This is our impromptu podcast session in-between patients in our OB Clinic. In this episode, Dr. Leon-Arango (Senior Resident) highlights the importance of looking “deeper” into a patient’s persistent complaint of depression despite a negative PHQ9 score, based on her encounter from today. This real example of a physician’s perception of need for intervention likely helped to change the trajectory of this patient’s life. Listen in as we go “beyond the PHQ9”.
Feb 16, 2023•8 min
The first case of placenta accreta listed on PubMed was reported in 1927 by Dr D.S. Forster out of Montreal. That was 1 case in 8000 deliveries! Now, according to the National Accreta Foundation, PAS occurs in 1 in 272 pregnancies. How did we get to this rate? In this episode we will highlight data from ACOG, SMFM, and the National Accreta Foundation. We will highlight key ultrasound markers, patient risk stratification, and review what a PAS Care Center is. This is how we win the battle against...
Feb 01, 2023•27 min
Delayed cord clamping (DCC) provides vital placental transfusion to newborns and is endorsed by ACOG, SMFM, March of Dimes, and the ACNM. However, DCC in nonvigorous newborns may not be provided owing to a perceived need for immediate resuscitation. Umbilical cord milking, in late-term and full-term neonates, is an alternative in these cases. In December 2020, the ACOG’s Committee Opinion stated a lack of outcomes data for umbilical cord milking in nonvigorous newborns. This Level 1 data has now...
Jan 29, 2023•15 min
Historically, IUDs where considered contraindicated in a patient with a prior ectopic pregnancy. This was due to concerns that IUDs may be causative of tubal gestations. Is this true? Are IUDs contraindicated with a past history of ectopic pregnancy? In this episode we will review the data from the CHOICE project, the CDC (US), and the Royal College of OBGYN (UK). We will also summarize key findings from a May 2022 Green Journal publication that investigated this very issue, and we will explain ...
Jan 27, 2023•19 min
A 2020 publication from JAMA Pediatrics reported that labor epidural analgesia may be associated with an up to 37% increased risk of offspring autism spectrum disorder. The ASA has rejected those results based on methodologic limitations of the study, the lack of biological plausibility. But some remain fearful of labor epidurals because of that publication. In February 2023, a new publication in AJOG will help put this matter to rest with the largest population-based analysis done to date. In t...
Jan 25, 2023•12 min
Platelet Rich Plasma (PRP) therapy is a HOT and TRENDY item right now. PRP use was initiated in sports medicine in the 1970s. It has since expanded into many medical specialty fields, and now it is being heralded as the new hope for diminished ovarian reserve for those desiring pregnancy…even in menopause! Can injecting the ovaries with PRP really rejuvenate the ovary? We’ll examine the evidence as it sits as of January 2023.
Jan 22, 2023•24 min
Routine, repetitive urine dipsticks (meaning at each prenatal visit) were introduced into prenatal care back in the 1960s and 70s. The idea was to act as an early screen for bacteriuria (ASB), proteinuria as a screen for preeclampsia, and glycosuria as a screen for GDM. That was based more on expert opinion rather than clinical trials. The utility of urine dipstick testing in pregnant women has been debated for years, with studies suggesting minimal use in asymptomatic patients. Urine dips as st...
Jan 19, 2023•18 min
Paragard, Mirena, and Liletta IUDs are the most effective types of emergency contraception. Data from the 1980s, now seemingly forgotten, showed that IUDs work primarily on inhibition of fertilization rather than implantation effects. Nonetheless, misperceptions regarding the IUDs mechanisms of action persist, with some websites stating IUDs are abortive agents. Do IUDs cause abortion? Let’s examine the evidence.
Jan 17, 2023•22 min
“Placentophagy” is not a new concept. Most non-human mammals eat their placentas after giving birth but humans, historically, have not. Is there evidence to support this practice? Where did this idea come from? How did Rolling Stone magazine help launch this phenomenon back in the 1970s? Is Kim Kardashian onto something cutting edge by advocating for Placental encapsulation? In this episode we will walk through history and learn some pretty remarkable things about this practice. Grab your favori...
Jan 15, 2023•21 min
The American College of Obstetricians and Gynecologists supports the use of both low-dose and high-dose oxytocin regimens to induce and augment labor, but does not specify MAXIMUM DOSE RATES. Most hospitals, however, have protocols that impose a maximum dose rate of oxytocin infusion. Is this evidence-based? Is there a danger with going above a certain threshold of infusion, for example, greater than 20 milliunits/minute? A new publication coming out in Obstetrics and Gynecology (the Green Journ...
Jan 12, 2023•21 min
The ACOG states, “In spite of its unproven value, antepartum fetal surveillance is widely integrated into clinical practice in the developed world”. Antepartum fetal surveillance can be done by a variety of techniques and, despite its unproven value, is a mainstay of obstetrical management. At what BMI should we offer fetal surveillance? Is this current BMI or pre-pregnancy BMI? And what about advanced maternal age? What is recommended for that? Did you know that there was a change in the ACOG w...
Jan 10, 2023•18 min
Breech presentation at term occurs in approximately 3 to 4% of pregnancies. While the vast majority are simply chance events, breech presentation could be a marker of other fetal comorbid conditions. When should ECV be attempted? Does the ACOG recognize neuraxial analgesia as a tool to increase ECV success rates? What’s better spinal or epidural block? What are relative contraindications to ECV? In this episode, we will summarize the latest data on fetal breech presentations and answer key quest...
Jan 08, 2023•33 min
On some current social media channels, there is a hot debate as to why professional medical societies still recommend prenatal folic acid compared to the more “biologically, active” L-methylfolate. Are they onto something here? Published data has shown that anywhere from 40-60% of the general population may have an MTHFR mutation leading to the inability to process folic acid. Should we be screening for this mutation? What about screening for homocystine levels? Are these medical societies incor...
Jan 04, 2023•24 min
Currently on social media, there seems to be an interest in prenatal choline supplementation. Choline, a B vitamin, is not typically within standard prenatal vitamins. Is this micronutrient important for prenatal supplementation? What do professional/medical societies have to say regarding prenatal supplementation? What’s the data? In this episode, we will summarize choline’s role in fetal/newborn development, examine the data regarding deficiency, and talk supplementation recommendations. (Shou...
Jan 02, 2023•30 min
Uterine fibroids are benign tumors that arise from a single genetically altered myometrial stem cell under the influence of gonadal hormones. Traditionally, it has been taught that fibroids universally diminish in size after menopause. However, an article published in 2021 showed a possibility of fibroid growth after menopause in overweight/obese women. Do fibroids need surveillance in menopause? Is HRT contraindicated in the fibroid patient? And which HRT is the most fibroid friendly? We will a...
Dec 28, 2022•25 min
I am a fan of the original hit TV show, “ER”. Although mostly melodramatic and outside of bounds of reality Medicine, one episode (season 6, episode 6) has a valuable life lesson for all of us. I originally viewed that episode when it was live and current, and I have never forgotten the message. In this episode, will discuss this important life lesson learned, and I promise you won’t be the same thereafter.
Dec 27, 2022•14 min
In January 2023, a new publication in Obstetrics and Gynecology- the Green Journal, will highlight the disheartening statements being made on social media (TikTok) regarding IUDs. IUDs are highly effective forms of contraception and the progesterone releasing variety have significant non-contraceptive benefits. Most of the dissatisfaction stated on social media surrounds pain during insertion. Do you offer topical lidocaine for IUD insertion? Ever consider lavender aromatherapy? What about music...
Dec 23, 2022•28 min
Pre-operative vaginal preparation before gynecological surgery has unquestionable benefit for the prevention of postop infectious morbidity. Does the same hold true for vaginal prep at C-section? There has been over a decade of data, but a new publication- soon to be released in AJOG- is calling previous results into question. Does iodine work as a vaginal prep? What about chlorhexidine? There’s answers for all of these questions, and we will summarize them in this episode.
Dec 20, 2022•23 min
Surgical site infection (SSI) is the most common complication resulting from cesarean section. Despite advances in infection control, SSIs remain a significant post-op burden, to the patient first, and to the healthcare system second. Negative pressure wound therapy devices (NPWT) are a potential solution to post C-section. wound infections/complications. Do these devices prevent incisional wound complications after C-section? In this episode, will dive into the data and review the specific CDC ...
Dec 18, 2022•27 min
Traditionally, the CDC has recommended delaying IUD insertion for 3 months in a woman diagnosed with asymptomatic, cervical Gonorrheal or Chlamydial infection. This is to first confirm a negative test of cure. However, this leaves the patient at a greater risk of unplanned pregnancy compared to the risk of PID. Is this really the most evidence-based approach? The CHOICE CONTRACEPTIVE Study data provides an alternative approach. In this episode, we will discuss this dilemma and allow the data to ...
Dec 15, 2022•18 min
In the upcoming (May) 2023 ACOG Annual Clinical Meeting, the College will have a highlighted session to “redesign, prenatal care”. The traditional model of prenatal care includes 12 to 14 in-person visits. However, there is no data that supports the theory that adverse outcomes are reduced by the number of prenatal contact visits. In 2020, at the height of the COVID-19 pandemic, women’s healthcare practitioners became more flexible in how they delivered prenatal care. Now, the ACOG is supporting...
Dec 13, 2022•22 min
Did you know that not all cases of a single umbilical artery (SUA) result in a 2-vessel cord? Some umbilical cords with a SUA still have 3 vessels! How is that possible? Although SUA is only found between 0.2 to 1% of all live births, they can have important clinical implications. Although sonographic absence of other congenital anomalies is very reassuring (isolated SUA), some fetal conditions may not be apparent until time of birth. In the session, we will review the etiology of, diagnosis of,...
Dec 10, 2022•23 min
The ACOG recommends universal screening for gestational diabetes between 24 and 28 weeks of pregnancy with occasional early screening for those at high risk. Is there an advantage to completing the 1-hour 50 g GTT while fasting? First studied in the 1990s, a new publication further validates the original study results. In this episode we will summarize this new publication soon to be released in Obstetrics & Gynecology (the Green journal) and discuss the paradox/conundrum of GTTs while fasti...
Dec 07, 2022•20 min
As I’ve said on previous podcasts, “we all need some encouragement every now and again”. Well this morning I received mine, through a small gift…from Germany!
Dec 06, 2022•2 min
Anti-D immune globulin has been advocated for use in appropriate patients since the 1970s. Historic data showed that 0.1ml of fetal D+ blood was all that was required to potentially sensitize an Rh negative mother. New data is questioning whether this prophylaxis is required in all cases of threatened miscarriage/abortion in early pregnancy, or if a more selective approach is appropriate. In this episode, we will highlight a soon to be released “Questioning Clinical Practice” commentary from Obs...
Dec 03, 2022•21 min
Fragile X Syndrome is the most common inherited form of intellectual disability, and the most common single gene cause of Autism Spectrum Disorder. It is also responsible for some cases of premature ovarian insufficiency. Do you recall the difference between a Fragile X “pre-mutation” versus the full mutation? Should we do universal screening for this as part of expanded maternal carrier testing, or should this be a targeted screening approach? Although we covered maternal carrier screening on N...
Dec 01, 2022•23 min
Marijuana is the most commonly used federally illegal drug in the United States; its use among pregnant and lactating women is on the rise. Is breast-feeding contraindicated with marijuana use? It is difficult to separate marijuana use from several confounding variables, leading to conflicting data in print. Is marijuana use and breast-feeding compatible? A patient friendly article on Parents.com, released on November 23, 2022 seems to imply just that. In this episode, we will review the data on...
Nov 28, 2022•31 min
Several cohort studies and meta-analysis have shown a direct association between poor oral health and adverse pregnancy outcomes. The key driver for this association is systemic inflammation. In this episode, we will review the ADA, ACOG, and CDC data on how maternal oral health can influence pregnancy outcomes. Although this association is pretty strong, remember that association does not necessarily prove causation. We will explain this in this episode.
Nov 26, 2022•29 min
Happy Thanksgiving, Podcast family! As we gather with family, friends, and loved ones… Let’s make the practice of gratitude a daily habit, not some thing that we do just once a year. There is real science on the art and practice of gratitude! In this brief episode, we will remind ourselves that gratitude is not just “something we do” on Thanksgiving, but really should be our way of life. We will cover gratitude’s effect on neurochemistry and it’s activation of critical brain centers. ❤️🦃❤️🦃❤️�...
Nov 24, 2022•16 min
On November 17, 2022 Wimbledon showed a major head nod to women’s health. Do you know what that was? Nonetheless, this recognition of menstruation is just one small move forward, noting that Period Poverty is still widespread right here in the US. In this episode, we will review “Wimbledon, the period, and lack”.
Nov 21, 2022•24 min
