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Clinical

Site Visit Summary

Posted by Arianne Diaz (she) on

For my Long Term Care rotation both of my site visits were held via zoom. Like my other rotations, I was tasked with preparing 10 total drug cards, 3 H&Ps, and one journal article with a summary. My classmates and I took turns presenting our patient, answering questions about our drug cards, and briefly summarizing the article we selected. For our mid-site evaluation, our site evaluator prepared a case scenario for us. We were tasked with developing differentials based on the vignette, ordering labs, and creating an assessment and plan. During this exercise I realized I needed to review antibiotic regimens for bacterial gastroenteritis. I was under the impression that fluoroquinolones such as ciprofloxacin were appropriate for most bacterial causes of gastroenteritis such as shigella, campylobacter, vibrio, legionella, etc. Our evaluator informed us, however, that this class of medication tends to be second-line. For our final site evaluation, our preceptor prepared 10 questions and we answered them as a group. This exercise was particularly helpful for emphasizing what I should review before I take my PANCE. For example, one of the questions presented a patient suffering from seasonal allergies. I initially thought that the best course of action would be to use nasal saline to irrigate the nostrils. I remember learning that seasonal allergy symptoms can be lessened by implementing this method so I felt confident in my selection. During review, however, our site evaluator revealed that oral antihistamines would be preferred for a patient with allergic rhinitis. There were no other site evaluations where the evaluator challenged us in this way, and I really appreciated going over treatment plans and questions to determine what my weak areas are.

Clinical

Reflection

Posted by Arianne Diaz (she) on

During my rotation in Long Term Care, I was given the opportunity to engage with patients who resided in a skilled nursing facility. My days were split between working with nurse practitioners, doctors, physical therapists, and occupational therapists. In these five weeks I learned the importance of interdisciplinary education and how each member of the team plays an important role in optimizing the patient. For example, physical therapy and occupational therapy were imperative for patients who were on the subacute rehab floors. These patients were able to improve their mobility and functionality after several weeks of engaging in exercises, which allowed them to be discharged home safely. Something I struggled with during this rotation was modifying my physical exam to evaluate patients who were bed bound. Many of the patients I was assigned to were unable to turn on their own, others were unable to follow instruction due to cognitive issues. I found myself consulting my preceptors on the best way to examine my patients for the first few days. By the time my rotation ended, I felt more confident performing my physical exam, and I was able to develop a sound assessment and plan based on the clinical presentation and my findings. One thing I wanted my preceptor and colleagues to notice about my work on this rotation was my ability to interact with patients. I enjoyed talking to patients at the bedside and making sure they felt comfortable, addressing any issues they may have experienced overnight. Having these types of conversation made the rotation extremely meaningful and I gained perspective on a patient population that I did not previously have. For instance, during my internal medicine rotation, I dealt with older patients who were chronically ill and not able to converse, which was not the case for this rotation.

One of the most challenging aspects of this rotation was interacting with patients who were receiving palliative care. I learned to handle my emotions while remaining sympathetic, but it was definitely challenging. I’ve never been exposed to palliative patients before so managing them was initially difficult. I made sure to attend rounds with the palliative fellows each week to learn more about these patients and how to make their stay at the facility as comfortable as possible. Seeing how the palliative care fellows interacted with the patients taught me which strategies can be implemented to demonstrate understanding and sympathy, not only for my upcoming rotation but for the rest of my career. Prior to this rotation, I was unaware of the role and responsibilities that palliative care providers have, but this has definitely changed. The experience I gained working at a skilled nursing facility for my long term care rotation was extremely valuable to me. I know I will carry this experience with me as I go further into my career.

Clinical

Journal Article w/ Summary

Posted by Arianne Diaz (she) on

Article: Oral Is the New IV – Challenging Decades of Blood and Bone Infection Dogma: A Systematic Review

Citation: Wald-Dickler N, Holtom PD, Phillips MC, et al. Oral Is the New IV. Challenging Decades of Blood and Bone Infection Dogma: A Systematic Review. Am J Med. 2022;135(3):369-379.e1. doi:10.1016/j.amjmed.2021.10.007

Abstract:

Background: We sought to determine if controlled, prospective clinical data validate the long- standing belief that intravenous (IV) antibiotic therapy is required for the full duration of treatment for three invasive bacterial infections: osteomyelitis, bacteremia, and infective endocarditis.

Methods: We performed a systematic review of published, prospective, controlled trials that compared IV-only to oral stepdown regimens in the treatment of these diseases. Using the PubMed database, we identified 7 relevant randomized controlled trials (RCTs) of osteomyelitis, 9 of bacteremia, 1 including both osteomyelitis and bacteremia, and 3 of endocarditis, as well as one quasi-experimental endocarditis study. Study results were synthesized via forest plots and funnel charts (for risk of study bias), using RevMan 5.4.1 and Meta-Essentials freeware, respectively.

Results: The 21 studies demonstrated either no difference in clinical efficacy, or superiority of oral vs. IV-only antimicrobial therapy, including for mortality; in no study was IV-only treatment superior in efficacy. The frequency of catheter-related adverse events and duration of inpatient hospitalization were both greater in IV-only groups.

Discussion: Numerous prospective, controlled investigations demonstrate that oral antibiotics are at least as effective, safer, and lead to shorter hospitalizations than IV-only therapy; no contrary

Type of Study: Systematic Review

Reason:

                  I selected this article because my patient, M.C., has osteomyelitis of the RT ischium. While discussing management strategies, the attending stated that IV and PO medications are not equal in their ability to manage bone infections, specifically, PO medications are not able to penetrate the bone. I was curious about the efficacy of PO vs IV antibiotics for the treatment of osteomyelitis.

Summary:

                  There is insufficient information dictating whether IV antibiotics are superior PO antibiotics in managing blood or bone infections. Authors of this study developed a systematic review which included prospective, interventional, quasi-experimental, and randomized control trials. All other studies, including studies where the infectious agent was a non-bacterial pathogen, were excluded. Twenty randomized control trials and one quasi-experimental study met the inclusion criteria. Eight randomized control trials comprised of 1,321 patients compared IV-only vs oral therapy for osteomyelitis. Six trials compared an oral fluoroquinolone with or without oral rifamycin to IV cloxacillin.  One study compared oral bactrim w/ adjunct rifampin to IV cloxacillin. One study compared the efficacy of “standard IV regimens” to “varied oral regimens” such as fluoroquinolones, penicillins, and macrolides. The first six trials demonstrated similar success rates between the IV and oral groups. One study demonstrated “superior cure rates” for oral ofloxacin when compared to IV imipenem/cilastin. Complications associated with IVs such as local cellulitis, phlebitis, and UE DVT were also eliminated in the oral group. Based on the evidence provided in this systematic review, I believe that the patient can be managed with an oral fluoroquinolone dependent on her kidney function. She should be monitored for fluoroquinolone toxicity which can precipitate QT prolongation and potentially Torsades De Pointes as well as tendon rupture.

Clinical

History and Physical

Posted by Arianne Diaz (she) on

Chief Complaint: “My back has been itchy for the past three days”

History of Present Illness:

            G.W. is an 81-year-old M resident w/ a PMHx HTH, HLD, BPH, GBS, major depressive disorder, and insomnia admitted to Gouverneur’s skilled nursing facility four years ago. He complains of pruritus along the RT side of his back x3 days. As per patient, the itch is constant and has been worsening since onset. He describes it as a tingly, burning sensation that travels from the RT side of the back of his neck to the midportion of his back. He states that his wife has been applying ammonium lactate to the area, but he does not experience any relief. Collateral was obtained from wife who states that she noticed a rash in the area where he complains of pruritus about 2 days ago. She reports he has a history of fungal infections but that this rash does not look like his typical fungal rash. As per wife, there are small clusters of fluid filled blisters, and multiple areas of erythema distributed along the back and neck. Patient denies fever, chills, fatigue, weakness, chest pain, blurry vision, SOB, palpitations,  nausea, vomiting, diarrhea, constipation, abdominal pain, recent travel, recent sick contacts, gross skin swelling, purulent discharge, sloughing of the skin, or current topical/PO steroid use.

Geriatric Assessment

  • ADLs: Dependent in dressing, using the bathroom, and personal hygiene
  • IADLs: Dependent in transportation, preparing meals, cleaning, and doing laundry
  • Home Health Aide: N/A
  • Visual impairment: Yes, patient uses shades; eyes are sensitive to light
  • Hearing impairment: None  
  • Falls in the past year: Three
  • Assistive devices used: wheelchair
  • Gait impairment: Patient requires wheelchair for ambulation
  • Urinary incontinence: None
  • Fecal incontinence: None
  • Cognitive Impairment: None
  • Depression: Hx Major Depressive Disorder  
  • Home safety issues: patient resides at SNF  
  • Health Care Proxy: Wife, M.W.
  • Advance Directives: Full code  

Past Medical History:

  • Hypertension
  • Hyperlipidemia
  • Benign prostatic hyperplasia
  • Hx Prostate Cancer
  • Guillan Barre Syndrome
  • TBI 2/2 MVA
  • Major depressive disorder
  • Generalized anxiety disorder
  • Chronic constipation
  • Insomnia
  • Hx pulmonary embolism

Immunization History:  

  • Vaccinations up to date except for influenza and RSV; both are contraindicated due to GBS

Preventative Medicine Screening:

Colonoscopy – patient does not recall, wife does not recall

Dental – 09/11/2024: patient requires “crown and core buildup”; partial dentures well-fitting

Ophthalmologic – appointment for mid-October, patient has developed sensitivity to light

Past Surgical History:

Bilateral hip replacement

Herniated disc L1-L2 laminectomy

Medications:

  • Lisinopril 2.5 mg PO daily for HTN
  • Atorvastatin 40 mg PO at bedtime for Hyperlipidemia
  • Sertraline HCl 25 mg PO daily for major depressive disorder
  • Tamsulosin HCl 0.4 mg PO daily for BPH
  • Polyethylene Glycol 3350 1 scoop PO daily for chronic constipation
  • Melatonin 3 mg PO at bedtime for insomnia
  • Eliquis 5 mg PO BID for “other pulmonary embolism”
  • Acetaminophen 2 tablets PO

Allergies:

Allergies to iodine and calcium channel blockers, reaction unknown

Denies environmental or food allergies

Family History:

  • Mother, deceased; died secondary to breast cancer at unknown age
  • Father, deceased; died secondary to myocardial infarction at unknown age
  • Brother, deceased; died secondary to prostate cancer at age 72

Social History:

G.W. is an 81-year-old M domiciled at Gotham Health Gouverneur’s SNF. He is visited daily by his wife. His children visit on the weekends.

Habits – No current tobacco, alcohol, or drug use. Patient states he drank excessively for 30 years but stopped after his TBI.

Travel – No recent travel

Diet – heart healthy diet, regular texture, thin consistency

Sleep – patient sleeps majority of the night, takes 1-2 naps a day

Safety measures – patient is a fall risk, must use call bell for wheelchair transfer

Occupation – retired, used to work in accounting

PCP – Dr. Gilchyonok

Proxy – Wife, M.W

Review of Systems:

General: Denies fever, chills, night sweats, fatigue, weakness, loss of appetite, recent weight gain or loss

Skin, hair, nails: Denies changes in texture, excessive dryness or sweating, discolorations, pigmentations, moles/rashes, pruritus, changes in hair distribution

HEENT: Admits to use of partial dentures. Denies headache, vertigo, head trauma, unconsciousness, coma, use of contacts, glasses, visual disturbances, fatigue, lacrimation, photophobia, deafness, pain, discharge, tinnitus, use of hearing aids, nasal discharge, epistaxis, bleeding gums, sore tongue, sore throat, mouth ulcers, voice changes

Neck: Admits pruritus on RT neck radiating to midback. Denies localized swelling/lumps, stiffness/decreased range of motion

Pulmonary system: Denies dyspnea, SOB, cough, wheezing, hemoptysis, cyanosis, orthopnea, PND

Cardiovascular system: Denies chest pain, HTN, palpitations, irregular heartbeat, edema/swelling of ankles or feet, syncope, known heart murmur

Genitourinary: Reports occasional frequency, urgency. Denies nocturia, incontinence, dysuria, oliguria, or pyuria  

Males: Last PSA: 09/10/2024. Reports occasional hesitancy, dribbling

Sexual history: Sexually active? No

Musculoskeletal System: Denies muscle/joint pain, deformity or swelling, redness, arthritis

Peripheral Vascular System: Admits brawny colored bilateral LE (chronic). Denies varicose veins, or peripheral edema, color change

Hematologic System: Denies easy bruising or bleeding, lymph node enlargement, hx of clot

Endocrine System: Denies polyuria, polydipsia, polyphagia, heat or cold intolerance, goiter, hirsutism

Nervous System: Denies seizures, loss of consciousness, loss of strength, change in cognition/mental status/memory, weakness

Psychiatric: Reports history of major depression and generalized anxiety disorder

Vital Signs:       

Temperature: 98.0 degrees Fahrenheit

O2 Sat: 95% on room air

Height: 71 inches

Weight: 200.6

BMI:  28 kg/m2

Respiratory Rate: 18 breaths per minute

Heart Rate: 68 beats per minute

Blood Pressure: 138/68, RT arm lying down

Physical:

General: Patient appears clean & well groomed, alert & oriented to time, place, and person. He is lying comfortably in bed, appears stated age, and is not in acute distress.

HEENT: Hair is white in color with silky texture and no sign of lice or nits. Head is normocephalic and atraumatic. Face is symmetrical with no signs of drooping, swelling, or trauma. Eyes are symmetrical OU, conjunctiva is white. Bilateral ears are symmetrical and appropriate in size without lesions, masses, or trauma on external ears. The nose symmetrical without masses, deformities, trauma, or discharge. Well-fitting dentures noted. No gingival hyperplasia or erythema. Pharynx is non-erythematous, uvula is midline.

Skin and Nails: Grouped vesicular lesions with erythematous base on the RT-most part of back and neck. Scaly, circular lesions with central clearing of various sizes noticed on the LT mid-back. The skin is warm and moist with good texture and turgor. Non-icteric with no swelling or signs of ecchymosis.

Nails do not exhibit digital clubbing, capillary refill less than 2 seconds in upper extremities.

Neck, Thyroid, and Lymph Nodes: The trachea is midline without masses or scars. The lymph nodes are freely mobile and non-tender.

Cardiac: No carotid bruits on auscultation. S1 and S2 are normal. No murmurs, S3, or S4 sounds on auscultation. No friction rubs or gallops noted.

Thorax and Lung:  Chest is symmetrical with no signs of deformity, or trauma. There are no scars or rashes. Respirations are unlabored without use of any accessory muscles. Patient has good airflow. No wheezing, rhonchi, or rales noted.

Abdomen: Abdomen is round and without rashes, bruising, or masses. Bowel sounds normoactive in all four quadrants. Non-tender to palpation, no guarding or rebounding noted.

Mental Status Exam: Patient is alert and oriented to name, date, time, and location. Speech and language ability intact, with normal quantity, fluency, and articulation. Conversation progresses logically. Insight, judgement, cognition, memory, and attention intact.

Peripheral Vascular Exam: The extremities are brawny in color. There is atrophy of bilateral lower extremities, +1 edema bilaterally, darkish discoloration of b/l lower extremities, elongated toenails. No calf tenderness bilaterally.  Homan’s sign not present bilaterally. Skin normal in color and warm to touch upper extremities bilaterally. No ulcerations noted

MSK Upper Extremity:  No soft tissue swelling, erythema, ecchymosis, atrophy, or deformities in bilateral upper extremities.

DDx:

  1. Herpes zoster
  2. Tinea corporis
  3. Contact dermatitis: allergic vs irritant
  4. Impetigo

Laboratory Findings

CMP w/ Magnesium & Phosphate                                   CBC w/ Differential

Anion Gap11                 WBC3.92Basophil %0.3
Sodium141RBC4.66Basophil Abs0.01
Potassium 4.0HGB14.3Imm Gran %1.3
Chloride 105HCT45.8LDH188
Co2 24MCV98.3PSA4.83
BUN 9MCH30.7
Creatinine 0.45MCHC31.2
Glucose 98RDW13.7
ALT (SGPT)20PLT106
AST (SGOT)12MPVN/A
Alkaline Phosphate 87Monocyte %7.9
Total Bilirubin0.4Monocyte Abs0.31
Calcium8.9Neutrophils Abs1.66
Total Protein 6.0Neutrophil %42.2
Albumin3.8Lymphocyte Abs1.88
MagnesiumN/ALymphocyte %48.0
Phosphorus N/AEosinophil %0.3
eGFR106Eosinophil Abs0.01

Assessment:

G.W. is an 81-year-old M resident w/ a PMHx HTH, HLD, BPH, GBS, major depressive disorder, and insomnia complaining of pruritus along the RT side of his back x3 days. Patient has a history of fungal skin infection as per collateral from wife. Two distinct rashes were visualized on physical exam: grouped vesicular lesions in two adjacent dermatomes, and scaly circular lesions with a central clearing.

Plan:

#herpes zoster

  • Initiate Valacyclovir 1 gm TID x14 days
  • If no improvement noted, consider dermatology consult
  • Monitor LFTs
  • Monitor for worsening erythema, warmth, discharge
  • Hold topical fungal cream

#pressure ulcer ppx

  • Turn patients every 1-2 hours
Clinical

Site Visit Summary OBGYN

Posted by Arianne Diaz (she) on

For my Women’s Health rotation, I had two site evaluations. Like my previous rotations, I had a mid site evaluation and a final site evaluation. Again, I was tasked with submitting three total H&Ps, ten drug cards, and one journal article with summary. Typically, I read my H&Ps off my laptop, occasionally glancing up to make eye contact with my site evaluator. This time, however, I was so excited to talk about my patients that I did not touch my laptop until it was time to discuss my drug cards. Both my mid-site and final site evaluations flowed like regular conversations, and I wound up talking in extensive detail about all three of my patients whereas in the past, I usually only had to present two. My preceptor provided me with valuable feedback on how to refine my differentials which I greatly appreciated. He also emphasized the importance of obtaining a comprehensive history for pregnant patients. He explained that it is essential to document what type of prenatal care these patients received to inquire about postpartum family planning options. It is important that future pregnancies are planned appropriately so providers always ask patients what their contraception plans are once they’ve given birth. I witnessed providers doing this during my time in the GYN clinic but I didn’t consider it for my own patient because I met her when she was already in the latent phase of labor. My preceptor also explained that patient education is imperative, especially for first-time mothers. Educating patients on proper latching techniques for breastfeeding as well as postpartum warning signs and symptoms can help mothers transition more seamlessly into this new role. Overall, this rotation truly helped me polish my clinical skills and I am grateful for the opportunity to have rotated at this location. 

Clinical

Site Visit Summary

Posted by Arianne Diaz (she) on

For my Women’s Health rotation, I had two site evaluations. Like my previous rotations, I had a mid site evaluation and a final site evaluation. Again, I was tasked with submitting three total H&Ps, ten drug cards, and one journal article with summary. Typically, I read my H&Ps off my laptop, occasionally glancing up to make eye contact with my site evaluator. This time, however, I was so excited to talk about my patients that I did not touch my laptop until it was time to discuss my drug cards. Both my mid-site and final site evaluations flowed like regular conversations, and I wound up talking in extensive detail about all three of my patients whereas in the past, I usually only had to present two. My preceptor provided me with valuable feedback on how to refine my differentials which I greatly appreciated. He also emphasized the importance of obtaining a comprehensive history for pregnant patients. He explained that it is essential to document what type of prenatal care these patients received to inquire about postpartum family planning options. It is important that future pregnancies are planned appropriately so providers always ask patients what their contraception plans are once they’ve given birth. I witnessed providers doing this during my time in the GYN clinic but I didn’t consider it for my own patient because I met her when she was already in the latent phase of labor. My preceptor also explained that patient education is imperative, especially for first-time mothers. Educating patients on proper latching techniques for breastfeeding as well as postpartum warning signs and symptoms can help mothers transition more seamlessly into this new role. Overall, this rotation truly helped me polish my clinical skills and I am grateful for the opportunity to have rotated at this location. 

Clinical

Reflection

Posted by Arianne Diaz (she) on

I recall the day I received my clinical year schedule. As I quickly glossed over the colorful rows, I made note of the rotations I was least looking forward to. At the time, Women’s Health was undoubtedly the top contender, it was the rotation I was dreading the most.

I still remember telling myself “Oh good! I won’t have to deal with this for another year” as I clicked off the Excel document detailing where I’d be rotating for the next 12 months.

I wanted to preface my reflection with this brief anecdote to demonstrate how foolish my thought process was. I didn’t feel very passionate about Women’s Heath and my opinions were based off the experiences of upperclassmen. These factors skewed my perception of the rotation, leading me to believe that I would not enjoy it. It was not until I was actually on my Women’s Health rotation that I realized how valuable, fascinating, and precious this specialty is. For my first two weeks I worked with PAs and attendings in the GYN clinic. I performed speculum examinations, bimanual examinations, collected cervical samples for pap smears and STI screening, assisted in family planning, measured fundal heights, listened to fetal heart sounds, and more. I was able to interact with patients of varying backgrounds, all with unique complaints. In particular, I remember one patient who came to the clinic with desires of becoming pregnant. The attending I worked with explained the most opportune time of each month to achieve pregnancy, and provided education on artificial methods for achieving pregnancy should she be unable to on her own. The patient expressed sincere gratitude and even asked for this attending to be assigned as her regular GYN provider moving forward. Working with providers like this inspires me to continue learning so that one day I can provide phenomenal patient centered care.

For my third week I was on GYN on-call. Each day, I worked closely with a different PA and, together, we examined consults. The majority of our consults were patients from the emergency room but I found myself scrubbing into two c-sections and assisting in a laparoscopic hysterectomy. During the lap hysterectomy, the PA I was paired with had to leave for an emergency consult. I was left in charge of the uterine manipulator which initially frightened me because I had never used one before. With the guidance of the attending and resident, however, I became more confident using this tool and the procedure was successful. By the end of this third week, I was considering GYN as a specialty but I wasn’t sure yet. This would change by the end of my 4th and 5th week.

During my last two weeks I was required to attend three overnight shifts and five day shifts on the labor and delivery unit. I assisted with two vaginal deliveries which I found absolutely life-changing. I will never forget the overwhelming happiness that came over me as I listened to the first cries of these babies. For the remainder of my time on labor and delivery, I was able to be more hands on with patients and perform postpartum examinations. The midwives, nurses, and other students on the unit were friendly, receptive, and eager to answer questions. It didn’t register until I was on my way home on my last day that I had more fun that I could have imagined. I loved my Women’s Health rotation, and I am proud to say this is now my top specialty. I learned to take the experiences of others with a grain of salt, and to go into every situation with my best foot forward. After all, “you get back what you put into these rotations!”

Clinical

Journal Article w/ Summary

Posted by Arianne Diaz (she) on

Article 1: Biophysical Effects, Safety, and Efficacy of Raspberry Leaf Use in Pregnancy: A Systematic Integrative Review

Abstract:

Background: Childbearing women have been using various herbs to assist with pregnancy, labor and birth for centuries. One of the most common is raspberry leaf. The evidence base for the use of raspberry leaf is however under-developed. It is incumbent on midwives and other maternity care providers to provide women with evidence-based information so they can make informed choices. The aim of this study was to review the research literature to identify the evidence base on the biophysical effects, safety and efficacy of raspberry leaf in pregnancy.

Methods: A systematic, integrative review was undertaken. Six databases were searched to identify empirical research papers published in peer reviewed journals including in vitro, in vivo, human and animal studies. The search included the databases CINAHL, MEDLINE, Cochrane Library, Scopus and Web of Science Core Collection and AMED. Identified studies were appraised independently by two reviewers using the MMAT appraisal instrument. An integrative approach was taken to analysis.

Results: Thirteen studies were included. Five were laboratory studies using animal and human tissue, two were experiments using animals, and six were human studies. Included studies were published between 1941 and 2016. Raspberry leaf has been shown to have biophysical effects on animal and human smooth muscle including the uterus. Toxicity was demonstrated when high doses were administered intravenously or intraperitoneally in animal studies. Human studies have not shown any harm or benefit though one study demonstrated a clinically meaningful (though non-statistically significant) reduction in length of second stage and augmentation of labor in women taking raspberry leaf.

Conclusions: Many women use raspberry leaf in pregnancy to facilitate labor and birth. The evidence base supporting the use of raspberry leaf in pregnancy is weak and further research is needed to address the question of raspberry leaf’s effectiveness.

Type of Study: Systematic Review

Summary:

                  This article focuses on the use of raspberry leaf in pregnancy as well as fetal outcomes. Raspberry leaf is associated with smooth muscle relaxation which, according to some studies, is particularly helpful during the active and latent phases of labor. One study conducted by Whitehouse demonstrated that raspberry leaves can relax the uterus without impacting blood pressure. While this is a significant finding, there are also unfavorable side effects associated with this product. For instance, in another study reported by Nguyen, women with gestational diabetes developed hypoglycemia after consuming 16 oz of raspberry tea leaf a day for 3 days. Care should be taken in women who are using insulin to manage their gestational diabetes as it may potentiate worsening hypoglycemia. Some women, however, may want to raspberry leaf to manage their gestational diabetes, though they must be monitored extremely closely.  Another study included in this article reported findings which demonstrated alterations of the CYP in offspring of mothers who used this herb during pregnancy. Other studies focused on the effect of raspberry leaf on pregnancy outcome. For one study, researchers documented increased incidence of c-section births in women using this herb. However, there were “no statistically significant differences” in between women who used raspberry leaf and women who didn’t where APGAR score, diastolic blood pressure, meconium-stained liquor, transfer to neonatal ICU, and postpartum hemorrhage were concerned. There were also no differences for other factors either such as labor augmentation, epidural, length of the stages of labor, etc. There is not enough evidence to indicate that use of this herb is beneficial in pregnancy and more research must be conducted before a definitive conclusion is established.

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