It has been a debate for many years: should we be doing routine screening for BV before hysterectomy/gynecology procedures? What about at C-section? It’s a good question especially acknowledging that there is a high rate of asymptomatic BV. In this episode, we will review an “expert review“ from the AJOG from March 2020 and a recently released rebuttal to that review. What does the ACOG say? Let’s take a look now.
Bacterial vaginosis (BV) is one of the most common vaginal diagnoses in women’s health practices. Over the years there has been increasing evidence that BV is not just an annoying vaginal condition but has true risks of heightened STI acquisition, PID, post-op vaginal complications, and even infertility. In this session, we will review a new soon to be released publication from the AJ0G. This article makes a strong case for the link between BV and infertility. We will summarize this new data her...
In this continuation, we will cover the reported potential, adverse reproductive outcomes with CUAs. Which surgical corrective procedures should be attempted, and when? Let’s cover that now.
The evaluation of congenital uterine anomalies can be traced back to the mid 19th-century. In this session, we will review the ASRM and the ESHRE classification schemes for these anomalies. What is the gold standard for diagnosis? When is an MRI necessary? We will answer these questions and more in the session. We will address reproductive outcomes in part 2.
On September 25, 2020, a new cervical cancer screening working group revised the algorithm (as a proposal) for management of minimally abnormal cervical cancer screening tests. This was released in JAMA. The new focus is on the presence/persistence of high risk HPV in the pathogenesis of cytology abnormalities. Let’s cover that in this session.
In October 2020, JAMA Pediatrics released a publication that is drawing MAJOR criticism from 5 major professional societies. This study highlighted a potential association between labor epidurals and child autism risk. However, there is a lot more to the story that needs to be told. In this session, we will break down the study and offer reassurance that “association“ does not prove “causation“. Also summarize the key rebuttals from these professional societies, which are pretty much ON FIRE.
In May 2020, the FDA approved a new novel, non-hormonal vaginal contraceptive that can be used “on demand“. Although this functions as a “pH regulator“ of the vagina with spermicidal properties, it is not nonoxynol-9-based. In this session, we will review the information in the instructions for use of Phexxi, and summarize key points from some published commentary on the subject.
There are calls to remove 17 OHP from the market based on the results of the PROMISE trial. This leaves us with a gap in tools for prevention of preterm birth. This is where CERCLAGE comes in. Cerclage is not only indicated in patients with previous history of incompetent cervix, as there is emerging data that cerclage plays a role in preterm birth prevention based on cervical length. In this podcast, we will give an in-depth summary of the data on how cerclage may be used as an intervention to ...
Over the past several years there’s been some alarming publications “linking“ endometriosis to certain ovarian epithelial malignancies. Is this a valid cause for concern? What is the absolute risk? In this podcast we will put the data into perspective and highlight information from the Lancet as well as MD Anderson‘s Gynecology Oncology data.
Antenatal corticosteroids help reduce a number of morbidities in the preterm infant. However, chorioamnionitis is generally considered a contraindication. The scientific basis for this is actually unclear. On September 28, 2020, the AJOG released a new publication ahead of print that helped shed some light on the subject. Are steroids harmful or beneficial to the preterm infant in the setting of Chorio? Let’s check it out.
Endometriosis, a chronic disease that afflicts millions of women worldwide, has traditionally been diagnosed by laparoscopic surgery. This diagnostic barrier delays identification and treatment by years, resulting in prolonged pain and disease progression. Development of a noninvasive diagnostic test could significantly improve timely disease detection. Recently, 2 innovative/non-invasive tools have gained attention for the diagnosis of Endo: MicroRNAs (Oct 2010; AJOG) and MRI (Sept 2020; Acad R...
One theory behind elevated post-partum blood pressure is that there is a large volume of sodium mobilized into the intravascular compartment in the post-partum period. Loop diuretics have been suggested as methods to accelerate post-partum blood pressure recovery due to their ability to mobilize sodium and fluid excretions. Is there level I data on the use of furosemide for postpartum preeclampsia/hypertension management? Does the use of Lasix affect serum magnesium levels? In this session, we w...
Stillbirths occur in approximately 6/1000 pregnancies in the US. Currently, the ACOG recommends placental histological analysis and fetal chromosomal study in these cases. However, as up to 50% (or more) of cases are left “unexplained“, more investigation/options are needed. On September 17, 2020, a new publication in the NEJM adds valuable insights as to how whole exon sequencing may help provide a genetic cause in an otherwise unexplained stillbirth. In this podcast, we will review this public...
Advanced Maternal Age (AMA) has long been associated with adverse obstetrical outcomes. However, is the same true for Advanced Paternal Age (APA)? What is the specific characteristic mutation associated with APA? What does paternal age have to do with chromosomal telomere length and how is that related to cancer in the child? In this podcast, we will review Data from the American College of Medical Genetics regarding APA. This information will be helpful in giving prenatal counseling to couples ...
Postpartum hemorrhage is a leading cause of maternal mortality even in the United States. In September 2020, a new device to help treat postpartum hemorrhage was FDA cleared (The Jada System). This is a novel device that uses vacuum pressure for uterine cavity collapse/myometrial compression. In the session, we will review this new data which was published ahead of print September 10, 2020 in Obstetrics Gynecology (Green Journal).
A prolonged second stage of labor, or failed vaginal vacuum extraction, can lead to a deeply impacted fetal head. Is the “push“ technique better than the “pull“ technique? Have you heard of the Patwardhan method? What is a C-section SPOON? And is the “Fetal pillow” actually helpful? In this podcast we will review each of these techniques in detail.
An EIF is a small echogenic area appearing within the fetal cardiac ventricle that has a sonographic brightness equivalent to that of bone. What are the clinical implications of an isolated EIF? Are structural malformations of the heart more common with EIF? What specific workup is required? In this session, we will review the SMFM management of this ultrasound finding.
A woman in her 20s with preeclampsia has a worse cardiovascular prognosis at 10 years compared to a woman in her 40s without previous preeclampsia. Additionally, preeclampsia is linked to other future maladaptive conditions (even dementia and renal disease) which have severe life impact. In this session, we will review the data on preeclampsia as a risk factor for future morbidity.
Intraventricular hemorrhage (IVH) is the most common type of intracranial hemorrhage in the neonate and is the most serious. Which antepartum therapy is proven to reduce IVH severity? Does Mag Sulfate reduce IVH? How is umbilical cord “milking” related to IVH? In this session we will cover this in detail and highlight professional societal guidelines.
Recurrent pregnancy loss affects between 3 and 5% of reproductive age couples. Traditionally, the category of “unexplained“ pregnancy loss made up 25% of cases. However, use of Chromosomal MicroArray analysis (CMA) has dropped the category of unexplained to approximately 10%. In this session, we will review the traditional and updated algorithm for recurrent pregnancy loss using CMA for the products of conception (source: Clinical Opinions in ObGyn, published ahead of print)
There is biological plausibility for vitamin D to play a role in pregnancy outcomes, given the presence of receptors in gestational tissues. Data has progressed since the ACOG committee opinion regarding vitamin D supplementation in pregnancy released in 2011. Does low maternal vitamin D actually affect maternal outcomes? In the session we will review the latest data from “Current Opinions in OB/GYN” regarding vitamin D supplementation in pregnancy, focusing on preeclampsia risk and GDM.
On August 12, 2020, the ACOG released a revised practice bulletin (226) on screening for fetal aneuploidy. In this session we will focus on cell free DNA genetic screening. How should we counsel younger women on this screening tool? Can cell free DNA be used after an abnormal QUAD screen? How is cell free DNA related to maternal malignancy? We will answer these questions and more in this session.
TOAs are typically considered the end result of severe PID. However, not all cases are PID related. TOAs may also be a harbinger of genital tract malignancy in a subgroup of patients. In this session, we will review the presentation, work-up, and management of TOAs and we will end with who may be at greater risk of genital tract cancer with them.
Fantastic! As healthcare professionals, we have to remember to use “patient centered“ terms when possible. This is a brief commentary describing a very important issue as a follow up to today’s educational podcast released just hours ago.
It is the age old question at Gyn Surgery… Candy Cane leg holders or Boot support? Is it just physician preference? In August 2020, a new RCT published in the journal Obstetrics & Gynecology addresses this issue. However, as we will discuss, the study raises more questions than answers.
VTE is a major cause of maternal morbidity and mortality in pregnancy, particularly in postpartum after a cesarean birth. In August 2020, the SMFM released consult series No. 51 on the prevention of VTE. What is the first-line pharmacological agent desired? Should prophylaxis be for 10 days, 2 weeks, or 6 weeks? What about risks of use? We will cover these questions and more, here..
Maternal genetic carrier screening is endorsed by the ACOG. Should this be ethnicity-based or should this be “pan-ethnic” screening of disorders? What are the 2 main genetic disorders that should be universally screened for? In this episode, we will cover the ACOG Committee Opinions 690 and 691.
On July 26, 2020, the AAP updated its guidance regarding infant separation from a COVID19 positive mother in the immediate postpartum interval. In this session, we will review this updated recommendation.
Your patient is a 22 yo female who has tested positive for SARS-CoV2. Will you keep her on her estrogen containing birth control? In this podcast, we will cover the ACOG response to this clinical dilemma as well as provide updated information from a soon to be released commentary in ENDOCRINOLOGY.
Yes, information keeps changing! That is why medical education is so important. In this session, we will review the ACOG updated recommendations for both healthcare providers and patients regarding COVID-19 management. These guidelines were released July 27, 2020.
