Dr. Chapa’s ObGyn Pearls.

Dr. Chapa’s ObGyn Pearls.

By Dr. Chapa’s ObGyn Pearls.
Relevant, evidence based, and practical information for medical students, residents, and practicing healthcare providers!
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COVID-19 (MOC Summary) and Pregnancy Data (Preliminary)
On February 14, 2020, the ABOG released a “double credit“ article for MOC credit, on the global alert of the novel viral outbreak. Originally called 2019-nCoV, the 2019 Novel,Chinese Coronavirus is now called COVID-19. In this session, we will highlight/summarize the CDC current update and clinical guidance as released by the ABOG. We will also summarize the February 12, 2020 Lancet retrospective review of nine pregnant patients with COVID-19 pneumonia. Although this brief retrospective review has several obvious limitations, it adds to the ever evolving data on the subject.
16:59
February 16, 2020
Cannabis Induced Hyperemesis
Cannabinoid Hyperemesis Syndrome: Although widely recognized in the gastroenterology and psychiatry literature, its occurrence in pregnancy is well known. The pathophysiology of this condition is not well known but potential MOAs have been published. How does this present? And what do “hot baths“/“hot showers“ have to do with his condition? In this podcast we will review this interesting and intriguing condition specifically as it relates to pregnancy.
11:14
February 11, 2020
ORAL SEX! (and HPV)
In 2013, actor Michael Douglas blamed frequent oral sex with his wife as a cause of his throat cancer. In the 17 years from 1999 through 2015, the mouth and throat replaced the cervix as the most common site of cancer associated with human papillomavirus (HPV) infection in the United States. What is a data show about vaginal to oral HPV transmission, and even oral to oral transmission? Does Gardasil have a role in prevention here as well? In this podcast, we were review published data on oral HPV transmission and trends of acquisition.
14:17
February 5, 2020
NonObstetrical Surgery in Pregnancy (MOC Summary)
Non-obstetric surgery during pregnancy happens. Historically, general surgical procedures were avoided in the first trimester because of fear of pregnancy loss; General surgery was avoided in the 3rd trimester because of fear of preterm birth. But are these fears real? New data say, “no“! Is external fetal monitoring recommended during these procedures? In this session, we will summarize and highlight one of the February 2020 MOC review articles on non-obstetric surgery during pregnancy.
17:57
February 3, 2020
Malignant GTD
Malignant GTD includes choriocarcinoma, invasive mole, and placental site trophoblastic tumor. When is single agent chemotherapy indicated? What about multiagent care? What is the classification system for malignant GTD? In this episode we will review the diagnosis, work up, and management of this condition.
12:06
January 31, 2020
Molar Pregnancies
Gestational Trophoblastic Neoplasia is a complex condition with various histological and clinical distinct entities. In this episode, we will review the benign variants of GTN, hydatidiform moles (complete and partial). We will review their clinical presentations, diagnosis, management, and follow up. Data for this podcast comes from the ACOG practice bulletin 53 as well as the SGO.
14:11
January 30, 2020
Throat/Rectal STI
Currently, the CDC does not recommend “routine screening” for extragenital gonorrhea or chlamydia in women, although it does make that recommendation for MSM or bisexual males. However, as most extragenital infections are asymptomatic, this is potentially missing a large reservoir of infection. In this episode, we will review the USPSTF and CDC screening guidelines and compared that to evolving prevalence data of extragenital STIs.
11:17
January 27, 2020
Naltrexone for Pregnancy OUD.
Opioid use disorder (OUD) Is a national crisis. Pregnancy is not immune to OUD. Traditionally, methadone and buprenorphine have been used as medical treatments for this condition in pregnancy, with concerns about naltrexone (an opioid antagonist) use. In January 2020, a new prospective cohort study (AJOH) adds reassuring data on the safety and effectiveness of this medication option.
10:38
January 24, 2020
Vaginal Vit C for BV? Yep, it’s DATA.
Up to 30% of initial BV diagnoses will have a recurrence. Does partner therapy (male or female) help reduce recurrence? Most of the original data which stated “No”, is now outdated. Additionally, what is the data on vaginal Vit C for recurrence prevention? Does that actually work? Let’s examine both of these questions...now.
18:27
January 18, 2020
Vaginismus
Vaginismus is the involuntary tightening of pelvic floor muscles that surround the vagina; this can make penetration very painful, if not impossible. The DSM5 reclassified female sexual dysfunction into 4 main categories, with vaginismus fitting in the “penetration disorder“ group. What role does medical therapy play with this condition? Does physical therapy have a role? In this session, we will review the July 2019 practice bulletin from the ACOG (213) focusing specifically on vaginismus.
15:59
January 16, 2020
Beyond the AFFIRM Trial: Fetal Movement Counting (Feb) 2020 Systematic Review and Meta-Analysis
In 2018, the Lancet released the AFFIRM trial. They reported a NONsignificant decrease in the stillbirth rate from 4.40/1,000 births in the control group to 4.06/1,000 births in the fetal movement counting intervention group. In February 2020, a new systematic review and meta-analysis reveals additional information on the clinical utility of maternal perception of fetal movement. Let’s review that data now.
08:14
January 13, 2020
HCV in Pregnancy: IDSA Update
Currently, the ACOG and SMFM recommend a “risk-based” approach to HCV screening in pregnancy. HOWEVER, a soon to be published original article (February 2020) in Obstet Gynecol confirms that “The reported prevalence of maternal HCV infection has increased 161% from 2009 to 2017”. The IDSA has called for UNIVERSAL screening of HCV. In the session, we will review the Nov 2019 IDSA HCV screening recommendations and provide key points from the Rossi et al Feb 2020 Green Journal publication.
12:00
January 12, 2020
HT VTE Risk by Route of Administration.
Most studies on the risks of post menopausal hormone therapy have focused on the oral route of administration. Does the transdermal route of estrogen delivery reduce the risk of VTE? In this episode, we will review the ACOG committee opinion (556) and ASRM guidelines on the use of transdermal estrogen vs oral estrogen therapy.
06:02
January 9, 2020
Vaginal E2 after Breast CA? Yes or No? ACOG CO 659.
Is vaginal E2 therapy safe in women with a history of breast cancer? What is the data regarding systemic absorption levels? Are you familiar with the recently FDA approved medication IMVEXXY? In the session, we will review the data behind the use of vaginal estrogen and vaginal, non-estrogen therapy for persistent genital atrophy symptoms in women with a current or past history of breast cancer.
12:50
January 7, 2020
Management of Menopausal SXs: ACOG PB 141
In North America, the median age of menopause is 51 years. Among women reporting menopausal symptoms, vasomotor and vaginal symptoms are the most closely associated with these hormonal changes. Can progesterone use alone relieve vasomotor symptoms? What about the use of testosterone? What is Intrarosa vaginal therapy? Does ospemifene increase endometrial a risk? In this session, we will answer these questions and review the medical management of menopause according to the ACOG practice bulletin 141.
15:16
January 5, 2020
Endometriosis & Fertility
Up to 30% to 50% of infertile women have endometriosis, based on laparoscopic diagnosis. Endometriosis affects fertility through a variety of mechanisms. In this session, we will review the ASRM position statement on endometriosis related infertility: work-up and patient management.
12:48
January 3, 2020
The Infertility Evaluation: ASRM Guidelines
Infertility can affect up to 15% of all couples. Male factor infertility can account for up to 40 to 50% of cases, while in 30% of couples there may no identifiable etiology (unexplained infertility). This session, we will review the ASR M guidelines for the infertility evaluation. Is postcoital testing still recommended? What role does laparoscopy play in the infertility evaluation? We will answer these questions and more in this session.(ACOG CO 781).
18:02
January 1, 2020
The BRCA Mutation Carrier
BRCA1 & BRCA2 are tumor suppressor genes; mutations in either are transmitted in an autosomal dominant pattern. Loss of both copies of either BRCA1 or BRCA2 is just the 1st step in the process of potential carcinogenesis. In this session, we will review the pathophysiology of BRCA mutations and review the NCCN guidelines for breast and ovarian cancer screening. We will also review the surgical & chemoprophylactic management of the BRCA positive patient.
13:42
December 30, 2019
Bartholin’s Abscess: Management Review.
Once considered pathognomonic for gonorrhea or chlamydia, Bartholin’s gland abscesses are now recognized to be polymicrobial. Is I&D alone 1st line therapy for a Bartholin’s abscess? What about Word Catheter use? Are there any alternatives to Marsupialization for recurrent cases? In this session, we will review the data behind diagnosis and management of this common gynecological condition.
13:13
December 28, 2019
The 2-Vessel Umbilical Cord: Management Review
There are 4 types of single umbilical artery (SUA), based on pathogenesis. The incidence of SUA is up to 1% of all singleton fetuses, and up to 4.6% of twins. SUA can occur either as an isolated finding or as part of a congenital anomaly syndrome. In this session we will review the pathogenesis, identification of, fetal work-up, and patient management of SUA. Data from the SMFM, and ACOG.
12:55
December 25, 2019
Understanding METH: MOA, Pregnancy Effects, and FALSE POSITIVE Tests.
Methamphetamine and amphetamine use has greatly increased all throughout the United States. While similar to cocaine, it’s mechanism of action is quite unique and dangerous. In this session we will cover the pharmacology of amphetamines/meth and its affects on pregnancy. We will also cover some common every day medications which can actually test false positive for meth/amphetamines on toxicology screening. Data for this podcast come from the ACOG, SMFM, and the CDC.
15:03
December 22, 2019
Cosmetic Genital Surgery: ACOG Jan 2020 Update
Interest in, and performance of, female cosmetic genital surgery increased 50% from 2014 to 2018. As close to 80% of US females have some degree of pubic hair removal, self awareness of vulvar variation is increasing. Although labial hypertrophy can be a true functional/medical concern requiring labial reduction, what about elective cosmetic genital procedures? In January 2020, the ACOG will release its updated committee opinion on this topic. These are important points to review as patients often seek “designer labioplasty“ or “vaginal rejuvenation“ from their gynecologist.
12:57
December 20, 2019
Understanding Factor V Leiden Mutations in Pregnancy
Pregnancy-related venous thromboembolism is the most common cause of maternal death and a significant cause of maternal morbidity. The factor V Leiden (FVL) mutation is the most common known genetic factor that predisposes to thrombosis. How does obstetric management differ regarding a heterozygous or homozygous carrier? When should anticoagulation be used, and at what dose? In this session we will review data from the SMFM, RCOG, and the ACOG practice bulletin 197.
14:21
December 17, 2019
Adolescent 1st Gyn Visit: Confidentiality & More (ACOG review)
The initial gynecological visit for an early teen/adolescent is crucial in establishing patient trust, education of gynecological health, and establishment of healthy personal and sexual behaviors. At what years should the first visit occur? What about patient confidentiality when dealing with minors? Is a clinical breast exam part of the adolescent screening exam? In this session, we will review the ACOG committee opinion (598) on the first gynecological visit.
18:42
December 12, 2019
Understanding Microdeletions in OB Genetics
Commercial laboratories offering cell free DNA for fetal prenatal screening are offering microdeletion testing. Is this valid? Microdeletions are varied and include 22q and 15q syndromes. In this session, we will review the pathophysiology of microdeletions and review 22q and 15q conditions. What does the SMFM have to say about cell free DNA screening for these conditions? How is Angelman syndrome related to Prader –Willi condition? Let’s cover this now.
16:59
December 10, 2019
Pregnancy Spacing After Stillbirth: 2019 Data
The “ideal“ interpregnancy interval depends on the outcome of the immediate, prior pregnancy. For example, the recommended interpregnancy interval following a 1st trimester miscarriage is different compared to a live, term birth. But what about the interpregnancy interval after a stillbirth? Are the recommendations the same? In this podcast will review updated data from 2019 regarding interpregnancy interval following stillbirth. The reference for this podcast summary is Regan AK, et al; Lancet, April 2019.
13:46
December 7, 2019
“Informed Refusal” of a Recommended C-section: An Ethical Review.
You find that there is a medical indication for a cesarean birth- yet the patient refuses! What are your next steps? Should you seek a court order to intervene? “Informed refusal” encompasses a complex, multifaceted, ethical dilemma. In this session, we will review some clear guidelines from the American Academy of Pediatrics, the ACOG, and the AMA regarding the management of this difficult situation.
14:06
December 3, 2019
Cesarean Section History: From “Lex Regia” to Modern day.
No! Julius Caesar was not born by cesarean birth. What does a pig-gelder in 1500 have to do with CS History? From Jacob Nufer to Munroe Kerr, we will walk down the path of the cesarean’s incredible history.
18:55
December 1, 2019
Burnout? Moral Injury? Here’s the VACCINE for both.
Medicine: it’s an incredibly rewarding profession. The opportunity and ability to comfort and heal the sick is an absolute privilege. BUT...if you are not careful, that wonderful of all professions can consume you, and may devour you. Two theories have been proposed to explain this: Burnout, and Moral Injury. But are these 2 separate conditions? How does the issue of mindset (fixed or growth) apply? In the session, we will review the latest (as of December 2019) on this ever evolving issue.
18:30
November 29, 2019
Ob QUANTITATIVE Blood Loss: Dec 2019 ACOG CO
In December 2019, the ACOG will release committee opinion 794 covering quantitative blood loss in obstetrics. Does QBL use ALONE improve clinical outcomes? The answer may surprise you! Nonetheless, there is great value in utilizing obstetric hemorrhage toolkits/bundles such as the California Maternal Quality Care collaborative strategy. In the session, we will review the use of QBL in practice in why having it as part of a larger toolkit helps reduce maternal morbidity and mortality.
10:27
November 25, 2019
Lactational Mastitis and Abscess
Breast-feeding mastitis is a common occurrence and a source of disruption of breast-feeding and negatively affects quality-of-life. In this session, we will review the Academy of Breastfeeding Medicine’s treatment protocol for the condition. When is abscess identification required? What about drainage? We will answer these questions and more in this episode!
11:59
November 22, 2019
Obesity-Stillbirth Link
Obesity is a known modifiable risk factor for complications of pregnancy- both antepartum and intrapartum. Data has confirmed a direct link/risk of stillbirth with obesity. In this session, we will review the data on this link as well as the effect of gestational age on the risk of stillbirth. We will also briefly review the ACOG practice bulletin on gestational diabetes and how this may relate to obesity’s risk of stillbirth. This podcast will also summarize the (conflicting) data on elective induction of labor at term as an attempt to reduce the risk of stillbirth in the obese population.
20:48
November 20, 2019
Periviable Birth
Periviable birth is defined as delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation. When is the earliest time to consider antenatal steroids for fetal lung maturation, and what about magnesium sulfate for neuroprotection? When should tocolytics be utilized? And when is the earliest just stational age to consider a C-section for fetal benefit? In this session, we will cover these questions according to the ACOG consensus statement #6.
17:36
November 17, 2019
MTHFR: The FACTS
MTHFR... Yep, it gets blamed for a variety of health and pregnancy concerns. But does the data actually confirm the presence of adverse pregnancy and adverse health issues with MTHFR variants? In this session, we will review the difference between the 2 most common variants (C677T, A1298C) and true MUTATIONS. We will also review statements from the ACOG, ACMG, SMFM, as well as the Canadian Guidelines regarding MTHFR screening.
13:55
November 14, 2019
Acute Bronchitis: Antibiotics?
Persistent cough, congestion, low-grade fever… Yep, typical symptoms of acute bronchitis! The CDC and the American College of Physicians have published guidelines on antibiotic stewardship regarding acute bronchitis. When are antibiotics indicated? What about beta-agonist therapy? Do mucolytics work? In this podcast we will review the presentation, etiology, and treatment algorithm of this common clinical diagnosis.
15:56
November 7, 2019
Keeping Patients Safe!
“Never events“, “Sentinel events”, and “Near misses”. These terms strike fear in any healthcare provider! The National Quality Forum, the Agency for Healthcare Quality and Research, and the Joint Commission, all have stressed the importance of patient safety in the operating room and medical wards. In this podcast we will review alarming statistics regarding preventable medical errors, and remind ourselves of ways to keep patient safe.
11:54
November 3, 2019
LUBE Library: Not all are the same.
That’s right… We’re talking about vaginal lubricants! In general, there are 3 main categories: water-based, silicone based, and oil based. Each has their own advantages and disadvantages. Some lubes can actually place the patient at risk of pregnancy if used with a latex condom! In this podcast, we will cover the “lube library“ so that we can better inform our patients since education is key!
11:41
October 31, 2019
Mirror (Ballantyne) Syndrome
Mirror syndrome (first described in 1892) is another term for what is also known as Ballantyne Syndrome or triple edema. Maternal mirror syndrome is a rare consequence of fetal hydrops. By convention, delivery is recommended in pregnancies complicated by mirror syndrome due to grave fetal prognosis. Severe maternal morbidity has also been described. In this session, we will review the clinical presentation, similarities to preeclampsia, and management of this grave complication.
08:16
October 28, 2019
ACOG Clinical Alert: (Oct 25, 2019) Progesterone for PTB Reduction
On October 25, 2019, the American Journal of Perinatology published the results of the PROLONG Trial. This study demonstrated no statistical difference in the co-primary outcome of preterm birth less than 35 0/7 weeks of gestation (P = 0.72) and neonatal composite index (P = 0.73) with 17-OHP use. Similarly, the rate of preterm birth less than 37 weeks and less than 32 weeks were not different. On October 25, 2019, the ACOG released a practice advisory about this. Let’s summarize this now.
04:12
October 25, 2019
Sepsis in Pregnancy (SMFM Data)
The rate of sepsis appears to be increasing. Maternal sepsis is a significant cause of maternal morbidity and mortality. Sepsis is not a specific illness, but a syndrome that includes organ dysfunction caused by this regulated host response to infection. In this session we will review the SOFA score and it’s utilization. Is fever necessary for a diagnosis of sepsis? Which antibiotics should be used? What is the rate of IV fluid resuscitation? Are steroids contraindicated in the septic patient? We will answer these questions and more in this episode which summarizes the SMFM expert series #47, sepsis in pregnancy.
16:22
October 25, 2019
Nitrous Oxide in Labor: YES, PLEASE.
N2O is a nonflammable, tasteless, odorless gas. It was first synthesized by the English scientist and theologian Joseph Priestly in 1772, and was first used as a labor analgesic by Stanislav Klikovich in Poland in 1881. Although much more frequently used in the UK and Canada, interest in nitrous oxide for labor pain management is increasing in the USA. What is its mechanism of action? Is it effective? What are the contraindications? Let’s review this topic...NOW.
13:19
October 22, 2019
Universal Thyroid Screening in Pregnancy: Pros and Cons.
Universal thyroid screening in pregnancy is a key debate in endocrinology and obstetrics. While some countries advocate universal screening, the UK and USA adopt a “high-risk” based strategy. ACOG’s Practice Bulletin 148 (April 2015) keeps its recommendation to NOT perform routine screening for thyroid disease in pregnancy. BUT, should we screen for thyroid abnormalities universally? This podcast will review the pros and cons and make a push for once stance over the other.
15:19
October 20, 2019
Intrapartum Fetal Tachycardia
Fetal Tachycardia (FT) is described as increase in baseline fetal heart rate (FHR) above 160bpm, for longer than 10 minutes. In clinical daily practice, management of mild-moderate uncomplicated tachycardia can be challenging because clinicians do not have clear guidelines for intervention in cases of uncomplicated fetal tachycardia (in the absence of maternal pyrexia or decelerations) in cases where tachycardia has not resolved with conservative measures like left lateral tilt, hydration and pain control have been explored. In this session, we will review the etiology of fetal heart rate tachycardia and review intrapartum management.
11:17
October 18, 2019
Fe Deficiency Anemia’s Effects on Pregnancy: A Controversial Topic.
With normal pregnancy, blood volume increases, which results in a concomitant hemodilution. Although red blood cell (RBC) mass increases during pregnancy, plasma volume increases more, resulting in a relative anemia. This results in a physiologically lowered hemoglobin (Hb) level, hematocrit (Hct) value, and RBC count, but it has no effect on the mean corpuscular volume (MCV). However, in women who are iron deficient, this problem is exacerbated due to low iron stores affecting the body’s ability to increase red blood cell production. Iron deficiency is the most common pathologic cause of anemia in pregnancy. Does IDA result in adverse maternal or neonatal outcomes? The data is more controversial than you would suspect. In this session, we will review the data regarding the impact of iron deficiency anemia on maternal neonatal outcomes.
16:28
October 15, 2019
Human Sex Trafficking: A Call for Awareness
The United States, along with Mexico and the Philippines, was ranked one of the world's worst places for human trafficking in 2018. In the US, there is no official number of human trafficking victims, but estimates place it in the hundreds of thousands. From illicit massage parlors, escort services, online pornography, and adult “dating” sites, women make up the majority of sex trafficked victims. In this session, we will review the ACOG committee opinion from September 2019, as well as review data from the US Homeland Security Bureau of statistics.
12:08
October 14, 2019
😳The G-SPOT😳: Why the CUV Complex Matters!
Ahhh...Oooh! The elusive G-Spot! First described in the 1950s by gynecologist Ernst Grafenberg, the “G-Spot” has been a “hot topic“ in sexual wellness circles. But does this exist? Is there a real “magic button“ for intense, female pleasure? New understandings of the relationship between the clitoris and anterior vaginal wall has resulted in a better name for this SPOT: The “Clitoral Urethral Vagina Complex" or "CUV." Let’s talk about that...now. {IMAGE/DIAGRAM on our Facebook page.}
11:56
October 12, 2019
Immediate PostPartum LARCS: ACOG and SMFM Review.
Approximately 45% of pregnancies in the United States are unintended. Similarly, 70% of pregnancies that occur within 1 year of delivery are also unplanned. Interpregnancy interval shorter than 6 months are associated with increased risk of perinatal complications. In this session, we will review the stance from the ACOG and the SMFM regarding immediate postpartum LARC initiation. What is the difference between “immediate” placement and “early postpartum“ placement? Are there any risks? We will cover these topics and more in this episode.
11:18
October 10, 2019
Omega-3s and Preterm Birth Prevention? A Data Review.
Preterm birth is now the 2nd leading cause of death in children under 5 years worldwide and accounts for half of all newborn deaths, according to the March of Dimes and the World Health Organization (WHO). Besides progesterone, does DHA have a role in reducing preterm birth risk? In this session, we will summarize recent data regarding “fish oil” supplements and preterm birth risk. We will also describe a new proposed “DHA maternal blood test” which may help identify women who would benefit the most from DHA supplementation.
09:51
October 7, 2019
OVFTP Cancer Treatment: FIGO’s 2018 Summary
In our previous episode, we covered the revised FIGO ovarian cancer staging which now includes fallopian tube and peritoneal malignancies. In this episode, we will cover the FIGO guidelines regarding the management of OVFTP cancer. What role do PARP inhibitors play? Does treatment for asymptotic recurrence based on CA125 help? Can tamoxifen be used in recurrent malignancy? Let’s find out… Now.
12:21
October 5, 2019
Staging for OVFTP malignancies: FIGO’s Revised Ovarian CA System
The lifetime risk of a woman in the USA developing ovarian cancer is approximately 1 in 70. Malignant tumors of the ovaries occur at all ages with variation in histologic subtype by age. For example, in women younger than 20 years of age, germ cell tumors predominate, while borderline tumors typically occur in women in their 30s and 40s—10 or more years younger than in women with invasive epithelial ovarian cancers, which mostly occur after the age of 50. About 23% of gyn cancers are ovarian, but 47% of all deaths from cancer of the female genital tract occur in women with ovarian cancer. In this podcast we will summarize the new FIGO classification system for ovarian cancer which now includes malignancies of the fallopian tube and peritoneum (OVFTP).
15:57
October 3, 2019
Endometrial CA (Part2): Adjuvant Therapy
In this session, we will review adjuvant therapy for endometrial carcinoma. What is the role of radiation therapy? What about chemotherapy? Is progestin therapy advised? We will end the podcast with a quick review of one of the most dreaded pathological findings: endometrial cancer AFTER hysterectomy was performed for presumed benign disease.
16:32
October 1, 2019
Endometrial CA: (Part1) FIGO 2018 Update
Endometrial carcinoma is the most common type of all the gynecological malignancies. The most common symptom is abnormal vaginal bleeding, especially in postmenopausal women. In 2018, the FIGO released it’s updated report on endometrial carcinoma. In the session, we will review the pathophysiology, local invasion, work up, and surgical staging of this malignancy. We will leave therapeutic options for the 2nd part of this 2 part series.
13:17
September 30, 2019
Cervical CA (Part 2):Management, 2018 FIGO Guidelines
In this Part 2, we will review the pathological reports which may influence cervical cancer clinical staging. We will also summarize the 2018 FIGO treatment guidelines. In brief: For stage 1A1-1B1: surgery is recommended; Stage 1B2-IIA1: surgery or radiation may be used; Stage 1B3-IVA: concurrent chemoradiation is standard; Stage IVA may need an exenteration; and Stage IVA is managed with chemoradiation.
13:38
September 28, 2019
Cervical CA 2018 FIGO Update (Part1): Revised Staging system.
Recent developments in imaging and increased use of minimally invasive surgery have changed the paradigm for diagnosis and management of cervical cancer. The FIGO Gynecologic Oncology Committee, in 2018, revised the Cervical Ca staging system based on these advances. Imaging evaluation may now be used in addition to clinical examination where resources permit. The revised staging permits the use of any of the imaging modalities according to available resources, i.e. ultrasound, CT, MRI, positron emission tomography (PET), to provide information on tumor size, nodal status, and local or systemic spread. In this session, which is Part 1, we will review the pathogenesis, epidemiology, symptomatology, and 2018 FIGO revised cervical cancer staging system. We will leave management of cervical cancer for Part 2.
16:53
September 27, 2019
Over-the-Counter Birth Control? A summary of ACOG’s UPCOMING Committee Opinion.
While offering OTC birth control may be controversial here in the U.S., it is a non-issue in many other countries. China, India, Greece, Turkey, Mexico, Brail, Portugal, South Africa, Korea and Russia are a few of the countries where women can get birth control pills without a prescription. Is that safe? What about the risk of VTE? Should there be an age restriction? In this episode, we will highlight the October 2019 ACOG committee opinion (788) on over-the-counter access to hormonal contraception.
13:14
September 26, 2019
💉💉Flu Vaccine 101! 💉💉💉
We all recommend it! The influenza vaccine. However, when asked specific questions about the vaccination, a fair number of healthcare providers will not know the answers. Is personal egg-allergy a contraindication? Can everybody receive the intranasal vaccine? What about pregnant women? In this podcast, we will cover the Advisory Committee on Immunization Practice (ACIP) guidelines for vaccination for the 2019- 2020 influenza season.
16:27
September 25, 2019
PreEclampsia Symptoms: Reliable or Not?
Eclampsia is a life-threatening pregnancy complication, defined as the new onset of seizures during pregnancy with a concomitant diagnosis of preeclampsia. Clinicians often ask patients with suspected preeclampsia about headaches, visual changes, or epigastric pain. Are the symptoms predictive of eclampsia? In this session, we will review the soon to be published (systematic review) evaluating the current literature regarding signs and symptoms that occurred before the onset of eclampsia and estimate their predictive value. Are they enough to determine who does/does NOT get MagSulfate? Let’s see.
13:34
September 23, 2019
Do Negative Pressure Wound Systems Prevent Wound Infection? A new RCT gives an answer!
The prevalence of obesity is at an all-time high in the United States, and the obesity rate among women is 40%, with 9.8% of women having class III obesity (BMI 40 or higher). As a result, obesity is a frequent and severe comorbidity of pregnancy. Whether or not incisional negative pressure wound therapy reduces wound morbidity is an important question for obstetricians and patients. In this podcast, we will summarize the key findings from a soon to be released RCT from my Alma Mater, UT Southwestern, investigating whether or not negative pressure devices applied at CS in obese patients prevents wound morbidity...or not.
13:27
September 21, 2019
Why are SCRUBS/O.R. Gowns Green (or Blue)? A Historical Review.
Are green scrubs just a fashion statement? What’s behind the choice of green (or sometimes blue) scrubs? Well, there actually is some science to that… In addition to just interesting history. Let’s take a look at that, now.
07:28
September 20, 2019
Breast CA Medical Risk Reduction: USPSTF Sept 2019 Guidelines
In Sept 2019, the USPTF revised and updated its 2013 recommendations on medications for risk reduction of primary breast cancer. Who qualifies for medical strategies? Which meds are recommended? In this session we will highlight the new USPSTF Guidelines, review the use of Prediction Models, and compare Tamoxifen, Raloxifene, and Aromatase Inhibitors.
15:27
September 18, 2019
“Backdoor” Activity? Ask,Screen,Treat: Nongenital STIs.
Once taboo, anal sex has slowly been slipping into the mainstream. A recent study found that 37% of women reported having anal sex with the opposite sex in their lifetime, and over 60% reported providing oral sex. However, the CDC does not specifically mention routine screening of extragenital sites for STIs. In this podcast, we will review the most up-to-date data on extragenital infection and make the case for “routine“ screening of extragenital STIs.
16:34
September 16, 2019
IC/Painful Bladder Syndrome (Part2): Treatment options
Treatment strategies for IC should proceed using more conservative therapies first with less conservative therapies employed if symptom control is inadequate for acceptable quality of life. Multiple, concurrent treatments may be considered if it is in the best interests of the patient. In this session, we will review the AUA clinical guidelines regarding management of IC with a review of the 1st-line to 6th-line treatment recommendations.
16:50
September 15, 2019
IC/Painful Bladder Syndrome: New AUA Guidelines
The effects of IC/BPS on psychosocial functioning and QoL are pervasive, damaging work life, psychological well-being, personal relationships and general health. There’s been a lot of new data regarding this condition and some historic information has been deleted. For example, potassium installation into the bladder is no longer recommended. That diagnostic test, occasionally still found in some gynecological texts, can cause exquisite pain if the bladder is acutely inflamed. Therefore, this is no longer considered a diagnostic tool. Additionally, options for treatment are now quite varied and include FIRST-line to SIXTH-line options. This is PART 1 covering IC pathophysiology, clinical presentation, and diagnostics (including physical exam and ancillary testing). We will leave treatment options for Part 2.
16:55
September 14, 2019
Funisitis
In 2017, the ACOG defined 3 classes of intraamniotic infection. Although most research/data has been on inflammation/infection of the placenta/membranes itself (chorioamnionitis), only recently has data on inflammation of the umbilical cord (funisitis) been forthcoming. Is inflammation of the umbilical cord directly related to microbial invasion? Does this have any neonatal implications? In this podcast we will review the pathological basis and clinical implications of funisitis.
13:26
September 12, 2019
OB Forceps’ Strange History
Obstetrical forceps have a strange history: considered by historians to have been created by William Chamberlain, a French surgeon, the tool was kept a close family “secret” for well over a century! Eventually, the device and concept was sold by a destitute Chamberlain family member. William Smellie would then take this device to the masses. In this podcast, we provide a brief historical perspective on obstetrical forceps.
07:46
September 11, 2019
9.1.1.
Never. Forget.
02:46
September 11, 2019
Female Athlete Triad
Exercise in the young female adolescent is wonderful! But like everything else, too much can be dangerous. The Female Athlete Triad is marked by: 1. low energy availability, 2. menstrual dysfunction, and 3. low bone density. However, all 3 do not have to be present for the issue to be a concern. This condition is a spectrum! In this session, we will review committee opinion 702 from the ACOG, and learn more about the Female Athlete Triad.
11:26
September 11, 2019
Beyond Gardnerella: BV Biofilm New Data.
Garderella Vaginalis may not be the only pathogen causing BV like symptoms. New data has linked BV with a vaginal BIOFILM ecosystem. It also increases the possible acquisition of other STIs, including HIV. In this session, we will review the pathophysiology, clinical symptoms, diagnostic methods, and of course treatment options for this common- and significant- vaginal condition. The recently FDA approved medication, Secnidazole, will also be briefly discussed (see separate, previous podcast).
13:38
September 8, 2019
Desquamative Inflammatory Vaginitis: An Old/New Awareness
The human vaginal ecosystem is highly dynamic. The vaginal microbiome can affect host physiology, and vice versa. In 1965, Desquamative Inflammatory Vaginitis was 1st described, but the condition fell out of the spotlight. Recently, new data has brought this condition back into the light. How is this diagnosis made? Is vaginal culture recommended? That answer may surprise you. In this episode, we will review the latest information on Desquamative Inflammatory Vaginitis: its presentation, diagnosis, and treatment.
13:24
September 7, 2019
BARE DOWN There? New data on STIs and going bare.
Pubic hair grooming is a highly prevalent practice with self-reported rates between 75 to 99% of women. Does this increase STI risk? In this podcast, we will review a recent September 2019 open access publication by Luster et al. There may be more to the story than what’s presented in that study. Let’s look at that...now.
09:01
September 5, 2019
Best Vaginal Prep PreCS? A new systematic review & meta-analysis.
Post CS endometritis is thought to be linked to ascending vaginal bacteria. In 2016, the CSOAP trial concluded that adding ZMAX to standard antibiotic prophylaxis before non-elective CS helps reduce infection. But what about vaginal prep? What’s the best solution and concentration? In this session, we will summarize a new systematic review/meta-analysis from September 2019 published in AJOG.
10:51
September 5, 2019
Mycoplasma genitalium: An Overlooked STI.
Mycoplasma genitalium is a facultative anaerobic organism which has been associated with cervicitis, endometritis, PID, infertility, susceptibility to HIV, and adverse birth outcomes, indicating a consistent relationship with female genital tract pathology. In 2015, the CDC listed it as an important, yet overlooked, STI. Now, a recently FDA approved test for the bacterium has increased awareness on this sexually transmitted pathogen. In this episode, we will review the microbiology, presentation, and treatment of this pathogen.
11:47
September 3, 2019
Adolescent BC leads to Depression? Let’s see.
Previous evidence suggests that use of oral contraceptives, especially during adolescence, may increase women’s vulnerability to depression in the short term. On August 28, 2019, a new publication by Canadian researchers in the Journal of Child Psychology and Psychiatry restated this association. Does this prove causation? Is it time to stop prescribing birth control to adolescents? Let’s take a critical look at this new study, as well as a prior 2016 publication, plus a 2018 systematic review, and provide clinical guidelines and perspectives.
10:54
September 2, 2019
⚠️ Labor 2nd Stage: Too Long?
In 2014, the ACOG released a consensus statement, “Safe Prevention of the Primary Cesarean”. This extended the 2nd stage of labor by 1 hour. Was this evidence-based? New data suggest it was not, and may be harmful. In 2016, Leveno et al (Parkland Hospital) issued the first clinical commentary as a rebuttal to these changes citing lack of evidence to support the prolongation. In this session, we will review the upcoming publication (ahead of print) from Nelson, McIntire, and Leveno (Parkland Hospital) again calling these 2014 labor time-limits into question, presenting new data.
13:48
September 1, 2019
Wound Healing Principles: A clinical review.
Wound healing is a complex and dynamic process! In this episode, we will review the 4 stages of wound healing using the analogy of “the broken house”. We will also describe the CDC criteria for surgical site infection (SSI) and review the 4 WHO classifications of wounds.
16:54
August 31, 2019
The V is NOT a TRUMPET! Air embolism after cunnilingus. 😳
Air embolism during pregnancy has been reported… usually linked to blowing air into the vagina during orogenital sex. In this session, we will review the literature, presentation, and management of this uncommon- yet potentially lethal- occurrence.😳😳😳🤔
08:06
August 29, 2019
Testosterone Use in Women: Wonder-Drug or Waste?
There is currently no FDA approved testosterone products for women. Internet sources, and some pharmacies, offer a variety of testosterone products for use by women. Is this evidence-based? In this session, we will review the summary statements from the US Endocrine Society and the British Menopause Society regarding testosterone supplementation in women. (US Endocrine Society Data and the British Menopause Society. Thank you, Lisa Felsman, for the podcast topic!)
10:02
August 27, 2019
Fertility Meds Cause Breast CA? Let’s look at the data.
Many studies have evaluated the relationship between fertility drugs and breast cancer. Are you aware of what the data shows? How would you cancel your patients? In this episode we will review the ASRM data regarding fertility medication use and breast cancer risk.
05:37
August 26, 2019
Fertility Meds Cause Ovarian CA? Let’s look at the data.
The use of fertility drugs that may cause alterations in endogenous hormones and multiple ovulations has raised concerns about the long-term safety of such medications. One concern is that are invasive ovarian cancer. Is this concern evidence-based? In this session, we will review the ASRM Practice Guideline on the subject (2016), as well as a more recent updated ASCO/ESHRE review from 2018.
09:32
August 25, 2019
Amniotic Fluid Embolus
Amniotic fluid embolism is a rare but potentially lethal condition. Because of the rarity of this condition, most physicians and institutions have limited experience with the management of amniotic fluid embolism. The typical presentation of AFE includes a triad: sudden hypoxia hypotension, and coagulopathy. In this podcast, we will cover the latest data from the SMFM, ACOG, and AHA on this terrifying condition.
16:25
August 24, 2019
Uric Acid for Preeclampsia Eval? No.
Serum uric acid levels are often ordered for the evaluation of hypertensive disorders of pregnancy. But why is this done? Is this test able to guide clinical management? A staple of PIH evaluation in the 1970s and 1980s, uric acid levels are still around. In this session, we will review why uric acid determinations for hypertensive disorders of pregnancy is not clinically useful – in general. Reference: Sept 2019 ACOG publication, “Questioning Clinical Practice”; Obstet Gynecol.
07:46
August 23, 2019
😳SEX Headaches😳: Yes...it’s a thing!
Yes...it’s a real diagnosis. Sexual headaches may be PRIMARY (without other etiology) or secondary (due to a more serious issue). Primary sexual headaches are divided into 2 types: orgasmic, and pre-orgasmic. In this episode, we will review the data from the International Headache Association regarding sex headaches.
07:55
August 22, 2019
How Committed are YOU? A life lesson from Julie Moss.
If you have never heard the story of Julie Moss (1982), start listening to this episode! This is an example of not just being interested in a project/work activity/hobby, but is an example of being PASSIONATELY committed. Let’s quickly review her story, now.
03:54
August 19, 2019
ERCP in Pregnancy
Surgery for biliary tract disease is among the top 3 reasons for non-obstetrical surgery during pregnancy (1:1500 to 1:10,000 pregnancies). What is the data on ERCP during pregnancy? Is radiation exposure a concern? What does ACOG recommend regarding intraoperative fetal monitoring? In this podcast, we will cover the ACOG, and AGA recommendations for this procedure in pregnancy.
12:33
August 18, 2019
Do Hurricanes Cause Labor?
💥Hurricanes💥! No… Not the traditional and historic drink from New Orleans! 🍹🍹We’re talking about the intense, devastating, natural weather phenomena⚡️⚡️🌊💨🌪. We are in hurricane season! Do hurricanes cause women to enter labor, or affect pregnancy outcome? Is it an “old wives tale”, or is it true? Let’s examine the evidence....now.
08:23
August 17, 2019
Fetal Kick Counts: Tradition VS Truths; The AFFIRM Trial Data.
Stillbirth is a pervasive problem worldwide. Maternal perception of reduced fetal movement has been identified as a potential strategy for stillbirth prevention. But is the strategy evidence-based? In this episode, we will review the 2018 randomized trial, the AFFIRM study (Lancet).
08:30
August 14, 2019
Don’t Steam the V! The V is not a teapot. Here are the potential risks of vaginal steaming.
Vaginal steaming has become a cult phenomenon since 2010. But this “alternative“ practice has some real potential risks. Where did this even come from? Why is it done? And what are the potential morbidities? This podcast will cover these questions, as well as a recent (August 2019) case report highlighting the harms of this practice.
07:42
August 12, 2019
OCPs/HRT in BRCA Carriers: What’s the Evidence?
Because of the increased risk for breast cancer, BRCA mutation carriers may have concerns about taking oral contraceptives or using hormone replacement therapy after a premenopausal prophylactic bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes). Here, we review the current literature about hormone use by BRCA mutation carriers.
08:53
August 11, 2019
Endometriosis and adverse OB outcomes.
Women with endometriosis may represent a unique population of women at greater risk for adverse outcomes across pregnancy and birth. In this session, we will summarize the soon to be in print publication by Farland et al in Obstetrics and Gynecology. Information from the study may be helpful in counseling women with endometriosis when when they conceive.
09:43
August 9, 2019
OB Outcomes per Advancing Weeks of Term Gestation.
Is 39 weeks the “sweet spot” for delivery? Neonatal and maternal adverse outcomes have been studied through increasing gestational ages from 37 weeks onward. In this episode, we will summarize the Aug 2019 publication by Chen et al, from Obstetrics and Gynecology. We will also review and apply the findings from the 2018 ARRIVE publication.
09:28
August 8, 2019
ALERT: Methylene Blue- A Potential Cause of Serotonin Toxicity
Healthcare professionals and patients may not realize that methylene blue has monoamine oxidase inhibitor (MAOI) properties. Methylene blue should generally not be given to patients taking serotonergic drugs. When should patients stop taking SSRIs prior to methylene blue use? When should they be restarted? In this session, we will review the MOA of this common dye utilized in surgery and review ways to prevent a possible lethal reaction.
07:08
August 7, 2019
Opioid Use in Pregnancy: Methadone and Buprenorphine Medical Therapy.
Opioid use in pregnancy is a real issue! This podcast will review 2 pharmacotherapies for opioid dependency in pregnancy. We will end the session with a “rapid fire” side-by-side comparison of these 2 agents.
10:33
August 6, 2019
Chronic Kidney Disease in Pregnancy.
Chronic kidney disease can affect anywhere from 0.1 to 4% of all pregnancies. Pre-existing renal disease can have severe consequences for a pregnancy. Should low-dose aspirin be used in these patients? If so, at what dose? What about calcium supplementation? Are immunosuppressive agents safe to use? In this podcast we will cover the June 2019 ACOG “clinical expert series” monograph on chronic kidney disease in pregnancy.
12:44
August 4, 2019
Depression/Anxiety Meds in Pregnancy.
Depression/anxiety can affect up to 20% of women during pregnancy. These 2 psychological conditions have adverse pregnancy outcomes in and of themselves. But what about medication use? Do SSRIs need to be tapered at end of pregnancy to reduce neonatal withdrawal? Are SSRIs linked to “Neonatal Persistent Pulmonary Hypertension”? What about other meds? This episode will review the ACOG/SMFM data on the subject.
13:44
August 2, 2019
Can SEX induce Labor?
For decades, women have been told that having intercourse/orgasms late in pregnancy can hasten the onset of labor. But is this a myth, or is this true? While it is well established that sexual intercourse/orgasms can trigger the onset of contractions, are those contractions enough to result in cervical change? Let’s take a look at the data.
07:09
July 31, 2019
Adnexal Torsion in Adolescents: New ACOG Opinion (Aug 2019)
Thirty percent of all cases of adnexal torsion occur in females younger than 20 years. In this episode, we will review the latest committee opinion from the ACOG on clinical presentation, use of diagnostic tests, and surgical management of adnexa torsion in adolescents. Here’s your quick test: 1. Do Doppler studies confirm a diagnosis? 2. What are the findings on CT or MRI? 3. Is cystectomy preferred over oophorectomy, or is another management option indicated? Answers...are...here!
08:53
July 27, 2019
NEW ERAS Post CS Guidelines
This Enhanced Recovery After Surgery Society guideline was created to support the most common surgical procedure in the industrialized healthcare world, the cesarean delivery. In this section, we will highlight THREE new recommendations that CHANGE how we “traditionally” care for the postop CS Patient: Refeeding as soon as 2 hours postpartum, elimination of the postop urinary cath...and even new data on the use of heparin for postop CS patients!
12:31
July 23, 2019
Interpregnancy Intervals and OB Outcomes.
Short interpregnancy intervals, as well as long intervals between pregnancies, are associated with some potential adverse obstetrical outcomes. What does the data show? What are the unique considerations that go into patient counseling regarding spacing of pregnancies? In this episode, we will review the SMFM data on interpregnancy intervals.
09:20
July 20, 2019
SLYND! The new, novel drospirenone oral BC pill.
How much do you know about the recently approved novel BC pill, SLYND? Do you know it’s efficacy? What are the contraindications? In this session, we will bring you up to speed on this new novel drosperinone only oral BC pill. (No financial disclosures).
08:43
July 17, 2019
How bad do you want it?
DISCLOSURE: Not for the PC! Not for those who lack determination, or GRIT. This is the antidote for mediocrity. Just a little motivation to KEEP YOU FOCUSED! Now... go-and-get-it!
08:29
July 16, 2019
Recurrent Preg Loss (Part 2).
Part 2: In this session, we will wrap up our discussion on recurrent pregnancy loss by focusing on 3 controversial areas: 1. Immunological therapy, 2. thrombophilia testing, and 3. Progesterone supplementation. (Data referenced from ACOG, RCOG, ASRM).
09:59
July 14, 2019
Recurrent Preg Loss (Part 1).
Recurrent pregnancy loss is devastating for the affected couple. In part 1, we will review the diagnosis of this condition. We will also cover parental genetics, APS, and uterine anomalies. In part 2, we will see if thrombophilia testing is indicated, discuss progesterone supplementation, and what role/if any, immunological reactions have with recurrent miscarriage. (Data from ASRM, ACOG, and RCOG).
13:31
July 13, 2019
OB Rapid-Fire Q&A! Common questions and concerns raised during pregnancy.
Howdy, all! Rather than discussing one topic, this session will review “quick facts“ on common OB concerns/questions. Should we screen for HSV during pregnancy? What about deli meat consumption? Are there any issues with air travel during pregnancy? Can pregnant women use hot tub? Can pregnant women dye their hair? We will answer these questions – and more! – in this session of clinical pearls.
11:34
July 11, 2019
Revised GBS Guidelines: ACOG CO 782 (July 2019)
On July 1, 2019 ACOG updated/revised the GBS algorithm for intrapartum prophylaxis. In this session, we will cover GBS prophylactic indications, NAAT testing for GBS, GBS Bacteriuria, and antibiotic dosages.
17:16
July 8, 2019
Does H. Pylori lead to Hyperemesis?
Persistent nausea and vomiting in pregnancy is a terrible condition! It affects quality-of-life, and impacts the mother’s overall psychological well-being. What is the role of helicobacter pylori infection in this condition? Is there a link? Let’s look at the data.
10:11
July 4, 2019
Less Fetal Movement?..Drink Sugary Drinks...Right?!! NO!
It has long been held that maternal perception of fetal movement may protect against stillbirth. However, the 2018 AFFIRM trial called the tradition into question. Related to that is the traditional recommendation to drink “sugary” drinks to increase fetal movements. Is this evidence-based? In this episode, we will review the AFFIRM trial and review sugary intake to increase fetal movement.
10:12
June 30, 2019
Boot Camp! 3 Life Lessons Learned!
Left...Right...Left...Right...Left! I just recently completed my military boot camp experience! That was an adventure. In this session, we will cover 3 brief “life lessons“ that I learned during my Texas Military Forces Boot Camp! This information will truly help you every single day! Hooah!!
10:49
June 27, 2019
New Female SEX Med? Is Vylessi the DESIRE wonder drug?
Sexual intimacy is an important part of a couples’ relationship. On June 21, 2019, the FDA approved a new novel medication for hypoactive sexual desire disorder in women. The medication, Vylessi, is a melanocortin receptor activator, which is different then the previously approved medication for the same condition, Addyi. In this episode, we will review the MOA and data behind this new medication.
07:43
June 24, 2019
Sunscreen Use in Pregnancy: Safe or Worrisome?
🌞🌞IT IS SUMMER!! 👏👏 Are sunscreens safe to use during pregnancy? What does ACOG say? In this session, we will review the ACOG practice statement as well as provide some SUN-SAFE 🌞🌞tips for pregnant women during summertime!👍👍
04:53
June 18, 2019
Can Turmeric (Curcumin) help PostPartum Depression?
Turmeric is an edible root used in cooking. It’s powdered into a bright yellow spice popular in Asian cuisine. Turmeric also has a history of medicinal use. It contains an active compound, curcumin, that has antioxidant and anti-inflammatory properties. Research has found that curcumin has the potential to improve a number of health conditions — including depression. This includes mild depression and even major depressive disorder (MDD). In this podcast, we will review the data as it applies to major depression as well as postpartum depression. ( NOTE: Although this podcast provides a summary of the supplement CURCUMEN, this podcast does not represent a paid endorsement for this or any other supplemental product).
13:39
June 17, 2019
I’ll Be Baaack!
Just a brief hiatus!
01:50
June 11, 2019
HbA1C and Birth Defects
What is the mechanism by which elevated hemoglobin A-1C causes birth defects? Is there a “cut off“ level for this affect? Let’s look at the data.
12:09
June 9, 2019
Cardiac Arrest in Pregnancy
Maternal cardiac arrest… a devastating condition! Techniques for maternal resuscitation have changed, even from when I was a resident. 30° left lateral tilt is no longer recommended by the American heart Association during CPR. Manual left uterine displacement is preferred! We’ll talk about this, as well as cover the basics of maternal cardiac resuscitation in this session. (Reference: AHA Scientific statement on cardiac arrest in pregnancy).
16:47
June 7, 2019
The Pill Made Me Fat! What?? Do OCPs cause weight gain?
Weight gain is commonly cited as a side effect of combination oral contraception, and is amount the top reasons for pill discontinuation. Do birth control pills make women gain weight? Where did this perception come from? What does the data show? In this session we will review systematic reviews and the Cochran database regarding this subject.
08:17
June 5, 2019
THRIVE (Part 3)! The FIRE of Your PASSION.
(Part 3): The Finale of our 3-Part series! Remember when you would have done anything to get into medical school, and cried/struggled to get that perfect residency?! Remember why you started! This brief session will wrap up our 3- part “mini-series” on THRIVE. (ERRATA: In part 2, we attributed the famed “The man in the arena” excerpt to Churchill. The author was not Churchill, but Theodore Roosevelt...with apologies to former Pres. Roosevelt.)
05:19
June 4, 2019
THRIVE (Part 2)! The Challenge!
(Part 2): Take the challenge! This is Principle #2 in our “mini-series”. It is easy to fall into a trap of “the routine“, and the mundane. Doing so leads to dissatisfaction and frustration. Great medical leaders in the past, innovators, and countless historical figures broke out of the routine, took the challenge, and changed history forever. So… Are you up to the challenge? (Post production ERRATA: In part 2, we attributed the famed “The man in the arena” excerpt to Churchill. The author was not Churchill, but Theodore Roosevelt...with apologies to Former Pres. Roosevelt!)
07:09
June 4, 2019
THRIVE! You have been warned....
WARNING: This is my most personal, and passionate podcast yet. In light of the recent CNBC news article regarding physician well-being, this podcast will cover centuries old dogmas PROVEN to make you thrive. What does the historic emperor Marcus Aurelius have in common with leaders like Zig Ziglar, Les Brown, and Stephen R. Covey?... this podcast answers that. BUT, you have been warned! Listening to this podcast has the potential to bring change to your life. The challenge is yours! THRIVE!
20:29
June 3, 2019
Maternal O2 use in Labor: Benefit or Harm?
For decades, common practice in Labor And Delivery has been to use supplemental maternal oxygen by facemask as a remedy for fetal heart rate decelerations. However, is more oxygen delivery to the fetus actually helpful? Does it change neonatal outcomes? Well… the data is not so clear, and there may be some cause for concern. In this podcast, we will cover the evolving data on the use of supplemental maternal oxygen for fetal heart rate decelerations, and we will briefly touch on supplemental oxygen during the second stage of labor for MATERNAL support.
12:52
May 31, 2019
AMAZING: The 1st Self- Appendectomy; The True Account of Dr. Evan O'Neill Kane.
This is TRUE, and a testament to what having a VISION, a strong will, and a desire to change the status-quo can accomplish! This is the remarkable true account of Dr. Kane, who performed 2 successful self-surgeries in 1921 and 1932.
07:39
May 30, 2019
cfDNA and Maternal Cancer: A Cause For Concern?
In 2011, cf DNA from the maternal serum became commercially available to screen for fetal aneuploidy. Overall, about 3% of test results will detect an aneuploidy, and false positive results are only seen in 0.05% to 0.1% of tests. Evolving data, however, suggest that in women who have more than one aneuploidy suspected by cfDNA testing but who are found by diagnostic testing to carry a genetically normal fetus may harbor a higher risk of occult maternal malignancy. In this session, we will review published data on the risk of maternal malignancy in women who have discordant cfDNA test results.
15:18
May 29, 2019
Pitocin For Early D&C? No!
Somethings in medicine are done by tradition. The use of Oxytocin during first trimester uterine evacuation is one such thing. Evidence seems to be lacking for the use of this common intervention. Remember, physiologically, oxytocin receptors show a linear increase in concentration as pregnancy progresses- rising quickly after 36 weeks of pregnancy, and are only present in negligible quantities on the myometeium in the first trimester! In this session, we will review the data on oxytocin use for first trimester OB D&C.
13:31
May 26, 2019
Brexanolone for PP Depression: Facts and Precautions.
In March 2019, the FDA approved the first medication specifically targeted for postpartum depression, brexanolone (Zulresso). However, this medication requires a 60 hour, inpatient, IV-continuous infusion and there are some safety concerns. In May 2019, the Cleveland Clinic announced that it would release a pilot inpatient program (at one of its sites) for this medication. In this session, we will review this new medication and the Cleveland Clinic’s protocol for Zulresso.
08:30
May 22, 2019
SMFM Dont’s! (Part 2)
Does finding an isolated echogenic cardiac focus or choroid plexus cyst require amnio? What about MTHFR testing for thrombophilia? AFI or deepest vertical pocket? Does cervical length screening matter after cerclage?In this session, which is part 2, we will complete our “OB don’ts“ from the SMFM.
07:34
May 21, 2019
SMFM Don’ts!! (Part 1)
(Part 1) Cerclage for twins? What about progesterone? Do gestational diabetics controlled with diet (A1) alone require antepartum fetal surveillance? In this session, we will review 10 (out of 15) obstetrical DON’TS from the Society of Maternal Fetal Medicine.
11:26
May 21, 2019
Send a Voice Message!
Now, regardless of which venue/platform you are listening to the podcast through, you can leave us a voice message! Simply go to “episode notes“ and scroll to the bottom of the note section. Click on, “send a voice message“ and record your message! Your voice memo will go directly to our inbox and we will get back to you as timely as we can! Thanks for listening… and feel free to be part of the conversation!
01:12
May 17, 2019
CALL TO ACTION: US Maternal Mortality and CVD
The CDC confirmed in a report recently released that about 700 women die each year in the United States from cardiovascular conditions, infections, hemorrhages and other complications related to their pregnancies — up to a year after delivering their babies. In about 60% of the cases, the deaths could have been prevented, in part, with proper medical intervention, better access to care, and early recognition of risk factors/signs. The leading cause of death is CV conditions, such as heart disease and stroke, which accounts for 33% of pregnancy-related deaths. Infections account for nearly 13%, and obstetric hemorrhage accounts for 11%. In this session, we will review the ACOG practice bulletin (#212) as well as the CDC recent report on maternal mortality and cardiovascular disease.
11:16
May 14, 2019
Am. Soc. Breast Surgeons: Updated Breast CA Screening Recs
Controversy surrounding screening mammography guidelines has resulted in conflicting recommendations from physicians and uncertainty for women. The Am Society of Breast Surgeons has released detailed/conservative screening recommendations for both average and high risk women. In this session, we will review their updated recommendations. We will also briefly review the following 4 supplemental screening modalities: 1. Contrast-enhanced Breast Magnetic Resonance Imaging (MRI), 2. Ultrasound, 3. Molecular Breast Imaging (MBI), and 4. Contrast-enhanced Mammography (CEM). (A summary table of screening recs can be found on our Facebook page).
14:16
May 11, 2019
Skin to Skin at CSection: Part 2
In this session (Part 2), we will cover skin to skin neonatal contact at time of Cesarean birth. Is this possible? What does the data show? This will wrap up our two-part series.
10:36
May 9, 2019
Skin to Skin Neonatal Contact: What’s the Big Deal?
Skin to Skin neonatal contact is endorsed/recommended by the AAP, AWHONN, the CDCP, and the WHO. What’s the data behind his practice? Are there any potential risks or safety concerns? And… What about C-Section deliveries? In this episode (PART 1) we will provide an introductory overview and discuss the data behind neonatal, post-birth, skin to skin contact.
14:18
May 8, 2019
Osteoporosis
Researchers estimate that approximately 10.2 million Americans have osteoporosis, and an additional 43 million have low bone density. Equally stark are the ramifications of these numbers. About 1 out of every 2 Caucasian women will experience an osteoporosis-related fracture at some point in their lifetime. In April 2019, the FDA approved a new dual action medication for osteoporosis therapy in postmenopausal women considered at high risk of fracture. This new medication is Evenity. In this episode, we will review the pathophysiology, diagnosis of, and treatment updates osteoporosis.
13:42
May 6, 2019
The “HYSTerical” Origins of Vibrators!
“Hysteria” referred to a constellation of psychological and physical ailments occurring only in women. It was thought to have its origin in the uterus. This can be traced back to ancient Egypt, the Greeks, and even the Roman era. Even the first FEMALE physician in Europe, Trota of Salerno (11th Century AD) propagated the theory. Ancient treatments for hysteria included “genital massage“ in order to release “unused materials” from the female body! Hence the origins of what persists today... the VIBRATOR.
14:22
May 5, 2019
The Non-Fundal IUD. What’s to do?!
Hey, we have all been there at one time or another: The ultrasound report shows an IUD/IUS in the endometrial cavity but it is NOT in the fundal location. What do we do? The answer lies mainly in the TYPE of IUD used! LNG-IUS devices seem to NOT be affected by low lying locations. The data on COPPER Ts, however, is still not clear....but risk of pregnancy is likely quite low. In this session, we will review the evidence regarding management of the non-fundal IUD.
12:04
May 2, 2019
Why PLACEBO pills in Birth Control Pills? The Surprising History.
What do Mexican Yams, menses, and the Pope have in common? The answer: the Birth Control Pill! In this session, we will review the interesting and slightly strange history of the oral contraceptive pill and the notion behind “withdrawal” monthly bleeding.
11:32
May 1, 2019
46XY Females: AIS vs Swyer Syndrome
Both Androgen Insensitivity Syndrome (AIS) and Swyer Syndrone (Pure Gonadal Dysgenesis) are characterized by phenotypical females who are genetic males (46XY). However, The 2 conditions are very different pathogenically and have different clinical implications. For example, AIS patients can not become pregnant; however, Swyer patients may become pregnant after therapy. In this session, we will review the pathogenesis and clinical implications of these 2 46XY conditions.
16:11
April 30, 2019
MEASLES!! ACOG Practice Advisory.
The US is currently experiencing the greatest number of reported cases of measles, also known as rubeola, since the disease was eliminated in 2000. Outbreaks have been confirmed in 22 states. When measles occurs in late pregnancy, congenital infection is possible with variable expression and increased risk of subacute sclerosing panencephalitis. In this session, we will review the April 2019 ACOG practice advisory on management of pregnant and reproductive-age women during a measles outbreak. We will also cover 2 CDC approved algorithms for management of individuals: 1. Exposed to measles, and 2. Presenting with symptoms of measles.
13:52
April 27, 2019
Female Ejaculation and “Squirting”: HEY...YOU ASKED!!
In the late 1950s, two researchers (Masters and Johnson) began breakthrough research on human sexuality. Since then, “sexologists” have expanded our understanding of the female sexual response including concepts like female ejaculation and even, “squirting”. Yes… We will cover this data!
14:34
April 23, 2019
Hysterotomy Closure Based on Data
During my Parkland training in the late 90s, all residents were taught to close the C-Section uterine incision with a single layer locked suture. This was thought to increase hemostasis. New data, however, suggest that doing so may lead to a weaker uterine wall! Single layer, or double layer? Locked or unlocked suture? In this episode, we will review an evidence-based approach to hysterotomy closure.
09:02
April 22, 2019
LIKE...What NOT to say!
I’m sorry… I had to release this pent-up frustration regarding a common occurrence! LoL. “Like... I really hope you, like, enjoy this session”.
03:21
April 18, 2019
Fetal Echogenic Bowel
Fetal Echogenic bowel is a non-specific finding observed during 0.2 to 1.8% of routine second trimester ultrasound. Possible causes include primary gastrointestinal pathology, aneuploidy, cystic fibrosis, and congenital viral infection. However, most fetuses with this finding, especially when isolated, have no detectable abnormality. In this session, we will review the SMFM algorithm for management of isolated echogenic bowel diagnosed on second trimester ultrasound. (SMFM Brief, isolated fetal echogenic bowel).
12:46
April 18, 2019
Does Progestin Only BC Cause Depression?
Birth control, especially progestin only methods, seem to take a lot of heat regarding their potential role in CAUSING depression. Although past individual studies have suggested a link, the most recent systematic review of 26 studies has debunked that possibility. In this podcast, we will review the study published in 2018, in the journal of Contraception, regarding this topic (Worly. The relationship between progestin hormonal contraception and depression: a systematic review. Contracep. 2018).
10:52
April 12, 2019
PreCS Vaginal Prep
In 2016, the CSOAP trial confirmed that adding Azithromycin 500 mg IV to standard cephalosporin antibiotic prophylaxis pre-Cesarian helps reduce post operative infection. However, mounting evidence supports the addition of iodine-based vaginal prep to pre-CS care. However, no trial yet has compared the Zithromax – cephalosporin regimen to vaginal preparation and cephalosporin prophylaxis. In this podcast, we will summarize the current commentary by Duffy et al from April 2019’s Green Journal on pre-CSection vaginal preparation.
11:01
April 7, 2019
IV vs Oral Iron Therapy in Pregnancy
Iron deficiency anemia during pregnancy has been linked to several obstetrical adverse events including preterm birth, low birth weight, Cesarian Section, and of course the need for blood transfusion. Babies born to iron deficient mothers are also at risk of being iron deficient themselves- a condition which has been linked to poor psychosocial development. In this session, we will review the data favoring IV iron therapy over oral iron therapy during pregnancy and the postpartum period, especially for women with severe iron deficiency (hemoglobin < 10).
16:11
April 4, 2019
Prolactinomas in Pregnancy
Prolactinomas are categorized as micro- or macroadenomas based on their size. These tumors are considered the most frequently diagnosed functioning, anterior pituitary tumor type. Most women with microprolactinomas will have no adverse effects during pregnancy; however, macroadenomas are at risk of tumor growth. In this session we will review the endocrine society’s management plan of prolactinomas during pregnancy.
13:12
April 1, 2019
Pavovirus B19 in Pregnancy
Parvovirus B 19 is a single-stranded DNA virus that causes the childhood exanthem known as fifth disease. The risk of maternal Parvo B19 infection varies with the level of exposure to the infected individual. Parvo B19 may cause asymptomatic fetal infection or may result in fetal loss, hydrops fetalis, or stillbirth. Currently, the ACOG does not recommend universal screening of Parvo B19 immunity. In this session, we will review the ACOG data on maternal and fetal Parvo B19 infection.
10:29
March 31, 2019
Toxoplasmosis in Pregnancy
In the United States, 1 out of 1,000-8,000 babies are born with toxoplasmosis. Vertical transmission increases per trimester but severity of fetal disease increases the earlier in pregnancy that transmission occurs. In this episode, we will review the ACOG data on maternal and fetal infection with T. gondii.
10:43
March 29, 2019
CMV in Pregnancy
CMV is the most common congenital infection, occurring in 0.2 to 2.2% of all neonates. Vertical transmission of this herpesvirus is possible throughout all pregnancy with increasing rates of transmission per trimester (3 > 1). In the session, we will review the ACOG data on maternal and fetal CMV infection.
13:51
March 29, 2019
Do OCPS help ovarian cysts resolve?
Historically, oral contraceptive pills were prescribed in attempt to help quicken resolution of ovarian cysts. Is this practice evidence-based? In this session we will review the Cochrane Database regarding this topic as well as the mechanism of action of how certain contraceptives (etonogestrel/levonorgestrel) pre-dispose to the “unruptured ovarian follicle“.
08:52
March 28, 2019
Universal Low-Dose ASA Use In Pregnancy?
In 2018, The ACOG expanded the possibility of low-dose aspirin use in pregnancy for preeclampsia prevention. Women deemed at moderate risk (1 or more risk factor), or high-risk (only 1 high risk factor needed) were included in low-dose ASA prophylaxis. Now, a call is being made to consider “universal adoption“ of this low-cost, low risk intervention. This is a summary of this soon to be published (green journal) current commentary, “A nudge towards universal aspirin for preeclampsia prevention“.
13:39
March 25, 2019
The PROLONG trial: Does 17-OH really prevent preterm birth?
Recently, the PROLONG Trial, investigating 17-OHP’s role in preventing recurrent preterm birth, called into question the effectiveness of this treatment regimen. However, most of the study patients in the manufacturer’s initiated study were outside of the United States and were significantly different than the original MFMU study participants. In this session, we will review both of these studies and put the results into proper perspective.
06:56
March 20, 2019
VTE and Gyn Surgery
In 1858, Virchow reported on the triad of hypercoagulability, venous stasis, and vessel wall injury as the factors pertinent to venous thromboembolism. In this session, we will review the ACOG practice bulletin as well as the executive summary from the American College of Chest Physicians regarding VTE in gynecological surgery.
14:44
March 16, 2019
Do BC Pills have to be stopped before GYN surgery?
Postop DVT and PE are potentially devastating to a postop patient. What does the ACOG and the American College of Chest Physicians say about stopping hormone replacement therapy or oral contraceptive pills before surgery? Let’s take a look at the data.
09:18
March 10, 2019
One abnormal value on 3 Hr GTT: Implications?
In the United States, GDM is diagnosed by a 3 hour GTT when 2 or more values are above a designated cut off. But what happens when only one value is elevated? In this session, we will review the data regarding this clinical dilemma. We will also review if there is a clinical difference if the 1 elevated value is the fasting blood sugar or 1 of the 3 post glucose challenge. Data taken from SMFM briefings.
06:59
March 7, 2019
ACOG: Umbilical Cord Blood Banking
Umbilical cord blood banking still carries significant misperceptions regarding its potential use. Did you know, that umbilical cord blood is not meant to be used as in an AUTOLOGOUS transplant because stored cord blood contains the same genetic variant or pre-malignant condition that led to the condition being treated in the donor! In other words, a child who develops a genetic condition cannot be treated with his own donated umbilical cord blood! In this session, we will summarize the ACOG committee opinion on umbilical cord blood banking from March 2019.
09:00
February 26, 2019
NS or LR: The IV Fluid Battle May Have Ended.
IV fluids?! Does it really make a difference if the patient receives normal saline (NS) or Lactated Ringers (LR)? Well, for short bouts of rehydration (1L to 2 L), probably not. However, data now confirms that prolonged IV therapy with NS results in poorer outcomes compared to LR! In this episode, we will review the basic science of a “balanced“ IV fluid and review the data which has now placed LR at the forefront of IV fluid hydration.
11:26
February 23, 2019
FOAMed!!
FOAMed!!! A shout out to “free open access medical education”. Thanks for the information, Scott C.-one of our clinical medical students!
01:50
February 20, 2019
Vanishing Twin Syndrome
Incredibly, Although the frequency of multiple gestation is 3 to 5% at 8 weeks, vanishing twin syndrome occurs in 20-30% of all multifetal gesstations! This is not a rare occurrence. Maternal and fetal morbidity- and possibly mortality- is linked to the timing of the single fetal loss. Risks increase when a single fetus is lost in the second or third trimester. In this session, we will review the ACOG and SMFM Data regarding the vanishing twin syndrome.
13:21
February 20, 2019
HIV PrEP
According to the CDC, 1 in 8 of the 1.2 million people living with HIV in the United States are unaware of their HIV status and only half of those known to be infected are receiving effective anti-retroviral therapy. The combination pill tenofovir/emtricitabine has been FDA approved for pre-exposure prophylaxis (PrEP). In this podcast will review the current state of PrEP therapy. (Reference: HIV pre-exposure prophylaxis, a review: JAMA, 2018.)
12:10
February 14, 2019
Screening for Perinatal Depression
Perinatal depression, which includes major and minor depressive episodes that occur during pregnancy or in the first 12 months after delivery, is one of the most common medical complications during pregnancy and the postpartum period. According to the ACOG, 1 in 7 women are affected by perinatal depression! In this session we will review the ACOG committee opinion on screening for perinatal depression from the winter of 2018 (committee opinion 132).
08:34
February 11, 2019
Polyhydramnios
Polyhydramnios is an abnormal increase in amniotic fluid volume typically diagnosed in the second or third trimester. Either the single deepest vertical pocket or AFI can be used for diagnosis. The two most common pathological causes are maternal diabetes and fetal anomalies. In this session, we will summarize the SMFM consult series #46 (2018) on the evaluation and management of polyhydramnios.
15:29
February 8, 2019
DKA in Pregnancy
Diabetic ketoacidosis in pregnancy is an obstetric and medical emergency and therefore requires prompt and aggressive treatment in a specialized care unit. Prompt and aggressive IV fluid management, IV insulin administration, and attention to key electrolytes are foundational to DKA management. In this podcast, we will review the SMFM protocol for DKA management in pregnancy.
14:51
February 6, 2019
Glycemic Effects After Steroids for FLM
Corticosteroid therapy for fetal lung maturity was first endorsed back in 1994. But what do we know about its affect on glycemic levels? Pregnant women with gestational diabetes, and of course pre-existing diabetes, are at higher risk of DKA at “lower” hyperglycemic levels compared to non-pregnant individuals. In this session, we will review the data on the effect of antenatal corticosteroids on the mothers’ glycemic levels.
06:36
February 4, 2019
This… Happened!
You just have to listen…
00:52
January 31, 2019
Mag Sulfate for Fetal Neuroprotection
Incidence of cerebral palsy is inversely related to gestational age a delivery. The first reported association between fetal exposure to mag sulfate and reduction in perinatal morbidity was published in 1992. Magnesium sulfate for fetal neuroprotection is now standard in women presenting with preterm labor at less than 32 weeks. In this podcast, we will review the data on mag sulfate for fetal neuroprotection and summarize current best practices. Data is taken from the ACOG, SMFM, and Cochrane review on mag sulfate for fetal neuroprotection.
10:51
January 28, 2019
Remembering the Tuskegee Syphilis Study
In 1932 a governmental agency called the Public Health Service began working with the Tuskegee Institute to study syphilis in black men. In 1947, when penicillin was discovered as the illness cure, participants in the study were denied treatment in “order to study the natural outcome of disease”. In the early 1970s, the “study” was finally deemed unethical and was stopped. As syphilis cases continue to rise in the US, we must not forget the principles of ethical scientific discovery and not forget those who participated in a study which violated all currently accepted ethical standards.
08:11
January 25, 2019
HRT and WHI (Part 2): NAMS 2017 Updated Statement
This is Part 2 of our critical reappraisal of the WHI study. In this episode we will cover the NAMS 2017 guidelines on HRT use. Does hormone therapy increase breast cancer in BRCA carriers? What is the data on ovarian cancer? Dementia? Listen to find out! We will also briefly touch on transdermal hormone replacement therapy, at the end of the podcast.
14:20
January 23, 2019
HRT and WHI: Fear vs Reality! (Part 1)
(Part 1) The media attention surrounding the publication of the initial results of WHI in 2002 led to fear and confusion regarding the use of hormonal therapy (HT) after menopause. In 2006, re-analysis of more complete data seemed to contradict the original findings. This led to a “retraction“ and re-explanation of the original data in 2007. Hormone therapy initiation in older women is NOT the same as initiation in younger women! In this session, we will take a critical look at the original WHI data from 2002 and the complete data and reanalysis released in 2007. We will separate fear from reality! Data for this episode comes from the WHI original trial, NAMS analysis, WHO data, as well as the international menopause society.
20:39
January 21, 2019
Nuchal Cords: Innocent or Guilty?
Nuchal cord (NC) is common, and the vast majority of term deliveries with nuchal cord have normal outcomes. However, nuchal cord associated fetal morbidity is closely correlated to the number on nuchal cords present and the degree of “strangulation”/tightness. Even Hippocrates noted that nuchal cords could be associated with fetal loss in one of his writings, circa 370 BC. In this session, we will review data from the ACOG executive statement on neonatal encephalopathy, as well as a literature review on NCs by Peesay (2017) from the Journal of Maternal Health, Neonatology, and Perinatology.
13:26
January 20, 2019
Umbilical Artery Dopplers
Umbilical Artery Doppler studies are a valuable tool to assess vital well-being in the growth restricted fetus. What are the indices that are evaluated? What is the management when abnormal results are noted? In this session, we will review fetal doppler umbilical artery velocimetry. Clinical management based upon findings will also be discussed. Dated taken from SMFM Clinical Briefs and ACOG practice bulletin 145.
09:06
January 16, 2019
Sickle Cell in Pregnancy: Part 2
In this episode, which is part 2, we will cover the role of “prophylactic” red blood cell transfusion during pregnancy. We will also cover the medical management of sickle cell crisis, and wrap up the episode with notes on intrapartum and postpartum care.
10:02
January 12, 2019
Sickle Cell in Pregnancy: Part 1
Sickle cell disease is the most common inherited condition worldwide. Sickle cell disease carries unique maternal and fetal risks during pregnancy. In this episode, which is part 1, we will review preconception care, medication use in pregnancy, and review specific obstetrical complications associated with the condition. (Reference: CDC, SMFM, RCOG data).
09:56
January 10, 2019
ACOG Emphasizes Interpregnancy Care: OB Care Consensus #8
The interpregnancy interval provides an ideal opportunity to discuss interventions which can maximize maternal as well as neonatal outcomes. Do you know at which interpregnancy interval adverse neonatal outcomes are highest? Is interpregnancy interval associated with higher TOLAC risk? In this session, we will summarize the ACOG obstetric care consensus report (#8) from January 2019.
08:42
January 8, 2019
Pitocin! From Discovery to Modern Day Use.
At what gestational age does the uterus become responsive to oxytocin? Can Pitocin result in hypertension or HYPOtension?...And who was Sir Henry Dale? In this podcast, we will review the origins, development, pharmacology, and potential adverse affects of synthetic oxytocin.
10:25
January 6, 2019
Peripartum Cardiomyopathy (Part 2)
Is Digoxin routinely used for peripartum cardiomyopathy? Can women who had peripartum cardiomyopathy take oral contraceptive pills? In this episode, which, is part 2, we will answer these questions as well as cover the workup, management, and prognosis of peripartum cardiomyopathy (Reference: Obstet Gynecol. Jan 2019).
09:15
January 3, 2019
Peripartum Cardiomyopathy (Part 1)
(Part 1): Peripartum cardiomyopathy occurs in about 1 in 2,000 births in the United States. Although relatively rare, it can be devastating to the mother. In this session we will summarize the January 2019 clinical expert series on peripartum cardiomyopathy from Dr. Gary Cunningham, et al (Obstet Gynecol. Jan 2019).
09:02
January 2, 2019
How “Blowing Smoke Up Someone’s A$$” went from medical treatment to a modern colloquial phrase.
Did you know the common, modern-day, colloquial expression about “blowing smoke up someone’s A$$” actually has a medical origin? Yep... it was a real therapy! In this podcast, we will review the bizarre practice, that made its way into modern vernacular.
07:40
December 30, 2018
Gestational HTN and PreEclampsia UPDATE: ACOG PB 202
In 2013, the ACOG released a comprehensive review on hypertensive disorders in pregnancy. In January 2019, the College re-visits gestational hypertension and preeclampsia and gives important updates. In this podcast, we will review 2 very clinically applicable aspects of intrapartum care for patients with gestational hypertension and preeclampsia. Who should get magnesium sulfate? And what’s the data on epidural use in these patients? Let’s find out what the ACOG has to say.
12:03
December 28, 2018
Beer 🍻 and Breastfeeding? What’s the data on alcohol use during lactation?
Alcohol use during pregnancy is well studied with well stated warnings. But what about alcohol use during breastfeeding? What’s the data on that? In the session, we will review alcohol intake by the mother during breastfeeding and take a look at some accepted recommendations.
11:25
December 25, 2018
Our Holiday Message to you!
Our BEST Holiday wishes to you!
00:31
December 24, 2018
ACOG UPDATE (Part 2): Chronic Hypertension in Pregnancy.
This is part 2 of our review of the ACOG practice bulletin #203. In this session, we will review low-dose aspirin for preeclampsia prevention, as well as target blood pressure goals for medical management of chronic hypertension in pregnancy. We will end this podcast with a quick word about NSAIDS for postpartum pain control in hypertensive patients.
09:51
December 24, 2018
ACOG UPDATE! AHA and Chronic Hypertension in Pregnancy.
Recent recommendations from the American College of Cardiology (ACC) and the American Heart Association (AHA) have changed the criteria for diagnosing hypertension in adults. In January 2019, the ACOG will release Practice Bulletin #203 addressing these changes, and provide renewed guidance for management of chronic hypertension in pregnancy. This is PART 1, of a 2-Part review of PB#203.
08:46
December 23, 2018
SCABIES!....In Pregnancy.
OK, so your pregnant patient comes to you with persistent itching between the fingers and toes and you suspect scabies. Which medication is safe to use in pregnancy? This is a brief review of scabies in pregnancy and its accepted medical treatments.
07:45
December 22, 2018
Is vaginal estrogen safe? New data from the Nurses’ Health Study!
Genitourinary syndrome of menopause causes a significant disruption in quality of life for many menopausal women. The ACOG and NAMS endorse vaginal estrogen to relieve local symptoms. However, the FDA has a current Black Box warning on vaginal estrogen. This podcast will cover brand new data from the Nurses Health Study, released December 20, 2018 in the journal, Menopause.
09:37
December 21, 2018
“Weed”, Sperm, and Epigenetics: A Cautionary Note!
As legal access to marijuana continues expanding across the US, more researchers are studying the effects of tetrahydrocannabinol, (THC), in teens, adults and pregnant women. New research from Duke Health suggests men in their child-bearing years should also consider how THC could impact their sperm and possibly the children they conceive during periods of Marijuana use. This is a tale of marijuana, sperm, and epigenetics! Data for this podcast came from the recently published study from Duke researchers, published in EPIGENETICS, 19 December 2018 (Murphey et al) and the medical news update from MDLinks (12/19/18).
10:25
December 20, 2018
Hello! From our 3rd Year ObGyn Med Students!
Just something fun to break up the monotony.
00:56
December 19, 2018
Vulvar Lichen Planus
Lichen Planus is a chronic inflammatory mucocutaneous disorder that can affect the mouth, vulva, vagina, and anus. Wickham’s Striae are characteristic of mucosal involvement. Biopsy is often needed to confirm the diagnosis and rule out other neoplastic conditions. The more afflicting type of Lichen Planus is erosive lichen planus. In this session, we will review the presentation, pathophysiology, diagnosis, and treatment of vulvar Lichen Planus. (Reference: ACOG expert series CME edition on vulvar skin dermatoses; 2018)
06:05
December 19, 2018
Vulvar Lichen Simplex Chronicus (2018 Update)
Vulvar Lichen Simplex Chronicus is a non-scarring, chronic inflammatory disease of the skin characterized by intense itching. 65% to 75% of patients have a history of allergic conditions including asthma or childhood dermatitis. In this session, we will review the presentation, diagnosis, and medical care of vulvar Lichen Simplex Chronicus. (Reference: ACOG clinical expert series, CME edition, “Diagnosis and Treatment of Vulvar Dermatosis“ ; 2018)
05:14
December 19, 2018
Vulvar Lichen Sclerosus (2018 Update)
Vulvar Lichen Sclerosus is a chronic inflammatory vulvar dermatosis. There is an association between this condition and various systemic autoimmune conditions (e.g., thyroid dysfunction, vitiligo). Additionally, patients with this condition have a 4-5% risk of vulvar cancer in the future! In this session, we will discuss the pathophysiology, diagnosis, and management options for this condition. (Reference: CME Series on “Diagnosis and Treatment of Vulvar Dermatosis”, 2018; Obstet Gynecol)
08:12
December 18, 2018
Ulipristal for NEXPLANON Bleeding?
The etonogestrel contraceptive implant is a type of LARC with proven high efficacy. Yet, similar to all progestin only contraception, abnormal bleeding can become bothersome to the patient- especially in the first 3 to 6 months of use. Ulipristal, a progesterone receptor modulator, has shown promise as a new medical agent to help relieve bothersome bleeding in these patients. In this podcast, we will review the latest data from a randomized controlled trial (Oct 2018) on ulipristal for bleeding control in Nexplanon users.
11:03
December 18, 2018
ACOG Practice UPDATE! 17OHP IM vs 17OHP SQ
On December 15, 2018, the ACOG released a Practice Update regarding subcutaneous use of 17OHP rather than IM 17OHP for preterm birth prevention. Weekly IM injections of 17OHP were endorsed by the ACOG after the 2003 MEIS MFM Network clinical study demonstrated a reduced risk of preterm birth in women with prior preterm birth, with its use. In this podcast, we will review the ACOG practice update regarding subcutaneous rather than IM 17 OHP for preterm birth prevention.
08:03
December 16, 2018
Nipple Discharge
Nipple discharge is a common breast symptom. Keys and clues to stratify patients as either low risk or high-risk include: the patient’s age, unilateral or bilateral discharge, single duct or multi duct, whether a mass is also present in the breast, and the color of the discharge. Most nipple discharge thankfully is benign, but some require more attention. In this session, we will review the ACOG practice bulletin number 164 regarding nipple discharge.
08:10
December 16, 2018
Let us hear from YOU!
Let us hear from you! Thanks for being a part of our podcast family! Did you know, you can send us feedback and recommendations/suggestions for future episodes? Here’s how…
01:29
December 15, 2018
Sex During Pregnancy
Pregnant women and their partners often ask whether or not sex is allowed in pregnancy and what possible consequences may occur. Does sex cause preterm labor? Is PID possible during pregnancy? Is oral sex allowed? Does sex induced labor? Let’s take a look at these questions... and provide answers!
12:32
December 15, 2018
“POI” in Young Women
Premature Ovarian Insufficiency (POI) has replaced the previous term of “premature ovarian failure” or “premature menopause”. POI is a stressful and emotional taxing diagnosis for any woman, especially the adolescent and young patient. Other endocrinopathies may be present in patients with POI including thyroid abnormalities and adrenal insufficiency. In this session, we will review the last ACOG Committee Opinion on POI in adolescents and young women (CO 605).
13:13
December 14, 2018
Does Progestin Birth Control Cause Depression?
Progestin only contraceptive options include the subdermal implant, Injection, IUS, and pills. Progestin based LARCs provide HIGHLY effective contraception. A common perception in the public community is that these options may result in depression! Do they? Let’s take a look at a systematic review from 2018 on the subject.
06:58
December 13, 2018
“Your name is Mudd!” How “Duty to Treat” ruined a physician’s life.
Dr. Samuel A. Mudd. Although few in modern times are aware of this physician, many have heard of the unwelcoming statement, “Your name is Mudd!“. In this brief “medicine in history” segment, we will cover the incredible story of Dr. Mudd.
03:36
December 11, 2018
Talc Before Panties? A look at the curious & controversial data on talc and female cancer.
Talc Before Panties? A look at the curious & controversial data on talc and female cancer... The controversy between the use of talc in the female genital area and risk of ovarian cancer dates back to the 1970s. This decades long conundrum still persists with more questions than answers. Recently, Health Canada issued a health advisory warning on the potential development of ovarian cancer after repeated exposure of the female genital area to talc. In this podcast, we will review the ever conflicting data on this subject and review the statements of the American Cancer Society, the FDA, and Health Canada.
10:49
December 11, 2018
Risk Reduction Salpingectomy
An evolving burden of evidence supports the theory that a large majority of high-risk ovarian epithelial cancers have a tubal origin. RRS is growing in practice as the preferred option at time of benign Gyn surgery and sterilization. Although RRSO is still preferred in high-risk women (germline mutation carriers), RRS is a possible alternative option, with delayed oophorectomy after age 40. In this podcast, we will review the pathophysiology of epithelial ovarian cancer, its tubal origin, and the role of RRS.
15:13
December 9, 2018
The “Big O”: Female Orgasm- The How, Why, and What of the BIG O!
The “BIG O”!! This podcast will cover the biology of, purpose of, and surprising health benefits of... female orgasm. (Yep...Oh, the topics we cover all in the name of SCIENCE!)
16:26
December 8, 2018
PRES: Posterior Reversible Encephalopathy Syndrome
PRES may be associated with Preeclampsia and Eclampsia. The condition is theorized to result from dys-autoregulation of posterior cerebral perfusion. In this session, we will cover the pathophysiology, presentation, workup, and prognosis of PRES.
12:21
December 7, 2018
Ovarian Torsion
Ovarian torsion is considered a gynecological emergency. Ovarian torsion can also occur in pregnancy. Recent data has confirmed the feasibility of ovarian conservation at time of laparoscopic surgery. In this session, we will review the pathophysiology, clinical presentation, work-up, and management of this condition.
12:06
December 5, 2018
The PALM-COEIN System for AUB
In 2011, the FIGO adopted a new nomenclature to characterize abnormal uterine bleeding in the reproductive age patient. ACOG subsequently adopted the system. Terms like menorrhagia, metrorrhagia, and dysfunctional uterine bleeding, were abandoned. In this session, we will review the PALM-COEIN nomenclature.
12:43
December 4, 2018
Diagnosis and management of palpable breast masses
Fibroadenomas are the most common cause of breast masses in adolescent girls and young women. Nonetheless, it is important to remember that the palpable breast mass is still the most common finding of symptomatic breast cancer. In this podcast, we will review the diagnosis and management of the palpable breast mass, according to the ACOG practice bulletin 164. We will also review the BI-RADS classification system.
17:29
December 3, 2018
Dysmenorrhea and Endometriosis in the Adolescent Patient
This podcast is a review of the ACOG Committee Opinion 760 from December 2018. Dysmenorrhea, or menstrual pain, is the most common menstrual symptom among adolescent girls and young women. Most adolescents with menstrual pain will have primary dysmenorrhea, but secondary dysmenorrhea (endometriosis) may also occur. This podcast will review symptoms, work-up, and therapy of both primary and secondary dysmenorrhea in the adolescent patient.
15:08
December 2, 2018
Septic Pelvic Thrombophlebitis
Septic pelvic thrombophlebitis can occur in the deep pelvic vessels alone or may involve the ovarian vein. Ovarian vein thrombosis is most frequent on the right side. This podcast will over the current data on presentation, workup, and use of anticoagulation in SPT cases.
15:34
December 2, 2018
Thank you!! Danke! Gracias!
Our mission is to educate, train, and develop healthcare professionals in women’s healthcare. Our podcast has hit a milestone!! This podcast, which is an independent, non-industry sponsored educational platform, has hit 50,000 1st time plays! Thank you for listening, and being a part of Clinical Pearls!!
00:50
November 27, 2018
Immediate Postpartum LARCs
Immediate postpartum LARCs are endorsed by the ACOG. This podcast will summarize the ACOG committee opinion 670, and review the new data (October 2018) regarding IUD expulsion rates based on timing of insertion, route of delivery, and IUD types.
09:01
November 27, 2018
Pregestational Diabetes Mellitus
This podcast will quickly summarize the ACOG practice bulletin number 201 on pre-gestational diabetes mellitus. This ACOG practice bulletin is set to be released December 2018.
12:08
November 22, 2018
Are “routine“ pelvic examination going extinct? Let’s take a look at the data.
Traditionally, a well-woman visit has included a pelvic examination defined as external genitalia inspection, speculum examination, and bimanual exam. However, the collective body of evidence is actually limited in support or rejection of the routine performance of the pelvic exam in an asymptomatic woman. This podcast will cover the ACOG committee opinion number 754 from the Fall of 2018 discussing the matter.
07:58
November 17, 2018
Elagolix: Indications, Data, and Dosing.
Endometriosis related pelvic pain affects approximately 8% of reproductive age women. Recently, the FDA approved a new oral GnRH antagonist for treatment of endometriosis related pelvic pain. This podcast will review the indication, data, and dosage options for this new novel medication. This podcast does not represent a specific endorsement of elagolix, and was produced without industry affiliation.
10:11
November 11, 2018
Migraine with Aura and Estrogen Containing Birth Control: What’s the Data on Risk?
Traditionally, migraines with aura were considered contraindicated for estrogen containing birth control. However, that recommendation was made in the 1960s and 1970s when the dose of estrogen in birth control pills was much higher than dosages used today. The risk of stroke is directly related to the amount of estrogen in birth control, and recent clinical opinions have suggested that ultra-low dose combination contraception is allowable. In this podcast, we will review the latest data and clinical opinions regarding the use of estrogen-containing birth control in patients with migraine with aura.
08:37
November 9, 2018
Opthalmia Neonatorum
Neonatal opthalmia refers to conjunctivitis of any cause occurring within the first 4 weeks of newborn life. Gonorrhea now accounts for less than 1% of the condition, however chlamydia is responsible for 2% to 40% of cases. Ocular prophylaxis is not effective against chlamydial conjunctivitis. In this podcast we will review this potentially devastating newborn ocular condition.
06:50
November 3, 2018
Asymptomatic microscopic hematuria in women
In this podcast, we will cover the combined committee opinion from the ACOG and AUGS regarding asymptomatic microscopic hematuria in women. The ACOG deviates from the American Urological Association recommendation for evaluation of asymptomatic microscopic hematuria in women over age 35, as the risk of any urological malignancy is very low. Data taken from the ACOG committee opinion 703, June 2017.
09:27
October 29, 2018
“The Savior of Women”: Ignaz Semmelweis
In this brief historical profile, we will cover the inspiring tale of Dr. Ignaz Semmelweis. The story begins in the year 1846. Dr. Semmelweis was the first to investigate childbed fever and proposed handwashing as a way to prevent maternal death. His story is one of research, revelation, and an untimely tragic end.
08:20
October 26, 2018
Marijuana use in pregnancy and while breast-feeding
In this podcast, we will review the new clinical expert series from the ACOG on marijuana use in pregnancy and while breast-feeding. This clinical expert series will be slated to be published in the November 2018 edition of Obstetrics & Gynecology (Metz et al).
09:53
October 23, 2018
Framed, or Famed? LoL. It’s OK to laugh at yourself at times.
A personal message regarding our last podcast to our listeners. 😁
00:40
October 20, 2018
How a famed surgeon changed the field of obstetrics: William Hallstead, postpartum hemorrhage, and brave genius.
This is a quick historical perspective of an ingenious approach to a deadly obstetrical problem in history. Dr. William Halstead, the father of modern surgery, is credited with performing the first blood transfusion following postpartum hemorrhage in the United States. However, it was British obstetrician James Blundell that first described blood transfusion to prevent death from postpartum bleeding. Let’s take a look at this amazing historical story.
04:26
October 20, 2018
Thrombocytopenia in pregnancy
Thrombocytopenia in pregnancy is defined as a maternal platelet count less than 150,000. In this podcast, we will review the ACOG practice bulletin number 166 reviewing gestational thrombocytopenia, as well as the two most common immune mediated thrombocytopenic conditions: ITP, and fetal-neonatal alloimmune thrombocytopenia.
16:24
October 18, 2018
Intrapartum Care of the HIV Positive Patient
There have been significant changes – and advancement – in the interparty management of the HIV infected patient. In this session, we will quickly review the intrapartum management of the HIV infected patient based on the IDSA guidelines.
13:02
October 8, 2018
Acute Fatty Liver of Pregnancy
Acute fatty liver of pregnancy is a rare but potentially life-threatening condition which usually presents in the 36th week of pregnancy. In this podcast we will cover the ACG (Am. Coll Gastro) clinical guidelines regarding acute fatty liver disease in pregnancy.
08:28
September 26, 2018
GBS in Pregnancy
In this session, we will review the ACOG committee opinion on prevention of early onset GBS neonatal infection. This comes from the committee opinion 485.
11:11
September 20, 2018
Does BMI affect emergency birth-control effectiveness?
Levonorgestrel and ulipristal are 2 oral emergency contraceptive options. Since 2010, pharmacokinetic studies have suggested a lower effectiveness of levonorgestrel in overweight and obese women. In this podcast, we will review the pharmacokinetic data as well as professional society opinions on this topic.
07:39
September 15, 2018
PMS and PMDD: Clinical Review
In this session, we will review the diagnostic criteria for premenstrual syndrome and premenstrual dysphoric disorder. Options for therapy will also be discussed. Data taken from the ACOG and the APA.
16:15
September 6, 2018
Umbilical Cord Prolapse
In this session, we will review and obstetrical emergency that has the potential to result in severe Ville and morbidity or even mortality… Umbilical cord prolapse.
13:17
August 30, 2018
Prophylactic Antibiotics in Labor & Delivery
In this session, we will review the ACOG practice bulletin (199) from September 2018 on the use of prophylactic antibiotics in labor and delivery. This podcast will cover the optimal dose of intravenous antibiotics before C-section, the use of vaginal cleansing, and the adjuvant use of Zithromax before cesarean birth. Care of the MRSA colonized patient, as well as infective endocarditis prophylaxis will be covered.
20:34
August 28, 2018
Ovarian Vein Thrombosis
Ovarian vein thrombosis was recently the subject of a clinical review by the American College of OBGYN in November 2017. Ovarian vein thrombosis occurs in 1 and 600 to 1 in 2000 pregnancies and may have severe sequelae including pulmonary embolism. In this podcast, we will review the latest information from the ACOG and the ACCP on the pathophysiology, diagnosis, and treatment of ovarian vein thrombosis.
11:48
August 20, 2018
Clarification- Klumpke's palsy: "Neuropathy at gyn surg".
Alright, as occasionally happens… There was an error in the editing of our prior podcast regarding nerve injury at gynecological surgery. This very brief section will clarify the occurrence of klumpke's palsy during steep trendelenburg positioning.
02:09
August 18, 2018
Nerve Injury at Gyn Surgery
Gyn surgery can be associated with iatrogenic nerve injury. Neuropathy can be classified into three types: neuropraxia, axonotmesis, and neurotmesis. The most severe form of injury is nerve transaction or complete nerve ligation (neurotmesis). In this session, we will review the mechanism of nerve injury during Gyn surgery, their presentations, and prevention tips. Material is taken from the AAGL and the Society of Gyn Surgeons.
18:40
August 17, 2018
Management of Intra-Amniotic Infection
In this podcast, we will review the ACOG updated guidelines regarding intra-amniotic infections. Three classifications have been given by the ACOG: 1. Isolated maternal fever in labor, 2. Suspected intra-amniotic infection, and 3. Confirmed intra-amniotic infection. We will review these three categories, their diagnosis, and treatment recommendations. Data taken from the ACOG committee opinion 712.
12:00
August 12, 2018
Delayed umbilical cord clamping after birth (ACOG CO 684)
The ACOG, as well as the AAP, recommends delayed umbilical cord clamping in stable term as well as preterm neonates. While once considered necessary to keep the Neonate at or below the level of the placenta, new data shows that placental to child transfusion still occurs if the child is placed on the maternal chest for skin to skin contact. Additionally, the presence of meconium stained fluid – in vigorous neonates – is not a contraindication to delayed umbilical cord clamping. In this podcast, we will review the ACOG committee opinion on delayed umbilical cord clamping.
10:21
August 6, 2018
Epithelial Ovarian Cancer
Ovarian cancer is the most deadly of all gynecological malignancies. Most cases present an advanced stage. Epithelial ovarian cancer is the most common histological class at diagnosis. In this session, we will cover the SGO data on presentation, staging, and treatment of epithelial ovarian malignancies. Avastin and PARP therapy will also be reviewed.
13:01
August 2, 2018
Follow us on Facebook
Howdy! Thanks for following our podcast. Be sure to find us, and follow us, on our Facebook page by the same name. Typically, additional information and data is posted on the Facebook feed which serves as a supplement to the podcast. Thanks for listening…
00:49
August 1, 2018
Cervical Cancer
Persistence of high-grade oncogenic HPV is the key risk factor for the development of cervical carcinoma. In this session, we will review the pathophysiology, clinical staging, and treatment regimens for cervical carcinoma. Additionally, we will review the 2014 approved medication (Avastin) for the treatment of advanced, metastatic, recurrent cervical cancer. (Data taken from the Society of Gynecologic Oncology and the American Cancer Society.
12:04
July 31, 2018
Endometrial Cancer
Endometrial carcinoma is the most commonly diagnosed gynecologic malignancy. The SGO and the ACOG released a practice bulletin in 2015 which is the most recent bulletin on the subject (149). In this podcast we will review the classification, symptoms, work up, and surgical management of endometrial adenocarcinoma.
16:34
July 28, 2018
Endometrial Intraepithelial Neoplasia
EIN Represents a true antecedent lesion in the endometrial cavity with the potential to develop into endometrial adenocarcinoma. This podcast will review the joint committee opinion released by the SGO and the ACOG (#631) covering pre-malignant endometrial pathology.
17:17
July 28, 2018
Emergency Contraception
In this session, we will cover emergency contraception: levonorgestrel, Ullipristal, and the copper IUD. Data for this podcast comes from the ACOG practice bulletin 152.
11:21
July 24, 2018
MRI use in Pregnancy: Is Gadolinium a Concern?
MRI offers some advantages over ultrasound as a diagnostic tool in pregnancy. In this session, we were review the ACOG committee opinion on MRI use in pregnancy with a focus on gadolinium contrast agent.
07:42
July 23, 2018
Ultrasound in Pregnancy PART2
In Part 1, we covered the basics of OB ultrasound. In this session, a short additional piece, we answer a few additional questions regarding ultrasound use in pregnancy. Data taken from the ACOG/AIUM practice bulletin 175
03:20
July 22, 2018
Ultrasound in Pregnancy
Ultrasound is the most common procedure performed during pregnancy. The ACOG recognizes three types of ultrasound: standard, limited, and specialized. In this session, we will review methods to date a pregnancy, determine fetal weight, discuss ultrasound use for genetic screening, and end with a quick recap of ultrasound use in multifetal gestations.
14:08
July 22, 2018
Pelvic Inflammatory Disease (PID)
Unrecognized or misdiagnosed PID may result in infertility, tubal pregnancy, and chronic pelvic pain. In this session, we will review the CDC guidelines for diagnosis and treatment of PID (2015 updated guidelines).
13:38
July 20, 2018
Thromboembolism in Pregnancy
In this session, we will review thromboembolism in pregnancy based on the July 2018 ACOG Practice Bulletin. We will cover DVT and PE presentation, work up, and management. Delivery considerations will also be reviewed.
19:29
July 17, 2018
Chancroid
In this session, we will review chancroid, a genital STI caused by H. Ducreyi. This bacterium causes ulcers presenting as painful sores (soft chancre) on the genitalia. We will cover presentation, diagnosis, and treatment. We will also review the differences between the genital ulcers of syphilis, LGV, and granuloma inguinale.
11:23
July 16, 2018
Syphilis
In this session, we will discuss the clinical stages of syphilis, diagnosis, treatments, and pregnancy considerations.
15:52
July 14, 2018
Gonococcal Infection
In this session, we will cover the microbiology and the pathophysiological processes of gonococcal infections. Screening, treatment, and prevention of neonatal infection will also be reviewed. Data is taken from the ACOG bulletin as well as the practice guidelines from the CDC.
09:57
July 13, 2018
Chlamydial Infection in Women
Chlamydia Trachomatis is the most common bacterial STI. In this session, we will review screening recommendations, treatment, pregnancy considerations, and end with a quick recap and review of the microbiology of the organism.
12:42
July 12, 2018
PART 2: Chronic Hypertension in Pregnancy
In this short session, we will cover recommended delivery times for women with chronic hypertension as well as breast-feeding on antihypertensive medications.
02:59
July 11, 2018
Chronic Hypertension in Pregnancy
Chronic hypertension affects 3 to 5% of all pregnancies. In this session, we will cover the SMFM and ACOG bulletins on the subject. Which patients need treatment? What meds should be used? What are the risks of chronic hypertension in pregnancy? Answers to these questioms AND MORE will be covered.
13:24
July 10, 2018
Pre-labor rupture of membranes (PROM)
In January 2018, the ACOG changed the terminology for PROM, now referred to as pre-labor rupture of membranes. In this session, we will review practice bulletin 188 and discuss the clinical management of both term and preterm PROM.
19:18
July 5, 2018
Lactation
In this session, we will review the process of mammogenesis and lactogenesis as well as the process of lactation. Mastitis and breast abscess management will also be reviewed.
13:41
July 5, 2018
Managing fetal macrosomia
Fetal macrosomia predisposes both the mother and child to increased risks. In this review, a summary of the ACOG practice bulletin #173, we will review risk factors for fetal macrosomia, the diagnosis, and when a primary elective C-section should be considered for the condition.
10:01
July 2, 2018
Fetal Growth Restriction
Fetuses with an estimated fetal weight by ultrasound of less than the 10th percentile are labeled as growth restricted. These infants are at high risk for morbidity and even mortality. In this session, we will review the ACOG and SMFM practice bulletins on fetal growth restriction: wrist factors, diagnosis, monitoring, and delivery.
14:12
July 2, 2018
Stillbirth
In this session, we will review risk factors for Intrauterine Fetal Demise (stillbirth) and discuss the ACOG algorithm for stillbirth evaluation.
10:44
June 28, 2018
Update on Maternal Alloimmunization (Part 2)
This is part 2 of our series on maternal alloimmunization. In this session, we will review prevention of RH isoimmunization with a brief review on RhoGAM use according to the ACOG practice bulletin # 181.
10:14
June 25, 2018
Update on Maternal Alloimminization (Part 1).
In March 2018, the ACOG released an updated practice bulletin on the management of alloimmunization during pregnancy. The ability to determine genotype of an RH positive father and the use of middle cerebral artery Doppler ultrasound have revolutionized the care of alloimmunization. This is part one of a two-part series.
11:23
June 25, 2018
Multifetal Gestations
Multifetal gestations are either dizygotic or monozygotic. The rate of monozygotic twins tends to be constant worldwide. Twin and triplet pregnancies are at risk of certain maternal and fetal complications. In this session, we will cover the ACOG practice bulletin on multifetal gestations as well as the SMFM bulletin on the topic.
17:26
June 23, 2018
Non-obstetrical surgical conditions in pregnancy
In this session we will cover general surgery comditiond in pregnancy. The three most common non-obstetrical surgical conditions in pregnancy are: appendicitis, gallbladder disease, and acute intestinal obstruction. In this session, we will cover the diagnostic evaluation and treatment of these non-obstetrical surgical conditions.
15:39
June 21, 2018
Cell free DNA for fetal aneuploidy screening
Cell free DNA screening evaluates short segments of DNA in a maternal serum and can be used to screen for fetal aneuploidy, fetal RH type, and sex chromosome abnormalities. In this session, we will review the data on cell free DNA screening from the ACOG practice bulletin number 163.
12:57
June 20, 2018
Spontaneous abortion (Early Preg Loss)
In this session, we will cover data from the ACOG practice bulletin number 150, on early pregnancy loss. We will cover etiology, diagnosis, and the three types of management: expectant management, medical management, and surgical management. We will end a podcast with a quick review of the different categories of spontaneous abortion (threatened, inevitable/incomplete, missed, blighted, septic).
10:57
June 10, 2018
Prenatal (Antepartum) Care: Part 3
In this final session, we will review RhoGAM use, GBS screening, and the ACOG update on vaccinations in pregnancy (Tdap).
05:02
June 9, 2018
Prenatal (Antepartum) Care: Part 2
This is part 2 of our 3 part series on antepartum care. In this session, we will cover ultrasound use, screens for aneuploidy, screening for inherited genetic conditions, and gestational diabetes screening.
18:54
June 9, 2018
Antepartum (Prenatal) Care: Part 1
In this session, we will review the ACOG guidelines regarding specific screening tests, monitoring, and interventions during routine prenatal/antepartum care. This is part 1 of the podcast set.
05:34
June 8, 2018
Preconception Care
In this session, we will review guidelines for pre-conception care based on the ACOG current commentary.
12:39
June 8, 2018
The Obsolete Friedman Curve
1955, Emmanuel Friedman described the labor progress of 500 nulliparous wowen. That curve became the standard for labor management for 60 years. However, in 2014, the ACOG revised the definitions of the active phase of labor and re-defined the second stage of labor. In this session, we will review these labor guidelines.
08:12
June 5, 2018
Mechanism of normal labor: the passenger and the pelvis
In this session, we will cover specifics of the mechanisms of labor. We will cover details on the fetus (lie, attitude, presentation, and position) and attributes of the maternal pelvis. We will cover the powers of labor (uterine contractions strength and the revised Friedman curve) in another session.
13:54
June 3, 2018
Intimate partner violence
In this session, we will review intimate partner violence which was presented in the American College of OB/GYN committee opinion #518.
06:08
June 2, 2018
Maternal physiologic respiratory changes in pregnancy
In this session we will cover the maternal physiological changes which occurr during pregnancy.
06:56
June 2, 2018
HPV!
In this session, we will review the pathophysiology of human papillomavirus infections. We will also cover HPV immunization, and contrast primary screening for cervical cancer ACOG recommendations with the recommendations of the US preventative services task force.
10:06
May 26, 2018
Sexual Assault
In this session, we will review the ACOG committee opinion (592) on sexual assault as well as the CDC algorithm for post exposure prophylaxis following sexual assault.
17:15
May 25, 2018
PCOS
In this session, we will cover polycystic ovarian syndrome. Although the etiology is not clearly understood, there are set diagnostic criteria for PCOS. Management of the condition depends on the patient's desire for immediate fertility as well as consideration of metabolic derangements.
06:02
May 16, 2018
Hyperprolactinemia
Hyperprolactinemia may be physiological, pharmacological, or pathological. In this session, we will review possible causes of, and workup for, an elevated prolactin. Information taken from the American Society of Reproductive Medicine.
05:47
May 10, 2018
Primary Amenorrhea
In this session, we will review the diagnostic algorithm for primary amenorrhea based on the American Society of Reproductive Medicine (ASRM). Primary amenorrhea is much less common than secondary amenorrhea. Primary amenorrhea occurs in less in
05:00
May 8, 2018
Methods for estimating pregnancy due date.
This is a brief review of the ACOG committee opinion number 700, Methods for Establishing the Due Date. We will review discrepancies between first, second, and third trimester ultrasound and the last menstrual period.
07:18
May 5, 2018
TXA for Postpartum Hemorrhage
Tranexamic acid is ACOG endorsed for the treatment of established postpartum hemorrhage. Postpartum hemorrhage is now defined as greater or equal to 1000mls estimated blood loss regardless of mode of delivery. In this brief session, we will review the dosing regimen for TXA for established PPH.
02:45
April 30, 2018
The "4th Trimester"!
In this session, we will cover the May 2018 new Committee Opinion from the ACOG on optimizing postpartum care. The postpartum interval, referred to as "the 4th Trimester", can pose unique health challanges to the mother. In an effort to better identify and treat postpartum complications, the ACOG has released new guidelines reviewed here.
08:41
April 28, 2018
Intrahepatic cholestasis of pregnancy
In this session, we will cover intrahepatic cholestasis of pregnancy. We will cover background, work-up, and management options for this condition.
08:24
April 25, 2018
Common Gallbladder Issues in Pregnancy
In this session, we will cover cholelithiasis and cholecystitis in pregnancy. Data taken from the society of maternal fetal medicine and the American College of OB/GYN.
09:07
April 24, 2018
Emergent therapy for acute onset, severe hypertension during pregnancy and postpartum interval.
In this session, we will review the ACOG committee opinion number 692 and the medical protocols for management of acute-onset, severe hypertension during pregnancy and postpartum period.
09:02
April 18, 2018
Hypertension in Pregnancy: ACOG Task Force summary
In this session, we will highlight the ACOG Task Force Report on Hypertension in Pregnancy.
11:01
April 14, 2018
Maternal Cardiovascular Effects of Pregnancy
In this session we will cover the vast cardiovascular changes which occur in the maternal compartment during pregnancy.
06:10
April 13, 2018
Pyelonephritis in Pregnancy
Pyelonephritis Affects up to 2% of women in pregnancy. Complications can include preterm labor, preterm rupture of membranes, Urosepsis, and ARDS. In this podcast, we will cover the clinical presentation, work up, and management of "Pyelo" in pregnancy. Data taken from the American College of OB/GYN.
10:23
April 11, 2018
Kidney Stones in Pregnancy: Part 2
In this session, part two, we will cover medical management of renal stones in pregnancy. We will also cover temporary methods of ureter decompression as well as uteroscopic stone removal.
07:08
April 8, 2018
Kidney Stones in Pregnancy: Part 1
Nephrolithiasis in pregnancy can be a diagnostic dilemma. However, most patients present with classic flank pain radiating to the groin, with or without nausea, and hematuria. In this session, part 1, we will cover incidence, presentation, diagnostic testing, and expectant management of kidney stones in pregnancy. Part 2 will cover medical management and surgical intervention.
11:16
April 7, 2018
HSV in Pregnancy PART 2
This is PART 2 of our HSV in pregnancy podcast. We will cover specifics on pregnancy management, both antepartum and intrapartum. Data is taken from the ACOG practice bulletin and data from the society of maternal fetal medicine.
11:49
April 5, 2018
HSV in Pregnancy
HSV in Pregnancy: Part 1. This session will cover the classification, diagnosis, and general principles of vertical transmission of Herpes Simplex Viral infections. Part 2 will cover specific points on pregnancy management.
06:35
April 5, 2018
Hepatitis B in Pregnancy
Hepatitis B management in pregnancy has had some changes. The Society for Maternal Fetal Medicine recommends the use of Tenofovir when maternal viral loads are > 6-8 Log 10 copies/ml. C-section is not recommended solely for the prevention of vertical transmission of hepatitis B. All infants delivered to hepatitis B surface antigen positive mothers should receive dual immunoprophylaxis with Hepatitis B vaccine and HBIG within 12 hours of birth. Data from case series 38, SMFM.
13:10
March 31, 2018
Hep C in Pregnancy: PART 2
We present data from the Society of Maternal Fetal Medicine regarding the medical management, intrapartum, and postpartum care of the hepatitis C virus-positive woman.
08:35
March 29, 2018
Hepatitis C in Pregnancy: Part 1
In this episode we will cover hepatitis C infection in pregnancy. This is part one of a two-part series based on the Society for Maternal Fetal Medicine's (Consult Series 43) most recent update on hepatitis C management in pregnancy.
12:32
March 29, 2018
Management of suboptimally dated pregnancy
Attempts to minimize risks of prematurity balanced with the risks of a postmature fetus, are central to the management of the poorly dated pregnancy. We will cover the committee opinion 688 from March 2017 from the American College of OB/GYN.
08:19
March 25, 2018
The Kleihauer Betke Test
A quick review on the science, indications, and utilization of the KB test in pregnancy.
08:33
March 19, 2018
Gestational Diabetes Update
A clinical review and synopsis of the practice bulletin from February 2018 from the American College of OB/GYN on gestational diabetes.
12:08
March 17, 2018