Products of conception

[SunBakedTrash]

Will anyone be changing the way they word products of conception or ectopic pregnancy cases to avoid unfair legal implications for patients? I report the presence or absence of chorionic villi, but I don’t know the whole clinical story behind these and would prefer more standard neutral terminology. Does anyone have suggestions for wording? If not, I will sign as benign uterine contents or negative for malignancy, as unhelpful as those may be. Appreciate any insight.

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[octopusprime]

If uterine and i see cv, i go descriptive and add 'c/w products of conception' at the end. If I don't see cv i almost invariably look up the history unless it's clearly just suspected retained poc and this is just a post delivery d&c; if it's a possible ectopic and i don't see cv, i usually call the clinician. if i can't get ahold of clinician i add a comment about correlating with clinical & any potential delivery history with lots of cya verbiage.

 

[LADoc00]

You could give patients the option:
1.) word it as "products of abortion"
2.) word it as "unsuccessful pregnancy/miscarriage"

Quite a few states where you could now upsell the report for an extra hundo to option 2.

Put a QR link to your Venmo account at the bottom with statement "would like the option to amend this report?"
Put in small print about a small admin fee needed.

 

[SunBakedTrash]

If uterine and i see cv, i go descriptive and add 'c/w products of conception' at the end. If I don't see cv i almost invariably look up the history unless it's clearly just suspected retained poc and this is just a post delivery d&c; if it's a possible ectopic and i don't see cv, i usually call the clinician. if i can't get ahold of clinician i add a comment about correlating with clinical & any potential delivery history with lots of cya verbiage.

I do the same currently. My new concern is my report following a patient back to a red state and it becoming part of a prosecution if they suspect the patient traveled for abortion care. If I can get away with ruling out a molar pregnancy and let the rest be “clinically correlated” I am alright with that.

 

[Med Director New England]

Just go somewhere where they don’t send tissue to pathology - Like in Dirty Dancing…

 

[octopusprime]

I do the same currently. My new concern is my report following a patient back to a red state and it becoming part of a prosecution if they suspect the patient traveled for abortion care. If I can get away with ruling out a molar pregnancy and let the rest be “clinically correlated” I am alright with that.

i'm not worried about it

 

[SunBakedTrash]

i'm not worried about it

Thank you.

 

[mike-sheree]

Just remember that if it becomes a medico-legal case it won’t matter how artful your sign- out is. Your sworn testimony under deposition will make it crystal clear exactly what is on that slide and the implications thereof.

 

[SunBakedTrash]

Just remember that if it becomes a medico-legal case it won’t matter how artful your sign- out is. Your sworn testimony under deposition will make it crystal clear exactly what is on that slide and the implications thereof.

Thanks, you are right. Maybe best to either turf to the coroner or let the chips fall where they may.

 

[HeyDalaron]

Why not just sign it out descriptively? The intention behind the procedure, whether therapeutic termination or removal of a nonviable conceptus is not directly evident from a slide diagnosis.

Turfing these to the coroner is an interesting suggestion as the laws in those states dictate conceptuses as 'people' now.

 

[SunBakedTrash]

Why not just sign it out descriptively? The intention behind the procedure, whether therapeutic termination or removal of a nonviable conceptus is not directly evident from a slide diagnosis.

Turfing these to the coroner is an interesting suggestion as the laws in those states dictate conceptuses as 'people' now.

My thoughts exactly and being that this would be a homicide case, I figure they would be better equipped than me to handle the wording of the report and legal aspects.

My concern was regarding my report being used as confirmation that a crime was committed/person murdered as opposed to excluding a molar pregnancy. I’m sure there would be other evidence if someone looked like the op note or a court ordered pelvic examination. Like Joe said, it won’t really matter when I get dragged to the patient’s murder trial and forced to testify, but I was hoping to fly under the political radar as much as possible while also not overtly implicating patients in a crime that was until last week the standard of care. Evidently there really isn’t a distinction in elective vs medical abortion in some of these states, and all “suspicious” abortions/miscarriages/stillbirths will be investigated as homicide. Ohio was even requesting ectopic pregnancies be reimplanted!

 

[Guest8]

What idiotic times we live in. SMH.

 

[octopusprime]

My thoughts exactly and being that this would be a homicide case, I figure they would be better equipped than me to handle the wording of the report and legal aspects.

My concern was regarding my report being used as confirmation that a crime was committed/person murdered as opposed to excluding a molar pregnancy. I’m sure there would be other evidence if someone looked like the op note or a court ordered pelvic examination. Like Joe said, it won’t really matter when I get dragged to the patient’s murder trial and forced to testify, but I was hoping to fly under the political radar as much as possible while also not overtly implicating patients in a crime that was until last week the standard of care. Evidently there really isn’t a distinction in elective vs medical abortion in some of these states, and all “suspicious” abortions/miscarriages/stillbirths will be investigated as homicide. Ohio was even requesting ectopic pregnancies be reimplanted!

There aren't going to be men in trenchcoats hanging outside OB offices; moreover, no law enforcement agency is suddenly going to be granted access to a person's medical records.
If you live in a deeply red state with lots of far right leaning Trumpers, just have a policy that you won't accept specimens from certain facilities. Or have your hospital generate a policy--lots of Catholic hospitals around the country that don't allow abortions at their facilities so they already have corporate policy in place.
There are certainly some extreme views on both sides of the argument (who are generally the loudest and/or most disruptive), but a large number of people in the middle either don't particularly care and want the convenience of routine abortion on demand or, conversely, think abortion is abhorrent and don't.

 

[mike-sheree]

Establish a policy that has 3 choices for the patient.
”Non viable human remains of any gestation will be handled as per patient request.”
Either 1) laboratory disposal. 2) routine pathological examination. 3) patient disposition
They choose and sign or it never gets in your door.

 

[SunBakedTrash]

There aren't going to be men in trenchcoats hanging outside OB offices; moreover, no law enforcement agency is suddenly going to be granted access to a person's medical records.
If you live in a deeply red state with lots of far right leaning Trumpers, just have a policy that you won't accept specimens from certain facilities. Or have your hospital generate a policy--lots of Catholic hospitals around the country that don't allow abortions at their facilities so they already have corporate policy in place.
There are certainly some extreme views on both sides of the argument (who are generally the loudest and/or most disruptive), but a large number of people in the middle either don't particularly care and want the convenience of routine abortion on demand or, conversely, think abortion is abhorrent and don't.

This is good advice, thank you.