Does finding an isolated echogenic cardiac focus or choroid plexus cyst require amnio? What about MTHFR testing for thrombophilia? AFI or deepest vertical pocket? Does cervical length screening matter after cerclage?In this session, which is part 2, we will complete our “OB don’ts“ from the SMFM.
(Part 1) Cerclage for twins? What about progesterone? Do gestational diabetics controlled with diet (A1) alone require antepartum fetal surveillance? In this session, we will review 10 (out of 15) obstetrical DON’TS from the Society of Maternal Fetal Medicine.
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The CDC confirmed in a report recently released that about 700 women die each year in the United States from cardiovascular conditions, infections, hemorrhages and other complications related to their pregnancies — up to a year after delivering their babies. In about 60% of the cases, the deaths could have been prevented, in part, with proper medical intervention, better access to care, and early recognition of risk factors/signs. The leading cause of death is CV conditions, such as heart diseas...
Controversy surrounding screening mammography guidelines has resulted in conflicting recommendations from physicians and uncertainty for women. The Am Society of Breast Surgeons has released detailed/conservative screening recommendations for both average and high risk women. In this session, we will review their updated recommendations. We will also briefly review the following 4 supplemental screening modalities: 1. Contrast-enhanced Breast Magnetic Resonance Imaging (MRI), 2. Ultrasound, 3. M...
In this session (Part 2), we will cover skin to skin neonatal contact at time of Cesarean birth. Is this possible? What does the data show? This will wrap up our two-part series.
Skin to Skin neonatal contact is endorsed/recommended by the AAP, AWHONN, the CDCP, and the WHO. What’s the data behind his practice? Are there any potential risks or safety concerns? And… What about C-Section deliveries? In this episode (PART 1) we will provide an introductory overview and discuss the data behind neonatal, post-birth, skin to skin contact.
Researchers estimate that approximately 10.2 million Americans have osteoporosis, and an additional 43 million have low bone density. Equally stark are the ramifications of these numbers. About 1 out of every 2 Caucasian women will experience an osteoporosis-related fracture at some point in their lifetime. In April 2019, the FDA approved a new dual action medication for osteoporosis therapy in postmenopausal women considered at high risk of fracture. This new medication is Evenity. In this epis...
“Hysteria” referred to a constellation of psychological and physical ailments occurring only in women. It was thought to have its origin in the uterus. This can be traced back to ancient Egypt, the Greeks, and even the Roman era. Even the first FEMALE physician in Europe, Trota of Salerno (11th Century AD) propagated the theory. Ancient treatments for hysteria included “genital massage“ in order to release “unused materials” from the female body! Hence the origins of what persists today... the V...
Hey, we have all been there at one time or another: The ultrasound report shows an IUD/IUS in the endometrial cavity but it is NOT in the fundal location. What do we do? The answer lies mainly in the TYPE of IUD used! LNG-IUS devices seem to NOT be affected by low lying locations. The data on COPPER Ts, however, is still not clear....but risk of pregnancy is likely quite low. In this session, we will review the evidence regarding management of the non-fundal IUD.
What do Mexican Yams, menses, and the Pope have in common? The answer: the Birth Control Pill! In this session, we will review the interesting and slightly strange history of the oral contraceptive pill and the notion behind “withdrawal” monthly bleeding.
Both Androgen Insensitivity Syndrome (AIS) and Swyer Syndrone (Pure Gonadal Dysgenesis) are characterized by phenotypical females who are genetic males (46XY). However, The 2 conditions are very different pathogenically and have different clinical implications. For example, AIS patients can not become pregnant; however, Swyer patients may become pregnant after therapy. In this session, we will review the pathogenesis and clinical implications of these 2 46XY conditions.
The US is currently experiencing the greatest number of reported cases of measles, also known as rubeola, since the disease was eliminated in 2000. Outbreaks have been confirmed in 22 states. When measles occurs in late pregnancy, congenital infection is possible with variable expression and increased risk of subacute sclerosing panencephalitis. In this session, we will review the April 2019 ACOG practice advisory on management of pregnant and reproductive-age women during a measles outbreak. We...
In the late 1950s, two researchers (Masters and Johnson) began breakthrough research on human sexuality. Since then, “sexologists” have expanded our understanding of the female sexual response including concepts like female ejaculation and even, “squirting”. Yes… We will cover this data!
I’m sorry… I had to release this pent-up frustration regarding a common occurrence! LoL. “Like... I really hope you, like, enjoy this session”.
Fetal Echogenic bowel is a non-specific finding observed during 0.2 to 1.8% of routine second trimester ultrasound. Possible causes include primary gastrointestinal pathology, aneuploidy, cystic fibrosis, and congenital viral infection. However, most fetuses with this finding, especially when isolated, have no detectable abnormality. In this session, we will review the SMFM algorithm for management of isolated echogenic bowel diagnosed on second trimester ultrasound. (SMFM Brief, isolated fetal ...
Birth control, especially progestin only methods, seem to take a lot of heat regarding their potential role in CAUSING depression. Although past individual studies have suggested a link, the most recent systematic review of 26 studies has debunked that possibility. In this podcast, we will review the study published in 2018, in the journal of Contraception, regarding this topic (Worly. The relationship between progestin hormonal contraception and depression: a systematic review. Contracep. 2018)...
In 2016, the CSOAP trial confirmed that adding Azithromycin 500 mg IV to standard cephalosporin antibiotic prophylaxis pre-Cesarian helps reduce post operative infection. However, mounting evidence supports the addition of iodine-based vaginal prep to pre-CS care. However, no trial yet has compared the Zithromax – cephalosporin regimen to vaginal preparation and cephalosporin prophylaxis. In this podcast, we will summarize the current commentary by Duffy et al from April 2019’s Green Journal on ...
Iron deficiency anemia during pregnancy has been linked to several obstetrical adverse events including preterm birth, low birth weight, Cesarian Section, and of course the need for blood transfusion. Babies born to iron deficient mothers are also at risk of being iron deficient themselves- a condition which has been linked to poor psychosocial development. In this session, we will review the data favoring IV iron therapy over oral iron therapy during pregnancy and the postpartum period, especia...
Prolactinomas are categorized as micro- or macroadenomas based on their size. These tumors are considered the most frequently diagnosed functioning, anterior pituitary tumor type. Most women with microprolactinomas will have no adverse effects during pregnancy; however, macroadenomas are at risk of tumor growth. In this session we will review the endocrine society’s management plan of prolactinomas during pregnancy.
Parvovirus B 19 is a single-stranded DNA virus that causes the childhood exanthem known as fifth disease. The risk of maternal Parvo B19 infection varies with the level of exposure to the infected individual. Parvo B19 may cause asymptomatic fetal infection or may result in fetal loss, hydrops fetalis, or stillbirth. Currently, the ACOG does not recommend universal screening of Parvo B19 immunity. In this session, we will review the ACOG data on maternal and fetal Parvo B19 infection.
In the United States, 1 out of 1,000-8,000 babies are born with toxoplasmosis. Vertical transmission increases per trimester but severity of fetal disease increases the earlier in pregnancy that transmission occurs. In this episode, we will review the ACOG data on maternal and fetal infection with T. gondii.
CMV is the most common congenital infection, occurring in 0.2 to 2.2% of all neonates. Vertical transmission of this herpesvirus is possible throughout all pregnancy with increasing rates of transmission per trimester (3 > 1). In the session, we will review the ACOG data on maternal and fetal CMV infection.
Historically, oral contraceptive pills were prescribed in attempt to help quicken resolution of ovarian cysts. Is this practice evidence-based? In this session we will review the Cochrane Database regarding this topic as well as the mechanism of action of how certain contraceptives (etonogestrel/levonorgestrel) pre-dispose to the “unruptured ovarian follicle“.
In 2018, The ACOG expanded the possibility of low-dose aspirin use in pregnancy for preeclampsia prevention. Women deemed at moderate risk (1 or more risk factor), or high-risk (only 1 high risk factor needed) were included in low-dose ASA prophylaxis. Now, a call is being made to consider “universal adoption“ of this low-cost, low risk intervention. This is a summary of this soon to be published (green journal) current commentary, “A nudge towards universal aspirin for preeclampsia prevention“.
Recently, the PROLONG Trial, investigating 17-OHP’s role in preventing recurrent preterm birth, called into question the effectiveness of this treatment regimen. However, most of the study patients in the manufacturer’s initiated study were outside of the United States and were significantly different than the original MFMU study participants. In this session, we will review both of these studies and put the results into proper perspective.
In 1858, Virchow reported on the triad of hypercoagulability, venous stasis, and vessel wall injury as the factors pertinent to venous thromboembolism. In this session, we will review the ACOG practice bulletin as well as the executive summary from the American College of Chest Physicians regarding VTE in gynecological surgery.
Postop DVT and PE are potentially devastating to a postop patient. What does the ACOG and the American College of Chest Physicians say about stopping hormone replacement therapy or oral contraceptive pills before surgery? Let’s take a look at the data.
In the United States, GDM is diagnosed by a 3 hour GTT when 2 or more values are above a designated cut off. But what happens when only one value is elevated? In this session, we will review the data regarding this clinical dilemma. We will also review if there is a clinical difference if the 1 elevated value is the fasting blood sugar or 1 of the 3 post glucose challenge. Data taken from SMFM briefings.
Umbilical cord blood banking still carries significant misperceptions regarding its potential use. Did you know, that umbilical cord blood is not meant to be used as in an AUTOLOGOUS transplant because stored cord blood contains the same genetic variant or pre-malignant condition that led to the condition being treated in the donor! In other words, a child who develops a genetic condition cannot be treated with his own donated umbilical cord blood! In this session, we will summarize the ACOG com...
