IV fluids?! Does it really make a difference if the patient receives normal saline (NS) or Lactated Ringers (LR)? Well, for short bouts of rehydration (1L to 2 L), probably not. However, data now confirms that prolonged IV therapy with NS results in poorer outcomes compared to LR! In this episode, we will review the basic science of a “balanced“ IV fluid and review the data which has now placed LR at the forefront of IV fluid hydration.
Feb 23, 2019•11 min
FOAMed!!! A shout out to “free open access medical education”. Thanks for the information, Scott C.-one of our clinical medical students!
Feb 20, 2019•2 min
Incredibly, Although the frequency of multiple gestation is 3 to 5% at 8 weeks, vanishing twin syndrome occurs in 20-30% of all multifetal gesstations! This is not a rare occurrence. Maternal and fetal morbidity- and possibly mortality- is linked to the timing of the single fetal loss. Risks increase when a single fetus is lost in the second or third trimester. In this session, we will review the ACOG and SMFM Data regarding the vanishing twin syndrome.
Feb 20, 2019•13 min
According to the CDC, 1 in 8 of the 1.2 million people living with HIV in the United States are unaware of their HIV status and only half of those known to be infected are receiving effective anti-retroviral therapy. The combination pill tenofovir/emtricitabine has been FDA approved for pre-exposure prophylaxis (PrEP). In this podcast will review the current state of PrEP therapy. (Reference: HIV pre-exposure prophylaxis, a review: JAMA, 2018.)
Feb 14, 2019•12 min
Perinatal depression, which includes major and minor depressive episodes that occur during pregnancy or in the first 12 months after delivery, is one of the most common medical complications during pregnancy and the postpartum period. According to the ACOG, 1 in 7 women are affected by perinatal depression! In this session we will review the ACOG committee opinion on screening for perinatal depression from the winter of 2018 (committee opinion 132).
Feb 11, 2019•9 min
Polyhydramnios is an abnormal increase in amniotic fluid volume typically diagnosed in the second or third trimester. Either the single deepest vertical pocket or AFI can be used for diagnosis. The two most common pathological causes are maternal diabetes and fetal anomalies. In this session, we will summarize the SMFM consult series #46 (2018) on the evaluation and management of polyhydramnios.
Feb 08, 2019•16 min
Diabetic ketoacidosis in pregnancy is an obstetric and medical emergency and therefore requires prompt and aggressive treatment in a specialized care unit. Prompt and aggressive IV fluid management, IV insulin administration, and attention to key electrolytes are foundational to DKA management. In this podcast, we will review the SMFM protocol for DKA management in pregnancy.
Feb 06, 2019•15 min
Corticosteroid therapy for fetal lung maturity was first endorsed back in 1994. But what do we know about its affect on glycemic levels? Pregnant women with gestational diabetes, and of course pre-existing diabetes, are at higher risk of DKA at “lower” hyperglycemic levels compared to non-pregnant individuals. In this session, we will review the data on the effect of antenatal corticosteroids on the mothers’ glycemic levels.
Feb 04, 2019•7 min
You just have to listen…
Jan 31, 2019•52 sec
Incidence of cerebral palsy is inversely related to gestational age a delivery. The first reported association between fetal exposure to mag sulfate and reduction in perinatal morbidity was published in 1992. Magnesium sulfate for fetal neuroprotection is now standard in women presenting with preterm labor at less than 32 weeks. In this podcast, we will review the data on mag sulfate for fetal neuroprotection and summarize current best practices. Data is taken from the ACOG, SMFM, and Cochrane r...
Jan 28, 2019•11 min
In 1932 a governmental agency called the Public Health Service began working with the Tuskegee Institute to study syphilis in black men. In 1947, when penicillin was discovered as the illness cure, participants in the study were denied treatment in “order to study the natural outcome of disease”. In the early 1970s, the “study” was finally deemed unethical and was stopped. As syphilis cases continue to rise in the US, we must not forget the principles of ethical scientific discovery and not forg...
Jan 25, 2019•8 min
This is Part 2 of our critical reappraisal of the WHI study. In this episode we will cover the NAMS 2017 guidelines on HRT use. Does hormone therapy increase breast cancer in BRCA carriers? What is the data on ovarian cancer? Dementia? Listen to find out! We will also briefly touch on transdermal hormone replacement therapy, at the end of the podcast.
Jan 23, 2019•14 min
(Part 1) The media attention surrounding the publication of the initial results of WHI in 2002 led to fear and confusion regarding the use of hormonal therapy (HT) after menopause. In 2006, re-analysis of more complete data seemed to contradict the original findings. This led to a “retraction“ and re-explanation of the original data in 2007. Hormone therapy initiation in older women is NOT the same as initiation in younger women! In this session, we will take a critical look at the original WHI ...
Jan 21, 2019•21 min
Nuchal cord (NC) is common, and the vast majority of term deliveries with nuchal cord have normal outcomes. However, nuchal cord associated fetal morbidity is closely correlated to the number on nuchal cords present and the degree of “strangulation”/tightness. Even Hippocrates noted that nuchal cords could be associated with fetal loss in one of his writings, circa 370 BC. In this session, we will review data from the ACOG executive statement on neonatal encephalopathy, as well as a literature r...
Jan 20, 2019•13 min
Umbilical Artery Doppler studies are a valuable tool to assess vital well-being in the growth restricted fetus. What are the indices that are evaluated? What is the management when abnormal results are noted? In this session, we will review fetal doppler umbilical artery velocimetry. Clinical management based upon findings will also be discussed. Dated taken from SMFM Clinical Briefs and ACOG practice bulletin 145.
Jan 16, 2019•9 min
In this episode, which is part 2, we will cover the role of “prophylactic” red blood cell transfusion during pregnancy. We will also cover the medical management of sickle cell crisis, and wrap up the episode with notes on intrapartum and postpartum care.
Jan 12, 2019•10 min
Sickle cell disease is the most common inherited condition worldwide. Sickle cell disease carries unique maternal and fetal risks during pregnancy. In this episode, which is part 1, we will review preconception care, medication use in pregnancy, and review specific obstetrical complications associated with the condition. (Reference: CDC, SMFM, RCOG data).
Jan 10, 2019•10 min
The interpregnancy interval provides an ideal opportunity to discuss interventions which can maximize maternal as well as neonatal outcomes. Do you know at which interpregnancy interval adverse neonatal outcomes are highest? Is interpregnancy interval associated with higher TOLAC risk? In this session, we will summarize the ACOG obstetric care consensus report (#8) from January 2019.
Jan 08, 2019•9 min
At what gestational age does the uterus become responsive to oxytocin? Can Pitocin result in hypertension or HYPOtension?...And who was Sir Henry Dale? In this podcast, we will review the origins, development, pharmacology, and potential adverse affects of synthetic oxytocin.
Jan 06, 2019•10 min
Is Digoxin routinely used for peripartum cardiomyopathy? Can women who had peripartum cardiomyopathy take oral contraceptive pills? In this episode, which, is part 2, we will answer these questions as well as cover the workup, management, and prognosis of peripartum cardiomyopathy (Reference: Obstet Gynecol. Jan 2019).
Jan 03, 2019•9 min
(Part 1): Peripartum cardiomyopathy occurs in about 1 in 2,000 births in the United States. Although relatively rare, it can be devastating to the mother. In this session we will summarize the January 2019 clinical expert series on peripartum cardiomyopathy from Dr. Gary Cunningham, et al (Obstet Gynecol. Jan 2019).
Jan 02, 2019•9 min
Did you know the common, modern-day, colloquial expression about “blowing smoke up someone’s A$$” actually has a medical origin? Yep... it was a real therapy! In this podcast, we will review the bizarre practice, that made its way into modern vernacular.
Dec 30, 2018•8 min
In 2013, the ACOG released a comprehensive review on hypertensive disorders in pregnancy. In January 2019, the College re-visits gestational hypertension and preeclampsia and gives important updates. In this podcast, we will review 2 very clinically applicable aspects of intrapartum care for patients with gestational hypertension and preeclampsia. Who should get magnesium sulfate? And what’s the data on epidural use in these patients? Let’s find out what the ACOG has to say.
Dec 28, 2018•12 min
Alcohol use during pregnancy is well studied with well stated warnings. But what about alcohol use during breastfeeding? What’s the data on that? In the session, we will review alcohol intake by the mother during breastfeeding and take a look at some accepted recommendations.
Dec 25, 2018•11 min
Our BEST Holiday wishes to you!
Dec 24, 2018•31 sec
This is part 2 of our review of the ACOG practice bulletin #203. In this session, we will review low-dose aspirin for preeclampsia prevention, as well as target blood pressure goals for medical management of chronic hypertension in pregnancy. We will end this podcast with a quick word about NSAIDS for postpartum pain control in hypertensive patients.
Dec 24, 2018•10 min
Recent recommendations from the American College of Cardiology (ACC) and the American Heart Association (AHA) have changed the criteria for diagnosing hypertension in adults. In January 2019, the ACOG will release Practice Bulletin #203 addressing these changes, and provide renewed guidance for management of chronic hypertension in pregnancy. This is PART 1, of a 2-Part review of PB#203.
Dec 23, 2018•9 min
OK, so your pregnant patient comes to you with persistent itching between the fingers and toes and you suspect scabies. Which medication is safe to use in pregnancy? This is a brief review of scabies in pregnancy and its accepted medical treatments.
Dec 22, 2018•8 min
Genitourinary syndrome of menopause causes a significant disruption in quality of life for many menopausal women. The ACOG and NAMS endorse vaginal estrogen to relieve local symptoms. However, the FDA has a current Black Box warning on vaginal estrogen. This podcast will cover brand new data from the Nurses Health Study, released December 20, 2018 in the journal, Menopause.
Dec 21, 2018•10 min
As legal access to marijuana continues expanding across the US, more researchers are studying the effects of tetrahydrocannabinol, (THC), in teens, adults and pregnant women. New research from Duke Health suggests men in their child-bearing years should also consider how THC could impact their sperm and possibly the children they conceive during periods of Marijuana use. This is a tale of marijuana, sperm, and epigenetics! Data for this podcast came from the recently published study from Duke re...
Dec 20, 2018•10 min
