On December 13, 2022, we released an episode describing a new concept in prenatal care, called the PATH model. This was to “redesign” prenatal care, as needed, for those who may have limitations for the “traditional” model of prenatal care visits. Well, what we covered 2.5 years ago is NOW an OFFIICAL guidance from the ACOG and will be out in May 2025. Similarly, the SMFM released their vision for redesigned maternal care teams on 16 April 2025 (J Pregnancy). We will BRIEFLY summarize these 2 pu...
Apr 19, 2025•18 min
Pelvic congestion syndrome is a controversial entity that does not currently have validated diagnostic criteria. In the ACOG PB 218 (2020), it states, “Pelvic congestion syndrome is a proposed etiology of chronic pelvic pain related to pelvic venous insufficiency. Although venous congestion appears to be associated with chronic pelvic pain, evidence is insufficient to conclude that there is a cause-and-effect relationship. In addition, there is no consensus on the definition of this condition, a...
Apr 17, 2025•43 min
On Monday April 7, 2025, the UK’s publication The Guardian wrote, “Surgeons are hailing an ‘astonishing’ medical breakthrough as a woman became the first in the UK to give birth after a womb transplant. Grace Davidson, 36, who was a teenager when diagnosed with a congenitally absent uterus, said she and her husband had been given ‘the greatest gift we could ever have asked for’. Grace’s sister donated her own womb during an eight-hour operation in 2023. Davidson said she felt shocked when she fi...
Apr 14, 2025•35 min
On March 19. 2025, The American College of Clinical Pharmacy published, "A review of antibiotic safety in pregnancy- 2025 Update". In this episode, we will review some of the confusion surrounding aminoglycosides, sulfa, and nitrofurantoin in pregnancy. Its interesting how different professions view certain medications in pregnancy. Does ACOG say you can use Sulfa in the third trimester? Can you use nitrofurantoin in the first trimester? Listen in for details. (SHOUT OUT to our partner podcast, ...
Apr 11, 2025•31 min
Well Podcast Family, in this VERY BRIEF episode, we will highlight a patient's perspective on IUS insertion with lidocaine jelly pre-insertion prep. As we have stated in past episodes, I am a BIG ADVOCATE of lidocaine jelly for IUD/IUS insertion. This patient agreed to share her experience of the EASY BREEZY IUS placement. (NOTE: HIPAA protected, patient agreed to participate in this episode).
Apr 10, 2025•4 min
Animal bites in humans are a common problem in the United States, with two to five million occurring each year. The vast majority of animal bites are caused by dogs (85 to 90 percent), with the remainder caused by cats (5 to 10 percent) and rodents (2 to 3 percent). Children are bitten more often than adults. The most feared complication of an animal bite is rabies, although skin infection is the most common complication. In our community high risk clinic, we recently saw a pregnant patient, who...
Apr 09, 2025•32 min
VVC is second to BV in vaginitis type, here in the USA. data indicate that 75% of women have experienced at least one episode of genital candida throughout their lives . VVC is currently classified as uncomplicated (sporadic infection with mild-to-moderate clinical symptoms in non-immunocompromised women) or complicated (recurrent or clinically severe infection that eventually affects immunocompromised women or is caused by non-Albican species). What is the best course of action for these patien...
Apr 04, 2025•37 min
Postural Orthostatic Tachycardia Syndrome (POTS), first described in the 1940s, is a heterogeneous and often debilitating condition affecting the autonomic nervous system, estimated to affect between 0.3% and 1% of the U.S. population. Its incidence is believed to be rising among people with a prior COVID-19 infection, as a likely component of so-called long COVID. The condition is characterized by chronic orthostatic intolerance in the absence of orthostatic hypotension manifested as excessive ...
Apr 02, 2025•43 min
Hematuria remains one of the most common urologic diagnoses, estimated to account for over 20% of urology evaluations. Women with hematuria have been especially prone to delays in evaluation, often due to practitioners ascribing hematuria to a urinary tract infection (UTI) or gynecologic source, resulting in inadequate evaluation and delay in cancer diagnosis. In this episode, we will review the recently released joint guidance form the AUA and SUFU regarding microhematuria. What defines this co...
Mar 31, 2025•37 min
HOT HOT HOT Off the News CycleL The FDA has just approved (1 hour ago) a new at-home STI test kit. Does this work? What is the data on accuracy? What does this test for? This is a developing story... Listen in for details!
Mar 28, 2025•16 min
Metabolic syndrome (MetSyn) is a cluster of conditions, such as increase in waist circumference, dyslipidemia (elevated triglyceride levels and reduced HDL), increased blood pressure, and increased fasting blood sugar levels that is related to insulin resistance, diabetes, and elevated risk of cardiovascular disease. Women with PCOS have a significantly higher prevalence of metabolic syndrome (MetS) compared to the general population, with studies indicating a prevalence of around 43-47% in PCOS...
Mar 28, 2025•33 min
Throughout their lifetime, over 50% of women experience uUTIs, with recurrent infection reported in approximately 30%. Today, on March 25, 2025, the FDA approved a new first-in-class oral antibiotic for uncomplicated UTIs in women! This is Blujepa! In this episode, we will review the EAGLE clinical trial data and review the main side effects reported in the study population. How does this new antibiotic work? Will it be approved for pregnancy? And, what other genital condition could it likely be...
Mar 25, 2025•20 min
Medicine has traditionally been practiced “in silos”. But compartmentalization of medical practice/interventions can leave gaps in patient care. Patients win when they have increased access to a variety of medical therapies or contraceptive options. In this episode, we will review a brand new publication (released ahead of print) from the AJOG. We've decided to call this episode, “Internists, IUDs, and Inspiration”. Listen in for details.
Mar 24, 2025•28 min
TWICE BEFORE, we have covered Pitocin use intrapartum: 1. On Oct 24, 2022 we covered, “Save the Pitcoin! Safe to Stop Pit Once in Active Phase?”, and 2. On Sept 24, 2024 we covered, “Labor Hacks: Pit Breaks”. Nonetheless, today's episode yet again focuses on pitocin in labor. On March 18, 2025, a new systematic review and meta-analysis was released ahead of print in the AJOG. This looks at cesarean delivery rates with discontinuation of pitocin in the active phase. Although the title of this new...
Mar 21, 2025•38 min
Fresh off the heels of our immediate last episode, we bring you a perspective from the trenches! Sarah, a Clinical Pearls podcast family member, is a health professional who works with autistic individuals. Sarah has provided clear and evidence-based data which helps to explain the rise of autism in the US over the last decades. Our podcast community is Incredible! Her noted and data driven perspective are the core concepts highlighted in this episode. Listen in for details.
Mar 20, 2025•24 min
Autism Spectrum Disorder (ASD) has an alarming trend of rise in the US. Currently, 1 in 36 (or 1 in 40 in some reports) have an ASD diagnosis. For this reason, ASD remains in the spotlight as researchers remain dedicated in explaining its origin. Over the last few years, there have been publications suggesting a link between one of the most common symptoms of pregnancy (nausea and/or nausea together with vomiting) and autism spectrum in the child. This is obviously a point of concern for those s...
Mar 19, 2025•32 min
Fasting during the lunar month of Ramadan (Feb 28 to March 30, 2025) is a core practice for Muslims across the world. During Ramadan, Muslims abstain from food and drink from dawn to sunset. However, during a singleton pregnancy, the ACOG recommends adding approximately 340 extra calories per day in the second trimester and 450 extra calories per day in the third trimester. Does fasting during Ramadan have negative perinatal outcomes due to the potential caloric restriction? In this episode, we ...
Mar 14, 2025•31 min
Infants born by vaginal birth are exposed to maternal vaginal bacteria, which are one of the contributing influences on the subsequent development of the infant’s microbiome. This process is altered by cesarean delivery, which changes the initial microbiome of the neonate. It is theorized that infants born by cesarean delivery have an increased risk of chronic inflammatory conditions due to altered early-life microbiome colonization, with associated aberrant immune and metabolic development. Vag...
Mar 13, 2025•38 min
On Feb 24, 2025, the FDA granted approval for MIUDELLA®, a hormone-free, low-dose copper IUD developed by US manufacturer Sebela Women's Health Inc (Georgia) for contraceptive use in females of reproductive potential for up to 3 years. MIUDELLA® utilizes a small, flexible nitinol frame and contains less than half the copper of currently available copper IUD. Where have we seen nitinol before?? How does this compare with the traditional ParaGard IUD? Can this be used for emergency contraception? ...
Mar 10, 2025•44 min
BV is a vaginal dysbiosis resulting from replacement of normal hydrogen peroxide and lactic-acid producing Lactobacillus species in the vagina with high concentrations of anaerobic bacteria. Recurrent BV can occur in 50-70% of women after an initial diagnosis. The concept of treating the male partner for BV recurrence prevention is not new, and the results have been conflicting. However, a new publication from Australia (released 03/5/25, in NEJM) has sparked new interest and new conversations a...
Mar 07, 2025•36 min
Thank you to our GREAT podcast family members who fixed by history regarding "Hollyweird" ! And thank you DANNY Thomas for your legacy at SJCRH. Go Memphis!
Mar 06, 2025•4 min
Screening for spinal muscular atrophy (SMA) should be offered to all women who are considering pregnancy or are currently pregnant. SMA is an autosomal recessive disease characterized by degeneration of spinal cord motor neurons that leads to atrophy of skeletal muscle and overall weakness. Once identified, oral therapy may be started in the neonatal interval for those with the most severe phenotype (SMA-1). However, on Feb 19, 2025, a medical team piloted an investigational PRENATAL protocol as...
Mar 06, 2025•28 min
Vitamin D gets a lot of attention, and it should, mainly for its known role in bone stability. However, vitamin D has significant additional roles in physiology. Vit D, and its metabolites, also functions as modulator of inflammatory and immune responses. According to a number of recent studies, this important micronutrient plays a complex role in numerous biochemical pathways in the immune system and disorders that are associated with them. In pregnancy, the association of Vit D deficiency and ...
Mar 03, 2025•37 min
According to published estimates, the prevalence of an NSAID allergy (hypersensitivity) in the general population is estimated to be between 0.5% and 2%, with some studies reporting a range of 1-3% of people experiencing a reaction to NSAIDs; however, this rate can be significantly higher in individuals with conditions like asthma, nasal polyps, or chronic urticaria, where it may reach up to 20-30%. Genetic and epigenetic backgrounds are implicated in various processes of NSAID-induced hypersens...
Feb 28, 2025•27 min
Its BACK. While the current outbreak is in western Texas and Eastern NM, it is expected to spread to other States. Measles is an acute viral respiratory illness characterized by fever, malaise, cough, conjunctivitis, a pathognomonic enanthema (oral lesions), followed by a maculopapular rash. In pregnancy, this could lead to significant maternal and fetal morbidity. What are Koplick Spots? What is the "Rule of 4" with measles, and what is important about the number 10? Listen in for this QUICK RE...
Feb 24, 2025•23 min
The ACOG's PB 205 (2019; reaffirmed Aug 2024) states that "when compared with spontaneous labor, induced labor is associated with a lower likelihood of achieving VBAC". Additionally, that guidance states, "Several studies have noted an increased risk of uterine rupture in the setting of induction of labor in women attempting TOLAC". These are important observations to review with a patient. However, according to a study soon to be published in March 2025, based on US Vital Statistics birth certi...
Feb 22, 2025•22 min
Funic presentation, the umbilical cord presenting as the leading feal component seen on ultrasound, may be a transient phenomenon and is usually considered insignificant until ~32 weeks. However, its persistence beyond that gestational age raises the possibility of cord prolapse intrapartum as cervical dilation progresses. Cord prolapse is a mostly unpredictable obstetric emergency, in which the umbilical cord comes through the cervical os in advance of (overt prolapse – usually palpable or even...
Feb 20, 2025•31 min
One in five women in the U.S. have a BMI of 30 or more at the START of pregnancy. Around 1 in 5 women gain more than 40 pounds during pregnancy, which is more than any woman should gain. Only about one-third of women gain the recommended amount of weight during pregnancy. Gaining too much weight during pregnancy can increase the risk of HDP, GDM, fetal macrosomia, and can cause complications of birth, such as shoulder dystocia or preterm birth. Excessive weight gain during pregnancy can also inc...
Feb 17, 2025•30 min
Estimates of Postpartum Urinary Retention (PUR) incidence vary widely from 1.5% to 17.9%, with undiagnosed cases making the true incidence difficult to determine. A postvoid residual (PVR) volume of <150 mL is typically considered appropriate for normal bladder emptying, but this has been in the nonpregnant/non-postpartum population. In this group, some have proposed a PUR of up to 500ml as normal! That protocol, using the 500ml cut off, was just recently published in the J Matern Fetal Neona...
Feb 15, 2025•35 min
In 2013, The ACOG’s Hypertension Task Force suggested that NSAIDS not be used in postpartum patients with hypertensive disorders of pregnancy due to theoretical concerns on BP aggravation. But “medicine moves fast”. In 2020, the ACOG “green lighted” ibuprofen use postpartum in these patients if no evidence of renal insufficiency was present. In episode, we will review a brand-new publication (soon to come out), in AJOG, released ahead of print on February 10, 2025. This study is a randomized tri...
Feb 12, 2025•24 min
