USC Verdugo Hills Ob/Gyn

Check out the latest article featuring one of our patients Candice! Bringing awareness and advocating for Black and Brown women are our speciality!

https://www.keckmedicine.org/magazine/maternity-care-black-women/

Dr. Mitchell has been recognized as a trailblazer of USC- check out her article examining her journey to becoming an ob/gyn, challenges being a female biracial doctor, her implicit bias curriculum at Keck, and how she is training the next generation of doctors 🖤

Our practice is here to provide world class care for the most complex conditions- congratulations again to Melody and family- we are blessed & honored to be a part of your health journey ♥️♥️♥️

https://www.keckmedicine.org/magazine/pregnant-brain-cancer-patient/

If you experience early pregnancy loss…

People feel the effects of early pregnancy loss long after it occurs. The following online resources can help people who experience early pregnancy loss find community and support. We encourage you to speak to your physician about other mental health resources that are available to you.

Exhale: nonjudgemental after-abortion support. 617-749-2948
Miscarriage Matters: A community of parents who have experienced loss.
Miscarriage for Men: Guidance and support for men and partners who have experienced loss.
Pregnancy After Loss Support (PALS): Support for people who are pregnant again after loss.
Return to Zero LGBTQIA+: Support for LGBTQ+ families in reproductive, pregnancy, and infant loss.
Sisters in Loss: A community of Black women sharing stories about infertility, pregnancy, and infant loss.
Star Legacy Foundation: Support groups for bereaved parents and families.
Tears Foundation: Lifts financial burden from families who have lost a child and provides comprehensive bereavement care.

How Is Early Pregnancy Loss Managed-

Early pregnancy loss is typically managed with expectant management, medication, or surgery. All three options are safe and effective, and complications are very rare.

Expectant management involves allowing the body to pass the pregnancy on its own. It can take the body days to weeks to pass the pregnancy. You may experience mild to moderate bleeding and cramping with this option. Your physician may educate on when and who to call for excessive bleeding and provide pain medications if desired. It may also be necessary to follow up with your physician for an ultrasound or blood b-hCG level to confirm complete passage of the pregnancy. Surgery may be required if the pregnancy is not completely expelled.

Medical management involves va**nal misoprostol with the possible addition of oral mifepristone. This can usually be completed outside of the clinic, wherever you feel comfortable. You will experience bleeding and cramping several hours after using the medication. Like expectant management, your physician may educate you about the amount of bleeding to expect and provide pain medication if desired. Compared to expectant management, medical treatment lessens the time to complete passage of the pregnancy and decreases the likelihood of surgical intervention.

Surgical intervention is also called dilation and curettage or uterine evacuation. It involves removal of the pregnancy with a vacuum or manual aspirator and can be performed with local anesthesia with additional sedation if desired. This option may be preferable if you have symptoms such as fever or excessive bleeding or conditions such as anemia or a clotting disorder.

Source: ACOG Practice Bulletin 200 (Early Pregnancy Loss)

What are some symptoms of early pregnancy loss, and how is it diagnosed? During pregnancy, it is common to experience some light va**nal spotting and abdominal cramps. If you experience heavy bleeding similar to me**es, or recurrent, painful cramping, your physician may want to evaluate for early pregnancy loss. These symptoms can happen in typical pregnancy or indicate other conditions, so it is important to conduct a thorough examination before initiating treatment.

The most common tests to evaluate for early pregnancy loss are blood levels of the hormone b-hCG, transva**nal or abdominal ultrasound, and speculum exam of the va**na and cervix. If these tests find decreased b-hCG levels, an empty gestational sac or nonviable pregnancy in the uterus, and/ or an open cervix with blood coming from the uterus, your physician may diagnose an early pregnancy loss.

Source: ACOG Practice Bulletin 200 (Early Pregnancy Loss)

Check out our next series by rockstar medical student

Let’s Talk About Early Pregnancy Loss-

Despite how common it is, early pregnancy loss is seldom talked about, especially in the media. In this series, we aim to explain what early pregnancy loss is, how it is diagnosed and managed, and how people who experience early pregnancy loss can find support and community.

Early pregnancy loss is defined as a nonviable, intrauterine pregnancy that occurs in the first 12 weeks and 6 days of gestation. Here is the frequency of early pregnancy loss by age group:
For 20-30 year olds, 9-17% of pregnancies will end in early pregnancy loss.
For 35 year olds, 20% of pregnancies will end in early pregnancy loss.
For 40 year olds, 40% of pregnancies will end in early pregnancy loss.
For 45 year olds, 80% of pregnancies will end in early pregnancy loss.

If so many people experience this, why is it so rarely spoken about in our society? It may be because of emotions that come with loss or lack of understanding of why early pregnancy loss happens. We hope to empower patients to ask questions about their loss and give physicians tools to effectively communicate with and provide support to their patients who have experienced early pregnancy loss.

Source: ACOG Practice Bulletin 200 (Early Pregnancy Loss)

And lastly - options only at times of in*******se

Thank you .med for your awesome series!

So lets discuss THE PILL

Next up- IUDs and Nexplanons!

Happy November everyone! This month we will be highlight amazing work from our USC medical students/ future doctors! Robin will be sharing posts regarding everything you’ve wanted to know about birth control- check them out! Make your appt to discuss more :)

This week, we would like to highlight a recent New York Times article written by Cristina Caron that features Dr. Mitchell.

She discussed ways patients can spot medical gaslighting and ways patients can advocate for themselves.

🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥🔥

🟥 How do you treat Endometriosis?
 
🟥 Endometriosis treatment is focused on reducing pelvic pain, decreasing menstrual bleeding, and maintaining future fertility in reproductive age patients.
 
🟥 For pain management, over the counter pain medication like NSAIDs are commonly used in conjunction with;

🟥 Hormonal agents (such as combined oral contraceptives, progesterone IUDs, the Depo-Provera injection, aromatase inhibitors, and gonadotropin-releasing hormone agonists)
 
🟥 In the case that medical management is not providing adequate symptom relief, or a patient is struggling with infertility, a conservative surgical treatment option includes laparoscopic removal of the misplaced endometrial tissue. Many women find that once they become pregnant, their endometriosis symptoms actually decrease. However, patients must keep in mind that this surgical treatment is not 100% effective, and recurrence is common because the uterine endometrial tissue and the hormones controlling endometriosis-related bleeding are still present via the uterus and ovaries.
 
🟥 If a patient is done having children, or they do not want to have children in the future, a more aggressive surgical approach may be taken.  A total hysterectomy with removal of both fallopian tubes and ovaries provides more than 85% of patients with symptom resolution.
 
🟥 Pursuing treatment for endometriosis is complex and is an important discussion to have with your doctor. Just because one form of medical management is not providing symptomatic relief, does not mean using a different hormonal agent or pain management strategy won’t either. Make sure to talk to your physician about future fertility goals when discussing treatment!
 
🗯 Source: ACOG Practice Bulletin 114 (Management of Endometriosis)

🟥 Unfortunately, the only definitive way to diagnose someone with endometriosis is to perform laparoscopic surgery and biopsy a suspected endometrial lesion. A positive lesion under a microscope will show endometrial glands and variable amounts of inflammation and fibrosis.
 
🟥 Since providers don’t want patients to undergo unnecessary and invasive procedures, there are ways to rule out other causes of pelvic pain, and rule in endometriosis.

🟥 This includes imaging studies, such as a trans-va**nal or pelvic ultrasound, MRI, or CT scan. Your doctor may be looking for the presence of a non-cancerous mass called an endometrioma that is associated with ovaries.

🟥 An endometrioma, or a “chocolate cyst” occurs when the bleeding endometrial tissue on an o***y gets surrounded by a cyst wall, resulting in old blood becoming encased.

🟥 Your doctor may also be looking for nodular uterine ligaments, which may indicate repeat inflammation and scarring of the tissue.
 
🟥 However, even if no endometriomas or irregular tissues are found on imaging studies, the diagnosis of endometriosis is not ruled out. A history concurrent with endometriosis symptoms; a thorough pelvic exam with findings like a fixed retroverted uterus, nodules felt within the posterior va**na, and tender ovarian masses; and a positive response to endometriosis treatment options (like oral contraceptives and NSAIDs) help create a clinical diagnosis of endometriosis.
 
🗯 Source: ACOG Practice Bulletin 114 (Management of Endometriosis)

What are signs of Endometriosis?

🟥 The clinical manifestations of endometriosis are variable and range in severity, with some women being completely asymptomatic.
 
🟥 Some of the most commonly recognized symptoms include:
-       Chronic pelvic pain
-       Menorrhagia: heavy menstrual bleeding
-       Dysmenorrhea: severe and painful periods
-       Dyspareunia: painful in*******se, especially deep penetrative in*******se, which is often increased during the time of me**es (this may also manifest as painful speculum placement during a routine pelvic exam)
-       Dyschezia: painful bowel movements, especially during the time of me**es
-       Dysuria and hematuria: painful urination, and potential blood in the urine, especially during the time of me**es
-       Infertility: due to scarring of fallopian tubes and ovaries from repeat bouts of inflammation, and due to other abnormalities in hormonal/inflammatory agents
 
🟥 (Keep in mind that since endometriosis can be found anywhere in the pelvis, other symptoms can occur that involve other pelvic organs)
 
Source: ACOG Practice Bulletin 114 (Management of Endometriosis)

Check out our series this week: we do a deep dive into endometriosis

Thank you to our awesome medical student Annie for creating this fab series !

Let’s Talk About Endometriosis!
🟥 a common chronic gynecologic condition that is found in about 6-10% of women of reproductive age.
🟥 Between 20-50% of infertile women have endometriosis
🟥 Between 70-90% of women who present with chronic pelvic pain have endometriosis
🟥 The most common age at diagnosis is between 30-40, even though the disease may start presenting in adolescence
 
🧐 Despite how prevalent it is, there is often a long delay between when women start to experience symptoms of endometriosis and receiving a diagnosis. Why is this? It may be due to cultural attitudes about menstruation and menstrual-related pain, misunderstanding of the disease by providers, and a long list of other possible diseases that could be causing a woman’s pelvic pain.
 
🗯 In this series we are going to be addressing what endometriosis is, symptoms of endometriosis, how it is diagnosed, and treatment options. Please reach out with any questions you would like addressed!
 
Source: ACOG Practice Bulletin 114 (Management of Endometriosis)

ABC debunks myths about abortion and abortion care in the United Stares. Dr. Mitchell provides expertise contribution.

Know the facts.

Tune in! Dr. Mitchell will be discussing women and sexual health 👏🏽

Congratulations to Dr. Mitchell and Dr. Al-Marayati for being named Los Angeles Top Doctors for 2022!

So happy for Dr. Johnson and can’t wait to meet her bun in the oven! Baby shower today ♥️

Many patients are very scared of undergoing tears during labor ! Here are some tips to help prevent or at least minimize 😊

Hey there Dr. Johnson !

Many patients are curious about the different types of IUD’s that are available… and the main differences between the two

Your Docs will be providing education on the disparities that affect the African American community, implicit bias, and ways providers can help eliminate disparities and biases 🖤💃🏽

💥 Dr. Laila Al-Marayati 💥

Did you know— Stress can significantly impact your periods! This study evaluates the level of stress and association with menstrual cycles, specifically during the pandemic.

Check out the graph to see how other patients are experiencing changes in periods during this time.

@ elevators in verdugo hills—- floor 5 please __ head to L&D for the best care you, partner, and baby deserve 👏🏽.