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Historically, IUDs where considered contraindicated in a patient with a prior ectopic pregnancy. This was due to concerns that IUDs may be causative of tubal gestations. Is this true? Are IUDs contraindicated with a past history of ectopic pregnancy? In this episode we will review the data from the CHOICE project, the CDC (US), and the Royal Colleg…
 
A 2020 publication from JAMA Pediatrics reported that labor epidural analgesia may be associated with an up to 37% increased risk of offspring autism spectrum disorder. The ASA has rejected those results based on methodologic limitations of the study, the lack of biological plausibility. But some remain fearful of labor epidurals because of that pu…
 
Platelet Rich Plasma (PRP) therapy is a HOT and TRENDY item right now. PRP use was initiated in sports medicine in the 1970s. It has since expanded into many medical specialty fields, and now it is being heralded as the new hope for diminished ovarian reserve for those desiring pregnancy…even in menopause! Can injecting the ovaries with PRP really …
 
Routine, repetitive urine dipsticks (meaning at each prenatal visit) were introduced into prenatal care back in the 1960s and 70s. The idea was to act as an early screen for bacteriuria (ASB), proteinuria as a screen for preeclampsia, and glycosuria as a screen for GDM. That was based more on expert opinion rather than clinical trials. The utility …
 
Paragard, Mirena, and Liletta IUDs are the most effective types of emergency contraception. Data from the 1980s, now seemingly forgotten, showed that IUDs work primarily on inhibition of fertilization rather than implantation effects. Nonetheless, misperceptions regarding the IUDs mechanisms of action persist, with some websites stating IUDs are ab…
 
“Placentophagy” is not a new concept. Most non-human mammals eat their placentas after giving birth but humans, historically, have not. Is there evidence to support this practice? Where did this idea come from? How did Rolling Stone magazine help launch this phenomenon back in the 1970s? Is Kim Kardashian onto something cutting edge by advocating f…
 
The American College of Obstetricians and Gynecologists supports the use of both low-dose and high-dose oxytocin regimens to induce and augment labor, but does not specify MAXIMUM DOSE RATES. Most hospitals, however, have protocols that impose a maximum dose rate of oxytocin infusion. Is this evidence-based? Is there a danger with going above a cer…
 
The ACOG states, “In spite of its unproven value, antepartum fetal surveillance is widely integrated into clinical practice in the developed world”. Antepartum fetal surveillance can be done by a variety of techniques and, despite its unproven value, is a mainstay of obstetrical management. At what BMI should we offer fetal surveillance? Is this cu…
 
Breech presentation at term occurs in approximately 3 to 4% of pregnancies. While the vast majority are simply chance events, breech presentation could be a marker of other fetal comorbid conditions. When should ECV be attempted? Does the ACOG recognize neuraxial analgesia as a tool to increase ECV success rates? What’s better spinal or epidural bl…
 
On some current social media channels, there is a hot debate as to why professional medical societies still recommend prenatal folic acid compared to the more “biologically, active” L-methylfolate. Are they onto something here? Published data has shown that anywhere from 40-60% of the general population may have an MTHFR mutation leading to the ina…
 
Currently on social media, there seems to be an interest in prenatal choline supplementation. Choline, a B vitamin, is not typically within standard prenatal vitamins. Is this micronutrient important for prenatal supplementation? What do professional/medical societies have to say regarding prenatal supplementation? What’s the data? In this episode,…
 
Uterine fibroids are benign tumors that arise from a single genetically altered myometrial stem cell under the influence of gonadal hormones. Traditionally, it has been taught that fibroids universally diminish in size after menopause. However, an article published in 2021 showed a possibility of fibroid growth after menopause in overweight/obese w…
 
I am a fan of the original hit TV show, “ER”. Although mostly melodramatic and outside of bounds of reality Medicine, one episode (season 6, episode 6) has a valuable life lesson for all of us. I originally viewed that episode when it was live and current, and I have never forgotten the message. In this episode, will discuss this important life les…
 
In January 2023, a new publication in Obstetrics and Gynecology- the Green Journal, will highlight the disheartening statements being made on social media (TikTok) regarding IUDs. IUDs are highly effective forms of contraception and the progesterone releasing variety have significant non-contraceptive benefits. Most of the dissatisfaction stated on…
 
Pre-operative vaginal preparation before gynecological surgery has unquestionable benefit for the prevention of postop infectious morbidity. Does the same hold true for vaginal prep at C-section? There has been over a decade of data, but a new publication- soon to be released in AJOG- is calling previous results into question. Does iodine work as a…
 
Surgical site infection (SSI) is the most common complication resulting from cesarean section. Despite advances in infection control, SSIs remain a significant post-op burden, to the patient first, and to the healthcare system second. Negative pressure wound therapy devices (NPWT) are a potential solution to post C-section. wound infections/complic…
 
Traditionally, the CDC has recommended delaying IUD insertion for 3 months in a woman diagnosed with asymptomatic, cervical Gonorrheal or Chlamydial infection. This is to first confirm a negative test of cure. However, this leaves the patient at a greater risk of unplanned pregnancy compared to the risk of PID. Is this really the most evidence-base…
 
In the upcoming (May) 2023 ACOG Annual Clinical Meeting, the College will have a highlighted session to “redesign, prenatal care”. The traditional model of prenatal care includes 12 to 14 in-person visits. However, there is no data that supports the theory that adverse outcomes are reduced by the number of prenatal contact visits. In 2020, at the h…
 
Did you know that not all cases of a single umbilical artery (SUA) result in a 2-vessel cord? Some umbilical cords with a SUA still have 3 vessels! How is that possible? Although SUA is only found between 0.2 to 1% of all live births, they can have important clinical implications. Although sonographic absence of other congenital anomalies is very r…
 
The ACOG recommends universal screening for gestational diabetes between 24 and 28 weeks of pregnancy with occasional early screening for those at high risk. Is there an advantage to completing the 1-hour 50 g GTT while fasting? First studied in the 1990s, a new publication further validates the original study results. In this episode we will summa…
 
Anti-D immune globulin has been advocated for use in appropriate patients since the 1970s. Historic data showed that 0.1ml of fetal D+ blood was all that was required to potentially sensitize an Rh negative mother. New data is questioning whether this prophylaxis is required in all cases of threatened miscarriage/abortion in early pregnancy, or if …
 
Fragile X Syndrome is the most common inherited form of intellectual disability, and the most common single gene cause of Autism Spectrum Disorder. It is also responsible for some cases of premature ovarian insufficiency. Do you recall the difference between a Fragile X “pre-mutation” versus the full mutation? Should we do universal screening for t…
 
Marijuana is the most commonly used federally illegal drug in the United States; its use among pregnant and lactating women is on the rise. Is breast-feeding contraindicated with marijuana use? It is difficult to separate marijuana use from several confounding variables, leading to conflicting data in print. Is marijuana use and breast-feeding comp…
 
Several cohort studies and meta-analysis have shown a direct association between poor oral health and adverse pregnancy outcomes. The key driver for this association is systemic inflammation. In this episode, we will review the ADA, ACOG, and CDC data on how maternal oral health can influence pregnancy outcomes. Although this association is pretty …
 
Happy Thanksgiving, Podcast family! As we gather with family, friends, and loved ones… Let’s make the practice of gratitude a daily habit, not some thing that we do just once a year. There is real science on the art and practice of gratitude! In this brief episode, we will remind ourselves that gratitude is not just “something we do” on Thanksgivin…
 
“The Lotus Birth”… Although first described back in the 1970s, this birthing trend is gaining popularity today mainly because of social media. Is this practice evidence-based? Is it safe? There are real concerns here which have spurred several professional organizations and societies to issue HARSH warnings about this practice. In this episode, we …
 
Systemic Lupus Erythematosis is several-fold more common in women than in men. As it primarily targets reproductive age women, identification of and proper management of patients with associated antiphospholipid antibodies is crucial to improve maternal and neonatal outcomes. In this episode, we will review the 2019 ACR diagnostic criteria for SLE …
 
The idea of keeping women “Nil per os” (NPO) during labor traces back to the 1940s with the pivotal work of Dr. Curtis Mendelson. His work on “aspiration pneumonitis” has kept women NPO during labor up to present day. But is this still evidence-based? Is it risky to allow women to have PO intake during an otherwise uncomplicated labor course? In th…
 
TXA was first found to reduce maternal morbidity at time of established postpartum hemorrhage in the WOMAN trial (2017). Since then, evidence has grown to include TXA as a prophylactic agent to prevent postpartum hemorrhage. Despite its known effectiveness in BOTH the prevention and treatment of postpartum hemorrhage, there is a renewed global warn…
 
Maternal carrier screening (either pan-ethnic or expanded carrier panel) is recommended by the ACOG and SMFM. Ideally, this is done pre-conception or with the first pregnancy. Did you know that in August 2022 the ACOG added an additional test for universal maternal carrier screening? Does this maternal carrier screen include BRCA? In this episode w…
 
Katie Couric recently described her path to her diagnosis of breast cancer, urging women with “dense breast tissue” to get supplemental breast imaging. Do these supplemental imaging tests improve overall survival? In this session, we will review the statements of 4 professional societies/organizations regarding the use of supplemental breast imagin…
 
Dense breasts can decrease the sensitivity of screening mammogram (MMG). Some US states have mandated reporting of breast density on MMG, while the rest of the states report on dense breasts voluntarily as a standardized reporting system. What supplemental breast imaging tools are advised as a follow up in these patients? Does the ACOG support supp…
 
The Enhanced Recovery After Surgery guidelines were birthed (no pun intended) as a way to curb post-op morbidity from colorectal surgery. In 2019, CSection ERAS guidelines were published in the AJOG. Despite widespread agreement that ERAS is valuable, one aspect of the guideline is controversial: timing of Foley removal. Should the Foley be removed…
 
The United States is currently facing an oxytocin shortage. How long this medication shortage is projected to continue is not clear. In an attempt to curb unnecessary use of oxytocin, is it safe to consider stopping oxytocin after induction, once the active phase of labor is reached? Is there data to support the practice? And what about using oxyto…
 
We are in ABOG Oral Board season! 😳😊 Did you know that the national pass rate for first time takers of the OBGYN oral board is 90%! That’s good news. Do you know what the common mistakes made by the 10% who do my pass are? In this session we will cover the common missteps made by candidates during their oral boards, and highlight 5 tips for a succe…
 
In 1964, John O’Sullivan published his original research describing abnormal cut off values following an oral glucose challenge in pregnancy. O’Sullivan laid the foundation for screening and diagnosis of gestational diabetes. We have learned a lot since that 1964 publication. In this session, we will review a new meta-analysis coming to print in No…
 
The ACOG and FIGO have 2 main “boxes” for AUB: 1. AUB in reproductive age women, and 2. postmenopausal bleeding. But AUB in the Menopausal Transition could be its own “box”. Is serum FSH a helpful test for AUB in the menopausal transition? In this episode we will cover this clinically relevant ABOG Oral Board prep question.…
 
Recently, we reviewed the 3 vaccines generally recommended for every woman, in each pregnancy. But as they often say on late night commercials, “but wait… There’s more!” In this session, we will review 3 separate vaccinations which are applicable in special populations. Do you know which 3 they are? In this session our special guest, Carley Hager (…
 
Fetal fibronectin was first reported as a possible biomarker for identifying those at risk of preterm birth back in 1991. Despite over 3 decades of ever evolving published data on FFN, underuse, misuse, and misunderstandings regarding what fetal fibronectin is and is not still persist. In the session we will review the SMFM recognized transvaginal …
 
Historically, only 2 vaccinations were recommended during pregnancy. Due to the COVID-19 pandemic, that has now changed to 3 vaccines (influenza, TDAP, and COVID-19 vaccinations). In this session we will summarize and present an easy to follow summary of these vaccinations, especially for those going into the ABOG, Fall, oral board season. Here are…
 
In 2015, the ACOG included immediate release nifedipine as an intervention for acute, emergent hypertension in pregnancy. But what about extended release nifedipine? Is there a role for this medication in patients with preeclampsia with severe features intrapartum? Does this calcium channel blocker prevent uterine contractility? In this session we …
 
Gestational diabetes (GDM) is a risk factor for adverse perinatal outcomes. Currently, the ACOG recommends early screening for GDM for women “at risk”. However, other experts disagree with this approach. In this session, we will review the latest controversies regarding early screening for gestational diabetes. Is hemoglobin A1c an option for early…
 
Anticoagulation sure has come along way from warfarin. Although largely replaced by direct oral anticoagulants (DOACs), warfarin is still in use- mainly for patients with mechanical heart valves. For those on anticoagulation chronically, who require gynecological surgery, how/when is bridge therapy performed? In this episode, we will cover the ins …
 
Up to 70% of women who are anticoagulated will experience episodes of heavy menstrual bleeding. Traditionally, progestin only hormonal agents have been used in these cases. Can combination birth control pills be used in the anticoagulated patient? Is there data regarding their safety? In this episode, we will walk down the data timeline starting in…
 
In January 2022, the American Heart Association conducted a study and concluded that labetalol may be the best antihypertensive medication antepartum. However, the ACOG has not endorsed one antihypertensive medication over the other. But what about Postpartum? Is labetalol the best to prevent postpartum hypertensive readmissions? In this episode we…
 
This message is for Dr. Rob in Northern California preparing for his OBGYN oral boards. Rob, thank you for your voice memo on the app! Great question and absolutely fantastic clinical insights. With that kind of clinical inquiry and drive, I am sure you will ACE your upcoming OB/GYN oral boards. Dr. Rob’s question is which progesterone would be bes…
 
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