According to the ACOG, pre-labor rupture of membranes (PROM) complicates 10% of all births in the United States and is a major contributor to perinatal morbidity and mortality. What is the best course of action when patients present with PROM with a “unfavorable cervix”? Should it be a pharmacological method of ripening, or a mechanical? What does the data say? In this episode, we will do a deep dive into published data from the 1980s up to 2023. We will also explain why the Bishop score “is irr...
Mar 27, 2024•54 min
Obstetrical vacuum and forceps are incredible tools, when used correctly, to assist vaginal delivery. Appropriately selected and used, they can be pivotal in reducing the number of unnecessary cesareans and potentially decreasing certain fetal and maternal complications. However, there are several pearls of wisdom to remember when using them. In this episode, we will focus on a rare – but potentially fatal – complication of vacuum use: subgaleal hemorrhage. Although subgaleal hemorrhage can occu...
Mar 25, 2024•47 min
Ovarian preservation by autologous transplantation has given hope to patients desiring future fertility after certain gonadotoxic therapies for malignant conditions. But now, the same procedure is being promoted as a “natural cure” for menopause. Can ovarian tissue-based therapies really be the female, endocrine “fountain of youth”? In this episode, we will highlight a recent publication from the AJOG describing the potential of this procedure. We will also discuss the history of ovarian autotra...
Mar 22, 2024•31 min
Since the late 1990s, the standard practice for GDM care has been to measure postprandial glucose values. For patients with pre-gestational diabetes, whether type I or type II, the ACOG recommends multi-level glucose checks (fasting, pre-meal , postprandial, and nighttime). But what about in the immediate postpartum interval? In patient’s with pre-existing diabetes, should blood sugars be checked pre-meal (qAC) or postprandial while still in the hospital, and after discharge? The topic for this ...
Mar 21, 2024•43 min
Is breastfeeding with Hepatitis C safe? The answer: Yes! But confusion persists today mainly surrounding the serum hepatitis C viral load. That’s the topic and focus of the new publication released March 2024 in the Green journal, Obstetrics and Gynecology. We will highlight this new study in this episode. Yep, we have learned a lot about hepatitis C, and HIV, and breast-feeding. In this episode, we will review: the different hepatitis C genotypes and their implications, current breast-feeding g...
Mar 18, 2024•47 min
It has been estimated that up to 4.4% of the US adult population has been diagnosed with ADHD. Use of ADHD medication is increasing among pregnant women. In the last several years, there’s been a litany of publications looking at the effects of pregnancy on ADHD, as well as the effects of medication on the pregnancy. In this episode, we will highlight a new publication released March 2024 (Archives Women’s Mental Health) examining prenatal outcomes in women who continued dexamphetamine in pregna...
Mar 15, 2024•36 min
Four years, the US National Vital Statistics System has reported an abnormally high maternal mortality rate in the United States, showing it to be nearly doubled from 17.4 in 2018 to 32.9 per 100,000 live births in 2021. The United States’s maternal mortality rate has been on the media radar for many years because of this. But that rate is completely WRONG. How is it that maternal mortality rates are more than 2 to 3 times higher than other developed countries despite our vast progress in obstet...
Mar 13, 2024•38 min
The ACOG, CDC, and WHO currently do not recommend universal screening for thrombophilia in the general population before starting oral contraceptive pills. However, a new publication in AJOG (March 2024) is challenging that stance. In this episode, we will review this new prospective population-based study to see if it makes the case for universal screening for thrombophilia variants before starting OCPs. In this episode, we’ll also discuss high-risk versus low-risk thrombophilia, discuss relati...
Mar 10, 2024•52 min
Gestational Diabetes (GDM) is vastly more prevalent in pregnancy compared to pre-existing diabetes. In 2009, the ACOG states that 7% of all pregnancies were complicated by a diabetes diagnosis, with 86% being GDM. The prevalence of GDM keeps rising in the US and globally. Metformin is increasingly prescribed in pregnancy, yet its long-term effect on the neurocognitive development of the offspring remains incompletely described. However, newly published data (March 6, 2024; AJOG) has changed that...
Mar 08, 2024•41 min
On this podcast, we have been following this story of the OPill for several months. Previous episodes on the subject can be found in our podcast library. As expected, this first ever daily use progestin only pill is now available over-the-counter in the US. 👏👏. On Wednesday, March 6, 2024, the ACOG released its Practice Advisory presenting some key reminders for clinicians regarding this new over-the-counter contraceptive option. In this episode, we will summarize this practice advisory and an...
Mar 07, 2024•30 min
Use of second-line noninsulin diabetic medications, like Glucagon-like peptide 1 (GLP-1) agonists and sodium-glucose co-transporter-2 (SGLT2) inhibitors, is rapidly increasing for treatment of T2D and other indications. As these drugs are being used by an increasing group of fertile women, it is expected that a few of them will get pregnant and data on their safety when used in the first trimester is needed. Is periconceptional use of glucagon-like peptide 1 (GLP-1) receptor agonists associated ...
Mar 05, 2024•40 min
Using mechanical options as a way to prime/ripen the cervix for labor is nothing new. Balloon catheters have been used for labor induction as far back as the 1890s. Embrey and Mollison reinvigorated the method in 1967 using it in combination with extraamniotic prostaglandins. Since then numerous studies have been performed worldwide, mostly using the Foley catheter. Then, in 1990, the double balloon catheter was introduced by Atad; this paved the way for the Cook Balloon. But what is the best wa...
Mar 01, 2024•45 min
It’s very important to stay up-to-date and current with new data. But sometimes you read something that is hot-off-the press and it makes you just stop and say, “hmmm”. In this episode, we will discuss the new USPSTF position statement on screening/treating iron deficiency anemia in pregnancy. We will also review the ACOG August 2023 clinical consensus #4 regarding UTI in pregnancy. In doing so, we present 2 things that “make you go hmmm”.
Feb 29, 2024•32 min
The “traditional“ Parkland management protocol for GDM included the immediate initiation of medical therapy for those with abnormal fasting blood sugar, in addition to another additional value, on the 3 hour GTT. These patients were automatically labeled as A2 GDM at time of diagnosis, rather than waiting the 1 to 2 weeks of nutritional/diet therapy. Does fasting hyperglycemia on the 100g GTT truly predict the need for subsequent medical therapy? In this episode, we will summarize new data on th...
Feb 28, 2024•47 min
Yes, the subject of RhoGAM/RHIG administration to RH negative patients under 12 weeks gestational age is a continuously controversial issue. We have covered this issue in past episodes, most recently- last month- on January 4, 2024. Today, February 26, 2024, the SMFM released their position statement on the subject. As you would guess, the controversy continues! In this episode, we will review this brand new, hot off the press, position statement regarding RHIG administration, or avoidance, unde...
Feb 26, 2024•15 min
February 2024 has seen its share of medical and mainstream media stories highlighting hypertensive disorders in pregnancy. While some of this can be considered “old news”, there is “new news” and new developments on the horizon. We have covered hypertensive disorders in pregnancy on several past episodes; however, in this episode, we are going to pick up where we left off and review what the current state of understanding is for AHA/ACC Stage 1 hypertension in pregnancy. Does stage I hypertensio...
Feb 24, 2024•36 min
Hyperemesis Gravidarum (HG) has a reported incidence of approximately 0.3–3% of pregnancies. Without prompt recognition and treatment, severe maternal dehydration, electrolyte abnormalities, cardiac arrhythmias, and potentially altered fetal neurodevelopment may result. Recently, HG made medical and general media news as new data has pinpointed 2 likely culprits of its origin- and neither one is estrogen. In this episode, we will discuss these 2 protein markers, and how researchers are looking t...
Feb 23, 2024•45 min
Women whose fetuses are in the occiput posterior head position at the time of delivery are known to have longer second stages of labor and more complicated deliveries, including more operative assisted births, more 3rd and 4th degree lacerations, PPH, and in some studies lower Apgar scores and lower umbilical cord arterial pH. At what point in labor should the healthcare provider attempt to rotate the fetal head: first stage or second stage of labor? Recent intrapartum studies using ultrasound t...
Feb 20, 2024•47 min
The ACOG has long-held that shoulder dystocia is “unpreventable and unpredictable”. Nonetheless, as it is a devastating obstetrical occurrence, researchers have attempted to identify a reproducible mathematical formula using ultrasonographic, anthropometric factors to better predict it. What is the data behind these math models? Does the ACOG recognize their use? What is their positive predictive value? In this episode, we will examine the data – going back 40 years – and we will end the episode...
Feb 17, 2024•40 min
The ACOG has consistently recommended universal screening for gestational diabetes between 24 and 28 gestational weeks. Although controversial, the ACOG does endorse earlier screening for GDM in patients with additional risk factors. But what about patients who present for prenatal care after the 28th or 29th week? Should screening for GDM be done in the 3rd trimester? And if we do screen in the then, what is the reference range for “normal “or “abnormal”? Is it the same interpretation as when i...
Feb 15, 2024•42 min
On February 6, 2024, a new publication in the Lancet Planetary Health received national and international headlines. This study, funded through the NIH, revealed a striking association between certain chemicals in our environment and preterm birth. But is this data really new? We have known that certain chemical components, called phthalates, have a strong association with preterm birth for over 10 years now. Nonetheless, it is always a good reminder to reduce or avoid exposures to potentially d...
Feb 14, 2024•40 min
YES, it’s true… Not even Super Bowl Sunday 🏈🏈can stop us from getting our podcast episode up and out! In this episode, we will summarize the key findings of a newly released RCT (ahead of print, Obstetrics and Gynecology) that is yet another “nail in the coffin” for late pre-term/early term steroids. This is perfect timing, as we just covered this topic on a separate episode last week. So listen in as we summarize this newly released, triple-blind RCT with eye-opening results.
Feb 11, 2024•21 min
We are still in an opioid crisis. The number of women with opioid-related diagnoses at delivery has increased by 131% over the last several years (CDC, Data and Statistics, 2023). The ACOG has recommended the use of opioid agonist pharmacotherapy for MOUD during pregnancy. Traditionally, medically supervised withdrawal has not been endorsed for pregnancy. However, some patients may elect to discontinue opioid therapy in favor of an opioid antagonist like naltrexone. In this episode, we will revi...
Feb 08, 2024•28 min
It is completely natural, and part of the human experience, to have some anticipatory concern about an upcoming delivery/childbirth. However, when that concern becomes overwhelming, it can develop into a debilitating phobia called Tokophobia. First coined as a term in 2000, there’s been growing awareness of this specific type of anxiety disorder/phobia. Even though it was first described in 2000, this extreme fear of pregnancy and childbirth has, of course, been part of the human experience For ...
Feb 07, 2024•52 min
In 1972, Liggins and Howie published their landmark study on the benefits of antenatal corticosteroids (ACS) regarding their reduction of prematurity’s morbidity and mortality. This led to the weekly administration of ACS until 34 weeks. Weekly courses of steroids are no longer given, but the steroid story keeps evolving. In 2016, the ALPS trial demonstrated reduction in short-term respiratory morbidity when steroids were given in the late pre-term interval. Many professional societies and organ...
Feb 05, 2024•50 min
On January 28, 2021, a non-inferiority RCT was published in the NEJM, “Levonorgestrelvs Copper T Device for Emergency Contraception”. This study concluded that the LNG 52mg IUD was “noninferior” to the CopperT IUD for emergency BC up to 120 hours after ill-protected intercourse. Since that time, use of the LNG 52mg IUS has remained controversial with some organizations endorsing its use as EC while others take a more cautionary stance. Now, as a February 1, 2024, a new commentary in the Green Jo...
Feb 03, 2024•51 min
On January 18, 2024, the FDA cleared a novel new device for osteopenia treatment. This is a vibrating belt (wearable device) that transmits low-amplitude, high-frequency (20 to 40 Hz) vibration to the spine and hips. This belt is called Osteoboost. Osteoboost previously received a breakthrough designation from the FDA in Dec 2020. This FDA clearance has already generated a lot of commentaries regarding the single RCT results. In this episode, we will review the results critically and explain why...
Feb 01, 2024•36 min
Bacterial vaginosis (BV) is the most common vaginal aberrant condition in women, in the general population. Even still, the majority of women with BV are asymptomatic. If BV is found at time of elective IUD/S placement, can the device still be inserted? Or is it an independent risk factor for upper tract infection? What category in the CDC MEC is vaginitis/vaginosis for IUD placement? There definitely is some confusion about this in clinical practice, highlighted by the 3 different clinicians wh...
Jan 30, 2024•32 min
Hypertensive Disorders of Pregnancy (HDP) affect 5 to 15% of women worldwide, and their increasing incidence is likely related to the growing levels of obesity, metabolic syndrome and advancing maternal age. It is widely accepted that women who have preeclampsia are at increased risk of future hypertension, cardiovascular disease, stroke, chronic kidney disease, and even diabetes in later life. But what is the association between HDP and dementia? In this episode, we will review the latest data ...
Jan 27, 2024•32 min
Uterine wall perforation at time of IUD placement has been published to occur, in general, about 1-2/1,000 cases. It happens! While there are some risk factors for uterine perforation (very antiflexed, retroflexed, recent postpartum state, lactating), sometimes uterine perforation can happen even with the best of technique and no risk factors. While most providers are concerned about immediate short-term gynecological complications like infection and bleeding, we don’t really consider the possib...
Jan 25, 2024•53 min
