Pearls of Exxcellence

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Contraception in Women with Diabetes Oct 22, 2018

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The prevalence of diabetes mellitus is increasing worldwide, including among women of childbearing age, with an additional 150 million adult cases projected by 2030. Diabetes poses significant risks to pregnant women and developing fetuses. These risks can be minimized through effective contraception and appropriate preconception care.

Evaluation & Management of Bleeding in Perimenopausal Women Oct 22, 2018

Show notes

The perimenopause is defined as the onset of intermenstrual cycle variability (±7 days) through two years after the final menstrual period. Menopause is achieved after 12 completed months of amenorrhea. During the menopausal transition, menstrual cycle inconsistencies are a reflection of the decreasing number of ovarian follicles and the resulting variability of hormone secretion and oligovulation.

Laparoscopic Port Site Hernias Oct 22, 2018

Show notes

Trocar site hernias occur in approximately 1% of laparoscopies. While rare, trocar site hernias are preventable. Risk factors for trocar site hernia include increasing age and BMI. Higher rates are observed with pyramidal trocars when compared to conical or blunt. Open entry (Hasson) technique is also associated with increased risk.

Management of Pelvic Pain After Negative Diagnostic Laparoscopy Oct 22, 2018

Show notes

Although considered gold standard in investigating acute or chronic pelvic pain, diagnostic laparoscopy may not demonstrate any causative factors in 30-50% of patients, leading to considerable disappointment. When endometriosis is not detected by gross inspection and or by biopsy, alternative etiologies should be considered.

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