Oh, the ever evolving drama of “progesterone in high risk obstetrics”. Today, April 13, 2023, the SMFM released its Special Statement response to the recent change in the progesterone PTB prevention landscape. Where does cerclage fit in? In this episode we will summarize the current recommendation for cerclage for preterm birth prevention and how it fits in to the vaginal progesterone story. Is cervical ultrasound surveillance after vaginal progesterone initiation warranted? We will make it clea...
Apr 13, 2023•10 min
We have come a long way in our understanding regarding the safety of intrauterine contraception. Once withheld from adolescents and immediately postpartum patients, the safety in both populations is now well established. Postpartum IUD/IUS placement is a balance between risk of expulsion and patient loss to follow up. In this episode, we will summarize a new RCT from JAMA discussing this very subject. Is it better to place immediately Postpartum, at 2 weeks after delivery, or as an interval proc...
Apr 12, 2023•25 min
This episode is in reply to one of our fantastic podcast family members who had some wonderful clinical questions regarding dosage of combination BC after listening to our past episode. In our immediate past episode, we discussed hypoestrogenemic symptoms on ultra low-dose pills in certain patients (young, thin). Is a 20 µg BC pill less thrombotic than a 30 or 35 µg pill? What does the data say? In this episode will answer this question and also dive deeper into serum estradiol levels not only w...
Apr 10, 2023•26 min
In 1972, a publication in which a radioimmunoassay measured serum estradiol levels in participants taking oral combination birth control concluded that levels of serum estrogen were “sufficient to prevent symptoms of estrogen deficiency”. Knowing NOW what we do, and looking back to that article, those authors’ conclusions were completely incorrect! Is it possible for a patient to experience hypoestrogenic symptoms despite taking an estrogen containing birth-control? What are normal, endogenous e...
Apr 08, 2023•20 min
Here’s proof that our catchphrase, “Medicine Moves Fast“ is 100% true! On October 30, 2022, and again on November 1, 2022, we released episodes on “Dense Breasts on MMG? What to do?”. Those episodes were in response to Katie Couric’s public outcry for the need for additional screening at time of mammogram in the setting of dense breasts. On March 9, 2023, the FDA issued a new ruling/guidance on patient notification of breast density at screening mammogram. And now, in April 2023, the ACOG has re...
Apr 07, 2023•10 min
A quick update and commentary on the recent (April 6, 2023) FDA decision to withdraw approval of Makena for preterm birth prophylaxis.
Apr 07, 2023•8 min
Pregnancy causes some well-known and well documented physical changes to the body. While hyperpigmentation, breast enlargement, and increase in vaginal discharge are non-disputed physical changes during pregnancy, other effects on mental capacity (memory and cognition) are more controversial. Does “mommy brain” really exist? Or is it a fulfilled psycho-social expectation? Does pregnancy actually change the brain? In this episode, we’ll present the data and provide some practical tips at the end ...
Apr 06, 2023•28 min
For a patient who presents after an episode of unprotected sexual intercourse, seeking testing for STIs, it’s important to know when to perform the test. The time between infection and a positive test is called the testing window. This testing window can be different for different pathogens. In this episode, we will review the importance of knowing this testing window, and we will also review the differences between pathogen inoculation, incubation/latency, and their overlap with the testing win...
Apr 04, 2023•24 min
Von Willebrand Disease (VWD) is the most common inherited bleeding disorder among American women, and it may present with a history of mucocutaneous bleeding patterns. Ideally, women should be screened/identified with this condition prior to pregnancy- but that is not always the case. How does VWD affect delivery? Is this a cause of immediate PPH? In this episode we will review the clinical manifestations of VWD in pregnancy. We will: 1. review appropriate labs tests for this evaluation, 2. summ...
Apr 02, 2023•28 min
For women’s healthcare, there are 3 ways to screen for genital GC, chlamydia, and trichomoniasis: 1. vaginal swab, 2. endocervical swab, or 3. first-catch urine. The CDC states that, “For female screening, specimens obtained with a vaginal swab are the preferred specimen type. Vaginal swab specimens are as sensitive as cervical swab specimens.” Why does it not favor urine screening? Although acceptable at a POPULATION level, there are several caveats to urine screening for STIs at an INDIVIDUAL ...
Mar 31, 2023•20 min
We have come a long way in our understanding of the “Stein and Leventhal Syndrome”. First described in 1935, our understanding of the pathogenesis and future health morbidities of PCOS has grown exponentially. We now know that AMH levels may help in the certain PCOS diagnoses. At the center of this clinical condition lies insulin resistance (IR). One of the manifestations of IR is Acanthosis nigricans (AN). (But AN can also be a marker of a much more deadly condition.) It is important to remembe...
Mar 29, 2023•36 min
The rate of vegetarianism in the United States is dramatically on the rise. While in 2014, a national survey found that only 1% of the US population considered themselves vegetarian, current estimates put that number up to 6%. But not all vegetarians are the same. Is being a strict vegetarian (a.k.a., vegan) associated with any adverse perinatal outcomes? Does being vegan increase your risk of preterm birth? In this episode, we will cover the latest data on how diet can affect perinatal outcomes...
Mar 26, 2023•29 min
Traditionally, fetal growth restriction (FGR) was diagnosed when the Hadlock EFW was < 10th percentile. However, in 2020, SMFM updated its publish guidelines endorsing the use of an isolated abdominal circumference (AC) under the 10th percentile as an additional diagnostic criterion. Is the isolated small AC linked to adverse perinatal outcomes? And what are the delivery recommendations for an isolated small AC? It’s a complicated issue with complicated data. In this episode we will provide t...
Mar 26, 2023•30 min
Our current discipline of obstetrics owes a lot to the practice of Midwifery. In a previous episode, we covered “lessons learned from Midwifery” and that is available on our podcast archive. In this episode, we will discuss the data regarding a practice originally propagated by Midwifery: the Birthing Ball. What is the origin of this, and how did it make its way into obstetrical practice? Is there data for it’s use? Does it really help reduce labor pain? In this episode we will summarize the dat...
Mar 24, 2023•18 min
Gerri, thank you for your voice message today! Welcome to our podcast family. Here’s some helpful notes for you. 😊😊
Mar 22, 2023•4 min
In Oct 2006, the ACOG released Opinion Number 346. This stated that “Based on current literature, routine prophylactic amnioinfusion for the dilution of amnioinfusion for meconium-stained amniotic fluid should be done only in the setting of additional clinical trials”. Back then, some experts criticized the decision to abandon amnioinfusion for meconium based on the limitations of the 2005 study which helped to motivate the ACOG decision. And now, a new systematic review and meta-analysis (publi...
Mar 20, 2023•22 min
Infertility. It’s real. It affects 10-15% of couples in the US. After a thorough investigation, 30% of couples will be left without an identifiable cause for their infertility. This has been termed unexplained infertility. While traditionally this may have been considered a reassuring result, new data is raising the yellow flag of caution in these patients. Research has now established the link between infertility and some potential future negative health outcomes. As “next generation“ genetic t...
Mar 18, 2023•25 min
Such a small gland… Yet so much confusion, and controversy: the THYROID gland in pregnancy. Let’s start with this foundational question: should we universally screen for thyroid abnormalities in pregnancy? And as a follow-up question, should we be checking for anti-thyroid antibodies? The answer to both of those queries depends on who you ask! In this episode, we will solve the conundrum of whether we should be screening for anti-thyroid antibodies pre-pregnancy and/or during pregnancy itself. D...
Mar 14, 2023•22 min
The traditional explanation and assumed pathophysiology of HELLP syndrome stated that it was a late manifestation/further progress of preeclampsia with severe features. But can HELLP present clinically without hypertension? What about without proteinuria? If a patient has lab criteria of HELLP alone, without hypertension, does she still require magnesium sulfate? In this episode, we will summarize data from 3 sources (ACOG practice bulletin on thrombocytopenia, ACOG practice bulletin on gestatio...
Mar 11, 2023•21 min
The pathophysiology of menopausal hot flashes has remained largely a mystery until about a decade ago when KNDy neurons were found to be the key triggers of the hot flash. Since then, research and development has been going fullsteam to develop a non-hormonal, receptor-based therapy for the common hot flash. In April 2023 in the journal, Obstetrics and Gynecology (the Green Journal), new safety data will be published on the revolutionary new medication, Fezolinetant. With Phase 3 study results a...
Mar 09, 2023•19 min
The fetal NST is a hallmark of antepartum fetal surveillance and a key component of the BioPhysical Profile (BPP). Historically, and still done today, one of the low-risk interventions for rectifying a non-reactive NST has been the maternal administration of glucose/PO challenge. Is this evidence-based? Does maternal hypoglycemia contribute to a nonreactive NST? In this episode, we will review the data spanning a 40-year interval that has sought to answer this question. And what about fetal move...
Mar 07, 2023•28 min
The Liggins and Howie trial demonstrating the benefit of antenatal corticosteroids (ACSs) on fetal lungs was published in 1972 in the journal Pediatrics. First adopted as weekly injections, ACSs were then found to be associated with decreased birth weights and decreased head circumferences. Hence, weekly administration was abandoned in the late 1990s. But the ACOG/SMFM does still recognize a single repeat dose “based on clinical scenario”, called a rescue dose. Is a rescue dose of steroids assoc...
Mar 05, 2023•23 min
This is a brief update regarding our recent podcast on “the French C-section”. Having an Israeli member of our podcast family…is priceless! ❤️Listen to the latest development regarding the extraperitoneal C-section in Israel and how this situation bears similarities to the US approval of ADDYI in 2015. Thank you Liel N.!! 😊😊
Mar 03, 2023•9 min
In 1999, the CDC had a national plan of action to “completely eliminate syphilis” by the year 2005. Although rates of syphilis did dramatically decrease to record lows during that time, we are now experiencing record HIGH rates of congenital syphilis. Some states are having a close to 500% increase in congenital cases. How did we get to this point? In this episode, we will review and summarize 3 key recent publications regarding the rise of congenital syphilis (Journal Women’s Health Issues [Els...
Mar 03, 2023•32 min
The historic saying is, “there is nothing new under the sun”. So true! Such is the case with the extraperitoneal C-section. First advocated in 1823 by French obstetrician, Louis-Auguste Baudelocque, this complex technique fell to the waste-side with the advent of antibiotic availability. But now, this extra-peritoneal cesarean technique, A.K.A. the "French AmbUlatory Cesarean Section" technique (FAUCS), is trending on social media. Is this safe? Does this have any advantage over a traditional C-...
Mar 01, 2023•21 min
The “cure” for preeclampsia is NOT delivery. Preeclampsia is an important signal for future cardiovascular complications once pregnancy is over. While there may not be a true “cure”, we do have options for chemoprophylaxis of preeclampsia. Currently, only low-dose aspirin is ACOG/SMFM endorsed for preeeclampsia prevention. But pravastatin is gaining steam. Pravastatin was previously classified (in the now discontinued FDA label) Category X. However, the FDA recently removed the warning regarding...
Feb 26, 2023•20 min
Some obstetrical publications discuss adverse perinatal outcomes based on a short interpregnancy interval (IPI). A separate, yet related topic, is a short interdelivery interval (IDI). Most obstetrical care providers are aware of the adverse obstetrical outcomes following a short IPI. However, short IPI has also been linked to adverse neurodevelopmental disorders in the child. Are repeat fetal growth ultrasounds indicated in a pregnancy following a short IPI? Is antepartum fetal surveillance ind...
Feb 25, 2023•24 min
In 2018, the ACOG recommended immediate induction of labor/delivery for patients with PPROM, who had sure gestational dating, and were at 34 weeks and 0 days or more. This was in order to reduce the risk of neonatal sepsis. This changed, however, in 2020 with ACOG Practice Bulletin 217 which discussed expected management for PPROM in the late preterm interval. Nonetheless, as is our tagline for this podcast, “medicine moves fast”. In February 2023, a current commentary was published in BJOG addi...
Feb 23, 2023•22 min
As part of our medical training and education, we often learn diagnoses in isolation. For example, we have learned that Proliferative Endometrium on EMB is a non-pathological finding. That result can be left alone without therapy, correct? But what if that is found in the context of a postmenopausal patient. Is it still considered a nonpathological finding? In this episode, we will summarize the current nomenclature for endometrial pathology and why one classification scheme is favored over the ...
Feb 20, 2023•21 min
Marginal cord insertions can be found on antenatal ultrasound. What is the data regarding marginal cord insertion and adverse neonatal outcomes? Is there a relationship, or is this a benign finding? Are serial growth ultrasounds recommended? What about antepartum fetal surveillance for isolated marginal cord insertion? In this episode, we will review the latest data on pregnancies with marginal cord insertion. We will end the episode with a summary of the expert opinions regarding best practice ...
Feb 19, 2023•21 min
