MTHFR... Yep, it gets blamed for a variety of health and pregnancy concerns. But does the data actually confirm the presence of adverse pregnancy and adverse health issues with MTHFR variants? In this session, we will review the difference between the 2 most common variants (C677T, A1298C) and true MUTATIONS. We will also review statements from the ACOG, ACMG, SMFM, as well as the Canadian Guidelines regarding MTHFR screening.
Persistent cough, congestion, low-grade fever… Yep, typical symptoms of acute bronchitis! The CDC and the American College of Physicians have published guidelines on antibiotic stewardship regarding acute bronchitis. When are antibiotics indicated? What about beta-agonist therapy? Do mucolytics work? In this podcast we will review the presentation, etiology, and treatment algorithm of this common clinical diagnosis.
“Never events“, “Sentinel events”, and “Near misses”. These terms strike fear in any healthcare provider! The National Quality Forum, the Agency for Healthcare Quality and Research, and the Joint Commission, all have stressed the importance of patient safety in the operating room and medical wards. In this podcast we will review alarming statistics regarding preventable medical errors, and remind ourselves of ways to keep patient safe.
That’s right… We’re talking about vaginal lubricants! In general, there are 3 main categories: water-based, silicone based, and oil based. Each has their own advantages and disadvantages. Some lubes can actually place the patient at risk of pregnancy if used with a latex condom! In this podcast, we will cover the “lube library“ so that we can better inform our patients since education is key!
Mirror syndrome (first described in 1892) is another term for what is also known as Ballantyne Syndrome or triple edema. Maternal mirror syndrome is a rare consequence of fetal hydrops. By convention, delivery is recommended in pregnancies complicated by mirror syndrome due to grave fetal prognosis. Severe maternal morbidity has also been described. In this session, we will review the clinical presentation, similarities to preeclampsia, and management of this grave complication.
On October 25, 2019, the American Journal of Perinatology published the results of the PROLONG Trial. This study demonstrated no statistical difference in the co-primary outcome of preterm birth less than 35 0/7 weeks of gestation (P = 0.72) and neonatal composite index (P = 0.73) with 17-OHP use. Similarly, the rate of preterm birth less than 37 weeks and less than 32 weeks were not different. On October 25, 2019, the ACOG released a practice advisory about this. Let’s summarize this now.
The rate of sepsis appears to be increasing. Maternal sepsis is a significant cause of maternal morbidity and mortality. Sepsis is not a specific illness, but a syndrome that includes organ dysfunction caused by this regulated host response to infection. In this session we will review the SOFA score and it’s utilization. Is fever necessary for a diagnosis of sepsis? Which antibiotics should be used? What is the rate of IV fluid resuscitation? Are steroids contraindicated in the septic patient? W...
N2O is a nonflammable, tasteless, odorless gas. It was first synthesized by the English scientist and theologian Joseph Priestly in 1772, and was first used as a labor analgesic by Stanislav Klikovich in Poland in 1881. Although much more frequently used in the UK and Canada, interest in nitrous oxide for labor pain management is increasing in the USA. What is its mechanism of action? Is it effective? What are the contraindications? Let’s review this topic...NOW.
Universal thyroid screening in pregnancy is a key debate in endocrinology and obstetrics. While some countries advocate universal screening, the UK and USA adopt a “high-risk” based strategy. ACOG’s Practice Bulletin 148 (April 2015) keeps its recommendation to NOT perform routine screening for thyroid disease in pregnancy. BUT, should we screen for thyroid abnormalities universally? This podcast will review the pros and cons and make a push for once stance over the other.
Fetal Tachycardia (FT) is described as increase in baseline fetal heart rate (FHR) above 160bpm, for longer than 10 minutes. In clinical daily practice, management of mild-moderate uncomplicated tachycardia can be challenging because clinicians do not have clear guidelines for intervention in cases of uncomplicated fetal tachycardia (in the absence of maternal pyrexia or decelerations) in cases where tachycardia has not resolved with conservative measures like left lateral tilt, hydration and pa...
With normal pregnancy, blood volume increases, which results in a concomitant hemodilution. Although red blood cell (RBC) mass increases during pregnancy, plasma volume increases more, resulting in a relative anemia. This results in a physiologically lowered hemoglobin (Hb) level, hematocrit (Hct) value, and RBC count, but it has no effect on the mean corpuscular volume (MCV). However, in women who are iron deficient, this problem is exacerbated due to low iron stores affecting the body’s abilit...
The United States, along with Mexico and the Philippines, was ranked one of the world's worst places for human trafficking in 2018. In the US, there is no official number of human trafficking victims, but estimates place it in the hundreds of thousands. From illicit massage parlors, escort services, online pornography, and adult “dating” sites, women make up the majority of sex trafficked victims. In this session, we will review the ACOG committee opinion from September 2019, as well as review d...
Ahhh...Oooh! The elusive G-Spot! First described in the 1950s by gynecologist Ernst Grafenberg, the “G-Spot” has been a “hot topic“ in sexual wellness circles. But does this exist? Is there a real “magic button“ for intense, female pleasure? New understandings of the relationship between the clitoris and anterior vaginal wall has resulted in a better name for this SPOT: The “Clitoral Urethral Vagina Complex" or "CUV." Let’s talk about that...now. {IMAGE/DIAGRAM on our Facebook page.}
Approximately 45% of pregnancies in the United States are unintended. Similarly, 70% of pregnancies that occur within 1 year of delivery are also unplanned. Interpregnancy interval shorter than 6 months are associated with increased risk of perinatal complications. In this session, we will review the stance from the ACOG and the SMFM regarding immediate postpartum LARC initiation. What is the difference between “immediate” placement and “early postpartum“ placement? Are there any risks? We will ...
Preterm birth is now the 2nd leading cause of death in children under 5 years worldwide and accounts for half of all newborn deaths, according to the March of Dimes and the World Health Organization (WHO). Besides progesterone, does DHA have a role in reducing preterm birth risk? In this session, we will summarize recent data regarding “fish oil” supplements and preterm birth risk. We will also describe a new proposed “DHA maternal blood test” which may help identify women who would benefit the ...
In our previous episode, we covered the revised FIGO ovarian cancer staging which now includes fallopian tube and peritoneal malignancies. In this episode, we will cover the FIGO guidelines regarding the management of OVFTP cancer. What role do PARP inhibitors play? Does treatment for asymptotic recurrence based on CA125 help? Can tamoxifen be used in recurrent malignancy? Let’s find out… Now.
The lifetime risk of a woman in the USA developing ovarian cancer is approximately 1 in 70. Malignant tumors of the ovaries occur at all ages with variation in histologic subtype by age. For example, in women younger than 20 years of age, germ cell tumors predominate, while borderline tumors typically occur in women in their 30s and 40s—10 or more years younger than in women with invasive epithelial ovarian cancers, which mostly occur after the age of 50. About 23% of gyn cancers are ovarian, bu...
In this session, we will review adjuvant therapy for endometrial carcinoma. What is the role of radiation therapy? What about chemotherapy? Is progestin therapy advised? We will end the podcast with a quick review of one of the most dreaded pathological findings: endometrial cancer AFTER hysterectomy was performed for presumed benign disease.
Endometrial carcinoma is the most common type of all the gynecological malignancies. The most common symptom is abnormal vaginal bleeding, especially in postmenopausal women. In 2018, the FIGO released it’s updated report on endometrial carcinoma. In the session, we will review the pathophysiology, local invasion, work up, and surgical staging of this malignancy. We will leave therapeutic options for the 2nd part of this 2 part series.
In this Part 2, we will review the pathological reports which may influence cervical cancer clinical staging. We will also summarize the 2018 FIGO treatment guidelines. In brief: For stage 1A1-1B1: surgery is recommended; Stage 1B2-IIA1: surgery or radiation may be used; Stage 1B3-IVA: concurrent chemoradiation is standard; Stage IVA may need an exenteration; and Stage IVA is managed with chemoradiation.
Recent developments in imaging and increased use of minimally invasive surgery have changed the paradigm for diagnosis and management of cervical cancer. The FIGO Gynecologic Oncology Committee, in 2018, revised the Cervical Ca staging system based on these advances. Imaging evaluation may now be used in addition to clinical examination where resources permit. The revised staging permits the use of any of the imaging modalities according to available resources, i.e. ultrasound, CT, MRI, positron...
While offering OTC birth control may be controversial here in the U.S., it is a non-issue in many other countries. China, India, Greece, Turkey, Mexico, Brail, Portugal, South Africa, Korea and Russia are a few of the countries where women can get birth control pills without a prescription. Is that safe? What about the risk of VTE? Should there be an age restriction? In this episode, we will highlight the October 2019 ACOG committee opinion (788) on over-the-counter access to hormonal contracept...
We all recommend it! The influenza vaccine. However, when asked specific questions about the vaccination, a fair number of healthcare providers will not know the answers. Is personal egg-allergy a contraindication? Can everybody receive the intranasal vaccine? What about pregnant women? In this podcast, we will cover the Advisory Committee on Immunization Practice (ACIP) guidelines for vaccination for the 2019- 2020 influenza season.
Eclampsia is a life-threatening pregnancy complication, defined as the new onset of seizures during pregnancy with a concomitant diagnosis of preeclampsia. Clinicians often ask patients with suspected preeclampsia about headaches, visual changes, or epigastric pain. Are the symptoms predictive of eclampsia? In this session, we will review the soon to be published (systematic review) evaluating the current literature regarding signs and symptoms that occurred before the onset of eclampsia and est...
The prevalence of obesity is at an all-time high in the United States, and the obesity rate among women is 40%, with 9.8% of women having class III obesity (BMI 40 or higher). As a result, obesity is a frequent and severe comorbidity of pregnancy. Whether or not incisional negative pressure wound therapy reduces wound morbidity is an important question for obstetricians and patients. In this podcast, we will summarize the key findings from a soon to be released RCT from my Alma Mater, UT Southwe...
Are green scrubs just a fashion statement? What’s behind the choice of green (or sometimes blue) scrubs? Well, there actually is some science to that… In addition to just interesting history. Let’s take a look at that, now.
In Sept 2019, the USPTF revised and updated its 2013 recommendations on medications for risk reduction of primary breast cancer. Who qualifies for medical strategies? Which meds are recommended? In this session we will highlight the new USPSTF Guidelines, review the use of Prediction Models, and compare Tamoxifen, Raloxifene, and Aromatase Inhibitors.
Once taboo, anal sex has slowly been slipping into the mainstream. A recent study found that 37% of women reported having anal sex with the opposite sex in their lifetime, and over 60% reported providing oral sex. However, the CDC does not specifically mention routine screening of extragenital sites for STIs. In this podcast, we will review the most up-to-date data on extragenital infection and make the case for “routine“ screening of extragenital STIs.
Treatment strategies for IC should proceed using more conservative therapies first with less conservative therapies employed if symptom control is inadequate for acceptable quality of life. Multiple, concurrent treatments may be considered if it is in the best interests of the patient. In this session, we will review the AUA clinical guidelines regarding management of IC with a review of the 1st-line to 6th-line treatment recommendations.
