question:
Will you or do you plan on producung any shows on Thoracic Anesthesia (particularly risk stratification/preparation and OLV) also, as I am a chronic pain doc have you had any other interest in this topic and will you have any chronic pain guests talk about things like CRPS, Neuropathic vs noiciplastic pain etc.
Look forward to hearing back.
All the best,
Thanks for your comments. I have touched on double lumen tube placement in a couple of episodes including episode 27, but I haven’t done an entire episode on thoracic anesthesia. It’s something I do have on my list to cover at some point in more detail. The same goes for chronic pain. I have a few folks who I have lined up to discuss some chronic pain topics and we’ll be trying to get to those at some point this year.