Tuberculosis (TB) was historically called "consumption" due to the dramatic weight loss and wasting away experienced by patients. The modern name "tuberculosis" was first published by J. L. Schönlein in 1832. Today, between 3% and 5% of the U.S. population are estimated to be living with latent TB infection. Contrast that with the worldwide statistics which state that nearly one fourth of the world population has TB infection. In some countries in sub-Saharan Africa and Asia, the annual incidenc...
Jul 19, 2024•40 min
Approximately 0.5% of all births occur before the 3rd trimester of pregnancy, and very early deliveries result in the majority of neonatal deaths and more than 40% of infant deaths. Preterm prelabor rupture of membranes (PPROM) is a known risk factor for preterm birth and is responsible for 30–40% of preterm deliveries. While PROM occurs around 8% of all (term) pregnancies, PPROM occurs around 1% of the time. Periviable birth is delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation. ...
Jul 17, 2024•52 min
Researchers estimate that more than 100 million women in over 120 countries use tampons during their menstrual cycle. Tampons are generally considered safe and healthy menstrual products. However, a new study conducted by researchers at the UC Berkeley School of Public Health has identified the presence of 16 different heavy metals in tampons from 14 different brands purchased in the U.S. and the U.K. This is causing a flurry of on-line commentaries, controversies, and conundrums. Are tampons to...
Jul 15, 2024•34 min
It's Summer…and its getting HOT in here! Although the effect of heatwaves in pregnancy has been studied various times, the data remains limited because these studies are observational, with very heterogenous populations, so its hard to prove causation between heat exposure and adverse outcomes. Nonetheless, these associations are indeed concerning. YES…just to be clear, there are past studies that have observed associations between heatwaves and PTB, low birthweight, and in some studies…stillbir...
Jul 13, 2024•42 min
Up to 1 in 10 reproductive-aged women are impacted by endometriosis. Dysmenorrhea is the most common pelvic complaint of adolescents. While most cases of primary dysmenorrhea in adolescents will be primary dysmenorrhea, Endo remains a possibility especially after 2-3 years of progressive symptoms. Although the true prevalence of endometriosis in adolescents is unknown, at least two thirds of adolescent girls with chronic pelvic pain or dysmenorrhea unresponsive to hormonal therapies and NSAIDs w...
Jul 11, 2024•30 min
Well, sometimes the "traditional", evidence-based recommendations don't have the desired result they are supposed to. When the "usual and standard" ways of doing things fail, its time for "shared-decision making"! In this episode, we will highlight, and give KUDDOS, to an OB care team who exampled thinking outside-the-box in order to care for an acutely ill patient s/p second trimester loss. This is soon to be released in the AJOG, and was released as a journal "pre-proof" July 9, 2024. This is ...
Jul 10, 2024•23 min
RSV season is just around the corner (Fall and Winter months). Newborns are 16x more likely to be hospitalized with serious RSV lung infection than the flu. On August 21, 2023, the FDA approved the first RSV vaccine, Abrysvo, for use in pregnant individuals to protect newborns and infants against severe RSV disease in the first 6 months after birth. The FDA approved the vaccine to be administered between 32 and 36 weeks and 6 days of gestation. Then, on September 22, 2023, the CDC’s Advisory Com...
Jul 09, 2024•39 min
A substantial collection of evidence indicates that the fallopian tube serves as the primary site of origin for a large portion of high-grade serous ovarian cancers. As a result, clinical practice guidelines (including from the ACOG) recommend salpingectomy for permanent contraception- when necessary- rather than simple tubal ligation. But an August 2023 publication, in JAMA Network Open, stated that women who undergo a salpingectomy are no more or less at risk of ovarian cancer compared to trad...
Jul 08, 2024•47 min
Approximately 20% to 25% of pregnancies end in miscarriage, and there are many medical reasons why it may occur. About half are caused by chromosome aneuploidy. However, less than 5% of women will experience a second first trimester loss, and less than 1% will experience three early losses. The incidence of early spontaneous pregnancy loss increases by maternal age. In this episode, we will highlight an ACOG Clinical Expert Series from May 2024, which discussed the evaluation of recurrent pregna...
Jul 05, 2024•37 min
Happy Independence Day, America! We hope you are enjoying this wonderful, national holiday. Yep...Its a PARTY in the USA! In light of the festivities, here's a clinical question for us: Do fireworks affect the fetus? Even broader than that, do loud sounds in general affect the developing child? The answer is both YES and NO. Listen in to this short- yet fun- episode as we prepare to light the night up in celebration of our nation's independence.
Jul 04, 2024•17 min
(Here’s a WONDERFUL QI Project for this New Residency Academic Year) With 70.8% of pregnancies among adolescents being unintended, there is a clear need for increased access to contraceptive services. Many adolescents use the emergency department (ED) as their primary healthcare source, highlighting the importance of providing comprehensive sexual health services in this setting. The risk of pregnancy is high among adolescents seeking ED care, indicating an opportunity to expand pregnancy preven...
Jul 02, 2024•27 min
PROM occurs in approximately 10% of pregnancies and leads to a risk of IAI in women that is 3 times higher than that in non-PROM women. The risk of early-onset sepsis of neonates born to mothers exposed to PROM is 20 times higher than in non-PROM mothers. An increasing time period with PROM increases the risk of infection for both mothers and newborns accordingly. Nonetheless, the ACOG states that there is insufficient evidence to justify the routine use of prophylactic antibiotics with PROM at ...
Jun 30, 2024•36 min
Podcast Family, I hope this episode gives you pause and brightens your day 🌞. Just a quick work and acknowledgement to likley our YOUNGEST podcast family member and his mother, a Co-OBGYN preparing for oral Boards. 👏👏 Let this speak to you as the message spoke to me! (and introducing callmestevieray & Connor Price, whose words/song- “GRATEFUL”- always lightens my load). 🎶👏🎶👏🎶
Jun 29, 2024•6 min
Oral Hormonal contraception gets the blame for a lot of things, including the development of hypothyroidism. Hypothyroidism is one of the most common endocrine disorders affecting 5 to 10 times more women than men, and its prevalence increases with age. This association of OCPs with hypothyroidism comes from a controversial article in BMJ published in 2021, but is still very active in current social media posts. Does combination oral birth control cause hypothyroidism with prolonged use? Are bir...
Jun 28, 2024•35 min
Podcast Fam, on March 27, 2024 our episode was called "Balloon for PROM: Yea or Nay". Although mechanical cervical balloons for induction were the focus, we also discussed which medication is better (based on published data) for labor induction after PROM. Well, in this episode, we pick up from March with ANOTHER NEW STUDY released today (June 25, 2024) in AJOG MFM. This RCT builds on the evidence that going straight to Pitocin (despite an unfavorable cervix) is the way to go after PROM. Althoug...
Jun 26, 2024•24 min
Anxiety disorders are the most common mental health issue in the United States, affecting nearly 1 in 5 adults, or 40 million people. Another 19 million adults – 8% of the population – has depression. Prenatal mood disturbances are known to affect the fetal brain, and endocrine system. Left amygdalar volumes were smaller in newborns whose mothers had high psychological distress during the COVID-19 pandemic, a small cross-sectional study suggested. Infants of mothers with elevated maternal distre...
Jun 23, 2024•34 min
Respect for patient autonomy is a fundamental part of the clinician-patient relationship and discussion of healthcare interventions. Some patients decline transfusion of blood products, either for religious or non-religious reasons, but most frequently as part of the Jehovah’s Witness faith. Acceptance of, and decision-making, surrounding blood products and human blood derived medications is complex, however, and some patients who decline certain blood products may still accept other interventio...
Jun 21, 2024•41 min
"HSDD" as a diagnosis has been gone for some time. According to the ACOG, the DSM-V defines the combined entity of female sexual interest/arousal disorder as a complete lack of or a substantial decrease in at least three of the following symptoms for at least six months: interest in sexual activity and sexual or erotic thoughts or fantasies. This is the most common sexual dysfunction in women, affecting an estimated 5.4–13.6% of women, based on who you read. It is most prevalent in women between...
Jun 19, 2024•44 min
Hypertensive disorders of pregnancy (HDP), including chronic hypertension, gestational hypertension, and pre-eclampsia, are increasingly common in the United States, complicating close to 15% of births, and the incidence is continuing to rise! On this show we have addressed medical management of urgent hypertension in pregnancy and in the immediate postpartum interval. This topic continues to EVOLVE, with a brand new study which has gained a lot of medical news attention. This new study was publ...
Jun 17, 2024•33 min
At time of post cesarean discharge, most providers prescribe a fixed number of opioid tablets. However, past data has shown that most patients don't use all the opioids they are prescribed. This leads to an excess of opioids in the community, which can ultimately lead to misuse and diversion. In this episode, we will highlight a new publication from the Green Journal (Obstet Gynecol) exemplifying an adoptable strategy using a individualized opioid prescribing protocol (IOPP). While this was publ...
Jun 14, 2024•29 min
Podcast Family, this episode has 2 parts: 1. First, a "non-medical" little life lesson that I heard recently which I will share with you...I hope it ENCOURAGES you, and 2. The MEDICAL part, which comes from Paul- one of our podcast family members. Paul had a GREAT question regarding the data covered in our immediate PAST episode on TOLAC....listen in for details!
Jun 11, 2024•24 min
After a primary CS, the decision to undergo trial of labor after cesarean (TOLAC) or schedule a repeat cesarean birth is one in which a patient’s values and preferences should be prioritized in a process of shared decision making. Some clinicians elect to utilize a TOLAC calculator as part of the shared decision-making process, while others use a more generalized counseling approach. Once TOLAC is decided upon, which is better: elective induction at 39 weeks, or expected management? Does electiv...
Jun 10, 2024•26 min
Hemorrhagic disease of the newborn (HDNB) was first identified over a century ago, and presents as unexpected bleeding, often with gastrointestinal hemorrhage, ecchymosis and, in many cases, intracranial hemorrhage. In newborns, HDNB is typically caused by vitamin K deficiency as neonates are innately deficient in vitamin K secondary to very little vitamin K transferred through the placenta to fetuses in utero, limited liver storage of vitamin K, and low amounts of vitamin K in breast milk. IM a...
Jun 09, 2024•36 min
Proving that our podcast tagline, “Medicine Moves Fast” is true… this episode highlights something that is, once again, 🔥🔥🔥 Off the Press! on June 4, 2024, the ACOG released a new Practice Update regarding the determination of paternal and fetal RBC genotyping in pregnancies affected by alloimmunization. This builds upon and updates PB #192 from 2018. There are 3 big areas of change here… And we will highlight each one!
Jun 05, 2024•24 min
June is CMV awareness month. And that’s the keyword there… Awareness! The way we prevent CMV transmission is by awareness. It would be great to have a vaccine against this virus, but we just don’t…yet. Until a safe and effective CMV vaccine is clinically available, primary prevention of cCMV relies on patient education and hygiene measures. In this episode, will take a look at this strategy and see what the data has to say about it. Will also discuss the very controversial (and non-ACOG recommen...
Jun 05, 2024•22 min
In 2011, Congress passed a resolution naming June "National CMV Awareness Month," to raise awareness about the most common congenital infection in the US, affecting 1 of 200 live births. It is the leading VIRAL cause of IUFD & miscarriage & the leading cause of neonatal hearing loss, second only to genetic causes. Furthermore, cCMV is more common than many other neonatal conditions, such as spina bifida and fetal alcohol syndrome. Neonates affected by the virus can experience a wide arra...
Jun 03, 2024•50 min
(VACAY EDITION) Recently in our high-risk OB clinic, I saw a patient who was disappointed that she “had to stop breastfeeding” as she entered her 3rd trimester with her 2nd child. Her first pregnancy was via vaginal birth, at term, with no complications. This situation is not frequently addressed and is a clinical dilemma. First, when nursing coincides with pregnancy, there is frequently a significant cultural taboo leading many women to wean their infants when they become pregnant again. Second...
May 29, 2024•35 min
In our podcast archive, we have an episode titled, “TikToc’s #IUD is Killing a Good LARC”. In that episode, I discussed our protocol of using viscous lidocaine applied topically to the cervix, cervical canal, and coating the IUD device for placement. This works! In this episode, we will build on that concept by reviewing a publication released on May 23, 2024 in the AJOG. Could this be the remedy for painful IUD insertion? Plus, have you heard of the CAREVIX device? Listen in for details.
May 28, 2024•27 min
It definitely is interesting how published data tends to have sporadic “groupings” in print. For example, last week 2 publications were released which could be placed under one “group”: prediction/prevention of spontaneous preterm birth. One publication (AJOG MFM) presented a systematic review and meta-analysis on universal cervical length screening. The second publication, SMFM’s consult series # 70, pertains to the management of a short cervix in individuals without a history of spontaneous pr...
May 23, 2024•32 min
It’s exciting to know that we are practicing a type of medicine that is alive and ever-evolving! Such is the case regarding our clinical practice/management of gestational diabetes. In this episode, we will review brand new (as of May 21, 2024) clinical guidance from the ACOG regarding gestational diabetes. Should we be screening for diabetes before 24 weeks? Is there one diagnostic threshold which is suggested for use over the other (CC versus NDDG)? And is it possible to screen for postpartum ...
May 22, 2024•29 min
