Today, 9/12/24, the FDA released a SAFETY COMMUNICATION regarding Veozah. As you may recall, we have been following this novel medication since March 2023. This episode is NOT our regularly planned episode- that topic will come out as scheduled tomorrow AM 9/13/24! This is a SPECIAL REPORT episode in response to the FDA's communication released today. Listen in for important information regarding fezolinetnet.
Back in January 2024, we summarized the SFP's position statement on RH IG use (or rather non-use) under 12 weeks IUP gestations. Then, in February 2024, we released an episode summarizing the more conservative stance from the SMFM. Well now, 7 months after that episode, we have a new Clinical Practice Update from the ACOG on this very issue. That is the focus of this episode...and as we have said better, WORDING matters. We will discuss in this episode.
In our last episode we tackled random questions with specific answers. After that episode went live, one of our nurses asked about the value of antibiotics with a Bakri balloon in place. This conversation happened as we were placing the balloon for PPH in a patient on Mag-Sulfate for Preeclampsia with Severe Features. That's antibiotic question is another random question that needs to be answered! So in this episode we will examine the data on prophylactic antibiotics with Bakri balloon for metr...
Welcome to this episode of "Random Questions: Specific Answers"! In this episode we will (surprise) answer random questions- with specific answers- from our podcast family members: 1. Can administration of IV Calcium at intrapartum CS reduce QBL?, 2. What are the 4 classes of CS performance urgency? and 3. If a normal MVP for amniotic fluid is 2-8cm on ultrasound, does an MVP of >8cm still get "2-points" at mBPP or full BPP? Listen in for details!
on 09/02/2024, we released an episode called, "Do SSRIs Raise PTB Risk?". In that episode, we highlighted a new publication from the AJOG (August 30. 2024) which indicated that SSRIs may raise PTB risk. This is in contrast to a separate cohort study released Feb 2024. This is a classic case of "He Said, She Said". But now we have a REFEREE on the field to settle the score. This new systematic review and metanalysis comes from the September 2024 O&G Open release. Listen in for details....
Tubal sterilization goes back to the 1880s. The first collaborative review of sterilization effectiveness was the CREST study published in 1996 in the AJOG. But that was with prior sterilization techniques. As a way to update the data researchers looked at the national survey for family growth (NSFG) from 2002 to 2015 to determine failure rates after more modern methods of tubal sterilization. This was published in NEJM Evidence on August 27, 2024. The results... Surprising! In this episode, we ...
Depressive disorders during pregnancy are common, with estimated prevalence ranging from 11% to 16%. Accordingly, antidepressant drugs, most commonly selective serotonin reuptake inhibitors (SSRI), are used by approximately 3–4% of pregnant women worldwide, with a higher prevalence in the United States compared to Europe. As antidepressants cross the placenta and the fetal blood-brain barrier, exposure during pregnancy raises concerns of potential risks of adverse pregnancy outcomes. On August 3...
Just when we thought we had put coronavirus in our rearview mirror for the most part, here comes mPOX again. We covered that in a previous episode. Unfortunately, that is not the only pathogen to be concerned about. Enter: OROPOUCHE VIRUS (OROV). This virus was first reported in 1955, but it is making news today due to a rapid increase in cases. Coming from the Amazon Basin, and even Cuba, there have been 21 cases in the USA diagnosed in US travelers. This virus is a concern for pregnant women. ...
Polycystic ovary syndrome (PCOS) was first described in 1935 by Irving Freiler Stein and Michael Leo Leventhal at the Central Association of Obstetricians and Gynecologists. Since that time, it has gone through several name changes: Stein-Leventhal syndrome, PCOD, and currently PCOS. Nonetheless, proponents and scientists are still recommending yet another name change for this syndrome, one that better incorporates the multi-metabolic dysregulation that it incorporates. PCOS is not simply a gyne...
Our immediate past episode focused on the “C-section scar pregnancy”. In that episode we discussed the ultrasound markers of early pregnancy (first trimester). Now – today – HOT 🔥🔥OFF THE PRESS- is a new publication in the AJOG, which is “A Lexicon For First Trimester US: Society of Radiologists in Ultrasound Consensus Conference Recommendations“. This consensus statement is through a MOU through the ACR, ACOG, AIUM, SMFM, ASRM, SFP, and the ACEP. For the first time, we have a proposed univers...
Cesarean scar pregnancy (CSP) occurs when an early pregnancy implants on the cesarean scar defect (CSD), myometrial tissue previously disrupted by cesarean delivery. The first case of CSP was reported in 1978 in a patient with a previous cesarean section (CS) who had heavy bleeding and abdominal pain after uterine curettage for a suspected miscarriage at 6 weeks. Eventual laparotomy revealed erosion of a major vessel in the scar sacculus by the products of conception which was successfully oblit...
(DISCLOSURE: Sexual Content) Back in April 2023, we released an episode on the “Jade Vaginal Egg” and vaginal weights for vaginal tightening. While we tackled the Jade Egg successfully, we now have a new player on the field: the VAGINAL TIGHTENING STICK. This over the counter “sex aid” can lead to chemical burns and severe vaginal dryness/agglutination. Marketed to improce vaginal laxity, some of these sticks have the real potential to cause tissue damage and scarring- as one of our podcast fami...
The IUD is a very safe and supremely effective contraceptive method. Given its increasing rate of use, practitioners are bound to see its relatively infrequent complications with greater regularity. Typical complications are considered “lost strings“, uterine perforation at placement, and expulsion. But there is another complication, device FRACTURE at removal. This can cause distress to the patient and can lead to additional interventions. Fracture of an intrauterine device (IUD) upon removal i...
In 1958, James et al. first described umbilical cord blood gas analysis to evaluate the fetus's metabolic condition at the time of delivery. It's recommended by both the British and American Colleges of Obstetrics and Gynecology for all high-risk deliveries. Cord blood gas provides the most accurate and objective evidence of fetal acidosis at the time of birth. Still, there is no universal agreement on when to perform umbilical artery gas analysis, or cord gas, for babies. Some suggest that all ...
According to the National Institutes of Health, almost 13,000 women in the United States are diagnosed with cervical cancer each year, resulting in around 4,000 deaths, with most of the deaths occurring among under-screened women. Now, there is potentially a barrier-breaker. As of August 15, 2024, self-collection kits for cervical cancer screening may be available in doctor's offices and other clinical sites, ready for use. The kits allow patients to collect their own vaginal sample for HPV test...
The rise of home testing for STIs/HIV started long before the recent pandemic (the FDA approved its first HIV home test collection kit way back in 1996), but COVID-19 seems to have accelerated the popularity of getting tested from the comfort of our homes. In Nov 2023, the Food and Drug Administration granted marketing authorization, the first of its kind, for an at-home test for chlamydia and gonorrhea. The test kit, called Simple 2, is available online through various offerings. Chlamydia and ...
The World Health Organization declared on 8/14/24 that the increasing spread of Mpox in Africa is a global health emergency, warning the virus might ultimately spill across international borders. Mpox, also known as monkeypox, was first identified by scientists in 1958 when there were outbreaks of a “pox-like” disease in monkeys. Until recently, most human cases were seen in people in central and West Africa who had close contact with infected animals. In 2022, the virus was confirmed to spread ...
On July 26, 2024, Boar’s Head issued its recall of 7 million pounds of ready-to-eat meat and poultry products that might be contaminated with the potential harmful bacteria, listeria. Sporadic listeria outbreaks are nothing new; in June 2024, chicken-based products were recalled for the same concern in Canada. The US recall includes more than 70 products — including liverwurst, ham, beef salami and bologna. Listeriosis is reportable to the local health department of the county in which the patie...
Our tagline, “Medicine moves fast“, is the absolute truth! Historically, identification of fetuses at risk of hemolytic disease of the fetus/newborn (HDFN) required amniocentesis for determination of the Delta OD450, Liley Curve. This was the first screen, which would then trigger cordocentesis for determination of the fetal hematocrit. We’ve now moved on to middle cerebral artery (MCA) doppler of the fetus for identification of those at risk. Additionally, we now have an ability to ascertain an...
Prior to the 1970s, when component therapy became the preferred method of resuscitation, whole blood (WB) was the resuscitative medium of choice for hemorrhagic shock. In modern medicine, sometimes it turns out that the old way is better than the new…and using whole blood for transfusions is one example. Research is emerging that shows whole blood works better for these patients than fractionated components of blood. Beginning in 2017, multiple stakeholders within the Southwest Texas Regional Ad...
MEC CHANGES ARE HERE! During January 2022, the CDC held virtual scoping meetings that included 27 participants with expertise in contraception, adolescent health, and thrombosis, as well as representatives from partner organizations, to solicit their individual input on the scope for updating both the 2016 U.S. MEC. The 27 invited participants represented various types of health care providers and health care provider organizations. This led to a subsequent expert meeting held during January 202...
In May 2023, the FDA approved fezolinetant (Veozah), an oral medication that's the first neurokinin 3 (NK3) receptor antagonist to treat moderate to severe hot flashes caused by menopause. Now, a separate oral medication which blocks the NK 1 and 3 receptor iis on the scene. Although not yet FDA approved, the published phase 1, 2, and 3 data make this approval very likely. Bayer, the manufacturer of elinzanetant, has just submitted a New Drug Application for its approval. In this episode, we wil...
Artificial Intelligence (AI) has arrived. Machine Learning is a form of AI which is being investigated/used for improving maternal outcomes. The UK has already launched the TOMMY APP (through the RCOG) for use to reduce PTB and stillbirths in the UK. In this episode we will highlight a new systematic review which assessed Machine Learning’s ability to predict stillbirth. Did this work? This is a hot topic, especially since the passage of the Maternal and Child Stillbirth Prevention Act here in t...
We all are aware that multiple adverse obstetrical outcomes have been linked to maternal obesity, such as stillbirth, preterm birth, NICUs admission, and congenital anomalies. But once delivery and hospital discharge occurs uneventfully, a new cohort study is raising the alarm for another possible adverse event up until the child’s first year of life: Sudden Unexpected Infant Death (SUID). SUID is devastating. In this episode we will review this new publication, which is making medical headlines...
Our immediate past episode summarized a validation study of cell-free DNA (cfDNA) isolated from maternal plasma for fetal RBC genotyping in alloimmunized patients. And now, in this episode, we will highlight a BRAND NEW ACOG Clinical Practice Update on this very subject! YEP... we now have new ACOG guidance regarding using maternal derived cfDNA for fetal RBC antigen detection as an option for care in alloimmunized pregnancies. This is how "medicine moves fast"! Listen in for details.
In September 2022, a cell-free DNA assay using next-generation sequencing and quantitative counting tech for fetal antigen status determination became clinically available in the USA. This allowed maternal screening for fetal RBC genotypes for RH negative patients. This test was recognized by thre ACOG in March 2024 as one option to “triage” anti-D immunoglobulin in RH negative women. But can this technology be trusted in alloimmunized patients? In women with antibodies against foreign antibodie...
First off, let’s all agree that everyone has a different STYLE of sexual intimacy, and that’s OK. Yep, we all understand that there's always been a lot of sexual act “diversity” in the world… and throughout history. But there is a more recent trend that has increased in popularity, some surveys attribute it to its representation in pornography, that may be dangerous. This was in recent print as of July 3, 2024! This is "sexual choking”. But this term is not accurate because it actually is a form...
Candida in women is being right? Afterall, vulvovaginal candidiasis during pregnancy is common. Candida species may be isolated from the vagina of 15 %-21% of nonpregnant women; this rate increases to 30% during pregnancy. While it is generally benign and isolated to the vagina clinically, some Candida species have the capacity to be troublemakers. C. Glabrata has the potential to be a bad player, with the possibility of invasive disease. Candida IAI is rare but can lead to neonatal infection, h...
Biomarker testing has arrived in Obstetrics. Of course, we have been using some biomarkers for years, like PAMG1 (Amnisure) and AFP+ILGFBP1 (ROM Plus) for ROM evaluation. In May 2023, the FDA cleared Thermo Fisher Scientific's maternal serum biomarker test for prediction of preeclampsia with severe features in hospitalized patients (and we have a prior episode on that). Now, as of July 9, 2024, published data has arrived for a new maternal serum biomarker ratio for the prediction of preterm birt...
Published studies, including 2 large network meta-analyses, support the safety and efficacy of misoprostol (PG E1) when used for cervical ripening and labor induction. Based on cumulative data, misoprostol administered vaginally at doses of 50 μg has the highest probability of achieving vaginal delivery within 24 hours. Prostaglandin E2 also has proven efficacy. Plus, we are all aware of the safety and efficacy of mechanical methods of cervical ripening; yes…we know that these options may be use...
