Chronic kidney disease can affect anywhere from 0.1 to 4% of all pregnancies. Pre-existing renal disease can have severe consequences for a pregnancy. Should low-dose aspirin be used in these patients? If so, at what dose? What about calcium supplementation? Are immunosuppressive agents safe to use? In this podcast we will cover the June 2019 ACOG “clinical expert series” monograph on chronic kidney disease in pregnancy.
Depression/anxiety can affect up to 20% of women during pregnancy. These 2 psychological conditions have adverse pregnancy outcomes in and of themselves. But what about medication use? Do SSRIs need to be tapered at end of pregnancy to reduce neonatal withdrawal? Are SSRIs linked to “Neonatal Persistent Pulmonary Hypertension”? What about other meds? This episode will review the ACOG/SMFM data on the subject.
For decades, women have been told that having intercourse/orgasms late in pregnancy can hasten the onset of labor. But is this a myth, or is this true? While it is well established that sexual intercourse/orgasms can trigger the onset of contractions, are those contractions enough to result in cervical change? Let’s take a look at the data.
Thirty percent of all cases of adnexal torsion occur in females younger than 20 years. In this episode, we will review the latest committee opinion from the ACOG on clinical presentation, use of diagnostic tests, and surgical management of adnexa torsion in adolescents. Here’s your quick test: 1. Do Doppler studies confirm a diagnosis? 2. What are the findings on CT or MRI? 3. Is cystectomy preferred over oophorectomy, or is another management option indicated? Answers...are...here!
This Enhanced Recovery After Surgery Society guideline was created to support the most common surgical procedure in the industrialized healthcare world, the cesarean delivery. In this section, we will highlight THREE new recommendations that CHANGE how we “traditionally” care for the postop CS Patient: Refeeding as soon as 2 hours postpartum, elimination of the postop urinary cath...and even new data on the use of heparin for postop CS patients!
Short interpregnancy intervals, as well as long intervals between pregnancies, are associated with some potential adverse obstetrical outcomes. What does the data show? What are the unique considerations that go into patient counseling regarding spacing of pregnancies? In this episode, we will review the SMFM data on interpregnancy intervals.
How much do you know about the recently approved novel BC pill, SLYND? Do you know it’s efficacy? What are the contraindications? In this session, we will bring you up to speed on this new novel drosperinone only oral BC pill. (No financial disclosures).
DISCLOSURE: Not for the PC! Not for those who lack determination, or GRIT. This is the antidote for mediocrity. Just a little motivation to KEEP YOU FOCUSED! Now... go-and-get-it!
Part 2: In this session, we will wrap up our discussion on recurrent pregnancy loss by focusing on 3 controversial areas: 1. Immunological therapy, 2. thrombophilia testing, and 3. Progesterone supplementation. (Data referenced from ACOG, RCOG, ASRM).
Recurrent pregnancy loss is devastating for the affected couple. In part 1, we will review the diagnosis of this condition. We will also cover parental genetics, APS, and uterine anomalies. In part 2, we will see if thrombophilia testing is indicated, discuss progesterone supplementation, and what role/if any, immunological reactions have with recurrent miscarriage. (Data from ASRM, ACOG, and RCOG).
Howdy, all! Rather than discussing one topic, this session will review “quick facts“ on common OB concerns/questions. Should we screen for HSV during pregnancy? What about deli meat consumption? Are there any issues with air travel during pregnancy? Can pregnant women use hot tub? Can pregnant women dye their hair? We will answer these questions – and more! – in this session of clinical pearls.
On July 1, 2019 ACOG updated/revised the GBS algorithm for intrapartum prophylaxis. In this session, we will cover GBS prophylactic indications, NAAT testing for GBS, GBS Bacteriuria, and antibiotic dosages.
Persistent nausea and vomiting in pregnancy is a terrible condition! It affects quality-of-life, and impacts the mother’s overall psychological well-being. What is the role of helicobacter pylori infection in this condition? Is there a link? Let’s look at the data.
It has long been held that maternal perception of fetal movement may protect against stillbirth. However, the 2018 AFFIRM trial called the tradition into question. Related to that is the traditional recommendation to drink “sugary” drinks to increase fetal movements. Is this evidence-based? In this episode, we will review the AFFIRM trial and review sugary intake to increase fetal movement.
Left...Right...Left...Right...Left! I just recently completed my military boot camp experience! That was an adventure. In this session, we will cover 3 brief “life lessons“ that I learned during my Texas Military Forces Boot Camp! This information will truly help you every single day! Hooah!!
Sexual intimacy is an important part of a couples’ relationship. On June 21, 2019, the FDA approved a new novel medication for hypoactive sexual desire disorder in women. The medication, Vylessi, is a melanocortin receptor activator, which is different then the previously approved medication for the same condition, Addyi. In this episode, we will review the MOA and data behind this new medication.
🌞🌞IT IS SUMMER!! 👏👏 Are sunscreens safe to use during pregnancy? What does ACOG say? In this session, we will review the ACOG practice statement as well as provide some SUN-SAFE 🌞🌞tips for pregnant women during summertime!👍👍
Turmeric is an edible root used in cooking. It’s powdered into a bright yellow spice popular in Asian cuisine. Turmeric also has a history of medicinal use. It contains an active compound, curcumin, that has antioxidant and anti-inflammatory properties. Research has found that curcumin has the potential to improve a number of health conditions — including depression. This includes mild depression and even major depressive disorder (MDD). In this podcast, we will review the data as it applies to ...
Just a brief hiatus!
What is the mechanism by which elevated hemoglobin A-1C causes birth defects? Is there a “cut off“ level for this affect? Let’s look at the data.
Maternal cardiac arrest… a devastating condition! Techniques for maternal resuscitation have changed, even from when I was a resident. 30° left lateral tilt is no longer recommended by the American heart Association during CPR. Manual left uterine displacement is preferred! We’ll talk about this, as well as cover the basics of maternal cardiac resuscitation in this session. (Reference: AHA Scientific statement on cardiac arrest in pregnancy).
Weight gain is commonly cited as a side effect of combination oral contraception, and is amount the top reasons for pill discontinuation. Do birth control pills make women gain weight? Where did this perception come from? What does the data show? In this session we will review systematic reviews and the Cochran database regarding this subject.
(Part 3): The Finale of our 3-Part series! Remember when you would have done anything to get into medical school, and cried/struggled to get that perfect residency?! Remember why you started! This brief session will wrap up our 3- part “mini-series” on THRIVE. (ERRATA: In part 2, we attributed the famed “The man in the arena” excerpt to Churchill. The author was not Churchill, but Theodore Roosevelt...with apologies to former Pres. Roosevelt.)
(Part 2): Take the challenge! This is Principle #2 in our “mini-series”. It is easy to fall into a trap of “the routine“, and the mundane. Doing so leads to dissatisfaction and frustration. Great medical leaders in the past, innovators, and countless historical figures broke out of the routine, took the challenge, and changed history forever. So… Are you up to the challenge? (Post production ERRATA: In part 2, we attributed the famed “The man in the arena” excerpt to Churchill. The author was no...
WARNING: This is my most personal, and passionate podcast yet. In light of the recent CNBC news article regarding physician well-being, this podcast will cover centuries old dogmas PROVEN to make you thrive. What does the historic emperor Marcus Aurelius have in common with leaders like Zig Ziglar, Les Brown, and Stephen R. Covey?... this podcast answers that. BUT, you have been warned! Listening to this podcast has the potential to bring change to your life. The challenge is yours! THRIVE!
For decades, common practice in Labor And Delivery has been to use supplemental maternal oxygen by facemask as a remedy for fetal heart rate decelerations. However, is more oxygen delivery to the fetus actually helpful? Does it change neonatal outcomes? Well… the data is not so clear, and there may be some cause for concern. In this podcast, we will cover the evolving data on the use of supplemental maternal oxygen for fetal heart rate decelerations, and we will briefly touch on supplemental oxy...
This is TRUE, and a testament to what having a VISION, a strong will, and a desire to change the status-quo can accomplish! This is the remarkable true account of Dr. Kane, who performed 2 successful self-surgeries in 1921 and 1932.
In 2011, cf DNA from the maternal serum became commercially available to screen for fetal aneuploidy. Overall, about 3% of test results will detect an aneuploidy, and false positive results are only seen in 0.05% to 0.1% of tests. Evolving data, however, suggest that in women who have more than one aneuploidy suspected by cfDNA testing but who are found by diagnostic testing to carry a genetically normal fetus may harbor a higher risk of occult maternal malignancy. In this session, we will revie...
Somethings in medicine are done by tradition. The use of Oxytocin during first trimester uterine evacuation is one such thing. Evidence seems to be lacking for the use of this common intervention. Remember, physiologically, oxytocin receptors show a linear increase in concentration as pregnancy progresses- rising quickly after 36 weeks of pregnancy, and are only present in negligible quantities on the myometeium in the first trimester! In this session, we will review the data on oxytocin use for...
In March 2019, the FDA approved the first medication specifically targeted for postpartum depression, brexanolone (Zulresso). However, this medication requires a 60 hour, inpatient, IV-continuous infusion and there are some safety concerns. In May 2019, the Cleveland Clinic announced that it would release a pilot inpatient program (at one of its sites) for this medication. In this session, we will review this new medication and the Cleveland Clinic’s protocol for Zulresso.
