(Part of the Doctor's Podcast Network) Relevant, evidence based, and practical information for medical students, residents, and practicing healthcare providers regarding all things women’s healthcare! This podcast is intended to be clinically relevant, engaging, and FUN, because medical education should NOT be boring! Welcome...to Clinical Pearls.
I love how our medical community can come together to discuss and brainstorm on better ways to care for our patients. Last night I received a message from Allison, from Chicago. Thanks Allison! She had a question regarding our recent RLS podcast and the potential role for magnesium supplementation for the condition. Is magnesium an effective treatment choice for RLS? Let’s review that data now.
Restless Leg Syndrome (RLS), now often referred to as Willis–Ekbom Disease (WED), is a common sensorimotor disturbance much more prevalent in women and during pregnancy. Do you know the potential pathophysiological tie between pregnancy and this condition? What are RLS symptoms? What about treatment? Let’s dive into this very common, yet largely overlooked, issue in the session.
The FDA has approved Brexafemme, an antifungal drug, for treating vaginal yeast infections. The drug represents the first new antifungal drug class in 20 years. How does this new medication work? and What's the dose? Does this work for recurrent vaginal cases? Please note that there are also some cautionary items that WE MUST address here... Lets cover that now!
PROM complicates 8% of term pregnancies, approximately 270,000 births in the US annually. In this session, we summarize and review a June 2021 Systematic Review/Meta-Analysis (of RCTs) where an intracervical balloon catheter was compared with a pharmacologic agent for the induction of labor after PROM,including preterm PROM.
Hepatitis C is the most commonly reported bloodborne infection in the United States. The ACOG is updating its Hepatitis C screening guidance regrading pregnancy. In this session, we will review the May 2021 ACOG Practice Advisory regarding hepatitis see screening in pregnancy.
The ACOG will release a new Practice Bulletin in June 2021 discussing obesity in pregnancy. The prevalence of obesity in reproductive age women in the United States is 39.7% In this session we will review some key practical issues regarding cesarean sections in the obese patient. Is one type of skin closure better than the other? What is the optimal VTE pharmacological protocol? Tune in and see!
The information in this section will shake your foundation regarding what you had previously been told about the origins of preeclampsia. Is the placenta the villain or the victim? This is Part 2 of our Myth-Busting Preeclampsia Episode. We will review the maternal cardiovascular changes that actually PRE-EXIST the development of preeclampsia.
The pathophysiology of preeclampsia continues to be discovered. For decades, the placenta has been portrayed as the “villain“ in the preeclampsia saga. But is it? Evolving data is putting that into question and is eliminating previously held concepts previously thought to be true. In this episode we will myth-bust some long-standing beliefs regarding preeclampsia.
Is the high dose Pitocin protocol (6 mU/min) associated with increased C-sections for fetal distress? What about perinatal outcomes? There are a variety of Pitocin protocols in L&D units across the country. In this episode, we will review a soon to be released publication out of Obstetrics and Gynecology. We will summarize an RCT comparing high-dose versus low-dose Oxytocin for labor augmentation in nulliparous women.
Given the known benefits to BMZ for preterm infants and the difficulty in predicting which women will actually deliver preterm, it is common for providers to administer antenatal corticosteroids in an effort not to miss the opportunity to give them before delivery and to try and get the maximal time benefit. However, many of these babies will be born at term. Do these term born babies benefit or experience adverse outcomes after steroid exposure? In this session, we will review an article that is published ahead of print from the AJOG. The results may surprise you. (Reference: McKinzie, A., et al. Are Newborn Outcomes Different for Term Babies Who Were Exposed to Antenatal Corticosteroids? AJOG 2021)
Sex can fulfill the human psychological needs of connectedness as well as the physical needs of intimacy. Being alone and lonely can cause major health and psychological problems for many. Is there data that sexual frustration impairs well-being? This session will review this often controversial subject as well as summarize an eye-opening study previously published from Carnegie Mellon describing state of happiness based on frequent of sex.
In 2017, ACOG adopted the NIDDK / ADA guidance on early screening for GDM before 24-28 weeks which takes in to account not only previous pregnancy history but also risk factors associated with GDM/type 2 diabetes. A recent presentation at the ACOG annual clinical meeting (ACM 2021) stated that despite these recommendations, the majority of women who meet early screening criteria are not tested early for gestational diabetes. Does early screening for gestational diabetes lead to reduced adverse outcomes? Is that evidence-based? In this episode we will review the ACOG ACM presentation and contrast that to the May 2020 AJOG RCT (ABOG MOC article) which investigated whether early screening and treatment for GDM actually resulted in better clinical outcomes or not.
In this session we wrap up our review of Adenomyosis. Are you familiar with the MUSA ultrasound criteria? What is the role of MRI in the diagnosis of Adenomyosis? And is there a role for hysteroscopic diagnosis? Let’s wrap up our discussion on Adenomyosis now.
Historically, Adenomyosis was a pathological diagnosis only. However, new imaging standards/techniques have moved Adeno into a clinical diagnosis. Is there a patient risk profile for this condition? Is this strictly a gynecological issue or is there adverse perinatal outcomes as well? Welcome to Part 1 of Adenomyosis where we will answer these questions and more.
OB Patients admitted with medical or obstetrical complications to an antepartum hospital unit face separation from loved ones, stress from their diagnosis, face isolation, and are prone to develop perinatal mood disorders. In this episode, we will review a soon to be released publication from the Green Journal (May 2021) addressing this under diagnosed and under recognized issue.
On April 12, 2021, Illinois agreed to provide Medicaid benefits to eligible mothers for up to 12 months postpartum, a major extension from the previous 60-day limit. Follow up of postpartum women for 12 months after delivery is gaining favor as data is evolving which shows that “the 4th trimester” (the first 12 weeks postpartum) is just not long enough to detect postpartum complications. In this episode we will review a new editorial which states that “the 4th trimester” is not long enough.
We often encounter the acutely agitated patient. Acute agitation may be from and uncontrolled medical condition, psychiatric condition, or illicit substance induced. The acutely agitated patient is also at increased risk of some prenatal complications. In this session we will review the evidence-based protocols for management of the acutely agitated OB patient.
The ACOG has stated that caffeine consumption in pregnancy should be limited to 200 mg/day. However, a new study published on March 25, 2021 in JAMA Network Open is questioning that recommendation. In this study, we will review this longitudinal cohort publication stating that “there may be no safe limit to caffeine consumption”.
The CDC released a health alert through its Health Alert Network on April 13, 2021, notifying physicians and other health care practitioners that the CDC and FDA are reviewing data involving six U.S. cases of a rare type of blood clot in individuals after receiving the Johnson & Johnson COVID-19 vaccine. In this session, we will review what CVST is, how it can present, the work-up, and potential treatment options. Do you give heparin for this? What is a correlation with thrombocytopenia? This is a vital summary of data that all healthcare practitioners should know.
The field of obstetrics was “birthed“ out of midwifery. The concept of second stage of labor in the lithotomy position was not how it was “always done”. In this episode we will review the evidence behind the “flexible sacral positions” and learn how maternal positional changes can assist with the labor process.
The prevalence of trauma is quite sobering. General population surveys have found extremely high rates of traumatic experiences encountered which span all races, ages, and socioeconomic status is. Nonetheless, some groups are disproportionately affected by trauma compared to others. This is why all healthcare providers should be aware of “trauma informed care” practices. In this episode, we will summarize the ACOG committee opinion from April 2021 on the subject. Do you know what the “4 Rs“ of trauma informed care are? How do we screen for this? Are traumatic events linked to chronic physical diseases as well? Let’s cover this very important topic now.
Hysteroscopy, and especially office-based hysteroscopy, is a fantastic tool in the evaluation of suspected endometrial abnormalities and/or heavy menstrual bleeding. In this session, we will review the ACOG committee opinion on hysteroscopy. At what fluid deficit should you stop the procedure if using normal saline? What about glycine? What is the significance of a “mill-wheel” murmur. Do you know what the Durant maneuver is? We answer all of these questions and more in this session!
Algorithms and opinions on cervical cancer screening change quickly. In this session, we will review the uses for HPV testing as a primary screening tool as well as post treatment surveillance. Are you familiar with which HPV tests can be used as primary screening? What is the frequency of tests? Let’s cover this now.
In this session, we will pick up where we left off with our immediate past podcast covering the SMFM “Choosing Wisely” recommendations. When should we screen for MTHFR for adverse pregnancy outcomes? When should we start screening for FGR with Umbilical Dopplers? We’ll answer these questions and much more in this session as we wrap up the SMFM “don’t do” list.
Sometimes what sounds good in clinical practice actually is not evidence-based. In March 2021, the SMFM updated the “Choosing Wisely”list of practices/recommendations for OB care. Should routine screening for microdeletions be done? What about serum screening for preterm labor? In this session we will cover the most recent 5 “don’t do“ items released by SMFM.
In the era of social media and easy to spread public opinion platforms, misinformation can grow rampant. Is the Covid vaccine associated with infertility in the general population? Where did this idea come from? What is “Syncytin-1” and how is this related to this controversy? Here we will review the origin of this story, any theoretical basis for the claims, and the conclusions from the CDC, FDA, and multiple professional societies regarding this.
Desire for Labioplasty has increased markedly over the last 10-15 years. Is there a “normal” appearance to the labia/vulva? In this session we will review the ABOG MOC (2021) article addressing labial appearance in adolescents. Is labioplasty allowed for this patient population? What is the most common indication for this request? And lastly, what is the stance from the ACOG? We will answer these questions and more in this session.
What are the delivery recommendations for pregnant Covid patients? When is expectant management favored compared with elective delivery? Is mechanical ventilation alone an indication for delivery? This is our second session in which we will wrap up our summary of the SMFM updated treatment guidelines for pregnant Covid patients (February 2021).
COVID-19 management guidelines change quickly. In this session we will review the February 2021 SMFM update regarding when to consider inpatient care for COVID-19 in pregnancy. Do you know which 02 saturation categorizes severe compared to moderate disease? What dose of dexamethasone is recommended for pregnant Covid patients that require oxygen? Is outpatient anticoagulation recommended? We will cover these and more in this session! (Source: SMFM COVID-19 in pregnancy guidance February 2021).
Use of anti-epilepsy medications (AEM) may complicate the use of contraception. However, some birth control pills may actually reduce the efficacy of the AEMs. Did you know that one AEM may actually lead to PCOS? Which contraceptive methods are preferred with AEM use? And which emergency contraceptive methods are approved with AEM use? We will address each of these questions and more in this session! (ABOG 2021 MOC article summary).
Heavy menstrual bleeding affects up to 30% of women. Combined hormonal contraceptives are a traditional treatment option to decrease menstrual flow. Oral TXA is also indicated for reduction of heavy menses. Is it safe to use both of them together? Is there an increased risk of VTE formation? In this podcast we will review a published commentary out of the journal Contraception which addresses this off-label use of TXA. (This article summary is also part of the ABOG MOC 2021 reading list).
We will continue our review of the SMFM Consult Series on FGR. What is the best way to perform antepartum fetal surveillance in these cases? When is delivery indicated? Is there a guidance regarding mode of delivery? We will answer these questions and more in this session.
Medical terms and management do change quickly. Did you know that the term “IUGR” is now outdated? In this session we will review the SMFM Update on Fetal Growth Restriction. Is symmetrical vs asymmetrical FGR important? Does aspirin help prevent FGR? And what about those TORCH serologies? This is PART 1 of 2. (SMFM Consult Series: FGR: MOC List 2021).
Currently in the United States, 2 mRNA vaccines have received EUA approval for use. Johnson and Johnson’s single shot vaccine is currently under review by the FDA for a potential EUA approval. Questions still remain regarding SarsCoV-2 vaccine use in pregnancy. In this session, we will review the March 2021 current commentary from the ACOG on “Coronavirus Disease-2019 Vaccines and Pregnancy“. This article is also on the ABOG MOC list.
In February 2021, the ACOG will release a new committee opinion (818) updating guidelines on “medically indicated late preterm and early term deliveries”. Are steroids still recommended in this preterm interval? How has new data on fetal morbidity with intrauterine growth restriction and intrahepatic cholestasis affected these guidelines? Listen… And find out!
Historically, brachial plexus palsy was considered proof of shoulder dystocia or traumatic birth. Can brachial plexus injuries occur with normal, uneventful deliveries? Do brachial plexus palsies happen even at C-section? The answer may surprise you. In this episode, we will review the different types of brachial plexus injuries and review the most recent data on the pathophysiology of these nerve conditions. Reference: Johnson et al. Obstetrics and Gynecology, October 2020,
There have been a variety of published and accepted clinical presentations of COVID-19: from lack of taste, GI disturbances, muscle aches, to the usual fever and shortness of breath. But this COVID-19 affect a woman’s menstrual cycle? There is increased chatter on the ever accurate Internet regarding this. But is there data? In this session we will go over the possible association between COVID-19 and irregular cycles.
Are you still treating urogenital gonorrhea with ceftriaxone and azithromycin? That was a standard for over a decade. But things have now changed. In December 2020, the CDC updated the treatment regimen for urogenital infections with neisseria gonorrhea. Is “dual-agent” still a therapy? Does cefixime still have a treatment role? What about test of cure? We will cover these questions and more in the session.
We all know there is a national opioid epidemic. This, like the current viral pandemic, is robbing people of their lives. Pregnant women are not immune to opioid use disorder. Is methadone endorsed for use in pregnancy? What about buprenorphine? Is naltrexone safe as an alternative treatment during pregnancy? In this session, we will review the updated literature regarding opioid use disorder and medical assisted treatment options (MATs).
Historically, CS prophylactic antibiotics were given after umbilical cord clamp and cut to prevent exposure of the neonate to antimicrobials. The recommendation then changed, in line with typical surgical practice, to give prophylactic antibiotics before skin incision. However, new data published in December 2020 is calling this practice into question. In this session we will review this new publication, co-authored from Rutgers university, which has some surprising results.
It’s the holiday season, but the holidays can exacerbate depression/anxiety and even increase suicidal ideation in some individuals. Suicide deaths are a leading cause of maternal mortality in the US, yet the prevalence and trends in suicidality (suicidal ideation and/or intentional self-harm) among childbearing individuals remain poorly described. Oddly, the CDC data excludes deaths from "accidental or incidental causes," such as suicide, overdose, or homicide in their maternal mortality reporting. In this session, we will review US maternal mortality rates and review new data regarding perinatal suicidal ideation and acts.
Historically, prophylactic oophorectomy was performed at time of benign hysterectomy in patients at/over 45 years of age. Is this still evidence based? Is the reduction in ovarian cancer development a net win or net loss compared to ovarian conservation? In this podcast we will review the data regarding risks/benefits of ovarian conservation at time of benign hysterectomy in the general population.
Considered controversial, traditionally steroids for fetal lung maturation were not given in patients with clinical chorioamnionitis. But is this really evidence-based? And since most patients will be delivered quickly after this diagnosis, how fast can steroids be expected to have a benefit on the child? In this session we will summarize a December 2020 Expert Review from the AGOG on that subject.
In the very near future, possibly just days away, the FDA is anticipated to approve at least 1 new COVID-19 vaccine. Were pregnant and/or lactating women included in the phase III vaccine clinical trials? What is the safety data for the vaccine in pregnancy? Are pregnant and/or lactating women part of the vaccine distribution framework? These are tough, and even controversial, aspects that must be considered. In this session, we will review the current state of the vaccine and how it applies to pregnant/lactating women.
A woman dies every 12 hours in this country from pregnancy-related complications. 2/3rds of these deaths are preventable! Let that sink in. On December 3, 2020, the US Surgeon General released a CALL TO ACTION to rectify this reality. In particular, ONE race is carrying this burden more than others. In this podcast we will summarize the main points of this 71 page monograph, and tie in potential solutions.
Once considered TABOO, women having receptive “Backdoor” sexual attention has gained a lot of press in both medical as well as non-medical publications. Does ACOG have a committee opinion on this? YES. And in this podcast we will discuss data on prevalence of, orgasmic response to, and possible STI implications of “backdoor activities” in women.
The two most common types of headaches in pregnancy are tension type and migraine. Is Imitrex safe to use in pregnancy? A common alternative medication regimen includes the use of Benadryl and Reglan for acute headache. Is there data for this? And what about Botox in pregnancy? In this podcast we will review the data on the medical management of migraine headaches in pregnancy.
In December 2020, ACOG will release an updated committee opinion on delayed umbilical cord clamping with 3 additional areas addressed: 1. multiple gestations, 2. cord milking in extreme premature infants, and 3. the effect of delayed cord clamping on umbilical cord blood collection. We will summarize these key points in this session!
In 2017, the American College of Cardiology and the American Heart Association revised the definition of normal BP, elevated BPs, and Stage 1 & 2 Hypertension. ACOG has not adopted these new classifications for pregnancy care. Are women with elevated blood pressures or Stage I hypertension at risk of adverse pregnancy outcomes? In this podcast, we will review a soon to be released publication from the AJOG which helps answer these questions. (Data from: “Perinatal outcomes in women with elevated blood pressure and stage 1 hypertension”, GREENBERG et al)
The birth control pill remains one of the most common medications used in reproductive aged women. As all birth control pills have a net antiandrogenic affect, does this result in less libido? What does the data say? Do you inform women of this potential side effect when they start combination birth control? We will tackle these questions in this session!
Ever since the first progestin was isolated and reproduced out of Mexican Yams in the early 1950s, the race was on to formulate a low-risk, highly effective, oral birth control agent. Birth control pills remain one of the most common medications used by reproductive age women. We are now in the 4th generation of synthetic progestins in the pill. But do these matter? Is anti-androgenic activity real or just something found in the lab? In this podcast, we will review not just the history of the pill but we will also review how to “choose the right one“. Thank you, Lindsey and Jeanna, for the recommendation.
Modafinil and armodafinil are stimulant meds called “smart meds”. Their use is on the rise, but there are important drug interactions with these meds and certain birth control (BC) options. Additionally, new data has revived attention to the association of the stimulants to congenital birth defects. In this session, we will review the MOA of these meds and discuss BC options with their use. We will also summarize the newly released data showing the association with congenital birth defects.
It has been a debate for many years: should we be doing routine screening for BV before hysterectomy/gynecology procedures? What about at C-section? It’s a good question especially acknowledging that there is a high rate of asymptomatic BV. In this episode, we will review an “expert review“ from the AJOG from March 2020 and a recently released rebuttal to that review. What does the ACOG say? Let’s take a look now.
Bacterial vaginosis (BV) is one of the most common vaginal diagnoses in women’s health practices. Over the years there has been increasing evidence that BV is not just an annoying vaginal condition but has true risks of heightened STI acquisition, PID, post-op vaginal complications, and even infertility. In this session, we will review a new soon to be released publication from the AJ0G. This article makes a strong case for the link between BV and infertility. We will summarize this new data here ( Ravel J et al; AJOG EPub Oct 19,2020).
The evaluation of congenital uterine anomalies can be traced back to the mid 19th-century. In this session, we will review the ASRM and the ESHRE classification schemes for these anomalies. What is the gold standard for diagnosis? When is an MRI necessary? We will answer these questions and more in the session. We will address reproductive outcomes in part 2.
On September 25, 2020, a new cervical cancer screening working group revised the algorithm (as a proposal) for management of minimally abnormal cervical cancer screening tests. This was released in JAMA. The new focus is on the presence/persistence of high risk HPV in the pathogenesis of cytology abnormalities. Let’s cover that in this session.
In October 2020, JAMA Pediatrics released a publication that is drawing MAJOR criticism from 5 major professional societies. This study highlighted a potential association between labor epidurals and child autism risk. However, there is a lot more to the story that needs to be told. In this session, we will break down the study and offer reassurance that “association“ does not prove “causation“. Also summarize the key rebuttals from these professional societies, which are pretty much ON FIRE.
In May 2020, the FDA approved a new novel, non-hormonal vaginal contraceptive that can be used “on demand“. Although this functions as a “pH regulator“ of the vagina with spermicidal properties, it is not nonoxynol-9-based. In this session, we will review the information in the instructions for use of Phexxi, and summarize key points from some published commentary on the subject.
There are calls to remove 17 OHP from the market based on the results of the PROMISE trial. This leaves us with a gap in tools for prevention of preterm birth. This is where CERCLAGE comes in. Cerclage is not only indicated in patients with previous history of incompetent cervix, as there is emerging data that cerclage plays a role in preterm birth prevention based on cervical length. In this podcast, we will give an in-depth summary of the data on how cerclage may be used as an intervention to prevent preterm birth. At what cervical length can cerclage be used? How does previous history come into play? Is this valid in twins? Let’s cover that… Now.
Over the past several years there’s been some alarming publications “linking“ endometriosis to certain ovarian epithelial malignancies. Is this a valid cause for concern? What is the absolute risk? In this podcast we will put the data into perspective and highlight information from the Lancet as well as MD Anderson‘s Gynecology Oncology data.
Antenatal corticosteroids help reduce a number of morbidities in the preterm infant. However, chorioamnionitis is generally considered a contraindication. The scientific basis for this is actually unclear. On September 28, 2020, the AJOG released a new publication ahead of print that helped shed some light on the subject. Are steroids harmful or beneficial to the preterm infant in the setting of Chorio? Let’s check it out.
Endometriosis, a chronic disease that afflicts millions of women worldwide, has traditionally been diagnosed by laparoscopic surgery. This diagnostic barrier delays identification and treatment by years, resulting in prolonged pain and disease progression. Development of a noninvasive diagnostic test could significantly improve timely disease detection. Recently, 2 innovative/non-invasive tools have gained attention for the diagnosis of Endo: MicroRNAs (Oct 2010; AJOG) and MRI (Sept 2020; Acad Rad). In the session, we will highlight these 2 interesting publications.
One theory behind elevated post-partum blood pressure is that there is a large volume of sodium mobilized into the intravascular compartment in the post-partum period. Loop diuretics have been suggested as methods to accelerate post-partum blood pressure recovery due to their ability to mobilize sodium and fluid excretions. Is there level I data on the use of furosemide for postpartum preeclampsia/hypertension management? Does the use of Lasix affect serum magnesium levels? In this session, we will review 2 recent RCTs on the use of furosemide for Postpartum hypertension management and briefly review the pharmacology of furosemide.
Stillbirths occur in approximately 6/1000 pregnancies in the US. Currently, the ACOG recommends placental histological analysis and fetal chromosomal study in these cases. However, as up to 50% (or more) of cases are left “unexplained“, more investigation/options are needed. On September 17, 2020, a new publication in the NEJM adds valuable insights as to how whole exon sequencing may help provide a genetic cause in an otherwise unexplained stillbirth. In this podcast, we will review this publication by Stanley et al.
Advanced Maternal Age (AMA) has long been associated with adverse obstetrical outcomes. However, is the same true for Advanced Paternal Age (APA)? What is the specific characteristic mutation associated with APA? What does paternal age have to do with chromosomal telomere length and how is that related to cancer in the child? In this podcast, we will review Data from the American College of Medical Genetics regarding APA. This information will be helpful in giving prenatal counseling to couples who present with fathers with age equal to/greater than 40.
Postpartum hemorrhage is a leading cause of maternal mortality even in the United States. In September 2020, a new device to help treat postpartum hemorrhage was FDA cleared (The Jada System). This is a novel device that uses vacuum pressure for uterine cavity collapse/myometrial compression. In the session, we will review this new data which was published ahead of print September 10, 2020 in Obstetrics Gynecology (Green Journal).
A prolonged second stage of labor, or failed vaginal vacuum extraction, can lead to a deeply impacted fetal head. Is the “push“ technique better than the “pull“ technique? Have you heard of the Patwardhan method? What is a C-section SPOON? And is the “Fetal pillow” actually helpful? In this podcast we will review each of these techniques in detail.
An EIF is a small echogenic area appearing within the fetal cardiac ventricle that has a sonographic brightness equivalent to that of bone. What are the clinical implications of an isolated EIF? Are structural malformations of the heart more common with EIF? What specific workup is required? In this session, we will review the SMFM management of this ultrasound finding.
A woman in her 20s with preeclampsia has a worse cardiovascular prognosis at 10 years compared to a woman in her 40s without previous preeclampsia. Additionally, preeclampsia is linked to other future maladaptive conditions (even dementia and renal disease) which have severe life impact. In this session, we will review the data on preeclampsia as a risk factor for future morbidity.
Intraventricular hemorrhage (IVH) is the most common type of intracranial hemorrhage in the neonate and is the most serious. Which antepartum therapy is proven to reduce IVH severity? Does Mag Sulfate reduce IVH? How is umbilical cord “milking” related to IVH? In this session we will cover this in detail and highlight professional societal guidelines.
Recurrent pregnancy loss affects between 3 and 5% of reproductive age couples. Traditionally, the category of “unexplained“ pregnancy loss made up 25% of cases. However, use of Chromosomal MicroArray analysis (CMA) has dropped the category of unexplained to approximately 10%. In this session, we will review the traditional and updated algorithm for recurrent pregnancy loss using CMA for the products of conception (source: Clinical Opinions in ObGyn, published ahead of print)
There is biological plausibility for vitamin D to play a role in pregnancy outcomes, given the presence of receptors in gestational tissues. Data has progressed since the ACOG committee opinion regarding vitamin D supplementation in pregnancy released in 2011. Does low maternal vitamin D actually affect maternal outcomes? In the session we will review the latest data from “Current Opinions in OB/GYN” regarding vitamin D supplementation in pregnancy, focusing on preeclampsia risk and GDM.
On August 12, 2020, the ACOG released a revised practice bulletin (226) on screening for fetal aneuploidy. In this session we will focus on cell free DNA genetic screening. How should we counsel younger women on this screening tool? Can cell free DNA be used after an abnormal QUAD screen? How is cell free DNA related to maternal malignancy? We will answer these questions and more in this session.
TOAs are typically considered the end result of severe PID. However, not all cases are PID related. TOAs may also be a harbinger of genital tract malignancy in a subgroup of patients. In this session, we will review the presentation, work-up, and management of TOAs and we will end with who may be at greater risk of genital tract cancer with them.
Fantastic! As healthcare professionals, we have to remember to use “patient centered“ terms when possible. This is a brief commentary describing a very important issue as a follow up to today’s educational podcast released just hours ago.
It is the age old question at Gyn Surgery… Candy Cane leg holders or Boot support? Is it just physician preference? In August 2020, a new RCT published in the journal Obstetrics & Gynecology addresses this issue. However, as we will discuss, the study raises more questions than answers.
VTE is a major cause of maternal morbidity and mortality in pregnancy, particularly in postpartum after a cesarean birth. In August 2020, the SMFM released consult series No. 51 on the prevention of VTE. What is the first-line pharmacological agent desired? Should prophylaxis be for 10 days, 2 weeks, or 6 weeks? What about risks of use? We will cover these questions and more, here..
Maternal genetic carrier screening is endorsed by the ACOG. Should this be ethnicity-based or should this be “pan-ethnic” screening of disorders? What are the 2 main genetic disorders that should be universally screened for? In this episode, we will cover the ACOG Committee Opinions 690 and 691.
On July 26, 2020, the AAP updated its guidance regarding infant separation from a COVID19 positive mother in the immediate postpartum interval. In this session, we will review this updated recommendation.
Your patient is a 22 yo female who has tested positive for SARS-CoV2. Will you keep her on her estrogen containing birth control? In this podcast, we will cover the ACOG response to this clinical dilemma as well as provide updated information from a soon to be released commentary in ENDOCRINOLOGY.
Yes, information keeps changing! That is why medical education is so important. In this session, we will review the ACOG updated recommendations for both healthcare providers and patients regarding COVID-19 management. These guidelines were released July 27, 2020.
⭐️Feb 11, 1990. ⭐️ It was a worldwide sports event. It has been called one of the greatest upsets in sports history. This brief recap of the Douglas-Tyson match has a powerful lesson applicable to today’s stressful times. Let this brief episode encourage you and motivate you on your life’s adventure. 🙂
Given the perceived safety of aspirin during pregnancy, there have even been increasing calls to administer aspirin universally to all pregnant women. However, there are no population-based studies addressing whether there is a bleeding risk with aspirin administration during pregnancy. In this session, we will review a recently accepted manuscript (July 2020) in AJOG which will soon be in print which is a population based study from Sweden. Are there risks with aspirin use in pregnancy? Lets analyze the data.
In August 2020, the ACOG will release a new Committee Opinion (809) reviewing the HPV vaccination. How many doses are required by age? Can the vaccine be given during pregnancy? What about breast-feeding? We will answer these questions and more in this episode.
CS deliveries are the most frequently performed inpatient surgeries in the US. The ERAS pathway for planned cesarean deliveries does not include preadmission CHG cloths because of the lack of evidence from randomized, controlled trials. In July 2020, the AJOG published the STRIPES RCT to see whether use of these cloths resulted in decreased SSI. We will cover this in this episode.
Pregnancy is a co-adaptive, quasi-symbiotic state. There are a variety of maternal physiological and anatomical adaptations which must not be interpreted as pathological. In this session we will review these vital changes as well as the fetal circulatory system and provide a quick review of fetal acid base status.
On January 1, 2021, the Joint Commission will release new standards for maternal safety at discharge from the hospital. Discharge teaching and postpartum follow up planning will be part of this mandate with a focus on patients with hypertensive disorders. To prepare everyone for this, the SMFM is releasing a new statement and checklist for postpartum discharge of hypertensive patients. In this session, we will review and summarize this new (July 2020) special statement which is scheduled to be in print in the American Journal of Obstetrics and Gynecology.
COVID19 can have varied clinical manifestations. In pregnancy, new data has highlighted its potential to cause a “preeclampsia like syndrome“. This, together with the increased thrombotic state of COVID-19, elevates the risk for VTE above that of pregnancy alone. Can TXA be used for PPH in these cases? In this podcast we will review these 2 high risk clinical manifestations of COVID-19 in pregnancy.
LARCS are endorsed by the ACOG due to the high efficacy. However, unpredictable bleeding can affect continuation rates. A new RCT has evaluated the use of tamoxifen to control and prevent future abnormal bleeding with etonogestrel implant use. Does this work? What is the MOA? In this session, we will summarize this new publication (published ahead of print) in Obstetrics and Gynecology.
Did you know that silver wire helped to dramatically reduce maternal mortality at cesarean section? And what does the Goodyear Rubber Company have to do with surgical techniques? In this episode we will wrap up our walk through history reviewing CS’s AMAZING History.
What does a pig gelder, a woman dressed as a man, and the Queen of England all have in common? The answer: ALL CONTRIBUTED TO CS’s history! The history of C-section has been called the combination of “death, deceit, and germs“. In this historical review (Part 1), we will take a look at the origin of this all too frequent abdominal surgery.
Prone positioning during invasive mechanical ventilation improves oxygenation, as shown in large randomized clinical trials of patients with ARDS. In an RCT that included 466 patients with moderate and severe ARDS, prone positioning for at least 16 hours per day with protective mechanical ventilation reduced 90-day mortality. Is prone positioning for respiratory support possible in pregnancy? In this session we will cover the beneficial effect of probe positioning and summarize an article (EPUB) soon to be in print in Obstetrics & Gynecology regarding prone therapy in pregnancy (Tolcher et al).
Gastroschisis occurs in about 1 in 1800 births in the US. Does this abdominal wall herniation usually occur to the right or left of the umbilical cord? Is this condition tied to chromosomal/genetic syndrome? What about antepartum fetal surveillance? Is a cesarean birth required? In this episode, we will review the SMFM and CDC data regarding management of gastroschisis.
Female genital mutilation (FGM) is also known as female circumcision. The ACOG and the World Health Organization have issued public statements condemning the practice. What is this procedure? What are the 4 different types of female genital cutting? In this session we will review these answers as well as the immediate and long-term complications of FGM. We will also review the WHO international response to this unnecessary medical practice.
Is labor affected by polyhydramnios? What is the suggested manner of performing artificial rupture of membranes in this setting? In this session, we will wrap up our discussion of polyhydramnios with a quick summary on intrapartum care.
Polyhydramnios can be mild, moderate, or severe. Is deepest vertical pocket (DVP) or AFI preferred for amniotic fluid assessment? Is antepartum Indocin a valid treatment option? What about antepartum fetal surveillance? In this session, which is Part 1, we will review the SMFM guidance regarding polyhydramnios.
Placenta accreta spectrum, formally known as morbidly adherent placenta, refers to a range of pathologic adherence of the placenta (accreta, increta, and percreta). There is significant risk of maternal morbidity and mortality including risk of blood transfusion, life-threatening hemorrhage, and hysterectomy. In this session, we will review the obstetric care consensus by the ACOG and SMFM regarding this condition (obstetric care consensus # 7).
On May 29, 2020, the U.S. FDA approved an novel oral drug, Oriahnn, for HMB use to fibroids. This medication (elagolix, estradiol, and norethindrone acetate) is the first oral medication designed specifically for Fibroid HMB. In this session, we will review this new medication. (No financial disclosures to report).
In this session, we will conclude our summary of the new ACOG clinical expert series, “Female Sexual Dysfunction“. This episode will focus on specific treatments of each of the 4 different DSM5 categories of female sexual dysfunction.
Human sexual response is a highly individual and emotional process. Sexual dysfunction is common among women and leads to personal distress. The ACOG has released a new “clinical expert series“ which currently is published ahead of print. In this session (Part 1), we will review the prevalence, risk factors, and DSM5 categories of female sexual dysfunction.
Unlike fetal thrombocytopenia resulting from maternal ITP, fetal- neonatal alloimmune thrombocytopenia may occur earlier in gestation and can lead to in-utero fetal intracranial hemorrhage. The condition can be severe. In this podcast, we will review the presentation, diagnosis, and management of this potentially lethal fetal acquired condition. (ACOG Data 2019).
On June 1, 2020, the American Journal of Obstetrics and Gynecology released a new publication with surprising results related to maternal oxygen use in labor for Category II fetal heart rate tracings. Although we have covered this in some form in previous episodes, we will provide new up-to-date information on this subject.
Medical information moves fast. Although the increased morbidity with fetal macrosomia has long been known, the ACOG has revised his practice bulletin on the subject (January 2020). In this session, we will review this updated practice bulletin. What’s the new data on exercise and fetal birthweight? Is operative vaginal delivery contraindicated in macrosomic infants? What about TOLAC with a suspected macrosomic infant? Let’s cover these topics, and more, in this session.
According to the ACOG, “Given approximately 40% of postpartum hemorrhage occurs in low risk women, every woman giving birth is at risk for obstetric hemorrhage“. The ABOG has released the MOC list for May 2020. This includes the ACOG committee opinion 794. In this podcast, we will summarize and highlight the sentinel components of this committee opinion.
Multiple societies and experts have weighed in on whether 2nd stage of labor warrants universal use of respirators (e.g., N95 masks) vs surgical masks. The ACOG/SMFM has petitioned the CDC for clarity on this issue. In May 2020, the AJOG published a new “clinical perspective“ in MFM which is pushing for use of 1 mask over the other. We will highlight this new development in this session.
Some experts have called for universal screening of all patients admitted to labor and delivery. The foundation of this opinion is to decrease exposure to healthcare workers and identification of asymptomatic women for the prevention of horizontal newborn transmission. However, there are some potential negative implications of this proposal. In this podcast, we will review a soon to be released editorial (Torri Metz, MD) from Obstetrics & Gynecology (the Green Journal) on the pros/cons of universal testing in Labor & Delivery.
Examination (macroscopic and microscopic) of the placenta can give valuable insights into the intrauterine environment. The College of American Pathologists has issued guidelines about when to submit a placenta for histological examination. In this session, we will review the “what, when, and whys“ of histological placental referral. We will also review abnormal umbilical cord insertion and it’s link to adverse obstetrical/neonatal outcomes. SHOUTOUT TO LAUREN (our podcast listener) for the podcast topic!
Does the ACOG endorse universal screening for thyroid disease in pregnancy? What about treating subclinical hyperthyroidism or subclinical hypothyroidism? And what about those pesky anti-thyroid autoantibodies? In this podcast, we will highlight the June 2020 ACOG Practice Bulletin (223) covering thyroid disease in pregnancy.
The benefit of antenatal corticosteroids in preterm infants was first reported in 1972, but it took 20 years for widespread adoption. Now, antenatal steroids are recommended by the ACOG up to 36 weeks and 6 days. However, a new study (JAMA May 2020) has raised concerns about steroid exposure in utero and possible behavioral and mental diagnoses in children up to age 5. These outcomes were significant for infants who were born full term. In this podcast, we will highlight this new study and summarize the editorial perspective in JAMA regarding this study.
Information can be confusing regarding COVID-19. The WHO, CDC, ACOG, AAP all have slightly different recommendations based upon what topic you’re looking at. Is a patient with COVID-19 allowed to breast-feed? In this episode, we will review the CDC/AAP recommendations for breast-feeding regarding a patient under investigation or confirmed positive case.