CS is the most important risk factor for postpartum infection with a 20-fold increase compared to the vaginal delivery route. For post-cesarean section metritis, infection is considered to be primary due to ascending bacteria from the vagina. Although antibiotic prophylaxis is thought to reduce postoperative infections, it has little effect on bacterial colonization of the vagina. Over the past 20 years, multiple randomized clinical trials have investigated the effect of preoperative vaginal pre...
Aug 04, 2023•25 min
Venous thromboembolic events (VTE) are among the top three causes of maternal death in developed countries and prevention with thromboprophylaxis has been identified as the most readily implementable means of reducing maternal mortality from VTE. Most guidelines address VTE prophylaxis after cesarean section, and/or in those with thrombophilias- not after vaginal delivery alone. The ACOG does not directly address inpatient pharmacologic thromboprophylaxis during antepartum admission nor after va...
Aug 04, 2023•41 min
We are still in an opioid crisis state in the US. Have you heard of Kratom? It is likely at your neighborhood health food store or even on the counter at your local gas station. A derivative of the coffee plant, Kratom is making national headlines. Whether Kratom, a legal, widely available herbal supplement, should be classified as an opioid is contentious. Although the US Food and Drug Administration has recently addressed this controversy, Kratom continues to be marketed as an over the counter...
Aug 01, 2023•37 min
In 2019, the ACOG released CO 767 discussing “Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period”. currently, 3 meds are recommended for the treatment of emergent hypertension in pregnancy: oral nifedipine, IV, labetalol, and IV hydralazine. But which one is “better” at normalizing blood pressure? A new meta-analysis, published on July 24, 2023, provides one answer. However, this meta-analysis did not take into account the most crucial factor determi...
Jul 30, 2023•43 min
We have learned so much about the natural progression of HPV induced cervical abnormalities. In 2019/2020, the ASCCP published its updated guidance using a “risk-based” algorithm for management of cervical intraepithelial neoplasia. Traditionally, HPV vaccination was considered ineffective once cervical dysplasia already was present. But recent data has proven this concept incorrect! In this episode, we’re going to summarize a brand new ACOG practice advisory released today, on July 28, 2023, re...
Jul 28, 2023•23 min
There are, indeed, FDA indicated applications for purified, amniotic membrane (wound healing). Is there also a role for the use of purified amniotic fluid as a “regenerative medicine” treatment option? Can amniotic fluid injections help repair osteoarthritis and aching joints? Can it be used as EYE DROPS for dry eyes? The subject is trendy on certain social media channels and on certain websites. But this concept of injecting amniotic fluid into various body locations has landed one Texas health...
Jul 26, 2023•34 min
Skin conditions can't affect pregnancy outcomes, right? After all, the skin is just the skin. WRONG! As a chronic inflammatory disease, hidradenitis suppurativa (HS) exemplifies the link between integumentary and comorbid systemic disease through shared inflammatory pathways. Patients have double the comorbidity burden compared with the general population, and hidradenitis suppurativa has independent associations with several individual comorbid diseases. During pregnancy, HS also is associated ...
Jul 25, 2023•40 min
In Feb 2023, the USPSTF recommended that clinicians “screen for hypertensive disorders of pregnancy”. Specifically, they stated that “measuring blood pressure at each prenatal visit is the best approach”. Mind blowing I know. 😳😊 But sarcasm aside, a new publication- set to be released next month in AJOG (Slade LJ et al; Aug 2023)- validates this recommendation…not that it needed validation, for frequent BP monitoring during pregnancy. This has to do with the “sensitivity” of BP results in preg...
Jul 23, 2023•40 min
On April 5,2023 the U.S. FDA withdrew its approval of Makena and generic forms of 17-a hydroxyprogesterone caproate for the prevention of recurrent preterm birth. Having the only medication which had been FDA approved for the prevention of preterm birth taken away, has left clinicians investigating other possible strategies that can cause a dent in preterm birth rate. As Bacterial vaginosis (BV) is the most common vaginal abnormality in reproductive age women, naturally the spotlight would fall ...
Jul 22, 2023•37 min
FYI. We just released our episode for today, July 14, 2023, and will be out until July 23!
Jul 14, 2023•2 min
Its hard to be pregnancy in the late third trimester, especially in a HOT state like TEXAS in the summer. Pregnant individuals will try just about anything "to just get this baby to come out already!" Historically, walking, spicy foods, and SEX have been "employed" to get the labor process going. Does it work? In this episode we will look at the data examining whether labor can induce spontaneous labor. Is this a myth or a real thing? What about CURB WALKING?! That works, right? Lots to cover an...
Jul 14, 2023•34 min
There’s no such thing as a “false positive syphilis confirmation test”, is there? After all… It’s right there in the name, CONFIRMATION test! Well, not all positive confirmation tests are true positives, especially when that test is the FTA-ABS. Yes, it’s true, the specificity for this is very good between 95 to 98%. But there are cases of BFPs (Biologic False Positives), which have been reported and published in the literature. This is why putting the test results in clinical context is very im...
Jul 13, 2023•33 min
The Bandl Constriction Ring. It is real. It exists. Its true incidence is unclear as it lacks uniform reporting when found at time of cesarean. As labor guideline are more permissive of slowed labor progress, some fear that the incidence of Bandl's Band may rise. What is this ring? What is the pathophysiology of this abnormal uterine response? Can ultrasound detect this labor abnormality? In this episode we will cover the fascinating and controversial history of the Bandl Band and review some ke...
Jul 11, 2023•34 min
Just a little description of what happens “behind the scenes“! Enjoy. 😊😊❤️❤️😩😩
Jul 10, 2023•6 min
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. On October 6, 2022 we released a podcast episode called “Early GDM Screening: Evidence-based?”. In that episode we covered the controversy regarding early GDM screening, in other words- screening under 24 weeks. We have been following this story and debate for over 2 years now; we first released...
Jul 09, 2023•30 min
Well, Well, Well, this is very interesting. Back in May 10, 2023, we released an episode on "OSA (Obstructive Sleep Apnea) in Pregnancy: Time to Screen?". In that episode, we summarized the impressive data on OSA in pregnancy and its association with some adverse perinatal sequelae. Spring forward to July 6, 2023, the ACOG has now released a brand new Consensus Statement on OSA in pregnancy. This statement is a joint guideline from the Society of Anesthesia and Sleep Medicine and the Society for...
Jul 06, 2023•26 min
The headline from CNN Health form June 28, 2023 reads, "HRT use by younger women linked to dementia, study says". That is FRIGHTENING to any patient using hormone therapy for menopausal symptoms. Does HT cause dementia? Or is HT a "easy suspect"? The question of HT and cognitive function has been a subject of controversy for many years. In this episode we will summarize the NAMS position statement on HT for cognitive issues (2022) as well as summarize this new June 2023 publication from BMJ caus...
Jul 06, 2023•32 min
First published in 1952, the Apgar Score has remained unchanged over 70 years and is entrenched in current OB/Pediatric/Neonatal care. The ACOG highlighted the Apgar Score in 2015 in CO 644. In that release, the ACOG reminds us that although it provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed, it has important limitations: A. The healthy preterm infant with no evidence of asphyxia may rec...
Jul 03, 2023•36 min
Listen to this! According to recent US statistics from both consumer reports and statista.org: 26% of Americans used CBD in 2022, 24% of people owning pets use CBD for their animals and themselves, 33% of Americans have used CBD products at least once, 64% of Americans have used CBD for pain, 49% of Americans use it for anxiety and stress, and 42% of Americans have used it for sleep and insomnia. CBD is super common, and it is super unregulated. CBD, or cannabidiol, is one of the numerous cannab...
Jul 01, 2023•33 min
This episode subject was requested by Emily, one of our podcast family members. She has noticed the reporting of “large placental, venous lakes” on antepartum ultrasound. Placental lakes are enlarged spaces in the placenta filled with maternal blood. These spaces are also called intervillous spaces because they are found between the placental villi the finger-like projections of the placenta that contain fetal blood vessels . The placental villi float in the intervillous spaces and absorb oxygen...
Jun 29, 2023•26 min
We recently had a patient in our OB high-risk community clinic whose maternal carrier screen result was either late or lost. Thinking the test may be lost, another resident ordered hemoglobin electrophoresis. The electrophoresis was NEGATIVE (that is, no abnormal hemoglobin was found at detectable levels)…by the way, good for that resident! After calling the lab for the genetic screen and not getting a clear answer from that location, they had the self- initiative in ordering a back-up test. AND...
Jun 28, 2023•33 min
Desquamative inflammatory vaginitis (DIV) made its debut in the medical literature in 1965, by the hands of Gray and Barnes. In that paper, they presented their findings on 478 women complaining of vaginal discharge. Then, in 2002, Donders et al. described a new entity, referred to as aerobic vaginitis (AV). This term emphasized the clear contrast with the far more common and acknowledged form of dysbiosis: bacterial vaginosis (BV). These 2 clinical conditions are now thought to exist on a clinica...
Jun 27, 2023•42 min
The word placenta, first used in a 1638 anatomy textbook, was borrowed from the New Latin phrase placenta uterina, meaning "uterine cake", because the circular, flat shape of the organ was thought to resemble a traditional Roman flat cake. Circumvallate is another Latin derived term meaning the "encircled placenta, by a rampart". Circumvallate placentas are a form of extrachorial placenta where the basal plate extends past the margins of the chorion plate resulting in the chorion and amnion fold...
Jun 23, 2023•29 min
Over the past decade, there’s been about a 700% increase in the cases of congenital syphilis in the United States. That’s 700%! Rates of congenital syphilis, meaning the number of cases for every 100,000 live births, are highest in the South and Southwest, in states such as Arizona, New Mexico, Louisiana, Mississippi and Texas. Individual states have seen increases that are even more astounding. From 2016 to 2021, cases shot up 3,300% in Mississippi, nearly 3,000% in Oklahoma, more than 2,200% i...
Jun 21, 2023•31 min
LARCS provide remarkable contraception. The IUD and the IUS are both HIGHLY effective, although they do not have the same typical-use failure rates. While it is common knowledge that active mucopurulent cervicitis is a contraindication for IUD/IUS placement, what about the presence of bacterial vaginosis (BV)? BV has been identified for years as an independent risk factor for Pelvic Inflammatory Disease. Is placement of an IUD/IUS in a patient with current BV contraindicated? What do the guideli...
Jun 18, 2023•25 min
Endometriosis is caused by endometrial-like tissue containing endometrial glands and extensive fibrotic tissue growing outside the endometrial cavity, most often in the pelvic peritoneum or ovaries, resulting in chronic pelvic pain and infertility. It is reported to affect 10 to 15% of women of reproductive age, with an unknown percentage of women who go on undiagnosed or misdiagnosed. For decades, Sampson's Theory has survived as the most "likely" to explain the pathogenesis of endometriosis. B...
Jun 15, 2023•30 min
The world of "Hypertension (HTN) in Pregnancy" is an ever-evolving environment! Many clinicians have adopted patients' home monitoring of blood pressure (BP) in their management of hypertensive disorders in pregnancy. Do you recommend home BP monitoring in your OB patients? On May 4, 2022 we summarized the results of 2 RCTs examining whether home BP monitoring during antepartum care prevents HTN morbidity and mortality. These were BUMP1 and BUMP2 (JAMA). We will again summarize the key findings ...
Jun 15, 2023•29 min
Just a quick clarification regarding a previous statement, on an earlier episode, regarding MSAFP….thank you Maggie Rey! ❤️❤️❤️this community.
Jun 13, 2023•4 min
Does the combination birth control pill cause depression? This has been a controversial subject for over 2 decades. While some observational studies have described a possible association, randomized clinical trials have shown little to no connection. On June 12, 2023, a new population-based cohort study from the UK sought to evaluate this possible association. This resulted in some interesting claims! These results, just within 24 hours, have now made their way to major news outlets and social m...
Jun 13, 2023•26 min
I recently received a message from one of our podcast family members requesting more gynecological topics...that was perfect timing, since the NAMS just released its 2023 Position Statement on "NonHormonal Therapies" for vasomotor symptoms on June 1st. In this episode we will summarize this 18 page monograph. The NAMS expert working work critically evaluated the published literature on all nonhormonal therapies for hot-flashes and grouped them into 5 categories: lifestyle modifications; mind-bod...
Jun 11, 2023•29 min
