1 00:00:08,041 --> 00:00:17,818 WELCOME TO THE PLACENTA ACCRA 2 00:00:17,818 --> 00:00:20,254 SPECUM. 3 00:00:20,254 --> 00:00:21,321 YOUR PRESENCE IS TRULY 4 00:00:21,321 --> 00:00:21,889 ECIATED. 5 00:00:21,889 --> 00:00:22,856 I'LOOKING FORWARD TO HEARING 6 00:00:22,856 --> 00:00:24,591 YOUR INSIGHTS AND 7 00:00:24,591 --> 00:00:26,026 RECOMMENDATION ON TS 8 00:00:26,026 --> 00:00:26,560 IMPOT TOPIC. 9 00:00:26,560 --> 00:00:30,530 I WOULD LIKE TO EXTEND MY THAS 10 00:00:30,530 --> 00:00:33,000 TO NICHD LEADERSHIP, 11 00:00:33,000 --> 00:00:38,305 SPECIFICALLY DR.HAKHTOUR AND 12 00:00:38,305 --> 00:00:40,674 DR. HAZRA IN TIR SUPPORT 13 00:00:40,674 --> 00:00:47,915 CO-CHAIRS FHE SIGFICANTK THE 14 00:00:47,915 --> 00:00:49,116 CONTRIBUTIONNRGIZG AND 15 00:00:49,116 --> 00:00:51,218 LEADIN THISORKSHO WITH ME. 16 00:00:51,218 --> 00:00:53,687 ADDITIALLY, MY THANKS GO OUT 17 00:00:53,687 --> 00:00:57,457 TO THE SOCIETY PTICITING 18 00:00:57,457 --> 00:00:57,958 WITH U 19 00:00:57,958 --> 00:01:02,162 I WOULD ALSO LIKE TO ANOWLEDGESS 20 00:01:02,162 --> 00:01:03,130 THAT ARE GOING TO BE PSENT 21 00:01:03,130 --> 00:01:04,731 WI US TODAY. 22 00:01:04,731 --> 00:01:06,166 NOW ANO FEW HOUSEKEEPINI WOU 23 00:01:06,166 --> 00:01:08,468 LIKE TO GO OVER WITH YOU NOW. 24 00:01:08,468 --> 00:01:10,537 AS YOU'RE AWARE, OUR ANDA IS 25 00:01:10,537 --> 00:01:15,475 VERY PACKE SO PLEASETICK TO 26 00:01:15,475 --> 00:01:22,683 YOUR ALLOCATED TIME. TIME OF 20 27 00:01:22,683 --> 00:01:22,950 MINUTES. 28 00:01:22,950 --> 00:01:24,685 THEY WILL NOTIF YOU 2 MINUTES 29 00:01:24,685 --> 00:01:27,087 US O SCHEDULE.ME IS UP TO KEEP 30 00:01:27,087 --> 00:01:31,224 PLEASEETN PROMPTLY FROM YOUR 31 00:01:31,224 --> 00:01:34,294 LUNCH, THERE IS A CETIAT ORD 32 00:01:34,294 --> 00:01:36,930 LOCATED ON THEIGHT SIDE OF THE 33 00:01:36,930 --> 00:01:38,765 BUILDING. 34 00:01:38,765 --> 00:01:40,200 YOUR BGE CONTAINS A 35 00:01:40,200 --> 00:01:41,068 COLOR-DED STICKER FOR YOUR 36 00:01:41,068 --> 00:01:41,501 WORKING GUP. 37 00:01:41,501 --> 00:01:42,836 WE HAVRIED TO AOMDATE 38 00:01:42,836 --> 00:01:51,011 ALYSE.FERENCEUT IT DOES IT IS T 39 00:01:51,011 --> 00:01:52,679 WHEN IT'S TIME FOR YOUR SESSION, 40 00:01:52,679 --> 00:01:54,982 PLEASE CE OVER WITH YR TENT 41 00:01:54,982 --> 00:01:56,483 CARD AND REMN THERE UNTIL THE 42 00:01:56,483 --> 00:01:58,585 END OF THE SESSION INCLUDING T 43 00:01:58,585 --> 00:02:00,220 DISCUSSION. 44 00:02:00,220 --> 00:02:04,458 TO ENSE ALL ATTENDEES CAN HEAR 45 00:02:04,458 --> 00:02:06,560 YOU, PLEASE REMBER TO SPE 46 00:02:06,560 --> 00:02:08,195 WELLNTO YOURICROPHONE AND 47 00:02:08,195 --> 00:02:13,867 REMEMBER TO UNMUTE AFTER 48 00:02:13,867 --> 00:02:14,735 VIDEO PARTICIPANTS CAN SEND YOUR 49 00:02:14,735 --> 00:02:19,006 PROVIDED BOW AND WE WAKEESS 50 00:02:19,006 --> 00:02:20,540 EVERY EFFORTO ADDRESS ALL 51 00:02:20,540 --> 00:02:20,974 INQUIRIES. 52 00:02:20,974 --> 00:02:22,843 TOMORR I G TO BE THE 53 00:02:22,843 --> 00:02:24,277 FIRST -- THE SECOND DAY OF OUR 54 00:02:24,277 --> 00:02:30,117 WILL BPENT IUR WORKING 55 00:02:30,117 --> 00:02:31,818 AS YOU PASS SECURIT COME TO 56 00:02:31,818 --> 00:02:32,919 YOUR ASSIGD WORKI GROUP 57 00:02:32,919 --> 00:02:34,454 ROOM. 58 00:02:34,454 --> 00:02:36,857 AFTER THAT, WE'LL RMEET IN 59 00:02:36,857 --> 00:02:37,758 THIS ROOM. 60 00:02:37,758 --> 00:02:40,260 NOW WITHOUT FURTHER ADO, I'M 61 00:02:40,260 --> 00:02:44,965 GIVING TO MY CEF, 62 00:02:44,965 --> 00:02:47,734 DR. CHAKHTOURA, OB-GYN, TO KICK 63 00:02:47,734 --> 00:02:50,704 OFF THIS MEETING. 64 00:02:50,704 --> 00:02:51,638 >> THANK YOU, MONICA. 65 00:02:51,638 --> 00:02:54,174 I REALLY WANT TO THANK Y ALL 66 00:02:54,174 --> 00:02:56,576 D WELCOME YOU TOOIN U FOR 67 00:02:56,576 --> 00:02:59,946 IMPOANT WORKSHOP, AND WANT 68 00:02:59,946 --> 00:03:01,381 TO THANKHE PEOPLE IN THE ROOM 69 00:03:01,381 --> 00:03:05,218 D ALSOOINING U BY 70 00:03:05,218 --> 00:03:05,552 VIDEOCAST. 71 00:03:05,552 --> 00:03:14,661 THANKING DR. MICA LONGOS LL A 72 00:03:14,661 --> 00:03:15,395 HERSELF BECAUSE I DON'T THI 73 00:03:15,395 --> 00:03:16,697 THIS MEETING WOULD HE HAPPENELD 74 00:03:16,697 --> 00:03:18,231 WITHOUT HER PERSISTENCE AND 75 00:03:18,231 --> 00:03:28,175 SO WITHOUT FURTHERSODO, IT IS MY 76 00:03:28,175 --> 00:03:34,948 PLEASURE TO INTRODUCE DR. RNOHAN 77 00:03:34,948 --> 00:03:36,183 HAZRA, DIRECTOR OF INTRAMURAL 78 00:03:36,183 --> 00:03:36,683 RESEAR. 79 00:03:36,683 --> 00:03:38,485 HE BECAME THE DIRECTOR OF 80 00:03:38,485 --> 00:03:39,986 EXTRAMURAL RESRCH COUPLE 81 00:03:39,986 --> 00:03:41,555 YES AGO AND BEFORE THAT, HE 82 00:03:41,555 --> 00:03:43,824 WAS THE BRANCH CHIEF OF THE 83 00:03:43,824 --> 00:03:45,992 BRANCH HERIN T DIVISION OF 84 00:03:45,992 --> 00:03:48,962 DRZRA RECEIVED HISH. 85 00:03:48,962 --> 00:03:50,697 MEDICAL DEGREE FROM JNS 86 00:03:50,697 --> 00:03:51,765 HOINS UNIRSYCHOOOF 87 00:03:51,765 --> 00:03:52,899 MEDICINE AND COMPLETED HIS 88 00:03:52,899 --> 00:03:56,970 PEATRIC RESIDCY A A 89 00:03:56,970 --> 00:03:58,472 PEDIATC DISEASE FELLOWSHIP AT 90 00:03:58,472 --> 00:04:02,342 CHILDR'S HOSPITAL IN BOSTON. 91 00:04:02,342 --> 00:04:05,712 BRANCH CHIEF WHE IAS WITH THE 92 00:04:05,712 --> 00:04:08,048 MATERNAL PEDIATR INFECTIOUS 93 00:04:08,048 --> 00:04:09,950 DISEASE BRAN,, AND IT'S MY 94 00:04:09,950 --> 00:04:10,817 PLEASURE TONVIM TO 95 00:04:10,817 --> 00:04:11,952 PROVIDE OUR OPENING REMARKS FOR 96 00:04:11,952 --> 00:04:19,192 THE MEETING 97 00:04:19,192 --> 00:04:24,865 >> THANK YOU VERY MUC NAHIDA.WOT 98 00:04:24,865 --> 00:04:27,400 HIRES A BRANCH CHIEF WASAHIDA 99 00:04:27,400 --> 00:04:29,803 AND ONE OF MY FIRST HIRES AS 100 00:04:29,803 --> 00:04:32,606 DIVISION DIRECR W NAHIDA AS 101 00:04:32,606 --> 00:04:35,375 CHIEF OFREGNANCY PERINATOLOGY 102 00:04:35,375 --> 00:04:36,910 BRCH SO IF NOTHINGLSE I'VE 103 00:04:36,910 --> 00:04:39,646 DONE THOSE TWO GOOD DEEDS. 104 00:04:39,646 --> 00:04:42,082 SO I WANT TO JOIN MONICAND 105 00:04:42,082 --> 00:04:43,049 NAHIDA TO WELCOME ALL OF Y. 106 00:04:43,049 --> 00:04:44,151 OFOURSE REALLY APPRECIE 107 00:04:44,151 --> 00:04:45,785 FOLKS THAT ARE ONLINE, BUT 108 00:04:45,785 --> 00:04:47,220 REALLYEALLY LIKE TO SEE THE 109 00:04:47,220 --> 00:04:50,390 NUER OF PEOPLE THATRE HEREIN PSL 110 00:04:50,390 --> 00:04:51,725 RECOGNIZE THAT IN PSON, 111 00:04:51,725 --> 00:04:53,994 THERS GOING TO BE A LOT OF 112 00:04:53,994 --> 00:04:55,395 SUBSNCE THAT HAPPE AS PART 113 00:04:55,395 --> 00:04:57,597 OF THE FORMAL MEE,UT TN 114 00:04:57,597 --> 00:05:00,133 ALSO EXPECTING AN EQUAL AMOUNT 115 00:05:00,133 --> 00:05:00,667 OF PRODUIVITY WITH 116 00:05:00,667 --> 00:05:02,135 COERSATIS THAT HAV HAPPED 117 00:05:02,135 --> 00:05:03,837 DURING BREAKS AND AFTER H AS 118 00:05:03,837 --> 00:05:05,605 WELL,O REALLY ARECIATE 119 00:05:05,605 --> 00:05:06,039 EVERNE THERE. 120 00:05:06,039 --> 00:05:11,611 THE THANKS BUT DO WANT TO BEING 121 00:05:11,611 --> 00:05:13,046 A OWLEDGEONICA LONGO AND ALL 122 00:05:13,046 --> 00:05:14,781 THE WOR SHE'S DE TO PUT THIS 123 00:05:14,781 --> 00:05:18,285 TOGETHER.PORTANT WORKSHOP 124 00:05:18,285 --> 00:05:25,725 SO DO I JT SAY NEXT SLI? 125 00:05:25,725 --> 00:05:26,693 OK, THERE WE G 126 00:05:26,693 --> 00:05:32,132 SO JUST TO REMIND ERYONE ABOUT 127 00:05:32,132 --> 00:05:34,568 OUR INITUTE' MISSION. 128 00:05:34,568 --> 00:05:36,970 DR. BIANCHI, O DECTOR, OFTEN 129 00:05:36,970 --> 00:05:38,838 WILL NOTE THA WHILE HAVE 130 00:05:38,838 --> 00:05:40,273 CHILD HEALTH IN OUR NE, WE 131 00:05:40,273 --> 00:05:43,376 HAVE A MAJOR, MAJOR EORT IN 132 00:05:43,376 --> 00:05:44,744 PREGNANCY AND REPRODUCTIVE 133 00:05:44,744 --> 00:05:45,979 HEALTH, WHH IS NOT REFLECTED 134 00:05:45,979 --> 00:05:47,280 IN OUR NAME, BUT CERLY 135 00:05:47,280 --> 00:05:48,481 REFLECTEIN OUR MSION AND 136 00:05:48,481 --> 00:05:49,649 ON. 137 00:05:49,649 --> 00:05:50,650 SO OUR MISSION IS TO LEAD 138 00:05:50,650 --> 00:05:51,851 RESEARCH AND TRAINING TO 139 00:05:51,851 --> 00:05:53,720 UNDERSTAND HUMAN DEVELOPNT, 140 00:05:53,720 --> 00:05:55,488 IMPROVE REPROCTIVE HEAH, 141 00:05:55,488 --> 00:05:56,857 ENHANCE THE LIVES OF CHILDREN 142 00:05:56,857 --> 00:05:58,091 AND ADOLEEN AND OPTIZE 143 00:05:58,091 --> 00:05:59,192 ABILITIES FOR ALL. 144 00:05:59,192 --> 00:06:05,198 AND OUR VION IS HEALTHY 145 00:06:05,198 --> 00:06:06,967 PREGNANCIES, HEALTHY CHILDREN 146 00:06:06,967 --> 00:06:07,834 AND OPTIMAL LIVES. 147 00:06:07,834 --> 00:06:10,437 JUST TOEMIND PEOPLE, AIN, 148 00:06:10,437 --> 00:06:12,439 THAT WHILE WE DON'T HAVE 149 00:06:12,439 --> 00:06:14,074 REPRODUCTI HEALTHR PREGNAN 150 00:06:14,074 --> 00:06:15,275 OR MATERNAL HEALTH IN OUR 151 00:06:15,275 --> 00:06:17,577 INSTUTE NAME, WE DO HAVE A 152 00:06:17,577 --> 00:06:19,079 SUBSTANTIAL INVESTMENT INHESE 153 00:06:19,079 --> 00:06:22,182 I MENTIONED, THEY' IN OUR 154 00:06:22,182 --> 00:06:22,849 MISSN AND VISION. 155 00:06:22,849 --> 00:06:24,584 TH WERE ALSO IN OUR ORIGINAL 156 00:06:24,584 --> 00:06:25,919 LEGISLATION THAESTABLISHEDHE 157 00:06:25,919 --> 00:06:26,987 INSTITUTE THAT PRESIDENT KENNEDY 158 00:06:26,987 --> 00:06:29,289 GNED BACK IN 1962. 159 00:06:29,289 --> 00:06:34,995 OF WHAT WE COVER WITH RESPECT TO 160 00:06:34,995 --> 00:06:36,529 MATERNAL HEALT ADVANCING 161 00:06:36,529 --> 00:06:37,030 SCIENTIFVIDENCEND 162 00:06:37,030 --> 00:06:38,265 KNOWLEDGE TO PROMOTE HEALTHY 163 00:06:38,265 --> 00:06:40,133 EGNANCIEAND IMPROVE 164 00:06:40,133 --> 00:06:40,567 OUTC. 165 00:06:40,567 --> 00:06:42,636 R EFFORTS SPAN SCROS MULTIPLE 166 00:06:42,636 --> 00:06:44,004 BRANCHES, SO WHI THE MAIN 167 00:06:44,004 --> 00:06:47,007 PRNANCY ANDERINOLOGYHE 168 00:06:47,007 --> 00:06:49,976 SEVEN OF O 12 EXTRAMURAL SIX OR 169 00:06:49,976 --> 00:06:52,145 BRANES TT ADDRESS MATERNAL 170 00:06:52,145 --> 00:06:54,681 HEALTH, INCDING, OBSTEIC 171 00:06:54,681 --> 00:06:55,982 PHARMACOLOGY, MERNAL 172 00:06:55,982 --> 00:06:58,618 INCTIOUS DISEASE, AND A NUMBER 173 00:06:58,618 --> 00:07:01,254 OF OTHERREAS AS WEL 174 00:07:01,254 --> 00:07:03,423 OUR RESEARCH INVTMENTS COVER 175 00:07:03,423 --> 00:07:04,858 NORMATIVE AND DISEASE PROCESSES, 176 00:07:04,858 --> 00:07:06,026 CLINICAL INTERVENTIONS, OF 177 00:07:06,026 --> 00:07:08,361 COURSE WE HAVE A MAJOR CLINICAL 178 00:07:08,361 --> 00:07:10,964 TRIAL EFFOR AS W IN MATERNAL 179 00:07:10,964 --> 00:07:12,732 HEALTH, ROUGH OUR MATNAL AND 180 00:07:12,732 --> 00:07:17,237 TALEDICINE NETWO. 181 00:07:17,237 --> 00:07:19,572 WE HAV A POPULATION DYNAMICS 182 00:07:19,572 --> 00:07:20,740 BRANCH THAT ADDRESSES A NUMBER 183 00:07:20,740 --> 00:07:23,777 OF TSE ISSUES, CLINICAL A 184 00:07:23,777 --> 00:07:24,744 STITIONAL CTORANDTHER 185 00:07:24,744 --> 00:07:26,346 ISSUES THAT M ILUENCE 186 00:07:26,346 --> 00:07:27,414 PREGNANCY AND CHILDBIRTH. 187 00:07:27,414 --> 00:07:29,516 WE BASICALLY LEAD AND/OR 188 00:07:29,516 --> 00:07:31,718 CONTBU TO SEVAL NIHIDE 189 00:07:31,718 --> 00:07:33,520 EFFORTS IN THIS AREA,NCLUDING 190 00:07:33,520 --> 00:07:35,922 THE IMPROVE INITIATE. 191 00:07:35,922 --> 00:07:37,357 SO JUST TO GO OR A LITTLE BIT 192 00:07:37,357 --> 00:07:39,426 ABT WHAT THIS FUNNG IS, SO 193 00:07:39,426 --> 00:07:41,494 WHAT WE'RE SHOWING HER IS THE 194 00:07:41,494 --> 00:07:44,998 AMOUNT OFDING IN MATERL 195 00:07:44,998 --> 00:07:47,634 HEALTH, D IN THE LOWER PART OF 196 00:07:47,634 --> 00:07:50,904 VESTMENT, AND THEN THE UPPER, 197 00:07:50,904 --> 00:07:52,339 ALL OF THE OTHER INSTITUTES. 198 00:07:52,339 --> 00:07:53,540 SO CLEARLY, YOU CAN SEE THAT 199 00:07:53,540 --> 00:07:56,376 WHILE WE AREHE LEAD, WE, IN 200 00:07:56,376 --> 00:07:57,911 FACT, FUND ONLY MINORITYF 201 00:07:57,911 --> 00:07:59,446 THIS TYPE OF RESEARCH, AND HENCE 202 00:07:59,446 --> 00:08:02,182 THE REALLY IMPORTANT EFFTS 203 00:08:02,182 --> 00:08:05,118 THAT WE DO IN CLABORATING AND 204 00:08:05,118 --> 00:08:06,219 COORDINATING ACROSS THE NIH WIT 205 00:08:06,219 --> 00:08:08,188 A NUMBER OF OTHER INSTITUTES 206 00:08:08,188 --> 00:08:09,189 INCLUDING, FOR EXAMPLE T 207 00:08:09,189 --> 00:08:10,824 NT HEALT INSTITUTE AND THE 208 00:08:10,824 --> 00:08:12,559 HEART, LUNG AND BLOOD INSTITUTE 209 00:08:12,559 --> 00:08:16,830 AS EXAMPLES. 210 00:08:16,830 --> 00:08:20,433 AND TS JUST SHOWS UP, AIN, 211 00:08:20,433 --> 00:08:21,634 BYNSTITUTE, WHERE THESE 212 00:08:21,634 --> 00:08:22,235 INVESTNTS ARE. 213 00:08:22,235 --> 00:08:23,703 AS I MTIONED, WLEE'RE 214 00:08:23,703 --> 00:08:26,873 THE LARGEST FUNDER, IT'S STILL A 215 00:08:26,873 --> 00:08:28,641 MINORITY, APPXIMATELY 35%ND 216 00:08:28,641 --> 00:08:30,176 L OF THE OTHER INSTITUTES AND 217 00:08:30,176 --> 00:08:33,613 THIS MATERNAL HEALTH RESEARCH, 218 00:08:33,613 --> 00:08:35,315 AND ASOUAN SEEHERE AS 219 00:08:35,315 --> 00:08:37,851 MENTIONED, NHL IA MAJOR 220 00:08:37,851 --> 00:08:44,891 THE MINORITY AND HEALTHHD IS 221 00:08:44,891 --> 00:08:46,893 DISPARITIES INSTITUTE, NIDDK IS 222 00:08:46,893 --> 00:08:48,995 DIGESTIVEISEASES AND KIDNEY, 223 00:08:48,995 --> 00:08:50,296 ENRONMENTAL HEALTH INSTITUTE 224 00:08:50,296 --> 00:08:52,399 THE NIH OFFICE OF THE DIRECTOR, 225 00:08:52,399 --> 00:08:54,901 AND THEN, AGAIN, A NUMBER OFUTE 226 00:08:54,901 --> 00:09:00,673 OTHERS ASELL. 227 00:09:00,673 --> 00:09:02,242 I JUST WANT TO REMIND Y ABOUT 228 00:09:02,242 --> 00:09:03,643 OUR SATEGIC PLAN. 229 00:09:03,643 --> 00:09:05,545 AS PART OF T0TH CTURY 230 00:09:05,545 --> 00:09:07,147 CURES A, ABOUT THE FINAL PIECE 231 00:09:07,147 --> 00:09:09,449 OF LEGISLATION THAT PRESINT 232 00:09:09,449 --> 00:09:11,985 OBAMA SIGNED IN NOVEMBER OF 233 00:09:11,985 --> 00:09:13,186 2016, THAT REQUID EACH 234 00:09:13,186 --> 00:09:17,557 FOR CHD, WE HAD ACTUALLY N 235 00:09:17,557 --> 00:09:19,426 NE ONE SINCE THE LAST CENTURY. 236 00:09:19,426 --> 00:09:20,860 THIS WAS REALLY A MAJ 237 00:09:20,860 --> 00:09:22,929 EFFORT LED BY OUR DIRECTOR, 238 00:09:22,929 --> 00:09:23,863 DR. BIANCHI, AND OVER T COUE 239 00:09:23,863 --> 00:09:27,534 OF ABOUT TWO YEARS, WE ENGAGED 240 00:09:27,534 --> 00:09:30,036 WITH NUMEROUS, NUMEROUS 241 00:09:30,036 --> 00:09:32,005 H ASELL AS EERL, INTERNAL TO 242 00:09:32,005 --> 00:09:33,206 OBABLY SOMEF YOU WERE 243 00:09:33,206 --> 00:09:38,378 AND BASICALLY WITH AN ITERATIVE 244 00:09:38,378 --> 00:09:40,680 PROCESS, TOOK OVER 200 245 00:09:40,680 --> 00:09:41,981 SCIENTIFIC THEMESND FOCUSED 246 00:09:41,981 --> 00:09:44,851 THEM DOWN TO THESE FIVE. 247 00:09:44,851 --> 00:09:46,719 THI STRATEGIC PLAN WAS 248 00:09:46,719 --> 00:09:47,887 LAUNCHED IN THE FALL OF 29, 249 00:09:47,887 --> 00:09:49,656 JUST BOR THE PANDEMI AND WE 250 00:09:49,656 --> 00:09:51,958 E NOW IN THE PROSS OF 251 00:09:51,958 --> 00:09:53,493 REFRESHING THAT STRATEGIC PN, 252 00:09:53,493 --> 00:09:56,463 SO WE'RE ENGAGING I A NUMBER OF 253 00:09:56,463 --> 00:09:57,063 LISTENING SESSIONS AGAIN THAT 254 00:09:57,063 --> 00:09:59,065 SOME OF YOU M B INVOLVED 255 00:09:59,065 --> 00:10:00,467 TH, AND THERE WILL ALSO BE A 256 00:10:00,467 --> 00:10:01,201 REQUESTOR INFORMATION THA 257 00:10:01,201 --> 00:10:03,536 WE'LL MAKE SURHAT FOLKS GET 258 00:10:03,536 --> 00:10:05,505 THAT LINK SO YOU'RE ABLE T 259 00:10:05,505 --> 00:10:06,506 PROVIDE INPUT. 260 00:10:06,506 --> 00:10:09,676 EXPECTING A MAJOR REVAMPING OF 261 00:10:09,676 --> 00:10:10,743 IT, BU REALLY WHAT WE'RE 262 00:10:10,743 --> 00:10:14,047 CALLING IT IS A STRATEGIC PN 263 00:10:14,047 --> 00:10:15,248 REFRESH. 264 00:10:15,248 --> 00:10:16,983 OUR CURRENT STREGIC PLAN THAT 265 00:10:16,983 --> 00:10:18,852 AS I SD WAS LAUNCHED I 2019, 266 00:10:18,852 --> 00:10:21,454 THESE ARE OUR FE SCIENTIFIC 267 00:10:21,454 --> 00:10:22,689 THES AND HIGHLIGHTEDRE IN 268 00:10:22,689 --> 00:10:24,123 RED,F COSE, IS THE ONE TT 269 00:10:24,123 --> 00:10:25,859 AI TOHI GROUP AND THIS 270 00:10:25,859 --> 00:10:26,960 WORKSH, WHICH IS SETTING THE 271 00:10:26,960 --> 00:10:29,262 PREGNANCIES AND LIFELONG 272 00:10:29,262 --> 00:10:29,529 WENESS. 273 00:10:29,529 --> 00:10:31,865 AND I THINK A KEY THEME HERE IS 274 00:10:31,865 --> 00:10:33,500 NOJUSTHE HEALTH OF A 275 00:10:33,500 --> 00:10:35,468 EGNANC BUT HOW IMPORTANT THE 276 00:10:35,468 --> 00:10:39,105 PREGNANCY IS IN THE LIF OF AN 277 00:10:39,105 --> 00:10:40,507 INDIVIDUAL IN TMS O-- BOTH 278 00:10:40,507 --> 00:10:41,941 AS A STRESS TEST F FUT 279 00:10:41,941 --> 00:10:45,645 HAINGER F OTHER IS AS 280 00:10:45,645 --> 00:10:46,412 WE 281 00:10:46,412 --> 00:10:48,147 SO REALLYORTANT THEME IS NOT 282 00:10:48,147 --> 00:10:50,583 JUST THE PREGNANCY, BUT REALLY 283 00:10:50,583 --> 00:10:53,086 THE HEAL AND WELLNESS OF THE 284 00:10:53,086 --> 00:10:54,420 PREGNANTERSON BEFORE AND AFT 285 00:10:54,420 --> 00:10:59,192 PREGNC 286 00:10:59,192 --> 00:11:00,960 SO OF URSELL OF YOUNOW 287 00:11:00,960 --> 00:11:03,363 EVEN BETTER THA I DO AS AN 288 00:11:03,363 --> 00:11:04,464 INFECTIOUS DISEA DOCTOR WHAT A 289 00:11:04,464 --> 00:11:06,766 ISIS WE' FACIN IN MERNAL 290 00:11:06,766 --> 00:11:08,301 MORBIDITY AND MORTALITYN THIS 291 00:11:08,301 --> 00:11:10,036 COUNTRY, ANDHIS GRAPH HERE IS 292 00:11:10,036 --> 00:11:11,604 SHOWINE CSES OF 293 00:11:11,604 --> 00:11:13,206 PREGNANCTED DEATHS IN THE 294 00:11:13,206 --> 00:11:16,376 HEU.ROM 2017 T 2020, AND AS 295 00:11:16,376 --> 00:11:18,144 YOU CAN SEE, HORAGE HERE IS 296 00:11:18,144 --> 00:11:20,780 LISTED AS A MAJORONTRIBUTOR, 297 00:11:20,780 --> 00:11:24,217 AND REALLY THE FOURTH LEADING 298 00:11:24,217 --> 00:11:25,151 USE OF MBIDITYND 299 00:11:25,151 --> 00:11:30,823 MORTALITY. 300 00:11:30,823 --> 00:11:33,059 AND I THINK WE ALSO ALL OR YOU 301 00:11:33,059 --> 00:11:34,427 ALL KNOW AGAIN BETTER THAN IO, 302 00:11:34,427 --> 00:11:36,629 I THINK THIS WHOLE ISSUE AROUNDA 303 00:11:36,629 --> 00:11:39,799 MATERNITY CARE DEZ ERT AS WELL. 304 00:11:39,799 --> 00:11:42,201 DES AS WELL. 305 00:11:42,201 --> 00:11:44,170 SO BASICAL WHILE THERE ARE 306 00:11:44,170 --> 00:11:46,372 URBAN CENTERS, ESPECIALLY ON THE 307 00:11:46,372 --> 00:11:47,774 COAST WHE WE HAVE A LOT OF 308 00:11:47,774 --> 00:11:48,975 AVAIBILITY OF CE, THERE ARE 309 00:11:48,975 --> 00:11:50,610 MANYMA AREAS INHIS COURY 310 00:11:50,610 --> 00:11:53,913 THAT REALL LACK APPPRIATE 311 00:11:53,913 --> 00:11:58,051 MATERNITY CARE. 312 00:11:58,051 --> 00:12:00,853 SO THEN WHAT ARE WE DOING WITH 313 00:12:00,853 --> 00:12:02,655 ALTH INFSTRUCTURE?N MATERL 314 00:12:02,655 --> 00:12:05,592 SO AS MENTIONED WE LEAD THIS 315 00:12:05,592 --> 00:12:07,026 NIH-WIDE EFFORT CALLED THE 316 00:12:07,026 --> 00:12:08,127 IMPROV INITIIVE. 317 00:12:08,127 --> 00:12:10,096 IMPROVE STANDS FOR IMPLEMENTING 318 00:12:10,096 --> 00:12:11,297 A MATERNALEALTH AND PREGNAN 319 00:12:11,297 --> 00:12:13,066 OUTCOMES VISION FOR EVERYONE. 320 00:12:13,066 --> 00:12:15,802 THIS WASCTUALLY LAUNCHED IN 321 00:12:15,802 --> 00:12:19,339 APPROPRIATED DOLLARS, A IT WAS 322 00:12:19,339 --> 00:12:22,342 ONLY AFTER019HA CONGRESS 323 00:12:22,342 --> 00:12:23,443 ACTUALLY SFICALLY GNT 324 00:12:23,443 --> 00:12:25,411 DOLLARS FOR THIS EFFORT, BUT 325 00:12:25,411 --> 00:12:32,619 WE ACTUALLY HAD DEDATEDEN BEFORE 326 00:12:32,619 --> 00:12:34,053 FUNDING FOR IT. 327 00:12:34,053 --> 00:12:36,789 CURRENTLY THE FUNNG FT 328 00:12:36,789 --> 00:12:38,625 IS -- NAHIDA CORRECT ME IF'M 329 00:12:38,625 --> 00:12:41,260 WRONG, BUT ABOUT $43 MILLI A 330 00:12:41,260 --> 00:12:43,229 YEAR AGAIN THAT WE AT NICHD A 331 00:12:43,229 --> 00:12:45,465 LEADING BUT A NUMBER OF OTHER 332 00:12:45,465 --> 00:12:47,367 INSTITUTES ARE INVVED. 333 00:12:47,367 --> 00:12:48,501 IT'S SORTF MULTIFACETED 334 00:12:48,501 --> 00:12:49,369 PRRAM. 335 00:12:49,369 --> 00:12:53,406 REDUCINGRENTABLE CAUSE OFUSH, ON 336 00:12:53,406 --> 00:12:54,407 MATERNAL DEATHS ANDMPROVING 337 00:12:54,407 --> 00:12:56,643 HEAL FOMEN BEFORE, DING 338 00:12:56,643 --> 00:12:57,877 AND AFTER DELIVERY. 339 00:12:57,877 --> 00:12:59,846 AGAIN, KEY T OUR SCIENTIFIC 340 00:12:59,846 --> 00:13:00,613 RESEARCH THEME ABOUT THAT IT'S 341 00:13:00,613 --> 00:13:02,582 T JUST ABOUT HLTH DURING 342 00:13:02,582 --> 00:13:04,350 HEALTHEFORE AND AFTTANCE ABOUT 343 00:13:04,350 --> 00:13:05,985 PREGNANCY ASL. 344 00:13:05,985 --> 00:13:07,420 D OF COURSE GIVEN 345 00:13:07,420 --> 00:13:10,356 THIS COUNTRY, THERE'S A SPECIAL 346 00:13:10,356 --> 00:13:11,324 EMPHASIS ON HEALTH DISPARIES 347 00:13:11,324 --> 00:13:13,526 AND POPULATIONS THAT ARE 348 00:13:13,526 --> 00:13:14,327 DISPROPORTIONATELY AFFECTED. 349 00:13:14,327 --> 00:13:16,496 AS I MENTIONED, THIS IS A 350 00:13:16,496 --> 00:13:18,331 MULTACETED PGRAM UNDER 351 00:13:18,331 --> 00:13:23,569 IMPLENTAON PROGRAM OR CALLED 352 00:13:23,569 --> 00:13:24,804 THE CIHERE'S THE MATERNAL 353 00:13:24,804 --> 00:13:26,105 ALTH RESEARCH CENTERS OF 354 00:13:26,105 --> 00:13:26,973 CELLENCE THAT WERJUST 355 00:13:26,973 --> 00:13:29,709 RECENTLY AWARDED AND WE'RE 356 00:13:29,709 --> 00:13:30,476 ANTIPATINGNOTHER ROUND OF 357 00:13:30,476 --> 00:13:33,112 EXCELLENCE.OSEENTERS O 358 00:13:33,112 --> 00:13:35,081 AGAIN, IMPORTANT FOR THIS IS NOT 359 00:13:35,081 --> 00:13:36,382 JUST BASICEARCH BUT 360 00:13:36,382 --> 00:13:38,785 IMEMENTATION, SO W HAV 361 00:13:38,785 --> 00:13:41,087 EFRTS IN THOSERT ARE AS WEL 362 00:13:41,087 --> 00:13:43,189 WE'RE ALSOF COURSE -- VER 363 00:13:43,189 --> 00:13:44,691 IMPORTANT TT THIS RESEARCH IS 364 00:13:44,691 --> 00:13:46,025 PARTNERED WITH COMMUNI, AND SO 365 00:13:46,025 --> 00:13:48,428 CONNECTING T COMNITY FOR A 366 00:13:48,428 --> 00:13:50,163 MATERNAL HEALTH CHALLENGE, AND 367 00:13:50,163 --> 00:13:51,531 THIS CHALLENGEIS MECNISMS A 368 00:13:51,531 --> 00:13:53,166 UNUE MECHANISM AT THE NIH 369 00:13:53,166 --> 00:13:54,600 THAT'SOT A GRA OR 370 00:13:54,600 --> 00:13:57,003 CONTRACT, BUT REALLY ALLOWS FOR 371 00:13:57,003 --> 00:13:58,404 ORGANIZATIONS THAT USUALLY DON 372 00:13:58,404 --> 00:14:00,707 COMPETE FORIHUNDING, AN 373 00:14:00,707 --> 00:14:02,975 ABILITY TO ACTUALLY ENGAGE WITH 374 00:14:02,975 --> 00:14:04,977 NIH AND SEEK FUNDINGS WELL. 375 00:14:04,977 --> 00:14:06,412 D THERE'SLSO ANOTHER 376 00:14:06,412 --> 00:14:10,016 REALLY T T ENCOURAGENG TO 377 00:14:10,016 --> 00:14:15,188 RADX, WHICH WAS A PROGRAM STOOD 378 00:14:15,188 --> 00:14:17,156 UP BY THE BIOMEDICAL ENGINEERING 379 00:14:17,156 --> 00:14:18,257 INSTITUTE DURING COVID, AND 380 00:14:18,257 --> 00:14:20,293 THEY'RE NOW TING THAT 381 00:14:20,293 --> 00:14:21,527 INFRTRUCTURE AND RESRCE AND 382 00:14:21,527 --> 00:14:25,598 REALXPANDING IT BEYOND COV 383 00:14:25,598 --> 00:14:26,766 R INNOVIVE TECHNOLOGS. 384 00:14:26,766 --> 00:14:28,634 ONE OF T FIRST NON-COVID 385 00:14:28,634 --> 00:14:31,104 CHALLENGESHAT THEY'RE DOING IS 386 00:14:31,104 --> 00:14:32,472 WELL.ATERNAL HLTH CHALLENGE AS 387 00:14:32,472 --> 00:14:33,773 AGAIN,HIS IS TO TRY TO 388 00:14:33,773 --> 00:14:34,774 ENURAGE TECHNOLOGIES TO 389 00:14:34,774 --> 00:14:40,646 AND MORTALITYRISIS.IDITY 390 00:14:40,646 --> 00:14:44,717 THE MATERNAL HEALTH RESEA,MP 391 00:14:44,717 --> 00:14:47,887 THE ITIAL SET OFWARDS FORADE 392 00:14:47,887 --> 00:14:51,124 ESE CENTERS WIT $24 MILLI 393 00:14:51,124 --> 00:14:53,993 YEAR AND WRE ANTICIPATING 394 00:14:53,993 --> 00:14:54,660 FURTHER AWARDSHIS YEAR. 395 00:14:54,660 --> 00:14:58,831 I MTIONED THE RADXECH FOR 396 00:14:58,831 --> 00:14:59,599 MATERNAL HEALTH CHAENGE 397 00:14:59,599 --> 00:15:02,001 THEREE'RE INVESNG UP TO 398 00:15:02,001 --> 00:15:02,769 $8 MILLION THROU SEVERAL 399 00:15:02,769 --> 00:15:06,606 PHASES OF INNATIO, THEN 400 00:15:06,606 --> 00:15:07,807 NNECTATHON, WE ALSO REALIZE IN 401 00:15:07,807 --> 00:15:09,575 THIS AGEF BIG DATA AND 402 00:15:09,575 --> 00:15:10,877 ELECTRONIC HEALTH RECORD WHAT A 403 00:15:10,877 --> 00:15:15,047 LUABLE RESE THO BIG DATARESOURCW 404 00:15:15,047 --> 00:15:16,783 DIFFICULT IT CAN SOMETIMES BE TO 405 00:15:16,783 --> 00:15:20,953 PRNANCY, DURING PREGNANCY, 406 00:15:20,953 --> 00:15:23,022 STREGNANCY AND OFT AGA 407 00:15:23,022 --> 00:15:26,092 IMPORTANTLY WH THE OFFSPHRING 408 00:15:26,092 --> 00:15:28,828 SPRING AS WELL, SO AGA UNDER 409 00:15:28,828 --> 00:15:31,497 NADA'S LEADERSHIP, WE HE THE 410 00:15:31,497 --> 00:15:33,432 CONNECTAON TO IB OVATE AROUND 411 00:15:33,432 --> 00:15:36,302 HOW WE CAN ACTUALLY CONNECT 412 00:15:36,302 --> 00:15:37,503 INDIVIDUALS ACROSS MULTIPLE 413 00:15:37,503 --> 00:15:38,938 ECONIC SYSTEMS TOE ABLE TO 414 00:15:38,938 --> 00:15:40,006 BETTER TCK, AGAIN, NOT JUST 415 00:15:40,006 --> 00:15:41,307 TH HEALTH OF T PREGNANCY BUT 416 00:15:41,307 --> 00:15:42,108 HEALTH BEFOR AND AFT 417 00:15:42,108 --> 00:15:48,881 MENTIONED ALREADY OF COURSE WE 418 00:15:48,881 --> 00:15:49,749 HAVE MAJORLICAL TRIAL 419 00:15:49,749 --> 00:15:51,384 EFFORTS I THESE AREAS WITH T 420 00:15:51,384 --> 00:15:54,220 MATERNAL FAL MEDICE NRK. 421 00:15:54,220 --> 00:15:54,987 AIN FOR INDIVUALS THAT ARE 422 00:15:54,987 --> 00:15:57,523 INTERESTED IN CLINIC TRIALS, 423 00:15:57,523 --> 00:15:59,926 WE HE TOTALLY REVAMPED OUR 424 00:15:59,926 --> 00:16:00,793 CLINICAL TRIAL INFRASTRUCTURE B 425 00:16:00,793 --> 00:16:02,662 BASICALLY OPENG IT UP TO 426 00:16:02,662 --> 00:16:04,363 OUTSID INVTIGATORS, AND SO 427 00:16:04,363 --> 00:16:05,731 WHILE, AGAIN, CERTAINLY WITHIN 428 00:16:05,731 --> 00:16:09,902 PROPOSE TRIE ARE ALSOARE ABLE TO 429 00:16:09,902 --> 00:16:10,803 ENURING INVESTIGATS THAT 430 00:16:10,803 --> 00:16:12,271 ARE NOT PART OFHE NETWORK TO 431 00:16:12,271 --> 00:16:13,306 PROPOSE TRIALS AS WL, AND WE 432 00:16:13,306 --> 00:16:18,611 HAVE A PROGRAM ANNOUNCEN THAT 433 00:16:18,611 --> 00:16:20,146 HIGHLIGHTS THAT AND WE CAN SHARE 434 00:16:20,146 --> 00:16:23,216 OF COURSEERY, VERY ALIGNED 435 00:16:23,216 --> 00:16:27,920 WITH MUCH OF WHAT WE DO, WE HAVE 436 00:16:27,920 --> 00:16:29,555 THE NEONATAL RESEARCH NETWORK 437 00:16:29,555 --> 00:16:31,858 AL, REALLY TRYI TO ENCOURAGE 438 00:16:31,858 --> 00:16:32,592 GREATER RGS ACROSS TSE 439 00:16:32,592 --> 00:16:37,096 TWO NETWORKS. 440 00:16:37,096 --> 00:16:38,865 I KNOW I'M PROBABLY RUNNING 441 00:16:38,865 --> 00:16:40,600 OF TE BUT WANT TO JUS END 442 00:16:40,600 --> 00:16:43,002 WI THIS SLIDE TO REALLY THINKABS 443 00:16:43,002 --> 00:16:44,303 FOR YOU ALLO ADDRESS OVERHE 444 00:16:44,303 --> 00:16:48,474 NEXT DAY AND HALF.AGAIN, AS A FE 445 00:16:48,474 --> 00:16:49,709 HAVE -- SOMETIMES I FEEL LIKE WE 446 00:16:49,709 --> 00:16:53,946 MY DISION, WE HAVE OF MONEY. 447 00:16:53,946 --> 00:16:54,714 $1.2 BILLION A YEAR, BUT OF 448 00:16:54,714 --> 00:16:57,016 COURSE WHEN YOU THINK ABOUT T 449 00:16:57,016 --> 00:16:58,417 BROAD IO OF NICHD,SE 450 00:16:58,417 --> 00:17:01,053 DOLLAR END UP GETTING SPREAD 451 00:17:01,053 --> 00:17:02,588 ACROSS MANY, MANY DIFFERENT 452 00:17:02,588 --> 00:17:06,859 VERY STREGIC IN HOW WE DEPLOBE 453 00:17:06,859 --> 00:17:08,160 THOSE RESOS ANDE REALLY 454 00:17:08,160 --> 00:17:09,595 RELY ON WORKSHOPS LIKE T TO 455 00:17:09,595 --> 00:17:13,199 REALLYELP US FOC THE BES 456 00:17:13,199 --> 00:17:13,633 WAY POSSIBLE. 457 00:17:13,633 --> 00:17:14,567 SO I THINK SE OF THE QUESTIONS 458 00:17:14,567 --> 00:17:16,602 FOR YOU ALL TOR ARE WHAT 459 00:17:16,602 --> 00:17:17,703 REURCES AND IRASTRUCTURE ARE 460 00:17:17,703 --> 00:17:21,874 NEEDED T ENHAN AND ADVANCE 461 00:17:21,874 --> 00:17:23,175 PLENTACCTA SPERUM 462 00:17:23,175 --> 00:17:24,110 SCREENING DIAGNOSIS AND 463 00:17:24,110 --> 00:17:24,810 MANAGEMENT, WHRE THE ECK 464 00:17:24,810 --> 00:17:26,979 SENIOR INVESTIGATORS GAPS AND 465 00:17:26,979 --> 00:17:31,817 SOLVING, HOW CAN WE MOTIVATE 466 00:17:31,817 --> 00:17:33,386 RESEAR TOTILIZE RESOUES 467 00:17:33,386 --> 00:17:35,621 CURRENTLY AT THE DSAL MORE 468 00:17:35,621 --> 00:17:36,489 EFFECTIVELY, LOOKING TO EMPLOY 469 00:17:36,489 --> 00:17:39,025 NEW RESOURCES BUT HOW CAN WE 470 00:17:39,025 --> 00:17:39,992 EMPLOY EXISTING RESOURCES TO 471 00:17:39,992 --> 00:17:41,294 ADDRESS THISSSUE AND HOW CAN 472 00:17:41,294 --> 00:17:43,729 WE AT NICHD ENHANCE PARTNERSHIP 473 00:17:43,729 --> 00:17:45,565 WITH INTERESTED STAKEHOLDERS TO 474 00:17:45,565 --> 00:17:46,766 ACEVE MUTUAL OBJECTIVES. 475 00:17:46,766 --> 00:17:48,634 WITH THAT, IIL AGAIN REALLY 476 00:17:48,634 --> 00:17:51,704 WANTO LCOM EVERYONE HERE, 477 00:17:51,704 --> 00:17:54,106 FOR ALL O THEORKT TAKES TOO 478 00:17:54,106 --> 00:17:55,308 PUT TOGETHER WORKSHO LIKE 479 00:17:55,308 --> 00:17:56,943 THIS, AND REALLY LOOK FORWARD TO 480 00:17:56,943 --> 00:17:58,945 HEARING ABOUT WHATOMES OUT OF 481 00:17:58,945 --> 00:18:00,980 THIS NEXT DAY AND HALF. 482 00:18:00,980 --> 00:18:11,157 THANK YOU. 483 00:18:21,367 --> 00:18:23,269 WE HAV TO FIX A LITTLE BIT 484 00:18:23,269 --> 00:18:27,206 OF THE SEEN BEFE WE PROCEED 485 00:18:27,206 --> 00:18:28,307 BECAUSE IN THE RM, THE SCREEN 486 00:18:28,307 --> 00:18:30,376 DOESN'T LOOK AS IT SHOULD. 487 00:18:30,376 --> 00:18:40,553 THANK YOU. 488 00:18:47,326 --> 00:18:49,195 >> HELLO, EVERYONE. 489 00:18:49,195 --> 00:18:50,496 WEE J THRILLED THAT YOU 490 00:18:50,496 --> 00:18:51,797 CAME HERE IN PERSON, AND THOSE 491 00:18:51,797 --> 00:18:56,068 WA TO REVIE THE GOA OF E, WE 492 00:18:56,068 --> 00:18:56,602 WORKSHOP. 493 00:18:56,602 --> 00:18:58,771 AME IS BRETT EINERSON, 494 00:18:58,771 --> 00:18:59,338 UNIVERSITY OF UTAH. 495 00:18:59,338 --> 00:19:02,541 I CHRISTIUZ YANG JIECHI 496 00:19:02,541 --> 00:19:10,182 FROM MASSA.H ENCOURAGED ALL OF S 497 00:19:10,182 --> 00:19:11,517 TO NOT INCLUDE THIS FIRSTULT 498 00:19:11,517 --> 00:19:12,518 IN THEIRRESENTATIONS TOD, 499 00:19:12,518 --> 00:19:14,587 BUT I THI AT LEAST ONCE TAY 500 00:19:14,587 --> 00:19:15,654 WE HAVE TO ACKNOWLEDGE THAT 501 00:19:15,654 --> 00:19:18,057 REASON WE'RE ALL IN THIS ROOM IS 502 00:19:18,057 --> 00:19:20,426 THAT PCENTA ACCRETA IS A 503 00:19:20,426 --> 00:19:22,662 SERIOU DISEASE TT TAKES 504 00:19:22,662 --> 00:19:23,696 SERIOU STRATEGS AND 505 00:19:23,696 --> 00:19:25,297 MANAMENT AND THATE A KNOW 506 00:19:25,297 --> 00:19:26,499 THAT FOR MANY OF US I THIS 507 00:19:26,499 --> 00:19:29,602 ROOM, THIS HASN A LIFELONG 508 00:19:29,602 --> 00:19:31,437 PASSION PROJECT, SO THIS IS A 509 00:19:31,437 --> 00:19:33,172 PLACE WHERE WE ARE HEFUL THAT 510 00:19:33,172 --> 00:19:34,407 WE'LL HAV THE OPPORTUNITY TO 511 00:19:34,407 --> 00:19:35,941 GET TOGETHER TO TALKBOUT NOT 512 00:19:35,941 --> 00:19:40,980 PRACTICE BUT TO TNK ABOUT HOW 513 00:19:40,980 --> 00:19:42,114 WE MOVE THE STATEF THEHE SCIENCE 514 00:19:42,114 --> 00:19:43,949 AND WHAT I KNOW FROM 515 00:19:43,949 --> 00:19:44,817 CONVERSATIS WITH S MY OF 516 00:19:44,817 --> 00:19:47,753 GHT NOWHERE WE HAVE AE 517 00:19:47,753 --> 00:19:48,854 THENE BEST PRACTICE A 518 00:19:48,854 --> 00:19:50,189 THERE ARE INSTITUTIONSHAT HE 519 00:19:50,189 --> 00:19:51,590 DIFFERENT STRATEGIESORT 520 00:19:51,590 --> 00:19:53,359 WORKS FOR THEM, AND THAT PEOPLE 521 00:19:53,359 --> 00:19:54,260 ARE SORT OF INDIVIDUALIZING 522 00:19:54,260 --> 00:19:55,761 WHERE THEY ARE WITHHAT WORKS 523 00:19:55,761 --> 00:19:57,329 FOR THEM AND WE REALLY NEED TO 524 00:19:57,329 --> 00:19:59,799 MOVE FROM THAT PHASE INTO A NEW 525 00:19:59,799 --> 00:20:03,169 PRACTICES A NEW APPROACHEST 526 00:20:03,169 --> 00:20:04,970 THAT WE CAN DO REAL SCICE ON, 527 00:20:04,970 --> 00:20:06,105 REAL RESEARCH, SO THE 528 00:20:06,105 --> 00:20:07,606 OPPORTUNITY OF THIS WORKSHOP IS 529 00:20:07,606 --> 00:20:09,975 FOR US T REALLY GET TOGETHEA 530 00:20:09,975 --> 00:20:12,712 PANEL OF ABSOLUT EXPERTS, AND 531 00:20:12,712 --> 00:20:15,781 WHEN WE WERE APPROACHED TO THINE 532 00:20:15,781 --> 00:20:16,749 PEOP THAT WERE GOING TO 533 00:20:16,749 --> 00:20:20,619 IN PLACENTA ACCRE SPECTRUM FOR 534 00:20:20,619 --> 00:20:23,089 US TO TACE, I WAS REALLY 535 00:20:23,089 --> 00:20:25,324 AMING OPPORTUNITY BRING THE 536 00:20:25,324 --> 00:20:26,859 LEADERS IN THE COURY, NATNAL 537 00:20:26,859 --> 00:20:29,695 HOW WE SHAPE THE FUTUR OFBOUT 538 00:20:29,695 --> 00:20:30,863 SPECTRUM.FOR PLACENTA ACCRETA 539 00:20:30,863 --> 00:20:32,231 SOHANK YOU ALLOR AEPTING 540 00:20:32,231 --> 00:20:36,836 BRETTND I, IT WAS A REALLYSE FOR 541 00:20:36,836 --> 00:20:38,504 TING MOMENT TO THINK WHO ARE 542 00:20:38,504 --> 00:20:39,872 E LEADE IN THE WORLD 543 00:20:39,872 --> 00:20:40,639 THINNGBOUT THIS A HOW D 544 00:20:40,639 --> 00:20:41,741 WE MOVE THE STATE OF THE SCIENCE 545 00:20:41,741 --> 00:20:42,174 FORWARD. 546 00:20:42,174 --> 00:20:44,477 SO THE GOALF THE WORKSHOP FOR 547 00:20:44,477 --> 00:20:46,112 THE NEXT DAY AND A HALF ARE FOR 548 00:20:46,112 --> 00:20:48,781 INSIGHTS, THINK ABO CONSENSUS 549 00:20:48,781 --> 00:20:50,382 ON WHAT ARE T TOPIC THAT NEED 550 00:20:50,382 --> 00:20:51,584 SOLUTE ADDRESS, WHERE ARE 551 00:20:51,584 --> 00:20:52,818 GAPS, AT ARE THE THING T TT 552 00:20:52,818 --> 00:20:54,453 WE DON'T KNOW OR WE'RE SORT OF 553 00:20:54,453 --> 00:20:55,654 MAKING UP AS WE'RE WORKING 554 00:20:55,654 --> 00:20:59,892 THROUGH CAREF PATIENTS, AND HO 555 00:20:59,892 --> 00:21:00,860 HIGHLIGHT AT ARE OUR 556 00:21:00,860 --> 00:21:01,193 OPPORTUNITIES. 557 00:21:01,193 --> 00:21:02,428 THIS ISEALLY INTENDED TO BE A 558 00:21:02,428 --> 00:21:05,564 CLICAL EXPERIENCE, SO 559 00:21:05,564 --> 00:21:06,198 CLINICLY-FOCUSED WORKSHOP, A 560 00:21:06,198 --> 00:21:08,234 I THINK THAT TT'S VERYPIC 561 00:21:08,234 --> 00:21:09,535 BSTETRICS, WE'RE MOVING TO 562 00:21:09,535 --> 00:21:11,403 THE CNICAL AS W MAYBE DON'T 563 00:21:11,403 --> 00:21:12,037 MPLELY UNDERSTAN THE 564 00:21:12,037 --> 00:21:13,139 SCIENCE, BUT WE'RE SLL WORKING 565 00:21:13,139 --> 00:21:13,772 THROUGH THAT. 566 00:21:13,772 --> 00:21:15,007 SO THINKING THROUGH HOW WE 567 00:21:15,007 --> 00:21:15,908 MANAGE THE PATIENTTHAT A IN 568 00:21:15,908 --> 00:21:18,811 FRONT OF US WELL. 569 00:21:18,811 --> 00:21:20,579 THEN TO ENHANCE UNDERSTANDING 570 00:21:20,579 --> 00:21:21,747 FOR ENTSND UNDERSTAND 571 00:21:21,747 --> 00:21:23,749 WHERE CAN WE BETTER INFORM OUR 572 00:21:23,749 --> 00:21:24,783 CLICAL RESEARCH EFFTS. 573 00:21:24,783 --> 00:21:28,220 >> YOU MAY NICE THAT NOTVERY 574 00:21:28,220 --> 00:21:32,791 SILEERSON OR SPECIALTY THAT 575 00:21:32,791 --> 00:21:33,592 TAKES PA IN PLACENTA ACCRETA 576 00:21:33,592 --> 00:21:34,660 ECTRUM IS PRESENT AT THE 577 00:21:34,660 --> 00:21:39,331 THAT ISOMETHING ACKNOWL 578 00:21:39,331 --> 00:21:39,832 KNOWLEDGE. 579 00:21:39,832 --> 00:21:43,435 BUT ALSO A WE THOUGHT ABOUT HOWN 580 00:21:43,435 --> 00:21:44,436 ACCOLISHING THE GOALS OF 581 00:21:44,436 --> 00:21:46,705 MOVINGLICAL RESEARCH 582 00:21:46,705 --> 00:21:48,140 FORWARD, WE HAD TOAKE SOME 583 00:21:48,140 --> 00:21:49,575 DECISIONS ABOUT WHO AND WHO 584 00:21:49,575 --> 00:21:50,776 COULDN'T BE HERE, BUT THAT DOES 585 00:21:50,776 --> 00:21:52,077 NOT MN THATE DON'T 586 00:21:52,077 --> 00:21:53,512 APPRECIATE T FACT THAT OTHER 587 00:21:53,512 --> 00:21:56,248 PEOPLE ARENVOLVED IN THEARE 588 00:21:56,248 --> 00:21:58,751 OF PIENTS AND THEESEARCH 589 00:21:58,751 --> 00:21:59,718 INVOLVED IN PLACTA ACCRETA 590 00:21:59,718 --> 00:22:01,587 ECTRUM. 591 00:22:01,587 --> 00:22:02,788 SO HOW A WE GOING TO BEING A 592 00:22:02,788 --> 00:22:03,355 PUISH OUR GOALS? 593 00:22:03,355 --> 00:22:05,090 ON DAY O, WRE GOING T HAVE 594 00:22:05,090 --> 00:22:07,493 FOCUSED PRESENTATIONS FROM 595 00:22:07,493 --> 00:22:09,028 BJECMATTER EXPTS BROKEN 596 00:22:09,028 --> 00:22:12,097 ROUGHLY INTO FOUR BAS TOPICAL 597 00:22:12,097 --> 00:22:12,298 AREAS. 598 00:22:12,298 --> 00:22:13,532 THERE IS SOME OVERLAP BETWEEN 599 00:22:13,532 --> 00:22:14,867 AREAS SO WE'VE INSTRUCTED OUR 600 00:22:14,867 --> 00:22:17,670 MOD RMORATORS TO KIND OF HELP KP 601 00:22:17,670 --> 00:22:24,076 GROUPS.IT UP BASED ON TSE FR DAY 602 00:22:24,076 --> 00:22:25,811 AND DAYWO, WE'REOING TO 603 00:22:25,811 --> 00:22:28,013 ENE WORKING GROUPS TO 604 00:22:28,013 --> 00:22:33,252 RESEARCH TARGETS FOR THE FURE 605 00:22:33,252 --> 00:22:34,153 AND THEN REPORT BACKAN TOHE 606 00:22:34,153 --> 00:22:35,921 GROUP WITH CONNSUS ON THOSE 607 00:22:35,921 --> 00:22:36,789 TOPIC PRIORITIES. 608 00:22:36,789 --> 00:22:37,756 EVENTUALLY, THAT WILL MAKE ITS 609 00:22:37,756 --> 00:22:39,525 Y IO WHITE PAPER, OF 610 00:22:39,525 --> 00:22:42,361 PEFULLY S ON RESEARCH AND 611 00:22:42,361 --> 00:22:49,368 WE'RE REALLY THALYFUL TOHOSE 612 00:22:49,368 --> 00:22:51,136 WHO AGREED T BE MODATORS. 613 00:22:51,136 --> 00:22:53,739 DR. CAHILL IS GOING TO LEAD OUR 614 00:22:53,739 --> 00:22:55,507 GROUP ONE ON PASPIDEMIOGY 615 00:22:55,507 --> 00:22:57,876 SCREENING AND DIAGNOSIS. 616 00:22:57,876 --> 00:23:02,181 DR. FO IS GOING TO WK 617 00:23:02,181 --> 00:23:02,815 THUGPREOPETIVE MAGEMENT 618 00:23:02,815 --> 00:23:06,752 AND PPARING FOR SURGERY. 619 00:23:06,752 --> 00:23:09,288 . WRIT ANDR. SDE ARE 620 00:23:09,288 --> 00:23:11,790 GOIN TO MODERATEUR SESSION ON 621 00:23:11,790 --> 00:23:15,828 OPERATIVE MANAGEMENT OF P 622 00:23:15,828 --> 00:23:18,030 DR. CARU IS GOING TO WK U 623 00:23:18,030 --> 00:23:20,966 THROUGH FOCUSED O PREVENTIVE 624 00:23:20,966 --> 00:23:22,101 AND PATNT-CENTERED APPROHES 625 00:23:22,101 --> 00:23:22,935 TOLACENTA ACCRA SPECTRUM. 626 00:23:22,935 --> 00:23:24,803 SO WE'RE VERY THANKFUL FOR THEM 627 00:23:24,803 --> 00:23:30,042 >> WE CERTAINLY ARE ALS GOING 628 00:23:30,042 --> 00:23:31,043 TO BE JOINING THESE WKING 629 00:23:31,043 --> 00:23:32,144 OUPS AND THIING THROUGH 630 00:23:32,144 --> 00:23:32,878 DIFFERENT STTEGIES GOING 631 00:23:32,878 --> 00:23:34,413 FORWD AND AO THIS IS GOING 632 00:23:34,413 --> 00:23:36,949 TO BE THE ITIAL CONTENT OF O 633 00:23:36,949 --> 00:23:39,618 DR. CAHI MERATING.IT 634 00:23:39,618 --> 00:23:42,187 U'LL NOTICE THAT WE ARE NOT 635 00:23:42,187 --> 00:23:44,023 GOING TO B DOING A L OF 636 00:23:44,023 --> 00:23:44,823 INTRODUCTIONS WE MOVE ON 637 00:23:44,823 --> 00:23:48,627 TIGHT.E THE TIMELESRE QUITE 638 00:23:48,627 --> 00:23:49,328 SO THIS IS OUR OPPORTUNITY FOR 639 00:23:49,328 --> 00:23:50,629 US TO SORT OF THI THROUGH THE 640 00:23:50,629 --> 00:23:51,063 ENDA. 641 00:23:51,063 --> 00:23:51,930 KNOW EVERYBODY HAS THE 642 00:23:51,930 --> 00:23:53,032 OPPORTUNY TO GRA THE AGENDA 643 00:23:53,032 --> 00:23:55,668 WHEN TY WALKED IN, PLEASE D 644 00:23:55,668 --> 00:23:57,736 BECAUSAS W SAID BEFORE, A 645 00:23:57,736 --> 00:23:59,705 DOG IN THIS CONFERENCE IS 646 00:23:59,705 --> 00:24:00,673 OVIDING OPPORTUNITIESOR FM 647 00:24:00,673 --> 00:24:02,775 PEOPLE TO GET TOGHER AND CHAT, 648 00:24:02,775 --> 00:24:12,084 SO DR. LYELL, DR. AHAR FOR 649 00:24:12,084 --> 00:24:14,019 >> SSIONWO, PREPARING FOR 650 00:24:14,019 --> 00:24:16,889 PAS SURGERY MODERATED BY 651 00:24:16,889 --> 00:24:18,190 DR. FOX, STARTING WITH 652 00:24:18,190 --> 00:24:18,724 DR. HERRERA. 653 00:24:18,724 --> 00:24:21,460 MODIFICATI TOHE SCHULE.GHT 654 00:24:21,460 --> 00:24:22,995 DR. FARBER ISOT ABLE TO MAKE 655 00:24:22,995 --> 00:24:29,635 ASED ON AN EMERGENCY, SO DR. CA, 656 00:24:29,635 --> 00:24:33,305 LAENT, AND THEN WE'REAT THE 657 00:24:33,305 --> 00:24:34,740 THRILLED TO HAVE DR. ROBTS 658 00:24:34,740 --> 00:24:38,911 PART OF SESSION T. THE TRD 659 00:24:38,911 --> 00:24:39,778 SESSION THREE, OPERATIVE 660 00:24:39,778 --> 00:24:40,879 NAGEMENTF PAS WIL BE 661 00:24:40,879 --> 00:24:44,683 MODETED BYR. I SDE AND 662 00:24:44,683 --> 00:24:48,087 DRWRIGHT. 663 00:24:48,087 --> 00:24:51,390 . SENTILHES, DR. HOBN, 664 00:24:51,390 --> 00:24:52,091 DR. SIBAI WILL SAKING 665 00:24:52,091 --> 00:24:52,758 DURING THI SESSION. 666 00:24:52,758 --> 00:24:54,493 SSI FR, PREVENTIVE 667 00:24:54,493 --> 00:24:56,328 AND PATIENT-CENTERED APPROACHES 668 00:24:56,328 --> 00:24:58,597 AGAIN MODERATED BY DR. CARI 669 00:24:58,597 --> 00:25:01,467 WILL INCLUDE THE PATIENT PERER 670 00:25:01,467 --> 00:25:05,204 PERSPECTIVE, DR.HAINR, 671 00:25:05,204 --> 00:25:06,839 SILVER AND BARTELS. 672 00:25:06,839 --> 00:25:08,140 HANK YOU FOR AGRING TO 673 00:25:08,140 --> 00:25:08,907 COME ANDIVE TALKS. 674 00:25:08,907 --> 00:25:10,209 VING PREVIEWED THE SLIDES, 675 00:25:10,209 --> 00:25:11,744 THEY'RE FANTASTIC, WE'RENOR 676 00:25:11,744 --> 00:25:12,311 A REALLY AMAZING DAY. 677 00:25:12,311 --> 00:25:13,612 I INK THIS IT'S GOING TO BE VER 678 00:25:13,612 --> 00:25:14,813 DIFFICULT FOR EH O THESE 679 00:25:14,813 --> 00:25:16,582 SPEAKERS TO STICK WITHIN THE 680 00:25:16,582 --> 00:25:20,152 ALLOTTED 2 MINUTES, S WHICH 681 00:25:20,152 --> 00:25:22,020 APOLOGIZE IN ADVANCE IF ABODY 682 00:25:22,020 --> 00:25:23,455 IS C OWP, THERE'S SO MUCH 683 00:25:23,455 --> 00:25:25,524 ING CONTT HE BUT GOOD 684 00:25:25,524 --> 00:25:26,859 FEUNTS ARE FUTURE TO CONNUE 685 00:25:26,859 --> 00:25:30,329 OUR ONGOINGISCUSSIONS TOMROW. 686 00:25:30,329 --> 00:25:33,298 ONE OF THE MOST IMPORTANT THINGS 687 00:25:33,298 --> 00:25:35,934 MONICA SAID WAS TT PLACENTAACCRM 688 00:25:35,934 --> 00:25:36,135 SPORT. 689 00:25:36,135 --> 00:25:37,369 I THINK WE ALL CAN ACKNOWLEDGE 690 00:25:37,369 --> 00:25:38,437 THAT AND THAT IT IS SETHI 691 00:25:38,437 --> 00:25:40,406 AT TES A L OF DFERENT 692 00:25:40,406 --> 00:25:41,407 AKEHOLRS, SO WE REALLY WANT 693 00:25:41,407 --> 00:25:44,676 TO THANK ALL OF THE DIFFERENT 694 00:25:44,676 --> 00:25:46,211 SOCIETIES WHO AGREED TO HAVE 695 00:25:46,211 --> 00:25:47,312 THEIR MEMBERS COME A JOIN. 696 00:25:47,312 --> 00:25:48,947 THIS IS A REALLY IMPORTANT PIECE 697 00:25:48,947 --> 00:25:52,117 OF THIS, NO SINGLE SOCIETY OWNS 698 00:25:52,117 --> 00:25:52,718 PLACENTA ACCRETA SCTRUM. 699 00:25:52,718 --> 00:25:54,119 IF ANYTHING, IT'S MOREMPORTANT 700 00:25:54,119 --> 00:25:55,187 FOR ALL OF US TO COME TOGETHER 701 00:25:55,187 --> 00:25:56,655 ABOUT WHAT ARE OUR VISIONS AND 702 00:25:56,655 --> 00:25:58,023 THE WAYSHAT WEANAGE, AND TO 703 00:25:58,023 --> 00:25:59,658 THIN THRGHHAT TOGETHER. 704 00:25:59,658 --> 00:26:02,294 SO THANK YOU TO EACH OF THE 705 00:26:02,294 --> 00:26:03,395 STEHOLDERS W AGRD TO 706 00:26:03,395 --> 00:26:04,430 ONSOR SOME OF THE SPEAKERS 707 00:26:04,430 --> 00:26:05,063 TOY. 708 00:26:05,063 --> 00:26:06,665 >> ANDE KNOW THAT WE HAVE TO 709 00:26:06,665 --> 00:26:14,773 RE TRA SHUFNLT WE ALSO WANTORE D 710 00:26:14,773 --> 00:26:17,609 TO POINT OUT A SPECIAL THANKS TO 711 00:26:17,609 --> 00:26:19,678 NAONALCCRETA FION AS 712 00:26:19,678 --> 00:26:21,213 WELL, A GRO OF PATIENT 713 00:26:21,213 --> 00:26:22,748 VOCATES REALLY PUSHING THAT 714 00:26:22,748 --> 00:26:23,849 AREAORWARD AND ARE MING SE 715 00:26:23,849 --> 00:26:24,950 THAT PATIENTS ASELL AS 716 00:26:24,950 --> 00:26:27,386 PHYSICIA KW ABOUT THI 717 00:26:27,386 --> 00:26:28,787 PROBLEM.DLOMPLEX ANDEADLY 718 00:26:28,787 --> 00:26:28,921 THAN 719 00:26:28,921 --> 00:26:31,757 . 720 00:26:31,757 --> 00:26:33,592 SO TT'S THE END OF OUR 721 00:26:33,592 --> 00:26:34,693 OVERVIEW FOR THEAY. 722 00:26:34,693 --> 00:26:40,599 FOR THE FIRST TALK AND AGA,YELL 723 00:26:40,599 --> 00:26:41,800 DR. CAHILL WILL BEERATING 724 00:26:41,800 --> 00:26:52,077 IS FIRSTESSION. 725 00:26:56,115 --> 00:26:57,082 >> GREAT. 726 00:26:57,082 --> 00:26:57,749 ANK YOU SO MUCH. 727 00:26:57,749 --> 00:27:00,953 I'M JUST WAINGOR MY VIEDZ TO SLS 728 00:27:00,953 --> 00:27:03,989 TO COME 729 00:27:03,989 --> 00:27:07,059 M DEIDRE LYELL, SNFORD, 730 00:27:07,059 --> 00:27:09,928 RENT BECAME THE CO-CHAI AND 731 00:27:09,928 --> 00:27:18,103 CO-PI OF -- AND IT IS DELIGHT T 732 00:27:18,103 --> 00:27:19,338 HERE. 733 00:27:24,309 --> 00:27:26,745 SO FIRST I HAVE DISCLOSURES 734 00:27:26,745 --> 00:27:28,180 NON-RELATED PLACENTA ACCRETA 735 00:27:28,180 --> 00:27:29,147 SPTRUM WHICH I'M GOING TO 736 00:27:29,147 --> 00:27:30,682 REFER TO AS PAS. 737 00:27:30,682 --> 00:27:36,722 WHEN I SAY PAS, I'M RERRING TO 738 00:27:36,722 --> 00:27:39,224 PLACENTA ACCRETA -- BUT I'M HERE 739 00:27:39,224 --> 00:27:42,127 ON BEHALFF THE PANAMERICAN 740 00:27:42,127 --> 00:27:42,694 SOCIETY FOR PLACENTACCRETA 741 00:27:42,694 --> 00:27:42,961 SPECTRUM. 742 00:27:42,961 --> 00:27:43,929 THIS IS OUR BOA OFIRECTORS. 743 00:27:43,929 --> 00:27:45,130 I F WANT TO TELL THETORY 744 00:27:45,130 --> 00:27:46,231 OF HOW WELL CAME TOGETHER 745 00:27:46,231 --> 00:27:48,534 BECAE I THINK IT'S REALL 746 00:27:48,534 --> 00:27:51,136 REFLECTIVE OF THE HISTORY OF 747 00:27:51,136 --> 00:27:53,705 ACCRETAND ACCRETA REARCH. 748 00:27:53,705 --> 00:27:56,008 ABOUT 15 YEARS AGO FOR SOME, 749 00:27:56,008 --> 00:28:01,346 AND LOT OF USERE THOSE WHOLOT 750 00:28:01,346 --> 00:28:03,115 WERE RUNNI OUR ACCRETA 751 00:28:03,115 --> 00:28:04,850 PROGRAMS WHICH MANY KIND OF 752 00:28:04,850 --> 00:28:08,587 AT MY OWN INSTION I FELTWNND 753 00:28:08,587 --> 00:28:10,856 LIKE IT WAS AN AREA THATDED 754 00:28:10,856 --> 00:28:12,457 STREAMLINING AND SO A LOTF US 755 00:28:12,457 --> 00:28:15,494 SORT OFAME DE FACCCRE 756 00:28:15,494 --> 00:28:17,262 PEOPLE. 757 00:28:17,262 --> 00:28:19,231 AND WE GET TOGETHER OFTEN IN THE 758 00:28:19,231 --> 00:28:21,333 HALLWAY AT LUNCH AND-HEREVER 759 00:28:21,333 --> 00:28:23,068 WEOULD FIND A SPACE A JT 760 00:28:23,068 --> 00:28:24,736 TALK ABOUT HOW ARE WE HDLING 761 00:28:24,736 --> 00:28:29,675 THIS, ARE WE HOSTI IR IN THEIR 762 00:28:29,675 --> 00:28:30,842 CASES, WHO'S DOI WHAT, WHEN 763 00:28:30,842 --> 00:28:31,376 ARE YOU DELIVERING. 764 00:28:31,376 --> 00:28:34,012 THERE WAS ATLEIT LESS 765 00:28:34,012 --> 00:28:35,347 GUIDANCEHAN THERE IS NOW, BUT 766 00:28:35,347 --> 00:28:38,550 FROM THIS, WE -- AND I THINK A 767 00:28:38,550 --> 00:28:40,152 LOT OF THISAME ABOUT BECAUSE 768 00:28:40,152 --> 00:28:41,687 ACCRETA USED TO BE A VERY 769 00:28:41,687 --> 00:28:44,122 COMMON THING, A W KNOW IT' 770 00:28:44,122 --> 00:28:46,525 BECOME MUCH MORE CMON. 771 00:28:46,525 --> 00:28:48,727 ENTUALLY USULY BOB SILVER 772 00:28:48,727 --> 00:28:52,631 HE HAD AN ACCRE MANUAL OF 773 00:28:52,631 --> 00:28:53,865 ATIONS THAT MANY OF US 774 00:28:53,865 --> 00:28:55,801 STARTED USING SHAT WE COULD 775 00:28:55,801 --> 00:28:57,235 START TO DO RESEARCH TOGETHER AS 776 00:28:57,235 --> 00:29:00,205 SND THIS INCLUDEDHE WE 777 00:29:00,205 --> 00:29:01,773 VE PIENTS COME IN THAT WE 778 00:29:01,773 --> 00:29:06,345 URINE, WE STORE TSE AT THE 779 00:29:06,345 --> 00:29:09,514 TI OF DELIVER WE'LL HAVE 780 00:29:09,514 --> 00:29:11,149 MYITTAL SAMPLES, PLACENTAL 781 00:29:11,149 --> 00:29:12,918 SAMPLES, SO NOW WE'VE GOT A 782 00:29:12,918 --> 00:29:14,353 PRETOOD SIZE DATAANK AND 783 00:29:14,353 --> 00:29:15,887 TISSUE BANK AND I TNK THAT'S 784 00:29:15,887 --> 00:29:20,258 IT JUST A THRILL TO SEE NIH 785 00:29:20,258 --> 00:29:22,327 IMPORTANT PROBLEM BECAU W ALL 786 00:29:22,327 --> 00:29:23,528 WANTO DO BETTER FOR OUR 787 00:29:23,528 --> 00:29:28,233 THIS IS A OBVIOUS DEVASTATING 788 00:29:28,233 --> 00:29:31,837 OBLEM 789 00:29:31,837 --> 00:29:33,038 SO ONE A LITTLE BIT O LEVEL 790 00:29:33,038 --> 00:29:35,007 SETTING, I UNDERSTAN WE DON'T 791 00:29:35,007 --> 00:29:36,108 WANT TO DO TOO MH, I THINK 792 00:29:36,108 --> 00:29:37,876 ST PEOPL HAVE SOME BASIC 793 00:29:37,876 --> 00:29:38,844 UNRSTANDING OF ACCRETA. 794 00:29:38,844 --> 00:29:39,878 I WAS ASKED TO DO SOMETHING THAT 795 00:29:39,878 --> 00:29:46,051 THAT'S DINING PAS EPIDEMIOLOG 796 00:29:46,051 --> 00:29:46,551 EPEMIOLOGY, SEVERITY, 797 00:29:46,551 --> 00:29:47,519 DETECTIONND SURVEILLANCE. 798 00:29:47,519 --> 00:29:48,854 WHAT I'MOING T GET AT I 799 00:29:48,854 --> 00:29:52,257 TRYI TO DO THATS SOME OF THE 800 00:29:52,257 --> 00:29:55,794 DERTH OF EITHE DATA OR DERTH OF 801 00:29:55,794 --> 00:29:56,628 CONSISTENCIN THE DA TO 802 00:29:56,628 --> 00:30:00,799 KN OUR TRUE NUMBERSABLE THAT WE 803 00:30:00,799 --> 00:30:02,668 I WANTO DESCRIBE THE 804 00:30:02,668 --> 00:30:04,536 CHALLEES AND UNDERSTANDING HOW 805 00:30:04,536 --> 00:30:07,806 PAS CONTRIBUTES TO SMM, SEVERE 806 00:30:07,806 --> 00:30:08,907 MARNAL MORDITY, ANDSE 807 00:30:08,907 --> 00:30:09,908 TREN OR TIME, THAT'S WHAT I 808 00:30:09,908 --> 00:30:10,842 S ASKED TO DO. 809 00:30:10,842 --> 00:30:13,111 IT'S A TOUGH QUESTION TO ANSWER. 810 00:30:13,111 --> 00:30:15,180 AND WE'LL TALK ABOUTHY. 811 00:30:15,180 --> 00:30:18,183 ALLENGESHAT ARE IERENTO 812 00:30:18,183 --> 00:30:20,318 USING THINGS LIKE ADMINISTRATE 813 00:30:20,318 --> 00:30:21,987 DA, BECAUSE WE D'T HAVE 814 00:30:21,987 --> 00:30:23,955 CONSISTENCY IN HOW PEOPLE DEFINE 815 00:30:23,955 --> 00:30:25,357 PAS ANDHERE ARE A LOT 816 00:30:25,357 --> 00:30:26,391 UNMEASURED DRIVERS OF 817 00:30:26,391 --> 00:30:28,760 VAABILITY THAT WE'LL TALK 818 00:30:28,760 --> 00:30:29,528 ABT. 819 00:30:29,528 --> 00:30:33,298 BU I THINK WEAN ALLGREE 820 00:30:33,298 --> 00:30:34,599 THAT PLACENTA ACCRETA SPECTRUM 821 00:30:34,599 --> 00:30:36,535 IS INCREASING, AND AAJOR 822 00:30:36,535 --> 00:30:39,971 RA HAS INCREASED. THE CESAREAN 823 00:30:39,971 --> 00:30:42,507 AND ESTATES IN THE 1960s, 824 00:30:42,507 --> 00:30:44,676 WH THE CESAREANATE WAS 825 00:30:44,676 --> 00:30:47,179 AROUND 5%, WE SOMEWHEREROUND 826 00:30:47,179 --> 00:30:47,512 1 IN 40,000. 827 00:30:47,512 --> 00:30:49,715 IT'S HD TO ARGUE HOBUST 828 00:30:49,715 --> 00:30:51,116 THAT ESTIMATES, BUT W CAN 829 00:30:51,116 --> 00:30:54,519 REALLY CLEARLY S THE RISE, THE 830 00:30:54,519 --> 00:30:57,389 BLACK LINE TO THE 1980s, WHEN 831 00:30:57,389 --> 00:30:58,590 IT BECAME AUC MOR COMN 832 00:30:58,590 --> 00:30:59,891 PROBLEM A THAT CESAREAN 833 00:30:59,891 --> 00:31:03,729 DEVERY RATE ROSE. 834 00:31:03,729 --> 00:31:06,264 IT'S DEBATLE WHAT T TRUE 835 00:31:06,264 --> 00:31:07,232 INCIDENCE ISODAY,ND I'M 836 00:31:07,232 --> 00:31:10,402 COUPLE MINUTES, BUT IT'SN A 837 00:31:10,402 --> 00:31:11,803 INTERESTING TOOTEHAT WE HAVE 838 00:31:11,803 --> 00:31:15,107 THIS HUGE RISE IN CAREAN 839 00:31:15,107 --> 00:31:16,174 DELIVERY RATES AND THIS BIG 840 00:31:16,174 --> 00:31:18,276 INCRSE IN ACCRETA O WHAT WE 841 00:31:18,276 --> 00:31:21,446 THINK T ESTIMATEDUM IS, 842 00:31:21,446 --> 00:31:27,786 AND YET WITH NOT AS MOR AN 843 00:31:27,786 --> 00:31:28,887 INCREASEN CAREAN DELIVERY 844 00:31:28,887 --> 00:31:33,492 I THINKT'S IMPTANT TOPRETTYMAJO. 845 00:31:33,492 --> 00:31:35,060 ACLEDG WHY, AND SOME OF 846 00:31:35,060 --> 00:31:39,197 THAT IS THE EVIL TWIN O 847 00:31:39,197 --> 00:31:42,033 CESAREAN, WHICH I EENTILY 848 00:31:42,033 --> 00:31:45,003 IN WORK T BOB DID REALLY 849 00:31:45,003 --> 00:31:46,037 ELEGANTLY AND OERS HAVE SHOWN, 850 00:31:46,037 --> 00:31:48,807 WE KNO THAT WHENOUAVE 851 00:31:48,807 --> 00:31:49,908 PREVIA AND A PRIORESAREAN 852 00:31:49,908 --> 00:31:52,644 LIVERY, THATVE IS A MAJOR 853 00:31:52,644 --> 00:31:56,715 PRIOR CESAREAN, THAT'S A MAJOR 854 00:31:56,715 --> 00:32:00,652 DRIVER OFCCRETA.WE KNOW THAT BHA 855 00:32:00,652 --> 00:32:01,620 INCREASING PREVIOUSLY BEEN 856 00:32:01,620 --> 00:32:02,387 INCREASING. 857 00:32:02,387 --> 00:32:02,954 I NT T ACKNOWLGE THAT 858 00:32:02,954 --> 00:32:05,891 PREVIA NEEDS TO BE HIGHLHTED 859 00:32:05,891 --> 00:32:10,695 WHEN WE APPROACH THI WORK. 860 00:32:10,695 --> 00:32:12,798 WE KNOW PREVIA RISK FACTORS 861 00:32:12,798 --> 00:32:14,232 IT'S HDER TO FIND DATA ON THE 862 00:32:14,232 --> 00:32:16,401 TRUE INCIDENCE OF ACCRETA -- I'M 863 00:32:16,401 --> 00:32:17,402 SORRY, PREVIA AND WHE IT'S 864 00:32:17,402 --> 00:32:20,038 BEEN AND WHERE IT ISOW, BUT 865 00:32:20,038 --> 00:32:24,709 ACCRETA -- BECAUSE WE'RE GETTI 866 00:32:24,709 --> 00:32:25,243 RE PREVIA. 867 00:32:25,243 --> 00:32:27,479 SO AGEPRIORREA AND THEN 868 00:32:27,479 --> 00:32:29,548 PRIORESAREAN DELIVERY I 869 00:32:29,548 --> 00:32:31,483 THERE ARE OERSOO BUT THO 870 00:32:31,483 --> 00:32:35,921 SO LET'S TK ABOHAT TO WE 871 00:32:35,921 --> 00:32:36,988 PAS? ABOUT THE PREVALEE OF 872 00:32:36,988 --> 00:32:39,991 I THINK A LOT OF WT'S 873 00:32:39,991 --> 00:32:41,860 CHALLENGING IN TRYING TO DEFINE 874 00:32:41,860 --> 00:32:47,999 THAT I IUSTRATED BY ERIC 875 00:32:47,999 --> 00:32:48,466 JAUNIAUX. 876 00:32:48,466 --> 00:32:51,870 IN THISORK HE DEFINED PREVI 877 00:32:51,870 --> 00:32:53,939 BY -- OR DEFINED PVALENCE BY 878 00:32:53,939 --> 00:32:56,908 THEUMBER OFAS CASES TT 879 00:32:56,908 --> 00:32:59,077 WERE FOUND INHE GENERAL 880 00:32:59,077 --> 00:33:00,512 POPULATION FORHE TOTAL NBER 881 00:33:00,512 --> 00:33:01,947 OF PREGNANCIES, BIRS AND 882 00:33:01,947 --> 00:33:04,749 DEVERIES IN TH POPULATION. 883 00:33:04,749 --> 00:33:06,985 AND ESTIMATING -- THE ESTIMATED 884 00:33:06,985 --> 00:33:09,421 PA PRESENCEF .01 T 1.1%. 885 00:33:09,421 --> 00:33:11,056 AT IS A HUG RAN. 886 00:33:11,056 --> 00:33:12,691 YOU KNOW, WE WANT T BE PCISE 887 00:33:12,691 --> 00:33:14,459 IN DATA, WE LEO BE PRECISE 888 00:33:14,459 --> 00:33:16,528 IN OUR ESTIMATES, BUT THAT IS 889 00:33:16,528 --> 00:33:17,629 QUITE AANGE FROM THESE 890 00:33:17,629 --> 00:33:18,930 STUDS. 891 00:33:18,930 --> 00:33:23,535 HE EIMATED A POOLED PREVALENCE 892 00:33:23,535 --> 00:33:25,837 OF 0.17%, AND NOTED AOUE OF 893 00:33:25,837 --> 00:33:26,938 THINGS THAT I THINKRE REALLY 894 00:33:26,938 --> 00:33:27,839 IMPORTAN WHEN WE'RE THINKG 895 00:33:27,839 --> 00:33:30,208 ABOUT GAPS IN THIS AREA. 896 00:33:30,208 --> 00:33:31,843 A THIRD OF SDIES HAD 897 00:33:31,843 --> 00:33:33,478 NO DESCRIPTION OF WHAT CLINICAL 898 00:33:33,478 --> 00:33:36,748 CRITERIAERESED FOR DIAGNOSI 899 00:33:36,748 --> 00:33:37,015 DIAGNOSIS. 900 00:33:37,015 --> 00:33:38,016 I THINK IT'S IMPORTANT FOR THOSE 901 00:33:38,016 --> 00:33:39,651 WHO MAYBE DON'T TAKE CEF 902 00:33:39,651 --> 00:33:41,286 THESE PATIENTS TO NOTE THA NOT 903 00:33:41,286 --> 00:33:43,688 EVERYONE GOES O TOAVE A 904 00:33:43,688 --> 00:33:45,457 CESARE HTERECTOM OR EVEN A 905 00:33:45,457 --> 00:33:45,991 HYSTERECTO. 906 00:33:45,991 --> 00:33:49,027 SO THERE ARE PEOE WHERE THE 907 00:33:49,027 --> 00:33:51,229 PLACENTA MHT JUST NOT DETACH 908 00:33:51,229 --> 00:33:55,634 AND RHAPS SOMEBODYAKES A 909 00:33:55,634 --> 00:33:59,437 AND REMOVES THE PLACENTA IN SOME 910 00:33:59,437 --> 00:34:00,772 THE. LER WHERE THE UTERUS IS 911 00:34:00,772 --> 00:34:04,976 E -- NO STUDIES DCRIBED WHAT 912 00:34:04,976 --> 00:34:06,311 THE CLINICAL FINDINGS WERE IN 913 00:34:06,311 --> 00:34:09,047 TERMS OF THE VASCULARITY THA 914 00:34:09,047 --> 00:34:10,315 ULD SUGGEST PLACENTA ACCRETA 915 00:34:10,315 --> 00:34:13,852 AND THIS ISMPORTANT BECAUSE AS 916 00:34:13,852 --> 00:34:15,720 RESEARCHERS AND LEADERSN THIS 917 00:34:15,720 --> 00:34:18,223 FIELD, WE ALSO NEED T BE 918 00:34:18,223 --> 00:34:19,124 LPING PROVIDERS AND SURGEONS 919 00:34:19,124 --> 00:34:21,393 KNOW WHAT ARE THE DIAGNOSTIC 920 00:34:21,393 --> 00:34:23,261 SIGNS THAT O MIGHT SEE THAT 921 00:34:23,261 --> 00:34:26,231 D SUEST PAS TO AID 922 00:34:26,231 --> 00:34:26,898 PLACENTAL DELIVER 923 00:34:26,898 --> 00:34:29,668 ACCRETA, YOU DON'T WANT TO 924 00:34:29,668 --> 00:34:30,769 LIVER THELACENTA, YOU'RE 925 00:34:30,769 --> 00:34:34,606 GOING TO TRIER A MASSIVE 926 00:34:34,606 --> 00:34:36,341 HEHAGE, AND THAT' SOME OF 927 00:34:36,341 --> 00:34:38,677 THOST DANGEROUS POINTS IN 928 00:34:38,677 --> 00:34:39,878 THESE DELIVER 929 00:34:39,878 --> 00:34:41,613 THINK ALL OF US ARE AWARE THAT 930 00:34:41,613 --> 00:34:44,616 THERE'S PRETTY LARGE POTENTIAL 931 00:34:44,616 --> 00:34:45,250 MATERNAL MORBIDITY. 932 00:34:45,250 --> 00:34:46,685 THIS IA VERYUICK SUMMARY. 933 00:34:46,685 --> 00:34:49,754 WE SEE ACUTE LIFE THREATEIN 934 00:34:49,754 --> 00:34:50,188 HERRHAGE. 935 00:34:50,188 --> 00:34:51,623 MOST PEOPL WHO HAVECCRETAO 936 00:34:51,623 --> 00:34:53,491 TO GETLOOD TRANSFUSIONS, 937 00:34:53,491 --> 00:34:54,592 SOMETIMETHAT MSIVE 938 00:34:54,592 --> 00:34:57,762 A LOT OF THE COMICATIONS ARE 939 00:34:57,762 --> 00:34:59,598 E CONSEQNCE O THATASSIVE 940 00:34:59,598 --> 00:35:01,032 BLOOD TRANSFUSION THAT CAN 941 00:35:01,032 --> 00:35:03,268 PEOPLE CAN BEDY. 942 00:35:03,268 --> 00:35:05,103 POSTOPATIVEL 943 00:35:05,103 --> 00:35:08,173 WE KNOW THE PENTIAL RENAL OR 944 00:35:08,173 --> 00:35:11,676 CAIACAMAGE, T BOL 945 00:35:11,676 --> 00:35:13,979 DISEASE, TRANSFUSION ASSIATE 946 00:35:13,979 --> 00:35:17,082 SUOUING ORGANRGICAL DAMAG TO 947 00:35:17,082 --> 00:35:20,018 USUALLY THELAER, ALSO 948 00:35:20,018 --> 00:35:20,352 HYSTERECTOMY. 949 00:35:20,352 --> 00:35:22,787 BUT THERE'S LOT OF INFECTIOUS 950 00:35:22,787 --> 00:35:25,790 MORBIDITY AS WELL. 951 00:35:25,790 --> 00:35:27,993 EMBOLISM IS N SOOMN.U 952 00:35:27,993 --> 00:35:30,762 PSYCH LOGIC HARM.O ACKNOWLED 953 00:35:30,762 --> 00:35:32,630 I THKN A LOT OF US WHO TAKE 954 00:35:32,630 --> 00:35:33,932 CARE OF THESE PATIENTS, WE DO 955 00:35:33,932 --> 00:35:37,902 SPEND A LOTF TIME NOW IN 956 00:35:37,902 --> 00:35:39,537 ADDRESSING THIS PIECE OF IT AND 957 00:35:39,537 --> 00:35:44,142 SOMEING THAT WE'LL STICK WILLTIH 958 00:35:44,142 --> 00:35:45,243 PEOPLE F A LONG TE DURIN 959 00:35:45,243 --> 00:35:46,177 THE PREGNAN AND TOUGHOUT 960 00:35:46,177 --> 00:35:48,747 THEIR T LIVES. 961 00:35:48,747 --> 00:35:50,615 E RISK OF DEAS QUOTED AT 6 TO 7. 962 00:35:50,615 --> 00:35:54,252 WONDING IF THAT'S THE TRUERT OF 963 00:35:54,252 --> 00:35:55,353 RISK, AND TRE'S SO MY 964 00:35:55,353 --> 00:35:59,057 DIFFERENT DRIRS, BUT I TAKE 965 00:35:59,057 --> 00:36:00,592 CARE OF A LOT OF PEOPLE IN 966 00:36:00,592 --> 00:36:01,926 CLINIC A TY COME IN AND MAY 967 00:36:01,926 --> 00:36:06,665 ACCRETA, THEY'RE PREGNT AGAIN, 968 00:36:06,665 --> 00:36:08,967 THEY SEE THIS NUMBER AND THAT' 969 00:36:08,967 --> 00:36:10,368 WHER THEY CAN'T GET PAS THAT. 970 00:36:10,368 --> 00:36:11,803 AND I TNK THAT WE CAN DO A 971 00:36:11,803 --> 00:36:13,705 BETTER JOB IN SORT OF DIVIDING 972 00:36:13,705 --> 00:36:17,942 OUT WHAT THE TRUE RISKS ARE 973 00:36:17,942 --> 00:36:19,678 END HOW WE SHOULD COUNSEL 974 00:36:19,678 --> 00:36:20,111 PELE. 975 00:36:20,111 --> 00:36:21,679 BUT LET'S LOOK AT TOHAT DEGREE 976 00:36:21,679 --> 00:36:26,484 THEN DOESAS CONTRIBUT TO SMM, 977 00:36:26,484 --> 00:36:29,454 ANJAUNIAUX IN THIS STUDYRELY COE 978 00:36:29,454 --> 00:36:31,089 ESTIMATE OF THE PREVALEE AND 979 00:36:31,089 --> 00:36:32,657 OUTCES, THASUR SMM, OF 980 00:36:32,657 --> 00:36:33,425 PLENTA ACCTA SPECTRUM IS 981 00:36:33,425 --> 00:36:36,227 VARYING CLINICAL CRITEAAUSE 982 00:36:36,227 --> 00:36:37,696 THAT USED TO DINE IT AT 983 00:36:37,696 --> 00:36:38,797 BIRTH,O LSFEOPLE IN 984 00:36:38,797 --> 00:36:43,501 ACCRETA? DO THEY TRULY HAVE 985 00:36:43,501 --> 00:36:45,303 AND THE LACK OF DETAILED 986 00:36:45,303 --> 00:36:46,604 PATHOLOGIC EXAM IN MOST OF O 987 00:36:46,604 --> 00:36:49,574 COHORT STUDIES. 988 00:36:49,574 --> 00:36:51,309 IHINK ONE GAP HERE IS THAT WE 989 00:36:51,309 --> 00:36:53,278 CLRLY NEED CONSTENT 990 00:36:53,278 --> 00:36:56,281 DEFINITIONS, PARTICULARLY IF 991 00:36:56,281 --> 00:36:58,683 AVAILABLE, A CONSISTENT AND 992 00:36:58,683 --> 00:36:59,984 DETAILED PATHOLOGIC EXAMS FOR 993 00:36:59,984 --> 00:37:03,521 WHAT WE'RE CALLING ACCRETA. 994 00:37:03,521 --> 00:37:04,289 ADMINISTVE DATA, HE 995 00:37:04,289 --> 00:37:07,158 ACKNOWLEDGES, CAN BE VERY USEFU 996 00:37:07,158 --> 00:37:07,892 FOR W-PREVALENCE CONDION 997 00:37:07,892 --> 00:37:09,227 BUT I'M GOING TO TALK A LITTLE 998 00:37:09,227 --> 00:37:13,198 THE CHALLENGES AND THE RISKS OF 999 00:37:13,198 --> 00:37:16,267 .SG THAT, RELYING TOO MH ON 1000 00:37:16,267 --> 00:37:18,303 SO ONE GAP ALSO ITHE DATA IS 1001 00:37:18,303 --> 00:37:19,904 WE'LL HAVE STUDYS THAT TALK 1002 00:37:19,904 --> 00:37:22,073 ABOUT PAS AND ALL THE RISKS, 1003 00:37:22,073 --> 00:37:23,842 BUT WHO ARE THEATIENTS THAT 1004 00:37:23,842 --> 00:37:25,376 HAVE PAS AND IT'S IMPORTANTO 1005 00:37:25,376 --> 00:37:27,145 REALIZEHAT NOT ALL P CREATES 1006 00:37:27,145 --> 00:37:28,680 THE SAME SMM. 1007 00:37:28,680 --> 00:37:33,518 WE KNOW T PCENTAREVIA ASI MENTIR 1008 00:37:33,518 --> 00:37:35,386 OF SEVE MATERNAL MORBITY. 1009 00:37:35,386 --> 00:37:36,621 IF YOU THINK ABOUT IT, LOOK AT 1010 00:37:36,621 --> 00:37:39,457 E PICTUN THE UPPER RIGHT, 1011 00:37:39,457 --> 00:37:41,526 THAT'S A UTERUS AND THA LOWER 1012 00:37:41,526 --> 00:37:43,094 PART IS -- OR THE LOWERART OF 1013 00:37:43,094 --> 00:37:45,830 MY SCREEN IS -- YOU CAN SEE THE 1014 00:37:45,830 --> 00:37:48,233 VASCULAR AREA.THAT'S THE 1015 00:37:48,233 --> 00:37:49,567 PREVIA JUST MEANS YOU'V G 1016 00:37:49,567 --> 00:37:50,869 ACTA IN T LEVEL OF THE 1017 00:37:50,869 --> 00:37:52,971 EP UTERINE VASLATURE. 1018 00:37:52,971 --> 00:37:55,507 THAT IS LIKYO A MUCH MORE 1019 00:37:55,507 --> 00:37:56,674 MORB CONDITION THAN IF 1020 00:37:56,674 --> 00:37:59,310 SOMEBO HAS, SAY, A FUNDAL 1021 00:37:59,310 --> 00:38:00,845 PLENTA,ND I THINK THIS GROUP 1022 00:38:00,845 --> 00:38:01,846 REALLYHOWED IT.T. 1023 00:38:01,846 --> 00:38:04,215 THEY UTILIZED THEATIONAL 1024 00:38:04,215 --> 00:38:05,483 INPAENT SAMPLE DATABASE. 1025 00:38:05,483 --> 00:38:06,351 AGAIN, THERE'S SOME CONCERN 1026 00:38:06,351 --> 00:38:08,219 ABOUT THE RELIABILITY OF THE 1027 00:38:08,219 --> 00:38:12,157 PATIENTS WH PAS AND PREVIA, 1028 00:38:12,157 --> 00:38:14,025 AN PATNT WITH PAS WITHOUT 1029 00:38:14,025 --> 00:38:14,359 EVIA. 1030 00:38:14,359 --> 00:38:15,560 THEY HAD SOME PRETTY GOOD 1031 00:38:15,560 --> 00:38:16,361 NUMBERS HERE. 1032 00:38:16,361 --> 00:38:18,229 AND REALLY MOSUTCO WERE 1033 00:38:18,229 --> 00:38:20,198 WORSE AND NONE WERE BETTER. 1034 00:38:20,198 --> 00:38:21,833 WHEN THE'SLACEA ARETA 1035 00:38:21,833 --> 00:38:25,703 SPECTRUM WITH PREVIA COMPAD TOPM 1036 00:38:25,703 --> 00:38:27,238 WITHOUT PREVIA. 1037 00:38:27,238 --> 00:38:29,841 AND BY THAT, THERE WASOREMM 1038 00:38:29,841 --> 00:38:30,074 OVERALL. 1039 00:38:30,074 --> 00:38:33,044 THERE WAS MORE SMM WITHOUT 1040 00:38:33,044 --> 00:38:33,611 TRSFUSION. 1041 00:38:33,611 --> 00:38:35,880 DEFINITELY MORE HYSTERECTOMY, 1042 00:38:35,880 --> 00:38:37,549 SHOCK, HEMORRHAGE, AND URINARY 1043 00:38:37,549 --> 00:38:38,516 TRACT INJURY. 1044 00:38:38,516 --> 00:38:40,618 THER WAS ALS GREATER LENGTH OF 1045 00:38:40,618 --> 00:38:42,720 STAY, TOTAL CRGES, AND TOTAL 1046 00:38:42,720 --> 00:38:47,091 COSTS. 1047 00:38:47,091 --> 00:38:48,826 IN DIFFERENT BIND OF 1048 00:38:48,826 --> 00:38:50,929 SIMILARLY CONDUCTED 1049 00:38:50,929 --> 00:38:53,198 META-ANALYS, JAUNIAU 1050 00:38:53,198 --> 00:38:54,566 ESTIMATED THAT FR THE 1051 00:38:54,566 --> 00:38:55,500 LIRATURE, GREATEHAN NINE AT 1052 00:38:55,500 --> 00:38:59,470 AMONG THOSE WH HTORY OFTO BE 1053 00:38:59,470 --> 00:39:01,272 PRIOR CESAREAN DELIVER AND 1054 00:39:01,272 --> 00:39:03,474 EITHER A LOW-LYI PLACENTA OR 1055 00:39:03,474 --> 00:39:04,008 PLENTAREVIA. 1056 00:39:04,008 --> 00:39:05,543 BUT AGAIN, TRE WERE LIMITED 1057 00:39:05,543 --> 00:39:06,644 DESCRIPTIONS OF THE PLACENTAL 1058 00:39:06,644 --> 00:39:07,512 APPEARCE, SO HD TO DRAW SOME 1059 00:39:07,512 --> 00:39:09,280 OF THE CCLIONS A THEY 1060 00:39:09,280 --> 00:39:10,949 COLUDE, AGAIN, THAT THEAIN 1061 00:39:10,949 --> 00:39:12,483 LIMITATION ISMI THE QLITY OF THE 1062 00:39:12,483 --> 00:39:19,591 DIAGNOSE PREVI ANDHAT WE'RNDW WE 1063 00:39:19,591 --> 00:39:23,528 W-LYING PLACENT IN THE 1064 00:39:23,528 --> 00:39:25,663 CLINICAL DIAGNOSIS OF PAS AND 1065 00:39:25,663 --> 00:39:27,765 CONFIRMATORY HISTOPATHOLIC 1066 00:39:27,765 --> 00:39:28,166 DATA. 1067 00:39:28,166 --> 00:39:29,834 SO JT A FEW OTH THINGS T 1068 00:39:29,834 --> 00:39:32,370 THINKBOUT WN WE WERETHINKING ABD 1069 00:39:32,370 --> 00:39:34,472 DRIVERS OF PAS MORDITY. 1070 00:39:34,472 --> 00:39:35,773 WE KNOHAT THERE -- YOU KNOW, 1071 00:39:35,773 --> 00:39:37,208 IF YOU LOOK AT ATUDY, IT'S 1072 00:39:37,208 --> 00:39:38,543 GOING BE REALLY IMPORNT TO 1073 00:39:38,543 --> 00:39:42,880 KWHAT THE DELIVERY TEAM. 1074 00:39:42,880 --> 00:39:44,515 AND THE CENTER MAKES 1075 00:39:44,515 --> 00:39:44,983 TREMENDOUS DIFFEREE. 1076 00:39:44,983 --> 00:39:46,084 ARE THEY EXPERIENC, AREHEY 1077 00:39:46,084 --> 00:39:50,455 DOINTHIS REGULARLY, ARE THEY 1078 00:39:50,455 --> 00:39:50,788 INPERIENCED? 1079 00:39:50,788 --> 00:39:54,092 S THIS A KNOWN ACCRETA INADVANCE 1080 00:39:54,092 --> 00:39:57,262 IN TERMS OFVERS OFDIFFERENCE 1081 00:39:57,262 --> 00:39:57,528 MORBIDITY. 1082 00:39:57,528 --> 00:39:59,464 A LOT OF STUDIES INCDE THIS 1083 00:39:59,464 --> 00:40:02,100 OCCULT ACCRETA OR MICROSCOPIC 1084 00:40:02,100 --> 00:40:02,700 ACCRETA. 1085 00:40:02,700 --> 00:40:07,238 AND PATHOLOGY BUT ESSENTIALLYY 1086 00:40:07,238 --> 00:40:08,473 THE PCENTA DELIVERS AND 1087 00:40:08,473 --> 00:40:10,775 THE'S SOME MYOMETRIAL FIBERS 1088 00:40:10,775 --> 00:40:11,643 ANTHAT GETS PULLE IN. 1089 00:40:11,643 --> 00:40:12,977 WE KNOW SOME OF THESE PATIENTS 1090 00:40:12,977 --> 00:40:14,412 HAVE ABSOLUTELY NO PROBLEM. 1091 00:40:14,412 --> 00:40:16,614 I S A LOT OF TSE PIENTS 1092 00:40:16,614 --> 00:40:18,149 WHO COME IN FORONSULTATIOOR 1093 00:40:18,149 --> 00:40:19,384 FURE PREANCY BAUSE THE 1094 00:40:19,384 --> 00:40:20,585 PLACENTAL PATHOLOGY C BACK, 1095 00:40:20,585 --> 00:40:24,289 VAGINAL DELIVERY, NO HEMRHAG 1096 00:40:24,289 --> 00:40:26,858 BUT THE PLACENTA CAME BACK WITH 1097 00:40:26,858 --> 00:40:28,159 SO MYOMETRIAL FIBERS AND NOW 1098 00:40:28,159 --> 00:40:29,027 THEY'RE CONCERNED. 1099 00:40:29,027 --> 00:40:32,230 SOMEEOE WHO HAVE THE 1100 00:40:32,230 --> 00:40:34,098 IT IS A BIGEAL.RS HEMORRHE AND 1101 00:40:34,098 --> 00:40:35,300 BUT IT'S IORTANT TOT' KNOW, ARE 1102 00:40:35,300 --> 00:40:37,969 THASASES ALSO MIXEDN WITH 1103 00:40:37,969 --> 00:40:39,570 THOSE WITH PREVIA ANDHOSE 1104 00:40:39,570 --> 00:40:39,904 WITHOUT. 1105 00:40:39,904 --> 00:40:44,542 AGN, DIFFERENT MORBITI 1106 00:40:44,542 --> 00:40:47,178 POTENTIALL AND AGAIN A LOTF 1107 00:40:47,178 --> 00:40:48,946 PEOPLE WHO HAVEAS WITHOUT 1108 00:40:48,946 --> 00:40:50,748 PREVIA HAVE A VERY MORBI 1109 00:40:50,748 --> 00:40:51,049 EXPERIENCE. 1110 00:40:51,049 --> 00:40:52,884 I DON'T MEAN TOINIMIZE THAT, 1111 00:40:52,884 --> 00:40:53,885 BUT TRE'S A RANGE. 1112 00:40:53,885 --> 00:40:55,653 WE ALSOEED TO CONSIDER WHO OR 1113 00:40:55,653 --> 00:40:57,121 WHAT SHOULD DEFINE PAS. 1114 00:40:57,121 --> 00:41:00,158 SHOULD THIS BE ALL 1115 00:41:00,158 --> 00:41:01,159 STOPATHOLOGIDIAGNOSIS A THE 1116 00:41:01,159 --> 00:41:03,261 MANY HAVE PROPOD THAT. 1117 00:41:03,261 --> 00:41:04,595 WE'RE GOI TO MISSHOSE WHO 1118 00:41:04,595 --> 00:41:06,197 HAVE THE CLINICAL DIAGNOSIS AND 1119 00:41:06,197 --> 00:41:10,168 PAOLOGY, PHAPS THEY HAVE A 1120 00:41:10,168 --> 00:41:16,541 RETAINED PLA SEP, THE PLACENTALT 1121 00:41:16,541 --> 00:41:17,442 FUNDAL ACCRE AND THEY'RE 1122 00:41:17,442 --> 00:41:19,310 MANAGEMENT.RGO EXPECTANT 1123 00:41:19,310 --> 00:41:21,512 AND FALLY, WHAT SHOD WEO 1124 00:41:21,512 --> 00:41:26,351 WITH MIKE SCOPIC MICROSC AND OCT 1125 00:41:26,351 --> 00:41:26,584 ACCRETA. 1126 00:41:26,584 --> 00:41:29,520 SO A LOT OF U GOT EXCIT ABOUT 1127 00:41:29,520 --> 00:41:31,189 IS ICD-10 CODE. 1128 00:41:31,189 --> 00:41:34,158 CRETA, AND MANY RESEARCHERS 1129 00:41:34,158 --> 00:41:38,363 HAVE P TOGETHER SORT OF WAYS 1130 00:41:38,363 --> 00:41:40,164 YOU CAN EIMATE IN LARGE 1131 00:41:40,164 --> 00:41:43,101 SOMEDY HAVE ARETA, AND NOW 1132 00:41:43,101 --> 00:41:45,837 THERE'S THIS ICD-10 C THAT 1133 00:41:45,837 --> 00:41:48,940 CAS O PLACENTA ARETA. 1134 00:41:48,940 --> 00:41:54,078 WE DID A VALIDATION STUDY AT 1135 00:41:54,078 --> 00:41:55,413 STANFORDSINGLE INSTITUTION, SO 1136 00:41:55,413 --> 00:41:56,314 THAT'S A LIMITATION. 1137 00:41:56,314 --> 00:41:57,849 T WE SEARCHED PRODURAL 1138 00:41:57,849 --> 00:42:05,590 REPORTS AND TRYING TODDRESSRGICL 1139 00:42:05,590 --> 00:42:07,959 HOW MANY WERE ASSIGNED THE 1140 00:42:07,959 --> 00:42:08,726 CORRECT CODE. 1141 00:42:08,726 --> 00:42:10,261 WE USED THIS PATHOLOGY TO 1142 00:42:10,261 --> 00:42:11,195 CROSS-REFERENCE WH THE 1143 00:42:11,195 --> 00:42:11,629 PATHOLOGY DATABASE. 1144 00:42:11,629 --> 00:42:15,333 WE DID NOT INCLU OULT 1145 00:42:15,333 --> 00:42:16,768 ACCRETA, SO THAT'SOOT PAS FOR 1146 00:42:16,768 --> 00:42:17,969 E PURPOSE OF UNDERSTANNG THE 1147 00:42:17,969 --> 00:42:18,169 CODE. 1148 00:42:18,169 --> 00:42:19,771 SOSEERE PEOPLE WHO REALLY, 1149 00:42:19,771 --> 00:42:21,072 MA JUSTRU HAD IT AND WE 1150 00:42:21,072 --> 00:42:23,408 FOUND THAT THEOSITIVE 1151 00:42:23,408 --> 00:42:24,509 PREDICVE VALUE OF THEOD 1152 00:42:24,509 --> 00:42:27,545 REAL WASN'T SO GREAT. 1153 00:42:27,545 --> 00:42:28,980 I THINK WE NEED T USE CAUTION 1154 00:42:28,980 --> 00:42:32,183 WHEN WE THINK ABOUT THESE DA 1155 00:42:32,183 --> 00:42:33,284 IN TSPPROACH. 1156 00:42:33,284 --> 00:42:37,722 E PRIMARY REASONS THAT THECODE T 1157 00:42:37,722 --> 00:42:39,557 WAS AIGNED IN A LOT O CASES 1158 00:42:39,557 --> 00:42:41,392 OF OCCULT ACCRETA,5%. 1159 00:42:41,392 --> 00:42:45,363 THERWERE CASES THAT HAD 1160 00:42:45,363 --> 00:42:46,697 CLINIC EVIDENCE OF PLACENTAL 1161 00:42:46,697 --> 00:42:49,300 ADHEE BUT WITHOUT THE 1162 00:42:49,300 --> 00:42:49,967 HISTOPATLOGIDINOSIS,O IN 1163 00:42:49,967 --> 00:42:51,769 THIS STUDY WESED THAT AS A 1164 00:42:51,769 --> 00:42:52,303 GOLDTANDARD. 1165 00:42:52,303 --> 00:42:54,839 AND ATST CASES THAT HAD THE 1166 00:42:54,839 --> 00:42:56,407 INRRECT CODE AIGNMENT TENDED 1167 00:42:56,407 --> 00:42:59,777 WITH THE CORRECT ASSIGNMT.SE 1168 00:42:59,777 --> 00:43:01,979 SO FORXAMPLE, THOSE WHO HAD 1169 00:43:01,979 --> 00:43:04,515 HYSTERECTOMY AT DELIVERY TENDED 1170 00:43:04,515 --> 00:43:09,887 NOT TO HAVE T INCORRECT CODE 1171 00:43:09,887 --> 00:43:14,292 SIGN, BOD TRANSFUSION, 1172 00:43:14,292 --> 00:43:16,694 ADMISSION TO THECU AGAIN. 1173 00:43:16,694 --> 00:43:18,563 JUST WT TO -- BECSEE'RE 1174 00:43:18,563 --> 00:43:19,864 TALKING ABOUT SURVEILLAE AND 1175 00:43:19,864 --> 00:43:21,966 CODES ANDORT OF LAR 1176 00:43:21,966 --> 00:43:30,975 INDICES., SMM CO-MORBID IT 1177 00:43:30,975 --> 00:43:32,877 SO WE KNOW THE SMM INDEX IS AN 1178 00:43:32,877 --> 00:43:34,178 IMPORTANT QUALITY INDICATOR. 1179 00:43:34,178 --> 00:43:36,280 WE CAN USEHAT FOR 1180 00:43:36,280 --> 00:43:37,882 SUEILLANCE, QI AND RESEARCH. 1181 00:43:37,882 --> 00:43:40,318 WE KNOWT'S BASED ON ICD 1182 00:43:40,318 --> 00:43:42,854 PROCEDURE CODESROM THE CDC'S 1183 00:43:42,854 --> 00:43:45,022 21 INDICORS, AND CO-MORBIDITY 1184 00:43:45,022 --> 00:43:46,357 INDIS ARE INTENDED TO REALLY 1185 00:43:46,357 --> 00:43:47,692 SUMMARIZAND SORT OF DO A RISK 1186 00:43:47,692 --> 00:43:49,026 ADJUSTMENT FOR PRE-EXISTING 1187 00:43:49,026 --> 00:43:50,661 CONDITIONS. 1188 00:43:50,661 --> 00:43:51,629 IN YR INSTUON A LOT OF 1189 00:43:51,629 --> 00:43:54,665 PEOP COME I YOUR TERTIARY 1190 00:43:54,665 --> 00:43:56,200 CARE CENTER, WITH SEVERE 1191 00:43:56,200 --> 00:43:57,168 MATERNAL MORBIDITY. 1192 00:43:57,168 --> 00:44:04,642 GHNSTIT INSTITUTIS DOINGUST FOR 1193 00:44:04,642 --> 00:44:07,378 OVERL BASE OND WHAT THE 1194 00:44:07,378 --> 00:44:08,713 BASELINE CHARACTERISTICS AND 1195 00:44:08,713 --> 00:44:09,514 PATIENT POPULATION ARE. 1196 00:44:09,514 --> 00:44:11,349 JUST WANT TO CAL OUT THE 1197 00:44:11,349 --> 00:44:13,451 ADJUSTED RK RATIO FOR PAS 1198 00:44:13,451 --> 00:44:15,353 RELY IN TS CO-MORBIDITY 1199 00:44:15,353 --> 00:44:16,654 INDEX I HIGHER THAN FORNY 1200 00:44:16,654 --> 00:44:20,691 OTHER CDION. 1201 00:44:20,691 --> 00:44:24,462 R SMM OVERALL IT WAS 30.5 AND 1202 00:44:24,462 --> 00:44:28,065 .OR NON-TRANSFUSIONMM, IT'S 1203 00:44:28,065 --> 00:44:29,400 SO I WANT TO TALK A LITTLE BIT 1204 00:44:29,400 --> 00:44:30,635 MO ABOUT DRIVE OF 1205 00:44:30,635 --> 00:44:31,969 VARIABILITY IN THE OUTCO, 1206 00:44:31,969 --> 00:44:36,107 DELIVERY TMND THESING ON THE 1207 00:44:36,107 --> 00:44:36,774 INSTITUTN. 1208 00:44:36,774 --> 00:44:39,744 AS MOSTF US I THIS ROOM ARE 1209 00:44:39,744 --> 00:44:41,612 AWARE. 1210 00:44:41,612 --> 00:44:44,682 , THERE'S SOMETHING THAT 1211 00:44:44,682 --> 00:44:45,783 THE CONCT OF CENTERS OF 1212 00:44:45,783 --> 00:44:47,451 EXCEENCE WHICH REALLY RTF 1213 00:44:47,451 --> 00:44:48,185 GHLIGHTS THAT EXPERIENCE AND 1214 00:44:48,185 --> 00:44:51,622 REURCES MA FER. 1215 00:44:51,622 --> 00:44:51,923 MATTER. 1216 00:44:51,923 --> 00:44:53,291 WE KNOW TS WAS DEFINED B 1217 00:44:53,291 --> 00:44:56,227 HAVING RIGHT TEAM IN AN 1218 00:44:56,227 --> 00:44:57,562 INUTION, HAVING INTENSIVE 1219 00:44:57,562 --> 00:45:01,098 AVAILABILITY OF TRANSFUSION 1220 00:45:01,098 --> 00:45:05,236 SERVICES AND BLOOD. 1221 00:45:05,236 --> 00:45:10,808 AN A PAPER FROM UTAH, THEY 1222 00:45:10,808 --> 00:45:12,910 UND EN TRE WAS A CENTEOF 1223 00:45:12,910 --> 00:45:14,579 EXCELLENCE LEV OF CARE 1224 00:45:14,579 --> 00:45:15,780 AVLABLE, THERE WAS FIVE FOLD 1225 00:45:15,780 --> 00:45:20,985 REDUCEOMPOSITE MATERNALRBIDITY,D 1226 00:45:20,985 --> 00:45:22,520 TRANSFUSION MORE THAN 4NITS 1227 00:45:22,520 --> 00:45:27,258 AND LS ROPERATION WITHIN THE 1228 00:45:27,258 --> 00:45:27,858 FIRST WEEK. 1229 00:45:27,858 --> 00:45:29,327 SOMEONE WHO JUST H A BABY WHO 1230 00:45:29,327 --> 00:45:32,063 NOW HAS A HIGHER RISK OF 1231 00:45:32,063 --> 00:45:33,264 THROMBMBOLIC DISEASE I 1232 00:45:33,264 --> 00:45:33,931 PARTICULAR, IT'S NOT AOOD 1233 00:45:33,931 --> 00:45:39,203 OPERATINOOM.CK TO THE 1234 00:45:39,203 --> 00:45:40,338 AND ONEEASON THAT THESE 1235 00:45:40,338 --> 00:45:42,907 FINDINGS WERE BETTER IS THERE'S 1236 00:45:42,907 --> 00:45:43,507 STANDARDIZATION OCARE 1237 00:45:43,507 --> 00:45:45,476 CE YOU START TO WKOGHER, 1238 00:45:45,476 --> 00:45:47,211 D DOOMETHINGITE, W 1239 00:45:47,211 --> 00:45:49,246 KNOW THAT YOU GET BETTER AT IT. 1240 00:45:49,246 --> 00:45:50,982 YOU IDENTIFY THE GAPS,OU 1241 00:45:50,982 --> 00:45:52,116 IDENTI WHAT ARE THE PROBLEMS, 1242 00:45:52,116 --> 00:45:55,086 AND IN A RETROSPECTIVE COHOR 1243 00:45:55,086 --> 00:45:59,657 STUDY THAT KARIN FOX CONCTED, 1244 00:45:59,657 --> 00:46:01,759 THEY LOOKED AT A 1245 00:46:01,759 --> 00:46:03,394 MULTIDISCIPLINARY ACCRETA TEAM 1246 00:46:03,394 --> 00:46:05,096 WHEN THEY ALSO ESTABLISHED A 1247 00:46:05,096 --> 00:46:05,830 PROTOCOLECAUSE THAT'SHAT YOU 1248 00:46:05,830 --> 00:46:08,032 DO WHEN YOU HAVE A LARGE TEAM, 1249 00:46:08,032 --> 00:46:09,400 AND TYOMPARED THIS TO TIR 1250 00:46:09,400 --> 00:46:12,136 DA WHEN THE WAS A 1251 00:46:12,136 --> 00:46:12,937 NON-MULTIDISCIPLINARY CARE, SO 1252 00:46:12,937 --> 00:46:20,711 WHEN THERE W NO PROTOCOL.ON 1253 00:46:20,711 --> 00:46:22,680 THEY IDENTIFIED THER WAS LESS 1254 00:46:22,680 --> 00:46:25,216 MEDIAN BLOOD LOSS WN THEY 1255 00:46:25,216 --> 00:46:27,318 TEAM.Z THE MTIDISCIPLINARY 1256 00:46:27,318 --> 00:46:28,085 EV AFTERHE PROAT WIL COULD, 1257 00:46:28,085 --> 00:46:29,487 THEY STARTED TO BEECOGNIZED 1258 00:46:29,487 --> 00:46:32,223 A CTER THAT DID AOT OF THESE 1259 00:46:32,223 --> 00:46:34,392 DELIVERIES AND THE HAD A LOT 1260 00:46:34,392 --> 00:46:37,762 MORE ACCRETAS, DESPITE THA THE 1261 00:46:37,762 --> 00:46:38,863 OUTCOMES WERE MUCH BETTERER 1262 00:46:38,863 --> 00:46:39,397 THE PROCOL. 1263 00:46:39,397 --> 00:46:42,933 WE KNOW MY INSTITUTIONS, ANY 1264 00:46:42,933 --> 00:46:44,135 ONE OF ALL OF THESEPEALTIES 1265 00:46:44,135 --> 00:46:45,569 MAY BE INVOLVED IN OUR 1266 00:46:45,569 --> 00:46:46,871 DELIRI. 1267 00:46:46,871 --> 00:46:48,572 BUT I WANT TO JUST CALL OUT 1268 00:46:48,572 --> 00:46:49,140 ANOTHER AREA BAUSE I THI 1269 00:46:49,140 --> 00:46:51,742 ISN IMPORTANT GAP THA 1270 00:46:51,742 --> 00:46:52,843 I'MG W ADDRESS THE 1271 00:46:52,843 --> 00:46:59,917 OFTEN DIAGNOSED AT DIVERY. 1272 00:46:59,917 --> 00:47:00,918 AND FOR ALL THI IF'RE 1273 00:47:00,918 --> 00:47:01,886 GOING TO HAVE THE RIGHT TEAM IN 1274 00:47:01,886 --> 00:47:04,989 THE ROOM, YOUEED TO KNOW ABO 1275 00:47:04,989 --> 00:47:07,525 BUT IN A PROSPECTIVE COHORT 1276 00:47:07,525 --> 00:47:10,294 STUDY INORDIC COUNTRIES, THEY 1277 00:47:10,294 --> 00:47:11,629 COLLECTED AOT O DATA ON A LOT 1278 00:47:11,629 --> 00:47:12,697 OF DIFRENTHINGS AND ONE 1279 00:47:12,697 --> 00:47:13,798 ACCRND 1280 00:47:13,798 --> 00:47:16,467 AND IDENTIFIEDT WERE 1281 00:47:16,467 --> 00:47:17,568 DIAGNOSE AT DELIVERY. 1282 00:47:17,568 --> 00:47:19,770 NOW THI IS LARGE DATA, IT'S 1283 00:47:19,770 --> 00:47:23,974 THEY WER USING THE WASNITIONS 1284 00:47:23,974 --> 00:47:27,812 BUT IN RETROSPECTIVE COHORT 1285 00:47:27,812 --> 00:47:30,147 LOOK AT YOUR PATHOLOGY DABASE, 1286 00:47:30,147 --> 00:47:32,650 WE SEE A LOT MORE ACCRETAS THAN 1287 00:47:32,650 --> 00:47:35,986 ONE MIG EXPECT. 1288 00:47:35,986 --> 00:47:39,190 A DIFFERENT STUDY BUT IN ONE OFF 1289 00:47:39,190 --> 00:47:43,828 THE TLES, IT SHOWS THAT 7 OF 1290 00:47:43,828 --> 00:47:48,065 THEIR ACCTAS WERE NOT 1291 00:47:48,065 --> 00:47:50,267 SUSPECTED, AND IN ITALY. 1292 00:47:50,267 --> 00:47:55,473 STANFORD, MORE THA HF WERERD 1293 00:47:55,473 --> 00:47:58,542 NOT SUSPECTED ANTENATALLY, THEY 1294 00:47:58,542 --> 00:47:59,744 WERE DIAGNOSED AT DELIVERY. 1295 00:47:59,744 --> 00:48:00,978 AMONGHOSE, IF YOU LOOD AT 1296 00:48:00,978 --> 00:48:02,446 THE NUMR OF ACCTAS THAT WE 1297 00:48:02,446 --> 00:48:07,852 WHEN IT GET A LITTLE WORSE, 1298 00:48:07,852 --> 00:48:09,019 THEN DEFINITELY THERE'S A MUCH 1299 00:48:09,019 --> 00:48:11,222 HIGHERIAGNOSTIC -- OR ABILITY 1300 00:48:11,222 --> 00:48:12,223 TO DIAGNOSE. 1301 00:48:12,223 --> 00:48:21,165 18% O INCRETAS WER MISSEDESSENT. 1302 00:48:21,165 --> 00:48:22,600 NONE OF THE PERCRETAS WERE 1303 00:48:22,600 --> 00:48:23,534 MISSED. 1304 00:48:23,534 --> 00:48:25,903 WENOW 95% OF MIKE SCOPIC 1305 00:48:25,903 --> 00:48:27,338 ACCRETAS WERE NOT SEEN ON 1306 00:48:27,338 --> 00:48:27,638 ULTRASOUND. 1307 00:48:27,638 --> 00:48:31,442 THE QUESTION I THINK WE CAISES 1308 00:48:31,442 --> 00:48:34,411 ASSUME THAT OUTCOME FROM A 1309 00:48:34,411 --> 00:48:36,881 DIAGNOSIS AT DELIVERY ARE GOING 1310 00:48:36,881 --> 00:48:38,182 TO BE WORSEND THAT'S NOT OFTEN 1311 00:48:38,182 --> 00:48:40,818 ACKNOWLEDGED IN THESE LARGE 1312 00:48:40,818 --> 00:48:41,085 DATASETS. 1313 00:48:41,085 --> 00:48:42,186 SO WHEN CNSELIN A PATIENT, 1314 00:48:42,186 --> 00:48:43,721 IT'S HARD TO KNOW AGAIN WHO WAS 1315 00:48:43,721 --> 00:48:44,155 THAT PATIENT? 1316 00:48:44,155 --> 00:48:46,924 JUST IN CLOSING, CRITICA 1317 00:48:46,924 --> 00:48:52,563 S INMM TRENDS, WE NEED MEASURE 1318 00:48:52,563 --> 00:48:54,999 RESECH WITH CONSISTENT 1319 00:48:54,999 --> 00:48:55,566 DEFINITIONS, STANDARDID 1320 00:48:55,566 --> 00:48:56,534 OUTCOM MEASURES A SOME 1321 00:48:56,534 --> 00:48:57,268 DELINEATION OF E POPULATIONS 1322 00:48:57,268 --> 00:49:00,871 WE NEED HISTOPATHOLOGIC 1323 00:49:00,871 --> 00:49:02,807 DEFINITIONS, CLINICAL 1324 00:49:02,807 --> 00:49:04,208 DEFINITIS, YOUEE TO CALL 1325 00:49:04,208 --> 00:49:08,212 OUT WHEN WE'RE CALLING MICRO 1326 00:49:08,212 --> 00:49:09,280 SCOPIC ACCRETA PAS IN GENERAL IN 1327 00:49:09,280 --> 00:49:10,948 STUDY, CALLINGUT WHEER THE 1328 00:49:10,948 --> 00:49:13,384 STUDYNCLUDED PASITH PREVIA 1329 00:49:13,384 --> 00:49:15,586 OR PAS WITUT PREVIA. 1330 00:49:15,586 --> 00:49:16,687 WHENAS IT DIAGNOSED 1331 00:49:16,687 --> 00:49:17,922 WAS IT DIAGNOSED PRIOR TO 1332 00:49:17,922 --> 00:49:18,589 DELIVERY WHEN YOU'VEOT THE 1333 00:49:18,589 --> 00:49:19,990 TT PEOPLE, LOTS OF BOD AND 1334 00:49:19,990 --> 00:49:22,226 LOTS OF IVs AND, YOU KNOW, 1335 00:49:22,226 --> 00:49:23,561 NTRAL LIS AND ALL TT TO 1336 00:49:23,561 --> 00:49:24,628 GIVE SOMEONE BLOOD QUICKLYR 1337 00:49:24,628 --> 00:49:26,831 OPERATING OM?D IN THE 1338 00:49:26,831 --> 00:49:28,866 AND W WAS THE TEAM PRESENT? 1339 00:49:28,866 --> 00:49:32,036 I THINK ALL O THIS WOULD EBLE 1340 00:49:32,036 --> 00:49:33,504 A LOT MORE RELIABLEURVEILLANCE 1341 00:49:33,504 --> 00:49:35,473 SYSTEMS ANDLSO MORE ACCURATE 1342 00:49:35,473 --> 00:49:36,140 DIVIDUALIZED PATIENT 1343 00:49:36,140 --> 00:49:36,640 COUNSELING 1344 00:49:36,640 --> 00:49:43,414 OF CNICAL GUIDANCEECAUSE WE WET 1345 00:49:43,414 --> 00:49:45,482 KN A LOT OF THESE ACCRETAS ARE 1346 00:49:45,482 --> 00:49:46,450 GOING E DIAGNOSED IN THE 1347 00:49:46,450 --> 00:49:47,618 OPERATING ROOND EVERY NOW AND 1348 00:49:47,618 --> 00:49:49,720 THEN, SOMEDY WHO MAY NOT BE 1349 00:49:49,720 --> 00:49:51,522 EQUIPPED MAY SEE A SURPRISE 1350 00:49:51,522 --> 00:49:52,623 ACCRETOW D WE TTHEM TO 1351 00:49:52,623 --> 00:49:53,724 RECOGNIZEHAT, HOW DOE TEACH 1352 00:49:53,724 --> 00:49:55,793 THEM TO ROGNI THAT? 1353 00:49:55,793 --> 00:49:57,628 ANDE ALSOEED FUND 1354 00:49:57,628 --> 00:49:59,029 MULTICENTER RESEARCH TO REDUCE 1355 00:49:59,029 --> 00:50:01,999 PROVE QUALITY EDENCE FO 1356 00:50:01,999 --> 00:50:03,934 THOSE BEST PRACTICES OF WHAT WE 1357 00:50:03,934 --> 00:50:05,569 KNOW IS A HIGY MBID 1358 00:50:05,569 --> 00:50:06,871 NDITIO TO ENABLE HIGHER 1359 00:50:06,871 --> 00:50:08,806 QUALITY RESEARCH, AND FINAL, 1360 00:50:08,806 --> 00:50:10,608 TO REDUCE RESEARCH SILOS. 1361 00:50:10,608 --> 00:50:20,384 THK YOU S MUCH. 1362 00:50:20,384 --> 00:50:23,687 >> DR. LYELLTHANK YOU SO M DH. 1363 00:50:23,687 --> 00:50:27,324 WE'REXCIT FOR DR.FSHAR'S 1364 00:50:27,324 --> 00:50:37,468 TA NEXT. 1365 00:50:42,840 --> 00:50:44,375 >> GOOD MORNING. 1366 00:50:44,375 --> 00:50:48,479 I TH THANK T ORGANIZERS FOR 1367 00:50:48,479 --> 00:50:49,780 CREATING THI SCE SPEAKING 1368 00:50:49,780 --> 00:50:52,383 ABOUT BIOLOGY, KIND OF IN EPI. 1369 00:50:52,383 --> 00:50:54,785 SO I HOPE YOU -- I CANSE THE 1370 00:50:54,785 --> 00:50:55,886 NEXT0 NUTE TO CONVIE YO 1371 00:50:55,886 --> 00:50:58,088 THAT BIOLOGY ACTUALL TOUCHES 1372 00:50:58,088 --> 00:51:03,127 ERY SINGLE ASPECT OF THE TALKS 1373 00:51:03,127 --> 00:51:04,428 INCLUDING ULTRASOUND PREVENTION 1374 00:51:04,428 --> 00:51:06,063 AND L'S JP RIGHT IN OF WHY 1375 00:51:06,063 --> 00:51:10,200 BIOLY MATTERS. 1376 00:51:10,200 --> 00:51:11,602 MY DISCLURES GENALOT 1377 00:51:11,602 --> 00:51:16,907 FOR PATENT ON SOME CIRCULATING 1378 00:51:16,907 --> 00:51:17,441 TROPHOBLT TECHNOLOGY. 1379 00:51:17,441 --> 00:51:20,077 DR. LYELL STARTED OFF WITH 1380 00:51:20,077 --> 00:51:22,680 THATE OF SMM, BUT I HOPEO 1381 00:51:22,680 --> 00:51:24,014 INSPIRE THAT WE HAVE DONE 1382 00:51:24,014 --> 00:51:24,615 ER. 1383 00:51:24,615 --> 00:51:27,151 THIS I FM ALMOST AENTURY 1384 00:51:27,151 --> 00:51:29,620 O, 90 YEARS AGO, SENIOR 1385 00:51:29,620 --> 00:51:31,689 THESIS WHERE THERE WAS 36 CASES 1386 00:51:31,689 --> 00:51:33,924 WHAT YOU CAN DED AS 1387 00:51:33,924 --> 00:51:37,094 72% OF THE PREGNT PEOPLE DIED. 1388 00:51:37,094 --> 00:51:38,429 WE HAVE DONE BETR. 1389 00:51:38,429 --> 00:51:40,497 AND THIWAS A HISTOLOGIC 1390 00:51:40,497 --> 00:51:42,199 COIRMATION OF ACCRETA. 1391 00:51:42,199 --> 00:51:43,634 SO INSPIRING, AS WE PS 1392 00:51:43,634 --> 00:51:45,602 FORWD. 1393 00:51:45,602 --> 00:51:47,571 BU HE'S WHERE WE HAVE NOT 1394 00:51:47,571 --> 00:51:49,306 MADE PROGRESS. 1395 00:51:49,306 --> 00:51:49,807 1937. 1396 00:51:49,807 --> 00:51:52,977 AROUND THEIME WHE WE START 1397 00:51:52,977 --> 00:51:54,311 DESCRIBING HISTOLOGI ACCRETA. 1398 00:51:54,311 --> 00:51:56,547 WHAT IS THE BASIS WHAT IS THE 1399 00:51:56,547 --> 00:51:57,514 BIOLOGY,OW DOES THIS TOU 1400 00:51:57,514 --> 00:51:59,083 WHATE DO? 1401 00:51:59,083 --> 00:52:02,987 MALDEVELOPMENT CH UTERUS, 1402 00:52:02,987 --> 00:52:07,558 METHING IS MESSED U WI WITH WITH 1403 00:52:07,558 --> 00:52:08,659 TH SOIL. 1404 00:52:08,659 --> 00:52:11,695 THERE'S EXCESSIVE GROWTH OF THE 1405 00:52:11,695 --> 00:52:15,065 CHORIONIC ELEMENTS, I LOVE 1406 00:52:15,065 --> 00:52:17,234 THIS INSUFFICIENT ANTI-FERMENT 1407 00:52:17,234 --> 00:52:17,901 PRODUCTION 1408 00:52:17,901 --> 00:52:18,869 THERS NO STOPIGNAL. 1409 00:52:18,869 --> 00:52:22,773 ELEMEN AND UNFORTUNATELY N 1410 00:52:22,773 --> 00:52:24,942 MADE SIGNIFICANTROGRESS IN THE 1411 00:52:24,942 --> 00:52:26,143 BIOLOGY OF THEISEASE THATE 1412 00:52:26,143 --> 00:52:28,278 HA IN ESSCE CREATED 1413 00:52:28,278 --> 00:52:28,612 SUICALLY. 1414 00:52:28,612 --> 00:52:31,582 SO LET'S MOV P L THI CLASSIC 1415 00:52:31,582 --> 00:52:31,882 DEFINITION. 1416 00:52:31,882 --> 00:52:33,517 YES, WE TRE IT AS THE GOLD 1417 00:52:33,517 --> 00:52:38,222 ANDARD OF THIS VIL 1418 00:52:38,222 --> 00:52:39,089 INTERDIGATGGH BUT I 1419 00:52:39,089 --> 00:52:40,124 PE TO CONVINCE YOU IS MO 1420 00:52:40,124 --> 00:52:43,460 THAN THIS. 1421 00:52:43,460 --> 00:52:45,729 I HOPE WE THINKF INVASIVE ONLY 1422 00:52:45,729 --> 00:52:48,198 TO OUR AREA.T ARE NON-NATIVE 1423 00:52:48,198 --> 00:52:51,435 I LOVE, LOVE PLANTING AND 1424 00:52:51,435 --> 00:52:51,769 RTICULTURE 1425 00:52:51,769 --> 00:52:54,405 SO THIS IS A NON-NATIVE SPECIES, 1426 00:52:54,405 --> 00:52:59,476 THIS IS A INNOVATIV SPECIES. 1427 00:52:59,476 --> 00:53:01,445 PLACENTAS AROT INVAI SI. THE 1428 00:53:01,445 --> 00:53:03,847 NORMAL PLACENTA THAT DEVELOPS IN 1429 00:53:03,847 --> 00:53:05,749 BIOLOGY, THE VILLI AROUND THREE 1430 00:53:05,749 --> 00:53:07,184 EKS, YES, IT STARTS INVING 1431 00:53:07,184 --> 00:53:10,888 SO YES, I TOOK THIS PICTURE FROM 1432 00:53:10,888 --> 00:53:11,889 INTEREST SILVER AND MYSELF, WE 1433 00:53:11,889 --> 00:53:12,289 AR T PBLEM 1434 00:53:12,289 --> 00:53:13,957 THIS IS NOT A CANCER. 1435 00:53:13,957 --> 00:53:16,860 THIS IS A SPECTRUM. 1436 00:53:16,860 --> 00:53:18,362 SOME OF THIS THA WE TRY TO DO 1437 00:53:18,362 --> 00:53:20,230 IS WHAT I THINK SPSHE 1438 00:53:20,230 --> 00:53:23,534 BIOLOGICAL UNDERSTANDING. 1439 00:53:23,534 --> 00:53:25,769 SO WHO WE ARE, AND DR. LYELL 1440 00:53:25,769 --> 00:53:27,738 POINTED TO SOME OF THIS BASIS, 1441 00:53:27,738 --> 00:53:29,973 THE LITERATUR ISILLED WITH AN 1442 00:53:29,973 --> 00:53:31,075 ABILITY TOPLE THIS, 1443 00:53:31,075 --> 00:53:33,277 RIGHT? 1444 00:53:33,277 --> 00:53:36,380 MAP, IEP,ORMALLY INVASIVE 1445 00:53:36,380 --> 00:53:37,381 PLACENTA, SOME MORE OTHE SAME 1446 00:53:37,381 --> 00:53:39,249 BUT SO MUC OVERLAP. 1447 00:53:39,249 --> 00:53:41,085 AND THEOAL OF THE LANGUAGE 1448 00:53:41,085 --> 00:53:43,454 WITH PLANTA ARETA W REALLY 1449 00:53:43,454 --> 00:53:45,422 WHAT I THE CONSEENCE, WHAT IS 1450 00:53:45,422 --> 00:53:52,096 THEBVIOUSET OBSTETRICAL CONSEQUT 1451 00:53:52,096 --> 00:53:55,432 UCHES US? 1452 00:53:55,432 --> 00:53:59,303 WE'RE AROHING IT AS AAY 1453 00:53:59,303 --> 00:54:00,170 COMPILATION OF WHAT WE S IN 1454 00:54:00,170 --> 00:54:02,072 THOPERATING RM, WHAT WE 1455 00:54:02,072 --> 00:54:04,141 COUPLE WITH ULTRASOUNDND WHAT 1456 00:54:04,141 --> 00:54:05,809 WE SEE LATERN ISEALLY GOING 1457 00:54:05,809 --> 00:54:09,913 TO PUSH US FORWARD. 1458 00:54:09,913 --> 00:54:12,316 SO LET'S ABANDON THIS CONCEPT OF 1459 00:54:12,316 --> 00:54:14,618 INVASION AS THE PROBLEMTHE 1460 00:54:14,618 --> 00:54:15,752 PAOPHYSIOLOG 1461 00:54:15,752 --> 00:54:17,321 THIS PCENTA, THIS HYSRECTOMY 1462 00:54:17,321 --> 00:54:19,056 SPECEN THAT'S SEEN INUR PATH 1463 00:54:19,056 --> 00:54:21,291 PATH GOINGO SAY?OR WHAT IS 1464 00:54:21,291 --> 00:54:24,294 WHAT WE SAW PRENATALLY, WHAT WE 1465 00:54:24,294 --> 00:54:25,395 SAW INTRAOPERATIVELY, TT IS 1466 00:54:25,395 --> 00:54:29,066 PART OF THIS. 1467 00:54:29,066 --> 00:54:30,868 SO I THINK THIS IS A HUGE, HUGE 1468 00:54:30,868 --> 00:54:32,636 THEME, BUT LOT OF THIS IS 1469 00:54:32,636 --> 00:54:34,037 GOING TO BEHY AND WHAT'SOING 1470 00:54:34,037 --> 00:54:35,038 ON, BECAUSE THERE'S ALWAYS A 1471 00:54:35,038 --> 00:54:35,639 LAYER. 1472 00:54:35,639 --> 00:54:37,274 INVASI.EVER TRU TRUE 1473 00:54:37,274 --> 00:54:38,275 THERE'S ALWAYS A LAYERF 1474 00:54:38,275 --> 00:54:41,912 PROTECTION. 1475 00:54:41,912 --> 00:54:45,883 WHEN MY KIDAS CUTER MUCHAS 1476 00:54:45,883 --> 00:54:46,984 SMLER, BUT REALLY FOUR ASPECTS 1477 00:54:46,984 --> 00:54:48,152 AT WE'RE GOING TOHINK ABOUT, 1478 00:54:48,152 --> 00:54:49,453 WHAT WE'REOINGYOU KNO 1479 00:54:49,453 --> 00:54:51,188 WE'VE BEEN SO FOCUSED ON THE 1480 00:54:51,188 --> 00:54:55,959 SEED AND THAT SCAR PLACENTATION 1481 00:54:55,959 --> 00:54:59,796 BUT THERE'S THE DESI D 1482 00:54:59,796 --> 00:55:02,599 ENVIRONMENT WHH'M CONVINCED 1483 00:55:02,599 --> 00:55:04,234 IS THE BASIS OF THIS DEASE 1484 00:55:04,234 --> 00:55:06,303 WE'V CREATED. 1485 00:55:06,303 --> 00:55:08,572 THE PLACENTAL CIRCULATION, IT'S 1486 00:55:08,572 --> 00:55:10,974 NOT NEOVASCULARIZATION LIKE 1487 00:55:10,974 --> 00:55:12,042 ONCOLOGYOULD THI ABOUT. 1488 00:55:12,042 --> 00:55:13,911 IS IS TRU NOREVELOPMENT 1489 00:55:13,911 --> 00:55:14,444 BIOLOGY. 1490 00:55:14,444 --> 00:55:17,147 THEN OPERATO TECHNIQUE, THIS IS 1491 00:55:17,147 --> 00:55:18,448 WHAT WE CAN DOETTER AND I 1492 00:55:18,448 --> 00:55:19,683 THINK WILL BE THE INSPIRATION 1493 00:55:19,683 --> 00:55:22,920 MOVING FORWARD.SO ONWARD TO UND. 1494 00:55:22,920 --> 00:55:24,521 I COMPILED SOME WORK PUBLISHED 1495 00:55:24,521 --> 00:55:26,290 SOME FROM US, SOME UNPUBLISHED, 1496 00:55:26,290 --> 00:55:27,691 ABOUT TING TO UERSTAND THE 1497 00:55:27,691 --> 00:55:28,258 ALLACENTA. 1498 00:55:28,258 --> 00:55:29,660 IT'S A NORMAL PHYSIOLOGIC 1499 00:55:29,660 --> 00:55:30,060 PROCESS. 1500 00:55:30,060 --> 00:55:31,762 HOW CAN WEK AT TND 1501 00:55:31,762 --> 00:55:34,331 FIGU OUT WHAT'S BEEN GOING ONN 1502 00:55:34,331 --> 00:55:35,165 THUGHOUT GESTATION FROM THE 1503 00:55:35,165 --> 00:55:37,234 SPECIM THAT WE SEET BIRTH. 1504 00:55:37,234 --> 00:55:39,770 ISS SOME MEMRS FROM MY 1505 00:55:39,770 --> 00:55:40,003 TEAM. 1506 00:55:40,003 --> 00:55:42,105 THUGHOUT A OF THIS, IT'S 1507 00:55:42,105 --> 00:55:43,440 TRULY A VILLAGE AND I'LL 1508 00:55:43,440 --> 00:55:45,509 ACOWLEDG THEM AT THE END. 1509 00:55:45,509 --> 00:55:47,277 MUCH O THEIR MOLECULAR STUDIES 1510 00:55:47,277 --> 00:55:50,380 ON ACCRETA TAKE THE PLACENTA, W 1511 00:55:50,380 --> 00:55:51,582 MOOSH ITOGHERND TNK 1512 00:55:51,582 --> 00:55:53,016 ABOUT WHAT ARE THE CHANGES AT A 1513 00:55:53,016 --> 00:55:55,485 CELLULAR LEFERL THATAUSES THIS 1514 00:55:55,485 --> 00:55:56,887 OCCURRENCE. 1515 00:55:56,887 --> 00:55:58,622 VERY ELEGANT WORK, MEMBERS IN 1516 00:55:58,622 --> 00:55:59,590 IS ROOM WER PART OF IT. 1517 00:55:59,590 --> 00:56:02,926 THEY LOOKED ATHE SINGLE GENES, 1518 00:56:02,926 --> 00:56:04,461 ADITIONAL P SAID WHAT GOES 1519 00:56:04,461 --> 00:56:06,563 WH GOES DOWN, AND THESE 1520 00:56:06,563 --> 00:56:08,699 ARE GENES THAT ARE RESPONSIBLE 1521 00:56:08,699 --> 00:56:11,735 FOR NORMAL EPITHELIAL 1522 00:56:11,735 --> 00:56:12,502 MENCHYMAL TRANSITION, TNGS 1523 00:56:12,502 --> 00:56:14,071 WE WOULD THINKHANGE IN NORMAL 1524 00:56:14,071 --> 00:56:14,871 BIOGY. 1525 00:56:14,871 --> 00:56:16,306 SUSAN FISHER'SROUP DID MICRO 1526 00:56:16,306 --> 00:56:18,942 AR, YOU KNOW, STANDARD MRO 1527 00:56:18,942 --> 00:56:19,643 ARRAYS. 1528 00:56:19,643 --> 00:56:21,745 THEYUT TOGETHER ACCRETA 1529 00:56:21,745 --> 00:56:23,847 ECIMENS FROM ACCRETAS VERSUS 1530 00:56:23,847 --> 00:56:24,948 PRETERM BIR, LOOKED AT THE 1531 00:56:24,948 --> 00:56:26,516 GENES, THEY GO UP AND DOWN, 1532 00:56:26,516 --> 00:56:27,050 CREATING A CCADE. 1533 00:56:27,050 --> 00:56:28,452 BUT A LITTLE BIT OF THE ISS 1534 00:56:28,452 --> 00:56:30,754 TH SOME OF THE BULK AND 1535 00:56:30,754 --> 00:56:31,955 SEQUENNG IS IT PS EVERYTHING 1536 00:56:31,955 --> 00:56:32,656 TOGETHER. 1537 00:56:32,656 --> 00:56:35,492 SO I LIVE I L.A., I BUY $20 1538 00:56:35,492 --> 00:56:38,595 SMOOTHIES ARE GREAT, THEY TASTE 1539 00:56:38,595 --> 00:56:41,164 REALLY GOOD, IS IT TANGY, SOUR, 1540 00:56:41,164 --> 00:56:43,133 BUT THE POWERF SINGLE CEL 1541 00:56:43,133 --> 00:56:48,438 WHICH I HAS REALLY FOUND ITS SPE 1542 00:56:48,438 --> 00:56:49,640 IN MATERNAL FETAL MEDICINE, I 1543 00:56:49,640 --> 00:56:52,943 INDIVIDUAL CELLULAR COMPONTS 1544 00:56:52,943 --> 00:56:55,112 THAT COME TOGETHE IN THAT 1545 00:56:55,112 --> 00:56:55,445 SMOOTHIE. 1546 00:56:55,445 --> 00:56:57,514 AND THIS IS SO IMPTANT FOR THE 1547 00:56:57,514 --> 00:56:58,515 BIOLOGY, BECAUSE WHO IS SAKING 1548 00:56:58,515 --> 00:57:00,784 TO WHO? 1549 00:57:00,784 --> 00:57:02,152 IT'S NOT J THE TPHOBLASTS. 1550 00:57:02,152 --> 00:57:05,889 WHERE IS T DECUA, WHAT 1551 00:57:05,889 --> 00:57:07,090 ENDOTHELIAL CELLS I IT SPEAKING 1552 00:57:07,090 --> 00:57:07,524 TO. 1553 00:57:07,524 --> 00:57:09,559 OTTORSAVE NOW PUBLISHED 1554 00:57:09,559 --> 00:57:12,396 PREPRINTS ON THIS WORK LOOKING 1555 00:57:12,396 --> 00:57:13,163 AT ACCRETA 1556 00:57:13,163 --> 00:57:18,402 SO WESE AN ACCRETA AT THE SITE 1557 00:57:18,402 --> 00:57:23,173 OF MOS ADHERENCE COMPARED TO A 1558 00:57:23,173 --> 00:57:24,441 SITE NOT - BECAUSE THE ENTIRE 1559 00:57:24,441 --> 00:57:26,109 PLACEN IS NOT ADHERENT TO THE 1560 00:57:26,109 --> 00:57:27,844 SAME DEGREE, ANDE TK 1561 00:57:27,844 --> 00:57:29,479 CONTROLS. 1562 00:57:29,479 --> 00:57:31,515 AND WE S WHAT'S DFERENT? 1563 00:57:31,515 --> 00:57:33,150 SO EACH O THESE INDIVIDUAL DOT 1564 00:57:33,150 --> 00:57:34,484 ARCELLS, WE THEN ASSIGN THEM 1565 00:57:34,484 --> 00:57:37,220 TO THE TYPE OF CELL T ARE, WE 1566 00:57:37,220 --> 00:57:38,055 SIGN THEM TO THE DISEASE THEY 1567 00:57:38,055 --> 00:57:41,124 INTERACTION AND WHAT'S CHANGED 1568 00:57:41,124 --> 00:57:42,292 IN AN ACCRETAERSUS A 1569 00:57:42,292 --> 00:57:45,662 WHAT'S CHANGEDN AN ADHERENCE 1570 00:57:45,662 --> 00:57:46,863 VERSUS NONDHERENCE SITE. 1571 00:57:46,863 --> 00:57:48,966 ANTHEN WE CAN PUT TOGETHER 1572 00:57:48,966 --> 00:57:50,767 KNOWN SIGOGLING PATHWAYS,E CAN 1573 00:57:50,767 --> 00:57:52,402 LOOK AT INDIVIDUAL GENES, AND WE 1574 00:57:52,402 --> 00:57:56,840 T MEMBES AND GENES 1575 00:57:56,840 --> 00:57:57,607 DIFFERENTILY EXPRESSED IN 1576 00:57:57,607 --> 00:57:58,141 ACCRETA. 1577 00:57:58,141 --> 00:58:00,444 FOR THOSE THAT THINK 1578 00:58:00,444 --> 00:58:01,645 BIOGICALLY, THERE'S NOO 1579 00:58:01,645 --> 00:58:02,546 SURPRISE. 1580 00:58:02,546 --> 00:58:03,814 THE LL SHAPE DIFNT, 1581 00:58:03,814 --> 00:58:05,115 CELL SIGNALING IS DIFFERE, THE 1582 00:58:05,115 --> 00:58:06,350 COMMUNICATION DIFFERE. 1583 00:58:06,350 --> 00:58:08,685 AND THEN WHAT ARE THE PATHWAYS, 1584 00:58:08,685 --> 00:58:10,120 GUESS WHAT,LOOD VSEL 1585 00:58:10,120 --> 00:58:11,421 DEVELOPMENT, NO SURPRIS 1586 00:58:11,421 --> 00:58:12,889 THIS IS SIGNIFICANTLYIFFENT 1587 00:58:12,889 --> 00:58:15,258 IN ARETA. 1588 00:58:15,258 --> 00:58:17,094 HOW I RESPONSE TO GROWTH 1589 00:58:17,094 --> 00:58:19,162 FACTORS, ANDHEN THE ACTIVELY 1590 00:58:19,162 --> 00:58:21,665 LAMENT YOU KNOW, BASEMENT 1591 00:58:21,665 --> 00:58:22,499 MEMBRA IMODERATED. 1592 00:58:22,499 --> 00:58:24,034 THESE ARE THINGS WE WOULD 1593 00:58:24,034 --> 00:58:27,637 IMPLY ANDIND OF CAN 1594 00:58:27,637 --> 00:58:29,039 HYPOTHESIZE EVEN JT 1595 00:58:29,039 --> 00:58:30,440 EMBRYOLOCALLY THIINGBOUT 1596 00:58:30,440 --> 00:58:32,542 NORMAL PLACEAL DELOPMENT, 1597 00:58:32,542 --> 00:58:33,844 BUT WHAT THEN ISNSPIRING IT, 1598 00:58:33,844 --> 00:58:35,479 HOW CAN WE THEN GO BACK AND 1599 00:58:35,479 --> 00:58:38,849 AFFECT THESE SIGNALI CASCADES. 1600 00:58:38,849 --> 00:58:42,519 COUCOMMUNICION, WE LOOK AT THEL 1601 00:58:42,519 --> 00:58:43,353 INDIVIDUAL GES, INDIVIDUAL 1602 00:58:43,353 --> 00:58:45,922 CELLS TT A DIFFERENT A 1603 00:58:45,922 --> 00:58:49,092 THEN WEE THE SPECIMENS AND 1604 00:58:49,092 --> 00:58:50,794 WEAP INDIVIDUAL AREAS OF 1605 00:58:50,794 --> 00:58:53,430 SLID AND WE CAN LOOK AT THE 1606 00:58:53,430 --> 00:58:55,165 CHANGEIN THE GENES AT SPECIFIC 1607 00:58:55,165 --> 00:58:56,266 AREAS. 1608 00:58:56,266 --> 00:58:58,101 AND SAY WHO IS LITALLYALNG 1609 00:58:58,101 --> 00:58:58,969 TO WHO? 1610 00:58:58,969 --> 00:59:02,038 WH IS DIFFENT ABO THIS 1611 00:59:02,038 --> 00:59:04,007 SLIDE OF ADHERENCE VERSUS IN 1612 00:59:04,007 --> 00:59:06,376 ANHERA OF T SAME 1613 00:59:06,376 --> 00:59:06,943 PLENTA. 1614 00:59:06,943 --> 00:59:08,545 ONE OTHE BIGGEST CHAES WE 1615 00:59:08,545 --> 00:59:14,351 SAWERE IN CLAGEN GES. 1616 00:59:14,351 --> 00:59:18,288 SPATIAL TRANSCRIPTOMICS AND 1617 00:59:18,288 --> 00:59:19,456 SITES OF ADHENCE, THE 1618 00:59:19,456 --> 00:59:20,957 MODULATION OF THEOLLAGE IS 1619 00:59:20,957 --> 00:59:22,092 COMPLETELY, COMPLELY 1620 00:59:22,092 --> 00:59:24,361 DIFFERENT. 1621 00:59:24,361 --> 00:59:26,329 THEN WE TOO CLAGENS AND SAID 1622 00:59:26,329 --> 00:59:28,198 HO DOES COLLAGEN SPEAK, HOW DO 1623 00:59:28,198 --> 00:59:29,399 THE CELLS SPEAK TO ONE ANOTHER? 1624 00:59:29,399 --> 00:59:31,501 LOOK AT? THIS LITTLE CIRCLELOT, 1625 00:59:31,501 --> 00:59:32,502 EVERCES STING AROUND IN 1626 00:59:32,502 --> 00:59:34,571 THEY'RE COMMUNITING.IENDS, 1627 00:59:34,571 --> 00:59:39,476 AND YOU CAN SEE THEEC OR 1628 00:59:39,476 --> 00:59:40,744 THE SOIL THAT'S DRIVING MTF 1629 00:59:40,744 --> 00:59:41,178 THE COMMUNICA. 1630 00:59:41,178 --> 00:59:42,913 'SALKING TO THE ENDOTHEAL 1631 00:59:42,913 --> 00:59:44,481 CELL, AND IT'S REALLY JUST K 1632 00:59:44,481 --> 00:59:48,885 OF SPRINKLG CONVERSIONS TO 1633 00:59:48,885 --> 00:59:49,553 THE TROPHOBLAS, WHICH IS A 1634 00:59:49,553 --> 00:59:50,754 VERY, VERY DIFFERENT PARADIGM 1635 00:59:50,754 --> 00:59:52,022 THAN TRATIONALLY THINKING 1636 00:59:52,022 --> 00:59:53,924 ABOU THE TROPHOBLASTS BEING THE 1637 00:59:53,924 --> 00:59:55,325 DRIVER OF THE SNALING. 1638 00:59:55,325 --> 00:59:59,029 STRONGER CONNECTION BETWE CELL 1639 00:59:59,029 --> 01:00:03,733 TYPES. 1640 01:00:03,733 --> 01:00:06,336 SO BECAU COLLAGEN WAS SO 1641 01:00:06,336 --> 01:00:07,871 DIFFERENTIALLY EXPRESSED INHE 1642 01:00:07,871 --> 01:00:11,107 THE EXTRACELLULAR MATRIX, WAR 1643 01:00:11,107 --> 01:00:13,743 STARD LKING AT SURGICALSPIMENS. 1644 01:00:13,743 --> 01:00:17,481 FROM THE OR, FRESH 1645 01:00:17,481 --> 01:00:20,050 HYSTERECTOMY SPECIMENS, DECIDED 1646 01:00:20,050 --> 01:00:22,786 MOST ADHERENCE VSUS 1647 01:00:22,786 --> 01:00:24,754 NON-ADHERENCE LERALLY JT 1648 01:00:24,754 --> 01:00:26,356 BIOP, FIXED TM AND IMAGED 1649 01:00:26,356 --> 01:00:26,690 THEM. 1650 01:00:26,690 --> 01:00:31,027 SPATIAY RESOLVED LABEL-FREE 1651 01:00:31,027 --> 01:00:34,097 IMAGING, STANDAR HSG IMAGI. 1652 01:00:34,097 --> 01:00:35,732 HARMIC GENATION. 1653 01:00:35,732 --> 01:00:37,033 IT REALLY LETSOU LOOK AT THEOU 1654 01:00:37,033 --> 01:00:37,868 COLLAGEN SUCTURE WITHOUT 1655 01:00:37,868 --> 01:00:41,271 HAVING TOO A STAINING. 1656 01:00:41,271 --> 01:00:43,106 ANWH WE CAN SEE CLEARLY,OU 1657 01:00:43,106 --> 01:00:46,776 E PURPLE IS COLLAGEN 1 AND 1658 01:00:46,776 --> 01:00:47,911 3. 1659 01:00:47,911 --> 01:00:50,514 BEAUTIFULYOMEIUM, V, 1660 01:00:50,514 --> 01:00:54,017 JUST AUTO FLUORES ESSENCE 1661 01:00:54,017 --> 01:00:57,287 BACKGROUND,IE L LIKE 1662 01:00:57,287 --> 01:01:00,657 FLOATING AWAY, DOING ITS THING 1663 01:01:00,657 --> 01:01:01,858 THIS ACCRETA SAMPLE AT A SITE 1664 01:01:01,858 --> 01:01:04,661 THATS NOT ADHERENT. 1665 01:01:04,661 --> 01:01:06,363 THIS IS QUITE DISTINC THAN I 1666 01:01:06,363 --> 01:01:07,831 THE SAME PLACENTA, THE SAME 1667 01:01:07,831 --> 01:01:10,200 PATIEN T COLLAGEN 1 AND 3, 1668 01:01:10,200 --> 01:01:12,068 PURPLE AGAIN, THAT'S REALLY, 1669 01:01:12,068 --> 01:01:13,370 REALLY INTDIGITATED THROUGHOUT 1670 01:01:13,370 --> 01:01:15,672 IT'S LE A BEAUTIFUL SCARF THAT 1671 01:01:15,672 --> 01:01:17,874 MES ITS WAY THROUGH THE THE 1672 01:01:17,874 --> 01:01:20,610 ENTIRE SPECIN. 1673 01:01:20,610 --> 01:01:25,582 YOU CAN LOOK CLOSER. 1674 01:01:25,582 --> 01:01:27,450 SO WE TAKE EACH O TSE,ND WE 1675 01:01:27,450 --> 01:01:28,752 HEM IMMEDIATELY. 1676 01:01:28,752 --> 01:01:32,088 UAN SEE IN 3D, W GETEEPER 1677 01:01:32,088 --> 01:01:38,395 MYOMETRIALORDER.LLYTAYS BY T 1678 01:01:38,395 --> 01:01:39,729 WE CAN ACTUALLY CORRELATE THIS 1679 01:01:39,729 --> 01:01:42,566 TO ULTRASOUND THAT WE DO WH 1680 01:01:42,566 --> 01:01:44,968 SIMILAR SHG THNOLOGO YOU 1681 01:01:44,968 --> 01:01:48,038 CAN DO SHG ON ULTRASOD AND 1682 01:01:48,038 --> 01:01:49,339 COUPLE THE ACTUAL SURGICAL 1683 01:01:49,339 --> 01:01:50,640 SPECIMEN AND ITATCHES 1684 01:01:50,640 --> 01:01:51,474 BEAUTIFULLY. 1685 01:01:51,474 --> 01:01:52,475 VERSUS AT THE SE OF ADHERENCE. S 1686 01:01:52,475 --> 01:01:55,278 YOU SEE THESE SERPENTE 1687 01:01:55,278 --> 01:01:57,113 AKE-LIKE COLGEN 1ND 1688 01:01:57,113 --> 01:01:58,815 3 WITHIN THE VILLI, WITHIN THAT 1689 01:01:58,815 --> 01:02:00,183 SAME PLACENTA OF T SAME PISHT 1690 01:02:00,183 --> 01:02:02,919 AT A SITE THAT'S ADHENT. 1691 01:02:02,919 --> 01:02:04,220 OUR EXCITEMEN WREDICTING, 1692 01:02:04,220 --> 01:02:04,788 RIGHT? 1693 01:02:04,788 --> 01:02:07,290 YOU CAN ACTUALLY MODULATE THIS 1694 01:02:07,290 --> 01:02:11,561 ENATALLY AS WELL. 1695 01:02:11,561 --> 01:02:14,531 SURGICAL SPECIMENS, ANDE 1696 01:02:14,531 --> 01:02:19,069 REACHED OUT TOHOSE THAT HAD 1697 01:02:19,069 --> 01:02:20,070 CREATED A MOUSE MODEL OF 1698 01:02:20,070 --> 01:02:20,403 ACCR 1699 01:02:20,403 --> 01:02:22,572 LO OF CAVEATS WITHIN THE MICE 1700 01:02:22,572 --> 01:02:23,673 AND, YOU KNOW, DEFINITEL MOUSE 1701 01:02:23,673 --> 01:02:25,742 IS NOT A HUMAN B IN A WAY TO 1702 01:02:25,742 --> 01:02:27,644 SAY HOW CAN WLOOK AT THE 1703 01:02:27,644 --> 01:02:32,749 WEN THE HUMAN SPECIMENS ING THAT 1704 01:02:32,749 --> 01:02:34,951 A MOUSE, BUT WE TOOK SHG AND 1705 01:02:34,951 --> 01:02:37,153 ADDED ANOER KIND O 1706 01:02:37,153 --> 01:02:39,556 TECHNOLOGY, NON-STAINING 1707 01:02:39,556 --> 01:02:41,491 TECHNOLOGY, FLI 1708 01:02:41,491 --> 01:02:44,227 THIS IS A BEAUTIFUL 1709 01:02:44,227 --> 01:02:44,995 SPECTROSCOPIST TT WE 1710 01:02:44,995 --> 01:02:46,730 COLLABORAT WITH. 1711 01:02:46,730 --> 01:02:48,131 ON THE TOP ROW, YOUE CONTR 1712 01:02:48,131 --> 01:02:49,799 MI, ONHE BOTTOM, YOUAV 1713 01:02:49,799 --> 01:02:51,468 CRETA MICE, AND JUST VISUALLY 1714 01:02:51,468 --> 01:02:53,169 IN THE MOUSE,OU SEE THE 1715 01:02:53,169 --> 01:02:54,170 DIFFERENCE. 1716 01:02:54,170 --> 01:02:55,739 GORGEOUS BORDER, THAT PLACENTA 1717 01:02:55,739 --> 01:02:57,641 IS RIGHT THERE, NIC LINE, 1718 01:02:57,641 --> 01:02:58,074 INTACT. 1719 01:02:58,074 --> 01:02:59,142 AND IN TH ACCRETAODEL THEY 1720 01:02:59,142 --> 01:03:00,477 HA, YOU SEE THAT IT'S 1721 01:03:00,477 --> 01:03:00,810 DIUPTED. 1722 01:03:00,810 --> 01:03:02,445 BUHAT WE'RE DOINGERE I 1723 01:03:02,445 --> 01:03:04,581 WE'RE ADDING FLIM AND SAYING 1724 01:03:04,581 --> 01:03:05,815 THAT LOOK AT THE COLLAGE LOOK 1725 01:03:05,815 --> 01:03:08,218 AT THE YELLOW AND T TURQUOISE. 1726 01:03:08,218 --> 01:03:10,387 NOT IN THE SAME PLACE AND VERY, 1727 01:03:10,387 --> 01:03:12,756 VERY DTINC AND DIFRENT 1728 01:03:12,756 --> 01:03:14,190 WE SEE THI OVER AND OVER AGAIN 1729 01:03:14,190 --> 01:03:16,126 IN MICE T WE'VE CREATED, 1730 01:03:16,126 --> 01:03:18,862 SIMILARLY TO THEIRS, AND W CAN 1731 01:03:18,862 --> 01:03:19,763 RECAPITULATE IT AND AUALLY 1732 01:03:19,763 --> 01:03:20,664 LA THE AMOUNT OF COLLAGEN 1733 01:03:20,664 --> 01:03:24,100 AT THIS BORDETO GET A 1734 01:03:24,100 --> 01:03:25,101 DIFFERENT PLA 16 TAITION AND 1735 01:03:25,101 --> 01:03:27,537 DIFFEREN BDER BETWEEN THE 1736 01:03:27,537 --> 01:03:28,872 TWO. 1737 01:03:28,872 --> 01:03:30,740 SO THE SURGICALPLES WERE A 1738 01:03:30,740 --> 01:03:32,008 WAY THAT WEAW THE GROSS 1739 01:03:32,008 --> 01:03:34,310 DIFFERENCES IN COLGEN. 1740 01:03:34,310 --> 01:03:35,845 CLEARLY CLEAR THAWAS INCITED 1741 01:03:35,845 --> 01:03:39,082 BY THE SINGLE CELL AND SPATIAL 1742 01:03:39,082 --> 01:03:41,284 SOLVED TRANSCRIPTOMICORK. 1743 01:03:41,284 --> 01:03:42,952 THEOUSEORROBORATED THAT, AND 1744 01:03:42,952 --> 01:03:48,792 EN HOPEFULLY TOU THET AO 1745 01:03:48,792 --> 01:03:51,561 TIENTS IS HOW CANPA WE LOOK ATTE 1746 01:03:51,561 --> 01:03:52,996 MODEL IT. 1747 01:03:52,996 --> 01:03:57,233 SO WEOOK TO HUMAN UTERINE 1748 01:03:57,233 --> 01:04:01,337 FIBROGUY 1749 01:04:01,337 --> 01:04:02,072 FIBRLASTS. 1750 01:04:02,072 --> 01:04:04,541 WE PLATED THEM ON AISH, WE 1751 01:04:04,541 --> 01:04:06,609 DESYDIZE THEM, MAKE THEM 1752 01:04:06,609 --> 01:04:08,745 REPTIVE TO PREGNANCY, YOU ADD 1753 01:04:08,745 --> 01:04:13,249 AORMONE COCKTAIL TO THEM,HEY 1754 01:04:13,249 --> 01:04:17,620 SECRETEGFPG1 -- THEY BECOME 1755 01:04:17,620 --> 01:04:18,521 PLUMP READY CELLS FOR A 1756 01:04:18,521 --> 01:04:18,988 SUBSEQUENT PREGNANCY. 1757 01:04:18,988 --> 01:04:22,425 TH WHAT WE DO IS THEY AUALLY 1758 01:04:22,425 --> 01:04:24,961 CREATE AN ECM THAT WE CAN IMAGE. 1759 01:04:24,961 --> 01:04:26,162 THEY CREATE AN ECM. 1760 01:04:26,162 --> 01:04:28,231 KNOW WHAT TO DO CELUST 1761 01:04:28,231 --> 01:04:30,100 EY A PROGRAMMED TO CREATE A 1762 01:04:30,100 --> 01:04:31,067 BEAUTIFULATRIX. 1763 01:04:31,067 --> 01:04:35,305 WEO THEURGERY ON I 1764 01:04:35,305 --> 01:04:36,573 THISS STANDAROUND MAKER IN 1765 01:04:36,573 --> 01:04:38,141 A DISH, AND WE ASSUME THIS I 1766 01:04:38,141 --> 01:04:44,247 OF LIKE OURESAREAN SCAR. 1767 01:04:44,247 --> 01:04:47,183 SOELLS I GREEN ARE THESE 1768 01:04:47,183 --> 01:04:49,486 MAN UTERINE FIBROBLASTS, WE 1769 01:04:49,486 --> 01:04:51,354 EA THATR, WE OPERATE ON 1770 01:04:51,354 --> 01:04:52,422 THERNLGS A THEY CLOSE. 1771 01:04:52,422 --> 01:04:52,789 GREAT. 1772 01:04:52,789 --> 01:05:02,065 WE CAN PLATE THE DIS WITH DISH. 1773 01:05:02,065 --> 01:05:03,666 COLLAGEN, WE COULD NOT PLATE IT 1774 01:05:03,666 --> 01:05:05,869 WITH COLLAGEN, WE CAN ADD 1775 01:05:05,869 --> 01:05:06,870 DIFFERENT MATRICES AND WE CAN 1776 01:05:06,870 --> 01:05:09,072 THINGS CLOSE, WHICH ARELY TSE 1777 01:05:09,072 --> 01:05:11,641 INSPIRING FM A SURGIL 1778 01:05:11,641 --> 01:05:15,245 PREGNANCY ON TOP.SEQUENT 1779 01:05:15,245 --> 01:05:17,013 SO YOU HAVE A SURGERY, THEOUND 1780 01:05:17,013 --> 01:05:19,048 IS CLOSED,ND THEN WE ADD 1781 01:05:19,048 --> 01:05:19,949 TROPHOBLAST CELLS ON TOP. 1782 01:05:19,949 --> 01:05:21,551 THIS IS JUST A SPLE WITH ONE 1783 01:05:21,551 --> 01:05:22,852 LINEF TROPHOBLASTS. 1784 01:05:22,852 --> 01:05:24,521 THERE'S MULTITUDE, THERE'S 1785 01:05:24,521 --> 01:05:26,456 PRIMARY CEL, AND THEN WE ADD 1786 01:05:26,456 --> 01:05:28,324 CELLS AND SAY HOWO CELLS 1787 01:05:28,324 --> 01:05:28,525 OSE? 1788 01:05:28,525 --> 01:05:30,393 SO THE WOUND IS CLOSED, GREEN IS 1789 01:05:30,393 --> 01:05:32,328 CLOSED, AND THEN THESE 1790 01:05:32,328 --> 01:05:33,897 OPHOBLAST CEL, WHICH SIGNIFY 1791 01:05:33,897 --> 01:05:35,865 PREGNANCY WHERE DO 1792 01:05:35,865 --> 01:05:37,400 THEY GO IN RELIONSHIP TO T 1793 01:05:37,400 --> 01:05:37,934 SCAR? 1794 01:05:37,934 --> 01:05:39,435 THEY GO IN, DO THEY GO ON 1795 01:05:39,435 --> 01:05:41,304 TO DO THEY GO IN ERENT 1796 01:05:41,304 --> 01:05:41,738 PLAC? 1797 01:05:41,738 --> 01:05:43,339 D THAT'S WHERE WRE MODELG 1798 01:05:43,339 --> 01:05:48,511 NOW. 1799 01:05:48,511 --> 01:05:51,915 SOOU TAKE THE FIBROBL, 1800 01:05:51,915 --> 01:05:53,216 GHT, FIBROASTS THEOUNDS 1801 01:05:53,216 --> 01:05:56,319 D WHAT THEY ACTUALLY D IS 1802 01:05:56,319 --> 01:05:59,355 I ALLUDED TO THAT. ECM. 1803 01:05:59,355 --> 01:06:03,059 SO WHITECMHAT THE CELL 1804 01:06:03,059 --> 01:06:04,027 ITSELF HASREATED. 1805 01:06:04,027 --> 01:06:05,295 THIS WND IS TOTALLY CLOSED. 1806 01:06:05,295 --> 01:06:06,796 YOUUYS S GREEN IN THE 1807 01:06:06,796 --> 01:06:07,997 MIDD, THIS IS GREEN 1808 01:06:07,997 --> 01:06:08,331 ERYWRE. 1809 01:06:08,331 --> 01:06:10,300 BUT T AA THAT THE SCAR 1810 01:06:10,300 --> 01:06:16,172 FORMED, SO THE HYSTEROTOMY HAS 1811 01:06:16,172 --> 01:06:18,341 NO ECM IN IT. 1812 01:06:18,341 --> 01:06:19,442 THIS WAS THEITE THE 1813 01:06:19,442 --> 01:06:20,577 PREVIOUS SCAR. 1814 01:06:20,577 --> 01:06:28,618 ECM.T THIS IS THE CELLS ENDENOUS 1815 01:06:28,618 --> 01:06:31,354 TROPHOBLAS DO NOT CREATE ANY 1816 01:06:31,354 --> 01:06:33,122 MAY TRICK. 1817 01:06:33,122 --> 01:06:34,057 SO NO WHITE HE. 1818 01:06:34,057 --> 01:06:35,291 TONS OF WHITE HERE, NO WHITE IN 1819 01:06:35,291 --> 01:06:36,059 THE TROPHOBLASTS. 1820 01:06:36,059 --> 01:06:43,466 DED WDESIDWELL CELLS, THE SOILS 1821 01:06:43,466 --> 01:06:46,302 SO WHEN WE LOOK AT TS AFTER A 1822 01:06:46,302 --> 01:06:47,837 SUEQUENT PREGNANCY, ADDIN THE 1823 01:06:47,837 --> 01:06:49,906 D, ADDING THOSE TROPHOBLASTS, 1824 01:06:49,906 --> 01:06:55,411 YOU SEE IN T SUBSEQUENT 1825 01:06:55,411 --> 01:06:56,412 EGNANCY, THE TROPHOBLASTS 1826 01:06:56,412 --> 01:06:57,747 DON'T GO NEAR WHERE THERE'S 1827 01:06:57,747 --> 01:06:58,181 WHITE. 1828 01:06:58,181 --> 01:07:00,884 THEY STAY AWAY FROMHE WHITE 1829 01:07:00,884 --> 01:07:01,351 EA. 1830 01:07:01,351 --> 01:07:05,355 TROPHOBLASTS ARE -- I'M SORRY, 1831 01:07:05,355 --> 01:07:06,923 TH'RE GOING WHERE THERE'S NO 1832 01:07:06,923 --> 01:07:07,390 EC 1833 01:07:07,390 --> 01:07:09,225 THEY'RE STAY AGO I WAY FM THE 1834 01:07:09,225 --> 01:07:10,426 WHIT THEY'RE GOING IN THAT AREA 1835 01:07:10,426 --> 01:07:11,527 RIGHT IN THEIDDLE, WHICH MAKES 1836 01:07:11,527 --> 01:07:12,295 SEE. 1837 01:07:12,295 --> 01:07:13,263 TH'S WHAT WE SEE WHERE THERE'S 1838 01:07:13,263 --> 01:07:15,431 A SCAR, THAT IS WHERE T 1839 01:07:15,431 --> 01:07:18,067 THERE'S SOME KIND OF 1840 01:07:18,067 --> 01:07:19,135 CO-HERE SIGNA THAT IS BEING 1841 01:07:19,135 --> 01:07:22,972 CREATED THERE. 1842 01:07:22,972 --> 01:07:24,507 WE CANHEN CNGE THISASED ON 1843 01:07:24,507 --> 01:07:26,609 IF WE ADD COLLAGEN OR DON'T ADD 1844 01:07:26,609 --> 01:07:27,377 COLLAGEN TO THAT AREA OF THE 1845 01:07:27,377 --> 01:07:31,948 SCAR EXOWB, . 1846 01:07:31,948 --> 01:07:36,019 WHEN T NO COATING, NO 1847 01:07:36,019 --> 01:07:37,020 COLLEN, THEY DON'T CARE, THEY 1848 01:07:37,020 --> 01:07:37,587 GO EWHERE. 1849 01:07:37,587 --> 01:07:39,322 THEY'RON T MIDDLE, BM, 1850 01:07:39,322 --> 01:07:39,956 TOP. 1851 01:07:39,956 --> 01:07:41,591 ECM OR NOT, THEY STI GO THER 1852 01:07:41,591 --> 01:07:43,993 BUTTHHEN WE ADD THAT COLGEN 1853 01:07:43,993 --> 01:07:50,233 CLEAR OF THAT AREA.TEER 1854 01:07:50,233 --> 01:07:54,037 MATTERS, MTIPLE PEOPLE HAVE 1855 01:07:54,037 --> 01:07:56,439 BUT WE CAN MODELS. 1856 01:07:56,439 --> 01:08:01,244 TH NICHD KNOWS THIS AND MOLES 1857 01:08:01,244 --> 01:08:03,212 OF PREGNCYESRCH A 1858 01:08:03,212 --> 01:08:05,415 PLACENLESEARCHAMEROM 1859 01:08:05,415 --> 01:08:08,251 VETERINARY ANDATE AND 1860 01:08:08,251 --> 01:08:09,585 AGRILTURE. 1861 01:08:09,585 --> 01:08:15,024 AND 11%F -- IF THI WOULD HAVE 1862 01:08:15,024 --> 01:08:21,164 DOESN'T COME OUT ON ITS OWN.ENTA 1863 01:08:21,164 --> 01:08:23,333 THEYCTUALLADD AITTLE 1864 01:08:23,333 --> 01:08:28,371 EXTINGUISH OF COLLAGENASE TO G 1865 01:08:28,371 --> 01:08:29,539 RID OFHE PLACENT 1866 01:08:29,539 --> 01:08:31,307 YOU GO IN,OUNO THAT LER, 1867 01:08:31,307 --> 01:08:37,113 I KN IS SO TEMING.IT UP. 1868 01:08:37,113 --> 01:08:39,616 I KNO-- BUT IT SAKS TO YOU. 1869 01:08:39,616 --> 01:08:43,453 YOU IMAGINE ADDING A LITTLE BIT 1870 01:08:43,453 --> 01:08:48,458 THIS IS T BAS OF HOW WE CAN 1871 01:08:48,458 --> 01:08:54,897 SO IN SUMMARY,OLLAGEN 1872 01:08:54,897 --> 01:08:55,865 DISORGANIZATION CHANGES IN 1873 01:08:55,865 --> 01:08:56,899 TH MICRO STRUCTURAL ALIGNMENT 1874 01:08:56,899 --> 01:08:58,801 AT SITE OF ADHENCE IS A 1875 01:08:58,801 --> 01:08:59,369 HALLMARK OF ACCRETA. 1876 01:08:59,369 --> 01:09:01,838 THIS IS TRUE IN THE SURCAL 1877 01:09:01,838 --> 01:09:04,474 SAMPS WE GET AND IN THE MOUSE 1878 01:09:04,474 --> 01:09:06,042 MOL. 1879 01:09:06,042 --> 01:09:07,777 THHE COLLAGENATRI IS 1880 01:09:07,777 --> 01:09:08,845 ESSENTL FOR WOU HLING AND 1881 01:09:08,845 --> 01:09:10,146 HOW TROPHOBLASTS GO TO WHERE 1882 01:09:10,146 --> 01:09:10,713 THEY GO. 1883 01:09:10,713 --> 01:09:13,783 U KNOW, THE LERUR 1884 01:09:13,783 --> 01:09:15,385 THE THE DERM LERATURE IS 1885 01:09:15,385 --> 01:09:18,021 FU OF BEAUTIFUL BIOLOGY 1886 01:09:18,021 --> 01:09:21,157 RELATED CLOSURE AND HEALING, 1887 01:09:21,157 --> 01:09:22,058 AND SOEALLY IHINK THAT'S 1888 01:09:22,058 --> 01:09:25,228 WHERE WEEEDO GET A LOT OF 1889 01:09:25,228 --> 01:09:27,530 THOUGHT FOROVING FORWARD. 1890 01:09:27,530 --> 01:09:31,601 AND THATOST SURCAL SCAR FIX 1891 01:09:31,601 --> 01:09:32,969 OCESS OF THE MYOMETRIUM REALLY 1892 01:09:32,969 --> 01:09:36,372 LEADS T LOS OF INTEGTY AND 1893 01:09:36,372 --> 01:09:37,707 DISORGANIZED MYOCY M LAYER. 1894 01:09:37,707 --> 01:09:39,342 THE REASONHAT PLANTIN THE 1895 01:09:39,342 --> 01:09:41,210 LOWER URINE SEGMENT IS WORSE, 1896 01:09:41,210 --> 01:09:43,780 WE JUST SAWHAT IN THEAST 1897 01:09:43,780 --> 01:09:45,381 TALK, ERE'S LESS MYOCYTES 1898 01:09:45,381 --> 01:09:51,554 SO IT'S JT NMAL BLOGY., YOU 1899 01:09:51,554 --> 01:09:53,389 THERE'S DEPN OF COLGE 1900 01:09:53,389 --> 01:09:55,591 AND FIBRIN, TRE'S EDEMA, 1901 01:09:55,591 --> 01:09:56,759 INFLAMMATION, I HAV'T SPOKEN 1902 01:09:56,759 --> 01:09:57,894 ABOUT TH IUNE MODULATION 1903 01:09:57,894 --> 01:09:59,629 THAT'S HERE AND THAT'S A HUGE, 1904 01:09:59,629 --> 01:10:04,000 HUGE MOVE FORWA. 1905 01:10:04,000 --> 01:10:05,001 BUT ONE KIND OFLEANT IN T 1906 01:10:05,001 --> 01:10:06,169 RO O WHAT I'M SPEIN ABO 1907 01:10:06,169 --> 01:10:07,503 AND THINKING ABOUT IS I'M 1908 01:10:07,503 --> 01:10:09,372 STUDYING THATLACENTA AT BTH. 1909 01:10:09,372 --> 01:10:10,973 THAT PLACENTA IS KIND OF DONE, 1910 01:10:10,973 --> 01:10:12,041 RIGHT? 1911 01:10:12,041 --> 01:10:16,512 LIKE, IT'S GONE THROUGH 34 OR 1912 01:10:16,512 --> 01:10:17,947 FI WEEKS OF GESTATION SO WE'RE 1913 01:10:17,947 --> 01:10:19,282 SSING A LOT OF THEIOLOGY 1914 01:10:19,282 --> 01:10:20,583 THAT'S HPENING REALLY, REALLY 1915 01:10:20,583 --> 01:10:20,917 EARLY ON. 1916 01:10:20,917 --> 01:10:22,318 IF TRE'S WAY TO LOOK AT SOME 1917 01:10:22,318 --> 01:10:26,022 PREGNANCY, I THINK TT'S WHERE 1918 01:10:26,022 --> 01:10:26,689 WE'RE AT. 1919 01:10:26,689 --> 01:10:31,260 FLIM IMAGINGHAT WE' DOINGHG A 1920 01:10:31,260 --> 01:10:32,895 WITH ULTRASOD COUPLING CAN 1921 01:10:32,895 --> 01:10:36,499 INSPIRE SOME OFHIS WORK. 1922 01:10:36,499 --> 01:10:38,167 SO A LUID BIOPSY THE WAY 1923 01:10:38,167 --> 01:10:38,801 GOING FORWARD. 1924 01:10:38,801 --> 01:10:40,136 THERE'S GNG TO B WHOLE TALKS 1925 01:10:40,136 --> 01:10:40,803 ON TS. 1926 01:10:40,803 --> 01:10:42,071 MANY GROUPS ARE DOING THIS WORK, 1927 01:10:42,071 --> 01:10:43,506 AND THIS I--'M GNG TO STAY 1928 01:10:43,506 --> 01:10:44,707 RIGHT ON TIME. 1929 01:10:44,707 --> 01:10:47,143 SO I KIND OF GIVE LITTL TEASERS 1930 01:10:47,143 --> 01:10:47,543 OF TS. 1931 01:10:47,543 --> 01:10:50,813 WANT TO G A LITTLE TEASE, 1932 01:10:50,813 --> 01:10:51,714 BUT UNDERSTANDING TLOGY 1933 01:10:51,714 --> 01:10:54,283 CAN REAY, REALLY HELP IDENTIFY 1934 01:10:54,283 --> 01:10:55,818 CRETA BIOMARKERS, DECREASE THE 1935 01:10:55,818 --> 01:10:57,453 INCIDENCE, BUT REALLY IT SHOULD 1936 01:10:57,453 --> 01:11:00,723 TOUCH ERY SINGLE ASPECT OF THE 1937 01:11:00,723 --> 01:11:02,692 WHY, LIK WHYSHY PREA WITH 1938 01:11:02,692 --> 01:11:03,693 ACETA WORSE THAN IN 1939 01:11:03,693 --> 01:11:04,327 NON-PREV? 1940 01:11:04,327 --> 01:11:06,195 AND IT'S ALLBOUT T BIOLOGY. 1941 01:11:06,195 --> 01:11:09,499 SO WITH THAT, IT'S THE SOIL, 1942 01:11:09,499 --> 01:11:12,135 SEED, WATER, AND THE OPETOR. 1943 01:11:12,135 --> 01:11:15,538 AND ANKS FOR TO THE TEAM A WE'LL 1944 01:11:15,538 --> 01:11:20,409 ST RIGHT ON TIME. 1945 01:11:20,409 --> 01:11:24,514 >> EXCELLENT,BVUSLY I'M 1946 01:11:24,514 --> 01:11:32,622 EXCITEDO INTRODUCE NEXTEN. 1947 01:11:32,622 --> 01:11:33,523 DR. ABUHAMAD WHO WILL BE 1948 01:11:33,523 --> 01:11:34,123 EAKING ABOUT ULTRASOUND. 1949 01:11:34,123 --> 01:11:44,233 THANKOU 1950 01:11:44,233 --> 01:11:44,867 >> ALL RIGHT.>> 1951 01:11:44,867 --> 01:11:46,302 THANK YOU FOR YOUR BRILL 1952 01:11:46,302 --> 01:11:46,836 WORK, AS ALWAYS. 1953 01:11:46,836 --> 01:11:48,171 SO I'M GOING TO GIVE YOU AN 1954 01:11:48,171 --> 01:11:49,906 OVERVI ON THE ROLE OF 1955 01:11:49,906 --> 01:11:51,774 ULTRASOU IN SCREENING AND 1956 01:11:51,774 --> 01:11:55,311 I'LL STAY A HIGH LEVE AND 1957 01:11:55,311 --> 01:11:56,145 SHARE SOME THOS WITH U 1958 01:11:56,145 --> 01:11:57,680 BASED ONY EXPIENCE ANDOME 1959 01:11:57,680 --> 01:11:59,115 OF THE LERATURE. 1960 01:11:59,115 --> 01:12:03,386 THE ADVIS BOA OF THET I'MN 1961 01:12:03,386 --> 01:12:04,787 FOLLOWING COMPANIES UNRELED T 1962 01:12:04,787 --> 01:12:06,322 MY TK TODAY. 1963 01:12:06,322 --> 01:12:08,958 SO THIS IS A COMPL AREA, 1964 01:12:08,958 --> 01:12:10,826 DESPITE EN W MAKE A DIAGNIS 1965 01:12:10,826 --> 01:12:12,662 SOMETIMES IT LOOKS VERY EVIDENT 1966 01:12:12,662 --> 01:12:14,530 BUAOTF PEOPLE HE 1967 01:12:14,530 --> 01:12:16,165 ATTEMPTED TO REALLY TRY TO 1968 01:12:16,165 --> 01:12:18,234 STANDARDIZE THIS APPROAC AND 1969 01:12:18,234 --> 01:12:22,738 TH EUREAN GROUP CAME TETHER 1970 01:12:22,738 --> 01:12:23,839 IN 26 TO T TO STANDARDIZE 1971 01:12:23,839 --> 01:12:25,041 TH MARRS OF PLACENTA ACCRETA 1972 01:12:25,041 --> 01:12:30,413 AND FIGO, IN 201HEY ADAPTED 1973 01:12:30,413 --> 01:12:33,583 E EUROPEAN CONSENSUS GROUP 1974 01:12:33,583 --> 01:12:35,351 CLASFICATION ALSO. 1975 01:12:35,351 --> 01:12:39,789 UNITED STATESIDE, A WITH THE 1976 01:12:39,789 --> 01:12:41,023 ADERSHIP O SCOTT, WEAME 1977 01:12:41,023 --> 01:12:42,858 TOGETHER IN BOSTON SEVERALEARS 1978 01:12:42,858 --> 01:12:45,695 AGO NOW WITH THE EORSEME OF 1979 01:12:45,695 --> 01:12:48,197 THE SOCIETIES, REALLY TO DO 1980 01:12:48,197 --> 01:12:48,664 TWO THINGS. 1981 01:12:48,664 --> 01:12:51,067 ONE, TORY TO STANDARDIZE THE 1982 01:12:51,067 --> 01:13:00,243 THE AROACH TO HOW DO WE DO THE 1983 01:13:00,243 --> 01:13:01,577 ULTRASOUND FOR PREGNANCIES WHEN 1984 01:13:01,577 --> 01:13:03,846 WEUSPECT THE PRESEE OF 1985 01:13:03,846 --> 01:13:06,282 SO LET MEAKE YOU THROUGH SOME 1986 01:13:06,282 --> 01:13:08,251 OF THEARRS THATST TODAY, 1987 01:13:08,251 --> 01:13:11,320 ING TOTART WITH THE FST I'M 1988 01:13:11,320 --> 01:13:12,722 TRESTER AND THEN SECOND AND 1989 01:13:12,722 --> 01:13:14,190 THIRD, THERE'S A L OF OVERLAP 1990 01:13:14,190 --> 01:13:15,925 AS IILL SHARE WITH YOU BETWEEN 1991 01:13:15,925 --> 01:13:17,960 THE MARKERS THA W USE IN THE 1992 01:13:17,960 --> 01:13:19,362 FIRS AND SECD D THI 1993 01:13:19,362 --> 01:13:20,396 EGNAY. 1994 01:13:20,396 --> 01:13:24,267 FIRST TRIMESTER, IS THE CAN 1995 01:13:24,267 --> 01:13:27,069 SEE THELE UTERUS, ANDEAN 1996 01:13:27,069 --> 01:13:29,071 ASSESSRE THE GESTATIONAL 1997 01:13:29,071 --> 01:13:32,275 SACK IS AND ONE OF THE MOST 1998 01:13:32,275 --> 01:13:36,412 IMPORTANT OR MOST CITED MARKER 1999 01:13:36,412 --> 01:13:37,847 FOR -- AS RISK FOR PLAA 2000 01:13:37,847 --> 01:13:42,685 CRETIS THE GESAL SAC 2001 01:13:42,685 --> 01:13:43,552 IMPLANTED IN THE LOWER HALF OF 2002 01:13:43,552 --> 01:13:44,220 THE UTERUS. 2003 01:13:44,220 --> 01:13:46,622 AND USING THE LENGTH OF THE 2004 01:13:46,622 --> 01:13:47,924 UTERUS EXCLUDING T CERX, YOU 2005 01:13:47,924 --> 01:13:51,861 QUADRANTS AND IT BECOMES AN EASY 2006 01:13:51,861 --> 01:13:55,031 APOACHO MAKE A DIAGNOSIS 2007 01:13:55,031 --> 01:13:56,232 OTHAT THERTANT TO 2008 01:13:56,232 --> 01:13:59,936 CESAREAN SR PREGNCY, AOITY 2009 01:13:59,936 --> 01:14:03,539 N ENTITY, IS A GESTATIAL SAC 2010 01:14:03,539 --> 01:14:05,541 IMPLANTED INHE SCAIN SOME 2011 01:14:05,541 --> 01:14:06,709 WAYS, ON IT ORNSIDE OF IT AS 2012 01:14:06,709 --> 01:14:08,377 U SEE H I ALSO A 2013 01:14:08,377 --> 01:14:10,212 GESTATIONAL SAC THAT IS IN THE 2014 01:14:10,212 --> 01:14:11,314 LOWER URINEEGMES. 2015 01:14:11,314 --> 01:14:14,283 NOW, NOT A GESTATIONAL SACS IN 2016 01:14:14,283 --> 01:14:18,421 TH LOWER UTERI SEGNTS END 2017 01:14:18,421 --> 01:14:24,560 UP IN THE PLACENTA ACCRETA 2018 01:14:24,560 --> 01:14:25,428 SPECTRUM OR PLURIPOTENT. 2019 01:14:25,428 --> 01:14:27,396 THIS I NOT THEAME PREGNANCY, 2020 01:14:27,396 --> 01:14:29,031 T TH HAVE THE TENDENCY SO 2021 01:14:29,031 --> 01:14:31,600 GROW TOWARDS THE LEAST RESISTANT 2022 01:14:31,600 --> 01:14:31,801 SPACE. 2023 01:14:31,801 --> 01:14:35,738 SO THERE'SN OORNITY AND A 2024 01:14:35,738 --> 01:14:37,273 WIOW IN THFIRSTRIMEER TO 2025 01:14:37,273 --> 01:14:38,140 SUSPECTHE PRESENCE OF AN 2026 01:14:38,140 --> 01:14:39,575 ACCRET ANDF YOU CO TO THE 2027 01:14:39,575 --> 01:14:41,544 END OF THE FIRST TRIMESTER, 13, 2028 01:14:41,544 --> 01:14:42,945 14 WEEKS, IT BECOMES LESS EY 2029 01:14:42,945 --> 01:14:45,381 TO ME THAT DIAGNOSIS A THE 2030 01:14:45,381 --> 01:14:46,782 SAC WOULD TDO GROW UP 2031 01:14:46,782 --> 01:14:50,453 TOWARDS THE FUNDU. 2032 01:14:50,453 --> 01:14:51,921 AS YOU LOOK AT THEK GESTATIONAL 2033 01:14:51,921 --> 01:14:52,855 SAC, I THINK IT' REAY 2034 01:14:52,855 --> 01:14:53,956 IMPORTANT TO LOOK B MORE 2035 01:14:53,956 --> 01:14:55,024 CLOSECAUSE THAT COULD BE A 2036 01:14:55,024 --> 01:14:57,126 LINK OR AT LEAST GIVE YOU A CLUE 2037 01:14:57,126 --> 01:14:59,628 TO T PSENCE OF ALACENTA 2038 01:14:59,628 --> 01:14:59,962 ACCRETA. 2039 01:14:59,962 --> 01:15:01,163 AS YOU SEE IN THIS PGNANCY, 2040 01:15:01,163 --> 01:15:03,366 YOU SEE HOW THE PLACENTA IS 2041 01:15:03,366 --> 01:15:06,001 THERO THE CESAREA SECTION 2042 01:15:06,001 --> 01:15:06,402 SCAR. 2043 01:15:06,402 --> 01:15:07,837 THIS IS AREGNCY THAT 2044 01:15:07,837 --> 01:15:10,139 PROBABLY STARTED AS A CESAREAN 2045 01:15:10,139 --> 01:15:11,841 SCAR PREANCY AND THEN EXPANDED 2046 01:15:11,841 --> 01:15:14,410 T UPPERNT WITH 2047 01:15:14,410 --> 01:15:23,018 AN IORTANT PART, OUR SECOND 2048 01:15:23,018 --> 01:15:24,019 TRIMESTER ULTRASOUND MARKERS 2049 01:15:24,019 --> 01:15:25,988 THAT WEEFINE VERY WELL IN THE 2050 01:15:25,988 --> 01:15:27,623 LITERATURE FOR A LONGIME, ARE 2051 01:15:27,623 --> 01:15:28,724 THEY PRESE IN THE FIRST 2052 01:15:28,724 --> 01:15:29,025 TRIMESTER. 2053 01:15:29,025 --> 01:15:31,427 ONE OF OUR FELLOWS SEVER YEARS 2054 01:15:31,427 --> 01:15:33,829 AGO DID A STUDY LKING AT 2055 01:15:33,829 --> 01:15:34,363 CONFIRMED ACENTACCTA 2056 01:15:34,363 --> 01:15:35,264 SPECTRUM PATIENTS VERS 2057 01:15:35,264 --> 01:15:36,866 PATIENTS WHO HAVEREVIA BUT 2058 01:15:36,866 --> 01:15:37,933 DO NOT HAVE AN PLACENTA ACCRETA 2059 01:15:37,933 --> 01:15:39,468 SPECTRUM AND LOOKING AT SERAL 2060 01:15:39,468 --> 01:15:45,074 AND YOU CAN SEE THAT PIENTSNDTR. 2061 01:15:45,074 --> 01:15:48,911 WHO END UP WITH A PLANTA 2062 01:15:48,911 --> 01:15:50,212 ACCRA SPECTRUM HAVE A LOT OF 2063 01:15:50,212 --> 01:15:51,714 THE CLASSIC MARKERS WE USEN 2064 01:15:51,714 --> 01:15:52,748 THE SECOND TRISTER, SUCH AS 2065 01:15:52,748 --> 01:15:56,452 THERESEE OF LACUNAE, MORE, 2066 01:15:56,452 --> 01:15:58,320 LARGER, MORE FLOW EITHER ON 2067 01:15:58,320 --> 01:16:00,923 GREYSCE OR COLOR DOPPLER 2068 01:16:00,923 --> 01:16:02,691 TH TACUNAEER SE. 2069 01:16:02,691 --> 01:16:05,561 ALSOVEN THE UTE RAH-PLACENTA 2070 01:16:05,561 --> 01:16:06,862 INTERFACE INT CLEAR ABNORMAL IN 2071 01:16:06,862 --> 01:16:09,064 SO RELNG ON THESE CLASSIC 2072 01:16:09,064 --> 01:16:10,933 GNS THAT WE USE IN THE SECOND 2073 01:16:10,933 --> 01:16:11,901 TRIMESTER I REALLY IMPORTA 2074 01:16:11,901 --> 01:16:13,335 ALSO IN THE FIRSTRIMESTER. 2075 01:16:13,335 --> 01:16:15,004 HERE S EXAMPLES, PREGNAN 2076 01:16:15,004 --> 01:16:15,871 AT 8 WKS. 2077 01:16:15,871 --> 01:16:17,973 YOU SEE THAT THERE IS A BIT OF 2078 01:16:17,973 --> 01:16:20,910 HERE AND IF YOU LOOK CLOSELY AT 2079 01:16:20,910 --> 01:16:23,012 THE PLACEA, THERE ARE -- WE 2080 01:16:23,012 --> 01:16:25,147 N'T CALL TM LACUNAE IN THE 2081 01:16:25,147 --> 01:16:27,750 FIRST TRIMESTER, MAYBE VASCULAR 2082 01:16:27,750 --> 01:16:29,618 SPACES BUT YOU CAN SEE HOW 2083 01:16:29,618 --> 01:16:30,920 IRRELAR TH PLACENTA IS IN A 2084 01:16:30,920 --> 01:16:32,121 PLACENTA PREVIA. 2085 01:16:32,121 --> 01:16:34,523 COLOR DOPPLER ALSO CLEARLY SHOWS 2086 01:16:34,523 --> 01:16:36,158 THE EXTENSIVE VASCULARITY,LS 2087 01:16:36,158 --> 01:16:38,461 THE PRESENCE OF LACUNAE WITHIN 2088 01:16:38,461 --> 01:16:40,563 THOS PLACENT, PER ASSAY. 2089 01:16:40,563 --> 01:16:51,373 NOWPER SE.NOW TH LOSS OF -- THAT 2090 01:16:51,373 --> 01:16:54,210 DEFIS ALACENTA ACCRAS 2091 01:16:54,210 --> 01:16:55,878 ALSO PRESENT INST TERM OF 2092 01:16:55,878 --> 01:16:56,212 PREGNANCY. 2093 01:16:56,212 --> 01:17:00,683 IF YLY CLOSELY, LOOK AT THE 2094 01:17:00,683 --> 01:17:01,917 LOSS OF T SPACE BETWEEN THAT 2095 01:17:01,917 --> 01:17:03,886 PLACENTA AND THE CERVIX. 2096 01:17:03,886 --> 01:17:05,221 I' GOI TO COME BACK TO THIS 2097 01:17:05,221 --> 01:17:06,722 PREGNCY LATER ON TO SHOW YOU 2098 01:17:06,722 --> 01:17:10,459 THE PROGRESSI IN THIS CASE. 2099 01:17:10,459 --> 01:17:11,327 AGAIN, IF YOU LOOK AT THIS 2100 01:17:11,327 --> 01:17:15,364 PREGNANCY THE A 11 WEEKS, 2101 01:17:15,364 --> 01:17:17,266 SEE IRREGUR BORRS OF THE 2102 01:17:17,266 --> 01:17:19,001 PLACENTA, AND YOU SEE THESE 2103 01:17:19,001 --> 01:17:20,636 CYICPACES IN THE PATIENT 2104 01:17:20,636 --> 01:17:22,505 TH ENDED UP WITH AN ACCTA. 2105 01:17:22,505 --> 01:17:24,940 WHATBOUT MARKE IN THE SECOND 2106 01:17:24,940 --> 01:17:27,109 SO ONE OFHE MARKERS THAT IS 2107 01:17:27,109 --> 01:17:29,178 ALWA CITED IS PLACENTA 2108 01:17:29,178 --> 01:17:31,046 LACUNAE, AND THAT'S PROBAY -- 2109 01:17:31,046 --> 01:17:32,114 THAT HAS BEEN SDIEDOST IN 2110 01:17:32,114 --> 01:17:32,581 THE LITERATE. 2111 01:17:32,581 --> 01:17:34,350 IF YOU LOOAT THE LITERATURE IN 2112 01:17:34,350 --> 01:17:36,018 MOREETAILS, THE MORE LACUNAE 2113 01:17:36,018 --> 01:17:40,789 YOU HAVE, THREE OR ME, LARGER 2114 01:17:40,789 --> 01:17:43,859 IN SIZE, IRREGULARITY OF THE 2115 01:17:43,859 --> 01:17:46,028 BOS RESENCE O HIGH 2116 01:17:46,028 --> 01:17:47,463 VELOCITY AND TURN LT BLOW 2117 01:17:47,463 --> 01:17:48,631 WITHIN HAVE BEEN CORRELATED WITH 2118 01:17:48,631 --> 01:17:50,599 THE PRESENCE OF PLACENTA ACCRA 2119 01:17:50,599 --> 01:17:50,866 SPECTRUM. 2120 01:17:50,866 --> 01:17:52,701 A LOT OF THIS CAME FROM THIS 2121 01:17:52,701 --> 01:17:55,437 RELYMPORTANT PAPER IN 1992 2122 01:17:55,437 --> 01:17:57,540 OF DR. FINBERGROM ARIZONA THAT 2123 01:17:57,540 --> 01:18:01,577 RI-BAS THE NUMBER OLASSIFYHE 2124 01:18:01,577 --> 01:18:02,678 LACUNAE. 2125 01:18:02,678 --> 01:18:03,979 WHAT ISMPORNT TO NOTE, AND 2126 01:18:03,979 --> 01:18:06,382 THAT HASEEN A BIT LOST IN THE 2127 01:18:06,382 --> 01:18:07,950 LITERATURE IN THATN HIS 2128 01:18:07,950 --> 01:18:10,586 POPULATION, WHEN HE DID THE 2129 01:18:10,586 --> 01:18:11,654 CLSIFITIONS, ALL HIS 2130 01:18:11,654 --> 01:18:12,988 PAENTS H PRIORESAREAN 2131 01:18:12,988 --> 01:18:20,262 ANGRADE 2R MORE, MEANIGRANGEVIAP 2132 01:18:20,262 --> 01:18:23,465 HAVINGOURACUNAE ORORE, HAS 2133 01:18:23,465 --> 01:18:26,969 100% RISK OF PLACENTA ACCRETA ON 2134 01:18:26,969 --> 01:18:28,604 IT'S REALLY IMPORTANT TO KNOW 2135 01:18:28,604 --> 01:18:30,339 THAT Y CANNO THIS DATA 2136 01:18:30,339 --> 01:18:31,407 AND ERAPOLA TO PREANES 2137 01:18:31,407 --> 01:18:33,943 WITHOUT A PREVIA ORITHO 2138 01:18:33,943 --> 01:18:35,945 PRIO CESAREAN SECTIONS. 2139 01:18:35,945 --> 01:18:37,246 LACUNAE BECO REALLY LESS 2140 01:18:37,246 --> 01:18:39,214 IMPORTANT BECAUSE THE ARE QUITE 2141 01:18:39,214 --> 01:18:46,021 COMMONN LOW RISK PREGNANCIES. 2142 01:18:46,021 --> 01:18:47,990 DR. PHILLIPS LOOKED AT A COHORT 2143 01:18:47,990 --> 01:18:51,827 THAT DID NOT HAVAN ACCRETALY AND 2144 01:18:51,827 --> 01:18:53,596 ULTITELY, AND LK AT HOW 2145 01:18:53,596 --> 01:18:55,998 OFTEN D WE PLACENTA ACCRETA 2146 01:18:55,998 --> 01:18:58,200 SPECTRUM MARKERS IN THIS 2147 01:18:58,200 --> 01:18:59,835 POPULATI WHEN WE LOOK 2148 01:18:59,835 --> 01:19:01,670 OBJECTIVELY AND WELL-DENED, IN 2149 01:19:01,670 --> 01:19:03,572 A WELL-FINED WAY. 2150 01:19:03,572 --> 01:19:07,142 LACUNAE IS QUITE COMMONN TSE 2151 01:19:07,142 --> 01:19:08,744 LOW RISK PREGNANCIES, WER 2152 01:19:08,744 --> 01:19:10,312 YOU'VE HAD PRIOR CESARN 2153 01:19:10,312 --> 01:19:10,846 SECTIONS OR T. 2154 01:19:10,846 --> 01:19:12,281 YOU CAN SEE THA ANY BLOOD FLOW 2155 01:19:12,281 --> 01:19:15,551 COONLSO IN THOSE.IUITE 2156 01:19:15,551 --> 01:19:17,219 EVEN WHEN YOUAVE MORE THAN ONE 2157 01:19:17,219 --> 01:19:18,854 MARKER, WHENOU SAY OKAY, I I 2158 01:19:18,854 --> 01:19:21,590 HAVE THREE OR MORE MARKERS, PLUS 2159 01:19:21,590 --> 01:19:25,628 LACUNAR MORE, HAVE THOSEOWUR 2160 01:19:25,628 --> 01:19:29,698 RISK PREGNANCIES, HAD THESE 2161 01:19:29,698 --> 01:19:30,332 MARKERS. 2162 01:19:30,332 --> 01:19:32,468 TRITIONAY USE IN A SETTI 2163 01:19:32,468 --> 01:19:34,303 OUTSID O A PREVIA OR PRIOR 2164 01:19:34,303 --> 01:19:35,838 CESARE SECTION REALLYOES N 2165 01:19:35,838 --> 01:19:36,839 WORK IN THAT COMPLEX. 2166 01:19:36,839 --> 01:19:38,374 LOOK AT TS PLACENTA RIGHT 2167 01:19:38,374 --> 01:19:39,842 HERE. 2168 01:19:39,842 --> 01:19:41,710 LOOK HOW EXTENSI T AMOUNT OF 2169 01:19:41,710 --> 01:19:42,444 LACUNAEXIST. 2170 01:19:42,444 --> 01:19:46,215 THIS IS A NORMAL PLANTA. 2171 01:19:46,215 --> 01:19:47,516 EAR RETRO PLACENTAL SPACE 2172 01:19:47,516 --> 01:19:48,017 BEHIND. 2173 01:19:48,017 --> 01:19:50,152 THIS IS N AN ISSUE AT ALL FOR 2174 01:19:50,152 --> 01:19:52,154 THOSE PREANCIES. 2175 01:19:52,154 --> 01:19:56,325 MULTIPLE VASCULA L LACUNAEAVE 2176 01:19:56,325 --> 01:19:57,293 HIGHREDICTIVE POWER IN 2177 01:19:57,293 --> 01:20:03,332 ASSOCIATIO WITH THE - 2178 01:20:03,332 --> 01:20:03,966 DINISHING SUBSTANTIALLY. 2179 01:20:03,966 --> 01:20:04,767 HE'S AN EXAMPLE OF A PLACENTA 2180 01:20:04,767 --> 01:20:06,835 PREVIA WH A LARGEACUNAE THAT 2181 01:20:06,835 --> 01:20:09,805 ISAEN FNT OF THE CERX, 2182 01:20:09,805 --> 01:20:10,873 CLEARLY AN ACCRETA,EE RIGHT 2183 01:20:10,873 --> 01:20:11,206 HERE. 2184 01:20:11,206 --> 01:20:18,347 HE'S A SINGLE LCUNA, SOM 2185 01:20:18,347 --> 01:20:19,548 PLACENTAL THIENIN AS YOU SEE 2186 01:20:19,548 --> 01:20:22,184 RIGHT HER AGAIN, A SIGNIFICANT 2187 01:20:22,184 --> 01:20:23,752 RISK FOR AN ACCRETA. 2188 01:20:23,752 --> 01:20:25,621 WHYWH DOACUN FORM? 2189 01:20:25,621 --> 01:20:27,589 UNEAR REALLY,UT IT IS 2190 01:20:27,589 --> 01:20:28,824 PRABLY THE STRUCTURE OF 2191 01:20:28,824 --> 01:20:30,325 PLACENTAL TISSUES WHEN IT'S 2192 01:20:30,325 --> 01:20:33,962 EXPOSED TOHE HIGHELOCITY 2193 01:20:33,962 --> 01:20:37,032 ALLY UNCAR WHY TYORM,S 2194 01:20:37,032 --> 01:20:39,201 ESPECILY OVER THE CVIX IN 2195 01:20:39,201 --> 01:20:40,002 PLACENTA ARETA. 2196 01:20:40,002 --> 01:20:42,104 NOW DO N MISTAKE, LACUN WITH 2197 01:20:42,104 --> 01:20:42,971 LARGE VCULA LAKES AS YOUEE 2198 01:20:42,971 --> 01:20:45,708 INHIS CASE WITH A FEEDI 2199 01:20:45,708 --> 01:20:49,244 SSEL AND YOU CAN SEE THAT 2200 01:20:49,244 --> 01:20:52,181 CELY, BRINGG BLOOD INT A 2201 01:20:52,181 --> 01:20:53,916 SINGLE LEG WITN THE PLACENTA. 2202 01:20:53,916 --> 01:20:58,987 THAT HAS NO CORRELATION WITH 2203 01:20:58,987 --> 01:21:05,527 POTHECOMMON FINDING IN THE OLD 2204 01:21:05,527 --> 01:21:06,528 LITERATURE WITH DITIONSUCH 2205 01:21:06,528 --> 01:21:08,831 AS STRIKING COLOR DOPPLER WHEN 2206 01:21:08,831 --> 01:21:16,171 POSTERIO BLADDER WALL.R BEHIND A 2207 01:21:16,171 --> 01:21:18,374 I WA TO CAUON YOU WITH 2208 01:21:18,374 --> 01:21:20,442 ADVANC TECHNOLOGYND 2209 01:21:20,442 --> 01:21:24,947 ULTRASOUND N EVERY PLACENTA IS 2210 01:21:24,947 --> 01:21:27,116 GHLY -- WE DON'T RELY ON THIS 2211 01:21:27,116 --> 01:21:28,250 PER SE BY ITSELF. 2212 01:21:28,250 --> 01:21:30,119 WHAT IS IMPORTANT TO NOTE IS 2213 01:21:30,119 --> 01:21:32,187 WHAT HAS BEEN REFERRE TO AS THE 2214 01:21:32,187 --> 01:21:34,823 RAIL SN, SEEING BRIDGING 2215 01:21:34,823 --> 01:21:36,825 VESSEL BWE THE PLACENTAL 2216 01:21:36,825 --> 01:21:38,961 SIDE AND THE UTERINEIDE, THA 2217 01:21:38,961 --> 01:21:40,195 HAS BEEN HIGHLY CORRELATED WITH 2218 01:21:40,195 --> 01:21:45,134 NO INCREASED VASCULARITY AND 2219 01:21:45,134 --> 01:21:47,636 PAS, AGAIN, PENETRATING VESSELS, 2220 01:21:47,636 --> 01:21:48,036 REALLY IMPORTA. 2221 01:21:48,036 --> 01:21:49,938 IEALLY, REALLY HHLIG T 2222 01:21:49,938 --> 01:21:51,240 IMPORTANCE OF CERVICAL INVASION 2223 01:21:51,240 --> 01:21:53,675 IN THOSE PREGNANCI. 2224 01:21:53,675 --> 01:21:55,344 IF YOU SEE VESSE CROSSING FROM 2225 01:21:55,344 --> 01:21:56,311 THE PLACENTA INTO THE CERVI 2226 01:21:56,311 --> 01:21:59,414 THAT HAS AERY HH CORRELATION 2227 01:21:59,414 --> 01:22:00,883 PLACENTA ACCRETAPECTRUM. 2228 01:22:00,883 --> 01:22:03,118 ANALMOST ALLF THOSE ARE IN 2229 01:22:03,118 --> 01:22:03,685 ASSOCIIONS WITHLACENTA 2230 01:22:03,685 --> 01:22:04,319 PREVIA. 2231 01:22:04,319 --> 01:22:06,321 HERE'SNOTHER EXAMPLE HERE, YOU 2232 01:22:06,321 --> 01:22:08,524 SEE E SIGNICANCE OF CL 2233 01:22:08,524 --> 01:22:11,760 INSIONS IN THIS PLACENTA 2234 01:22:11,760 --> 01:22:13,162 PREV PIENTS WITHHE 2235 01:22:13,162 --> 01:22:13,996 PLACENTA ACCRETA SPECTRUM. 2236 01:22:13,996 --> 01:22:16,432 ANOTHER CE HERE TOIGHLIG, 2237 01:22:16,432 --> 01:22:18,400 HOW ITANT IT I TO LOOK FOR 2238 01:22:18,400 --> 01:22:20,169 CUNA WHICH A LOT OF TE A 2239 01:22:20,169 --> 01:22:21,270 ACTUALLY VASCULAR SPACES,ND 2240 01:22:21,270 --> 01:22:24,439 YOU SEE THE ECK PANICS AND PANID 2241 01:22:24,439 --> 01:22:26,875 OGRESSION OF THESE VESSELS 2242 01:22:26,875 --> 01:22:28,510 WITH CERVICA INVASN RIGHT 2243 01:22:28,510 --> 01:22:29,077 RE 2244 01:22:29,077 --> 01:22:30,612 ANOTHER CASE HERE SHOWING 2245 01:22:30,612 --> 01:22:32,781 EXPANSIVE CERVICAL INVASN IN 2246 01:22:32,781 --> 01:22:34,183 TH PATIENT, AND STUDIES HE 2247 01:22:34,183 --> 01:22:43,158 SHN THAT CERVICAL CERVICAL LACUN 2248 01:22:43,158 --> 01:22:44,526 THE RVIX, THESE ARE THE 2249 01:22:44,526 --> 01:22:45,527 PRNANCIES THAT REST IN 2250 01:22:45,527 --> 01:22:46,528 GNIFICANTLOOD TRAFUSIONS 2251 01:22:46,528 --> 01:22:52,534 AT THE TIMEF CESAREAN 2252 01:22:52,534 --> 01:22:54,069 AGAIN IT REALLY IMPORTANT TO 2253 01:22:54,069 --> 01:22:56,939 UNDERSTAND THE EFFEC OF 2254 01:22:56,939 --> 01:22:57,706 OCESSING AND THE IMAGE. 2255 01:22:57,706 --> 01:23:00,542 THIS IS THE SAM IMAGE HERE WITH 2256 01:23:00,542 --> 01:23:03,412 FILTERS, AND HER WITH -- I 2257 01:23:03,412 --> 01:23:04,513 AYED A LITTLE WIT THE IMAGE 2258 01:23:04,513 --> 01:23:08,617 ALL THESE VCUR SPASU CAN ME 2259 01:23:08,617 --> 01:23:11,453 FILTER AND YOU HAVE A LOW GAI 2260 01:23:11,453 --> 01:23:12,020 AND SO FORTH. 2261 01:23:12,020 --> 01:23:15,557 ADJUST YOUR ULTRAUND SYSTEM W TO 2262 01:23:15,557 --> 01:23:17,092 FAR AS YR EVALUATIO 2263 01:23:17,092 --> 01:23:18,794 WHAT AUT THE RETROCENTAL 2264 01:23:18,794 --> 01:23:19,294 CLEAR SPACE? 2265 01:23:19,294 --> 01:23:20,796 AGAIN, VY, VERY IMPORTANT. 2266 01:23:20,796 --> 01:23:23,565 HERE ARE THREE PLACENTAS WIT 2267 01:23:23,565 --> 01:23:24,700 NOAL RRO PLACENTAL CLEAR 2268 01:23:24,700 --> 01:23:24,900 SPACE. 2269 01:23:24,900 --> 01:23:26,401 THIS IS THE MT IMPORTANT 2270 01:23:26,401 --> 01:23:27,903 ULTRASOUND MARKE HAS NOT 2271 01:23:27,903 --> 01:23:30,372 GOTTEN REALL THE CREDIT THAT IT 2272 01:23:30,372 --> 01:23:32,875 SERVES BECAUSE THIS IS WHAT 2273 01:23:32,875 --> 01:23:34,209 FINES AN ACCRETA, THE LOSS OF 2274 01:23:34,209 --> 01:23:34,643 THIS MARKER. 2275 01:23:34,643 --> 01:23:40,716 MA AND IS REQUIRED FORAGNOSIS. 2276 01:23:40,716 --> 01:23:42,117 SO HERE'S THREE EXAMPLES. 2277 01:23:42,117 --> 01:23:44,219 U CAN SEE EVEN WHEN YOU HAVE A 2278 01:23:44,219 --> 01:23:46,955 YOU TEND TO LOSE THE THE T CERX, 2279 01:23:46,955 --> 01:23:47,723 DIFFERENTIATIONETWEEN THE 2280 01:23:47,723 --> 01:23:49,491 PLACENTA AND THE CERVICAL 2281 01:23:49,491 --> 01:23:49,925 TISSUE. 2282 01:23:49,925 --> 01:23:51,360 AGAIN HERE ON THE ANTR 2283 01:23:51,360 --> 01:23:52,561 DOMINAL WALL, YOU C SEE THE 2284 01:23:52,561 --> 01:23:57,266 CLEAR SCE. RETRO PLACENTA 2285 01:23:57,266 --> 01:23:59,535 NOW,NOTHER MARKER IS THE 2286 01:23:59,535 --> 01:24:00,669 PLACTA THAS THICKED IN 2287 01:24:00,669 --> 01:24:06,541 YOU S THE THICKNESS, YOU CAN 2288 01:24:06,541 --> 01:24:07,843 USE ULTRASOUND PARAMERS TO GET 2289 01:24:07,843 --> 01:24:09,511 THE FULL PLACENTA IN ONE AGE 2290 01:24:09,511 --> 01:24:12,214 AND YOU CAN ASSES THE THICKNESS 2291 01:24:12,214 --> 01:24:16,552 AND THIS DATA FROM T U.K. 2292 01:24:16,552 --> 01:24:17,819 GROUPHAT'S REALLY HIGHLIGHTED 2293 01:24:17,819 --> 01:24:20,522 TH ISHAT YOU SEE WHEN AREARKER. 2294 01:24:20,522 --> 01:24:23,926 YOU OPEN TTERUS, A BULGING 2295 01:24:23,926 --> 01:24:26,461 LOWER SEGMENT WITH A LOTF ST 2296 01:24:26,461 --> 01:24:27,663 TIB LAIRTS OUTSIDE. 2297 01:24:27,663 --> 01:24:30,399 NOW HOW TO OPTIMIZE YOURULTROUN. 2298 01:24:30,399 --> 01:24:31,533 WE DON'T HAVE LOT O 2299 01:24:31,533 --> 01:24:32,734 INFORMATION ON THI A I WOULD 2300 01:24:32,734 --> 01:24:34,736 HOPEHAT THIS GROUPHI WOULD COME 2301 01:24:34,736 --> 01:24:36,538 WIT SOME STANDARDIZED 2302 01:24:36,538 --> 01:24:37,706 APPROACHOW TO DO THE 2303 01:24:37,706 --> 01:24:40,342 ASOUHEN YOUUSPE THE 2304 01:24:40,342 --> 01:24:42,611 PRESENCE OF PLACENTA ACCTA. 2305 01:24:42,611 --> 01:24:44,379 YOUHOULD ALWAYS USE THE 2306 01:24:44,379 --> 01:24:46,181 TRANSVAGINAL APPROACH F ANY 2307 01:24:46,181 --> 01:24:49,651 THE PRESENCE OF AN ACCRETA.R 2308 01:24:49,651 --> 01:24:51,186 U HAVE TO EVALUATE THE 2309 01:24:51,186 --> 01:24:54,589 PLACENTA IN REALTE, ASSESS -- 2310 01:24:54,589 --> 01:24:56,158 MINIMI PRESSURE ON THE ABDOM 2311 01:24:56,158 --> 01:25:00,162 USING THE TNSABDOMINAL 2312 01:25:00,162 --> 01:25:01,530 APCH BECAUSE A B O 2313 01:25:01,530 --> 01:25:02,965 PRESSURE COULD REALLYAKE THE 2314 01:25:02,965 --> 01:25:06,435 RETROLACENTAL CLEAR SPACE 2315 01:25:06,435 --> 01:25:08,971 DISAPPEAR, AND LOOK FOR CERL 2316 01:25:08,971 --> 01:25:10,539 INVASION AND HAVE A PROCOL ON 2317 01:25:10,539 --> 01:25:10,973 TE 2318 01:25:10,973 --> 01:25:13,842 REMEMBER THE PLACEA IS A 2319 01:25:13,842 --> 01:25:14,476 THREE-MENSIONAL ORN, SO U 2320 01:25:14,476 --> 01:25:16,812 HAVE TO ASSESS THE FULL PLAULNTA 2321 01:25:16,812 --> 01:25:18,981 TO LOOK F FOCAL ACCRETAS ANG 2322 01:25:18,981 --> 01:25:20,782 THE Y. 2323 01:25:20,782 --> 01:25:26,054 NOW, CERT, STRIFNG THE RISK FOR 2324 01:25:26,054 --> 01:25:28,323 BLEENG, WE TEND TO SAY THIS IS 2325 01:25:28,323 --> 01:25:29,358 SUGGESTIVE FOR ACCRETA BUT ALSO 2326 01:25:29,358 --> 01:25:30,792 WE ASSESS THEISKOR BLEED 2327 01:25:30,792 --> 01:25:36,732 LIKE THIS ISLELY A PATIENT 2328 01:25:36,732 --> 01:25:37,633 AT SIGNIFICANT RISFOR BEDING 2329 01:25:37,633 --> 01:25:38,800 AT TIME OF DELIVER 2330 01:25:38,800 --> 01:25:41,637 THIS IS PATNT THAT I KNOW I 2331 01:25:41,637 --> 01:25:44,306 HOSPAL, IERY LOW RISK FOR 2332 01:25:44,306 --> 01:25:44,573 BLEEDING. 2333 01:25:44,573 --> 01:25:45,841 A PATIENT LIKE THIS WHERE THERE 2334 01:25:45,841 --> 01:25:48,577 IS SOME LOSS OF THE CLEAR SPA 2335 01:25:48,577 --> 01:25:50,779 AND THICKENING, THIS IS 2336 01:25:50,779 --> 01:25:52,447 INRMEDIATEISK. 2337 01:25:52,447 --> 01:25:55,684 THAT CANELIVER AT 37, 38NCY 2338 01:25:55,684 --> 01:25:57,986 U DON'T HAVE TO DO AN EARLY 2339 01:25:57,986 --> 01:25:59,821 DELIVERY, BECAUSE THERE'S 2340 01:25:59,821 --> 01:26:02,824 RISKOR BLEEDING IN THOSE 2341 01:26:02,824 --> 01:26:03,492 PREGNANC 2342 01:26:03,492 --> 01:26:05,027 NOW, THERE PROGRESON OF PAS 2343 01:26:05,027 --> 01:26:06,228 RKERS IN PGNANCY? 2344 01:26:06,228 --> 01:26:07,796 AND AT'SN IMPORTANT QUESTION 2345 01:26:07,796 --> 01:26:10,599 THAT WE ARE THE PROCESS OF 2346 01:26:10,599 --> 01:26:12,234 EVALUATI ON A LARGE CT OF 2347 01:26:12,234 --> 01:26:13,535 PATIENTS NOW. 2348 01:26:13,535 --> 01:26:17,572 I SWED YOU EARLIER AT 12NCY THAT 2349 01:26:17,572 --> 01:26:18,573 WEEKS,UT THE ONLTHIN I 2350 01:26:18,573 --> 01:26:22,844 COULD SEE ON THE ULTRASOUND IS 2351 01:26:22,844 --> 01:26:24,279 ONE ESAREANTION IS THE 2352 01:26:24,279 --> 01:26:27,916 SPACE ANDHE PSEE OFNTAL CLE 2353 01:26:27,916 --> 01:26:30,786 PLENTA OVER THE INTERNAL LOSS. 2354 01:26:30,786 --> 01:26:32,454 FULLLTRASOUNDT7 WEEKS, 2355 01:26:32,454 --> 01:26:34,656 LOOK ATHE INVASION OF THE 2356 01:26:34,656 --> 01:26:37,059 CEIX IN THIS PREGNANCY WITH 2357 01:26:37,059 --> 01:26:38,593 SIGNIFANT VASCULARITY HER AND 2358 01:26:38,593 --> 01:26:39,761 SOME LACUNAE INSIDE. 2359 01:26:39,761 --> 01:26:41,029 THISS A PATIENT THAT HAD 2360 01:26:41,029 --> 01:26:42,831 JUST TO SHOW YOU HOW IMPORTANT 2361 01:26:42,831 --> 01:26:46,168 IS HAVING A HIGHSE OF 2362 01:26:46,168 --> 01:26:47,035 INERESS T FIRST 2363 01:26:47,035 --> 01:26:47,502 TRIMESTER. 2364 01:26:47,502 --> 01:26:50,672 THIS PATIENT ENDEDP WITH ECMO 2365 01:26:50,672 --> 01:26:52,407 FR SIGNIFICANT RESRATORY 2366 01:26:52,407 --> 01:26:54,976 FAURET TIME OF DELIVERY. 2367 01:26:54,976 --> 01:26:56,611 I'M USING THIS PICTURE WITH HER 2368 01:26:56,611 --> 01:26:57,145 RMISON. 2369 01:26:57,145 --> 01:27:01,149 CHILDREN DAYSFTER SURRY. 2370 01:27:01,149 --> 01:27:02,684 SO WHAT IS THE W ROLE O M? 2371 01:27:02,684 --> 01:27:06,121 SECTIO ON MRI IN THE GROUPSG 2372 01:27:06,121 --> 01:27:07,756 FROM UTAH, THE LEADERSHIP OF BOB 2373 01:27:07,756 --> 01:27:09,724 AND OTHERS, HAV LOOKED AT THIS, 2374 01:27:09,724 --> 01:27:12,828 AND CLELY MRI SHOULD NOT B 2375 01:27:12,828 --> 01:27:14,496 THE FIRST LINE FORCREENI FOR 2376 01:27:14,496 --> 01:27:15,430 PLACENTA ACCRETA. 2377 01:27:15,430 --> 01:27:17,999 IT COULD B MISLEADING IN SOME 2378 01:27:17,999 --> 01:27:20,402 VENUESASHEY HAVE SWN THATYOU CNT 2379 01:27:20,402 --> 01:27:26,708 INCORRECT DIAGNOSIS IN ABOUT 21% 2380 01:27:26,708 --> 01:27:27,209 OF THE TIME. 2381 01:27:27,209 --> 01:27:29,845 SO WE HAD TO BE CAUTIOUS, 2382 01:27:29,845 --> 01:27:30,645 CERTAINLY U NEED AOT OF 2383 01:27:30,645 --> 01:27:31,813 OEXPERTISE IN THAT BUT YOU HAVE 2384 01:27:31,813 --> 01:27:33,615 TO BE CAUTIOUS IN RELYI ON AN 2385 01:27:33,615 --> 01:27:33,782 MRI. 2386 01:27:33,782 --> 01:27:38,120 IS THERE AOLE FOR MRI IN THIS 2387 01:27:38,120 --> 01:27:38,587 ARENA? 2388 01:27:38,587 --> 01:27:40,422 MAYBE IN POSTERIOR PLACENTA, 2389 01:27:40,422 --> 01:27:41,990 PATIENTS HAVE MULTIPLEURRIES 2390 01:27:41,990 --> 01:27:44,326 WHERE THEY HAV FIBSED AND YOU 2391 01:27:44,326 --> 01:27:46,394 CAN'T SEE REALLY WL BUT MY 2392 01:27:46,394 --> 01:27:47,729 PERIENCE, IT'S VERY RARELY 2393 01:27:47,729 --> 01:27:53,268 NOT BEHE FIRST LE. AND SHOULD 2394 01:27:53,268 --> 01:27:54,002 SOME THOUGHTS FOR DISCUION FOR 2395 01:27:54,002 --> 01:27:57,405 THE GROUP. 2396 01:27:57,405 --> 01:28:00,742 I THINK WE NEE TO WORKARD 2397 01:28:00,742 --> 01:28:01,710 STANDARDIZATION OF TIE GNOSTIC 2398 01:28:01,710 --> 01:28:03,145 RATERS F ULTRAUND 2399 01:28:03,145 --> 01:28:04,479 DESPITE WORK TT'S BEEN DON I 2400 01:28:04,479 --> 01:28:06,348 THIN THE'S CONFUSIONN THE 2401 01:28:06,348 --> 01:28:08,550 LITERATUREH THE ROLE OF 2402 01:28:08,550 --> 01:28:09,751 LACUNAE, PCENTAL CLEAR SPACES 2403 01:28:09,751 --> 01:28:12,420 AND SO FTH. 2404 01:28:12,420 --> 01:28:13,622 I THINWE SHOULD RE-THINK T 2405 01:28:13,622 --> 01:28:16,925 VALUE OF FIRST TRIMEST 2406 01:28:16,925 --> 01:28:18,226 ULTRASOUND IN PASCREENING 2407 01:28:18,226 --> 01:28:18,760 DIAGSIS. 2408 01:28:18,760 --> 01:28:20,662 A LOTF THE ACCRETA PATIENTS WE 2409 01:28:20,662 --> 01:28:21,563 AGNOSED IN THE SECOND 2410 01:28:21,563 --> 01:28:22,197 TRIMESTER NOW HE SOMEIGNS 2411 01:28:22,197 --> 01:28:23,832 TH WE CAN S IN THE FIRST 2412 01:28:23,832 --> 01:28:24,099 IMESTER. 2413 01:28:24,099 --> 01:28:27,068 TIONAC IS, B THERE AREJESS 2414 01:28:27,068 --> 01:28:28,703 SOME IMPORTANT PARAMETERS THA 2415 01:28:28,703 --> 01:28:31,039 WE CAN USEND TRY TO DEFINE. 2416 01:28:31,039 --> 01:28:32,674 I THINK WE NEEDO CLEARLY 2417 01:28:32,674 --> 01:28:34,109 DEFINE FALSE POSITIVE AND FALSE 2418 01:28:34,109 --> 01:28:35,110 NEGATIVE DIAGNOSIS. 2419 01:28:35,110 --> 01:28:36,378 KING A FALSE POSITIVE 2420 01:28:36,378 --> 01:28:40,048 BJECTED PATIENT TO EARLY 2421 01:28:40,048 --> 01:28:43,118 OF MORBIDITY ALS ASSOCIATED 2422 01:28:43,118 --> 01:28:45,086 WITH THIS, LET ALONE INCREASED 2423 01:28:45,086 --> 01:28:46,321 COST OF CARE, SO WE HAVE TO B 2424 01:28:46,321 --> 01:28:49,324 ABLE TO CLEARLY DEFINE TSE 2425 01:28:49,324 --> 01:28:50,525 MARKERS AND MAYBE WORK 2426 01:28:50,525 --> 01:28:55,063 COECTIVELY TO HA HAVE SOME 2427 01:28:55,063 --> 01:28:55,997 MEANINGFUL -- IT'S CONFUSING 2428 01:28:55,997 --> 01:28:57,999 BEUSE NOBODY RELIES ON ANY 2429 01:28:57,999 --> 01:28:59,100 DEFINITIONS IN THESE MARKERS 2430 01:28:59,100 --> 01:29:00,569 REALLY. 2431 01:29:00,569 --> 01:29:07,075 BUT BECAUSE I'VE SHOWN YOU THAT 2432 01:29:07,075 --> 01:29:08,843 IN T NORMAL PREGNANCY TRE'S 2433 01:29:08,843 --> 01:29:10,278 A LOT OF LACUN AND A LOTF 2434 01:29:10,278 --> 01:29:14,049 HER MKES, A.I. WOULD 2435 01:29:14,049 --> 01:29:15,684 RUGGLE TOEALLY DIFFERENTIATE 2436 01:29:15,684 --> 01:29:16,751 NORMAL FM AORMAL. 2437 01:29:16,751 --> 01:29:18,153 SO HERE NEED W LARGE DATABASES 2438 01:29:18,153 --> 01:29:21,656 END UP WITH A REGISTRY FORWE 2439 01:29:21,656 --> 01:29:22,290 PLACENCCRETA SPERUM, PART 2440 01:29:22,290 --> 01:29:24,659 OF THAT REGISY SHOULD BE, I 2441 01:29:24,659 --> 01:29:26,895 STRONGLY BELIEVE, ULTRAUND 2442 01:29:26,895 --> 01:29:27,996 REGISTRY TTS WELL-DEFINED 2443 01:29:27,996 --> 01:29:32,367 CASES WITH WELL-DEFINED IMAGES. 2444 01:29:32,367 --> 01:29:33,668 AND T FUTURE WILL PBABLY BE 2445 01:29:33,668 --> 01:29:34,703 A COROINATIONFLTRASOUND 2446 01:29:34,703 --> 01:29:38,907 MARKERS WITH BIOMARKERS AND I 2447 01:29:38,907 --> 01:29:43,011 HOPEFUL THAT THAT WOULD HELPENHY 2448 01:29:43,011 --> 01:29:43,912 OF ULTRASOUND.LT 2449 01:29:43,912 --> 01:29:44,779 SO THANK YOU VERY MUC FOR YOUR 2450 01:29:44,779 --> 01:29:48,049 ATTENTION. 2451 01:29:48,049 --> 01:29:48,717 >> THANK YOU SO MUCH. 2452 01:29:48,717 --> 01:29:50,118 WE'RE ING TO TURN OVER TO 2453 01:29:50,118 --> 01:29:53,955 FORHIS SESSION AND I ALSWANTA 2454 01:29:53,955 --> 01:29:56,424 TO ACKNOWLEDGE DR.HIP WHO IS A 2455 01:29:56,424 --> 01:29:59,160 PANELIST FOR THIS DISCUSSIO 2456 01:29:59,160 --> 01:30:09,271 ALSO. 2457 01:30:14,910 --> 01:30:15,443 >> GREAT. 2458 01:30:15,443 --> 01:30:16,745 N EVERYBODY HEA ME? 2459 01:30:16,745 --> 01:30:16,945 AY. 2460 01:30:16,945 --> 01:30:18,113 ANKS. 2461 01:30:18,113 --> 01:30:21,082 THOS WERE THREE FANTASTIC TALKS 2462 01:30:21,082 --> 01:30:23,785 TO GET US STARTED HERE, SO WE'RE 2463 01:30:23,785 --> 01:30:25,987 GOING TO SND THE NEXT BIT HERE 2464 01:30:25,987 --> 01:30:29,157 I WANT TO OPEN THIS TO TSSION. 2465 01:30:29,157 --> 01:30:30,425 GROUP AND SEE WHAT SOROF 2466 01:30:30,425 --> 01:30:31,626 QUESTIONS AND COMS PEOPLE 2467 01:30:31,626 --> 01:30:33,995 HAVE AND I'LL TRY AND KEE 2468 01:30:33,995 --> 01:30:34,195 TRACK. 2469 01:30:34,195 --> 01:30:36,731 IN THIS ROOM, WE'LLSE HUMAN 2470 01:30:36,731 --> 01:30:39,668 SOMEBODY CAN HEL US WITH THE 2471 01:30:39,668 --> 01:30:41,469 ZOOM SEEN TO CONVERT IT OVER 2472 01:30:41,469 --> 01:30:42,437 SORE ABLE TO SEEHE CHAT? 2473 01:30:42,437 --> 01:30:48,843 >> YES, WE WOU MODERATE. 2474 01:30:48,843 --> 01:30:50,211 >> PERFECT. 2475 01:30:50,211 --> 01:30:51,546 LET'S STT HERE. 2476 01:30:51,546 --> 01:30:52,380 >> THANK YOU. 2477 01:30:52,380 --> 01:30:53,248 WONDERFUL PSENTATIONS AS 2478 01:30:53,248 --> 01:30:53,615 ALWAYS 2479 01:30:53,615 --> 01:30:54,883 THIS ISARIN FOX. 2480 01:30:54,883 --> 01:30:57,552 I HAVE TWO QUESTIONS 2481 01:30:57,552 --> 01:31:03,692 ONE FOR DEIRDRE AND YALDA AND 2482 01:31:03,692 --> 01:31:07,963 E OTHER FOR DR.- MAYBE IT'S 2483 01:31:07,963 --> 01:31:10,198 THGHT OF AS MORE COMMONLY 2484 01:31:10,198 --> 01:31:11,533 MINOR RI FTOR, BUT THERE IS 2485 01:31:11,533 --> 01:31:14,235 FERTILIZATION ANDROBAY THE 2486 01:31:14,235 --> 01:31:16,204 BIOLOGIN THE CROSSTALK THERE 2487 01:31:16,204 --> 01:31:19,240 BETWEEN THE DECIDUAND 2488 01:31:19,240 --> 01:31:20,675 ESPECIALLY PRIOR PRESERVED 2489 01:31:20,675 --> 01:31:22,911 BRYOS IREASES THE RK, AND 2490 01:31:22,911 --> 01:31:25,547 TO RECALL IN THISOO FOR US 2491 01:31:25,547 --> 01:31:27,882 ESPECIALLY THAT IVF USES 2492 01:31:27,882 --> 01:31:28,750 INCREASELSO BY ABOUT THREE 2493 01:31:28,750 --> 01:31:30,018 FOLD SO THINK WE HAVEO 2494 01:31:30,018 --> 01:31:30,552 KNOWLEDGE THERE MAY BE 2495 01:31:30,552 --> 01:31:31,186 SOMETHING THERE. 2496 01:31:31,186 --> 01:31:34,889 USING F BUT WEAY WANT TO OT BE 2497 01:31:34,889 --> 01:31:35,690 IT. 2498 01:31:35,690 --> 01:31:44,632 AND THENOR DR. YOU ABUDAMAD, I 2499 01:31:44,632 --> 01:31:47,569 THINK WE NEED TO LOOK AT A WAY 2500 01:31:47,569 --> 01:31:49,204 LOOK ATHE UTERUS, NOT JUST 2501 01:31:49,204 --> 01:31:50,171 THE PLACENTA. 2502 01:31:50,171 --> 01:31:52,040 MAYBEOUEE THE WOMAN HEAD, 2503 01:31:52,040 --> 01:31:55,143 E YOUNG W'S HEAD, THE O 2504 01:31:55,143 --> 01:31:56,277 WOMAN'S HEAD DEPENDING ON WHAT 2505 01:31:56,277 --> 01:31:57,746 YOU'RE LOOKING AT AND SEEING 2506 01:31:57,746 --> 01:31:59,314 TH IS REALLY ESSENTIAL. 2507 01:31:59,314 --> 01:32:00,014 I' OPEN THE FLOOR. 2508 01:32:00,014 --> 01:32:01,049 >> THANK YOU, KAROR 2509 01:32:01,049 --> 01:32:01,616 BRINGING THA 2510 01:32:01,616 --> 01:32:03,785 I WAS TKING LESS ABOUT THE 2511 01:32:03,785 --> 01:32:06,588 RI FTO AND MORE OF ABOUT 2512 01:32:06,588 --> 01:32:10,025 LITERA,UT YES, IS ATHE 2513 01:32:10,025 --> 01:32:10,625 CAUSE. 2514 01:32:10,625 --> 01:32:12,727 I IN TO QUANTIF EXACTLY HOW 2515 01:32:12,727 --> 01:32:15,296 CH THE RISK IS IS VERY 2516 01:32:15,296 --> 01:32:16,064 CHALLENGING, AND IT'S NOT CLEAR 2517 01:32:16,064 --> 01:32:17,899 IS IT MEDICATIONSS I THE 2518 01:32:17,899 --> 01:32:19,534 PROCEDES, IS I PLACEMENT OF 2519 01:32:19,534 --> 01:32:20,835 THOSOU KNOW, WHEN YOU PLACE 2520 01:32:20,835 --> 01:32:22,771 THE EMBRYO INSIDE THE UTERUS, I 2521 01:32:22,771 --> 01:32:24,839 THINKT THERE'S -- THERE'S A 2522 01:32:24,839 --> 01:32:26,141 LOT O OPPORTUNITY TOEALLY 2523 01:32:26,141 --> 01:32:28,710 EXPLOREOR THAT. 2524 01:32:28,710 --> 01:32:29,110 THANK YOU. 2525 01:32:29,110 --> 01:32:37,652 >> SO THE SOIL LET ME TURN I 2526 01:32:37,652 --> 01:32:37,819 ON. 2527 01:32:37,819 --> 01:32:42,390 TOUCHES B ON YOUR FITD THA 2528 01:32:42,390 --> 01:32:44,058 QUON AND YOUR SECOND TO LOOK 2529 01:32:44,058 --> 01:32:46,795 AT THE ENTIRE UTERUS. 2530 01:32:46,795 --> 01:32:51,299 SO THE ENVIRONMENT THAT THE 2531 01:32:51,299 --> 01:32:52,934 ACTUAL -- THA DESYD YOU'LL 2532 01:32:52,934 --> 01:32:53,735 LAYER IS RY IMPORTANT 2533 01:32:53,735 --> 01:32:56,504 OF MANCHESTER LOOKING AT THEUT 2534 01:32:56,504 --> 01:32:59,741 EARLY, EAR PLACEAL 2535 01:32:59,741 --> 01:33:00,909 IMPLTAON AND ACTUALLY WHE 2536 01:33:00,909 --> 01:33:03,344 IT IS INVADINGORMALLY INTO T 2537 01:33:03,344 --> 01:33:05,079 DECIDU SO TNKHOSE GUPS 2538 01:33:05,079 --> 01:33:08,249 TH REALLY STU IVF AND 2539 01:33:08,249 --> 01:33:09,317 IMPLANTATIONRE SET UP TO ASK 2540 01:33:09,317 --> 01:33:10,885 THAT QUESTION IN A VERYLEGANT 2541 01:33:10,885 --> 01:33:12,153 S I THINK IT'SOMETHING 2542 01:33:12,153 --> 01:33:13,254 TO THINK ABOUT B REALLY I 2543 01:33:13,254 --> 01:33:14,656 WOULD SAY MOREHAN IVF, JUS 2544 01:33:14,656 --> 01:33:17,459 WHAT ISHE EIRONMENT OF 2545 01:33:17,459 --> 01:33:20,328 IMPLANTATION? 2546 01:33:20,328 --> 01:33:22,730 >> I THINK THAS A RLLY 2547 01:33:22,730 --> 01:33:25,733 IMPORTANT QUESTION, KARIN, AND 2548 01:33:25,733 --> 01:33:29,871 ONE THING THAT WE HAVE FOUND IN 2549 01:33:29,871 --> 01:33:32,073 OUR MULTIDIIPLINA REVIEWS OF 2550 01:33:32,073 --> 01:33:35,777 THESE CASES THAT WE DO THAT IS 2551 01:33:35,777 --> 01:33:40,682 MEANINGFUL TO MS THE IVF 2552 01:33:40,682 --> 01:33:41,282 ENTS, A LOT OF TIMES WE 2553 01:33:41,282 --> 01:33:42,450 DON'T SEE THE TYPICAL SIGNS THAT 2554 01:33:42,450 --> 01:33:44,619 WE WLD WANT TO SEE ON 2555 01:33:44,619 --> 01:33:45,687 ULTRASOU AND THEY' VERY 2556 01:33:45,687 --> 01:33:46,454 CHALLENGING TO DIAGNOSE. 2557 01:33:46,454 --> 01:33:48,523 SO I THI WE DEFINYEED TO 2558 01:33:48,523 --> 01:33:51,893 BETTER UNDERSTAND THEM TO MAKE 2559 01:33:51,893 --> 01:33:56,397 SOME PROGRESS HERE. 2560 01:33:56,397 --> 01:33:58,766 >> CERTAINLY AGREE, KARIN, 2561 01:33:58,766 --> 01:33:59,868 BECAUSE EN WE LOOK AT THE SER 2562 01:33:59,868 --> 01:34:02,103 VICK WE'REKING AT TH 2563 01:34:02,103 --> 01:34:05,406 UTERUS, WE'RE LOOKINGT THE 2564 01:34:05,406 --> 01:34:06,407 THICKNES S THINESS OF T 2565 01:34:06,407 --> 01:34:07,475 UTERUS BECESMPORNT IN THE 2566 01:34:07,475 --> 01:34:09,110 LOSEGMENT SO IT IS NOT IN 2567 01:34:09,110 --> 01:34:10,311 ISOLATION BUT ALSO I PART OF 2568 01:34:10,311 --> 01:34:16,718 THE EXAM IELF. 2569 01:34:16,718 --> 01:34:19,554 GLL BEFO 2570 01:34:19,554 --> 01:34:21,089 >> BORE YOU START, IHOUGHT 2571 01:34:21,089 --> 01:34:24,192 YOU WE GOING TO BE NICE. 2572 01:34:24,192 --> 01:34:31,266 >> LL TELL YOU,E DON'T -- 2573 01:34:31,266 --> 01:34:33,401 THEY'RE NOT ALLOWED TO PUT THAT 2574 01:34:33,401 --> 01:34:34,102 IN THE REPOR 2575 01:34:34,102 --> 01:34:36,938 WH WE SAY YOUAVE TO MEASURE 2576 01:34:36,938 --> 01:34:39,340 THEE OF THE ARETA, HO 2577 01:34:39,340 --> 01:34:40,441 MUCH DISRUPTION THERE IS,HICH 2578 01:34:40,441 --> 01:34:48,283 IS- BETTER DESCRIPTI. 2579 01:34:48,283 --> 01:34:50,585 DIFFERENT IMPRESSN,IFFERENT 2580 01:34:50,585 --> 01:34:51,686 PEOPLE DON'TNOW, WHAT DO 2581 01:34:51,686 --> 01:34:52,854 YOU THINK ABOUT THA 2582 01:34:52,854 --> 01:34:57,525 >> S DIAGNOSING FAL -- IS A 2583 01:34:57,525 --> 01:34:58,860 VERY CHALLENGING DIAGNOSIS. 2584 01:34:58,860 --> 01:35:02,697 >> REALLY.S W -- 2585 01:35:02,697 --> 01:35:04,465 AND IT SHOULD BE BASED ON EITHER 2586 01:35:04,465 --> 01:35:07,268 A FOCAL INVASION OF THE 2587 01:35:07,268 --> 01:35:09,404 SCULARITY FROM THE PLACENTA 2588 01:35:09,404 --> 01:35:15,476 SIDE OF THELACENTA IO THEEN, SO 2589 01:35:15,476 --> 01:35:16,911 MYOMETRIUM, OR A CLE LOSS OF 2590 01:35:16,911 --> 01:35:18,446 THEETRO PLACENTA CLEAR SPACE 2591 01:35:18,446 --> 01:35:20,315 FROM MULTIPLE ANGLES LOOKING 2592 01:35:20,315 --> 01:35:20,848 INHAT. 2593 01:35:20,848 --> 01:35:23,685 BUIT IS NOTNASY DIAGNOSIS 2594 01:35:23,685 --> 01:35:25,086 TO MAKE, AND I AGREE WHOU, 2595 01:35:25,086 --> 01:35:27,455 IT SHOULD BE MADE WITA LOTF 2596 01:35:27,455 --> 01:35:29,657 EXPERTISE ON THE SIDE OF THE 2597 01:35:29,657 --> 01:35:33,261 MA TIMESE MISS IT AND IT'S A 2598 01:35:33,261 --> 01:35:35,363 FOCAL ACCRETA AT THE TIME OFIM 2599 01:35:35,363 --> 01:35:35,630 DELIVERY. 2600 01:35:35,630 --> 01:35:38,132 >>HY NOT DESCRIBEHAT'S 2601 01:35:38,132 --> 01:35:38,333 THERE? 2602 01:35:38,333 --> 01:35:41,569 SEEING.E EXACTLY WT YOU ARE 2603 01:35:41,569 --> 01:35:46,641 I HAVE TO -- MICROSCOPIC 2604 01:35:46,641 --> 01:35:49,110 ACCRETA, REMINDS ME, YOU KNOW, 2605 01:35:49,110 --> 01:35:56,084 ING THE TERM MICROSCOPIC 2606 01:35:56,084 --> 01:35:59,654 ADENOMEIOSIS. 2607 01:35:59,654 --> 01:36:05,460 -- MROSCOPIC ACCRETA MEANS 2608 01:36:05,460 --> 01:36:06,894 >> I THINK IT COMES DOWNO 2609 01:36:06,894 --> 01:36:08,730 LOT OF PATHOLOGY REPORTS, T 2610 01:36:08,730 --> 01:36:10,264 JUST IN MY ITITUTION BUT 2611 01:36:10,264 --> 01:36:11,366 SEWHER BECAUSE I GET THESE 2612 01:36:11,366 --> 01:36:12,533 PATIENTS COMING INND THERE 2613 01:36:12,533 --> 01:36:15,269 LOOKING AT WH HAPPENS IN THE 2614 01:36:15,269 --> 01:36:19,974 THERE IS A HIGHER RISK OF 2615 01:36:19,974 --> 01:36:21,609 IT'S NOT BIG, BUT I DON'T THINK 2616 01:36:21,609 --> 01:36:23,011 IT'S AN AREA THA WE SHOULD 2617 01:36:23,011 --> 01:36:23,578 ENTIRELY IGNE. 2618 01:36:23,578 --> 01:36:25,079 I THINK, THOUGH, THE CLLGE 2619 01:36:25,079 --> 01:36:26,347 BECOMES MANY OF THESE PATIENTS, 2620 01:36:26,347 --> 01:36:29,684 MOST OF THESE PATIENTS WILL D 2621 01:36:29,684 --> 01:36:32,286 WELLN A FUTUREREGNANCY AND 2622 01:36:32,286 --> 01:36:33,254 THEY SEE TS WOR ON A 2623 01:36:33,254 --> 01:36:34,355 PATHOLOGY RE. 2624 01:36:34,355 --> 01:36:36,991 >> SO THE PROEM IS, ARE W 2625 01:36:36,991 --> 01:36:40,028 GOING TO SCARE THE PATIENT YOU 2626 01:36:40,028 --> 01:36:43,998 STARDOING LOT OFEXPECT TO DO, 2627 01:36:43,998 --> 01:36:48,970 INRVENTIONS -- 2628 01:36:48,970 --> 01:36:52,940 IF EVERYDY COULD JUST STATE 2629 01:36:52,940 --> 01:36:54,509 YOUR NAME BEFORE YOUR COMMENTS, 2630 01:36:54,509 --> 01:36:55,810 THATOULD BE GREAT 2631 01:36:55,810 --> 01:37:01,616 WE'LL GOVER HE. 2632 01:37:01,616 --> 01:37:03,051 >> THOSE WERE GREAT TALKS. 2633 01:37:03,051 --> 01:37:03,384 THANK YOU ALL. 2634 01:37:03,384 --> 01:37:04,952 ST IN TH INTEREST OF 2635 01:37:04,952 --> 01:37:05,853 STIMULATING CONVERSION, I 2636 01:37:05,853 --> 01:37:08,723 ULD LE TO ASK GROUP 2637 01:37:08,723 --> 01:37:11,759 QUESON THAT -- LOV TO HEAR 2638 01:37:11,759 --> 01:37:12,527 YOUR ONIONS IN THE WHOLE 2639 01:37:12,527 --> 01:37:12,894 GROUP. 2640 01:37:12,894 --> 01:37:17,865 YOU GUY GAVE GREATKS, AND 2641 01:37:17,865 --> 01:37:19,901 SOME OF THE THINGS THA YOU SAID 2642 01:37:19,901 --> 01:37:24,005 WERELACK, YOU KOOK,E OFHE WAY 2643 01:37:24,005 --> 01:37:26,708 WE'VE -- OUR NOMCLATURE IS 2644 01:37:26,708 --> 01:37:29,444 KIND OF OUTTED WITH REGARD TO 2645 01:37:29,444 --> 01:37:30,044 THPATHOPHYSIOLOGY ANDHAT 2646 01:37:30,044 --> 01:37:34,148 SO OF OUROMENCLATUREOESN 2647 01:37:34,148 --> 01:37:36,984 NECESSARILY REFLECT CLINICAL 2648 01:37:36,984 --> 01:37:38,453 RISK SO WHAT CAN WE DO ABOUT I 2649 01:37:38,453 --> 01:37:41,456 SO THAT WE DON'T -- STHAT WE 2650 01:37:41,456 --> 01:37:44,525 USE TERMINOLOGY THAT REFLECTS 2651 01:37:44,525 --> 01:37:47,361 OUR CURRE UERSTANNG OF 2652 01:37:47,361 --> 01:37:48,996 PATHOPHYSIOLOGY IN TERMS OF 2653 01:37:48,996 --> 01:37:50,198 INVAON, YOU KNO A STUFF 2654 01:37:50,198 --> 01:37:51,966 LIKE THAT, IS THERE NOMENCLATURE 2655 01:37:51,966 --> 01:37:54,569 THAT WOULD BE BETTER TO USE, AND 2656 01:37:54,569 --> 01:37:57,004 TH WOULD BE BETTER TO USE TO 2657 01:37:57,004 --> 01:38:02,477 HELP US MORE CNICAY, AND 2658 01:38:02,477 --> 01:38:03,778 WE'RE NOT HAVING A DEBATE ABOUT 2659 01:38:03,778 --> 01:38:05,446 BRIEF YA AND IVF, BUT I THINK 2660 01:38:05,446 --> 01:38:06,614 MOST OFS WOULD AEE THAT 2661 01:38:06,614 --> 01:38:09,250 REGALESS WHATT IS, THE 2662 01:38:09,250 --> 01:38:11,953 SES THAT ARE PRECESAREANS AND 2663 01:38:11,953 --> 01:38:15,289 PREVIA ARE CLINICAY 2664 01:38:15,289 --> 01:38:17,458 DIERENT THAN A FOCAL ACCRETA 2665 01:38:17,458 --> 01:38:19,660 WITHVF. 2666 01:38:19,660 --> 01:38:22,296 AND SO IS THERE A WAY THAT WE AS 2667 01:38:22,296 --> 01:38:26,167 A GROUP C COME OUT WITH SOME 2668 01:38:26,167 --> 01:38:28,236 NOMENCLATURE THAT WOULD B MORE 2669 01:38:28,236 --> 01:38:28,936 REFLECTIVE OF WHAT WEURRENTLY 2670 01:38:28,936 --> 01:38:34,142 KNOW AND ALSO MAY MORE USEFUL 2671 01:38:34,142 --> 01:38:34,442 CLINICALLY 2672 01:38:34,442 --> 01:38:34,709 THANK 2673 01:38:34,709 --> 01:38:37,445 THATAS BOB SILR. 2674 01:38:37,445 --> 01:38:41,816 >> THANKS, BOB, FOR RSING THIS 2675 01:38:41,816 --> 01:38:42,083 QUESTION 2676 01:38:42,083 --> 01:38:45,653 AND I THINK DESTE THE FACT AS 2677 01:38:45,653 --> 01:38:46,954 YOUAN SEE MULTIPLE 2678 01:38:46,954 --> 01:38:48,823 ORGANIZATION ANDOCIETIES HAVE 2679 01:38:48,823 --> 01:38:49,791 ATMPTED TO -- I'MOING TO 2680 01:38:49,791 --> 01:38:51,559 LK ABOUT THE ULTRASOUND SIDE, 2681 01:38:51,559 --> 01:38:52,860 HAVE ATTEMPTED TO STANDARDIZE 2682 01:38:52,860 --> 01:38:55,930 THE ULTRASOUNKNOW NOMENCLATURE R 2683 01:38:55,930 --> 01:38:56,664 THESE RKERS. 2684 01:38:56,664 --> 01:38:58,099 THE MAJOR PROBLEM WE FACE IS 2685 01:38:58,099 --> 01:39:00,902 THAT A LOT OF THOSE STUDIES ARE 2686 01:39:00,902 --> 01:39:02,436 RETROSPECTIVE STUES THAT ARE 2687 01:39:02,436 --> 01:39:05,740 T WELL DESIGNED, THATAVE USE 2688 01:39:05,740 --> 01:39:07,508 DOLLARS DIFFERENT DEFITNS SO 2689 01:39:07,508 --> 01:39:09,944 THE DATA WE HE HAVE TO WORK 2690 01:39:09,944 --> 01:39:10,812 WI TO TRY TO STANDARDIZE IS 2691 01:39:10,812 --> 01:39:14,182 FLAWEDN MY OPINION. 2692 01:39:14,182 --> 01:39:16,851 I'M HIN THROUGH THIS MEETIHI 2693 01:39:16,851 --> 01:39:20,488 HE, WE COME UP TO COLLE SOME 2694 01:39:20,488 --> 01:39:22,323 REAL RETROSPECTIVEATA ON 2695 01:39:22,323 --> 01:39:26,060 IMAGING, ON SURGICAL APPROACHES, 2696 01:39:26,060 --> 01:39:27,728 FOR, IN A LARGEATABASE 2697 01:39:27,728 --> 01:39:29,430 THAT WE CAN THEN USE TO REALLY 2698 01:39:29,430 --> 01:39:31,699 LIKE I GAVE SHORTLY THE EXAMPLEE 2699 01:39:31,699 --> 01:39:33,000 OF LACUNAE. 2700 01:39:33,000 --> 01:39:36,270 EVERYLACENTA I SEE HAS 2701 01:39:36,270 --> 01:39:39,207 MULTIPLE LACUNUN. 2702 01:39:39,207 --> 01:39:40,308 IT'S THEACK OFF GOOD 2703 01:39:40,308 --> 01:39:45,379 PROSPECTCTELY COLLECTED DATA 2704 01:39:45,379 --> 01:39:46,848 THAT WE NEED TO BE ABLE TO 2705 01:39:46,848 --> 01:39:47,982 ARRIVE AT SOMETANDARDIZAZAON 2706 01:39:47,982 --> 01:39:48,850 THAT WOULDLD MAKAK SENSE FOR 2707 01:39:48,850 --> 01:39:50,418 EVERYBODY. 2708 01:39:50,418 --> 01:39:52,119 AT'STH MY PERSONAL O ONINI 2709 01:39:52,119 --> 01:39:54,956 LOOKING G OM THE ULTLTSOUND SI 2710 01:39:54,956 --> 01:39:57,692 SIDEDE 2711 01:39:57,692 --> 01:39:59,660 >>>> ISST CLINICALLY RELEVANTT O 2712 01:39:59,660 --> 01:40:01,462 THE P PIENT IN THE OPERATING 2713 01:40:01,462 --> 01:40:06,100 ROOM IS THE QUESTION.I THINK THM 2714 01:40:06,100 --> 01:40:14,408 I FORGOTOTOUR QUESTION OUOU OH, 2715 01:40:14,408 --> 01:40:15,743 THE POINT EARLIER ABOUT FOYOYOY, 2716 01:40:15,743 --> 01:40:22,250 CAL,NOT FOCAL, IT'S AN ACCRETA.. 2717 01:40:22,250 --> 01:40:23,251 YES, IT'SSLACKCKNDNDHITETE 2718 01:40:23,251 --> 01:40:28,256 NEVER COMPLETELY ADHERENT. 2719 01:40:28,256 --> 01:40:31,826 BLEEEENGNGHAT WASASLLUDED TO IN 2720 01:40:31,826 --> 01:40:35,830 A C CPLPL PAPERS DR. ABUHAMAD IS 2721 01:40:35,830 --> 01:40:38,599 WHAT WE CAN D DO VERY E ELY ON 2722 01:40:38,599 --> 01:40:39,901 BIOLOGICALLY AND B ULTRASOUND. 2723 01:40:39,901 --> 01:40:43,170 SOS THE PATIENT AT A HIGH RISK 2724 01:40:43,170 --> 01:40:45,940 OF THAT FIBRINONO LAYER NOT 2725 01:40:45,940 --> 01:40:47,074 COMING OFF BECAUSE THAT'SSHAT'S 2726 01:40:47,074 --> 01:40:48,175 ING TO BE RELATED TO THE 2727 01:40:48,175 --> 01:40:49,777 AMOUNTNTF BLEEDING ANDND THE 2728 01:40:49,777 --> 01:40:50,978 SURGICAL APPROACAC THAT W S SULD 2729 01:40:50,978 --> 01:40:51,312 BE TAKING.G. 2730 01:40:51,312 --> 01:40:55,249 SO M MIFY THE LANE IN 2731 01:40:55,249 --> 01:40:56,384 DEDERIBIBI, I AGREE. 2732 01:40:56,384 --> 01:40:57,885 >> YEAH,H, AGREE WITH BOTH OF 2733 01:40:57,885 --> 01:41:00,187 THE COMMENTSS SO FAR. 2734 01:41:00,187 --> 01:41:03,791 AND JUST A LITTLTL B B -- NOT 2735 01:41:03,791 --> 01:41:07,862 LALAUAUA NEEDS TO CHANGE.FERENT 2736 01:41:07,862 --> 01:41:10,364 ANDHAT'S VERYY IMPMPMPNT. 2737 01:41:10,364 --> 01:41:12,867 AS WEETTER UNDERSTAND THE 2738 01:41:12,867 --> 01:41:19,507 DR. EINERSON'S PAPER FROM N NND 2739 01:41:19,507 --> 01:41:21,075 FOUR YEARS AGO OPENED MY EYES TO 2740 01:41:21,075 --> 01:41:22,944 A DIFFERENT PROCESS, AND I THIHI 2741 01:41:22,944 --> 01:41:24,679 THERE'S MORE LITERATUREE TO 2742 01:41:24,679 --> 01:41:27,848 SUSUORT THE LACKKK O I IASION AD 2743 01:41:27,848 --> 01:41:31,986 IT'SORE AN EVOVOTION IN O O 2744 01:41:31,986 --> 01:41:34,255 UNDERSTANDING OF HOWOW PLACENTA 2745 01:41:34,255 --> 01:41:37,291 ACCRETA DEVELELS. 2746 01:41:37,291 --> 01:41:40,962 SO NECESSARILY, LANANANE WILL 2747 01:41:40,962 --> 01:41:47,969 CONTINENENEOO CONTINUE TO DEVELN 2748 01:41:47,969 --> 01:41:48,369 THIS. 2749 01:41:48,369 --> 01:41:50,071 >> I HAVE A QUESTION ABOUT THE 2750 01:41:50,071 --> 01:41:50,604 OLOGY. 2751 01:41:50,604 --> 01:42:00,414 IT'S NOT JUST FOR DR. AFSHAR, 2752 01:42:00,414 --> 01:42:04,151 BITS FOR THE WHOLELE SPECIFICAL, 2753 01:42:04,151 --> 01:42:05,453 IN ADVERSE PREREANCYUTCOME 2754 01:42:05,453 --> 01:42:07,088 WHEN WE TAKE THE PLACENTA AFTER 2755 01:42:07,088 --> 01:42:08,055 DELIVERY, NOT ONLY FROMHE 2756 01:42:08,055 --> 01:42:10,691 PATIENTS WITH PASAS BUT EVEN N E 2757 01:42:10,691 --> 01:42:12,960 CONTROL,AUSE AT NTE END TO 2758 01:42:12,960 --> 01:42:14,161 TETE THESE BIOLOGY, YOU HAVE 2759 01:42:14,161 --> 01:42:15,062 TO HAVE T T C C COL. 2760 01:42:15,062 --> 01:42:16,697 HOW CAN WE BE CERERIN THAT WHAT 2761 01:42:16,697 --> 01:42:19,734 WEWEE SEEING ISS NOT A A A RESPE 2762 01:42:19,734 --> 01:42:21,902 TOTOOMETHING ELSEE THAT'S NOT TE 2763 01:42:21,902 --> 01:42:24,972 CAUSEE OF T T PAS, INCNCDING THE 2764 01:42:24,972 --> 01:42:26,374 COMPARISON WITH THEONTROL, 2765 01:42:26,374 --> 01:42:27,375 BECAUSE THEESPONSE E HE 2766 01:42:27,375 --> 01:42:30,244 CONTNTL IS ALSO THERE TO 2767 01:42:30,244 --> 01:42:31,545 SOMETHING ELSE. 2768 01:42:31,545 --> 01:42:34,982 ANANWHEN WE SAY THAHA PAS ISS 2769 01:42:34,982 --> 01:42:38,352 ALLYLY A DEHISCENCE, WHY ARE WE 2770 01:42:38,352 --> 01:42:39,887 LOOKING ATHELACENTA ALSO 2771 01:42:39,887 --> 01:42:42,923 LY OR, ANYNYY, AND SECECD, 2772 01:42:42,923 --> 01:42:44,992 SHOULD WEE BE LOOKING AT OTHER 2773 01:42:44,992 --> 01:42:46,761 ETIOLOGIES, NOT JUST THE 2774 01:42:46,761 --> 01:42:48,295 OLOGY, B B THE WAY WE CLOSE 2775 01:42:48,295 --> 01:42:50,464 THETERUS, THE WAY WE TAKE CARE 2776 01:42:50,464 --> 01:42:52,533 OF THESEATIEIESER THEIR 2777 01:42:52,533 --> 01:42:56,070 PRPRR C-S-STION ALSO IS PROBABY 2778 01:42:56,070 --> 01:42:57,171 MORE IMPORTANT IN THIS REGARD 2779 01:42:57,171 --> 01:43:03,911 THTH THE BIOLOGY.. 2780 01:43:03,911 --> 01:43:05,012 I AGREE. 2781 01:43:05,012 --> 01:43:06,647 BUT YOU ALLUDE TO THE POINT 2782 01:43:06,647 --> 01:43:09,383 OF - - -D I HOPOP I WAS VERYY 2783 01:43:09,383 --> 01:43:15,423 CLEAR, I 10000GREE... 2784 01:43:15,423 --> 01:43:20,327 THTH PLACENTA IN THE OR IS 2785 01:43:20,327 --> 01:43:22,229 COOKED/D/DE PLACENTA,, AND SOME 2786 01:43:22,229 --> 01:43:23,464 OF THEHEOLKS THAT ARERE A AE TO, 2787 01:43:23,464 --> 01:43:29,503 BY ULTLTSOUND, BY BIOI BIOMARKEY 2788 01:43:29,503 --> 01:43:34,241 THE PLACECEA EARLYN, LOOKTOOK AA 2789 01:43:34,241 --> 01:43:36,744 THAT C CSURE, HOW DOES THAT ONEE 2790 01:43:36,744 --> 01:43:38,145 OR TWO LAYER OR DOUBLE O OR 2791 01:43:38,145 --> 01:43:40,548 WHATEVER ELSE YOU PUT IN THERE 2792 01:43:40,548 --> 01:43:41,282 CLOSURE E KE A DIFFEFENCE. 2793 01:43:41,282 --> 01:43:43,084 SO I0000GREE. 2794 01:43:43,084 --> 01:43:44,085 ALL OF THE WORK THAT WAS 2795 01:43:44,085 --> 01:43:47,154 WAY THE MYOMETRIUM AS WELL, SO 2796 01:43:47,154 --> 01:43:48,122 THE SCACAIN ADDITION TOO THE 2797 01:43:48,122 --> 01:43:49,924 PLACENTA. 2798 01:43:49,924 --> 01:43:51,158 SO STOP BLAMING THE PLALANTNT 2799 01:43:51,158 --> 01:43:53,160 >> WE'RE L L LNG FORWARD TO 2800 01:43:53,160 --> 01:43:56,397 TALKINGBOUT THE NICHE AND THE 2801 01:43:56,397 --> 01:43:59,233 SCARRING IF THE FOURTHH SESSION 2802 01:43:59,233 --> 01:43:59,600 TOTO 2803 01:43:59,600 --> 01:44:01,502 >> WE'REREOING TO COME OVER HERE 2804 01:44:01,502 --> 01:44:01,702 NEXT. 2805 01:44:01,702 --> 01:44:05,873 >> SCOTT SHAINKER. 2806 01:44:05,873 --> 01:44:07,842 THANKS F F THE G GAT TALKSKS 2807 01:44:07,842 --> 01:44:11,212 THIS MAY BE A IMPORTANTNT- 2808 01:44:11,212 --> 01:44:12,012 >>>> INTNTDUCE YOURSELF. 2809 01:44:12,012 --> 01:44:13,180 >> I DID. 2810 01:44:13,180 --> 01:44:16,183 SCSCT SHAINKER. 2811 01:44:16,183 --> 01:44:20,788 >>WE TRY TO COME UP WITIT 2812 01:44:20,788 --> 01:44:26,060 NOMENCLATURE, STATA DAITION OF N 2813 01:44:26,060 --> 01:44:29,096 LANGUAGE TO PATHOLOGY FIELD HAS 2814 01:44:29,096 --> 01:44:30,698 AS WELL BUT ACTUALLY WE DON'T 2815 01:44:30,698 --> 01:44:31,098 USE IT. 2816 01:44:31,098 --> 01:44:33,601 WE'RE STILL USISI THE TERM 2817 01:44:33,601 --> 01:44:36,871 ACCRETA, EVEVE BOB USED THE WORR 2818 01:44:36,871 --> 01:44:39,073 THAT SAID IT'S NOTOT INVASION. 2819 01:44:39,073 --> 01:44:41,242 IT'S US, SO W N ND T T T COME UP 2820 01:44:41,242 --> 01:44:43,310 WITHTH- WE NEEDD TO ACCEPT 2821 01:44:43,310 --> 01:44:44,078 THESE -- ALL THEHEORK THAT WE'RE 2822 01:44:44,078 --> 01:44:47,681 ALREADY D DOING AND JUST MOVE OO 2823 01:44:47,681 --> 01:44:52,620 CATEGORIESESRYONON DESCRIBES 2824 01:44:52,620 --> 01:44:55,456 AS.3 NOW, HOPEFULLY, BUT I 2825 01:44:55,456 --> 01:44:58,425 DON'T KNOW IF I NECESSARILYLYLYU 2826 01:44:58,425 --> 01:45:00,928 ALAL THINK ABOUT THIS, D DO WE D 2827 01:45:00,928 --> 01:45:02,363 TO R RNVENT THAT WHEELEL R OR DE 2828 01:45:02,363 --> 01:45:07,168 NEED TOOUSTIND OFOFCCEPT IT? 2829 01:45:07,168 --> 01:45:09,803 YOU PUT A LOTOT OF WORK INTO T T 2830 01:45:09,803 --> 01:45:10,004 AND -- 2831 01:45:10,004 --> 01:45:11,105 >>>> MAYBE -- I DON'T K K K I HE 2832 01:45:11,105 --> 01:45:13,974 WITHEEDD TO REINVENT THE WHEEL. 2833 01:45:13,974 --> 01:45:15,509 MAYBE WE NEEEE TO LOOK INTO THE 2834 01:45:15,509 --> 01:45:17,678 BRBRES A AITTLE BITORE.E. 2835 01:45:17,678 --> 01:45:20,848 I THINK WHAT I'M ASKING OR AT 2836 01:45:20,848 --> 01:45:22,149 LEAST PROPOSING OR HOPING FORORS 2837 01:45:22,149 --> 01:45:23,918 THATATE CAN REFINEE T T 2838 01:45:23,918 --> 01:45:26,220 DEFINITIONS THAT WE HAVEECAUSE 2839 01:45:26,220 --> 01:45:27,621 THEM. CONFUSINGNGVEVEBODY WITH 2840 01:45:27,621 --> 01:45:30,124 TO SOME EXTXTT. 2841 01:45:30,124 --> 01:45:31,759 AND T T PROBLEM WE'RE STUCK WITH 2842 01:45:31,759 --> 01:45:33,360 ISISE'RESING THEXISTING DATA 2843 01:45:33,360 --> 01:45:38,632 DEFINITIONS AND ASS YOU KNOW THE 2844 01:45:38,632 --> 01:45:41,001 DATA IS NOT ACCURATE. 2845 01:45:41,001 --> 01:45:44,138 I THINK THE VASCULARITY OF H H 2846 01:45:44,138 --> 01:45:46,941 VASCULARARARON C COROPPLER 2847 01:45:46,941 --> 01:45:49,210 MEANAN NOTHINGNG I TODAY'S 2848 01:45:49,210 --> 01:45:50,211 EQEQPMENT, IT MEAEA ABSOLUTELEL 2849 01:45:50,211 --> 01:45:50,544 NOTHING. 2850 01:45:50,544 --> 01:45:52,079 IAN MAKE EVERY PLACECEA LOOK 2851 01:45:52,079 --> 01:45:53,380 LIKE AN A ARERERE IF THAT'S THEE 2852 01:45:53,380 --> 01:45:54,582 DEFINITION. 2853 01:45:54,582 --> 01:45:57,985 SOSO'M HOPING THAT WITH US 2854 01:45:57,985 --> 01:46:00,688 COLLECTING MEANINGFUL DATA 2855 01:46:00,688 --> 01:46:02,456 OSPECTIVELY IN A STANDARDIZEZE 2856 01:46:02,456 --> 01:46:04,858 WAY, WE CAN THEN SAY THIS IS A 2857 01:46:04,858 --> 01:46:09,230 LACUNAE THAT MAKES SENSE. IT'SNF 2858 01:46:09,230 --> 01:46:10,631 IT HASASAS FLOW IN IT AND THE 2859 01:46:10,631 --> 01:46:11,865 PRPRENCE A AER PREVIA. 2860 01:46:11,865 --> 01:46:12,733 OTHEHEISIS IGNORE A A THE 2861 01:46:12,733 --> 01:46:14,134 THTHE ARE THE THINGS THAT I'MHA 2862 01:46:14,134 --> 01:46:15,569 HOPIPI FOR THAT WEE CAN COME 2863 01:46:15,569 --> 01:46:18,839 TOGETHER AND REALLY PROVIDE SOME 2864 01:46:18,839 --> 01:46:22,009 INFORMATION TORE THE WORLD ABOUT 2865 01:46:22,009 --> 01:46:24,845 WHWH M MTERS INLTRASOUNDLTLT 2866 01:46:24,845 --> 01:46:27,715 DIDINOSISSNDNDHAT DOESN'T. 2867 01:46:27,715 --> 01:46:31,719 >> I DON'T THINK W NEED TOO 2868 01:46:31,719 --> 01:46:33,053 REINVENT THINGS. 2869 01:46:33,053 --> 01:46:35,155 MODIFICATION ARE I THINK IS IN 2870 01:46:35,155 --> 01:46:36,190 LINE AND HOPEFULLY THAT'S S E 2871 01:46:36,190 --> 01:46:37,625 THING THATS ES OUT OF THIS 2872 01:46:37,625 --> 01:46:41,362 TWO-DAY SESSION. 2873 01:46:41,362 --> 01:46:42,630 I WANT TO BEIEI A KNOWLEDGE, 2874 01:46:42,630 --> 01:46:43,497 WE'V'V TALKED ABOUT SORT OF THE 2875 01:46:43,497 --> 01:46:45,933 LOT OF G GD WORK DONE TOO THATA 2876 01:46:45,933 --> 01:46:47,568 WE C C BUIUI UPON, AND AGAININI 2877 01:46:47,568 --> 01:46:51,171 MOMOFICATION BECAUSE THEREREBOUT 2878 01:46:51,171 --> 01:46:52,706 O MANYYY GAPSOR HOW C CMON 2879 01:46:52,706 --> 01:46:56,877 THIS PROBLEM I I 2880 01:46:56,877 --> 01:46:58,512 >> I WOULD ADD ONE C CMENT TO 2881 01:46:58,512 --> 01:46:59,747 GIVE YOU AN EXAMPLE, W WRE 2882 01:46:59,747 --> 01:47:00,981 STRURULING WHAT TO DO WITH THE 2883 01:47:00,981 --> 01:47:03,050 FIRST TRIRISTER ULTRASOUND IN 2884 01:47:03,050 --> 01:47:04,218 THE PATIEIE W WH ONE PRIOR 2885 01:47:04,218 --> 01:47:05,319 CESAREAN SECTION, , R INSTANCE, 2886 01:47:05,319 --> 01:47:05,853 TO D DE. 2887 01:47:05,853 --> 01:47:07,154 THERE'S NO NATIONAL STANDARDS ON 2888 01:47:07,154 --> 01:47:10,057 THE STANDNDD SAYS DO NOT USE 2889 01:47:10,057 --> 01:47:11,358 UNLELE IT'S INDNDATION-DRIVEN. 2890 01:47:11,358 --> 01:47:15,929 GIVEVE THEORBIDITY OF THIHIT? 2891 01:47:15,929 --> 01:47:19,233 DISEASE, SHOULD WE BE DOING 2892 01:47:19,233 --> 01:47:23,470 FIRST TRIMESTERLTRASOUNDS 2893 01:47:23,470 --> 01:47:27,041 WITH -- ESE ARE THINGS WE 2894 01:47:27,041 --> 01:47:28,909 COULD HELP WITHHHING TO 2895 01:47:28,909 --> 01:47:29,276 CONSENSUS ABOUT. 2896 01:47:29,276 --> 01:47:35,749 >>CHRIRIRIA DUZYJ-B-BIAK, IF 2897 01:47:35,749 --> 01:47:37,318 IS ROOM O OF EXPERT CAN'T COME 2898 01:47:37,318 --> 01:47:38,852 TO A A CONSENSUS ABOUT W WTT A 2899 01:47:38,852 --> 01:47:40,721 ULTRASOUND DIAGNOSIS IS, THENN 2900 01:47:40,721 --> 01:47:45,192 READING A 76805 DEFINITELY W W W 2901 01:47:45,192 --> 01:47:46,593 KNOW WHO TO REFERER INTO OUR 2902 01:47:46,593 --> 01:47:47,594 EXPERTRT EYES. 2903 01:47:47,594 --> 01:47:50,197 SO I'D'DOVE FOR USO 2904 01:47:50,197 --> 01:47:51,098 STANDARDIZE NOMENCLATURE ALSO 2905 01:47:51,098 --> 01:47:54,501 FOR WHO NEEDS REFERRAL, WHO 2906 01:47:54,501 --> 01:47:55,502 WARRANTS THEHEEFERRAL TO COMOM N 2907 01:47:55,502 --> 01:47:57,137 TO THEXPERT EYES TOEGININ 2908 01:47:57,137 --> 01:47:59,440 WITH, BECAUSUS TO DR. LYELL'S 2909 01:47:59,440 --> 01:48:00,307 ORIGININ POINT IN HER 2910 01:48:00,307 --> 01:48:01,942 ESENTATION, IF 70% ARE 2911 01:48:01,942 --> 01:48:04,678 DIAGNOSED UNTIL THEYRE IN THEHEE 2912 01:48:04,678 --> 01:48:05,813 O.O.O., THEN WE N N NOOVE 2913 01:48:05,813 --> 01:48:07,581 DIDINOSIS UPSTREAM, SO I THINK 2914 01:48:07,581 --> 01:48:08,449 MENCLATURE IS REALLY IMPORTANT 2915 01:48:08,449 --> 01:48:08,982 THERE TOO. 2916 01:48:08,982 --> 01:48:10,851 >> I WANT TOO ADD JUST ONON THIG 2917 01:48:10,851 --> 01:48:12,419 ON THE FIRST T TMESTST 2918 01:48:12,419 --> 01:48:16,190 ULTRASOUOU IS, I MY PERSONAL 2919 01:48:16,190 --> 01:48:18,525 OPPORTUNITY FOR THE D DGNGNIS 2920 01:48:18,525 --> 01:48:20,627 ANFO SCREENING F F PLACENTA 2921 01:48:20,627 --> 01:48:23,530 ACCRETA B BAUSESESES MUCH EASIER 2922 01:48:23,530 --> 01:48:25,933 TO DO THAN YOU DO IN THEHEECOND 2923 01:48:25,933 --> 01:48:27,034 D THIRD T TMESTER BECAUSE YOU 2924 01:48:27,034 --> 01:48:28,802 SEE THEULL PLACENTNT 2925 01:48:28,802 --> 01:48:30,804 SO THIS ISHYT'T'T' R RLLY A 2926 01:48:30,804 --> 01:48:35,442 WIWIOW U UNG WORDS FROM -- 2927 01:48:35,442 --> 01:48:38,912 WINDOW I I THE FUTURE,E,OW THEHE 2928 01:48:38,912 --> 01:48:40,013 WINDOW -- IF WE COME TO O 2929 01:48:40,013 --> 01:48:41,415 AGREEMENT OF HOW TO STANDARDIZE 2930 01:48:41,415 --> 01:48:43,384 AT, THAT, I THINK, , A A HUGEE 2931 01:48:43,384 --> 01:48:43,751 SERVICE. 2932 01:48:43,751 --> 01:48:47,921 SOMEMEINGGG J JT BUILDING ON TH, 2933 01:48:47,921 --> 01:48:49,656 WE HAVAV'T TALKED ABOUT T T 2934 01:48:49,656 --> 01:48:51,091 NON-PREVIA ACCRETAS, YET WE K KW 2935 01:48:51,091 --> 01:48:52,960 THAT THEY'RE MORBID,D,HEY 2936 01:48:52,960 --> 01:48:54,695 HAPPEN, IN MY EXPERIENCNCNC AREE 2937 01:48:54,695 --> 01:49:01,034 ONES THAT WE HAVE TOTOTLY MIS 2938 01:49:01,034 --> 01:49:03,237 MISSED -- IN S SEOEO WHO REALLYR 2939 01:49:03,237 --> 01:49:04,338 RISK FACTORS, BUT THAT'T' 2940 01:49:04,338 --> 01:49:05,973 SOMETHING, HOW CAN WE DO BETTETE 2941 01:49:05,973 --> 01:49:09,710 ATOSING NON-PREVIA 2942 01:49:09,710 --> 01:49:11,445 CRETAS? 2943 01:49:11,445 --> 01:49:12,212 I'M CURIOUS TOO KNOW YOUR 2944 01:49:12,212 --> 01:49:13,614 THOUGHTS IN GENERAL ABOUT HOW WE 2945 01:49:13,614 --> 01:49:15,416 CANMPROVE THAT, BUT ALSO O 2946 01:49:15,416 --> 01:49:17,418 THE FIRST TRIMESTER.. 2947 01:49:17,418 --> 01:49:19,086 >> THE FIRST TRIMESTER COULD BE 2948 01:49:19,086 --> 01:49:20,053 ANAN IMPORTANT WINDODO THEN, 2949 01:49:20,053 --> 01:49:22,122 BECAUSE WE COULD SEE MAYBE A LOT 2950 01:49:22,122 --> 01:49:24,158 OF THOSE PLACENTAS HAVE ACTUALLY 2951 01:49:24,158 --> 01:49:27,494 STARTED AS A LOW LYING PREVIAS 2952 01:49:27,494 --> 01:49:29,797 AND MIGRATED POSTERIORLY, AND 2953 01:49:29,797 --> 01:49:32,633 THERER COULD BE --UT I AGREEEEEE 2954 01:49:32,633 --> 01:49:33,867 WITH YOU, THEY ARE VERY COMOMEX 2955 01:49:33,867 --> 01:49:35,602 TO D DGNOSE AND DIFIFCULT AND WW 2956 01:49:35,602 --> 01:49:37,137 PRPRABLY MISS A LOT OF THEM. 2957 01:49:37,137 --> 01:49:37,938 ESESCIALLY ON THEOSTERIOR SIDE 2958 01:49:37,938 --> 01:49:39,273 THAT HE WITH CANANANEE, BUT 2959 01:49:39,273 --> 01:49:40,908 THERE E ULD BE A WININW IN THE 2960 01:49:40,908 --> 01:49:41,408 FIFIT TRIMESTER. 2961 01:49:41,408 --> 01:49:42,709 I DON'T HAVE THAT. WE ARE 2962 01:49:42,709 --> 01:49:47,314 LOOKING INTO THIS NOW, BUT -- 2963 01:49:47,314 --> 01:49:50,150 >> QUESTION HERE, B BNG THE MOST 2964 01:49:50,150 --> 01:49:52,286 SENIOR PERSON IN T P P P ROOM H, 2965 01:49:52,286 --> 01:49:55,556 YOU DON'T ADDRESS THIS ISSUE 2966 01:49:55,556 --> 01:49:57,224 NOW, , U'LL BE INHE SAME 2967 01:49:57,224 --> 01:49:59,626 SITUATION WE ARE WITH 2968 01:49:59,626 --> 01:50:00,427 HYPERTENSIVEISORDERS OF 2969 01:50:00,427 --> 01:50:01,061 PREGNANCY. 2970 01:50:01,061 --> 01:50:08,001 WE H HE CONFUSED THE HEALTH OF 2971 01:50:08,001 --> 01:50:11,438 EVERYBODY, H HERTENSION, 2972 01:50:11,438 --> 01:50:12,473 PREEEEAMPSIA, WHOO IS -- AND WHO 2973 01:50:12,473 --> 01:50:15,008 IS NOT. 2974 01:50:15,008 --> 01:50:19,046 I HAVE -- MORE WITIT - -- 2975 01:50:19,046 --> 01:50:21,348 HYHYHYENENONONMORERE THAN 45HA 2976 01:50:21,348 --> 01:50:27,621 WE ARE STILL TRYING TO DEFINENE 2977 01:50:27,621 --> 01:50:28,121 WHAT WE DID.. 2978 01:50:28,121 --> 01:50:30,257 IF YOU DON'T DEAL WITH THIS NOW, 2979 01:50:30,257 --> 01:50:33,293 YOU WILLL B B--BOBO THIS 1 1 2980 01:50:33,293 --> 01:50:35,596 15,, 40 0 ARS F FM NOW THE WAYAE 2981 01:50:35,596 --> 01:50:35,896 DID. 2982 01:50:35,896 --> 01:50:37,297 THIS IS WHY IT H H TO BEONON 2983 01:50:37,297 --> 01:50:38,265 RIGHTT NOW. 2984 01:50:38,265 --> 01:50:39,299 >>>>HANKS. 2985 01:50:39,299 --> 01:50:40,501 HOPEFULLLLTHAT'S WHY WE'RE HERE. 2986 01:50:40,501 --> 01:50:42,236 THEREAS A COMMENT OR A 2987 01:50:42,236 --> 01:50:47,474 QUESTION FROMEHIND YOUOU 2988 01:50:47,474 --> 01:50:49,843 RISTINA? 2989 01:50:49,843 --> 01:50:54,314 >> MY NAME JEANILMAN, I'M FROM 2990 01:50:54,314 --> 01:50:55,449 DUKE.. 2991 01:50:55,449 --> 01:50:59,019 I APPRECIATE THE COMOMNTNTHAT -- 2992 01:50:59,019 --> 01:51:03,290 DEDEDENG THIS DISEASE SHOULUL 2993 01:51:03,290 --> 01:51:08,362 MPLE SEE UNDER THE GRANULAR 2994 01:51:08,362 --> 01:51:09,229 MICROSCOPE AND COMEEACK T TO WHA 2995 01:51:09,229 --> 01:51:10,430 IS GOING TO MATTERO THE 2996 01:51:10,430 --> 01:51:12,065 PATIENT, AND IN ORDER TO 2997 01:51:12,065 --> 01:51:13,300 RERERE--AVAVTHE GREATEST 2998 01:51:13,300 --> 01:51:15,869 IMPAPA,,T BECOMES OUR 2999 01:51:15,869 --> 01:51:19,072 RESPONSISILITY TOREATE STRATAA 3000 01:51:19,072 --> 01:51:22,476 OF -- AND RECOGNINI IT'SS A 3001 01:51:22,476 --> 01:51:23,310 LTIPIPX DIAGNOSIS,S, SO IT ISS 3002 01:51:23,310 --> 01:51:24,811 VERY MUCHHIKE PREECLAMPSISI 3003 01:51:24,811 --> 01:51:27,214 WHERE THEREAS TO B A 3004 01:51:27,214 --> 01:51:29,049 CONSIDERATION OF PROXIMITY TO 3005 01:51:29,049 --> 01:51:30,717 THE ORIGIGIGI INJURY TOHEHE 3006 01:51:30,717 --> 01:51:32,586 UTERUS, SO PROXIXITYO A SCAR, 3007 01:51:32,586 --> 01:51:34,154 NOTT JUSTHE PREVIA, BUT 3008 01:51:34,154 --> 01:51:36,323 PROXIMIMY TO THE P POR SCAR, 3009 01:51:36,323 --> 01:51:38,058 BECAUSE IT DEPENDS WHEHE YOU'RE 3010 01:51:38,058 --> 01:51:41,461 DOING THE ULTLTSOSOD OR WHAT 3011 01:51:41,461 --> 01:51:45,299 ULTIMATELYECOMOM OUR JOB IS TO 3012 01:51:45,299 --> 01:51:46,266 LAY OUT THE TABLE THATT TALKS 3013 01:51:46,266 --> 01:51:51,004 ABOUT THE PRIMARY RISKS AND THE 3014 01:51:51,004 --> 01:51:53,807 PRIMARY MARKERS, ANDHEN HOW 3015 01:51:53,807 --> 01:51:55,442 MULTIPLE COMBINATIONS OF THEHE 3016 01:51:55,442 --> 01:52:00,480 CA LEADO LOW IPT INTERMEDIDIE 3017 01:52:00,480 --> 01:52:02,916 OR HIGH RISK STRATA FOFO M MININ 3018 01:52:02,916 --> 01:52:04,985 DECISIONS FOR DELIVIVY TIMING, 3019 01:52:04,985 --> 01:52:08,689 SOURCES.S.OCATION ANDNES N NESSY 3020 01:52:08,689 --> 01:52:09,389 >> THANK YOU FOR THAT COMMENT. 3021 01:52:09,389 --> 01:52:13,260 WE'RE GOING TO GO O OR HERE, 3022 01:52:13,260 --> 01:52:14,595 STT WITH JASON AND THEN 3023 01:52:14,595 --> 01:52:17,331 GEOROR.>> JASONON- C CUMBIA UNU. 3024 01:52:17,331 --> 01:52:20,300 TALKS. ALL FOR T T REALLY GREAT 3025 01:52:20,300 --> 01:52:25,238 WHAT'S T TOLE O MRI INUHAHAD. 3026 01:52:25,238 --> 01:52:26,239 DIAGNOSIS AND I GUESS MANAGEMENT 3027 01:52:26,239 --> 01:52:27,140 IN GENERALAL 3028 01:52:27,140 --> 01:52:28,875 >> W WLL OFTEN USE IT IN 3029 01:52:28,875 --> 01:52:30,377 SUSUSU DECISION-MAKING BUT IS 3030 01:52:30,377 --> 01:52:32,980 >> I THINKNK THERE'S'S CONTROVEY 3031 01:52:32,980 --> 01:52:33,180 HAT. 3032 01:52:33,180 --> 01:52:35,616 AND I THINK SOME OF THENK STUDIS 3033 01:52:35,616 --> 01:52:44,591 AND II KNOWRETT AND F -- HAD AEY 3034 01:52:44,591 --> 01:52:45,692 NICE PAPER ON THE EXPERTISE THEE 3035 01:52:45,692 --> 01:52:47,794 HAHAHA IN CREATIV T TTRI 3036 01:52:47,794 --> 01:52:49,029 SOMETIMES IS MISGUIDED IN 3037 01:52:49,029 --> 01:52:51,999 GUGUING YOU ONE WAIVERS US 3038 01:52:51,999 --> 01:52:54,234 OTOTR, EVEN FALSENN POSITIVES 3039 01:52:54,234 --> 01:52:55,669 AND FALSE NEGATIVES AND I SHARED 3040 01:52:55,669 --> 01:52:56,570 THE SLIDE WITH THAT. 3041 01:52:56,570 --> 01:52:59,172 I I ININ THE V VUE OF AN MRI IS 3042 01:52:59,172 --> 01:53:01,308 HIGHLY DEPEPDENT ON THEGHGH SKIL 3043 01:53:01,308 --> 01:53:05,112 OF THE SONOLOGISTS T T TTTOU HAE 3044 01:53:05,112 --> 01:53:08,315 TIN YOUR UNITS AND THE 3045 01:53:08,315 --> 01:53:10,617 TRANSVSVSVAL APPROACH TO THE 3046 01:53:10,617 --> 01:53:11,852 PLACENTA. 3047 01:53:11,852 --> 01:53:13,754 IF MOST OFOFHE PATHOLOGY IN THEE 3048 01:53:13,754 --> 01:53:14,988 PLACENTA IS IN N EE LOWERERER 3049 01:53:14,988 --> 01:53:15,455 SEGMENT, 3050 01:53:15,455 --> 01:53:16,757 THEHEI THINK 3051 01:53:16,757 --> 01:53:18,892 TRANSVAGINAL UNDER SOUND ISERER 3052 01:53:18,892 --> 01:53:22,262 REALLY SUPERIOIO TORI I INEALLY 3053 01:53:22,262 --> 01:53:24,798 DEFINING -- INVASIONS W W WREHE 3054 01:53:24,798 --> 01:53:28,402 POSTERIOR -- ALL THAT. 3055 01:53:28,402 --> 01:53:30,370 -- WHERE YOU CAN DEFEFE THE 3056 01:53:30,370 --> 01:53:31,705 DEPTHS OF INVASION INTO 3057 01:53:31,705 --> 01:53:36,810 SELECT PLACENTAS,T LEAST IN MY 3058 01:53:36,810 --> 01:53:37,644 RERE OF THE L L LATATE. 3059 01:53:37,644 --> 01:53:41,481 I EVER R NOTOTOT THAT I I SAYAG 3060 01:53:41,481 --> 01:53:45,819 GOOD O OR B B, BUT I DON'T THIHI 3061 01:53:45,819 --> 01:53:48,555 EVER ORDERED AN MRI OUR LAB 3062 01:53:48,555 --> 01:53:53,860 REDEFINE THE DIAGNGNIS. 3063 01:53:53,860 --> 01:53:57,531 VARIEDRORO INSTITUTION TOEMELY 3064 01:53:57,531 --> 01:53:58,298 INSTITUTION. 3065 01:53:58,298 --> 01:53:58,765 DR. S H 3066 01:53:58,765 --> 01:53:59,332 RERA IS ACTUALLY 3067 01:53:59,332 --> 01:54:01,468 GOING TO TALK A A LITTLE BIT ABT 3068 01:54:01,468 --> 01:54:05,472 IS GOIOI TO BE GREAT.ON, WHICH 3069 01:54:05,472 --> 01:54:07,107 >> SO HANG TIGHT FOR T TT. 3070 01:54:07,107 --> 01:54:09,976 WEWEL GO TO G GRGE NEXT. 3071 01:54:09,976 --> 01:54:11,578 >> I JUST WANTO GO BACKKO 3072 01:54:11,578 --> 01:54:13,146 KNNOMEMELATURE, AND TALK ABOUT 3073 01:54:13,146 --> 01:54:14,681 WHETHER DO WE CONSIDER 3074 01:54:14,681 --> 01:54:17,584 ULTRASOUND OR IMAGING, IF MRI -F 3075 01:54:17,584 --> 01:54:20,854 THE OTHER O O, THESE DYING 3076 01:54:20,854 --> 01:54:22,389 NOSTIVE TESTS OR ARE THEHE 3077 01:54:22,389 --> 01:54:23,523 SCREENING TESTS? 3078 01:54:23,523 --> 01:54:25,592 AND ALTHOUGH WHILE THIS MAY 3079 01:54:25,592 --> 01:54:27,360 SOUNDD TRIVIAL, NOMENCLATUREE 3080 01:54:27,360 --> 01:54:28,795 TRIVIVL, IT'SS ACTUALLY NOTOT 3081 01:54:28,795 --> 01:54:30,530 CAUSE E WE ARE SAYING THAT 3082 01:54:30,530 --> 01:54:32,966 THE DIAGNOSIS IS DONON AT 3083 01:54:32,966 --> 01:54:34,835 DELIVERY, L L'S SAY, EITHERYY 3084 01:54:34,835 --> 01:54:38,105 PATHOLOGY Y Y YHE PATIENT 3085 01:54:38,105 --> 01:54:39,406 OUTCOME, THEN THE ULTRASOSOD 3086 01:54:39,406 --> 01:54:43,443 BECOMES A SCREENING MODALITY. 3087 01:54:43,443 --> 01:54:46,680 AND IT'S IMPMPTANT T DEFINE I I. 3088 01:54:46,680 --> 01:54:48,648 BECAUSE EN YOU HAVE FALSE 3089 01:54:48,648 --> 01:54:49,416 POPOPOVE, FALSESEEGATATE. 3090 01:54:49,416 --> 01:54:50,717 YOU ACCEPT THAT. 3091 01:54:50,717 --> 01:54:55,122 AND THEN ALSO,O, YOU INTERPRET T 3092 01:54:55,122 --> 01:54:57,657 BASESE O O THE PHE-TEST 3093 01:54:57,657 --> 01:54:59,392 PROBABILITY. 3094 01:54:59,392 --> 01:55:06,333 PROBABILITY IS HIGHER THANTESTAA 3095 01:55:06,333 --> 01:55:08,301 SOMEBODY WITHOHO PREVIOUS 3096 01:55:08,301 --> 01:55:10,837 C-SECTION, EVEN THOUGH THE 3097 01:55:10,837 --> 01:55:12,639 FINDINGS ON ULTRASOUND A A THE 3098 01:55:12,639 --> 01:55:14,674 SAME, N N YOUR POSOSTESTST 3099 01:55:14,674 --> 01:55:15,542 PRPRABILITY IS DIFFERENT.. 3100 01:55:15,542 --> 01:55:18,278 WE ACKNONOEDED THAT, IF THERE 3101 01:55:18,278 --> 01:55:20,147 IS SOMETHING WE NEED TO ACCEPT 3102 01:55:20,147 --> 01:55:22,449 AT THIS CONFERENCE, TO G GO BACK 3103 01:55:22,449 --> 01:55:24,651 TO WHAT BA HRK A IS SAYING, IS 3104 01:55:24,651 --> 01:55:25,652 DEFINING WHETHER IT'S A 3105 01:55:25,652 --> 01:55:29,856 SCREENENG TESESOR A DIAGNOSTIC 3106 01:55:29,856 --> 01:55:30,624 TEST. 3107 01:55:30,624 --> 01:55:31,391 OBVIOUSLY MY OPINION IS IT'T'T' 3108 01:55:31,391 --> 01:55:32,392 SCSCENINGGEST AND WE SHOULD U U 3109 01:55:32,392 --> 01:55:34,628 AS SUCH, SO WE STATA WITH A 3110 01:55:34,628 --> 01:55:41,334 PRE-TEST PROBABILITY, THE TEST,. 3111 01:55:41,334 --> 01:55:43,503 HEREREH HEUNCH MORE PEOPLEEE 3112 01:55:43,503 --> 01:55:45,205 IN THEORNER. 3113 01:55:45,205 --> 01:55:49,009 >> HI, THISSAHIDA 3114 01:55:49,009 --> 01:55:50,477 CHAKHTOURARAI'M ASKING A QUESTIG 3115 01:55:50,477 --> 01:55:51,845 US BACK TO T T BIOLOGY F FM A 3116 01:55:51,845 --> 01:55:55,582 MEMBER OF THERANCH, 3117 01:55:55,582 --> 01:55:56,783 DR. GIRARDI, WHO WASSKING 3118 01:55:56,783 --> 01:56:02,889 SPSPIFICALLY ABOUT, FOR Y Y, DRF 3119 01:56:02,889 --> 01:56:05,058 CELLS YOU'RE USISISI FOR THE 3120 01:56:05,058 --> 01:56:09,996 PLACENEN ON THE PLATE, THE GJGJG 3121 01:56:09,996 --> 01:56:11,865 THREE CELLS THAHA A A 3122 01:56:11,865 --> 01:56:16,203 CARCININENIC INSTEAD OF -- SO IF 3123 01:56:16,203 --> 01:56:17,137 YOU COULD EXPLAIN THAT. 3124 01:56:17,137 --> 01:56:19,539 >> SO WHEN WE CREATED THE 3125 01:56:19,539 --> 01:56:23,410 ACCRETETN A A DISH, LS CELLS IN 3126 01:56:23,410 --> 01:56:25,846 RED -- THESE ARE KNOWN AS 3127 01:56:25,846 --> 01:56:29,649 RCINOMA C CLS, ABSOLUTE NOT 3128 01:56:29,649 --> 01:56:31,651 SO THEY'RE EASY Y WORK WITH. 3129 01:56:31,651 --> 01:56:33,486 WHEN WE CREATE THE MODEL,, WE'E' 3130 01:56:33,486 --> 01:56:34,588 DONE THIHI WITH TWO OTHER CELEL 3131 01:56:34,588 --> 01:56:37,190 LINES THAT AREREASILY AVAILABLE, 3132 01:56:37,190 --> 01:56:38,692 WE'VE ALSO CREATED THEMITH 3133 01:56:38,692 --> 01:56:40,560 PRIMARARCELL LINES, BUT PRIMARY 3134 01:56:40,560 --> 01:56:47,067 WITH EACHH -- WE'RE DOING THATSS 3135 01:56:47,067 --> 01:56:48,768 KIND OF IN PARALLEL. 3136 01:56:48,768 --> 01:56:50,270 SO JUST FOR EASE AND CREATING 3137 01:56:50,270 --> 01:56:52,672 EEISIS 3138 01:56:52,672 --> 01:56:54,274 DISH BUT ABSOLUTELY 3139 01:56:54,274 --> 01:56:56,509 ACKNOWLEDGE A L LTLE BIT OF 3140 01:56:56,509 --> 01:56:59,613 DIFFERENCE IN BIOLOGY. 3141 01:56:59,613 --> 01:57:01,915 >>>>>> THERE'S A A COMMENT O ORN 3142 01:57:01,915 --> 01:57:02,782 RAIGHT IN THE BACK THERE. 3143 01:57:02,782 --> 01:57:03,650 >> Y Y, THANKNKOU. 3144 01:57:03,650 --> 01:57:04,351 N YOUU HEAR ME? 3145 01:57:04,351 --> 01:57:06,453 HIT THEUTTON.N. 3146 01:57:06,453 --> 01:57:08,188 >>>> THERE IT GOES. 3147 01:57:08,188 --> 01:57:13,460 OU HEAR ME NOW? 3148 01:57:13,460 --> 01:57:18,732 ALIGHT. 3149 01:57:18,732 --> 01:57:24,437 ANK YOU.U. 3150 01:57:24,437 --> 01:57:34,881 MY NAME ISSS ALEX. 3151 01:57:37,751 --> 01:57:39,686 ANK YOU FOR GREAT TALKS. 3152 01:57:39,686 --> 01:57:45,492 I I INTRIGUED BYO HOW DO YOUOU 3153 01:57:45,492 --> 01:57:46,693 BIOLOGOGALLY EXPLAIN S SE OFHE 3154 01:57:46,693 --> 01:57:49,062 ULTRASOUND FINDINGS T TT WE'R'R 3155 01:57:49,062 --> 01:57:49,996 LKING ABOUT? 3156 01:57:49,996 --> 01:57:54,367 THE DISRURURUN OF THE DECIDUA 3157 01:57:54,367 --> 01:57:58,571 CAUSES THIS L LK OF STOP OR THE 3158 01:57:58,571 --> 01:58:00,640 TROPOPBLASTS, BUT WE AREEEING 3159 01:58:00,640 --> 01:58:02,175 ABNORMAL PLALANTATIOIO AWAY FROM 3160 01:58:02,175 --> 01:58:09,215 TH SCAR, SO I WONDER IF WE HAVE 3161 01:58:09,215 --> 01:58:13,386 VE - TRANSLATION FOR THAT. 3162 01:58:13,386 --> 01:58:15,722 >> THE ONLY THREAD WE'REEEINGGEE 3163 01:58:15,722 --> 01:58:17,357 SOSO FARSS THE EXTRACELLULAR 3164 01:58:17,357 --> 01:58:18,258 MATRIX THAT'T' CREATEDED 3165 01:58:18,258 --> 01:58:24,130 SOSO THE S SR DEFINITELY D DS HP 3166 01:58:24,130 --> 01:58:27,233 ACCELERATE THAT FIBRINOID 3167 01:58:27,233 --> 01:58:28,735 DEFINITION THAT T CANCTUALLY 3168 01:58:28,735 --> 01:58:29,736 CREATE IN VITIT, BUT W WN 3169 01:58:29,736 --> 01:58:32,706 THERE'SS NO SCAR, WETILL SEE 3170 01:58:32,706 --> 01:58:33,773 SOME ENDOGENOUS PRODUCTION. 3171 01:58:33,773 --> 01:58:34,908 SO SOMETHIHI THAT I DIDN'T SHARE 3172 01:58:34,908 --> 01:58:38,211 AT ALL, WORK FRORO MULULPLE O MR 3173 01:58:38,211 --> 01:58:40,180 ININITUTIONS, IS RELATATOHEHE 3174 01:58:40,180 --> 01:58:43,350 IMMUNE MACROPHAGEE C CMUNICATIT, 3175 01:58:43,350 --> 01:58:47,654 DEFINITELY INCREASES THAT, BUTR 3176 01:58:47,654 --> 01:58:49,289 THERE' S SETHING STILL GOING ON 3177 01:58:49,289 --> 01:58:50,390 UNRELATED TO THE S SR. 3178 01:58:50,390 --> 01:58:56,896 SO I T TNK THE NE MU COMPONENT S 3179 01:58:56,896 --> 01:59:03,937 SEE PLACENTA ACCRETA AWAY F FMEE 3180 01:59:03,937 --> 01:59:05,071 THE CESAREAN SCAR, BUTUT T TRE E 3181 01:59:05,071 --> 01:59:09,075 A LOTF OTHER PROCEDURES, D & 3182 01:59:09,075 --> 01:59:10,276 Cs, PROBABAY T TNGS THAT WE 3183 01:59:10,276 --> 01:59:15,415 DON'T WELL ASCERTAIN WUR CURRENY 3184 01:59:15,415 --> 01:59:19,452 THATATAN DAMAGE T T D DIDUA AND 3185 01:59:19,452 --> 01:59:20,820 THE MYOMETRIUM ANDANAN LEAEA TOO 3186 01:59:20,820 --> 01:59:22,322 THIS DISTANT FROMM THE CESARARAR 3187 01:59:22,322 --> 01:59:32,032 >> ANNE ROBERTSTS UCSD.NENE 3188 01:59:32,032 --> 01:59:38,938 I HAVE A QUESTION FOR DR. AF 3189 01:59:38,938 --> 01:59:42,442 ELELELT TALKLK EVEVEBODY, VERY 3190 01:59:42,442 --> 01:59:43,209 ELEGANT TALK. 3191 01:59:43,209 --> 01:59:45,745 MY Q Q QION IS, WHY IS IT THAT 3192 01:59:45,745 --> 01:59:48,915 SOME PATIEIES G G AN ACCRETA, 3193 01:59:48,915 --> 01:59:50,784 BUT THEN WE H HE INCRETAS AND 3194 01:59:50,784 --> 01:59:53,753 MOST IMPORTANTLY PERCRETAS, 3195 01:59:53,753 --> 01:59:55,955 WHWH-- WHAT GOES ON THERE THAT'S 3196 01:59:55,955 --> 01:59:59,826 CAUSING THAT?T? 3197 01:59:59,826 --> 02:00:00,994 >> THANK YOU, DR. ROBERTS. 3198 02:00:00,994 --> 02:00:02,295 I WOULDCTUALLY R RSE IT AND 3199 02:00:02,295 --> 02:00:04,097 YY WHY D DO MOST PEOPLE NOT GET 3200 02:00:04,097 --> 02:00:11,971 D I CON'T KNOW, BUT MOTHER 3201 02:00:11,971 --> 02:00:13,506 NATURE BYYATURAL HISTORY HAS 3202 02:00:13,506 --> 02:00:14,674 NE THATTXPERIMENT FOR US. 3203 02:00:14,674 --> 02:00:16,676 SO I THINKNK UNDERSTANDING THE 3204 02:00:16,676 --> 02:00:19,345 RMAL SCACAREPAIR IS WHERE IT'S 3205 02:00:19,345 --> 02:00:19,579 AT. 3206 02:00:19,579 --> 02:00:21,081 AIN I HAVE NO IDEA BUT 3207 02:00:21,081 --> 02:00:22,215 FOCUSING ONHEN I HAPPENSNS 3208 02:00:22,215 --> 02:00:23,349 RIGHT IS SOMOMHING WE DONON DO 3209 02:00:23,349 --> 02:00:23,650 AS MUCH. 3210 02:00:23,650 --> 02:00:25,051 IT'S H HDEDE TO STUDY ACCESS TO 3211 02:00:25,051 --> 02:00:28,221 THE TISSUE IS LIMITED,E 3212 02:00:28,221 --> 02:00:29,589 SEE IN EXTREME FORM. 3213 02:00:29,589 --> 02:00:30,990 SO I THINKT'S WITHIHI THAT 3214 02:00:30,990 --> 02:00:32,425 SPECTRUM, AND I DON'T HAVE THE 3215 02:00:32,425 --> 02:00:32,759 ANANER, 3216 02:00:32,759 --> 02:00:39,265 MOMO CASES NOT OCCUR.HY DO 3217 02:00:39,265 --> 02:00:41,134 >> I THINK THAT'S A GOOD MOMOMOM 3218 02:00:41,134 --> 02:00:44,537 EXCELLENTTOB OF STAYING ON AN 3219 02:00:44,537 --> 02:00:47,607 TIME, SO THANK YOU VERY MUCH TO 3220 02:00:47,607 --> 02:00:48,341 THE PANENESTS FOR A WONDERFUL 3221 02:00:48,341 --> 02:00:49,476 SCUSSION THIS MORNING. 3222 02:00:49,476 --> 02:00:50,844 I WOULD ENCOURAGE EVERYBODY TOO 3223 02:00:50,844 --> 02:00:52,245 TAKE A LOOKT YOUR B B B. 3224 02:00:52,245 --> 02:00:53,346 YOUR STICKERERN YOUR BADGE 3225 02:00:53,346 --> 02:00:54,848 NOTES WHICH W WKING GROROROOU 3226 02:00:54,848 --> 02:00:55,215 WILL JOIN. 3227 02:00:55,215 --> 02:00:59,185 IF YOUOUE A GREEN BA GREENSTICKU 3228 02:00:59,185 --> 02:01:02,622 WILL BE JOINING DISCUSSIONNNNUP 3229 02:01:02,622 --> 02:01:05,058 WE DO HAVE A 10-MINUTE BREAK, 3230 02:01:05,058 --> 02:01:06,659 MAYBE 9 MINUNUS NOW, S S S PLEAE 3231 02:01:06,659 --> 02:01:07,994 FEEL FREE TO USE T TACILITIES. >>LL T T T WAY IN T T BACK TO THTH LEFT. 3232 02:01:10,363 --> 02:01:12,165 THE BREAK..B BK, EVERYBODY, FROM 3233 02:01:12,165 --> 02:01:13,600 I THINK WE'RE GOING TO GO AHEAD 3234 02:01:13,600 --> 02:01:16,236 AND GET STARTED WITHHE SECOND 3235 02:01:16,236 --> 02:01:17,971 SESSION, PREPANG FOR PASAS 3236 02:01:17,971 --> 02:01:19,873 RGERY, AND CHRISTINA HERRERA, 3237 02:01:19,873 --> 02:01:23,943 PLEASE GO A A. 3238 02:01:23,943 --> 02:01:28,815 >>>> I'MSSISSSNT PROFESSOR,OR 3239 02:01:28,815 --> 02:01:30,416 RECEREED TULTIDISCIPLINARY 3240 02:01:30,416 --> 02:01:31,718 S TEAMEA AT PARKLANKL HEALTH LTD 3241 02:01:31,718 --> 02:01:33,520 II HAVE AESEARCEA IMAGEMAMA IN 3242 02:01:33,520 --> 02:01:35,522 AGING AG MANAGEMENT OF PAS. 3243 02:01:35,522 --> 02:01:37,423 I AM FUN FD BY THE NIH AND A THE 3244 02:01:37,423 --> 02:01:38,358 CHD, STHANK YK FOR HAVING 3245 02:01:38,358 --> 02:01:41,194 ME HERE TEAY.. 3246 02:01:41,194 --> 02:01:43,396 SO PAS IS A TOPIC IN WHICH I 3247 02:01:43,396 --> 02:01:44,764 THINTH THE T'S SIGNIFICANT 3248 02:01:44,764 --> 02:01:46,232 ANXIETY DERIVED FROMRO THE 3249 02:01:46,232 --> 02:01:48,635 HEARD IN THE EARLIERLI TALKS.E'E 3250 02:01:48,635 --> 02:01:49,769 WE ALL WANT TO BE PREPARED FOR 3251 02:01:49,769 --> 02:01:51,404 WHEN WE ON AN ABD AEN A AND IT 3252 02:01:51,404 --> 02:01:52,205 LOOKS LIKE THIS PIC PRE HER H ON 3253 02:01:52,205 --> 02:01:54,374 THE RIGHT, WHERE YOUOU SEE THE 3254 02:01:54,374 --> 02:01:57,944 FANT HAS BEEN DELIVERED -- 3255 02:01:57,944 --> 02:02:01,147 THERTHS LARGEGELA CENTRAL BOWLS, 3256 02:02:01,147 --> 02:02:03,650 HYPERVASCUASRITY ALONGHE 3257 02:02:03,650 --> 02:02:05,285 ENTIRE UTERINENE SEGMENT,NT 3258 02:02:05,285 --> 02:02:07,120 ULTIMATELY THIS HAS BEEN 3259 02:02:07,120 --> 02:02:10,456 CONSISNSNT WITHLICAL GRAILD 3260 02:02:10,456 --> 02:02:11,991 3 -- T-- OECTIVETI OF MY TALK 3261 02:02:11,991 --> 02:02:13,293 ARE FIRST TO REVIEWIEW CURREURRE 3262 02:02:13,293 --> 02:02:17,564 LIMITATIONS IN PREDICTING PAS 3263 02:02:17,564 --> 02:02:19,699 MORBIDITY, SECONDON TO DCRIBE 3264 02:02:19,699 --> 02:02:21,935 THE ROLE IN PRE PERATIVE 3265 02:02:21,935 --> 02:02:23,369 DIAGNOSI P AND STAGITA OFF P AN 3266 02:02:23,369 --> 02:02:26,239 COMPONENTSTSF IDE I PREOPERATIVE 3267 02:02:26,239 --> 02:02:28,408 PAS STAGING SYSTEM F 3268 02:02:28,408 --> 02:02:36,416 ULASOUNDOUEALLY IS THE KEY FOR R 3269 02:02:36,416 --> 02:02:44,157 THE INITIAL SEENING FOR PAS.AS 3270 02:02:44,157 --> 02:02:45,458 AND THE MOST -- THE FIRST STE S 3271 02:02:45,458 --> 02:02:49,128 IN MOSTOSOS ALGORITHMS ARE SCREN 3272 02:02:49,128 --> 02:02:50,430 PATIENTS HIGH H RK. 3273 02:02:50,430 --> 02:02:52,699 WE'VE KNOWN SINCE THE T STUDY IN 3274 02:02:52,699 --> 02:02:55,168 200620HOSE WERE HHESTST RISK TIP 3275 02:02:55,168 --> 02:02:57,437 THIPICALLYLY HAV HAVRIORORISTORF 3276 02:02:57,437 --> 02:02:58,905 CEAN AS WELL AS PLACENTANT 3277 02:02:58,905 --> 02:02:59,405 PREVIA.. 3278 02:02:59,405 --> 02:03:03,243 IVF I D D D THINK IS INCREASINAY 3279 02:03:03,243 --> 02:03:04,677 BECOBENG A CONCERN.RN 3280 02:03:04,677 --> 02:03:09,048 FORCE IN 21 OUTLINEDED THESEK 3281 02:03:09,048 --> 02:03:11,484 DEAF SITIONS TNST RAISED CONCERN 3282 02:03:11,484 --> 02:03:17,390 FORHE PRESENCE OF LACUNAE, 3283 02:03:17,390 --> 02:03:25,365 ADDITIONTILYLY PLACENTCENT BULGE 3284 02:03:25,365 --> 02:03:29,969 PORTENDD PASS SEVERITY MORE IN I 3285 02:03:29,969 --> 02:03:31,971 THE ACCRETA RANGE. 3286 02:03:31,971 --> 02:03:34,374 I DO THINKNK THAT DIAGNOSIS CANE 3287 02:03:34,374 --> 02:03:35,908 MADEMAS EARLY ASS THE FIRST 3288 02:03:35,908 --> 02:03:37,310 TRIMESTER. 3289 02:03:37,310 --> 02:03:41,147 EVEN THOUGH SUSPICION FOR IORORS 3290 02:03:41,147 --> 02:03:44,217 SECOND OR THIRD, WE KNOW THOSE 3291 02:03:44,217 --> 02:03:49,455 WITH CESAREAN --N AND THATHA TE 3292 02:03:49,455 --> 02:03:50,556 WITH -- PLANTATION CEN REAN ALSO 3293 02:03:50,556 --> 02:03:51,891 REMAIN AT RISK. 3294 02:03:51,891 --> 02:03:53,092 EN DEMONSTRATED HDE ON THE 3295 02:03:53,092 --> 02:03:55,728 TOPIC PRC NANCY.Y. CES CEAN SCAR 3296 02:03:55,728 --> 02:03:59,999 THISORREORTED WITH --H END E UP 3297 02:03:59,999 --> 02:04:02,302 HAVING BLADDLA INVOLVEOLNT 3298 02:04:02,302 --> 02:04:06,139 IN THEARARIGHT I'M SHOWING YOU 3299 02:04:06,139 --> 02:04:08,541 OWER PNTATION -- CESAREAN 3300 02:04:08,541 --> 02:04:08,875 TIMES ONS 3301 02:04:08,875 --> 02:04:13,813 SHE DIDN'T HAVE ANY CLINICALGRAL 3302 02:04:13,813 --> 02:04:15,014 HYPERVASCULACUTY PAS PAS GRADINF 3303 02:04:15,014 --> 02:04:15,415 3A.3A 3304 02:04:15,415 --> 02:04:18,418 I REALLY HE BEENNTERESERESES IN 3305 02:04:18,418 --> 02:04:20,820 ERS OF PASSE OF POWER 3306 02:04:20,820 --> 02:04:27,694 VASCULARIZATIZAT ALONGHEBLDE IN. 3307 02:04:27,694 --> 02:04:29,562 WE FOUND BOTHH I I CES CEA C 3308 02:04:29,562 --> 02:04:30,963 ECTOPIC PREGNANCIES AS WELL AS 3309 02:04:30,963 --> 02:04:32,198 LOWER PLANTATIOATATITH PRI P 3310 02:04:32,198 --> 02:04:33,933 SAREAN THAT THAT IS SOMEWHAT 3311 02:04:33,933 --> 02:04:37,437 HAVE PAS THATEQUIREUIES ON TO 3312 02:04:37,437 --> 02:04:37,570 ST 3313 02:04:37,570 --> 02:04:38,404 ECMY AND THATT CORRELATES 3314 02:04:38,404 --> 02:04:41,274 WITH THESE INCRENCES VASCULAR 3315 02:04:41,274 --> 02:04:42,442 INDICES COM CRED TO TOMEN WHO DO 3316 02:04:42,442 --> 02:04:42,975 NOT.NO 3317 02:04:42,975 --> 02:04:45,311 SO IMAGE A ISHOWING Y A 3318 02:04:45,311 --> 02:04:48,314 WOMAN THAT WENTN TO RUIRE 3319 02:04:48,314 --> 02:04:49,515 HYSTERECTOMY VERSUS B, AATIEAT 3320 02:04:49,515 --> 02:04:55,888 CESAREAN DELIVERIVAVING A 3321 02:04:55,888 --> 02:04:57,290 MULTIPLE META-ANALYSES HAVE 3322 02:04:57,290 --> 02:04:58,591 DEMONSTRATED IED TED TAS T 3323 02:04:58,591 --> 02:05:00,126 ITYY OF ULTRASORADRA AND MRR TO 3324 02:05:00,126 --> 02:05:04,831 SCREEN FOROR PAS. 3325 02:05:04,831 --> 02:05:07,800 EYEY TYPICALLY HAVE DEMONSTRATED 3326 02:05:07,800 --> 02:05:08,801 LATIVELY HIGHIGENSIENVITYTY AND 3327 02:05:08,801 --> 02:05:09,435 SPECIFICITY. 3328 02:05:09,435 --> 02:05:11,404 I THINK MOST OF THE T STUDIESES 3329 02:05:11,404 --> 02:05:12,271 ARE ARMITED BY THE FACT THAT 3330 02:05:12,271 --> 02:05:14,140 THEY ARE AT HIGH VOLUMEE CENTERS 3331 02:05:14,140 --> 02:05:18,411 THAT SPECIALIZE I I PAS CARE.ARR 3332 02:05:18,411 --> 02:05:19,512 ADDITIONALLY THE THE A LOT O O 3333 02:05:19,512 --> 02:05:21,481 HETEROGENEIT IN TERMS O O W'S 3334 02:05:21,481 --> 02:05:22,915 CLUDEDUDN TERMS OTHE PATIENT 3335 02:05:22,915 --> 02:05:24,016 POPULATIONTI HOW HOW APP APPH TO 3336 02:05:24,016 --> 02:05:24,784 SCREENING AND DIAGNOSIS 3337 02:05:24,784 --> 02:05:27,987 PERSONNTERPRETING THAT DATA ASE 3338 02:05:27,987 --> 02:05:30,289 WELLWES THE OHECOME USED FOR THE 3339 02:05:30,289 --> 02:05:33,025 DIAGDISISFFF PAS, WHETHER THAT 3340 02:05:33,025 --> 02:05:35,361 WAS MADE OPERATIVELYERSUSSUSSUS 3341 02:05:35,361 --> 02:05:39,632 MOREOVER IF ANY OFHESE STUDIESES 3342 02:05:39,632 --> 02:05:43,002 REALLY USE -- INTRODUCEDN 2019 3343 02:05:43,002 --> 02:05:45,972 RESPECTIVELIV. 3344 02:05:45,972 --> 02:05:47,974 WHILE MOST STUDIES GIVE THE 3345 02:05:47,974 --> 02:05:48,975 ABILITY TO SCREENEE AND PDICT 3346 02:05:48,975 --> 02:05:50,276 PRESENCE OF P, THINK FEW 3347 02:05:50,276 --> 02:05:52,245 OF THE STUDIES AUALLY ADDRESS 3348 02:05:52,245 --> 02:05:56,749 WITH PAS SEVERITY.CLATELA 3349 02:05:56,749 --> 02:05:58,451 ERE WAS THISTUDYDY IN 2018 3350 02:05:58,451 --> 02:06:02,021 AT LOOKED PROSPECTIVELY AT 210 3351 02:06:02,021 --> 02:06:03,322 PREGNANT INDIVIDUALS. 3352 02:06:03,322 --> 02:06:04,257 EY H PRIORRI CES CEAN AND A 3353 02:06:04,257 --> 02:06:06,826 ABILIBI OF ULTRASOUNDV ITIGATED 3354 02:06:06,826 --> 02:06:11,297 SCIENCE TO CORRELATETETE BASED F 3355 02:06:11,297 --> 02:06:12,098 THE HISTOPATHOLOGY. 3356 02:06:12,098 --> 02:06:16,369 LOSS OF THE CAREERONE, 3357 02:06:16,369 --> 02:06:17,637 LACUNAE, BLADDER WALL 3358 02:06:17,637 --> 02:06:18,538 INTERRUPTIONON ANDND 3359 02:06:18,538 --> 02:06:19,105 HYPERVASCULALATY... 3360 02:06:19,105 --> 02:06:22,175 SPSPIFICICY AND POSITIVE HIGIG 3361 02:06:22,175 --> 02:06:23,376 PREDICTIVE VALUE WERER LIMITEDED 3362 02:06:23,376 --> 02:06:24,811 PARTICULARLY IN THEHE MORE 3363 02:06:24,811 --> 02:06:32,118 INTETEEDIATE RANGE OFCCCCTA. 3364 02:06:32,118 --> 02:06:33,252 A STANDARDIZEZE ULTRARARAD 3365 02:06:33,252 --> 02:06:34,554 APPROACH IN THE SECECD AND THIRD 3366 02:06:34,554 --> 02:06:35,755 TRIMESTETEIS A AILABLE. 3367 02:06:35,755 --> 02:06:38,391 AT MY INSTITUTION IN 2020 THEY 3368 02:06:38,391 --> 02:06:40,026 DEVELOPED THE PLACENTNTCCRETA 3369 02:06:40,026 --> 02:06:44,730 INDEX USING BOTH CLINICAL ANDND 3370 02:06:44,730 --> 02:06:47,266 ULTRASOUND FINDINGS TO YIELD A 3371 02:06:47,266 --> 02:06:52,205 PRIOR CESAREANS ALONG W WH THEHE 3372 02:06:52,205 --> 02:06:55,408 PRESENCE AND RATING OF LACAC 3373 02:06:55,408 --> 02:06:56,242 LACUNAE -- THEHERESENCNCF ANY 3374 02:06:56,242 --> 02:06:59,312 PORTION OF THAT PLACENTA BEING 3375 02:06:59,312 --> 02:07:02,482 ANTERIOR PREVIA AS WELL AS S 3376 02:07:02,482 --> 02:07:06,786 SSELS CAN YIELD A SCORE -- 3377 02:07:06,786 --> 02:07:08,087 POSITIVE PREDICTIVEALUE, 3378 02:07:08,087 --> 02:07:09,188 NENETIVE PREDIDIIVE V VUE, THE 3379 02:07:09,188 --> 02:07:11,724 LIKELY IT T THAT PAS ISROR 3380 02:07:11,724 --> 02:07:12,158 PRESENT. 3381 02:07:12,158 --> 02:07:13,893 THESESLTRASOUND VARARBLESES 3382 02:07:13,893 --> 02:07:16,562 NONOBLY ARE A AAINED AFTER TRANS 3383 02:07:16,562 --> 02:07:18,297 ABDOMINAL AND SAGITTAL AND 3384 02:07:18,297 --> 02:07:23,569 FILLEDED M MERNANAEDLADDER.LLYLY 3385 02:07:23,569 --> 02:07:30,676 THE ORIGINAL INDEX WAS FORMED 3386 02:07:30,676 --> 02:07:33,212 USING R RROROECTITI -- PRIOR 3387 02:07:33,212 --> 02:07:34,013 CESAREAN AND EITHER R ACENTA 3388 02:07:34,013 --> 02:07:35,815 PREVIA OR LOWYING PLACENTA IN 3389 02:07:35,815 --> 02:07:36,816 THE THIRD TRIRISTER. 3390 02:07:36,816 --> 02:07:38,251 ABOUT H HF F THE WOMOM 3391 02:07:38,251 --> 02:07:40,553 UNDERWENT HYSTETECTOMY. 3392 02:07:40,553 --> 02:07:42,522 AND USININ A A THRESHOLD SCORERF 3393 02:07:42,522 --> 02:07:44,056 GREATER THAN 4, WE FOUND THAT 3394 02:07:44,056 --> 02:07:46,526 THE PAI H H AN A ALITYO 3395 02:07:46,526 --> 02:07:53,165 PREDEDT O O A A A 8 8 AUC. 3396 02:07:53,165 --> 02:07:56,002 THE PAIAS BEEN VALIDATED 3397 02:07:56,002 --> 02:07:57,537 REPEATEDLY IN BOTH RETROSPECTIVE 3398 02:07:57,537 --> 02:07:59,071 AND PROSPECTIVE STUDIES, AND 3399 02:07:59,071 --> 02:08:00,740 MOST S SDY, IT HAS A G GD TO 3400 02:08:00,740 --> 02:08:05,645 EXCELLENT AUC OBSERERD. 3401 02:08:05,645 --> 02:08:07,179 WE H HE HAVE CONONONED AT OUR 3402 02:08:07,179 --> 02:08:08,848 ININITUTION TO REFINEHE P AI. 3403 02:08:08,848 --> 02:08:10,049 WE S S SED TO MEAEARE THE LENGTH 3404 02:08:10,049 --> 02:08:13,219 OFOFHERANSVERSE IRRRRULARITIT 3405 02:08:13,219 --> 02:08:15,154 ALALALTHE INTERFACE AS WE 3406 02:08:15,154 --> 02:08:15,855 GHT THIHIWOULD CORORSPOND 3407 02:08:15,855 --> 02:08:16,822 WITH WHERE SURGEONS HAD 3408 02:08:16,822 --> 02:08:17,490 PREVIOUSLY BEEEE 3409 02:08:17,490 --> 02:08:20,126 SHOWN INHISMAGEGEN T T 3410 02:08:20,126 --> 02:08:23,863 LENGTH OF TRANSFERSTING THAT 3411 02:08:23,863 --> 02:08:24,630 IRIRGULARITY. 3412 02:08:24,630 --> 02:08:26,165 WE DEFEFE THIS A A THE LARARST 3413 02:08:26,165 --> 02:08:27,800 AMETER OF CONFLUENT V VSELS ON 3414 02:08:27,800 --> 02:08:30,870 A SINGLE IMAGEBSERVED IN N E 3415 02:08:30,870 --> 02:08:32,305 2D TRANSFEFE COLOR DOPPLER. 3416 02:08:32,305 --> 02:08:33,506 ITITAN INCLUDE BOTH THE BLADDER 3417 02:08:33,506 --> 02:08:37,109 WE FOUND THAT WHENNE ADDEDHISM. 3418 02:08:37,109 --> 02:08:39,812 OUR PAI, IT SLILILIY INPROVED 3419 02:08:39,812 --> 02:08:44,750 THE AUC TO78 .89 AND CERTAINLY 3420 02:08:44,750 --> 02:08:46,686 LARGER STUDIES A A NEEDED T 3421 02:08:46,686 --> 02:08:48,220 CONFIRM IFHIS PROVIVIS 3422 02:08:48,220 --> 02:08:49,221 ADDITIONON DIAGNOSTIC 3423 02:08:49,221 --> 02:08:50,856 DISCRIMINANANA. 3424 02:08:50,856 --> 02:08:53,025 ULTRASOUND IHINK HAS 3425 02:08:53,025 --> 02:08:56,128 SPECIFICITYYIMIMATIONS. 3426 02:08:56,128 --> 02:08:57,530 ECIFICALLY INN THAT 3427 02:08:57,530 --> 02:08:58,230 INDETERMINANT RANANAN 3428 02:08:58,230 --> 02:09:00,766 NORMAL, AND WHEN IT'S BAD, IT'SS 3429 02:09:00,766 --> 02:09:02,735 REALAL BAD. 3430 02:09:02,735 --> 02:09:03,402 BUT OUTSIDE THOHO TWO,,HINK 3431 02:09:03,402 --> 02:09:05,938 'S D DFICULTO D DFERENTIATE. 3432 02:09:05,938 --> 02:09:07,707 WE ALSO K KW OUR FIELD OFIEW 3433 02:09:07,707 --> 02:09:09,542 USING ULTRASOUND ISRIMARILY 3434 02:09:09,542 --> 02:09:11,310 ANTERIORLY ALOLO THAT 3435 02:09:11,310 --> 02:09:14,480 THEREFORE, ASSSSSMENT OF EITHER 3436 02:09:14,480 --> 02:09:16,449 LATERAL, POSTERIOR OR SUPERIOR 3437 02:09:16,449 --> 02:09:18,317 N BE L LITED AND MISS THOSE 3438 02:09:18,317 --> 02:09:21,954 AREAS OF INVOLOLMENT.WE KNOWWHAN 3439 02:09:21,954 --> 02:09:24,590 WHEN THEY DON'TAVE A PRIORORL 3440 02:09:24,590 --> 02:09:26,659 HISTORY OF CESAREAN BUT RATHER 3441 02:09:26,659 --> 02:09:29,862 SK FACTORSRSUCHSS IVF, PRIOR 3442 02:09:29,862 --> 02:09:31,063 MYOMECTOMYMYR D D DATION ANDND 3443 02:09:31,063 --> 02:09:34,900 YPICICLY THOSE INVASIONS CAN 3444 02:09:34,900 --> 02:09:37,103 TYPICACAY OCCUR IN AN ATYPICAL 3445 02:09:37,103 --> 02:09:38,771 AREA, AND I DOO THINK THEHE 3446 02:09:38,771 --> 02:09:41,674 ULTRASOUND IS LIMITED IN 3447 02:09:41,674 --> 02:09:43,442 IDENTIFYING PAS OUTSIDE OF THE 3448 02:09:43,442 --> 02:09:45,978 LOLOR UTERINE SEGMENT. 3449 02:09:45,978 --> 02:09:47,747 I'LL NEXT REVIEW W E ROLEOL OF I 3450 02:09:47,747 --> 02:09:53,786 IN PAS MANAGEMENT.T. 3451 02:09:53,786 --> 02:09:55,421 SO AFTER MANANEAEA THE VALUEUEUE 3452 02:09:55,421 --> 02:09:57,089 ADAD OF MRI H H BEEN UNCERTAIN. 3453 02:09:57,089 --> 02:09:59,191 WE KNOW ITT HAS BETTETE SPATIAL 3454 02:09:59,191 --> 02:10:01,694 THEMAMA ON THE RIGHT WHERE D 3455 02:10:01,694 --> 02:10:07,733 WE'RE SEEING MULTIPLE2 DARK 3456 02:10:07,733 --> 02:10:10,703 LINEARAR BANDS HIGHLIGHTED HERE 3457 02:10:10,703 --> 02:10:12,104 IN YELLOW. 3458 02:10:12,104 --> 02:10:13,406 HIGHERENSITIVITY HAS CERTAINLY 3459 02:10:13,406 --> 02:10:15,641 ENEN O O OVED WITH MR BUT THAT 3460 02:10:15,641 --> 02:10:21,681 MAY BEELECTION BIAS D D TO -- 3461 02:10:21,681 --> 02:10:22,348 ADDITIONAL LIMITATIONS INCLUDE 3462 02:10:22,348 --> 02:10:24,417 IS NOT AVAILABLE EVERYRYERE, 3463 02:10:24,417 --> 02:10:26,485 INTERPRERETION R RAINS 3464 02:10:26,485 --> 02:10:28,287 BJECECVE, AND AS OFET NO 3465 02:10:28,287 --> 02:10:28,921 VALIDATED STANDARDIZEDEDEPORTITI 3466 02:10:28,921 --> 02:10:33,426 IS IN USE.. 3467 02:10:33,426 --> 02:10:35,995 MR MARKERSRSAVE BEEN SHOWN T T 3468 02:10:35,995 --> 02:10:39,865 CORRELATE WITH NEED FORM 3469 02:10:39,865 --> 02:10:43,169 HYSTERECTOTO. 3470 02:10:43,169 --> 02:10:46,539 RKERS INCLUDE --- FIBRIN DEP 3471 02:10:46,539 --> 02:10:50,509 NIGMS WITH ODDS RATIOS BETWEEN . 3472 02:10:50,509 --> 02:10:52,712 MORE RECENTLY MR MARKERSAVE 3473 02:10:52,712 --> 02:10:54,146 BEEN BETTER DEFINED. 3474 02:10:54,146 --> 02:10:56,115 THE SOSOSOY OF ABDOMOMOM 3475 02:10:56,115 --> 02:11:00,619 IN 20200AMAM OUT WITH ARIOLOGY 3476 02:11:00,619 --> 02:11:01,620 NSENSUSTATEMENT HIGHLIGHTING 3477 02:11:01,620 --> 02:11:02,488 THE RECOMMENDED AS WELL ASSSHAHA 3478 02:11:02,488 --> 02:11:04,123 I'M SHOWING IN THEEE PARENTHESES 3479 02:11:04,123 --> 02:11:05,791 UNCECEAIN MARKERSRS O O PAS 3480 02:11:05,791 --> 02:11:08,728 AS YOU CAN SEE, M MY O O O T TSE 3481 02:11:08,728 --> 02:11:10,563 MARKERS ARE SIMILAR TOO 3482 02:11:10,563 --> 02:11:14,700 OR ABNORMAL VASCULARITY,,UTBULGE 3483 02:11:14,700 --> 02:11:16,235 OTHERS ARE MOREE SPECIFICCUCH AS 3484 02:11:16,235 --> 02:11:22,441 THE T2 DARKK INTRAPLACENTAL BA 3485 02:11:22,441 --> 02:11:24,343 BANDS. 3486 02:11:24,343 --> 02:11:25,778 --- BASED ON THIS CONSENSUS 3487 02:11:25,778 --> 02:11:26,846 STATEMEMT AND WE HOPE TO REPORT 3488 02:11:26,846 --> 02:11:28,647 THESE OUTCOMEME IN THE FUTURE.. 3489 02:11:28,647 --> 02:11:31,817 JUJUEMONSTRATING THE MULTIPLEN S 3490 02:11:31,817 --> 02:11:36,322 T2 DARK LINEAR BANDS ANDND 3491 02:11:36,322 --> 02:11:38,290 PLACENTALULGE. 3492 02:11:38,290 --> 02:11:41,460 SO I'VE DONON THIS WORK ALONG W 3493 02:11:41,460 --> 02:11:47,299 TODADA W W COMPARE THES HERE 3494 02:11:47,299 --> 02:11:49,268 ULTRASASND PAI TOOO OUR 3495 02:11:49,268 --> 02:11:50,836 STANDARDIZED RADLOGY APPROROH 3496 02:11:50,836 --> 02:11:52,471 WHICH INCLUDES PRORODING 3497 02:11:52,471 --> 02:11:53,706 GREATETE DIMENSISI OF INVASION 3498 02:11:53,706 --> 02:11:55,541 AS W WL AS A RADIOLOGIGI 3499 02:11:55,541 --> 02:11:57,610 IMPRESSION, GREATEST D DENSION 3500 02:11:57,610 --> 02:12:00,346 OF INVNVION WE'VE DEFEFEDED AS T 3501 02:12:00,346 --> 02:12:01,680 SINGLELE PLANE,HE LARGEST THATT 3502 02:12:01,680 --> 02:12:03,849 S EITHEHE2 DARK LINEAEA BANDS 3503 02:12:03,849 --> 02:12:05,451 LENGTH O OINVOLVLVENT ALONGNG 3504 02:12:05,451 --> 02:12:08,387 THE BLADDER-S-SOSAL INTERFACE OR 3505 02:12:08,387 --> 02:12:11,223 RARARAISIS IMPMPSSION IS JUST 3506 02:12:11,223 --> 02:12:12,892 THATATRERECTIONN O OINVASION 3507 02:12:12,892 --> 02:12:18,164 BABAD ONON IMAGING. 3508 02:12:18,164 --> 02:12:19,465 SO WHAT I'M DEMONONRATING HERE 3509 02:12:19,465 --> 02:12:22,835 IN THIS IMAGE ARE SOMEXAMPLES 3510 02:12:22,835 --> 02:12:23,869 OF THAT GREATESESIMENSION OF 3511 02:12:23,869 --> 02:12:24,303 INVAGUE. 3512 02:12:24,303 --> 02:12:27,239 THENEN THESE ARE LITTLE MORE 3513 02:12:27,239 --> 02:12:27,473 OBVIOUS.S. 3514 02:12:27,473 --> 02:12:31,811 ACENTA ACCRETA..WERE DEEMED AS A 3515 02:12:31,811 --> 02:12:33,879 I WANT TO SHOW A LITTLEE BIT MOR 3516 02:12:33,879 --> 02:12:35,181 RE, THTH GREATEST E EMPLE OF 3517 02:12:35,181 --> 02:12:37,449 INVASION HERE IS 28 MILLIMETERS. 3518 02:12:37,449 --> 02:12:39,752 ON THE CORRESPONDING WEIGHTED 3519 02:12:39,752 --> 02:12:42,488 IMAGE, THIS CORRESPONDED WITH T2 3520 02:12:42,488 --> 02:12:43,622 DARK INTRAPLACENENEN B BDS. 3521 02:12:43,622 --> 02:12:47,092 THIS I IHE TREUL -- SEQUENCE, 3522 02:12:47,092 --> 02:12:53,799 WHICH IS A -- SEQEQNCE, THE 3523 02:12:53,799 --> 02:12:55,034 LACUNAE WILL APPEAR WHITE.. 3524 02:12:55,034 --> 02:12:57,002 IN THISASE SPECIFICALLYY THE 3525 02:12:57,002 --> 02:13:00,039 PLACENTA D D DELIVIV BUT WEE HAE 3526 02:13:00,039 --> 02:13:03,375 PLACENTAL IMPLANTATATN SITE 3527 02:13:03,375 --> 02:13:07,313 BLEEDING CONSISTENEN WITH -- 3528 02:13:07,313 --> 02:13:08,848 PATHOLOLOL GRADEDE. 3529 02:13:08,848 --> 02:13:10,683 WE DID WANT TOO COMPARE 3530 02:13:10,683 --> 02:13:14,887 THRESHOLDSDSOR NEAR-PEPEECT 3531 02:13:14,887 --> 02:13:15,487 SENSITIVITY, CAPTURED MOST OF 3532 02:13:15,487 --> 02:13:17,523 THE PATIENTS DIAGNOSED WITH PASS 3533 02:13:17,523 --> 02:13:18,157 AT DELIVERY. 3534 02:13:18,157 --> 02:13:20,259 WE FOUND THAT THATT S SSITIVITY 3535 02:13:20,259 --> 02:13:22,561 COCOELATED WITHIN ULTRASOUND PAI 3536 02:13:22,561 --> 02:13:24,997 CUTOFF OFREATER THAN OR EQUAL 3537 02:13:24,997 --> 02:13:31,036 UAUATO 3.5.5 3538 02:13:31,036 --> 02:13:34,106 ON THE X AXIXIIS THE U URASOUND 3539 02:13:34,106 --> 02:13:36,442 PAPA AND ON THE Y AXIS IS THE 3540 02:13:36,442 --> 02:13:39,144 GREATETEIMENSION O INVASION 3541 02:13:39,144 --> 02:13:44,917 BY MR, AND THEN INNN THEHE BLUEE 3542 02:13:44,917 --> 02:13:46,218 TRIANGLES WE'RE SHOWINGOMEN 3543 02:13:46,218 --> 02:13:51,357 E PINK CIRCLESES HADAD CESAREAN 3544 02:13:51,357 --> 02:13:52,124 DELIVERY.. 3545 02:13:52,124 --> 02:13:53,058 THESE DEMONSTSTTE WE DODOAPTURE 3546 02:13:53,058 --> 02:13:54,493 THE MAJORIRI OF WOMEN WHO END UP 3547 02:13:54,493 --> 02:13:59,598 NEEDING AYSTERECTOMY.Y. 3548 02:13:59,598 --> 02:14:03,736 AT T TS 96% LEVEL OF 3549 02:14:03,736 --> 02:14:09,241 SPSPIFICITY AND POSOSIVEALLY 3550 02:14:09,241 --> 02:14:10,542 PREDICTIVE VALUE OVEVEVE THAT 3551 02:14:10,542 --> 02:14:17,016 ULTRASOUND P PAI. 3552 02:14:17,016 --> 02:14:19,118 THE POSITIVE PREDICTIVE V VUE 3553 02:14:19,118 --> 02:14:21,954 FOR UNDER S SND S WAS 80% VERERS 3554 02:14:21,954 --> 02:14:22,721 6363 3555 02:14:22,721 --> 02:14:24,723 THE SENSITIVITIESND NEGATIVEE 3556 02:14:24,723 --> 02:14:25,824 PRPRICTIVE VALUESSERE SIMILAR. 3557 02:14:25,824 --> 02:14:28,127 I DO THINK THIHI IS CLINICALLY 3558 02:14:28,127 --> 02:14:28,627 MEANINGFUL. 3559 02:14:28,627 --> 02:14:32,665 IN FEW P PIENTS S REMOVE THE 3560 02:14:32,665 --> 02:14:35,634 CONCERN FOR P P AND THOSE WITH 3561 02:14:35,634 --> 02:14:38,304 GREATER -- LESS T T T 2 2OR 3562 02:14:38,304 --> 02:14:41,006 BETTERERELINEATED THOHO WHOWOUL. 3563 02:14:41,006 --> 02:14:45,277 WE ALSO WANTED TO E ELUATE IF 3564 02:14:45,277 --> 02:14:47,913 THERE'S AN -- THRESHOLD SO WE 3565 02:14:47,913 --> 02:14:50,582 LOOKOK AT THE PAI IN THE THIRD 3566 02:14:50,582 --> 02:14:52,985 TRTRESTER ANDND DEFINED OPTIMAL 3567 02:14:52,985 --> 02:14:55,020 THRESHOLDDD OF6% SENSITIVITY AS 3568 02:14:55,020 --> 02:14:58,691 WELL ASS AN OPTIMALAL THRESHOHOF 3569 02:14:58,691 --> 02:14:59,591 96% SPECIFICICY.Y. 3570 02:14:59,591 --> 02:15:01,460 THAT SENSITIVITYTY WAS CONSISTET 3571 02:15:01,460 --> 02:15:05,297 3.5 AND WE FOUND A CUTOFF OF 3572 02:15:05,297 --> 02:15:09,568 THEREFOREEE DEFINEDNY, SOOO 3573 02:15:09,568 --> 02:15:11,136 INDEDERMINATE RANGEAN B BWEEN 3574 02:15:11,136 --> 02:15:12,671 3.5 AND 8 AND WE PLAN TO LOOKK 3575 02:15:12,671 --> 02:15:13,772 REALLY MOREEPECIFICALLY AT T T 3576 02:15:13,772 --> 02:15:16,942 VALUE ADD OF MR WITITN THIS M ME 3577 02:15:16,942 --> 02:15:24,984 PRESENTLY U UNG BOTH MR 3578 02:15:24,984 --> 02:15:32,091 WE HAVE FOUND LATERER DELIVERY F 3579 02:15:32,091 --> 02:15:34,760 POSSSSLE IN CERTAIN PATIENTS 3580 02:15:34,760 --> 02:15:35,961 WITH LESS I I IT MORBIDITY. 3581 02:15:35,961 --> 02:15:38,931 IF THEHE MR IS N NATIVE, WE PLAN 3582 02:15:38,931 --> 02:15:42,534 BABAD OFF THE USUAL OBSTETRICAL. 3583 02:15:42,534 --> 02:15:44,536 WE'V'V'V DEFINEDED ACCRETA AS LS 3584 02:15:44,536 --> 02:15:47,339 HAVE INCREASAS THE GESTATIALD WE 3585 02:15:47,339 --> 02:15:49,675 AGE A D DIVERY. 3586 02:15:49,675 --> 02:15:51,010 WE HAVE TOO R RORT IN THEHEEXT 3587 02:15:51,010 --> 02:15:53,979 YEAR U UNG T TSE THRESHOLDS. 3588 02:15:53,979 --> 02:15:59,418 WEWE U UD -- WE TYPICALLY DELIVR 3589 02:15:59,418 --> 02:16:02,721 ACCRETA/ININETA AROUND 36 WEEKS, 3590 02:16:02,721 --> 02:16:04,423 WE HAVE GYNECOLOGIC ONCOLOLY 3591 02:16:04,423 --> 02:16:08,894 THAN -- WE DO HAVE A A MANUSCRIT 3592 02:16:08,894 --> 02:16:11,363 BASED OFF OFF THISSS MANAGEMEMTR 3593 02:16:11,363 --> 02:16:13,732 REVIEW. 3594 02:16:13,732 --> 02:16:16,702 SO OPTIMIZINGGG OURUR PREDIDIIOF 3595 02:16:16,702 --> 02:16:19,972 PAS. 3596 02:16:19,972 --> 02:16:21,306 I THINK OURBIBITYTYO PREDICTCT 3597 02:16:21,306 --> 02:16:22,641 PASS IMPROVING BUT IT'SAR 3598 02:16:22,641 --> 02:16:25,244 DARDIZED APPROACH.USING A 3599 02:16:25,244 --> 02:16:28,247 CAPTURE A A REPORT ULTRASOUND 3600 02:16:28,247 --> 02:16:31,083 AND MR DATA. 3601 02:16:31,083 --> 02:16:33,619 FIRST STANDARDIDING VALALATING 3602 02:16:33,619 --> 02:16:34,420 APPROACH FOR THISSND SHOULD BE 3603 02:16:34,420 --> 02:16:36,055 MORE WIDIDY IMPLEMENTED. 3604 02:16:36,055 --> 02:16:42,027 INK SECOND OUR CRITERIA FOR 3605 02:16:42,027 --> 02:16:42,961 MR REFERRARA NEEDDO BE 3606 02:16:42,961 --> 02:16:44,830 ESTABLISHEDND VALALATED, AS 3607 02:16:44,830 --> 02:16:47,366 LL A A WE NEED TO JUST HAVE A 3608 02:16:47,366 --> 02:16:49,902 INTERPRET THE A REPORT.HOW WE 3609 02:16:49,902 --> 02:16:52,438 I DO THINKNK THAHA F FURE 3610 02:16:52,438 --> 02:16:53,505 PUBLICATIONS, WE SHOULD ALL BE 3611 02:16:53,505 --> 02:16:59,378 WORKING TO INCNCPORARA FIGIG 3612 02:16:59,378 --> 02:17:00,579 CLINICAL AND PATHOLOGICAL 3613 02:17:00,579 --> 02:17:02,481 GRADING WHEN FEASIBLE, THERE MAY 3614 02:17:02,481 --> 02:17:04,016 BE ADDITIONAL VALUE ADD OF MR IN 3615 02:17:04,016 --> 02:17:05,884 THOSE C CES THAT MANAGAG 3616 02:17:05,884 --> 02:17:07,219 RE CONSERVATIVELY. 3617 02:17:07,219 --> 02:17:09,421 COME TOGREEMENT WHEN THISTO 3618 02:17:09,421 --> 02:17:11,623 IMAGINGG IS ATTAINED. 3619 02:17:11,623 --> 02:17:13,158 I'VE PROVIDED HERERER JUST HOW E 3620 02:17:13,158 --> 02:17:14,493 ARE SCREENENG AT MYNSTITUTION, 3621 02:17:14,493 --> 02:17:18,197 IDENENFIED HIGH RISK IN THE A 3622 02:17:18,197 --> 02:17:21,767 FIRST TRY MESS TE I USUALLY HAVE 3623 02:17:21,767 --> 02:17:26,572 CESAREAN ECTOPIC PREGNANCY, 3624 02:17:26,572 --> 02:17:28,574 DODOG ADDITIONAL IMAGING AT 10 3625 02:17:28,574 --> 02:17:29,675 TO 13 WEEKS LOOKING ATHE 3626 02:17:29,675 --> 02:17:30,442 VASCULAR INDICES. 3627 02:17:30,442 --> 02:17:32,311 IN THE SECOND T TMESTST,, WE'RE 3628 02:17:32,311 --> 02:17:33,645 SCREENING ALL OF T TSE THAT HAVE 3629 02:17:33,645 --> 02:17:35,714 A PRIOR CESAREAN ANDNDND AT 18 O 3630 02:17:35,714 --> 02:17:37,382 W WKS AND THEN WE'RE DOINGNG 3631 02:17:37,382 --> 02:17:39,017 CONFIRM THRI ULTRASOUND AT T 3632 02:17:39,017 --> 02:17:39,218 WEEKS. 3633 02:17:39,218 --> 02:17:40,786 WE DO THAT AT L LSTST O OE JUST 3634 02:17:40,786 --> 02:17:45,591 CAUSE THERE IS A DEGREE OF PLA 3635 02:17:45,591 --> 02:17:50,229 PLACENTALL- TROPHISM -- AS THAHA 3636 02:17:50,229 --> 02:17:50,996 CONCNCN RESOLVES. 3637 02:17:50,996 --> 02:17:53,432 ANY OF T TSE THATFAVE A 3638 02:17:53,432 --> 02:17:58,437 POSITIVE -- MR AT 30 T 3 3 3639 02:17:58,437 --> 02:18:01,974 I DID A PAS PREDICTCTN, EACH 3640 02:18:01,974 --> 02:18:04,276 ININITUTION SHOULD BEEEN 3641 02:18:04,276 --> 02:18:05,110 INTUITIVE PROCESES 3642 02:18:05,110 --> 02:18:06,712 WE'VEE P PCTICED THE60 REVIEW 3643 02:18:06,712 --> 02:18:08,814 OF ALLF OURE. 3644 02:18:08,814 --> 02:18:10,482 WE REVIEW WITH THE 3645 02:18:10,482 --> 02:18:11,083 MULTIDISCIPLINARY Y Y S SFOR 3646 02:18:11,083 --> 02:18:12,818 ANY OFF OURUR UPCOMING CASESEE 3647 02:18:12,818 --> 02:18:14,553 REVIEWEWOTH THE ULTRASOUNDTTTR 3648 02:18:14,553 --> 02:18:15,554 TOGETHER.. 3649 02:18:15,554 --> 02:18:17,890 THOSE OPOPATIVEINDINGS ANDREVIEW 3650 02:18:17,890 --> 02:18:20,492 DELIVERY O OD AND F FALLY WE 3651 02:18:20,492 --> 02:18:21,860 BRING IN PATHOLOGY WHERE WE LOOK 3652 02:18:21,860 --> 02:18:23,195 AT BOTH T T T GROSSND 3653 02:18:23,195 --> 02:18:24,496 MICRCOCOC TO TRY TO 3654 02:18:24,496 --> 02:18:26,231 CONTININLLLL IDENTIFY AREASAS FR 3655 02:18:26,231 --> 02:18:29,234 IMPROVEMENT IN OUR ALGORORHM. 3656 02:18:29,234 --> 02:18:31,537 THINK THAT ARE OCCASIOIOLLY 3657 02:18:31,537 --> 02:18:32,538 MR P PCENTAL RENDERINGNG CAN 3658 02:18:32,538 --> 02:18:34,106 TUALLY BE HELPFUL IN SURGICAL 3659 02:18:34,106 --> 02:18:35,541 PLANNING. 3660 02:18:35,541 --> 02:18:37,609 THIS ISHOWNN THEEE LEFT IS A 3661 02:18:37,609 --> 02:18:40,345 3D RENDERING OF THE U URUSHERE 3662 02:18:40,345 --> 02:18:43,549 THETERUS IS RED, THE PLACENTA 3663 02:18:43,549 --> 02:18:45,317 IS GREEN, AND THENHERE'S 3664 02:18:45,317 --> 02:18:46,652 BLUE LITTLE PART INHERE THAT'S 3665 02:18:46,652 --> 02:18:52,291 THIS WASE AT 27 WEEKS, ONTION. 3666 02:18:52,291 --> 02:18:53,792 THE E GHT I'MHOWING YOU T T 3667 02:18:53,792 --> 02:18:56,662 UTERUS W WH THEHE PLACENTA IN SU 3668 02:18:56,662 --> 02:18:57,095 ATATAT WEEKS. 3669 02:18:57,095 --> 02:18:59,298 I DO THINK THATT THIS RENDERING 3670 02:18:59,298 --> 02:19:01,500 WAS HELPFUL IN THAT A A 3671 02:19:01,500 --> 02:19:03,302 DEMOMOTRATES A SYMMETRICEATURE 3672 02:19:03,302 --> 02:19:05,470 THAT ACTUALLY A LARGE AREA 3673 02:19:05,470 --> 02:19:06,672 POSTERIORXTENSISI AND WAS 3674 02:19:06,672 --> 02:19:10,442 HELPFUL IN LETTING US KNOW WE 3675 02:19:10,442 --> 02:19:13,612 SHOULD MAKE A -- DECISISN 3676 02:19:13,612 --> 02:19:15,047 THAT -- TOO THE POSTERIOR SIDE.. 3677 02:19:15,047 --> 02:19:16,048 FINALLY I DO THINKY THE 3678 02:19:16,048 --> 02:19:17,616 APPLICATION OF AI I LL L LELY 3679 02:19:17,616 --> 02:19:18,717 ENHANCE OUR PREDICTIVE 3680 02:19:18,717 --> 02:19:20,118 CACABILITY IN THTHTHUTURE. 3681 02:19:20,118 --> 02:19:23,922 MY OWNWNRERE WORKING TO SEGMENT 3682 02:19:23,922 --> 02:19:25,991 THE UTERUS AND THELACENTA ON 3683 02:19:25,991 --> 02:19:28,594 MRO DISTINGUISH MULTIPLE 3684 02:19:28,594 --> 02:19:31,163 CHARACTERISTICS OF T T T PLACEN, 3685 02:19:31,163 --> 02:19:32,364 OXYGENATION, P PEUTION, 3686 02:19:32,364 --> 02:19:33,765 DIFFUSION, ALSOOOKINGNG AT 3687 02:19:33,765 --> 02:19:34,766 TEXTUAL DIFFERENCES.. 3688 02:19:34,766 --> 02:19:36,868 THE IMAGE ON THE TOP RIGIG IS 3689 02:19:36,868 --> 02:19:42,441 PLACENTA IN THEHEHE AMNIOTIC 3690 02:19:42,441 --> 02:19:46,311 ACADADY -- I IF THE MANUALL 3691 02:19:46,311 --> 02:19:47,412 SEGMGMTATITI, BASICALLY THEHE 3692 02:19:47,412 --> 02:19:52,584 LINES A A THE ALGLGITHM THATT HS 3693 02:19:52,584 --> 02:19:55,554 BEENEN -- - ER THEOLIDIDOLORS. 3694 02:19:55,554 --> 02:19:57,856 D D E B BTOTO IS SHOWING A 3DD 3695 02:19:57,856 --> 02:20:00,592 RECONSNSUCUCONROM MANUAL 3696 02:20:00,592 --> 02:20:02,928 SEGMENTATION AND A AORITHM 3697 02:20:02,928 --> 02:20:04,329 APPLICATION. 3698 02:20:04,329 --> 02:20:06,999 SO I THINK UNFORTUNATELY MOST 3699 02:20:06,999 --> 02:20:08,267 SEGMENTATION AT THISISOINT IS 3700 02:20:08,267 --> 02:20:10,202 NOT FULLY AUTOMATATAT BUT I THIK 3701 02:20:10,202 --> 02:20:11,403 ONCE IT IS AUTOMATED IT WILL TEE 3702 02:20:11,403 --> 02:20:13,138 CRCRSE OUR PROCESSSSG TIME AND 3703 02:20:13,138 --> 02:20:15,007 MAY REMOVE THAT SUBJECTIVITYY OF 3704 02:20:15,007 --> 02:20:16,174 INTERPRETATION THAT CURRENTLY IS 3705 02:20:16,174 --> 02:20:16,808 ESENT. 3706 02:20:16,808 --> 02:20:19,211 SO IN CONCLUSION, I THINK WE'VE 3707 02:20:19,211 --> 02:20:21,513 ACHIEVED IMPROVED ABILITY T TO 3708 02:20:21,513 --> 02:20:28,253 PREDICT WHO HAS PLACENTARETA 3709 02:20:28,253 --> 02:20:29,554 ECTRUM BUT WE NEED TOOO 3710 02:20:29,554 --> 02:20:30,822 STANDARDIZE OUR APPROACH A AWELL 3711 02:20:30,822 --> 02:20:32,391 AS REPORTITI OFF ULTRARAUND MR 3712 02:20:32,391 --> 02:20:32,591 TA. 3713 02:20:32,591 --> 02:20:34,860 IO THINK THAT MR CAN BE 3714 02:20:34,860 --> 02:20:36,128 UTILIZED TO ENHANCE S SCIFICITY 3715 02:20:36,128 --> 02:20:37,863 ANDD POSITIVE PREDIDIIVE VALUE. 3716 02:20:37,863 --> 02:20:40,365 WE USE OUR MR ALONG W W W OUR 3717 02:20:40,365 --> 02:20:42,000 ULTRASOUND TO ASSIST IN BOTH OUR 3718 02:20:42,000 --> 02:20:43,368 DELIVERY TIMING AND P PNNING. 3719 02:20:43,368 --> 02:20:45,137 FOR PATIENTS WITH LOWER CONCERNN 3720 02:20:45,137 --> 02:20:49,508 FORNVASION -- ROUTINELY 3721 02:20:49,508 --> 02:20:51,677 DELIVER AT LATER GESTATIONAL 3722 02:20:51,677 --> 02:20:52,711 AGES. 3723 02:20:52,711 --> 02:20:54,279 THINK AS WE DEVELOPOPREDICTIVE 3724 02:20:54,279 --> 02:20:56,014 MODELS, IT'S CRITICAL THAT WE 3725 02:20:56,014 --> 02:20:57,783 CONTININ TOO VALIDIDID AND I 3726 02:20:57,783 --> 02:21:02,421 ININRPORATION OF A.I. W WL BE 3727 02:21:02,421 --> 02:21:04,656 BENENECIALALF INTERPRETETION 3728 02:21:04,656 --> 02:21:06,124 THATE CURRENTLYLY HAVE. 3729 02:21:06,124 --> 02:21:08,694 AND I'D JUSTIKE TOHANK 3730 02:21:08,694 --> 02:21:09,695 EVERYONENE AT MY INSTITITION, TT 3731 02:21:09,695 --> 02:21:11,596 WE HAVAV A MASSIVE PLACENTA 3732 02:21:11,596 --> 02:21:12,431 ACCRETA TEAM AS WELL AS A 3733 02:21:12,431 --> 02:21:13,565 RESEARCH TEAM PARTICIPATINGNGN 3734 02:21:13,565 --> 02:21:13,899 THIS R REARCRC 3735 02:21:13,899 --> 02:21:24,142 SO THANK YOU. 3736 02:21:29,414 --> 02:21:39,658 >> NEXT WE'RE GOING TOAVE -- 3737 02:21:39,658 --> 02:21:41,360 EAKING FOR DR. FARBERPEAKING 3738 02:21:41,360 --> 02:21:43,128 ABOUT ANESTHEHEA, TRANSFUSION 3739 02:21:43,128 --> 02:21:44,830 AND CRITICAL CARE 3740 02:21:44,830 --> 02:21:46,098 >> THANK YOUVERYBODY FOR YOUR 3741 02:21:46,098 --> 02:21:46,698 FLFLIBILITY THIS MORNINGNG 3742 02:21:46,698 --> 02:21:49,334 DR. FARBER, UR KNOWWHE WOULD 3743 02:21:49,334 --> 02:21:50,669 OBABLY NEED TOO BEE INTUBATAT 3744 02:21:50,669 --> 02:21:52,170 HERSELF TOOISS OUTN GIVING A A 3745 02:21:52,170 --> 02:21:53,805 TALK AND I'M HAPAPO SAY SHE 3746 02:21:53,805 --> 02:21:54,906 S A NATURAL A AWAY. 3747 02:21:54,906 --> 02:21:56,441 E'S DOING OKAY BUTUTUT 3748 02:21:56,441 --> 02:21:57,609 UNFORTUNATELY WAS STSTL TOO O LL 3749 02:21:57,609 --> 02:21:58,176 BE HEREEHIS MORNINI. 3750 02:21:58,176 --> 02:21:59,644 SHSHIS LISTENING ONLINE RIGHT 3751 02:21:59,644 --> 02:22:00,145 NOW. 3752 02:22:00,145 --> 02:22:01,346 I'VE CONFIRMED THAT. 3753 02:22:01,346 --> 02:22:03,315 SO I HAVE TO GIVE HER AUICK 3754 02:22:03,315 --> 02:22:04,516 LITTLE APOPOGY FOR WHATTT 3755 02:22:04,516 --> 02:22:07,018 GOININ TO DO TO HERER SLIDES. 3756 02:22:07,018 --> 02:22:09,855 II DO WORK WITH HER CLOSELY, IIO 3757 02:22:09,855 --> 02:22:12,124 RESEARCH WITH HER, I'VE HEARD 3758 02:22:12,124 --> 02:22:13,625 HER R LK M MY TIMIM, BUT I HAVAV 3759 02:22:13,625 --> 02:22:15,961 TOIVE THE D DCLAIMER, I'M NOTOT 3760 02:22:15,961 --> 02:22:17,896 AN A ASTHESIOLOGIST.SO MOVING O. 3761 02:22:17,896 --> 02:22:20,065 THESE ARERE DR. FARBER'S 3762 02:22:20,065 --> 02:22:21,166 DISCLOSURES. HAVE NOTOTNG TO 3763 02:22:21,166 --> 02:22:26,171 ADADONOP OF THAHA 3764 02:22:26,171 --> 02:22:28,039 SOME O O THESE. QUICKLY THROUGH 3765 02:22:28,039 --> 02:22:29,374 I HAD A CHANCEEO REVIEW HER 3766 02:22:29,374 --> 02:22:30,909 IDESND THEY'RE VERY 3767 02:22:30,909 --> 02:22:32,310 COMPRERENSIVE, BUT SOME OF THEM 3768 02:22:32,310 --> 02:22:33,945 DO O ORLAP WITHALAL THAT WE'VE 3769 02:22:33,945 --> 02:22:37,015 HAD THISORNING. 3770 02:22:37,015 --> 02:22:39,317 THERE ARE FOUR AREAS OF 3771 02:22:39,317 --> 02:22:41,653 ANESMHESIA KNOWLEDED GAPS THAT 3772 02:22:41,653 --> 02:22:43,221 SHSH WANTEDO EMPHASIZE, THE 3773 02:22:43,221 --> 02:22:45,891 FIRST ONE BEING THE PRE-DELIVERY 3774 02:22:45,891 --> 02:22:46,525 PLPLNING.. 3775 02:22:46,525 --> 02:22:47,526 WE KNKN, THEHE ANENENESIA TEAM 3776 02:22:47,526 --> 02:22:51,663 THIS.ARETTY ESSENTIAL PART OFF 3777 02:22:51,663 --> 02:22:52,664 THIS ISS A A ART GOINGHROUGH 3778 02:22:52,664 --> 02:22:55,367 THE RISK FACTORS F F POSTPARTUM 3779 02:22:55,367 --> 02:22:58,437 APPLYINGO EVERY SINGLELD BE 3780 02:22:58,437 --> 02:22:59,204 BIRTHING PATIENT IN THE HOSPITAA 3781 02:22:59,204 --> 02:23:01,339 THTHE DAYS ANDMPHASIZING IN 3782 02:23:01,339 --> 02:23:05,544 THTHHIGH RISIS CLOM, SUSPECTED 3783 02:23:05,544 --> 02:23:06,678 PLACENTA PREVIA ANDLACENTA 3784 02:23:06,678 --> 02:23:10,682 PREVEV ARE THE VERY TOP OF THEL. 3785 02:23:10,682 --> 02:23:11,983 WEWEALKEDBOUT PRIOR CESARARN 3786 02:23:11,983 --> 02:23:12,851 AND PLPLENEN PREVIA BEING AT THE 3787 02:23:12,851 --> 02:23:14,619 VEVE TOP IN BOLD, THOSE ARE BY 3788 02:23:14,619 --> 02:23:18,223 R THE MOSTBVIOUS, THE MOST 3789 02:23:18,223 --> 02:23:20,058 STAND OUTURININ RESEARCH, AND 3790 02:23:20,058 --> 02:23:23,228 THAT HAD T T T HIGHEST ABSOLUTUT 3791 02:23:23,228 --> 02:23:24,629 RISK OF H HINININ PAS. 3792 02:23:24,629 --> 02:23:26,131 SHE LISTED MANANER RISK 3793 02:23:26,131 --> 02:23:27,499 FACTORS AT THE BOTTOM, INCLUDING 3794 02:23:27,499 --> 02:23:29,100 MORNININ WE TALKED ABOUT THIS 3795 02:23:29,100 --> 02:23:31,169 IMPORTANT RISK FACTORS, T TY 3796 02:23:31,169 --> 02:23:32,504 CONSISTENTLY AREREHOWN H HE AS 3797 02:23:32,504 --> 02:23:33,538 FACTORS I ITHE LITERATURE, BUT 3798 02:23:33,538 --> 02:23:35,340 WEWEE TALKINGBSOLUTE RISKS FOR 3799 02:23:35,340 --> 02:23:37,409 SOME O THESESE SUCH AS WITH IVF 3800 02:23:37,409 --> 02:23:39,578 THAT'SROROBLY NOT M M MN 3801 02:23:39,578 --> 02:23:43,949 2 2 3%. 3802 02:23:43,949 --> 02:23:46,785 U MULTIPLY THAT BY THE ENTIERM 3803 02:23:46,785 --> 02:23:47,652 POPULATION, IT'S HARDD TO 3804 02:23:47,652 --> 02:23:49,087 RESEARCH WHEN YOU HAVE AN 3805 02:23:49,087 --> 02:23:50,288 ABABLULU RISK LIKEHAT. 3806 02:23:50,288 --> 02:23:52,924 WE USE ULTRASOUNUN A LOT WHEN 3807 02:23:52,924 --> 02:23:56,228 EACH OTHER.NICATING RISKS TO 3808 02:23:56,228 --> 02:24:00,599 CERTAIN U URASOUND FACTOTO OR 3809 02:24:00,599 --> 02:24:02,467 AGING FACTORS OR ANY KIND O OF 3810 02:24:02,467 --> 02:24:04,636 RISKSKTRATIFIFATION FACTORS THAT 3811 02:24:04,636 --> 02:24:05,737 CACAOT JUST PRERERE THAHA PHE 3812 02:24:05,737 --> 02:24:07,372 PLACENTA WILLE ADHERENT, BUT 3813 02:24:07,372 --> 02:24:10,208 IT CAN ACTUALLY PREDICT THE 3814 02:24:10,208 --> 02:24:14,346 MORBIDITY IS ADHDHENT, H H T T 3815 02:24:14,346 --> 02:24:19,151 RISKSKTRIK STRATIFY THEM FURTHE. 3816 02:24:19,151 --> 02:24:20,485 SO H HE S S REALLY WANTED TO 3817 02:24:20,485 --> 02:24:21,620 EMFA SIELS HOW THEHE OTHER P PPE 3818 02:24:21,620 --> 02:24:23,555 ARE BRINGING UP ASELL, USINGSI 3819 02:24:23,555 --> 02:24:27,926 A.I., U UNG MACHINE LEARNING TOD 3820 02:24:27,926 --> 02:24:30,195 BIOMARKERS, BUT ULTRASOUND 3821 02:24:30,195 --> 02:24:31,863 OMARKERSRS RISK FACTORS, 3822 02:24:31,863 --> 02:24:36,434 MORE ABOUT THEHE AND CANEARN 3823 02:24:36,434 --> 02:24:38,970 PLACE OFARE AS WELL AS SET UPT 3824 02:24:38,970 --> 02:24:42,340 THE RIGHT SURGEGE REAL FOR THEM. 3825 02:24:42,340 --> 02:24:43,108 SURGERY FOR THEM,ND 3826 02:24:43,108 --> 02:24:46,678 USING BIOMARKRKS TO ADD TOO T TT 3827 02:24:46,678 --> 02:24:49,881 STRATIFICATION.. 3828 02:24:49,881 --> 02:24:54,686 ACCRETAS ARE -- H HING A PREREA 3829 02:24:54,686 --> 02:24:57,289 WITH A AN A ARETA IS JUST LIKE 3830 02:24:57,289 --> 02:25:00,058 RE GRAPHICICLY MORBID ANDWIWI 3831 02:25:00,058 --> 02:25:01,026 OBVIOUS TOTOTO 3832 02:25:01,026 --> 02:25:03,128 THESE KIND OHOTOS AND THESE 3833 02:25:03,128 --> 02:25:05,096 KIND OF IMAGES DEFINITELY GET 3834 02:25:05,096 --> 02:25:06,431 A ASTHESIOLOGISTS' ATTENTION 3835 02:25:06,431 --> 02:25:09,134 AND IFTEN SEE T TM WITHH THEIR 3836 02:25:09,134 --> 02:25:10,669 FACES DOWN AT THE OTHER END OFF 3837 02:25:10,669 --> 02:25:12,103 THE TABLE WHEN WE'RE LOOOONG A T 3838 02:25:12,103 --> 02:25:13,305 PLACENTA A AER WE G G INTO THE 3839 02:25:13,305 --> 02:25:14,606 ABDOMEN BECAUSE THEHEREREOING TO 3840 02:25:14,606 --> 02:25:15,941 RESPONON M M M DIFFERENTLY T TA 3841 02:25:15,941 --> 02:25:17,609 UTERUSUSHAT LOOKSKSKS LIKE THISN 3842 02:25:17,609 --> 02:25:20,645 TO A UTETETE T TT HAS A MORE 3843 02:25:20,645 --> 02:25:22,480 NORMAL EXTERNAL EXPERIENCE AND I 3844 02:25:22,480 --> 02:25:23,315 THINK WE'R'R'R UNDERAPPRECIATITI 3845 02:25:23,315 --> 02:25:27,452 BLE AFTER THEYEE SOMETHING THE 3846 02:25:27,452 --> 02:25:28,086 LILILIHAT. 3847 02:25:28,086 --> 02:25:29,454 TALKING G ROUGH AS A TEAM, LIKE 3848 02:25:29,454 --> 02:25:31,356 WHAT ARE WE GOING TO DO 3849 02:25:31,356 --> 02:25:35,160 SURGICALLY TO MINIMIZE THE BLOOD 3850 02:25:35,160 --> 02:25:39,698 ININRVENTIONS THAT HAVE BEEN 3851 02:25:39,698 --> 02:25:40,665 PUBLISHED FROM VARIOUS 3852 02:25:40,665 --> 02:25:41,232 INSTITITIONS. 3853 02:25:41,232 --> 02:25:46,238 THIS IS USING A UTERINE STAPLER. 3854 02:25:46,238 --> 02:25:47,439 USING CONSERVATIVE MANAGEMENT, 3855 02:25:47,439 --> 02:25:48,340 I'M HAPPY WE'REREOINGNGO HAVE A 3856 02:25:48,340 --> 02:25:49,541 LE B B OF DISCUSSION A AUT 3857 02:25:49,541 --> 02:25:51,376 THISISODAYAYULL WILL A NEW I IA 3858 02:25:51,376 --> 02:25:53,578 MAYBE IFE JUST COMOMETELY 3859 02:25:53,578 --> 02:25:55,547 ANGE THE WAY WEE TREAT THESE 3860 02:25:55,547 --> 02:25:57,082 PAPAENTS, WE CACAHAVEVE A BIGGEE 3861 02:25:57,082 --> 02:25:59,150 IMIMCT ON CUTUTNG DOWN THEHE 3862 02:25:59,150 --> 02:25:59,584 MORBRBITIT 3863 02:25:59,584 --> 02:26:01,686 IT'S A DIFFERENT SURGERY, IT'S 3864 02:26:01,686 --> 02:26:02,821 DIFFERENT T Y OF A AESESNG THE 3865 02:26:02,821 --> 02:26:04,122 PATITITI IN THE O.R. AND WHAT'S 3866 02:26:04,122 --> 02:26:05,190 THE ANESTHESISIOGIST'S ROLE 3867 02:26:05,190 --> 02:26:06,958 THROUGH THAT PROCESS. 3868 02:26:06,958 --> 02:26:09,594 USING A HYBRID OPERARANGNGOOM, 3869 02:26:09,594 --> 02:26:11,763 AGAGN, SOMOMOM CENTERS DO THIS 3870 02:26:11,763 --> 02:26:13,698 ROUTINELY A A SEEM TO DO A 3871 02:26:13,698 --> 02:26:14,833 PRETTY I I ISSIVEEE WITH IT. 3872 02:26:14,833 --> 02:26:16,301 NOT ALL CENTERS ARE THE SAME. 3873 02:26:16,301 --> 02:26:17,836 NOT ALL HAVE THE SAME ACCESS TO 3874 02:26:17,836 --> 02:26:18,703 SOURCECECEND I THINK W WRE 3875 02:26:18,703 --> 02:26:20,138 STILL FIGURING OUTHAT'S THE 3876 02:26:20,138 --> 02:26:21,773 RIGHT WAY TO DO THIS AND WHAT'S 3877 02:26:21,773 --> 02:26:23,308 RIGHT S S SON FOR USING 3878 02:26:23,308 --> 02:26:24,943 IT, ANDDOW DO W WE HAVEHE RIGHT 3879 02:26:24,943 --> 02:26:27,245 RESOURCES. 3880 02:26:27,245 --> 02:26:29,648 SO FROM AURURCAL CONSISIRATION 3881 02:26:29,648 --> 02:26:30,749 AND AN ANESTHTHIA QUESTION, I 3882 02:26:30,749 --> 02:26:34,119 K THEHE MOST COMMONN ONE THAT 3883 02:26:34,119 --> 02:26:34,986 I'VE HEAEAEA MENTIONEDED THAT SE 3884 02:26:34,986 --> 02:26:36,121 ALSO MENTITIED HERE ISISHAT 3885 02:26:36,121 --> 02:26:38,990 SHOULD WE BE DOING WITH 3886 02:26:38,990 --> 02:26:40,292 UTEROTONONS, SH AS A SMALL 3887 02:26:40,292 --> 02:26:41,926 ESTION IN COMPARISON T TA LOTOTT 3888 02:26:41,926 --> 02:26:43,895 OF THESE BIGGER P P PRERE 3889 02:26:43,895 --> 02:26:45,130 QUQUTIONS THAT YOU'VETI BEEN 3890 02:26:45,130 --> 02:26:46,898 ANSWERING, BUT SHOULD WE B 3891 02:26:46,898 --> 02:26:50,302 SOME PEOPLEAY ABSOLOLELY 3892 02:26:50,302 --> 02:26:51,836 NEVER, Y Y'RE G GNG TO MAKE YOUR 3893 02:26:51,836 --> 02:26:53,271 TIENT HEMORRHAGE, A A WE TALK 3894 02:26:53,271 --> 02:26:55,273 TO CENTERSRSHAT DO IT ON EVERY 3895 02:26:55,273 --> 02:26:56,007 SINGLE PATATNTNT 3896 02:26:56,007 --> 02:26:57,776 NOTT THAHA HARD OFF A QUESTION O 3897 02:26:57,776 --> 02:26:59,311 ANSWER BUT SOMETETET FOROR US TO 3898 02:26:59,311 --> 02:27:02,580 WHEN S SULD WE BEE USING UTERINE 3899 02:27:02,580 --> 02:27:05,650 CONSNSVATION, ARE WERULY GOING 3900 02:27:05,650 --> 02:27:15,026 ARE THE ANENEHESISIOGISTS' ROLEH 3901 02:27:15,026 --> 02:27:15,794 IN THAT. 3902 02:27:15,794 --> 02:27:17,329 OBVIVISLY THENESTHESIA TEAMAMT 3903 02:27:17,329 --> 02:27:19,497 THE HEAD OF THEHE BED IS THINKIG 3904 02:27:19,497 --> 02:27:20,498 ABOUOUIN MUCHHREATER DETAIL 3905 02:27:20,498 --> 02:27:22,801 THAN WE OFTEN ARE WHEN WE'RERE 3906 02:27:22,801 --> 02:27:23,668 CONCENTRATING ON SURGEGE.. 3907 02:27:23,668 --> 02:27:24,636 THESE ARE THEHINGNG THEY'RE 3908 02:27:24,636 --> 02:27:31,342 TRAVAVAVS ACCESES HAVING AR RDY. 3909 02:27:31,342 --> 02:27:38,349 RAPID INFUSER,, HAVING A --- LI, 3910 02:27:38,349 --> 02:27:40,952 AND IMPORTANT TO T TM, WHERE AND 3911 02:27:40,952 --> 02:27:43,688 WHEN WE'REREOING TO CONVERT TOGT 3912 02:27:43,688 --> 02:27:45,323 USING IT FROM THE BEGINNINI. 3913 02:27:45,323 --> 02:27:45,957 COMMUNICICION WITH THE SURURURS 3914 02:27:45,957 --> 02:27:47,826 IS REALLLL ESSENENAL HERE. 3915 02:27:47,826 --> 02:27:48,960 THEYEYEED TO KNOW WHATE'RE 3916 02:27:48,960 --> 02:27:50,395 THINKING AND WHAT WE'RE SEEING 3917 02:27:50,395 --> 02:27:51,596 AND HOWE COMMUNICATETE THE BLOOD 3918 02:27:51,596 --> 02:27:53,665 LOSS THAT W WRE SEEING, WHICH 3919 02:27:53,665 --> 02:27:58,169 CANNHANGE QUICKLY. 3920 02:27:58,169 --> 02:28:01,639 OTHER PEOEOE H HE DESCRIBED T T 3921 02:28:01,639 --> 02:28:04,309 US INHE.R. FOROR HOW WE 3922 02:28:04,309 --> 02:28:06,911 INTERPRET T MORRHAGE. 3923 02:28:06,911 --> 02:28:11,483 THERE'S RATE OF BLOODOD LOSS. 3924 02:28:11,483 --> 02:28:12,951 WE CAN COMMUNICATE OH, THE 3925 02:28:12,951 --> 02:28:15,120 PATIENT IS BLEEDING,G, BUT I IS 3926 02:28:15,120 --> 02:28:21,760 BIBIBIFFERENCE WHETHER -- PER 3927 02:28:21,760 --> 02:28:23,528 HOUR OR LITER OF BLOLO IN AEW 3928 02:28:23,528 --> 02:28:25,296 MINUNUS S OBVIOUSLY REALLY 3929 02:28:25,296 --> 02:28:25,897 CRITICAL COMMUNICATION THAT'S 3930 02:28:25,897 --> 02:28:27,265 GOING TO CHANGE THEHA ANESTHESIA 3931 02:28:27,265 --> 02:28:30,301 TEAMAM APPROACH. 3932 02:28:30,301 --> 02:28:38,743 WE -- P PTING A A TOURNIQUET, 3933 02:28:38,743 --> 02:28:41,679 THINKING ABOBO THIHIHI THATT CAN 3934 02:28:41,679 --> 02:28:43,882 STOP B BEDING Q QCKLY IFF NEEDE. 3935 02:28:43,882 --> 02:28:46,918 A BIG TOPIC THEHE DAYS, WHETHERR 3936 02:28:46,918 --> 02:28:53,191 WEWE PLACE A -- IN TERMS O WHO 3937 02:28:53,191 --> 02:28:55,593 GETS I I HOW WE USESE IT, CAN 3938 02:28:55,593 --> 02:28:57,028 USE IT, WHO HAS ITT AVAILABLE, 3939 02:28:57,028 --> 02:28:58,263 BUT JUST THINKING A STETETE BEYD 3940 02:28:58,263 --> 02:28:59,898 THAT, WHATT ABOUT JUST 3941 02:28:59,898 --> 02:29:00,865 COMPRESSSSG THE AORTA? 3942 02:29:00,865 --> 02:29:02,400 YOUUU DON'T NEED TO O VE THE S E 3943 02:29:02,400 --> 02:29:06,137 KIKI OECHNICALAL RESOURCES IN 3944 02:29:06,137 --> 02:29:09,107 YOURUR O OR. 3945 02:29:09,107 --> 02:29:12,944 WE WERE GIVINGG A T TK TOGOGHER 3946 02:29:12,944 --> 02:29:16,548 PRETTY STRTRKY HOW MANY PEOPLE 3947 02:29:16,548 --> 02:29:19,017 ININ THAT ROOM, OB,STHESIA, ASS 3948 02:29:19,017 --> 02:29:21,953 WESLL AS OB, HAD COMPRESSED AN 3949 02:29:21,953 --> 02:29:23,621 AOAOA DUDUNG A POSTPARTUTU 3950 02:29:23,621 --> 02:29:25,223 HEHERRHAHA, PROBABLY F F MOREE 3951 02:29:25,223 --> 02:29:26,858 UNITED STATES.R SEE IN THEHE 3952 02:29:26,858 --> 02:29:28,693 BUBUBUMPORORNTNT TO THINK ABOBOS 3953 02:29:28,693 --> 02:29:32,163 THE FAIRLY -- CAN MAKE A BIG 3954 02:29:32,163 --> 02:29:33,565 DIFFERENCE. 3955 02:29:33,565 --> 02:29:36,601 ANDD HERE'S A PAPER FROM ONE OF 3956 02:29:36,601 --> 02:29:38,369 OUR COLLEAGUESESOWN IN COLUMBIA, 3957 02:29:38,369 --> 02:29:40,038 JUST ABOUT -- JUST R RINDING 3958 02:29:40,038 --> 02:29:41,005 LE HOW TO D D THIS AND THAT 3959 02:29:41,005 --> 02:29:43,508 AS A FAIRLY LOW 3960 02:29:43,508 --> 02:29:45,844 TECH INTERVENTION THAHA CAN MAKE 3961 02:29:45,844 --> 02:29:47,679 A BIG DIFFERENCE. 3962 02:29:47,679 --> 02:29:48,446 OUSLY E ERY H HPITATA THAT IS 3963 02:29:48,446 --> 02:29:49,814 GOING TOGO GIVEE A A ATA CARE 3964 02:29:49,814 --> 02:29:52,517 SHOULD HAVE AASSISI 3965 02:29:52,517 --> 02:29:57,021 HAPPEN TO HAVE P PNT OF H HARE, 3966 02:29:57,021 --> 02:29:57,989 THE E HOLASTIC TESTING, I THINK 3967 02:29:57,989 --> 02:30:01,492 ANESTHESIAIA OR OBB ANESTHESIA, 3968 02:30:01,492 --> 02:30:02,727 WHETETR R IS I I GOING T TO MAKA 3969 02:30:02,727 --> 02:30:04,696 DIDIERERER IN T TMS OF PATIENT 3970 02:30:04,696 --> 02:30:11,903 CARE AND PATIENTRANSFUSIONON. 3971 02:30:11,903 --> 02:30:14,005 -EUALLY S SNT YEARS 3972 02:30:14,005 --> 02:30:15,607 COCOUCTING A RANDOMIZED TRIALO 3973 02:30:15,607 --> 02:30:17,175 TRY TOOO ANSWER THAT QUESTIOIOAD 3974 02:30:17,175 --> 02:30:18,810 LEARNED HOW HARD IT IS TO DO A 3975 02:30:18,810 --> 02:30:19,811 RANDOMIZED TRIAL TO ANSWER THIHI 3976 02:30:19,811 --> 02:30:20,511 QUESTIONON 3977 02:30:20,511 --> 02:30:24,749 WE ENROLLED 250 PATIENTS,ND 3978 02:30:24,749 --> 02:30:26,484 THAT WERE -- WHOHOHO ACTUALLY DD 3979 02:30:26,484 --> 02:30:30,822 RARAOMIZED THEM T EITHER MANAGAG 3980 02:30:30,822 --> 02:30:34,392 WE FOUOU USING THE ROTEM DIDN'T 3981 02:30:34,392 --> 02:30:35,493 KE A DIFFERENCE BUT WE ALSO 3982 02:30:35,493 --> 02:30:36,694 DIDN'T P PSCRIBE TOUR 3983 02:30:36,694 --> 02:30:38,329 PROVIDERS HOW WE SHOULD FRANCE 3984 02:30:38,329 --> 02:30:40,031 FUSE THE PATIENT, BUT W W W SAWI 3985 02:30:40,031 --> 02:30:42,000 THEEE RESESTSTS THEY WERE ALLLLD 3986 02:30:42,000 --> 02:30:44,736 TO TRANS TRANSFUSE THE PATIENTSS 3987 02:30:44,736 --> 02:30:48,106 TIMES WHERE THEY ITOLLOW A 3988 02:30:48,106 --> 02:30:48,573 PRPROCOL, THERE WAS A 3989 02:30:48,573 --> 02:30:48,873 DIFFERENCE. 3990 02:30:48,873 --> 02:30:50,742 IT WAS SECONDARY OUTUTME SO I IT 3991 02:30:50,742 --> 02:30:52,544 NEEDS A LITTLE MOROR 3992 02:30:52,544 --> 02:30:53,144 INVESTIGATION, BUT STILL A LOT 3993 02:30:53,144 --> 02:30:55,813 HOW T TO USE TOOLS LIKE THISO 3994 02:30:55,813 --> 02:30:59,517 MAMAMA TRANSFUFUON. 3995 02:30:59,517 --> 02:31:00,552 SO IN TERMS OF M MOR QUESTSTNS 3996 02:31:00,552 --> 02:31:02,720 WEHOULD BE THINKING ABOUT, 3997 02:31:02,720 --> 02:31:03,721 WHWH ARE THE PROCEDURES WE 3998 02:31:03,721 --> 02:31:05,456 SHOUOU BE DOING TO DECREASE 3999 02:31:05,456 --> 02:31:07,425 BLOOD LOSS, SHOULD WE BE USINGNG 4000 02:31:07,425 --> 02:31:09,394 CELL S SVAGE, HOW SHOULD WEEEE 4001 02:31:09,394 --> 02:31:11,362 USING C CL SALVAGE, CAN WE PICK 4002 02:31:11,362 --> 02:31:12,463 OUT WHICHHATIENTS AREOING TO 4003 02:31:12,463 --> 02:31:12,897 NENET FROMOMT.T. 4004 02:31:12,897 --> 02:31:17,835 AND THEN SHE ADDED IN HERE 4005 02:31:17,835 --> 02:31:18,670 TRANEXAMIC ACID, WE GIVE KNENE 4006 02:31:18,670 --> 02:31:20,972 JERKRKRK ANYBODY HAVAVG 4007 02:31:20,972 --> 02:31:23,708 SHOULD WE BE USING IT IN THESE 4008 02:31:23,708 --> 02:31:24,142 CASES? 4009 02:31:24,142 --> 02:31:27,111 DOCA IT MAKE S SSE TO GIVEN 4010 02:31:27,111 --> 02:31:28,646 EASY MEDICAL INTERVENTION TO 4011 02:31:28,646 --> 02:31:29,948 SOMEMEDY WITH MASSIVE SURGIGIL 4012 02:31:29,948 --> 02:31:30,515 BLOADING? 4013 02:31:30,515 --> 02:31:33,017 PRPRABLY LOW RISK B B THE 4014 02:31:33,017 --> 02:31:34,552 QUESTION STILL ISN'T A AWEWED. 4015 02:31:34,552 --> 02:31:40,224 EVERYBYBY HERE T T T HAS AN, 4016 02:31:40,224 --> 02:31:42,093 ACCRETA CENTER I'M SURUR HAS A 4017 02:31:42,093 --> 02:31:43,027 MULTIDISCIPLININY TEAM AND A LOT 4018 02:31:43,027 --> 02:31:44,629 OFROTOCOLS IN PLACE WHICHCHCH IS 4019 02:31:44,629 --> 02:31:46,164 GREAEA FOR SUSPECTED CASES. 4020 02:31:46,164 --> 02:31:49,901 THE CASES THAT ARE NOT P PKEDH 4021 02:31:49,901 --> 02:31:51,436 UP, THE PATATNTS WHOHO B BE ARET 4022 02:31:51,436 --> 02:31:53,171 SEEN B B ULTRASOUND OR I IGINGNR 4023 02:31:53,171 --> 02:31:54,606 WHO AREN'T PICICD OUT EVEN BY 4024 02:31:54,606 --> 02:31:56,374 RISK FACTORS BY THEIR COMMUNITY 4025 02:31:56,374 --> 02:32:00,979 DESCRIBE T T DIFFERENCE.ERE T 4026 02:32:00,979 --> 02:32:04,048 THIS ISS YOUR ANTICICATED ACCREA 4027 02:32:04,048 --> 02:32:04,916 RERERRED INTO THE CENTER, THIS 4028 02:32:04,916 --> 02:32:06,684 IS YOUR UNSCHEDULUL A ARETATA AD 4029 02:32:06,684 --> 02:32:08,686 THIS IS HOW IT FEELSLS DURINGG H 4030 02:32:08,686 --> 02:32:09,454 OF T TSE CASES. 4031 02:32:09,454 --> 02:32:11,623 WHICH IS WHY FOR PATIENTS WHO 4032 02:32:11,623 --> 02:32:12,423 HAVE AND STUTUESESAVE SHOWN 4033 02:32:12,423 --> 02:32:14,625 PATITITS THAT DON'T HAVE A 4034 02:32:14,625 --> 02:32:17,662 PRPRIA SEEM TO HAVE LESS -- 4035 02:32:17,662 --> 02:32:19,998 HESISITE TO USE THE WORD 4036 02:32:19,998 --> 02:32:22,400 INVAVAVE BUS LESS VASCULAR, LESS 4037 02:32:22,400 --> 02:32:23,468 MORBRBCCRETATA BUTAVE A LOT 4038 02:32:23,468 --> 02:32:25,169 OF BLEEDININININHE O.R..ROBABLY 4039 02:32:25,169 --> 02:32:29,540 BEFOREHAND ANDHEIR SURGICAL 4040 02:32:29,540 --> 02:32:30,842 TEAM ISN'T PREPARED. 4041 02:32:30,842 --> 02:32:33,811 SO SHE WENT OVER HERE, THINK WE 4042 02:32:33,811 --> 02:32:37,882 KNOW ABOBO HAVING A C CTER OF 4043 02:32:37,882 --> 02:32:44,122 ITAL COMPONENTS OF YOURAT ARE TE 4044 02:32:44,122 --> 02:32:45,657 ACCRETA CENTER,R, NICE R REARCH 4045 02:32:45,657 --> 02:32:46,958 SHOWNN IMPLEMENTING AN ACCRETA 4046 02:32:46,958 --> 02:32:48,826 CENTER AND HAVING STANDARDIZED 4047 02:32:48,826 --> 02:32:49,827 CARE IS GOING T T DECREASE 4048 02:32:49,827 --> 02:32:51,696 MORBIDITY.Y. 4049 02:32:51,696 --> 02:32:54,432 ANANTHEN T TS IDEA THAT, AGAGA, 4050 02:32:54,432 --> 02:32:56,734 NOT SO MUCH TO THOSE OF US S O 4051 02:32:56,734 --> 02:32:58,169 ARE RUNUNNGCCCCTATA CENTERSRS BT 4052 02:32:58,169 --> 02:33:00,238 TO PEOEOE IN OUR GENERER 4053 02:33:00,238 --> 02:33:01,039 COMMUNITY, W W W THEY SHOULD BE 4054 02:33:01,039 --> 02:33:02,140 DOINGGGN THEHEPEPE UP A CASAS 4055 02:33:02,140 --> 02:33:04,342 AND THEY SEE SOMETHIHIHAT 4056 02:33:04,342 --> 02:33:06,177 LOOKS BAD A A HOPEFULUL 4057 02:33:06,177 --> 02:33:07,412 SOMETHINGGIKE THIS ISISETTING 4058 02:33:07,412 --> 02:33:08,713 PICKCK UP AHEAD OF TIME BUT 4059 02:33:08,713 --> 02:33:09,380 THEY'RE NOT ALWAYS. 4060 02:33:09,380 --> 02:33:10,782 ANDD THAT'S THE THING WE TEACH 4061 02:33:10,782 --> 02:33:12,250 OUR RESIDENEN, IS HOW DO YOU 4062 02:33:12,250 --> 02:33:14,852 THINK ABOUTHIS IF YOU'RE IN 4063 02:33:14,852 --> 02:33:20,591 IT OKAY TOLOSE THE P PIENTHWH IS 4064 02:33:20,591 --> 02:33:21,125 BACK UP? 4065 02:33:21,125 --> 02:33:22,326 HOW DODO YOU T TNSFER? 4066 02:33:22,326 --> 02:33:27,799 THIS I IA THAT EVEN IF YOU'REE 4067 02:33:27,799 --> 02:33:28,566 NOT AN ACCRETA C CTER YOUOU NEED 4068 02:33:28,566 --> 02:33:30,234 TO HAVE A PROTOCOL OF WHAT 4069 02:33:30,234 --> 02:33:32,570 RE GOING TO DO I IN PATIENTNTNT 4070 02:33:32,570 --> 02:33:35,807 LIKE THIS. 4071 02:33:35,807 --> 02:33:40,344 HOWO M MAGE UNANTICIPATEDKLIST N 4072 02:33:40,344 --> 02:33:40,611 ACCRETET. 4073 02:33:40,611 --> 02:33:45,450 IT GOT O O THERE TOHE 4074 02:33:45,450 --> 02:33:46,084 Ms -- TEMPORARY OBSTETRICIAN 4075 02:33:46,084 --> 02:33:47,952 O MIMIT RUN INTOO T TS 4076 02:33:47,952 --> 02:33:50,154 SITUATION, PROBABLY C CAVE A 4077 02:33:50,154 --> 02:33:53,424 MUCH BIGGER -- IMPORTANT T TNGS 4078 02:33:53,424 --> 02:34:01,699 HAVEVE P P PCOLS FOR ALL CENTERE 4079 02:34:01,699 --> 02:34:04,035 EMERGENCIES AND WE DON'T EVEN 4080 02:34:04,035 --> 02:34:05,002 SAY EMERGENCY, W W CALL IT 4081 02:34:05,002 --> 02:34:05,636 VARIANCE. 4082 02:34:05,636 --> 02:34:07,638 EVERY TIME SOMETHING I NOT 4083 02:34:07,638 --> 02:34:09,440 WITHIN COMPLETELY N NMAL ON OUR 4084 02:34:09,440 --> 02:34:11,909 UNIT, THERE I IS AN ACTIVATIOIO 4085 02:34:11,909 --> 02:34:13,111 SYSTEM AND IT RAMAM UP. 4086 02:34:13,111 --> 02:34:14,979 SO WE STATA ATT LEVEL ONE WHEN 4087 02:34:14,979 --> 02:34:16,114 THE BLOOD PRESSUSU IS HIGH, , 4088 02:34:16,114 --> 02:34:16,881 WHEN THERE'S BLEEDINGG THAT'S 4089 02:34:16,881 --> 02:34:19,050 MORE THAN EXPECTED, AND GET INTO 4090 02:34:19,050 --> 02:34:21,052 A STSTE THREE WHERE WE'RE 4091 02:34:21,052 --> 02:34:22,820 CALLING IN EXTRA SURGEONS. 4092 02:34:22,820 --> 02:34:24,555 BUT THIS IDEA OF CARE MODELEL 4093 02:34:24,555 --> 02:34:27,525 THAT ARE TAILORED T T YOUR 4094 02:34:27,525 --> 02:34:29,660 NTER, , YOUR RESOURCES, TO 4095 02:34:29,660 --> 02:34:30,928 THE TYPES OFF PATIENTS THAHAHAOU 4096 02:34:30,928 --> 02:34:32,463 SEE, AND KNONONG WHAT THOSE 4097 02:34:32,463 --> 02:34:34,866 RESOURCESSRE AND WHO W W YOU CAN 4098 02:34:34,866 --> 02:34:36,667 CALL. 4099 02:34:36,667 --> 02:34:40,171 THE HEMORRHAGE CART IS ALL 4100 02:34:40,171 --> 02:34:45,209 HOSPITALSS THAT DO -- OBSTETRICS 4101 02:34:45,209 --> 02:34:45,543 SHSHLD H HE. 4102 02:34:45,543 --> 02:34:47,645 EASY TOO PUT ATOCOL ON PAPER, 4103 02:34:47,645 --> 02:34:48,846 TEACHING EVERYBODY IN YOUR 4104 02:34:48,846 --> 02:34:52,683 COMMUNITY TO IDENTNTY AND REFER 4105 02:34:52,683 --> 02:34:55,386 WHOLE DIFFERENT BALL G GE A A AE 4106 02:34:55,386 --> 02:34:56,487 CONTINUOUSLY WORK O O THAT. 4107 02:34:56,487 --> 02:34:57,655 AND THEN SIMULATION. 4108 02:34:57,655 --> 02:34:59,056 THE ANESTHESIA TEAMS DOO A 4109 02:34:59,056 --> 02:34:59,490 WONDERFUL JOB. 4110 02:34:59,490 --> 02:35:03,161 THEY RU RUN THE SIMULATION IN OR 4111 02:35:03,161 --> 02:35:03,494 HOSPITALAL 4112 02:35:03,494 --> 02:35:08,299 SHE'S SHOWING EXAMPLES HERE, 4113 02:35:08,299 --> 02:35:12,436 RESOURCES TOGEGEERERER H HPNY 4114 02:35:12,436 --> 02:35:17,275 CRETA SINCE IT'S A HIGH IMPACAC 4115 02:35:17,275 --> 02:35:19,777 BUT RELATIVEVEVEOWOW FREREENCY 4116 02:35:19,777 --> 02:35:21,145 EVEVT. 4117 02:35:21,145 --> 02:35:24,215 AND I R R RY APPRECIATE THATT SE 4118 02:35:24,215 --> 02:35:26,083 EMPHASIZED HERE, YOU KNOW, IT'S 4119 02:35:26,083 --> 02:35:27,819 NOT A SPECICIC ANESTHESIA 4120 02:35:27,819 --> 02:35:31,923 QUESTITI BUT UNDERSTSTDING HOW 4121 02:35:31,923 --> 02:35:34,225 IDENTIFY, REFER, M MAGE FROM 4122 02:35:34,225 --> 02:35:35,626 WHATEVER SETTINGNG PERSONNS IN, 4123 02:35:35,626 --> 02:35:40,364 AND THAT'S GOING TO IMPACT THE 4124 02:35:40,364 --> 02:35:41,999 OBSTETRICIANS AS WELL AS THE 4125 02:35:41,999 --> 02:35:43,968 ANESESESLOLOSTS, HAVINGG 4126 02:35:43,968 --> 02:35:45,403 BACKUP,,THER ANESTHESIA 4127 02:35:45,403 --> 02:35:46,103 PROVIDERS WHO ARE IN SMALLERER 4128 02:35:46,103 --> 02:35:48,506 CECEERS WITH THE SURPRISE 4129 02:35:48,506 --> 02:35:49,574 ACCRETA,A, JUSUS AS IMPORTANT TO 4130 02:35:49,574 --> 02:35:51,475 HAVE THOSE PROTOCOLS I PLACE 4131 02:35:51,475 --> 02:35:52,476 AND PROVIDE SUPPORT. 4132 02:35:52,476 --> 02:35:54,645 THEN IMPORTANTLY, SHEHE HADAD TE 4133 02:35:54,645 --> 02:35:55,446 WHOLE SECTION HERE E OUT THE 4134 02:35:55,446 --> 02:35:58,916 CERTAINLY -- HAS EVOLVED OVER 4135 02:35:58,916 --> 02:35:59,383 THE YEARS.. 4136 02:35:59,383 --> 02:36:05,189 'S A BIGIG TEAM, AND L LTLE 4137 02:36:05,189 --> 02:36:05,957 CONTROVEVEIAL 1 1YEARS AGO, 4138 02:36:05,957 --> 02:36:09,026 MAYBE NOT AT C CTROVERSIAL NOW 4139 02:36:09,026 --> 02:36:11,095 IS DO YOU DO NEWERER AXIXIXI 4140 02:36:11,095 --> 02:36:13,431 ANESTHESIA AT ALL, AND I WANT TO 4141 02:36:13,431 --> 02:36:16,067 SAYAYBE 10 OR 15 YEARSGO, 4142 02:36:16,067 --> 02:36:22,506 NEURAXIAL L ESTHESIA FOR SOMEONE 4143 02:36:22,506 --> 02:36:25,710 WITH PAS O OMORE SEVERER P P. 4144 02:36:25,710 --> 02:36:27,044 IN GENERAL ANESTHESIA, OBVIOUSLY 4145 02:36:27,044 --> 02:36:28,212 E AIRWAY ISS SECURUR A ATHE 4146 02:36:28,212 --> 02:36:31,449 YOUVOIDHEYPOTOTSION THAT 4147 02:36:31,449 --> 02:36:35,653 COMESITH SYMPATHECTOMY. 4148 02:36:35,653 --> 02:36:38,256 IF YOU'R'RRURUING IT WITHHH AN 4149 02:36:38,256 --> 02:36:39,457 IDURAL, THE PATATNTNTS GOING 4150 02:36:39,457 --> 02:36:42,293 TO HAVE HYPERTENSION. 4151 02:36:42,293 --> 02:36:48,466 OFESUSCITATION, AND AVOID VALIUM 4152 02:36:48,466 --> 02:36:50,134 MANAGEMEME OF AN EPIDURAL 4153 02:36:50,134 --> 02:36:55,072 CATHETER INN A PATIENT WHOAY BE 4154 02:36:55,072 --> 02:37:01,212 SIGNIFICICTLY COAGULOLOTHIC. 4155 02:37:01,212 --> 02:37:04,048 EVEVYBODY HAS PATIENTS -- WEE 4156 02:37:04,048 --> 02:37:08,619 OWOW ACCRETA PATIENTS WANT TO BE 4157 02:37:08,619 --> 02:37:09,720 AWAY. 4158 02:37:09,720 --> 02:37:10,921 PATITITS WHO REMEMN AWAKE 4159 02:37:10,921 --> 02:37:12,957 ROROH T TIR CASE MAYE 4160 02:37:12,957 --> 02:37:15,793 QUICKER TO BONONWITH THEIR 4161 02:37:15,793 --> 02:37:17,295 BABIBI. 4162 02:37:17,295 --> 02:37:18,929 - -WHOSE BABIES ACTUAUAY STAYY 4163 02:37:18,929 --> 02:37:20,598 IN THE IR F F THE ENTIRE JOURNEY 4164 02:37:20,598 --> 02:37:23,034 OF THE PAS CASE AND THERE'S MORE 4165 02:37:23,034 --> 02:37:25,303 BONDININGOGOG ON WITH T T 4166 02:37:25,303 --> 02:37:26,203 PARENTS AT THAT TIME. 4167 02:37:26,203 --> 02:37:28,172 YOU AVOID A VERY IMPORTANT TOPIC 4168 02:37:28,172 --> 02:37:34,111 FAILEDED INTUBATIONN A A 4169 02:37:34,111 --> 02:37:35,980 ASPIRATION. 4170 02:37:35,980 --> 02:37:37,715 WHATAT DOES DO TOO AIENT BEINGNG 4171 02:37:37,715 --> 02:37:39,450 AWAKE FOR AURGERYRYIKE THAT 4172 02:37:39,450 --> 02:37:41,385 THAT CAN BEHAT CRITICAL.L.L. 4173 02:37:41,385 --> 02:37:45,556 AND THENVOIDINGGG HER LONG 4174 02:37:45,556 --> 02:37:48,159 POSTPARTUM VENTILATION AND 4175 02:37:48,159 --> 02:37:51,662 IS I I I SUMMARYHAT S OUR OB 4176 02:37:51,662 --> 02:37:58,602 ABOUT USE OF GENERAL VERSUSUTUE 4177 02:37:58,602 --> 02:37:59,270 NEURAXIAL ANESTHESIA. 4178 02:37:59,270 --> 02:38:01,005 IF YOUOUOOK HE IT PUBLICATION 4179 02:38:01,005 --> 02:38:08,479 LOOK ATT THE PUBLICATIONTES, T . 4180 02:38:08,479 --> 02:38:11,816 PRIMARY INTERACTION ANESTHESIA 4181 02:38:11,816 --> 02:38:20,291 IS NOT I A M MAJORITITOFOFHE CA. 4182 02:38:20,291 --> 02:38:22,760 AT OUR CENTER, 73% WHICH WAS AT 4183 02:38:22,760 --> 02:38:25,663 THE HIGH END. 4184 02:38:25,663 --> 02:38:27,098 'S NOW DOWN TOUT --- SHEHE 4185 02:38:27,098 --> 02:38:30,067 MAY KNOW BETTER -- 1 1R L L L 4186 02:38:30,067 --> 02:38:32,269 SO JUST TOO DETAIL HERE, W 4187 02:38:32,269 --> 02:38:34,338 PUBLISHED THISTUTU ABOUTSING 4188 02:38:34,338 --> 02:38:35,373 NEWER AXIAL ANESTHESIA. 4189 02:38:35,373 --> 02:38:39,009 IS AN IMPORTANTNT RESEARCH POIN, 4190 02:38:39,009 --> 02:38:42,012 PATATATSS WITH SUSPEPEED PASAS 4191 02:38:42,012 --> 02:38:44,382 FROM 1997 TO 2015. 4192 02:38:44,382 --> 02:38:46,083 I REALLY WANT TO EMPHASISI THAHA 4193 02:38:46,083 --> 02:38:46,984 BECAUSE WHEN W WRE DOINGNG 4194 02:38:46,984 --> 02:38:49,019 REREARCH ON P PNNING AND 4195 02:38:49,019 --> 02:38:50,588 EXECUTION OF C CES, WE HAVE TO 4196 02:38:50,588 --> 02:38:52,923 TALKBOUT S SPECTED PAS, NOT 4197 02:38:52,923 --> 02:38:54,125 NFIRMEDDAS. 4198 02:38:54,125 --> 02:38:55,493 DO NOT H HE A PATATLOGY 4199 02:38:55,493 --> 02:38:58,629 REPORT WHEN W WRE PLANNING OUR 4200 02:38:58,629 --> 02:38:59,563 PATIENT'S SURGERY. 4201 02:38:59,563 --> 02:39:00,765 IT'S IMPMPTANT TO T TNKNK ABOUT, 4202 02:39:00,765 --> 02:39:03,734 BECAUSE H HING S SE NON-ACCRETAS 4203 02:39:03,734 --> 02:39:05,136 IN THERE IS GOING TO MAKE 4204 02:39:05,136 --> 02:39:08,906 GOING G NTNTDUCE NEW MORBIBITYS 4205 02:39:08,906 --> 02:39:10,107 TORAISISS. 4206 02:39:10,107 --> 02:39:11,542 IF P PIENTS ARE SUSPECTED OF PAS 4207 02:39:11,542 --> 02:39:12,777 AND IT'S A FALSE POSOSIVE 4208 02:39:12,777 --> 02:39:17,148 REEN, THEY'R GOING TOAVEE A 4209 02:39:17,148 --> 02:39:18,149 LATETETETERM DELIVERY 4210 02:39:18,149 --> 02:39:19,116 POTENTIAIAY AND COMPLETELY 4211 02:39:19,116 --> 02:39:20,184 DIFFERERT ORIENTATION OF THEIR 4212 02:39:20,184 --> 02:39:20,584 ININSION. 4213 02:39:20,584 --> 02:39:22,553 THEY MAY HAVE A DIFFERENT PERSON 4214 02:39:22,553 --> 02:39:23,988 ING THEHEHE SURGERYRY 4215 02:39:23,988 --> 02:39:26,157 RHAPS THERE'S SOME WHOHO HAVE A 4216 02:39:26,157 --> 02:39:27,792 HYSTERERTOMY BASED ONNNUSPICION 4217 02:39:27,792 --> 02:39:29,960 D DON'T HAVAV P P CONFIRMRM ON 4218 02:39:29,960 --> 02:39:30,828 THEIR P P PLOGY. 4219 02:39:30,828 --> 02:39:31,996 SOSOEALLY IMPORTATATAHEN WE 4220 02:39:31,996 --> 02:39:32,630 THINK ABOUT RESEARCH 4221 02:39:32,630 --> 02:39:33,597 SPECIFICALLY ON SURGIGIL 4222 02:39:33,597 --> 02:39:34,598 TECHNIQUE. 4223 02:39:34,598 --> 02:39:36,567 BUT IT WAS ALL PATIENTSSHO WERE 4224 02:39:36,567 --> 02:39:42,406 THRESHOLDS FOR SUSPICION ANDLOW 4225 02:39:42,406 --> 02:39:44,074 LOOKED ATTHE MODE O ANESTHESIA 4226 02:39:44,074 --> 02:39:49,480 MORBIDITY BETWEEN STRAIGHT 4227 02:39:49,480 --> 02:39:51,248 NENEAXIAL ORRR PRIMARY AND GENEL 4228 02:39:51,248 --> 02:39:52,082 THESIA. 4229 02:39:52,082 --> 02:39:53,384 THIS WAS OUR F FW CHART. 4230 02:39:53,384 --> 02:39:57,888 95% OF THE PATIENTNT HAD PRIMARY 4231 02:39:57,888 --> 02:39:58,656 NEURAXIAL ANESTHESIAIA 4232 02:39:58,656 --> 02:40:00,624 RATE HYSYSRECTOMOM WAS 4233 02:40:00,624 --> 02:40:02,092 RELALAVELY LOW A AT 62% BOTOT2% 4234 02:40:02,092 --> 02:40:04,929 BECAUSE WE INCLUDEDDLL 4235 02:40:04,929 --> 02:40:08,899 SUSPICION EVEN MILD SUSPICION 4236 02:40:08,899 --> 02:40:10,634 GOING BACK TO THE EARAR 2000s. 4237 02:40:10,634 --> 02:40:15,906 D T T T 12% HAVEE ANESTHESIA. 4238 02:40:15,906 --> 02:40:18,142 WHWH IT WAS H HTERECTOMY, IT WAS 4239 02:40:18,142 --> 02:40:18,309 21%. 4240 02:40:18,309 --> 02:40:19,109 AGAIN, THAT'S P PBABLYY LOWER 4241 02:40:19,109 --> 02:40:19,443 NOW. 4242 02:40:19,443 --> 02:40:21,412 AND THROUGHOUTMERGENEN CASES, 4243 02:40:21,412 --> 02:40:23,080 THESE WERE ALL PATIENTS WHO W WE 4244 02:40:23,080 --> 02:40:24,748 SPECTED AND HAD A NONONMERGENT 4245 02:40:24,748 --> 02:40:30,321 SO THE BOTTOM LINEAS, WE 4246 02:40:30,321 --> 02:40:32,323 COULDN'T CARE MORBIDITY OUTCOMES 4247 02:40:32,323 --> 02:40:34,425 BETWEEN THE GENERAL AND 4248 02:40:34,425 --> 02:40:36,494 NEURAXIAL B BAUSESE THE PATIENTS 4249 02:40:36,494 --> 02:40:38,329 WERERE TOO DISSIMILAR TO DO THA, 4250 02:40:38,329 --> 02:40:39,396 AND BEBEUSE THE RATE OF GENERAL 4251 02:40:39,396 --> 02:40:40,764 ANESTHESIA WASOO LOW, B B B IT 4252 02:40:40,764 --> 02:40:42,700 WAS A FAIRLY NOVEL, BUT IT 4253 02:40:42,700 --> 02:40:43,367 SHOWED WE COULD PUT PATIENTNT 4254 02:40:43,367 --> 02:40:44,602 THROUGH AN E EIRE PRORODURE 4255 02:40:44,602 --> 02:40:47,104 DER NEURAXIXI ANENEHEHEHE AND 4256 02:40:47,104 --> 02:40:48,472 THEYEY COULD GET THROUGH SAFELY. 4257 02:40:48,472 --> 02:40:50,541 I W WL SAY J JT THAT STATEMENT 4258 02:40:50,541 --> 02:40:52,176 ALONE GENERATED A A A LOT OF HAE 4259 02:40:52,176 --> 02:40:54,278 MAIL BACKK IN 2015. 4260 02:40:54,278 --> 02:40:56,947 LOTORE NOW.ELE ARE ACCEPTEDT A 4261 02:40:56,947 --> 02:40:59,316 ALTHOUGH I'D SAY PROBABLYY D 4262 02:40:59,316 --> 02:41:00,784 CENTERERCONVERT TO GENERAL 4263 02:41:00,784 --> 02:41:01,685 ANESTHESIA AT THE TIMEF 4264 02:41:01,685 --> 02:41:02,553 HYSTERECTOMY, AND I T TNK IT'S 4265 02:41:02,553 --> 02:41:03,654 ALSO REALLY IMPORTANTNT TO 4266 02:41:03,654 --> 02:41:08,192 EMPHPHIZE THAT WE HADADF THE 4267 02:41:08,192 --> 02:41:08,859 CONVERSIONS THREE PATATNTS WITIT 4268 02:41:08,859 --> 02:41:09,827 A DIFFICULT AIRWAY. 4269 02:41:09,827 --> 02:41:12,162 TOTOMPHASIZE.LLY IMPORTANT POINT 4270 02:41:12,162 --> 02:41:14,498 WE'RE WORKING AT A CENTER WHERE 4271 02:41:14,498 --> 02:41:17,968 WE HAVE BEEN MANY 4272 02:41:17,968 --> 02:41:18,869 ANESTHESIOLOGISTS IN THE ROOM 4273 02:41:18,869 --> 02:41:20,337 WHEN THERE'S AN EMERGENCYCYN 4274 02:41:20,337 --> 02:41:22,640 IF Y Y HAVE ONE OR TWO AND A 4275 02:41:22,640 --> 02:41:24,608 PATIENT HAS A UNSECURED AIRWAY 4276 02:41:24,608 --> 02:41:27,545 ANDD MASSIVE HEMORRHAGAG WITH AN 4277 02:41:27,545 --> 02:41:29,380 ACCRETA, THEN IT NOT SAFE FOR 4278 02:41:29,380 --> 02:41:31,682 THEM TO HAVE AN UNSECURED 4279 02:41:31,682 --> 02:41:34,518 AIRWAY, SOHEY MAY N ND G GERERER 4280 02:41:34,518 --> 02:41:35,920 ANESTHTHIA UP FRONT. 4281 02:41:35,920 --> 02:41:36,787 I WILL MOVE ON QUIUILY, 4282 02:41:36,787 --> 02:41:41,959 RUNNING OUT OF TIME. 4283 02:41:41,959 --> 02:41:42,560 ANOTHER VERY IMPORTANT POINT, 4284 02:41:42,560 --> 02:41:43,594 PAPAENT EXPERIENCE, WHICH I 4285 02:41:43,594 --> 02:41:45,496 NTIONED, WE CAN D W T TSESE 4286 02:41:45,496 --> 02:41:47,498 PROCEDURES WITH THE PATIENT 4287 02:41:47,498 --> 02:41:49,266 DER N NRAXIAL ANESTSTSIA. 4288 02:41:49,266 --> 02:41:50,467 WERYO HELP PATIENTS 4289 02:41:50,467 --> 02:41:51,769 UNUNRSTAND THATHEY W WL HAVAV 4290 02:41:51,769 --> 02:41:54,572 CONTROL OVER THEIREVEV OF 4291 02:41:54,572 --> 02:41:56,740 AWARENESS, W WN PATIENTS HEAR,R, 4292 02:41:56,740 --> 02:41:58,709 THEY'REOT UNDERGOING GENERAL 4293 02:41:58,709 --> 02:41:59,343 ANESTHESIA. 4294 02:41:59,343 --> 02:42:05,416 SOME ARE AFRAIDDF THATT, OF 4295 02:42:05,416 --> 02:42:07,518 BEING PUT TO SLEEP IN A A 4296 02:42:07,518 --> 02:42:08,152 POPONTIAL LIFEEATENING 4297 02:42:08,152 --> 02:42:09,520 SITUATION. 4298 02:42:09,520 --> 02:42:10,821 OTHERS ARE VERER CONCERNED ABOUT 4299 02:42:10,821 --> 02:42:13,190 BEING AWAKE IN A PROCECERE 4300 02:42:13,190 --> 02:42:16,927 AT'S HIGH ACUTITI. 4301 02:42:16,927 --> 02:42:19,663 MANY OF OUR P PIENTSS D DO UNDEO 4302 02:42:19,663 --> 02:42:20,931 SOSO LEVEL OF SEDEDEDN DURING 4303 02:42:20,931 --> 02:42:22,032 THEURURUR. 4304 02:42:22,032 --> 02:42:24,635 TO THE POINT W WE'RE PROBABLY OL 4305 02:42:24,635 --> 02:42:26,270 DOING SOMOM GENERAL ANESTHESISI 4306 02:42:26,270 --> 02:42:27,771 WITH A NATURAL AIRWAY. 4307 02:42:27,771 --> 02:42:28,939 THERE'S AITTLE BIT OF RESEARCH 4308 02:42:28,939 --> 02:42:34,144 OUT THEREBOUT WHAT ARE T T 4309 02:42:34,144 --> 02:42:38,616 PATIENTSN IMAWL TAIAIVEE, A A 4310 02:42:38,616 --> 02:42:41,585 PROJECTSTSAVE D DCRIBIBEEING 4311 02:42:41,585 --> 02:42:44,321 VERY MORBID S SUATIONS A AUND 4312 02:42:44,321 --> 02:42:45,723 SEEIEI BLOOD HANGING, REALIZING 4313 02:42:45,723 --> 02:42:50,828 SOSO THINK THERE'S A LOTOT OFY 4314 02:42:50,828 --> 02:42:51,362 SEARCHCHPCOMING AND IN 4315 02:42:51,362 --> 02:42:52,396 PROGRESS JUSUS T T HELEL UNDERSD 4316 02:42:52,396 --> 02:42:53,631 WHAT'S THE R RHTHING TO DO FOROR 4317 02:42:53,631 --> 02:42:54,898 THESE PATIENTS FROM THAT 4318 02:42:54,898 --> 02:42:55,199 PERSPECTIVE. 4319 02:42:55,199 --> 02:42:56,967 HIHILIGHTED MANY POINTS HERE 4320 02:42:56,967 --> 02:43:00,504 THAT AREUST A FEW OF 4321 02:43:00,504 --> 02:43:01,105 ANESTHESIA-RELELED T T TS THAT 4322 02:43:01,105 --> 02:43:02,906 NEEDED RESEARCH. 4323 02:43:02,906 --> 02:43:04,241 IIHINK W WE HAVE A REALLY 4324 02:43:04,241 --> 02:43:06,777 NDERERL GROUPPP OF OBSTETRIC 4325 02:43:06,777 --> 02:43:07,878 ANESTHESIOIOIOSTS WHO ARE VERY 4326 02:43:07,878 --> 02:43:08,912 INTERESTED INN THIS AND SPEND A 4327 02:43:08,912 --> 02:43:13,550 VERY MOTIVATED TO DO RESEARCHHDE 4328 02:43:13,550 --> 02:43:14,618 AND I'M HAPPY THATE'RE KEEPIPI 4329 02:43:14,618 --> 02:43:15,919 THEM IN MIND. 4330 02:43:15,919 --> 02:43:17,788 SO SHE IS ONLINE, SHE WILL BE 4331 02:43:17,788 --> 02:43:22,126 ASKUEUEIONSNS AND I'LLL ANSWER - 4332 02:43:22,126 --> 02:43:25,229 SHE CANAN ANSWER T TOUGH ME, BUT 4333 02:43:25,229 --> 02:43:26,964 THANK YOUOUOR YOUR ATTTTTIONND 4334 02:43:26,964 --> 02:43:34,872 R LETTING ME SPEPE. 4335 02:43:34,872 --> 02:43:44,448 ENDOVASCULAR INTERVENTIONNN TO 4336 02:43:44,448 --> 02:43:49,820 PREVENT OR TRERE HEMORORAGE. 4337 02:43:49,820 --> 02:43:50,487 >> GOODD MORNINGNG 4338 02:43:50,487 --> 02:43:51,755 IT'S A DELIGHT T T T B HERE. 4339 02:43:51,755 --> 02:43:53,957 I REALLYPPRECIATE THE FACTT 4340 02:43:53,957 --> 02:43:58,996 THAT THIS I ISOINGN. 4341 02:43:58,996 --> 02:44:00,097 AND PART OF THE REASON IS 4342 02:44:00,097 --> 02:44:02,399 BECAUSE I'M O O, A A IAD 4343 02:44:02,399 --> 02:44:04,068 FORGOTTEN HOW ACTUALLY OLD I 4344 02:44:04,068 --> 02:44:04,501 S. 4345 02:44:04,501 --> 02:44:07,771 I WENT BACKOOKING AT MYY FIRST 4346 02:44:07,771 --> 02:44:10,174 SLIDID ON THIS, AND REALILID 4347 02:44:10,174 --> 02:44:11,842 THAT WEE DEVELOPED A 4348 02:44:11,842 --> 02:44:14,044 MULTIDIDCIPLINARARPROTOCOLNNN 4349 02:44:14,044 --> 02:44:17,848 1919, SO 3 3YEARS AGOGOHEHE WE 4350 02:44:17,848 --> 02:44:19,817 HAD D D ENTS THAT HAD SUSUSCIOUS 4351 02:44:19,817 --> 02:44:24,655 ULTRASOUOUNDININNGS, AN MRI AND 4352 02:44:24,655 --> 02:44:31,061 PLACEMENT OF BILATERAL ILIACC 4353 02:44:31,061 --> 02:44:32,730 ARTERY BALLOON CATATTERS, WHIHI 4354 02:44:32,730 --> 02:44:36,066 STARTING TO BE DONE AT VARIOUS 4355 02:44:36,066 --> 02:44:36,734 CENTERS BOTH IN THE U.S. AND 4356 02:44:36,734 --> 02:44:37,101 INTERNATIONANAY. 4357 02:44:37,101 --> 02:44:40,471 SO WE LOOKED AT THIS BACKHEN 4358 02:44:40,471 --> 02:44:43,340 AND ACTUALLY IN 2001, WEUT 4359 02:44:43,340 --> 02:44:44,775 TOTOTHER THIS DATA. 4360 02:44:44,775 --> 02:44:49,279 THISIS WAS JUST THE ULTRASOUNDS, 4361 02:44:49,279 --> 02:44:51,849 AND T T MRIs WHICH WERE VERY 4362 02:44:51,849 --> 02:44:53,617 HELPFUL INERMS OF STAGING THE 4363 02:44:53,617 --> 02:44:54,585 PATIENTS, NOT NECESSARILY MAKING 4364 02:44:54,585 --> 02:44:55,652 THE DIAGNOSIS. 4365 02:44:55,652 --> 02:45:03,594 CATHETERS INHE ANGIOLAB AND WENN 4366 02:45:03,594 --> 02:45:04,928 WOULD INFLATE THEALLOONS, MAKE 4367 02:45:04,928 --> 02:45:08,132 SURE THAT THEY WOULD STOP THE 4368 02:45:08,132 --> 02:45:08,799 BLOOD FLOW ANDNDOU'L'L NOTICIC 4369 02:45:08,799 --> 02:45:11,001 THAT THEY'RE IN THE INTERNAL 4370 02:45:11,001 --> 02:45:13,303 ILIACC ARTERERS, NOT T T UTERINE 4371 02:45:13,303 --> 02:45:14,538 TERIES, NOT THE ANTERIOR 4372 02:45:14,538 --> 02:45:16,840 DIVISION, BUT THE INTERNAL I IAC 4373 02:45:16,840 --> 02:45:17,708 ARTERIES. 4374 02:45:17,708 --> 02:45:19,810 WE LOOKED AT OURATIENTNTND WE 4375 02:45:19,810 --> 02:45:22,246 FOUND T TT WE HAD 23 INHE 4376 02:45:22,246 --> 02:45:24,114 CONTROLROUP THAT DIDN'T HAVE 4377 02:45:24,114 --> 02:45:25,849 BALLOONS AND 17 INHEALLOON 4378 02:45:25,849 --> 02:45:26,950 GROUP. 4379 02:45:26,950 --> 02:45:28,952 INTERESTINGLY ENOUGUG AND 4380 02:45:28,952 --> 02:45:31,822 IMPORTANT,T,HIS IS W WRE I THINK 4381 02:45:31,822 --> 02:45:33,690 WE REALLYAVE TO LOOK HARD TOO 4382 02:45:33,690 --> 02:45:37,094 FIGURE T TS DATA O O O IS WE HAD 4383 02:45:37,094 --> 02:45:38,629 22% PERCRETAS I ITHEE CONTROL 4384 02:45:38,629 --> 02:45:43,901 GROUP 94% PERCRCRAS IN THE 4385 02:45:43,901 --> 02:45:44,802 BALLOON CATHETER GROUP. 4386 02:45:44,802 --> 02:45:46,370 D THIS IS ALL M- THESE WER 4387 02:45:46,370 --> 02:45:48,472 ALAL PATATNTS THAT HAD 4388 02:45:48,472 --> 02:45:51,108 HYHYERECECMIES, SO WE HAD 4389 02:45:51,108 --> 02:45:53,043 PATHOLOGIC CONFIRMRMION O O 4390 02:45:53,043 --> 02:45:54,945 WHETHER OR NOT THERE W W A 4391 02:45:54,945 --> 02:45:55,379 PERCRETA. 4392 02:45:55,379 --> 02:45:58,482 13 OF THOSE PATIENTS IN THE 4393 02:45:58,482 --> 02:46:00,184 CONTROL GROUP HAD COMPLEXEX 4394 02:46:00,184 --> 02:46:01,819 PERCRETAS, IN OTHER WORDS, THTHH 4395 02:46:01,819 --> 02:46:04,621 IN T T PELVIHE SIDE WALLS, THEY 4396 02:46:04,621 --> 02:46:07,858 REREN THE C CVIX,ND THIS WAS 4397 02:46:07,858 --> 02:46:10,394 OBVIVISLY ANMPMPTANT THING.. 4398 02:46:10,394 --> 02:46:11,929 E UNFORTUNATE THIHI WAS THAT 4399 02:46:11,929 --> 02:46:15,365 WE DIDN'N' REAEAY FIND T TT WE 4400 02:46:15,365 --> 02:46:19,002 IMPROVED THE BLOOD LOSS, AND 4401 02:46:19,002 --> 02:46:22,172 ALTHOUGH IN FAIRNESS WE H H H A 4402 02:46:22,172 --> 02:46:26,443 MUCH MOROR DIFFICUCU GROUP IN TE 4403 02:46:26,443 --> 02:46:29,346 BALLLLN GROUP,ND WE ALSO 4404 02:46:29,346 --> 02:46:29,980 LEARNENESOMETHING WHICIC W W NOT 4405 02:46:29,980 --> 02:46:31,181 TOTO INFLATEHE BALLOONS 4406 02:46:31,181 --> 02:46:32,182 IMMEDIATELEL W WCHCHCHS WHATT WW 4407 02:46:32,182 --> 02:46:35,018 WERE DOING, INSTETE TO WAIT 4408 02:46:35,018 --> 02:46:36,153 UNTIL THERE WAS EVIDENCE OF 4409 02:46:36,153 --> 02:46:37,888 BLEEDING AND THENNFLALA, WIT 4410 02:46:37,888 --> 02:46:42,192 THE IDEAHAT WE WOULDLD DECREASE 4411 02:46:42,192 --> 02:46:43,026 COLLATERERER FLOW INTO THE 4412 02:46:43,026 --> 02:46:46,997 SURGICAL BED. 4413 02:46:46,997 --> 02:46:53,036 WAS THAT WE HAD MANY FEWERND 4414 02:46:53,036 --> 02:46:54,838 SURGICALAL COMPLPLATIONS IN THE 4415 02:46:54,838 --> 02:46:55,539 BALLOON GROUP, SO THIS WAS AT 4416 02:46:55,539 --> 02:46:57,174 LEAST AN IMPMPTANT THING AND 4417 02:46:57,174 --> 02:47:01,211 MADE US CONTINUEE THIS A A AACH. 4418 02:47:01,211 --> 02:47:08,151 AS I SAID -- BALLOONS U U LATE 4419 02:47:08,151 --> 02:47:09,019 WAS A VERY IMPORTATA PART OF 4420 02:47:09,019 --> 02:47:09,219 THIS. 4421 02:47:09,219 --> 02:47:10,454 NOWHE IMPORORNT THINGNG I TAKE 4422 02:47:10,454 --> 02:47:12,856 AWAY FROM THIHI WHOLE MEETING 4423 02:47:12,856 --> 02:47:14,525 THAT WE'RE HAVING IS REALLY 4424 02:47:14,525 --> 02:47:18,262 KING THE CORRECTIAIAOSIS. 4425 02:47:18,262 --> 02:47:20,330 D IT'S NOT PROBABLY THATTT ALL 4426 02:47:20,330 --> 02:47:23,467 INVAVAVE PL PLACENTASEQUIRE 4427 02:47:23,467 --> 02:47:25,202 TERVENENONAL PROCEDURES, B B 4428 02:47:25,202 --> 02:47:26,904 THE E RE I IASIVE THE PLACENTA, 4429 02:47:26,904 --> 02:47:29,539 THE E RERE AGGRESSIVE THE APPROC 4430 02:47:29,539 --> 02:47:30,073 NEEDS TO BE. 4431 02:47:30,073 --> 02:47:31,708 C CRSE A A WE'E'ALKEDBOUT, 4432 02:47:31,708 --> 02:47:32,976 THTHE PATIENTS REALLY SHOULD BE 4433 02:47:32,976 --> 02:47:34,912 TRIAGED D FACACITIESSHERE 4434 02:47:34,912 --> 02:47:38,882 RI CARE T TM AVAILABLE.INIAN 4435 02:47:38,882 --> 02:47:40,984 SO IN ACCRETAS, IT MAY BE THATT 4436 02:47:40,984 --> 02:47:43,854 THERE'S NOT A NEED FOR 4437 02:47:43,854 --> 02:47:44,388 ININRVENTIONAL RADIOLOGY. 4438 02:47:44,388 --> 02:47:46,123 WE DON'T NEED TO PUT IN BALLOONS 4439 02:47:46,123 --> 02:47:47,524 IN THOHO PATIEIESS OR DO ANYTHIG 4440 02:47:47,524 --> 02:47:48,725 ELSE WITH THEM. 4441 02:47:48,725 --> 02:47:51,495 UNLESSSS THERE'S A PLAN FOR 4442 02:47:51,495 --> 02:47:52,062 CONSERVATIVE MANAGEMENT,T,N 4443 02:47:52,062 --> 02:47:53,497 WHICH CASE YOU'RE GOING TO NEED 4444 02:47:53,497 --> 02:47:55,032 AN INTERVENTIONALADIOIOGIST 4445 02:47:55,032 --> 02:48:01,305 PROBABAB TO D AN EMBOLLIZATION 4446 02:48:01,305 --> 02:48:01,872 AT SOME P P P. 4447 02:48:01,872 --> 02:48:03,407 IN THE PERCRETAS, THERE'S 4448 02:48:03,407 --> 02:48:04,374 VARIETYF DIFFEFENT 4449 02:48:04,374 --> 02:48:05,642 INTERVENTIONAL THINGS THAT CAN 4450 02:48:05,642 --> 02:48:09,146 BE DONE,NCLUDING THE BALLOON 4451 02:48:09,146 --> 02:48:13,850 CATHETERS, YOU CAN DO 4452 02:48:13,850 --> 02:48:15,619 EMBOBOIZATIONLOWING THEHE 4453 02:48:15,619 --> 02:48:17,854 DELIVERYRY Y Y CAN D POST 4454 02:48:17,854 --> 02:48:19,690 SURGICAL EMBOLIZATION, OR YOU 4455 02:48:19,690 --> 02:48:21,558 CAN DO POSOS SURGERY WITH 4456 02:48:21,558 --> 02:48:24,461 CONSERVATIVE MANAGEMENTTT AND TN 4457 02:48:24,461 --> 02:48:34,404 SO W W LOOKED AT OUR D DA LATER 4458 02:48:34,404 --> 02:48:35,505 IN 2017 AND WE DID FIND IN 4459 02:48:35,505 --> 02:48:39,076 PATIENTS WHERE WE PLALALA BALN 4460 02:48:39,076 --> 02:48:40,043 BALLOONS, THAT T FACT T ERE WAS 4461 02:48:40,043 --> 02:48:47,184 S DECREASES I INN PLATELETS ANDD 4462 02:48:47,184 --> 02:48:50,587 ALAL KINDS O O TRANSFUSISI 4463 02:48:50,587 --> 02:48:52,122 REQUIREMENTSTSHAHA THOSE PATIENS 4464 02:48:52,122 --> 02:48:54,658 NEEDED. 4465 02:48:54,658 --> 02:48:57,461 SO W W FELTT THAT THERE WAS 4466 02:48:57,461 --> 02:48:58,562 PROBABLY A GOOD REASONN W WWERE 4467 02:48:58,562 --> 02:48:59,963 DOING THESESESVEN THOUGH IT 4468 02:48:59,963 --> 02:49:00,631 WASNSN PERFECT. 4469 02:49:00,631 --> 02:49:01,932 THERE'S AN I IERESESNG STUDY 4470 02:49:01,932 --> 02:49:07,137 THAT CAMAMAM OUTROM THE - - SYSM 4471 02:49:07,137 --> 02:49:09,006 WHERE THEY TOOK ALLHOSE 4472 02:49:09,006 --> 02:49:14,244 CENTERS THAT ARE DOING PLACENTAA 4473 02:49:14,244 --> 02:49:15,912 OBSTETRICS AND LOOKING AT THE 4474 02:49:15,912 --> 02:49:20,517 PLACENTA PATIENTS, AND FOUND 4475 02:49:20,517 --> 02:49:22,686 THAT THERE'S CENTERSHAT JUST 4476 02:49:22,686 --> 02:49:23,787 WENT DIRECT TO CESAREAN 4477 02:49:23,787 --> 02:49:24,621 HYSTERECTOMY. 4478 02:49:24,621 --> 02:49:25,856 THERERWERERERE PATATNTS THAT DID 4479 02:49:25,856 --> 02:49:30,660 SURGRGAL LIGATION AND THERERE WR 4480 02:49:30,660 --> 02:49:33,397 WHERE T T T D D BALLOONONPLALAS 4481 02:49:33,397 --> 02:49:34,097 OCCLUSION. 4482 02:49:34,097 --> 02:49:35,265 E INTERESTING THING ABOUTUTHIS 4483 02:49:35,265 --> 02:49:36,500 TO ME, AND THIS AGAIN G GS BACK 4484 02:49:36,500 --> 02:49:40,871 TO THE IMPORTANCE OF D YOU N ND 4485 02:49:40,871 --> 02:49:43,240 WITH JUST AN ACCRETETATIENEN 4486 02:49:43,240 --> 02:49:46,009 SO YOU CAN SEE THAT IN THE 4487 02:49:46,009 --> 02:49:48,211 DIRECT HYSTERECTOMY,Y,HOSE 4488 02:49:48,211 --> 02:49:51,214 PATIENTS, 40% OFF THEMAD AN 4489 02:49:51,214 --> 02:49:53,850 ACCRETA, ONLY0% OR 21% HADAD 4490 02:49:53,850 --> 02:49:55,252 PERCRETA.. 4491 02:49:55,252 --> 02:49:56,820 AND IN THE SURURCAL LIGATIOIOIO 4492 02:49:56,820 --> 02:49:58,989 THTHE WASASAS HIGHEHE PERERNTAGF 4493 02:49:58,989 --> 02:50:01,758 PAPAENTS WITHF A PERCRCRA AND 4494 02:50:01,758 --> 02:50:08,498 PATIENTS HAD HER KREEAS.HOSE 4495 02:50:08,498 --> 02:50:09,966 SO IF YOU LOOK AT THE ESTIMATED 4496 02:50:09,966 --> 02:50:13,070 OOD LOSOSITH THE SURGICAL 4497 02:50:13,070 --> 02:50:15,472 LIGATION IT A AOSOS4 LITERS, 4498 02:50:15,472 --> 02:50:21,478 BALLOOT OCCLULUON, 1800, AND SO 4499 02:50:21,478 --> 02:50:28,552 HYSTERECTOMY, ABOUT 2600. 4500 02:50:28,552 --> 02:50:34,257 CREASE IN THE TOTALERTAINLY A 4501 02:50:34,257 --> 02:50:35,025 TRANANUSION REQUIREMENTS IF YOU 4502 02:50:35,025 --> 02:50:37,294 USE THE BALLOLOLO THE OPERATITI 4503 02:50:37,294 --> 02:50:40,130 ROOM TIME WAS LESS, AND T TSESE 4504 02:50:40,130 --> 02:50:41,431 TIENTS HAD BALLOONON OCCLUSION,, 4505 02:50:41,431 --> 02:50:45,302 DID NOT REQUIRECUCU ADMISSION. 4506 02:50:45,302 --> 02:50:49,206 AND ALSO THE ADVERER E ENTS WERE 4507 02:50:49,206 --> 02:50:49,973 SIGNIFICANANY LOWER I INNHAT 4508 02:50:49,973 --> 02:50:53,376 GROUP. 4509 02:50:53,376 --> 02:50:55,045 ANDSE ARE SOME OF THE 4510 02:50:55,045 --> 02:50:58,849 IMPOPOANT BECAUSE THAT'S ONEF AE 4511 02:50:58,849 --> 02:51:00,183 THE T T TSHAT THE PATIENT IS 4512 02:51:00,183 --> 02:51:02,185 GOING TOTOAVE T LIVE WITH 4513 02:51:02,185 --> 02:51:04,020 SOMETIMES, BLADDER INJURY,Y, AND 4514 02:51:04,020 --> 02:51:05,956 AT W W ONES WHERE THEY WEREN'T 4515 02:51:05,956 --> 02:51:07,023 PLANNING ONNININ OUT P PT OF 4516 02:51:07,023 --> 02:51:09,459 THELADDDD, WHIHI DOES 4517 02:51:09,459 --> 02:51:14,364 VIOUOUY OCCCC WITH THE 4518 02:51:14,364 --> 02:51:15,565 ACENTATA PERCRCRAS... 4519 02:51:15,565 --> 02:51:17,200 BUT PROBLEM IS, W WH THE 4520 02:51:17,200 --> 02:51:19,936 BALLOON O OLUSION, THERE ARE 4521 02:51:19,936 --> 02:51:21,238 JUST E ERMOUS NUMBER OFFEPORTSTS 4522 02:51:21,238 --> 02:51:22,205 ON THIS. 4523 02:51:22,205 --> 02:51:24,174 MOSTSTF T TM RETROSPECTIVE. 4524 02:51:24,174 --> 02:51:27,777 MOSTF THEMM USING INTERNAL 4525 02:51:27,777 --> 02:51:29,212 IAC BALLOON CATHETERS BUTOME 4526 02:51:29,212 --> 02:51:30,614 OFOFHEM T TY'VEUT IN THE 4527 02:51:30,614 --> 02:51:31,515 UTERINE ARTERY, SOMETIMES 4528 02:51:31,515 --> 02:51:33,150 THEYEYEY IN THENTERIOR 4529 02:51:33,150 --> 02:51:34,651 DIVISION, S,ET,ET THE THE IN 4530 02:51:34,651 --> 02:51:36,219 E INTERNTLNT ILIAC, SOMETIMES 4531 02:51:36,219 --> 02:51:38,021 'REE USINGSI OCCLUSIONALLOONLOON 4532 02:51:38,021 --> 02:51:39,089 H ARE SOFTALLOONS, 4533 02:51:39,089 --> 02:51:41,491 S THEY'REY UNG 4534 02:51:41,491 --> 02:51:43,026 ANGIOPLASTY BAY OONS WHICHHI RM 4535 02:51:43,026 --> 02:51:47,631 AND THENHEHERE AHE PATIEATS 4536 02:51:47,631 --> 02:51:51,101 GETTINGG AORTIC BALLOON CATHE 4537 02:51:51,101 --> 02:51:51,268 THETTHS. 4538 02:51:51,268 --> 02:51:56,973 BENEFIT POT NTIALLY WITH THEL 4539 02:51:56,973 --> 02:51:58,809 AORTIC BALLOON CATHETERS, 4540 02:51:58,809 --> 02:51:58,842 CA 4541 02:51:58,842 --> 02:52:00,043 E AS I'M GNG TO SHOW 4542 02:52:00,043 --> 02:52:01,244 YOU, THEHE BIG PROBLEM 4543 02:52:01,244 --> 02:52:06,449 RTICULARLY W W THE PERCRETAS 4544 02:52:06,449 --> 02:52:08,852 IS THE FACT THAT YOU HAVE A N 4545 02:52:08,852 --> 02:52:10,053 MASSMASSUNT OF COLLATERALRALOWW 4546 02:52:10,053 --> 02:52:12,255 THAT'S GOING TO EVERY ARYAF 4547 02:52:12,255 --> 02:52:12,589 PLACENTA. 4548 02:52:12,589 --> 02:52:14,524 THIS IS WSRESEOPLEEALLY GET 4549 02:52:14,524 --> 02:52:18,161 INTO TRO TLE WITH THE BLEEDING 4550 02:52:18,161 --> 02:52:20,864 IN THE T PERCRETA PATIENTS. 4551 02:52:20,864 --> 02:52:22,599 SO THERE WAS A NICE STUDY THATT 4552 02:52:22,599 --> 02:52:31,441 YOU KNOW, THE STUDIES LOOKING AT 4553 02:52:31,441 --> 02:52:33,076 PUTTINGN AORTIC BALLOON 4554 02:52:33,076 --> 02:52:33,743 S, AND AHE QSTIOST IST 4555 02:52:33,743 --> 02:52:35,912 WHERE DO YOU PUT PHEM? 4556 02:52:35,912 --> 02:52:38,648 SO THEY ACTUALLY SRTED IN 4557 02:52:38,648 --> 02:52:40,817 THEIR INR ITUTIONIONTING THEM 4558 02:52:40,817 --> 02:52:42,719 JUST B B THE REN R ARTERIEER 4559 02:52:42,719 --> 02:52:43,186 HERE. 4560 02:52:43,186 --> 02:52:46,923 YOU CAN GET COLLATERALS FROMRO E 4561 02:52:46,923 --> 02:52:49,492 SUPESUPE MESENTERICRIRTERY THAT 4562 02:52:49,492 --> 02:52:51,494 ME AROUNDUNNTO THE INF IIOR 4563 02:52:51,494 --> 02:52:56,099 MESENTERIC ARTERYER AND THEN DOD 4564 02:52:56,099 --> 02:52:57,901 THESE COLLATERALS CANANEVELOP 4565 02:52:57,901 --> 02:52:58,468 REALLY QUITE QUICKLY. 4566 02:52:58,468 --> 02:52:59,669 THEYHANGEDNG-NG THEY FND 4567 02:52:59,669 --> 02:53:00,537 THOU THEIR SURGEONGEON WERE SAYG 4568 02:53:00,537 --> 02:53:02,072 THAT THEY WERE STILL HAVING A 4569 02:53:02,072 --> 02:53:05,942 LOT LO TROUBRO WITH BLEEDING, SO 4570 02:53:05,942 --> 02:53:07,544 THEYEY CHANGED TIR TEC TIQUEIQ A 4571 02:53:07,544 --> 02:53:10,647 APUT THE BALLOON DOWNOW JUST 4572 02:53:10,647 --> 02:53:12,716 ABOVE OVE AOR AC BIFURCATION AND 4573 02:53:12,716 --> 02:53:16,519 THAT IMPROVED THEIR OUTCOMES. 4574 02:53:16,519 --> 02:53:22,626 META-ANALYSIS OF A NUMBER OFF 4575 02:53:22,626 --> 02:53:24,561 PATIENTS WITH AORTIC BALLBAN 4576 02:53:24,561 --> 02:53:25,795 CATHCATHETERS, AND AGAIN, YOU YY 4577 02:53:25,795 --> 02:53:27,097 INTOTO REA R PROBLEM LOOKING AT 4578 02:53:27,097 --> 02:53:28,465 THIS INNERMS OF OAT WERE THEY 4579 02:53:28,465 --> 02:53:31,534 TRYING TO DO.. 4580 02:53:31,534 --> 02:53:33,036 SO MOST OFHESE WERE COMING OUT 4581 02:53:33,036 --> 02:53:34,804 OF CHINA, AND THEY WEY REMOVING 4582 02:53:34,804 --> 02:53:37,307 THETH PLACENTA AND SAID THAT THS 4583 02:53:37,307 --> 02:53:39,175 WAS FOR PLACENTANTCCRETARE 4584 02:53:39,175 --> 02:53:41,378 SO THIS MAY BE A WHOLE DIFFERENT 4585 02:53:41,378 --> 02:53:47,217 GROUP OF PATIENTSHAN THEHE 4586 02:53:47,217 --> 02:53:47,984 PATIENTS WTSRE DEALINGITH 4587 02:53:47,984 --> 02:53:54,424 MOSTLY IN IR WHICH WE THE PRO 4588 02:53:54,424 --> 02:53:59,329 KREE TA PIENTS. 4589 02:53:59,329 --> 02:54:00,530 PERCRETA PATIENTS. 4590 02:54:00,530 --> 02:54:01,498 THE FIRST GROUPROSROHE ONE O WIH 4591 02:54:01,498 --> 02:54:04,067 THE HIGH BALLOONLO THE SECOND 4592 02:54:04,067 --> 02:54:05,402 WAS THE LOWER BAL BONS. 4593 02:54:05,402 --> 02:54:10,540 FAIRLY HIGH PERCENTAGNT OFA 4594 02:54:10,540 --> 02:54:12,142 RETASS AND INC ITAS IN BOTH 4595 02:54:12,142 --> 02:54:13,143 OFOF THOSE,ARTICULA TY IN THE 4596 02:54:13,143 --> 02:54:17,647 SECOND ONE, AND THEY FOUND TT 4597 02:54:17,647 --> 02:54:20,483 THEIR BODOD LOSSOSS WAS W ABO A- 4598 02:54:20,483 --> 02:54:23,320 ALMOST A 50% DECREASE IN TERMS 4599 02:54:23,320 --> 02:54:24,854 OF ESTIMATED BLOOD LOS L 4600 02:54:24,854 --> 02:54:26,356 DEPENDING ON WRE THEY PUT PUTHE 4601 02:54:26,356 --> 02:54:27,123 BALLOON. 4602 02:54:27,123 --> 02:54:28,425 SO CLEARLY,LYHIS IS REALLY GOING 4603 02:54:28,425 --> 02:54:31,928 TO BE IMPORTANT IN TERMS OF I I 4604 02:54:31,928 --> 02:54:38,068 YOU'YO GOINGOO USE A BALLOON 4605 02:54:38,068 --> 02:54:39,035 CATHETER, WHERE YOU'RE GOING TO 4606 02:54:39,035 --> 02:54:39,336 PUIT. 4607 02:54:39,336 --> 02:54:43,840 FUSIONON IN 22% AND 15% OF THEIH 4608 02:54:43,840 --> 02:54:50,080 PATIENTS. 4609 02:54:50,080 --> 02:54:53,183 SO MY BOTTBO LINE ON THIS ISOW 4610 02:54:53,183 --> 02:54:58,288 CRITCRAL THE T COLLATERAL PATHWS 4611 02:54:58,288 --> 02:54:59,556 ARE FOR PATIENTIEWITHTH PERCRERS 4612 02:54:59,556 --> 02:55:01,391 OR IRETAS. 4613 02:55:01,391 --> 02:55:02,992 TNK THIS IS PROBABLY NOT 4614 02:55:02,992 --> 02:55:04,294 GOING T BE ASASELEVANEV FOR 4615 02:55:04,294 --> 02:55:06,596 CRETA.TS WHO SIMPLY HAD AN 4616 02:55:06,596 --> 02:55:08,565 WHAT YOUANT TTDO IS YOU WANT 4617 02:55:08,565 --> 02:55:09,966 TO TREATAT ALL OF THOSESE 4618 02:55:09,966 --> 02:55:11,167 ATERALS, SO HERE IS A 4619 02:55:11,167 --> 02:55:12,268 PATIENT, AT, I'M GOINGO TALKK 4620 02:55:12,268 --> 02:55:14,838 ABOUT WHAT WE'VE BEEN DOING WITH 4621 02:55:14,838 --> 02:55:18,241 THIS, IS I HERE'S A PATIENT 4622 02:55:18,241 --> 02:55:20,310 AFTER DELIVERY,ER BUT BEFORE THE 4623 02:55:20,310 --> 02:55:21,644 HYSTERECTOMY, AND YOU Y C SEE S 4624 02:55:21,644 --> 02:55:27,717 HAVE BEEN RECRUITRU,, AND SONEHT 4625 02:55:27,717 --> 02:55:30,787 HE T TS T I TELL MYELLOWS 4626 02:55:30,787 --> 02:55:35,792 HYPEHYASCULAR TUMOR.IKE A 4627 02:55:35,792 --> 02:55:38,428 ITIT WILL SUCKN BOD FLOW FROM 4628 02:55:38,428 --> 02:55:39,896 ANYWHERE THAT IT CAN GET IT. 4629 02:55:39,896 --> 02:55:41,564 AND IN THE T PEL PS, THERE'S A T 4630 02:55:41,564 --> 02:55:43,633 OF PLACES THAT IT CAN GET BLOODO 4631 02:55:43,633 --> 02:55:44,167 FLOW. 4632 02:55:44,167 --> 02:55:45,969 SO TSOS ISHA IT LOO L LIKEE 4633 02:55:45,969 --> 02:55:49,038 AFTER YOU DO A SEL STIVE 4634 02:55:49,038 --> 02:55:49,572 EMBOLIZATIONTION 4635 02:55:49,572 --> 02:55:51,107 THIS, AGAINGA ISS BORE THE 4636 02:55:51,107 --> 02:55:52,542 HYSTERECTOMY. 4637 02:55:52,542 --> 02:55:53,510 AND NOW YOU CAN SEE S BASICALLYL 4638 02:55:53,510 --> 02:55:59,048 ALLAL OF THA T BLOOD FLOW HAS N 4639 02:55:59,048 --> 02:56:07,357 BEEN STO SED TO THE T UTERUSS. 4640 02:56:07,357 --> 02:56:10,627 SO WE KNOW A LOT ABOUT DOI D 4641 02:56:10,627 --> 02:56:21,538 POSTPARTUST -- ISSS BECAUSESEFFE 4642 02:56:24,908 --> 02:56:27,877 APNE, THAT'S A WHOLE DIFFEIFNTIF 4643 02:56:27,877 --> 02:56:30,079 BALL GAMEE THAN SON BODY WHO'S 4644 02:56:30,079 --> 02:56:36,453 GOTGONVASIVEIV PLACENTAACCRETA. 4645 02:56:36,453 --> 02:56:37,153 IT REQ RRES FLUOROSCOPY, IT 4646 02:56:37,153 --> 02:56:38,354 TAKETA SOMEE TIME IM DO BUT 4647 02:56:38,354 --> 02:56:42,725 ACTUALLY IT GIVES US A GD -- 4648 02:56:42,725 --> 02:56:44,561 VES US A GOOD OUTCOME FOR 4649 02:56:44,561 --> 02:56:45,562 ESE PATIENTS. 4650 02:56:45,562 --> 02:56:45,995 AY. 4651 02:56:45,995 --> 02:56:47,764 SO THEREAS A PAPER THA T CAME 4652 02:56:47,764 --> 02:56:53,536 OUT A A UCSF, 2019, I THINKHITT 4653 02:56:53,536 --> 02:56:56,439 WAS, WHE W THEYY TKKATIEATS 4654 02:56:56,439 --> 02:57:01,211 O HAD AN INCRETA, AND AFTER 4655 02:57:01,211 --> 02:57:04,981 THEEE DELIVERY,HEY TNSPORTED 4656 02:57:04,981 --> 02:57:08,184 THE PAE ENT EN THE IR SUITE AND 4657 02:57:08,184 --> 02:57:13,656 EMBOLIZED THEM.EM 4658 02:57:13,656 --> 02:57:15,191 THEY COMPARED THAT TO PATIENTS 4659 02:57:15,191 --> 02:57:17,560 WHO THEYTHIDN'T EMB EIZE, AND 4660 02:57:17,560 --> 02:57:18,761 IMPORTANTLANTLN THIS, THEY ONLY 4661 02:57:18,761 --> 02:57:20,263 EMBOLIZED THE UTERINERTERIES.IE 4662 02:57:20,263 --> 02:57:21,931 THEYTHIDN'T EMBOLMBE ANYTHING 4663 02:57:21,931 --> 02:57:23,099 ELSE, JUST THE UTERINERTERIES. 4664 02:57:23,099 --> 02:57:24,767 BUT THEY DID SHOW THAT TY HAD H 4665 02:57:24,767 --> 02:57:27,704 DECREASE IN THE T BLOOD LOSS, 4666 02:57:27,704 --> 02:57:31,608 THEY HAD A DEC DASEEN THEIR 4667 02:57:31,608 --> 02:57:32,208 TRANSFUSSFN REN IREMENTS, AND A 4668 02:57:32,208 --> 02:57:33,843 EYEY DIDN'ID HAVE ANY ADVERDV 4669 02:57:33,843 --> 02:57:37,013 CT I THOSE SMALL NUMBER OF 4670 02:57:37,013 --> 02:57:43,086 ENTSTS 4671 02:57:43,086 --> 02:57:44,287 E PRE LEMM IS YOU HAVE TO 4672 02:57:44,287 --> 02:57:45,054 TRANSPORT SOMEBODY FYM THE 4673 02:57:45,054 --> 02:57:46,189 OPERATING ROOM T T IRRNDR OF 4674 02:57:46,189 --> 02:57:48,424 COURSE YOU KNOW THEY CAN'T B B B 4675 02:57:48,424 --> 02:57:49,058 BLEEDING TOO MOOH OR YOU DON'T 4676 02:57:49,058 --> 02:57:50,293 WANT TO TRA TPORTRT THEM. 4677 02:57:50,293 --> 02:57:52,061 ACTUALLY WHENHEHEY COMPAREDRE JT 4678 02:57:52,061 --> 02:57:55,532 THE INCRETAS, BECAUSEAUAU THEY'D 4679 02:57:55,532 --> 02:57:59,435 PERCRETAS AND -- ACCRETA, SRY, 4680 02:57:59,435 --> 02:58:01,738 IN THAT CON COLOL GRO G,HEY 4681 02:58:01,738 --> 02:58:06,409 STILL FOUND THAT THEY HAD HAD 4682 02:58:06,409 --> 02:58:07,610 DECREASED ADVEADE EVENTS,NT TY 4683 02:58:07,610 --> 02:58:11,114 D DREASEDLOODLO LOSS, AND 4684 02:58:11,114 --> 02:58:13,082 THEY HADECREASE IN THEHE NEED 4685 02:58:13,082 --> 02:58:19,455 FORFO TRANSFUSIFUS.S. 4686 02:58:19,455 --> 02:58:22,392 SO WE HAD THE UNFORTUORTETE 4687 02:58:22,392 --> 02:58:23,726 SITUATION WHERE WE HAD TWO 4688 02:58:23,726 --> 02:58:26,229 TIENTS WITHIN HI REALLY SHORT 4689 02:58:26,229 --> 02:58:28,197 PERIODRIF TIME F FONE ANOTHNO 4690 02:58:28,197 --> 02:58:29,599 HAD BAL BON CATHETERS PLACEDD 4691 02:58:29,599 --> 02:58:32,001 AND WHO DIED OFFEMORRHAGRH 4692 02:58:32,001 --> 02:58:34,637 AND ITIT WASN'T TOT TLY CLE C, E 4693 02:58:34,637 --> 02:58:38,908 PREGNANCY THAT WASN'T PICKED UP 4694 02:58:38,908 --> 02:58:42,478 EARLYRLN. 4695 02:58:42,478 --> 02:58:44,981 T WE'RE'ROT REALLY SURE WHAT 4696 02:58:44,981 --> 02:58:45,648 PPENED WITH THETHTHER ONE. 4697 02:58:45,648 --> 02:58:47,183 BUT THE THING WAS IS THATHA WE T 4698 02:58:47,183 --> 02:58:48,618 DOWN AS A GROUP AND SAID THIS IS 4699 02:58:48,618 --> 02:58:52,121 ACCEPTABLE, WE CANNOT HAV HAV 4700 02:58:52,121 --> 02:58:53,523 THESE PATIENTS DYI D D ON US. 4701 02:58:53,523 --> 02:58:56,359 AND SO WHAT WE DECIDED THAT WE 4702 02:58:56,359 --> 02:58:59,596 WOULDUL DO, ONE OF THE P PNTS 4703 02:58:59,596 --> 02:59:01,164 PARTPAULARLY WAS A PATIENT THAT 4704 02:59:01,164 --> 02:59:02,365 I GOT -- IENT UP TO THE 4705 02:59:02,365 --> 02:59:04,133 OPERATING ROOM TM SEE WHA WHA WS 4706 02:59:04,133 --> 02:59:07,170 GOING ON, AND AHEY COULDN'TT 4707 02:59:07,170 --> 02:59:08,371 ROL HER BLOODLOOD LS AND I 4708 02:59:08,371 --> 02:59:08,404 ID 4709 02:59:08,404 --> 02:59:10,139 GET HER DOWNO IR A 4710 02:59:10,139 --> 02:59:11,874 WE'LL EMBOLIZEIZ HER. 4711 02:59:11,874 --> 02:59:13,343 THEY COULDN'T KEEP HER STABLE 4712 02:59:13,343 --> 02:59:14,577 ENOUGH TO DO THAT,HA ANDHE DIED 4713 02:59:14,577 --> 02:59:18,815 SO WE SAID AFD R THAT, WE'RE NOT 4714 02:59:18,815 --> 02:59:19,782 ING IN DO THISTHIS ANYMORE. 4715 02:59:19,782 --> 02:59:24,621 WE'RE'R GOING TO HAVEAV FLUOROSY 4716 02:59:24,621 --> 02:59:27,657 ANDAN EMBOLIZATION AVAILABLE IN 4717 02:59:27,657 --> 02:59:29,826 SO WE BAE CALLY GOT IN A FIGHTHT 4718 02:59:29,826 --> 02:59:33,563 OUR CARDIOLOGISOG AND AOLAID, WE 4719 02:59:33,563 --> 02:59:35,298 ED TO HAVE A HRID ROOM 4720 02:59:35,298 --> 02:59:36,499 LABLEE TO US. U 4721 02:59:36,499 --> 02:59:38,901 AND THEY SAID OH, OH, WEL W WELE 4722 02:59:38,901 --> 02:59:43,840 I SAID,AI LOOK,K, YOU ARE TREATG 4723 02:59:43,840 --> 02:59:44,707 EAR-OLD PATIENTS WHO HAVE AE 4724 02:59:44,707 --> 02:59:49,312 PATIENTSHAT NEEDD THE LEADATREGG 4725 02:59:49,312 --> 02:59:50,713 REPLACEMENT, WHICH IS ELECTIVE, 4726 02:59:50,713 --> 02:59:55,952 ARE YOUNG, WHOAVE FAM FAMS, WHO 4727 02:59:55,952 --> 02:59:57,587 AND WHO HAVE HUSBANDS, AND 4728 02:59:57,587 --> 02:59:58,454 YOU'RE GOING TO LEA L THEM 4729 02:59:58,454 --> 02:59:59,455 WITHOUT A MOTHER AND A Y A'RE'R 4730 02:59:59,455 --> 03:00:04,694 GOG TO LEAVE THEMITHOUT AUT 4731 03:00:04,694 --> 03:00:04,894 WIFE. 4732 03:00:04,894 --> 03:00:07,997 AND SD THEY FINALLY AGREED.EE 4733 03:00:07,997 --> 03:00:10,633 AY, SO WANT WE'VEVEVENDED UP 4734 03:00:10,633 --> 03:00:13,369 DOINWA ALL OF OUR PATIENTS 4735 03:00:13,369 --> 03:00:14,871 GET MRIs AHEAD OFF TIME, SO 4736 03:00:14,871 --> 03:00:17,173 THAT WE CAN C REALLYYY STAGE WHS 4737 03:00:17,173 --> 03:00:17,840 GOING ON AND WE KNOW THAT 4738 03:00:17,840 --> 03:00:20,777 THERE'S GOING TO BO PROBLEMBL. 4739 03:00:20,777 --> 03:00:22,545 AND THIS IS WHATHA WE STARTED 4740 03:00:22,545 --> 03:00:26,382 DOING, WAS WE WOULDOUO THE 4741 03:00:26,382 --> 03:00:27,450 AORTOGRAMRA IN THN OPERATING R, 4742 03:00:27,450 --> 03:00:29,285 IN T HYBRID ROOM AFT A THE T 4743 03:00:29,285 --> 03:00:31,621 DELIDERED THE BABY, AY, WHAT W W 4744 03:00:31,621 --> 03:00:38,194 VESSELS THAT NEEDED -- THAT WERE 4745 03:00:38,194 --> 03:00:41,364 SUPPLYINGIN THISHI PLACENTA,ND 4746 03:00:41,364 --> 03:00:42,665 SOMETIMES WE COULDN'TT EVEN 4747 03:00:42,665 --> 03:00:44,400 FIGURE OUT WHAT THE VES VLS 4748 03:00:44,400 --> 03:00:47,270 WERE, BUT B WE KNEW THA THAEYHAE 4749 03:00:47,270 --> 03:00:49,539 SUPPLYING THEHE PLA PNTA SO WE 4750 03:00:49,539 --> 03:00:49,806 BOLIZED THEM. 4751 03:00:49,806 --> 03:00:52,508 AND THIS WAS W OUR PROTOCOL. 4752 03:00:52,508 --> 03:00:54,610 THIS IS ONE ONHE GYNECOLOGOLTS 4753 03:00:54,610 --> 03:01:00,483 PUT TETHER THIS PASTIME 4754 03:01:00,483 --> 03:01:03,319 PROTOCOL, OLACENTA, ACCRETA, 4755 03:01:03,319 --> 03:01:04,320 SPECTRUM, TREATMENT,T, 4756 03:01:04,320 --> 03:01:06,089 INTEROPERATIVE, MULTIVESSEL, 4757 03:01:06,089 --> 03:01:06,389 LIZATION. 4758 03:01:06,389 --> 03:01:08,991 SO WE HAVE AVEE HIISTORICAL GROO 4759 03:01:08,991 --> 03:01:09,559 D THIS IS TS NEW GROUPRO 4760 03:01:09,559 --> 03:01:10,860 ID LOT OF MAKING SURE THAT 4761 03:01:10,860 --> 03:01:13,930 ANESANESANLOGISTGITO THE FROM TE 4762 03:01:13,930 --> 03:01:16,099 INTERVTETIONAL RADIOLOGIST T T 4763 03:01:16,099 --> 03:01:20,503 THE GYN ONCOLOGOLT, YOU KNOW, 4764 03:01:20,503 --> 03:01:22,905 NEONATAL, EVERYBODY WAS INV IVED 4765 03:01:22,905 --> 03:01:24,107 IN KNOWING ABOUT THESEATIENTSS 4766 03:01:24,107 --> 03:01:25,408 AHEAAHOFIME, ANDATIENT SAW 4767 03:01:25,408 --> 03:01:26,876 ALL OF THE T T PEOPLEOAHEADEAEA 4768 03:01:26,876 --> 03:01:29,178 TIMETIO KIND OF TELL THEM WHAT'S 4769 03:01:29,178 --> 03:01:30,146 GOING TO HAPPEN AND AND THEY'RE 4770 03:01:30,146 --> 03:01:37,386 GOING TO DOAND THENR SC SNNING,O 4771 03:01:37,386 --> 03:01:38,588 THIS WAS PRETTYY MUCH THE SAME. 4772 03:01:38,588 --> 03:01:42,492 WE DID GENERAL ANESTHESIA BUT 4773 03:01:42,492 --> 03:01:43,025 W WE'VE'VEEN DON G MUCH MORE 4774 03:01:43,025 --> 03:01:44,060 IN THE WAY OFF REGIONAL 4775 03:01:44,060 --> 03:01:45,728 ANESTHESIA, AND THE T GYN 4776 03:01:45,728 --> 03:01:49,232 THE BEGINNING AND WE DID THISHIS 4777 03:01:49,232 --> 03:01:52,235 INTEROPERATIVETIMBOLIZATION. 4778 03:01:52,235 --> 03:01:54,737 THEHE THI T I I THINK THAT'S 4779 03:01:54,737 --> 03:01:57,273 IMPORTANRT AND I'M SURE A LOT OF 4780 03:01:57,273 --> 03:01:59,909 AT IT ADDSDD TIME TO THE, IS 4781 03:01:59,909 --> 03:02:00,476 PROCEDURE. 4782 03:02:00,476 --> 03:02:01,911 SO AS OOSEDO THE BAE OOE , 4783 03:02:01,911 --> 03:02:03,513 WHICH ICS NOT N A BIG DL, TL,K 4784 03:02:03,513 --> 03:02:05,648 ABOUTOU A HF ANN HOUR, AND THEN 4785 03:02:05,648 --> 03:02:07,884 EY WOULD GO U U A AET T 4786 03:02:07,884 --> 03:02:12,688 FOR THESE PATIENTS, WE DOO PUT N 4787 03:02:12,688 --> 03:02:15,324 SOME SHEATHS WHICH TAKES US 4788 03:02:15,324 --> 03:02:18,261 ABOUTT 10 MINUTES TO T PUT IN I 4789 03:02:18,261 --> 03:02:19,896 SHEATH, AND WE U ULY DO IT 4790 03:02:19,896 --> 03:02:21,130 ILE THE ANE AHESIOLSIOLTSOLRE 4791 03:02:21,130 --> 03:02:22,532 PUING ININHEIR LINES AND 4792 03:02:22,532 --> 03:02:23,833 EVERYTHING ELSE.E. 4793 03:02:23,833 --> 03:02:25,802 AND THEN THEY DO THE CESAREAN. 4794 03:02:25,802 --> 03:02:28,070 WEWE DO THEO EMBOLIZATIOAT 4795 03:02:28,070 --> 03:02:28,304 OCEDURE. 4796 03:02:28,304 --> 03:02:30,273 AND THEN THEY GO AHEAD AND DO 4797 03:02:30,273 --> 03:02:35,077 THE HYSTERECTOMY. 4798 03:02:35,077 --> 03:02:41,951 WHAT WE'VEE' FOUND IS BASICALICE 4799 03:02:41,951 --> 03:02:43,886 HAD IN THIS PARTICRTAR STUDYTU 4800 03:02:43,886 --> 03:02:46,556 THERE HADEE SOM SIN THE 4801 03:02:46,556 --> 03:02:46,589 ST 4802 03:02:46,589 --> 03:02:54,330 WE H BASICALLY VERYY FEW 4803 03:02:54,330 --> 03:02:57,800 ADVERSE RCTIONS, N N 4804 03:02:57,800 --> 03:02:58,401 POSTPOERATIVE BLEEDING AND NO N 4805 03:02:58,401 --> 03:03:03,940 DEATHS. 4806 03:03:03,940 --> 03:03:05,041 AS YOU COU C IMAGINE, THE 4807 03:03:05,041 --> 03:03:06,609 HEME.RMOHIMO ARE PRE PYY MYH THE 4808 03:03:06,609 --> 03:03:15,451 MOST OF THEM WER W SCHEDULEDWO 4809 03:03:15,451 --> 03:03:15,484 OU 4810 03:03:15,484 --> 03:03:22,558 20 20% 2 WEREE EMERGENT. 4811 03:03:22,558 --> 03:03:26,362 VERY FEWEW NUMBER BER ACCRETAS, 4812 03:03:26,362 --> 03:03:30,733 BECAUSE WE MAD M THE DIAGNOSIS 4813 03:03:30,733 --> 03:03:32,335 AHEAD EA TIME AND WE KNEW WHAT 4814 03:03:32,335 --> 03:03:35,638 WE WERE UP AGAINSTINN THAT CASE. 4815 03:03:35,638 --> 03:03:36,606 >> ONE MINUTE LEFT. 4816 03:03:36,606 --> 03:03:38,140 >> OKAY,Y,ERY GOOD. 4817 03:03:38,140 --> 03:03:39,909 SO THE FLUOROSCOOS TIME IS A 4818 03:03:39,909 --> 03:03:42,879 LITTLE BITIT HEAI HIG HR OBVIOU, 4819 03:03:42,879 --> 03:03:45,515 LONGER, BUT WE' W FOUNDOUHAT WE 4820 03:03:45,515 --> 03:03:49,452 WERE EMBOLIZING ALL KINDS OF 4821 03:03:49,452 --> 03:03:49,719 ARTERIES. 4822 03:03:49,719 --> 03:03:52,188 TH UTERINE, THE SUPERIOER 4823 03:03:52,188 --> 03:03:53,155 VESICULAR, OTHER ONES. 4824 03:03:53,155 --> 03:03:54,156 AND T T MOST IMPORTANT THI T IS 4825 03:03:54,156 --> 03:03:56,092 WEOUNDHAT WE WERE EMBOLIZING 4826 03:03:56,092 --> 03:03:57,093 THE ROUNDND LIGAMENT,T, AND THAS 4827 03:03:57,093 --> 03:03:58,294 THE THING THAT YOU TON'T'TET 4828 03:03:58,294 --> 03:04:00,162 YOU INN BALLOALS,S 4829 03:04:00,162 --> 03:04:02,298 YOU'RE NOT N GOING TO BLOCK THEE 4830 03:04:02,298 --> 03:04:02,665 ROUND LIGALINT.NT 4831 03:04:02,665 --> 03:04:04,367 AND THAT MAY BEE WHY THE AORTICI 4832 03:04:04,367 --> 03:04:05,268 ONES DO WEL W 4833 03:04:05,268 --> 03:04:06,969 SO HE'S WHAT THE ROUNDOU 4834 03:04:06,969 --> 03:04:10,740 ANDT'S SUPPLYIPL THE PLACENTA 4835 03:04:10,740 --> 03:04:14,911 ANDOHAT IS A REALEAOURCE OF 4836 03:04:14,911 --> 03:04:15,678 PROBLEMS FOR FS. 4837 03:04:15,678 --> 03:04:16,779 AND I WON'T GO THROUGH -- THISHI 4838 03:04:16,779 --> 03:04:18,414 IS BAS BALLY VERY CY C TO WHA W 4839 03:04:18,414 --> 03:04:20,283 W W---- I WAS TALKINGKI ABOUT 4840 03:04:20,283 --> 03:04:22,685 JUST ANOTHER STUDY,UT W W HAVE 4841 03:04:22,685 --> 03:04:25,187 ALL OF THESE THINGHI THIT WE C 4842 03:04:25,187 --> 03:04:26,856 THE MOST IMPORTANT TNGNG IN 4843 03:04:26,856 --> 03:04:29,525 MY MIN M IS THA T WE PLAN IT OUT 4844 03:04:29,525 --> 03:04:31,494 AND GETGEGE EVERYBODYNVOLVED SD 4845 03:04:31,494 --> 03:04:33,663 THAT WE MAK M IT A AAFE 4846 03:04:33,663 --> 03:04:34,664 EXPERIENCEENCE THESE PATIENTS. 4847 03:04:34,664 --> 03:04:44,941 THANK YKERY MUCH.. 4848 03:04:45,875 --> 03:04:47,643 >> WE'RE GOING TNG MOVEOV TO OUR 4849 03:04:47,643 --> 03:04:51,347 PANEL DISCUSSION,N, ANDND DR. F, 4850 03:04:51,347 --> 03:04:54,250 DR. HERRERA, DR. ROBERTS, INN 4851 03:04:54,250 --> 03:05:04,593 PEON, DR. CR.USI.I. 4852 03:05:13,836 --> 03:05:15,905 >> GEORGEAADE. 4853 03:05:15,905 --> 03:05:16,572 THANTHYOTH VERY MUCH. 4854 03:05:16,572 --> 03:05:18,074 GREAT TALKS,KSE DON'T N'ALN' GET 4855 03:05:18,074 --> 03:05:20,643 TO S S THE T TALKS HERE THATT 4856 03:05:20,643 --> 03:05:24,080 OFTEN. 4857 03:05:24,080 --> 03:05:25,281 OW THE TIME WAS SHORT, BUT 4858 03:05:25,281 --> 03:05:26,716 WE U UTO DO A LOT OT THINGS 4859 03:05:26,716 --> 03:05:29,418 HAVE MY OWN OPINIONNIBOUTHEM,I 4860 03:05:29,418 --> 03:05:34,924 BUT, LIKE, CAN YOUALK ABOUT 4861 03:05:34,924 --> 03:05:40,496 CELL SAVER, HEMODELUSION, ALL 4862 03:05:40,496 --> 03:05:41,831 THESE THINGS WE USE UTO DO 4863 03:05:41,831 --> 03:05:42,064 BEFORE? 4864 03:05:42,064 --> 03:05:44,266 >> YOU'RE TALKING TO DR. FARBER, 4865 03:05:44,266 --> 03:05:45,901 I'LL SLLAK TO T THAT. 4866 03:05:45,901 --> 03:05:48,137 I THINK SOMEOMOM OF U U UO STILE 4867 03:05:48,137 --> 03:05:49,105 CELL SAVER. 4868 03:05:49,105 --> 03:05:50,406 QUITE FREQUENTLY WE DIDN'TDNALK 4869 03:05:50,406 --> 03:05:51,073 ABOUT OURE SO MUCHMU 4870 03:05:51,073 --> 03:05:51,741 IT DEPENDS. 4871 03:05:51,741 --> 03:05:53,175 IT DEP DDS O O HOWOW EASY IT IO 4872 03:05:53,175 --> 03:05:55,611 GETGE TO YOUR UNIT, DT,FERENT 4873 03:05:55,611 --> 03:05:57,046 UNITS HAVE PEO PE ON SITE, SOME 4874 03:05:57,046 --> 03:05:59,548 PEOPLE HAVE TO CALLAL THEM IN. 4875 03:05:59,548 --> 03:06:03,719 EN I WAS DOWNTOWN INN HOUSTON, 4876 03:06:03,719 --> 03:06:07,123 WE FOUND EITHER YOU NEEDEDD MUCC 4877 03:06:07,123 --> 03:06:08,257 MUCHMUORE OE YOU Y Y DIDN'T COLT 4878 03:06:08,257 --> 03:06:09,558 ENOUGH TGHOCTUALLY TRANSFUSE 4879 03:06:09,558 --> 03:06:10,860 BACK, SO IT KITD OF DEPENEP ON 4880 03:06:10,860 --> 03:06:11,994 WHATWHR YOO UNIT IS. 4881 03:06:11,994 --> 03:06:16,532 COMMONLY.T IN IERY 4882 03:06:16,532 --> 03:06:21,737 THE LAST PATIENTS I HAD, WHEN 4883 03:06:21,737 --> 03:06:25,007 COLLECTED -- THE PATIENT LOST 2L 4884 03:06:25,007 --> 03:06:30,713 IT CAN CE EXTREMELY USEFUL.RS.. 4885 03:06:30,713 --> 03:06:35,751 NOW AS FAS AS -- DELUSIONIO, THE 4886 03:06:35,751 --> 03:06:37,820 PROBLEM IS NOW IT'S HARDER TO 4887 03:06:37,820 --> 03:06:37,953 LL 4888 03:06:37,953 --> 03:06:39,922 T THE TYE OF BLOOD 4889 03:06:39,922 --> 03:06:40,956 COLLECTION BAGS TT ALLOW TO 4890 03:06:40,956 --> 03:06:42,258 YOU DO THAT BECAUSE A LOT OF THH 4891 03:06:42,258 --> 03:06:43,993 BLOOD BANKINGKIENTERS HAVE 4892 03:06:43,993 --> 03:06:45,294 CHANGED THE WAY W T WIR BAGS ARE 4893 03:06:45,294 --> 03:06:47,596 PRODUCED AND YOU CANNOT CONNECT 4894 03:06:47,596 --> 03:06:50,166 DEPEDEING ON WHAT YOUR SUPPLIES 4895 03:06:50,166 --> 03:06:50,332 ARE. 4896 03:06:50,332 --> 03:06:53,002 >> W W USE CELLER QTE A 4897 03:06:53,002 --> 03:06:53,169 BIT. 4898 03:06:53,169 --> 03:06:54,870 AND OFTEN WE'RE NOT REINFUSING, 4899 03:06:54,870 --> 03:06:56,305 SO THERE'S A A AUESTION AUT 4900 03:06:56,305 --> 03:06:57,706 URCE UTI UZATION, IF WE'RE 4901 03:06:57,706 --> 03:06:59,008 G TO STARTTAETTING IT UP AND 4902 03:06:59,008 --> 03:07:00,042 COLLECLLNG FNG ALL TLLSELL CASES 4903 03:07:00,042 --> 03:07:01,343 ANDD A MINORITORCTUALLY GET THE 4904 03:07:01,343 --> 03:07:01,711 BLOODOOACK. 4905 03:07:01,711 --> 03:07:03,412 SO I THINK THERE'S SOME TRIAGING 4906 03:07:03,412 --> 03:07:03,879 TO DO THERE. 4907 03:07:03,879 --> 03:07:05,781 AND THEN THE TSSUE THAT DR. FOX 4908 03:07:05,781 --> 03:07:09,285 OUGHTP THAT WE HAVE TO TELL 4909 03:07:09,285 --> 03:07:10,753 THETHIENTS,S, YOU MUST BE 4910 03:07:10,753 --> 03:07:13,122 WILLING TO ACCEPT ALLOGENIC 4911 03:07:13,122 --> 03:07:14,323 PRODUCTSUC BUCAUSE WE'REE' ONLY 4912 03:07:14,323 --> 03:07:16,292 VING RED BLOODLOLO CELLS, AND WE 4913 03:07:16,292 --> 03:07:18,294 CAN'T REPLAEPAGINALAL BLOOD 4914 03:07:18,294 --> 03:07:18,594 LOSS. 4915 03:07:18,594 --> 03:07:20,796 BUT I DO THINK FROM A RESOURCERC 4916 03:07:20,796 --> 03:07:22,098 PERSPECTIVE FOR SOMEOM OF THESE 4917 03:07:22,098 --> 03:07:24,233 HIGH BLO BLOOSS CASES, ITT DOES 4918 03:07:24,233 --> 03:07:25,301 DECREASE THE AMOUNTUN OF PRODUCT 4919 03:07:25,301 --> 03:07:26,535 THAT WE HAVE TO GET FRO FTHE 4920 03:07:26,535 --> 03:07:27,503 BLOOD BANK. 4921 03:07:27,503 --> 03:07:28,771 AND PATIENTS VERY ERCHERIKE THE 4922 03:07:28,771 --> 03:07:29,105 CONCEPT OF IT. 4923 03:07:29,105 --> 03:07:32,341 THEY OFTEN ARE ASKING ABOUT 4924 03:07:32,341 --> 03:07:34,009 ALLOGENICNIONATION DUR DG 4925 03:07:34,009 --> 03:07:35,077 PREGPRNCY WHICH WE DON D WANT 4926 03:07:35,077 --> 03:07:36,312 THEMTHO DO, DE'RE PUMPING THEM 4927 03:07:36,312 --> 03:07:38,147 WITH IRON, WE'T WANTO BE 4928 03:07:38,147 --> 03:07:38,180 KI 4929 03:07:38,180 --> 03:07:39,482 THE RED BLO B CELLS O 4930 03:07:39,482 --> 03:07:40,616 SO THE T T THEHE CONCEPT OF 4931 03:07:40,616 --> 03:07:41,784 IVING THEIR OWN BLOOD. O 4932 03:07:41,784 --> 03:07:43,853 >> AND TO ANS AR THAT, I TNK 4933 03:07:43,853 --> 03:07:47,356 THERE IS SOMEOM MOREPCOMING 4934 03:07:47,356 --> 03:07:51,527 RESEARCH, SOME PRELIMINAMI DATA, 4935 03:07:51,527 --> 03:07:53,395 A FEW SDIESES THAT HAVE BEEN 4936 03:07:53,395 --> 03:07:54,864 , MORE TO COME, ABOUT THEHE 4937 03:07:54,864 --> 03:07:55,297 USE OF WHOLE BLEOD. 4938 03:07:55,297 --> 03:07:58,601 GOING BACK TO WHAT WASWA OLD IS 4939 03:07:58,601 --> 03:07:59,001 NEW. 4940 03:07:59,001 --> 03:08:02,404 >> DR. ROBERTS. 4941 03:08:02,404 --> 03:08:04,039 YOU DIDN'T COMMENT ABOUT SOME OF 4942 03:08:04,039 --> 03:08:06,775 THEE COMPLICATIONS RELATED TO 4943 03:08:06,775 --> 03:08:08,644 DOING A LOT OF T PROCEDURES, 4944 03:08:08,644 --> 03:08:12,581 WHETWHR IT IS THE -- 4945 03:08:12,581 --> 03:08:14,517 EMBOLIZATIONTI WHEREHE THE CASE- 4946 03:08:14,517 --> 03:08:15,951 BECAUSE SOMEOM OFF TSE WOMEN, 4947 03:08:15,951 --> 03:08:20,990 EY HAVE LIK L AN -- FISTULATU 4948 03:08:20,990 --> 03:08:24,260 THERE,ER AND --- TO EMB EIZE 4949 03:08:24,260 --> 03:08:25,127 ACTUALTU GOES TO THE LUNG. 4950 03:08:25,127 --> 03:08:28,197 REASON I HAVE PICTUREF 4951 03:08:28,197 --> 03:08:29,498 ABOUT 50 EMBOLIOL T THE LUNG 4952 03:08:29,498 --> 03:08:32,902 AFTER THR EMBOLIZATION. 4953 03:08:32,902 --> 03:08:37,039 AND -- CT SCAN MELF ---- BELIEVE 4954 03:08:37,039 --> 03:08:40,009 THIS IS SOM SHING THAT SHOWS 4955 03:08:40,009 --> 03:08:43,879 DAMAGES, SO I HAVE AVU SEENSEHI? 4956 03:08:43,879 --> 03:08:44,446 EMBOEMZAEMZA TO THE LUNG. 4957 03:08:44,446 --> 03:08:46,849 HAT ARE THE COMPLI KAIGS OF 4958 03:08:46,849 --> 03:08:49,418 EMBOLIZATION AND HAVE YOU SEEN 4959 03:08:49,418 --> 03:08:50,819 EMBOLIZATION OF THE MATERATLL TO 4960 03:08:50,819 --> 03:08:58,260 THE LUNGS. 4961 03:08:58,260 --> 03:09:00,563 >>ERE THE PATIENTS WE'VE BEEN 4962 03:09:00,563 --> 03:09:01,864 EMBOLIZING IN THE OR, WE'VE HAD 4963 03:09:01,864 --> 03:09:03,866 WE EMBOLIZE THEM WITH PARTICLES 4964 03:09:03,866 --> 03:09:07,236 ANDCCASIONALLYLL WE'RE GOING 4965 03:09:07,236 --> 03:09:08,571 TO HAVE -- IF THERE'S A ARTERY 4966 03:09:08,571 --> 03:09:10,639 THATTHOOKSKS LIK L IT'S I GOI 4967 03:09:10,639 --> 03:09:10,739 SO 4968 03:09:10,739 --> 03:09:13,709 EMBOLIZATION TO T GO, WE'LL PUTN 4969 03:09:13,709 --> 03:09:15,511 A COIL TO BLO IT SO THAT IT 4970 03:09:15,511 --> 03:09:15,611 GO 4971 03:09:15,611 --> 03:09:17,213 WHERE WHE WHEE WANT W IT. 4972 03:09:17,213 --> 03:09:18,847 THAT'S NOT TOOOMMON, BUT 4973 03:09:18,847 --> 03:09:18,948 TH 4974 03:09:18,948 --> 03:09:22,918 'S SOMETHING THAT WE CAN C DO. 4975 03:09:22,918 --> 03:09:26,188 HAVNOT SEEN ANYNNY KIND K O K 4976 03:09:26,188 --> 03:09:26,288 PR 4977 03:09:26,288 --> 03:09:35,731 LEMS WITH BTIK ISCHEMIAAA,, 4978 03:09:35,731 --> 03:09:36,799 ADDER ISSUE IE'VE NOTEEN 4979 03:09:36,799 --> 03:09:37,333 ANY OF THAT. 4980 03:09:37,333 --> 03:09:40,769 >> ZERO OUT OF 20, THAT'S A BIG 4981 03:09:40,769 --> 03:09:41,537 CONFIDENCE -- THIS IS WHAT I'M 4982 03:09:41,537 --> 03:09:41,837 SAYING. 4983 03:09:41,837 --> 03:09:44,139 I DON'T THINK WE HE HNOUGH 4984 03:09:44,139 --> 03:09:46,742 CASES WITH EMBOLIZATIONO SAYAY 4985 03:09:46,742 --> 03:09:47,943 WE DON HAVE THESE 4986 03:09:47,943 --> 03:09:49,945 COMPLICOMPONCO 4987 03:09:49,945 --> 03:09:52,748 MY SECOND POINT, FOR THE AORTIC 4988 03:09:52,748 --> 03:09:58,287 TO PUT -- OF TH O PATIENT WITH 4989 03:09:58,287 --> 03:09:58,387 TH 4990 03:09:58,387 --> 03:10:00,990 MRI A EVERYBODY THOUG T 4991 03:10:00,990 --> 03:10:05,628 SHE H -- SHE ENDED UP HAVING 4992 03:10:05,628 --> 03:10:12,167 A ---- THROMBUSOM AND - A A ANDE 4993 03:10:12,167 --> 03:10:12,268 TH 4994 03:10:12,268 --> 03:10:12,501 MBECTOMY. 4995 03:10:12,501 --> 03:10:14,203 THAT'S WHY I W SAY WG THESE 4996 03:10:14,203 --> 03:10:17,773 PROCEDURES UNLESS WE ARE -- THEY 4997 03:10:17,773 --> 03:10:18,908 ARE -- AND ONCE WE STA 4998 03:10:18,908 --> 03:10:22,745 PROMOTING THEM T -- A LOT OF ESE 4999 03:10:22,745 --> 03:10:23,512 COMPLICATILIS. 5000 03:10:23,512 --> 03:10:25,581 IN THEM.YBODY HAS THE EXPERTISEI 5001 03:10:25,581 --> 03:10:27,683 M.>>M. THERE'S NO QUESTION TN YY 5002 03:10:27,683 --> 03:10:33,389 KNOW,XPERIENCEERERND -- ISREAL E 5003 03:10:33,389 --> 03:10:36,892 CLRLY IT'S ONE OF THE RNS 5004 03:10:36,892 --> 03:10:41,597 THEY DO A DO OFF THIS.TERS WHEE 5005 03:10:41,597 --> 03:10:46,435 WE'VE NE HAD AROBLEMRO WITH 5006 03:10:46,435 --> 03:10:48,837 THROMBOSIS OF AN ARTERY. 5007 03:10:48,837 --> 03:10:53,042 IN OUR EERIENCENCOTOT BEEN BUT 5008 03:10:53,042 --> 03:10:55,210 VE COMMON. 5009 03:10:55,210 --> 03:11:01,517 IT'S -- WHER- WH WE'RE USING --- 5010 03:11:01,517 --> 03:11:08,424 TH WE'RE MAKING IN THE ARTERY. 5011 03:11:08,424 --> 03:11:09,958 AND -- WHICH I O OF THE 5012 03:11:09,958 --> 03:11:10,759 PROBLEMS POTENTIALLY YOU GET 5013 03:11:10,759 --> 03:11:16,999 CATHETERS, IS THA THERE'S A 5014 03:11:16,999 --> 03:11:17,099 LA 5015 03:11:17,099 --> 03:11:17,966 ERLAHEATH AND MOREE LEELY TO 5016 03:11:17,966 --> 03:11:20,836 HAVE A A COMPLICATION.IO 5017 03:11:20,836 --> 03:11:23,339 >> DR. WRIGHT, IGHURNO YOU, 5018 03:11:23,339 --> 03:11:24,573 EN I I DO VE AVEOMMENTOMME ALSO 5019 03:11:24,573 --> 03:11:26,275 THE ATIC BALLOONS. 5020 03:11:26,275 --> 03:11:29,178 >> JASONON WRIGHT FROM COLUMBIA. 5021 03:11:29,178 --> 03:11:30,646 THANK YOU YLL FOR YOUR YLKR 5022 03:11:30,646 --> 03:11:31,013 IT JUSIT STRIKES 5023 03:11:31,013 --> 03:11:36,885 THINGS ARE SOO HARD TO STUDY, AD 5024 03:11:36,885 --> 03:11:40,589 OCCLUSIONIO CATHETERS AND 5025 03:11:40,589 --> 03:11:41,890 EMBOLIEMTIONTIHE LAST 15 YEARS 5026 03:11:41,890 --> 03:11:44,460 AND LOONGOOT THE LITERATITE. 5027 03:11:44,460 --> 03:11:47,730 DOITH IT COMRED TO HISTORICWHATO 5028 03:11:47,730 --> 03:11:48,163 CONTROLS. 5029 03:11:48,163 --> 03:11:49,932 SO UNTILE REALLY CAN COME 5030 03:11:49,932 --> 03:11:51,934 ER AND STUDY THIS 5031 03:11:51,934 --> 03:11:52,034 PR 5032 03:11:52,034 --> 03:11:54,670 PEPRIVELY AND RCTs THAT 5033 03:11:54,670 --> 03:11:57,072 ARE CONTR CLED, I JUST DON'T'T 5034 03:11:57,072 --> 03:12:01,810 THINK WE'RE EVEREGOING TO AWERW. 5035 03:12:01,810 --> 03:12:03,545 IF CENTERS WOULD PROBLY A 5036 03:12:03,545 --> 03:12:06,415 PROACH OLUSI A -- IN 5037 03:12:06,415 --> 03:12:07,916 DIFFERENT ERNNERS AND IT JUST 5038 03:12:07,916 --> 03:12:11,086 REALLY SPEAKS TO I THINK THE --- 5039 03:12:11,086 --> 03:12:13,422 TO THE LITER LURE. 5040 03:12:13,422 --> 03:12:15,591 >> CANNOT LUMPN ILI 5041 03:12:15,591 --> 03:12:17,059 N WITH AITH AORTICTI BALON, 5042 03:12:17,059 --> 03:12:18,894 IT ISOT THE SAME OCCLUSION. 5043 03:12:18,894 --> 03:12:20,262 AND THERE ARE DIFFEREIF SIZE 5044 03:12:20,262 --> 03:12:20,562 THETERS. 5045 03:12:20,562 --> 03:12:22,631 THERE A N FOUR FNCH 5046 03:12:22,631 --> 03:12:25,534 AORTA, AND WHEN WE WERE W DOWNTW 5047 03:12:25,534 --> 03:12:26,835 USING THESEHE BALLOONS, WEAD -- 5048 03:12:26,835 --> 03:12:28,070 I HAD THREE PATIENTS BACTO 5049 03:12:28,070 --> 03:12:34,610 BACK WHO HADAD VENOU THROMBOTIC 5050 03:12:34,610 --> 03:12:36,044 WITH T T 7 FRENCH. 5051 03:12:36,044 --> 03:12:37,746 WE SAID NO, WE HAVE TO RE- R 5052 03:12:37,746 --> 03:12:38,847 AT THIS, IT'S NOT BIGN. 5053 03:12:38,847 --> 03:12:41,550 AND WHEN WHEE W LOOKED ALSO ALS 5054 03:12:41,550 --> 03:12:42,418 ALL-COMER, THIS IS STILL 5055 03:12:42,418 --> 03:12:43,719 ISHED DATA, BUT WE ONLY 5056 03:12:43,719 --> 03:12:45,053 ACTUALLY FILLED T BALLOON WHEN 5057 03:12:45,053 --> 03:12:47,055 TTIN THE ACCESS THERE 20% OF 5058 03:12:47,055 --> 03:12:47,156 TH 5059 03:12:47,156 --> 03:12:47,489 THE. 5060 03:12:47,489 --> 03:12:49,258 SO THERERE REALLYEAS THE NEED FR 5061 03:12:49,258 --> 03:12:51,193 INTRAOPERATIVETAGINGTA 5062 03:12:51,193 --> 03:12:52,928 OKING AT OURR LOGISTICS,ND 5063 03:12:52,928 --> 03:12:55,564 EN OF COURSE WE HAD ZERO ZER 5064 03:12:55,564 --> 03:12:56,899 PROBLEMS WITH THE SMALLER 5065 03:12:56,899 --> 03:12:59,168 CATHETER, AND WEXPTED. 5066 03:12:59,168 --> 03:13:01,403 >> WELL, IT IS I DO THINK 5067 03:13:01,403 --> 03:13:05,574 IT'SIT REALLYLL IMPORTANT THAT E 5068 03:13:05,574 --> 03:13:08,844 NEED TO BE B ABLE TOO DIF DNT D 5069 03:13:08,844 --> 03:13:10,712 BEEEN AN ARETA,RE WHICH 5070 03:13:10,712 --> 03:13:11,914 PROBABLY YOU SHOULD BUL ABLEO 5071 03:13:11,914 --> 03:13:16,452 GET CONTROLOL OFF, WITHOUT HAVIG 5072 03:13:16,452 --> 03:13:18,387 TO USEALLOSR ANYTHINNY ELSE 5073 03:13:18,387 --> 03:13:20,589 AND JUST HAVE HNTERVENTIONALIO 5074 03:13:20,589 --> 03:13:21,423 RADIOLOGY AVAILABLE IN CASE YOU 5075 03:13:21,423 --> 03:13:23,091 GET INTONT TROUBLE WITH HEMORRHE 5076 03:13:23,091 --> 03:13:25,794 DOWN THEHE LINE,IN VSUS A 5077 03:13:25,794 --> 03:13:26,695 RETA, WHERE IT'S I GROWINGRO 5078 03:13:26,695 --> 03:13:28,664 INTO TINTOIN CERVIXX WHEREHE IT' 5079 03:13:28,664 --> 03:13:30,999 THE VAGIN V WHERE IT'S, YOUS, 5080 03:13:30,999 --> 03:13:32,334 KNOW, INTO THE BLADDER AND A 5081 03:13:32,334 --> 03:13:33,001 PELVIC SIDE WALLS. 5082 03:13:33,001 --> 03:13:34,736 II MEAN, THOSE ARE TRE PATNTS 5083 03:13:34,736 --> 03:13:38,140 RE GOING GO -- MAYBE 5084 03:13:38,140 --> 03:13:40,342 NOT UT ARE ANG TO REALLY 5085 03:13:40,342 --> 03:13:42,911 NEED, YOU KNOW, K EXPERTARE. 5086 03:13:42,911 --> 03:13:46,381 IMPORTANT ABOUT TS, IS TRYINGRYY 5087 03:13:46,381 --> 03:13:54,656 TO GET THOSE PATIENTS TRIAGED. 5088 03:13:54,656 --> 03:13:57,259 >> AOLUTELY. 5089 03:13:57,259 --> 03:13:57,359 >> 5090 03:13:57,359 --> 03:13:58,827 -- BROUGHT UP A REALLY 5091 03:13:58,827 --> 03:13:59,394 IMPORTANT POINT, YOU WERE 5092 03:13:59,394 --> 03:14:01,330 TALKING ABOUT THIS, JUS WITH 5093 03:14:01,330 --> 03:14:01,730 EXPERIENRI. 5094 03:14:01,730 --> 03:14:04,833 MEINGS WITH OBNN OENOME RESEARCH 5095 03:14:04,833 --> 03:14:05,601 ESIOLOGIIOS WHEN THEY'RE 5096 03:14:05,601 --> 03:14:06,969 TALKING ABOUT THESE ISSUES, AND 5097 03:14:06,969 --> 03:14:08,303 EY OFTENFTFT COMMENT AND THEY 5098 03:14:08,303 --> 03:14:09,505 LAUGH A LEE BIT WHEN THHE STH 5099 03:14:09,505 --> 03:14:12,140 IT BUT THE BIGGEST PREDICTOR OF 5100 03:14:12,140 --> 03:14:12,908 MORBIDITY IS WHO'SSTANDING ON 5101 03:14:12,908 --> 03:14:14,510 THE OTHER SIDE OFIDHEABLE. 5102 03:14:14,510 --> 03:14:15,878 AND I THINK WE TALE AUT THE AUT 5103 03:14:15,878 --> 03:14:17,379 INTERVENTIONS ANON PUT OUT 5104 03:14:17,379 --> 03:14:18,680 STUDIES FROM REALLY EXPERIENCED 5105 03:14:18,680 --> 03:14:19,915 CENTS, AND WE CAN'T ASSUMEE 5106 03:14:19,915 --> 03:14:22,417 THAT WE'RE GOING TOET THE SAME 5107 03:14:22,417 --> 03:14:25,721 TCOMES WHEN WE ADVOCATE FOR 5108 03:14:25,721 --> 03:14:28,090 IN.HINK WE NEED SOME WAY OF 5109 03:14:28,090 --> 03:14:30,359 MEURING ORCCOUNTING FOR 5110 03:14:30,359 --> 03:14:31,860 LEARNINGNIURVESVE AND EXPERIEXPE 5111 03:14:31,860 --> 03:14:36,965 D SKILL. 5112 03:14:36,965 --> 03:14:42,471 >> HEE HELENA FROM FUBLI FUB 5113 03:14:42,471 --> 03:14:44,106 COMMENT INT I JUST AROUND A LOT 5114 03:14:44,106 --> 03:14:46,608 THE STUDIES MAYBE ARE A 5115 03:14:46,608 --> 03:14:48,510 SUGGESTING THATT MORE TOWARDS 5116 03:14:48,510 --> 03:14:50,012 REGIONALAL ANESTHESIA AND MORE 5117 03:14:50,012 --> 03:14:51,547 AWAY FRO GENERAL ANESTHENEA AND 5118 03:14:51,547 --> 03:14:51,647 TH 5119 03:14:51,647 --> 03:14:54,950 SO I WLD JUST SAUSISAHINK IT'S 5120 03:14:54,950 --> 03:14:56,084 IMPORTANT TO ASKOMS 5121 03:14:56,084 --> 03:14:57,286 THAT HAVAT ACTUALLY BEEN TOUGH 5122 03:14:57,286 --> 03:14:57,386 TH 5123 03:14:57,386 --> 03:14:58,253 TH EXPERIEXPE SIXE ONTHE 5124 03:14:58,253 --> 03:14:59,388 LATER, DID THEY ACTUALLY UAINK 5125 03:14:59,388 --> 03:15:00,522 THAT THEY DHE HAVEAV BETTER 5126 03:15:00,522 --> 03:15:01,490 BONDING WITHHHEIR BABY BECAUSE 5127 03:15:01,490 --> 03:15:04,560 THEY WE AWAKE FOR PROCE PRE 5128 03:15:04,560 --> 03:15:06,862 THAT LOTAT OF PPLEPL WOU 5129 03:15:06,862 --> 03:15:06,962 CO 5130 03:15:06,962 --> 03:15:08,063 IDER QUITE TRAUMATIC AND 5131 03:15:08,063 --> 03:15:08,830 QUITE FRIGHTENING.IN 5132 03:15:08,830 --> 03:15:08,931 I 5133 03:15:08,931 --> 03:15:11,500 GET SOMEONE THROUGH THELWAYS 5134 03:15:11,500 --> 03:15:11,600 PR 5135 03:15:11,600 --> 03:15:13,135 EDURE EE E THROUGH REGIONALIO D 5136 03:15:13,135 --> 03:15:13,969 IT'S VERY SAFE FROM F A SURGICAL 5137 03:15:13,969 --> 03:15:16,238 LPOINT OF VIEW, VERY SAFE FROM A 5138 03:15:16,238 --> 03:15:17,072 ANESTHESIA POIIA OF VIEW, WHEREW 5139 03:15:17,072 --> 03:15:18,740 IT'S ACTUALLY MYY EXPERIENCEIEIH 5140 03:15:18,740 --> 03:15:20,475 SPEAKING WITNG LOTS ANDND LOT OF 5141 03:15:20,475 --> 03:15:22,477 MOMS FROM F ALL DIFFERENT 5142 03:15:22,477 --> 03:15:25,981 CENTERS LATES ATEOTTEF THEM DO 5143 03:15:25,981 --> 03:15:28,951 FIND IT REALLY FRIGHTERING TO BE 5144 03:15:28,951 --> 03:15:29,051 AW 5145 03:15:29,051 --> 03:15:32,554 E,E, SOEE HAVE AROUNDUN HALF 5146 03:15:32,554 --> 03:15:39,828 ET A MOM THA RRETS HAVINGI RARER 5147 03:15:39,828 --> 03:15:42,030 BEEN ASLEGEEP WHENHE WAS WELL 5148 03:15:42,030 --> 03:15:44,666 ED AND I DON'T BELIEVE 5149 03:15:44,666 --> 03:15:49,071 IS AWAKEWAFTER, THE PARTNER IS I 5150 03:15:49,071 --> 03:15:52,674 THEREE, MIDWIFEID SOMEONE IS ABL 5151 03:15:52,674 --> 03:15:55,310 SUPPORT HER WITH THE BY, 5152 03:15:55,310 --> 03:15:56,411 SKIN-TO-SK-T, THEYHE START 5153 03:15:56,411 --> 03:15:57,312 G, I DON'T THINK THAT 5154 03:15:57,312 --> 03:15:58,614 THERE IS LESSES BONDINGNG 5155 03:15:58,614 --> 03:16:03,018 NECESSARILY, BUT I TNK THE T 5156 03:16:03,018 --> 03:16:04,987 TIENT -- IS ZORAN IMPORTANT 5157 03:16:04,987 --> 03:16:06,622 ANDAN DON'T THINKHAT EVERYVE MOM 5158 03:16:06,622 --> 03:16:11,727 WANTS TO BE AWAKE AND I DON'T 5159 03:16:11,727 --> 03:16:11,827 TH 5160 03:16:11,827 --> 03:16:12,327 K -- IK THEY WANT TOANE 5161 03:16:12,327 --> 03:16:13,128 ASLEEP BECEPSEECHEY'RE AFRAIDAI 5162 03:16:13,128 --> 03:16:14,229 BECAUSE TUSY'RE NOT DOI ANY 5163 03:16:14,229 --> 03:16:16,331 HARM TO THEIR BABY B ORRR DOINGY 5164 03:16:16,331 --> 03:16:17,399 RM TO THEM AS MOMS MR 5165 03:16:17,399 --> 03:16:17,499 AN 5166 03:16:17,499 --> 03:16:19,735 HING,HI ANDND I THINK THI 5167 03:16:19,735 --> 03:16:23,271 NVERTION IF YOU'RE LEANING 5168 03:16:23,271 --> 03:16:24,640 MOARDS REGIONAL, THAT'S 5169 03:16:24,640 --> 03:16:27,609 GREAT, LESS COMPLICATION,ATESS 5170 03:16:27,609 --> 03:16:29,277 BLEEDING, THAT'SHAREAT, BUT, TAK 5171 03:16:29,277 --> 03:16:30,012 TO THESE MOMSE SIX MONTHS, ONE 5172 03:16:30,012 --> 03:16:32,481 YEARATER YOU Y MAYOUND FD 5173 03:16:32,481 --> 03:16:33,949 OUT YES, SHE DIDREFER, THAT'S 5174 03:16:33,949 --> 03:16:36,318 GREAT, BUT TAKE THAT INTO 5175 03:16:36,318 --> 03:16:37,019 COIDERATION BECAUSE IT'S 5176 03:16:37,019 --> 03:16:37,719 ,ALEALLY IMPORTANT. 5177 03:16:37,719 --> 03:16:43,292 EMPHASIZE TOO TTOO T NEURAXIAL 5178 03:16:43,292 --> 03:16:44,126 ANESTHESIA AND BEING AWAKE 5179 03:16:44,126 --> 03:16:46,061 COCIOUS.CIATSAT 5180 03:16:46,061 --> 03:16:46,995 CI A PRETTY RE PATIENT THAT T 5181 03:16:46,995 --> 03:16:49,297 WE SEE WHO IS I ACTUALLY FULLY 5182 03:16:49,297 --> 03:16:51,066 CONSCICOS THROUGH THUG ENTIREOU 5183 03:16:51,066 --> 03:16:51,366 PROCEDURE. 5184 03:16:51,366 --> 03:16:54,870 MAYBE A GRADE I PAS WITH A 5185 03:16:54,870 --> 03:16:56,605 38-WEEK BABY WHO ISAVINGAV A 5186 03:16:56,605 --> 03:16:59,975 PRETTY EASY E E HYSTERECTOMY, BE 5187 03:16:59,975 --> 03:17:02,144 TY LIBERALLY USESE SEDATION, 5188 03:17:02,144 --> 03:17:03,679 D IT'S AT' REALLY IMPORTANTRT 5189 03:17:03,679 --> 03:17:05,547 POINT TO DISCUSS,O, BECAUSESE WN 5190 03:17:05,547 --> 03:17:08,116 THEY HEAR TY'RE N UNDERGOIN 5191 03:17:08,116 --> 03:17:08,917 GE ANESTHESIA, THEY'RE 5192 03:17:08,917 --> 03:17:10,585 AFRAID OFF BNG AWAKE DURING THIN 5193 03:17:10,585 --> 03:17:11,453 SURGERY ZOO IT IS REALLYEAY 5194 03:17:11,453 --> 03:17:12,988 IMPORTANT TO TALK TO THEMM AUT 5195 03:17:12,988 --> 03:17:15,290 THEIRIR CIOUSNESS I 5196 03:17:15,290 --> 03:17:16,591 D. 5197 03:17:16,591 --> 03:17:21,063 THE TAILORED APPROACH IS BEST,ES 5198 03:17:21,063 --> 03:17:22,864 WE NORMALIZE ITT BUT BE NEED TO 5199 03:17:22,864 --> 03:17:25,000 DO MORE M LONG-TERM FOLLOW-UP. 5200 03:17:25,000 --> 03:17:25,333 >> EXCELLENT. 5201 03:17:25,333 --> 03:17:26,268 REALLY QUILY Q, I'D LIKE TOAK 5202 03:17:26,268 --> 03:17:29,504 THE PREROGATIVE TO ASK YOU A 5203 03:17:29,504 --> 03:17:29,604 QU 5204 03:17:29,604 --> 03:17:31,173 TIQU. 5205 03:17:31,173 --> 03:17:32,007 CHRISTINRI 5206 03:17:32,007 --> 03:17:33,442 I THINK IT'S REALLYEAASCINATINGI 5207 03:17:33,442 --> 03:17:37,713 ULTRASOUND VERSUS MRI, WE KNOW 5208 03:17:37,713 --> 03:17:38,747 W THAT THHA PATHOLOGYHOLO ALO 5209 03:17:38,747 --> 03:17:41,283 COMBINATIONAT OFCAR, FIBROSIS,RI 5210 03:17:41,283 --> 03:17:43,719 AND VASCULATURE, AND WE CAN SEEE 5211 03:17:43,719 --> 03:17:44,953 MYOMETRIUM, WE CAN SEEETHE 5212 03:17:44,953 --> 03:17:46,455 PLACENTA, WEE CANEE VASLAR 5213 03:17:46,455 --> 03:17:48,023 REALLY WELL WITBOTH. 5214 03:17:48,023 --> 03:17:49,357 AT WE REALLY STRUGGLE TGL SEE, 5215 03:17:49,357 --> 03:17:51,960 I THK, I THE FIBROSIS. 5216 03:17:51,960 --> 03:17:54,062 YOU OFTTIMES CAN'T SEE THAT 5217 03:17:54,062 --> 03:17:54,930 UNTIL YOU GET INTO THE O.R. 5218 03:17:54,930 --> 03:17:57,999 Y FOREE ANYNY ROLE OF MRIRI 5219 03:17:57,999 --> 03:18:00,669 ON THAT PATHWAY ATLL? 5220 03:18:00,669 --> 03:18:03,271 >> I INOWNOOR SUREURHAT WE'RE 5221 03:18:03,271 --> 03:18:03,372 CE 5222 03:18:03,372 --> 03:18:04,473 AICEY ON THE M NOTING THAT 5223 03:18:04,473 --> 03:18:07,342 THEREER IS FIBRIN DEPOSITION THT 5224 03:18:07,342 --> 03:18:09,778 I'M GOING TO HAVTO RECALL TO 5225 03:18:09,778 --> 03:18:12,748 STUDYY BY ONE OF MYY CLEAGUES,U, 5226 03:18:12,748 --> 03:18:15,884 DIANEE TERKL T, BUT WHEN WHEY 5227 03:18:15,884 --> 03:18:17,519 OKED AT THE FIBRIN, THERE 5228 03:18:17,519 --> 03:18:18,720 WASN'T AS'TLEAR OF 5229 03:18:18,720 --> 03:18:19,354 ATION BUT CLEARLY YOULYAN 5230 03:18:19,354 --> 03:18:26,228 SEE SOME OF THAT EVIDENCEE O O . 5231 03:18:26,228 --> 03:18:27,362 >> BRIANANNDERSON. 5232 03:18:27,362 --> 03:18:29,598 >> BRIAN ANDERSON, UNIVERSITY OF 5233 03:18:29,598 --> 03:18:30,031 . 5234 03:18:30,031 --> 03:18:32,968 I THINK IT'S IMPOR INT THAT WE 5235 03:18:32,968 --> 03:18:35,937 TRY TO CE TO ANO AGREEMEGR ON 5236 03:18:35,937 --> 03:18:37,806 WHAT WE'RE TRYING TO PODICT IN 5237 03:18:37,806 --> 03:18:40,208 OUR PLANNING. 5238 03:18:40,208 --> 03:18:42,210 E OF THEOFHEHEENTRAL FRUSTRATIOS 5239 03:18:42,210 --> 03:18:43,812 OF READINGDI LITERATURE IN PAS S 5240 03:18:43,812 --> 03:18:45,313 JU TO KNOW THASOMEEOPL 5241 03:18:45,313 --> 03:18:46,681 LOONGOOT PRESENCE ORR 5242 03:18:46,681 --> 03:18:47,682 ABSENCE OF DEASE, SOME PEOPLE 5243 03:18:47,682 --> 03:18:50,185 ARE LOOKING AT HISTOPAISOLOGIC 5244 03:18:50,185 --> 03:18:51,286 CONFIRMATION, SOME PEOPLE ARE 5245 03:18:51,286 --> 03:18:52,521 OKING AT DIFFE DNTFEGINGGI 5246 03:18:52,521 --> 03:18:53,822 SYSTEMS, PEOPLE ARE A AING TO T 5247 03:18:53,822 --> 03:18:58,260 DIFFERENT BASET BA YOUR APPRO 5248 03:18:58,260 --> 03:18:59,194 APPROACH. 5249 03:18:59,194 --> 03:19:01,596 PEOPLE ARE TRYING TO PREDICT 5250 03:19:01,596 --> 03:19:05,567 IR INTER INTION OR ANY OTHER 5251 03:19:05,567 --> 03:19:07,435 INTERVENTION OR REFERRAL TO 5252 03:19:07,435 --> 03:19:08,203 PAS CENTER. 5253 03:19:08,203 --> 03:19:09,104 T MAYBE ABE OF THOSE THING THI 5254 03:19:09,104 --> 03:19:10,472 IMPORTANT, TAT DO YOU HAVE A 5255 03:19:10,472 --> 03:19:11,673 SENSE FOR WHAT WULD BE HELPF HF 5256 03:19:11,673 --> 03:19:16,444 TARGET IN OUR STUDIES MOVING 5257 03:19:16,444 --> 03:19:25,053 FORWARFOAR? 5258 03:19:25,053 --> 03:19:28,623 SENSITIVITY ATYEING ABLE TOO 5259 03:19:28,623 --> 03:19:29,257 PREDICPR TIC PRESENCE. 5260 03:19:29,257 --> 03:19:30,692 I THINKHI WE' MORE REMOVED IN 5261 03:19:30,692 --> 03:19:32,227 TERMS OF CLEAR PREDICTION OF 5262 03:19:32,227 --> 03:19:32,327 SE 5263 03:19:32,327 --> 03:19:34,596 THINK WKN IT' NORMAL, WE CAN 5264 03:19:34,596 --> 03:19:35,063 TALK. 5265 03:19:35,063 --> 03:19:37,265 AND I THINK WHEN IT'S REALLY 5266 03:19:37,265 --> 03:19:37,933 BAD, WE CAN TELL. TL. 5267 03:19:37,933 --> 03:19:43,538 ANDANDL. TNK IT'S THAT GREY 5268 03:19:43,538 --> 03:19:44,506 INTERMEDIATE ZONE WHEREE'RE 5269 03:19:44,506 --> 03:19:48,076 BETTER DISCRIMINCRION, AND THAT 5270 03:19:48,076 --> 03:19:50,245 GOES INTO THE MTHEEMENE OF WHO 5271 03:19:50,245 --> 03:19:55,483 >> I'M GOING TO ADD TON THAT. 5272 03:19:55,483 --> 03:19:56,551 I THII WE HIT ON THAT A LITTLE 5273 03:19:56,551 --> 03:19:58,620 BITT EARLIER TODER TOO,, I, 5274 03:19:58,620 --> 03:20:00,655 UNTRY FULL OF MATERNALRN CARE 5275 03:20:00,655 --> 03:20:02,624 SERTS, IT REALLY IS I I IETTING 5276 03:20:02,624 --> 03:20:03,692 THE PATIENTS TO THE RIGHT SIGE. 5277 03:20:03,692 --> 03:20:05,694 I MEAN,N, AGAIN, IF PEOPLE ARE 5278 03:20:05,694 --> 03:20:08,396 GETTING THEIR CAREAR ATT THEIRHE 5279 03:20:08,396 --> 03:20:09,598 LOCAL GENERAL LIS CLINIC, IT 5280 03:20:09,598 --> 03:20:15,437 MAYE A VERYIFNT 5281 03:20:15,437 --> 03:20:16,071 TRASOUND IMAGE, A GETTA GEIT 5282 03:20:16,071 --> 03:20:17,138 IS IN THE EYEF THEE BEHOLDER 5283 03:20:17,138 --> 03:20:17,839 RD WHAT PEOPLE ARE BEING 5284 03:20:17,839 --> 03:20:19,541 LOOKING FORS OPPOSED TO GOING 5285 03:20:19,541 --> 03:20:20,642 TO A CENTER WHERE PEOPLE KNOW 5286 03:20:20,642 --> 03:20:23,078 AT, HEY, THI, IS WT WE 5287 03:20:23,078 --> 03:20:23,845 NEED TO LOOK FOR.OR 5288 03:20:23,845 --> 03:20:25,213 SO I THINK TT'S A LITTLE BIT OFT 5289 03:20:25,213 --> 03:20:26,848 ALL OF THE ABOVE A 5290 03:20:26,848 --> 03:20:26,948 I 5291 03:20:26,948 --> 03:20:28,516 GREE WITHHOU,T'SEALLY 5292 03:20:28,516 --> 03:20:28,617 CH 5293 03:20:28,617 --> 03:20:29,718 LENGG WHEN WE'RE LOOKING 5294 03:20:29,718 --> 03:20:33,455 AT THE L TERATURE. 5295 03:20:33,455 --> 03:20:33,788 BOB SILVER. 5296 03:20:33,788 --> 03:20:37,058 MORE GREAT G PRESENTATIONS.NS 5297 03:20:37,058 --> 03:20:39,361 SEM JUST GOING TO THROW OUT 5298 03:20:39,361 --> 03:20:40,729 ANOTHER PROVOCATIVO COMMENT TONT 5299 03:20:40,729 --> 03:20:41,196 THE GROUP. 5300 03:20:41,196 --> 03:20:45,033 I THINKHE IR STUFF STU HAS 5301 03:20:45,033 --> 03:20:46,434 TREMENDOUSUS POTENTIAL, AND THE 5302 03:20:46,434 --> 03:20:50,272 TECHNOLOGY KEEPSETTINGETTER. 5303 03:20:50,272 --> 03:20:52,874 AND WE KEEPAVING SUCH S DEBATES 5304 03:20:52,874 --> 03:21:00,715 ABOUT IT, RIGHTLY SO, PEOPLE 5305 03:21:00,715 --> 03:21:05,120 WILL SAY I'VE GOT A NEWROVEDME 5306 03:21:05,120 --> 03:21:06,521 TECHNIQUE THAT'S EVEVE BETTER AD 5307 03:21:06,521 --> 03:21:07,622 DON'T HAVE COMPLICATIONS. 5308 03:21:07,622 --> 03:21:10,225 THERE'SER CERTAINLY A LOT OF 5309 03:21:10,225 --> 03:21:11,126 OPERATOR DEPENDENCE AND THIS AND 5310 03:21:11,126 --> 03:21:12,694 THAT BUT IHINK TO REALLY 5311 03:21:12,694 --> 03:21:15,497 REQUE RCTs, ANDNE OF THETO 5312 03:21:15,497 --> 03:21:15,597 BE 5313 03:21:15,597 --> 03:21:19,234 IS WE HAVE A BUN OFEOPLETINGTT 5314 03:21:19,234 --> 03:21:20,735 WITH A BUNCH OF PATIENTS WHO 5315 03:21:20,735 --> 03:21:25,340 MIGHT BE WILNG TO PTICIPATE 5316 03:21:25,340 --> 03:21:25,440 IN 5317 03:21:25,440 --> 03:21:27,676 RCTs AND IS THERE AATHAT 5318 03:21:27,676 --> 03:21:29,778 FORWARDRWOR RCT TO REALLY ASSESS 5319 03:21:29,778 --> 03:21:31,479 TH IN A PROPERLY SCIENTIFIC 5320 03:21:31,479 --> 03:21:32,981 WAY, BECAUSE I THINK THAT'S THE 5321 03:21:32,981 --> 03:21:36,384 WAY TO MOVEOV THINGS FORWARD.RD 5322 03:21:36,384 --> 03:21:37,819 BUT IT'S VERY, VERY HARD TO DO 5323 03:21:37,819 --> 03:21:39,821 FOR ALFOHE REANS THAT YOHAT L 5324 03:21:39,821 --> 03:21:49,931 KNOW. 5325 03:21:52,067 --> 03:21:53,735 I THINK HONESTLY IT'S GOING 5326 03:21:53,735 --> 03:22:02,711 TO BE B TOUGH TOUGH BECAUSE I TS 5327 03:22:02,711 --> 03:22:04,779 SMUCH AS WE W WLDLD SAY RANDOMID 5328 03:22:04,779 --> 03:22:07,182 CONTROCOTRROL IRO REALL R THE TL 5329 03:22:07,182 --> 03:22:11,653 STANDARD,,DA IHINKHINK AT OUR 5330 03:22:11,653 --> 03:22:15,290 INSTITUTION, I'M NOT SURE H 5331 03:22:15,290 --> 03:22:18,893 WELL OUR GYNECOLOGICOL CLEAGUELE 5332 03:22:18,893 --> 03:22:21,529 ULDAKE TOHE IA,A, WELL, 5333 03:22:21,529 --> 03:22:25,600 YOVE GOT A PLACENTA PCRETACR 5334 03:22:25,600 --> 03:22:32,474 THAT'S GROWING IWIO GIGINA AND 5335 03:22:32,474 --> 03:22:34,275 LET'S GET THOSE AND RANDOMIZE 5336 03:22:34,275 --> 03:22:40,782 THERY.ETWEEN NANENMI TRAPY AND 5337 03:22:40,782 --> 03:22:41,449 I DON'TW. 5338 03:22:41,449 --> 03:22:44,386 THEYEY FEEL ABOUT THAT BUT I HAE 5339 03:22:44,386 --> 03:22:45,420 A FEELING THAT THEY WILL SAY,G 5340 03:22:45,420 --> 03:22:48,590 NOT RANDOMIZING TT 5341 03:22:48,590 --> 03:22:51,159 PATIENT TO BALLOONS, TO 5342 03:22:51,159 --> 03:22:53,028 EMBOLIZATION, TO WHATEVER AND 5343 03:22:53,028 --> 03:22:53,128 NO 5344 03:22:53,128 --> 03:22:58,566 SO I GUESS G IT WOULD DULEND WHW 5345 03:22:58,566 --> 03:23:01,102 KIND OF RANDOMIZATION YOU W YEE 5346 03:23:01,102 --> 03:23:03,138 GOING TO T 5347 03:23:03,138 --> 03:23:05,440 WITH THE EMBOLIZATION OF 5348 03:23:05,440 --> 03:23:06,107 MULTI-ARTERY EMBOLIZATION THAT 5349 03:23:06,107 --> 03:23:08,610 WE'RE DOING,, THERERE HAVE H BEO 5350 03:23:08,610 --> 03:23:08,710 MA 5351 03:23:08,710 --> 03:23:13,448 BEEN NO -- THERE'S BASICALLYE 5352 03:23:13,448 --> 03:23:14,649 BEEN MORE M PAT MNTS THA HAVE 5353 03:23:14,649 --> 03:23:16,618 BEEN TRANSFUSED AT ALL AND MOST 5354 03:23:16,618 --> 03:23:17,919 OF THEM,M,NE UNIT, NON OF THEM 5355 03:23:17,919 --> 03:23:18,019 HA 5356 03:23:18,019 --> 03:23:23,658 GONEO THECU.CU 5357 03:23:23,658 --> 03:23:24,092 I DON'T KNO'T'T 5358 03:23:24,092 --> 03:23:25,693 I THINK WE MI WT BE W A LITTL W 5359 03:23:25,693 --> 03:23:28,396 HARDHAREED TO DO THAT, BUTUT IF 5360 03:23:28,396 --> 03:23:31,132 WE -- IF THERE'S A CENTE C TT 5361 03:23:31,132 --> 03:23:36,471 DOESN'T DO THAT NOW, ANDND MAYBE 5362 03:23:36,471 --> 03:23:40,308 WILLING TOO GO FM NOT N DOI 5363 03:23:40,308 --> 03:23:42,577 IT T NOWOW DOING IT,T,T, THAT MT 5364 03:23:42,577 --> 03:23:47,182 BE ONENE WAY TO GO AO UTO UTT. 5365 03:23:47,182 --> 03:23:47,282 BU 5366 03:23:47,282 --> 03:23:50,018 I DON'T KNOW K. 5367 03:23:50,018 --> 03:23:52,220 I DON'T KNONO WHAT THE ANSWER I. 5368 03:23:52,220 --> 03:23:55,924 QUESTIONESS,ES DO YOU PUT WOMAN 5369 03:23:55,924 --> 03:23:57,659 THROUGHHO PROCEDURE WITH THE 5370 03:23:57,659 --> 03:24:01,196 POTENTIAL REALLY BAD OUTCOMEUT 5371 03:24:01,196 --> 03:24:03,665 >> I THINK T TT'S A TRIFIC 5372 03:24:03,665 --> 03:24:05,567 POINT, AND IT'S LIKE THIS WITH A 5373 03:24:05,567 --> 03:24:09,237 LOT OF THINGS THAT T ARE 5374 03:24:09,237 --> 03:24:10,572 CONTROVERSIAL. 5375 03:24:10,572 --> 03:24:12,841 YOU' GOT SOME PEOEE THAT 5376 03:24:12,841 --> 03:24:14,809 ALREADY DECIDED AND TANY DON'TON 5377 03:24:14,809 --> 03:24:18,513 HA EQUIPOISE. 5378 03:24:18,513 --> 03:24:19,747 I THINK IF YOU DON'T,ONT'SONS 5379 03:24:19,747 --> 03:24:23,718 DEPENDS UPON HOW MANW AND IT 5380 03:24:23,718 --> 03:24:23,818 PE 5381 03:24:23,818 --> 03:24:25,120 LE HAVE EQUIPOISE. 5382 03:24:25,120 --> 03:24:27,622 YOU DON'T D WANT W DO 5383 03:24:27,622 --> 03:24:29,357 RANDOMIZED TRIAL OF DOING A 5384 03:24:29,357 --> 03:24:29,457 PA 5385 03:24:29,457 --> 03:24:30,992 UTE JPING OUT OF AN 5386 03:24:30,992 --> 03:24:32,093 AIRPLANE THINE TG IT WORKS, BUTT 5387 03:24:32,093 --> 03:24:35,730 DON'TN' KNOW THAT -- I THINK T 5388 03:24:35,730 --> 03:24:38,233 TSTST CENTERS DON'T DO THI 5389 03:24:38,233 --> 03:24:39,434 ROUTINELY AND STILL HAVE 5390 03:24:39,434 --> 03:24:40,001 EQPOISE. 5391 03:24:40,001 --> 03:24:42,003 IT ALMOST SEEMS LIKE YOU NEED 5392 03:24:42,003 --> 03:24:44,906 TO R RZE TO A CENTER. 5393 03:24:44,906 --> 03:24:46,474 KE -- TO - CHA -E THE WAY W THAT 5394 03:24:46,474 --> 03:24:48,877 THEY MANAGE THE PATIENTS SEEMS 5395 03:24:48,877 --> 03:24:50,378 LIKELI YOU'RE ASKING FOR TROUBLE 5396 03:24:50,378 --> 03:24:52,580 IF PEOPLE HAVE, OVER TIME, 5397 03:24:52,580 --> 03:24:55,083 EVOLVED INTO I A SAFE SAF WAY WE 5398 03:24:55,083 --> 03:24:56,951 CARE OF THEIR PATIENTS.IE 5399 03:24:56,951 --> 03:24:58,353 BUT I DON'T KNOW IF THERE'S A 5400 03:24:58,353 --> 03:24:59,988 WAY TO RANDOMIZE TO LOCATION OF 5401 03:24:59,988 --> 03:25:00,188 RE. 5402 03:25:00,188 --> 03:25:01,890 ISSUE.HT HELP GET AROUND THE T 5403 03:25:01,890 --> 03:25:03,591 >> WE'VE GOT A LOT OF HANDSOT UU 5404 03:25:03,591 --> 03:25:06,327 I'D LIKE TOO GO FIRSO TO -- T N 5405 03:25:06,327 --> 03:25:07,929 BEHIND CISTINA, AND THEDID 5406 03:25:07,929 --> 03:25:10,798 HAND UP.RISTCHASTOU HAD YOUR 5407 03:25:10,798 --> 03:25:12,433 >> THANK YOUNK VERY MUERY 5408 03:25:12,433 --> 03:25:14,002 IT'S VERY INTERESTING AND THANK 5409 03:25:14,002 --> 03:25:15,904 YOU FOR ALL THE GREATALKS. 5410 03:25:15,904 --> 03:25:22,310 JUST AOMMENTNT FROM THE -- 5411 03:25:22,310 --> 03:25:24,078 RANDOMRAED CONTROLRIALS. 5412 03:25:24,078 --> 03:25:28,082 IT'S A SITUATION THE'SHE SOUCH 5413 03:25:28,082 --> 03:25:29,751 MORBIDITY, IITS SOO HIGH, SO ITS 5414 03:25:29,751 --> 03:25:31,819 SO DIFFICULT T PERFORM 5415 03:25:31,819 --> 03:25:34,222 RNIZ CONTROLON TRIAL B YOU 5416 03:25:34,222 --> 03:25:36,624 LITTLELE TM BECAU B A FERN 5417 03:25:36,624 --> 03:25:37,825 DOESN'T WANT TO TESS SOMETHING 5418 03:25:37,825 --> 03:25:38,927 BECAUSE THEY DO NOT BELIEVE IT 5419 03:25:38,927 --> 03:25:41,196 COULD BE INTER ITIER, AND 5420 03:25:41,196 --> 03:25:44,065 ANOTHER POINT IS P WHEN YOU 5421 03:25:44,065 --> 03:25:44,165 PE 5422 03:25:44,165 --> 03:25:46,601 ORM THEM AS CONTROLONTR TRIAL 5423 03:25:46,601 --> 03:25:51,139 THE TEAM HAS THEHE SAME EXPERIEE 5424 03:25:51,139 --> 03:25:53,107 FOR THE TWO GROUPS, FORS, EXAMP, 5425 03:25:53,107 --> 03:25:58,279 IF PERFORM CONTR C TRIAL -RI S - 5426 03:25:58,279 --> 03:26:01,149 IF I DISCOVER THAT FINALLY THE 5427 03:26:01,149 --> 03:26:03,618 RESULT IS NOTN FAVOR F OF -- YOU 5428 03:26:03,618 --> 03:26:08,122 WOULDULAY YESOU HAVE NO -- 5429 03:26:08,122 --> 03:26:09,557 WHY YOU PARTICIPATEN 5430 03:26:09,557 --> 03:26:14,896 CONTROLLED TRIALS,RI SO --ACCRE. 5431 03:26:14,896 --> 03:26:16,431 >> AND IT MAY BE THAT MAYBE MT 5432 03:26:16,431 --> 03:26:18,066 NOT RANDOMIZE CZETROL TRIALS BUT 5433 03:26:18,066 --> 03:26:22,136 CERTAINLYROSPECTIVETIVE TALSALS. 5434 03:26:22,136 --> 03:26:22,804 LISA? 5435 03:26:22,804 --> 03:26:24,906 I'M SORRY S. 5436 03:26:24,906 --> 03:26:27,275 >>>> HI. 5437 03:26:27,275 --> 03:26:27,942 JENN GELLA G 5438 03:26:27,942 --> 03:26:36,618 I THINK THE -- I AGREEGR WE WILL 5439 03:26:36,618 --> 03:26:39,921 NOT BE TO SOLVE TS ISSUE,SS 5440 03:26:39,921 --> 03:26:42,023 AND I COME FROMRO ANN ITITUTITI 5441 03:26:42,023 --> 03:26:45,560 WHEREE'VE EMULATEMED MANY OF THE 5442 03:26:45,560 --> 03:26:47,629 SAMESA THIS, HAVEHE SAME KINDIN 5443 03:26:47,629 --> 03:26:49,731 OF OUTCO OS, NOBODYOD IN E I IC, 5444 03:26:49,731 --> 03:26:51,366 VERY LITTLE TRANSFUSION OVER 5445 03:26:51,366 --> 03:26:54,035 RMANY YEARS TE,HE DEVIL DIL 5446 03:26:54,035 --> 03:26:54,802 BECOS IN THE DETAILS. 5447 03:26:54,802 --> 03:26:56,804 I THINK THIS TS WHAT IS MRING 5448 03:26:56,804 --> 03:27:02,410 THE CURRENTLY AVAILABLELITERALIL 5449 03:27:02,410 --> 03:27:02,510 IS 5450 03:27:02,510 --> 03:27:03,845 CREED E PARTICULARLY 5451 03:27:03,845 --> 03:27:05,380 WITHINWIHEWI PELVIS, SO THERE'T' 5452 03:27:05,380 --> 03:27:08,483 MA TMANGS THATHAORACAC OF 5453 03:27:08,483 --> 03:27:09,951 TIME TO GO INTO ANT THEHE DETAI, 5454 03:27:09,951 --> 03:27:12,186 I THINK, DR. ROBERTSON, YOU 5455 03:27:12,186 --> 03:27:14,389 DIDN'T HAVE A CHANCE TO GET 5456 03:27:14,389 --> 03:27:20,628 INTO, ADAPTING THEHEE, 5457 03:27:20,628 --> 03:27:21,863 TREMENDOUSLY DECREASE THE NUMBER 5458 03:27:21,863 --> 03:27:24,232 OR NON-TARGET 5459 03:27:24,232 --> 03:27:24,832 EMBOLIZATION COMPLICATIONSAT 5460 03:27:24,832 --> 03:27:27,468 HERE'S SO MANY OF THESE 5461 03:27:27,468 --> 03:27:29,237 DETAILS THAT WITH PROSPECTIVEEC 5462 03:27:29,237 --> 03:27:32,507 RANDOMRAND ORA NOT, PROSPECTIVE 5463 03:27:32,507 --> 03:27:33,741 STUDY WILL ALLOW US TO NARROW 5464 03:27:33,741 --> 03:27:35,376 DOWN THE MIXF THE DATA THAT 5465 03:27:35,376 --> 03:27:36,110 WE'R LOOKING AT. 5466 03:27:36,110 --> 03:27:39,147 SO WE'RE NOT JUST TRYING 5467 03:27:39,147 --> 03:27:40,214 COMPARE, OH, THERE WAS W 5468 03:27:40,214 --> 03:27:43,384 LLED O IR BECAUSE IT'SE WE 5469 03:27:43,384 --> 03:27:46,888 LEADINGADO A MASS M M OF DATA TT 5470 03:27:46,888 --> 03:27:49,624 CONCLUSIONS TO.TANDARDIZED 5471 03:27:49,624 --> 03:27:54,228 SO THERE IS THATT NEENG A 5472 03:27:54,228 --> 03:27:54,996 PROSPEPRIVEIV APPROACH. 5473 03:27:54,996 --> 03:27:56,864 EVEN THOUGH THEH AHE MANY OF US 5474 03:27:56,864 --> 03:27:58,433 WHO, I AGREE, I'M HAVING A HARD 5475 03:27:58,433 --> 03:28:01,703 TIME BEINGNGILLING TO T WITHO W 5476 03:28:01,703 --> 03:28:02,870 THE MULTIVESSEL EMBOLIZATION 5477 03:28:02,870 --> 03:28:04,305 THAT WE'RE DOING, BUT AUT 5478 03:28:04,305 --> 03:28:07,208 WILLINGLLO THINK THROUGHOUOU HAG 5479 03:28:07,208 --> 03:28:08,876 THE STANDARDIZED APPROACH TOPP 5480 03:28:08,876 --> 03:28:10,411 DOING TO DETERMINENE WHICH PIECP 5481 03:28:10,411 --> 03:28:11,379 IS REAISY MAKING T BIGGEST 5482 03:28:11,379 --> 03:28:11,612 IMPACT. 5483 03:28:11,612 --> 03:28:13,548 >>OU'RE SAYING WE NEED REAY 5484 03:28:13,548 --> 03:28:14,949 GOOD ENDND STAGE DIGN IS WHAT 5485 03:28:14,949 --> 03:28:16,451 I'M HEARING ALSO. 5486 03:28:16,451 --> 03:28:18,653 II SEE BABA B AND -- 5487 03:28:18,653 --> 03:28:22,323 ->> GO AHEAD. 5488 03:28:22,323 --> 03:28:27,962 >>>> USC. 5489 03:28:27,962 --> 03:28:28,396 TRANSFURAON.RA 5490 03:28:28,396 --> 03:28:30,932 A CONVE CATION WITH MY 5491 03:28:30,932 --> 03:28:33,234 SHORT TERM T CMLE CUE AND THEYND 5492 03:28:33,234 --> 03:28:36,704 TALK ABOUT THEIR ONGOING 5493 03:28:36,704 --> 03:28:41,909 RANDOMIZED -- MULTICOMPONENT -- 5494 03:28:41,909 --> 03:28:49,217 PATIENTS, AND THENN BASED ON O R 5495 03:28:49,217 --> 03:28:54,222 THINKINKIN THIS --S IN THIS TC 5496 03:28:54,222 --> 03:28:56,290 WOULD THAT BE THEHE CASEAS TO TS 5497 03:28:56,290 --> 03:29:00,328 SAMEAM THING -- 5498 03:29:00,328 --> 03:29:00,762 >> I THINK SO. 5499 03:29:00,762 --> 03:29:05,233 IN A LOT OF OUR DATAAVEVEEXTRAPA 5500 03:29:05,233 --> 03:29:06,768 TRAUMA LAUERATURE, WHICH IS 5501 03:29:06,768 --> 03:29:06,868 WH 5502 03:29:06,868 --> 03:29:08,035 E THIS WHOLE W BLOOD ALOOD 5503 03:29:08,035 --> 03:29:10,872 WALKINGLOOD TRANS TSION -- ORR 5504 03:29:10,872 --> 03:29:12,306 WALKING BLOOL BLOOD BANK 5505 03:29:12,306 --> 03:29:13,808 LITERATURE COMES FROM, FHERE ARE 5506 03:29:13,808 --> 03:29:15,076 SOME SSOLLTUDIES LOOKING 5507 03:29:15,076 --> 03:29:17,211 SPECIFICECLYEC APLACTA ACCRE A 5508 03:29:17,211 --> 03:29:19,747 SPECTRUMTR WITHIT WHOLE BLO OUTF 5509 03:29:19,747 --> 03:29:20,314 TONIO THAT HAVE HAD 5510 03:29:20,314 --> 03:29:21,783 SITISIESULSI WITH LESS W 5511 03:29:21,783 --> 03:29:21,883 TR 5512 03:29:21,883 --> 03:29:22,650 SFUSIOSF 5513 03:29:22,650 --> 03:29:25,486 JUSTUS NEED LARGERGEGE SDIES, D 5514 03:29:25,486 --> 03:29:26,888 THAT'S A VERY EASY LEAP TO MAKE, 5515 03:29:26,888 --> 03:29:28,890 AND THED ARE SOMEOM SDIESDI THAT 5516 03:29:28,890 --> 03:29:30,024 E ONGOING A PLANNED. 5517 03:29:30,024 --> 03:29:31,192 >> SEE>>NE OF BIGGE B 5518 03:29:31,192 --> 03:29:36,664 TH A PAIN AMOUNT OF PAIN THE T T 5519 03:29:36,664 --> 03:29:36,831 HAS. 5520 03:29:36,831 --> 03:29:37,965 S.WHETHER YOHEGO OUT AND SURVEY 5521 03:29:37,965 --> 03:29:39,133 TIENTS,ENENHAT WAS THE WORST 5522 03:29:39,133 --> 03:29:40,568 THING YOU HAD IN THEOSPITAL, 5523 03:29:40,568 --> 03:29:43,037 THE EMBOLIZATION.ATN. 5524 03:29:43,037 --> 03:29:45,139 THEY HAVE EXTREME PAIN AFTER THE 5525 03:29:45,139 --> 03:29:48,876 THIS IS ANOTHER ONEER OF THESE 5526 03:29:48,876 --> 03:29:49,944 OBLEMSOBLET REALLY WE'RE 5527 03:29:49,944 --> 03:29:50,912 FACING. 5528 03:29:50,912 --> 03:29:52,580 LIZATION, YOU DOU'T DOUAVE THE 5529 03:29:52,580 --> 03:29:54,982 SKIN CHANGES AND IT'S VERY 5530 03:29:54,982 --> 03:29:56,784 PAINL. 5531 03:29:56,784 --> 03:30:00,421 ELL, ALL OFF OUR PATIENTS ARE 5532 03:30:00,421 --> 03:30:00,521 GO 5533 03:30:00,521 --> 03:30:02,156 GGON TO CESAREAN 5534 03:30:02,156 --> 03:30:02,924 HYSTERECTOMY. 5535 03:30:02,924 --> 03:30:08,763 THAN TANY WOULD HAVE WITHITHHPAI 5536 03:30:08,763 --> 03:30:09,530 HYSTERECTOMY. 5537 03:30:09,530 --> 03:30:11,833 SO THEY DON'T D HAVE ISCHEMISC 5538 03:30:11,833 --> 03:30:15,703 I MEAN, OBVIOUSLYUS IF THERE WAS 5539 03:30:15,703 --> 03:30:16,337 NON-TARGETTAMBOLIZATION, WE 5540 03:30:16,337 --> 03:30:20,541 ULD ES PECT SOME ISCHEMIA, BUT 5541 03:30:20,541 --> 03:30:24,846 YOU COULD HAVE LEG ISCMIA,A, 5542 03:30:24,846 --> 03:30:25,847 BOWEL ISCHEMIA, BLADDER 5543 03:30:25,847 --> 03:30:29,917 BUT WE HAVEN'T SEENN THAT IN ANY 5544 03:30:29,917 --> 03:30:34,288 OF OUR PATIENTS. 5545 03:30:34,288 --> 03:30:35,756 SO AGAIN, WE'RE A CENTER THAT'S 5546 03:30:35,756 --> 03:30:37,258 SBEEN DOING THISEN FOR 30 YEARSW 5547 03:30:37,258 --> 03:30:42,396 IN O W O O ANOTHERND 5548 03:30:42,396 --> 03:30:43,631 THAT'S NOT TYPICAL OF EVERYER 5549 03:30:43,631 --> 03:30:43,831 PLACE.PL 5550 03:30:43,831 --> 03:30:45,366 >> THISSS W WE NEE TO 5551 03:30:45,366 --> 03:30:47,235 LLECT THIS DATA PROSPECTIVELY,, 5552 03:30:47,235 --> 03:30:47,335 DE 5553 03:30:47,335 --> 03:30:47,668 NITELY.LY 5554 03:30:47,668 --> 03:30:49,337 >> I THINK THIS MIGHT B OUR 5555 03:30:49,337 --> 03:30:51,472 NAL QUESL ON, DR.QU DDE. 5556 03:30:51,472 --> 03:30:52,940 >> GEORGE SAADE. 5557 03:30:52,940 --> 03:30:54,775 MY QUEION IABOUT THE AORTICOR 5558 03:30:54,775 --> 03:30:58,279 BALLOON. 5559 03:30:58,279 --> 03:31:00,248 AND I'M NOT ABLE A T RONCILECICI 5560 03:31:00,248 --> 03:31:04,018 WHAT IEAD ABOUT IT IN THE 5561 03:31:04,018 --> 03:31:06,587 TRAUMA LITER LURE WITH THE 5562 03:31:06,587 --> 03:31:08,222 HOITAL APPLICATIONCA AND 5563 03:31:08,222 --> 03:31:12,193 THEN WITHOUTXPERIENCE HAS BEEN 5564 03:31:12,193 --> 03:31:14,462 AN ACCRETA WITH WHEN TAKIN T SO 5565 03:31:14,462 --> 03:31:15,696 LONG TO PUT THE SHEET O THEHE 5566 03:31:15,696 --> 03:31:18,866 CATHETER, AND IONRING 5567 03:31:18,866 --> 03:31:20,401 WHETHER THEHE ELIBILITYLITYFTY W 5568 03:31:20,401 --> 03:31:24,505 WE USE IT IS IIS WRONG,RO VSUS W 5569 03:31:24,505 --> 03:31:28,442 THE TRAA USES IT, WHICH IS 5570 03:31:28,442 --> 03:31:28,976 TEMPORALLIZATION UNTIL THE 5571 03:31:28,976 --> 03:31:30,411 PATIENT CAN BE TAKENN CARE. 5572 03:31:30,411 --> 03:31:33,047 I'M WONDM ING IF I THERE IS A RE 5573 03:31:33,047 --> 03:31:36,350 FORR IT IN CASN WRE YOU NEED 5574 03:31:36,350 --> 03:31:37,151 THAT TIME IN ORDIN TO GET YOUR 5575 03:31:37,151 --> 03:31:38,286 TEAM TOGETHER, IF R,UF EPARTMENT 5576 03:31:38,286 --> 03:31:43,024 DIDN'THAVE TO ST TT WITH,H, OR U 5577 03:31:43,024 --> 03:31:44,325 CAN CONTROLOMOFOM THE T BLEEDING 5578 03:31:44,325 --> 03:31:46,727 RATHER THANSINGNG IT 5579 03:31:46,727 --> 03:31:51,032 PROPHYLACTICALLY. 5580 03:31:51,032 --> 03:31:55,303 >> JUST SAY THAT ONE OFONHE 5581 03:31:55,303 --> 03:31:56,370 THINGS THAGSS REALLY IMPORTANT, 5582 03:31:56,370 --> 03:31:57,905 THIS GOES TO COMICATIONS AND 5583 03:31:57,905 --> 03:32:02,043 AT KIND OF THING, IS IF YOU, 5584 03:32:02,043 --> 03:32:06,180 ONE, ARE AUTTING IN BALLO B IN 5585 03:32:06,180 --> 03:32:10,651 NOT BEING ABLE TO SEE WHERECOPYY 5586 03:32:10,651 --> 03:32:10,751 YO 5587 03:32:10,751 --> 03:32:14,755 RE GOING,, AND JUST PUSHING 5588 03:32:14,755 --> 03:32:17,058 THIS FAIRLY LARGEGE DEVIC D INTO 5589 03:32:17,058 --> 03:32:21,062 THE AORTA AOR WITHOUTHO ANY KINF 5590 03:32:21,062 --> 03:32:24,565 GUIDANCECE,OU CAN C GET INTO 5591 03:32:24,565 --> 03:32:24,865 TROUBLE. 5592 03:32:24,865 --> 03:32:25,766 S WHERE I THINKEOPLE 5593 03:32:25,766 --> 03:32:29,637 HAVE PROBLEMS WITH ISCHEMIC LEGS 5594 03:32:29,637 --> 03:32:30,438 AND THATD IND OF THING. 5595 03:32:30,438 --> 03:32:31,539 SO THERE'S -- I THINK THERE'S A 5596 03:32:31,539 --> 03:32:36,243 SE TO BE MADE, AND THIS 5597 03:32:36,243 --> 03:32:39,814 ASSUMEAS YOUHINK YOU'REOUOINGOIS 5598 03:32:39,814 --> 03:32:42,550 TO HAVE THAT DITAL -IT IF 5599 03:32:42,550 --> 03:32:44,385 U'RE GU'RE TU'OO UO THAT DEVE, 5600 03:32:44,385 --> 03:32:45,453 HAVE IT PUT IN USING 5601 03:32:45,453 --> 03:32:46,320 FLUOROSCOPY, CHECKING TOAKEE 5602 03:32:46,320 --> 03:32:50,591 SURE HOWOW BIG THE T BALON NEEDS 5603 03:32:50,591 --> 03:32:52,193 TO BE INFLATED LA ORDER TO STOP 5604 03:32:52,193 --> 03:32:54,996 E BLOOD FLOW GOING G INTO THEE 5605 03:32:54,996 --> 03:32:56,330 PELVIS, AND THAT ISONE MUCH 5606 03:32:56,330 --> 03:32:59,233 BETTER WHEN YOU'RE NOT IN AN 5607 03:32:59,233 --> 03:33:01,769 EMERNT SUATION WHERE 5608 03:33:01,769 --> 03:33:04,705 SOMEBODY IS BLEEDING. 5609 03:33:04,705 --> 03:33:06,974 >> YEAH, AND I THINK ALSO -- 5610 03:33:06,974 --> 03:33:07,341 2 MINU2 , OK2 . 5611 03:33:07,341 --> 03:33:07,975 SO FROM FY PERSO PL EXPERIENCERI 5612 03:33:07,975 --> 03:33:11,579 USING THE BALLOONS AS WELL, TOO, 5613 03:33:11,579 --> 03:33:13,347 AGAIN, OFTENTIFTS THESE ARE 5614 03:33:13,347 --> 03:33:14,115 PLACED WITH ULTRASOUND GUIDA GE 5615 03:33:14,115 --> 03:33:14,181 C 5616 03:33:14,181 --> 03:33:15,216 SEE THE VESSEL REALLY 5617 03:33:15,216 --> 03:33:15,383 WELL 5618 03:33:15,383 --> 03:33:19,687 WE'RE VERYERSED ISE THAT. 5619 03:33:19,687 --> 03:33:24,291 IT'S NICE TO HAVE HE 5620 03:33:24,291 --> 03:33:24,925 FLUOROSCUOIC RADIATION, THEY'RE 5621 03:33:24,925 --> 03:33:27,662 H, I CAN HARY SEE THE 5622 03:33:27,662 --> 03:33:30,698 MRI YOU'VE DONE DRE - DRE BUT IN 5623 03:33:30,698 --> 03:33:32,033 SEE EXACTLY WHERE THIS IS, I'LLI 5624 03:33:32,033 --> 03:33:33,467 LGOO T WHATEVER AND YOU CAN 5625 03:33:33,467 --> 03:33:35,202 JUST SHOOT A QUICK FILM RHER 5626 03:33:35,202 --> 03:33:40,908 ALTERNATIVELY WHEN I HAD H TO VE 5627 03:33:40,908 --> 03:33:45,880 SEE EXACTLY WHERE ITT IN ANDLD 5628 03:33:45,880 --> 03:33:47,715 THAT WAS GREAT,, HAD RLTIME 5629 03:33:47,715 --> 03:33:49,283 CON CONFIRMATION, BUT I DOHINK 5630 03:33:49,283 --> 03:33:50,718 THERE'S SE'ETHING TO SAYBOUT 5631 03:33:50,718 --> 03:33:52,153 INTEROPERATIVETITANGPE AND 5632 03:33:52,153 --> 03:33:52,253 LO 5633 03:33:52,253 --> 03:33:53,521 ING AT THE TOP OG FEE O F F 5634 03:33:53,521 --> 03:33:54,522 WHAT YOU SEE. 5635 03:33:54,522 --> 03:33:56,390 THERE'S ER VERY NICE N PER PROM 5636 03:33:56,390 --> 03:33:58,059 COLUMBIA WHERE THERE STARTEDTART 5637 03:33:58,059 --> 03:33:59,060 PUTTING A BALLOON IN EVERYBODY 5638 03:33:59,060 --> 03:34:03,330 BALLOON IF NEEDED, AND WHEN 5639 03:34:03,330 --> 03:34:03,431 WE 5640 03:34:03,431 --> 03:34:06,133 OUR DATA WAS OASY -- ONLNL 5641 03:34:06,133 --> 03:34:06,600 FILLED IT I 5642 03:34:06,600 --> 03:34:08,102 20% 2F CASES, SO, 5643 03:34:08,102 --> 03:34:11,439 YOU'RE RIGHT, TO WE USEHIS 5644 03:34:11,439 --> 03:34:12,440 PURELY PROYLROTICALLY, BUT IT 5645 03:34:12,440 --> 03:34:13,741 JUST THAT, IT IS TO BUY TIME 5646 03:34:13,741 --> 03:34:15,776 TO GET CTROL OF O THEURGICAL 5647 03:34:15,776 --> 03:34:16,043 NG.E 5648 03:34:16,043 --> 03:34:16,944 IT'S NOT INTENDED TO LEAVE IT 5649 03:34:16,944 --> 03:34:18,679 THERE FOR LONG TERM,M, WHEN IT'S 5650 03:34:18,679 --> 03:34:19,113 AORTIC BALLOON. 5651 03:34:19,113 --> 03:34:21,248 >> KARIN KJUST OUT OF CURIOSITY. 5652 03:34:21,248 --> 03:34:22,817 IN THE T PATIENTSNT WRE YOU DIDT 5653 03:34:22,817 --> 03:34:25,753 INFLATEE IT, WHAT WAS THE 5654 03:34:25,753 --> 03:34:26,787 PATHOLOGY IN THOSE PATIENTS? 5655 03:34:26,787 --> 03:34:27,855 >> IT I DEPENDED. 5656 03:34:27,855 --> 03:34:30,524 SOME WERE TRUE, LIKE BIC BMESIG 5657 03:34:30,524 --> 03:34:32,626 TENSE WHAT WE'D CALL 5658 03:34:32,626 --> 03:34:34,929 RCRETARCN THE PAS, BUT THERE 5659 03:34:34,929 --> 03:34:35,029 WE 5660 03:34:35,029 --> 03:34:42,203 INVOLVINVOED, LOTS OFF BLADD B 5661 03:34:42,203 --> 03:34:44,438 INVOLVEMENT, HUMONGOUS VSELS 5662 03:34:44,438 --> 03:34:49,043 WHERE -- I HAD TO FILL AND 5663 03:34:49,043 --> 03:34:50,144 UNFILL TREE TIMES, CERTAINLY HAD 5664 03:34:50,144 --> 03:34:52,680 HAND ON THE AORTA A BUT THAT 5665 03:34:52,680 --> 03:34:52,780 TA 5666 03:34:52,780 --> 03:34:59,653 TO WORK WO W A LITTL L MORERE 5667 03:34:59,653 --> 03:35:00,121 CHALLECHING. 5668 03:35:00,121 --> 03:35:01,422 NO EASY ANSWERS.RS 5669 03:35:01,422 --> 03:35:03,290 OR THERE ARERE OTHERS WHOS HAVE 5670 03:35:03,290 --> 03:35:06,727 REPORTED VERYY CLELY ABOUT A JUT 5671 03:35:06,727 --> 03:35:09,597 CROSS-CLAMPING TPI ATA, BUTT 5672 03:35:09,597 --> 03:35:11,799 A MATTER OF HAVIN H H CONTROLON 5673 03:35:11,799 --> 03:35:13,501 STILL NOTLLBLE TO 5674 03:35:13,501 --> 03:35:14,702 CONCILE HOW THE TRAUMA PEOE 5675 03:35:14,702 --> 03:35:17,404 CAN DO IT ON THE HIGHWAYIG OR IN 5676 03:35:17,404 --> 03:35:18,706 THE EERGENCY ROOM AND WE CANNOT 5677 03:35:18,706 --> 03:35:20,341 DO IT IN THE OPETING ROOM. R 5678 03:35:20,341 --> 03:35:20,441 TH 5679 03:35:20,441 --> 03:35:21,008 'S ALL. 5680 03:35:21,008 --> 03:35:23,844 >> AND I IHI YOU'R Y EXACTLY 5681 03:35:23,844 --> 03:35:24,278 RIGHT. 5682 03:35:24,278 --> 03:35:25,346 NOW THNOW WAS ONE MORE RECEN R 5683 03:35:25,346 --> 03:35:26,680 STUDY THAT SHOWED THAT T 5684 03:35:26,680 --> 03:35:28,716 EMERGENTER CASESON IN THE 5685 03:35:28,716 --> 03:35:29,216 TRAUMA, THEY ARE I ATHE 5686 03:35:29,216 --> 03:35:30,484 OPERATING ROOM, DIDN'TT 5687 03:35:30,484 --> 03:35:31,685 NECESSARILY HAVE A LOWEROW 5688 03:35:31,685 --> 03:35:34,088 MORTALITY, BUT AGAIN A HAD THEY 5689 03:35:34,088 --> 03:35:35,089 YPUT THE BALLOON IN THAT EARLY E 5690 03:35:35,089 --> 03:35:37,191 THEN THEY T PROBABLYBAEREER THET 5691 03:35:37,191 --> 03:35:37,925 SEVERESERAREA CREES TOO. 5692 03:35:37,925 --> 03:35:38,859 >> I AEE. 5693 03:35:38,859 --> 03:35:41,328 >> I'M GOING TO TAKE THEE CHA'S 5694 03:35:41,328 --> 03:35:43,664 UP.ROGATIVE HERE THE WRAP THAT 5695 03:35:43,664 --> 03:35:45,900 WITH THE KNOWLEDGE THAT IT WAN 5696 03:35:45,900 --> 03:35:47,301 GO BACO B TO WHAT GEOTE SAID, , 5697 03:35:47,301 --> 03:35:48,636 WHICH IS THAT EVERYTHINRY THAT'S 5698 03:35:48,636 --> 03:35:49,270 OLD IS NEW AGAIN. 5699 03:35:49,270 --> 03:35:49,370 WH 5700 03:35:49,370 --> 03:35:50,771 I'M HEARING MOSY FROM 5701 03:35:50,771 --> 03:35:52,439 THIS GROUPS IS DO THIS BECAUSE 5702 03:35:52,439 --> 03:35:55,576 I HAD PATIE PSIEHO HAD THATT.. 5703 03:35:55,576 --> 03:35:57,211 WE AREWE ALL THE COLLECTIVEUM OF 5704 03:35:57,211 --> 03:35:58,646 OUR INDIVIDU TRAUMAS, AND THATT 5705 03:35:58,646 --> 03:36:02,683 DOES NOT DATA D MAKE, TT 5706 03:36:02,683 --> 03:36:03,551 ANECDOTEECDOES. 5707 03:36:03,551 --> 03:36:05,686 SO TME, T RL TEAWAY FROM F 5708 03:36:05,686 --> 03:36:07,555 TH SESSIONESS H CANAN WEAKE 5709 03:36:07,555 --> 03:36:09,623 WITH DR. HERRERA ISONE AND 5710 03:36:09,623 --> 03:36:11,792 TRANSLATE IT INTOIN WHO NEEDS WT 5711 03:36:11,792 --> 03:36:12,760 DR. ROBERTS BERT AND WHAT 5712 03:36:12,760 --> 03:36:15,830 DR. FARB. DOES, AND HOW C W 5713 03:36:15,830 --> 03:36:17,097 PRE-SPECIFY THAT 'S NOT BASED B 5714 03:36:17,097 --> 03:36:19,166 ON OUR OLD INDIVIDUAL BIAS AND 5715 03:36:19,166 --> 03:36:20,501 OUTCOMES BUT BASED ON ACTUAL 5716 03:36:20,501 --> 03:36:20,701 DATA. 5717 03:36:20,701 --> 03:36:23,103 MENU OF OPTIONS FOR US TSS THE T 5718 03:36:23,103 --> 03:36:24,505 CONSIDER WHAT WE WILLL GO FORWAD 5719 03:36:24,505 --> 03:36:24,605 WI 5720 03:36:24,605 --> 03:36:45,759 >> WE'RE GOING TO TAKO TAKREAK 5721 03:37:10,357 --> 03:37:12,092 ,>> GOOD AFTERNOON. 5722 03:37:12,092 --> 03:37:16,597 IS IT POSSIBLE TO SEE MY 5723 03:37:16,597 --> 03:37:17,097 PRESENTATION? 5724 03:37:17,097 --> 03:37:17,197 TH 5725 03:37:17,197 --> 03:37:18,032 K YOU VERY MUCH. 5726 03:37:18,032 --> 03:37:20,634 SO WRE GOING TO DISCUSS 5727 03:37:20,634 --> 03:37:23,404 UTERINE SPANG FREETMENT FOR 5728 03:37:23,404 --> 03:37:24,038 PAS. 5729 03:37:24,038 --> 03:37:33,814 CARE IN U.S. U COMPAREOM WITH W 5730 03:37:33,814 --> 03:37:36,116 FRANCE. 5731 03:37:36,116 --> 03:37:38,652 WE HAVEANY EXPERIENCEE WH 5732 03:37:38,652 --> 03:37:40,087 CONSERVATIVE MAGEMENAG WITAG 5733 03:37:40,087 --> 03:37:51,065 SO I HAV TO DISCLOSE OF THIS. 5734 03:37:51,565 --> 03:37:53,167 CONSULTINGNGEES BUT I HAVE NO 5735 03:37:53,167 --> 03:37:54,368 DISCLOSURE FOR PAS. 5736 03:37:54,368 --> 03:37:55,469 SO THE GOALS OF MY PRESENTATSEN 5737 03:37:55,469 --> 03:37:59,139 IS TOO DEFINE UTENEPARRING 5738 03:37:59,139 --> 03:38:01,875 TREATMENTS FOR PAS INCLUDINGDI 5739 03:38:01,875 --> 03:38:03,744 IN SITUU EXPECT TANAN MANAGEMENT 5740 03:38:03,744 --> 03:38:03,844 AN 5741 03:38:03,844 --> 03:38:06,547 MMETRIAL RESECTION AND 5742 03:38:06,547 --> 03:38:11,919 EATMENTSTMO TRYO AID OUTCOMEUT F 5743 03:38:11,919 --> 03:38:15,089 STERECTOMYECTOND TO CONSIDEONDE 5744 03:38:15,089 --> 03:38:16,824 Y INNATION GAPS RELPSED TO 5745 03:38:16,824 --> 03:38:18,792 EDERINEIN SPARRING TREATMENT AND 5746 03:38:18,792 --> 03:38:19,560 POTENTIAL STUDY DESIGN TO 5747 03:38:19,560 --> 03:38:21,662 ADDRESS THESE GAPS. 5748 03:38:21,662 --> 03:38:21,762 SO 5749 03:38:21,762 --> 03:38:23,430 HASO IS CONSERVATSEE 5750 03:38:23,430 --> 03:38:23,964 MANAGEMENT?ME 5751 03:38:23,964 --> 03:38:28,669 'S DESCRIBEDCR WHERE 5752 03:38:28,669 --> 03:38:32,272 HYSTERECTOMY TO DECREASE -- 5753 03:38:32,272 --> 03:38:36,610 COMPARED TO --F CRSE IF 5754 03:38:36,610 --> 03:38:39,480 SUESSFUL, WEWE CAN AVOID UTERINE 5755 03:38:39,480 --> 03:38:39,580 PR 5756 03:38:39,580 --> 03:38:44,051 ERVATION, FIRST AIMT A AS TO 5757 03:38:44,051 --> 03:38:45,586 DECREASE --SE-- ASSOC ATED A TO 5758 03:38:45,586 --> 03:38:51,492 CESAREAN HYSRECTOMY.OM 5759 03:38:51,492 --> 03:38:53,560 SOSO THERE ARE THREE UTERINE 5760 03:38:53,560 --> 03:38:56,196 G OPTIONS. 5761 03:38:56,196 --> 03:38:59,566 IX TIRPTIVIR METHOD, NO LONGER 5762 03:38:59,566 --> 03:39:02,603 MYOME MIAL RESECTION A 5763 03:39:02,603 --> 03:39:06,740 REPAIRN TU EXPECTANT 5764 03:39:06,740 --> 03:39:08,442 MANAGEMENT.ME 5765 03:39:08,442 --> 03:39:18,719 SO EX-TI EX-TIRPTIVEETHOD -- 5766 03:39:18,719 --> 03:39:20,521 NSERVATIER MANAGEMENT IN 5767 03:39:20,521 --> 03:39:21,421 SECOND PERIOD. 5768 03:39:21,421 --> 03:39:24,691 AS YOU CAN SEE,EE CONRVATIVE 5769 03:39:24,691 --> 03:39:28,095 MANAGEMENT, LOWW RAT O MASSIVE 5770 03:39:28,095 --> 03:39:32,099 PPH A I THINK NOBODY TRIED TO T 5771 03:39:32,099 --> 03:39:38,338 HAVE A - TO TRY T HE ---- 5772 03:39:38,338 --> 03:39:38,672 UTERUS. 5773 03:39:38,672 --> 03:39:47,014 SO TH THE T TRIPLEPL P PROCEDURI 5774 03:39:47,014 --> 03:39:49,149 EXCISE THEE E MYOMETRIUM WITH 5775 03:39:49,149 --> 03:39:51,885 PAS DISDER TISSUE AND TO 5776 03:39:51,885 --> 03:39:52,452 RECONSTITUTETITERINE DEFNET. 5777 03:39:52,452 --> 03:39:58,358 INCLUDECL ULTRASOUNDSOUN LOCALIN 5778 03:39:58,358 --> 03:40:00,227 OF THEHE SUPERIOR EDGE OFDG THE 5779 03:40:00,227 --> 03:40:03,230 PLACENPLAC PELVIC DAS 5780 03:40:03,230 --> 03:40:07,267 INAARTERIALERALLOER CATHERS, 5781 03:40:07,267 --> 03:40:09,636 AND NO ATTEMPT TO REMOV R THE RV 5782 03:40:09,636 --> 03:40:15,475 RE PLACENTA AND HAVE H THE 5783 03:40:15,475 --> 03:40:21,181 CILITY TO U LOCAL AGENTSGE. 5784 03:40:21,181 --> 03:40:23,183 INTRAOPERATIVETI DETAILS OF 50 5785 03:40:23,183 --> 03:40:27,454 WOMEN AND A FILIESITH BOD 5786 03:40:27,454 --> 03:40:30,624 LOSSSS MORE M THAN 5787 03:40:30,624 --> 03:40:32,259 2,000 MILLIMETERS,ER EACHOMAN 5788 03:40:32,259 --> 03:40:35,229 WHO HAD A TRI OF RESORPTION PT 5789 03:40:35,229 --> 03:40:42,970 UTERUSUT WAS SUCSSFUL TO AVOID A 5790 03:40:42,970 --> 03:40:49,443 HIS RECTHYSTERECTOMY. 5791 03:40:49,443 --> 03:40:56,416 EXPERIENCEEN WH COMPARISON 5792 03:40:56,416 --> 03:41:01,221 BETWEEN --N WITH OTHER SURE 5793 03:41:01,221 --> 03:41:03,490 TOURS, IS, DON KNOW WHAT THIS IS 5794 03:41:03,490 --> 03:41:05,525 EXACTLY, AND THEY FIND THAT 5795 03:41:05,525 --> 03:41:09,563 SUTURE PROCE PRECE WIT-- T T 5796 03:41:09,563 --> 03:41:17,905 LOWER BLOODOO LOSS,VERUMEF 5797 03:41:17,905 --> 03:41:18,438 TRANSFUSIONS. 5798 03:41:18,438 --> 03:41:21,842 TO READ AND AS YOU CANAN SEELT 5799 03:41:21,842 --> 03:41:24,444 BETWEEN 300 WOMEN THAT HAHABEEN 5800 03:41:24,444 --> 03:41:29,149 INCLUDIN IN THE STUDY S -- OY 5801 03:41:29,149 --> 03:41:29,249 IN 5802 03:41:29,249 --> 03:41:35,923 - CASEAS PUBLISHED, THE SAME 5803 03:41:35,923 --> 03:41:39,393 TEAMUBSEENT OUTCOMES CO 5804 03:41:39,393 --> 03:41:41,061 PREGNANCEG, KZs. 5805 03:41:41,061 --> 03:41:45,832 IT WASASAS MAY TPL T P 5806 03:41:45,832 --> 03:41:48,268 PROCEDURE, AS YOU CAN SEE, THEY 5807 03:41:48,268 --> 03:41:48,368 HA 5808 03:41:48,368 --> 03:41:56,643 ONLY LESSES THAN 2%FF WOMEN HAD 5809 03:41:56,643 --> 03:41:58,245 HYSTERECTOMY, THAT IS I VER 5810 03:41:58,245 --> 03:42:00,714 RPRISING, SID FINDLYIN THEY 5811 03:42:00,714 --> 03:42:10,457 THEY HAD DESCRIBED -- S S THAT 2 5812 03:42:10,457 --> 03:42:16,763 NANCYNA - AND ONLYY 22 -- 5813 03:42:16,763 --> 03:42:20,968 PREGNAPRYNA DESCRIBEE RISK OF 5814 03:42:20,968 --> 03:42:22,803 CURRENCEF PLACENTA ACCRETA 5815 03:42:22,803 --> 03:42:28,275 UM OF ABOUT 20% OF 2ASES. 5816 03:42:28,275 --> 03:42:33,647 -- - - WORKING IN ADJUNCT -- IN 5817 03:42:33,647 --> 03:42:41,855 BAY NUFOOWED BY THE INVADED 5818 03:42:41,855 --> 03:42:43,724 UTERINUT-- TO PERFORM THIS T KD 5819 03:42:43,724 --> 03:42:43,824 OF 5820 03:42:43,824 --> 03:42:50,030 SURGERY,HEY -- VCULAR 5821 03:42:50,030 --> 03:42:50,130 DI 5822 03:42:50,130 --> 03:42:54,101 ONNEION OF NEWOF FORMED 5823 03:42:54,101 --> 03:42:55,268 SSELS AND THE SEPARATIONAT OF 5824 03:42:55,268 --> 03:42:57,037 INVADED UTERINE TISSUESSS FROM F 5825 03:42:57,037 --> 03:43:01,508 INVADED VESD CAL C TISSUESIS --E 5826 03:43:01,508 --> 03:43:03,276 ENTIREEN PLACENTA.NT 5827 03:43:03,276 --> 03:43:07,214 TY T PERFORM --RMHE MAIN 5828 03:43:07,214 --> 03:43:07,314 ST 5829 03:43:07,314 --> 03:43:11,551 IES INCLUDED 3,02626 W26EN, AS 5830 03:43:11,551 --> 03:43:14,621 YOU CAN SEE, THE RATE OF 5831 03:43:14,621 --> 03:43:17,057 HYSTERECTOMYEC 30% O 3 CASES 5832 03:43:17,057 --> 03:43:19,359 ANDAN THE RISK OF FAILUREAIF THT 5833 03:43:19,359 --> 03:43:19,459 PR 5834 03:43:19,459 --> 03:43:22,262 EDPRE INCREASEDRE WITH 5835 03:43:22,262 --> 03:43:26,433 SEVERITY OF DISEASE SO THEY SAID 5836 03:43:26,433 --> 03:43:30,604 URINE CONSE CATION HAS 5837 03:43:30,604 --> 03:43:32,906 BEEN --- BE IN ALMOSTOS 80% OF 5838 03:43:32,906 --> 03:43:35,175 CAS. 5839 03:43:35,175 --> 03:43:37,778 EY ALSO AS WE CAN SEE 5840 03:43:37,778 --> 03:43:41,748 DESCRIBED OUTMES, SOO BOT B B 5841 03:43:41,748 --> 03:43:44,484 1,000 -- OCCURRED IN 30% 3 OF 5842 03:43:44,484 --> 03:43:48,889 CASES THEEED TO -- IN 15% 5843 03:43:48,889 --> 03:43:52,159 CASES, IN ONLY 4% OF CASES 5844 03:43:52,159 --> 03:43:54,761 AND -- WAS A VERY, VER LOWER 5845 03:43:54,761 --> 03:43:57,431 WEIG WITH ONLY 2% OF CASESES, 5846 03:43:57,431 --> 03:43:57,531 AG 5847 03:43:57,531 --> 03:43:59,699 N I THINK QUITE SURPRISING, 5848 03:43:59,699 --> 03:44:03,770 AND THE RATE OF PCEDURES 5849 03:44:03,770 --> 03:44:07,574 S -- AND SO PUBLISHED 202 5850 03:44:07,574 --> 03:44:09,376 BSEQUENT PREGNANCIES AFT ONE 5851 03:44:09,376 --> 03:44:15,782 STEP CONSERVATIVE SGERY AND 5852 03:44:15,782 --> 03:44:19,786 THERE'S -- NO CASE OF PLACENTA 5853 03:44:19,786 --> 03:44:21,054 APREVIAR ACENTA ACCRETACC 5854 03:44:21,054 --> 03:44:22,889 SPECTRUM AFTER THISHI KIN KFF 5855 03:44:22,889 --> 03:44:26,393 SO AGAIN, I THINK IT'S 5856 03:44:26,393 --> 03:44:26,493 QU 5857 03:44:26,493 --> 03:44:34,167 PERIENCES. WITH W OTH W 5858 03:44:34,167 --> 03:44:37,571 SO I FIN THIS PAPER INTER ITING 5859 03:44:37,571 --> 03:44:47,514 BECAUSEE FEASIBILITY -- TRIALS Y 5860 03:44:47,514 --> 03:44:51,918 NIETO-CAETACHE WORKINGLOSELY, 5861 03:44:51,918 --> 03:44:54,321 ERFORM THIS STUDY IN T 5862 03:44:54,321 --> 03:44:57,124 CENTERS, ONES, O IN COLOMBIA ANE 5863 03:44:57,124 --> 03:44:59,826 IN AENTINA, EGIBLE WOMEE 5864 03:44:59,826 --> 03:45:00,961 WERE WEN WITHITLACENTA PREVIA 5865 03:45:00,961 --> 03:45:01,061 IAWI 5866 03:45:01,061 --> 03:45:05,699 SAREAN SECTIONECO WE CAN SEE 5867 03:45:05,699 --> 03:45:09,936 WOMEN TRIEN TO HAVE -- SUSPECTE 5868 03:45:09,936 --> 03:45:10,704 EDPAS ON ULTRASULNDASUL THE AIM 5869 03:45:10,704 --> 03:45:10,804 WA 5870 03:45:10,804 --> 03:45:15,075 TOO ASSESSS THESSEASIBILISISI 5871 03:45:15,075 --> 03:45:17,244 RCT, NOT,T, SAMPLEIZE CALCULATIU 5872 03:45:17,244 --> 03:45:17,344 WA 5873 03:45:17,344 --> 03:45:18,879 FUNDING.RF THERE WAS NO 5874 03:45:18,879 --> 03:45:22,482 RANDOMIZATION TO TYSRECTOMRE OF 5875 03:45:22,482 --> 03:45:26,286 ONE STEP CONSERVATIVRV SURGERYWD 5876 03:45:26,286 --> 03:45:29,356 IT WAS W T FIRST TIME TAT I'VEE 5877 03:45:29,356 --> 03:45:29,456 SE 5878 03:45:29,456 --> 03:45:32,859 SE I'VE READEA THISORMULAMU, 5879 03:45:32,859 --> 03:45:34,060 R ONE STEP CONSERVATIVRVAT 5880 03:45:34,060 --> 03:45:37,764 SURGERY.RV 5881 03:45:37,764 --> 03:45:45,772 AS AS YOU CANOU SEE, - UTERUSR, 5882 03:45:45,772 --> 03:45:48,408 THE WOME HAD TO HAVE 5883 03:45:48,408 --> 03:45:53,146 2 CENTIMETERS OF SC MIAMI 5884 03:45:53,146 --> 03:45:54,447 TREUM -- SHOULD BE LER LER TN 5885 03:45:54,447 --> 03:45:57,484 % OF THE AXIALAL CIRCUMFERENCE, 5886 03:45:57,484 --> 03:46:00,587 SO YOU CAN SEE THATTT IT'S NOT N 5887 03:46:00,587 --> 03:46:08,962 RY --CE -- SPECTRUM. 5888 03:46:08,962 --> 03:46:10,397 THE PRIMARYY OBJECTIBJEC WAS W 5889 03:46:10,397 --> 03:46:11,698 PROPORTIOPOR OF ELIBLE PBLIENTS 5890 03:46:11,698 --> 03:46:13,233 OO AEEDEE TO PARTI PPATI IN THE 5891 03:46:13,233 --> 03:46:15,135 UDY, FREQU FCY O FALSEAL 5892 03:46:15,135 --> 03:46:15,769 POSITIPOS, NUMBER OF PATIENTS 5893 03:46:15,769 --> 03:46:16,770 ASSIGNED TGNO EACH E ARM OF THE 5894 03:46:16,770 --> 03:46:16,970 STUDY. 5895 03:46:16,970 --> 03:46:20,774 SO THEY HAD 64 ELIGIBLE WOMEN, 5896 03:46:20,774 --> 03:46:20,874 TH 5897 03:46:20,874 --> 03:46:28,615 WERE ABLE TOOO ENROLLNROLOL 60 5898 03:46:28,615 --> 03:46:30,850 WOMEN, THE SAME POSBILITY 5899 03:46:30,850 --> 03:46:33,019 OF -- IN IN FRANCE,RAND ARAS YON 5900 03:46:33,019 --> 03:46:41,127 STEP CONSERVATIVE SURGE S,GEGE D 5901 03:46:41,127 --> 03:46:42,762 ONG THIS GROUP, Y, CAN S 5902 03:46:42,762 --> 03:46:45,165 ONLY 18 WOMEN RECEIVEDEI 5903 03:46:45,165 --> 03:46:47,000 ASSIGNEDNTERNTION AND 9 DID 5904 03:46:47,000 --> 03:46:48,902 NOT MEET THEUIREMENTS TO T 5905 03:46:48,902 --> 03:46:50,971 HAVE ONE STEPP CONSERVATSEE 5906 03:46:50,971 --> 03:46:51,404 SURGERY. 5907 03:46:51,404 --> 03:46:57,410 Y.AND FOR THE HTERECTOMY GROUP,D 5908 03:46:57,410 --> 03:47:00,480 ASGNED INTERVENTION BUTUT7 WOMEP 5909 03:47:00,480 --> 03:47:02,849 CONSERVANSVEVEGERY BGEAU B WE 5910 03:47:02,849 --> 03:47:04,718 FOUND THAT THERERE WAS ULTRASOUD 5911 03:47:04,718 --> 03:47:08,655 FALSE POSIVE. 5912 03:47:08,655 --> 03:47:15,128 -THISIS MORNG - PERFORM A 5913 03:47:15,128 --> 03:47:16,930 SURGERY AND TO PERFORMOR ONE STP 5914 03:47:16,930 --> 03:47:21,201 NSERVATIVE SURGERY AND NOT S S A 5915 03:47:21,201 --> 03:47:24,838 STERECTOMY. 5916 03:47:24,838 --> 03:47:29,276 SO YOU C SEE --EE - CHANGE -- 2% 5917 03:47:29,276 --> 03:47:31,344 OFASES OFFHE -- GROUP, YOU 5918 03:47:31,344 --> 03:47:35,282 CANCA S THE WASAS NOOO -- 5919 03:47:35,282 --> 03:47:39,753 SIAG IN IN ABOUT 25% OFASESA 5920 03:47:39,753 --> 03:47:44,691 CASES -- FS SE POSITIVEIV CASESO 5921 03:47:44,691 --> 03:47:47,460 THEE FIGOO CLASSIFICSSIOIC NO P 5922 03:47:47,460 --> 03:47:51,298 DURINGNG SURGERY, SURPRISING DNR 5923 03:47:51,298 --> 03:47:56,169 HYSTERECSTMY IST A FORM NO PAS - 5924 03:47:56,169 --> 03:47:58,471 RING THE SURGERY. 5925 03:47:58,471 --> 03:48:01,508 AND SO YOUOAN SEE T SRE WAS NO 5926 03:48:01,508 --> 03:48:03,043 DIFFERENCES FOR BEN 5927 03:48:03,043 --> 03:48:04,044 STERECTOMY OTOTHE ONE S OP 5928 03:48:04,044 --> 03:48:11,918 CONSERVATIVE SURGERY VERSUS -- 5929 03:48:11,918 --> 03:48:16,956 FOR MORE TNN -- UNIT BETEN 5930 03:48:16,956 --> 03:48:20,460 THE TWOEROWOS AND FOR F THE 5931 03:48:20,460 --> 03:48:24,164 SURGICALIC REINTEREINTIONS AND - 5932 03:48:24,164 --> 03:48:27,233 ADVERSE EVENTS WAS QUITE LOWER 5933 03:48:27,233 --> 03:48:28,702 IN THE HYSTERECTOMY GOMUP BUTUPT 5934 03:48:28,702 --> 03:48:30,870 WAS NOT NIGNIFICANT, AND YOU CAO 5935 03:48:30,870 --> 03:48:32,272 SEESE THE ADVERSE EVENTS WAS 5936 03:48:32,272 --> 03:48:38,511 DEFINED BY BLE BG OF MOREHAN 5937 03:48:38,511 --> 03:48:39,679 2,000 MILLILITERS OR OTHER 5938 03:48:39,679 --> 03:48:40,947 SITUATION THIO PROLONGED 5939 03:48:40,947 --> 03:48:41,948 HOSPITALIZATION. 5940 03:48:41,948 --> 03:48:44,617 THEE PROPORTION OF FAILED ONE 5941 03:48:44,617 --> 03:48:47,787 STEPONEPRVATIVE SURGERY 5942 03:48:47,787 --> 03:48:49,189 REQUIRING HIS RECT ME WAS NOT 5943 03:48:49,189 --> 03:48:50,490 REPORTED INHIS PAPER 5944 03:48:50,490 --> 03:48:53,360 UNFORTUNATELY.Y.Y. 5945 03:48:53,360 --> 03:49:03,837 SO THE IUE RELATED TO T RCT ---- 5946 03:49:03,837 --> 03:49:05,705 THE TIMING OF TANZATION, 5947 03:49:05,705 --> 03:49:05,805 AS 5948 03:49:05,805 --> 03:49:09,442 ISHAOTOTOTOF USE.ME THATHA 5949 03:49:09,442 --> 03:49:11,077 DETERMININGIN THE T T CLASSIFICN 5950 03:49:11,077 --> 03:49:20,487 SO SSOE,SO CLI CL E LY IS NOTOT 5951 03:49:20,487 --> 03:49:22,255 EQUIPOEQE ISSUE AND WONDE W IF 5952 03:49:22,255 --> 03:49:23,823 ITT ANALYSIS IS APPPRIATEPRIA 5953 03:49:23,823 --> 03:49:26,426 NOTNOTPR ABLE TO -- ANALYSES,LY 5954 03:49:26,426 --> 03:49:27,961 BLINDING WAS IMPSIBL AND 5955 03:49:27,961 --> 03:49:28,061 WH 5956 03:49:28,061 --> 03:49:29,796 H HOSPITALS SHOULD 5957 03:49:29,796 --> 03:49:31,498 PARTICIPATE BECAUSE AS YOU KNOW, 5958 03:49:31,498 --> 03:49:31,598 TH 5959 03:49:31,598 --> 03:49:33,800 ISSUE RELAT R TO VUM V 5960 03:49:33,800 --> 03:49:39,472 AVAILABLE RESOURCES.ONS,IO AND 5961 03:49:39,472 --> 03:49:40,774 SO I WILL DISCUSS NOW THE T 5962 03:49:40,774 --> 03:49:41,541 CONSERVANSVEVA TREATMENT. 5963 03:49:41,541 --> 03:49:46,813 I TOLD YOUE NO 5964 03:49:46,813 --> 03:49:50,517 PERIENCE WITH --H AND SO 5965 03:49:50,517 --> 03:49:54,988 CONSERVATIVE MANVEEMENT, WE -- 5966 03:49:54,988 --> 03:49:58,591 OPENED THE ABDOMENE CONFIRM 5967 03:49:58,591 --> 03:49:58,691 TH 5968 03:49:58,691 --> 03:50:02,529 SPECTRUM -- IN TERMS OFMSHEF 5969 03:50:02,529 --> 03:50:06,699 PLACENTA, CUT CORD C ASTS 5970 03:50:06,699 --> 03:50:09,502 PLACENTAL INSERTION, AND A FINAN 5971 03:50:09,502 --> 03:50:15,208 AND DISAPPEISANCE OAN THEECASE 5972 03:50:15,208 --> 03:50:20,814 PLACENTAND ITT TAKES -- MORE NOE 5973 03:50:20,814 --> 03:50:22,415 THAN SIX MONTHS IN THE MAJORITY 5974 03:50:22,415 --> 03:50:27,187 OF CASES. 5975 03:50:27,187 --> 03:50:29,823 AS YOU CAN SEE S IN 2010 ANDAN , 5976 03:50:29,823 --> 03:50:32,759 IT WAS NOT CONSIDERED AN OPTIONN 5977 03:50:32,759 --> 03:50:39,599 FOR WOMAN WITH PAS, FINALLY -- 5978 03:50:39,599 --> 03:50:45,271 ENCOURAGCO-- OBVIOUSLY FOR THE 5979 03:50:45,271 --> 03:50:50,643 IT WAS W POSSIBLE FOR -- CES FOR 5980 03:50:50,643 --> 03:50:52,278 WOMEN WHO ARE PROPERLY MOTATEDED 5981 03:50:52,278 --> 03:50:57,217 TORY TO CONSERVE TTERUS, 5982 03:50:57,217 --> 03:51:05,425 AND ASD A -- I LIKE --- SAFET T 5983 03:51:05,425 --> 03:51:08,161 AND IEREST O CONSERVATIVRV 5984 03:51:08,161 --> 03:51:10,997 MENA INASEFAS 5985 03:51:10,997 --> 03:51:17,403 COMPARED WITH --. 5986 03:51:17,403 --> 03:51:18,571 FINALLY -- GROUP SAID 5987 03:51:18,571 --> 03:51:20,139 APPROPRIATE MANAGEMENT STRATEGTR 5988 03:51:20,139 --> 03:51:21,407 FOR WOMENOM WISHING TO PRESERVE 5989 03:51:21,407 --> 03:51:25,512 THEIR FERTILITY, AND I I HE 5990 03:51:25,512 --> 03:51:33,686 ACENTA -- UTERUS AND 5991 03:51:33,686 --> 03:51:37,524 SO W HAVEAVAV THEREFOHE. 5992 03:51:37,524 --> 03:51:41,361 RETROSPECTIVE -- IN FRANC F IN 5993 03:51:41,361 --> 03:51:49,002 2010, IT HAS HEEN IDINGDIDI 40 5994 03:51:49,002 --> 03:51:49,569 CENTERS, ENCOURAGING 5GI OF 5995 03:51:49,569 --> 03:51:54,774 CASES WE'VE WAD INCLUDED ONE OF 5996 03:51:54,774 --> 03:51:54,874 16 5997 03:51:54,874 --> 03:52:03,149 AFTER AF OF CASES AND4 HOUT 5998 03:52:03,149 --> 03:52:08,821 FIRST 24 HOURS -- OF CASES 5999 03:52:08,821 --> 03:52:20,033 CONSERVE THE T UTERUS --YS, D 6000 03:52:21,334 --> 03:52:27,073 80, -- 8 OFASES -- 6001 03:52:27,073 --> 03:52:28,708 ED IN -- I IERESTING TOO 6002 03:52:28,708 --> 03:52:34,547 2% OF WOMOF HADHAT ONLY 6003 03:52:34,547 --> 03:52:37,483 ANSFUSIOSFUSND ONLY5% OF 6004 03:52:37,483 --> 03:52:42,755 WOMEN HAD -- MOREEHA FIVE 6005 03:52:42,755 --> 03:52:42,956 UNITS. 6006 03:52:42,956 --> 03:52:43,056 S. 6007 03:52:43,056 --> 03:52:48,995 DEATHH THAT WAS RELED -- WHOERNR 6008 03:52:48,995 --> 03:52:52,932 HAD - AFTER INJECTIONONON OFF 6009 03:52:52,932 --> 03:52:58,504 METHOTREXAOT WITH ORGAN FLURE, 6010 03:52:58,504 --> 03:53:00,840 PLACENTA AENRETA WAS CONFIRMED 6011 03:53:00,840 --> 03:53:03,109 ON HISTOLOGICALXAMINATION,ON AN 6012 03:53:03,109 --> 03:53:03,209 EM 6013 03:53:03,209 --> 03:53:07,580 SPONTANEOUSLY INN 75% 75% O CASS 6014 03:53:07,580 --> 03:53:07,680 AF 6015 03:53:07,680 --> 03:53:10,917 DELIVERY. M OF 14 WEEKS AFTERFT 6016 03:53:10,917 --> 03:53:19,759 .AND W HAVE -- WE WERE ABLE T 6017 03:53:19,759 --> 03:53:21,160 CONTACTNLY 70% OF THE WOMEN 6018 03:53:21,160 --> 03:53:25,231 AS YOUAS CAN SEE, WE H 6019 03:53:25,231 --> 03:53:30,370 DESCRIBED --BE FOR 2ATIENTS -- 6020 03:53:30,370 --> 03:53:33,139 PREGNANCEG SO 18 WOMEN W GAVE 6021 03:53:33,139 --> 03:53:36,676 BIRTHO 21 HEALTHY DURING THE 6022 03:53:36,676 --> 03:53:39,145 THIRD TRIMESTER OF PGNANCY BUTCY 6023 03:53:39,145 --> 03:53:45,251 PPHHCCURRED IN 19% OF CASESESND 6024 03:53:45,251 --> 03:53:55,895 RECOMMDED FOR CSERVIVESIDEOND -- 6025 03:53:55,895 --> 03:53:56,596 MA 6026 03:53:56,596 --> 03:53:58,164 GEMENT,,FFICACY FOR THIS 6027 03:53:58,164 --> 03:53:59,399 AS NEVER BEEN 6028 03:53:59,399 --> 03:54:05,304 NDEMONSTRATED, ONL, CNLE RNLORTE 6029 03:54:05,304 --> 03:54:08,007 CESAREAN HIS RECT ME OR 6030 03:54:08,007 --> 03:54:14,247 LEAVING THE PLACENTA INU.S.NU IU 6031 03:54:14,247 --> 03:54:18,618 I THINK IT'S --S TRIAL THATHA S 6032 03:54:18,618 --> 03:54:22,221 , VY VY IMPORTANT AND 6033 03:54:22,221 --> 03:54:23,656 INSTRUCTIVRU--IVIFFICULT TO 6034 03:54:23,656 --> 03:54:27,026 PERFORM THIS KINDD OF -- BF AUSE 6035 03:54:27,026 --> 03:54:27,126 A 6036 03:54:27,126 --> 03:54:29,295 T OF -- BELIEVES 6037 03:54:29,295 --> 03:54:30,763 CONSERVATIVE MANAGEMENT IS A 6038 03:54:30,763 --> 03:54:30,863 VE 6039 03:54:30,863 --> 03:54:37,537 AND SO WEEE PERFORM PRO SPEC SIE 6040 03:54:37,537 --> 03:54:39,672 STUDIES TO TRY TODD ADDIT ANAL 6041 03:54:39,672 --> 03:54:43,576 CREDENCE TO T T LITERATURE.. 6042 03:54:43,576 --> 03:54:49,282 -- STUDY, THE - T T WAS -- WITT 6043 03:54:49,282 --> 03:54:54,320 IN FOR OF THE CONSERVATIVELL 6044 03:54:54,320 --> 03:54:57,056 TREATMENT COMPARED WITHD ESAREAN 6045 03:54:57,056 --> 03:54:59,692 HYSTERECTOMY, ALL AAVEASURED 6046 03:54:59,692 --> 03:55:02,295 LIMITATIONS SO POPULATION-BASED 6047 03:55:02,295 --> 03:55:03,396 COHORT STUDIES PROVIDE AVI UNIQE 6048 03:55:03,396 --> 03:55:03,496 OP 6049 03:55:03,496 --> 03:55:05,264 RTUNITY TOO ASSS MATERNALNA 6050 03:55:05,264 --> 03:55:06,999 TCOME ASSOCIATED WITHE O 6051 03:55:06,999 --> 03:55:08,634 SURGICAL MANAGEMANT IN AN 6052 03:55:08,634 --> 03:55:09,235 UNSELECTED POPULATION OF WOMEN 6053 03:55:09,235 --> 03:55:10,903 WITH PAS. 6054 03:55:10,903 --> 03:55:11,003 SO 6055 03:55:11,003 --> 03:55:13,306 E COMPAREDPA SEVERE MATERNAL 6056 03:55:13,306 --> 03:55:15,608 OUTCES IN WOMENOM WITH P 6057 03:55:15,608 --> 03:55:17,343 BETWEEN THOSE WHO W HAD CESAREAN 6058 03:55:17,343 --> 03:55:20,546 HYSTERECTOMY AND ALSO WHO HAD H 6059 03:55:20,546 --> 03:55:21,948 CONSERVATIVE MANAGEMANT,AN AND O 6060 03:55:21,948 --> 03:55:24,417 LIMIT THE IND IIONN BARRIERS, 6061 03:55:24,417 --> 03:55:30,523 WE USE A PROPENSROYNSRO SCORE 6062 03:55:30,523 --> 03:55:31,858 ANALYSIS. 6063 03:55:31,858 --> 03:55:40,933 STUDYDY HAD -- WHOHO HAD H HVAN 6064 03:55:40,933 --> 03:55:44,904 E, THE -- WAS 520,000,0 6065 03:55:44,904 --> 03:55:48,608 DELIVERIESRI FROM 176 M 1ERNITIS 6066 03:55:48,608 --> 03:55:50,910 IN EIGHT FRENCH REGIONS. 6067 03:55:50,910 --> 03:55:53,579 INCIDENCE OF WEN TRANSFUSEDFU OF 6068 03:55:53,579 --> 03:55:55,915 MORE THAN 4 UTS UFF PACKED RED 6069 03:55:55,915 --> 03:55:57,817 BLD CELLS UNTIL 6 MONTHS 6070 03:55:57,817 --> 03:55:58,417 POSTPARTUM. 6071 03:55:58,417 --> 03:56:01,087 AS I TOLDOLDOL YOU, THE TIME T S 6072 03:56:01,087 --> 03:56:05,024 VERY LONG,ORE THAN SIX MONS 6073 03:56:05,024 --> 03:56:08,294 SIN SOMIN CASES,ES SO WE TRY TO 6074 03:56:08,294 --> 03:56:11,464 ASSESS ALL THE PRIMARY AND A A 6075 03:56:11,464 --> 03:56:12,999 SECONDSECOOUTCOMES AFTER SEVERAL 6076 03:56:12,999 --> 03:56:13,099 MO 6077 03:56:13,099 --> 03:56:15,201 HS. 6078 03:56:15,201 --> 03:56:20,106 SO AS YOU CAN SEE, THE RATEAT OF 6079 03:56:20,106 --> 03:56:21,774 WHO HAD PLA PA PREVI PRE 6080 03:56:21,774 --> 03:56:23,876 WAS THE SAME BETWEEN THE TWO 6081 03:56:23,876 --> 03:56:26,913 GROUPS ANDNDND MORE THAN OF 6082 03:56:26,913 --> 03:56:29,248 CASES ANDS HE RAT RAT R OFLACELA 6083 03:56:29,248 --> 03:56:30,650 PREVIA WEV PROCERO INT 6084 03:56:30,650 --> 03:56:33,152 SECTION WAS ALMOST --% O CASES C 6085 03:56:33,152 --> 03:56:36,422 BETWEEN THE TWO GROUPS AND -- 6086 03:56:36,422 --> 03:56:36,522 SU 6087 03:56:36,522 --> 03:56:37,423 ION OFAS -- I -THE CASE 6088 03:56:37,423 --> 03:56:38,724 OF WOMEN WITH W CONSERVATIVEAT 6089 03:56:38,724 --> 03:56:38,825 TR 6090 03:56:38,825 --> 03:56:45,798 ALSO THE POINT THAT T IS 6091 03:56:45,798 --> 03:56:47,433 IMPORTIMT, AS YOU CAN SEE, 6092 03:56:47,433 --> 03:56:48,734 REFERRAL CENTE C MANAGE THESE 6093 03:56:48,734 --> 03:56:50,603 SES INN ONLYY 70% OFF CASES 6094 03:56:50,603 --> 03:56:56,275 EE IN SOME TIMES, THERE WAS 6095 03:56:56,275 --> 03:56:59,679 NO -- O PAS P SO -- THE STUDY, 6096 03:56:59,679 --> 03:57:06,352 THESEESES WE MANAGED BY B 6097 03:57:06,352 --> 03:57:08,988 FERRALFEENTEFE. 6098 03:57:08,988 --> 03:57:12,158 -- WITLADDER IASIONN WAS -- 6099 03:57:12,158 --> 03:57:17,096 CONSERVATIVE GROUP COMPARED WITH 6100 03:57:17,096 --> 03:57:17,496 S RECT ME GRP. 6101 03:57:17,496 --> 03:57:21,367 SO THE PRIMARYRI OUTCOME WAS WON 6102 03:57:21,367 --> 03:57:23,769 IN CONSERVATIVE MIVAGEMENT 6103 03:57:23,769 --> 03:57:30,243 GROUP, YOU CAN SEE IN 16% OF O 6104 03:57:30,243 --> 03:57:33,179 CASES, -- WITH RESPECTCTO THESE 6105 03:57:33,179 --> 03:57:36,682 AND SOME PEOPLEEOEO CAN CANAN ST 6106 03:57:36,682 --> 03:57:40,453 THIS WAY IS HIGHER AND -- 6107 03:57:40,453 --> 03:57:40,553 CE 6108 03:57:40,553 --> 03:57:46,259 REAN HIS R HT H HYSTE HCTTEYCTT- 6109 03:57:46,259 --> 03:57:50,196 CENTERCE MANAGEAG HIS R HIS HRY 6110 03:57:50,196 --> 03:57:50,630 CASES. 6111 03:57:50,630 --> 03:57:54,166 THE OTHER OUTCOMES WERE LOWER II 6112 03:57:54,166 --> 03:58:00,940 TO BLOODLO LOSS, AOSS YOU CAN S- 6113 03:58:00,940 --> 03:58:04,277 IN 20% OF CASESN CONSERVATIVE 6114 03:58:04,277 --> 03:58:05,678 MANAGEMENTNTNT GROUP, IT W AGAIN 6115 03:58:05,678 --> 03:58:12,551 CONSISTENS WITH OUR --- RESULT, 6116 03:58:12,551 --> 03:58:18,524 WHEN COMPARED W W 6117 03:58:18,524 --> 03:58:19,625 RETROSPECTIVEE STUDY, 30 WOMENWO 6118 03:58:19,625 --> 03:58:21,460 NO TRANSFUSIONFU IN 6119 03:58:21,460 --> 03:58:22,795 CONSVATIVE MTIVEEMENT GROT 6120 03:58:22,795 --> 03:58:24,563 ED WITH ALMOST 90% OF 6121 03:58:24,563 --> 03:58:32,305 WOMEN WHO HAD TRAFUSION --- 6122 03:58:32,305 --> 03:58:34,273 MEN WITH WIT CONRVATIVE 6123 03:58:34,273 --> 03:58:36,409 MANAGEMENT RUIRED READMISEAONS 6124 03:58:36,409 --> 03:58:40,780 CASES S IT'SS A REALI ITI ALMTT 6125 03:58:40,780 --> 03:58:46,686 PROBLEM FOR F THE POSAROSM 6126 03:58:46,686 --> 03:58:57,263 PERIODOD BECAUSE -- WOMEN NEED - 6127 03:58:58,230 --> 03:59:04,003 TO MUCH --SOSO THE STRENGTH OF T 6128 03:59:04,003 --> 03:59:06,072 WAS AROSPECTIVE MULREGIONALGI 6129 03:59:06,072 --> 03:59:06,939 DESIGN, LARGE POPUL PION OF O 6130 03:59:06,939 --> 03:59:08,808 WOMEN WITH PAS, WE HAVE H SOME 6131 03:59:08,808 --> 03:59:10,009 EXHAUSTIVENETI OF THEF 6132 03:59:10,009 --> 03:59:12,044 RECRUITMENT THAT WTH CHECKED, 6133 03:59:12,044 --> 03:59:14,313 THE TH CASES WERE FOLWEDDP 6134 03:59:14,313 --> 03:59:16,916 SIX MTHS -- P AND AND 6135 03:59:16,916 --> 03:59:18,718 TCOMESES WERE PDEFINED, WOMEN 6136 03:59:18,718 --> 03:59:20,720 WE FOLLOWED UNT SIX MONTHS 6137 03:59:20,720 --> 03:59:24,323 STPARTUM, AND CONTROL 6138 03:59:24,323 --> 03:59:24,991 INDICATIDI BIADI 6139 03:59:24,991 --> 03:59:25,091 WE 6140 03:59:25,091 --> 03:59:26,892 E HAD NO N HISTOLOGIC 6141 03:59:26,892 --> 03:59:27,760 CONFIRMATION OF P O FOR THE 6142 03:59:27,760 --> 03:59:30,796 SES WITHOUTHOUT HYSTERECTOMIES, 6143 03:59:30,796 --> 03:59:34,200 AND SO SOME S MAY ADVISE -- SOM- 6144 03:59:34,200 --> 03:59:37,269 MAY WONYR IF IF ALLLLASES -- WEE 6145 03:59:37,269 --> 03:59:41,774 I HAVE TVEO SAYAY THAT THET RAF 6146 03:59:41,774 --> 03:59:44,877 PAS CASES WAS ONE FOR 5,000 6147 03:59:44,877 --> 03:59:44,977 DE 6148 03:59:44,977 --> 03:59:46,512 VERY SO I BELIEVE THAT YES 6149 03:59:46,512 --> 03:59:50,416 BECAUSE THE RATE OF IF S NOT 6150 03:59:50,416 --> 03:59:52,885 OTOTTOO MUCH, BUCH WE DON'T'T KW 6151 03:59:52,885 --> 03:59:52,985 BE 6152 03:59:52,985 --> 03:59:57,923 USE WE HO -- WE VE 6153 03:59:57,923 --> 04:00:02,528 NOT -- BETWEENEN THE TWO GROUP G 6154 04:00:02,528 --> 04:00:05,164 AND -- SO T MAIN LIMITATION OF 6155 04:00:05,164 --> 04:00:07,500 PARTICULARLY INDICATNDN BIAS 6156 04:00:07,500 --> 04:00:09,201 THAT MAY PERSIST EVEN EITH E 6157 04:00:09,201 --> 04:00:10,469 USE OFF PROPENSROYROY SCORE 6158 04:00:10,469 --> 04:00:11,237 ANALYSAN.. 6159 04:00:11,237 --> 04:00:12,438 SOSOUR RESULTS SHOULD BE 6160 04:00:12,438 --> 04:00:14,940 INTERPRETED WITD CAUTION. 6161 04:00:14,940 --> 04:00:15,041 AN 6162 04:00:15,041 --> 04:00:19,145 WE E ARE THAT THE 6163 04:00:19,145 --> 04:00:24,483 MANAGEMENT OF PAS IS HIGHLYY 6164 04:00:24,483 --> 04:00:29,188 DENDENTNDEN O -- CONSERVATIVE 6165 04:00:29,188 --> 04:00:31,090 MANAGEMENT FOR A A VERY LONG TIE 6166 04:00:31,090 --> 04:00:38,497 RESULTSLT CAN BE EXTRAPOLATED FR 6167 04:00:38,497 --> 04:00:42,301 OTHER CENTE C, C OTHER COUNT C. 6168 04:00:42,301 --> 04:00:44,170 U ONE MINUTE. 6169 04:00:44,170 --> 04:00:46,639 >> OKAY.KA 6170 04:00:46,639 --> 04:00:48,274 THE LEVEL OF EVIDENCE FOR 6171 04:00:48,274 --> 04:00:50,076 CHOOSING THE BEST TREATMENT AND 6172 04:00:50,076 --> 04:00:51,177 MANAGING WOMENITH PAS P REMAINSM 6173 04:00:51,177 --> 04:00:53,379 SEEMS REASONABLSO TO PROPOSE 6174 04:00:53,379 --> 04:00:56,315 IN THE PRESE P STATE OF 6175 04:00:56,315 --> 04:01:05,191 ELI THAT -- FOR SOMEOMANCE WE 6176 04:01:05,191 --> 04:01:08,494 WOMEN -- FOROMEN WHO WANT THE T 6177 04:01:08,494 --> 04:01:10,563 F FUTURE PREGNANCY AND 6178 04:01:10,563 --> 04:01:12,264 MONITORINI.NI CLOSE FOLLO FUP 6179 04:01:12,264 --> 04:01:13,899 IN CENTERS WITDEQUATE 6180 04:01:13,899 --> 04:01:17,436 EQUIPMEQT ANDND RESOURCES -- 6181 04:01:17,436 --> 04:01:19,438 AND I BELVE ADDIT ANAL 6182 04:01:19,438 --> 04:01:21,140 IDENCE IS R IUIRED FOROR TOR T 6183 04:01:21,140 --> 04:01:21,574 TRIPLE P PROCEDURE. 6184 04:01:21,574 --> 04:01:22,875 YOU VERY MUCH FOR Y FR 6185 04:01:22,875 --> 04:01:30,716 >> OKAY, OKA THANK YOU FOR TT. 6186 04:01:30,716 --> 04:01:33,319 NEXT TALKAL ISY DR. HOBSO H WHOO 6187 04:01:33,319 --> 04:01:44,697 HYSTERECTOMY FOR PAS..EDCESAREAN 6188 04:01:45,131 --> 04:01:47,099 >> HI, EVERYONE. 6189 04:01:47,099 --> 04:01:48,501 E.PLEASE TELL ME YOU CAN SEE. 6190 04:01:48,501 --> 04:01:49,602 >> YES. 6191 04:01:49,602 --> 04:01:51,704 >> O I LOVEOV THAT.HAHA 6192 04:01:51,704 --> 04:01:57,543 ICM HUMBLED TLE T T PSE P AFTERT 6193 04:01:57,543 --> 04:01:57,643 WE 6194 04:01:57,643 --> 04:01:58,744 TEND T PRESE P ONE AFTERFT THE 6195 04:01:58,744 --> 04:02:01,413 OTHER ANDT'ST' LUCKY THAT T 6196 04:02:01,413 --> 04:02:02,548 MOST NON-CONFRONTATIONTA PEOPLE 6197 04:02:02,548 --> 04:02:06,452 THAT YOU CANAN FIND. 6198 04:02:06,452 --> 04:02:08,654 SOSO HELLO,LO AS YR UGLY COUSIN 6199 04:02:08,654 --> 04:02:11,423 FROM THE TORTH, I'MM JOINING YOU 6200 04:02:11,423 --> 04:02:15,161 FROM EDMONTON FM MY HOTELOT ROOM 6201 04:02:15,161 --> 04:02:19,198 WHERE WERVEEEN RUNNING OUR 6202 04:02:19,198 --> 04:02:20,166 CANADIAN NATIONAL CONFERENCFE AD 6203 04:02:20,166 --> 04:02:22,001 FOR THE LT THREE TAYS. 6204 04:02:22,001 --> 04:02:28,174 I'MI' BIT SEP-DOUGH PRIEVEDRIED. 6205 04:02:28,174 --> 04:02:29,775 IT'S OUR FIRST ADVANCED SURGICAL 6206 04:02:29,775 --> 04:02:30,976 SURGICAL SKILLSN OBSTETRICTE 6207 04:02:30,976 --> 04:02:32,244 COURSE WHISEHI HAS BEEASA LOT OF 6208 04:02:32,244 --> 04:02:33,279 N BUT TODN I'MN OING T TALK 6209 04:02:33,279 --> 04:02:34,446 TO YOU ABOUTUT CESAREANEAEA 6210 04:02:34,446 --> 04:02:36,448 HYSTERECTOMY ANDELAYED 6211 04:02:36,448 --> 04:02:37,483 INTERVAL HYSTEREYSOMY. 6212 04:02:37,483 --> 04:02:39,018 SO IN TERMS OF OY DECLARATIONS, 6213 04:02:39,018 --> 04:02:41,987 S,WORK IN A CENTER THAT DOES A 6214 04:02:41,987 --> 04:02:44,823 LOT OF CESAREANAR HYSTERECTOMY 6215 04:02:44,823 --> 04:02:48,961 WRITING OUT CANADIANIA GUIDE GNS 6216 04:02:48,961 --> 04:02:52,164 AND THE THE FIGO GUILINES. 6217 04:02:52,164 --> 04:02:52,264 SO 6218 04:02:52,264 --> 04:02:53,499 ORSOY GOALS OF TOD, I I WANT 6219 04:02:53,499 --> 04:02:55,134 TO TALK ABOUT ABO EXPECTED 6220 04:02:55,134 --> 04:02:57,503 SHORT-TERM OUTCOMES ANDANAN 6221 04:02:57,503 --> 04:03:01,207 LIMITATIONS OF C-HYST ANDT A 6222 04:03:01,207 --> 04:03:08,080 ECTRUM.TRYSTYS FOR ACCRETA 6223 04:03:08,080 --> 04:03:10,216 ECIAY AND NON-SPECIALTY IN 6224 04:03:10,216 --> 04:03:12,184 KNOWLEDGE GAPS THAT TE HAVE ANDE 6225 04:03:12,184 --> 04:03:14,220 WHAT ARE THE SORHE O 6226 04:03:14,220 --> 04:03:15,187 INTRAOPERATIPE TECHNIQUESS AND 6227 04:03:15,187 --> 04:03:16,488 INTERVENTIONENTIHAT WE CAN C DOO 6228 04:03:16,488 --> 04:03:20,693 WE'VE'VEARD A LOTOT OF AP OES AD 6229 04:03:20,693 --> 04:03:21,660 THERE'S A LOT OF ORANGES AND 6230 04:03:21,660 --> 04:03:23,195 ARS IN THE ROOM TODAY. 6231 04:03:23,195 --> 04:03:25,464 ANDAN TT'S WHAT MAHAS PRESENTING 6232 04:03:25,464 --> 04:03:25,564 ON 6233 04:03:25,564 --> 04:03:27,199 HIS SO DIFFICUIF O EVERY 6234 04:03:27,199 --> 04:03:29,802 SINGLE TOPLE THAT WE'VE HE'RD SO 6235 04:03:29,802 --> 04:03:29,902 FA 6236 04:03:29,902 --> 04:03:31,003 . 6237 04:03:31,003 --> 04:03:34,273 IN TERMS OF THEF RADITIONALTI 6238 04:03:34,273 --> 04:03:36,008 APPROAAPPRMOST OF THE TIME IN 6239 04:03:36,008 --> 04:03:39,979 MOST OF O OUR OLDER GUIDELIUIS, 6240 04:03:39,979 --> 04:03:46,452 IMMEDIIME CESAREAN HYSTERECTTEY 6241 04:03:46,452 --> 04:03:47,353 HAS BEENECOMMENDED. 6242 04:03:47,353 --> 04:03:48,554 NOW THE OPERATIPE RTIPE ISS 6243 04:03:48,554 --> 04:03:50,022 AN INSANE PLACE WITH SOMETIMESET 6244 04:03:50,022 --> 04:03:51,290 MOREMO THANHA 20 PEOP0 OP IN THM 6245 04:03:51,290 --> 04:03:52,524 WITH T MOST IMPORTANT PERSON 6246 04:03:52,524 --> 04:03:54,860 THE CENTER SURUNURD BY B A 6247 04:03:54,860 --> 04:04:00,833 ARE NAREUSNDNDND EITED, AND A A 6248 04:04:00,833 --> 04:04:02,468 E VY CARING TO GET THE BEST 6249 04:04:02,468 --> 04:04:03,035 PO OUTPOOME FOMEHEE 6250 04:04:03,035 --> 04:04:04,670 PATIENT AND TIRABY. 6251 04:04:04,670 --> 04:04:08,340 WHEN WE GENERALIZE ITHE 6252 04:04:08,340 --> 04:04:09,108 LARGEST WAYTHE ORATIVE 6253 04:04:09,108 --> 04:04:13,112 WILL UNDERGO SOME FORM OMATIENTT 6254 04:04:13,112 --> 04:04:14,947 ANESTHESIA, OURS UNDERGUN 6255 04:04:14,947 --> 04:04:15,914 REGIONAL FORALHE VASAJORITY 6256 04:04:15,914 --> 04:04:17,216 OF CES. 6257 04:04:17,216 --> 04:04:19,985 A URINARYRIATHETEAT ILACED 6258 04:04:19,985 --> 04:04:21,887 MOST OFT O HOOKED UP TO 6259 04:04:21,887 --> 04:04:21,987 ME 6260 04:04:21,987 --> 04:04:27,226 D DEFREIGHT THE DEFLATE THE T BH 6261 04:04:27,226 --> 04:04:27,760 GHTHE PROCEDURECE 6262 04:04:27,760 --> 04:04:32,031 OUND TOUIDE OUR SKIPERATIVE 6263 04:04:32,031 --> 04:04:33,399 INCISION AND UTE U IISION 6264 04:04:33,399 --> 04:04:34,466 LL AWARIY FROM TOM PLANTA. 6265 04:04:34,466 --> 04:04:35,968 WE DO A SURGICALCACA TE OUT 6266 04:04:35,968 --> 04:04:37,836 BECAUSECA WE'REREUSUSUS GD SURGS 6267 04:04:37,836 --> 04:04:38,671 TRYING TO FO TOW THE RULES, AND 6268 04:04:38,671 --> 04:04:40,739 THEN SOME GROUPSUP WILLIL PROCEN 6269 04:04:40,739 --> 04:04:45,844 TO CYSTO COPY C AND UROTAIRK 6270 04:04:45,844 --> 04:04:51,950 STENTIST, WE, DON AND A THEN -- 6271 04:04:51,950 --> 04:04:53,585 EE LAPAROTOMY OT AOT HUGE POINT 6272 04:04:53,585 --> 04:04:54,153 OF CONTE CION. 6273 04:04:54,153 --> 04:04:57,923 DO WE DO A MIDLINE, A WIDE, WIDE 6274 04:04:57,923 --> 04:04:59,792 FIN AND STEEL, TEL OPTIONS ARERE 6275 04:04:59,792 --> 04:04:59,892 EN 6276 04:04:59,892 --> 04:05:00,225 ESS. 6277 04:05:00,225 --> 04:05:02,695 WE ENTER THE T UTERUS, DOS, YOU 6278 04:05:02,695 --> 04:05:02,795 US 6279 04:05:02,795 --> 04:05:05,531 A AUTO STAPLER FOR THEHEHE 6280 04:05:05,531 --> 04:05:09,501 PLACENTA PREVIA CASES OR DON'TOT 6281 04:05:09,501 --> 04:05:10,836 YOU. 6282 04:05:10,836 --> 04:05:12,137 BE THEN THE BEAUTIFULUT BABY IS 6283 04:05:12,137 --> 04:05:12,237 BO 6284 04:05:12,237 --> 04:05:14,239 , BUTUT THE PLACENTA IS LEFT 6285 04:05:14,239 --> 04:05:16,308 U AND THE UTERUS I 6286 04:05:16,308 --> 04:05:16,542 CLOSED. 6287 04:05:16,542 --> 04:05:18,243 AND MOST OF USF WHO W USE U CELL 6288 04:05:18,243 --> 04:05:20,212 SALVAGELVILLUCTION T 6289 04:05:20,212 --> 04:05:21,447 NIOTIC FLUID OUT OF THE WAY 6290 04:05:21,447 --> 04:05:23,682 AND THEN STAN S USING A CELL 6291 04:05:23,682 --> 04:05:26,785 SAVER BUVE WITHODERN LKO LTE 6292 04:05:26,785 --> 04:05:27,853 DPEE PLEETIONIO FILTERS THE'S 6293 04:05:27,853 --> 04:05:29,555 O MUCH OF A NEED TO DO THAT 6294 04:05:29,555 --> 04:05:31,523 AN BELIEVE IT REMNSNS AN A A 6295 04:05:31,523 --> 04:05:32,758 UNANSWERED QUESTIOUE ANDUE 6296 04:05:32,758 --> 04:05:34,393 CERTAINLY WE SUCTIONTI ALL OF TE 6297 04:05:34,393 --> 04:05:35,327 VAGINAL BLOODLO AND USE TOIVE 6298 04:05:35,327 --> 04:05:36,528 BACK TO THE PATIENT WITH A CELL 6299 04:05:36,528 --> 04:05:36,628 SA 6300 04:05:36,628 --> 04:05:39,398 INTER INTIONAL RADIOLOGY, 6301 04:05:39,398 --> 04:05:39,498 ,WE 6302 04:05:39,498 --> 04:05:40,065 E HEARD A LOT ABOUT THAT 6303 04:05:40,065 --> 04:05:41,266 TODAY. 6304 04:05:41,266 --> 04:05:42,868 OUR GROUP ABA ABA THAT ABOUTUT 6305 04:05:42,868 --> 04:05:44,837 SEVEN YEARSYEGOSECAUSE OF OUR 6306 04:05:44,837 --> 04:05:47,339 HIGH COMPLICATION RATESES WITH , 6307 04:05:47,339 --> 04:05:49,141 11%, AND WE DO SURGICAL LIGATION 6308 04:05:49,141 --> 04:05:54,012 ONLY IF WE ENCOUNTNCNT BLEEDING. 6309 04:05:54,012 --> 04:05:56,515 D THEND EN PROENED ON WITH THE 6310 04:05:56,515 --> 04:05:59,585 HYSTERECTOMY.TO 6311 04:05:59,585 --> 04:06:03,355 SO IN TERMS TER THE CRITICAL 6312 04:06:03,355 --> 04:06:04,123 STEPS OF GETTI G INTO HEMOR HAGH 6313 04:06:04,123 --> 04:06:05,657 FOR IMMIATE CESAREAN 6314 04:06:05,657 --> 04:06:07,526 CRITICAL POINT P PVE GOT A FEWEW 6315 04:06:07,526 --> 04:06:09,294 SO FIRSTLY WE'VE GOT DELIVERY OF 6316 04:06:09,294 --> 04:06:09,395 TH 6317 04:06:09,395 --> 04:06:11,363 WE CAN GET G INTO I MORELEEDING 6318 04:06:11,363 --> 04:06:13,165 ERE AND MNDBEBE THINGS LIK ANN 6319 04:06:13,165 --> 04:06:13,265 AU 6320 04:06:13,265 --> 04:06:15,401 STAPLERTAPLL HELP, HEL AS 6321 04:06:15,401 --> 04:06:18,537 SUPER THICK, AICNUTOTAPLER 6322 04:06:18,537 --> 04:06:20,205 CAN'T EVEN COME CLOSE TO CUTTING 6323 04:06:20,205 --> 04:06:21,306 THITSECOND PLACE WE CAN RUN INTT 6324 04:06:21,306 --> 04:06:23,375 DING IS WTHER WEER W TAKE THE 6325 04:06:23,375 --> 04:06:26,845 UTERO OVARIAN LIGAM LT. 6326 04:06:26,845 --> 04:06:27,446 LUCKILY MOIL OF THE F ME THAT 6327 04:06:27,446 --> 04:06:28,380 ELL, BUT I'VE GOT A FEW 6328 04:06:28,380 --> 04:06:29,815 POINTS I WANT WOO TALK ABOUT AIH 6329 04:06:29,815 --> 04:06:30,115 THAT.. 6330 04:06:30,115 --> 04:06:34,219 DISSECTION OF THE BLADDER DOWNIS 6331 04:06:34,219 --> 04:06:35,421 OFF THE FRONT WALL OF THE T 6332 04:06:35,421 --> 04:06:37,790 UTUS, AND TRE'S TWO 6333 04:06:37,790 --> 04:06:41,226 INSTAYS ST AROACHES T THIS,S, 6334 04:06:41,226 --> 04:06:42,294 THE SO OF SLASH AND ARAB 6335 04:06:42,294 --> 04:06:43,729 APPROACH AND THE SLOWW AND STEAY 6336 04:06:43,729 --> 04:06:44,696 PROACH. 6337 04:06:44,696 --> 04:06:46,832 I MEAN SLASHLASH AND GRA IN I 6338 04:06:46,832 --> 04:06:48,367 ANY NEG NE WAY, BUT IT'S A 6339 04:06:48,367 --> 04:06:49,902 MUCH QUICKER, MORE RAPIDD 6340 04:06:49,902 --> 04:06:53,205 PROACH TO BLADDER DISSE DION 6341 04:06:53,205 --> 04:06:54,339 WITH MORE IENTIONALONYST TO 6342 04:06:54,339 --> 04:06:56,175 THE ME, ANDND MAYBE THAT' TA GD 6343 04:06:56,175 --> 04:06:57,609 ING RHER THAN THE PNFUL 6344 04:06:57,609 --> 04:06:59,111 ULSLOW AND STEAD S S DISSECTIOSA 6345 04:06:59,111 --> 04:07:01,079 WE DO THA CAN TAKE AN HOUR AND 6346 04:07:01,079 --> 04:07:02,481 HF, TWOF,OURS TOU G TOU THE 6347 04:07:02,481 --> 04:07:05,517 BLADDEROWN. 6348 04:07:05,517 --> 04:07:06,919 E NEXT NPOT WE CAN RUN INTO I 6349 04:07:06,919 --> 04:07:09,021 BLEEDING IS WN WE TAKE T THE 6350 04:07:09,021 --> 04:07:11,089 VASCULARAR PEDICLES FOR T 6351 04:07:11,089 --> 04:07:12,558 HYSTERECTOMYECNDMYHENMYH A RLLYL 6352 04:07:12,558 --> 04:07:13,659 CHALLENGING PART FOR A LOT OF US 6353 04:07:13,659 --> 04:07:16,161 STILL IIL HOWS DO WE ENTER E E E 6354 04:07:16,161 --> 04:07:16,895 T AND HOW DO WE W CLOSEHE 6355 04:07:16,895 --> 04:07:18,764 VAULT IN A WAY TTINIMIZESES 6356 04:07:18,764 --> 04:07:19,965 OOD LOSS THE BHET AND THERE'S 6357 04:07:19,965 --> 04:07:22,067 A NUMBERBE OF ARO AHES, A 6358 04:07:22,067 --> 04:07:25,270 STERIOR APPRR CH USINGNG A 6359 04:07:25,270 --> 04:07:26,772 BRASKE RETRACTOR AND THERE T A 6360 04:07:26,772 --> 04:07:28,874 LOT OF OPPORTUNITY TNI RESEARCH 6361 04:07:28,874 --> 04:07:28,974 TH 6362 04:07:28,974 --> 04:07:32,244 TH. 6363 04:07:32,244 --> 04:07:34,313 REMEMBER I SAID I WANTEDANO TAL 6364 04:07:34,313 --> 04:07:37,049 ABOUT THE UTERO OVARIAN LIGAMENT 6365 04:07:37,049 --> 04:07:41,487 TAKING THE BLOOD YOU ISLYLY 6366 04:07:41,487 --> 04:07:41,820 THERE. 6367 04:07:41,820 --> 04:07:42,688 IINK IT'S IMPORTANT TO 6368 04:07:42,688 --> 04:07:43,956 UNDERSTANDTA SOME SOM THE NEW 6369 04:07:43,956 --> 04:07:48,427 STUDIESN 1.5 TESLA, WE'VEONEE 6370 04:07:48,427 --> 04:07:49,895 OUR CENTERHAT'S BET' 6371 04:07:49,895 --> 04:07:51,129 TED BUT NOT PUBLISHED YET, 6372 04:07:51,129 --> 04:07:52,130 JUST IN THE PROCE P, WHERE WE'VE 6373 04:07:52,130 --> 04:07:55,767 GOT EARLY DAYS D OF RECRU RMENTF 6374 04:07:55,767 --> 04:07:56,935 FOUR PATIENTS WITHS LACENTA 6375 04:07:56,935 --> 04:07:57,035 AAC 6376 04:07:57,035 --> 04:07:59,838 NTROLSNT IGNORE THE DATA WITHAH 6377 04:07:59,838 --> 04:08:01,640 PLACENTALEN INSUFFINSENFI BUT IS 6378 04:08:01,640 --> 04:08:04,276 IN THERE, A WE'RERE DOINGSE 6379 04:08:04,276 --> 04:08:06,612 O DO NON-C NTRASTAS 6380 04:08:06,612 --> 04:08:09,081 ANGIOGANPHY TO TY AND A QUANTIY 6381 04:08:09,081 --> 04:08:12,351 USINGG TIMEF FLIGHT SEQUENCESUEE 6382 04:08:12,351 --> 04:08:14,686 AND THEND TH CIN PHASESE CONTRAO 6383 04:08:14,686 --> 04:08:16,722 WORK O HOWUC BLOOD FLOW IS 6384 04:08:16,722 --> 04:08:17,055 GOING WHEG. 6385 04:08:17,055 --> 04:08:18,357 D WHAD IT BASICALLYLY SHOWS, IF 6386 04:08:18,357 --> 04:08:23,128 CAN SUMMARIZE, IS TH I IN 6387 04:08:23,128 --> 04:08:23,228 PL 6388 04:08:23,228 --> 04:08:23,695 ENTA ACCRETA COMPARED PA 6389 04:08:23,695 --> 04:08:26,198 INCREASECREA DOUBLING,BLBL IN BD 6390 04:08:26,198 --> 04:08:28,400 AORT THROU T THE DESHENDING 6391 04:08:28,400 --> 04:08:31,870 HAVE A SIGNI SCANT INCRE IE 6392 04:08:31,870 --> 04:08:33,438 IN UTERINE ARIER A FLOW AND 6393 04:08:33,438 --> 04:08:34,573 OVARIAN ARTERY FLOW, BUT , E 6394 04:08:34,573 --> 04:08:35,674 PLACE WHERE THE BLOOD ISEAVING 6395 04:08:35,674 --> 04:08:37,643 THETERUS IS NOT DOWN THE 6396 04:08:37,643 --> 04:08:39,278 BOTTOM, IT'S RIGHT AT THEOP 6397 04:08:39,278 --> 04:08:40,879 THROUGH THE OVARIAN VEINS. 6398 04:08:40,879 --> 04:08:43,382 HUGE INCASE IN BLOOD FLOW 6399 04:08:43,382 --> 04:08:44,816 THROUGHHE OVARI O VEINS. 6400 04:08:44,816 --> 04:08:46,652 SO IT'S IMING IN NGROUGH ROE 6401 04:08:46,652 --> 04:08:47,452 BOTTOM AND HEADING OUTNG THROUGH 6402 04:08:47,452 --> 04:08:50,389 THE TOP, AND THAT'S WHY W I THII 6403 04:08:50,389 --> 04:08:52,257 WEWE SHOULDHOXPLORE A LITTLE BIT 6404 04:08:52,257 --> 04:08:52,357 TFU 6405 04:08:52,357 --> 04:08:54,493 HER THE CONCEPTONPT OF O PUTTING 6406 04:08:54,493 --> 04:08:56,995 SOME LONG STRAIGHTAIT CLAMPS OVR 6407 04:08:56,995 --> 04:08:59,631 THE UTERO UVARIANAN PEDICLES, 6408 04:08:59,631 --> 04:09:00,999 S,BECAUSE CA ARE THEN T EFFECTIY 6409 04:09:00,999 --> 04:09:02,768 OCKING OFF T VENOUS DRAINAGE 6410 04:09:02,768 --> 04:09:05,370 FOR OUR UTERUSS AND POTTIALTI 6411 04:09:05,370 --> 04:09:08,073 INCREASING THE PRESSURESUR AND 6412 04:09:08,073 --> 04:09:08,740 MORRHAGIRRSEQUELAE FOR SOM 6413 04:09:08,740 --> 04:09:09,107 PATIENTS. 6414 04:09:09,107 --> 04:09:10,208 .SO I THINK WE SHOULD EXPLORE 6415 04:09:10,208 --> 04:09:11,977 THIS.TH 6416 04:09:11,977 --> 04:09:14,246 NOW, VERY BRIEF B, I, WANTED TO 6417 04:09:14,246 --> 04:09:17,249 RT OF TALK ABOUT SOMOF THE 6418 04:09:17,249 --> 04:09:19,751 ORT RM CONQUONCES OF AN 6419 04:09:19,751 --> 04:09:20,419 IMMEDIATE HYSTERECTOMY, AND A I 6420 04:09:20,419 --> 04:09:22,588 HAVEHA TO DO THIS WITHINIT THE 6421 04:09:22,588 --> 04:09:25,958 CANADA.DADATHE T U AND OF OF 6422 04:09:25,958 --> 04:09:30,195 SO THESE ARE A COUPLE OF PAPERS 6423 04:09:30,195 --> 04:09:34,866 QUITEIT HIGH VOLUMEENTERSISH IN 6424 04:09:34,866 --> 04:09:36,835 SHOWING THE OUTCOMES OF 6425 04:09:36,835 --> 04:09:36,935 IM 6426 04:09:36,935 --> 04:09:41,406 DIATE CESAREAN HYSTERECTOMREOMY, 6427 04:09:41,406 --> 04:09:41,506 SO 6428 04:09:41,506 --> 04:09:43,542 I'VE MUSHED THEM TLL TLLET TR 6429 04:09:43,542 --> 04:09:45,911 AND IT'S'S THE CTEMPORARY 6430 04:09:45,911 --> 04:09:47,412 OUTCOME, IT'S NOT THE 10-AR 6431 04:09:47,412 --> 04:09:48,747 HIORY, IT'SS THE RECENTEN 6432 04:09:48,747 --> 04:09:49,815 OUTCOMES AFTER WE'VE HAD A FAI 6433 04:09:49,815 --> 04:09:52,184 TIME ON OURUR SURGI SLGIEARNING 6434 04:09:52,184 --> 04:09:52,884 CURVE. 6435 04:09:52,884 --> 04:09:55,587 SO OFSO OURATIENTS, THES, VASTAS 6436 04:09:55,587 --> 04:09:58,423 MAJORITY, 70 TO T 90% THEM ARE 6437 04:09:58,423 --> 04:10:02,127 STAGE II TO OR INCRETA 6438 04:10:02,127 --> 04:10:04,529 PERCRETA, WERE DELIVERING AT THT 6439 04:10:04,529 --> 04:10:11,169 APPRECIAPR THE PROROND LOWTO 6440 04:10:11,169 --> 04:10:16,708 IN CENTERS TTET DO THIS ALLSHELL 6441 04:10:16,708 --> 04:10:18,377 TIME, AND THIS ITHRETH FOLDDD 6442 04:10:18,377 --> 04:10:20,012 LOWER THAN MANY OFHE OTHER 6443 04:10:20,012 --> 04:10:21,847 OUTCOMES THAT WE'VE SVEN TAL T 6444 04:10:21,847 --> 04:10:25,150 ABOUT TODAYOD. 6445 04:10:25,150 --> 04:10:27,452 EE BLADDER DISSECTION AS N 6446 04:10:27,452 --> 04:10:29,421 MENTIONED, THEHE FAST APPROACPP 6447 04:10:29,421 --> 04:10:30,989 VERSUS THE SLOW AND STEADY 6448 04:10:30,989 --> 04:10:32,457 APPROACH NEEDS TO BE EXPLORED 6449 04:10:32,457 --> 04:10:36,695 MUCH MORE IN DAIL, AND I GUESS 6450 04:10:36,695 --> 04:10:37,629 IF YOU ARE HAVIN H GOOD OCOMEME 6451 04:10:37,629 --> 04:10:37,729 WI 6452 04:10:37,729 --> 04:10:43,001 JUST DO WHAT YHA'RE USE TO, BUT, 6453 04:10:43,001 --> 04:10:43,769 I THINI THE CENERS WHICH WCH ARE 6454 04:10:43,769 --> 04:10:45,303 LEARNING A TECHNIQUE, I THINK 6455 04:10:45,303 --> 04:10:48,140 THEY SHOULD TUL AND STICK S TO E 6456 04:10:48,140 --> 04:10:49,274 AND DO IT ALL THE TIME.TIME 6457 04:10:49,274 --> 04:10:50,909 TERMS OFF THEHEROLOGICAL 6458 04:10:50,909 --> 04:10:51,009 OU 6459 04:10:51,009 --> 04:10:54,746 OMES IN OUR T O GROUPS, WHEN 6460 04:10:54,746 --> 04:11:02,387 WENKNK ABOUTBO CYSTOSCOPYND 6461 04:11:02,387 --> 04:11:02,487 UR 6462 04:11:02,487 --> 04:11:03,155 ERIC STENTING, WIN HARY 6463 04:11:03,155 --> 04:11:03,255 EV 6464 04:11:03,255 --> 04:11:05,457 DO IT, 1% 1R LES 6465 04:11:05,457 --> 04:11:06,124 FOR THE HUGHES TOOES GROUP, THEY 6466 04:11:06,124 --> 04:11:08,193 YDO IT ABOUT 65 TO 6 70% OF THE 6467 04:11:08,193 --> 04:11:09,061 TIME. 6468 04:11:09,061 --> 04:11:11,063 BUT IF YOU LOOK DOWNN THE BTOM, 6469 04:11:11,063 --> 04:11:12,397 OUR ADVERSEEROLOGIROLGI OCOMES 6470 04:11:12,397 --> 04:11:14,132 ARE ALMOSTOS IDENTICAL INN TERMF 6471 04:11:14,132 --> 04:11:20,305 AAOTAL NUMBE N OF CYSTOTOMIES, 6472 04:11:20,305 --> 04:11:26,078 URETERIC INJURIESS AND FISTULAS. 6473 04:11:26,078 --> 04:11:28,513 IF YIF DON'T -- BUT YOU DO DO 6474 04:11:28,513 --> 04:11:29,581 DOTHISDOLL THE TIME, ACTUALLY HE 6475 04:11:29,581 --> 04:11:31,450 THE SAME RESULT.T. 6476 04:11:31,450 --> 04:11:33,785 SO NOWN TO DAYED INTVAL 6477 04:11:33,785 --> 04:11:38,156 PUBLISHED ON THIS.EEN A FEW PAPS 6478 04:11:38,156 --> 04:11:39,458 THAT'S'S THAT INITIAL C-SECTI-S 6479 04:11:39,458 --> 04:11:41,293 AWAY FROAY THE PLACENTA, THE 6480 04:11:41,293 --> 04:11:42,928 DECISION WHAT YOU'REOUOING TONGO 6481 04:11:42,928 --> 04:11:45,797 TRAOPERATIVELY, THEE UTERUSS AND 6482 04:11:45,797 --> 04:11:47,165 ABDON ARE THERE CLOSE C AND 6483 04:11:47,165 --> 04:11:49,034 SOME PATIENTS WILS GOO FOR IR O 6484 04:11:49,034 --> 04:11:49,501 EMBOLIZATION. 6485 04:11:49,501 --> 04:11:51,937 TH HAVE ANTIBIOTICS AWEWE 6486 04:11:51,937 --> 04:11:53,271 KNOW, METHOTREXATESS NOT GIVEN, 6487 04:11:53,271 --> 04:11:54,573 THE PATIE P SYS FOR A SHORT 6488 04:11:54,573 --> 04:11:55,907 TIME IN THE HOSPITALPI IF THEY'E 6489 04:11:55,907 --> 04:11:57,509 WELL AND A THEN THEYY HEAOFF HOE 6490 04:11:57,509 --> 04:11:58,944 AS LONAS AS THEYON'TON LIVE TOO 6491 04:11:58,944 --> 04:11:59,478 FAR AWAY. 6492 04:11:59,478 --> 04:12:01,780 EY'RE MONITORED WITHH LHS AND 6493 04:12:01,780 --> 04:12:03,615 ULTRASOUND FOROR REGRESSION, AIO 6494 04:12:03,615 --> 04:12:03,715 IO 6495 04:12:03,715 --> 04:12:05,884 HEYY EVEUALLYYY HAVEE A 6496 04:12:05,884 --> 04:12:07,219 HYSTERHYTOMY FOUR T S WEEKS 6497 04:12:07,219 --> 04:12:08,186 LATER IFTE EIFRYTHING GOES WELL, 6498 04:12:08,186 --> 04:12:09,788 WE ALSO NEED TO DO SOME 6499 04:12:09,788 --> 04:12:11,223 IMPORTANT MEASURING OFF 6500 04:12:11,223 --> 04:12:13,425 PSYCHOSOCIAL IMPACTS WITH THISH 6501 04:12:13,425 --> 04:12:14,926 APPROACH BECAUSE LIVING UNDER UA 6502 04:12:14,926 --> 04:12:16,428 EAT OF A BADD OCOME 6503 04:12:16,428 --> 04:12:19,765 UNTIL YOUUT WAIT F YOUR D-DAYS 6504 04:12:19,765 --> 04:12:23,702 IS A B BHING TOO THROUGHOU. 6505 04:12:23,702 --> 04:12:30,242 NOW CALLED IAIP AIP P HEHE 6506 04:12:30,242 --> 04:12:31,443 POTENTIAL COMPLICAMPONS OF DOIFI 6507 04:12:31,443 --> 04:12:34,212 A SECOND INTENTIONAL SURGICALL 6508 04:12:34,212 --> 04:12:34,946 PROCEDURE POTEE IALLY OUTWEIGHED 6509 04:12:34,946 --> 04:12:43,355 PUBLISHED THEIR PAPER AFTER TFTY 6510 04:12:43,355 --> 04:12:44,456 GUIDELINES WERES RELEASED. 6511 04:12:44,456 --> 04:12:46,291 A RETSPECTIVE STUDYVER AT A 6512 04:12:46,291 --> 04:12:47,692 SIX-YEAR PERIOD IN NASHVILLE 6513 04:12:47,692 --> 04:12:47,793 WH 6514 04:12:47,793 --> 04:12:49,895 E 34 PATIENTS HAD HNTIPARTUM 6515 04:12:49,895 --> 04:12:51,530 DIAGNODIS OF STAGE IIGE TOO 6516 04:12:51,530 --> 04:12:52,998 3 DIASE. 6517 04:12:52,998 --> 04:12:54,299 314 HAD 6518 04:12:54,299 --> 04:12:56,668 DELAYEDEL HYSTERECTOMY COMPARED 6519 04:12:56,668 --> 04:13:00,038 C-SECTION HYSTEREYSOMY.YS 6520 04:13:00,038 --> 04:13:02,140 I THINK IF WE LOOK AT THEEL 6521 04:13:02,140 --> 04:13:03,775 IMMEDIATE GROUPS, THE 6522 04:13:03,775 --> 04:13:05,210 SURGICALRGIMESERE VERY 6523 04:13:05,210 --> 04:13:09,347 FFERENFFFF INITIALLYLY FOR THE 6524 04:13:09,347 --> 04:13:11,216 DELAYED AND A IMMEDIATE GROUP, D 6525 04:13:11,216 --> 04:13:12,184 IMPORTANTLY, THEY, ESTIMATED BLD 6526 04:13:12,184 --> 04:13:15,620 LOSS THA THEY REPOR RED WAS 6527 04:13:15,620 --> 04:13:18,356 OFOUNDLY LOWORHEESAREAN,EA 6528 04:13:18,356 --> 04:13:22,427 0 MLS, AND HYSTERECTOMY, 750Y, 6529 04:13:22,427 --> 04:13:26,464 MLS FOR A CBINED TOT OF 13000 6530 04:13:26,464 --> 04:13:29,668 UT THE IMMED ITEROUP HAD 6531 04:13:29,668 --> 04:13:30,969 3 LITERS OTEVERAGE OF BLOODOD 6532 04:13:30,969 --> 04:13:33,672 LOSS, VERY DFERENT TO WHAT WE 6533 04:13:33,672 --> 04:13:36,441 HADHAD W1,000 TO 1500 MLS,LS 6534 04:13:36,441 --> 04:13:36,908 RY, VERY DIFFERENT. 6535 04:13:36,908 --> 04:13:39,077 SO ISO THINKHI THE VOLUME OF CAS 6536 04:13:39,077 --> 04:13:42,013 ISIS VER IMPORTANT IN YOUR 6537 04:13:42,013 --> 04:13:43,215 DECISION-MAKING, SO JUST TO BE 6538 04:13:43,215 --> 04:13:45,517 NTROVERSIAL, IN DETERMINING 6539 04:13:45,517 --> 04:13:46,384 WHICH OPTIONOP PERHAPS IT'S TT'T 6540 04:13:46,384 --> 04:13:47,752 CASELOADND EXPERIENCE WHICH 6541 04:13:47,752 --> 04:13:50,655 MIGHT HELP YECIDE WHERE CAN 6542 04:13:50,655 --> 04:13:53,191 I SUGST THAT LOW OR MID VOLUME 6543 04:13:53,191 --> 04:13:56,995 DELAYED HYSTERECTOMYEC BUT FOR F 6544 04:13:56,995 --> 04:14:00,065 VERY HIGH VOL VOLOL CTERS, 6545 04:14:00,065 --> 04:14:02,067 IMMEDIATE HYST CHYST BE TH BWAYA 6546 04:14:02,067 --> 04:14:02,300 GO 6547 04:14:02,300 --> 04:14:02,334 TH 6548 04:14:02,334 --> 04:14:02,934 CAN BE FURTE R DISCUSSED 6549 04:14:02,934 --> 04:14:09,274 BEAUTIFULLAPL WHICH CHAED MY K 6550 04:14:09,274 --> 04:14:10,609 WORLD IN THEINAY THAAY I CAN TAK 6551 04:14:10,609 --> 04:14:13,245 ABOUT THIS. 6552 04:14:13,245 --> 04:14:15,413 I REALLY ENJOYED THIS PHIS P OFA 6553 04:14:15,413 --> 04:14:19,951 INDIVIINALS INO HAD A C-H AT F 6554 04:14:19,951 --> 04:14:20,051 PL 6555 04:14:20,051 --> 04:14:24,155 CENTERS, AND T BASE OF THIS T 6556 04:14:24,155 --> 04:14:25,891 WAS OUTS F CALIFORNIA. 6557 04:14:25,891 --> 04:14:28,159 AND THEY FOUND FOR SURGICAL 6558 04:14:28,159 --> 04:14:29,928 MORBITY THE TURNING POINT PTHE 6559 04:14:29,928 --> 04:14:30,495 REFLECTION POINT WHERE THEY 6560 04:14:30,495 --> 04:14:32,163 STARTED TO HAVE H A SIGNIFICANT 6561 04:14:32,163 --> 04:14:32,998 DIFFERENCE DEPENDING ON NG O 6562 04:14:32,998 --> 04:14:37,235 NUMBERNUF CASES WASES W 25 CASER 6563 04:14:37,235 --> 04:14:38,637 YEAR, AND AS SOON ASYEYE YOU DID 6564 04:14:38,637 --> 04:14:41,973 MORE THAN T 25 OR5 E ME M CASESR 6565 04:14:41,973 --> 04:14:44,876 BETTERBE THAN T THE T MEDIU M OW 6566 04:14:44,876 --> 04:14:47,712 VOLUMEVO CENTERSEN. 6567 04:14:47,712 --> 04:14:54,252 ANDANHINK ABOUT VOLUMES.RWARD 6568 04:14:54,252 --> 04:14:55,253 SO F HYSTERECTOMY, I'M 6569 04:14:55,253 --> 04:14:57,289 WRAPNG UPOON,VER ALL THE 6570 04:14:57,289 --> 04:14:58,390 IDEALEA CDI CTE IN I IYPIYON 6571 04:14:58,390 --> 04:15:08,433 WI OR CIRCUMFERCUTIAL DISSE,SE 6572 04:15:08,433 --> 04:15:08,533 YO 6573 04:15:08,533 --> 04:15:11,603 PRESERVATIER SURRY YOU'RE 6574 04:15:11,603 --> 04:15:11,703 ES 6575 04:15:11,703 --> 04:15:14,906 E CORES OFF THE CERVIX.THE 6576 04:15:14,906 --> 04:15:15,006 WH 6577 04:15:15,006 --> 04:15:18,443 THERE'S BLAER CERVIX OR 6578 04:15:18,443 --> 04:15:19,711 IR ME TREEL INVASION, WHEN 6579 04:15:19,711 --> 04:15:21,680 THERE'S A MASSIVE AREAA OF O 6580 04:15:21,680 --> 04:15:23,882 DEHYDRATIODR WITH A REALLY LOW 6581 04:15:23,882 --> 04:15:24,783 INFERIOR BORDEROR THAT YOU CAN 6582 04:15:24,783 --> 04:15:27,886 GET DOWN TO STITCH UP, EMERGENCY 6583 04:15:27,886 --> 04:15:30,088 LO I I THINK ARE GOODS O BLOODLO 6584 04:15:30,088 --> 04:15:30,555 CANDIDATES.ES 6585 04:15:30,555 --> 04:15:32,090 PATIENT PREFERENCFE ISFE VERY 6586 04:15:32,090 --> 04:15:33,858 PLEIR FAMILY.HEN THEYN E COMPLEL 6587 04:15:33,858 --> 04:15:34,893 WHEN THERE T A CONCURRENT 6588 04:15:34,893 --> 04:15:37,729 INDICATION FOR F A HYST WITH A 6589 04:15:37,729 --> 04:15:39,664 HISTORYOR OF HYPERPLASIA O 6590 04:15:39,664 --> 04:15:41,232 FIBROIDS, WDSVE DONVE THAT A FEW 6591 04:15:41,232 --> 04:15:42,500 FMES, AME WHEN THE 6592 04:15:42,500 --> 04:15:43,101 MULTIDISCIPLINARY TEAMY REFERS 6593 04:15:43,101 --> 04:15:44,502 IT. 6594 04:15:44,502 --> 04:15:45,236 SO IN SO IIDERING DELAYED 6595 04:15:45,236 --> 04:15:46,338 HYSTERECTOMY, WE HAVEE O BE SUR 6596 04:15:46,338 --> 04:15:48,406 THATHE TEAMEA ANDNDIENT 6597 04:15:48,406 --> 04:15:50,909 SUPPORTS ARE ALL ON THE SAME 6598 04:15:50,909 --> 04:15:51,209 GE. 6599 04:15:51,209 --> 04:15:53,078 THAT THE SURGICAUR TEAM IS 6600 04:15:53,078 --> 04:15:55,280 AVAIBLAI 24/7 FOR7 7 THESE 6601 04:15:55,280 --> 04:15:57,449 PATIENTS WHO DON'T GETET TETOO R 6602 04:15:57,449 --> 04:15:58,616 PLAND HYSTERECTOMY DATE, AND 6603 04:15:58,616 --> 04:16:01,319 M CARE CS C SO 6604 04:16:01,319 --> 04:16:04,255 IMPORTANT.ANT.SO FOR T ONTARIO N 6605 04:16:04,255 --> 04:16:06,257 CONTEXT, FORT,OWN TORONTO, 6606 04:16:06,257 --> 04:16:08,426 I ALL THE TIMIM HAVE PASAS PATIS 6607 04:16:08,426 --> 04:16:12,330 FROM TWOOURSOU AWAY IN ORILIA, 6608 04:16:12,330 --> 04:16:12,430 4 6609 04:16:12,430 --> 04:16:17,836 2 HOURS AWA IN SUDDE S SUDPURN,8 6610 04:16:17,836 --> 04:16:22,574 HOURS A WAY IN I THUNDER BAY A 6611 04:16:22,574 --> 04:16:24,709 WHATSOEVER.'T HAVE ANY RHODESDE 6612 04:16:24,709 --> 04:16:25,510 SO OUR KNOWLEDGEED GAPS AND 6613 04:16:25,510 --> 04:16:26,945 SEARCH DIRECTIONEC TO DISCUSS 6614 04:16:26,945 --> 04:16:28,780 MORE TOMORROW, DOW, D DO 6615 04:16:28,780 --> 04:16:30,882 CYSTOSCOPYPY AND A YOU'R Y TAIRK 6616 04:16:30,882 --> 04:16:32,851 STENTING,, DO WE W ENGAGE WITHIA 6617 04:16:32,851 --> 04:16:34,119 HYBRID OBR THE RATINGAT ROOM AND 6618 04:16:34,119 --> 04:16:35,320 RECOMMEND IT, WHA D WE DO WITH 6619 04:16:35,320 --> 04:16:36,688 OH YOUH SOU AND HOW DOUGH 6620 04:16:36,688 --> 04:16:38,323 WITH DO THAO THA IN A SYSTEMATIY 6621 04:16:38,323 --> 04:16:38,857 BEFORE WE START. 6622 04:16:38,857 --> 04:16:42,260 WHAT IS THE BEST SKI INCISIONCNC 6623 04:16:42,260 --> 04:16:45,096 OR WHAT SKI INCISION SUITS WHATA 6624 04:16:45,096 --> 04:16:48,366 PATIENT. 6625 04:16:48,366 --> 04:16:51,236 I DO TXA -- DON'T WAI UNTIL 6626 04:16:51,236 --> 04:16:54,539 ANSWERED THAT QUESTION.NOBODY'SS 6627 04:16:54,539 --> 04:16:59,778 DO WE GIVEIVIV UROTONICS OR NOT, 6628 04:16:59,778 --> 04:17:02,280 NOBODY KNONO. 6629 04:17:02,280 --> 04:17:02,380 WH 6630 04:17:02,380 --> 04:17:04,649 DO WE DWITH THE INTERNAL 6631 04:17:04,649 --> 04:17:06,317 ILIAC ARTERY SURGICALLGI ANDND D 6632 04:17:06,317 --> 04:17:07,852 WE DISSECTCTT OUT AND OY CLIP C 6633 04:17:07,852 --> 04:17:09,554 THEMTHF WE RUN INT BLEING? 6634 04:17:09,554 --> 04:17:11,322 WE DO SSH AND GB, DO WEE 6635 04:17:11,322 --> 04:17:12,424 DO SLOW AND STEADY?TE 6636 04:17:12,424 --> 04:17:14,325 WHAT'S T'S BT WAY TO T ENTER TNT 6637 04:17:14,325 --> 04:17:14,426 VA 6638 04:17:14,426 --> 04:17:16,161 T AND AVOID THAT BLEEDING? 6639 04:17:16,161 --> 04:17:20,298 ARIANOUS DRAINAGE DURINGRVESERV 6640 04:17:20,298 --> 04:17:21,166 THE SURGERY AND NOT BLOCK IT O 6641 04:17:21,166 --> 04:17:23,234 SO THAWE C MOVE THE UTERUS 6642 04:17:23,234 --> 04:17:23,568 AROUND? 6643 04:17:23,568 --> 04:17:25,336 WHAT ARE THE BESTPWISE 6644 04:17:25,336 --> 04:17:26,738 APPROACHES TO THE HYSTERECTOMRE 6645 04:17:26,738 --> 04:17:28,706 OULD WLDLDOMMENDOM TOTAL OR 6646 04:17:28,706 --> 04:17:29,207 SUBTOTAL? 6647 04:17:29,207 --> 04:17:31,209 HOW DO W ENGAGE WITH MACHINEAC 6648 04:17:31,209 --> 04:17:32,844 LEARNILE AND A.I. TOOELP UN 6649 04:17:32,844 --> 04:17:33,378 PREDICTION? 6650 04:17:33,378 --> 04:17:35,280 WHAT ARE THE BEST WAYS T 6651 04:17:35,280 --> 04:17:37,248 EDUCATE IN SURGERY, PRODUCING 6652 04:17:37,248 --> 04:17:38,283 VIDEOS ODE SIMULATION?IO 6653 04:17:38,283 --> 04:17:42,220 ANDANFE GOO DOWN A PATH OF 6654 04:17:42,220 --> 04:17:44,923 DUCINGDU PRIMARY C-SECTION 6655 04:17:44,923 --> 04:17:45,924 STERECTOMYEC ARE OURUR NUMBERS 6656 04:17:45,924 --> 04:17:47,125 GOING TO PLUMMET AND THEN WE 6657 04:17:47,125 --> 04:17:48,126 LOSE OUR SURGICAL SKILLS AND 6658 04:17:48,126 --> 04:17:51,830 S LITERATURE IUR TRICKYRI TO 6659 04:17:51,830 --> 04:17:52,263 INTERPRET. 6660 04:17:52,263 --> 04:17:56,334 BUT AT THE MOMENT, C-HYST 6661 04:17:56,334 --> 04:17:58,703 MAINS A PREFERRED APPROACHRO BYC 6662 04:17:58,703 --> 04:17:59,671 MANYMA AMERICAN CENTERSENND 6663 04:17:59,671 --> 04:18:00,205 GUIDELGUID. 6664 04:18:00,205 --> 04:18:01,539 LUME IS VERY, V VERYMPORTANT, 6665 04:18:01,539 --> 04:18:04,809 OPPORTUNITY TOITY LOREY HIS. 6666 04:18:04,809 --> 04:18:06,578 AND THERERE ARE A SEVERAL KEY 6667 04:18:06,578 --> 04:18:07,779 OWLEDGE GAPS AND TECIQUES 6668 04:18:07,779 --> 04:18:09,514 THAT WTHATEED TO EXPLORE 6669 04:18:09,514 --> 04:18:10,181 TOGETHER. 6670 04:18:10,181 --> 04:18:10,849 AS WE M WEORWARD. 6671 04:18:10,849 --> 04:18:12,684 W HAVEE TO COME C C WH OPEN 6672 04:18:12,684 --> 04:18:14,452 MINDS TO LOOK ATTHAT WE W CAN 6673 04:18:14,452 --> 04:18:16,321 ARN FROM EACH OTHER TO REFINENE 6674 04:18:16,321 --> 04:18:17,889 THE OPTIMAL RESULT, WHATEVER 6675 04:18:17,889 --> 04:18:20,125 THAT MAY BE FOR F EH INDIVIDUAIV 6676 04:18:20,125 --> 04:18:20,592 PERSON. 6677 04:18:20,592 --> 04:18:21,426 .SO THANK YOU,OU THANK YOU, THAK 6678 04:18:21,426 --> 04:18:30,001 YOU. 6679 04:18:30,001 --> 04:18:30,101 >> 6680 04:18:30,101 --> 04:18:30,869 HANKS,S, DR.OBSON. 6681 04:18:30,869 --> 04:18:32,203 PRECTE YOU JOININGNI REMOTELY. 6682 04:18:32,203 --> 04:18:34,139 WE'RE GOING TO MOVE ONOVO T 6683 04:18:34,139 --> 04:18:44,215 ALTERNATIVRNO CAREAN SIBAI, 6684 04:18:44,215 --> 04:18:44,849 ECTOMY IN THE UNITEDUN 6685 04:18:44,849 --> 04:18:55,059 EDSTATES.ATES 6686 04:18:58,963 --> 04:19:00,765 >> THANK YOU EVERYBODY. 6687 04:19:00,765 --> 04:19:03,168 MY TALKK IS GOING TCOMPLEMENT 6688 04:19:03,168 --> 04:19:05,270 THETH PREVIOURE ONES, PROBABLY E 6689 04:19:05,270 --> 04:19:05,537 CO 6690 04:19:05,537 --> 04:19:06,804 AND QUESTIONSNS ABOUT A 6691 04:19:06,804 --> 04:19:15,079 WHAT WOULD WLD W THE NEXTTEP? 6692 04:19:15,079 --> 04:19:17,048 SO FOR HISTORICAL BACROUN 6693 04:19:17,048 --> 04:19:17,782 TRADITIONALLY TREATMENT OF PAS 6694 04:19:17,782 --> 04:19:19,984 IN T UNITED STATES HAS BEENN 6695 04:19:19,984 --> 04:19:21,519 CESAREANSAYSTERECTOMY THAT WAS 6696 04:19:21,519 --> 04:19:24,122 ED FIRST IN 1937. 6697 04:19:24,122 --> 04:19:25,857 HOWEVER,WEINCE THE THE HHEE 6698 04:19:25,857 --> 04:19:28,560 EN AEN LOT OF QUESTIONS WHETHERH 6699 04:19:28,560 --> 04:19:35,466 IT SHOULD BE THE PRORAPPROACHPR 6700 04:19:35,466 --> 04:19:37,669 IN 1951, COMMENTED IN I THE NEWE 6701 04:19:37,669 --> 04:19:39,837 GLAND JOANNAL OFL MEDICINE,IC 6702 04:19:39,837 --> 04:19:44,776 WITH THE GHEERAL OPINION THATT 6703 04:19:44,776 --> 04:19:47,412 HYSTERECTOMY ITO THE TREATMENT F 6704 04:19:47,412 --> 04:19:55,386 CHOICEN PLACENTA ACCRETA. 6705 04:19:55,386 --> 04:19:58,256 IS IMMEDIATETECTOMY TOM 6706 04:19:58,256 --> 04:20:00,024 BEST APPROACH, PARTICULARLY -- 6707 04:20:00,024 --> 04:20:00,892 RE'S AN EXAMPLE OF A PATNT 6708 04:20:00,892 --> 04:20:04,295 LOSS WAS 29 LITERS.ATIVE BLOOD 6709 04:20:04,295 --> 04:20:08,399 I WAS WAS INVOLVEDOLVED THIS PA. 6710 04:20:08,399 --> 04:20:08,499 AB 6711 04:20:08,499 --> 04:20:13,404 T ABX OR EIGR EEEKSEEGO 6712 04:20:13,404 --> 04:20:16,441 D YOU LOOK AT ALL OF THESEHE 6713 04:20:16,441 --> 04:20:22,880 CENTERS AND SO ONNN, MORBIDITY S 6714 04:20:22,880 --> 04:20:27,418 I HIGHLIGHTED FOR YOU IN RHE 6715 04:20:27,418 --> 04:20:32,457 NUMBER OF PACKEDD RED BLOODLO 6716 04:20:32,457 --> 04:20:37,562 NIGMS TO THE ICU.OLISM, ADD 6717 04:20:37,562 --> 04:20:41,165 SHOULD ITE -- MANEMENT FOR 6718 04:20:41,165 --> 04:20:47,739 ALL PATIENTS WITTS ACCRETA. 6719 04:20:47,739 --> 04:20:47,839 HO 6720 04:20:47,839 --> 04:20:50,008 ABOUT WHEN YOU HAVEOUOU REALLYY 6721 04:20:50,008 --> 04:20:51,743 SEVERE INVOLVEMENTVEF THE 6722 04:20:51,743 --> 04:20:52,844 BLADDER? 6723 04:20:52,844 --> 04:20:55,780 THE IDEA ISSS ACTUALLY TO DO 6724 04:20:55,780 --> 04:20:58,349 CONSERVATIVE MANAGEMENT, LEAVE 6725 04:20:58,349 --> 04:21:02,620 PLACENTA IN SITU. 6726 04:21:02,620 --> 04:21:04,389 SO HOWSO DO WE COUNSELUR 6727 04:21:04,389 --> 04:21:04,689 PATIENTS? 6728 04:21:04,689 --> 04:21:07,659 STARTED THIS IN 2015,OORY 6729 04:21:07,659 --> 04:21:07,759 TO 6730 04:21:07,759 --> 04:21:10,695 ENTA IN SITU.TS IE LEAVE THEVE E 6731 04:21:10,695 --> 04:21:12,330 SO FIRSO QUESTION WHEN WE TALK 6732 04:21:12,330 --> 04:21:16,534 THE P P, FUTUREUR 6733 04:21:16,534 --> 04:21:18,836 FERTILITY, PRESERVE THE UTERUS. 6734 04:21:18,836 --> 04:21:20,338 THEYTHTILL WANT THE URUS EVEN 6735 04:21:20,338 --> 04:21:25,043 THOUGH THEYHE DON'T WANT CHILDR. 6736 04:21:25,043 --> 04:21:25,643 SO WE TIE THE TUBES AND LEAVE 6737 04:21:25,643 --> 04:21:33,484 THE PLANTA INS SITU. S IT'S NOE 6738 04:21:33,484 --> 04:21:34,252 UTERUS FOR FERTILITY. 6739 04:21:34,252 --> 04:21:34,352 TH 6740 04:21:34,352 --> 04:21:35,219 ARE OTHER REASONS THEYHE 6741 04:21:35,219 --> 04:21:37,855 WANT TO KEEP IT. 6742 04:21:37,855 --> 04:21:41,326 TO HAVE ADEQUATE FOLLO FUP WITLA 6743 04:21:41,326 --> 04:21:44,729 US, AND THEN WN W HAVE TO TAKE 6744 04:21:44,729 --> 04:21:49,434 INTO CONSIDERATION IURANCECE 6745 04:21:49,434 --> 04:21:54,372 STATUSSTAT, -- THEN EXTT OF 6746 04:21:54,372 --> 04:21:56,207 PLACENTALEN INVASIONIO TODJACENC 6747 04:21:56,207 --> 04:21:56,441 GANS. 6748 04:21:56,441 --> 04:21:58,609 AFTER THAT, YOUAVE FOUR 6749 04:21:58,609 --> 04:21:59,143 OPTIONS. 6750 04:21:59,143 --> 04:22:04,315 S.YOU CAN DO CESAREANEA 6751 04:22:04,315 --> 04:22:10,722 LAYED HYSTERECTOMY, UTERINERINES 6752 04:22:10,722 --> 04:22:13,024 RESECTION AND RECONSTRUCTION, 6753 04:22:13,024 --> 04:22:15,960 ANI'M GOING TO T SW SU THEY 6754 04:22:15,960 --> 04:22:22,967 ACTUALLYTUALAL DO PLANTAL RESEC. 6755 04:22:22,967 --> 04:22:26,337 THIS ISOW A PARTIAL RESECTION 6756 04:22:26,337 --> 04:22:28,239 DONE.ON 6757 04:22:28,239 --> 04:22:33,177 EY DO A- THEN THE UTERUS IS 6758 04:22:33,177 --> 04:22:39,884 T BTK TOGETHER. 6759 04:22:39,884 --> 04:22:45,990 NOW I'M GOING TO SHOW YOU WH 6760 04:22:45,990 --> 04:22:56,467 WHAT -- SO S WHAT THEYO, TYY 6761 04:23:01,406 --> 04:23:02,907 START DIARECTING -- OF THE T 6762 04:23:02,907 --> 04:23:03,007 BL 6763 04:23:03,007 --> 04:23:05,276 DER. 6764 04:23:05,276 --> 04:23:07,278 THE -- THE VESSE VESF VHE 6765 04:23:07,278 --> 04:23:08,179 BLADDER, THEN AFTER YOUR O 6766 04:23:08,179 --> 04:23:09,147 DISSECDION, DIVAS 6767 04:23:09,147 --> 04:23:15,586 OF -- AFTEROINGHIS -- AS YOUN 6768 04:23:15,586 --> 04:23:17,822 N SEE, S THEY PULL THE PCENTA 6769 04:23:17,822 --> 04:23:27,965 T.T. 6770 04:23:38,543 --> 04:23:42,547 --HEREHE THE T PLACENTA 6771 04:23:42,547 --> 04:23:45,716 ACTUALLY -- THEE -- THE PLACENTA 6772 04:23:45,716 --> 04:23:51,189 REMOVED COMPLETELY. 6773 04:23:51,189 --> 04:23:52,757 AND THEN YOU CAN S T T 6774 04:23:52,757 --> 04:24:03,634 ACCOUNT CUT ALL OFTHATFF AREA.RE 6775 04:24:12,610 --> 04:24:14,745 ANDD THIS IS -- YOU CAN SEEOW 6776 04:24:14,745 --> 04:24:19,383 THE PLACE PA ACCRETA WAS TWO 6777 04:24:19,383 --> 04:24:23,321 ACTUALLY INCISIONSIS ONE AT THEE 6778 04:24:23,321 --> 04:24:29,327 TOP ---- AND ONENE BELOW. 6779 04:24:29,327 --> 04:24:32,129 SOMETHING NEING HE ANSWER IS NO. 6780 04:24:32,129 --> 04:24:37,134 FOR SOME OF OOU -- WHEN WESED 6781 04:24:37,134 --> 04:24:39,871 TO OPERATE WITH ABDOM ABD 6782 04:24:39,871 --> 04:24:45,009 USED TO LEAVEHE PLACENTA INO, E 6783 04:24:45,009 --> 04:24:45,276 NSITU. 6784 04:24:45,276 --> 04:24:48,613 WHEN YOUOUO DELERY OFERHE 6785 04:24:48,613 --> 04:24:50,882 SEND TWIN, MOST PEOPLE DON'T 6786 04:24:50,882 --> 04:24:52,383 REALIZE WE ARE LEAVI LEA THE 6787 04:24:52,383 --> 04:24:54,785 TA IN SITU. 6788 04:24:54,785 --> 04:25:02,827 SO LEAVI L PLACENTA IN SITU ISUY 6789 04:25:02,827 --> 04:25:08,533 YEARS - THIS IS WT ARE 6790 04:25:08,533 --> 04:25:08,633 AV 6791 04:25:08,633 --> 04:25:10,268 LEAVINGVIHE PLACENTA 6792 04:25:10,268 --> 04:25:11,969 AIN SITU, EVERYTHING THAT TT 6793 04:25:11,969 --> 04:25:14,005 EVERYBODY HAS BEEN TALKING 6794 04:25:14,005 --> 04:25:17,208 ABOUT. 6795 04:25:17,208 --> 04:25:23,347 IN 2015. IS I MY PROTOCOLTOLL ST 6796 04:25:23,347 --> 04:25:25,683 WE DO SURGERY INN LABOR/DABIVER, 6797 04:25:25,683 --> 04:25:28,119 DO MIDLINE INCISIONC WE EXTENDX 6798 04:25:28,119 --> 04:25:28,853 THEMBILICMB. 6799 04:25:28,853 --> 04:25:34,759 I DO A FUNDALDAYSTETOMY,, 6800 04:25:34,759 --> 04:25:35,693 TRANSVERSE. 6801 04:25:35,693 --> 04:25:38,362 WE LIGATE T T CORD IN PROXIMITY 6802 04:25:38,362 --> 04:25:39,196 TYTO INSTION. 6803 04:25:39,196 --> 04:25:39,297 WE 6804 04:25:39,297 --> 04:25:44,802 THESE WOMENRE GIVEN GIVTAMICIN 6805 04:25:44,802 --> 04:25:46,504 AND CLINDAMYCIN. 6806 04:25:46,504 --> 04:25:48,706 WE EVALUATVATHEM FOREM BLEING. 6807 04:25:48,706 --> 04:25:50,007 EY ARE KEPAT THE HOSPITAOSTA 6808 04:25:50,007 --> 04:25:51,642 FORFO SIX DAYS. 6809 04:25:51,642 --> 04:25:55,980 THEN WEOLLOW THEM WITH 6810 04:25:55,980 --> 04:25:57,081 ULTRASOUND EVERY TWO TO FOUR 6811 04:25:57,081 --> 04:26:00,418 WEEKS AND WE MONITOR FOR 6812 04:26:00,418 --> 04:26:09,760 THIS WILLE THEHE -- PL -ENTA 6813 04:26:09,760 --> 04:26:13,798 PREV -- - AT 21 WEEKS. 6814 04:26:13,798 --> 04:26:17,234 TO HAVE MORE CHILDREN.D SHE WANE 6815 04:26:17,234 --> 04:26:21,606 THIS IS WHY I DECIDEDID TO OER O 6816 04:26:21,606 --> 04:26:24,542 RHAT.T. 6817 04:26:24,542 --> 04:26:26,844 -- THREE MONTHS LATER,OT 6818 04:26:26,844 --> 04:26:33,751 PREGNANT AGAIN AND --- SO NOW I 6819 04:26:33,751 --> 04:26:37,421 ABOUT TOUO SHOW I YOU, THOU IS E 6820 04:26:37,421 --> 04:26:37,521 OF 6821 04:26:37,521 --> 04:26:47,999 HE MOST RECENT CASES C I DID 6822 04:26:47,999 --> 04:26:49,166 NEED HELP HERE. 6823 04:26:49,166 --> 04:26:49,533 OKAY. 6824 04:26:49,533 --> 04:26:52,370 HERE ITT I 6825 04:26:52,370 --> 04:26:55,640 SO YOUOUAN SEE S THE -- GET THE 6826 04:26:55,640 --> 04:27:06,584 TAKES TAS TO 40 MINUTES --RE 6827 04:27:58,703 --> 04:27:59,804 EVERYBODY IS HAPPY. 6828 04:27:59,804 --> 04:28:02,206 THIS ISS SOMSOF THE CASES C WE'W 6829 04:28:02,206 --> 04:28:05,042 REABOUT TO SOW SOU, GDU GLY G -- 6830 04:28:05,042 --> 04:28:10,981 UTERUS THROUGHHRHE ABDOMINALAL 6831 04:28:10,981 --> 04:28:11,082 IN 6832 04:28:11,082 --> 04:28:12,249 SION, WON DO THERANSVERSNS 6833 04:28:12,249 --> 04:28:16,987 CISION. 6834 04:28:16,987 --> 04:28:20,224 THIS IS ONE PATIENTNTHO HAD THE 6835 04:28:20,224 --> 04:28:21,392 PLACENTA PERCRETA, YOU SEE 6836 04:28:21,392 --> 04:28:25,463 IT IS, DETACHED FROM THE -- 6837 04:28:25,463 --> 04:28:31,235 AN WE DECIDED TO DOO THE DAYED 6838 04:28:31,235 --> 04:28:31,602 ERECTOMY ON HER. 6839 04:28:31,602 --> 04:28:32,970 THIS IS WHAT IT LOOKED BEFOREOR 6840 04:28:32,970 --> 04:28:34,905 THE CESAREAN WAS DONE. 6841 04:28:34,905 --> 04:28:37,742 OOD LOSS WAS 300CC. 6842 04:28:37,742 --> 04:28:40,711 THISIS IS -- BYAITING FOR 6843 04:28:40,711 --> 04:28:43,447 VASCULARITY TO GO GOY ANDY YOU 6844 04:28:43,447 --> 04:28:46,250 HAVE LESS BLOOD SUPPLY. 6845 04:28:46,250 --> 04:28:48,352 THIS ISSOW UTERUSTE LOOKED AFTER 6846 04:28:48,352 --> 04:28:50,755 YOUU DO THE DELAYED HYSTERECTOM. 6847 04:28:50,755 --> 04:28:52,990 THIS LAST PATIENT, YOU CAN SEE, 6848 04:28:52,990 --> 04:28:55,960 IT WAS DONE R ROBOTIC ANDND TNDT 6849 04:28:55,960 --> 04:28:59,029 BLOOD LOSS WAS W 50CC. 6850 04:28:59,029 --> 04:29:02,867 TH IS THE DIFFERENCE -- 6851 04:29:02,867 --> 04:29:05,503 TRANSFUSION WHETHER YOU DO 6852 04:29:05,503 --> 04:29:05,603 IM 6853 04:29:05,603 --> 04:29:11,408 DIATELY OR WITH THE DELAY. 6854 04:29:11,408 --> 04:29:16,113 AND THE PATIE T DEE VERETHRE. 6855 04:29:16,113 --> 04:29:17,915 THERE IS ABOUT FOUUT DAYUT LATE, 6856 04:29:17,915 --> 04:29:21,085 THAT ONENE TKBOUT SEVEN WEEKS, 6857 04:29:21,085 --> 04:29:24,922 ANDD ONE WAS 16 WE 1S. 6858 04:29:24,922 --> 04:29:27,191 SO ONE O O MY FLOWS WHO'S HER 6859 04:29:27,191 --> 04:29:33,831 >> CANAN Y REMOVE THE RINER? 6860 04:29:33,831 --> 04:29:35,432 ?>> I DON'T D SEE IT HERE. 6861 04:29:35,432 --> 04:29:45,810 IT'S NOT ON MY SCREEN. 6862 04:30:06,163 --> 04:30:12,570 SO - THE BLOOD LOS650 AND 6863 04:30:12,570 --> 04:30:13,804 E -- 200 2 1,000. 6864 04:30:13,804 --> 04:30:16,941 .E UTERUS WAS PRESERVED IN SIX, 6865 04:30:16,941 --> 04:30:23,581 FOUR HAD H SUBSEQUENT PREANCI. 6866 04:30:23,581 --> 04:30:25,449 -- AND A ONLY ONE REQUIRED 6867 04:30:25,449 --> 04:30:30,221 ABDOMINAL HYSTERECTOMY. 6868 04:30:30,221 --> 04:30:30,321 TH 6869 04:30:30,321 --> 04:30:38,696 NUMBERS -- BY --S IS -- I 6870 04:30:38,696 --> 04:30:39,563 WE CONTINUE TO COLLECT DATA D OD 6871 04:30:39,563 --> 04:30:43,634 THIS 6872 04:30:43,634 --> 04:30:43,734 AN 6873 04:30:43,734 --> 04:30:47,805 PLACENTA LOO BEFEURGERY. 6874 04:30:47,805 --> 04:30:51,942 .THIS IS HOW THE PLACENTA CE WEW 6875 04:30:51,942 --> 04:30:52,943 FOLLOWED THE PLACENTA, T 6876 04:30:52,943 --> 04:30:54,712 VOLUMEVOFVO PLACENTA,CEHEA,ROP N 6877 04:30:54,712 --> 04:30:56,013 BLOOD SOOPLY TO THE PLACENTA. 6878 04:30:56,013 --> 04:30:57,681 AND YOU CAN SEE THIS PATIENT 6879 04:30:57,681 --> 04:31:02,086 HERE WITH W PLACENTA COMING --I 6880 04:31:02,086 --> 04:31:06,156 WE WENWE W AHEAD AND REMOVED THE 6881 04:31:06,156 --> 04:31:09,627 PLACENTA. 6882 04:31:09,627 --> 04:31:09,727 SO 6883 04:31:09,727 --> 04:31:12,129 WHAT ARE POTENTIOTOT 6884 04:31:12,129 --> 04:31:14,865 THETHE IMMEDIAMM HEMORRHAGE FROM 6885 04:31:14,865 --> 04:31:18,335 HAPPENS ONE W OHIN TO THREE 6886 04:31:18,335 --> 04:31:18,669 YS. 6887 04:31:18,669 --> 04:31:20,337 THIS ISHILE WE KE W THEM IN 6888 04:31:20,337 --> 04:31:20,437 TH 6889 04:31:20,437 --> 04:31:30,080 HOSPITAL FORALBOUTALIXUT DAYS. 6890 04:31:30,080 --> 04:31:33,884 ABDOMINAL PAIN, P CRAMPINGIN AND 6891 04:31:33,884 --> 04:31:38,722 NESS. 6892 04:31:38,722 --> 04:31:44,628 -- SOM-- S OF THEM.HEHE 6893 04:31:44,628 --> 04:31:47,464 LAYED DIC TAKES ABOUT THREE T 6894 04:31:47,464 --> 04:31:47,731 SIX WEEKS. 6895 04:31:47,731 --> 04:31:49,867 HEEEN PATIENTS 6896 04:31:49,867 --> 04:31:52,703 - VET NONE N N OF O THEM HADADAD 6897 04:31:52,703 --> 04:32:02,112 TO CONSERVONIVE MANAGEMENT.T.OMY 6898 04:32:02,112 --> 04:32:09,320 ABDOMIABL PAIN ONEO TWO WEE,, 6899 04:32:09,320 --> 04:32:11,021 ONE OF THEM PREGNANCY ISIS 6900 04:32:11,021 --> 04:32:11,689 POSSIBLE, THE OTHERTHS 6901 04:32:11,689 --> 04:32:12,556 IBLE. 6902 04:32:12,556 --> 04:32:15,292 FOLLOW-UP ISNEO TWOWO TES, 6903 04:32:15,292 --> 04:32:18,495 EVERY TWO TO FOUR WEEKS FOR THE 6904 04:32:18,495 --> 04:32:19,463 OTHERHENE.NE. 6905 04:32:19,463 --> 04:32:21,865 BOTH CANTH C HAVE H INTCOURSE SX 6906 04:32:21,865 --> 04:32:28,806 WEEKS LATER.R. 6907 04:32:28,806 --> 04:32:36,547 HOW ABOUTBO RECURRENCESES OF - 6908 04:32:36,547 --> 04:32:40,617 U CAN SEE THE -- IS I PROBABLY 6909 04:32:40,617 --> 04:32:40,718 SO 6910 04:32:40,718 --> 04:32:49,460 SUBSEQSUBS PREGNANRE.TA IN A 6911 04:32:49,460 --> 04:32:51,228 THESE ARE DATA FDAM VARIOUS 6912 04:32:51,228 --> 04:32:51,328 CO 6913 04:32:51,328 --> 04:32:51,962 TRIES. 6914 04:32:51,962 --> 04:32:54,264 SO WHATHA ARE DELIVERY OPTIONS R 6915 04:32:54,264 --> 04:33:05,142 PLACENPL ACCRETA?IN THE PASAS 6916 04:33:06,243 --> 04:33:07,077 ACENTA -- - IMMEDIATE 6917 04:33:07,077 --> 04:33:07,177 HY 6918 04:33:07,177 --> 04:33:07,678 ERECMY SHOULD BE T B 6919 04:33:07,678 --> 04:33:10,247 OPTI FOR EVERYONE. 6920 04:33:10,247 --> 04:33:15,119 I THINK THEREHE IS A PLACE NOW O 6921 04:33:15,119 --> 04:33:18,188 DO DELAY -- PLU- OR MINUS 6922 04:33:18,188 --> 04:33:19,990 EMBOLIZATILI, LEAVINGVI PLACENTA 6923 04:33:19,990 --> 04:33:22,259 INITU ANDU DOINGU U U PLACENTL 6924 04:33:22,259 --> 04:33:22,526 RESECTION.CT 6925 04:33:22,526 --> 04:33:31,435 >> THANK Y, SIBAI.H. 6926 04:33:31,435 --> 04:33:34,498 NEXT IS DR. KOJI MATSUO, MULTI-SPECIAL SURGICALRGICERTISE 6927 04:33:36,678 --> 04:33:38,614 >> I MADE THIS VIDEO TO KEEP THE 6928 04:33:38,614 --> 04:33:41,617 20 MINUTES TIMELINE BUT IT LOO 6929 04:33:41,617 --> 04:33:50,058 KE -- 6930 04:33:50,058 --> 04:33:52,728 >> I HAVEE NO DI NLOSURE.SUSU 6931 04:33:52,728 --> 04:33:57,332 PRESENTATIONRERE T DISCUSS THE 6932 04:33:57,332 --> 04:33:59,201 SURGEON'S ROLE AT PAS 6933 04:33:59,201 --> 04:34:02,771 HYSTERECTOMYECANDAN TOO IRODUCE 6934 04:34:02,771 --> 04:34:05,607 HYERECTOMY.ECHNIQUEHNIQ FOR PASP 6935 04:34:05,607 --> 04:34:07,042 THE FITHT PART ISHE SURGEON'SONS 6936 04:34:07,042 --> 04:34:14,483 WHOERRMS THE T HYSTERECTTEYTE 6937 04:34:14,483 --> 04:34:17,586 FOR P P HAS BEEN THE ACTIVEIV AA 6938 04:34:17,586 --> 04:34:19,454 OF RESRCH INTEREST. 6939 04:34:19,454 --> 04:34:23,058 LTIPLE SOCIETIES AND -- 6940 04:34:23,058 --> 04:34:25,027 EXPERIENCED SURGEONS SUCH AS 6941 04:34:25,027 --> 04:34:29,398 GYNECOLOGICOL ONCOGNCTTS 6942 04:34:29,398 --> 04:34:29,498 SU 6943 04:34:29,498 --> 04:34:31,166 ORTINGTI AGENCIES FOR THIS 6944 04:34:31,166 --> 04:34:31,533 SRECOSENDATIONDA 6945 04:34:31,533 --> 04:34:35,037 IS IS A 2015 PAS CENTER OF 6946 04:34:35,037 --> 04:34:40,609 EXCEENCE CTERIA, SURGEON IS 6947 04:34:40,609 --> 04:34:43,645 SHOWN IN RED BOX. 6948 04:34:43,645 --> 04:34:49,584 2018 STATEMENT --COG -- 6949 04:34:49,584 --> 04:34:50,986 SURGEONS ARE UERLINED. 6950 04:34:50,986 --> 04:34:54,923 THIS ISS 2019IS-AIP SPECI S 6951 04:34:54,923 --> 04:34:59,528 SURGEON RGOWN IN RED BOX. 6952 04:34:59,528 --> 04:35:03,532 THIS IS I 2024 PANAM PANAN SOCIY 6953 04:35:03,532 --> 04:35:05,734 REVIEW, THEW DO N SPEFICALLY 6954 04:35:05,734 --> 04:35:09,438 ATEYN-ONCYNS REC RNDED 6955 04:35:09,438 --> 04:35:10,439 SURGEON. 6956 04:35:10,439 --> 04:35:14,242 OUR SDI SDIECOMMEECING -- 6957 04:35:14,242 --> 04:35:17,612 PRIMARILYIL FOCUSED ON 6958 04:35:17,612 --> 04:35:19,348 GYNECOLOGICAL ONCALOGIST. 6959 04:35:19,348 --> 04:35:23,185 IS RETSPECTIVETI STUDYROM UC 6960 04:35:23,185 --> 04:35:26,989 FETAL CSORTIUM COMPARED THE 6961 04:35:26,989 --> 04:35:33,328 SURGICAL OUT COM C BETEN GYN 6962 04:35:33,328 --> 04:35:42,004 THIS WAS STATISTICTI DIFFERENCEC 6963 04:35:42,004 --> 04:35:46,041 WASWA NOT CONNE CED TO CRITICALA 6964 04:35:46,041 --> 04:35:56,551 DIFFERENCE OF 2.2 VERSUS 25 -- 6965 04:35:57,586 --> 04:36:01,023 SAMPLEMP SIZE W 122ASES. 6966 04:36:01,023 --> 04:36:05,227 DATA SUGGESTED GYN G O N 6967 04:36:05,227 --> 04:36:06,161 INVOLVEMENTENS INCREASING AIN 6968 04:36:06,161 --> 04:36:07,662 THEY ARE MORE LIKELY TO BE 6969 04:36:07,662 --> 04:36:10,499 INVOLVIN IN SE FORM OF PAS. 6970 04:36:10,499 --> 04:36:11,900 IS SINE CENTE CRETRO SPEO 6971 04:36:11,900 --> 04:36:15,637 STUDY INCDING 98 CASES 6972 04:36:15,637 --> 04:36:18,040 OF PAS P HYSTERECTOMY EXAMINEXA 6973 04:36:18,040 --> 04:36:22,044 TIMINGTI OF GYN ONC INVVEMENT 6974 04:36:22,044 --> 04:36:22,144 ST 6975 04:36:22,144 --> 04:36:28,383 TING WITH GYN ONC, AS NEEDED 6976 04:36:28,383 --> 04:36:35,323 ANDO INVOLVEMENT.NT 6977 04:36:35,323 --> 04:36:37,592 -- FROM BEGINNING ONIASES ISSAE 6978 04:36:37,592 --> 04:36:39,795 RGICAL OUT COME COMPARED TO 6979 04:36:39,795 --> 04:36:44,332 NC CALLED AS NEEDED. 6980 04:36:44,332 --> 04:36:48,637 IN 2024,ESEARCESRS IN U.S. 6981 04:36:48,637 --> 04:36:50,405 EX THEEXREMIERE DATABASEASE 6982 04:36:50,405 --> 04:36:54,643 TO ASSESS CHARACTERISTICS -- 6983 04:36:54,643 --> 04:36:58,280 IMMEDIATE DI PAS BASED ON 6984 04:36:58,280 --> 04:37:00,282 SURGEON -- INCLUDINGDIENAL 6985 04:37:00,282 --> 04:37:05,754 LIST, GYN ONC AND MFM. 6986 04:37:05,754 --> 04:37:08,990 AAOTAL OF WITH IT THOANDAN 240 6987 04:37:08,990 --> 04:37:10,559 40SES WERE EVAATED. 6988 04:37:10,559 --> 04:37:10,659 PA 6989 04:37:10,659 --> 04:37:13,128 JORT JOR O PAS HYSTERECTOMYERE 6990 04:37:13,128 --> 04:37:17,999 PERFORPED BY GENERAL LISTS -- 6991 04:37:17,999 --> 04:37:18,100 TH 6992 04:37:18,100 --> 04:37:23,638 ION INCREASED TASEE FOLDT -- 6993 04:37:23,638 --> 04:37:29,010 T20.% TOO8% BETWE B 2016 TO T 6994 04:37:29,010 --> 04:37:32,581 THETILIZATIONZA OF EU RECEIPTPT 6995 04:37:32,581 --> 04:37:35,317 RAL STE AND A EO ARTERIAL 6996 04:37:35,317 --> 04:37:35,417 PR 6997 04:37:35,417 --> 04:37:36,118 EDURES GRADUALLY INCREASED 6998 04:37:36,118 --> 04:37:39,087 DURING THE S TDY PERIOD OF TIMOF 6999 04:37:39,087 --> 04:37:39,488 PERIOD. 7000 04:37:39,488 --> 04:37:41,790 THIS TABLE SHOWS TARGET 7001 04:37:41,790 --> 04:37:45,026 PROCEDUROC INCLUDING TXA 7002 04:37:45,026 --> 04:37:46,862 INDUCTION, UTE RAL STENT 7003 04:37:46,862 --> 04:37:49,931 INSERTIONIO AND A END ARTERIAL 7004 04:37:49,931 --> 04:37:50,832 OCCLUSION. 7005 04:37:50,832 --> 04:37:56,505 AS SHOWN IN THE RED BOX, THE -- 7006 04:37:56,505 --> 04:38:05,080 S -- ME LIKELY TO PREPAREFMFM 7007 04:38:05,080 --> 04:38:06,615 AN - PASYSTERECTOMY IN 7008 04:38:06,615 --> 04:38:08,783 SWS THE SURGICAL 7009 04:38:08,783 --> 04:38:10,185 MORBIDITRBRB FOR PAS HYSTERECTOY 7010 04:38:10,185 --> 04:38:12,287 ACROSS THE SURGEON'SGE SPEALTY. 7011 04:38:12,287 --> 04:38:16,224 RATE OF HEMORRHAGE, INJURY, 7012 04:38:16,224 --> 04:38:20,662 SHOCK AND COALOPATHY WERE ALSOOO 7013 04:38:20,662 --> 04:38:22,864 SUBSTASUIAL AIAOSS THE THREE 7014 04:38:22,864 --> 04:38:24,733 THEPS.OU 7015 04:38:24,733 --> 04:38:28,403 SGEONON EXPERIENCE MAY 7016 04:38:28,403 --> 04:38:30,739 MORE MMPORTANT THAN SURGEON'S 7017 04:38:30,739 --> 04:38:33,108 SPECIALTY ALONE. 7018 04:38:33,108 --> 04:38:37,712 HOWEVER,HERE'S TOO LIMITED 7019 04:38:37,712 --> 04:38:39,681 DATA -- SURGEON'S'S EXPERIENCEIN 7020 04:38:39,681 --> 04:38:43,351 THE OUTCE OU OF PASF HYSTEREYSM 7021 04:38:43,351 --> 04:38:45,654 BASEDSE O-- CENTER STU DINED 7022 04:38:45,654 --> 04:38:49,758 THAT P SPECI SIST IS SURGEON 7023 04:38:49,758 --> 04:38:52,994 IN PAS ANDNDIGHH LEVEL OFIECAE 7024 04:38:52,994 --> 04:38:53,895 KNOWLEDGE AND SKILLS RELATING TO 7025 04:38:53,895 --> 04:38:56,398 S. 7026 04:38:56,398 --> 04:38:56,498 IN 7027 04:38:56,498 --> 04:38:59,267 AS HYSRECTOMY --Y SPECIALTY 7028 04:38:59,267 --> 04:39:01,069 SURGEON RGS ASSOCIATED WITHITH 7029 04:39:01,069 --> 04:39:03,705 INCREASEEED -- BOD LOSS. L 7030 04:39:03,705 --> 04:39:06,441 HOW DOW W GYNEC GOGIC G ONCOLOS 7031 04:39:06,441 --> 04:39:10,312 VI THEIR PAS HYSTERECTOMRE 7032 04:39:10,312 --> 04:39:13,048 THE RECENTEC SOCIETY -- T- 7033 04:39:13,048 --> 04:39:14,883 XTTENDING SURGEONSN SGO. 7034 04:39:14,883 --> 04:39:14,983 TH 7035 04:39:14,983 --> 04:39:17,118 FIGURE SHOWS ANNUAL 7036 04:39:17,118 --> 04:39:19,454 HYSTERECTOMY CASE VOLUME FOR F S 7037 04:39:19,454 --> 04:39:20,088 R SURGEONUR 7038 04:39:20,088 --> 04:39:22,824 INAJORY OF GYNEC GOGY 7039 04:39:22,824 --> 04:39:27,929 OF PAS HYSTERECTOMY CTY CT YEARY 7040 04:39:27,929 --> 04:39:29,898 YEAR ONE --F MORERE TN 10N 7041 04:39:29,898 --> 04:39:32,200 CASES CA YEA 7042 04:39:32,200 --> 04:39:36,271 E RESPONSE RATE -- 7043 04:39:36,271 --> 04:39:38,873 N-RESPONRERS MAY --AY WHERE 7044 04:39:38,873 --> 04:39:42,944 THERE'S NO OBB PRACTICE. 7045 04:39:42,944 --> 04:39:45,714 -- PAS IS INCASNCG IN RECENT 7046 04:39:45,714 --> 04:39:47,048 YEARS.AR 7047 04:39:47,048 --> 04:39:49,284 NEARLY HALLYLY HAVE EXPERIENCER 7048 04:39:49,284 --> 04:39:50,051 CONSERVATIVEVAANAGEMENT, ABOUT 7049 04:39:50,051 --> 04:39:52,254 HALF ARE A INVOLVED FROM THE --F 7050 04:39:52,254 --> 04:39:54,256 THETH CAS. 7051 04:39:54,256 --> 04:39:55,557 IMPORTANTLY, THREE QUARTERS HAVE 7052 04:39:55,557 --> 04:39:55,657 EX 7053 04:39:55,657 --> 04:39:56,558 RIENCED MORE THANAN 7054 04:39:56,558 --> 04:39:58,059 FIVE LITERSITER BLOOD LOSS, AND 7055 04:39:58,059 --> 04:39:59,261 NEARLYAR ONE-THIRD-T HAV 7056 04:39:59,261 --> 04:40:01,296 EXPERIENCED MORE THAN 10 LITERS 7057 04:40:01,296 --> 04:40:03,131 OF BLOOD LOSS. 7058 04:40:03,131 --> 04:40:03,231 NE 7059 04:40:03,231 --> 04:40:05,066 LY 50% OF RESPONDENT ARE 7060 04:40:05,066 --> 04:40:09,704 INTERESTED IN PAS -- AND THIS 7061 04:40:09,704 --> 04:40:11,906 POSITIVE VIEW WAIE QWATED IN IN 7062 04:40:11,906 --> 04:40:16,945 2023, SGO -- SUMMIT.MI 7063 04:40:16,945 --> 04:40:19,347 HOW ABOUT -- OF PAS 7064 04:40:19,347 --> 04:40:20,649 HYSTERECTOMY?TOTO 7065 04:40:20,649 --> 04:40:25,520 ACGME PROVIDES THE --- FOR 7066 04:40:25,520 --> 04:40:26,621 GRADUATE MEDICALALDUCATION IN 7067 04:40:26,621 --> 04:40:29,024 FLTED STATES. 7068 04:40:29,024 --> 04:40:37,666 SPECIALIST 20, IT SPECIFIES FOR 7069 04:40:37,666 --> 04:40:39,634 HYSTERECTOMYMYMY BUT NOTOR -- 7070 04:40:39,634 --> 04:40:41,069 SURGICAL EXPERIENCE.IENCE.ALAL 7071 04:40:41,069 --> 04:40:45,707 IN A VIEW OF -- 20, SEV0,AL -- 7072 04:40:45,707 --> 04:40:48,743 RAISE A CONCERNCE FOR INCASING 7073 04:40:48,743 --> 04:40:48,843 LEX 7074 04:40:48,843 --> 04:40:54,449 LELE OFF SURGERY- IN 2020N 7075 04:40:54,449 --> 04:40:59,454 PROPOSEDOP A FUTURE DIRECTION 7076 04:40:59,454 --> 04:41:00,855 IN -- GAIN EXPERIENCER WITPAS 7077 04:41:00,855 --> 04:41:04,125 MANAGEMENTGEMEME 7078 04:41:04,125 --> 04:41:12,400 MFMM SURY SHOWS MAJORITY O MFM 2 7079 04:41:12,400 --> 04:41:15,370 LLOW ARE NOT COMFORTABFO TO T 7080 04:41:15,370 --> 04:41:18,206 PERFORM C-HYSTEREYSOMRE WITHOUTT 7081 04:41:18,206 --> 04:41:22,544 GYN ONC. 7082 04:41:22,544 --> 04:41:25,714 SHOW SATISFACTIONCT FOR P -- ISI 7083 04:41:25,714 --> 04:41:27,482 LOWER THAN --HA INCREASING PASAS 7084 04:41:27,482 --> 04:41:30,452 CASES AND DECREASE IN I SURGICAA 7085 04:41:30,452 --> 04:41:36,057 EXPERIENCE OF COMPLEX PELVICVI 7086 04:41:36,057 --> 04:41:38,793 SURGERY WAS W ALSO --LS---- TAKN 7087 04:41:38,793 --> 04:41:38,893 THER 7088 04:41:38,893 --> 04:41:42,197 THESE T DATA CALL FOR 7089 04:41:42,197 --> 04:41:44,132 PORTUNPOY TO PROPOSE -- 7090 04:41:44,132 --> 04:41:46,468 --SPECIFIC TO PAS ACROSSOS THE 7091 04:41:46,468 --> 04:41:48,303 SOCIETY GENERALEN LIST, GYNYN OC 7092 04:41:48,303 --> 04:41:51,339 AND MFM. 7093 04:41:51,339 --> 04:41:53,007 SUCH AREA MAY INCLUDE 7094 04:41:53,007 --> 04:41:54,642 ESTABLISHING A FOUNDATION 7095 04:41:54,642 --> 04:42:01,950 PATIENTAT CAN OBSERVE CENTERTE 7096 04:42:01,950 --> 04:42:03,818 EXPERIENCED PASURONS 7097 04:42:03,818 --> 04:42:05,320 TENIQUE USING THIS ---- 7098 04:42:05,320 --> 04:42:07,856 E SECONDALF OF THE 7099 04:42:07,856 --> 04:42:13,128 PRESENTATION IS TO -- OPERATIPE 7100 04:42:13,128 --> 04:42:18,166 TECHNIQUE FOR PAS HYSTERECTTEY. 7101 04:42:18,166 --> 04:42:21,336 -- PLACENTA CONTA CING -- 7102 04:42:21,336 --> 04:42:26,808 SEGMENT OR -- AND A INCREASEDED- 7103 04:42:26,808 --> 04:42:29,644 MAKE SURGERY COMPLEX AND MORBID. 7104 04:42:29,644 --> 04:42:31,413 POSSIBLESS CONSEQUONSE OF ORDINL 7105 04:42:31,413 --> 04:42:35,183 HYSTERECTOMY APPROACPP FOR PAS Y 7106 04:42:35,183 --> 04:42:38,653 APPLYINGYI THE SURGICALCA CLAMPT 7107 04:42:38,653 --> 04:42:41,022 THE LOWER SEGMENT ABOVE THE T 7108 04:42:41,022 --> 04:42:48,396 TISSUE RESULTED IN HE IRRHAGING. 7109 04:42:48,396 --> 04:42:50,031 EXTENSEXEEXE NEOVASCULARIZATION 7110 04:42:50,031 --> 04:42:50,131 BE 7111 04:42:50,131 --> 04:42:52,767 EEN THE LUS AND BDDER 7112 04:42:52,767 --> 04:42:54,869 IS -- CHALLENGE INN PAS 7113 04:42:54,869 --> 04:43:00,275 HYSTERECSTMY.. 7114 04:43:00,275 --> 04:43:03,978 DRUPTEDPT LUS IS I SEEN IN 7115 04:43:03,978 --> 04:43:06,648 PAS, ONCE WALL IS DISRUPTED -- 7116 04:43:06,648 --> 04:43:11,286 BLEEDIBLEEAPPLYING THEHE FIBRIN 7117 04:43:11,286 --> 04:43:13,488 PAH TO THE STIONITE CAN 7118 04:43:13,488 --> 04:43:19,260 INUR HPITAL, WE RENTLYNG. 7119 04:43:19,260 --> 04:43:22,430 HARMONIZRM THE CO CONSENSON OF - 7120 04:43:22,430 --> 04:43:26,134 APPROACHPR AND INTERPRETIVE 7121 04:43:26,134 --> 04:43:28,670 FINDINGS- GS THE --HE 7122 04:43:28,670 --> 04:43:32,373 EVIDENCE -- - CONCERN FOR 7123 04:43:32,373 --> 04:43:33,174 HYSTERECSTMY -- OR KNOWN 7124 04:43:33,174 --> 04:43:35,243 HYSTERECSTEREC AROACH.H.H. 7125 04:43:35,243 --> 04:43:39,280 TIMING OF O O COMPLICATION AT TO 7126 04:43:39,280 --> 04:43:42,784 WEEKS TOS ONE WEEK AND 7 T 7127 04:43:42,784 --> 04:43:46,488 WEEKSS -- BE REANABLE TO SET 7128 04:43:46,488 --> 04:43:47,755 ON FR WEEKS. 7129 04:43:47,755 --> 04:43:49,390 HERE -- TECHNIQUE IS PPOSEO 7130 04:43:49,390 --> 04:43:54,496 ADDRESS THE UNIQUE CHALLENGELLGN 7131 04:43:54,496 --> 04:43:57,031 PA HYSTERECTOMY, I SHOWW A VIDEO 7132 04:43:57,031 --> 04:43:58,233 FOR TWO-HAND TECHN TUE. 7133 04:43:58,233 --> 04:44:01,402 >> AIQ TWO-HAND TECHNIQUE IN 7134 04:44:01,402 --> 04:44:02,303 CESAREAN HYSTERECTOMY FOR 7135 04:44:02,303 --> 04:44:02,837 PLACENTA ACCRETA SPECTRUM.CT 7136 04:44:02,837 --> 04:44:06,674 E NO DOSUR. 7137 04:44:06,674 --> 04:44:09,577 THERE HAS BEEN A RIDING 7138 04:44:09,577 --> 04:44:10,178 INCIDENCE OF PLACENTA ACCRE A 7139 04:44:10,178 --> 04:44:11,412 WELL DESCRIBED IIBEDHEHE LERATET 7140 04:44:11,412 --> 04:44:13,181 LIKELY DKE TO INCREASE IN 7141 04:44:13,181 --> 04:44:16,117 CESAREAN DREANERY RATES,ESLDER 7142 04:44:16,117 --> 04:44:16,718 MATERNAL AGE, PLACENTA PRETAA. 7143 04:44:16,718 --> 04:44:19,988 THE'S A 74.5% MORBIDITY 7144 04:44:19,988 --> 04:44:21,723 INCLUDING HIGHH VOLE BLOOD 7145 04:44:21,723 --> 04:44:23,858 LOSS,SSCU LCU OF CARE, BLOOD 7146 04:44:23,858 --> 04:44:27,795 4 UNITS, ANDND PROLO PED HOSPITL 7147 04:44:27,795 --> 04:44:27,996 STAYS. 7148 04:44:27,996 --> 04:44:30,231 S.WHEN THERE'S A PERCRETA PRESE, 7149 04:44:30,231 --> 04:44:32,000 THERE'S A MORTALITY RLIEE O O 7150 04:44:32,000 --> 04:44:35,537 1.4%, IN, OTHER WORDS W1 IN1 I. 7151 04:44:35,537 --> 04:44:37,171 A CENT SURVE S OF THE 7152 04:44:37,171 --> 04:44:37,272 GY 7153 04:44:37,272 --> 04:44:38,373 COLOGIC ONCOLOGISOLOL SHOWE S 7154 04:44:38,373 --> 04:44:43,545 THEY HAVE ALSO NOTICEDIC INCREAS 7155 04:44:43,545 --> 04:44:44,312 IN PLACENTA ACCRETA CASES INES 7156 04:44:44,312 --> 04:44:45,480 PRACTICE. 7157 04:44:45,480 --> 04:44:45,580 82 7158 04:44:45,580 --> 04:44:47,649 %AVE A MULTIDISCIPLINARY 7159 04:44:47,649 --> 04:44:48,249 TEAM APPROACH. 7160 04:44:48,249 --> 04:44:49,784 78.7 HAVE EXPERIENCEDNCASES WITH 7161 04:44:49,784 --> 04:44:51,119 EATEEA THA 5 LIT 5S 5 OF BLOOD B 7162 04:44:51,119 --> 04:44:51,519 LOSS. 7163 04:44:51,519 --> 04:44:54,289 CASE FROM THE T T BEGIN BNG, BND 7164 04:44:54,289 --> 04:44:56,824 ABOUT HALF H OFESPONDENTS 7165 04:44:56,824 --> 04:44:58,393 EXPRESSED INTED ST IN ACCRETA 7166 04:44:58,393 --> 04:45:00,762 SURGERIES FOR FUTURE PRACTICE. 7167 04:45:00,762 --> 04:45:01,829 CONSIDERATIONS IN I PREPARATIPA 7168 04:45:01,829 --> 04:45:03,398 FOR PLFOENPL ACCRETACCASES ARE 7169 04:45:03,398 --> 04:45:03,898 SUMMARSUED IN THE TABLE 7170 04:45:03,898 --> 04:45:05,900 DISPLADID.LA 7171 04:45:05,900 --> 04:45:07,702 PREPARPRIONS TAKNS TOR OURUR CAE 7172 04:45:07,702 --> 04:45:13,308 TEAM, CELL SAVER, CYSSCOPY, WE W 7173 04:45:13,308 --> 04:45:14,742 WILL REVIEW SURGICAL APPRO AH 7174 04:45:14,742 --> 04:45:17,145 SHORTLY, A URINE ARTERY 7175 04:45:17,145 --> 04:45:18,546 EMBOLIZATIONZAZA W UTILIZED. 7176 04:45:18,546 --> 04:45:20,081 ALSOALOORDINATED WITH OUR 7177 04:45:20,081 --> 04:45:23,117 SURE WE WAD AN EXPERIENCED TEAM 7178 04:45:23,117 --> 04:45:24,152 MFORTAMFE WITH MASSIVE 7179 04:45:24,152 --> 04:45:25,019 TRANUSANN PROTOCOLOTOT 7180 04:45:25,019 --> 04:45:28,356 THEOT BLOOD BANAS AWARE, 7181 04:45:28,356 --> 04:45:29,691 ADDITIONAL ANESTHESIA BACKUP WAS 7182 04:45:29,691 --> 04:45:31,225 ADDITIONAL, ADDITIONALIONA ACCES 7183 04:45:31,225 --> 04:45:35,830 WAS ESTABLISHED ALONG A WITH -- 7184 04:45:35,830 --> 04:45:37,932 SIA WAS AWARE OF THE 7185 04:45:37,932 --> 04:45:41,235 TIMELINE AND AND AEADY TO AD%IR 7186 04:45:41,235 --> 04:45:41,402 TXA. 7187 04:45:41,402 --> 04:45:43,972 THE CASEASE'LL USEOODEL 7188 04:45:43,972 --> 04:45:45,273 TWO-HAND THAHNIQUE IS A 7189 04:45:45,273 --> 04:45:48,276 5 DAYS WDAH AIS ARY OF TWOD 7190 04:45:48,276 --> 04:45:50,044 CESARE DELIVERIES, AND 7191 04:45:50,044 --> 04:45:50,144 UL 7192 04:45:50,144 --> 04:45:52,647 ASOUND FINDINGS CONCERNINCEG 7193 04:45:52,647 --> 04:45:52,747 FO 7194 04:45:52,747 --> 04:45:53,615 R PLACENTLACECRETA SPECTRUM 7195 04:45:53,615 --> 04:45:57,485 WIWITH A PLACENTA PREVIA AND HIH 7196 04:45:57,485 --> 04:46:01,089 SUSPICION FOR -- INV-ION AN 7197 04:46:01,089 --> 04:46:05,093 HIGH VASCULARITY IN THTHE CERVI. 7198 04:46:05,093 --> 04:46:07,161 FIRST, THE SNOWMAN CONFIRMONS TE 7199 04:46:07,161 --> 04:46:07,261 CL 7200 04:46:07,261 --> 04:46:10,698 AGNOSIS OF PLACENTA ACCRETA 7201 04:46:10,698 --> 04:46:11,165 ECTR.. 7202 04:46:11,165 --> 04:46:17,505 YOU CAN C SEE HERE THAT LOWER 7203 04:46:17,505 --> 04:46:24,345 SEGMENSE - - AFTER DELIVERY OF - 7204 04:46:24,345 --> 04:46:25,880 TXA IS ADMISTEREDTEND THE 7205 04:46:25,880 --> 04:46:27,949 ACENTA IENEN LEFT IN SIGH TEU DE 7206 04:46:27,949 --> 04:46:33,187 TO LACK OF D DENT. D 7207 04:46:33,187 --> 04:46:34,689 ONCE IONCE I CLOSED, ATEXT IS 7208 04:46:34,689 --> 04:46:34,789 TU 7209 04:46:34,789 --> 04:46:36,758 ED TO THE CYSTS C CYSTOSCOPTO 7210 04:46:36,758 --> 04:46:39,494 THE BLADDERLA SURVEYED TO RULE T 7211 04:46:39,494 --> 04:46:41,896 ANY EVIDENCENCE O PLACENTAL 7212 04:46:41,896 --> 04:46:44,932 INVASION. 7213 04:46:44,932 --> 04:46:48,169 ALT STENTS ARE PLACED LAD'REE 7214 04:46:48,169 --> 04:46:50,438 DATTENTATNN IS TURNED BACKK TOOE 7215 04:46:50,438 --> 04:46:52,507 ANDDOMEN. 7216 04:46:52,507 --> 04:46:53,941 IN OUR CASE THERE WAS HIGH 7217 04:46:53,941 --> 04:46:55,109 SPICION FOR HYPERVASCULARITY 7218 04:46:55,109 --> 04:46:56,577 IN THEERICERVICAL ANDNDVICAL 7219 04:46:56,577 --> 04:46:58,746 AREAS SEA THE FASCIA WAS CLOASD, 7220 04:46:58,746 --> 04:46:58,846 AL 7221 04:46:58,846 --> 04:47:02,150 ERINE ARINRY EMBOLIZATIONAT WAT 7222 04:47:02,150 --> 04:47:02,917 PERFORMERFRF 7223 04:47:02,917 --> 04:47:06,788 EXTENSIVE PARASITIRAESSELS THERS 7224 04:47:06,788 --> 04:47:09,891 NOTED BETWEEN THE UTERUS AND T 7225 04:47:09,891 --> 04:47:10,224 BLADDER.DE 7226 04:47:10,224 --> 04:47:12,527 WE NEXT PROCEED TO DEMONSTRATE 7227 04:47:12,527 --> 04:47:15,163 3, 2, 1 APPROACH FAC COMPLETING 7228 04:47:15,163 --> 04:47:17,298 CESAREAN HYSTERECTOMYOM FOR 7229 04:47:17,298 --> 04:47:19,600 PLACENTA ACCRETA F SPECTRUM WHIH 7230 04:47:19,600 --> 04:47:23,738 IS IMPISMENTED AFTER. 7231 04:47:23,738 --> 04:47:25,006 WE FIRST BEGAN IN SEQUENTIAL 7232 04:47:25,006 --> 04:47:27,709 ORDER WITH W THE POSTERIOR CUL E 7233 04:47:27,709 --> 04:47:35,049 ASPE, AND ANTER AR ASPECT BYL 7234 04:47:35,049 --> 04:47:39,721 THE END PELVIC FASCIA ACTION TO 7235 04:47:39,721 --> 04:47:40,388 CERVIX. 7236 04:47:40,388 --> 04:47:42,457 BLEEDING WERE TO OCCUR, IT IS 7237 04:47:42,457 --> 04:47:44,325 OFTEN FROM THE BLAHEER 7238 04:47:44,325 --> 04:47:44,759 DISSECTION. 7239 04:47:44,759 --> 04:47:47,695 DUE TOTO ENGORGED VASCULAASRE AD 7240 04:47:47,695 --> 04:47:49,297 DISRUPTION OFONHIF UTERI U WALL 7241 04:47:49,297 --> 04:47:53,601 WHICH IS ALMOST POSSIBLESS TO IO 7242 04:47:53,601 --> 04:47:56,337 REPAIRPANCE DRUPTED. 7243 04:47:56,337 --> 04:47:57,939 SPECIAL ATIANTIOIANTOULD BE 7244 04:47:57,939 --> 04:48:00,575 KEN IN THE PCENTACCRETAA 7245 04:48:00,575 --> 04:48:00,842 SURGERIES. 7246 04:48:00,842 --> 04:48:03,878 WE THEN T PROCEED DISCTING 7247 04:48:03,878 --> 04:48:09,250 TOWARDS THETH LIGAMENT, A 7248 04:48:09,250 --> 04:48:10,785 POTENTIAL STEP WITHH A HIGH RISK 7249 04:48:10,785 --> 04:48:11,352 OF BLOOD LOSS. 7250 04:48:11,352 --> 04:48:17,358 IT IS UFULL TOO DIVOE THIS INTO 7251 04:48:17,358 --> 04:48:19,861 TWO PEDICLESDIONE BNG 7252 04:48:19,861 --> 04:48:26,434 OMINANTLY FIBROUSIB T TEE 7253 04:48:26,434 --> 04:48:30,538 ENTERG TTE SPACE AND EXTENDINGN. 7254 04:48:30,538 --> 04:48:32,507 IT LAT RAYLY, COMPLETOMYETOM 7255 04:48:32,507 --> 04:48:34,308 DETACHES THE T PERITONEUM FREU E 7256 04:48:34,308 --> 04:48:38,446 WHERE THE PLACENTA CAN C BE NOTD 7257 04:48:38,446 --> 04:48:40,281 TO BE BULGING. 7258 04:48:40,281 --> 04:48:40,381 TH 7259 04:48:40,381 --> 04:48:41,616 STEP EASILY ALLOWS 7260 04:48:41,616 --> 04:48:43,151 LATERALIZATION OF THE URETERS. 7261 04:48:43,151 --> 04:48:43,251 TH 7262 04:48:43,251 --> 04:48:49,056 ZATION OF THEF UTERUSRU,ORER 7263 04:48:49,056 --> 04:48:50,258 THEREFORER FACILITATING THE NEXT 7264 04:48:50,258 --> 04:48:52,660 EP, WHI, IS THELADDER 7265 04:48:52,660 --> 04:48:54,529 DISSECDION TO THE ENDO PELVIC 7266 04:48:54,529 --> 04:48:55,530 FASCIA OF THE CERVIX. 7267 04:48:55,530 --> 04:49:00,568 IS ELEVATEDD WH A DRYTHETERUS 7268 04:49:00,568 --> 04:49:06,340 LAPAROTOMY STONG INSTE I OF -- 7269 04:49:06,340 --> 04:49:08,342 TRADITIONALLY SELL IN TOTALOT 7270 04:49:08,342 --> 04:49:09,911 ABDOMINAL HYSTERECTTEIES. 7271 04:49:09,911 --> 04:49:13,681 THISTH IS TO AVOID PROULINGS,IN 7272 04:49:13,681 --> 04:49:21,022 NING.ETE TO THE DELICATELTERINE 7273 04:49:21,022 --> 04:49:24,091 SO IDENT IY IHE END PELVIC 7274 04:49:24,091 --> 04:49:25,626 SCIA FIRST BECAUSE THIS AREARE 7275 04:49:25,626 --> 04:49:29,964 RARELYRA HAS -- THEATHOLOGY AGYA 7276 04:49:29,964 --> 04:49:31,065 AAT THE VERY END. 7277 04:49:31,065 --> 04:49:34,068 IN THIS STEP,TE BACKFILLIKF THE 7278 04:49:34,068 --> 04:49:36,704 BLADDERRITRDE 100DEs OF SALINE 7279 04:49:36,704 --> 04:49:38,472 CILITATESTATA THE IDENTITY OF TE 7280 04:49:38,472 --> 04:49:42,910 R EDGE. 7281 04:49:42,910 --> 04:49:44,745 NOT STARTINTA ANTERIORLY WRLRE 7282 04:49:44,745 --> 04:49:48,549 THE YELLOW Xs ARE A MARKED, YOU 7283 04:49:48,549 --> 04:49:50,718 AVOID ENCOUNTEROUGER THOSE 7284 04:49:50,718 --> 04:49:55,089 ADHESIONSON A PROGRESSINGES INNA 7285 04:49:55,089 --> 04:49:56,090 MEDIAL DIREC DON.. 7286 04:49:56,090 --> 04:49:57,391 THISIS PISTION OTHEE DISSECTION 7287 04:49:57,391 --> 04:50:01,028 N TE ANYWHERE BETWEEN 30 TO 7288 04:50:01,028 --> 04:50:01,996 45 MINUTES DUE TOO THE 7289 04:50:01,996 --> 04:50:03,431 SIGNIFICANT DEVELOPMENTNT OFF 7290 04:50:03,431 --> 04:50:08,436 BETWEEBETWBE THE LOWER -OWSEGMED 7291 04:50:08,436 --> 04:50:10,204 E BLE BL WHICH NEEDS TO BE 7292 04:50:10,204 --> 04:50:12,607 TIFIEDTIFI ISOLATEDLA AND 7293 04:50:12,607 --> 04:50:15,643 DISSECTED MICULOUICY.ICY.IT IS T 7294 04:50:15,643 --> 04:50:18,045 THESEESSELS SHOD STAY WITH 7295 04:50:18,045 --> 04:50:19,480 THE UTERUS AND A THE BLADDER 7296 04:50:19,480 --> 04:50:21,315 OULD BE DISSECTED OFF O OTHEM. 7297 04:50:21,315 --> 04:50:23,117 ONCE YOU ARE CONFIDENT YOU ARE 7298 04:50:23,117 --> 04:50:25,620 BELOWHE PLACENTA AND 7299 04:50:25,620 --> 04:50:28,623 IDENTIFIEN THEEN FASCIA ON THE 7300 04:50:28,623 --> 04:50:30,091 CERVIX, THE TECHE TUE CAN BE 7301 04:50:30,091 --> 04:50:33,928 THIS ULTIMATELY HELY H SECURE TE 7302 04:50:33,928 --> 04:50:34,295 UTERINE VESSELS. 7303 04:50:34,295 --> 04:50:35,696 YOU CAN SEE HEREE NE THIS 7304 04:50:35,696 --> 04:50:37,665 SCHEMATICCHAT AN ORDIN OY O 7305 04:50:37,665 --> 04:50:40,268 PLACED IN T LOWER UTERINETERIE 7306 04:50:40,268 --> 04:50:43,104 SEGMENT FAR AWAY FROM THEHE 7307 04:50:43,104 --> 04:50:44,639 UTERINE VESSELS. 7308 04:50:44,639 --> 04:50:49,176 HOWEVER, IN IN PLANTA KREE T, 7309 04:50:49,176 --> 04:50:50,678 THE SURGEON RGNDS ARND PLACED 7310 04:50:50,678 --> 04:50:55,716 ANTERIORLY POST POSTERIOSLY BLYE 7311 04:50:55,716 --> 04:50:57,118 PLACENTAL BED. 7312 04:50:57,118 --> 04:50:57,518 TH 7313 04:50:57,518 --> 04:51:02,890 LIGAMELI, ME, THIS POI THE TWOO 7314 04:51:02,890 --> 04:51:05,793 HANDS ARES E GENERALLY MOVED 7315 04:51:05,793 --> 04:51:07,962 UPWARDS, THIS STEPNABLES 7316 04:51:07,962 --> 04:51:10,564 CREATION OFF SAFE ANATOMICAL 7317 04:51:10,564 --> 04:51:11,098 DISTANDISTROM SURROUNDING 7318 04:51:11,098 --> 04:51:13,234 STRUCTURES AND ISOLATIONLA OF 7319 04:51:13,234 --> 04:51:14,835 FTHE --E ALIGNMENT BETWEEN THEE 7320 04:51:14,835 --> 04:51:17,405 TERIOR AND POSTERIOR FIGURES. 7321 04:51:17,405 --> 04:51:21,108 HERE IS A DEMONSTRAONONONON OF W 7322 04:51:21,108 --> 04:51:23,878 ADITIONALLY WOLLD YOLL TRAMP 7323 04:51:23,878 --> 04:51:26,614 AND TRANSECRA UTE WIN VESSELSESN 7324 04:51:26,614 --> 04:51:27,481 WHAT APPEARSPPO BE THE LOWER 7325 04:51:27,481 --> 04:51:27,581 SE 7326 04:51:27,581 --> 04:51:29,083 ENT THEHE UTERUS. 7327 04:51:29,083 --> 04:51:31,485 IFIF THEY'RE TAKENAK UP AT THIHI 7328 04:51:31,485 --> 04:51:32,386 IGHT YOU WOULD HOUE TO T 7329 04:51:32,386 --> 04:51:32,954 SEQUENTIALLY LATLYALIZE THE 7330 04:51:32,954 --> 04:51:35,122 VESSELS ALL T A WAY DOWN TN T 7331 04:51:35,122 --> 04:51:38,426 SER FIX, INCREASING YOUR RISK OF 7332 04:51:38,426 --> 04:51:41,262 TRANSECTING ORETTING INTNY 7333 04:51:41,262 --> 04:51:42,496 NEOVASCULARIZATION, INCREASING 7334 04:51:42,496 --> 04:51:43,164 YOUR RISUR OF HEMORRHAGE. 7335 04:51:43,164 --> 04:51:44,165 HERE NHE WE'RE G TO 7336 04:51:44,165 --> 04:51:45,566 DEMONSTRMOE THE TWO-H TD 7337 04:51:45,566 --> 04:51:48,069 TECHNIQUENIND SAFELYEL CTURE THE 7338 04:51:48,069 --> 04:51:49,637 UTERINE VESSELS. 7339 04:51:49,637 --> 04:51:53,274 E SURGEON HANDS ARE PCED 7340 04:51:53,274 --> 04:51:53,841 AN POSTERIORLY AT THE 7341 04:51:53,841 --> 04:51:56,243 LOWER UTERINE SEGMENTEGELOW THE 7342 04:51:56,243 --> 04:51:57,211 PLACENTAL BED.. 7343 04:51:57,211 --> 04:51:58,846 THE FINGERTIPS OF BOTH HANDSDS 7344 04:51:58,846 --> 04:51:58,946 ME 7345 04:51:58,946 --> 04:52:00,715 AT A THE T CARNAL LIGENT 7346 04:52:00,715 --> 04:52:03,451 BELOW THE PLACENTA AT THE LEVEL 7347 04:52:03,451 --> 04:52:07,922 OF THE UPPER U CERVI C OR VAGIN. 7348 04:52:07,922 --> 04:52:10,024 AT THIS POINTT THE TWO HANWO ARE 7349 04:52:10,024 --> 04:52:11,359 GENTLY MOVED UPWARDS CARRYINGIN 7350 04:52:11,359 --> 04:52:13,661 THEEE PLACENTA CONTAINING LOWERW 7351 04:52:13,661 --> 04:52:14,762 TERNALEGMENT. 7352 04:52:14,762 --> 04:52:16,897 THISTEPSTE ENABLESHE CREATION 7353 04:52:16,897 --> 04:52:19,934 SURROUND STRUCTURES AND FROMM 7354 04:52:19,934 --> 04:52:21,702 OLATIONAT BETWEEN ANTERIOR AND 7355 04:52:21,702 --> 04:52:21,802 PO 7356 04:52:21,802 --> 04:52:24,105 ERIOR FINGERS, ALLOWINGGAFE 7357 04:52:24,105 --> 04:52:26,841 PLACEMENT OF THEF F ACCEPT LIN 7358 04:52:26,841 --> 04:52:28,909 AMP. 7359 04:52:28,909 --> 04:52:34,148 FORHE -- FOLLOWED BY SH BPLY B 7360 04:52:34,148 --> 04:52:36,684 TELITED ASTEHEY WOULD IN A 7361 04:52:36,684 --> 04:52:38,853 TRADITIONAL ABDOM AALAL 7362 04:52:38,853 --> 04:52:39,487 HYSTERECTOMY. 7363 04:52:39,487 --> 04:52:41,222 THE SAME IS RE IATED ONN THEHE 7364 04:52:41,222 --> 04:52:42,656 CONTRALATERAL SIDE, ADE,HE 7365 04:52:42,656 --> 04:52:48,863 THROUGHORO THE REMAINDER OF THE 7366 04:52:48,863 --> 04:52:50,498 PROCEDURE. 7367 04:52:50,498 --> 04:52:52,199 SURGICAL TECHNIQUEIQ FOR PLANTA 7368 04:52:52,199 --> 04:52:52,900 ACCRETA SPECTRUM CTRTINUES TO 7369 04:52:52,900 --> 04:52:54,235 EVOLVE. 7370 04:52:54,235 --> 04:52:56,103 THISROPOSERO TWO-HAND TECHNIQUE 7371 04:52:56,103 --> 04:52:58,706 IS EASYAS TO PERRM ANDND 7372 04:52:58,706 --> 04:53:02,443 REPRODUCIBOD AND CAN ULTRAMAY 7373 04:53:02,443 --> 04:53:13,554 WITH FIGO F FA. PATHO PGY 7374 04:53:15,022 --> 04:53:17,758 EES ANDREW VALLEJO, 7375 04:53:17,758 --> 04:53:18,659 CALIFORNIA.RF SERFERNER 7376 04:53:18,659 --> 04:53:19,794 KE TO THANK ALL 7377 04:53:19,794 --> 04:53:24,365 MYCOAUTHORS ANDHE DEPARTMENT 7378 04:53:24,365 --> 04:53:25,366 DEPARTMENT -- FOR THEIR SUPPORT 7379 04:53:25,366 --> 04:53:26,434 WITH THIS T PROJECT. 7380 04:53:26,434 --> 04:53:26,534 AN 7381 04:53:26,534 --> 04:53:27,868 ON BEHALF OF O TEAM, I 7382 04:53:27,868 --> 04:53:29,670 WOULD LIKE TO THANK TOU ALL FOR 7383 04:53:29,670 --> 04:53:40,114 YOUR ATTENTION HERE TODAY. 7384 04:53:52,626 --> 04:53:55,663 >> THANK TOU, DR. MATSUO. 7385 04:53:55,663 --> 04:53:57,565 DISCUSSION.V30 MINUTES OFF 7386 04:53:57,565 --> 04:54:00,768 SO WE WILL GO THROUGH0. 7387 04:54:00,768 --> 04:54:00,868 AN 7388 04:54:00,868 --> 04:54:04,705 NEXT BREAK SINCEIN WEE TOOK TE 7389 04:54:04,705 --> 04:54:06,073 BREAK, AND WE'LL MAKE UP TIME TT 7390 04:54:06,073 --> 04:54:06,173 TH 7391 04:54:06,173 --> 04:54:08,742 END E WITH LESS TIME SPENT ON 7392 04:54:08,742 --> 04:54:19,186 CHARGECHO WORKING GROUP G 7393 04:54:23,591 --> 04:54:25,759 >> JUST KIN MIND THAT YOU'RE 7394 04:54:25,759 --> 04:54:28,963 STILL GOING TO HAVE DR. HOBR.N 7395 04:54:28,963 --> 04:54:32,933 ON THE TOOMM AVAILABLE. 7396 04:54:32,933 --> 04:54:33,033 >> 7397 04:54:33,033 --> 04:54:35,302 I THINK T BIG ISSUE WE'RE 7398 04:54:35,302 --> 04:54:35,970 IDENTIFYING ACROSS THE BOARD IS 7399 04:54:35,970 --> 04:54:37,171 THE NEED FOR STAARDIZATION IN 7400 04:54:37,171 --> 04:54:39,440 TERMS OF ULTRASOUNRA AND -- BUTT 7401 04:54:39,440 --> 04:54:41,709 DEFINIDELY IN YR CATEGORAT 7402 04:54:41,709 --> 04:54:43,110 WHO'S THE CONSERVATIVE 7403 04:54:43,110 --> 04:54:43,210 CA 7404 04:54:43,210 --> 04:54:44,011 IDATE, AND F WHICHHI 7405 04:54:44,011 --> 04:54:45,446 PROCEDURE ARE THEY CANDIDATES 7406 04:54:45,446 --> 04:54:47,982 FOR AND CAN WE AN W TO CONSENSUS 7407 04:54:47,982 --> 04:54:49,717 WHOMHO WEE SHOULD EVEN BE 7408 04:54:49,717 --> 04:54:51,285 COIDERING THIS IN. 7409 04:54:51,285 --> 04:54:53,954 II KNO DR. -- WILL TALK ABO 7410 04:54:53,954 --> 04:54:56,457 2 CENTIMETERS BELOW THERE 7411 04:54:56,457 --> 04:54:59,426 LESS THAN 50% OF THE 7412 04:54:59,426 --> 04:55:00,427 CIRCUMFERENCE IVE 7413 04:55:00,427 --> 04:55:00,528 I' 7414 04:55:00,528 --> 04:55:01,896 I'URUS, DO YOU O REE WITH 7415 04:55:01,896 --> 04:55:08,702 THAT, ARE THEE OTHER CAVEATS?>>E 7416 04:55:08,702 --> 04:55:10,504 CONSERVANSVE MANAGEMENT IS WHAT 7417 04:55:10,504 --> 04:55:12,173 THE PATENT WNTTS. 7418 04:55:12,173 --> 04:55:14,808 FOTHETH PATIENT.,NGNG THE SITUAN 7419 04:55:14,808 --> 04:55:20,748 ORSESE WHO HAVE VISION -- WE 7420 04:55:20,748 --> 04:55:23,484 HAVE GOT A HUGE BULGE, 7421 04:55:23,484 --> 04:55:25,019 PARTICPAARLY AT THE -- SID ANDND 7422 04:55:25,019 --> 04:55:29,089 WHERE YOU SEEEE THESESESE BRIDGG 7423 04:55:29,089 --> 04:55:30,658 VESSELS, ALL THESE PATNTAT THE 7424 04:55:30,658 --> 04:55:32,159 HINGOR YOU SO TO LEAVE 7425 04:55:32,159 --> 04:55:33,661 PCENTA AND FOLLOW YOUB 7426 04:55:33,661 --> 04:55:35,296 MAKE DECISION SIX TOSIIGHT 7427 04:55:35,296 --> 04:55:37,364 WEEKSATER, WHETHER WE CONTINUE 7428 04:55:37,364 --> 04:55:41,302 THE SE PROCESSCE O IF YOU WANT 7429 04:55:41,302 --> 04:55:43,337 YOUR UTERUS TORU BE REMOVED, THN 7430 04:55:43,337 --> 04:55:45,673 WE CAN DO THE -- SO THIS IS 7431 04:55:45,673 --> 04:55:47,208 REALLY BASED ONED THE MRI, 7432 04:55:47,208 --> 04:55:48,776 ULTRASOUND, ALL,F THESE 7433 04:55:48,776 --> 04:55:53,113 NDINGS. 7434 04:55:53,113 --> 04:55:59,453 >> YES, I SEE -- THE WOM AND I 7435 04:55:59,453 --> 04:56:01,956 ITOLDLDLDOU IN FRANCE, WE DO NT 7436 04:56:01,956 --> 04:56:04,191 CON FEND CONSERVATIVE -TIVE FOR 7437 04:56:04,191 --> 04:56:04,391 WOMEN. 7438 04:56:04,391 --> 04:56:05,492 SO IT DEPENDS ON THE SITUATION.I 7439 04:56:05,492 --> 04:56:07,061 THE MAIN MAIT WHENHE WE DISCUSS 7440 04:56:07,061 --> 04:56:08,662 WITH A WOMAN IS T FOLLOW-UPLO 7441 04:56:08,662 --> 04:56:08,762 TH 7442 04:56:08,762 --> 04:56:12,266 FOR THE WOMAN TO HAVE H A LITTLE 7443 04:56:12,266 --> 04:56:15,169 BUMP INMP THE ABDOMEN THAT COULD 7444 04:56:15,169 --> 04:56:16,704 AT ANY WAY A ANY 7445 04:56:16,704 --> 04:56:17,037 TIME. 7446 04:56:17,037 --> 04:56:19,873 IT'S NOT SO EASY FOR THE WOMAN. 7447 04:56:19,873 --> 04:56:25,980 I'M NOT TOO -- I JUST JUST TOE 7448 04:56:25,980 --> 04:56:28,816 N. 7449 04:56:28,816 --> 04:56:32,219 D R CIVIC CASES,ES WE BELVEVE 7450 04:56:32,219 --> 04:56:35,222 FRANCE, IT DEPENDS ONDSHE 7451 04:56:35,222 --> 04:56:35,789 ORGANIZATION OF KAI IT'S NOT 7452 04:56:35,789 --> 04:56:37,291 KE CANADA OR I THINKHI IT'S NOT 7453 04:56:37,291 --> 04:56:40,828 LIKE U.S. WHERE WHEAVE A LOT OFO 7454 04:56:40,828 --> 04:56:42,596 CENTS VERY NEAR FROM THE H THE 7455 04:56:42,596 --> 04:56:43,397 OF THEOF TOMAN.AN 7456 04:56:43,397 --> 04:56:48,636 SO WE HAVE NOAV WOMAN WHO LIVE T 7457 04:56:48,636 --> 04:56:54,942 8 -- FROM THE CENTERS -- SOME 7458 04:56:54,942 --> 04:56:56,510 EMOST FAR AWAY IS LES THANHA 7459 04:56:56,510 --> 04:57:00,547 100 MILES. 7460 04:57:00,547 --> 04:57:02,516 SO WHEN WE RECVE CASES IT'S 7461 04:57:02,516 --> 04:57:04,752 T DIFFICDIT TO PERFORM 7462 04:57:04,752 --> 04:57:06,186 CONSERVATIVE MAGEMENT. 7463 04:57:06,186 --> 04:57:10,357 WHATWH DIFFICULT IS AFTER, THE T 7464 04:57:10,357 --> 04:57:11,792 POSTPARTUM PERIO THE TIME TO 7465 04:57:11,792 --> 04:57:14,228 TALK ABOUT IT DURING MY TALK, 7466 04:57:14,228 --> 04:57:14,328 BU 7467 04:57:14,328 --> 04:57:19,466 TO KNOW WHEN W HAVE T-- THE 7468 04:57:19,466 --> 04:57:21,935 WOMAN, WHEN WE HE TO GIVE SOME 7469 04:57:21,935 --> 04:57:24,471 ANTIBIOTIC, WHEN, E HAVE TO T 7470 04:57:24,471 --> 04:57:27,107 PERFORM -- WHEN WEN HAVE TO DO 7471 04:57:27,107 --> 04:57:27,207 AG 7472 04:57:27,207 --> 04:57:28,108 NAG SURGERYUR SETIMES IN 7473 04:57:28,108 --> 04:57:28,208 EM 7474 04:57:28,208 --> 04:57:28,776 GENCY. 7475 04:57:28,776 --> 04:57:32,179 SO FOR SERIOUSUS CAS, PLACENTA 7476 04:57:32,179 --> 04:57:34,248 ACCRETA, IT'S NOT DIFCULT TO 7477 04:57:34,248 --> 04:57:35,115 RFORM CONSERVONIVE MANAGEMENT, 7478 04:57:35,115 --> 04:57:37,551 SO WE CAN OFFER FOR THEM.M. 7479 04:57:37,551 --> 04:57:37,651 AN 7480 04:57:37,651 --> 04:57:41,121 W BELVEEL IN FRANCE IF WEF 7481 04:57:41,121 --> 04:57:46,060 HAVE THE ABILITYO AVOID A 7482 04:57:46,060 --> 04:57:47,127 RY -- FOR ME IS BETTER FOR 7483 04:57:47,127 --> 04:57:48,295 THESEE CASES. 7484 04:57:48,295 --> 04:57:49,797 GUESS IN US ., IT'S THE 7485 04:57:49,797 --> 04:57:50,998 RY, W,RERE YOU CONSIDER 7486 04:57:50,998 --> 04:57:55,736 THAT WHEN WE HAVE H VERYER SERUS 7487 04:57:55,736 --> 04:57:56,770 CASES,CAT'S T DANGEROAN TO 7488 04:57:56,770 --> 04:57:58,305 LEAVE THE WOMAN W AT HOME, THATT 7489 04:57:58,305 --> 04:58:00,174 CAN BNE BE VERY DANGEROUS AND YU 7490 04:58:00,174 --> 04:58:05,879 NEED TO HAVE THE THEROCESSESSS 7491 04:58:05,879 --> 04:58:12,319 TO MANAGE WAN --AN SO IT'S QUITE 7492 04:58:12,319 --> 04:58:13,954 DIFFERENT -- BETWEEN OUR TWO 7493 04:58:13,954 --> 04:58:14,521 COUNTRIES.IE 7494 04:58:14,521 --> 04:58:16,056 DO NOT SAY S'M RIGHT RHT I JUSTI 7495 04:58:16,056 --> 04:58:20,327 SAY HOW DO IN FRANCE AND 7496 04:58:20,327 --> 04:58:26,033 HOW -- SO WE WO HAVE -- IT'SS NN 7497 04:58:26,033 --> 04:58:29,937 LIKE -- - I I ASSURE YOU -- SURY 7498 04:58:29,937 --> 04:58:33,974 WRI THE PAPER FOR -- I 7499 04:58:33,974 --> 04:58:35,409 THOUGHT THAT IT WAS POSSIBLE FOL 7500 04:58:35,409 --> 04:58:38,045 ANY WOMAN AND I THINK IT WAS - W 7501 04:58:38,045 --> 04:58:40,681 E WHEN WE HAVE -- ME SURE 7502 04:58:40,681 --> 04:58:46,086 AND VISION, I DON KNOW HOW TO 7503 04:58:46,086 --> 04:58:48,856 REMOVE THE PLACENTA ANDHE 7504 04:58:48,856 --> 04:58:49,823 ERUS AT THE SAME TIME,TIOR, ME 7505 04:58:49,823 --> 04:58:52,726 IT'S LIK'S HYSTERECTOMRE 7506 04:58:52,726 --> 04:59:03,003 FINALLFI, -- SO THE WOMAN HAS TO 7507 04:59:03,003 --> 04:59:04,538 AGREE, SHEE, HAS TO WANT IT, AND 7508 04:59:04,538 --> 04:59:08,208 SHE HAS TO HAVE THE POSBILITYBI 7509 04:59:08,208 --> 04:59:09,176 TO UNDERSTANER WHAT'S INVOLVED 7510 04:59:09,176 --> 04:59:10,511 ER AND FOROR HERAMILY,AMT 7511 04:59:10,511 --> 04:59:18,619 CETERA. 7512 04:59:18,619 --> 04:59:21,188 >> -- THE ORG,HE WANT TO 7513 04:59:21,188 --> 04:59:24,358 SPEND TWO YEARS WITH THEM -- AND 7514 04:59:24,358 --> 04:59:26,427 THEN SHE WTE A A PAPERER I 7515 04:59:26,427 --> 04:59:26,527 EN 7516 04:59:26,527 --> 04:59:31,165 AGE ERYBODYBOBO TO READ, 7517 04:59:31,165 --> 04:59:38,639 E CHALLENGE WE'RE FACING, BUTC . 7518 04:59:38,639 --> 04:59:40,808 HI TO COMPARE OURREESULTS TO 7519 04:59:40,808 --> 04:59:43,243 THEM, BECAUSE THEY HAVE A 7520 04:59:43,243 --> 04:59:45,979 NATIONNA - HEALTH SYSM, T 7521 04:59:45,979 --> 04:59:49,149 DON'T HAVE A LOT L O L TS -- OUR 7522 04:59:49,149 --> 04:59:51,718 BIGGEST CHAENGE -- WE SEE A 7523 04:59:51,718 --> 04:59:53,587 LOT OFT WOM W A W 7524 04:59:53,587 --> 04:59:57,758 UNDOCUMENTED. 7525 04:59:57,758 --> 04:59:58,091 IMMIGRANT. 7526 04:59:58,091 --> 05:00:00,794 AND WE HAVE TO -- SO MA SO S 7527 05:00:00,794 --> 05:00:06,166 THIN, A LOT OF TIMES IANTO 7528 05:00:06,166 --> 05:00:10,904 TO -- SHE'SE' AFRAIDD IILL ----O 7529 05:00:10,904 --> 05:00:11,004 TR 7530 05:00:11,004 --> 05:00:14,007 EL AND A THEY MUST --EPORT 7531 05:00:14,007 --> 05:00:14,107 TH 7532 05:00:14,107 --> 05:00:19,413 SOSO WE W WE HE A L OF CLLENGES 7533 05:00:19,413 --> 05:00:20,714 IN WHAT WOULD BE THE BEST 7534 05:00:20,714 --> 05:00:20,814 TOP 7535 05:00:20,814 --> 05:00:20,948 ON. 7536 05:00:20,948 --> 05:00:22,583 IT MIGHT NOT BE THE BEST MEDICAC 7537 05:00:22,583 --> 05:00:24,017 ONN MY OPINIONPI BUT I I 7538 05:00:24,017 --> 05:00:29,857 STILL GO AHEAD AND DO TO PROTECT 7539 05:00:29,857 --> 05:00:30,023 HER. 7540 05:00:30,023 --> 05:00:33,794 >> WONDERFUL PRESENTATIONS 7541 05:00:33,794 --> 05:00:33,994 NSAGAIN. 7542 05:00:33,994 --> 05:00:38,398 ORANGES TOGEEARS ANALOGY,ES TOO 7543 05:00:38,398 --> 05:00:39,399 SEBASTIAN, THAT YOU GAV 7544 05:00:39,399 --> 05:00:40,167 ONE OF THE THINGS THAT IT THI T 7545 05:00:40,167 --> 05:00:42,102 IS REALLY CHALLENGING WITH THIS 7546 05:00:42,102 --> 05:00:42,836 F RESEARCH, TCHUGH, TOO,OO 7547 05:00:42,836 --> 05:00:43,937 IS IT'S HARDO COMPARE 7548 05:00:43,937 --> 05:00:46,139 SOMETHING THA LASTS FOR SIX 7549 05:00:46,139 --> 05:00:49,943 THAT IS COMPLETED AT ONENGHI 7550 05:00:49,943 --> 05:00:50,777 SURGERY. 7551 05:00:50,777 --> 05:00:57,251 I THINK IT'S EASIER TO COMPARE 7552 05:00:57,251 --> 05:00:58,919 CONSERVATIVE SURGICAL MANAGEMENE 7553 05:00:58,919 --> 05:00:59,019 NT 7554 05:00:59,019 --> 05:01:01,588 TH CONSE CATIVE LEAVE THE 7555 05:01:01,588 --> 05:01:04,291 ACENTANSEED SURGICAL 7556 05:01:04,291 --> 05:01:06,793 MANAGEMENT OR TO COMPARE 7557 05:01:06,793 --> 05:01:08,095 TIME WHAT W IS THE BESTD ALL THT 7558 05:01:08,095 --> 05:01:08,428 MANAGEMENAGENA 7559 05:01:08,428 --> 05:01:11,498 THAT'STHUMBER ONE. 7560 05:01:11,498 --> 05:01:12,900 NUMBER TWO, HAVE YOU ALL THOUGHH 7561 05:01:12,900 --> 05:01:14,535 ABOUT FOR THEONSERVATIVE 7562 05:01:14,535 --> 05:01:15,736 DELAYEDLAYEDYE HYSTERECTY, IS TE 7563 05:01:15,736 --> 05:01:16,370 AN OPTIMAL TIME? 7564 05:01:16,370 --> 05:01:18,071 I THINK T THAT' TONE OF THEHE 7565 05:01:18,071 --> 05:01:18,939 BIGGEST UNANSWERED QUESTIONS, IS 7566 05:01:18,939 --> 05:01:20,374 SHOULDT BE ONE WEEKFT,, 7567 05:01:20,374 --> 05:01:21,775 SHOULD ITT BE TWO WEEKS AFTER A 7568 05:01:21,775 --> 05:01:23,210 OULD ITLD BE SI BWEEKS AEKER? 7569 05:01:23,210 --> 05:01:25,145 >> AGAIN, I DIDT HAVE TIME T TOT 7570 05:01:25,145 --> 05:01:29,283 SHARE, WHEN WESHTARTED TS, 7571 05:01:29,283 --> 05:01:32,753 THEN WETHAIDD SINCE INSURANCE DD 7572 05:01:32,753 --> 05:01:35,689 NOT COVER THE THE ONE AFTER SIX 7573 05:01:35,689 --> 05:01:38,225 WEEKS, AND N CNGE -- WE 7574 05:01:38,225 --> 05:01:39,860 STARTED DOING THEM WHILE THEY 7575 05:01:39,860 --> 05:01:40,894 ARE INARHE HOSPITAL. 7576 05:01:40,894 --> 05:01:50,504 BECAUSEE WE FOUND --O WE DON'T D 7577 05:01:50,504 --> 05:01:51,939 KN ABOUT THIS. 7578 05:01:51,939 --> 05:01:54,675 BUT NOW SINCEIN NOW N THEY CAN T 7579 05:01:54,675 --> 05:01:58,445 INSURAINE COVERED IN TEXAS -- -I 7580 05:01:58,445 --> 05:02:03,216 DON'T BELIEVE THERE IS A PLACE 7581 05:02:03,216 --> 05:02:04,084 FOR -- 11 --EK1 7582 05:02:04,084 --> 05:02:05,385 OUR EXPERIENCE HASE EEN VERY VAD 7583 05:02:05,385 --> 05:02:10,123 AND WE STOPPED DOING IT. 7584 05:02:10,123 --> 05:02:20,601 >> SOSOSO I -- SC- MA IN MY 7585 05:02:21,435 --> 05:02:22,269 PRESENTAESON OVER WHICH WE 7586 05:02:22,269 --> 05:02:24,104 DISCUSSEDHIS POTENTIAL 7587 05:02:24,104 --> 05:02:26,740 PROPOSAL AT OUR INSTITUTION 7588 05:02:26,740 --> 05:02:30,110 INGR. WRIR.T UNDET 7589 05:02:30,110 --> 05:02:32,879 SUPERVISION, MY COLLEAGUE FROM 7590 05:02:32,879 --> 05:02:36,483 JAPAN JAPA PREVIOUSLY PUBLICATIN 7591 05:02:36,483 --> 05:02:38,919 PUBLISHED IN -- IN WCH HE 7592 05:02:38,919 --> 05:02:43,824 PUBLISHEDISHEDATABL FOR THE 7593 05:02:43,824 --> 05:02:45,826 PLACENTA ACCRETA UNDER 7594 05:02:45,826 --> 05:02:47,127 CONSERVANSVE MNSAGEMENT AND THEN 7595 05:02:47,127 --> 05:02:49,563 THE PEAKE FF THE COMPLICATIONIO 7596 05:02:49,563 --> 05:02:55,235 OCCURCU AFTER - ANDND TOPICS, OE 7597 05:02:55,235 --> 05:02:59,973 IN THE SIR S TOO WEEKS,EE THEN 7598 05:02:59,973 --> 05:03:03,310 FOLLOWED BY KIND OF A PTEAU 7599 05:03:03,310 --> 05:03:04,611 ASE, THEN AFTER SEVENEN WEEKS, 7600 05:03:04,611 --> 05:03:09,650 EN PEA P OCCUR AECONDON O, 7601 05:03:09,650 --> 05:03:20,594 IMPRESSION THAT THERE MAY BE 7602 05:03:25,966 --> 05:03:34,007 HYPO -- WDOW --DO THE OTH 7603 05:03:34,007 --> 05:03:40,847 PPORTINGORTI SO --O WE DECIDEID 7604 05:03:40,847 --> 05:03:44,918 >> -- DOES NOT HAPPEN FORBOUT 7605 05:03:44,918 --> 05:03:46,353 FOUR WEEKS AKS BEYOND BECAUSE WE 7606 05:03:46,353 --> 05:03:46,453 HA 7607 05:03:46,453 --> 05:03:49,956 BEEN FOLLOWING -- DATA ON 7608 05:03:49,956 --> 05:03:52,659 THIS, AND AS OF TODAY I DIDED 7609 05:03:52,659 --> 05:03:53,994 NOT TO MONITOR THA ANYMORE 7610 05:03:53,994 --> 05:03:55,562 BECAUSE WHAT TWHY'RE GOING TO DO 7611 05:03:55,562 --> 05:03:56,830 WITH THAT INFOR ITION? 7612 05:03:56,830 --> 05:03:59,232 I HAVE SEEN THEEE--ROP- AS LOWOW 7613 05:03:59,232 --> 05:04:00,434 7 7614 05:04:00,434 --> 05:04:00,534 - 7615 05:04:00,534 --> 05:04:04,671 BEDING,ING,O -- WE DIDWEHIS 7616 05:04:04,671 --> 05:04:05,906 AIN A LON A TIME AGO, WE USED 7617 05:04:05,906 --> 05:04:08,108 TO HAVEABIES WHO WHO DIED IN 7618 05:04:08,108 --> 05:04:13,046 UTERO, AND A WE KEPT K DEBATE WH 7619 05:04:13,046 --> 05:04:18,452 FO WKS, WE USED T GIVE THEM 7620 05:04:18,452 --> 05:04:20,320 SUBCUTANBCUS HEPARIN WHICH WE 7621 05:04:20,320 --> 05:04:21,688 DON'T DO ANYMORE, BUTUT WE STARD 7622 05:04:21,688 --> 05:04:29,830 DOING IT BECAUSE -- - - 7623 05:04:29,830 --> 05:04:40,207 >> IOULDN'T AGREE WH YOU 7624 05:04:41,808 --> 05:04:44,678 MORET THE T PATIENTS' WISHS 7625 05:04:44,678 --> 05:04:45,812 ARE THE NBER O PRIOR PY, BUT 7626 05:04:45,812 --> 05:04:48,215 I DO TNK WE OWE THEM A 7627 05:04:48,215 --> 05:04:48,682 COMMDATI.. 7628 05:04:48,682 --> 05:04:50,517 .WE DO NEED TOECOMMEND TO THE 7629 05:04:50,517 --> 05:04:52,052 PATIENTTIPA THAT IF THE'S 7630 05:04:52,052 --> 05:04:57,157 SOMETHING ON IMAGI I THAT YOU 7631 05:04:57,157 --> 05:05:00,360 WOULD RECMEND O APPROACH 7632 05:05:00,360 --> 05:05:00,894 VERSUSVE ANOTHER. 7633 05:05:00,894 --> 05:05:02,529 I THINK THE MANAGEMANT NEEDS TO 7634 05:05:02,529 --> 05:05:03,897 DOVETAIL TO OUR VERSI V OF THE 7635 05:05:03,897 --> 05:05:04,131 BIOLOGY. 7636 05:05:04,131 --> 05:05:07,734 IF YOU KIND OF PUT P THISND 7637 05:05:07,734 --> 05:05:10,437 THAT TOGETHER, MAYBE THE MORE 7638 05:05:10,437 --> 05:05:13,173 W ADHERENCE MAYBE AROUND AREN' A 7639 05:05:13,173 --> 05:05:15,041 THE BEST OPTIONS F 7640 05:05:15,041 --> 05:05:16,009 CONSERVATIVE MANAGEMENT, MAYBE 7641 05:05:16,009 --> 05:05:18,845 E THEY'RE N'R'R DEEPL D INTOVE 7642 05:05:18,845 --> 05:05:21,148 THE WALL,AL THE FIBRIN DEPOSITIN 7643 05:05:21,148 --> 05:05:24,184 ISN'T AN' GREAT, INFLAMMATORY 7644 05:05:24,184 --> 05:05:26,153 OCESS ISN'T ASS GREAT,, THEN 7645 05:05:26,153 --> 05:05:30,991 MAYBE THAT DOVETAILS, THERE'S A 7646 05:05:30,991 --> 05:05:37,664 >>>> THIS T IS WHY WE CALL IT -- 7647 05:05:37,664 --> 05:05:39,166 AGAIN, I AGREE WITH YOU, TO 7648 05:05:39,166 --> 05:05:44,538 THOSEOSOS WHO DON'T HAVE THE - N 7649 05:05:44,538 --> 05:05:51,011 MRI, A MAJOR -- UNLESS SHE 7650 05:05:51,011 --> 05:05:52,946 WANTED TO KEEP HER H UTERUS, THE 7651 05:05:52,946 --> 05:05:54,381 WEWEAN'T ARGUE WITH THAT. 7652 05:05:54,381 --> 05:05:55,382 WE'LL GIVE THE RECOMMENDATION, 7653 05:05:55,382 --> 05:05:58,385 N,BUT FOBU SOME WOMEN YOU HAVE O 7654 05:05:58,385 --> 05:06:03,557 SAY, IS IT BETTER TO DOHISS 7655 05:06:03,557 --> 05:06:04,758 OR --HE WHOLE COULERY. 7656 05:06:04,758 --> 05:06:06,726 IS IS THE PROEM SOMETIMESE 7657 05:06:06,726 --> 05:06:13,066 . FA 7658 05:06:13,066 --> 05:06:15,569 >> -- TO MAKE -- 7659 05:06:15,569 --> 05:06:18,638 ENCOTIONS OF -- BECAUSE IT 7660 05:06:18,638 --> 05:06:23,743 S ON FACTORS. 7661 05:06:23,743 --> 05:06:27,914 -- THE- OUTCOMES, YOU WILL HE 7662 05:06:27,914 --> 05:06:30,584 WOMEN --EN - THE THE MAIHEPOINT 7663 05:06:30,584 --> 05:06:31,985 IS TO TRY TRY KEEPHE UTERUS 7664 05:06:31,985 --> 05:06:33,453 BECAUSECAUSE IMPORTANT FOR HER. 7665 05:06:33,453 --> 05:06:34,621 .YOU HAVE OTHER O WOMEN YOU SAYI 7666 05:06:34,621 --> 05:06:36,990 WANT WHEN I LEAVE THE HOS HTAL 7667 05:06:36,990 --> 05:06:38,158 FINISH TO HAVE H SOME PROBLEMS. 7668 05:06:38,158 --> 05:06:42,762 OF COURS CYOU CAN HAVE SOME -- 7669 05:06:42,762 --> 05:06:45,932 SOME LIMITATIONS OF THE RISK, I 7670 05:06:45,932 --> 05:06:47,567 N'T WANT TO LEAVE THE HOSPITAL 7671 05:06:47,567 --> 05:06:48,768 TH MAJOR RAJOR I DON'T'T CAROL 7672 05:06:48,768 --> 05:06:51,404 IF I HAVE THE MAJ RIS OF 7673 05:06:51,404 --> 05:06:55,008 BLEEDING DURING SURGERY, GET DO 7674 05:06:55,008 --> 05:06:55,475 E THIE THAT I 7675 05:06:55,475 --> 05:06:58,945 REALLY ----O IO 7676 05:06:58,945 --> 05:07:04,317 VERY, VER-- ANDND IT ALSO -- I I 7677 05:07:04,317 --> 05:07:09,256 DON'TT- IT'S THE TM T SHOULD 7678 05:07:09,256 --> 05:07:09,356 AG 7679 05:07:09,356 --> 05:07:10,590 E, ANY- SHOULD AGREE, 7680 05:07:10,590 --> 05:07:11,625 EVERYBODY SHOULD BE AGREED, YOU 7681 05:07:11,625 --> 05:07:15,295 KNOW, WHEN W YOU HAVEE ONE CONCN 7682 05:07:15,295 --> 05:07:19,065 THAT IS NOTOT OKAY FOR 7683 05:07:19,065 --> 05:07:21,468 CONSERVATIVE MANAGEMENAG, SO I 7684 05:07:21,468 --> 05:07:23,670 OULD BOU B SHARE S SY ALS MEMBES 7685 05:07:23,670 --> 05:07:25,839 OF THE T TEAM. 7686 05:07:25,839 --> 05:07:27,407 M. I THINK DR. HOB SOBOB WANTS O 7687 05:07:27,407 --> 05:07:28,208 COMMENT ASO WELL. 7688 05:07:28,208 --> 05:07:30,043 OH, THANK YOU. 7689 05:07:30,043 --> 05:07:32,312 I'LL BE BRIEF. B 7690 05:07:32,312 --> 05:07:33,013 WE ALL AGREE AGRT WE NEED TO 7691 05:07:33,013 --> 05:07:35,515 TAKE INTO AOUNT THEATIENT 7692 05:07:35,515 --> 05:07:35,615 PR 7693 05:07:35,615 --> 05:07:39,219 ERENCESCE, WE ALL AGREE WE 7694 05:07:39,219 --> 05:07:41,488 NEED TO WORKK ON EDICVE 7695 05:07:41,488 --> 05:07:42,722 VEMODELS AND PATIE P DEMOGRAPHIH 7696 05:07:42,722 --> 05:07:47,294 AND ULTRASOUND FINDINGS, MRIRI 7697 05:07:47,294 --> 05:07:49,195 FINDINGS, TO T AND AND HELP US 7698 05:07:49,195 --> 05:07:49,829 FIND A PATHW P THW THE SOLUTION 7699 05:07:49,829 --> 05:07:51,431 WHICH SUITS THATT INDIDUAL 7700 05:07:51,431 --> 05:07:54,434 LSO DON THINKHI WE CAN 7701 05:07:54,434 --> 05:07:56,803 DISCOUNTSCROMRO THIS CONVERSATIN 7702 05:07:56,803 --> 05:07:56,903 IN 7703 05:07:56,903 --> 05:07:58,238 VIDUAL INSTITUTIONTI OUTCOMES 7704 05:07:58,238 --> 05:07:59,673 ANDANHAT THEY'RE ACTUALLY VERY, 7705 05:07:59,673 --> 05:08:01,107 VERY DIFFERENT, AND CERINLY 7706 05:08:01,107 --> 05:08:05,111 IT'S LINKED TO VOLUME IN A VERY 7707 05:08:05,111 --> 05:08:09,616 STRONG WAYAY BUT B WE STILL HAVE 7708 05:08:09,616 --> 05:08:11,184 CASES THAT DO LESS TN 25 CASES 7709 05:08:11,184 --> 05:08:13,153 SA YEAR THAT HAVE OUTANUTNG 7710 05:08:13,153 --> 05:08:14,421 OUTCOMES BUT THE CNS CNS HAS 7711 05:08:14,421 --> 05:08:15,522 TO BE B TAI BREAI WITHIN THE 7712 05:08:15,522 --> 05:08:15,622 CO 7713 05:08:15,622 --> 05:08:18,425 ES ARE FOR THOSESEURGICAL 7714 05:08:18,425 --> 05:08:18,525 IN 7715 05:08:18,525 --> 05:08:19,426 VIINAL SURGEONS AND SURGICAL 7716 05:08:19,426 --> 05:08:20,193 TEAM 7717 05:08:20,193 --> 05:08:22,028 AND SO I THINK THAT'S AS A RY 7718 05:08:22,028 --> 05:08:23,496 IMPORTANTRTARTRT OF 7719 05:08:23,496 --> 05:08:32,205 DECISION-MAKING. 7720 05:08:32,205 --> 05:08:33,506 >> MY QYSTION RELATES TO THE 7721 05:08:33,506 --> 05:08:33,840 AL TEAM. 7722 05:08:33,840 --> 05:08:37,010 AGREEING, EVERYONE IN E ROOM, 7723 05:08:37,010 --> 05:08:39,479 NE HAS A PLAN AND WE KNOW 7724 05:08:39,479 --> 05:08:40,180 HOW MULTIDISCIPDINAIP TEAMS 7725 05:08:40,180 --> 05:08:40,747 WORK. 7726 05:08:40,747 --> 05:08:41,948 T AS A POINT OF TH O WORKSHOP, 7727 05:08:41,948 --> 05:08:44,150 CAN WE SAY THAT THE SURGICALL 7728 05:08:44,150 --> 05:08:45,285 TEAM NEE SDS TO BE ITHE 7729 05:08:45,285 --> 05:08:47,153 OPERATING ROOAT THE START OF 7730 05:08:47,153 --> 05:08:48,321 FIS CASE, AND I ASK THAT ONLY 7731 05:08:48,321 --> 05:08:49,856 YBECAUSE I DON'T KNOW HOW -- I 7732 05:08:49,856 --> 05:08:52,792 TRY TO LOOK L AT AHIS LITERATUR. 7733 05:08:52,792 --> 05:08:54,627 THE DATH IN GYN AND ONCOLOGY, 7734 05:08:54,627 --> 05:08:55,628 ARE THEY THERE -- IF THEY'RE 7735 05:08:55,628 --> 05:08:55,729 GO 7736 05:08:55,729 --> 05:08:58,465 G TO BE THE ONES DOING THE 7737 05:08:58,465 --> 05:09:02,369 CALLED IN TO CHAOS WHEN Y'VE 7738 05:09:02,369 --> 05:09:03,803 ALADY LOST 10 LI 1RS OF BLO, 7739 05:09:03,803 --> 05:09:05,405 SHOULD THEYE THERE AT THE 7740 05:09:05,405 --> 05:09:05,805 START OF THE CASHE C 7741 05:09:05,805 --> 05:09:08,274 HE CM USING GYN ANDOLOGY AS AN 7742 05:09:08,274 --> 05:09:09,509 AMPLE, BUTE, B FEEL FIKE THIS IS 7743 05:09:09,509 --> 05:09:10,944 A CASE THAT WEHAEED TO MAKE THAT 7744 05:09:10,944 --> 05:09:12,078 CLEAR IF IFHE POINT IS TSM PROVE 7745 05:09:12,078 --> 05:09:15,548 SO MAY IT BE THEFM WHO'S DOING 7746 05:09:15,548 --> 05:09:19,152 STMY OST THE UROGYN OR 7747 05:09:19,152 --> 05:09:20,687 E GYN ONCOLOGY DO WE HAVE 7748 05:09:20,687 --> 05:09:23,857 ENOUGH DAY TOOAY THE SURGICAL 7749 05:09:23,857 --> 05:09:24,791 TEAM NEEAM TO BEE THERE T 7750 05:09:24,791 --> 05:09:26,860 INTRAOPERATIVELY AND NOT NO 7751 05:09:26,860 --> 05:09:34,067 >> JUST ARIEF SMALL DATA D 7752 05:09:34,067 --> 05:09:37,570 E -- GYN ONC IOLVEMENT 7753 05:09:37,570 --> 05:09:39,005 BEGINNING -- ACCTA O COME 7754 05:09:39,005 --> 05:09:40,840 IMPROVED.ED 7755 05:09:40,840 --> 05:09:48,481 AND ALSO GYN GYNNC'S VIEW BASEDN 7756 05:09:48,481 --> 05:09:51,651 O, AREO,NVOLVING -- BEGNING, 7757 05:09:51,651 --> 05:09:54,154 NEARLY HALF OF THOSEHO RESPONDED 7758 05:09:54,154 --> 05:09:55,155 EN MANY ARE ACTIVELY 7759 05:09:55,155 --> 05:09:56,356 EXPRES INTEREST. 7760 05:09:56,356 --> 05:10:03,596 AND IF SO, MY HBLEED BEGINNINGI 7761 05:10:03,596 --> 05:10:06,466 RECOMMENDATION TO THEM WOULD BEE 7762 05:10:06,466 --> 05:10:08,635 AT,, PROBABLYBA MOREORMPORTANT O 7763 05:10:08,635 --> 05:10:11,438 BE ALSO INVOLVING IVITHE -- IN 7764 05:10:11,438 --> 05:10:13,239 TERM OF MANAGEMENAGEMHAT TY'RE 7765 05:10:13,239 --> 05:10:16,643 INCLUDING MAYBEIAGNOSISA 7766 05:10:16,643 --> 05:10:18,745 MADE -- CASE SCENARIO-NASED NOT 7767 05:10:18,745 --> 05:10:21,247 JUSTST BNG B- IS NOTOT PROBABLYY 7768 05:10:21,247 --> 05:10:30,957 THE BEST UTILIZATIONTI - TO BE - 7769 05:10:30,957 --> 05:10:32,158 DISCUSSION -- THAT'S HOWOWOW WE 7770 05:10:32,158 --> 05:10:35,061 I DON'T KNOW IF THAS 7771 05:10:35,061 --> 05:10:37,664 NO GOOD -- 7772 05:10:37,664 --> 05:10:40,633 >> ARE>> GOI>> TO BE INVOLVEDOLN 7773 05:10:40,633 --> 05:10:44,671 R AFFAIRS, THEY'RE GNGO 7774 05:10:44,671 --> 05:10:48,575 ATTEMPT THE MULTIDISCIPLINARY 7775 05:10:48,575 --> 05:10:50,777 DISCUSSION, THEY GO AND VEEE THE 7776 05:10:50,777 --> 05:10:54,080 THEY WANT TO BE IN THE OPERATING 7777 05:10:54,080 --> 05:10:56,850 ROOM AND SEE THE PATIENTS OR O 7778 05:10:56,850 --> 05:10:57,217 STAFF AFTERWARTE 7779 05:10:57,217 --> 05:11:04,724 >> ONE MORE. 7780 05:11:04,724 --> 05:11:06,226 NATION NUMBER O DREASING 7781 05:11:06,226 --> 05:11:08,428 CASES, WSEKING CAS AND THEN 7782 05:11:08,428 --> 05:11:14,767 THETH SURGEON TO -- CHEMO CEY 7783 05:11:14,767 --> 05:11:18,938 CHEMOTHERAPY -- POINT OFF VIEWIE 7784 05:11:18,938 --> 05:11:27,547 AND THEN TYPICALLY THEHE MIs --s 7785 05:11:27,547 --> 05:11:31,251 SO MORE EXPERIENCED SURGE SS 7786 05:11:31,251 --> 05:11:35,955 ARE --AR LOTS OF GYN ONC IS --S 7787 05:11:35,955 --> 05:11:40,093 INSTEAD OFD ASKING QSTIONS. 7788 05:11:40,093 --> 05:11:44,063 BASED ON THE -- PROSPECTIVE DATA 7789 05:11:44,063 --> 05:11:46,833 WHICH --H THE DATASE, BUT TT 7790 05:11:46,833 --> 05:11:50,236 TTHEY HAVE SPECIFIC INFOR ITION 7791 05:11:50,236 --> 05:11:53,406 AND IT SHOWS OUT COME OF 7792 05:11:53,406 --> 05:11:57,477 IALLY SAYING THE SUR 7793 05:11:57,477 --> 05:12:04,851 Y -- OB GYN -- YNYBE 7794 05:12:04,851 --> 05:12:09,722 CALLED FOR -- CASE OR -- O 7795 05:12:09,722 --> 05:12:15,228 ING BUIN TO ME GYN ONCN ONCES -- 7796 05:12:15,228 --> 05:12:16,629 LAST 10 YEA I THINK IT'S 7797 05:12:16,629 --> 05:12:18,298 NOT -- C-- AND NEED T BE 7798 05:12:18,298 --> 05:12:22,902 SOMEONE WHO HAS EXPERIENCED 7799 05:12:22,902 --> 05:12:26,506 SURGEON REALLY HAVENOWLGEWL 7800 05:12:26,506 --> 05:12:29,209 SKILL -- UNIQUE -- CHANGE TO 7801 05:12:29,209 --> 05:12:31,644 THE -- NEED TEE BEAISING HAND 7802 05:12:31,644 --> 05:12:42,021 SOCIETSOCIPPACH IS MYIZE A CLO 7803 05:12:42,021 --> 05:12:43,256 OPINION. 7804 05:12:43,256 --> 05:12:44,090 >> THANK YOU. 7805 05:12:44,090 --> 05:12:48,161 I'M GOINGOING TOUSTT ADDT TO WHT 7806 05:12:48,161 --> 05:12:48,728 YALDA HAD SAID HERE. 7807 05:12:48,728 --> 05:12:49,462 I THINK PART OF THE DISCUSSIONS 7808 05:12:49,462 --> 05:12:51,030 WE'RE HAVG IS,HICH IS THE 7809 05:12:51,030 --> 05:12:53,967 BEST APPROACH, WITH CONSERVATIVE 7810 05:12:53,967 --> 05:12:57,804 MANAGEMANT VERSUSSU HYSTEREYSOM, 7811 05:12:57,804 --> 05:12:59,239 AND WE'RE BIASED, I THINK T 7812 05:12:59,239 --> 05:13:01,241 BECAUSE WE'RE TAKIN T OUR OWN 7813 05:13:01,241 --> 05:13:02,408 'S EXPERTISE INTSE THIS THI 7814 05:13:02,408 --> 05:13:04,143 DECISIONCIAKONG.ON 7815 05:13:04,143 --> 05:13:05,478 I THINK THI TOST OF THE MORBIDIY 7816 05:13:05,478 --> 05:13:07,947 FROM THIS DISEASESE HAPPENS IN 7817 05:13:07,947 --> 05:13:08,815 UNDIAGNODID PATIENTS THAT SHOW 7818 05:13:08,815 --> 05:13:11,150 UP TO THE COMMUNITY HOSPITALS,, 7819 05:13:11,150 --> 05:13:14,187 AND THEIN THE T T MDLE OF THE 7820 05:13:14,187 --> 05:13:16,656 TRYING TO DEAL WITH THIS.N ICI I 7821 05:13:16,656 --> 05:13:19,192 I THINK IT'S A OORTUNIOR FOR 7822 05:13:19,192 --> 05:13:21,694 US TO USE U THENOWLEDGEWL WE HAE 7823 05:13:21,694 --> 05:13:24,530 FROMOM CONSERVATIVE MANAGEMENTEN 7824 05:13:24,530 --> 05:13:27,033 BECAUSE THAT'S -- THE 7825 05:13:27,033 --> 05:13:28,668 CONSERVATIVETI MANAGEMENT CT SAE 7826 05:13:28,668 --> 05:13:29,369 LIVES. 7827 05:13:29,369 --> 05:13:32,705 AND WHERE WE AS A GROUP SHOULDUL 7828 05:13:32,705 --> 05:13:33,806 MAKE SOME RECOMMENDATIONS, HOW 7829 05:13:33,806 --> 05:13:39,479 ABDOMEN AND SEE THA THE --HEHE 7830 05:13:39,479 --> 05:13:40,246 FIRST WE NEED TO INFORM NFAT 7831 05:13:40,246 --> 05:13:42,315 IS AN ACCRETA POTEN PALLY 7832 05:13:42,315 --> 05:13:43,516 AND TOD T PROVIDERO SOME INFORMN 7833 05:13:43,516 --> 05:13:46,753 ON THE APPROACH USING ULTRA UUND 7834 05:13:46,753 --> 05:13:52,825 TO AVOID THE PLACENTA, GET G THE 7835 05:13:52,825 --> 05:13:57,297 BABYBY OUT, -- FORHE LOWOWOW HAG 7836 05:13:57,297 --> 05:13:59,599 FRUIT THAT CAN HAVE TREMENDOUS 7837 05:13:59,599 --> 05:14:00,833 BENEFIT AND REDUCE MORTALITY 7838 05:14:00,833 --> 05:14:04,137 RELATED TO TS CONDITION. 7839 05:14:04,137 --> 05:14:07,373 >> JUST JUS J TO FOLLOW OL THE 7840 05:14:07,373 --> 05:14:08,975 CONSERVATIVE MANAGEMENT 7841 05:14:08,975 --> 05:14:09,075 DI 7842 05:14:09,075 --> 05:14:10,076 USSION, TOTALLYAL AGREE BUT 7843 05:14:10,076 --> 05:14:14,147 BABA IN, AND SEND THE P TIENTHE 7844 05:14:14,147 --> 05:14:14,414 ELSEWHERE. 7845 05:14:14,414 --> 05:14:16,182 BUT I THINK WHAT WE'RE TALKING 7846 05:14:16,182 --> 05:14:17,984 ABOUT HERET EAREYRELL CALLS FORA 7847 05:14:17,984 --> 05:14:18,418 REGISTRY.RY 7848 05:14:18,418 --> 05:14:20,019 I THINK IT'S A GAA 7849 05:14:20,019 --> 05:14:24,424 OF CONSERVATSEE MANAGEMENT AST 7850 05:14:24,424 --> 05:14:26,192 YOU SAID S S THE UNITED STATES 7851 05:14:26,192 --> 05:14:30,196 ANDD OUR OUTCOMES ARE S 7852 05:14:30,196 --> 05:14:30,496 DIFFERDIT. 7853 05:14:30,496 --> 05:14:33,166 I THINK WE NEED MORE M 7854 05:14:33,166 --> 05:14:34,667 PUBLICATBLNS ON THE PATIENTS FOR 7855 05:14:34,667 --> 05:14:36,869 WHOM IT FA IS,FAND IN 7856 05:14:36,869 --> 05:14:39,706 DIFFERDICEER BETEREN SOMEBODY WO 7857 05:14:39,706 --> 05:14:44,043 S PREVIA PRO PRO KREE TA AND 7858 05:14:44,043 --> 05:14:45,378 PLACENTA STILLTI IN.LL 7859 05:14:45,378 --> 05:14:46,679 IF TIFT GETS ALL LUMPEDUM 7860 05:14:46,679 --> 05:14:48,514 TOGETHER, I I THINK T TT'S VERY 7861 05:14:48,514 --> 05:14:49,282 DIFFICULT IC KNOIC KW TO COUNSEL 7862 05:14:49,282 --> 05:14:51,584 A PATIENTENAD S SAYS I WANT MY 7863 05:14:51,584 --> 05:14:52,985 AND AFTERFT HAVG THE 7864 05:14:52,985 --> 05:14:54,654 RISK, SHE MAY N M WANT ITAN 7865 05:14:54,654 --> 05:14:55,988 IIEA SCO'S COMMENT THAT I 7866 05:14:55,988 --> 05:14:57,590 THINK WE OWE TO THE PATIENTSS TO 7867 05:14:57,590 --> 05:15:00,293 MAKE A RECOMMENDATION AS WELL, 7868 05:15:00,293 --> 05:15:00,893 AND IS IS ONE AREA WHERE I 7869 05:15:00,893 --> 05:15:02,528 THINKIN IT'S PRETTYY CHALLENGINN 7870 05:15:02,528 --> 05:15:10,336 IF YOU LOOK AKTHE DATA. 7871 05:15:10,336 --> 05:15:10,436 >> 7872 05:15:10,436 --> 05:15:11,871 SO I WANT TOOCKNOWLEDNO 7873 05:15:11,871 --> 05:15:12,772 CAUSE I'M NOT GOING TO BE IN 7874 05:15:12,772 --> 05:15:14,640 THIS WORKING GRO TOMORROWRO BUT 7875 05:15:14,640 --> 05:15:16,476 THE QEION I HAVEEOR Y IS, 7876 05:15:16,476 --> 05:15:19,579 S,ONE OFOF THE DIFFICULTIES I IU 7877 05:15:19,579 --> 05:15:23,149 WHEN YOU ASK --E HAVE ONEE E 7878 05:15:23,149 --> 05:15:23,750 WHERE IT'S READILY AVAILABLE, 7879 05:15:23,750 --> 05:15:23,850 TH 7880 05:15:23,850 --> 05:15:26,686 HAVTO B ONNITNI WE'RENOT THATTE 7881 05:15:26,686 --> 05:15:28,788 GOINGINO ND THEM, BUT THEY'RE 7882 05:15:28,788 --> 05:15:29,922 STILL HAVING TO HOLD THEIR T O.R 7883 05:15:29,922 --> 05:15:30,990 TIME. 7884 05:15:30,990 --> 05:15:33,092 SO JUSTIFICATIONTI FTIOW WE MAKM 7885 05:15:33,092 --> 05:15:36,729 RE THERE'S COMNSATION FOR F 7886 05:15:36,729 --> 05:15:37,897 THIS VALUA VEUAIME THAT WE'RE 7887 05:15:37,897 --> 05:15:39,365 BOOKING OKT THEY DON END UP 7888 05:15:39,365 --> 05:15:41,968 SENT AY. AEING BNGNG NEEDEDD ANA 7889 05:15:41,968 --> 05:15:46,506 THESE CES?ME TOE TERMSER WITH 7890 05:15:46,506 --> 05:15:50,209 THEY'RE INCREDIBLY COSTLY T 7891 05:15:50,209 --> 05:15:51,544 GYNECOLOGICHE 7892 05:15:51,544 --> 05:15:53,713 EXPERTISE WN WE'RERE ASKING TO 7893 05:15:53,713 --> 05:15:53,813 BE 7894 05:15:53,813 --> 05:15:54,280 BE T. 7895 05:15:54,280 --> 05:15:57,016 >> THAT' T EXACTLYCTCTHEEBAT 7896 05:15:57,016 --> 05:16:08,728 ERE W -- EARLY 2000,00 ACCRETA D 7897 05:16:11,497 --> 05:16:12,965 A HUGE DEBATE. 7898 05:16:12,965 --> 05:16:15,001 AT WAS ONE PRESENTATION FROM 7899 05:16:15,001 --> 05:16:19,739 JOHNS HOPKINSNDHEY ARE -- 7900 05:16:19,739 --> 05:16:21,808 DON'TN' CAL-- WANT TOO FOCUS ON 7901 05:16:21,808 --> 05:16:26,312 NCER SURGERY, SO WHAT THHA ARE 7902 05:16:26,312 --> 05:16:29,615 DOING ISIS SHIFTING, GIVING THE- 7903 05:16:29,615 --> 05:16:36,856 ED -- TEACHING THNIQUE 7904 05:16:36,856 --> 05:16:46,365 D -- TECHNIQEC, ---- THE CENTER. 7905 05:16:46,365 --> 05:16:49,135 I THINK THIS IS A BIG 7906 05:16:49,135 --> 05:16:49,669 DISCUSDION NATIONAATY. 7907 05:16:49,669 --> 05:16:50,870 I THINK DIFFE DNTFEFE HOSPITALSE 7908 05:16:50,870 --> 05:16:53,473 PROVIDING THIS IHIS DIFFERENT 7909 05:16:53,473 --> 05:16:55,875 WAYS, YOU HEHE PUBLIC 7910 05:16:55,875 --> 05:16:57,443 SURGEON WHO'S GOING TO BE TO RE 7911 05:16:57,443 --> 05:16:57,543 EV 7912 05:16:57,543 --> 05:16:58,811 IEV THEY' T JUST ONTANDBY,ND 7913 05:16:58,811 --> 05:17:00,112 BUT CLEARLY, WT DO YOU THINK 7914 05:17:00,112 --> 05:17:01,848 ABOUTABATIONAL SOLUTIONS, I 7915 05:17:01,848 --> 05:17:02,849 THINKBOUT THE SURGICAL 7916 05:17:02,849 --> 05:17:04,817 EXPERIEXCE, HOW TO COMPENSOME,OE 7917 05:17:04,817 --> 05:17:06,886 AVAILABLE I THINK NEEDS TO BE A 7918 05:17:06,886 --> 05:17:07,753 PART OFBEBE IT. 7919 05:17:07,753 --> 05:17:09,288 I HAVE A FOLLOW-UP QUESTION 7920 05:17:09,288 --> 05:17:09,789 S. T 7921 05:17:09,789 --> 05:17:13,159 MOST COMPETENT SURGEON ORO HAVTR 7922 05:17:13,159 --> 05:17:17,964 WHATEVER IT BE, GYNON GS GISTISR 7923 05:17:17,964 --> 05:17:19,065 WHATEVER PRESENT FROM THE 7924 05:17:19,065 --> 05:17:20,500 BEGINNINGI WHAT ARE THE OTHER 7925 05:17:20,500 --> 05:17:21,133 SURGEONS DOING THEN? 7926 05:17:21,133 --> 05:17:25,204 WHY ARE THEY THERE?HE 7927 05:17:25,204 --> 05:17:28,474 >> IN MY CASE, GYN ONC STANDING 7928 05:17:28,474 --> 05:17:29,942 BEHIND THE LEGS AND THEY SUPPORT 7929 05:17:29,942 --> 05:17:34,247 C-SECTIONEC AND -- - GO HIGR, 7930 05:17:34,247 --> 05:17:37,683 YEAH, GO -- AID ADHION, 7931 05:17:37,683 --> 05:17:38,417 DON'T WORRY ABOUT THAT ADHESION, 7932 05:17:38,417 --> 05:17:39,452 KIND OF NUANCE.NCNC 7933 05:17:39,452 --> 05:17:41,554 EN AFTER THE BABY IYY OUT, THEN 7934 05:17:41,554 --> 05:17:45,825 FROM THE PATIENT'S RIGHT SIDE 7935 05:17:45,825 --> 05:17:47,126 ANDAN THEN -- HYSTERECTOMY. 7936 05:17:47,126 --> 05:17:51,063 MAYBE THAT'S WHERE THE COST 7937 05:17:51,063 --> 05:17:52,565 SAVINGS SHOULD HAPPD IS THE 7938 05:17:52,565 --> 05:17:53,866 OTHER SURONS DON'T NEED TO BE 7939 05:17:53,866 --> 05:17:54,133 TH 7940 05:17:54,133 --> 05:17:54,166 >> 7941 05:17:54,166 --> 05:17:58,838 I AGREE WGRHH GEORGE, ALL 7942 05:17:58,838 --> 05:18:06,846 GYNONICS GGYNONCOLOGISTS D CESAN 7943 05:18:06,846 --> 05:18:14,854 SO THESO DONSO NEED TO BE THERE. 7944 05:18:14,854 --> 05:18:22,495 >> DANIEL -- I HAVE TOOME BACK 7945 05:18:22,495 --> 05:18:34,974 SHIFT FOR US.K IS AN IORTANT PAG 7946 05:18:35,708 --> 05:18:37,310 I TNK T IT'S HARD TO IGNORE ONOO 7947 05:18:37,310 --> 05:18:38,611 REFUSE, I THINK THEARDEST PART 7948 05:18:38,611 --> 05:18:38,711 AS 7949 05:18:38,711 --> 05:18:40,413 OU'VEAID IS MANAGINAN THESE 7950 05:18:40,413 --> 05:18:41,814 PATIENTSEELS LIKE THE E LD, 7951 05:18:41,814 --> 05:18:43,783 WILD WESLD. 7952 05:18:43,783 --> 05:18:44,984 THERE'THA LOT OF DESCRIPTION OUT 7953 05:18:44,984 --> 05:18:46,619 THERE, THERE'S NOT REALLY ANY 7954 05:18:46,619 --> 05:18:50,323 EVIDENCEIDASEDIDED GUIDELINES, D 7955 05:18:50,323 --> 05:18:50,423 LO 7956 05:18:50,423 --> 05:18:51,190 , YOUR COUNTRY, YOU HAVE 7957 05:18:51,190 --> 05:18:51,290 BE 7958 05:18:51,290 --> 05:18:53,159 SO HELPF H IN GIVING USG THE 7959 05:18:53,159 --> 05:18:54,660 DECADESCA WORTH OF DA O, BUT ARE 7960 05:18:54,660 --> 05:18:57,630 YOU HONINGG IN ONATIE 7961 05:18:57,630 --> 05:18:58,731 FFERENCES ANDS ANAGEMANT 7962 05:18:58,731 --> 05:19:01,367 DIFFERENCES AND WHO NEEDS 7963 05:19:01,367 --> 05:19:03,869 EMBOLIZATION, WHO CAN BEAFELY 7964 05:19:03,869 --> 05:19:07,473 ONCE ION A WHILE, WHOAN ORTSLE 7965 05:19:07,473 --> 05:19:08,708 SHOU BE INSTRUMENTEDMET SOME 7966 05:19:08,708 --> 05:19:11,410 POINT POR THE PLANTA, THESE 7967 05:19:11,410 --> 05:19:12,912 ARE ALLE REALLY IMPORTANT THINS 7968 05:19:12,912 --> 05:19:14,780 TO HAVE A HANDLE ON AND I 7969 05:19:14,780 --> 05:19:15,982 JUST WONDERONHEREREE'RE AT WITH 7970 05:19:15,982 --> 05:19:16,649 UNDERSTANDING IT. 7971 05:19:16,649 --> 05:19:19,819 >> Y, THANKK YOU FOR YOUR 7972 05:19:19,819 --> 05:19:21,454 ESTION. 7973 05:19:21,454 --> 05:19:22,755 I GIVE SE DETAILS AAIUT ALL 7974 05:19:22,755 --> 05:19:24,857 DETAILS OF CONSERVATIVE 7975 05:19:24,857 --> 05:19:29,528 MANAGEMENT, WE HAVE NOT ED ASOU 7976 05:19:29,528 --> 05:19:30,196 DO IT'S IT'OSSIBLE TO RESPOND TO 7977 05:19:30,196 --> 05:19:31,297 ALL THE QUESTIONSST THAT'S WHY I 7978 05:19:31,297 --> 05:19:36,202 DO NOT BELIEVE IN RCT FOR FOR AL 7979 05:19:36,202 --> 05:19:41,474 BECAUSE WE -- TOSE OXYTOCINCI R 7980 05:19:41,474 --> 05:19:45,277 -- FOR THE DURATION -- FOR 7981 05:19:45,277 --> 05:19:50,583 IMPOSSIBLE. FST -- IT'SS 7982 05:19:50,583 --> 05:19:54,687 .SO I SONGLY BELIEVE THAT GOOD 7983 05:19:54,687 --> 05:19:56,522 OSPECTIVE --E ESTABLISH -LISH 7984 05:19:56,522 --> 05:19:56,622 WO 7985 05:19:56,622 --> 05:19:58,124 D BEE INTERESTINGESO TRY T 7986 05:19:58,124 --> 05:19:59,892 OHEHEHE DIFFERENT 7987 05:19:59,892 --> 05:20:02,061 NTQUESTIONS.S. 7988 05:20:02,061 --> 05:20:07,833 VE NO -- RESPONSE.NS 7989 05:20:07,833 --> 05:20:08,668 CLEAR RESPONSES 7990 05:20:08,668 --> 05:20:11,003 >> ALL THE TIMESIM BUT I KNOW K 7991 05:20:11,003 --> 05:20:19,679 DO LIKEEE THAT AND SOMETIMES I Y 7992 05:20:19,679 --> 05:20:20,880 TO NOT DIRECT THAT FOR MORE 7993 05:20:20,880 --> 05:20:25,685 CASES CATH NO MRH A IF YOUU HAV 7994 05:20:25,685 --> 05:20:27,720 SOMESO TROUBLES AND IAN-- YOU HE 7995 05:20:27,720 --> 05:20:31,057 SEEN, WE DO NOT PERFORM -- SOME 7996 05:20:31,057 --> 05:20:33,459 DINGSO IT'S VERY DIFFICULT 7997 05:20:33,459 --> 05:20:38,264 TO CHANGE CULTURE OF A TEAM SO 7998 05:20:38,264 --> 05:20:41,333 THAT'S WHY BELIEVE THAT 7999 05:20:41,333 --> 05:20:42,001 PROSPECTIVE -- WOULD BE B 8000 05:20:42,001 --> 05:20:43,302 INTERESTING ANDUST RESPONDES 8001 05:20:43,302 --> 05:20:46,672 TO KARIN, THE T CLINICAL SITUATI 8002 05:20:46,672 --> 05:20:48,741 IS VERY DFICULT, VERY V 8003 05:20:48,741 --> 05:20:50,810 DIFFERENT BETWEEN THE FST TWO 8004 05:20:50,810 --> 05:20:52,211 WEEKS, THE FIRST TWO WEEKS YOU 8005 05:20:52,211 --> 05:20:53,779 CAN HAVN MASSIVEVE BLEEDINGS AND 8006 05:20:53,779 --> 05:20:56,615 TO PERFORMURGERY EMERGENCY ATT 8007 05:20:56,615 --> 05:20:59,819 TWOTWO HOURS -- WEEKEND.KE 8008 05:20:59,819 --> 05:21:01,020 BUT AFBUR AFE FIRST TWO WEEKS, 8009 05:21:01,020 --> 05:21:03,856 IT'S MORE LITTLE IECTIONS TIS 8010 05:21:03,856 --> 05:21:06,826 SMALL -- - OR -- IT'SS NOT 8011 05:21:06,826 --> 05:21:07,426 MASSIVE BLIVDING SO YOU HYOE 8012 05:21:07,426 --> 05:21:07,526 MO 8013 05:21:07,526 --> 05:21:10,696 TIME TO TORGIZEE TO PLANO 8014 05:21:10,696 --> 05:21:11,030 RATIONS. 8015 05:21:11,030 --> 05:21:14,667 IT'S NOT THE SAM CLINICALL 8016 05:21:14,667 --> 05:21:18,471 SITUATIOTUATIO 8017 05:21:18,471 --> 05:21:20,973 I THINK ALL OF YOU IN THEN 8018 05:21:20,973 --> 05:21:21,774 AVE TO BE PREPA PD TO 8019 05:21:21,774 --> 05:21:22,641 ART OFFERING THIS. T 8020 05:21:22,641 --> 05:21:24,477 MANYMANY WOMEN NOW ARE AWARE OF. 8021 05:21:24,477 --> 05:21:27,446 I ASSURE YOU THATOW WE' 8022 05:21:27,446 --> 05:21:32,685 DOING ONENE TO TWO EVERY WEEK, D 8023 05:21:32,685 --> 05:21:33,352 O US-- WOMEN ARE COMING T 8024 05:21:33,352 --> 05:21:34,720 BECAUSBE THEY ARE REFUSING WHAT 8025 05:21:34,720 --> 05:21:40,092 I HAVE PATIENTS OM ALL OF THEN . 8026 05:21:40,092 --> 05:21:41,794 NOT ONLY FROM TEXAS T 8027 05:21:41,794 --> 05:21:44,730 I GET EMAILS EVERY ETHER DAY,, 8028 05:21:44,730 --> 05:21:50,636 ECES, SHEENT ME -- SAYINGVE 8029 05:21:50,636 --> 05:21:51,937 MY -- WANT TO DO D ONL 8030 05:21:51,937 --> 05:21:54,273 THIS IS THE ONLY OPTION.. 8031 05:21:54,273 --> 05:21:56,342 SO THIS IS BECOMING VERY COM COC 8032 05:21:56,342 --> 05:21:58,544 YOU ED TO PPARE,PA MANY WOMEN 8033 05:21:58,544 --> 05:22:00,246 NOW ARERE RLIZING THIS IS AN 8034 05:22:00,246 --> 05:22:01,046 TIONND THEY'RE GOING TO 8035 05:22:01,046 --> 05:22:04,550 DEMAND IT. 8036 05:22:04,550 --> 05:22:06,719 -HEN THEY DO T ULTRA UUND 8037 05:22:06,719 --> 05:22:11,090 ON THE TATIENT. 8038 05:22:11,090 --> 05:22:13,192 THE LASTE PATIENT -- NTMILY -- 8039 05:22:13,192 --> 05:22:16,996 REFUSED FU LET US DO I.. 8040 05:22:16,996 --> 05:22:18,631 WHETHER IT IS I A ACCRETA OR NO, 8041 05:22:18,631 --> 05:22:19,198 THAT WAS THE OPTION. 8042 05:22:19,198 --> 05:22:23,936 SO WE NEED TEEO START PRERING 8043 05:22:23,936 --> 05:22:24,203 FOR IT. 8044 05:22:24,203 --> 05:22:26,872 >> CAN YOU COMMENT, THOUG T ON 8045 05:22:26,872 --> 05:22:28,941 MEASURES A PATIENT EXPERIEXPE 8046 05:22:28,941 --> 05:22:30,843 AFTER AS WELL, BECAUSE I THINK 8047 05:22:30,843 --> 05:22:32,444 THAT'S KEY PIECE. 8048 05:22:32,444 --> 05:22:34,113 EE MEDICALUTCOMESS 8049 05:22:34,113 --> 05:22:35,815 IMPORTANT AND THATHASHANE AS 8050 05:22:35,815 --> 05:22:44,957 WELL.WE 8051 05:22:44,957 --> 05:22:49,195 >> --HE ONE W O CUT THEIRUTERUT 8052 05:22:49,195 --> 05:22:49,528 AGN. 8053 05:22:49,528 --> 05:22:50,529 THEY LTHVE THE HOSPITAL, 8054 05:22:50,529 --> 05:22:53,399 ME OF THEM,THHEY COME BACK 8055 05:22:53,399 --> 05:22:54,200 BLEEDING.EE 8056 05:22:54,200 --> 05:22:56,702 THE BIGGEST --T FT THEM IS THE 8057 05:22:56,702 --> 05:22:57,036 SCHARGE. 8058 05:22:57,036 --> 05:22:59,038 E.SOME OF THEM SAY I HE THE 8059 05:22:59,038 --> 05:22:59,905 SMELL OF DISCHARIS THAT'S 8060 05:22:59,905 --> 05:23:00,239 MING. 8061 05:23:00,239 --> 05:23:01,640 .SOME OF THEM, THEY TON'T HAVE 8062 05:23:01,640 --> 05:23:02,107 ANYTHING. 8063 05:23:02,107 --> 05:23:04,076 IT'S GOINGO VARYASED ON OLLLL 8064 05:23:04,076 --> 05:23:06,011 OF IT. I I 8065 05:23:06,011 --> 05:23:08,647 NOW, DO IO HAVE H ENOUGH NUMBERO 8066 05:23:08,647 --> 05:23:11,684 SAY I -- EXPERIENCE RIGHTHT NOW 8067 05:23:11,684 --> 05:23:13,919 SO AS WE'RE WOLRECTING DATA, D 8068 05:23:13,919 --> 05:23:14,787 WE'LL START TO T COLLECT ALLF 8069 05:23:14,787 --> 05:23:19,124 >>T WANT TANO T FOLLOW ULO ON 8070 05:23:19,124 --> 05:23:21,060 THIS. 8071 05:23:21,060 --> 05:23:24,029 SO WE'REALKING ABOUT I IN 8072 05:23:24,029 --> 05:23:25,664 DIFFERENT WAYS OF DOI IT BY 8073 05:23:25,664 --> 05:23:29,268 DIERENTT CENTERS AND CONTINUETI 8074 05:23:29,268 --> 05:23:29,835 ING ATOU'RE US'R TO IN 8075 05:23:29,835 --> 05:23:32,438 YOUR CENTEREN OR WE'LL SEE WHA 8076 05:23:32,438 --> 05:23:36,041 THE PATIENT WANTS OR THE 8077 05:23:36,041 --> 05:23:38,978 IMMIGRATION ISSUE IS DETERMINING 8078 05:23:38,978 --> 05:23:39,178 THIS. 8079 05:23:39,178 --> 05:23:42,081 I DON'T THIT THIS SHOULD BE THEE 8080 05:23:42,081 --> 05:23:45,217 WAY WE PRACTICE MEDICINE. 8081 05:23:45,217 --> 05:23:47,853 BECAUSE IF IE BELIEVE WHATT YOU 8082 05:23:47,853 --> 05:23:49,688 SAID THAT THIS IS LESS MORBID 8083 05:23:49,688 --> 05:23:51,190 THAN THE HYSTERECTOMY, THEN WE 8084 05:23:51,190 --> 05:23:53,158 SHOULD PROVE THAT. 8085 05:23:53,158 --> 05:23:56,695 NOT JUST SAY,H, IT INDSNDSON TI 8086 05:23:56,695 --> 05:23:59,298 DISCUSSION.THIS IS AS WONDERFUL 8087 05:23:59,298 --> 05:24:01,267 YOU'RE GOING TOE ALLLL TOGETHER 8088 05:24:01,267 --> 05:24:06,272 ANDITH FEW OTHERS, SO YOU CGROUP 8089 05:24:06,272 --> 05:24:08,107 CONTUE THAT AFTER. 8090 05:24:08,107 --> 05:24:15,080 THANK YOU, DR. HOBSON,OBOON, 8091 05:24:15,080 --> 05:24:16,115 >> I ALSO THINK THAKWASK A 8092 05:24:16,115 --> 05:24:18,751 NTASTIC SEG NA OUR NEXT 8093 05:24:18,751 --> 05:24:19,151 N 4. 8094 05:24:19,151 --> 05:24:20,686 WE ARE GOING TO BE SKIPPING THE 8095 05:24:20,686 --> 05:24:21,854 BREAK, SO IF ANYBODYBO DOES NSD 8096 05:24:21,854 --> 05:24:23,489 TO TAKE TAK AAK, PLEASE FEELL 8097 05:24:23,489 --> 05:24:25,891 FREE TO DO SO. 8098 05:24:25,891 --> 05:24:27,726 SOESSION 4 IS GOING TO BE 8099 05:24:27,726 --> 05:24:29,094 MODERATED BY DR. CARUSI, 8100 05:24:29,094 --> 05:24:30,129 EAKING OF W OT THE PATIENTS 8101 05:24:30,129 --> 05:24:31,864 LY WAN WANANE'RERE REALLYEA 8102 05:24:31,864 --> 05:24:32,598 HONORED TODAY TO HAVE THE 8103 05:24:32,598 --> 05:24:34,767 PATIENTEN PERSPECTIVE GIVEN TO S 8104 05:24:34,767 --> 05:24:36,735 KRISTIN TERLY SEE FOR THE 8105 05:24:36,735 --> 05:24:38,070 NATIONALON ACCRETA FRENDATION. 8106 05:24:38,070 --> 05:24:40,906 THANK YOU SO MUCH FORH COMING. 8107 05:24:40,906 --> 05:24:41,006 KR 8108 05:24:41,006 --> 05:24:51,250 N TERLIZZI.LI 8109 05:25:16,275 --> 05:25:18,410 >> SO MY TALK IS GSNG TO BE 8110 05:25:18,410 --> 05:25:19,345 MORE RELEVANT TODAY THAN I EVENE 8111 05:25:19,345 --> 05:25:20,980 EXPECTED. 8112 05:25:20,980 --> 05:25:22,548 I'MRISTINERLIZZI,I,NDI,ND I'M 8113 05:25:22,548 --> 05:25:26,852 O TALK TO T YOU ABO THE 8114 05:25:26,852 --> 05:25:30,189 TIENTT EXPERIENCE OF PLACENTA 8115 05:25:30,189 --> 05:25:31,323 ETA SPETA UM.. 8116 05:25:31,323 --> 05:25:31,924 RIEXCED PLACENTA ACCRETA 8117 05:25:31,924 --> 05:25:32,024 IN 8118 05:25:32,024 --> 05:25:33,826 MY SECOND PREGNANCY.CY 8119 05:25:33,826 --> 05:25:37,096 TODAY WITH AWIUOTE.UO MY TT MYT 8120 05:25:37,096 --> 05:25:39,298 ANDANDT'AN A QUOTE FROMRONE 8121 05:25:39,298 --> 05:25:39,932 BROWN. 8122 05:25:39,932 --> 05:25:41,567 WHAT ELSE IS A STORY SIF NOT N 8123 05:25:41,567 --> 05:25:45,938 DATA WITTA A SOUL?I AM A CHAMPIT 8124 05:25:45,938 --> 05:25:47,673 STORIES, AND THE DATA THAT THEY 8125 05:25:47,673 --> 05:25:51,143 AND AS CO-FOUNDEFOF NATIONAAT 8126 05:25:51,143 --> 05:25:52,211 ACCRETA FOUNDATIOND I'VE HEARDEA 8127 05:25:52,211 --> 05:25:53,545 HUNDREDS OF ORIES.OR 8128 05:25:53,545 --> 05:25:55,080 I SPENT THE PAS SEVEN YEARS OR 8129 05:25:55,080 --> 05:25:57,916 AT THIS COLLECTOR, THIS 8130 05:25:57,916 --> 05:25:59,685 CURATOR OF ACCRE A PIENT 8131 05:25:59,685 --> 05:26:00,219 ORIES. 8132 05:26:00,219 --> 05:26:02,187 ANDD PATIENT STOESTO HAVE AEE WY 8133 05:26:02,187 --> 05:26:03,956 GETTINGNG US NEW INSIGHTS. 8134 05:26:03,956 --> 05:26:05,691 THEY CAN HELAN US TO SEE ASPECTS 8135 05:26:05,691 --> 05:26:07,126 OF CARE THAT MAYBE M WE DIDN'TID 8136 05:26:07,126 --> 05:26:10,295 REALIZE OR NOTICE BEFORE. 8137 05:26:10,295 --> 05:26:10,396 AN 8138 05:26:10,396 --> 05:26:13,265 FOR US THINGS THAT WE MAY 8139 05:26:13,265 --> 05:26:14,733 ALREADY KNOW, BUT WE C'T QUI'T 8140 05:26:14,733 --> 05:26:16,702 FIND THE WORDS W W FOR.OR 8141 05:26:16,702 --> 05:26:18,670 I'VE FOUND WHENE SPEAK IN AKE 8142 05:26:18,670 --> 05:26:20,639 LANGUAGE OF PATIENT STORIES, WE 8143 05:26:20,639 --> 05:26:22,408 ARE AAR OF SUDDEN ARMEDRM WITH 8144 05:26:22,408 --> 05:26:24,443 THESE SPECIFICC EXAMPLES AND 8145 05:26:24,443 --> 05:26:26,912 ILLUSTRATIONS OF DATA. 8146 05:26:26,912 --> 05:26:28,747 AND WHEN THAT HAPPENS, O 8147 05:26:28,747 --> 05:26:31,917 UNRSTAING GAINS A DEPTH D TO 8148 05:26:31,917 --> 05:26:34,586 A NUMBER OR SR TISTIC 8149 05:26:34,586 --> 05:26:35,821 DOESN'TESN' CESRY ASSS EASILY OS 8150 05:26:35,821 --> 05:26:38,791 MY STU OF PATIENT STORIESTO 8151 05:26:38,791 --> 05:26:40,092 I'VE NOTICED THAT T SOME WAYS, 8152 05:26:40,092 --> 05:26:42,294 ONE PATIENTAT STORYAN 8153 05:26:42,294 --> 05:26:46,298 T'S STORY.LTLY BE ERY 8154 05:26:46,298 --> 05:26:50,135 CARRYCAY THE SOUL O MANY. 8155 05:26:50,135 --> 05:26:55,607 ANDD I'MLWAYS STRUCKTR HOW HISOA 8156 05:26:55,607 --> 05:26:57,242 PREGNAPRY FEELS, YET HOWOW 8157 05:26:57,242 --> 05:26:58,544 UNERSAANDONSISTENT SOT MANY 8158 05:26:58,544 --> 05:27:02,748 DEITE CETY DIFRENT ARE.RERE 8159 05:27:02,748 --> 05:27:04,283 CLINICAL CASES. 8160 05:27:04,283 --> 05:27:07,219 THISTH FASCINATES ME. 8161 05:27:07,219 --> 05:27:09,621 D I HOPEOP IF ITE DOESN'TLREADYY 8162 05:27:09,621 --> 05:27:10,222 Y ATE END OF THAT TLK, 8163 05:27:10,222 --> 05:27:13,025 THAT ITASCINATES YOUOO.OO 8164 05:27:13,025 --> 05:27:13,125 SO 8165 05:27:13,125 --> 05:27:14,460 THE YEARS SINCE I'VE 8166 05:27:14,460 --> 05:27:16,462 EXPEENCECE PCENTA ACCRETA, I 8167 05:27:16,462 --> 05:27:17,029 SHAREDSHARSTORY A LOT. 8168 05:27:17,029 --> 05:27:18,230 KE A LOT. 8169 05:27:18,230 --> 05:27:20,532 AND THAT'S ME STANDING ON MY O O 8170 05:27:20,532 --> 05:27:21,967 PEONALOUNTAIN BECNSE ITTT 8171 05:27:21,967 --> 05:27:23,602 FEELS LIKES LIT SOMETIMES,IM 8172 05:27:23,602 --> 05:27:25,704 G OUTHERE'S'S THIS THING T 8173 05:27:25,704 --> 05:27:27,439 CALLED PAS AND IT'S A DEAL! 8174 05:27:27,439 --> 05:27:28,240 RIGHT? 8175 05:27:28,240 --> 05:27:31,343 AND I'MOING TO KEEPO ELLINGY 8176 05:27:31,343 --> 05:27:32,744 STORY UNTIL WE REACH RY GL, 8177 05:27:32,744 --> 05:27:34,279 WHICH IS FOR F ACCRETACCARE AND 8178 05:27:34,279 --> 05:27:37,116 PERIENCE TO ADVANCE SO MUCH 8179 05:27:37,116 --> 05:27:38,150 THAT MY STORY IS NO N N LONGEIS 8180 05:27:38,150 --> 05:27:41,420 RELEVANT.VA 8181 05:27:41,420 --> 05:27:42,855 SO I HOPEOP THAT T HEARING MY SY 8182 05:27:42,855 --> 05:27:45,090 TO GROUNDDDOUN W WE 8183 05:27:45,090 --> 05:27:45,624 AREAR HERE. H 8184 05:27:45,624 --> 05:27:47,025 ANDANHEAN WORK TORK W NEED TO D. 8185 05:27:47,025 --> 05:27:50,729 OF THE HUMAN ASPECT OF THIS HY 8186 05:27:50,729 --> 05:27:55,534 WORK, A THE MOST IMPORTANT PAR 8187 05:27:55,534 --> 05:27:57,703 PATIENT STORIESP RECONFIRM 8188 05:27:57,703 --> 05:27:58,403 YOUOW IORTANT THIS WORK 8189 05:27:58,403 --> 05:28:01,507 AND THE T TREMENDOUS IMPACT 8190 05:28:01,507 --> 05:28:02,174 THAT YOUATAVE.AV 8191 05:28:02,174 --> 05:28:06,145 ALONG WITIT ME ON PATNTYOU Y 8192 05:28:06,145 --> 05:28:07,112 EXPERIENCE JOURNEY. 8193 05:28:07,112 --> 05:28:08,213 I'M GOING TO TAKE YOU Y YHROUGH 8194 05:28:08,213 --> 05:28:10,249 SOME OMY STORY WITH PLACENTA 8195 05:28:10,249 --> 05:28:11,517 ACCRETA, AND I A AOEO 8196 05:28:11,517 --> 05:28:13,418 BRING IN SE OF THE WORDS AND 8197 05:28:13,418 --> 05:28:16,054 OF OTH WOMEN WHO'VE 8198 05:28:16,054 --> 05:28:17,389 EXPERIENCED IT AS WELL.L. 8199 05:28:17,389 --> 05:28:20,993 I'LL SRT MY STORYTO AT ONE OF MY 8200 05:28:20,993 --> 05:28:24,129 SO USUALLY, MY ULTRASOUNDT 8201 05:28:24,129 --> 05:28:25,097 APPOINTMENTS HAD BEEN HAPPY. 8202 05:28:25,097 --> 05:28:26,431 DOCTORS WOULD W SAY THINGSS LIK, 8203 05:28:26,431 --> 05:28:26,598 LO 8204 05:28:26,598 --> 05:28:28,367 T THAT CE NOSE,ND 8205 05:28:28,367 --> 05:28:30,102 POINT TO THESE PICTURES THAT 8206 05:28:30,102 --> 05:28:31,170 STLY I CLYLD NEVER REALLY 8207 05:28:31,170 --> 05:28:31,270 UN 8208 05:28:31,270 --> 05:28:33,338 RSTAND.TA 8209 05:28:33,338 --> 05:28:36,575 BUT NOWAT MYY 30-WEEK 8210 05:28:36,575 --> 05:28:37,376 APINTMT AT A NEW PRACTICE, 8211 05:28:37,376 --> 05:28:37,476 NO 8212 05:28:37,476 --> 05:28:38,310 NE WASAS SAYING ANYTHING LIKE L 8213 05:28:38,310 --> 05:28:39,411 THAT 8214 05:28:39,411 --> 05:28:42,181 AND IN FAC MOST M OF MY 8215 05:28:42,181 --> 05:28:42,748 OUTR WASN'T EVEN SPENT 8216 05:28:42,748 --> 05:28:43,815 OKING OK MY BABY. B 8217 05:28:43,815 --> 05:28:47,419 IT WAS SPENT HOVERING OVERVE THT 8218 05:28:47,419 --> 05:28:49,087 THEY TELL ME TL T IT LT KS L 8219 05:28:49,087 --> 05:28:50,055 LIKE MY PLACENTA HAS GROWN 8220 05:28:50,055 --> 05:28:53,559 AND PROBABLY YOUR BLADDERER TOO, 8221 05:28:53,559 --> 05:28:54,860 THEY ADDED. 8222 05:28:54,860 --> 05:28:55,827 I HADI NOWN AUT T UTERUS 8223 05:28:55,827 --> 05:28:59,665 PART FOR A FEWAYS,S, BUT THE 8224 05:28:59,665 --> 05:29:03,402 AND THAT WAS SOMETHINGET BEGANIT 8225 05:29:03,402 --> 05:29:04,403 WONDERING ABOUT 10 MINUTESIN 8226 05:29:04,403 --> 05:29:06,371 EARLIEEAINHE APPNTMENT, WHE 8227 05:29:06,371 --> 05:29:08,807 THE COMPLETELYELILENT ULTRASOUND 8228 05:29:08,807 --> 05:29:10,776 TECH WAS SPENDINPEINPE WAY TOO G 8229 05:29:10,776 --> 05:29:12,311 GOING BACK AND FORTHVER MY 8230 05:29:12,311 --> 05:29:12,411 BL 8231 05:29:12,411 --> 05:29:12,611 DER. 8232 05:29:12,611 --> 05:29:23,021 AND SO THEY TOLD MEO COME IN 8233 05:29:28,093 --> 05:29:30,429 FULL F BER. OINTMENT THAT DAY D 8234 05:29:30,429 --> 05:29:31,730 SOMETHING THINTH MY M PRE PS 8235 05:29:31,730 --> 05:29:33,398 PRACTICE HAD NEVER TOLD ME TO 8236 05:29:33,398 --> 05:29:34,199 Y THE WAY. 8237 05:29:34,199 --> 05:29:35,767 AND I'M A VERYER COMIANT 8238 05:29:35,767 --> 05:29:37,502 PATIENT, SO I DRANK THISIKE 8239 05:29:37,502 --> 05:29:39,071 ORMOUS COFFEE ON THE WAY 8240 05:29:39,071 --> 05:29:39,638 THERE.TH 8241 05:29:39,638 --> 05:29:41,373 D I CAN TELL YOUOU THATHA IT' 8242 05:29:41,373 --> 05:29:43,775 ONFUSION TODD OUT THAT 8243 05:29:43,775 --> 05:29:46,645 MY BLADDER, DDE ONLY ONE I IET, 8244 05:29:46,645 --> 05:29:49,615 ALTHOUGH AT THE MOMEN MOMT 8245 05:29:49,615 --> 05:29:56,989 BECAUSE WHILE I'M PCE PING ALL 8246 05:29:56,989 --> 05:29:59,424 OF THISNFORMATION, I ALSI WAS 8247 05:29:59,424 --> 05:30:00,292 HOLDING MY BREATH BECAUSE I HAD 8248 05:30:00,292 --> 05:30:00,392 ADTO 8249 05:30:00,392 --> 05:30:01,960 EEO BAD BAD FADM THATT ENORMOUS 8250 05:30:01,960 --> 05:30:03,729 COFFEE... 8251 05:30:03,729 --> 05:30:05,897 SO THEY SWHECH THE ULTRASOUND 8252 05:30:05,897 --> 05:30:07,866 INTO VASCU VRITY MODE, A A NOW 8253 05:30:07,866 --> 05:30:10,135 IT LOOKS LIKE A WEATHEREREPORT. 8254 05:30:10,135 --> 05:30:12,037 AND ITT DOESN D RLLY MATTER 8255 05:30:12,037 --> 05:30:13,672 I DON'T KNOW HOW TO 8256 05:30:13,672 --> 05:30:16,008 AD IT BECAUSE LOGIC AND 8257 05:30:16,008 --> 05:30:18,210 CONTEXT ARE REALLYLL ALLLL IT TS 8258 05:30:18,210 --> 05:30:18,744 TO THINK THANKALL OFALHESE 8259 05:30:18,744 --> 05:30:20,512 BRIGHTLYOLORED ILLUMINATIONS 8260 05:30:20,512 --> 05:30:21,480 TWISTITW AROUNDRONTO WHAT I CAN 8261 05:30:21,480 --> 05:30:24,950 BLADDER, THAT IHAS NOT A N G ADD 8262 05:30:24,950 --> 05:30:26,485 THING.TH 8263 05:30:26,485 --> 05:30:27,786 AND THESE ARERE ALL THINGS I'VEE 8264 05:30:27,786 --> 05:30:29,421 BEENBE SURING THE INTERNET OVER 8265 05:30:29,421 --> 05:30:31,523 S WEEK. 8266 05:30:31,523 --> 05:30:32,724 MY PVIOUS PRACTICE IICIC 8267 05:30:32,724 --> 05:30:33,992 DIAGNOSED ME WITH PLACENTA 8268 05:30:33,992 --> 05:30:36,495 PREVIA AT MYA ANAMY ULTRASOLTD, 8269 05:30:36,495 --> 05:30:37,663 I HAD LEARNED ORN THEI 8270 05:30:37,663 --> 05:30:39,398 KIPEDIA PAGE, YESON THEHE 8271 05:30:39,398 --> 05:30:41,166 WIKIPEWIA PAGE, YOU GUYSUY LOVE 8272 05:30:41,166 --> 05:30:43,735 THAT, RIGHT, WHE, PATIENTS GO TO 8273 05:30:43,735 --> 05:30:54,446 WIKIPEDIA, -->> I THINK WE LOST. 8274 05:31:00,218 --> 05:31:01,787 >> ALL THE ELECTROLECS ARE 8275 05:31:01,787 --> 05:31:06,725 FAILG. 8276 05:31:06,725 --> 05:31:08,627 I LEARNED TT PLACENTA PREVIA 8277 05:31:08,627 --> 05:31:10,796 PLUS A PRIOR CESAREAN CAN BE THE 8278 05:31:10,796 --> 05:31:12,964 PEECT STORM FOR A SEVE 8279 05:31:12,964 --> 05:31:13,565 COMPLICATILI THAT I HAD NEVER 8280 05:31:13,565 --> 05:31:14,833 HEARD OF CALD PLACD TA 8281 05:31:14,833 --> 05:31:16,902 ACCRETA. 8282 05:31:16,902 --> 05:31:20,472 MY PRACTICE ABOUT THAT AND THEY 8283 05:31:20,472 --> 05:31:21,473 SAID, OH, NO, NO, YOU'RE GOING 8284 05:31:21,473 --> 05:31:22,074 TO BE FINEIN 8285 05:31:22,074 --> 05:31:22,107 TH 8286 05:31:22,107 --> 05:31:23,909 SAID THED WOMENOM WHO GET 8287 05:31:23,909 --> 05:31:24,843 THAT, THEY'VTHHAD LIKE MANY, 8288 05:31:24,843 --> 05:31:25,711 MANY, MANY C-SECTIONS. 8289 05:31:25,711 --> 05:31:28,747 EY SAID YOUDE ONLYNL HAD ONE 8290 05:31:28,747 --> 05:31:29,348 C-SECTC-N, YOU'R YGOING TO BE 8291 05:31:29,348 --> 05:31:29,581 FINE. 8292 05:31:29,581 --> 05:31:30,916 AND THEDT ON TREATINGAT ME 8293 05:31:30,916 --> 05:31:33,318 LIKELIKE A RTINE PREGNANRE FOROR 8294 05:31:33,318 --> 05:31:35,320 ANOTHER TWO M TTHS OFTHS FLAGS 8295 05:31:35,320 --> 05:31:35,420 UN 8296 05:31:35,420 --> 05:31:36,988 L I GOT CONCERNEDED ENOUGH TO T 8297 05:31:36,988 --> 05:31:39,157 MAKE MY OWN SECONDEC OPINIONPI 8298 05:31:39,157 --> 05:31:42,561 HOSPHO -- OH OR APPOINTMENT.TM 8299 05:31:42,561 --> 05:31:44,229 SO AT THIPOINININ THE 8300 05:31:44,229 --> 05:31:45,430 APPOINTMENT, DOCTORS ARE STILLLL 8301 05:31:45,430 --> 05:31:45,530 TA 8302 05:31:45,530 --> 05:31:47,699 ING, I'M JUS'M CATCHING 8303 05:31:47,699 --> 05:31:48,867 SNPPETS OF INFORMATION,ON 8304 05:31:48,867 --> 05:31:49,968 ADMITTEDLYTTROBABLRO THE WORST 8305 05:31:49,968 --> 05:31:51,036 ES. 8306 05:31:51,036 --> 05:31:55,307 HEAR 99% CHANCEHA OF MASSIVE 8307 05:31:55,307 --> 05:31:56,274 HEMORRHAGE AND HYSTERECTOMRE 8308 05:31:56,274 --> 05:32:02,981 I HR 9R CNCE OF ICU TIME TN 8309 05:32:02,981 --> 05:32:03,315 ILATOR. 8310 05:32:03,315 --> 05:32:04,616 I DON'T WN'T TO DIE FROM 8311 05:32:04,616 --> 05:32:05,283 CHILDBIRTH. 8312 05:32:05,283 --> 05:32:09,454 OUNDS LIKEE SOMEE 19TH9T 8313 05:32:09,454 --> 05:32:11,223 CENTURYNT OREGON TRAIL TYPE OF 8314 05:32:11,223 --> 05:32:11,323 FDE 8315 05:32:11,323 --> 05:32:13,291 F A LIVE IN I 8316 05:32:13,291 --> 05:32:13,625 SAN FRANCISCO. 8317 05:32:13,625 --> 05:32:14,526 I HAVE GAT HEALTHCARE. 8318 05:32:14,526 --> 05:32:16,895 I TAKE PRENATALL VITAMINS. 8319 05:32:16,895 --> 05:32:17,863 I FLOSS ALMOST EVET E DAY. 8320 05:32:17,863 --> 05:32:20,399 I HAV BEEN DOING D ERYTHG 8321 05:32:20,399 --> 05:32:22,367 THAT I AM SUPSED TO DO. 8322 05:32:22,367 --> 05:32:24,536 AND SO AT THIS POINT, TNTRE'S'S 8323 05:32:24,536 --> 05:32:26,471 TEARSTREAMINGGOWN MY FES 8324 05:32:26,471 --> 05:32:27,773 JUSTHIINGINBOUT HOW MUCH 8325 05:32:27,773 --> 05:32:31,009 GI HAVEE TE LOSE.OSOS 8326 05:32:31,009 --> 05:32:32,010 ERE'SE'LL THIS SWEAT 8327 05:32:32,010 --> 05:32:32,110 PO 8328 05:32:32,110 --> 05:32:37,149 CK PLUS PAPERAP BEDED COV THAT'S 8329 05:32:37,149 --> 05:32:39,184 MAKING ALLLLFLLHIS WORSE. 8330 05:32:39,184 --> 05:32:40,786 WHAT AWHI SUPPOSEDPPO DO? D 8331 05:32:40,786 --> 05:32:43,088 SO FOR THEEN LIKEYSELF WHO 8332 05:32:43,088 --> 05:32:47,192 ARE LUCKY ENOUGH T BEE DIAGNOSI, 8333 05:32:47,192 --> 05:32:48,727 HOW DO WE LEA TOOPE WH 8334 05:32:48,727 --> 05:32:52,964 THIS DIAGNOSIS? 8335 05:32:52,964 --> 05:32:54,499 IT ISHE I WEIRDESEIRD FEELING IN 8336 05:32:54,499 --> 05:32:56,134 THE WORLD TDO NOT BEOTXCITED 8337 05:32:56,134 --> 05:33:01,573 ARE ALSO TERRI TED OF DYING.U YY 8338 05:33:01,573 --> 05:33:03,508 ACCRETA MOM MOM SAYS, I RESEARD 8339 05:33:03,508 --> 05:33:04,509 AND READ ACCRETA STOESTO EVERYRY 8340 05:33:04,509 --> 05:33:06,478 NIGHT WGHLE IAIDN BED NOTOT 8341 05:33:06,478 --> 05:33:06,912 SLEEPING. 8342 05:33:06,912 --> 05:33:09,781 I EVEN WATCHED VIDEOS OF O 8343 05:33:09,781 --> 05:33:10,615 CESAREAN HTERECTOMIES. 8344 05:33:10,615 --> 05:33:12,851 THE FEAR OF DYING CONSUMED ALL 8345 05:33:12,851 --> 05:33:15,987 MY THOUGHTS. 8346 05:33:15,987 --> 05:33:17,789 PLACENTA ACCRETA OFTEN SEPARATEP 8347 05:33:17,789 --> 05:33:20,192 WOMEN FROM THEIR FAMIES,ND 8348 05:33:20,192 --> 05:33:22,360 IT CHANGES EVERY FAMILY DYNAMICM 8349 05:33:22,360 --> 05:33:25,497 I WAS CEO A ORGAN OER OF MY 8350 05:33:25,497 --> 05:33:27,666 HOME, AND WHE I WASASAS ADMIT A, 8351 05:33:27,666 --> 05:33:30,035 MY HUSBAND BECAME AAMINGLE DAD 8352 05:33:30,035 --> 05:33:30,335 OVNIGHT. 8353 05:33:30,335 --> 05:33:32,404 ALL OF A SUDDEN, EVEN,THINGIN IS 8354 05:33:32,404 --> 05:33:34,172 GOING WRONG FNG TNGOMEN.. 8355 05:33:34,172 --> 05:33:34,272 AN 8356 05:33:34,272 --> 05:33:36,641 MANY ARERERE ACULYCULY AWARE OF 8357 05:33:36,641 --> 05:33:42,180 A ACCRETA MOMAY I'M'M AONTROL. 8358 05:33:42,180 --> 05:33:43,048 PLANNER AT HEART AND SOMEWHAT OF 8359 05:33:43,048 --> 05:33:44,983 CONTROL FREAK, AND THIS 8360 05:33:44,983 --> 05:33:45,517 CONDITIOND WENT AGAT A 8361 05:33:45,517 --> 05:33:45,984 EVERYTHING I HAVE 8362 05:33:45,984 --> 05:33:49,888 EVER E KNOWN. 8363 05:33:49,888 --> 05:33:51,323 I WAS W ADMITTED SHORT S AFTER A 8364 05:33:51,323 --> 05:33:53,425 THAT ULTRA UUND APPOINTPPNT. 8365 05:33:53,425 --> 05:33:56,161 I W TD T THAT T WOM WITH 8366 05:33:56,161 --> 05:33:59,264 WELL IN THE ONSIDE WORLD IFDO 8367 05:33:59,264 --> 05:34:00,699 ING WEREG O HAPPEN. 8368 05:34:00,699 --> 05:34:00,799 TH 8369 05:34:00,799 --> 05:34:02,234 CHANGE INNGHE LEVEL O CARE 8370 05:34:02,234 --> 05:34:04,202 WAS IMMEDIATELY AELARENT. 8371 05:34:04,202 --> 05:34:07,739 AND THERE WAS A PIECE AND A A 8372 05:34:07,739 --> 05:34:08,240 FINALLY FEELING LIKE MY 8373 05:34:08,240 --> 05:34:10,141 NDITION WASN BEING TAKEN T 8374 05:34:10,141 --> 05:34:11,409 SERIOUSLY. 8375 05:34:11,409 --> 05:34:13,211 AND ONCE I GOT INT THE 8376 05:34:13,211 --> 05:34:15,947 HOSPITAL, ITIT WAS W SREALAL TOL 8377 05:34:15,947 --> 05:34:17,582 ELCOMPLETELY HEALTHY AND FE 8378 05:34:17,582 --> 05:34:19,217 WHILE THIS TEAM OF PEOPLE THAT I 8379 05:34:19,217 --> 05:34:21,620 HAD J MET MET WAS W BEING ASSEMD 8380 05:34:21,620 --> 05:34:21,720 TO 8381 05:34:21,720 --> 05:34:23,321 EM PN OUTN THE DETHELSETF WHAT 8382 05:34:23,321 --> 05:34:25,724 WAS EENTIALLYHISHI LIKE 8383 05:34:25,724 --> 05:34:27,392 TERRIBLE ACCIDENT THAT MEE AE MY 8384 05:34:27,392 --> 05:34:27,492 UN 8385 05:34:27,492 --> 05:34:30,595 RN SON WERE ABOUT TO TO BE 8386 05:34:30,595 --> 05:34:32,330 AND ONE OF THE THIHES THATOF 8387 05:34:32,330 --> 05:34:33,765 BOTHERED ME MOST WAS TT I I I WS 8388 05:34:33,765 --> 05:34:33,865 GO 8389 05:34:33,865 --> 05:34:36,167 G TO T BE THE LT ONE TO KNOW 8390 05:34:36,167 --> 05:34:37,035 ABEVERYTHING. 8391 05:34:37,035 --> 05:34:39,971 I WAS GOING UNDER U AND I HAD N 8392 05:34:39,971 --> 05:34:41,506 IDEA WHEN I WOULDOULDOU WEP OR 8393 05:34:41,506 --> 05:34:43,775 WHAT IOULD WAKE UP . 8394 05:34:43,775 --> 05:34:48,480 AND THATEVEL OF SUSPENSE IS 8395 05:34:48,480 --> 05:34:49,814 PRETTY HAR TO TO MATCH. 8396 05:34:49,814 --> 05:34:52,384 AN UNDIAGNOSED ACCRE A MRE SAYS, 8397 05:34:52,384 --> 05:34:53,018 MY HUSMYND WATCHED ME WHEELED EE 8398 05:34:53,018 --> 05:34:57,856 WHEELED IN TO THE NICU, NOTSONON 8399 05:34:57,856 --> 05:35:00,025 KNOWING WHETHER WE'D SURVIVE. 8400 05:35:00,025 --> 05:35:02,394 AN ACCRETACC MOM SAYS, THE TERRR 8401 05:35:02,394 --> 05:35:04,162 OF WAKING UP IN AN INTENSIVE 8402 05:35:04,162 --> 05:35:06,264 CARE UNITNI AND N N KNOWI KNOHEE 8403 05:35:06,264 --> 05:35:12,571 OUTCOMEOM OF O YOUR CHILD BIR. 8404 05:35:12,571 --> 05:35:15,941 I KNOW THIS AND TOLD MY HUSBAND, 8405 05:35:15,941 --> 05:35:20,478 Y SON, I SAID SHAT IF HE'TN' 8406 05:35:20,478 --> 05:35:21,146 WASN'T OKAY, I DIDN'T WANT TO 8407 05:35:21,146 --> 05:35:21,546 KNOW THAT. 8408 05:35:21,546 --> 05:35:21,646 I 8409 05:35:21,646 --> 05:35:23,715 ASKED HIM TO KEEP THATHA FM F 8410 05:35:23,715 --> 05:35:26,084 ME, IF THAT'S HOWS HT ENDEDP, 8411 05:35:26,084 --> 05:35:27,986 BECAUSE I WORED THAT TF I 8412 05:35:27,986 --> 05:35:28,086 WA 8413 05:35:28,086 --> 05:35:32,691 THAT TTHT WOULD BREAK ME, IN A A 8414 05:35:32,691 --> 05:35:34,125 WAY THAT I DN'T KNOWNO IF I 8415 05:35:34,125 --> 05:35:39,731 COULDEAL WITH INEAN THAT SETTIN. 8416 05:35:39,731 --> 05:35:41,499 THESE ARE THEYPES OF THINGS 8417 05:35:41,499 --> 05:35:42,167 THAT YOUR PATRNTS ANT THINKINGNK 8418 05:35:42,167 --> 05:35:43,368 ABOUT AND DISCUSSING WITH THEIR 8419 05:35:43,368 --> 05:35:45,003 FAMILIFA.LI 8420 05:35:45,003 --> 05:35:47,472 SO MY HBAND DIDN' D H DEEE TO LE 8421 05:35:47,472 --> 05:35:50,542 TO ME,TOND OUR SON D S WELL. 8422 05:35:50,542 --> 05:35:51,977 WHICH WHTUALLY MADE IT VERY 8423 05:35:51,977 --> 05:35:57,182 LLING ME THAMEBECAMEECA YOU ARET 8424 05:35:57,182 --> 05:35:58,817 NO, HE DID.HE DID GREAT. 8425 05:35:58,817 --> 05:36:00,018 MADE TODE MYLANN DERY, 8426 05:36:00,018 --> 05:36:04,856 AND MY SON LEO W AT 33 8427 05:36:04,856 --> 05:36:06,458 WEEKS AND HE W 5 POUNDS 8428 05:36:06,458 --> 05:36:07,659 12 OUNCES, WHICH WS PRETTY 8429 05:36:07,659 --> 05:36:10,028 ENORMOUS FOR THAHA GESTATIES,ESY 8430 05:36:10,028 --> 05:36:10,261 THE WAY. 8431 05:36:10,261 --> 05:36:11,863 THAT CRAZY PLACENTACE DEFINITELY 8432 05:36:11,863 --> 05:36:13,198 HAD A FAVORITE, WAS LOOKINGUT 8433 05:36:13,198 --> 05:36:14,065 FOR HIM. 8434 05:36:14,065 --> 05:36:17,736 APPRECIATEE THAT.T. 8435 05:36:17,736 --> 05:36:19,804 BUT UNFOT UNATELY FOR ME, ATT MY 8436 05:36:19,804 --> 05:36:20,872 DELIVERY, IT WAS W DISVERED THAT 8437 05:36:20,872 --> 05:36:32,050 IAD A MUC MUC MORXPEN PA EXPSIVA 8438 05:36:34,753 --> 05:36:35,887 THEY ENDEDP STOPPING THE 8439 05:36:35,887 --> 05:36:37,522 SURGERY AND GOING OUT TO TELL MY 8440 05:36:37,522 --> 05:36:38,556 FAMILY TMIT THEY COULDN'T FIND 8441 05:36:38,556 --> 05:36:39,991 SURGICAL PLANE TO T BEGIN THEHE 8442 05:36:39,991 --> 05:36:41,092 ECTOMY THAT WASN'T COVERED 8443 05:36:41,092 --> 05:36:42,661 IN PLACENTA.NT 8444 05:36:42,661 --> 05:36:43,428 OLD MYOL FAMOLY TH THE 8445 05:36:43,428 --> 05:36:46,931 BLOOD BLSSD BL COMING OFF OF O Y 8446 05:36:46,931 --> 05:36:49,434 IN DIAMETER.E IEREX FINGERIN SIE 8447 05:36:49,434 --> 05:36:51,369 AND THERE WASERIOUS CONCERN 8448 05:36:51,369 --> 05:36:53,471 THAT NONATATF MY M M BLADDERDD E 8449 05:36:53,471 --> 05:36:58,109 SALVAGSABLE.THEY DECIDED IT WASO 8450 05:36:58,109 --> 05:36:59,778 PROCEED OCTH THE HYSTERECTOMY, 8451 05:36:59,778 --> 05:36:59,878 AN 8452 05:36:59,878 --> 05:37:01,513 MAN M CARELANN INSTANTLYTA 8453 05:37:01,513 --> 05:37:03,515 CHANGECHANGECHO UNE UTED 8454 05:37:03,515 --> 05:37:05,817 CONSERVATIVE MTIAGEMTIT.T. 8455 05:37:05,817 --> 05:37:08,520 I WOKE WE UP IN ICU,CU SHOCKED O 8456 05:37:08,520 --> 05:37:10,689 LEARN THATN HEYHE DIDN'TN'T DO . 8457 05:37:10,689 --> 05:37:12,023 I KNEW THAT EVERYONE H 8458 05:37:12,023 --> 05:37:14,726 EXPEED MY CASE C TO TO BE SO 8459 05:37:14,726 --> 05:37:16,695 SEVERE,VEO TON TO T FIND OUT THT 8460 05:37:16,695 --> 05:37:17,295 IT WAS ACTUALLY WORSE THAN 8461 05:37:17,295 --> 05:37:27,605 HADXPECED? 8462 05:37:45,356 --> 05:37:47,158 THE SURGERY HAD BEENEEMED 8463 05:37:47,158 --> 05:37:49,627 LAST RESORT, AND NO ONE REALLY 8464 05:37:49,627 --> 05:37:50,829 KNEW WHAT WASASOING TO HAPPEN 8465 05:37:50,829 --> 05:37:52,363 NEXT. 8466 05:37:52,363 --> 05:37:55,033 WHAT IT HAD EXPTED TO B A 8467 05:37:55,033 --> 05:37:55,133 SP 8468 05:37:55,133 --> 05:37:56,234 NT TURNED INTO A MARATHON. 8469 05:37:56,234 --> 05:37:58,970 I FELT LIKE L A A TIME BOMBAITIG 8470 05:37:58,970 --> 05:38:04,175 NARNINGAROW TO BE AULL TERM 8471 05:38:04,175 --> 05:38:04,375 BABY. 8472 05:38:04,375 --> 05:38:06,544 TODDLER HAD MOVED IN WITH MY 8473 05:38:06,544 --> 05:38:08,179 PARENTPA AND MY HUSND SPENTPENT 8474 05:38:08,179 --> 05:38:13,885 IT FELT LIKE IASTILLSPITAL WITIT 8475 05:38:13,885 --> 05:38:14,152 PREGNANT.NA 8476 05:38:14,152 --> 05:38:14,786 ANXIOUSLY AWAITING ETIHER THAT 8477 05:38:14,786 --> 05:38:17,255 SCARYSCELIVERY O SOME ACCIDENT, 8478 05:38:17,255 --> 05:38:19,424 EXCEPT NOW MAYBEBE FOREVER? 8479 05:38:19,424 --> 05:38:21,559 AND FOR THE FIRST SIX WEEKS THAT 8480 05:38:21,559 --> 05:38:24,863 I LIVED WITH MY ENTIRENTLACENTA 8481 05:38:24,863 --> 05:38:27,699 HAPPENED.NOTHING REALL RLL R 8482 05:38:27,699 --> 05:38:27,799 UN 8483 05:38:27,799 --> 05:38:28,800 L ONE MORNING, I WOKEE UP 8484 05:38:28,800 --> 05:38:33,271 WITH BLEEDINLE ANDATER THATHA 8485 05:38:33,271 --> 05:38:35,573 DAY, I PD MY KNEEY N THE 8486 05:38:35,573 --> 05:38:36,307 BEDSIDBETABLE AND WATCHEWA THIS 8487 05:38:36,307 --> 05:38:38,209 LIKE EGGANT PPLEPL BPLISE 8488 05:38:38,209 --> 05:38:40,545 SPREAD OVER MY SKIN LIKE IAD 8489 05:38:40,545 --> 05:38:43,248 NEVERNE SEEN, AND A STAT BLOOD 8490 05:38:43,248 --> 05:38:43,982 ST WLD SOON REVNL TNT I 8491 05:38:43,982 --> 05:38:46,818 HAD FIBRINOGENGE LEVEL OF 46 AND 8492 05:38:46,818 --> 05:38:48,720 I HADHA DELOPED DOP FROM F 8493 05:38:48,720 --> 05:38:51,055 RETAINED PLACENTA. 8494 05:38:51,055 --> 05:38:53,892 AS I MADE MY WAY FROMM THE CAR 8495 05:38:53,892 --> 05:38:55,693 BACK INTO THE HOSPITAOS AGAIN TT 8496 05:38:55,693 --> 05:38:56,194 BE RE-ADMITTAD FOR THAT 8497 05:38:56,194 --> 05:38:58,263 EMERGENCYGENCYURGERY, I FELT LEI 8498 05:38:58,263 --> 05:38:59,831 COULDNCO WALKAST ENOUGH. 8499 05:38:59,831 --> 05:39:02,200 I WAS SO SD THAT SOHATHING 8500 05:39:02,200 --> 05:39:03,835 ELSE WOULD HAPPEN, THAT I WOU 8501 05:39:03,835 --> 05:39:05,236 IMPLODE BODOREOR I GOT THROUGHOU 8502 05:39:05,236 --> 05:39:08,306 THOSETH DOORS. 8503 05:39:08,306 --> 05:39:11,009 7 WEE 7 OLD LEO AND MY 20 8504 05:39:11,009 --> 05:39:12,544 NTH OLNT EVERETT, THEY WERE 8505 05:39:12,544 --> 05:39:13,578 SSED ADETWEEN WTEVER 8506 05:39:13,578 --> 05:39:14,379 RFAMILY AND FRIENDS WERDS ABLE O 8507 05:39:14,379 --> 05:39:16,514 GET THERE TN TIME TOO HELP. 8508 05:39:16,514 --> 05:39:17,782 WHILE MY HUSBAND AND MY PARENTS 8509 05:39:17,782 --> 05:39:20,151 SAT IN AN WAITING ROOM ALL DAY, 8510 05:39:20,151 --> 05:39:21,586 WONDERINGER WHICH WAY THIS WAS 8511 05:39:21,586 --> 05:39:23,054 GOING TO GO. 8512 05:39:23,054 --> 05:39:26,324 I HAD AN A EMERGENCY HYSTERECTOE 8513 05:39:26,324 --> 05:39:29,594 INCLUDING BLADDER RESEC RON, 8514 05:39:29,594 --> 05:39:30,228 REIMPLANTMPION AND OTHER 8515 05:39:30,228 --> 05:39:30,461 REPAIRS. 8516 05:39:30,461 --> 05:39:30,562 TH 8517 05:39:30,562 --> 05:39:32,463 STHGERY WASAS CPLICED, IT 8518 05:39:32,463 --> 05:39:35,433 TOOK A FULL F DAY, AND INC ID 8519 05:39:35,433 --> 05:39:38,002 THE TRANSFUSION OF 26 UNITS U OF 8520 05:39:38,002 --> 05:39:39,871 BLOOD PRODUCTS.. 8521 05:39:39,871 --> 05:39:41,506 EVERYONE SAID THAT T THE SGERY 8522 05:39:41,506 --> 05:39:43,007 WENT MUCH BETTER THAN IT WOULT 8523 05:39:43,007 --> 05:39:44,409 HAVE BEEN BN DELIVERY. 8524 05:39:44,409 --> 05:39:46,711 AND THAD MY PLACENTA HAD H 8525 05:39:46,711 --> 05:39:48,313 ACTUALLY DECREASED IN SIZEVER 8526 05:39:48,313 --> 05:39:51,182 L.ER 8527 05:39:51,182 --> 05:39:54,219 HAT PER P BETWEEN MY M 8528 05:39:54,219 --> 05:39:55,653 DIAGNOSIAG DEL DY AND MY 8529 05:39:55,653 --> 05:39:59,023 EMERGENCYGE SURGERY AT 7 WEEKS 8530 05:39:59,023 --> 05:40:00,091 POSTPARTUM, I HAD KNOWN THAT MY 8531 05:40:00,091 --> 05:40:02,393 BODY.NTA HAD BEEN RAVAGINGY 8532 05:40:02,393 --> 05:40:04,796 BUT IADN'T UNDERSTOOD UNTIL I 8533 05:40:04,796 --> 05:40:09,167 WAS DEEP INTONT THIS ACCRETAEXPO 8534 05:40:09,167 --> 05:40:10,368 MUCHMU MORE THOR A PHYSICAL 8535 05:40:10,368 --> 05:40:10,468 CO 8536 05:40:10,468 --> 05:40:11,803 ITION. 8537 05:40:11,803 --> 05:40:14,372 AND THADURING THIS TIME,E, MY 8538 05:40:14,372 --> 05:40:16,341 PLACENTA WOULD HD M HOSTAGE.GE 8539 05:40:16,341 --> 05:40:18,309 IT WOULD TAKE EVERYTHING I HAD 8540 05:40:18,309 --> 05:40:20,712 THOUGHT ABOUT THE WORLD AND I 8541 05:40:20,712 --> 05:40:22,714 TURNED IT UPSID UDOWN. 8542 05:40:22,714 --> 05:40:24,916 WHAT IS THE MOST OVERL OKED 8543 05:40:24,916 --> 05:40:28,152 ORGAN INVOLVEMENT THAT 8544 05:40:28,152 --> 05:40:33,191 'S BEEN BREE YEARS SRSCE THACET 8545 05:40:33,191 --> 05:40:34,826 MENT FOR ME. 8546 05:40:34,826 --> 05:40:37,328 AND NOT A DAY D GOES BY THAT I'T 8547 05:40:37,328 --> 05:40:37,829 SOMEHOSOCOLORECOBY THAT 8548 05:40:37,829 --> 05:40:41,065 EXPERIENCE. 8549 05:40:41,065 --> 05:40:43,034 ACCRE A MOM SAY HOW H WAS I 8550 05:40:43,034 --> 05:40:43,134 SU 8551 05:40:43,134 --> 05:40:44,769 OSED TOEDO BACK HOMEE AND 8552 05:40:44,769 --> 05:40:47,872 PPENED?N ASF NOTHING HAD HVER 8553 05:40:47,872 --> 05:40:52,310 PAINFUPA WHEN FRIDS OR FAMILYMI 8554 05:40:52,310 --> 05:40:54,846 SITUATION.TIAND THE TEVITEV OF 8555 05:40:54,846 --> 05:40:56,514 U LOOK HEALTHY,LT THE T BABY IS 8556 05:40:56,514 --> 05:40:57,882 DOING GREAT. 8557 05:40:57,882 --> 05:40:59,784 WHAT'S THE PROBLEM? 8558 05:40:59,784 --> 05:41:01,719 ACCRETA MOM SAYS,S, MYIDSS REALL 8559 05:41:01,719 --> 05:41:03,254 EDEDE TO BE TRE T TOR THEM 8560 05:41:03,254 --> 05:41:06,925 AND NOT N NRYING ALL T T TIME. . 8561 05:41:06,925 --> 05:41:07,025 FO 8562 05:41:07,025 --> 05:41:10,528 MANYAN US, ATA ISN 8563 05:41:10,528 --> 05:41:11,863 HENHE OUR PLA PAS ARE 8564 05:41:11,863 --> 05:41:13,598 GONE. 8565 05:41:13,598 --> 05:41:17,602 AND FOR M F I TOOK TIME AND A 8566 05:41:17,602 --> 05:41:19,370 ALLY SOLID NETWORK O O FRIENDS 8567 05:41:19,370 --> 05:41:20,972 AND FAMILYAM FAM ME TO T FEEL SE 8568 05:41:20,972 --> 05:41:23,474 AGAIN. 8569 05:41:23,474 --> 05:41:32,383 THAT I I SWITCHED HOSPITALS AT T 8570 05:41:32,383 --> 05:41:35,219 11TH HOUR AND THAT I H T ACCESSS 8571 05:41:35,219 --> 05:41:37,822 TO APPROPRIATE MEDAL CARE AND 8572 05:41:37,822 --> 05:41:38,723 AN EMPATHETIC CARE TEAM. 8573 05:41:38,723 --> 05:41:39,624 THERE'S MY SONEO.. 8574 05:41:39,624 --> 05:41:40,725 TODAY YOU WOULD NEVER EVEN KNOW 8575 05:41:40,725 --> 05:41:43,094 TH LEO W L EVER A VEEEMIE. 8576 05:41:43,094 --> 05:41:44,929 HE'S AEISTY AND A DETERMINED 8577 05:41:44,929 --> 05:41:47,098 9-YEAR-OLD, AND, WE'RE W PRETTY 8578 05:41:47,098 --> 05:41:51,369 CONVINCED THCECE MY M PLACENTAAV 8579 05:41:51,369 --> 05:41:52,670 USUS SOME MAXMAN POWERS. 8580 05:41:52,670 --> 05:41:54,906 SO I CONCLUSION,US NEED TO T 8581 05:41:54,906 --> 05:41:55,473 YOU WITH SOME PATIENT 8582 05:41:55,473 --> 05:41:55,907 CALLS TO ACTION. 8583 05:41:55,907 --> 05:41:57,875 WE ND TO BETTERET UNDERSTAND WHY 8584 05:41:57,875 --> 05:42:01,646 DO TO PREVENT ITENORITEN ALL O E 8585 05:42:01,646 --> 05:42:02,413 INCREDIBLE WORKKHAT'S BEING 8586 05:42:02,413 --> 05:42:04,382 DONE IN THIS ROOM TODAY, WE NEEE 8587 05:42:04,382 --> 05:42:06,384 REDUCEEDUCUC AMOUNT OF WOMEN 8588 05:42:06,384 --> 05:42:07,385 ENWHO REQUI R ALL OF THIS T TO E 8589 05:42:07,385 --> 05:42:08,052 A BABY.AB 8590 05:42:08,052 --> 05:42:08,152 AN 8591 05:42:08,152 --> 05:42:13,524 WE NEEDD TO T TNK T ABOUT- 8592 05:42:13,524 --> 05:42:16,294 PROPERLYOPDUCATE PATIENTS ANTUT 8593 05:42:16,294 --> 05:42:17,061 NG-TERM RISKS. 8594 05:42:17,061 --> 05:42:18,830 WOMEN PLAYLA A ROLE IN THE RISK 8595 05:42:18,830 --> 05:42:21,299 FACTORFA TOOFA BUT THEY DON'T HR 8596 05:42:21,299 --> 05:42:22,800 THE WORD ACCRETATA UNTIL THEIL T 8597 05:42:22,800 --> 05:42:23,668 DIAGNOSED WITH IT. 8598 05:42:23,668 --> 05:42:27,271 WEWE NEED TO IDENTIFDE THESE WON 8599 05:42:27,271 --> 05:42:28,973 EARLY AND GET THEM TO THE RIGHE 8600 05:42:28,973 --> 05:42:29,173 PLACE. 8601 05:42:29,173 --> 05:42:30,742 THIS IS NO SHA INEFERRALS, 8602 05:42:30,742 --> 05:42:32,310 AND IANTHE MAJORITAJ OF CASES, I 8603 05:42:32,310 --> 05:42:34,345 KNOW THATHAT PRHAESSHAORKS, 8604 05:42:34,345 --> 05:42:34,445 BU 8605 05:42:34,445 --> 05:42:36,080 'M HERTO T TU IT 8606 05:42:36,080 --> 05:42:37,281 ESN'ESPPENES AS CONSISTENTLY 8607 05:42:37,281 --> 05:42:39,250 YASYOU MAY THINK. 8608 05:42:39,250 --> 05:42:40,651 THERE ARE LARGE MEDICALIC 8609 05:42:40,651 --> 05:42:41,919 PRACTICES OUT THERE LIKRE THE OE 8610 05:42:41,919 --> 05:42:47,191 AL INTERNANTERNT POLICY OF NOT 8611 05:42:47,191 --> 05:42:48,793 REFERRREG OUT FOR ANY PGNANCY 8612 05:42:48,793 --> 05:42:50,661 CONDITIONECSE T'S -- 8613 05:42:50,661 --> 05:42:52,497 EY TREAT THEM ALL. 8614 05:42:52,497 --> 05:42:53,831 THERLL ARE OTHER PRACTICES WES 8615 05:42:53,831 --> 05:42:56,868 MAYMA NOT HAVE A POLICY, B THEY 8616 05:42:56,868 --> 05:42:58,403 DIAGNOSEAGNDEEP N-EMERGENT 8617 05:42:58,403 --> 05:43:01,339 THA THEY SHOULDN'T. 8618 05:43:01,339 --> 05:43:02,874 THEIR PATIENTS FIND F, WE HEAR 8619 05:43:02,874 --> 05:43:03,808 RTHRR STORIES, WE CAN READEA 8620 05:43:03,808 --> 05:43:05,643 BETWEEN THE LINES AND A IT' 8621 05:43:05,643 --> 05:43:06,377 HE 8622 05:43:06,377 --> 05:43:07,979 NO PATIENT SHOULD HAVE THE 8623 05:43:07,979 --> 05:43:10,181 BURDEN OF HAVING TO T BECOMEE AN 8624 05:43:10,181 --> 05:43:12,917 EXPERT IN AESSING MATERNAL 8625 05:43:12,917 --> 05:43:13,017 LE 8626 05:43:13,017 --> 05:43:14,485 LS OF CARF 8627 05:43:14,485 --> 05:43:18,022 TO SHARE A QUO FROM DR. N D SH. 8628 05:43:18,022 --> 05:43:19,223 WOMEN WANT MORE FROMM CLDBIRTLD 8629 05:43:19,223 --> 05:43:19,323 TH 8630 05:43:19,323 --> 05:43:21,159 TO EMERGE UNSCATHED. 8631 05:43:21,159 --> 05:43:23,661 AND THIS IS I TE FOR PLACENTLA 8632 05:43:23,661 --> 05:43:25,129 ACCRETA MOMSS TS 8633 05:43:25,129 --> 05:43:27,398 ESPECIALLY AS WE MAKE MOGRE M 8634 05:43:27,398 --> 05:43:31,869 IN TREATMENT METHODS, ANDS THE T 8635 05:43:31,869 --> 05:43:32,670 BAR RAISES IN THE CARE THAT'S 8636 05:43:32,670 --> 05:43:35,006 BEEN DELIVERED, WE CAN'TORGET 8637 05:43:35,006 --> 05:43:37,442 ILDBIRTH EXPERIENCE.'S 8638 05:43:37,442 --> 05:43:39,444 AND SOME HOSPITALS ARE OFFER OGR 8639 05:43:39,444 --> 05:43:41,045 THINGS TO THEIR PAS PATIE PS 8640 05:43:41,045 --> 05:43:44,816 LIKE DIFFERENT INCISION TYPES, 8641 05:43:44,816 --> 05:43:46,818 WEEE YDRAPES,APE HEAR ABOUTOU 8642 05:43:46,818 --> 05:43:49,921 AND IHERE TO SAY THAT 8643 05:43:49,921 --> 05:43:51,556 WHETHEWHYOU'RE AWARE AF IT OR 8644 05:43:51,556 --> 05:43:52,657 NOT, PATIENT EXPER ENCE IS 8645 05:43:52,657 --> 05:43:55,693 QUICKLY BOMING T NEXT 8646 05:43:55,693 --> 05:44:02,266 AT NATIONAL ACCRETA FOUNDATION,R 8647 05:44:02,266 --> 05:44:03,935 OUACCRETA PATIE PS AND STORIES 8648 05:44:03,935 --> 05:44:04,335 HELP.P. 8649 05:44:04,335 --> 05:44:12,710 THANK YOU. 8650 05:44:12,710 --> 05:44:14,378 >> FOLLOWINGRISTIN IS ALWAYS 8651 05:44:14,378 --> 05:44:25,356 DR. SHAINKER IS UP TO IT.T. 8652 05:44:45,910 --> 05:44:47,278 >>>>OU CAN HEAR MEEA 8653 05:44:47,278 --> 05:44:47,478 GREAT. 8654 05:44:47,478 --> 05:44:50,515 I JUST WANT WAN W TO ECH EVERYOY 8655 05:44:50,515 --> 05:44:52,583 THANKS TO BRETT AND CHRISTINA. 8656 05:44:52,583 --> 05:44:54,218 THANK YOUK TI FOR A GREAT, GREAT 8657 05:44:54,218 --> 05:44:54,385 DAY. 8658 05:44:54,385 --> 05:44:56,821 MY NAME N IS SCOTT SHAINKER, I'M 8659 05:44:56,821 --> 05:44:57,722 FROMFR BETH ISRAEL. 8660 05:44:57,722 --> 05:44:59,924 WE'RE GOING TO PIVOT A BIT. 8661 05:44:59,924 --> 05:45:01,559 ALWAYS TOUYS TO FOLW KRISTIN,ST 8662 05:45:01,559 --> 05:45:01,659 BU 8663 05:45:01,659 --> 05:45:03,861 TALK ABOUT BIOMARKERS. 8664 05:45:03,861 --> 05:45:05,796 HERE ARE MY DI MLOSURES. 8665 05:45:05,796 --> 05:45:05,897 TH 8666 05:45:05,897 --> 05:45:08,065 E IS ONE AT THEOTM THAT 8667 05:45:08,065 --> 05:45:11,035 PROBABLY ISS PERTINENT TO THIS 8668 05:45:11,035 --> 05:45:15,039 I'M NOTNO MAKING MONEG ON IT. 8669 05:45:15,039 --> 05:45:17,141 R THOSE OF YOU W Y FOLWEDWE 8670 05:45:17,141 --> 05:45:21,879 WORK WWO MWOE M KIND K OF EARLIT 8671 05:45:21,879 --> 05:45:24,415 OPPORTUNISTIC TO BE QUI 8672 05:45:24,415 --> 05:45:24,515 HO 8673 05:45:24,515 --> 05:45:25,616 ST.ST 8674 05:45:25,616 --> 05:45:25,716 SO 8675 05:45:25,716 --> 05:45:27,418 OFFOU IN THE ROOM ARE SOME 8676 05:45:27,418 --> 05:45:28,686 THERE.HE FIRHE TO PUT THE WORK T 8677 05:45:28,686 --> 05:45:28,786 WH 8678 05:45:28,786 --> 05:45:33,391 COULD KIND OF RETROSPECTIVELY 8679 05:45:33,391 --> 05:45:36,093 OK ANDOK SAY DID D ANEUPLOIDYY 8680 05:45:36,093 --> 05:45:37,395 EXAMPLESMPELP US TO 8681 05:45:37,395 --> 05:45:39,864 IDENTIFY PATIENTSSITH PAS, SOAS 8682 05:45:39,864 --> 05:45:52,543 HYPERTBLIE COSHYPERGHYCOSYLATEDG 8683 05:45:52,543 --> 05:45:55,479 EARLY E WORK I SYNONYMOUSS 8684 05:45:55,479 --> 05:45:58,883 WITH PWIEE CLAMS WRA W WORKOR T. 8685 05:45:58,883 --> 05:46:01,485 IT'S NOT SURPRISING THATHA MY 8686 05:46:01,485 --> 05:46:03,454 MENTOR WAS A PRELAMPSIA 8687 05:46:03,454 --> 05:46:10,261 BIOLOGISOLIS A NE FROF GIS NEPHO 8688 05:46:10,261 --> 05:46:11,929 WE'VEAKEN A LOT OF CLUES FRO 8689 05:46:11,929 --> 05:46:14,899 AT WE'E' LEARNEDEAN THE 8690 05:46:14,899 --> 05:46:19,036 CA BHALL AND S WHATHA PTE PS B 8691 05:46:19,036 --> 05:46:19,136 WE 8692 05:46:19,136 --> 05:46:20,438 IND AND WHATHA PEOPLE HAVEE 8693 05:46:20,438 --> 05:46:21,205 DONE WITH PAS. 8694 05:46:21,205 --> 05:46:23,107 SO I JUST WANTO WALTOTHROUGH A 8695 05:46:23,107 --> 05:46:24,208 STORY OFORIND OF WHAT W 8696 05:46:24,208 --> 05:46:31,082 DO KIN OFF CHANNELHA- THEY DLL T 8697 05:46:31,082 --> 05:46:32,516 HAVEVEOME BIOLOGICALGIGI 8698 05:46:32,516 --> 05:46:32,617 PL 8699 05:46:32,617 --> 05:46:34,252 SIBITY HERTY HUTUTHE FIRST 8700 05:46:34,252 --> 05:46:34,885 ONE THON KINON OIN-- AND I'M 8701 05:46:34,885 --> 05:46:36,187 GOING TING WALK YOU TOUGH 8702 05:46:36,187 --> 05:46:36,821 GESTATION TO DO THIS. 8703 05:46:36,821 --> 05:46:42,059 THE MOST SOSTTT LSTOBABLY MABLMA 8704 05:46:42,059 --> 05:46:44,262 BIOLOGICALLY WAS HEPP-A.EPEP 8705 05:46:44,262 --> 05:46:50,234 WHEN W W WEREER DOIN PAPP-A IS 8706 05:46:50,234 --> 05:46:51,435 ASSOCIATSO WATH PLACE PAL GROWTH 8707 05:46:51,435 --> 05:46:51,535 SO 8708 05:46:51,535 --> 05:46:53,938 FSOSO YOU EXTRAPOLATETE WHAT WEE 8709 05:46:53,938 --> 05:46:54,705 KNOW ABOOW AAS, AHAT WE KNOW 8710 05:46:54,705 --> 05:46:54,805 AB 8711 05:46:54,805 --> 05:47:00,278 T IMAGING, THEY'REY'Y' HEAVIER,R 8712 05:47:00,278 --> 05:47:02,880 PAPP-AAPA WOULD BE BEIG BR 8713 05:47:02,880 --> 05:47:03,147 WITH PAS. 8714 05:47:03,147 --> 05:47:05,283 SO THISHI EARLY WORK ACTUALLY 8715 05:47:05,283 --> 05:47:06,917 DID SHO THAT. 8716 05:47:06,917 --> 05:47:09,553 UNFORTUNATELY IT HASN'TT BEEN 8717 05:47:09,553 --> 05:47:11,756 REPRODUCIBLE IN I ROBUSTT WAY AT 8718 05:47:11,756 --> 05:47:14,158 ALL,AL BUT IT IOES SHOW S THAT 8719 05:47:14,158 --> 05:47:15,860 OVERTHE LAST 10ASEARS, WE HAVE 8720 05:47:15,860 --> 05:47:17,094 STARTED LOOKING AT THE BIOLOGY 8721 05:47:17,094 --> 05:47:19,297 GYOF PAS AND A AOW WE CAN FIN A 8722 05:47:19,297 --> 05:47:20,831 BIOMARKERAROR IT. 8723 05:47:20,831 --> 05:47:22,366 IF YOU MOVE A LITTLEIT BIT FARTR 8724 05:47:22,366 --> 05:47:27,371 ALONG IN I GESTATIESTA, 8725 05:47:27,371 --> 05:47:30,975 AFP MAKESMA SENSE, RELEASEELFROM 8726 05:47:30,975 --> 05:47:34,245 MATERNAL FAL INTER ICE, AN AN 8727 05:47:34,245 --> 05:47:37,448 THERE'S A BREDORE I MATERNAL 8728 05:47:37,448 --> 05:47:39,183 PLACENTAL INTERFACE WIAC PWI AND 8729 05:47:39,183 --> 05:47:41,652 NDSURENOUGH,UG WE FND THA A 8730 05:47:41,652 --> 05:47:46,357 P IS HIGHER IN PAS CASES.ESES 8731 05:47:46,357 --> 05:47:48,526 AGAIN, THESERE NOT 8732 05:47:48,526 --> 05:47:50,494 PARTICULRTLYUL SPECI SC, BUT DOS 8733 05:47:50,494 --> 05:47:53,464 SPEAK TO SOME APPLICATION OF 8734 05:47:53,464 --> 05:47:56,767 AND IF YOUIF FAST FORWARD AND A, 8735 05:47:56,767 --> 05:48:00,604 WELL, WHAT ABOUT SUBSETS OF ACGA 8736 05:48:00,604 --> 05:48:02,640 AG COMES FROM THE PLANTA, 8737 05:48:02,640 --> 05:48:05,376 THERE'TH HCG THAT IS ACTUALLY 8738 05:48:05,376 --> 05:48:11,215 INVOLVED IN I I THE PLUG -- THE- 8739 05:48:11,215 --> 05:48:13,617 DEEPESDE FORM OF OF THE -- MAYBE 8740 05:48:13,617 --> 05:48:17,988 THAT ACTUALLY COULD BE HIGHER IG 8741 05:48:17,988 --> 05:48:23,394 PEOPLE HAVE LKED AT THIS HCG, 8742 05:48:23,394 --> 05:48:23,494 IT 8743 05:48:23,494 --> 05:48:26,997 EXCRETED FROM T 8744 05:48:26,997 --> 05:48:30,201 DIDN'T REALLY PAN P OUT, FAIRLY 8745 05:48:30,201 --> 05:48:30,301 RO 8746 05:48:30,301 --> 05:48:33,037 STTUDY ACTUALLY LOOKING AT 8747 05:48:33,037 --> 05:48:35,406 NORMAL PREVIOUS AND P VARIOUS 8748 05:48:35,406 --> 05:48:38,809 RMS OF PLACENTALAL ADHERENCE, 8749 05:48:38,809 --> 05:48:40,111 D UNFORTUNATELY THAT DIDN'T 8750 05:48:40,111 --> 05:48:40,478 REALLY PAN OUT. 8751 05:48:40,478 --> 05:48:42,380 THEN I THINK IF YOU TRY TO LOOK 8752 05:48:42,380 --> 05:48:44,348 AT THEOMMENTARIES, MAYBE THREE 8753 05:48:44,348 --> 05:48:49,787 OR FOUR YEARS AFTER A NI BTATA 8754 05:48:49,787 --> 05:48:50,888 D COMING OUTAY 8755 05:48:50,888 --> 05:48:53,190 ACTUALLY THE ANSWER, 8756 05:48:53,190 --> 05:48:56,494 FETALTA FRACTION, OKAY, WLLIN 8757 05:48:56,494 --> 05:48:59,463 ENTIFY PAS EARLY,LY SURENOUGH, 8758 05:48:59,463 --> 05:49:01,165 JU'L USE IT SE IIT DIDITT 8759 05:49:01,165 --> 05:49:01,832 REALLY WALK WALORTUNATELY. 8760 05:49:01,832 --> 05:49:05,102 NOBODY HAS TO EXPLAIN WHY. 8761 05:49:05,102 --> 05:49:07,271 I THK BIOLOGICALLY I STILL 8762 05:49:07,271 --> 05:49:08,305 HAVE A HARD TIME UNDERSTANDING 8763 05:49:08,305 --> 05:49:12,676 SHOTN TO BE HELPFUL INTION HAS T 8764 05:49:12,676 --> 05:49:16,781 IDTIFYINTI 8765 05:49:16,781 --> 05:49:17,882 OTENTIALLY, KIND K OF 8766 05:49:17,882 --> 05:49:21,752 ACENTAL FUNCTION WILL WELP.NG OF 8767 05:49:21,752 --> 05:49:24,655 SO I'M GOING TO PIVOT AVOTIT 8768 05:49:24,655 --> 05:49:27,725 JUST -- THE P LGF RATIO. 8769 05:49:27,725 --> 05:49:31,529 SFLT A YOU KNO IS --AN 8770 05:49:31,529 --> 05:49:34,465 INHIBIT ---- IT'SN ANGIOGENIC 8771 05:49:34,465 --> 05:49:36,267 FACTOR AND INHIBITSIT THE FUNCTN 8772 05:49:36,267 --> 05:49:41,038 VEGF,F, PLGF DISPL DES VEGF,F,S 8773 05:49:41,038 --> 05:49:42,807 NOSURPRISINGLYNGLY FOR 8774 05:49:42,807 --> 05:49:47,144 SOAYBE IT'S THETHSE RUP 8775 05:49:47,144 --> 05:49:48,813 OPPOSITE FORM FRR A PHENOTYPE. 8776 05:49:48,813 --> 05:49:50,548 PEOPLE HAVE LKED AT THAT.THAT 8777 05:49:50,548 --> 05:49:53,150 IN PRETTY ROBT WAY ACTUALAC 8778 05:49:53,150 --> 05:49:58,155 HAVE ADVOCATEDAT FOR THIS TO BEL 8779 05:49:58,155 --> 05:49:59,023 BIR. 8780 05:49:59,023 --> 05:49:59,924 PERSONPELY, I DON'T THINK THAT'S 8781 05:49:59,924 --> 05:50:03,427 ERE IT I IUT FROM A BIOLOGY 8782 05:50:03,427 --> 05:50:04,628 PERSPEIVE, IT DOES MAKE SENSE. 8783 05:50:04,628 --> 05:50:06,997 SO THIS IS A STUDY LOOKING AT 8784 05:50:06,997 --> 05:50:13,237 VERSU V -- HOW- OW- I GET R G 8785 05:50:13,237 --> 05:50:16,941 GOFHAT -- PAS, P CTROLLED PASAS 8786 05:50:16,941 --> 05:50:20,344 D JUST PVIA, SFLTFL WITHINSS 8787 05:50:20,344 --> 05:50:23,347 AN ANGGENIBINIKER OR 8788 05:50:23,347 --> 05:50:30,488 EIN IS DOWNREGULATED PASONAS 8789 05:50:30,488 --> 05:50:36,026 VERSUS PLACS TAAC PREVIAS, THEE 8790 05:50:36,026 --> 05:50:36,794 PINK, AND, HEN PLACENTA PREVIA 8791 05:50:36,794 --> 05:50:40,631 VERSUS CONTROLON IS ALMOST -- IF 8792 05:50:40,631 --> 05:50:45,202 YOU LOOK AT PLGF, AGAIN, PF IS 8793 05:50:45,202 --> 05:50:47,371 DOWNGULATED IN I PREEC PMPSIA, 8794 05:50:47,371 --> 05:50:49,874 AGAIN, BIOLOGICALLY SHOULD IT B 8795 05:50:49,874 --> 05:50:51,308 UPREGULATED IN PAS. 8796 05:50:51,308 --> 05:50:56,046 WAS SHOWN, SLIGHTLY LESS 8797 05:50:56,046 --> 05:50:58,315 ROBUST THAN SFLT, AND THENN IF 8798 05:50:58,315 --> 05:51:00,117 YOU LOOK AT THE RATIO,IO IT 8799 05:51:00,117 --> 05:51:04,054 ACTUALAC IS T I MOS ROBUS R DA 8800 05:51:04,054 --> 05:51:04,255 DATA.DA 8801 05:51:04,255 --> 05:51:05,523 IN OUR LAB WE LOOKED AT THIS A 8802 05:51:05,523 --> 05:51:06,657 BACK AND SAIDELL, CELLD 8803 05:51:06,657 --> 05:51:09,693 WE LWEK AT A ST AND PLGF ANDANAY 8804 05:51:09,693 --> 05:51:10,995 WELL, CAN, WLOOK ALOLO THE 8805 05:51:10,995 --> 05:51:13,631 TA LEVEL IN VARIOUS FORMS 8806 05:51:13,631 --> 05:51:19,904 OF PASs BEFORE WEESE-- FIGO 8807 05:51:19,904 --> 05:51:20,170 CRITERIA. 8808 05:51:20,170 --> 05:51:23,073 SOEFT,HESE AREERMINAL 8809 05:51:23,073 --> 05:51:24,508 VILLI WITHTH SFLT, YOU CANEE 8810 05:51:24,508 --> 05:51:28,379 HERE KINDF LOW EXPRE EION 8811 05:51:28,379 --> 05:51:30,814 ERE THE DARROWND I HIGH 8812 05:51:30,814 --> 05:51:31,448 EXPRESEXON CREATED TATS TCALEPR 8813 05:51:31,448 --> 05:51:38,455 HAVE AHAORE HIGHER LIKELIHOOD TO 8814 05:51:38,455 --> 05:51:39,590 HAVE INVASIVE PHENOTYPE. 8815 05:51:39,590 --> 05:51:43,027 SO KIND OF APPLYING WHAT WE 8816 05:51:43,027 --> 05:51:44,361 ALREADALKNEW FROM F SUM 8817 05:51:44,361 --> 05:51:45,362 PERSPECTIVE AND PUT IT IACKAC TO 8818 05:51:45,362 --> 05:51:48,899 THE SAMPLES RETROSPECTIVELY. 8819 05:51:48,899 --> 05:51:51,335 AGAIN, TRYN,GN, TO TPPLY 8820 05:51:51,335 --> 05:51:53,304 BIOLOGY TO COME UP U WITH 8821 05:51:53,304 --> 05:51:57,341 FAST FORWARD TO KIND OF THREE 8822 05:51:57,341 --> 05:52:01,579 WHAT I THINK ARE THREE TF KIND 8823 05:52:01,579 --> 05:52:05,883 OF THE MOST ROBT STUDIES, THIS 8824 05:52:05,883 --> 05:52:05,983 IS 8825 05:52:05,983 --> 05:52:08,085 STUDY MTUY GROUP DID,, MY 8826 05:52:08,085 --> 05:52:16,527 OTHER SITES, AND USES -- BASED 8827 05:52:16,527 --> 05:52:18,362 TECHNOTECHNOOAPTURE A VERY 8828 05:52:18,362 --> 05:52:24,635 DIFFERENTIERE BWEEN PAS ANDEAN E 8829 05:52:24,635 --> 05:52:25,169 NON-PANO 8830 05:52:25,169 --> 05:52:26,403 THIS IS A PLATFORM THAT WE USE 8831 05:52:26,403 --> 05:52:31,308 ANDANOU CANANEE THE ARE JUST 8832 05:52:31,308 --> 05:52:33,410 REGULATEGU AMONGST THE PAS P THT 8833 05:52:33,410 --> 05:52:36,046 BLUE IS DOWNREGULATED, YOU CAN 8834 05:52:36,046 --> 05:52:37,915 SEE THEY REALLYEAO DIFFE DNTIATE 8835 05:52:37,915 --> 05:52:38,248 QUITE NIITLY. 8836 05:52:38,248 --> 05:52:46,757 THIS WAS AT THE TIME,IME,UKE --U 8837 05:52:46,757 --> 05:52:50,494 21 PROTEINS, YOU CAN DEDUCEOSET 8838 05:52:50,494 --> 05:52:52,262 WHAT QUITE NICE LIE -- THIS- SIS 8839 05:52:52,262 --> 05:52:53,631 OWING ANYTHING ABOUT 8840 05:52:53,631 --> 05:52:56,033 PATIENTEMOGRAPHICS, NO 8841 05:52:56,033 --> 05:53:01,105 ULTRASOUNDOU DATA, -- - AND TN 8842 05:53:01,105 --> 05:53:05,876 WHAT WEE DID W THAT ATHA TIME 8843 05:53:05,876 --> 05:53:06,844 ERE WASOMCONTROVERSY 8844 05:53:06,844 --> 05:53:07,645 YWHETHER OR NOT THAT T PLATFORMR 8845 05:53:07,645 --> 05:53:08,946 KINDKI OF BIOLOGICALLY ACCEPTABA 8846 05:53:08,946 --> 05:53:12,016 WE JUST CONFIRMED -- AND SURE 8847 05:53:12,016 --> 05:53:12,116 EN 8848 05:53:12,116 --> 05:53:14,618 GH WE DID FOUR COMMERCIALLYY 8849 05:53:14,618 --> 05:53:16,820 AVAILABLE. 8850 05:53:16,820 --> 05:53:19,757 PROTEINS, THEY T ALL WER 8851 05:53:19,757 --> 05:53:27,031 SIGNIFICANT AND CONFIRMRME ON E 8852 05:53:27,031 --> 05:53:31,135 ONELA. 8853 05:53:31,135 --> 05:53:31,235 TH 8854 05:53:31,235 --> 05:53:33,037 ISOT ANYTHING OTHEG OTAN 8855 05:53:33,037 --> 05:53:34,772 THE BIOLO B, THAT T T AUCs A THA 8856 05:53:34,772 --> 05:53:40,544 WERE SWEEWHEREHEHEETWEEN 75 7 A 8857 05:53:40,544 --> 05:53:43,414 90%90%.%. 8858 05:53:43,414 --> 05:53:45,482 ABOUT 50% OF CASES IN THE U.S. 8859 05:53:45,482 --> 05:53:48,752 AREOINGNGAR UNDIAGNOSED. 8860 05:53:48,752 --> 05:53:50,921 HOPE, WHO'S WH THE BACK, FIRST 8861 05:53:50,921 --> 05:53:51,555 AUTHOR ON THIS PAPER IS OUT OF 8862 05:53:51,555 --> 05:53:52,589 THE BRIGHAM, THEY LOOKED AT 8863 05:53:52,589 --> 05:53:54,024 MICRO PARTICLES.CL 8864 05:53:54,024 --> 05:53:56,326 SO MICRORO PTICLES LIKE -- 8865 05:53:56,326 --> 05:53:56,427 BA 8866 05:53:56,427 --> 05:54:03,634 BISY,F YOUU WILL, AND SO THE 8867 05:54:03,634 --> 05:54:05,703 PINK -- SORRY, THE GREEN IS THE 8868 05:54:05,703 --> 05:54:06,303 MICRO PARTICLE EXPRESSIONSSOR 8869 05:54:06,303 --> 05:54:06,403 PA 8870 05:54:06,403 --> 05:54:08,105 COMPARED TO THE T KD K K THE 8871 05:54:08,105 --> 05:54:08,806 WHOLE COREE 8872 05:54:08,806 --> 05:54:11,175 THEYY FOUND IN THE SECOND 8873 05:54:11,175 --> 05:54:12,376 TRIMESTRR, THEY WERE ABLE-- 8874 05:54:12,376 --> 05:54:19,049 THEEE AUC WAS .72 COMPARED TO ., 8875 05:54:19,049 --> 05:54:20,417 DEMOGRAPHICS, IN, THE THIRD 8876 05:54:20,417 --> 05:54:21,985 TRIMESTER, SLIGHTLY LESS ROBT 8877 05:54:21,985 --> 05:54:24,888 THAN THE T SECOND TR TRIMESTER,T 8878 05:54:24,888 --> 05:54:26,824 AGAIN, SAILLLLOPEFUL. 8879 05:54:26,824 --> 05:54:27,925 AND WHATD HEY DID WAS THWA 8880 05:54:27,925 --> 05:54:29,660 IDENTIFIEDFIFI BOTH SECOND AND D 8881 05:54:29,660 --> 05:54:31,762 TRESTER PROTEINS, AND I WOULD 8882 05:54:31,762 --> 05:54:35,265 JUST POINT TO T BIOLO BIOL 8883 05:54:35,265 --> 05:54:38,102 NCTION, KUDOS TO THE GRO F 8884 05:54:38,102 --> 05:54:40,170 DOING THIS, BUT, REALLY THINKING 8885 05:54:40,170 --> 05:54:41,839 ABOUT PAS IN A WAY O WHAT W 8886 05:54:41,839 --> 05:54:42,940 PROTEINS MAKNS SAKSE ISE TERMS F 8887 05:54:42,940 --> 05:54:45,442 HOWHO WE UNDERSTANDAN THEHE BIOY 8888 05:54:45,442 --> 05:54:48,812 THE DISEASE,SE ANDND CAN WE APPY 8889 05:54:48,812 --> 05:54:49,780 THESE PROTEINS TO IT. 8890 05:54:49,780 --> 05:54:57,654 PROTNS, UCsN T0% WHICH FOUR 8891 05:54:57,654 --> 05:54:58,956 AGAIN IS I JUST J FABUL FS. 8892 05:54:58,956 --> 05:55:01,792 AND ID I I THINK NOT SURPRISING 8893 05:55:01,792 --> 05:55:08,265 THIS MORNING ING THINK IS TRULYT 8894 05:55:08,265 --> 05:55:14,905 FABULOFA, AT UCL THEY THE USE TS 8895 05:55:14,905 --> 05:55:15,806 VELCRO NANOKINDOK OF PLATFORM TT 8896 05:55:15,806 --> 05:55:17,441 FOR CIRCULATING CELLS. 8897 05:55:17,441 --> 05:55:21,545 THEY FOUND F CIRCULATING 8898 05:55:21,545 --> 05:55:22,179 TROPHOBLASTS ARE MORE LIKELY TO 8899 05:55:22,179 --> 05:55:27,584 OBE FOUND IN PASASAS AS OPPOSED- 8900 05:55:27,584 --> 05:55:34,024 AND CLUSTEREDEDER CIRCU CTINGNG 8901 05:55:34,024 --> 05:55:34,658 SPECIFICALLY OR CLUSTERED, THEY 8902 05:55:34,658 --> 05:55:35,259 DID ADIABULOUS PAPER SAPWING 8903 05:55:35,259 --> 05:55:38,762 NGTHATERY, VERY KIN K KF DEEP D 8904 05:55:38,762 --> 05:55:39,296 BIOLOGY. 8905 05:55:39,296 --> 05:55:41,131 YOU CAN G C LOST IN IT, IN MY 8906 05:55:41,131 --> 05:55:43,767 N,INUT REALL REALL JUSTYY 8907 05:55:43,767 --> 05:55:44,434 AMAZING.. 8908 05:55:44,434 --> 05:55:47,137 AND WHAT THEY FOUND, OUMPARED 8909 05:55:47,137 --> 05:55:49,439 PAS TO PREVIA A NORMAL AND 8910 05:55:49,439 --> 05:55:53,377 SHOWEDOW SINGLEININ CIRCULATINGG 8911 05:55:53,377 --> 05:55:55,712 TROPHOBLAST INT CLUSTERSTERSUSER 8912 05:55:55,712 --> 05:55:56,380 CIRCLING TROPHOBLAPHS IN 8913 05:55:56,380 --> 05:56:02,486 TO T BE -- PAS P THAN NOT ANDE 8914 05:56:02,486 --> 05:56:03,587 THEN APPLIED IT, THIS IS WRERE I 8915 05:56:03,587 --> 05:56:04,988 THINK THIS GROUP HAS GONE BEYD 8916 05:56:04,988 --> 05:56:06,423 WHAT OTHERS HERE DONE,ON ALTHOUH 8917 05:56:06,423 --> 05:56:11,128 I TNK WNKL WANKL WA APPLY T 8918 05:56:11,128 --> 05:56:14,731 ULTRASOUNDASOU. 8919 05:56:14,731 --> 05:56:22,940 TAK SOMEOM DEMOGRAPHIC, 8920 05:56:22,940 --> 05:56:23,941 BIOLOGICAL DICA, PUT IT I TOGETR 8921 05:56:23,941 --> 05:56:30,113 GRPP IN COMPARING IT, SO REA R 8922 05:56:30,113 --> 05:56:32,816 JUST FULOUS WORK.K. 8923 05:56:32,816 --> 05:56:35,552 AUCsF .9 AND ABO, THA T 8924 05:56:35,552 --> 05:56:40,824 WHERE WE SHOWE SBE, RIGHT? 8925 05:56:40,824 --> 05:56:42,926 FAR ASS I KNOW THIW IS NOT 8926 05:56:42,926 --> 05:56:45,863 READY FOROR CLINICAL APPLICAPPLP 8927 05:56:45,863 --> 05:56:48,498 YET, I THINK IS FAIRLY 8928 05:56:48,498 --> 05:56:50,033 EXPENSIVE, BUT THISSHOUL BE 8929 05:56:50,033 --> 05:56:51,435 OUR GOAL, TO APPLY WHAT WE' 8930 05:56:51,435 --> 05:56:56,139 BIOLOGY AND ALY UNDERSTANER THEO 8931 05:56:56,139 --> 05:57:03,714 TREAENTS. 8932 05:57:03,714 --> 05:57:05,883 I THINK WE HAVE MADE GRADE 8933 05:57:05,883 --> 05:57:06,550 ES IN I BIOMARKER 8934 05:57:06,550 --> 05:57:09,853 INVESTIGATSTN SSTCE WE STARTED. 8935 05:57:09,853 --> 05:57:13,223 IOINTEDUTUT O THAT NEXTEXT SLIDE 8936 05:57:13,223 --> 05:57:14,424 HOPE'S GROUP BUTP IMILAR TO 8937 05:57:14,424 --> 05:57:15,859 OUR FINDR GS AND SIMAR TOO 8938 05:57:15,859 --> 05:57:18,161 OTHER STUDIESDI I D NOT MENTION, 8939 05:57:18,161 --> 05:57:22,766 PROTEINS THANS PEOPL P ARE 8940 05:57:22,766 --> 05:57:31,642 SUGGESSUNG, AND A CERINLY TIS AG 8941 05:57:31,642 --> 05:57:33,911 GENESIS TISSUE INVAS INVAND 8942 05:57:33,911 --> 05:57:34,678 CELLULAR ADHARION ARIO THE PRIHE 8943 05:57:34,678 --> 05:57:37,848 GE OGEORTUGETY AND WEHOD T A 8944 05:57:37,848 --> 05:57:39,449 FOCUS ON IS, WHATEVER 8945 05:57:39,449 --> 05:57:39,549 KI 8946 05:57:39,549 --> 05:57:40,384 OFNOWLGE GAPS WS NEED 8947 05:57:40,384 --> 05:57:42,252 TOTO FILL, F APPLYINGIN URASOUND 8948 05:57:42,252 --> 05:57:44,187 CLINICAL DATA DO THE BIOLOGY IS 8949 05:57:44,187 --> 05:57:44,521 JUST CRITICARI 8950 05:57:44,521 --> 05:57:46,690 WE HAVE TO LINK THOSE TWO, 8951 05:57:46,690 --> 05:57:48,692 OTHERWISE WE'REIND OF NOT 8952 05:57:48,692 --> 05:57:50,661 REALLY MOVING THE BIOMARKERER 8953 05:57:50,661 --> 05:57:52,195 FIELD AT ALL. 8954 05:57:52,195 --> 05:57:53,530 THERE ARE ANIMAL MELS OELS O 8955 05:57:53,530 --> 05:57:53,630 TH 8956 05:57:53,630 --> 05:57:56,266 E, THEY'RE NOT THATT GREAT. 8957 05:57:56,266 --> 05:57:57,768 WE HAVE HEEF THEM. 8958 05:57:57,768 --> 05:57:59,069 IT'S'S MUCH MORE ROBUST MSTEL TT 8959 05:57:59,069 --> 05:58:01,805 NEEDS TO BE B DONE,E, VER 8960 05:58:01,805 --> 05:58:02,072 EXPENSIVE. 8961 05:58:02,072 --> 05:58:08,979 E.BUTE. APPLYIN THE ANIMAL MODET 8962 05:58:08,979 --> 05:58:10,747 EVALUATE -UATEFECT,FEIND OF GET 8963 05:58:10,747 --> 05:58:12,783 THE PLANTA AT THE END, SO IT'S'S 8964 05:58:12,783 --> 05:58:14,217 REALLY --LYE'RE GETTI G THE 8965 05:58:14,217 --> 05:58:15,619 BYPRODUCT OF POTENTIALLY THEHE 8966 05:58:15,619 --> 05:58:17,020 WHOLEE CASCADEASND WE DON'TDO 8967 05:58:17,020 --> 05:58:18,088 TREALLY KNOW, BUT T BUT ANIMALMA 8968 05:58:18,088 --> 05:58:20,824 MODEL ALLOWS YOU TO T KIND OF TT 8969 05:58:20,824 --> 05:58:22,859 IT ATIT VARIOUS POIUSS DURING TE 8970 05:58:22,859 --> 05:58:24,995 GESTATION WHICH WE'VEVE DONE DED 8971 05:58:24,995 --> 05:58:27,164 SHOWSH DIFFEREIFRE EXPSSION AND 8972 05:58:27,164 --> 05:58:32,436 RIOUS JESS TAIGA T T GESTATIONA, 8973 05:58:32,436 --> 05:58:33,737 STO THINK ABOUT THEIR 8974 05:58:33,737 --> 05:58:34,538 FUTURE TARGETS. 8975 05:58:34,538 --> 05:58:36,773 YING THE ADVANCEDV IN PROTEIN 8976 05:58:36,773 --> 05:58:37,040 PLATFORMS. 8977 05:58:37,040 --> 05:58:37,140 S.SO 8978 05:58:37,140 --> 05:58:39,109 DIDT TALK ABOUTINGLE 8979 05:58:39,109 --> 05:58:40,310 RNA SEQ, I DIDN'T TALK ABOUT 8980 05:58:40,310 --> 05:58:41,511 CELL. 8981 05:58:41,511 --> 05:58:42,379 THERE THE JUST SO MANY PLATFORMS 8982 05:58:42,379 --> 05:58:46,783 OFD HEARD THIS EXPRESSION,SSHED 8983 05:58:46,783 --> 05:58:51,388 SMOOTH EE ANALIENALOGY, K, K OFR 8984 05:58:51,388 --> 05:58:54,124 GAJGA IN,ARBAGE OUT, O THINK 8985 05:58:54,124 --> 05:58:54,791 IT'S REALLY ILLORTANT HOW THESEE 8986 05:58:54,791 --> 05:58:55,993 SPECENS ARE PROCESSED AND HOW 8987 05:58:55,993 --> 05:58:58,428 WE KIND OF DEVELOP THESE TISSUEE 8988 05:58:58,428 --> 05:58:58,528 BA 8989 05:58:58,528 --> 05:58:59,863 S ANDAN BBA BS. 8990 05:58:59,863 --> 05:59:01,298 KUDOSDO TOO BOB FOR KIND KINF 8991 05:59:01,298 --> 05:59:03,467 STARTING THAT S.O.P. BUT ALL 8992 05:59:03,467 --> 05:59:05,202 KIND OF CHANGED IT OVER THE TIME 8993 05:59:05,202 --> 05:59:07,204 OVEN IN BOSTON, WE HAVEAV 8994 05:59:07,204 --> 05:59:08,205 THREE DIFFERENT ONES GOING ON, 8995 05:59:08,205 --> 05:59:10,207 OBAB ISOTOT THE MOST 8996 05:59:10,207 --> 05:59:14,978 FICIENT WAY TO DO THISS. 8997 05:59:14,978 --> 05:59:16,079 LALY THELY MAY BE TWO OR REERE 8998 05:59:16,079 --> 05:59:19,216 ON METABOLOMABOL ANDND 8999 05:59:19,216 --> 05:59:19,850 NOTHING ON LIPID LMICS, NO,NE 9000 05:59:19,850 --> 05:59:19,950 IS 9001 05:59:19,950 --> 05:59:22,753 EALLYYTARTING TO GET INTOO 9002 05:59:22,753 --> 05:59:22,853 TH 9003 05:59:22,853 --> 05:59:25,122 LEVEL AT ALL SO I THINK 9004 05:59:25,122 --> 05:59:27,457 IT'SITINDD AN A UNKWN WLD 9005 05:59:27,457 --> 05:59:31,361 AN JUST KIND OF OPEN OPE TO 9006 05:59:31,361 --> 05:59:31,795 EXPLORATION. 9007 05:59:31,795 --> 05:59:32,796 THANKTHOU AND LOOK L FORWARD TO 9008 05:59:32,796 --> 05:59:38,935 HEARING MORE. 9009 05:59:38,935 --> 05:59:39,503 >> SCOTT, THANK YOU SO MUCH. 9010 05:59:39,503 --> 05:59:41,538 WE'RE GOING TO CTINUE WITH 9011 05:59:41,538 --> 05:59:43,173 TALKSTAHAT A SORT OF ON THE 9012 05:59:43,173 --> 05:59:48,178 ONTIERS OFTT IS S 9013 05:59:48,178 --> 05:59:48,812 RESEARCHSEURRENTLY AND WE'RE W 9014 05:59:48,812 --> 05:59:59,056 REGOINGGOO HEAR FROM D SILVER.R. 9015 05:59:59,056 --> 05:59:59,156 >> 9016 05:59:59,156 --> 06:00:01,358 THANK YOU GUYS FOR HAVING ME. 9017 06:00:01,358 --> 06:00:01,458 IT 9018 06:00:01,458 --> 06:00:02,325 GREAT TO BE HERE. H 9019 06:00:02,325 --> 06:00:02,426 TH 9020 06:00:02,426 --> 06:00:06,029 IS KIND OINF A FUNNYALK,AL 9021 06:00:06,029 --> 06:00:07,464 AND IT'S MY OWN FAUECAUSE I 9022 06:00:07,464 --> 06:00:11,334 SAID TO THESE GUYS, LISTEN, I'LL 9023 06:00:11,334 --> 06:00:12,436 LK ABOUT WHATEVEHATE IS LEFT OVE 9024 06:00:12,436 --> 06:00:13,637 AND NOBODY EODE WANTS WTS TO TAK 9025 06:00:13,637 --> 06:00:17,808 BUT IT'S ACTUALLY, I THI,,IND 9026 06:00:17,808 --> 06:00:19,976 OF FUN BUT IT WILLEE DIFFERENT, 9027 06:00:19,976 --> 06:00:31,154 SO IT'S OCCURRED UR ME AS I GET 9028 06:00:33,857 --> 06:00:35,125 DE INSTEADTE OF -- WHEN YOU'RE 9029 06:00:35,125 --> 06:00:36,960 YOUNG YOU WAN TO TAKE CARE OF 9030 06:00:36,960 --> 06:00:37,527 FTHE SICKESSIPATIENTSTIOU CAN 9031 06:00:37,527 --> 06:00:38,628 SSIBLY FIND, FHAT'SS T MOST 9032 06:00:38,628 --> 06:00:39,629 INTERESTINGST THINGHI TO DO, BUT 9033 06:00:39,629 --> 06:00:41,431 WOULD BE BETTER FOR R MANS IF 9034 06:00:41,431 --> 06:00:42,099 YOU COULU ACTU LLCT PREVENT THM 9035 06:00:42,099 --> 06:00:44,134 FROMETTI SICK IN THE FIRST 9036 06:00:44,134 --> 06:00:48,004 SO WE'RE GOING TO GO STREAM 9037 06:00:48,004 --> 06:00:49,606 TALKBOUT PREVE PION OF 9038 06:00:49,606 --> 06:00:57,481 SO HISTORICALLY,HE 9039 06:00:57,481 --> 06:00:57,581 PA 9040 06:00:57,581 --> 06:00:58,849 OPHYSIOLHYY,OLOU'VEE ALL 9041 06:00:58,849 --> 06:01:00,150 LEARNED THIS, ABSEN AEN OR 9042 06:01:00,150 --> 06:01:03,320 DEFICIENCY OFITABUCH'S LAYER 9043 06:01:03,320 --> 06:01:03,420 OR 9044 06:01:03,420 --> 06:01:10,560 PONGIOSUS LAY OF OF O THE T 9045 06:01:10,560 --> 06:01:14,030 CIDUA, THE THE PLACENTA DOES NOT 9046 06:01:14,030 --> 06:01:14,664 SEPARATE AND YOU GET BLEEDINGS. 9047 06:01:14,664 --> 06:01:16,133 WW W REAZEEAHIS IHIS PROBABLY 9048 06:01:16,133 --> 06:01:18,034 YNOT TRUE. 9049 06:01:18,034 --> 06:01:20,871 THISS INCSISTENTITH ININ 9050 06:01:20,871 --> 06:01:25,375 INFINDINGS ANDONSISTENTT, WH 9051 06:01:25,375 --> 06:01:27,577 SO DESPITE THE FACT THAC I KEEP 9052 06:01:27,577 --> 06:01:30,947 PROBABLY SHOULDN'T DOO IT 9053 06:01:30,947 --> 06:01:33,116 ANYMORE. 9054 06:01:33,116 --> 06:01:33,216 AN 9055 06:01:33,216 --> 06:01:34,851 ORE.E. 9056 06:01:34,851 --> 06:01:39,990 THE IN VIVO EVIDENCE,E, KREDD IE 9057 06:01:39,990 --> 06:01:51,201 INCREDIBLCREDITTO BRETT B, IT DO 9058 06:01:52,536 --> 06:01:53,403 THROUGH. 9059 06:01:53,403 --> 06:01:54,938 IT MAYEE CONTAINED BY SCARCA 9060 06:01:54,938 --> 06:01:56,339 TISSUE BUT THERE T NO TRUE 9061 06:01:56,339 --> 06:01:56,439 IN 9062 06:01:56,439 --> 06:01:56,840 SIIN. 9063 06:01:56,840 --> 06:01:59,976 AND THE PLACENTACE AAEARSOO 9064 06:01:59,976 --> 06:02:01,945 PROTRUDEOTR INNOVATE SOMETIMES 9065 06:02:01,945 --> 06:02:04,447 AFTER YOU PULL ON THETH URUS AND 9066 06:02:04,447 --> 06:02:06,149 THEN TH THE PATHO PGIST SAYS, O, 9067 06:02:06,149 --> 06:02:07,217 LOOK, THIS THING T I COMING 9068 06:02:07,217 --> 06:02:18,128 THROUGH,H, IT'S A P PREKR PERCR. 9069 06:02:20,697 --> 06:02:23,533 SEVERE MORBIDITY RATEDAT TO 9070 06:02:23,533 --> 06:02:25,936 ADHESIVE DISEA D,BNORMAL 9071 06:02:25,936 --> 06:02:26,570 VASCULARITY, THEY'RE NOT 9072 06:02:26,570 --> 06:02:26,670 AC 9073 06:02:26,670 --> 06:02:28,004 ALLY DALTH OF INVASIONN AND 9074 06:02:28,004 --> 06:02:30,574 THEREEAY IS CORRELATION 9075 06:02:30,574 --> 06:02:31,508 BETWEEN SCARREDARXISTENCE AND 9076 06:02:31,508 --> 06:02:31,942 DEPTH OF INVASION.IO 9077 06:02:31,942 --> 06:02:33,376 SO YOUOU NEED N A SCAR, YCAR, NA 9078 06:02:33,376 --> 06:02:36,346 OR YOU N YD A DAMAGED 9079 06:02:36,346 --> 06:02:38,415 UTERUS IN SOMN WAY, AND AGAIN, 9080 06:02:38,415 --> 06:02:44,988 IS THEHE PAP THAT BRETT HADHADPG 9081 06:02:44,988 --> 06:02:46,389 ATTENTION TO T TS AND THE HAVE 9082 06:02:46,389 --> 06:02:48,258 SEVERALERALTHERAL PAPERSS WITHH 9083 06:02:48,258 --> 06:02:50,627 THE SAM S FINDINGS. 9084 06:02:50,627 --> 06:02:52,429 SO TS ALTERNATIVE MEL, THE 9085 06:02:52,429 --> 06:02:52,529 GR 9086 06:02:52,529 --> 06:02:56,766 TH IS I BY DEHISCENCE, NNC 9087 06:02:56,766 --> 06:02:58,335 INVASIONVAAND MORBIDITY IS 9088 06:02:58,335 --> 06:03:01,504 REALLYAL DUE TO ABNORMAL BMAODMA 9089 06:03:01,504 --> 06:03:05,342 VESSELS OR VASCULARITYLA AND 9090 06:03:05,342 --> 06:03:08,011 ONS RATHER THAN DEATH. 9091 06:03:08,011 --> 06:03:09,980 AND AS Y'ALL SHOW WHEN A 9092 06:03:09,980 --> 06:03:11,514 PLACENTA ATTACHESHEOO SCAR 9093 06:03:11,514 --> 06:03:13,583 TISSUE,,IOCHEMICALLY, IT DOES 9094 06:03:13,583 --> 06:03:23,660 SO THE T PRIMARY PROBLEM IS THIS 9095 06:03:23,660 --> 06:03:24,761 EE UTENE WALL 9096 06:03:24,761 --> 06:03:26,062 USUALLY DUE TOOURGICAL SCAR SR 9097 06:03:26,062 --> 06:03:30,333 CESAREAN AND THEN YOUET THIS 9098 06:03:30,333 --> 06:03:33,203 ATTACHMENT TO THE SCAR TISSUESUR 9099 06:03:33,203 --> 06:03:36,039 DEFEIVE DECIDUA AND 9100 06:03:36,039 --> 06:03:38,008 PROGREPRIVEPR DEHISCENCE OF 9101 06:03:38,008 --> 06:03:39,209 RIUM. 9102 06:03:39,209 --> 06:03:40,610 SO YOU'VE HEARD ABOUTUTUT THE 9103 06:03:40,610 --> 06:03:45,882 INCREASED DRAMATDRALATDRVER THE 9104 06:03:45,882 --> 06:03:46,883 YEARS, AND THERE'S NO QUESTION 9105 06:03:46,883 --> 06:03:50,353 THAT IT'S INCREASED DRAMATICALLY 9106 06:03:50,353 --> 06:03:51,688 ITANTLY WITH WH IREASE IN 9107 06:03:51,688 --> 06:03:55,492 SO EDEMIOLOGICALLY, I THINK 9108 06:03:55,492 --> 06:03:59,863 THAT OBSERVATION ITITI IMPOR INT 9109 06:03:59,863 --> 06:04:03,133 YOUYO ALL KNOW THERE'S BEENEE 9110 06:04:03,133 --> 06:04:03,800 DRAMATIC INCREASE IN RATES OF 9111 06:04:03,800 --> 06:04:07,203 UNTRIES,TRUT ITR ALSOO WONDER 9112 06:04:07,203 --> 06:04:08,838 WHETHEWH THEWH'S BEEN A CHANGE N 9113 06:04:08,838 --> 06:04:09,339 AN TECHNIQUE. 9114 06:04:09,339 --> 06:04:10,307 EVEN THOUG TI'VE BEEN BN DOING S 9115 06:04:10,307 --> 06:04:11,708 FOR A LONG TIME AND I'M GOING TO 9116 06:04:11,708 --> 06:04:16,880 N SOMEOM OF MY OLDERER 9117 06:04:16,880 --> 06:04:19,716 COES, BAJA, ALFD AND 9118 06:04:19,716 --> 06:04:20,583 GEORGE, BACK IN THE DAY WHEN WE 9119 06:04:20,583 --> 06:04:23,219 WERE TRAIN TG, WE ACTUALLCTSAW 9120 06:04:23,219 --> 06:04:24,921 WPATIENTS WHO HAD LOTS OFS 9121 06:04:24,921 --> 06:04:27,624 NOT AS MANY AS DAY BUT THERE 9122 06:04:27,624 --> 06:04:29,926 WERE STILL PTINT PNT OF THEMNDE 9123 06:04:29,926 --> 06:04:33,163 DIDN'T SEEEE TS. 9124 06:04:33,163 --> 06:04:36,833 LIKE A CASE A YEAR. 9125 06:04:36,833 --> 06:04:38,468 AND MAYUR CESEAN RATE WAS 9126 06:04:38,468 --> 06:04:41,671 18% OR 15%, NOT 30%, BUT WE JUST 9127 06:04:41,671 --> 06:04:42,872 DIDN'T SEE IEE 9128 06:04:42,872 --> 06:04:42,972 SO 9129 06:04:42,972 --> 06:04:44,841 YOU HAVEAV TO WONDER, IS THERE 9130 06:04:44,841 --> 06:04:46,476 A CHANGE IN THEESARN 9131 06:04:46,476 --> 06:04:47,711 TECHNIQUE. 9132 06:04:47,711 --> 06:04:49,112 IS IT BECAUSE WE'RE USI 9133 06:04:49,112 --> 06:04:51,414 RUNNINGNNG SUTURES,ECAUSE WE'RE 9134 06:04:51,414 --> 06:04:52,315 CKING THE SUTURES, BECSEEC 9135 06:04:52,315 --> 06:04:55,485 CLOSURE, IS IT THE TYPE OL 9136 06:04:55,485 --> 06:04:56,019 SUTURESU 9137 06:04:56,019 --> 06:04:59,689 ANALLL THE CESAREAN STUDIES 9138 06:04:59,689 --> 06:04:59,789 WI 9139 06:04:59,789 --> 06:05:00,857 HE DO, MOST OF T OM, WE 9140 06:05:00,857 --> 06:05:04,461 DA, DAX WEEKS AND WE SAY THEY TY 9141 06:05:04,461 --> 06:05:07,664 T BETTT TTT TT FASTER AND ITT TS 9142 06:05:07,664 --> 06:05:08,398 THREE MINUTES LESSES TESDO THE 9143 06:05:08,398 --> 06:05:09,999 CESAREANREO THISS IS GOOD. 9144 06:05:09,999 --> 06:05:11,634 WE HAVEN'TENEN FOLLO FD THE LONG 9145 06:05:11,634 --> 06:05:12,202 NGTERM CONSEQUENCES OF THIS. 9146 06:05:12,202 --> 06:05:13,603 SO YOU HAVE TOO WONDER, IS I ITT 9147 06:05:13,603 --> 06:05:23,613 REAN TECHNIQUE.. 9148 06:05:23,613 --> 06:05:23,713 I 9149 06:05:23,713 --> 06:05:25,582 DNI SAYF WE QUIT DOINGOING ANGS 9150 06:05:25,582 --> 06:05:26,449 MANY CESAREAES THAT WOULD BE 9151 06:05:26,449 --> 06:05:26,649 GREAT.GR 9152 06:05:26,649 --> 06:05:29,386 THAT WOULD BELD A WHOLE W DIFFET 9153 06:05:29,386 --> 06:05:29,919 AND IT WOULD BE A DIVERSION 9154 06:05:29,919 --> 06:05:31,321 BUT I DON I WANT TO LOSEE SHT 9155 06:05:31,321 --> 06:05:32,856 OF THE FACT THAT IF I WRE GOIRE 9156 06:05:32,856 --> 06:05:34,824 TO PUT F PTH A PESEARCH CHARGE 9157 06:05:34,824 --> 06:05:36,526 AND KWLEDGE GAPS, I DON'T KNOW 9158 06:05:36,526 --> 06:05:37,627 WHAT THE THE OPTIMAL CESAREAN RE 9159 06:05:37,627 --> 06:05:41,064 FOR THEEST MATERNAL A 9160 06:05:41,064 --> 06:05:42,699 FETAL OUTCOMES BUT I BETT'S 9161 06:05:42,699 --> 06:05:43,900 NOT %.%. 9162 06:05:43,900 --> 06:05:45,101 AND WE SHOULD WORK ON THAT. 9163 06:05:45,101 --> 06:05:46,903 AND YOU KNOW, THERE ARERE MEDICL 9164 06:05:46,903 --> 06:05:49,406 THINGS THAT CAN HELP REDEEDE THE 9165 06:05:49,406 --> 06:05:51,474 CESAREAN RATE,ATERTAINLY 9166 06:05:51,474 --> 06:05:56,946 REVISINGRITERIA FOR FABORE,CE 9167 06:05:56,946 --> 06:05:57,947 ARRESTS SEEM VERY PROMISINGSI 9168 06:05:57,947 --> 06:05:59,282 ALTHOUGH ITASN'T TRANS TTENS ASA 9169 06:05:59,282 --> 06:06:01,317 LL CLILL CLLY. 9170 06:06:01,317 --> 06:06:03,286 ACTIVE MANAGEMENAG OF LABOR,AB 9171 06:06:03,286 --> 06:06:04,487 THERE'S STILL S SOME PROMISING 9172 06:06:04,487 --> 06:06:05,588 STUDIES AND IT SURE S WOU BE 9173 06:06:05,588 --> 06:06:07,157 EATEA TO HAVE BHATE BSTRA BSTES 9174 06:06:07,157 --> 06:06:08,391 ADDRESS FETAL STATUS. 9175 06:06:08,391 --> 06:06:10,260 THERE HAVE BEEN SEVAL 9176 06:06:10,260 --> 06:06:12,061 ATTEMPTS, NONE OFFF THEM HAVE 9177 06:06:12,061 --> 06:06:12,162 TR 9178 06:06:12,162 --> 06:06:13,430 YMPACTED OUR CESAREAN 9179 06:06:13,430 --> 06:06:19,903 AGAIN, YOU'RE -- LOWER L CESAREN 9180 06:06:19,903 --> 06:06:24,974 RATE, I'M NOT SAYING EVERYBODY 9181 06:06:24,974 --> 06:06:26,709 G G ELECTIVENDUCTION BUT 9182 06:06:26,709 --> 06:06:28,011 IT CERTAINLY IS A STRATEGY THAT 9183 06:06:28,011 --> 06:06:31,014 SHOULD BE IN THE THE THELBOX. 9184 06:06:31,014 --> 06:06:31,681 THIS IS A SLIDE THAT I SHOW WHEN 9185 06:06:31,681 --> 06:06:43,760 37 WEEK7 BUT IF YOU LOOK ATATF 9186 06:06:44,294 --> 06:06:46,062 THESE STUDIES SHOWE S A LOWER 9187 06:06:46,062 --> 06:06:47,664 RATECESAREAN SO THAT'S A 9188 06:06:47,664 --> 06:06:48,298 POSSIBILSSY.IL 9189 06:06:48,298 --> 06:06:50,166 AND THERE AREANY NON-MEDICAL 9190 06:06:50,166 --> 06:06:53,670 WORK SOME S THE TIME, NONE WKEM 9191 06:06:53,670 --> 06:06:55,305 ALL OF THE TIME TT YOU CANAN DO 9192 06:06:55,305 --> 06:06:58,675 AND FAMILIES A EDUCATION, TINSNT 9193 06:06:58,675 --> 06:06:59,843 YOU DO IU DOVEU IONS TARGETING 9194 06:06:59,843 --> 06:07:00,710 HEALTHCARE PCAFESSIONALS WITH 9195 06:07:00,710 --> 06:07:03,680 EDUCATIOUCATUIDELINES, SECOND 9196 06:07:03,680 --> 06:07:04,180 IONS, AUDITS, ANTS, EN YOU 9197 06:07:04,180 --> 06:07:05,014 N DO THINGS WNGH HEALTHCARE 9198 06:07:05,014 --> 06:07:05,348 ORGANIZAGAONS.GA 9199 06:07:05,348 --> 06:07:09,285 WE PROBABLY OUGHT O TOO LOWER L 9200 06:07:09,285 --> 06:07:10,820 ESAREAES RATE. 9201 06:07:10,820 --> 06:07:11,721 THAT'S ONE WAY TO DO PRIMARY 9202 06:07:11,721 --> 06:07:14,657 EVENTION. 9203 06:07:14,657 --> 06:07:16,626 ANOTHEANTHING, ANDLFRED TALKS 9204 06:07:16,626 --> 06:07:19,229 ABOUT THIS A LITTLEIT B IS 9205 06:07:19,229 --> 06:07:22,599 CESAREAN SCAR S E E E PREGNANREE 9206 06:07:22,599 --> 06:07:24,100 IMPLANIMTION OF THE EMBRY ERYRYO 9207 06:07:24,100 --> 06:07:27,837 OHIS TERROTOMYCAR AND 9208 06:07:27,837 --> 06:07:31,975 MICRO OR MACRO SCOPIC DEHISCENCE 9209 06:07:31,975 --> 06:07:34,511 AND EARLY ALTERATIOER OFF THE 9210 06:07:34,511 --> 06:07:34,611 IN 9211 06:07:34,611 --> 06:07:35,378 RVILLOUSND UTEROPLACROTAL 9212 06:07:35,378 --> 06:07:36,346 CIRCULATION AND THEN YOU GET A A 9213 06:07:36,346 --> 06:07:37,480 CESARECE SRER OR ECTICCT 9214 06:07:37,480 --> 06:07:37,780 NCY. 9215 06:07:37,780 --> 06:07:46,189 WE'RE DOING EARLY EKE SCREENINGN 9216 06:07:46,189 --> 06:07:47,423 EVERYBODY WOULD HAVE H A VALUE, 9217 06:07:47,423 --> 06:07:48,725 EARLY DIAGNOSIS OF 9218 06:07:48,725 --> 06:07:49,158 ABNORMALITIES. 9219 06:07:49,158 --> 06:07:51,928 I ALWAYS LIKE TE SAY WE HAVEN H 9220 06:07:51,928 --> 06:07:52,529 NECESSARILY GOTTEN STTRTER BUT 9221 06:07:52,529 --> 06:07:58,768 AND WE CAN HE ANRGUMENT OVERETTR 9222 06:07:58,768 --> 06:07:59,536 THE COST-EFFECTIVENESS OF THAT,, 9223 06:07:59,536 --> 06:07:59,636 BU 9224 06:07:59,636 --> 06:08:00,837 I THI THIT HAS POTENTIAL. 9225 06:08:00,837 --> 06:08:02,372 AND I'M NOT N REQUESTING TO GO 9226 06:08:02,372 --> 06:08:05,475 INTO HOW T DIAGN DEGN THISHI 9227 06:08:05,475 --> 06:08:06,676 NLY BUT THERE ARE REALLY 9228 06:08:06,676 --> 06:08:08,645 NICE CRITERIA FOR HOW TOWO TOW 9229 06:08:08,645 --> 06:08:11,881 DIAGNODI ANOESAREAN SCAR TOPIC 9230 06:08:11,881 --> 06:08:12,448 IF TWO THIRDS OF THEOFAC IS 9231 06:08:12,448 --> 06:08:14,183 SABOVE THEHE ENDOMETRIAL LINE, T 9232 06:08:14,183 --> 06:08:22,692 IS A NICE SLIDE THAT SHOWS S IT. 9233 06:08:22,692 --> 06:08:31,801 HERE YOU Y CAN SEE MRI AND A THN 9234 06:08:31,801 --> 06:08:33,036 IS CESAREAN ECTOPICCTND IT ITT 9235 06:08:33,036 --> 06:08:35,238 DS UP BEING BEIN ACCRETACC A 9236 06:08:35,238 --> 06:08:42,078 AREN'TERYER GOOD INYN CASE SERSS 9237 06:08:42,078 --> 06:08:43,179 BUT BOTTT LINE IS IFS OU HAVE 9238 06:08:43,179 --> 06:08:45,582 AN SCAR ECTOPIC, IT', 9239 06:08:45,582 --> 06:08:46,182 REALLYREOING TO BE A PLACENTLA 9240 06:08:46,182 --> 06:08:48,885 ACCRETA AND WHETHER IT'S 82%, 9241 06:08:48,885 --> 06:08:53,022 92% OR 9 # 99% DOESN'T REALLY 9242 06:08:53,022 --> 06:08:53,122 MA 9243 06:08:53,122 --> 06:08:54,190 , THIS IS HOW IT HAPPENS. 9244 06:08:54,190 --> 06:08:56,259 SO IF WE GOT TM EARLY, WE 9245 06:08:56,259 --> 06:08:57,760 COULD TREAT THEM AND THEN HAVEEA 9246 06:08:57,760 --> 06:08:59,596 BETTER OUT COMUT AND THAT'SS 9247 06:08:59,596 --> 06:09:06,970 ANOTHER PREVENTION STRATEGY, AND 9248 06:09:06,970 --> 06:09:09,272 MOR-ISCH HAD A 9249 06:09:09,272 --> 06:09:11,040 NON-RANDOMRAED RETRO RECTIVE 9250 06:09:11,040 --> 06:09:13,343 THESE CESAREAN SCACA ECTOPICS AD 9251 06:09:13,343 --> 06:09:13,443 YO 9252 06:09:13,443 --> 06:09:14,344 TREAT TEATT EARLY, THEY T DO 9253 06:09:14,344 --> 06:09:17,013 TTERER THAN IF YN T YAT THEAT 9254 06:09:17,013 --> 06:09:17,914 LATE. 9255 06:09:17,914 --> 06:09:19,749 IN RED YOU YANANEEANHE RATE OF 9256 06:09:19,749 --> 06:09:25,221 ADVERSEE OUTMES -- 9 WEEKS, 9257 06:09:25,221 --> 06:09:25,321 MU 9258 06:09:25,321 --> 06:09:26,923 HIG HIF Y H TREAT THEAT 9259 06:09:26,923 --> 06:09:27,023 LA 9260 06:09:27,023 --> 06:09:28,424 THANF YOU F EAT TEAM 9261 06:09:28,424 --> 06:09:29,325 EARLY, DRAMATICALLY.CA 9262 06:09:29,325 --> 06:09:30,293 IT MAKES SENSE. 9263 06:09:30,293 --> 06:09:32,295 LESS VASCULARITY,TY YOU KNOW, SO 9264 06:09:32,295 --> 06:09:36,132 ON AND SND FORTH. 9265 06:09:36,132 --> 06:09:37,233 NOW, I ALSO THINK THERE'S AN 9266 06:09:37,233 --> 06:09:38,101 OPPORTUNITY TO FIGURE OUT WHAT 9267 06:09:38,101 --> 06:09:39,969 THE BESTREATMENT IS, AND THEND 9268 06:09:39,969 --> 06:09:42,972 NDUTHUT IS, REALLY DON'TDONOW. 9269 06:09:42,972 --> 06:09:43,072 IT 9270 06:09:43,072 --> 06:09:44,607 JUSTUS LIKE IT'S BEENN 9271 06:09:44,607 --> 06:09:46,509 FASCINATINGATO ME BECAUSE WAURE 9272 06:09:46,509 --> 06:09:47,810 ALLL THEORETICALLY EXPERIENCEE 9273 06:09:47,810 --> 06:09:51,114 PEOPLE WHO KNOW MOREOR ABOUT THN 9274 06:09:51,114 --> 06:09:52,749 R COLLEAGUES, ANDND D'T 9275 06:09:52,749 --> 06:09:52,849 TH 9276 06:09:52,849 --> 06:09:54,717 KTHHREE OF US DO THIOO THE 9277 06:09:54,717 --> 06:09:58,054 SO HOPULLY AT LYE END OF THIS 9278 06:09:58,054 --> 06:09:59,022 ETING, WE'LL WORK TOWARDS 9279 06:09:59,022 --> 06:09:59,822 FIGURING THAT OUT. 9280 06:09:59,822 --> 06:10:01,924 BUT IT'S THE SAME SING WITH 9281 06:10:01,924 --> 06:10:03,459 THCESAREAN SCAAN ECTOP E 9282 06:10:03,459 --> 06:10:06,863 SO ACCEPTABLEBLBL OPTIONS ARE 9283 06:10:06,863 --> 06:10:11,401 ULTRASOUND GUINDD UTERINE 9284 06:10:11,401 --> 06:10:12,168 ASPIRATION ESPECIASPY WH 9285 06:10:12,168 --> 06:10:15,104 BALLOON OO OCCLUSION OF THE SCAA 9286 06:10:15,104 --> 06:10:18,274 ALSO HE HE LAPAROSCOPIC 9287 06:10:18,274 --> 06:10:18,875 RESECTION REPAIRREF THE SCAE 9288 06:10:18,875 --> 06:10:21,244 YOU CAN SEE THESE 9289 06:10:21,244 --> 06:10:22,345 INTRESTATIONALTIACALTI 9290 06:10:22,345 --> 06:10:22,445 ME 9291 06:10:22,445 --> 06:10:25,815 MY O PSONABIAS IS WE'VE 9292 06:10:25,815 --> 06:10:26,549 GOTTEN AWAY FROM TFRT, BUT 9293 06:10:26,549 --> 06:10:28,384 OTHERS MAY STILL BE DOIOI THA 9294 06:10:28,384 --> 06:10:30,586 EVERYBODYGREES JUSTUS DOING A 9295 06:10:30,586 --> 06:10:30,687 AD 9296 06:10:30,687 --> 06:10:31,688 C WITHOUT SEEING WHAG W YOU'R Y 9297 06:10:31,688 --> 06:10:33,523 DOING IS I NOT A GOOD IDEA, ANDA 9298 06:10:33,523 --> 06:10:41,731 METHOTREXATE I'T A GOODD IDEA. 9299 06:10:41,731 --> 06:10:41,831 WE 9300 06:10:41,831 --> 06:10:47,370 DO OW ALL THESESEHINGS WILL 9301 06:10:47,370 --> 06:10:48,571 LL -- NONE- OF THESE THISES LET 9302 06:10:48,571 --> 06:10:50,540 US KNOW K WT'S THE BEST TESNG IF 9303 06:10:50,540 --> 06:10:52,542 THEY DECIDE TO T GET PREETANT 9304 06:10:52,542 --> 06:10:53,009 AGAIN. 9305 06:10:53,009 --> 06:10:54,510 CERTAINLY A THE RET R CAL BALIS 9306 06:10:54,510 --> 06:10:56,345 IF YOU Y WERER TERO PUT SOMEE SS 9307 06:10:56,345 --> 06:10:57,947 D HEAL THAT SCAR, ICASEEMS 9308 06:10:57,947 --> 06:10:58,915 LIKE IT MIGHT BE BETTERR THAN IF 9309 06:10:58,915 --> 06:11:00,583 YOU JUSTEFTEF HOLE FOR F THERE 9310 06:11:00,583 --> 06:11:04,153 TO BEE ANOTHER CESAR CESSCAR 9311 06:11:04,153 --> 06:11:04,253 EC 9312 06:11:04,253 --> 06:11:04,387 PIC. 9313 06:11:04,387 --> 06:11:08,658 BUT WE DON'T REALLY KNOWNO THAT. 9314 06:11:08,658 --> 06:11:10,526 IF YOU EVALUATEE CASERIES OF 9315 06:11:10,526 --> 06:11:12,395 WHO WON T GET 9316 06:11:12,395 --> 06:11:13,496 PREGNANTEG AGAIN, MOST OF T TIME 9317 06:11:13,496 --> 06:11:21,037 THIS WORKS PRETTY WELL BUT THEEE 9318 06:11:21,037 --> 06:11:22,638 XPECTED RATE OF PREGN PCY 9319 06:11:22,638 --> 06:11:22,739 LO 9320 06:11:22,739 --> 06:11:24,273 ABOUT 15%. 9321 06:11:24,273 --> 06:11:24,907 THERE'S NO CLEAR ADVANTAGE BASED 9322 06:11:24,907 --> 06:11:25,308 TREATMENTATYPE.AT 9323 06:11:25,308 --> 06:11:27,009 SO WE W REALLY ND MORE DATA,UT 9324 06:11:27,009 --> 06:11:29,212 EARLY SONOGRAM IS ADVISED,IS NO 9325 06:11:29,212 --> 06:11:32,615 TWO WAYS ABOUTT. 9326 06:11:32,615 --> 06:11:34,484 SO LET'S L TALK A LITTLE BIT ABO 9327 06:11:34,484 --> 06:11:38,287 TYTH OF CLOSURELOHEAING AND THEH 9328 06:11:38,287 --> 06:11:39,555 THERETHAVE BEEN SOMNTUDYS THAT 9329 06:11:39,555 --> 06:11:42,425 HAVE TRIED TO ASSESS THIS. 9330 06:11:42,425 --> 06:11:42,959 CERTAINLY SINLLE VERSE YOU 9331 06:11:42,959 --> 06:11:43,593 DOUBLE LAYER L SOMETHING WE ALL 9332 06:11:43,593 --> 06:11:44,861 THINK AUT, EXCLUSION O 9333 06:11:44,861 --> 06:11:48,831 CLUSIOCLOF THE DECIDUAUAUA SHOUS 9334 06:11:48,831 --> 06:11:51,134 SUTURE. CONTE UOUS OR LOCKING 9335 06:11:51,134 --> 06:11:52,568 WE'RE ALWAYS TAUGHT THAT T T LOL 9336 06:11:52,568 --> 06:11:54,537 SURE I MORHEMOSTHEICSTHE 9337 06:11:54,537 --> 06:11:55,772 MAYBEYB IT CAUSES MORE TISSUE 9338 06:11:55,772 --> 06:11:56,572 NECROSIS. 9339 06:11:56,572 --> 06:11:59,308 THINK SOMEOM OF US US UITA L OF 9340 06:11:59,308 --> 06:11:59,876 ENBABLY THINK IT 9341 06:11:59,876 --> 06:12:03,279 DOESN'T MATTER AT A 9342 06:12:03,279 --> 06:12:04,814 BUT IT'S A THING. 9343 06:12:04,814 --> 06:12:06,482 CERTAINLY DIFFERENT SUTUREE TYPT 9344 06:12:06,482 --> 06:12:07,984 MAY MAKE A DIFFERENCE. 9345 06:12:07,984 --> 06:12:10,820 YOU HAVE HAVE ANOTHER PREGNANCY 9346 06:12:10,820 --> 06:12:11,754 SEEMS TO MAKE AIFFERENCE. 9347 06:12:11,754 --> 06:12:13,322 WHETHER OR NOT YOU HAVE 9348 06:12:13,322 --> 06:12:14,457 INFECTION AND WHAT KIND OF 9349 06:12:14,457 --> 06:12:14,557 HE 9350 06:12:14,557 --> 06:12:15,324 INHEIN PROBABLROMAKES A 9351 06:12:15,324 --> 06:12:17,894 FFERENCE, AND THEN ARE THERE 9352 06:12:17,894 --> 06:12:18,528 TREATMENTS TO PROMOTE HEALING, 9353 06:12:18,528 --> 06:12:21,297 CAN WE DO A BETTER CTEAREAN. 9354 06:12:21,297 --> 06:12:22,732 IT'S'SERY DIFFICULT TO T STUDY 9355 06:12:22,732 --> 06:12:28,805 THISECAUSE YOU ROUO REALLY NEED 9356 06:12:28,805 --> 06:12:28,905 RA 9357 06:12:28,905 --> 06:12:30,006 OMIZED TRIALS, IT'S J NOTOT 9358 06:12:30,006 --> 06:12:30,106 CO 9359 06:12:30,106 --> 06:12:33,009 STUDIED THISD N A MEANINGEAL WAY 9360 06:12:33,009 --> 06:12:34,644 SO YOU'R Y LEFT WITH CE CTROL 9361 06:12:34,644 --> 06:12:37,313 NO ACCRETAS AND THEN GO BACK AND 9362 06:12:37,313 --> 06:12:38,815 Y TO SEE WHAT W KIND OF CESAREAN 9363 06:12:38,815 --> 06:12:39,382 THEY HAD.. 9364 06:12:39,382 --> 06:12:41,384 YOU COULD UOU SUROUGATE 9365 06:12:41,384 --> 06:12:44,253 MARKERS SO YOU CAN CSECARR 9366 06:12:44,253 --> 06:12:45,788 THICKNESS AESS Y CAN UAN NICHE 9367 06:12:45,788 --> 06:12:49,358 ANDDHEN YOU CAN U ANIMA A A 9368 06:12:49,358 --> 06:12:50,259 MODELS. 9369 06:12:50,259 --> 06:12:59,402 THE UTERUS,EFINED AS BEINMUS OFO 9370 06:12:59,402 --> 06:12:59,936 MORE THAN 2 MILLIMETERS IN 9371 06:12:59,936 --> 06:13:00,136 DEPT 9372 06:13:00,136 --> 06:13:02,538 YOU CAYO ALSO MEASU M THEESI 9373 06:13:02,538 --> 06:13:02,638 DU 9374 06:13:02,638 --> 06:13:04,974 MYOMETRIAL THICKNESS, WHICH 9375 06:13:04,974 --> 06:13:05,775 HOW HH NORMAL MYOMETRIUM 9376 06:13:05,775 --> 06:13:11,247 THERE IS, AND THERE ARE CRITERIA 9377 06:13:11,247 --> 06:13:13,583 FOR HOW TO TEASU T THIS. T T 9378 06:13:13,583 --> 06:13:14,817 IT SHOULD BE IN THE SAGETAL MID 9379 06:13:14,817 --> 06:13:17,119 PLANE PL A NON-PREGNANT PANIENT. 9380 06:13:17,119 --> 06:13:18,421 THE SITE O PRIOR CESAREAN, ANDN, 9381 06:13:18,421 --> 06:13:20,223 YOU CAN USE SEVER SEVERGING 9382 06:13:20,223 --> 06:13:21,691 MODALITIES. 9383 06:13:21,691 --> 06:13:25,261 2D OR 3D SONOGRAM, IRA SHOULDULB 9384 06:13:25,261 --> 06:13:25,361 TR 9385 06:13:25,361 --> 06:13:27,530 SVAGINAL, BE YOU CAN USE 9386 06:13:27,530 --> 06:13:29,632 SALINE OR GEL INFUSION, MRI, ANA 9387 06:13:29,632 --> 06:13:31,467 CAN BE TRIANGULARR SEMICIRCLE 9388 06:13:31,467 --> 06:13:32,635 SHAPEDSH 9389 06:13:32,635 --> 06:13:34,804 SO HERE ARE PICTURES OFF NICHESC 9390 06:13:34,804 --> 06:13:39,942 FROM PAUL WDWARDAR. 9391 06:13:39,942 --> 06:13:40,710 THIS SHOW UP? 9392 06:13:40,710 --> 06:13:43,145 HERE YOU C SEE THERE'SHERE'S A 9393 06:13:43,145 --> 06:13:43,246 LI 9394 06:13:43,246 --> 06:13:43,813 LE D THERE, THAT'S WATRE 9395 06:13:43,813 --> 06:13:47,216 YOUR SCAR IS. 9396 06:13:47,216 --> 06:13:48,751 HEREOU SEE A S HOLE, ANDND THE 9397 06:13:48,751 --> 06:13:50,920 HOLE IS WHERE THE NIC IS AND 9398 06:13:50,920 --> 06:13:54,957 CAN MEASURE THESE THINGS. 9399 06:13:54,957 --> 06:13:58,895 THE GROSS SPECIMEN, YOU COULD 9400 06:13:58,895 --> 06:14:07,737 SEE WHAT THE NICHE LOOKS LIKE. 9401 06:14:07,737 --> 06:14:08,838 SO THESO INCIDENCE OF OF NICHE 9402 06:14:08,838 --> 06:14:10,373 BECAUSBE YOU CAN USE THESE 9403 06:14:10,373 --> 06:14:13,276 ANDIFFERENT DEENNITIONS HASS HAS 9404 06:14:13,276 --> 06:14:14,477 REPORTED SOMEWHERE BETWEEN 199 9405 06:14:14,477 --> 06:14:15,244 AND 100%. 9406 06:14:15,244 --> 06:14:19,448 AT'S NOTERRIY USEFULSESE.. 9407 06:14:19,448 --> 06:14:20,016 THIS VARIATION TECONIQUE AND 9408 06:14:20,016 --> 06:14:21,183 DEAF ANYTHINNY, BUTERTAINLY 9409 06:14:21,183 --> 06:14:23,486 BIGGER NICHES SHEMHE TO BE WORS. 9410 06:14:23,486 --> 06:14:23,586 AL 9411 06:14:23,586 --> 06:14:25,121 MOST PEOPLE WITH NIITES 9412 06:14:25,121 --> 06:14:27,390 ESARE FINE. 9413 06:14:27,390 --> 06:14:29,225 THERE MERER BE ASSOCIASSON WITHW 9414 06:14:29,225 --> 06:14:32,728 DOING A CESAREAN THAT'S IN THE 9415 06:14:32,728 --> 06:14:36,933 CERVIX RATHERHEHAN IN THEHE LOWR 9416 06:14:36,933 --> 06:14:38,467 UTERINEEREGMENTEG 9417 06:14:38,467 --> 06:14:39,001 SOMEBODY YOU WOULD DO IFO 9418 06:14:39,001 --> 06:14:40,336 MEBODY HBO SECONDEC STAGE ARRT 9419 06:14:40,336 --> 06:14:40,436 AN 9420 06:14:40,436 --> 06:14:46,075 PUSHING TOO T LONG, YOU GETOU 9421 06:14:46,075 --> 06:14:48,244 FRACTURING OF T O LOWER UTERINE 9422 06:14:48,244 --> 06:14:48,577 SEGMENT. 9423 06:14:48,577 --> 06:14:51,414 E THOUGHT IS IF YOU DO A 9424 06:14:51,414 --> 06:14:55,818 THERE'S MORE GLANDS AND THATTUE, 9425 06:14:55,818 --> 06:14:58,020 SHEN IMPAIR HEALING 9426 06:14:58,020 --> 06:15:01,590 NORMAL DECUA. 9427 06:15:01,590 --> 06:15:03,793 THERE MAY BEOMELATIONSHIIO 9428 06:15:03,793 --> 06:15:06,996 TO THE HYSROTOMY CLOSURE 9429 06:15:06,996 --> 06:15:07,430 TECHNIQUE. 9430 06:15:07,430 --> 06:15:09,065 WHETHER YOU'RE LOCKINLOONE OR 9431 06:15:09,065 --> 06:15:11,534 O LAYERSUTURE TYPE. 9432 06:15:11,534 --> 06:15:13,269 HHERE'S SOME ASSOC ATION W 9433 06:15:13,269 --> 06:15:13,936 E RETRO REEX UTERUS.RU 9434 06:15:13,936 --> 06:15:15,604 A SSET OF THESE PATIENTAT WNTL 9435 06:15:15,604 --> 06:15:16,572 HAVESE GYNECOLOGIC SYMOMS.OMS. 9436 06:15:16,572 --> 06:15:17,940 THEY'LL HAVE PAIN, CHRONICHR 9437 06:15:17,940 --> 06:15:19,909 BLEEDING, AND THEY MAY EVEN HAVH 9438 06:15:19,909 --> 06:15:20,676 PROBLEMS WITH FERTILITYTI BUTTIE 9439 06:15:20,676 --> 06:15:21,811 VASTAJORITY OF THESE PATIENTSIE 9440 06:15:21,811 --> 06:15:24,480 ARE FINE. 9441 06:15:24,480 --> 06:15:30,019 SO IT NEVER BEEN -- IT'S NEVER 9442 06:15:30,019 --> 06:15:32,221 SEEN CLINICALLYCA WORTHWHILE TO 9443 06:15:32,221 --> 06:15:34,757 SCREEN FOR THESE PATNTAT 9444 06:15:34,757 --> 06:15:35,358 SYMPTOMATICALLTICAF SOMEBODY 9445 06:15:35,358 --> 06:15:37,426 COMES IN WITHH BLEED WLEEDED ORR 9446 06:15:37,426 --> 06:15:38,027 AND YOU DON'T KNOW WHAT TO DO 9447 06:15:38,027 --> 06:15:39,261 AND THEY TAVE THIS, THEN YOU MAY 9448 06:15:39,261 --> 06:15:40,896 TREAT THEM. 9449 06:15:40,896 --> 06:15:42,398 OBSTETOBCALLY,HEY'REHEORE 9450 06:15:42,398 --> 06:15:43,599 LIO HAVE PAS,AS UTERINE 9451 06:15:43,599 --> 06:15:45,668 RUPTURE OR A CESAREAN SCAR 9452 06:15:45,668 --> 06:15:47,603 ECTOPIC, BUT AGAIN A THE POSITIE 9453 06:15:47,603 --> 06:15:49,572 PREDECORATIVE VALUE OLUEUSTTFINH 9454 06:15:49,572 --> 06:15:53,209 THAT NO ATE I RECOMMENDING THAT 9455 06:15:53,209 --> 06:15:53,809 WE ASYMPTOMATICAMAY SCMAENSCOR 9456 06:15:53,809 --> 06:15:56,712 ORTHESE FOLKS. 9457 06:15:56,712 --> 06:15:58,147 WE DOO BETTERETRR CESAREAN, 9458 06:15:58,147 --> 06:16:00,282 AND IT'SERY DIFFICULTLTO 9459 06:16:00,282 --> 06:16:01,584 STUDY,STGAINSTYOU NEEDU RCT 9460 06:16:01,584 --> 06:16:04,854 WTE CAN USE THESEHE OTH 9461 06:16:04,854 --> 06:16:07,289 MARKERS. 9462 06:16:07,289 --> 06:16:10,760 PEOPLE HAVE TRIED TO DO TO T 9463 06:16:10,760 --> 06:16:12,628 USINTHESE SURGATE MARKERSAR 9464 06:16:12,628 --> 06:16:14,997 SO THERE WAS ONEAS RECENT 9465 06:16:14,997 --> 06:16:17,199 SYSTEMATIC REVIEW META-ANALYSISL 9466 06:16:17,199 --> 06:16:17,666 2020 9467 06:16:17,666 --> 06:16:20,536 STUDIES, 15,000 PATIENTS IN 9468 06:16:20,536 --> 06:16:23,672 RCTs, THEYHEY ADDRESSED URINE 9469 06:16:23,672 --> 06:16:26,842 NICHES, THE RESIDUAL YOU'LL 9470 06:16:26,842 --> 06:16:26,942 MY 9471 06:16:26,942 --> 06:16:28,144 ETRIAL THICKNESS AND HEANG 9472 06:16:28,144 --> 06:16:28,577 RATIO. 9473 06:16:28,577 --> 06:16:28,677 IN 9474 06:16:28,677 --> 06:16:31,013 THIS META-ANALYSIS, A SINGLE 9475 06:16:31,013 --> 06:16:31,714 CLOSURCL WAS WORSE THAN A 9476 06:16:31,714 --> 06:16:33,115 DOUBLE LUBER CLOSURE, AND YOU Y 9477 06:16:33,115 --> 06:16:40,289 HAD DECASED RESI DUALESIDUALOU'L 9478 06:16:40,289 --> 06:16:42,825 MYOMETMYALET TCKNESS OF O 1 TO 9479 06:16:42,825 --> 06:16:43,359 CENTETERS. 9480 06:16:43,359 --> 06:16:45,428 WHETHER THAT'S CLINICALLNI 9481 06:16:45,428 --> 06:16:46,028 IMPORTANT IS HT D TO SAY, YOU 9482 06:16:46,028 --> 06:16:50,766 UHAD DECREASEDRE EL HEALING RAD 9483 06:16:50,766 --> 06:16:50,866 IT 9484 06:16:50,866 --> 06:16:52,001 AS WORSE WITH A LOCD 9485 06:16:52,001 --> 06:16:52,234 SUTURE. 9486 06:16:52,234 --> 06:16:55,971 THERE ALSOLS SEEMEDD TOO BEE 9487 06:16:55,971 --> 06:16:58,774 SED NHE IF YO I EXCDEXCXC 9488 06:16:58,774 --> 06:16:58,874 TH 9489 06:16:58,874 --> 06:16:59,542 ECIDUA.UA 9490 06:16:59,542 --> 06:17:01,477 SO WHEN WHE W I WAS TRAINED,, IS 9491 06:17:01,477 --> 06:17:12,455 UGHT TO EXCLUDE THE DI SYD EXCLA 9492 06:17:14,190 --> 06:17:17,493 BUT AT LEA INN THE POOR QUALITY 9493 06:17:17,493 --> 06:17:20,362 EVIDENCE INCLUDING THE DIDUA 9494 06:17:20,362 --> 06:17:22,765 IN YOURR INCIS IN, SEEME SOE 9495 06:17:22,765 --> 06:17:27,436 ASSOCIATED WITH -- ANOTHERTH 9496 06:17:27,436 --> 06:17:30,439 AND AEE COHORTS, THE,RE WAS 9497 06:17:30,439 --> 06:17:32,775 DID THE SAME STUFF STHEY STHEY 9498 06:17:32,775 --> 06:17:33,375 MIXED RESULTS, BUTS,GAINS,THEY 9499 06:17:33,375 --> 06:17:36,011 HAD BHATERTEUTCOMEUT WITH WO 9500 06:17:36,011 --> 06:17:42,184 LAYER CLOSURES AND INCLUDING THE 9501 06:17:42,184 --> 06:17:42,751 A IN THE CLOSURE. 9502 06:17:42,751 --> 06:17:46,255 YOU WOULD ARGUEHIS IS STILL A 9503 06:17:46,255 --> 06:17:48,023 DGE GADG WHAT THE BEST 9504 06:17:48,023 --> 06:17:48,824 AN TECHNIQUE IS.UE 9505 06:17:48,824 --> 06:17:49,925 BUT IF WE'RE GOING TO TAKE 9506 06:17:49,925 --> 06:17:52,228 WHAT'S OAT THERE, IT SEEMS LE 9507 06:17:52,228 --> 06:17:52,795 ETWO LATWRS ARE BETTER THAN 9508 06:17:52,795 --> 06:17:54,797 NWURNTIWU ANDWUNCLUDING THEHE 9509 06:17:54,797 --> 06:17:55,764 DECIDUA IS BA ISRHAN NOT 9510 06:17:55,764 --> 06:17:57,833 CLUDES T DID D. 9511 06:17:57,833 --> 06:17:58,501 AND THEND HERE'S A WHOLE FIELD F 9512 06:17:58,501 --> 06:17:59,902 THERE THAT'SEALLY, REALLY 9513 06:17:59,902 --> 06:18:00,769 INTERESTING, BUTG, IT'S VERY 9514 06:18:00,769 --> 06:18:00,870 PR 9515 06:18:00,870 --> 06:18:03,105 IMINY. 9516 06:18:03,105 --> 06:18:03,539 OF IMPROVED HEALING. 9517 06:18:03,539 --> 06:18:06,008 CAN WE MAKEAK A BETTERR WOUND BY 9518 06:18:06,008 --> 06:18:07,877 ADDING STUFF 9519 06:18:07,877 --> 06:18:11,514 AGAIN, YOU ALL A RAISEAISED THEE 9520 06:18:11,514 --> 06:18:11,981 OF THEHE 9521 06:18:11,981 --> 06:18:12,715 NFLAMMATORYAT RESPONSE, 9522 06:18:12,715 --> 06:18:12,815 WO 9523 06:18:12,815 --> 06:18:14,350 D HEALINGEQUIRES 9524 06:18:14,350 --> 06:18:16,452 INFLAMMATION BUT N TOO MUCH 9525 06:18:16,452 --> 06:18:17,052 INFLAMMATION, AND SO HERE'S A 9526 06:18:17,052 --> 06:18:17,153 LI 9527 06:18:17,153 --> 06:18:22,525 MOLECULES OR AI-INFLAMMATORY 9528 06:18:22,525 --> 06:18:24,860 MOLECULES, YOU CAN USE KOL JEB J 9529 06:18:24,860 --> 06:18:26,529 LDS,LD MESENCHESAL STEM S 9530 06:18:26,529 --> 06:18:26,862 CELLS. 9531 06:18:26,862 --> 06:18:31,567 WE DID SOME STUDIES IN UTAH THAT 9532 06:18:31,567 --> 06:18:33,269 HOHT WERE VERY INTERESTIER 9533 06:18:33,269 --> 06:18:34,670 BUT WAYREMATURE AND I'LL JUST J 9534 06:18:34,670 --> 06:18:35,638 SHARE A LITTLE BIT WHERERE YOU 9535 06:18:35,638 --> 06:18:38,774 COULD USULTEM CELLS C ANDNDND TE 9536 06:18:38,774 --> 06:18:44,146 WERE STEM S CELL SHEETS WE W DID 9537 06:18:44,146 --> 06:18:46,315 THEM IN MICE, YOU CAN USE 9538 06:18:46,315 --> 06:18:47,516 ALLOGENEICGETEM CELLS WHICH IS 9539 06:18:47,516 --> 06:18:49,552 LESS CUMBERSOME TO TRY TO BUIO 9540 06:18:49,552 --> 06:18:52,855 BETTER SCAR.SO YOU HAD THISHIHI, 9541 06:18:52,855 --> 06:18:56,959 U COULD PUT THE STEM CELLNS, OR 9542 06:18:56,959 --> 06:18:59,128 ON O ONE H ON, NOT THE OTHER 9543 06:18:59,128 --> 06:18:59,228 HO 9544 06:18:59,228 --> 06:19:00,663 , YOU DO YOUR CESAREAN, YOU 9545 06:19:00,663 --> 06:19:03,799 HORN.THE STEM SLL SHEET ON ONEO 9546 06:19:03,799 --> 06:19:03,899 AN 9547 06:19:03,899 --> 06:19:09,471 T TURNS T OUT IF YOU SLAP THE 9548 06:19:09,471 --> 06:19:11,240 STEM CELL SET YOU GET AETTER 9549 06:19:11,240 --> 06:19:11,340 SC 9550 06:19:11,340 --> 06:19:12,508 . 9551 06:19:12,508 --> 06:19:13,042 THIS IS DIFFERENT WAYS OF 9552 06:19:13,042 --> 06:19:13,442 RATING THAT. 9553 06:19:13,442 --> 06:19:16,879 THEN YOU HAVE A GREATERRETERINE 9554 06:19:16,879 --> 06:19:22,284 WALL THICK TSS AND A A LESS 9555 06:19:22,284 --> 06:19:24,820 ARRING ANDND THIS IS A STUDY 9556 06:19:24,820 --> 06:19:26,555 THAT SEVERAL FOLKSNCLUNGLU 9557 06:19:26,555 --> 06:19:32,261 BRETT DID D IN UTAH. 9558 06:19:32,261 --> 06:19:34,630 SO THIS IS VERYERREMINARY AND 9559 06:19:34,630 --> 06:19:35,197 A LITTLE BIT OUTITHERE BHE I 9560 06:19:35,197 --> 06:19:36,432 T WILL STIMULATETE A LITTLETL 9561 06:19:36,432 --> 06:19:36,899 CONVERSATIERSA 9562 06:19:36,899 --> 06:19:39,468 SO THESO BESTHE SATEGY IS FEW 9563 06:19:39,468 --> 06:19:39,902 CESAREAN DELIVERIES. 9564 06:19:39,902 --> 06:19:41,270 LET'S LESO THINK AHIUT DOING 9565 06:19:41,270 --> 06:19:43,672 BETTER CESAREAN DELIV DIES,IES,D 9566 06:19:43,672 --> 06:19:46,809 THEN EAR DIAGNIS OF CESAREAN 9567 06:19:46,809 --> 06:19:49,345 TREATMENT OF CESEAN SCAR 9568 06:19:49,345 --> 06:19:49,545 PICS 9569 06:19:49,545 --> 06:19:56,585 THANKS. 9570 06:19:56,585 --> 06:19:58,887 >> DR. SILR.R, I DIDN'T THINK IN 9571 06:19:58,887 --> 06:19:59,521 WAS YOU THAT WAS GOING TO BRING 9572 06:19:59,521 --> 06:20:03,025 US BACK ON OIME BUT THAT WAS 9573 06:20:03,025 --> 06:20:03,359 FANTASTIC. 9574 06:20:03,359 --> 06:20:05,894 IN THE LAST OF OUR SPEAKERS FOR 9575 06:20:05,894 --> 06:20:06,929 THE DAY BEFORE THE FINAL F PANE, 9576 06:20:06,929 --> 06:20:09,298 WE'RE EITED TO HEAR FROMRO 9577 06:20:09,298 --> 06:20:18,874 DR. BARTELS.S. 9578 06:20:18,874 --> 06:20:18,974 >> 9579 06:20:18,974 --> 06:20:21,310 HANK YOU SO MUCH FORORAVININ 9580 06:20:21,310 --> 06:20:25,581 I'M HELENA BARTELS,TE FROMRO DUB 9581 06:20:25,581 --> 06:20:26,849 I KNOW I'M THE LT SPEAKER OF 9582 06:20:26,849 --> 06:20:29,251 THE DAY, THE D TAD DAD D LT SLOT 9583 06:20:29,251 --> 06:20:31,553 OPE YOU CAN GIVE ME YR 9584 06:20:31,553 --> 06:20:32,621 ATTENTION FOR THEHE LAST 202020 9585 06:20:32,621 --> 06:20:35,758 MINUTES BEFORE WE G TO OUR GIN 9586 06:20:35,758 --> 06:20:39,495 AND TONG TONICS OR WHAVER ELSE 9587 06:20:39,495 --> 06:20:50,372 SO T TITLE OF MY TALK,ER ON. 9588 06:20:52,941 --> 06:20:54,076 PSYCHOPSGIHOLGIALL OUT OFF PAS,, 9589 06:20:54,076 --> 06:20:54,176 BU 9590 06:20:54,176 --> 06:20:56,111 WE'RE SUCH AROUP OF 9591 06:20:56,111 --> 06:20:59,682 PROBABLY K ABOUT TBOS SO S I S 9592 06:20:59,682 --> 06:21:02,284 KINDHIKINDF THOUGHT INSTEAD I 9593 06:21:02,284 --> 06:21:03,819 HIGHLIGHGHSOME THINGS I THOUGHT 9594 06:21:03,819 --> 06:21:03,919 WO 9595 06:21:03,919 --> 06:21:05,421 D BE INTBEESTING FOR 9596 06:21:05,421 --> 06:21:06,288 DISCUSSION TOMORROW RATWR THAN 9597 06:21:06,288 --> 06:21:07,823 GOING VINYY DEEPLY INTHINGS 9598 06:21:07,823 --> 06:21:07,923 TH 9599 06:21:07,923 --> 06:21:10,159 HOPEFULLYEF MANY MFOU A 9600 06:21:10,159 --> 06:21:11,627 FAMILIARARITH, BUT MAYBE WE CAN 9601 06:21:11,627 --> 06:21:12,995 COME BACK AT THE PANELEL TALK FF 9602 06:21:12,995 --> 06:21:14,229 TOMORROW. 9603 06:21:14,229 --> 06:21:17,066 I'M GOING TO BRIEFLY BE 9604 06:21:17,066 --> 06:21:19,535 TALKINGLK ABOUT KIND OF OUR 9605 06:21:19,535 --> 06:21:20,135 EXPERIENCE OF FAMILY CEILERED 9606 06:21:20,135 --> 06:21:20,936 CARE ACA I SUPPOSE OUR 9607 06:21:20,936 --> 06:21:22,471 ENCE OFXPRING THE 9608 06:21:22,471 --> 06:21:25,307 LIVED EXPERIENCE OFCEARFTS. 9609 06:21:25,307 --> 06:21:29,545 I GUESS G MY M RE R COMESOM IN, 9610 06:21:29,545 --> 06:21:30,512 SURGERIERG LOOKING AKIER THESE 9611 06:21:30,512 --> 06:21:32,648 MOMS, BUT APART FRORT THAT, I 9612 06:21:32,648 --> 06:21:33,949 ALSO CALCHAIR OUAI PATNT 9613 06:21:33,949 --> 06:21:37,786 ADVOCACY GROUPRO CALLLED PLAEDNT 9614 06:21:37,786 --> 06:21:42,391 WE ARE FIVE YEARS OLD NOW. 9615 06:21:42,391 --> 06:21:44,093 I WORK WITH AN AMAZING GROUP ORP 9616 06:21:44,093 --> 06:21:46,829 PEOPLEPEHATT ARE IMPACTEDDD THIT 9617 06:21:46,829 --> 06:21:48,731 CONDITION THAT RY COME BACK 9618 06:21:48,731 --> 06:21:51,033 ANDDVOCATEOC AEE SHARE THEIRHE 9619 06:21:51,033 --> 06:21:53,102 STORIEST W US IN OUR GROUP,, 9620 06:21:53,102 --> 06:21:53,202 BU 9621 06:21:53,202 --> 06:21:55,104 I'VE REALLY SKEN TH 9622 06:21:55,104 --> 06:21:55,771 HUNDREDS OF PEOPLE FROM ALL OVER 9623 06:21:55,771 --> 06:21:56,338 THE WORLD THAD HAVE TAVS 9624 06:21:56,338 --> 06:21:57,673 CONDITION AND I REALLYYANT TO 9625 06:21:57,673 --> 06:22:00,309 ECHOHATT KRISTIN SAID SAT THIAT 9626 06:22:00,309 --> 06:22:00,409 IS 9627 06:22:00,409 --> 06:22:04,213 SO PROBABLYBA WHEREVER YOU'RE 9628 06:22:04,213 --> 06:22:08,384 DELIVERING CARE TO THESE 9629 06:22:08,384 --> 06:22:09,818 PROGRAMS, THE ---S PROBABLY 9630 06:22:09,818 --> 06:22:10,919 FLECTED IN TH I WORK THAT WE'VEW 9631 06:22:10,919 --> 06:22:15,324 DONE, AND TN TALK A LITTLE 9632 06:22:15,324 --> 06:22:20,295 TREATMENT.EE PREFERENCESRENC FOR 9633 06:22:20,295 --> 06:22:23,999 WHAT ARE A SOM AOF THE IMPORTANT 9634 06:22:23,999 --> 06:22:24,099 TH 9635 06:22:24,099 --> 06:22:25,567 GS ABOGSOR WH 9636 06:22:25,567 --> 06:22:25,834 ADVOCATES. 9637 06:22:25,834 --> 06:22:27,536 SO IEALLY BELIEVE THAT WORKING 9638 06:22:27,536 --> 06:22:33,175 ANY OF THIS T WORK BECAUSE WEE S 9639 06:22:33,175 --> 06:22:34,510 ALTHCARE PROVIDERSRS AND AS 9640 06:22:34,510 --> 06:22:36,578 PEOPLE HEREERN THIS ROOM, WE 9641 06:22:36,578 --> 06:22:37,413 LOTS OFOTNOOFEDGE BECAUSE 9642 06:22:37,413 --> 06:22:38,981 ARE EXPERTSTS ITS WHAT WE DO, E 9643 06:22:38,981 --> 06:22:41,583 HAVE GONE TO MICAL SCHOO SCHOO E 9644 06:22:41,583 --> 06:22:45,220 HAVE STUVEED THIS CANE, CDITIOT 9645 06:22:45,220 --> 06:22:46,655 WE REALLY NEED TO HAVE THE 9646 06:22:46,655 --> 06:22:47,356 PATIENT EXPERIENCE AS PART OF 9647 06:22:47,356 --> 06:22:49,324 THAT BECAUSE THEY AREXPERTS BER 9648 06:22:49,324 --> 06:22:49,992 EXPERIENCE. 9649 06:22:49,992 --> 06:22:53,462 AND BY B DISINVOLVING THEM WE'RE 9650 06:22:53,462 --> 06:22:54,096 MISSING A HUGE PART OF THE UMIIT 9651 06:22:54,096 --> 06:22:55,230 PUZZLE AND WE HAVE TO UNDERSTANR 9652 06:22:55,230 --> 06:22:57,900 THEM AND WHAT DO THEY CARE C 9653 06:22:57,900 --> 06:22:58,534 EABOUT, BECAUSE WITHOUTITHAT, WE 9654 06:22:58,534 --> 06:22:59,568 EDON'T REALLY KNOW HOW H TO IMPE 9655 06:22:59,568 --> 06:22:59,668 LI 9656 06:22:59,668 --> 06:23:05,374 FOR THESE PEOPLE. 9657 06:23:05,374 --> 06:23:10,579 THISTH IS THE EE KO T T T ETHOSW 9658 06:23:10,579 --> 06:23:12,514 ERE WE HAVEEATIENTAT RLLY 9659 06:23:12,514 --> 06:23:13,348 INVOLVED IN ED IY S IGLE ASPEC A 9660 06:23:13,348 --> 06:23:16,418 OF CARE, SO WE ALWAYS SAY 9661 06:23:16,418 --> 06:23:16,518 WO 9662 06:23:16,518 --> 06:23:20,222 ING A LOT LN AN ONCOGY, 9663 06:23:20,222 --> 06:23:20,322 TH 9664 06:23:20,322 --> 06:23:20,856 E'THNOTHING ABOUT ME WITHOUT 9665 06:23:20,856 --> 06:23:21,023 ME. 9666 06:23:21,023 --> 06:23:21,623 SO EVERY PIECE OF WORK THAT 9667 06:23:21,623 --> 06:23:22,925 WE'RE DOING AND RESEARCH TT 9668 06:23:22,925 --> 06:23:25,093 WE'RE WEING, THERE HAS TO BE A 9669 06:23:25,093 --> 06:23:26,261 VOICEVOHERE THAT' T REPRESENTING 9670 06:23:26,261 --> 06:23:26,995 THE PATIENT. 9671 06:23:26,995 --> 06:23:27,996 DOESN'T HAVE TO BE SOMEONEOM 9672 06:23:27,996 --> 06:23:32,034 BE SOMBENE TBENE IT'SS THEIR CAC 9673 06:23:32,034 --> 06:23:32,267 FAMILY. 9674 06:23:32,267 --> 06:23:34,603 -- THE SISTER OF A LADY L THAT 9675 06:23:34,603 --> 06:23:36,038 UNFORTUNATELY DIED FROM 9676 06:23:36,038 --> 06:23:36,638 COMPLICOTIONS BUT WE HT WE TO 9677 06:23:36,638 --> 06:23:38,407 HAVE SOMVEOM VOI THEREHE THATS 9678 06:23:38,407 --> 06:23:41,276 HELPINGS TO INDICATE A A 9679 06:23:41,276 --> 06:23:41,910 PERSPECTIVE ON WHAT THIS IS ALL 9680 06:23:41,910 --> 06:23:43,779 ABOUT.ABAB 9681 06:23:43,779 --> 06:23:45,848 AND I D'T D WANT TO GO INTO I TO 9682 06:23:45,848 --> 06:23:45,948 MU 9683 06:23:45,948 --> 06:23:49,351 DETAIL BECAUSEEC I HOPE LOTS 9684 06:23:49,351 --> 06:23:52,020 OF YOU ARE FAMILIARITH THE --HE 9685 06:23:52,020 --> 06:23:54,389 AND OTHERS A SAL COLLINS IN 9686 06:23:54,389 --> 06:23:55,724 THE K. BUT REALLY THE T 9687 06:23:55,724 --> 06:23:57,960 IMPORTANT THINGSTH FRO LIVNG 9688 06:23:57,960 --> 06:23:58,660 WITH THIS CHIDI CON IS THAT WEHA 9689 06:23:58,660 --> 06:24:01,697 KNOW THAT IT'ST' HUGELY -- IT'SA 9690 06:24:01,697 --> 06:24:02,764 AL TOLL FOR F MOMS AND 9691 06:24:02,764 --> 06:24:06,502 THEIRRAMILIESIL TO RE TIVE THIS 9692 06:24:06,502 --> 06:24:09,238 YOU MIGHT HAVE THIS CONDITION.HI 9693 06:24:09,238 --> 06:24:10,772 LOTS O THEMM GONTOO SURVIVAL 9694 06:24:10,772 --> 06:24:13,909 MODE AND THE IMPRESSION THAT WE 9695 06:24:13,909 --> 06:24:14,910 OFTEN GETE WHETHER THEY'RE IN 9696 06:24:14,910 --> 06:24:16,411 THAT SURVIVAL MODE IS THERE 9697 06:24:16,411 --> 06:24:17,412 DOING WELL BELAUSE I ILWAYS SAYY 9698 06:24:17,412 --> 06:24:19,715 THEY HAVE THEIR EYES ON TH O 9699 06:24:19,715 --> 06:24:20,883 PRIZE HOW TO DO ANYTHINNY TO GET 9700 06:24:20,883 --> 06:24:25,854 BABY,BA SO THEY MIGHTHT BE OPENO 9701 06:24:25,854 --> 06:24:26,488 HAVING A CONVERSATION ABOUT HOW 9702 06:24:26,488 --> 06:24:27,856 TH IS IMPACTING THEM T OR EVEN 9703 06:24:27,856 --> 06:24:29,258 BEING ABLE A TO THINKHI ABOUTBOT 9704 06:24:29,258 --> 06:24:30,759 IF WEEON'T START THAT 9705 06:24:30,759 --> 06:24:31,360 CONVERSATIONSAND CREATE THAE 9706 06:24:31,360 --> 06:24:31,460 SA 9707 06:24:31,460 --> 06:24:32,761 SPACE, SO WE ND TO 9708 06:24:32,761 --> 06:24:35,464 ACKNOWLEDGE THAT THIS IHI REALLY 9709 06:24:35,464 --> 06:24:36,031 NALLY CHLLLENGING FOR 9710 06:24:36,031 --> 06:24:37,766 BUEMBU THEY OFTEN O COPE WELLEL 9711 06:24:37,766 --> 06:24:40,235 BECAUSE THEY GO INTTHE 9712 06:24:40,235 --> 06:24:42,371 SURVIVAL MALE. 9713 06:24:42,371 --> 06:24:44,540 THEN REALLY THEOST IMPORTANT 9714 06:24:44,540 --> 06:24:45,007 RT IS FROM THE LIVED 9715 06:24:45,007 --> 06:24:47,809 TRIMESTER,TE SO THEY'VEIVENTHRTT 9716 06:24:47,809 --> 06:24:49,878 BIRTH AND IT'S ALL OVE 9717 06:24:49,878 --> 06:24:51,046 AND TANS IS WHEN A LOT OF ITF 9718 06:24:51,046 --> 06:24:53,348 THE CARE TT UNFORTUNATELY WER 9719 06:24:53,348 --> 06:24:53,448 EPR 9720 06:24:53,448 --> 06:24:54,550 EE. 9721 06:24:54,550 --> 06:24:58,053 THIS ISS NOT JUST ABOUT PAS BUT 9722 06:24:58,053 --> 06:24:59,688 IN PGN P I GENAL, WOMENOM 9723 06:24:59,688 --> 06:25:02,991 HAVE HIGVE RIGK PREGNANCIES, THY 9724 06:25:02,991 --> 06:25:04,126 GET A VERY STRUCTURED CARE 9725 06:25:04,126 --> 06:25:05,460 PATHWAPA ANDPAUDDENLY THEY'VE 9726 06:25:05,460 --> 06:25:06,762 BIRTH,, IT'S ALL OVER AND 9727 06:25:06,762 --> 06:25:08,697 THEY DON'T GET GET ANY SUPPORT. 9728 06:25:08,697 --> 06:25:09,331 SO ACTUA AY TH A HAVEN H REALL R 9729 06:25:09,331 --> 06:25:10,232 BEEN ABLE AO THINK TBONK HOW H 9730 06:25:10,232 --> 06:25:12,434 THIS HAS IMPACTEMP THEMPHEURING 9731 06:25:12,434 --> 06:25:14,836 THE PREGNANCYNAT ALLAND NOWOW 9732 06:25:14,836 --> 06:25:16,605 THEY'VE GIVEN BIRTH, NOW NHEY N 9733 06:25:16,605 --> 06:25:17,573 ALLY NEED SUPPORTRT A SOMNE 9734 06:25:17,573 --> 06:25:20,008 TO TALK TO AK THE MILESTONEES 9735 06:25:20,008 --> 06:25:20,676 ARE REALLY AROUND SIXD ONTHS AND 9736 06:25:20,676 --> 06:25:21,043 ONE YEAR. 9737 06:25:21,043 --> 06:25:23,879 T ONE-YEAR MAR IT'S THEHE 9738 06:25:23,879 --> 06:25:25,380 RTHDAY, EVERYONE ISNE REALLY 9739 06:25:25,380 --> 06:25:26,481 EXCITE, BLOWING OWI CANDLES,DL 9740 06:25:26,481 --> 06:25:27,783 FAMILY IS THERE, BUT BEALLY FOR 9741 06:25:27,783 --> 06:25:29,384 THEM, THE T THINKING BACK TO 9742 06:25:29,384 --> 06:25:30,118 THIS REALLY, REALLY FRIGHTENIGH 9743 06:25:30,118 --> 06:25:33,855 ISOLATEDOLATAUSE THEY DON'TBE HY 9744 06:25:33,855 --> 06:25:40,929 ALLYLY HE ANYONE TO SPEAK S TO,Y 9745 06:25:40,929 --> 06:25:41,496 PSYCHOLOGIHOL FOLLOW, THEIR 9746 06:25:41,496 --> 06:25:42,331 PARTNERS HAVRS MOVED ON, EVERYOE 9747 06:25:42,331 --> 06:25:45,367 KING AT THEM AND SAYING 9748 06:25:45,367 --> 06:25:45,467 YO 9749 06:25:45,467 --> 06:25:46,101 BABY IS HERE, EERRY EING E IS 9750 06:25:46,101 --> 06:25:47,169 FINE, SO REALLYOSTNATAL 9751 06:25:47,169 --> 06:25:48,203 PART IPA REALLY, REALLY 9752 06:25:48,203 --> 06:25:54,810 IMPORTANT. 9753 06:25:54,810 --> 06:25:58,880 ABOUT OURUR PANEL DISCUSSION 9754 06:25:58,880 --> 06:26:01,783 TOMORROW, WHAT WRE THINGS WE CAN 9755 06:26:01,783 --> 06:26:02,351 TUALLY DO TO HELP MOMS AMO 9756 06:26:02,351 --> 06:26:03,118 THEIFAMILIFA. 9757 06:26:03,118 --> 06:26:05,654 I THI OHI O OHI THE THINGSNG IN 9758 06:26:05,654 --> 06:26:07,823 FAMILY CENTERED CARE, THAT WE'T 9759 06:26:07,823 --> 06:26:09,658 ALLY TAKING A APPROACH WACREACRT 9760 06:26:09,658 --> 06:26:15,230 MRI, PLANNING THEIR SURIR S, BUT 9761 06:26:15,230 --> 06:26:16,965 ACTUALLY MAKING SUREURHIS FAMILY 9762 06:26:16,965 --> 06:26:19,134 IS REALLY WELL LOOKED AFTER. 9763 06:26:19,134 --> 06:26:19,768 THIS PTHIE P IS SAYING THENGDIHE 9764 06:26:19,768 --> 06:26:21,036 E BEST THE COULD BUT THE 9765 06:26:21,036 --> 06:26:21,970 WHOLE EXPERIENCE WASERRIFYING 9766 06:26:21,970 --> 06:26:23,939 AND I THINK THAT'S REALLY 9767 06:26:23,939 --> 06:26:24,573 ECHOING SOME OF THE THINGS WE'RE 9768 06:26:24,573 --> 06:26:25,440 UT TODUT. 9769 06:26:25,440 --> 06:26:26,975 WE WANT TO T BE DOI SO MUCH 9770 06:26:26,975 --> 06:26:29,011 BETTER THANUST HING MS 9771 06:26:29,011 --> 06:26:29,111 SU 9772 06:26:29,111 --> 06:26:31,647 IVE THIS CONDI CON. 9773 06:26:31,647 --> 06:26:31,747 BU 9774 06:26:31,747 --> 06:26:33,181 ACTUALLCT THATHAT THEY ARE WELW 9775 06:26:33,181 --> 06:26:34,716 IN THEIRHEIRHEENTALL A PHYSICAL 9776 06:26:34,716 --> 06:26:36,351 IN THE LONHE LRM. 9777 06:26:36,351 --> 06:26:37,519 LK ABOUT THINGS FOROR 9778 06:26:37,519 --> 06:26:38,520 EVIDENCE-BASEDRAUMA TREE 9779 06:26:38,520 --> 06:26:39,121 VE 9780 06:26:39,121 --> 06:26:45,027 S,PREVENTION, INONLVING THIN IN 9781 06:26:45,027 --> 06:26:45,127 DE 9782 06:26:45,127 --> 06:26:49,164 SION-MAKING,G, LKI LKI ATT 9783 06:26:49,164 --> 06:26:49,364 CARE. 9784 06:26:49,364 --> 06:26:50,032 THESE ARE THE RECOMMENDATMENS 9785 06:26:50,032 --> 06:26:51,900 FOR CARE WE'VE MADE BASED ON OUN 9786 06:26:51,900 --> 06:26:52,300 CHSE 9787 06:26:52,300 --> 06:26:57,005 I'M NOTI IFF OT GOING TONG T G M 9788 06:26:57,005 --> 06:26:59,808 ALL, BUT EVEUT TVEEE THAT YOU'RE 9789 06:26:59,808 --> 06:27:00,942 REINTERECTING WITH THESEHEHE PA, 9790 06:27:00,942 --> 06:27:04,012 ALSO TAKINGAK IO ACCOUNT HOWNT E 9791 06:27:04,012 --> 06:27:07,983 SUPPORT THAT THEHE NEED?ND MTA A 9792 06:27:07,983 --> 06:27:10,385 WE PREFER ALL OF OURF PATIE PS 9793 06:27:10,385 --> 06:27:12,120 I CHAT WIT W THEIR PTNERS TO 9794 06:27:12,120 --> 06:27:13,221 E THEY'RE INFORMED AND 9795 06:27:13,221 --> 06:27:16,258 THEY NEEDEEEE TO HAVSOMEBODY WIH 9796 06:27:16,258 --> 06:27:16,892 THEM THAT'S GOING TO HG E THEIR 9797 06:27:16,892 --> 06:27:19,094 BACK AND MAYBEBE IF THEY'RE IN A 9798 06:27:19,094 --> 06:27:20,295 SITUATSIN WHERE THEY'RE NOT ABLE 9799 06:27:20,295 --> 06:27:24,900 TO ADVOCATE FOR THEMSELVES, THAS 9800 06:27:24,900 --> 06:27:26,902 WHERE YER HAVE EDUCATION 9801 06:27:26,902 --> 06:27:27,269 INFORMED. 9802 06:27:27,269 --> 06:27:29,571 MAYBE WE CAN C COMNT IN OUR 9803 06:27:29,571 --> 06:27:30,338 OUP TOMORROW A LOWTLE BIT. 9804 06:27:30,338 --> 06:27:31,807 AND IN THINKINGGBO- ONE OF 9805 06:27:31,807 --> 06:27:31,907 TH 9806 06:27:31,907 --> 06:27:32,908 THINGS THAT A ACTUA ACT 9807 06:27:32,908 --> 06:27:38,847 EVIDENCEVIDENCE-BASCE ALREADY,DD 9808 06:27:38,847 --> 06:27:40,282 TO BUILDUI TRUST ANDELATIONSHIIS 9809 06:27:40,282 --> 06:27:44,386 WITH THESE PATNTATAT DINGIN WHEN 9810 06:27:44,386 --> 06:27:45,053 THEY HEY THIS BUT ALSO THAT WE 9811 06:27:45,053 --> 06:27:46,254 CONTINUE THAT THA THE POSTNATAL 9812 06:27:46,254 --> 06:27:47,122 PERIOD. 9813 06:27:47,122 --> 06:27:49,124 YOU WON'T BELIEVE HIE MUCH YOUR 9814 06:27:49,124 --> 06:27:50,759 CARE, KINDNESS AND S MPASSION 9815 06:27:50,759 --> 06:27:51,359 MEANS TO THESE FAMILIES AND A 9816 06:27:51,359 --> 06:27:53,962 CONTINUITYINF CARE C C IS ABSOLY 9817 06:27:53,962 --> 06:27:54,730 ESSENTIAL. 9818 06:27:54,730 --> 06:27:57,099 THEY'RE NOT JUST IN THISN YOU 9819 06:27:57,099 --> 06:27:59,367 KNOW, KIND OF ASS OF FEAR O O 9820 06:27:59,367 --> 06:28:01,503 TH'RE TOO AFRAIDFR TO ASKSK 9821 06:28:01,503 --> 06:28:02,137 QUESTIONS OR THEY'RE TOO AFRAID 9822 06:28:02,137 --> 06:28:02,237 DTO 9823 06:28:02,237 --> 06:28:03,071 VEN TALK TOUT WHATHAIGHT BE 9824 06:28:03,071 --> 06:28:03,171 HA 9825 06:28:03,171 --> 06:28:05,240 ENING TO T THE T BUT THEY'RE 9826 06:28:05,240 --> 06:28:07,342 LY -- A RLLY SAFE SPA 9827 06:28:07,342 --> 06:28:07,843 D AB TO SAY WE'RE A 9828 06:28:07,843 --> 06:28:08,710 SPECIALIST TEAM, WE'VE GE' THIS, 9829 06:28:08,710 --> 06:28:09,811 WE'VE DONE THIS TEFORE, THISHI S 9830 06:28:09,811 --> 06:28:09,911 WH 9831 06:28:09,911 --> 06:28:11,713 'S GNGNG TO PPEN DURING 9832 06:28:11,713 --> 06:28:12,447 E PREGNANCY, AND CREATINGIN 9833 06:28:12,447 --> 06:28:14,082 PLACES WHERE WE CAN HAVE REALLY 9834 06:28:14,082 --> 06:28:15,584 MEANINGFUL CONVERSATIONS WITHH 9835 06:28:15,584 --> 06:28:18,820 THEM. 9836 06:28:18,820 --> 06:28:30,265 ADD VOD VOCACY GROUP, WE HAVEE S 9837 06:28:30,265 --> 06:28:32,367 WEBSITE, ALLE,F THESE THINGS, 9838 06:28:32,367 --> 06:28:33,435 THERE'S JUST SOMETHING ABOUT 9839 06:28:33,435 --> 06:28:34,302 HAVING SOMET SNG TANGIBLE THAT T 9840 06:28:34,302 --> 06:28:34,402 TH 9841 06:28:34,402 --> 06:28:35,403 CANO HOMEE WITH. 9842 06:28:35,403 --> 06:28:41,877 Y DON'T HAVE INFOR ITION, 9843 06:28:41,877 --> 06:28:43,512 TH'RE T A A PRIORITY, THEY'RE 9844 06:28:43,512 --> 06:28:46,081 CONVERSATIONS WITH YOU.SE 9845 06:28:46,081 --> 06:28:49,851 AND DDENLY GET ARETA.ARE BORNOR 9846 06:28:49,851 --> 06:28:49,951 MO 9847 06:28:49,951 --> 06:28:52,988 OF THEF PEOPLE BECAU B OF OFTHY 9848 06:28:52,988 --> 06:28:53,088 GI 9849 06:28:53,088 --> 06:28:54,189 BIRTH AND SOME OF THESE T 9850 06:28:54,189 --> 06:28:55,724 TIMES THEY'VE ALREADY 9851 06:28:55,724 --> 06:28:55,824 EX 9852 06:28:55,824 --> 06:28:57,359 RIENCED BIRTH TRAUMA. 9853 06:28:57,359 --> 06:28:57,459 BI 9854 06:28:57,459 --> 06:28:59,961 H TRAUMA IMPACTS 1 IN 9855 06:28:59,961 --> 06:29:00,996 N IS THIS IS VER LIKELYY 9856 06:29:00,996 --> 06:29:01,730 TO HAVE HAPPE HD. 9857 06:29:01,730 --> 06:29:03,098 SS REALLY,LLEALLY IORTANTOR 9858 06:29:03,098 --> 06:29:04,833 NTWE SPEWEPEWE ABOUT TBOT AND AS 9859 06:29:04,833 --> 06:29:05,634 ABOUT THOSE PAS EXPERIENCES 9860 06:29:05,634 --> 06:29:07,502 BECAUSE THAT'S GOINGNG TO 9861 06:29:07,502 --> 06:29:08,503 NCE HOW THEY'REHEOING TO 9862 06:29:08,503 --> 06:29:11,773 RECOVER FROM THISHI AFTERWARDS.C 9863 06:29:11,773 --> 06:29:12,541 LITTLE BIT. B 9864 06:29:12,541 --> 06:29:15,877 IS IT CHOICEHOHO? 9865 06:29:15,877 --> 06:29:20,248 CHOICE OR HAV THOSEE W CSIDER AA 9866 06:29:20,248 --> 06:29:22,851 CONVERSATIONS, AND I TNDK AUT 9867 06:29:22,851 --> 06:29:24,586 THOSE --UT FOR THEHE ANESTHESIA 9868 06:29:24,586 --> 06:29:25,921 RT, FAMILIES WHERERE WE DO THINT 9869 06:29:25,921 --> 06:29:26,021 TH 9870 06:29:26,021 --> 06:29:27,556 S SOMETHINMEIMPORTANPOTHAT 9871 06:29:27,556 --> 06:29:28,123 THEY FEEL IS AN I AOR INT 9872 06:29:28,123 --> 06:29:29,191 DECISION THAT THEY CAN MAKAN AND 9873 06:29:29,191 --> 06:29:31,459 BEBENVOLVED WITH, BUT B THEY CHE 9874 06:29:31,459 --> 06:29:32,093 O THATO F WE PROVIDE THEDE 9875 06:29:32,093 --> 06:29:36,598 TH INFORMATIONTI. 9876 06:29:36,598 --> 06:29:40,869 WE WORK THROUGHOU DECISION AIDID 9877 06:29:40,869 --> 06:29:42,437 WITH OUR PATIENTS, WHETHER OR 9878 06:29:42,437 --> 06:29:48,810 SCREENING OR ALL THESERENTAVEROU 9879 06:29:48,810 --> 06:29:50,812 THINGS SO WE KNOW THAT THEY 9880 06:29:50,812 --> 06:29:51,012 RK. 9881 06:29:51,012 --> 06:29:54,115 THE WAY WE U THEM,M, YOU YIVE 9882 06:29:54,115 --> 06:29:55,116 NFORMATION DURINGUR THE 9883 06:29:55,116 --> 06:29:55,951 CONSULTATIUL, YOU, IVE THE 9884 06:29:55,951 --> 06:29:58,053 READ ABOUT.HEYG ANG GO HOME ANA 9885 06:29:58,053 --> 06:29:58,920 IT'S NOT FRIGHT EPIPI 9886 06:29:58,920 --> 06:29:59,888 INFORMATION BUT IT'S REALITY OF 9887 06:29:59,888 --> 06:30:01,389 AT C C HAPPEN, TPEY CAN C 9888 06:30:01,389 --> 06:30:02,924 CKCK AND YOU CANOUHAT ABOUT IT 9889 06:30:02,924 --> 06:30:04,359 AGAIN. 9890 06:30:04,359 --> 06:30:06,027 ENDT MIGHT BE SIMILARIM 9891 06:30:06,027 --> 06:30:07,329 HAT YOU DISOU DED IN THEHE 9892 06:30:07,329 --> 06:30:10,432 FIRST PLACE, ITIGHT BE YOU 9893 06:30:10,432 --> 06:30:10,999 NEED ONE PARNECULAR TYLA OF 9894 06:30:10,999 --> 06:30:11,099 TR 9895 06:30:11,099 --> 06:30:12,500 ENT BECAUSE OF HOW YOUR 9896 06:30:12,500 --> 06:30:12,601 CO 9897 06:30:12,601 --> 06:30:13,602 ITION I BUT THIS IS GOING 9898 06:30:13,602 --> 06:30:15,470 TO THEN UNDERSTAND THE 9899 06:30:15,470 --> 06:30:15,971 REASONS FOR THAT. 9900 06:30:15,971 --> 06:30:16,538 USE AUSOT OF TH O TIME WITH 9901 06:30:16,538 --> 06:30:17,706 THE POSTNATAL PERIODIOHENN 9902 06:30:17,706 --> 06:30:19,441 THEY'RE THINE NG BACK, THEY HAVE 9903 06:30:19,441 --> 06:30:20,575 A LOT OF REGRET, THEY HYE A LOT 9904 06:30:20,575 --> 06:30:21,676 OF GUILT AND TNDT'S BECAUSE THEY 9905 06:30:21,676 --> 06:30:22,711 DIDN'TEALLYEA UNDERSTAND WHAT 9906 06:30:22,711 --> 06:30:24,212 TWAS HAPPENING AND THIS ISHIEAIY 9907 06:30:24,212 --> 06:30:25,280 TO PLAN FORNHAT LATERER SO THEY 9908 06:30:25,280 --> 06:30:26,581 REASONSRSTANER ALL THE 9909 06:30:26,581 --> 06:30:28,717 WHY DIFFERDIT MANAGEMENT 9910 06:30:28,717 --> 06:30:29,251 DECISIONS SIRE HAPPENIAP. 9911 06:30:29,251 --> 06:30:29,885 AND THEY WILYALSO UALERSTAND 9912 06:30:29,885 --> 06:30:32,821 THAT WE CAN PREDICT ERYTHING 9913 06:30:32,821 --> 06:30:35,590 BUT SIMPLY -- IS RE ILYRE 9914 06:30:35,590 --> 06:30:40,829 IMPORTANT AS WELL.L. 9915 06:30:40,829 --> 06:30:43,665 I DON'T'T KNOW K K I-- THEIR THE 9916 06:30:43,665 --> 06:30:44,733 PRIORITIES, WHATEVER WE W WT TO 9917 06:30:44,733 --> 06:30:46,801 CALL THEM, BUT I TNK IT'S 9918 06:30:46,801 --> 06:30:50,305 OBVIOUOBTHAT BY B FAR THE MOST 9919 06:30:50,305 --> 06:30:51,840 IMPORTANT THANG TO ALL OFHESESE 9920 06:30:51,840 --> 06:30:55,343 PEOPLE IS THAT T THEY'RE SAFE, S 9921 06:30:55,343 --> 06:30:56,745 THERE'TH THREE MANAG MENT OPTIOS 9922 06:30:56,745 --> 06:30:57,746 NSWE CAN ONLY DO ONE OF THEM 9923 06:30:57,746 --> 06:30:59,080 SAFELY, OBVIOUSLY THAT'S WHAT'S 9924 06:30:59,080 --> 06:31:00,482 SGOING TO HAPPEN TO THAT PATIEN. 9925 06:31:00,482 --> 06:31:02,784 BUT EQULY, DIFFERENT COUNTRIOU 9926 06:31:02,784 --> 06:31:05,520 PARTICULAR MANAGEMENT, ARE YOU 9927 06:31:05,520 --> 06:31:07,455 ABLE TABLEAB REFER THEM SOMEWHEH 9928 06:31:07,455 --> 06:31:08,056 ELSEWHERE WHEY CAN HAVE THIE 9929 06:31:08,056 --> 06:31:10,392 AND IFAN NOT, MAYBE THAT'S OKAY 9930 06:31:10,392 --> 06:31:15,530 INTERNETET EXISTS, AND THE NEED, 9931 06:31:15,530 --> 06:31:17,065 TO UERSTAND IF THEY'RE MEETINGEI 9932 06:31:17,065 --> 06:31:19,834 AN ADVOCATE IN I A CHAT RM OR 9933 06:31:19,834 --> 06:31:23,004 SOMEONE ELSEM DOWOW THE LINEE I 9934 06:31:23,004 --> 06:31:26,908 GOESACK TOTT REGRET PCE 9935 06:31:26,908 --> 06:31:28,777 THEY FEEL LAT. 9936 06:31:28,777 --> 06:31:29,377 IF WE IFVE ESTABLISHED SAFETY 9937 06:31:29,377 --> 06:31:33,748 AND WE HAVE -- ABLE TO HAVE 9938 06:31:33,748 --> 06:31:34,616 CHOICE,OIXPANDING WHAT ARE THE 9939 06:31:34,616 --> 06:31:36,618 DIFFERENT OPTT O THAT WE OFFER 9940 06:31:36,618 --> 06:31:38,820 AND ACTUALLY --Y MAYBE ONLY 9941 06:31:38,820 --> 06:31:39,921 SUITABLE FOR ONE OF THEM BHE 9942 06:31:39,921 --> 06:31:44,392 THIS ITH I THE REASON WHY.HY 9943 06:31:44,392 --> 06:31:45,827 NG THINGS OUT,AVG 9944 06:31:45,827 --> 06:31:46,928 VISUALSUAL AIDS, PATIENT ARE 9945 06:31:46,928 --> 06:31:48,363 UNDERSTAND OH YEAH, IF THIS IS 9946 06:31:48,363 --> 06:31:50,665 RIGHT HERET NN THE SURFACE, IT 9947 06:31:50,665 --> 06:31:51,866 PROBABLY DOESN'T MAKE SENSE THA 9948 06:31:51,866 --> 06:31:56,104 YOU CUTFF HALF MY --Y AND I 9949 06:31:56,104 --> 06:31:58,640 VE NON N LEF N TO T PUT P BACK 9950 06:31:58,640 --> 06:32:00,075 TOGETHER. 9951 06:32:00,075 --> 06:32:01,242 INFORMATION ISIOEALLY 9952 06:32:01,242 --> 06:32:07,582 WE OFTEN O HEARR THIS BUT A LOTF 9953 06:32:07,582 --> 06:32:08,717 ME,,F THEY'RERE SAYING 9954 06:32:08,717 --> 06:32:11,553 THOSEOSE KIND OF THINGS, WE NEEO 9955 06:32:11,553 --> 06:32:12,988 T PTPLEE INFORMATION SO THEY 9956 06:32:12,988 --> 06:32:13,755 CAN UNDERSUNND THE REASON. 9957 06:32:13,755 --> 06:32:15,256 LOT OF THE TIME PEOPLE DO WANT 9958 06:32:15,256 --> 06:32:18,159 TO BE INVVED IN THEIRIR 9959 06:32:18,159 --> 06:32:19,594 HEALTHCARE AND DECIS DN-MA DNG 9960 06:32:19,594 --> 06:32:23,665 ANDAN THE CONFUSION, ACTUALLY -- 9961 06:32:23,665 --> 06:32:24,366 ER YOU'R YSAYING IS BEST, 9962 06:32:24,366 --> 06:32:24,466 TH 9963 06:32:24,466 --> 06:32:25,867 'S OKAY TOO, BUT WE NEEDO 9964 06:32:25,867 --> 06:32:27,402 HAVE THOSEHO CONRSATIONS. 9965 06:32:27,402 --> 06:32:29,137 I'M N GOINGO REALO G G 9966 06:32:29,137 --> 06:32:31,106 THROUGH ALL OF THESE, KRISTIN 9967 06:32:31,106 --> 06:32:34,509 OF THE T PATIENT STORIESRI ALREY 9968 06:32:34,509 --> 06:32:36,578 T WHEHEE TALKBO DIFFERENT 9969 06:32:36,578 --> 06:32:40,749 TREATMENTS, EN KNOWNON TRUK 9970 06:32:40,749 --> 06:32:42,884 ECTOMY THERE'S A GUPUP OF 9971 06:32:42,884 --> 06:32:44,652 MOMS THAT A VERY UPSET, TETS 9972 06:32:44,652 --> 06:32:46,187 ISN'TH ONLYPTION,PT AND THI 9973 06:32:46,187 --> 06:32:48,323 KIND OKI GROUP INUP TNUP MDLE TT 9974 06:32:48,323 --> 06:32:49,124 E LIKE WOWKE I DON'T REALLY 9975 06:32:49,124 --> 06:32:49,858 KNOW, I SUPPOSE WHATEVER YOU 9976 06:32:49,858 --> 06:32:51,092 THINK IS BESTOR ME. 9977 06:32:51,092 --> 06:32:54,262 AFTER ALL OF TSE T KIND O O, 9978 06:32:54,262 --> 06:32:55,296 THERE IS A HUGE VARIETY OF TYPES 9979 06:32:55,296 --> 06:32:56,498 OF PATOFNTS THAT WE'RE SING.G. 9980 06:32:56,498 --> 06:32:57,799 WE NEEDOEMEMBER THAT 9981 06:32:57,799 --> 06:32:59,334 HYSTERHYTOER, IT'S T JUSTT 9982 06:32:59,334 --> 06:33:03,271 ABOUTER FERTILIER. 9983 06:33:03,271 --> 06:33:04,706 THERE'S HUE' PSYCHOSEXUALUAUA II 9984 06:33:04,706 --> 06:33:08,543 WHEN MOMS HAOM THIS DONE AS 9985 06:33:08,543 --> 06:33:09,511 THEY WON'T REALL R THINK 9986 06:33:09,511 --> 06:33:11,379 ABOUT THAT DURING THE PREGNANCY. 9987 06:33:11,379 --> 06:33:13,681 THEY'RE REALLY THINKING ABOUT 9988 06:33:13,681 --> 06:33:14,315 G A BABY THAT' T ALIVE AND 9989 06:33:14,315 --> 06:33:15,116 THEY'LL DO ANYTHING TIN MAKE THY 9990 06:33:15,116 --> 06:33:16,418 , AND IFOU'REOUAYEGAY THE 9991 06:33:16,418 --> 06:33:18,286 LY THING TS NGSTERECTOMY, THEN 9992 06:33:18,286 --> 06:33:19,354 THAT'S WATT WHEY'RE GOING TO 9993 06:33:19,354 --> 06:33:24,826 HEAR, BUT WE ALLOW A THESE MOMES 9994 06:33:24,826 --> 06:33:28,263 LATER, THIS IS REALLYEA AFFECTIG 9995 06:33:28,263 --> 06:33:29,531 HOW I FEEL ABOUT AT A WOMAN AND 9996 06:33:29,531 --> 06:33:30,632 FORWARD AND ALL O THOSE 9997 06:33:30,632 --> 06:33:31,299 INGS 9998 06:33:31,299 --> 06:33:33,201 WE DIDN'TID FTD A DIFFERENCE BY 9999 06:33:33,201 --> 06:33:33,768 EGNANCY OUTCOME. 10000 06:33:33,768 --> 06:33:38,239 WHAT I MEAN M BY B TT T IS WHATI 10001 06:33:38,239 --> 06:33:41,709 MEAN --OTS MOMSOM WHO REA 10002 06:33:41,709 --> 06:33:42,477 TAINED TINIR UTERUS ALSO DID, 10003 06:33:42,477 --> 06:33:43,178 THAT'STHECAUSE TAUY' T GY'E 10004 06:33:43,178 --> 06:33:44,446 THROUGH THEHE WHOLE PHOGNANCY 10005 06:33:44,446 --> 06:33:47,949 PERIENCE THECE SAMEAYS -- 10006 06:33:47,949 --> 06:33:49,684 HYSTERECTOMYECTO E, THEY STILL 10007 06:33:49,684 --> 06:33:51,286 HAVE THAT FEAR, AR,IETY ANDTY 10008 06:33:51,286 --> 06:33:52,520 WORRY, AND INFORM@MAFM@HEY 10009 06:33:52,520 --> 06:33:53,288 EXCE A LOT OF 10010 06:33:53,288 --> 06:33:54,789 MPLICATIONS IN T SAMWAY. 10011 06:33:54,789 --> 06:33:54,889 Y. 10012 06:33:54,889 --> 06:33:58,660 ABOUT THIS NO ONE IN THE ROOM 10013 06:33:58,660 --> 06:34:01,029 EDS TO BE TOLD THAT WE W SHOULDO 10014 06:34:01,029 --> 06:34:07,836 BE GIVING SPECIALISTIS, MULTI- - 10015 06:34:07,836 --> 06:34:11,739 CARE TO THESE PARTS, SO WO 10016 06:34:11,739 --> 06:34:13,808 SHOULD BE GIVINGIN IT BAUSESE 10017 06:34:13,808 --> 06:34:14,709 THEY WAND'AN DESERVE, 10018 06:34:14,709 --> 06:34:15,910 NOT ONLY BECSE WE KNOW IT'S 10019 06:34:15,910 --> 06:34:16,010 BE 10020 06:34:16,010 --> 06:34:16,578 PRACTICE. 10021 06:34:16,578 --> 06:34:19,547 THESE ARE JUST SOMEOM OF O THEHE 10022 06:34:19,547 --> 06:34:19,647 QU 10023 06:34:19,647 --> 06:34:22,417 ES ITHESEE MOMSIN-- 10024 06:34:22,417 --> 06:34:24,419 AS OPPOSED TO THEY'REY'RE FEELIG 10025 06:34:24,419 --> 06:34:26,154 THEY'RE BETWEENWE HOSPITALS THA 10026 06:34:26,154 --> 06:34:27,889 AREN'T LOOKING AFTER THEM, IT'S 10027 06:34:27,889 --> 06:34:28,356 REALLY UNSETTLNSG. 10028 06:34:28,356 --> 06:34:29,457 LASTLA WANT TO TALK ABO OUR O 10029 06:34:29,457 --> 06:34:33,561 ROLE IN OUR PATIENT ADVOCACYOC 10030 06:34:33,561 --> 06:34:33,661 WO 10031 06:34:33,661 --> 06:34:33,761 . 10032 06:34:33,761 --> 06:34:34,395 IS IS A HUGEA ART AND REALLY 10033 06:34:34,395 --> 06:34:36,531 I REALLY SEEEE THIS AS VY 10034 06:34:36,531 --> 06:34:38,333 SYMBIOTIC THAT TTHAT LEARN FEAMF 10035 06:34:38,333 --> 06:34:38,900 ME BUT I LEARN SEAMUCH FROM 10036 06:34:38,900 --> 06:34:39,134 THEM. 10037 06:34:39,134 --> 06:34:41,136 IT'S HUGE PRILEGE FOROR ME TO 10038 06:34:41,136 --> 06:34:42,537 HAVE THESE CONVERSONIONS WITHH 10039 06:34:42,537 --> 06:34:44,305 SEMANY MOMS FROM AFROMVER THE 10040 06:34:44,305 --> 06:34:45,507 WORLD WHO REALLY LEARN WHAT W 10041 06:34:45,507 --> 06:34:46,708 THEIRTORIESTO ARE LIKE AND HOW 10042 06:34:46,708 --> 06:34:49,644 WE CAN HEL HEM. 10043 06:34:49,644 --> 06:34:50,311 THIS QUOTE KIND OF FD S A LITTLE 10044 06:34:50,311 --> 06:34:51,913 IN KRISTIN'S, IT'S ABOUT BEING 10045 06:34:51,913 --> 06:34:54,716 ANDVOCATE OF THEHEHEEOPLE AND 10046 06:34:54,716 --> 06:34:55,383 USES IUSORTANT TO USING TSI 10047 06:34:55,383 --> 06:34:56,684 MO POWERFUL TOOL YOU HAVE, 10048 06:34:56,684 --> 06:34:59,954 AF TRMATH OF THIS PREGN PCY,E T 10049 06:34:59,954 --> 06:35:04,492 CA FEEL QUITE ALONE, SO BEINGNG 10050 06:35:04,492 --> 06:35:05,260 ABLE TO CONNECT WITH A GTHUP OF 10051 06:35:05,260 --> 06:35:06,361 MS OR PEOPL PEOHAT WE 10052 06:35:06,361 --> 06:35:08,029 UNRSTA, THIS, S SO POWERFUL, 10053 06:35:08,029 --> 06:35:09,964 AND ITHEY CAN KNOW KARING 10054 06:35:09,964 --> 06:35:11,266 THEIR STORYORYY HELPED SOMEONE , 10055 06:35:11,266 --> 06:35:14,602 THEM, AND IT'S SOMETHING THAT 10056 06:35:14,602 --> 06:35:16,638 THEY'RE REAEY PROUD TOUDO. 10057 06:35:16,638 --> 06:35:16,804 AN 10058 06:35:16,804 --> 06:35:18,740 I SUPPOSE SOME OF THE THINGSNG 10059 06:35:18,740 --> 06:35:20,875 CONSIDERING WHEN WE'RE WORKING 10060 06:35:20,875 --> 06:35:23,211 WITH ADVOCATDVOC AN ADVOCATE 10061 06:35:23,211 --> 06:35:26,247 DOESN'T HAVE H TO BE SOMEBODY LL 10062 06:35:26,247 --> 06:35:29,050 KRISTIN, IT JUST HAS TO BE 10063 06:35:29,050 --> 06:35:29,651 SOMEBODY AT THE HOSPITHO THAT 10064 06:35:29,651 --> 06:35:30,285 WANTS TO COME BACK AND G AE YOUE 10065 06:35:30,285 --> 06:35:32,921 THAT'S A SIMPLEHI TO DO,DO 10066 06:35:32,921 --> 06:35:33,454 ON'T NEED N START A 10067 06:35:33,454 --> 06:35:34,522 PATIENT TIOUP OR START A CAREERE 10068 06:35:34,522 --> 06:35:34,622 WI 10069 06:35:34,622 --> 06:35:35,590 THEIR LIVES,, BUT WHE WE 10070 06:35:35,590 --> 06:35:38,459 ARE WORKING -- WE W DO NEED TO 10071 06:35:38,459 --> 06:35:42,297 PERSONAL JOUEYS. IN I I THEIR, 10072 06:35:42,297 --> 06:35:44,199 SOME OF THESE PEOPLE THAT 10073 06:35:44,199 --> 06:35:45,433 CONTACT OUR GROUP ARE VERY M M 10074 06:35:45,433 --> 06:35:47,202 INHE TRAUMAUM PHASE, THEY'RE 10075 06:35:47,202 --> 06:35:49,637 SEEKINGGUPPORT, THERE NOT 10076 06:35:49,637 --> 06:35:51,039 REALLY READY TEA BE INVOLVIN IN 10077 06:35:51,039 --> 06:35:51,706 RESEARCH, SPEAK AT K CONFERENCE 10078 06:35:51,706 --> 06:35:52,707 OR ANYOR OF THOSE THIS.HI 10079 06:35:52,707 --> 06:35:52,807 TH 10080 06:35:52,807 --> 06:35:54,542 'RE VERY MUCHUC THERE FOR 10081 06:35:54,542 --> 06:35:56,778 PERSONAL SUPPORT. 10082 06:35:56,778 --> 06:35:58,213 AND THEY'REOCUSEDOC ON TIR OWN 10083 06:35:58,213 --> 06:35:59,981 EXPERIEXCE WHERE SOMEOM MOMRR 10084 06:35:59,981 --> 06:36:02,517 PARTNERS OR ANYBODY THATY 10085 06:36:02,517 --> 06:36:03,218 IMPACTED BY TH B CONDITION, THEY 10086 06:36:03,218 --> 06:36:03,318 TH 10087 06:36:03,318 --> 06:36:04,519 THRANSITRAN TO WANTING TO 10088 06:36:04,519 --> 06:36:04,619 AD 10089 06:36:04,619 --> 06:36:07,622 IN A MUCH MOREEANINGEAL WEA,LVEV 10090 06:36:07,622 --> 06:36:09,123 AND I DD 'THINK THAT' T RELATED 10091 06:36:09,123 --> 06:36:11,292 TOTO TIME. 10092 06:36:11,292 --> 06:36:11,926 SOME PEOPLE EOE THERE DURING THE 10093 06:36:11,926 --> 06:36:12,961 PREGNANCY, SNCE PEOPLE WANT TOT 10094 06:36:12,961 --> 06:36:14,495 DO -SOME PEOPLE DON'T G 10095 06:36:14,495 --> 06:36:14,596 TH 10096 06:36:14,596 --> 06:36:16,497 E FOR YEARS AND SOME PEOPLE 10097 06:36:16,497 --> 06:36:17,765 THAT'S FINE ASE WELEO THAT ANDND 10098 06:36:17,765 --> 06:36:19,167 WHEN WE'RE W WORKING IN A RLLY 10099 06:36:19,167 --> 06:36:20,768 CLOSE RELAT RNSHIP WITH 10100 06:36:20,768 --> 06:36:21,469 ADVOCATES, WE HAVE THA T TNK 10101 06:36:21,469 --> 06:36:23,538 ABOUT THINGS LE ADVOCACYOC 10102 06:36:23,538 --> 06:36:26,474 FATIGUE BECAUSE WE WE OBVIOUSLY- 10103 06:36:26,474 --> 06:36:27,108 WE'RE COMPENSATED FOR D R TIME, 10104 06:36:27,108 --> 06:36:27,909 THIS IS OUR JOB, THIS IS OURUR 10105 06:36:27,909 --> 06:36:28,910 CAREER, EVEN THOUGH WE'RE DOI 10106 06:36:28,910 --> 06:36:32,513 LOTS O THESE THINGS VOLUNTARY, 10107 06:36:32,513 --> 06:36:33,581 IT'S STI'S A LITTLE BIT B 10108 06:36:33,581 --> 06:36:36,317 TO COMPLETELY GELE UPHEIR TIME 10109 06:36:36,317 --> 06:36:39,954 RESPECTFSP OF O THATT INN THINKG 10110 06:36:39,954 --> 06:36:41,055 HOW MUCH THEY'RE ACTLLY 10111 06:36:41,055 --> 06:36:47,295 A VERY TRAUMATIZUM WAY AND IT'SN 10112 06:36:47,295 --> 06:36:48,596 ALMOSTALIKEE TO DISTRACT 10113 06:36:48,596 --> 06:36:51,065 THEMSELVEM FROM TIR OWNTORY 10114 06:36:51,065 --> 06:36:51,666 WE HA W THABE MHABE M ABO M 10115 06:36:51,666 --> 06:36:52,267 THAT. 10116 06:36:52,267 --> 06:36:53,468 AND ESPECIALLYLL WITH 10117 06:36:53,468 --> 06:36:54,902 COMPENSATION, IN THIS GROUP WSA 10118 06:36:54,902 --> 06:36:58,172 MOMS FINANCIALLY FOR GIVING 10119 06:36:58,172 --> 06:36:59,707 IME, NOBODY IS GIVINGG 10120 06:36:59,707 --> 06:37:02,110 MONEY TO ACCRETA SO WON'T 10121 06:37:02,110 --> 06:37:05,046 HAVE ANYON MONEYATIES ARE 10122 06:37:05,046 --> 06:37:05,146 VE 10123 06:37:05,146 --> 06:37:08,983 ACTIVELY INVOLVED,HEY'REHE 10124 06:37:08,983 --> 06:37:11,719 LIKE WELLL NO I DON'T WANTT YOUO 10125 06:37:11,719 --> 06:37:12,353 GIVE THIS BACKS O ME, LME'S DO 10126 06:37:12,353 --> 06:37:13,921 SOMETHINMETH RLLY COOL, LET'S 10127 06:37:13,921 --> 06:37:18,626 E.BSD RESOURCES, L,'S DO OUR 10128 06:37:18,626 --> 06:37:20,795 WHERE IN IT'S VET'-- THE'SHE'S 10129 06:37:20,795 --> 06:37:22,130 TONS OF DRUG COMPANIES, WE HE 10130 06:37:22,130 --> 06:37:26,601 IAL SUPPORT IN THOSE MOU G SO MH 10131 06:37:26,601 --> 06:37:28,703 CA GROUPS,UP IT'S VERY EY 10132 06:37:28,703 --> 06:37:28,803 TO 10133 06:37:28,803 --> 06:37:31,005 IVE MOMS BK FOR THEIR TIME 10134 06:37:31,005 --> 06:37:32,040 BUT ALSO WE HAVE TO REMBER 10135 06:37:32,040 --> 06:37:34,709 THOSE ARE CONRSATIONS YOU TONGO, 10136 06:37:34,709 --> 06:37:37,045 SHOULD BE HING BECAU B PEOPLE 10137 06:37:37,045 --> 06:37:37,545 MIGHT FEGH DIFFERENTLY. 10138 06:37:37,545 --> 06:37:37,645 WE 10139 06:37:37,645 --> 06:37:40,415 FREQUENTLYLYLY WITHINUR GROUP 10140 06:37:40,415 --> 06:37:41,516 AN PD THAT'S AN IORTA THING THI 10141 06:37:41,516 --> 06:37:46,554 DO FOR INVOLVING PEOPLE IN A 10142 06:37:46,554 --> 06:37:47,955 PROFESSIONAL WAY.AY 10143 06:37:47,955 --> 06:37:50,925 AND MOST MIMAR TO NATIONALIONANA 10144 06:37:50,925 --> 06:37:53,695 ACCRETACNDION,E WANT TO T 10145 06:37:53,695 --> 06:37:54,262 SUPPORSUMOMS AND WE NDNT TO 10146 06:37:54,262 --> 06:37:55,129 ADVOCATE FOR THEM. 10147 06:37:55,129 --> 06:37:57,965 D THE WAY WE'VE DON THAT I 10148 06:37:57,965 --> 06:37:59,901 REALLY ---ESOURCESES THAT ARE 10149 06:37:59,901 --> 06:38:02,070 BL TO PEOPLE, WE'VE MADE SOME S 10150 06:38:02,070 --> 06:38:05,073 VIDEOSVI ARE WE HAVE THE WEBSIT, 10151 06:38:05,073 --> 06:38:07,241 ALL OF OUR WK IS I DONEN 10152 06:38:07,241 --> 06:38:07,875 COLLABATION WITH OUR PATIENTSIE 10153 06:38:07,875 --> 06:38:09,944 SO THAT IT'S INFORMATION TT 10154 06:38:09,944 --> 06:38:13,014 FIND F ACCESSICCE AND THEY 10155 06:38:13,014 --> 06:38:15,149 FINDFINTERESTING AND IT'SN A 10156 06:38:15,149 --> 06:38:15,750 WAY THAT THEY CAN SHARE WARE 10157 06:38:15,750 --> 06:38:16,117 ETHEIR FAMILIFA. 10158 06:38:16,117 --> 06:38:17,385 WE'VE BEEN DOING THAT IN IRELAND 10159 06:38:17,385 --> 06:38:19,620 BUT ABUO SETTINGET UP GROUPS 10160 06:38:19,620 --> 06:38:19,721 EL 10161 06:38:19,721 --> 06:38:20,388 WHERE NOW BECAUSE WE RLLY 10162 06:38:20,388 --> 06:38:25,026 GROUP, WORKING TOGETHER WITH LET 10163 06:38:25,026 --> 06:38:25,693 CARE PCAVIDECA IS SO IMPORTANT, 10164 06:38:25,693 --> 06:38:26,928 SO WE'VE SETP A GRORO IN I 10165 06:38:26,928 --> 06:38:29,130 FRANCE NOW WHICH IHI ANMAZING 10166 06:38:29,130 --> 06:38:29,764 GROUP OF MOMS THAT HAVE REALLY 10167 06:38:29,764 --> 06:38:30,998 YTAKEY THIS ON ANDND HAVE BN 10168 06:38:30,998 --> 06:38:32,633 PRODUCING THEIRIR OWN INFORMATIR 10169 06:38:32,633 --> 06:38:32,734 IN 10170 06:38:32,734 --> 06:38:34,669 FRENCH, OBVIOUSBVIOLL OFLLUR 10171 06:38:34,669 --> 06:38:37,705 RESOURRES ARE IN ENGLISHLI, AND 10172 06:38:37,705 --> 06:38:37,805 TH 10173 06:38:37,805 --> 06:38:41,075 REASON WEE NEEE NEE TO T HAVE H 10174 06:38:41,075 --> 06:38:42,844 RESOURCESO IS NOT J NT TO PROVIE 10175 06:38:42,844 --> 06:38:43,711 ITH EDUCATION DURG 10176 06:38:43,711 --> 06:38:47,215 PREGNANCY BUT AUTOITH THE 10177 06:38:47,215 --> 06:38:51,519 AFRMATH, ALL OF THESEF 10178 06:38:51,519 --> 06:38:55,022 NOT NECESSARIESES HE TIMEO DOGHG 10179 06:38:55,022 --> 06:38:55,123 DOIN 10180 06:38:55,123 --> 06:38:57,992 OUR PRACTICE BUT ACTUALLY 10181 06:38:57,992 --> 06:38:59,894 VING -- TOALK ABOUT THAT IS 10182 06:38:59,894 --> 06:38:59,994 A 10183 06:38:59,994 --> 06:39:02,563 RLLY G G RESOURCES 10184 06:39:02,563 --> 06:39:07,034 SIMILARLY OURATIENTS SRE OUR 10185 06:39:07,034 --> 06:39:09,971 IFEANS THEY DON'T HAVE TO BEUSEU 10186 06:39:09,971 --> 06:39:10,938 HAVING TVIT CONVERSATN AGAN 10187 06:39:10,938 --> 06:39:12,273 AGAIN EXPLAINING WHAT WHIS 10188 06:39:12,273 --> 06:39:15,343 IS, TY T CUST SAYAY WAT THIS 10189 06:39:15,343 --> 06:39:15,977 VIDEO, LDETEN TOTEHIS AND T AN 10190 06:39:15,977 --> 06:39:16,878 THE A GROUPUP OF PEOPLE 10191 06:39:16,878 --> 06:39:21,215 AROUND THEMHE THAT ARE ARE EDUCD 10192 06:39:21,215 --> 06:39:22,984 AND -- THAN TO HAVE A GRE P OF 10193 06:39:22,984 --> 06:39:25,753 OP SAYING OH EVERYTHING I 10194 06:39:25,753 --> 06:39:28,156 FINE, WHEREAS ACTUALLY SING I 10195 06:39:28,156 --> 06:39:31,459 RIS LISNEISIS TO THIS, I'M GOING 10196 06:39:31,459 --> 06:39:32,560 TO CHECK IN AND A MAKE SURE THAT 10197 06:39:32,560 --> 06:39:35,730 EVERYTHING IS OKAY. 10198 06:39:35,730 --> 06:39:37,732 WE HOLWE A HE ARETA 10199 06:39:37,732 --> 06:39:39,567 FUER EVERY EVERY YEAR, WE CALL 10200 06:39:39,567 --> 06:39:43,704 THE WORD THERE SO PEOPLEPEOPWWAN 10201 06:39:43,704 --> 06:39:44,305 WHAT THEY'RE COMING TOO 10202 06:39:44,305 --> 06:39:44,405 FU 10203 06:39:44,405 --> 06:39:44,639 IS 10204 06:39:44,639 --> 06:39:46,707 HAD 50000EOPLE COMING TOG THIS 10205 06:39:46,707 --> 06:39:48,476 EVENT, IT LIKE HAVINGAV WEDDING 10206 06:39:48,476 --> 06:39:49,811 YEAR, WE LOVE TO HAVEAV A 10207 06:39:49,811 --> 06:39:51,012 GREAT TIME SO THIS IA 10208 06:39:51,012 --> 06:39:53,214 BRILLIBRT WAY TO GET PATIENTS 10209 06:39:53,214 --> 06:39:53,481 STOGETHER. 10210 06:39:53,481 --> 06:39:56,717 THIS PICTURE HERE IS OF A A MOMM 10211 06:39:56,717 --> 06:39:58,820 D -- WHO HAD A HYSTERECTOMRE 10212 06:39:58,820 --> 06:40:01,589 SHE LOSH HER TWINSWIWI UNFORTUNY 10213 06:40:01,589 --> 06:40:02,490 BUT WE ALWAY A HAVE A VIDEO AT 10214 06:40:02,490 --> 06:40:04,892 THIS LUNCH LHICH CAN BE QUITE QQ 10215 06:40:04,892 --> 06:40:10,932 HERE TO UNDERSTAND AND LEA ALLLL 10216 06:40:10,932 --> 06:40:12,133 THIS TOGETHERRND,ROU KNOW,NO 10217 06:40:12,133 --> 06:40:13,868 SHOWING THEMHE THE RESOURCESOUND 10218 06:40:13,868 --> 06:40:16,571 SO I JUS WANT TO FINISH WITH A. 10219 06:40:16,571 --> 06:40:18,506 QUOTE THAT I REAY LIKE, AND I 10220 06:40:18,506 --> 06:40:20,741 SUPPOSE IT'S AS PLAY ON REALLY 10221 06:40:20,741 --> 06:40:22,677 LISTENING TO UNDERSTAND, RATHER 10222 06:40:22,677 --> 06:40:24,712 THAN JT LISTENING TO RESPOND, 10223 06:40:24,712 --> 06:40:26,013 AND I THIHAT'S THE ONLY WAY 10224 06:40:26,013 --> 06:40:27,548 WE CAN MAKE MEANINGEALNG CHANGEN 10225 06:40:27,548 --> 06:40:29,450 OUR SERVI SS AND IN I OUR 10226 06:40:29,450 --> 06:40:30,818 PRACTICE, IF WE INVOLVE 10227 06:40:30,818 --> 06:40:31,819 PATIENTS, INVITE PEOPLE TO TELL 10228 06:40:31,819 --> 06:40:36,624 ACTUALLY WE LISTEN ANDND SAY YOU 10229 06:40:36,624 --> 06:40:38,125 KNOWOW WHAT, WE'RE GOINGNGO MAKE 10230 06:40:38,125 --> 06:40:40,528 CHANGE BASED ON WHATHA YOUOLD 10231 06:40:40,528 --> 06:40:40,695 US. 10232 06:40:40,695 --> 06:40:40,795 I 10233 06:40:40,795 --> 06:40:41,295 ANK YOU SO MUCH, AND HAPPY 10234 06:40:41,295 --> 06:40:50,404 OF THE PANEL.ELUESTIONIONS ON PR 10235 06:40:50,404 --> 06:40:52,540 >> DESPITE DR. BARR.E'S 10236 06:40:52,540 --> 06:40:53,708 ADRTISEMENT,EME'RE NOTOT QUITE Q 10237 06:40:53,708 --> 06:40:57,478 AT GIN AND TONGUE 10238 06:40:57,745 --> 06:40:58,546 C 10239 06:40:58,546 --> 06:41:07,688 ARICS YET SO WE'LL TURITVER TO E 10240 06:41:07,688 --> 06:41:18,065 THIS PANEL DISSSION.SS 10241 06:41:29,443 --> 06:41:31,012 >> THANKS, EVERYBODY, FOR 10242 06:41:31,012 --> 06:41:32,246 STICKING AUND AT THE FINAL F 10243 06:41:32,246 --> 06:41:37,251 MINUTEMI OF OUR SESSION AND THE 10244 06:41:37,251 --> 06:41:39,554 DAY HAS BEEN LONG IN HOURSRS BUB 10245 06:41:39,554 --> 06:41:40,955 REALLY SMULATING A 10246 06:41:40,955 --> 06:41:42,623 INTERESTING AND FANM MY 10247 06:41:42,623 --> 06:41:44,091 PERSPECTIVE FLEW BY. 10248 06:41:44,091 --> 06:41:45,026 SO THANKS FOR B FNG HERE. 10249 06:41:45,026 --> 06:41:46,327 ANYBODY HAVE QAVEION FORHE 10250 06:41:46,327 --> 06:41:49,163 I KNOW IT WAS A WATTLEWAIT OF IT 10251 06:41:49,163 --> 06:41:52,600 MIXED BAG OF TOPICS, BUT REAY 10252 06:41:52,600 --> 06:41:53,935 INTEREININGIN TALKS. 10253 06:41:53,935 --> 06:41:57,772 DR. FOX. 10254 06:41:57,772 --> 06:41:59,874 >>>> HELENA, YOUA,OUCHEDOUN I 10255 06:41:59,874 --> 06:42:01,175 VERY BRIEFLY, AND I'M GRATEFULTE 10256 06:42:01,175 --> 06:42:04,345 TO YOUHAT YOU YNCLUDEDATRS 10257 06:42:04,345 --> 06:42:05,546 OR OTHER FAMILY MEMBERS INNHIS 10258 06:42:05,546 --> 06:42:08,716 PSYCHOLOGICAL IMPACT. 10259 06:42:08,716 --> 06:42:11,485 I'D LOVE TOO HEAR H YOUR 10260 06:42:11,485 --> 06:42:13,321 PERSPECTIVE AND WHATD OURD AMILY 10261 06:42:13,321 --> 06:42:13,921 MEMBERS WENT THROUGH BOUAUSE I 10262 06:42:13,921 --> 06:42:14,021 CA 10263 06:42:14,021 --> 06:42:16,157 T TELL YOU HOW MANY TIMES T 10264 06:42:16,157 --> 06:42:16,257 IT 10265 06:42:16,257 --> 06:42:19,994 BEEN THE PARTNERAR WHO 10266 06:42:19,994 --> 06:42:21,729 SAYS -- OR EVEOROR THE PATIENT L 10267 06:42:21,729 --> 06:42:22,229 SAY I THINK HE WAS MORAS 10268 06:42:22,229 --> 06:42:22,997 AUMATIZED THAN I WAS JUST 10269 06:42:22,997 --> 06:42:25,700 AKCAUSE I WAS AEEP, HE WAS WAS 10270 06:42:25,700 --> 06:42:29,670 CTIVES.TED TO HEARO OUR 10271 06:42:29,670 --> 06:42:30,371 >> 100 10272 06:42:30,371 --> 06:42:32,673 I TNK ANY ANY REARCH INTONTO THS 10273 06:42:32,673 --> 06:42:36,410 KIND OF NDRK HAS TO INCLUDECL TE 10274 06:42:36,410 --> 06:42:40,481 PARTNERRT A PTNERS CAN SUFFER 10275 06:42:40,481 --> 06:42:42,683 PTSD, BIRTHTH TRAUMA AND ALL 10276 06:42:42,683 --> 06:42:43,050 OF THOSE THISES. 10277 06:42:43,050 --> 06:42:43,751 THAT WAS IMPORTANT TO US O THE 10278 06:42:43,751 --> 06:42:44,085 TSET.TS 10279 06:42:44,085 --> 06:42:46,721 SO THERE'S A COUPLE OFPLE REAS. 10280 06:42:46,721 --> 06:42:47,488 FIRSTLFITHTLFITHARTNERS OFTEN FL 10281 06:42:47,488 --> 06:42:49,123 LIKE THEY'RE AYSTANDYSTANDYSHEY 10282 06:42:49,123 --> 06:42:52,793 DON'T REALL RFEEL R INCLUDED LUE 10283 06:42:52,793 --> 06:42:55,963 TO AT THE ANTENATAL 10284 06:42:55,963 --> 06:42:57,031 CONSULTATION, THEYTHRRIVE ONHE 10285 06:42:57,031 --> 06:42:58,766 DAY OFHE BIRTH, THEY'RE 10286 06:42:58,766 --> 06:43:00,001 COMPLETELY BLIND BIDED B WHAT'S 10287 06:43:00,001 --> 06:43:01,435 HAPPENHAG ENHAHEY DON'T D REALLY 10288 06:43:01,435 --> 06:43:03,504 KNOW HOW TOOW HELP BECAUSE THEY 10289 06:43:03,504 --> 06:43:05,506 TH O POSTP PTUM PD, WE SAWAWO 10290 06:43:05,506 --> 06:43:06,407 THIS TRANS TION WHERE W THE 10291 06:43:06,407 --> 06:43:15,282 PARTNERS ARE JUST SO -- THEY 10292 06:43:15,282 --> 06:43:18,452 DON'T WANTNTO TALK OR -- WHE--AS 10293 06:43:18,452 --> 06:43:18,552 FO 10294 06:43:18,552 --> 06:43:20,221 THE MOMS, LIKE LIKE I WAS SAYIN, 10295 06:43:20,221 --> 06:43:22,556 THEY'RE INE THA SURVIVAL MODE 10296 06:43:22,556 --> 06:43:23,991 NOT TALKING AKIUT IT, NOT HAVING 10297 06:43:23,991 --> 06:43:24,859 A CONVERSATION WITH THEIRIR 10298 06:43:24,859 --> 06:43:26,661 PARTNERS BECAU B THEY' T TOO T 10299 06:43:26,661 --> 06:43:27,595 TERRIFIED TO ACTUALLCT TAL ABOUT 10300 06:43:27,595 --> 06:43:29,664 OH MYOH GOD, I MIG LOSEOS MOSY F 10301 06:43:29,664 --> 06:43:32,433 AND MAN CHILDREN OR MY BABYY THT 10302 06:43:32,433 --> 06:43:33,701 I'M GROWING NOW, SO THEY TN'T 10303 06:43:33,701 --> 06:43:35,703 HAVE ANY CONVERSATIONS, THEN THE 10304 06:43:35,703 --> 06:43:38,773 BABY COMES ALONG, THE MOM 10305 06:43:38,773 --> 06:43:40,975 SEVENSEONTHS LER IS REL RGSIX OO 10306 06:43:40,975 --> 06:43:42,276 EVERYTHIER THAT'S BEEN HAPPENINI 10307 06:43:42,276 --> 06:43:44,445 THAT'S FINALLY TAL PCE WHERE 10308 06:43:44,445 --> 06:43:45,146 E CAN TALKN BOUT, BUT HER 10309 06:43:45,146 --> 06:43:46,347 PARTNER HAS MOVAS ON, ERYONERY 10310 06:43:46,347 --> 06:43:49,617 DOESN'T HAVE ANYONE TO TALK 10311 06:43:49,617 --> 06:43:49,717 AB 10312 06:43:49,717 --> 06:43:51,152 T SO'S'S REALLYLL ISOLATED. 10313 06:43:51,152 --> 06:43:53,521 SO THEHE PARTNERAREEER TO T BE B 10314 06:43:53,521 --> 06:43:54,188 INVOLVED DURING URE PREGNAPRY SO 10315 06:43:54,188 --> 06:43:54,889 THAT DOESN'T HAPPEN, SO THEY AHY 10316 06:43:54,889 --> 06:43:57,191 INFORMEDFOND E ED THAT THEY 10317 06:43:57,191 --> 06:43:58,993 KNOW WHATHA TS T GOING TO BE 10318 06:43:58,993 --> 06:44:00,194 LIKE. 10319 06:44:00,194 --> 06:44:00,828 PARTNERS PREVIOUSLY SAY TOYE, 10320 06:44:00,828 --> 06:44:02,163 IF I HAD KNOWN THIS AND THEN 10321 06:44:02,163 --> 06:44:03,798 THEN IENEN COULD HAVE DONE THIS, 10322 06:44:03,798 --> 06:44:09,503 ANY O THAT.TEAD THEY TON'T KNOWO 10323 06:44:09,503 --> 06:44:11,238 UNDERSTAND THERE'S'S CHILD CARE 10324 06:44:11,238 --> 06:44:11,338 TH 10325 06:44:11,338 --> 06:44:13,207 GS BUT I JUST HAVE MY OWN 10326 06:44:13,207 --> 06:44:14,008 CONSULTATIONS WONRE I EXPLAIN TT 10327 06:44:14,008 --> 06:44:15,643 EM WHAT' WHAHA GOING ON O TO PRE 10328 06:44:15,643 --> 06:44:18,045 THEMTH HOWHEYAN HELP THE 10329 06:44:18,045 --> 06:44:18,846 PARTNER DURIR THE PREG SL, S 10330 06:44:18,846 --> 06:44:20,614 MOSTMPORTANTLY IN THE POST 10331 06:44:20,614 --> 06:44:21,582 POSTPARTUM PERIOD, SAME FOROR 10332 06:44:21,582 --> 06:44:23,684 OTHER FAMILY MEMBERS, THRS, HERS 10333 06:44:23,684 --> 06:44:24,251 VE TO BE INVOLVENV BECAUSE 10334 06:44:24,251 --> 06:44:25,653 THEY'RE ALL PART OARF THIS LIKE, 10335 06:44:25,653 --> 06:44:29,924 U KNOW, MOMSOMNDOM WOMEN ARE 10336 06:44:29,924 --> 06:44:31,692 OFTENOF THE LINCHPIN OF THE FAMY 10337 06:44:31,692 --> 06:44:33,427 ILL TODAY, SO WHENNHAT PERSON 10338 06:44:33,427 --> 06:44:34,962 IS MAY ADMITTED TO THE 10339 06:44:34,962 --> 06:44:35,062 HO 10340 06:44:35,062 --> 06:44:36,931 ITAL DURINGUR THE PGNANCYCY 10341 06:44:36,931 --> 06:44:37,531 FOR A LONGA IME IF TE T' T THE 10342 06:44:37,531 --> 06:44:38,499 CASE OR ISS VERY UNAWARE AARERAR 10343 06:44:38,499 --> 06:44:39,567 THE BIRTHND THERE'S OTHER 10344 06:44:39,567 --> 06:44:43,771 BE PREPAREDEP TO DO UP THE PIEE 10345 06:44:43,771 --> 06:44:45,072 THAT IN IN WAY THAT'S MEANINGFUL 10346 06:44:45,072 --> 06:44:46,907 AND I I I THINK IT'S IMPLETELY 10347 06:44:46,907 --> 06:44:47,641 SENTIAL THAT WE INVOLVE TLV 10348 06:44:47,641 --> 06:44:47,742 PA 10349 06:44:47,742 --> 06:44:48,542 NER, WHOEVER ELSE TRE 10350 06:44:48,542 --> 06:44:50,411 THERE TERE SUPPORT. 10351 06:44:50,411 --> 06:44:51,912 SOMETIMES THETH PARTNERS ARE NOT 10352 06:44:51,912 --> 06:44:52,546 THAT GTHAT OR ARE NOT AVAIT BLAI 10353 06:44:52,546 --> 06:44:52,646 FO 10354 06:44:52,646 --> 06:44:53,047 ATEVER REASON. 10355 06:44:53,047 --> 06:44:53,147 TH 10356 06:44:53,147 --> 06:44:56,383 AND I'VE HAD LOTS OF FAMIF ES 10357 06:44:56,383 --> 06:44:57,351 WHERE IT'S ACTUALLCT THEHE SISTR 10358 06:44:57,351 --> 06:44:58,686 THE FRIEND THAT COMES IN TOO 10359 06:44:58,686 --> 06:45:00,621 THEONSULT ORLT REALLY WAN TO 10360 06:45:00,621 --> 06:45:01,222 BE THAT PERSONPEHAT'S GOING TO 10361 06:45:01,222 --> 06:45:02,757 HELP AND ADVOCATEOCR ISOING TONT 10362 06:45:02,757 --> 06:45:07,762 BE ONBEN THE T POSTPARTUM FLO, , 10363 06:45:07,762 --> 06:45:08,395 WE'VE BEEN THROU T ALL TF THIS, 10364 06:45:08,395 --> 06:45:09,463 BECAE SOMETIMES PARTNERS ARE A 10365 06:45:09,463 --> 06:45:20,141 THETH TIME THEY'RE DELIGHTED TOE 10366 06:45:20,141 --> 06:45:21,909 THE STEPS AND THINGS THAT 10367 06:45:21,909 --> 06:45:25,079 THEY CANAN DO AND REALLY BE 10368 06:45:25,079 --> 06:45:25,446 INVOLVED. 10369 06:45:25,446 --> 06:45:28,582 >> I'LL JUST -- I AGREE WITH 10370 06:45:28,582 --> 06:45:32,086 EVERYTHING YOU SAID, HELEN HEN 10371 06:45:32,086 --> 06:45:36,590 BUALLY BEING ABL TO INVOLVE 10372 06:45:36,590 --> 06:45:38,359 .O.SPATIENTS' NETS'RK AS A MUCHS 10373 06:45:38,359 --> 06:45:44,598 IN MY SITUATION, I HAD A BIG 10374 06:45:44,598 --> 06:45:45,699 OFAMILY, DEFINITELY 10375 06:45:45,699 --> 06:45:48,569 LEANED ON MY M HUSBAND AOT FOR 10376 06:45:48,569 --> 06:45:49,203 OREMOTIONAOTSUPPORT, AND HE WAS 10377 06:45:49,203 --> 06:45:49,303 IN 10378 06:45:49,303 --> 06:45:50,671 LVED THROUGHOUT THEHE PROSS 10379 06:45:50,671 --> 06:45:50,771 SSWH 10380 06:45:50,771 --> 06:45:53,073 H HELPED,EL BUT B I DID PUT A 10381 06:45:53,073 --> 06:45:53,707 T OF BUROFN ON HIM BECAUSE HE 10382 06:45:53,707 --> 06:45:54,608 WAS RESPONSIBLE FOR HELPING ME 10383 06:45:54,608 --> 06:45:56,243 TO G THROUGHHIS WHILE ALSO 10384 06:45:56,243 --> 06:45:59,346 GO TO WORK AND TING CAREG F 10385 06:45:59,346 --> 06:46:02,416 OUR SON AND HOLDING A LOT O 10386 06:46:02,416 --> 06:46:04,251 RESPONSISPLITY AT THE SAME TIME. 10387 06:46:04,251 --> 06:46:07,988 HE HADHE H SOME STORY,RY AFTER 10388 06:46:07,988 --> 06:46:08,989 DELIVEDE WHEN I HEN IN ICUIN I 10389 06:46:08,989 --> 06:46:10,191 SAID HIS FEET DIDN'T WORK, HE 10390 06:46:10,191 --> 06:46:12,927 THIS CRAZY C STO OF H H H PAI P 10391 06:46:12,927 --> 06:46:13,260 ET WERE. 10392 06:46:13,260 --> 06:46:14,895 AND HE KEPT KTAWING ABOUT IT, 10393 06:46:14,895 --> 06:46:16,130 EVERYONE IS LIKE WHO CES ABO 10394 06:46:16,130 --> 06:46:18,999 YOUR FT? 10395 06:46:18,999 --> 06:46:19,967 BUT JUST POINTING OUTG HATHE 10396 06:46:19,967 --> 06:46:24,138 NEGLECT THAT T WEE OEN PLACE ONO 10397 06:46:24,138 --> 06:46:25,206 SUPPORTPPEOPLEPLELE W THERE 10398 06:46:25,206 --> 06:46:27,107 H IT WHICH,HI IN TURN, 10399 06:46:27,107 --> 06:46:29,410 MAKES THEM LESS ABLE TO SUPPO S 10400 06:46:29,410 --> 06:46:31,612 MOM. 10401 06:46:31,612 --> 06:46:34,882 >> HI. 10402 06:46:34,882 --> 06:46:37,218 YOU GUYS SO MUCH FOROR ALL 10403 06:46:37,218 --> 06:46:37,685 UR WONDERFUL TRFKS. 10404 06:46:37,685 --> 06:46:42,756 I JUST WANTED TTE T JUSTUS UERSE 10405 06:46:42,756 --> 06:46:45,125 WHAT WAS SAI DING D THE TALK 10406 06:46:45,125 --> 06:46:46,660 ED FOROR SOPs A 10407 06:46:46,660 --> 06:46:46,760 TH 10408 06:46:46,760 --> 06:46:48,696 MPORTANCENCNCHENHE COLLECTINLE 10409 06:46:48,696 --> 06:46:50,865 OSPECIOSNS, AND A THINK THE 10410 06:46:50,865 --> 06:46:51,899 RIGOR OF OUR VALIDATIOID STUDIEU 10411 06:46:51,899 --> 06:46:57,371 ANDININ T FUTURE WILL NEED TO BE 10412 06:46:57,371 --> 06:46:58,906 MOREIKE MULTICEULERS SS 10413 06:46:58,906 --> 06:47:01,475 IN A STANDARDINDD WAY WILL BE 10414 06:47:01,475 --> 06:47:04,745 D THEN ALSO AO ECHO ACHO LOTF 10415 06:47:04,745 --> 06:47:04,845 WH 10416 06:47:04,845 --> 06:47:06,513 THOSE HAVE SAID EARLIERERN 10417 06:47:06,513 --> 06:47:08,549 THE DAYBOUT TUT IMPORTANCE OEFF 10418 06:47:08,549 --> 06:47:15,055 STUDYINGUD OURURUR NON-R ACCRET, 10419 06:47:15,055 --> 06:47:20,561 THATTH REALLY HAS - DECTION, 10420 06:47:20,561 --> 06:47:23,664 ENSURING TT WE'RE BRIDGINGIN OUR 10421 06:47:23,664 --> 06:47:27,668 YBE WE CAN USE -- TOMORROW TONDN 10422 06:47:27,668 --> 06:47:29,436 STRIKE THAT JAIT HOW T H DO THAT 10423 06:47:29,436 --> 06:47:31,939 OME SORT OF SYSTEMATIC WAY, 10424 06:47:31,939 --> 06:47:33,207 IT'S DIFFICULT TCU PICK THEM UP 10425 06:47:33,207 --> 06:47:36,010 YOU Y DON'T HAVE H ANNRETA BUT 10426 06:47:36,010 --> 06:47:39,013 FINDING A WAY W TO START -- 10427 06:47:39,013 --> 06:47:39,113 >> 10428 06:47:39,113 --> 06:47:40,481 HRISTINA. 10429 06:47:40,481 --> 06:47:41,282 I WANT TO FOLLOW UP ON THAT 10430 06:47:41,282 --> 06:47:41,382 CO 10431 06:47:41,382 --> 06:47:42,283 ENT BECAUSE I WE REAY 10432 06:47:42,283 --> 06:47:45,619 INKING ABOUT SCOTT IN TS 10433 06:47:45,619 --> 06:47:49,123 BUT HAVING BIORKERS, ANDND IF IO 10434 06:47:49,123 --> 06:47:51,892 REALLY HAD H A PIEN THE SKYKYKY 10435 06:47:51,892 --> 06:47:52,459 DREAM ABOUT WHAT WE COULD DO 10436 06:47:52,459 --> 06:47:53,560 WITH ACCRETA CARE, IT WOULD BE 10437 06:47:53,560 --> 06:47:55,462 NALT TO KNOW IN ADVANCE 10438 06:47:55,462 --> 06:47:55,562 CEWH 10439 06:47:55,562 --> 06:47:58,198 HADAD A PREDISPOSITION FOR 10440 06:47:58,198 --> 06:48:00,234 WOUNDWOEALING SUCH THAT WHAT IF 10441 06:48:00,234 --> 06:48:02,636 WE COULD PRECISIONON MEDICINE 10442 06:48:02,636 --> 06:48:03,871 RCONCEPTIONAL INTERVAL FOR 10443 06:48:03,871 --> 06:48:06,740 PATIENTS SUCH THAT WEIDHEIR 10444 06:48:06,740 --> 06:48:10,678 SURGERY, TO T DR. SILVER'S WAY 10445 06:48:10,678 --> 06:48:12,846 TH A COLLAGEN SNET IN THERE, 10446 06:48:12,846 --> 06:48:14,581 OTED WOUND HEANG BUT ALS 10447 06:48:14,581 --> 06:48:14,682 UN 10448 06:48:14,682 --> 06:48:17,451 ENOUGH TO SAY YES IVF MOM, M Y,Y 10449 06:48:17,451 --> 06:48:19,386 CAN HAVE A PGNANCY AGAIN IGA 10450 06:48:19,386 --> 06:48:20,554 NTHS EVEHS THOUGHUG WE W 10451 06:48:20,554 --> 06:48:21,555 NORMALLY TELL EVEBODY 12 TO 10452 06:48:21,555 --> 06:48:24,558 18, SO TO ME, IFF YO IT WOULD BE 10453 06:48:24,558 --> 06:48:26,393 REALLYRE NEAT TO KNOW NOT ONLYYN 10454 06:48:26,393 --> 06:48:27,795 PREGNANCY WHATT THEIOMARKERS 10455 06:48:27,795 --> 06:48:30,597 SHOW FOR THE ACCRETA -- BUT ALSO 10456 06:48:30,597 --> 06:48:34,702 WHAT DO WEO NOWBOUT UPSTROMA, 10457 06:48:34,702 --> 06:48:34,802 TH 10458 06:48:34,802 --> 06:48:39,573 ONE TO BEGIN WITH.WIHAVING 10459 06:48:39,573 --> 06:48:40,874 SO THAT TOHAE IS AIS REALLY COOL 10460 06:48:40,874 --> 06:48:41,608 FRONTIER, IF YOU HAVE ANY 10461 06:48:41,608 --> 06:48:42,042 THOUGHTSOUBOUT THAT. 10462 06:48:42,042 --> 06:48:43,844 CER CLY NOT DOING IT BUT 10463 06:48:43,844 --> 06:48:48,315 AFFILIATFI WITH ME AT ALL THAT'' 10464 06:48:48,315 --> 06:48:49,016 ACTUALLY COLLECTING MEINTRUAL 10465 06:48:49,016 --> 06:48:51,752 D IN DE DIVA CUP AND 10466 06:48:51,752 --> 06:48:54,054 ING PROSPECTIVELY 10467 06:48:54,054 --> 06:48:59,026 AT NOT ACCRETA BUT OTHERTHNG 10468 06:48:59,026 --> 06:49:00,127 PREGNANCY OUTCOMES, SO PEOPLE 10469 06:49:00,127 --> 06:49:01,962 ARE LOOKINGOO FOLLOWINGLOWI THA 10470 06:49:01,962 --> 06:49:04,098 TRN OF LOG. 10471 06:49:04,098 --> 06:49:04,665 I THINK IT'S -ITYOU KNOW, I 10472 06:49:04,665 --> 06:49:07,334 DON'T KNOW,NO Y'ALL LOO AND -- 10473 06:49:07,334 --> 06:49:09,370 WE DO THAT? 10474 06:49:09,370 --> 06:49:11,405 I MEAN, LIKE MAYBE, MAYBE 10475 06:49:11,405 --> 06:49:13,040 THERE'S SOME SIGNAL COMINGG IN 10476 06:49:13,040 --> 06:49:14,141 MENSTRUAL BLOOD THAT WLD 10477 06:49:14,141 --> 06:49:19,513 IDENTIFY WOMEN WOMON'TON 10478 06:49:19,513 --> 06:49:25,519 AREN'T -- WHO'S GOINGNG TO FUN 10479 06:49:25,519 --> 06:49:26,320 IT. 10480 06:49:26,320 --> 06:49:26,787 >> DR. WRIR. WRI 10481 06:49:26,787 --> 06:49:29,490 >> CONATULATIONSNS ON ALL THE 10482 06:49:29,490 --> 06:49:29,790 GREAT TALKS. 10483 06:49:29,790 --> 06:49:32,693 I WAS S WUCK WITH D SILVER'SS 10484 06:49:32,693 --> 06:49:37,631 SSLIDE WIT19 TO A HUNDRED% OF 10485 06:49:37,631 --> 06:49:40,801 PATIENTS WITHIST MUST SEALS OR 10486 06:49:40,801 --> 06:49:43,103 CALL THIS EITY.VER WE WANT T T 10487 06:49:43,103 --> 06:49:45,606 IT JT DN'T EXIST 10 YEARS 10488 06:49:45,606 --> 06:49:46,273 AGO, AND N A THE INCIDENNC IS SO 10489 06:49:46,273 --> 06:49:47,241 HIGH. 10490 06:49:47,241 --> 06:49:47,341 I' 10491 06:49:47,341 --> 06:49:48,308 SURE THERE'S MEASUREMENT 10492 06:49:48,308 --> 06:49:51,879 PEOPLE WITH A HOLE IN THE UTHRUS 10493 06:49:51,879 --> 06:49:55,049 SOMEF THESESESE FOLKS ONKED UP 10494 06:49:55,049 --> 06:49:57,051 ULTRASOUND, IND GUESS WHAT'S 10495 06:49:57,051 --> 06:49:57,718 CHANGED SO DRAMATIRALLY IN THEHE 10496 06:49:57,718 --> 06:50:03,724 BIOLOGY?Y?TORS AND THE UTERINE 10497 06:50:03,724 --> 06:50:06,093 THAT'S WHAT WE'RE ALL HERE TO 10498 06:50:06,093 --> 06:50:06,193 FI 10499 06:50:06,193 --> 06:50:08,996 RE OUT. 10500 06:50:08,996 --> 06:50:10,064 SO TWO COMMENTOM 10501 06:50:10,064 --> 06:50:11,065 NUMBER OMB, O I DO THINK THERE'S 10502 06:50:11,065 --> 06:50:13,901 BEEN A CHANG CIN THE TECH KNEC 10503 06:50:13,901 --> 06:50:18,372 SOMEHOW AND TECHNIQUEAND WE REAY 10504 06:50:18,372 --> 06:50:20,040 THAT.AT 10505 06:50:20,040 --> 06:50:20,707 COND, CO DID NOTICE SOME OSO US 10506 06:50:20,707 --> 06:50:21,909 A CERTA C C AGE IN THE ROOM, 10507 06:50:21,909 --> 06:50:25,312 BACK WHEN WE DO A A TRIAL AFTER 10508 06:50:25,312 --> 06:50:28,615 CESAREAN WE'D HAV SUCCESSFULSS 10509 06:50:28,615 --> 06:50:29,817 FEEDBACK, WE'D STICK OUR HAND II 10510 06:50:29,817 --> 06:50:31,185 TO SEE IF THE WAS AOLE, AND 10511 06:50:31,185 --> 06:50:33,387 NDA LOTAF TIMES THEREAS A HOLE 10512 06:50:33,387 --> 06:50:34,154 AND WEANIDN'T DO AT DOING.G. 10513 06:50:34,154 --> 06:50:35,689 AND NOTHING BAD HAPPENED AND WE 10514 06:50:35,689 --> 06:50:37,891 QUIT DOING DNG IT, IUT THERE WAS 10515 06:50:37,891 --> 06:50:47,434 S THIS NICHE.IC SEEHETHER THERE 10516 06:50:47,434 --> 06:50:47,901 WE CALLED IT SOMITHING 10517 06:50:47,901 --> 06:50:48,569 DIFFERENT, YOU KNOW, WE CALLEDAL 10518 06:50:48,569 --> 06:50:54,041 FOUND A LOT OF TSE THINGS.DR, YU 10519 06:50:54,041 --> 06:50:56,243 BUT THEHEHEUESTION W HAD IS, WAS 10520 06:50:56,243 --> 06:51:01,815 IT SAFE F THEM TO T HAVE A 10521 06:51:01,815 --> 06:51:02,149 D LABOR? 10522 06:51:02,149 --> 06:51:03,383 WHAT WE FOUNDOU IS IT DIDT M 10523 06:51:03,383 --> 06:51:05,486 ANY DIFFERENCE, AND AOST OFHEM 10524 06:51:05,486 --> 06:51:06,553 DIDN'TDIAVE ANY SYMPTOMS W 10525 06:51:06,553 --> 06:51:08,288 QUIT THINKING ABO IT TIL 10526 06:51:08,288 --> 06:51:09,456 THEY STHRTED HAVING ALL A THESE 10527 06:51:09,456 --> 06:51:11,225 DAMN ACCRETAS AND NND WE HE TO 10528 06:51:11,225 --> 06:51:11,758 REVISIT IT. IT. 10529 06:51:11,758 --> 06:51:13,961 SO I THINK WE'VE ALWAY AHAD 10530 06:51:13,961 --> 06:51:15,195 THESE SCARS. 10531 06:51:15,195 --> 06:51:17,498 JUST ONLY ASSESSSHORT TERM 10532 06:51:17,498 --> 06:51:19,366 OUTCOMESTCF THE SCARS WHICH 10533 06:51:19,366 --> 06:51:23,370 WEREN'T SO BAD, AND WE HAVEN'TTM 10534 06:51:23,370 --> 06:51:24,872 IMPLICATIONS OF THEF SCARS. 10535 06:51:24,872 --> 06:51:26,807 BUT I'MTTAKINGAK THAT UP AND I'D 10536 06:51:26,807 --> 06:51:27,441 LOVE TO HEAR FROM AROBODY ELSE 10537 06:51:27,441 --> 06:51:28,775 ANOTHER THOUGHT. MIGHT HAVE 10538 06:51:28,775 --> 06:51:31,345 >> I WONDERR IF ANOER TNG T 10539 06:51:31,345 --> 06:51:32,880 THAT CHANGED ING ULTRASOUNRAUN E 10540 06:51:32,880 --> 06:51:34,515 OUR ULTRASOUND ISNDS MUCHETTERET 10541 06:51:34,515 --> 06:51:38,051 THAN THEY WERE WHEN IEN STARTED 10542 06:51:38,051 --> 06:51:40,554 PRACTICING AND - ANDND SO 10543 06:51:40,554 --> 06:51:41,989 HISTOGRAMS HAPPE H H PATIENTS 10544 06:51:41,989 --> 06:51:44,992 ARE -- I GET AOT OF NHE 10545 06:51:44,992 --> 06:51:45,092 CO 10546 06:51:45,092 --> 06:51:46,293 ULTS CULING FROM FFERN TILT 10547 06:51:46,293 --> 06:51:47,828 ACTICES BECAU B THEY'RERE DOINGI 10548 06:51:47,828 --> 06:51:48,929 SOME HISTO HISS H SO IT' KIND OF 10549 06:51:48,929 --> 06:51:52,499 NOWENOE SEEINGEE A THESET ANDND 10550 06:51:52,499 --> 06:51:53,500 THINGS TINTIN MAYBE MERE ALWES 10551 06:51:53,500 --> 06:51:53,800 THERE. 10552 06:51:53,800 --> 06:51:56,603 INTERESTING THAT DEIRD DEIROUGHT 10553 06:51:56,603 --> 06:51:58,405 UP IN THE VERYIRSTECTURE IS 10554 06:51:58,405 --> 06:52:00,007 THATEEON'T TALK ABOUTUT PREVIA 10555 06:52:00,007 --> 06:52:04,878 REALLY AT ALL,LL A IF A PATIENT 10556 06:52:04,878 --> 06:52:11,285 C-SECTIONS, FUND, PLACENTA, 10557 06:52:11,285 --> 06:52:14,054 SAYS HOWYSONCERNED ARE Y A ABOUT 10558 06:52:14,054 --> 06:52:16,790 ACCRETA AND WEE SAY WE'RE NOT, N 10559 06:52:16,790 --> 06:52:18,091 ARE WE HAVING MORE M PREVIAS? 10560 06:52:18,091 --> 06:52:22,996 DON'T KONW THE ANSWER TO THAT. 10561 06:52:22,996 --> 06:52:28,969 BUT -- THERE OTHER THINGS, WE 10562 06:52:28,969 --> 06:52:30,304 HA ASKED THE QUESTION, WE 10563 06:52:30,304 --> 06:52:30,404 DO 10564 06:52:30,404 --> 06:52:32,139 T KNOW WHAT THEY ARE, BUT 10565 06:52:32,139 --> 06:52:33,440 MAYBE THE ISSUE HAS AAY AAY A BN 10566 06:52:33,440 --> 06:52:35,075 HERENUTUTOWUTOW WEE HAVE HAV PRI 10567 06:52:35,075 --> 06:52:37,077 SITTING INN NICHES SO MAYBE WE 10568 06:52:37,077 --> 06:52:37,644 WENEED TO BE LOOKING AT THAT. 10569 06:52:37,644 --> 06:52:39,980 >> JUS>> TO JASON'S POINT,,OT 10570 06:52:39,980 --> 06:52:42,783 ONLY IS THE CLO C DIFFE DNT 10571 06:52:42,783 --> 06:52:44,151 POTENTIALLY BUT I THINK OHI 10572 06:52:44,151 --> 06:52:45,519 OBSTETRICS IS JUST DIFFERE I. 10573 06:52:45,519 --> 06:52:48,589 WE'RE LETTING PATIENTSIE PUSH MH 10574 06:52:48,589 --> 06:52:49,623 LONGER, SO AIB THAT'S -- AND 10575 06:52:49,623 --> 06:52:52,459 E'RE DOINGOI SECON MUCH 10576 06:52:52,459 --> 06:52:53,360 LAR IN THE SECOND STAGE THAN 10577 06:52:53,360 --> 06:52:55,796 USED TO OR -O I THINKHERERE 10578 06:52:55,796 --> 06:52:57,431 ARE OTH O VARIABLESESHAT MAYBE 10579 06:52:57,431 --> 06:53:00,634 WE'RE NOT QUITE TNK TG ABOUT. 10580 06:53:00,634 --> 06:53:02,369 THE EFFECT OF INFLAMMATION AT 10581 06:53:02,369 --> 06:53:02,469 IN 10582 06:53:02,469 --> 06:53:04,404 CTION ON THATEMELING. 10583 06:53:04,404 --> 06:53:06,039 I THINK THOSE T ARE ALLRE KINF 10584 06:53:06,039 --> 06:53:09,910 PRIME TARGETS TO HELP IDENTIFY 10585 06:53:09,910 --> 06:53:11,812 THE WHY. 10586 06:53:11,812 --> 06:53:11,912 .>> 10587 06:53:11,912 --> 06:53:18,452 -- DS NOT REFLECT THE 10588 06:53:18,452 --> 06:53:19,886 NATIONALTI DOTIE HEEEE ACTUALLY 10589 06:53:19,886 --> 06:53:20,454 NATIONAL DATA? 10590 06:53:20,454 --> 06:53:23,123 I ALWAYSWA GIVEE THE EXAMPLE, II 10591 06:53:23,123 --> 06:53:25,492 WERE TO REPORT EPTE OF ECLAMPSIA 10592 06:53:25,492 --> 06:53:29,630 WHERE I AM,ROBABLYBL ABO 2250, 10593 06:53:29,630 --> 06:53:30,130 NATIONALLY IT'S 2,000. 10594 06:53:30,130 --> 06:53:33,433 IT'S A REFLECTION OFIO THE T CT. 10595 06:53:33,433 --> 06:53:36,870 THERE WERERE ACTUALLYLL -- I DOT 10596 06:53:36,870 --> 06:53:41,875 THINKINE HAVE THIS THING. 10597 06:53:41,875 --> 06:53:43,644 >> DR. HERRERA. 10598 06:53:43,644 --> 06:53:45,379 >> JUS>> TO KIND OF PIGGY BACK,I 10599 06:53:45,379 --> 06:53:47,814 WAS GOING TO T SAY BEFE SCOTT 10600 06:53:47,814 --> 06:53:48,448 BROUGHT IT UP, WE PAY ATTENTATN 10601 06:53:48,448 --> 06:53:49,249 NTO TNTO NICHES ANDN ANGS BNG 10602 06:53:49,249 --> 06:53:51,918 WE DON'T G'T BACK TO WHAT WASHE 10603 06:53:51,918 --> 06:53:52,552 PRIOR SURGICAL HISTORY TO THE 10604 06:53:52,552 --> 06:53:55,155 EXTENT ONT WTT IT FIRST STAGE, 10605 06:53:55,155 --> 06:53:57,157 SECOND STAGE, TACOND STAGE WITH 10606 06:53:57,157 --> 06:53:58,258 BECAUSE WE KE W TE RE'S 10607 06:53:58,258 --> 06:53:59,593 ASSOCIATIONS WITH PRETERM BIRTHS 10608 06:53:59,593 --> 06:54:00,894 SO THERE'S SOM'SHING CHANG CG IN 10609 06:54:00,894 --> 06:54:04,965 AT LOWER UTERINE SEGMENT 10610 06:54:04,965 --> 06:54:06,066 ALREADY, SO Y, REALLY THINK THAT 10611 06:54:06,066 --> 06:54:07,801 WE NEED TO KIND OF POWER THE 10612 06:54:07,801 --> 06:54:09,403 DATA LOOKING AKIA LITTLEITOREOO 10613 06:54:09,403 --> 06:54:09,503 DE 10614 06:54:09,503 --> 06:54:11,271 LIVERIESRIS WE CARRY IT 10615 06:54:11,271 --> 06:54:11,371 FO 10616 06:54:11,371 --> 06:54:12,339 ARD WHEN WE'RE LOOKING AT 10617 06:54:12,339 --> 06:54:14,274 OUR CLOSURE, ANDND I DO THINKTH 10618 06:54:14,274 --> 06:54:15,542 THERE ARE -- ANTON HAD THIS 10619 06:54:15,542 --> 06:54:17,944 PAPER WHERE MAYBE WAYRE ACTUALLY 10620 06:54:17,944 --> 06:54:18,779 EVERTING PARTICULARLY IF I IS I 10621 06:54:18,779 --> 06:54:20,147 ALREADY THINTH AND YOU ALREADY 10622 06:54:20,147 --> 06:54:21,114 HAVE VERY, VERY LITTLE 10623 06:54:21,114 --> 06:54:22,115 MYOMETRIUM THAT YOU'REE PUTTING 10624 06:54:22,115 --> 06:54:22,215 TO 10625 06:54:22,215 --> 06:54:23,083 THER, IT MAKES SENSE T 10626 06:54:23,083 --> 06:54:24,785 MAYBE IN SOME OOMF THESE CASES 10627 06:54:24,785 --> 06:54:24,885 WE 10628 06:54:24,885 --> 06:54:34,294 E CREEING THAT DHATT. 10629 06:54:34,294 --> 06:54:40,767 >> DR. SHAINKER'SS QUESTION -- 10630 06:54:40,767 --> 06:54:45,038 SIGNALSIIGN FORMMUNE PATHWAYAT 10631 06:54:45,038 --> 06:54:46,673 DR. DID CAN WEIGH IN, BUT 10632 06:54:46,673 --> 06:54:50,744 IS IFH -- HYPERACYPVATION IN I 10633 06:54:50,744 --> 06:54:53,046 THISMMUNE ACTIVITY, THEN I WAS 10634 06:54:53,046 --> 06:54:56,149 THINKING BASED ON SOMEN EVOLVINN 10635 06:54:56,149 --> 06:55:03,857 CONCEPT OF OUROUOU USE OF -- 10636 06:55:03,857 --> 06:55:08,895 RECEPTOR -- FOR THEHE GESTATN 10637 06:55:08,895 --> 06:55:11,765 GESTATIONAL -- PLACENTAL SITE -- 10638 06:55:11,765 --> 06:55:16,837 DATATA F RUSSIA,USUS PATIENTIE 10639 06:55:16,837 --> 06:55:19,206 DIFFUSE -- AND THEY PROVIDERO A 10640 06:55:19,206 --> 06:55:22,175 MEMBERER OF ---- THERAPY -RA 10641 06:55:22,175 --> 06:55:26,346 DISAPPEARED, IFD, SO -- SCCRETA 10642 06:55:26,346 --> 06:55:37,090 OF -- TREATMERE.RIL IMMUNE -- 10643 06:55:37,090 --> 06:55:40,794 >> IHI WE'RE JUST STARTING 10644 06:55:40,794 --> 06:55:46,700 INFLAMINTORYRYATHWAY WITH THE 10645 06:55:46,700 --> 06:55:48,135 BER DEPOSITION AND THEHE ROLE OF 10646 06:55:48,135 --> 06:55:48,468 ACCRETA. 10647 06:55:48,468 --> 06:55:50,303 I THINK THI TO HER POINT PWE'RE 10648 06:55:50,303 --> 06:55:52,539 LOOKING --N THE FOURTH 10649 06:55:52,539 --> 06:55:53,306 TRIMESTER, WE'RE LOOKING AFTER R 10650 06:55:53,306 --> 06:55:54,908 LIVERY, SO WHAT I THINK WOULD 10651 06:55:54,908 --> 06:55:56,676 BE GREAT IS HELPING TO TO 10652 06:55:56,676 --> 06:55:58,412 UNDERSTAND TTAT PATHWAY DURING 10653 06:55:58,412 --> 06:56:01,481 GESTATION ORVEN PREGESTATION 10654 06:56:01,481 --> 06:56:02,249 AN 10655 06:56:02,249 --> 06:56:02,916 FIGUREGU OUT WHEUT CAN WE 10656 06:56:02,916 --> 06:56:03,316 BLOCK IT. 10657 06:56:03,316 --> 06:56:05,952 WE HAVE A MICRO ARRAY,AY 10658 06:56:05,952 --> 06:56:07,120 INFLAMMATORY MICRY ARRAYRR O 10659 06:56:07,120 --> 06:56:10,824 AG BN, THERE ALL T ALL AES BUT B 10660 06:56:10,824 --> 06:56:13,126 TRIMESTERR SAMPLES. 10661 06:56:13,126 --> 06:56:15,095 SO TRE T ARE A PEOPLE W W HAVE 10662 06:56:15,095 --> 06:56:17,998 DE TS TMENT, YOU GIVEIV 10663 06:56:17,998 --> 06:56:19,966 PRETTY HIGHH POTENCY 10664 06:56:19,966 --> 06:56:21,268 NFLAMMATORY TOAN THEHE MOUSEOU 10665 06:56:21,268 --> 06:56:23,470 MODEL AND SEE WHAT W HAPPENS WH 10666 06:56:23,470 --> 06:56:26,139 R SOME OTHER ANIMAL MEL.. 10667 06:56:26,139 --> 06:56:27,340 SO YES, Y PEOPLE ARE START STA S 10668 06:56:27,340 --> 06:56:29,342 T THAT, IT'ST' NOT WHERE OUR 10669 06:56:29,342 --> 06:56:29,443 URFO 10670 06:56:29,443 --> 06:56:30,143 URFO B W I KNOW YOU'VE B 10671 06:56:30,143 --> 06:56:33,547 LOOKT IT A LITTLE BIT, THE 10672 06:56:33,547 --> 06:56:36,616 LE OF INFORMATION. 10673 06:56:36,616 --> 06:56:39,352 -- CAREANS FOR PGNANCY, 10674 06:56:39,352 --> 06:56:39,453 IT 10675 06:56:39,453 --> 06:56:40,353 HPENS LOCALLY. 10676 06:56:40,353 --> 06:56:43,323 THIS IS -- YOU KNOW,ERSUS IN 10677 06:56:43,323 --> 06:56:45,926 THAT SCOTT ALLUDED TO WERE INDI 10678 06:56:45,926 --> 06:56:47,160 MATERNAL SERUM. 10679 06:56:47,160 --> 06:56:49,596 BUT THE CHANGES THAT PEOPLE AT 10680 06:56:49,596 --> 06:56:51,131 THE SCRIBE AT THE IMMUNE LEVEL 10681 06:56:51,131 --> 06:56:53,867 ARE LITERALLY THE MACROPHAGES 10682 06:56:53,867 --> 06:56:56,536 AND VILLI SO IT'S AS A VERY V LL 10683 06:56:56,536 --> 06:56:59,840 EFFECT VESE VERSUS SYSTE SC EFF, 10684 06:56:59,840 --> 06:57:02,476 SO YES THEORETICALLY B A L 10685 06:57:02,476 --> 06:57:06,146 MOREORK HAS TOE DONE TO 10686 06:57:06,146 --> 06:57:09,082 THINK ABO SYSTEMIC 10687 06:57:09,082 --> 06:57:11,318 CONSEQUENCES OF SUCH A LOCAL 10688 06:57:11,318 --> 06:57:11,585 DULATOR. 10689 06:57:11,585 --> 06:57:12,719 >> JUST TO AT ON THAT,UR 10690 06:57:12,719 --> 06:57:18,024 TRIMESTER WTEE MUCH MORE MRD T T 10691 06:57:18,024 --> 06:57:21,127 INVOLVED IN THO IMMUNOMODULAR 10692 06:57:21,127 --> 06:57:23,396 PAWAYS WHEREAS IN SECOND 10693 06:57:23,396 --> 06:57:29,870 SEMESTERRE MOR ANGIOGENIC -- 10694 06:57:29,870 --> 06:57:31,605 POTTIALLY BE MODULATED TO 10695 06:57:31,605 --> 06:57:35,242 PRENT ACCRETARE BUT -- -->> W SM 10696 06:57:35,242 --> 06:57:39,980 SAMPLES AS WELL, LOOK AT 10697 06:57:39,980 --> 06:57:40,947 MIC PLATFORMS,MSHERE'S A 10698 06:57:40,947 --> 06:57:41,948 SHIFT INN EXPRESSION, THE 10699 06:57:41,948 --> 06:57:45,018 ESTI IS WHY. 10700 06:57:45,018 --> 06:57:45,118 >> 10701 06:57:45,118 --> 06:57:45,385 ABS LUTELY. 10702 06:57:45,385 --> 06:57:46,453 >> DR.AADE.. 10703 06:57:46,453 --> 06:57:48,722 >> SOOO GOO BACO TO THE 10704 06:57:48,722 --> 06:57:51,491 INCREASING RATE OF ARETA, AS 10705 06:57:51,491 --> 06:57:53,260 BOB SAID, WE USED TO T SEE THEST 10706 06:57:53,260 --> 06:57:57,497 DEFECTDEIN THE T PAS,ND THERE 10707 06:57:57,497 --> 06:57:59,799 S NO ACCRETA, BUT INBURDER TO 10708 06:57:59,799 --> 06:58:00,400 HAVE AN AC AETA, YOU HAVE TOE 10709 06:58:00,400 --> 06:58:05,839 EHAVE THE T IMPLANTATION ON THEE 10710 06:58:05,839 --> 06:58:08,742 INCISION, S---- THE QUESTION WAS 10711 06:58:08,742 --> 06:58:09,709 ASISED, IS THE INCREASED RATE 10712 06:58:09,709 --> 06:58:09,809 OF 10713 06:58:09,809 --> 06:58:18,184 CORRELATE WITH MATER MAT AGE AND 10714 06:58:18,184 --> 06:58:23,089 MI,MIMI THE T MORE LOWYINGYI D 10715 06:58:23,089 --> 06:58:25,559 RE ACCRETA E EOU'RE GOING TO 10716 06:58:25,559 --> 06:58:25,759 HAVE. 10717 06:58:25,759 --> 06:58:28,328 THE OTHER OTY YOU COULDCO IT,T, 10718 06:58:28,328 --> 06:58:29,629 THE INCIS IN ON THE THE T LOWERR 10719 06:58:29,629 --> 06:58:32,799 CLOWSER OWD CLOSER TO THE CG C P 10720 06:58:32,799 --> 06:58:34,634 FUNDUS, SO TIGHER THE 10721 06:58:34,634 --> 06:58:34,734 IN 10722 06:58:34,734 --> 06:58:36,937 SION, THE MORE LIKELY THE 10723 06:58:36,937 --> 06:58:37,571 PLACENTA IS GOING TO NGACH THAT 10724 06:58:37,571 --> 06:58:37,837 INCISION. 10725 06:58:37,837 --> 06:58:38,672 OF THESE SHOSED BE 10726 06:58:38,672 --> 06:58:38,772 IN 10727 06:58:38,772 --> 06:58:39,439 STINATED ALONG WITH THE 10728 06:58:39,439 --> 06:58:45,045 TECHNIQUE AND T AND CLORE. 10729 06:58:45,045 --> 06:58:46,079 DR. FOX. 10730 06:58:46,079 --> 06:58:47,914 >> COULDN'T AGREE MORE M WH 10731 06:58:47,914 --> 06:58:51,484 NEEDING TO T KNOW WHERE KUTTING 10732 06:58:51,484 --> 06:58:51,751 AR. 10733 06:58:51,751 --> 06:58:52,519 IT'S INTERESTING TO HEAR THE 10734 06:58:52,519 --> 06:58:53,253 DIFFERENT HYPOT HYES. 10735 06:58:53,253 --> 06:58:54,688 I HEAR SOME SAY LOWER L BECAUSE 10736 06:58:54,688 --> 06:58:59,092 YOU T T B BTTERLY DERP 10737 06:58:59,092 --> 06:58:59,659 ONES ANDESIGHER -- YOU KNOW, 10738 06:58:59,659 --> 06:59:01,328 THERE'S DIFFERENT RISKS AND IT 10739 06:59:01,328 --> 06:59:04,798 PACTS RUPTURE. 10740 06:59:04,798 --> 06:59:06,633 I HAVE TO AGREE AITEEWHAT YOU 10741 06:59:06,633 --> 06:59:08,802 SAID, BOB, A NOT NOT HAVGHE 10742 06:59:08,802 --> 06:59:11,237 LOITUDAL DATA, BECAUSE I HAVEAV 10743 06:59:11,237 --> 06:59:11,905 TO WONDER ALSOR THERE ARE P ANY 10744 06:59:11,905 --> 06:59:13,540 OF WOMEN WOM MAY HAVE SYMOMSS 10745 06:59:13,540 --> 06:59:17,277 OF A CAREAN SCAR NICHE BUT ITTT 10746 06:59:17,277 --> 06:59:18,578 NDND OF GOES UNDERRECOGNIZED. 10747 06:59:18,578 --> 06:59:25,452 LITTLE BITLE TL OF TROUBLEUBLEE 10748 06:59:25,452 --> 06:59:29,356 INTRAMENTRRUAL -- I- DO THIO T 10749 06:59:29,356 --> 06:59:30,023 HAVING SOME MORE LONG-STONDIST 10750 06:59:30,023 --> 06:59:36,196 WE DO TO U OURATIENTS WOULD BETA 10751 06:59:36,196 --> 06:59:38,531 REALLY, REAY HELPFUL,,OT JUST 10752 06:59:38,531 --> 06:59:42,002 FROM AN ACCRETA PERSPECTIVE BUT 10753 06:59:42,002 --> 06:59:46,973 A CECTION A - A 10754 06:59:46,973 --> 06:59:49,275 A>> IT SOUNDS LIKE WE REALLYY D 10755 06:59:49,275 --> 06:59:52,412 SOMESO RCTs WITHH LONG-TERM 10756 06:59:52,412 --> 06:59:52,979 LLOW-UP AND I'M SUI' THEY 10757 06:59:52,979 --> 06:59:56,282 YWOULD BE DELHTED TO T FUND THIS 10758 06:59:56,282 --> 06:59:58,051 CRITICALLY IMPORTANT ISSUE 10759 06:59:58,051 --> 07:00:00,253 THAT'S JUST SUCH A FUNDAMEUNAL 10760 07:00:00,253 --> 07:00:02,656 ASPECT OF OBSTE OICS THAT' T 10761 07:00:02,656 --> 07:00:08,828 STILLST SO S POORLY UNDERSTOOD. 10762 07:00:08,828 --> 07:00:11,564 >> THE OER THING I'LL ADD TO 10763 07:00:11,564 --> 07:00:12,766 THAT IS I THINK I'MNKNK REALLY 10764 07:00:12,766 --> 07:00:16,302 D THAT WE HAD -- THATTE 10765 07:00:16,302 --> 07:00:17,904 HAVEVE HEREE GYNECOLOGICOL 10766 07:00:17,904 --> 07:00:19,305 ONCOLOGISTLO 10767 07:00:19,305 --> 07:00:19,939 THINK THE OTHER PLACE THAT THIS 10768 07:00:19,939 --> 07:00:22,475 COMESME UP ISS WITH OUR REI 10769 07:00:22,475 --> 07:00:24,177 COLLEAGUES. 10770 07:00:24,177 --> 07:00:26,246 OUR REI COLLEAGUES MANAGE NICHES 10771 07:00:26,246 --> 07:00:27,881 COMPLETEMP SEPARATELY THE WAYE 10772 07:00:27,881 --> 07:00:34,921 FERTILITY.Y. RELATEDEL TO 10773 07:00:34,921 --> 07:00:35,522 - TOLLTODIFFERENT THAN ALL 10774 07:00:35,522 --> 07:00:37,023 OF OUR O SOCIETYTY GUIDELINES, I 10775 07:00:37,023 --> 07:00:43,963 THINK THIN ISUGH TO T -- THEHE 10776 07:00:43,963 --> 07:00:46,266 STAKEHSTDEEHGROUP KEEPSEP WIDENG 10777 07:00:46,266 --> 07:00:49,002 WHO WEE N TOET ACCESS TO, TO 10778 07:00:49,002 --> 07:00:54,174 GROUPS OOU PEOPLE ORE IORTA., LE 10779 07:00:54,174 --> 07:00:54,741 >> DR. R DERTS. 10780 07:00:54,741 --> 07:00:57,043 >> THIS MAY BE AN 10781 07:00:57,043 --> 07:01:02,782 UNCOMFORCOBLE -- THIS IS -- 10782 07:01:02,782 --> 07:01:05,151 ROBERTS, TRTS MAY BE ---- I IAS 10783 07:01:05,151 --> 07:01:06,786 REALLY TAK BY YOUR IMAGES OF 10784 07:01:06,786 --> 07:01:09,089 THE SR PREGNANCY AND PICKING 10785 07:01:09,089 --> 07:01:11,658 THAT UP EARLY. 10786 07:01:11,658 --> 07:01:17,330 HAVIN BEENNVOLVED IN ONE OF 10787 07:01:17,330 --> 07:01:23,436 QUESTIQUTI WHICH IS, IF W SAYNGI 10788 07:01:23,436 --> 07:01:25,505 WE'RE GOING TO TRYRYRY A G 10789 07:01:25,505 --> 07:01:26,473 , PARTICULAR PEOPLE THATHA 10790 07:01:26,473 --> 07:01:31,911 HAVE HAD CESAREAN SECONEC EARLY 10791 07:01:31,911 --> 07:01:33,146 IMAGING,AGHEG, THEUESTN 10792 07:01:33,146 --> 07:01:39,919 HAPPENS WITH THOSE PATIENTS IN I 10793 07:01:39,919 --> 07:01:40,487 TEXAS, WXARE YOU SEE THEEE'S 10794 07:01:40,487 --> 07:01:43,123 T HAS ATCAR 10795 07:01:43,123 --> 07:01:50,663 PREGNANCY, YOUR FEAR IS TT TT 10796 07:01:50,663 --> 07:01:53,700 COMES ACCRETCR AND YET Y Y 10797 07:01:53,700 --> 07:01:54,334 THING ABOUT IT OTHIT 10798 07:01:54,334 --> 07:01:56,436 THAN MAYBE SEND THEM TO T 10799 07:01:56,436 --> 07:01:56,703 R -- 10800 07:01:56,703 --> 07:02:00,006 >> SEND THEM TO CALIFORALA. 10801 07:02:00,006 --> 07:02:03,376 >>N, IT'S DIFFICULTFI 10802 07:02:03,376 --> 07:02:04,277 THOUGH, BEC,SE I THINK WE 10803 07:02:04,277 --> 07:02:05,912 SHOULD BEOING EAR 10804 07:02:05,912 --> 07:02:08,815 TRASOUND, I I WLD FEEL 10805 07:02:08,815 --> 07:02:09,315 STRONGLY THAT PEOPLE FOR 10806 07:02:09,315 --> 07:02:09,916 CESAREAN SECTIONS, THES,SHOULD 10807 07:02:09,916 --> 07:02:11,985 HAVE IHA EAR E. 10808 07:02:11,985 --> 07:02:13,353 BUT THENHETAISES THE ISSUE OF 10809 07:02:13,353 --> 07:02:17,157 WHAT HAPPENS NEXT. 10810 07:02:17,157 --> 07:02:19,225 >> I'D LOVE TO HEAR WHA ALFRED 10811 07:02:19,225 --> 07:02:20,660 S TO SAY BECAUSE I THINK HE'S 10812 07:02:20,660 --> 07:02:23,429 T ABOUT THIS AS MUCH M 10813 07:02:23,429 --> 07:02:26,633 ANYBODY. 10814 07:02:26,633 --> 07:02:27,734 THERE'S NO N CORRECT ANSWERNSRNI 10815 07:02:27,734 --> 07:02:29,369 THINK THOSE ARE CRITICALLY 10816 07:02:29,369 --> 07:02:31,237 IMPORTANT ISSUES, MANY BEYDY 10817 07:02:31,237 --> 07:02:33,173 THE SCOPE OF WHAT WE CO WD DO, 10818 07:02:33,173 --> 07:02:34,007 BUT I WOULD ADVOCATE F A 10819 07:02:34,007 --> 07:02:34,674 UPHINGS. 10820 07:02:34,674 --> 07:02:41,247 IS, I TNK THENK EARLIEROU 10821 07:02:41,247 --> 07:02:41,981 AGNO THIS, THE BETTER OFFFF 10822 07:02:41,981 --> 07:02:46,986 THE PATIENTS WILL BE, ANDND I 10823 07:02:46,986 --> 07:02:50,256 CORRECT.AT'S PROBABLY MEDICALLY 10824 07:02:50,256 --> 07:02:50,356 NU 10825 07:02:50,356 --> 07:02:52,425 ER TWO I WHATEVER TVE 10826 07:02:52,425 --> 07:02:54,294 LOGISTICALSTICALSTS ARE, THEY 10827 07:02:54,294 --> 07:02:57,063 BE LESS EARLIER IN 10828 07:02:57,063 --> 07:03:00,433 PREGNANCY, SO I THINK TRYING TO 10829 07:03:00,433 --> 07:03:02,068 DO WHAT'S MEDICALLY BESTT A A 10830 07:03:02,068 --> 07:03:03,903 THEN FIGING OUT THE BEST WE 10831 07:03:03,903 --> 07:03:04,637 CAN DOCAITH THE LOGWETICS ISS 10832 07:03:04,637 --> 07:03:09,008 PROBABLY A BETTER STRAT SY S THN 10833 07:03:09,008 --> 07:03:11,077 NOT DONOG WHAT' W MEDICALED BEST 10834 07:03:11,077 --> 07:03:13,112 BECAUSEUS OF LOGISTICALCA HASSL. 10835 07:03:13,112 --> 07:03:14,314 I THI THERE'S ONE MORE POINT 10836 07:03:14,314 --> 07:03:16,816 THAT YOU DIDN'T RAISE BECAUSE 10837 07:03:16,816 --> 07:03:17,417 YOU WERE BEING POLITE BUT I 10838 07:03:17,417 --> 07:03:18,051 THINK IT'SK MPORTANT TO RAISE,AI 10839 07:03:18,051 --> 07:03:22,222 AND THAT IS, FOR USS 10840 07:03:22,222 --> 07:03:24,190 OBSTETRICIANRI AAN FOR 10841 07:03:24,190 --> 07:03:27,894 RADIOLOGISTSOG WHO ARE NOTXPE 10842 07:03:27,894 --> 07:03:30,396 EXPERTS, IT CAN BE RLLY TRICKY 10843 07:03:30,396 --> 07:03:36,469 TO DIAOSIA A CESEANEAEACAR. 10844 07:03:36,469 --> 07:03:37,770 THE SCARIEST DIAGNOSIS IS 10845 07:03:37,770 --> 07:03:39,572 SOMEBODY IN I A SMALL SMAMUNITY 10846 07:03:39,572 --> 07:03:39,672 HO 10847 07:03:39,672 --> 07:03:40,640 ITAL SAYING OH, THISHI IS LIKE 10848 07:03:40,640 --> 07:03:42,742 A MISS KAIRNL THAT'S GOING TO 10849 07:03:42,742 --> 07:03:43,476 BECAUSE THERE'S A FUNNY 10850 07:03:43,476 --> 07:03:45,578 G SAC IN THE LOWER UTE RUN 10851 07:03:45,578 --> 07:03:46,012 SEGMENT. 10852 07:03:46,012 --> 07:03:48,481 SO I THINK IFF WF START DNG 10853 07:03:48,481 --> 07:03:49,115 IS, IT'S AITO GOING TO REQUIRE 10854 07:03:49,115 --> 07:03:52,619 UCATINUCAND TRAINING PEOPLE 10855 07:03:52,619 --> 07:03:55,388 WHO DO EARLY URASOUNDS, 10856 07:03:55,388 --> 07:03:58,091 ESPECIALLY IN N-TERTIARY CARE 10857 07:03:58,091 --> 07:03:58,391 S.NT 10858 07:03:58,391 --> 07:04:04,264 SHOULD.NMAPEOPLEOPHINKS ABOUTRWE 10859 07:04:04,264 --> 07:04:04,364 >> 10860 07:04:04,364 --> 07:04:04,931 WAS GOING TO GO BACK TO THE 10861 07:04:04,931 --> 07:04:06,266 HESURGICAL AICROACIC 10862 07:04:06,266 --> 07:04:08,601 I TINK TTT COULD BE TRICKY. 10863 07:04:08,601 --> 07:04:10,370 I THINK THERE ARE SOME CASEE 10864 07:04:10,370 --> 07:04:12,672 THATAT ARE CLEARLY EASY T 10865 07:04:12,672 --> 07:04:13,640 DIAGNOSE BUT THERE ARE SOMEE THT 10866 07:04:13,640 --> 07:04:15,208 ARE NOT. 10867 07:04:15,208 --> 07:04:16,442 YOU HAV HAVLOWER SEGMENT 10868 07:04:16,442 --> 07:04:16,643 IM 10869 07:04:16,643 --> 07:04:17,744 ANTATION, TIE SAC ISAC 10870 07:04:17,744 --> 07:04:21,547 LITTLE BIT CROOKED TETHERED 10871 07:04:21,547 --> 07:04:24,217 S THEHE SCAR, THE PLAHENTA 10872 07:04:24,217 --> 07:04:25,518 IS MAYBE A BIT TOWDSOWHE 10873 07:04:25,518 --> 07:04:29,422 RELATIVELY NORMAL PGNANCY.E A 10874 07:04:29,422 --> 07:04:29,956 SO THERE WILL BE A LOT OF 10875 07:04:29,956 --> 07:04:33,326 THAT, BUT I TRULY BLYIEVE THA 10876 07:04:33,326 --> 07:04:37,463 WE WILL GET TO A POINT WHERE THT 10877 07:04:37,463 --> 07:04:39,198 RSTRS TRIME TERME ULTRASOUNDSOOD 10878 07:04:39,198 --> 07:04:44,003 PLAY A BIGIG ROLE INN ETA 10879 07:04:44,003 --> 07:04:45,738 DIS. 10880 07:04:45,738 --> 07:04:46,339 BUT THBUREASON I SAY IT'AYVERY 10881 07:04:46,339 --> 07:04:48,274 TRICKY BECAUSE WESEAVE SEEN 10882 07:04:48,274 --> 07:04:49,475 SSION IN THE MARKERS THAT 10883 07:04:49,475 --> 07:04:52,145 WE SEE FROM FIRST TO SECOO AND 10884 07:04:52,145 --> 07:04:52,946 THIRD AND I SHOW THE CASE HOW 10885 07:04:52,946 --> 07:04:55,548 SICK THAT PIENT BECAME WITH 10886 07:04:55,548 --> 07:04:57,951 JUST THE VERY V SUBTLE FINDINGIN 10887 07:04:57,951 --> 07:04:59,852 THE FIRST ULTRASOUND,SOO WE NEED 10888 07:04:59,852 --> 07:05:01,421 DTO BEEALLYYOOD ATAKINGIN 10889 07:05:01,421 --> 07:05:02,622 THESE DIAGNOSIS AND WE NEED TEEE 10890 07:05:02,622 --> 07:05:07,327 START LOOKING AT A THE FIRSTST R 10891 07:05:07,327 --> 07:05:08,628 OUND TRYIN T TO FIND MORE 10892 07:05:08,628 --> 07:05:12,799 SUBTLE SIGNS TIGN JUST A LOWER 10893 07:05:12,799 --> 07:05:13,766 SEGMENT IMPNTMPION. 10894 07:05:13,766 --> 07:05:15,735 SOSO THINK THERE'S A LOT OF WORK 10895 07:05:15,735 --> 07:05:18,471 RKBUT I'M HOPEFUL THEIRST 10896 07:05:18,471 --> 07:05:19,639 TRIMESTER ULTRASOUND HAVE BIGGER 10897 07:05:19,639 --> 07:05:21,841 ROLE TO TLA IN THE DIAGN DIS 10898 07:05:21,841 --> 07:05:22,041 EARLY. 10899 07:05:22,041 --> 07:05:22,542 BECAUSE IF WE'RE DOING 10900 07:05:22,542 --> 07:05:25,011 BIOMARBIRS AND THE VALUE OF 10901 07:05:25,011 --> 07:05:28,381 BIOMARKERSKE EARLY IN I PREGNANY 10902 07:05:28,381 --> 07:05:29,482 HAVING THE COMPLEMENTARY 10903 07:05:29,482 --> 07:05:30,616 ULTRASOUND BECOMES REALLY 10904 07:05:30,616 --> 07:05:30,717 IM 10905 07:05:30,717 --> 07:05:31,684 RTANT IN THAT SETTING.NG 10906 07:05:31,684 --> 07:05:34,687 I WAND TO GO BACK TO THE 10907 07:05:34,687 --> 07:05:39,692 SURGICAL APPROACH BSE THOSE 10908 07:05:39,692 --> 07:05:40,960 OF YOU THAT POINTED OUT WE'VE 10909 07:05:40,960 --> 07:05:42,729 BEEN DOING THISHI FOR A LONG TIE 10910 07:05:42,729 --> 07:05:44,964 DEIDT SEE S THAT HIGH RATE 10911 07:05:44,964 --> 07:05:49,635 OF ACCRETAS IN THE T P P P, WE T 10912 07:05:49,635 --> 07:05:52,271 NT TO GIVE THE IMPRESSION THAT 10913 07:05:52,271 --> 07:05:55,441 WE WEREE SO SYSTEMATICALLY 10914 07:05:55,441 --> 07:05:56,042 ORGANIZED AND WE DID CESAREAN 10915 07:05:56,042 --> 07:05:58,177 SECTIONS AND W AE ALL FLOWEDLO O 10916 07:05:58,177 --> 07:06:01,280 THIRD YEAR, THE SECOND YEARHE T 10917 07:06:01,280 --> 07:06:01,981 WOULD TRAIN THE TIRST YEAR AND 10918 07:06:01,981 --> 07:06:03,649 IT W HAPHAZARD AND IT WAS ALL 10919 07:06:03,649 --> 07:06:05,218 OVER. 10920 07:06:05,218 --> 07:06:06,886 SO I'M A LITTLE BIT HESITANT TO 10921 07:06:06,886 --> 07:06:07,520 SAY THSAE'S A LOT TO SAY ABOUT 10922 07:06:07,520 --> 07:06:08,588 THE SURGICAL APPROACH WITH 10923 07:06:08,588 --> 07:06:10,857 GARDS TO WHETHER WEAVE 10924 07:06:10,857 --> 07:06:11,457 NICHES OR NO OAND WHETHER THAT 10925 07:06:11,457 --> 07:06:15,495 PREGNANCY.T ONHE SECOND 10926 07:06:15,495 --> 07:06:23,903 IT'S -- - THE WAYAY WE TINEDAS 10927 07:06:23,903 --> 07:06:24,537 CH AN ORGANIZED PROCESS OFES 10928 07:06:24,537 --> 07:06:25,505 DOING CESAREAN SECTIONS THAT NOW 10929 07:06:25,505 --> 07:06:25,605 WE 10930 07:06:25,605 --> 07:06:27,707 ENTEN THE WRONG WAY OR THE 10931 07:06:27,707 --> 07:06:28,341 OTHER WAY THAT RESULTED IN THAT 10932 07:06:28,341 --> 07:06:30,043 PREVALENCE OF THE DISEASE.AND 10933 07:06:30,043 --> 07:06:31,544 I DON'T KNOW. 10934 07:06:31,544 --> 07:06:35,681 IT'S JUST SO MUCH TO PUT O T T T 10935 07:06:35,681 --> 07:06:38,851 CLOSE THE YR IS RELATING 10936 07:06:38,851 --> 07:06:41,254 TO WHETHER THAT RVES IN SUC 10937 07:06:41,254 --> 07:06:43,089 HUGE INCREASE IN ACCRETA 10938 07:06:43,089 --> 07:06:44,957 GREE 100%.I DON'I THINK TE'RE O 10939 07:06:44,957 --> 07:06:49,996 HAVE A SINGLEIN THING. 10940 07:06:49,996 --> 07:06:50,663 I THINK WHENEVER ANYTHINNYIS 10941 07:06:50,663 --> 07:06:52,732 THIS COMPLICATED AND ALL WEE HAE 10942 07:06:52,732 --> 07:06:54,167 ARDEMIOLOGYAR CLUES, WE'RE 10943 07:06:54,167 --> 07:06:57,170 ALWAYS LOOKING FOR THAT ONHA 10944 07:06:57,170 --> 07:06:58,604 MAGIC MAUE THAT WE 10945 07:06:58,604 --> 07:06:59,806 STIFICATION, AND IJU THINK IT' 10946 07:06:59,806 --> 07:07:01,107 THINGS.ION OF A THESE T 10947 07:07:01,107 --> 07:07:04,110 I WL SAY WE MIGHT HAVE HAD THE 10948 07:07:04,110 --> 07:07:05,445 INTERN TEACHING THEIN THIRD YEAR 10949 07:07:05,445 --> 07:07:05,545 ME 10950 07:07:05,545 --> 07:07:07,413 ME STUDENT HOW TO DO D IT, B WE 10951 07:07:07,413 --> 07:07:13,853 WAYS DID A TWO-LAYER CLOSURE. 10952 07:07:13,853 --> 07:07:16,456 HINK EACH ONE OF THE THINGS 10953 07:07:16,456 --> 07:07:17,023 DERVDESTUDY. 10954 07:07:17,023 --> 07:07:18,991 AN RCT OF CONSERVATIVE 10955 07:07:18,991 --> 07:07:20,526 MANAGEMENT OF ACCRE ARE A IS VEY 10956 07:07:20,526 --> 07:07:27,533 HARD BECAUSE IT'S RARE, A LOT OF 10957 07:07:27,533 --> 07:07:33,072 PEOPLE DON'TON HAVE H HCK PO EQT 10958 07:07:33,072 --> 07:07:34,841 WE SHOULD BE ABLE TO DO RCTs 10959 07:07:34,841 --> 07:07:36,709 OF CESAR CN TECHNIQUE BECAUSE WE 10960 07:07:36,709 --> 07:07:37,310 CERTAINLY DO ENODOH OF THEM. 10961 07:07:37,310 --> 07:07:42,181 >> I THINK YOU HIT ON WHAT I WAT 10962 07:07:42,181 --> 07:07:45,751 SECTION, WE TRIED DNG IT IN 10963 07:07:45,751 --> 07:07:46,319 N DATA ADA IT'S REALLY 10964 07:07:46,319 --> 07:07:46,953 HARD, ESPECIALLY IF PE ILE ARE 10965 07:07:46,953 --> 07:07:48,087 COMING FROM ANOTHERNOTER, A 10966 07:07:48,087 --> 07:07:49,856 VAST MVAORITY OF PEOPLEEO 10967 07:07:49,856 --> 07:07:51,757 DELIVERING IN SMALLER COMMUNITYI 10968 07:07:51,757 --> 07:07:52,725 OU JUST GET THEIR 10969 07:07:52,725 --> 07:07:55,161 DICTATION AND WHETHERHETT WASNE 10970 07:07:55,161 --> 07:07:55,761 LAYER, TWO L TER LANERHOW THEY 10971 07:07:55,761 --> 07:07:56,896 REALLY DID IT BECOMES VERY HARDD 10972 07:07:56,896 --> 07:07:58,431 TOEASEEA OUT. O 10973 07:07:58,431 --> 07:08:04,070 WASWA IT THE LAST C-SECTION OROE 10974 07:08:04,070 --> 07:08:05,304 FIRST C-SECTIONCTHAT CAUSED THE 10975 07:08:05,304 --> 07:08:05,538 PROBLEM. 10976 07:08:05,538 --> 07:08:07,173 >> I THINK THANKS A GREAT POINT, 10977 07:08:07,173 --> 07:08:08,975 JUST THROWN OUT BECAUSEEC 10978 07:08:08,975 --> 07:08:09,509 SEWE'RE GOING GOINALK ABOUT 10979 07:08:09,509 --> 07:08:12,512 RESEARCH TOMORROWOR, WE AREAR DD 10980 07:08:12,512 --> 07:08:19,519 LE OUT, LET'S'S GETASTG, WE SENU 10981 07:08:19,519 --> 07:08:22,021 200 ACCRETAS AND FIGURE OUT WHAT 10982 07:08:22,021 --> 07:08:23,356 GEANALL THESE VARIABLES, ANDNDDN 10983 07:08:23,356 --> 07:08:23,456 TH 10984 07:08:23,456 --> 07:08:29,462 COUN'OU DO D I. 10985 07:08:29,462 --> 07:08:31,998 USTT REALLY HARD TEXTRACT 10986 07:08:31,998 --> 07:08:32,999 TTHAT DTHA, BUT YOU COULD DO A 10987 07:08:32,999 --> 07:08:35,201 PROSPECTIVE OBSVATIAL COHORT 10988 07:08:35,201 --> 07:08:38,171 WHERE YOU COLLECTED THOSE 10989 07:08:38,171 --> 07:08:39,005 DATA AND IT WOULD TAKE TAK SAKE 10990 07:08:39,005 --> 07:08:39,906 MONEY BECAUSE YOU HAD TO FOLLOWW 10991 07:08:39,906 --> 07:08:41,007 THEM FOR A FEW F FRS BUT I B 10992 07:08:41,007 --> 07:08:43,109 ULD STILD BE RELATIVELY 10993 07:08:43,109 --> 07:08:44,210 INEXPENSIVE AND MAYBE EASIER TO 10994 07:08:44,210 --> 07:08:45,912 DO THAN RCT, SO S THOSESE ARE AL 10995 07:08:45,912 --> 07:08:52,318 THINGSTHHAT WE SHOULDUL ALL THIK 10996 07:08:52,318 --> 07:08:52,518 ABOUT. 10997 07:08:52,518 --> 07:08:54,720 T.>> LOOKSKS LE WE NEED TO HAVEA 10998 07:08:54,720 --> 07:08:54,820 C 10999 07:08:54,820 --> 07:09:00,059 KEKONAC-SECTION REGISTRY, WHRYP 11000 07:09:00,059 --> 07:09:02,461 HAVE THEIRECOND OR THIRD T 11001 07:09:02,461 --> 07:09:05,531 HAPPENED IN THAN LABOR AAB THIS 11002 07:09:05,531 --> 07:09:05,765 SURGERY. 11003 07:09:05,765 --> 07:09:09,268 IT WOULD BE A H AE NUMBER 11004 07:09:09,268 --> 07:09:11,237 PEOPLEPEYOU COULD FOLLOW WHATHAA 11005 07:09:11,237 --> 07:09:14,540 HAPPENS IN SUBSEQUENT 11006 07:09:14,540 --> 07:09:14,840 NCIES. 11007 07:09:14,840 --> 07:09:15,441 AT'S WHY WE'RE HERE, TO TALK 11008 07:09:15,441 --> 07:09:18,311 ABOUTABIGAB PROJECTS.JE 11009 07:09:18,311 --> 07:09:28,654 >> THANK YOUNK GUYS. 11010 07:09:47,907 --> 07:09:50,309 THANKK Y,,HAWAS ABSOLUTELYLU 11011 07:09:50,309 --> 07:09:50,843 AN AMAZINGMA DAY.. 11012 07:09:50,843 --> 07:09:50,943 DI 11013 07:09:50,943 --> 07:09:52,144 WE NOT S IN THE MORNING IT 11014 07:09:52,144 --> 07:09:54,146 S GOING TO BE AMAZING? 11015 07:09:54,146 --> 07:09:56,515 THEE SLIDES WERE AMAZING ALL D A 11016 07:09:56,515 --> 07:09:57,049 LONG. 11017 07:09:57,049 --> 07:09:58,584 SO THANK TOU, EVE,BODY, FOR 11018 07:09:58,584 --> 07:09:59,018 UR PRESENTATIONS. 11019 07:09:59,018 --> 07:10:01,187 THAT WAS THE EASY PART. 11020 07:10:01,187 --> 07:10:01,787 SO WE'RE GOING TOI DISCUSS NOW 11021 07:10:01,787 --> 07:10:08,294 WHAT WWHRE HOPG FORG TOMORROW. 11022 07:10:08,294 --> 07:10:08,461 YES. 11023 07:10:08,461 --> 07:10:11,764 S.>> SO OUR WORKINGORROUPRO GLS, 11024 07:10:11,764 --> 07:10:12,465 FIRST OF ALL, YOU'RE ASSIGNED TO 11025 07:10:12,465 --> 07:10:14,600 WORKINGKI GROUP BED O O O YOUR 11026 07:10:14,600 --> 07:10:15,935 BADGEE COLOR, WHICH WEE WEL GO 11027 07:10:15,935 --> 07:10:18,604 BUT THE GTHL OTH EACH WORKING 11028 07:10:18,604 --> 07:10:23,776 GROUP IS T T IDENTIFYIFIF REALLT 11029 07:10:23,776 --> 07:10:27,246 IS NOT KWNWNBOUT PLACENTA 11030 07:10:27,246 --> 07:10:27,346 AC 11031 07:10:27,346 --> 07:10:28,080 ETA SPECTRUM WITHIN YOURN 11032 07:10:28,080 --> 07:10:28,748 ASSIGNED SECTION. 11033 07:10:28,748 --> 07:10:30,049 YOUR MODERATORS HAV KEY 11034 07:10:30,049 --> 07:10:30,149 QU 11035 07:10:30,149 --> 07:10:32,118 TIONS FOR YOU YOU TO DISCU D AND 11036 07:10:32,118 --> 07:10:35,721 THEN THE WORKING GROSRO WILLIL 11037 07:10:35,721 --> 07:10:36,889 IDENTIFY THREE TO FIVE FP T 11038 07:10:36,889 --> 07:10:42,361 EAS TO INFORM FUTURE RRCH. 11039 07:10:42,361 --> 07:10:42,461 AL 11040 07:10:42,461 --> 07:10:43,663 INTIFYINGIF BARRIERSER TO 11041 07:10:43,663 --> 07:10:44,764 CONDUCTING RESEARCH THATHA WILL 11042 07:10:44,764 --> 07:10:47,900 INFORM THESE GAPS AND SUGGESTINN 11043 07:10:47,900 --> 07:10:49,001 THE ACTUAL METHODOETGIES AGI 11044 07:10:49,001 --> 07:10:53,706 PROBLEMS OF THE CURRENT RESRCH 11045 07:10:53,706 --> 07:10:56,409 SUCHSUS SMALLMA SAMPLE SIZE, 11046 07:10:56,409 --> 07:10:57,843 INSTITUTIONAL VARIATION, AND 11047 07:10:57,843 --> 07:10:57,943 DI 11048 07:10:57,943 --> 07:11:03,182 ACQUISITION, AND THEN IT'S ALSO, 11049 07:11:03,182 --> 07:11:05,151 I THINK, IMPK,TANT THAT WE 11050 07:11:05,151 --> 07:11:07,887 IDENFY WHO THE KEY 11051 07:11:07,887 --> 07:11:09,855 STAKEHOLAKEH AREEHITHINN EAC 11052 07:11:09,855 --> 07:11:09,955 SE 11053 07:11:09,955 --> 07:11:12,058 ION SON WE CAN MAK SIN 11054 07:11:12,058 --> 07:11:16,128 THE FUTUE TO INCLUDINTHEM. 11055 07:11:16,128 --> 07:11:17,296 SO FO TOMROW, THERE T 11056 07:11:17,296 --> 07:11:18,764 GOING TO BE TWO-HOUR TIME 11057 07:11:18,764 --> 07:11:20,700 WHERE EACHE WORKI W GROUP WILLE 11058 07:11:20,700 --> 07:11:21,367 ABLE TO COMOAND SORT OF WRANGLEA 11059 07:11:21,367 --> 07:11:22,234 WITH THESE QSTIONSIONS 11060 07:11:22,234 --> 07:11:25,871 INDIVIDUALLY AND A TNK THROUGH 11061 07:11:25,871 --> 07:11:27,773 PRIOR PIES THAT WE'RE 11062 07:11:27,773 --> 07:11:28,674 HOPING FOR AND THEN TO REPORT 11063 07:11:28,674 --> 07:11:30,543 SO WE PVIDED EACHH MODERATOR 11064 07:11:30,543 --> 07:11:33,079 WI A TEMPL TE FOREOR A A FEW SLS 11065 07:11:33,079 --> 07:11:37,383 TOMORROW AFTER THAT T TIME. 11066 07:11:37,383 --> 07:11:41,053 MODERATOR BUT AO AA CO-LEAD TO 11067 07:11:41,053 --> 07:11:42,722 TO MAKTO SURE THAT WE SO W OF OE 11068 07:11:42,722 --> 07:11:45,358 DEVELOP SOMEOM MORE BEST IDEASDE 11069 07:11:45,358 --> 07:11:47,193 HERE 11070 07:11:47,193 --> 07:11:47,727 ULTIMATELYMAN ADDITION TO 11071 07:11:47,727 --> 07:11:48,327 SUMMARY SLIDE, WIDE, GOING TO 11072 07:11:48,327 --> 07:11:49,595 HOPE FORPEN ABOUT AUT MONTH M ME 11073 07:11:49,595 --> 07:11:52,164 SORT OF A REPORT FROM EH 11074 07:11:52,164 --> 07:11:52,732 INDIVIDUAL WORKINGORROUP TOUP 11075 07:11:52,732 --> 07:11:56,869 PAPER.R.GETHER FOR A A AHITE PA 11076 07:11:56,869 --> 07:11:57,970 WE'VE PREPARED BOTH A SHORT 11077 07:11:57,970 --> 07:12:00,473 RSION AND A LONG L VERON OF 11078 07:12:00,473 --> 07:12:00,573 CO 11079 07:12:00,573 --> 07:12:01,107 IDERATIONS FOR EACH WORKING 11080 07:12:01,107 --> 07:12:02,808 GROUP, SO THE MERATORS HAVE A 11081 07:12:02,808 --> 07:12:05,244 LONGERNG VERSION OF DIFRENT 11082 07:12:05,244 --> 07:12:08,247 POTENTIAL QUESTIONS THAT COULDLD 11083 07:12:08,247 --> 07:12:10,750 DIRECTIVE, SO QUESTIONS WERE 11084 07:12:10,750 --> 07:12:12,818 MEANTT TO BE SORTE OF 11085 07:12:12,818 --> 07:12:15,755 THOUGHT-PROVOKING RATHERIN TN 11086 07:12:15,755 --> 07:12:16,756 DIRECTDIE. 11087 07:12:16,756 --> 07:12:27,633 BEST PRACTICES FORORBE SCRNINGND 11088 07:12:27,633 --> 07:12:29,235 DIAGNOSIS TO DR. SAADE'S POINT P 11089 07:12:29,235 --> 07:12:33,439 ABT WHAT ARE WE TALKING T ABOUT 11090 07:12:33,439 --> 07:12:35,274 HER DO WE IMPROVE 11091 07:12:35,274 --> 07:12:38,344 OUR GATEST CHALLENGE TO TRY TR , 11092 07:12:38,344 --> 07:12:40,146 GET AT THOSE CASES WE'RE 11093 07:12:40,146 --> 07:12:41,480 TALKINTA ABOUT UNDIAGNOSED PRIOR 11094 07:12:41,480 --> 07:12:42,047 TO SURGERY. 11095 07:12:42,047 --> 07:12:45,751 WHAT ISATHE ROLEE OF UNIVERSNIVE 11096 07:12:45,751 --> 07:12:48,687 WHAT IWH O RPONSIBILITY TOANDCR 11097 07:12:48,687 --> 07:12:49,789 COMMUNITIES IN TERMS OF THINKING 11098 07:12:49,789 --> 07:12:51,624 THROUGH PEOHE WHO ARE DOING 11099 07:12:51,624 --> 07:12:52,591 SCREENING OUT G THEHEHE 11100 07:12:52,591 --> 07:12:53,826 COMMUNCOIES, HOW CAN WEMPROVE 11101 07:12:53,826 --> 07:12:56,095 WHAT IS DONE UVERSALLYLY AT THI 11102 07:12:56,095 --> 07:12:58,497 INT,HICH PATIENTS NEED 11103 07:12:58,497 --> 07:12:59,598 REFERRAL TO PAS SPECIALTY 11104 07:12:59,598 --> 07:13:01,434 CENTERS AND A HOW CAN WE USE U R 11105 07:13:01,434 --> 07:13:04,603 UNDERSTANDING OF THE T 11106 07:13:04,603 --> 07:13:05,237 PATHOPPASIOLOGSIAND THE SCIENCE 11107 07:13:05,237 --> 07:13:06,839 TO INFLUENNFEN SCREENING DIAGNOS 11108 07:13:06,839 --> 07:13:07,373 AND PREDICTION.N. 11109 07:13:07,373 --> 07:13:14,613 IF YOU'RE'R BLUE, JOIE, J ME, 11110 07:13:14,613 --> 07:13:16,682 DR. PHACS ANDS DR.I RARE RAH 11111 07:13:16,682 --> 07:13:23,489 KEY QUESTIOUE TOTART WITH HOW 11112 07:13:23,489 --> 07:13:25,458 CAN POPERATIVE STAGING AND 11113 07:13:25,458 --> 07:13:26,325 MORBIDITY PREDY TION BE 11114 07:13:26,325 --> 07:13:26,692 IMPROVED? 11115 07:13:26,692 --> 07:13:26,792 HO 11116 07:13:26,792 --> 07:13:29,395 DO WE ADDRESSDD MARKED 11117 07:13:29,395 --> 07:13:31,063 RIATION IN MANAGEMENA 11118 07:13:31,063 --> 07:13:31,931 DECISION-MAKING INCLUDINGDI 11119 07:13:31,931 --> 07:13:33,666 LOCATION, TIMING OMI DELIVERY AD 11120 07:13:33,666 --> 07:13:34,233 ANESTHESIA MANAGEMENT? 11121 07:13:34,233 --> 07:13:36,168 WE WANTED TTE MAKE IT A PRT RITY 11122 07:13:36,168 --> 07:13:37,336 FOR THIS GROUP, AND ANESTHESIA 11123 07:13:37,336 --> 07:13:38,504 AMANAGEMENTGE 11124 07:13:38,504 --> 07:13:40,039 WHO ELSE IS NEEDED AS AS PART P 11125 07:13:40,039 --> 07:13:42,541 THETHTHULDISCIPLINARYLIEAM IN 11126 07:13:42,541 --> 07:13:44,109 INTHE PERIOPERATIVE MANAGEMENT. 11127 07:13:44,109 --> 07:13:45,744 AND WHATTHER INTERVENTIONSIO 11128 07:13:45,744 --> 07:13:47,713 IMPROVE OUTCOMES LIKE TIK ONES 11129 07:13:47,713 --> 07:13:50,649 THAT WE STARTED TO TALK ABOUT 11130 07:13:50,649 --> 07:13:50,749 TO 11131 07:13:50,749 --> 07:13:54,286 Y. GROUP THREE, THIS I 11132 07:13:54,286 --> 07:13:54,386 OP 11133 07:13:54,386 --> 07:13:58,123 ATIVE MANAGEMENT OF PAS. 11134 07:13:58,123 --> 07:13:59,291 THIS I I THEHEED TEAM. 11135 07:13:59,291 --> 07:14:00,960 >> ARO AIATELY. 11136 07:14:00,960 --> 07:14:08,767 >> DR. WRIR.T, S DEAND -- HOW S. 11137 07:14:08,767 --> 07:14:09,835 HOW DW WE STRATIFY PATIENTSIEORE 11138 07:14:09,835 --> 07:14:11,103 TARGETED A PIE P-CENTEREDTE 11139 07:14:11,103 --> 07:14:14,740 TENAGEMENT OPTIONS, IMMIATE 11140 07:14:14,740 --> 07:14:16,041 HYSTERECTOMY, DRAIDRAYSTERECTOMY 11141 07:14:16,041 --> 07:14:17,576 VERSUSVE RESECTION AND PLACENTAA 11142 07:14:17,576 --> 07:14:18,043 IN SITIN 11143 07:14:18,043 --> 07:14:20,813 HOW DO WE DEVELOP INSTITUTIONAL 11144 07:14:20,813 --> 07:14:21,714 CAPACITY FOR MULTIPLETIANEEMENTM 11145 07:14:21,714 --> 07:14:23,716 OPTIONS AND ARERE 11146 07:14:23,716 --> 07:14:25,117 INTRAOPERATIVE TECVE TUES THATHA 11147 07:14:25,117 --> 07:14:25,818 IMPROVIM OUTCOMES. 11148 07:14:25,818 --> 07:14:28,654 THEN GROUP FOR IN YELLOW, 11149 07:14:28,654 --> 07:14:31,624 THIS ISIS DR. CARUSI ANDI BARTE. 11150 07:14:31,624 --> 07:14:35,027 WHAT ARE THE FRONTIERS OF PAS 11151 07:14:35,027 --> 07:14:37,029 IDENTIFICATION ANDREVENTION. 11152 07:14:37,029 --> 07:14:40,666 ACCRETA RESEARCH AND WHATT WE'T 11153 07:14:40,666 --> 07:14:43,536 AT ARE THE TYPHE O SPECIMENSCID 11154 07:14:43,536 --> 07:14:45,170 TECHNOLOGIES AND RESEARCH 11155 07:14:45,170 --> 07:14:46,939 APPROACHESCH ESSEN EAL FOR 11156 07:14:46,939 --> 07:14:47,573 EFFECTIVE BIIVARKERS FOR PAS. 11157 07:14:47,573 --> 07:14:50,509 WHAT IS THE IMPACT ON PAS ON THE 11158 07:14:50,509 --> 07:14:56,549 GYN HEALTH BUTRONGED MENEDLTERM 11159 07:14:56,549 --> 07:14:58,551 HEALTHHEWHAT DO YOU NEED TOEEO 11160 07:14:58,551 --> 07:14:59,552 TO EMOTOONALLY SUPPORT WOM 11161 07:14:59,552 --> 07:15:00,619 UNDERGUNNG THENGNG DECISIONS AND 11162 07:15:00,619 --> 07:15:03,622 AT ARE OUR OPPORTUNITIES TO T 11163 07:15:03,622 --> 07:15:05,991 MITIGATEHAT IMPACT. 11164 07:15:05,991 --> 07:15:06,725 >> OKAY. 11165 07:15:06,725 --> 07:15:07,726 SO WE'VE W REACHED THE END. 11166 07:15:07,726 --> 07:15:12,665 RIGHT?HT 11167 07:15:12,665 --> 07:15:15,534 CERTAINLY IF YOUIFAVEIF QUESTION 11168 07:15:15,534 --> 07:15:17,036 NEED ANYTHING FRO ELSE, FEEL 11169 07:15:17,036 --> 07:15:19,138 FREE TO REACHUT TO CHRISTINA 11170 07:15:19,138 --> 07:15:24,610 WHAT THE GROUPSRO A A SUPPOSEDPO 11171 07:15:24,610 --> 07:15:24,710 BE 11172 07:15:24,710 --> 07:15:25,244 DOING.NG 11173 07:15:25,244 --> 07:15:28,247 IF THE MODERATORS WANT TAN CHAT 11174 07:15:28,247 --> 07:15:28,347 AS 11175 07:15:28,347 --> 07:15:28,881 ELL, WE'RE HAPPY TO DO THAT. 11176 07:15:28,881 --> 07:15:29,949 WE'RE GOING TOI HEAD OVER THERE 11177 07:15:29,949 --> 07:15:32,885 PRETTY SOONOOO YOU'REITED TOO 11178 07:15:32,885 --> 07:15:37,723 DRINKS, LIGHTHT FOOD, FOME 11179 07:15:37,723 --> 07:15:38,490 SATION, WOULD LOVE TO TEE 11180 07:15:38,490 --> 07:15:40,926 CERTAINLRTTHIS IS NOT S QUIREDQU 11181 07:15:40,926 --> 07:15:41,927 LLY OPTIO OL B OLOVE TO SO 11182 07:15:41,927 --> 07:15:42,094 IT. 11183 07:15:42,094 --> 07:15:46,332 MORE MINUT M, M WE GET TO THE ED 11184 07:15:46,332 --> 07:15:47,533 THAT A WE TAKE A PTURE 11185 07:15:47,533 --> 07:15:47,900 ALLALOGETHER. 11186 07:15:47,900 --> 07:15:50,603 THANK YOU. Y Y 11187 07:15:50,603 --> 07:15:52,905 >> MAYBE NOT WITH THE DRINKS IN 11188 07:15:52,905 --> 07:15:56,742 THE BACKGROUND. 11189 07:15:56,742 --> 07:15:59,578 AND JUST A THANK YOU Y TO THE 11190 07:15:59,578 --> 07:16:01,914 NICHD FOR PUTTING TTISTI TOGETHE 11191 07:16:01,914 --> 07:16:07,987 TO IMIN WITH, BECA BEG B WITH. 11192 07:16:07,987 --> 07:16:08,587 WE THANK YOU SO MUCHO OUR 11193 07:16:08,587 --> 07:16:12,257 PASSION PROJECT, A INHEHEHE ROOM 11194 07:16:12,257 --> 07:16:12,725 HAVE DONE FOR ACCRETA 11195 07:16:12,725 --> 07:16:13,392 MANAGEMENT, SO THANK YOU A Y SO 11196 07:16:13,392 --> 07:16:23,469 OMUCH.