The ACOG has stated that caffeine consumption in pregnancy should be limited to 200 mg/day. However, a new study published on March 25, 2021 in JAMA Network Open is questioning that recommendation. In this study, we will review this longitudinal cohort publication stating that “there may be no safe limit to caffeine consumption”.
The CDC released a health alert through its Health Alert Network on April 13, 2021, notifying physicians and other health care practitioners that the CDC and FDA are reviewing data involving six U.S. cases of a rare type of blood clot in individuals after receiving the Johnson & Johnson COVID-19 vaccine. In this session, we will review what CVST is, how it can present, the work-up, and potential treatment options. Do you give heparin for this? What is a correlation with thrombocytopenia? Thi...
The field of obstetrics was “birthed“ out of midwifery. The concept of second stage of labor in the lithotomy position was not how it was “always done”. In this episode we will review the evidence behind the “flexible sacral positions” and learn how maternal positional changes can assist with the labor process.
The prevalence of trauma is quite sobering. General population surveys have found extremely high rates of traumatic experiences encountered which span all races, ages, and socioeconomic status is. Nonetheless, some groups are disproportionately affected by trauma compared to others. This is why all healthcare providers should be aware of “trauma informed care” practices. In this episode, we will summarize the ACOG committee opinion from April 2021 on the subject. Do you know what the “4 Rs“ of t...
Hysteroscopy, and especially office-based hysteroscopy, is a fantastic tool in the evaluation of suspected endometrial abnormalities and/or heavy menstrual bleeding. In this session, we will review the ACOG committee opinion on hysteroscopy. At what fluid deficit should you stop the procedure if using normal saline? What about glycine? What is the significance of a “mill-wheel” murmur. Do you know what the Durant maneuver is? We answer all of these questions and more in this session!
Algorithms and opinions on cervical cancer screening change quickly. In this session, we will review the uses for HPV testing as a primary screening tool as well as post treatment surveillance. Are you familiar with which HPV tests can be used as primary screening? What is the frequency of tests? Let’s cover this now.
In this session, we will pick up where we left off with our immediate past podcast covering the SMFM “Choosing Wisely” recommendations. When should we screen for MTHFR for adverse pregnancy outcomes? When should we start screening for FGR with Umbilical Dopplers? We’ll answer these questions and much more in this session as we wrap up the SMFM “don’t do” list.
Sometimes what sounds good in clinical practice actually is not evidence-based. In March 2021, the SMFM updated the “Choosing Wisely”list of practices/recommendations for OB care. Should routine screening for microdeletions be done? What about serum screening for preterm labor? In this session we will cover the most recent 5 “don’t do“ items released by SMFM.
In the era of social media and easy to spread public opinion platforms, misinformation can grow rampant. Is the Covid vaccine associated with infertility in the general population? Where did this idea come from? What is “Syncytin-1” and how is this related to this controversy? Here we will review the origin of this story, any theoretical basis for the claims, and the conclusions from the CDC, FDA, and multiple professional societies regarding this.
What are the delivery recommendations for pregnant Covid patients? When is expectant management favored compared with elective delivery? Is mechanical ventilation alone an indication for delivery? This is our second session in which we will wrap up our summary of the SMFM updated treatment guidelines for pregnant Covid patients (February 2021).
COVID-19 management guidelines change quickly. In this session we will review the February 2021 SMFM update regarding when to consider inpatient care for COVID-19 in pregnancy. Do you know which 02 saturation categorizes severe compared to moderate disease? What dose of dexamethasone is recommended for pregnant Covid patients that require oxygen? Is outpatient anticoagulation recommended? We will cover these and more in this session! (Source: SMFM COVID-19 in pregnancy guidance February 2021).
In February 2021, the ACOG will release a new committee opinion (818) updating guidelines on “medically indicated late preterm and early term deliveries”. Are steroids still recommended in this preterm interval? How has new data on fetal morbidity with intrauterine growth restriction and intrahepatic cholestasis affected these guidelines? Listen… And find out!
Historically, brachial plexus palsy was considered proof of shoulder dystocia or traumatic birth. Can brachial plexus injuries occur with normal, uneventful deliveries? Do brachial plexus palsies happen even at C-section? The answer may surprise you. In this episode, we will review the different types of brachial plexus injuries and review the most recent data on the pathophysiology of these nerve conditions. Reference: Johnson et al. Obstetrics and Gynecology, October 2020,
There have been a variety of published and accepted clinical presentations of COVID-19: from lack of taste, GI disturbances, muscle aches, to the usual fever and shortness of breath. But this COVID-19 affect a woman’s menstrual cycle? There is increased chatter on the ever accurate Internet regarding this. But is there data? In this session we will go over the possible association between COVID-19 and irregular cycles.
Are you still treating urogenital gonorrhea with ceftriaxone and azithromycin? That was a standard for over a decade. But things have now changed. In December 2020, the CDC updated the treatment regimen for urogenital infections with neisseria gonorrhea. Is “dual-agent” still a therapy? Does cefixime still have a treatment role? What about test of cure? We will cover these questions and more in the session.
We all know there is a national opioid epidemic. This, like the current viral pandemic, is robbing people of their lives. Pregnant women are not immune to opioid use disorder. Is methadone endorsed for use in pregnancy? What about buprenorphine? Is naltrexone safe as an alternative treatment during pregnancy? In this session, we will review the updated literature regarding opioid use disorder and medical assisted treatment options (MATs).
Historically, CS prophylactic antibiotics were given after umbilical cord clamp and cut to prevent exposure of the neonate to antimicrobials. The recommendation then changed, in line with typical surgical practice, to give prophylactic antibiotics before skin incision. However, new data published in December 2020 is calling this practice into question. In this session we will review this new publication, co-authored from Rutgers university, which has some surprising results.
It’s the holiday season, but the holidays can exacerbate depression/anxiety and even increase suicidal ideation in some individuals. Suicide deaths are a leading cause of maternal mortality in the US, yet the prevalence and trends in suicidality (suicidal ideation and/or intentional self-harm) among childbearing individuals remain poorly described. Oddly, the CDC data excludes deaths from "accidental or incidental causes," such as suicide, overdose, or homicide in their maternal mortality report...
A brief explanation regarding our podcast just released, “Ovaries In or Out”!
Historically, prophylactic oophorectomy was performed at time of benign hysterectomy in patients at/over 45 years of age. Is this still evidence based? Is the reduction in ovarian cancer development a net win or net loss compared to ovarian conservation? In this podcast we will review the data regarding risks/benefits of ovarian conservation at time of benign hysterectomy in the general population.
Considered controversial, traditionally steroids for fetal lung maturation were not given in patients with clinical chorioamnionitis. But is this really evidence-based? And since most patients will be delivered quickly after this diagnosis, how fast can steroids be expected to have a benefit on the child? In this session we will summarize a December 2020 Expert Review from the AGOG on that subject.
In the very near future, possibly just days away, the FDA is anticipated to approve at least 1 new COVID-19 vaccine. Were pregnant and/or lactating women included in the phase III vaccine clinical trials? What is the safety data for the vaccine in pregnancy? Are pregnant and/or lactating women part of the vaccine distribution framework? These are tough, and even controversial, aspects that must be considered. In this session, we will review the current state of the vaccine and how it applies to ...
A woman dies every 12 hours in this country from pregnancy-related complications. 2/3rds of these deaths are preventable! Let that sink in. On December 3, 2020, the US Surgeon General released a CALL TO ACTION to rectify this reality. In particular, ONE race is carrying this burden more than others. In this podcast we will summarize the main points of this 71 page monograph, and tie in potential solutions.
Once considered TABOO, women having receptive “Backdoor” sexual attention has gained a lot of press in both medical as well as non-medical publications. Does ACOG have a committee opinion on this? YES. And in this podcast we will discuss data on prevalence of, orgasmic response to, and possible STI implications of “backdoor activities” in women.
The two most common types of headaches in pregnancy are tension type and migraine. Is Imitrex safe to use in pregnancy? A common alternative medication regimen includes the use of Benadryl and Reglan for acute headache. Is there data for this? And what about Botox in pregnancy? In this podcast we will review the data on the medical management of migraine headaches in pregnancy.
In December 2020, ACOG will release an updated committee opinion on delayed umbilical cord clamping with 3 additional areas addressed: 1. multiple gestations, 2. cord milking in extreme premature infants, and 3. the effect of delayed cord clamping on umbilical cord blood collection. We will summarize these key points in this session!
In 2017, the American College of Cardiology and the American Heart Association revised the definition of normal BP, elevated BPs, and Stage 1 & 2 Hypertension. ACOG has not adopted these new classifications for pregnancy care. Are women with elevated blood pressures or Stage I hypertension at risk of adverse pregnancy outcomes? In this podcast, we will review a soon to be released publication from the AJOG which helps answer these questions. (Data from: “Perinatal outcomes in women with elev...
The birth control pill remains one of the most common medications used in reproductive aged women. As all birth control pills have a net antiandrogenic affect, does this result in less libido? What does the data say? Do you inform women of this potential side effect when they start combination birth control? We will tackle these questions in this session!
Ever since the first progestin was isolated and reproduced out of Mexican Yams in the early 1950s, the race was on to formulate a low-risk, highly effective, oral birth control agent. Birth control pills remain one of the most common medications used by reproductive age women. We are now in the 4th generation of synthetic progestins in the pill. But do these matter? Is anti-androgenic activity real or just something found in the lab? In this podcast, we will review not just the history of the pi...
Modafinil and armodafinil are stimulant meds called “smart meds”. Their use is on the rise, but there are important drug interactions with these meds and certain birth control (BC) options. Additionally, new data has revived attention to the association of the stimulants to congenital birth defects. In this session, we will review the MOA of these meds and discuss BC options with their use. We will also summarize the newly released data showing the association with congenital birth defects.
