Severe nausea and vomiting in pregnancy/hyperemesis gravidarum (HG) takes a toll on patient, and the healthcare system. According to a June 2024 ACOG Clinical Expert Series on the subject, GFD15 and IGFBP7 both play important roles in placentation, appetite, and cachexia that are linked to hyperemesis gravidarum. Specifically, LOW pre-pregnancy GFD15 is associated with increased frequency of HG as GFD15 levels spike post pregnancy in an otherwise "naive" system. Since metformin increases GFD15, ...
Jun 29, 2025•33 min
OASIS (3rd and 4th degree perineal lacerations) occur at a rate of 4-11% (average around 5.5%). OASIS lacerations have both short term and ling term potential morbidities. Practice Bulletin 198, from 2018, briefly discusses counseling patients following OASIS on subsequent mode of delivery options. Now, in a soon to be released AJOG publication, authors have provided a wonderful and comprehensive review on "patient-centered" guidance regarding mode of delivery in a subsequent pregnancy following...
Jun 27, 2025•50 min
Ladies and gentlemen, welcome back to another addition of “You asked, We answered”! In this brief episode, we will tackle 2 very appropriate clinical questions:1. Why do cervical psychology reports still state the presence or absence of endocervical cells/TZ component if it does not change management, and 2. Does continued magnesium sulfate infusion during C-section increased blood loss? We have done similar “you asked, we answered” episodes in the past and we will continue to do them as questio...
Jun 24, 2025•27 min
The Bishop Score was originally developed in 1964 by Dr. Edward Bishop and remains the central assessment tool for determining the appropriateness of cervical ripening for labor induction. We have covered pharmacologic and mechanical methods of cervical ripening for labor induction many times in prior episodes. Ut now, in July 2025, there will be a new clinical practice guideline (#9) from the ACOG which has some notable items. Does the ACOG recognize COMBINATION mechanical and pharmacologic age...
Jun 21, 2025•34 min
Second and/or Third trimester vaginal bleeding is a common reason for L&D Triage patient assessment. The evaluation starts with determining the status of maternal hemodynamic stability. This together with IV access are key first steps. This is followed by an assessment of fetal-placental status. Typically this includes bedside ultrasound for fetal position, visual confirmation of FHTs, amniotic fluid determination, and placental location. At the same time, lab data is obtained to guide care:...
Jun 18, 2025•37 min
Antenatal Corticosteroids (ACS) for Fetal Lung Maturation (and more) is an ever evolving saga. This is how science and medicine evolve, by always seeking more information. The effect of antenatal corticosteroids on neonatal/child neurodevelopmental outcomes is controversial and may be influenced by the gestational age at which exposure occurred. In this episode we will highlight TWO recent publications, one from May 2025 (JAMA Netw) and the other from June 2025 (Obstet Gynecol). The first adds d...
Jun 15, 2025•37 min
Innovation in medicine is happening. In our immediate past episode, we summarized how AI is improving standard mammography to now PREDICT breast cancer rather than just diagnosing it once it was appeared. In a past episode, we covered a new and novel “first in class” oral medication for uncomplicated UTIs in women called Blujepa. This is innovation! Well now, as of June 10, 2025, the FDA has granted a New Drud Application for a new and noval oral antibiotic against gonococcal (GC) infection! In ...
Jun 12, 2025•23 min
Each year, more than 2.3 million women worldwide are diagnosed with breast cancer—including over 370,000 in the United States alone. For more than 60 years, mammograms have saved lives by detecting early-stage cancers. Now, advancements in AI have lead to a first of its kind breast imaging algorithm that can PREDICT future (5-year) breast cancer risk in the patient (CLARITY BREAST). This is GROUNDBREAKING. Yes, there has been other new tools, like the recent contrast enhanced mammography data, f...
Jun 10, 2025•21 min
It’s interesting how, at times, different medical societies can look at the same data and arrive at different recommendations. It happens! In April 2025, the Society of Family Planning (SFP) released its new clinical recommendations for the medical management of early pregnancy loss (EPL), AKA miscarriage. This clinical guidance has 4 remarkably interesting differences when compared to the ACOG practice bulletin # 200 on early pregnancy loss. In this episode, we will review these 4 key differenc...
Jun 08, 2025•35 min
The white-coat effect is a measure of blood pressure change from before to during the visit in office/clinic when the blood pressure is recorded by a physician or nurse; this was first described in 1983 by Mancia et al, and was initially thought to represent a benign process. But it was unclear what this actually meant for pregnancy. Ambulatory blood pressure monitoring (ABPM) has been used in pregnancy for about 20 years now. Use of this monitoring option has revealed a subgroup of patients who...
Jun 05, 2025•44 min
Uterine incarceration in pregnancy, is a rare but troublesome complication. This occurs when a retroverted uterus becomes trapped in the pelvic cavity during pregnancy. This happens when the uterus fails to move forward as it grows, becoming stuck between the sacral promontory and pubicsymphysis. It's more common in women with prior pelvic issues or uterine anomalies. Urinary retention is the most common symptom that occurs because of elongation of the urethra by displacement of the cervix, loss...
Jun 02, 2025•36 min
In May 2024, the FDA approved vaginal self-collection for HPV as a cervical cancer screening tool. This was limited to health care settings. While this self collection option can help address some of the emotional deterrents to a speculum examination, it fails to overcome the remaining substantial clinic access barriers cited among those who are underscreened, including time off work, arrangement of child or elder care, and transportation. Then, the FDA approved the first at-home cervical cancer...
May 29, 2025•18 min
In the US, an estimated 70-75% of women who give birth use an epidural for pain relief during labor. Epidural anesthesia during labor can affect bladder function by delaying the return of bladder sensation and potentially leading to urinary retention. This can be due to the nerves that control bladder function being affected by the epidural, reducing the sensation of bladder fullness and the urge to urinate. Intrapartum, there is no universal guidance regarding bladder management with labor epid...
May 27, 2025•36 min
At the end of April 2025, we released an episode summarizing the ERAS update for 2025. In that episode/update, we summarized the data on extended spectrum prophylactic antibiotics at cesarean section in patients living with obesity. The ERAS protocol recognized the value of oral cephalexin and metronidazole for 48 hours in patients with obesity who receive single agent Cephalosporin prophylaxis preop. Now, a new (RCT) publication soon to be released in the Green Journal, evaluates whether using ...
May 25, 2025•28 min
We have covered menopause on this show on various occasions. That’s fitting and non-surprising as we are a women’s health education podcast! While vaginal dryness and hot flashes get most of the attention in menopause, and they should, less attention often is given to skin changes. Nonetheless, these dermal manifestations of perimenopause and menopause can be just as disturbing to those affected. Estrogen helps skin produce oil and hold onto water, so extremely dry skin during menopause is commo...
May 22, 2025•44 min
In 2014, the International Society for the Study of Women's Sexual Health together with the North American Menopause Society introduced the term “Genitourinary syndrome of menopause” to replace the prior term vulvovaginal atrophy. Ten years after that, in 2024, a related term “Genitourinary Syndrome of LACTATION, was introduced to better capture the genitourinary issues lactating women may experience. A new systematic review, soon to be released in the journal obstetrics and gynecology, provides...
May 21, 2025•30 min
Endometriosis is a prevalent gynecologic condition that affects approximately 10–15% of women of reproductive age worldwide. For endometriosis related pelvic pain, continuous combination birth control pills have long been the first-line pharmacologic intervention of choice. But new data published May 15, 2025 (ahead of print) in Obstetrics and Gynecology is challenging that tradition. In this episode , we will summarize the key findings of this brand new network systematic review and metanalysis...
May 19, 2025•32 min
In August 2024, the CDC updated its MEC. This included a recommendation for local anesthesia for IUD/S placement and also had guidance regarding misoprostol for that procedure. Coming up in July 2025, the ACOG will officially release a new clinical consensus on “Pain Management for In-Office Uterine and Cervical Procedures”. Are these recommendations similar to the CDC’s? What about misoprostol? Was the non-use of local anesthesia for these office-based procedures rooted in racism and sexism? Li...
May 17, 2025•36 min
Asthma is more prevalent in adult women than in adult men. Specifically, data from the National Health Interview Survey (NHIS) indicates that 9.7% of adult women had asthma, compared to 5.5% of adult men. This higher prevalence is observed across various racial and ethnic groups within the adult female population. At the end of April 2025, new population-level data was published (UK) describing an alarming association between progastrin only pills and asthma exacerbations. Is this a new finding?...
May 14, 2025•39 min
Female Genital Mutilation (FGR) is condemned by the WHO, Unicef, and the US. Nonetheless, it is still being performed worldwide, and in North America. In this episode, we will recently published data (April 2025) from BMC regarding this practice. This episode's topic was brought to me by one of our podcast family members who currently has a pregnant patient with FGR. Does this patient require a cesarean section? What are the 4 types (classifications) of FGR? Listen in for details.
May 12, 2025•29 min
(Topic Requested): Serum Magnesium and Calcium have an intimate and complex relationship best described as “love-hate”. One of our podcast family members sent me this fascinating question: “Should we be following serum calcium levels in patients undergoing IV Mag Sulfate use in obstetrics, in order to identify dangerous hypocalcemia?...Should we be giving these patients prophylactic calcium?” Thera are indeed published case reports of hypocalcemia induced tetany in patients. However, are there n...
May 09, 2025•26 min
Some debates in medicine and in OBGYN are “the same ol’ thing”. Like the debate on when to remove the urinary catheter after a “routine” cesarean section. In the original 2019 ERAS publication, the authors stated that “immediate” removal of the urinary catheter was “strongly recommended”. This drew concern and criticism as being too early in the recovery process. Not, in the UPDATED ERAS guidelines (as of end of April 2025), this recommendation has once again changed! In this episode, we will re...
May 07, 2025•26 min
The term "genitourinary syndrome of menopause" (GSM) was introduced in 2014 by the International Society for the Study of Women's Sexual Health and the North American Menopause Society (now the Menopause Society). This new term was created to replace older terms like vulvovaginal atrophy, urogenital atrophy, and atrophic vaginitis, and it encompasses the range of symptoms related to hormonal changes in the vulvovaginal and urinary tract areas that can occur during menopause. Recurrent UTIs are m...
May 05, 2025•24 min
The ERAS (Enhanced Recovery After Surgery) concept was initially developed for colorectal surgery in 1997 to standardize surgical protocols. The ERAS Society then first published a guideline for cesarean section (ERAC) in 2018-2019. Now, as of April 28, 2025, the ERAS Society has released a NEW UPDATE for ERAS-CS. In this episode we will focus on 2 main areas: 1. Vaginal prep at CS, and 2.Extended antibiotic prophylaxis in patients with obesity! Medicine moves fast, and this data exemplifies tha...
May 03, 2025•28 min
I know this sounds braggadocious, but I'm going to say it anyway: I work with some incredible people! We recently released a podcast on updated TOLAC uterine rupture data. One of our former residents reached out to me with a question about this: “Did they include interdelivery interval in their assessment?” You see, I work with really smart people! There's an answer to that question, and we're going to cover that in this episode. PLUS, a current resident, Spencer, had a great question about proo...
May 02, 2025•23 min
Spontaneous twin pregnancies occur in about 1 out of every 250 pregnancies. A real world clinical question has to do with dating a spontaneous twin gestation: Do we use the smaller crown rump length or the larger for dating in the 1st trimester? Do we use the smaller or larger measurement of biometry in the 2nd trimester? We had this discussion today in our prenatal clinic, and in true form and fashion, I turned it into an episode! PLUS, there is practice guidance from Jan 2025 (ISUOG) to settle...
Apr 30, 2025•22 min
In the ACOG Practice Bulletin 205 (Reaffirmed August 2025), the stated risk of uterine rupture with TOLAC is stated as 0.7% (after 1 prior LTCS). However, as our podcast tag list holds true, "Medicine Moves Fast". In an new upcoming publication from Obstet Gynecol (The Green Journal), May 2025, authors looked at the rate of uterine rupture with TOLAC over a 12 year interval. The rate of uterine rupture was NOT close to the national quoted rate in the Practice Bulletin. This information, which wa...
Apr 27, 2025•28 min
As healthcare professions we are often pulled in different directions ALL AT ONCE. It happens. We "multitask" every day. Or do we? Neuroscience actually states that we don't multitask at all; rather, we "task-switch" and that may lead to increased physiologic and mental stress and patient error. Yep, there is a MYTH about multitasking. In this brief episode, we remind ourselves that its OK to put somethings off, as able, until one task is completed. As the famed stoic philosopher Publilius Syrus...
Apr 25, 2025•21 min
I love my home state of TEXAS. I am definitely full of Texas pride. We have Texas barbecue, Texas, hospitality, and of course, the Texas music scene! Our state definitely has some issues to improve on, mainly access to maternity care. We have a HUGE state and 50% of our counties are maternity care deserts. It’s a vast vast Land to cover! Texas has also received a lot of criticism regarding its heartbeat law originally named SB8, which was passed in 2021. Commentaries since then have stated that ...
Apr 23, 2025•27 min
There have been various publications and commentaries published on “evidence-based” cesarean section techniques. Still, one of the persistent controversies on abdominal wall closure relates to the rectus. With transverse fascial entries, should we close/reapproximate the rectus or not? In June 2025, a new RCT looking at this very issue will be printed in the European J Obstetrics Gynecology and Reproductive Biology. Listen in for details.
Apr 22, 2025•24 min
