The Clinical Problem Solvers Episode 421: Baby on Board – and a surprise guest! Listen to Greg and Bobby discuss how to manage the guest tagging along for the ride!!
Sep 18, 2025
Greg Kirshen, a maternal-fetal medicine specialist, and Bobby Brar, a fellow in maternal-fetal medicine and clinical genetics, join Anna Jarvis, an OB/GYN resident, to discuss a complex case involving a 10-week pregnant woman with severe abdominal pain and large-volume ascites. They explore differential diagnoses, including infection and malignancy, and share insights on management strategies. The conversation emphasizes the importance of a broad differential and offers practical counseling for future pregnancies.
AI Snips
Chapters
Transcript
Episode notes
Paracentesis Labs Guide Next Steps
- Use serum-ascites albumin gradient (SAAG) and total protein to narrow ascites causes: SAAG <1.1 points away from portal hypertension.
- Send ascites fluid for extended cultures including TB and cytology when initial workup is unrevealing.
Corpus Luteum Cysts Suggest HCG Effect
- Bilateral corpus luteum cysts plus large ascites are unusual and may suggest an HCG-driven hyperstimulation process.
- Cell-free DNA and routine imaging can help but may not definitively exclude malignancy or trophoblastic disease.
Case Course: From Ascites To Term Delivery
- The patient had a CT showing moderate ascites and bilateral corpus luteum cysts but was otherwise asymptomatic and progressed to term.
- She later underwent repeat cesarean with intraoperative findings of 150 cc straw-colored ascites and benign corpus luteal cyst pathology.
