Thinking About Ob/Gyn: Recent Episodes
Antonia Roberts and Howard Herrell
Howard Herrell and Stuart Winkler question long-standing OB-GYN habits that feel “routine” but do not add value, then replace them with evidence and practical decision-making. We move from hysterectomy follow-up and cuff dehiscence management to the data behind cesarean sutures, endometrial cancer evaluation in postmenopausal bleeding, and the ongoing shift to HPV-based cervical cancer screening.
• why routine 6 to 8 week vaginal cuff exams after hysterectomy may not prevent or predict dehiscence
• how telehealth post-op care can improve access while keeping symptom-driven safety nets
• four tips for evaluating and managing vaginal cuff dehiscence, including when laparoscopy matters
• what Ethicon discontinuing chromic and plain gut could mean for cesarean technique choices
• how the CORONIS trial informs chromic vs Vicryl decisions and why transfusion risk is part of the conversation
• where the 4 mm endometrial stripe rule came from and why it can fail in real-world care
• why persistent postmenopausal bleeding still warrants endometrial biopsy despite reassuring ultrasound
• how race, tumor subtype, and fibroids affect endometrial cancer detection and counseling
• the arc from Pap smear cytology to HPV DNA testing, vaccines, and primary HPV screening
• why self-collected HPV testing may raise screening uptake for patients avoiding speculum exams
Be sure to check out thinking about obgyn.com for more information, and be sure to follow us on Instagram.
0:00 Welcome And Today’s Game Plan
0:35 Rethinking The Six-Week Pelvic Exam
13:25 Four Practical Tips For Cuff Dehiscence
24:42 Chromic Gut Is Disappearing
35:40 CORONIS Trial And Cesarean Sutures
42:22 Postmenopausal Bleeding And The 4 mm Rule
53:12 HPV Testing Takes Over Screening
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We follow the footnotes on a common gyn rule, then use that same evidence-first lens to question popular fertility add-ons and persistent pregnancy myths. Along the way, we talk pretest probability, counseling tradeoffs, and why simple cutoffs often replace better clinical reasoning.
• tracing the “biopsy Bartholin cysts after 40” claim back to weak citations
• using pretest probability and exam features to decide on selective biopsy
• weighing hysteropexy versus hysterectomy for prolapse with long-term cancer risk in mind
• breaking down a Lancet review of IVF add-ons and what actually shows benefit
• spotting how marketing and online forums amplify unproven fertility interventions
• reviewing data on sedentary time in pregnancy and why activity restriction persists
• debunking “walking progresses labor” with randomized trial evidence
• clarifying early diabetes testing as screening for preexisting diabetes and when A1C makes more sense than early glucose tolerance tests
Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram.
0:00 Welcome And What’s Ahead
0:23 Bartholin Cyst Biopsy Age Rule
14:17 Prolapse Repair With Uterus Preservation
21:45 IVF Add-Ons And The Lancet Review
37:35 Pregnancy Activity Myths And New Data
50:53 Early Diabetes Testing And A1C
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Howard and guest hose Sivani Aluru unpack why the new PMOS name matters, how PCOS got tied to “cysts,” and what the evidence actually says about diagnosis, metabolic risk, and treatment. We also challenge a few habits we have all inherited, from pre-op antibiotic dosing to the way we talk about hormones, weight, and fertility with patients.
• the evidence gap behind 2 g vs 3 g cefazolin in obese cesarean patients and how practice inertia forms
• why PMOS shifts attention toward insulin resistance, metabolic screening, and multidisciplinary care
• how NIH, Rotterdam, and androgen excess criteria shape who gets diagnosed and who gets missed
• SHBG and free testosterone as a practical way to explain symptoms when total testosterone looks normal
• why ovarian follicles are not the same as painful ovarian cysts and why ultrasound can mislead
• patient frustration with “just take birth control” and how we explain progesterone protection for the endometrium
• lean PMOS, weight-focused bias, and realistic conversations about lifestyle change, GLP-1s, and bariatric surgery
• fertility takeaways from PPCOS II, metformin limitations, and what lifestyle trials suggest preconception
Be sure to check out thinkingaboutobgyn.com for more information, and be sure to follow us on Instagram.
0:00 Welcome And Guest Introduction
2:01 The 3-Gram Ancef Habit
12:02 PCOS Becomes PMOS
12:55 How The Criteria Got Complicated
22:00 Insulin Resistance And Free Testosterone
30:40 Hormone Panels And TikTok Myths
32:30 Ovarian Follicles Are Not “Cysts”
36:03 Treating Symptoms Without Dismissing People
46:12 Fertility Trials And Lifestyle Results
57:27 ACOG At 75 And Why Join
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We push back on the idea that obstetrics “deserves” a malpractice crisis and explain how bad incentives and junk science can turn normal evidence-based care into courtroom blame. We also break down a few widely shared clinical myths and new research so we can practice with clearer eyes and less narrative noise.
• placental grading on ultrasound as low-value data with poor predictive power and high reader variability
• how malpractice commentary can seed plaintiff-friendly arguments against evidence-based off-label use
• why blaming misoprostol or “high-dose” oxytocin oversimplifies multifactorial outcomes
• quality improvement bundles as useful tools but weak proof without controls or causal clarity
• how massive verdicts and paid expert testimony can clash with modern science on cerebral palsy and HIE
• the FAA’s five hazardous attitudes and practical antidotes for high-stakes clinical work
• new data on LEEP versus cold knife cone for CIN, recurrence, HPV clearance, and access tradeoffs
• genetics and BMI as major drivers of gut microbiome patterns, not influencer narratives
• what a 1993 Doppler trial can and cannot prove, plus why replication changes conclusions
Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram.
0:00 Welcome And Season Update
1:15 Placental Grading Myth On Ultrasound
6:44 Calling Out A Malpractice Influencer
14:06 The 2011 Policy Bundle Examined
23:20 What Drives The OB Malpractice Crisis
30:00 How Mega Verdicts Get Made
36:59 Five Hazardous Attitudes From Aviation
44:31 LEEP Versus Cone For CIN
48:04 Genetics And The Gut Microbiome
52:17 Does Doppler Ultrasound Harm Babies?
1:00:37 Recommendations And Closing
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We sit down with Joshua Oommen to get nerdy about clinical reasoning, FDA standards, and why “good evidence” is harder to define than most of us admit. We challenge the reflex to trust p-values and meta-analyses, then test our instincts against real OBGYN examples where the literature has whiplashed practice.
• why the podcast is called Thinking About OBGYN and how clinical reasoning shapes our work
• the NEJM proposal to make one pivotal trial the FDA default and what “confirmatory evidence” might mean
• medical reversal, surrogate endpoints, and how trust erodes when practice changes late
• why Bayesian thinking fits how clinicians interpret tests, trials, and prior beliefs
• how meta-analyses fail through small study effects, publication bias, p-hacking, and heterogeneity
• the amnioinfusion comeback as a case study in applicability and overconfident conclusions
Be sure to check out thinking about obgyn.com for more information and be sure to follow us on Instagram.
0:00 Welcome And Today’s Big Question
3:48 Why “Thinking About OBGYN” Exists
11:54 The NEJM Push For One Trial
16:38 Medical Reversal And Trust Problems
24:43 AI Proteins And CRISPR Pressure Tests
32:33 Bayes Thinking Beyond P Values
36:43 Why Meta-Analyses Often Mislead
41:08 Bias And Heterogeneity Red Flags
46:24 Amnioinfusion And A Meta-Analysis Comeback
1:02:29 Final Warnings And How To Learn
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We bring back the biggest takeaways from the ACOG ACSM, then move fast through the newest guidance and the newest hype shaping real OBGYN care. We focus on what the evidence actually supports, where practice still lags behind, and how “labels” can quietly push patients toward harm.
• conference highlights including rural OBGYN access and what gets attention on the exhibit floor
• vitamin K shot refusal trends and why late bleeding still matters weeks after birth
• 2026 ACOG cervical cancer screening changes with primary HPV testing preferred for ages 30 to 65
• self-collected HPV screening and the systems needed to keep follow-up safe
• why annual Pap testing and cytology-only strategies increase overdiagnosis and can miss HPV risk
• postmenopausal bleeding workup shifting toward ultrasound plus endometrial biopsy up front
• large baby induction data and why outcomes can worsen without neonatal benefit
• third-trimester ultrasound screening performance and the real-world labeling effect
• early proof-of-concept therapy for preeclampsia targeting sFlt1 removal to prolong pregnancy
• hysterectomy duration and route as drivers of venous thromboembolism risk
• laboring down claims from retrospective reports versus randomized trial findings
• debunking physiologic third stage claims and reaffirming active management to prevent hemorrhage
Be sure to check out thinkingaboutobgyn.com for more information, and be sure to follow us on Instagram.
0:00 ACOG Meeting Takeaways And Rural Access
3:58 Vitamin K Refusal And Newborn Bleeding
6:37 Cervical Screening Moves Toward HPV
14:48 Postmenopausal Bleeding Now Needs Biopsy
20:00 Tylenol Data And Macrosomia Induction
28:34 Ultrasound Labeling Effect And Liability Fears
37:29 Removing sFlt1 To Buy Time
40:14 Longer Hysterectomy Surgeries Raise VTE Risk
42:14 Laboring Down Claims Versus RCT Reality
49:59 Counseling Fatigue Without Ignoring Risk
54:21 Third Stage Myths And Hemorrhage Prevention
58:42 Evidence Literacy And Closing Notes
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We answer vaccine questions head-on, using real numbers to separate online fear from how vaccines, immunity, and public health actually work. We break down why diseases feel “gone,” what the modern schedule really exposes babies to, and how to spot misleading claims around ingredients, autism, and VAERS. Featuring Kate Moloney and our vaccine-hesitant friend Anah.
• why vaccine success makes diseases look eradicated while risk returns when coverage drops
• Stanford modeling estimates for measles, diphtheria, polio, and rubella without vaccination
• meningococcal meningitis basics, who is most at risk, and why outcomes can be catastrophic
• why clean water and sanitation do not explain protection from droplet-spread viruses
• what antigens are and why antigen exposure is far lower than decades ago
• downsides of delaying vaccines including longer vulnerability and more office visits
• aluminum, formaldehyde, and mercury claims explained with real-world comparisons
• “natural immunity” tradeoffs including measles pneumonia, immune amnesia, and SSPE
• long flu and post-viral inflammatory syndromes as quality-of-life consequences
• how vaccine schedules change, why the autism claim is debunked, and what profit incentives really look like
• what VAERS can and cannot tell you, plus how bias and viral claims distort reports
• why newborn hepatitis B vaccination exists, screening gaps, and true serious side effects
• rubella history and why vaccination primarily protects fetuses
1:05 Do We Vaccinate Too Much
3:32 Modeling A World Without Vaccines
6:20 Meningitis And Fast Catastrophes
8:28 Clean Water Is Not A Vaccine
11:02 Antigens And The Modern Schedule
15:44 Why Spacing Shots Can Backfire
16:53 Aluminum Formaldehyde Mercury Facts
22:00 Natural Immunity And Measles Damage
26:16 Long Flu And Post Viral Illness
28:26 Profit Fears And Autism Claims
31:26 VAERS Limits And Bad Math
38:39 Why Newborns Get Hepatitis B
45:09 Real Side Effects And Detox Scams
48:37 Rubella And Protecting Fetuses
51:57 Final Takeaways And Next Steps
Be sure to check out thinkingaoutobgyn.com for more information and be sure to follow us on Instagram.
Follow us on Instagram @thinkingaboutobgyn.
We take on four stubborn myths in modern obstetrics and follow the evidence instead of the vibes, from thrombophilia testing to bed rest to seizure prophylaxis. We also spotlight a patient-empowering insulin strategy that may improve gestational diabetes outcomes faster than usual care.
• distinguishing recurrent pregnancy loss evaluation from venous thromboembolism testing
• focusing thrombophilia workups on antiphospholipid antibody syndrome when criteria are met
• explaining why MTHFR variants and PAI-1 polymorphisms do not belong in routine panels
• unpacking how social media and narrative fallacies keep low-value tests alive
• reviewing the AWARE trial and why activity restriction lacks benefit and carries harms
• clarifying reasonable pregnancy activity modifications versus false labor prevention claims
• assessing late preterm antenatal corticosteroids for twins and the hypoglycemia signal
• discussing inertia of practice and why weak evidence becomes hard to undo
• breaking down patient-led insulin titration for gestational diabetes and why it may reduce macrosomia
• evaluating laboring down and long-term pelvic floor outcomes plus statistical pitfalls
• answering a listener question on Keppra alternatives to magnesium for preeclampsia seizures
Be sure to check out thinking about obgyn.com for more information, and be sure to follow us on Instagram.
0:00 Welcome And What We’re Reviewing
0:28 Thrombophilia Testing After Miscarriage
3:51 What Belongs In A VTE Panel
5:55 MTHFR And PAI1 Myth Busting
13:36 Activity Restriction And The AWARE Trial
23:27 Practical Counseling Without False Promises
27:08 Late Preterm Steroids For Twins
32:53 Patient-Led Insulin Titration In GDM
38:38 Laboring Down And Pelvic Floor Outcomes
47:51 Keppra Versus Magnesium For Preeclampsia
1:00:25 Wrap Up And Where To Follow
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We talk with Dr. Emily Donelan about how conflicting labor management guidelines can derail communication between nurses and physicians and quietly raise patient safety risks. We map the biggest friction points and lay out practical ways to reconcile guidance locally while pushing for a unified national approach.
• defining “communication dystocia” and why guideline discrepancies create real bedside conflict
• how evidence gaps drive teams toward institutional culture and inertia in practice
• the ARRIVE trial as a case study in differing priorities and framing
• a detailed induction vignette showing where amniotomy, oxytocin titration and uterine activity definitions collide
• why the 20 mU/min oxytocin threshold persists and what newer data suggests
• tachysystole rules, Category II tracings and how prescriptive language shapes nursing behavior
• delayed pushing versus pushing at complete dilation and the moral distress it can create
• the need for standardized evidence grading and cleaner citations across organizations
• a national interprofessional reconciliation program and who must be at the table
• one actionable step for tomorrow: stay curious and surface the real reason behind the disagreement
Be sure to check out thinking about obgyn.com for more information and be sure to follow us on Instagram.
0:01 Why Guideline Conflicts Matter
3:52 The ARRIVE Trial Framing Problem
12:23 A Labor Case Where Rules Collide
24:08 Oxytocin Thresholds And Litigation Fear
33:26 Pushing Timing And Moral Distress
38:05 Who Should Write Unified Guidance
44:04 Evidence Grading And Bedside Decisions
52:05 Inertia In Practice And De-Implementation
1:00:14 Takeaways Plus A No-Evidence Pet Peeve
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We use a plotline from The Pit to separate ovarian torsion facts from TV fiction and explain why Doppler findings can’t replace clinical judgment. Then we answer a listener question on trial of labor after myomectomy and how we counsel when the data are thin and the details matter.
• why “competency porn” and “certainty porn” can distort real expectations of care
• how color Doppler actually works and why red and blue do not always mean artery and vein
• PCOS misconceptions and what really increases torsion risk
• ovarian torsion as a clinical diagnosis and why preserved Doppler flow cannot rule it out
• ultrasound clues that help beyond flow alone, including the whirlpool sign and peripheral follicles
• when oophoropexy might be considered and why it remains controversial
• why detorsion usually beats oophorectomy even with a black or blue ovary
• limits of lab tests and the need to think in probabilities, not binaries
• false positives and false negatives in pregnancy testing, including the hook effect and real-world mix-ups
• counseling on vaginal delivery after myomectomy, focusing on depth, cavity entry, number and location of incisions, and shared decision-making
Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram
0:01 Welcome And What We Cover
0:32 The Pit Torsion Plot Setup
3:06 Competency Porn And Public Expectations
8:39 Color Doppler Basics BART Rule
10:09 PCOS Myths And Torsion Risk
13:27 Endometriosis Guidance And Clinical Diagnosis
18:29 Torsion Diagnosis Beyond Doppler Flow
24:30 Oophoropexy When It Helps And Harms
29:22 Scoring Tools For Torsion Triage
32:48 Detorsion Versus Oophorectomy And Recovery
37:09 Certainty Porn And Limits Of Tests
41:09 Pregnancy Tests False Positives And Negatives
47:10 Listener Question TOL After Myomectomy
50:01 Counseling Factors And Limited Rupture Data
55:31 Closing And Next Guest Tease
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We unpack the Gray Journal’s special edition on Cesarean Delivery, separating strong evidence from expert habit, and spotlight where technique, culture, and policy collide. From TXA and barbed sutures to better metrics and imaging, we share what to adopt now and what to question. Featuring Maddie White.
• evidence versus expert opinion across the special issue
• TXA at cesarean shows no meaningful outcome gains
• barbed versus braided sutures and the cost of “speed”
• why fundamentals beat gadgets for blood loss and time
• critique of New Jersey NTSV study and outcome framing
• imaging pearls for post‑cesarean complications
• infection prevention steps supported by trials
• history of cesarean steps and why we dropped some
• rising cesarean rates driven by non‑clinical forces
• better classification systems and dyadic metrics
• balancing maternal and neonatal outcomes
• tool use in obesity and cost‑conscious choices
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0:01 Why A Massive C‑Section Special Issue Matters
3:15 Expert Opinion vs Evidence: Read With Caution
5:44 Safety Basics: Wear Eye Protection
7:46 Evidence‑Based Technique Still Stands
10:55 TXA At Cesarean: Reanalyzing TRAAP2
18:19 Barbed Sutures And The Myth Of Speed
27:30 Operative Time: Fundamentals Over Gadgets
33:54 New Jersey QI Study: Claims And Confounders
42:05 Outcomes Framing: “Cone Heads” And Bias
49:15 Imaging After Cesarean: What To Look For
54:35 Infection Prevention And SSI Takeaways
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We examine why U.S. maternal mortality headlines mislead, showing overdose and violence dominate early postpartum deaths while obstetric causes decline. We then cover strong evidence for opportunistic salpingectomy, debunk a shaky Cochrane-fueled home birth claim, clarify Nexplanon’s five-year approval and bleeding management, confirm no Tylenol-autism link, and walk through modern syphilis testing in pregnancy before closing with pragmatic magnesium use after delivery.
• overdose and violence as leading postpartum deaths
• pitfalls of cross-country maternal mortality comparisons
• fentanyl trends and infant risk
• opportunistic salpingectomy reduces ovarian cancer risk
• how bad meta-analyses distort home birth safety claims
• intent-to-treat and risk matching in birth setting data
• Nexplanon five-year efficacy and bleeding treatments
• no association between acetaminophen and autism
• syphilis screening algorithms and pregnancy timing
• magnesium postpartum as seizure prophylaxis, not BP treatment
Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram
0:00 Setting The Agenda: What Really Kills Moms
0:33 Redefining Maternal Mortality And Comparisons
2:11 Violence, Overdose, And Postpartum Risk
5:33 State Variability And Media Narratives
8:15 Data On Drugs, Fentanyl, And Infant Harm
11:06 Opportunistic Salpingectomy: New Evidence
14:06 Population Study And Risk Reduction Ranges
16:16 Cochrane Review And Home Birth Claims
20:24 Why Bad Meta-Analyses Mislead
24:15 Real-World Data And Intent-To-Treat For Birth Setting
28:02 Pain, Epidurals, And Cultural Narratives
31:00 Nexplanon Five Years And Bleeding Fixes
35:21 Tylenol And Autism: Meta-Analysis Revisited
38:04 Syphilis Testing In Pregnancy: Why It’s Hard
42:25 Traditional Vs Reverse Algorithms Explained
47:05 Managing Discordant Results And Reinfection
50:11 History, Ethics, And Tuskegee Lessons
54:15 Listener Question: Magnesium Duration Postpartum
59:05 Clinical Judgment Over Dogma And Wrap
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We map a prevention-first approach to OBGYN surgical complications—from environmental fixes and technique to early detection, skilled repair, and honest recovery—so fewer patients are harmed and clinicians carry less hidden burden. Practical steps, board-level reasoning, and real cases bring it to life.
• applying primordial to quaternary prevention to surgical harm
• avoiding unnecessary hysterectomy and favoring safer routes
• bladder repair tactics by size and location
• ureter injury recognition, stenting, and reimplant options
• bowel injury triage, Lembert technique, and resection thresholds
• four practical tips to prevent bowel injury
• vascular control from aorta to epigastrics and presacral bleeds
• preventing neuropathies with smarter positioning and retractors
• disclosure with HEAL and supporting clinicians with just culture
• key historical insights
0:00Framing Complications With Prevention
2:55Primordial To Quaternary: The Model
7:30Urologic Risks: Bladder First
16:20Trigone, Stents, And Calling For Help
23:45Ureter Injury Playbook
33:20Delayed Ureter Injuries And Management
38:05Small Bowel: From Serosa To Resection
46:30Colon Injuries: Repair Or Resect
52:40Four Tips To Prevent Bowel Injury
58:10Vascular Injury: Aorta To Epigastrics
Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram
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We unpack new studies that reshape how we counsel on VBAC after short intervals, update what we tell BRCA carriers about estrogen therapy, and explore how self-collected HPV tests can reduce screening gaps. We also question surgical marketing, workforce trends, and the shaky evidence behind aspirin dosing for preeclampsia.
• Short interpregnancy interval as a VBAC risk factor, not a contraindication
• Absolute uterine rupture rates in spontaneous vs induced labor
• Estrogen therapy in BRCA carriers and treated gyn cancers
• Cervical screening overuse and underscreening in insured populations
• Self-collected HPV testing intervals and access benefits
• OB-GYN workforce shortages and rural distribution gaps
• Endometriosis surgery indications versus fertility claims
• Robotics versus laparoscopy outcomes and training priorities
• Aspirin dose trials, lack of placebo arms, and abruption signals
• Reading statistics correctly and demanding better editorial standards
0:00Setting The Agenda: New Studies
0:40Short Interval Pregnancy And VBAC Risk
3:10Quantifying Uterine Rupture By Spacing
8:10Induction, Augmentation, And Rupture Math
9:40HRT In BRCA Carriers: New Evidence
13:05Estrogen After Gyn Cancers: Practice Gaps
17:40Cervical Screening: Overuse And Underscreening
22:30Self-Collected HPV Testing Guidance
27:00OB-GYN Shortages And Distribution
33:20Endometriosis Surgery And Fertility Claims
41:20Robotics Vs Laparoscopy: Outcomes And Training
47:20Aspirin Dosing For Preeclampsia: No Signal
55:30Interpreting Stats And Editorial Standards
59:20Closing Notes And Next Steps
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Jamie Perry joins this episode as we share ten standout women’s health breakthroughs from 2025 and then get practical about value in endoscopic hysterectomy. The focus is simple: cut waste, save time, protect quality, and expand access through better selection, technique, and team flow.
• Key 2025 breakthroughs shaping care and counseling
• Why OR time outweighs device price
• Preference cards as a lever to reduce waste
• Three-arm robotics and smarter instrument choices
• Laparoscopic tips: barbed suture, simulation, quadrant workflow, vessel skeletonization
• Robotic tips: patient selection, docking discipline, turnover efficiency, data tracking
• Same-day discharge and ERAS as non-negotiables
• When vaginal route is truly better and why referrals matter
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0:00Setting The Stage: Why Endoscopy
1:12Ground Rules And Focus On Value
2:12Top 10 Women’s Health Breakthroughs Of 2025
15:56Defining Value In Hysterectomy
18:20Preference Cards And Instrument Waste
21:28Three-Arm Robotics And Instrument Costs
24:04Time As The Biggest Cost Driver
29:56Same‑Day Discharge And ERAS
33:44Four Laparoscopic Efficiency Tips
41:28Four Robotics Efficiency Tips
47:02When To Choose Vaginal Hysterectomy
54:10Data Tracking, Referrals, And Culture Change
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We unpack what WHI actually showed about estrogen-only therapy and breast cancer in light of new supporting data, then confront the free birth trend’s preventable harms and the business model behind it. We share clear tools to spot false claims, review new aspirin data on preeclampsia, and outline twelve practical ways to cut waste in gyn surgery.
• estrogen-only therapy associated with lower breast cancer diagnosis and mortality
• combined estrogen plus progestogen neutralizing estrogen’s protective signal
• rare abdominal pregnancy case illustrating basic testing safeguards
• free birth movement risks, censorship of bad outcomes, and money incentives
• red flags in birth-related posts and the SIFT fact-checking method
• four quick filters to vet social content before sharing
• nuanced view on aspirin for preeclampsia with mixed trial evidence
• twelve surgical sustainability steps that save cost and reduce waste
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1:11Estrogen Therapy And Breast Cancer Risk
6:41What WHI Actually Showed
11:22Progesterone, HRT Fads, And Risks
15:35Wild Case: Abdominal Pregnancy Behind Tumor
20:42Free Birth Trend And Tragic Outcomes
25:37How The Misinformation Business Works
30:10Red Flags In Birth Content Online
35:10The SIFT Method For Fact-Checking
40:20Four Tips To Vet Social Posts
46:25Live Walkthrough: Debunking A Viral Post
52:40Digital Hygiene And Curating Feeds
56:48Aspirin For Preeclampsia: Mixed Evidence
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We trace the arc from variolation and Jenner to mRNA, show how vaccines leverage natural immunity, and explain why maternal shots protect both parent and newborn. Data, history, and personal stories make the case that prevention beats cure for OBGYN care.
• pertussis surge in Kentucky and preventable infant deaths
• child mortality then and now and what changed
• variolation to Jenner and the origins of vaccination
• how innate and adaptive immunity learn and remember
• vaccine types and why today’s antigens are fewer
• effectiveness data across polio, measles, rubella, Hib
• sanitation myths versus vaccine impact
• Wakefield’s fraud and why autism claims fail
• three major studies debunking autism myths
• essential pregnancy vaccines and timing
• RSV options and COVID safety during pregnancy
• herd immunity as protection for newborns
0:02Setting The Stage: Vaccines Under Fire
1:09Pertussis Surge And Preventable Tragedy
2:20Child Mortality Then And Now
4:19What Killed Children In 1850
5:31Out Of Sight, Out Of Mind
9:51Origins Of Vaccination: Variolation To Jenner
15:20Vaccines Use Natural Immunity
20:00Types Of Modern Vaccines Explained
25:30Innate And Adaptive Immunity 101
28:40How Effective Are Vaccines Really
33:40Polio’s Human Cost And Iron Lungs
39:00Measles, Rubella, And Pregnancy Risks
44:20Sanitation Myths Versus Vaccine Impact
47:05The Wakefield Fraud And Aftermath
52:20Big Studies Debunk Autism Claims
55:20Essential Vaccines In Pregnancy
58:00Takeaways And Next Steps
Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram
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We share a practical, clinic‑tested system for hereditary cancer screening that standardizes intake and education, then confront how malpractice pressures distort obstetric decision‑making, fetal monitoring, and access to care. Former ACOG president Dr. Richard Waldman offers data, history, and solutions we can use now.
• digital workflow that screens every patient annually from age 18
• video education improving informed consent and test completion
• one in four patients meeting hereditary testing criteria
• management changes after testing including MRI, meds, referrals
• addressing cost and genetic discrimination concerns
• OBGYNs as leaders in genetics amid counselor shortages
• malpractice landscape, rising verdicts, and physician burnout
• neonatal encephalopathy criteria grounding courtroom science
• fetal monitoring limits, category II overreaction, cesarean pressure
• VBAC safety tied to selection, readiness, and team systems
• safety culture, simulation, and checklists reducing risk
Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram
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Antonia and special guest Kristi Angevine explore how physicians can rethink habits beyond routines to include default thoughts, feelings, and reactions, and how that shift relieves burnout and restores purpose. Practical micro-habits, internal validation, and redefining productivity help us lead better and live better.
• habits as automatic thoughts, feelings, reactions
• perfectionism, people pleasing, catastrophizing as learned solutions
• survival seasons and low‑friction wins
• two micro‑habits: emotional check‑ins and box breathing
• escaping all‑or‑nothing with iterative learning
• redefining productivity around alignment, not to‑do lists
• internal validation and making yourself make sense
• training culture, criticism, and choosing supportive mentors
• identity beyond “doctor first” to include rest and health
• coaching options: group community and private work
Be sure to check out Thinking about obgyn.com for more information, and be sure to follow us on Instagram
0:01Setting The Stage: Habits In Medicine
0:32Introducing Dr. Kristi Angevine
2:05Redefining What A Habit Really Is
4:20Perfectionism, People Pleasing, Catastrophizing
7:12Coping Gone Sideways And Burnout Risk
11:21Unrealistic Standards And The Inner Critic
15:54When Work Ethic Becomes Self-Neglect
19:30Why Simple Routines Aren’t Easy
23:12Survival Seasons And Low-Hanging Fruit
26:12Two Five-Minute Habits That Stick
30:45Escaping All-Or-Nothing Thinking
36:05Internal Validation As A Mental Habit
41:05Success Beyond The To-Do List
48:39Burnout’s Roots And Moral Injury
52:42Training Culture, Criticism, And Resilience
57:05Coaching Options And Community
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We challenge long-held beliefs about fibroids, highlight new ectopic pregnancy nuances, and dig into real-world dermoid cyst outcomes. We also unpack the evidence and ethics of 39-week induction after IVF and ICSI, balancing small absolute risks with maternal tradeoffs.
• Evidence overturning links between fibroids and miscarriage, PROM and abruption
• Distinguishing spontaneous versus iatrogenic preterm birth in fibroid pregnancies
• Why myomectomy can raise early delivery and cesarean rates in some patients
• Ectopic care updates: tube-sparing choices, HCG thresholds, two-dose methotrexate
• Experimental adjuncts to methotrexate remain unproven
• Dermoid data supporting laparoscopy, irrigation, and specimen bags over open surgery
• Surgical decision making during pregnancy and avoiding uterine manipulators
• IVF and ICSI timing: late stillbirth risk signals, limits of testing, 39-week logic
• Shared decision making when absolute risks are low but values differ
Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram
1:33Fibroids And Miscarriage Myths
5:53Preterm Birth, PROM, And Hemorrhage
9:31Myomectomy: Risks, Scars, And Outcomes
13:25Ectopic Pregnancy: What’s New
18:37Surgery Versus Methotrexate Nuances
22:05Experimental Add-Ons To Medical Therapy
27:47Dermoid Cysts: Real-World Data
32:48Laparoscopy, Spillage, And Pregnancy
36:06When Open Surgery Makes Things Worse
40:34IVF, ICSI, And 39-Week Induction
48:05Stillbirth Risk: What The Data Shows
55:20Testing, Timing, And Shared Decisions
1:04:10Practical Counseling And Tradeoffs
Follow us on Instagram @thinkingaboutobgyn.
In this episode, Howard and Maddie White challenge shaky claims linking autism to circumcision and Tylenol, then zero in on speed as the byproduct of essential, evidence-based surgery. We show how essentialism, confidence, and efficiency reduce complications, lower costs, and improve outcomes in the OR.
• correlation vs causation in autism narratives and bias in research
• why operative time predicts complications across procedures
• surgeon volume, variability, and outcome differences
• evidence-based cesarean steps that cut time and bleeding
• tool and method choices that are safer and faster
• confidence as self-efficacy, not arrogance
• practical efficiency: setup, flow, visualization, debrief
• lean thinking, standardization, and reducing variation
Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram
00:00:00 Opening Banter & Autism Claims
00:02:35 Circumcision, Bias, and Correlation vs Causation
00:09:54 Why Speed in Surgery Matters
00:15:35 Surgeon Variability and Outcomes
00:19:35 Evidence-Based Cesarean: Essential Steps
00:27:20 Less Bleeding Through Minimal Dissection
00:31:20 Choosing Methods and Tools that Save Time
00:35:05 Confidence vs Arrogance in the OR
00:40:05 Practical Efficiency: Filming, Flow, and Setup
00:45:05 Visualization, Assisting, and Debriefing
00:50:00 Tools, Tech, and Mastering Basics
00:55:00 Standardization, Lean Thinking, and Takeaways
Follow us on Instagram @thinkingaboutobgyn.
We push back on claims that Tylenol or vaccines cause autism and explain how weak methods, conflicts of interest, and cherry-picked data fuel public panic. We also unpack why diagnoses have risen—broad criteria, screening, and access—not because of a new environmental villain.
• Summary of claims made at the press event and why they fail
• What the cited acetaminophen paper did and didn’t show
• Conflicts of interest, pay-to-publish venues, and bias
• Why correlation isn’t causation; confounding by indication
• Bradford Hill criteria applied to acetaminophen and autism
• Sibling-controlled studies as the strongest current evidence
• Amish and Cuba myths; diagnosis versus true prevalence
• DSM-5 changes driving higher autism diagnoses
• State-by-state variation explained by services and funding
• Vaccine safety evidence contrasted with myths
• Practical counseling: treat fever; use clear, strong evidence
Be sure to check out thinking about obgyn.com for more information and be sure to follow us on Instagram
0:00 Setting The Record Straight
2:30 The Press Conference Claims
5:30 Tylenol, Vaccines, And Autism
9:30 The Study Behind The Hype
14:30 Conflicts, Bias, And Bad Methods
19:30 Correlation Isn’t Causation
23:00 Bradford Hill 101
28:30 Amish, Cuba, And Diagnosis Rates
33:30 Screening Tools And Subjectivity
37:30 Sibling Studies: The Strongest Signal
42:00 Why Meta-Analyses Can Mislead
46:00 What The “Navigation Guide” Misses
51:00 Vaccine Myths In Perspective
54:00 Why Autism Diagnoses Rise
59:00 DSM-5 And Access To Services
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Dr. Howard Harrell explores common questions about birth alternatives posed by Anna, a mom-to-be with questions, examining scientific evidence behind claims often found online that challenge evidence-based obstetric practices. The discussion separates facts from philosophy by analyzing actual research data on interventions like epidurals, oxytocin, and birthing positions.
• Maternal mortality has decreased 173-fold since 1850, coinciding with the rise of modern obstetrics
• The "cascade of interventions" theory isn't supported by scientific evidence
• Studies show epidurals don't increase cesarean delivery rates, contrary to popular belief
• Oxytocin augmentation, when properly used, can decrease cesarean rates rather than increase them
• Upright birthing positions don't show improved outcomes compared to lying on back
• Hospital/provider cesarean rates matter more than specific interventions in predicting your risk
• For low-risk pregnancies, intermittent rather than continuous fetal monitoring may reduce unnecessary interventions
• Best approach combines respecting physiologic birth while using appropriate medical tools when needed
Visit thinkingaboutobgyn.com for more information and follow us on Instagram. We'll be back in two weeks.
00:00:02 Introduction to Natural Birth Questions
00:02:09 Historical Maternal Mortality Statistics
00:05:54 Nutrition Myths and Modern Food Safety
00:11:34 Debunking the Cascade of Interventions Theory
00:21:32 Epidurals: Facts vs. Misconceptions
00:35:59 Birth Positions and Perineum Protection
00:44:20 Avoiding Unnecessary Cesareans
00:48:56 Continuous vs. Intermittent Fetal Monitoring
00:56:24 Artificial Rupture of Membranes Discussion
Follow us on Instagram @thinkingaboutobgyn.
Howard and Antonia explore the safety of medications during pregnancy and the controversial reporting requirements for breast density on mammograms, examining how science is being overshadowed by fear-mongering in healthcare decision-making.
• Examining the evidence behind avoiding fluconazole (Diflucan) in first trimester, finding that short courses likely pose minimal risk
• Discussing the important distinction between possibility and probability when evaluating medication safety in pregnancy
• Analyzing the wide variation in cesarean delivery rates across US counties, from 5.4% to over 53% for low-risk patients
• Critiquing politically-motivated FDA actions on SSRIs, food dyes, and other health policies not supported by scientific evidence
• Explaining why the FDA's requirement to notify women of dense breasts on mammograms may cause more harm than good
• Demonstrating how supplemental testing for women with dense breasts leads to false positives and unnecessary procedures
• Reviewing the historical development of prenatal diagnosis from early ultrasound to cell-free DNA testing
00:00:33 Evidence for Diflucan in Pregnancy
00:12:12 Cesarean Delivery Rates Across US Counties
00:16:39 FDA's Position on SSRIs and Food Dyes
00:28:46 Managing Dense Breasts in Mammography
00:44:46 History of Prenatal Abnormality Diagnosis
Follow us on Instagram @thinkingaboutobgyn.
Dr. Jacqueline Vidosh shares her powerful journey as both an obstetrician and mother to Noah, who has trisomy 18, challenging traditional medical understanding of this condition and providing insights into compassionate patient care. Her story, recently featured in The New York Times, illustrates how medical perspectives on chromosomal conditions can evolve through lived experience, highlighting the spectrum nature of trisomy 18 and the importance of accurate, unbiased counseling.
• Receiving the diagnosis during pregnancy and navigating the emotional process when medical training suggested a fatal outcome
• Discovering that trisomy 18 exists on a spectrum with possibilities beyond what medical textbooks described
• Managing Noah's complex medical needs including ventilator, tracheostomy, and gastrostomy tube while balancing family life
• Advocating for appropriate medical interventions by challenging the assumption that care would be "futile"
• Celebrating Noah's achievements and joys – his love of music, lights, and his unique ways of communication
• Recent medical literature supporting interventions for trisomy 18/13 on a case-by-case basis
• Using the SPIKES protocol for delivering difficult news with respect and compassion
• Implementing trauma-informed care for families experiencing complicated pregnancies and NICU stays
Read more about Noah's story in The New York Times article, available through the free link provided in our show notes.
https://www.nytimes.com/2025/07/31/magazine/trisomy-18-edwards-syndrome-baby-treatment-care.html?unlocked_article_code=1.ak8.JRBu.7-qMQhelsVYx∣=url-share
00:00:00 Introduction to Trisomy 18 Discussion
00:08:40 Receiving the Diagnosis
00:17:45 Challenging Medical Assumptions
00:27:30 Noah's Daily Life and Care
00:38:20 Joy and Connection with Noah
00:47:10 Navigating the Medical System
00:54:00 Breaking Difficult News Effectively
Follow us on Instagram @thinkingaboutobgyn.
Recent evidence challenges the practice of prescribing oral antibiotics after Cesarean delivery in obese patients, finding no significant reduction in infection rates compared to standard preoperative antibiotics alone. Howard and Antonia analyze studies showing why this once-promising intervention may not be necessary.
• ACOG updates delayed cord clamping guidance to minimum 60 seconds for preterm infants
• Baby born at 21 weeks and zero days celebrates first birthday, highlighting advances in neonatal care
• Systematic reviews show no difference between chlorhexidine and iodine for vaginal prep before hysterectomy
• Conservative management of placenta accreta spectrum disorders shows improved outcomes over immediate cesarean hysterectomy
• Labor arrest Cesareans have highest blood loss among non-accreta cesarean indications
• New HPV testing terminology recommends "HPV detected" rather than "positive" to avoid relationship misunderstandings
• USPSTF preeclampsia prevention guidelines classify 89% of pregnant women as aspirin candidates despite limited evidence
• Endometrial sampling best practices include stepwise approach starting with ultrasound before considering hysteroscopy
In two weeks, Jacqueline Vidosch returns to discuss her son Noah who has trisomy 18, following a feature in the New York Times.
00:00:00 Episode Introduction
00:06:43 Post-Cesarean Antibiotics: Evidence Review
00:17:11 Delayed Cord Clamping Updates
00:22:13 Extreme Preterm Survival Case
00:26:40 Vaginal Prep and Placenta Accreta Management
00:30:11 Cesarean Blood Loss by Indication
00:34:21 HPV Testing Language Changes
00:37:45 Aspirin for Preeclampsia Prevention
00:51:33 Endometrial Sampling Question
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Dr. Scott Guthrie joins us to explore the significant advances in neonatal care and the critical partnership between obstetricians and neonatologists to improve outcomes for newborns. Highlights include:
• Successful implemented delayed cord clamping across Tennessee hospitals through collaborative quality improvement project
• Neonatal mortality has decreased 30% between 1999-2022 due to advances in medical care and prenatal management
• Survival rates for 22-week premature infants have improved to 30-40%, with many having normal development
• Modern ventilation strategies now allow extremely premature babies to avoid intubation completely
• Delivery room practices have shifted from routine suctioning to prioritizing effective ventilation
• Therapeutic cooling has revolutionized treatment for hypoxic ischemic encephalopathy when initiated within 6 hours
• Historical treatment of meconium stained fluid has evolved as we better understood its pathophysiology
• Neonatal intensive care advances were catalyzed by Patrick Kennedy's death from hyaline membrane disease in 1963
Join us for our continuing exploration of obstetrical and neonatal advances as we work together to improve outcomes for mothers and babies.
00:00:00 Introduction to Neonatal Care Advances
00:10:13 Neonatal Mortality Trends and Challenges
00:16:27Technological Evolution in NICU Care
00:24:07 Periviable Infants: Improved Survival Rates
00:31:09 Delivery Room Best Practices for Newborns
00:38:44 Modern Meconium Management Approaches
00:47:19 Therapeutic Hypothermia for HIE
00:55:42 Causes and Detection of Hypoxic Ischemic Encephalopathy
01:03:01 History of Neonatal Care Evolution
01:12:25 Concluding Thoughts on Collaborative Care
Follow us on Instagram @thinkingaboutobgyn.
Howard and Antonia dive into their tenth season with a critical look at several new studies. Topics include:
• Estrogen-soaked vaginal packing after surgery lacks evidence for benefits while carrying unnecessary costs
• Recent studies on vaginal birth after cesarean deserve careful interpretation beyond aggregate outcomes
• Hospital uterine rupture rate is 0.2-0.4%, with only 8% resulting in catastrophic outcomes when properly managed
• Warnings against infant co-sleeping date back to ancient times, predating modern pediatric recommendations
• Vaginal hysterectomy continues to decline despite shorter OR times, lower costs, and similar complication rates
• Swedish study shows only 25% of ideal candidates receive vaginal hysterectomies, with projections showing disastrous decline in rates of appropriate surgeries
Stay tuned for our next episode featuring Scott Guthrie discussing neonatal resuscitation and other neonatal concepts important for OB-GYNs to understand.
00:00:00 Season 10 Introduction
00:01:13 No Evidence for Estrogen Packs After Surgery
00:10:35 VBAC Studies: Interpreting Maternal Risks
00:19:12 Catastrophic Uterine Rupture: Hospital vs Home
00:28:53 King Solomon and Infant Co-Sleeping Dangers
00:39:50 Vaginal Hysterectomy: Declining Despite Evidence
00:54:09 Cost and Time Analysis of Hysterectomy Routes
01:06:24 Closing Thoughts on Season 10
Follow us on Instagram @thinkingaboutobgyn.
Surgical techniques in gynecology vary widely between surgeons, creating both excitement and frustration for residents trying to learn the "right way" to perform procedures. Howard and guest host Maddie White discuss this and more:
• Trocar placement during laparoscopy requires careful consideration of patient factors and potential adhesions
• Elevating the abdomen during trocar placement remains standard practice, though definitive evidence on its necessity would require studies of over 100,000 patients
• Surgeons should understand power analysis to recognize when studies are underpowered to detect meaningful differences in rare complications
• Visceral slide technique using ultrasound can identify adhesions and determine the safest entry point for laparoscopic surgery
• Palmer's point may no longer be the safest entry point for many patients given the prevalence of bariatric surgeries
• Jain's point (lateral to the umbilicus) may now be statistically safer for many patients with complex surgical histories
• Vaginal cuff dehiscence rates are 6-10 times higher with laparoscopic/robotic hysterectomy compared to vaginal approaches
• The higher dehiscence rate stems from using energy devices for colpotomy rather than cold scalpel techniques
• Barbed sutures simplify cuff closure but don't reduce dehiscence rates compared to standard suturing techniques
• Surgery consists of "a thousand little things done well" - mastering these micro-skills distinguishes excellent surgeons
00:00:00 Surgical Techniques: Excited and Frustrated
00:08:00 Elevation During Trocar Placement
00:17:00 Evidence and Power Analysis
00:21:35 Visceral Slide Technique
00:35:10 Alternative Trocar Entry Points
00:40:10 Cuff Closure and Dehiscence Risk
00:51:45 Laparoscopic vs Vaginal Colpotomies
01:03:00 First Accredited OB-GYN Residency Program
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Howard Herrell and Antonia Roberts explore evidence-based practices in obstetrics and gynecology, examining both established protocols and emerging research with critical perspectives on medical misinformation.
• Serial cervical length monitoring after LEEP procedures lacks evidence for improving outcomes despite being common practice
• SMFM's 2016 recommendation explicitly advises against routine cervical length screening for patients with history of cervical procedures
• Retrospective studies on induction timing require careful interpretation due to inherent biases in methodology
• Understanding the difference between intent-to-treat and per-protocol analysis is crucial when evaluating medical research
• Pseudoscience and alternative medicine have gained mainstream acceptance over decades through celebrity endorsements and media platforms
• Reusable surgical instruments like stainless steel uterine manipulators offer both economic and environmental advantages over disposable options
• Plus, Learn the history of The Green Journal's distinctive color
Be sure to check out thinkingaboutobgyn.com for more information and follow us on Instagram. We'll be back in two weeks.
00:00:35 Monitoring Cervical Length After LEEP
00:10:30 Understanding Intent-to-Treat Analysis
00:28:54 MAHA Movement and Medical Misinformation
00:53:49 Carbon Footprint of Uterine Manipulators
00:57:30 History of the Green Journal
Follow us on Instagram @thinkingaboutobgyn.
Cervical cancer represents a success story in developed countries due to screening and vaccination, yet remains a significant global health problem with over 340,000 deaths annually worldwide. We explore the current state of cervical cancer prevention, screening, and treatment while discussing exciting advances that could eventually eliminate this disease.
• Different levels of prevention for cervical cancer: primordial, primary, secondary, tertiary, and quaternary
• HPV vaccination as the most effective primary prevention method, with Australia on track to make cervical cancer rare by 2035
• Evolution from Pap smears to primary HPV testing, with potential future urine-based screening options
• Less radical surgical approaches for early-stage disease, improving quality of life without compromising outcomes
• Immunotherapy advances showing 6-12 month survival benefits in metastatic disease
• Howard Kelly's pioneering work with radium in the early 1900s, establishing foundations for radiation therapy
• Importance of addressing healthcare disparities, as rural Americans are 25% more likely to develop cervical cancer and 42% more likely to die from it
Visit our website at thinkingaboutobgyn.com for more information and follow us on Instagram for updates.
00:00:00 Introduction to Cervical Cancer
00:08:10 Prevention Strategies Explained
00:18:02 HPV Screening Evolution
00:26:51Treatment of Early-Stage Disease
00:37:09Advances in Locally Advanced Disease
00:50:31 Radium and Howard Kelly's History
01:02:48 Final Thoughts on Prevention
Follow us on Instagram @thinkingaboutobgyn.
Howard and Antonia explore the evidence behind pit breaks in labor, cannabis use in pregnancy, and IUD options for hormone replacement therapy.
• Pit breaks in labor lack substantial evidence of benefit when used in active labor
• Current research suggests stopping oxytocin during active labor may slightly increase cesarean rates rather than decrease them
• Long pit breaks (up to 8 hours) in latent labor may be beneficial by allowing rest and promoting patience
• Recent systematic review shows prenatal cannabis use increases risk of low birth weight by 75%, preterm birth by 50%, and perinatal mortality by 29%
• Cannabis use during pregnancy (7.2% of pregnant women) now exceeds tobacco use
• Retrospective studies on doula care show association with better outcomes, but can't establish causation due to inherent differences in patients who seek doulas
• 52mg levonorgestrel IUDs (Mirena/Liletta) are suitable for endometrial protection during HRT, but evidence only supports use up to 5 years
• Most systematic reviews combine heterogeneous studies and shouldn't be considered level 1 evidence
We'd love to hear your questions! Send them to us through our Instagram or website thinkingaboutobgyn.com.
00:04:52 Pit Breaks in Labor
00:15:32 Examining Evidence on Oxytocin Discontinuation
00:26:08 Prenatal Cannabis Use and Adverse Outcomes
00:36:07 Doula Care Study Analysis
00:57:22 Levonorgestrel IUD Use in HRT
Follow us on Instagram @thinkingaboutobgyn.
Join Howard and Janeen Arbuckle for this discussion of pediatric and adolescent gynecology essentials. Pediatric and adolescent gynecology is a newer discipline bringing specialized care to young women with unique gynecologic needs, with a focus on counseling, education, and age-appropriate interventions.
• Abnormal uterine bleeding in adolescents is rarely caused by structural problems (unlike in adults) and typically relates to immaturity of the hypothalamic-pituitary-ovarian axis
• Hematologic workup should be considered for adolescents with heavy menstrual bleeding as this may be the first time their clotting system is challenged
• Hormonal therapies are safe to use once menarche has occurred, with no impact on bone growth
• Long-acting reversible contraceptives offer superior pregnancy prevention (1 in 10,000 for implants vs 8 in 100 for typical pill use) but require thoughtful counseling
• Private interviews with adolescent patients create trust while preparing them for independent healthcare navigation
• Tranexamic acid is effective for heavy menstrual bleeding in adolescents but pill size and frequency can limit compliance
• Most ovarian cysts in adolescents represent normal physiologic function and rarely require intervention
• Preservation of reproductive organs should be prioritized in adolescent surgery, including leaving ovaries after torsion when possible
• Vaginal bleeding in pre-pubertal girls requires assessment for secondary sexual characteristics to distinguish precocious puberty from other causes
00:00:00 Introduction to Pediatric Gynecology
00:07:20 Abnormal Uterine Bleeding in Adolescents
00:19:36 Contraception Choices for Young Patients
00:29:40 Managing Difficult Patient-Parent Conversations
00:38:04 Pelvic Pain and Endometriosis
00:46:58 Adnexal Pathology and Ovarian Issues
00:50:51 Congenital Anomalies and Vaginal Bleeding
Follow us on Instagram @thinkingaboutobgyn.
In this episode, Antonia and Howard explore the groundbreaking study on treating male partners for bacterial vaginosis, revealing significantly reduced recurrence rates and challenging our traditional understanding of BV pathophysiology.
Plus:
• Evidence doesn't support treating mild gestational hypertension with antihypertensives
• Studies confirm acetaminophen in pregnancy doesn't cause ADHD or autism
• New research questions the benefit of routine postpartum thromboprophylaxis
• The history of heparin and coumadin
00:00:34 Treating Mild Hypertension in Pregnancy
00:06:14 Distinguishing Chronic vs. Gestational Hypertension
00:15:46 Male Partner Treatment for Recurring BV
00:27:09 Understanding Bacterial Vaginosis Pathophysiology
00:35:42 Ineffective Treatments and Alternative Approaches
00:53:04 Tylenol in Pregnancy: Debunking ADHD Claims
00:58:02 Postpartum Thromboprophylaxis: Evidence Against Overuse
Follow us on Instagram @thinkingaboutobgyn.
This episode features our favorite podcast ninja, Dr. Maddie White. She and Howard discuss how medical dramatizations misrepresent obstetric emergencies (yes, we are watching The Pitt). Then, we dissect evidence-based approaches to common triage scenarios including labor evaluation, rupture of membranes, and preterm labor assessment.
• Television shows like "The Pitt" and "ER" portray shoulder dystocia and postpartum hemorrhage inaccurately, lacking proper urgency and technique
• Hospital-based labor triage often costs approximately 10 times more than office-based evaluation, often without clinical benefit
• Understanding pretest probability fundamentally changes how test results should be interpreted for suspected rupture of membranes
• Most expensive tests like Amnisure (>$500) provide minimal additional value over traditional approaches when interpreted properly
• Evidence doesn't support routine use of fetal fibronectin testing in preterm labor evaluation
• We discuss universal cervical length screening for prevention of preterm labor in the midtrimester and later in pregnancy for evaluation of threatened preterm labor
00:00:53 Critiquing Obstetric Emergencies in TV Shows
00:10:13 Proper Management of Shoulder Dystocia
00:14:52 Postpartum Hemorrhage Management Approaches
00:19:59 Evaluating Term Labor Complaints
00:25:35 Rupture of Membranes Testing Strategies
00:34:12 Understanding Test Probability and Performance
00:42:26 Cervical Length Screening Evidence
00:51:23 Preterm Labor Triage Tools
01:00:23 Concluding Thoughts on Evidence-Based Practice
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Antonia Roberts and Howard Herrell review several new articles:
• Epifoam for postpartum pain lacks evidence of effectiveness compared to simple ice packs while costing nearly $100 per unit
• AMH levels above 5.39 are associated with PCOS diagnosis, providing a specific threshold for clinical use
• External aortic compression demonstrated as a life-saving technique during severe obstetric hemorrhage
• Vaginal estrogen in breast cancer survivors shows no increased risk of cancer recurrence or mortality
• Delayed cord clamping in preterm twins reduces mortality by 30% and significantly decreases transfusion needs
Then they discuss new birth control options while questioning the value of expensive pharmaceutical products compared to established, less costly alternatives.
• New birth control options like Balcoltra ($280/month), FemLyv ($215/month), and Nextstellis ($250/month) offer minimal innovation over generic alternatives costing $10-15/month
• Marketing terms like "bioidentical" and "plant-based" are often misleading as all hormonal contraceptives are synthesized from plant precursors
• Progestin-only pills like Slynd provide only marginal DVT risk reduction (5 vs 4 per 100,000 person-years) compared to low-dose combined pills
Check our Instagram for more information and join us again in two weeks for our next episode.
00:00:00 Introduction and Epifoam Discussion
00:06:27 Financial Impact of Unnecessary Treatments
00:11:09 AMH Levels for PCOS Diagnosis
00:15:11 External Aortic Compression for Hemorrhage
00:20:22 Vaginal Estrogen and Delayed Cord Clamping
00:21:51 New Birth Control Products Overview
00:31:05 Analyzing Dissolvable Birth Control Pills
00:34:22 Slynd: Drosperinone-Only Pill Evaluation
00:42:09 Nextstellis and "Bioidentical" Estrogen Claims
00:56:37 History of Birth Control Development
Follow us on Instagram @thinkingaboutobgyn.
We discuss the pressing issues surrounding operative vaginal deliveries, including trends in their usage and the disparities impacting delivery outcomes. Join us as we navigate these critical insights with expert guests Jamie Perry and Howard Herrell, revealing the complexities and nuances surrounding forceps and vacuum deliveries.
• Examining the historical context of operative vaginal deliveries
• Analyzing the decline in forceps and vacuum usage since the 1990s
• Discussing the rise of cesarean deliveries as an alternative
• Revealing racial disparities adjacent to delivery practices
• Outlining effective techniques for both forceps and vacuum-assisted deliveries
Learn more about this pressing topic and gain valuable insights by listening to our episode.
00:00:00 ntroduction and Overview of the Episode
00:01:18 The Decline in Operative Vaginal Deliveries
00:05:24 Forceps
00:24:21 Vacuums
00:49:30 Advice For Trainees
00:55:38 Four Tips for Forceps and Vacuums
Follow us on Instagram @thinkingaboutobgyn.
This episode dives into the debate surrounding the efficacy and cost of barbed sutures in surgical practice, questioning whether their time-saving advantages are justified compared to traditional techniques, especially for uterine closure. Additionally, it explores the implications of non-invasive prenatal testing for cancer detection and recent maternal mortality statistics, while advocating for evidence-based practices in both surgical and obstetric care.
• Analysis of barbed suture use and cost implications
• Discussion of unexpected cancer detection via NIPS
• Exploration of maternal mortality statistics and misconceptions
• The relative value of baby (a discussion of the perverse economics of pediatric and obstetric care)
• Summary of recent findings on aspirin dosages for preeclampsia
• Examination of venous thromboembolism risks with hormonal contraceptives
00:00:01 Barbed Suture in OBGYN Surgery
00:09:13 Comparing Surgical Sutures
00:17:11 NIPS Results and Maternal Cancer Detection
00:24:04 Maternal Mortality Trends and Data Analysis
00:38:50 Medical Reimbursements and Healthcare Priorities
00:47:20 Risk Factors in Birth Control Thromboembolism
00:54:37 Birth Control and Thromboembolism Risk
Follow us on Instagram @thinkingaboutobgyn.
Join Howard with guest host Jacqueline Vidosh as we explore the challenges of maternal cardiac arrest. This episode emphasizes the urgent need for specialized training in obstetric life support. From discussing causes of maternal mortality to sharing practical tips for first responders, the insights presented aim to enhance awareness and preparedness in critical situations.
• Discussing the alarming rise in maternal mortality rates
• Identifying common causes of maternal cardiac arrest
• The importance of OBLS training and education for healthcare providers
• Emphasizing the need for left uterine displacement during resuscitation
• Addressing healthcare disparities affecting Black women
• Sharing unique physiological adaptations in pregnant patients
• Strategies for improving outcomes in maternal cardiac arrest cases
• Highlighting the value of simulation training for all healthcare personnel
Every healthcare professional plays a role in improving maternal health outcomes. Listen in for tips and insights on how we can enhance readiness for maternal cardiac arrest situations.
00:00:01 Obstetric Life Support
00:03:34 Maternal Mortality and OBLS Training
00:15:23 Maternal Health Disparities and Physiologic Changes
00:27:53 Cesarean Delivery and Post-Delivery Care
00:41:15 History and Implementation of CPR
Follow us on Instagram @thinkingaboutobgyn.
In this episode, Howard and Antonia focuses on the evolving guidelines for HPV screening and the implications for women's health, highlighting its superior effectiveness over traditional Pap smear tests. Additionally, we explore the reliability of pregnancy apps for information and address a listener question about Group B Streptococcus screening and management.
• Discusses the transition to HPV testing as primary cervical cancer screening
• Reviews a recent study confirming HPV's effectiveness in preventing cervical cancer
• Examines the reliability and misinformation in pregnancy apps
• Answers listener questions regarding Group B Streptococcus management
00:00:01 Circumvallate Placenta
00:13:51 Evaluating Pregnancy Apps for Accuracy
00:26:56 Evaluating Risks of Pregnancy Apps
00:36:51 Gestational Diabetes Treatment Options
00:45:47 Manage GBS Risk Factors
Follow us on Instagram @thinkingaboutobgyn.
Discover how cesarean hysterectomy, once a procedure shrouded in fear, has evolved into a life-saving operation with contributions from pioneering figures like Eduardo Porro and Lawson Tate. In this episode, we are joined by gynecologic oncologist Stuart Winkler, who shares invaluable insights into both unplanned and planned cesarean hysterectomies. Explore the primary indications for these critical surgeries, from uncontrollable bleeding in unplanned emergencies to managing known conditions like placenta accreta in planned scenarios. You'll gain a deep understanding of the strategic decision-making required, especially in resource-limited environments, to ensure the best outcomes for patients.
Navigate the complexities of performing cesarean hysterectomies under challenging circumstances, particularly when severe hemorrhage threatens patient safety. We delve into surgical tips and techniques, emphasizing the significance of early and careful bladder dissection, effective use of energy sealing devices, and confident decision-making. Our discussion highlights innovative strategies for uterine preservation in placenta accreta spectrum disorders, offering creative solutions when complete resection isn't feasible, and exploring new protocols that balance operative blood loss and patient fertility.
Finally, take a journey through the historical evolution of cesarean hysterectomy with us, as we trace its transformation from a fearful, last-resort measure to a cornerstone of modern obstetric care. Learn about the pivotal technological advancements that have shaped current practices, such as preoperative arterial occlusion techniques, equipping today's surgeons with a wide array of tools to tackle even the most complex cases. This episode promises a comprehensive blend of historical insights and practical advice, making it an essential listen for both seasoned professionals and those new to the field.
00:00:01 Cesarean Hysterectomy
00:09:14 Surgical Tips for Cesarean Hysterectomy
00:17:42 Advanced Techniques in C-Hysterectomy
00:23:56 Surgical Tips for Planned C-Hysterectomy
00:31:36 Surgical Techniques for Hemorrhage Control
00:41:38 Uterine Preservation in Spectrum Placenta
00:53:37 Evolution of Cesarean Hysterectomy
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Challenge preconceived notions in obstetrics and gynecology with our latest episode, where we dismantle myths that have long influenced medical practices, even in the absence of scientific backing. From unraveling the misunderstood reaction between alcohol and metronidazole to examining the overlooked risks of clindamycin cream, we'll look at how these misconceptions take root in medical culture. We continue with a critical analysis of intrapartum GBS prophylaxis, correcting widespread misunderstandings around its purpose and timing during labor and how it affects labor management.
We address the rise of dubious hormone tests, like the DUTCH Test, marketed to consumers, painting a cautionary picture of how social media amplifies these unvalidated products. We highlight the importance of consulting healthcare professionals while discussing the potential paradigm shift that self-collected HPV testing could bring to cervical screening, as recommended in the coming cervical cancer screening guiudelines. This new approach might revolutionize screening rates and quality of care, especially for underserved populations, all while realigning healthcare providers' focus on more pressing medical needs.
Prepare for an engaging conclusion as we scrutinize the comparative effectiveness of postpartum hemorrhage devices Jada and Bakri, emphasizing the ethical implications of cost versus efficacy. We'll take you on a historical journey through the concept of "quickening" in pregnancy, reflecting on its cultural significance and evolution with modern science.
Plus, changes for next season!
00:00:02 Metronidazole and Alcohol
00:13:03 Intrapartum GBS Prophylaxis Guidelines Clarified
00:24:54 Hormone Testing and Cervical Screening
00:31:07HPV Self-Collect Screening Implications
00:42:54 Comparative Efficacy of Postpartum Hemorrhage Devices
00:51:29 Historical Perspectives on Fetal Development
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In this episode, we give four simple tips for performing a Pap smear. Then we dive into the complicated problem of obstetric units closing across the United States and actions we need to take to stop this dangerous trend that threatens the safety of pregnant women and newborns. Also, we highlight the important of hospital based obstetric programs and the history of why births moved into the hospitals in the beginning of the 20th Century and the 99% decline in maternal and neonatal mortality that followed.
00:00:02 Cervical Cancer Screening Tips
00:14:13 Hospital Closures Affect Obstetric Care
00:37:27 Rural Obstetric Units Closing Challenges
00:44:53 Hospital vs. Home Birth Safety
00:49:40 Healthcare Disparities for Women and Children
00:55:08 Evolving Birth Settings in America
01:02:28 Email Advocacy for Healthcare Reform
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Do patients in labor need continuous bladder drainage? We will review the literature comparing intermittent to continuous drainage.
Next, we venture into the art and science of manual rotation for persistent posterior fetal presentations, a skillful maneuver that might just hold the key to lowering cesarean rates. Drawing from comprehensive reviews and trials, including the TURN-OUT trial and studies from UCSF, we debate the efficacy and applicability of manual rotation in various clinical settings. From ultrasound-guided techniques to hands-on learning, gain a nuanced understanding of how this practice might enhance delivery outcomes and reduce interventions.
Finally, we learn about Cesarean Scar Disorder, a relatively new diagnosis with important clinical ramifications.
00:00:10 Urinary Catheterization in Labor Management
00:16:10 Manual Rotation of the OP Fetus
00:49:32 Effectiveness of Labor Positioning Techniques
00:58:03 Cesarean Scar Disorder
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In this episode, we discuss four tips for effective birth control counseling. By dissecting communication techniques, we highlight how striking a balance between relational and task-oriented approaches can maximize patient interactions and ensure comprehensive, evidence-based care regarding birth control choices.
Then we delve into several studies from the recent ABOG MOC cycle that we found interesting or curious and point out several informative nuggets.
Finally, we discuss the book "Feminine Forever" and its impact on estrogen replacement therapy perceptions.
00:00:02 Communication Strategies for Birth Control Counseling
00:11:56 Effective Communication of Birth Control Risks
00:21:08 PAS After Myomectomy
00:23:03 Risk-Reducing Surgery Adherence Discussion
00:30:33 Issues With Modern Labor Curves
00:38:49 Stopping ASA Early
00:42:17 Prophylactic Slings
00:46:01 Clinical Updates on UTIs
00:51:34 Mental Health Guidelines and Other Articles
00:55:51 Feminine Forever
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Can IV fentanyl use during labor actually be safe for mothers and newborns beyond six centimeters of dilation? Join us as we unpack a pivotal 1989 study and question the stereotypes surrounding fentanyl use in labor.
Our second segment tackles sensational claims about IUDs and breast cancer, as we dissect a Danish study recently published in JAMA. Listen as we unpack the methodological nuances and confounders that mainstream publications have overlooked, and explore the media's role in shaping public perception with incomplete or skewed interpretations of data.
This episode closes with an in-depth look at the biases that pervade pharmaceutical research, particularly when funding sources have a vested interest in outcomes. By examining the "sponsorship effect" and its implications on research validity, we highlight the need for rigorous, unbiased scientific inquiry. We examine the evidence for the new Pretrm Test for preterm labor risk. Learn about the challenges of implementing biomarker testing for predicting preterm births and why high-quality evidence must remain the cornerstone of clinical practice. As we celebrate our 100th episode, we discuss the need for truth and transparency in scientific research—creating a future where clinical practices are driven by reliable, evidence-based insights.
00:00:02 Navigating IV Fentanyl Use in Labor
00:07:56 Debunking Misconceptions About IUDs and Breast Cancer
00:22:17 Evaluating Biomarker Testing for Preterm Birth: The PreTRM test
00:38:50 Conflicts of Interest in Medical Research
00:45:15 Biased Influence in Medical Research
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In this episode, we discuss four tips for finding evidence based answers quickly. Then we discuss some new literature about pap smears and new guidelines regarding iron supplementation in pregnancy. We also discuss the history of corticosteroids for fetal maturity and the hype cycle in medicine.
00:00:02 Finding Evidence-Based Clinical Answers Quickly
00:13:36 Understanding Evidence-Based Clinical Practice
00:23:30 Cervical Cancer Screening During Pandemic
00:33:51 Optimal Timing for Cervical Cancer Prevention
00:40:12 Iron Supplementation in Pregnancy
00:47:13 Corticosteroids and Hype in Medicine
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In this episode, we discuss the evidence behind one layer and two layer Cesarean closures with an emphasis on inclusion of the endometrium and the risk of cesarean scar ectopics and placenta accreta spectrum disorders. Plus, we define minimally invasive surgery and trace the origin of the term and it's introduce a new concept: less invasive vs minimally invasive surgery.
00:00:02 Hysterotomy Closure Techniques in Cesarean Deliveries
00:14:46 Debunking Claims About Cesarean Techniques
00:27:20 Uterine Closure Techniques in Cesarean Deliveries
00:36:44 Defining Minimally Invasive Surgery
00:48:18 Advanced Techniques in Minimally Invasive Surgery
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In this episode, we discuss four tips for placing and using catheters for induction of labor. Then we revisit the issue of small for gestational age versus fetal growth restriction. We also discuss the most common mistake made in calculating due dates and how this can have a negative impact on pregnancies. Finally, we discuss the history of postpartum depression and the literature and stories of Kate Chopin and Sylvia Plath.
00:00:35 Four Tips for Cervical Catheter Placement
00:23:00 SGA vs FGR
00:28:55 Correcting Due Dates Prevents Mistakes
00:46:10 History of Postpartum Depression, Chopin and Plath
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In this episode, we discuss the frequency of Pap smears for twin pregnancies as well as the need for using twin-based growth data for the diagnosis of fetal growth restriction in twins. We will poke the fire of controversy of the use of the terms "fetal growth restriction" and "small for gestational age" and discover how the terms might harm pregnancies.
Next, we discuss the new AAP guidelines for diagnosis of tongue ties. Finally, we answer a listener question about pushy doctors, paying for unnecessary tests, and the disconnect many gynecologists have with guideline and evidence based care.
00:00:02 Ultrasound Use in Twin Pregnancies
00:14:06 Twin Growth and Fetal Growth Restriction
00:20:00 Fetal Growth Assessment in Twin Pregnancies
00:29:10 Overdiagnosis of Tongue Tie in Infants
00:38:05Breastfeeding and Tongue Tie Recommendations
00:45:43 Controversy Surrounding Pelvic Exams
00:58:21 Unnecessary Physical Exams and IUD Preferences
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In this episode, we discuss prevention of thromboembolism during pregnancy and the postpartum period and the evidence for which patients should receive anticoagulation. Plus, the history of heparin and four tips for preventing embolism.
00:00:02 Four Tips for Preventing Thromboembolism in Obstetrics
00:08:39 Anticoagulation Recommendations in Pregnancy
00:22:29 Assessing Anticoagulation Recommendations in Pregnancy
00:35:22 Evaluating Anticoagulation Protocols in Pregnancy
00:42:22 Debating Risks of Obstetric Anticoagulation
00:59:28 History of Heparin
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In this episode, we challenge the reliability of traditional tests like Homan's sign and cervical motion tenderness. Learn how understanding and applying likelihood ratios can vastly improve diagnostic accuracy, and why combining multiple findings is more reliable than putting faith in isolated tests.
Then we discuss a new JAMA study linking advanced endometriosis with a heightened risk of ovarian cancer. The study brings to light the complexities and gaps in our knowledge, underscoring the importance of personalized patient discussions regarding risks and treatment options.
Next, we discuss a new study about how surgical residents are treated during residency. From inadequate parental leave to cultural pressures, we highlight the urgent need for systematic changes to foster a supportive and equitable environment.
Then expose the deceptive practices in the umbilical cord blood banking industry, revealing the ethical issues and questioning the touted benefits.
Finally, we answer listener questions about use of sterile gloves for cervical exams and trials of labor after two cesareans.
00:00:02 Obsolete Physical Exam Maneuvers in Gynecology
00:14:25 Endometriosis and Ovarian Cancer Risk
00:20:47 Residency Challenges for Parents and Discrimination
00:33:10 Deceptive Practices in Cord Blood Banking
00:49:19 Debate on Mammography Guidelines
00:54:17 Listener Questions: Sterile Gloves and VBA2C
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In this episode, we discuss four tips for Cesarean under local. Then we discuss some new literature including full versus empty bladder during gyn procedures and endometrial ablation vs IUD for abnormal uterine bleeding. We also discuss the inertia of old ideas in obstetric practice. Finally, we discuss the history of the diagnosis of preeclampsia and eclampsia.
00:00:02 Cesarean Delivery Under Local Anesthesia
00:07:04 Emergency Cesarean Delivery Procedure
00:19:47 Bladder Status in Gynecological Procedures
00:29:01 Endometrial Ablation vs IUD for Treatment
00:38:43 Inertia in Obstetrics Practice Trends
00:47:45 Historical Evolution of Eclampsia Diagnosis
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In the season 8 premiere, we discuss over-utilization of serial quantitative HCGs. Then we discuss several famous or influential studies in obstetrics, including the WOMAN trial, the CLASP trial, the ARRIVE trial, MagPIE, and several more. Finally, we discuss the history of how magnesium sulfate came to be used in obstetrics.
00:00:02 Overuse of HCG
00:13:17 Aspirin for Preeclampsia Prevention Debate
00:18:51 Debate on the ARRIVE Trial
00:29:10 MagPIE
00:39:05 Fetal Fibronectin Trials
00:44:53 Induction at 41 Weeks Discussion
00:55:16 History of Magnesium Use in Obstetrics
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In this episode, we discuss four tips for uterine inversion. Then, we discuss mistreatment and abuse of trainees in OB/GYN plus physician suicide. Finally, we answer a question about closure of peritoneum.
00:00:02 Managing Uterine Inversion in Obstetrics
00:13:39 Combatting Harassment in Medical Training
00:25:41 Addressing Mistreatment in Medical Training
00:31:13 Workplace Mobbing and Bystander Dynamics
00:37:29 Identifying and Addressing Workplace Abuse
00:59:30 Listener Question
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In this episode, we discuss routine bacterial vaginosis screening in patients with preterm labor symptoms. Then, we discuss some dietary and other less-discussed findings from the Women's Health Initiative. We also discuss a new review article about first trimester anatomic ultrasounds. Finally, we answer a listener question about implementing postpartum sterilization routinely into unsupportive hospitals.
00:00:02 Testing for BV in Preterm Labor
00:12:28 Clinical Diagnosis of Bacterial Vaginosis
00:21:14 First Trimester Ultrasound in Women's Health
00:34:12 First Trimester Ultrasound Anomalies and Costs
00:38:29 The Cost-Effectiveness of Early Ultrasounds
00:46:32 Improving Postpartum Sterilization Access
00:55:32 Strategies for Postpartum Sterilization Procedures
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In this episode, we discuss four tips for IUD insertion. Then we discuss the qualities of good teachers and the important of teaching students and residents, with some practical advice thrown in as well. Finally, we discuss the history of blood transfusion.
00:00:02 IUD Insertion Techniques and Anxiety Management
00:23:04 Qualities of a Great Teacher
00:35:16 The Benefits of Teaching in Medicine
00:45:42 Teaching Strategies for Clinical Preceptors
00:52:33 History of Blood Transfusion & Obstetrics
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In this episode, we discuss the risks and counseling related to higher numbers of Cesareans. Then, we finish our discussion about vaginal hysterectomy with tips and tricks for some common problems. Finally, we answer a listener question about external cephalic version.
00:00:02 Considerations for Multiple Cesarean Deliveries
00:08:13 Risks and Outcomes of Cesarean Hysterectomies
00:16:09 Uterine Dehiscence and Vaginal Hysterectomy
00:24:01 Tips for Vaginal Hysterectomy Assistants
00:35:24 Mastering the Anterior Colpotomy Technique
00:44:01 Vaginal Hysterectomy Tips and Techniques
00:55:36 Teaching Vaginal Hysterectomy Techniques
00:57:55 Listener Question about ECV
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In this episode, we discuss four tips for managing the deeply impacted fetal head at the time of Cesarean. Then we discuss the optimal route of hysterectomy (hint: its a vaginal hysterectomy). Finally, we discuss the obstetric history of the Taj Mahal.
00:00:02 Four Tips For Deeply Impacted Head at Cesarean
00:13:53 Advantages of Vaginal Hysterectomy
00:25:16 Optimizing Vaginal Hysterectomy Techniques
00:31:53 Advancing Skills in Minimally Invasive Surgery
00:40:24 Advancements in Vaginal Hysterectomy Technique
00:49:20 Debating the Merits of v-Notes
00:58:06 Taj Mahal and Maternal Mortality
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In this episode, we discuss the latest recommendations for treatments for osteopenia and osteoporosis, including vitamin D and calcium, as well as bisphophonates and other medications.
Then we discuss new literature about best methods for induction of labor and risks factors for uterine rupture during a trial of labor after Cesarean. We also discuss a new trial about late preterm antenatal steroids.
Also we talk about a new article about mammalian menopause the evolutionary rolls of menopause and concealed ovulation (fun people, we know!)
Finally, we answer a listener question about bleeding during surgery.
00:00:02 Treatment of Osteopenia and Osteoporosis
00:14:40 Vaginal Birth After Cesarean Recommendations
00:24:05 Effectiveness of Late Preterm Steroids
00:35:49 Menopause and Evolution in Mammals
00:41:05 Concealed Estrus and Weight Gain Recommendations
00:47:56 Managing Surgical Hemostasis and Bleeding
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In this episode, Dr. Stuart Winkler returns to discuss new evidence about the risks and benefits of radical hysterectomy for cervical cancers. Also, for fun, we torture a Gyn-Onc with a four tips for managing cord prolapse. Also, we discuss a new commentary on activity restriction after gynecologic surgery.
00:00:02 Management of Cord Prolapse in Labor
00:11:01 History and Evolution of Radical Surgery
00:25:03 Recent Trials on Cervical Cancer Surgery
00:48:33 Activity Restrictions in Surgical Practice
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In this episode, we discuss which laparoscopic ports need to be closed and how. Plus, we discuss more evidence that the current narrative about maternal mortality in the US is false. Finally, we answer listener questions about oxytocin protocols and the history and utility of the Bishop's Score.
00:00:02 Closing Laparoscopic Ports
00:13:32 The Maternal Mortality Rate Debate
00:21:04 Maternal Mortality Misconceptions and Progress
00:30:30 Maternal Mortality Misconceptions and Data Accuracy
00:39:27 The Bishop's Score
00:45:41 Debating Oxytocin and Labor Policies
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In this episode, we discuss four tips for breech vaginal delivery. Then, we respond to the Alabama Supreme Court's decisions about embryos and the impact on IVF and reproductive rights. Finally, we discuss the best methods for initial laparoscopic entry and discuss the history of laparoscopy.
00:00:02 Four Tips for Vaginal Breech Deliveries
00:13:17 Alabama Supreme Court and IVF
00:29:15 Initial Laparoscopic Entry
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In this episode, we discuss the use of supplemental oxygen for fetal decelerations. Then we get into part 2 of our discussion of interpreting clinical studies and when to adopt new interventions into practice, including a discussion of intranasal metoclopramide, elagolix, and a new study about an app based doula service. Finally, we answer user questions about surprise billing at the time of annual exams and the pros and cons of egg freezing.
00:00:02 Oxygen Supplementation in Labor
00:11:00 Interpreting studies part 2: intranasal metoclopramide
00:22:07 Evaluating Efficacy of Elagolix for Endometriosis
00:38:23 Doulas and Birth Outcomes
00:44:32 Listener Question: Surprise Billing
00:51:30 Listener Question: Egg Preservation
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In this episode, we discuss four tips for external cephalic version. Then we dive into the basics of interpreting scientific studies. Finally, we discuss the pregnancy history of Jackie Kennedy.
00:00:20 Tips for External Cephalic Version
00:17:10 Evaluating Clinical Studies
00:53:13 Jackie Kennedy's Impact on Cesarean Deliveries
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In this episode, we discuss performing Cesarean for fetal weights at lower thresholds than currently recommended. Then we discuss new literature regarding utility of pelvic exams or screening asymptomatic women and early rupture of membranes after cervical ripening with a Foley bulb. Then we discuss an editorial discussing selecting the best test and hysteroscopy for miscarriage after embryo transfer. Plus, a new RCT that examines stopping oxytocin once a patient is in active labor. Finally, we answer listener questions about harms of yearly pap smears and whether we plan to use Zuranolone for treatment of postpartum depression. Buckle up!
00:01:00 Cesarean for Fetal Weight > 4000 g
00:13:20 Pelvic Exams in Asymptomatic Women
00:30:10 Early Amniotomy After Foley Bulbs
00:33:43 The Best Test: Hysteroscopy for Miscarriage
00:40:59 Stopping Oxytocin in Active Labor
00:45:00 Listener Question: Harms Of Yearly Paps
00:55:26 Listener Question: Zuranolone
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In the first episode of our new season, we introduce a new segment with Four Tips for managing fetal heart tracings. Then we discuss the new mammography guidelines. And finally we discuss a case of a viable pregnancy in a woman who had had a hysterectomy.
00:20:45 Mammography Guidelines
00:30:12 Debating the Effectiveness of Mammography Screening
00:41:01 Breast Cancer Screening and Overdiagnosis
00:55:50 Pregnancy After Hysterectomy
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In this episode, we discuss five more myths about hormone replacement therapy. Also, we discuss the utility of cervical exams at later pregnancy visits and the history of synthetic hormones.
00:00:02 Intro and Routine Cervical Exams
00:07:51 Myth #6: Lowest dose, shortest duration
00:17:27 Myth #7: Women without a uterus need progesterone
00:22:44Myth #8: Transdermal estrogen is safer than oral
00:36:25 Myth #9: All menopausal women should also be on Testosterone replacement
00:39:50 Myth #10: Ineffective alternative treatments
00:53:04 History of hormone products
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In this episode we debunk the first of five myths about menopausal hormone replacement therapy.
00:00:02 Hormone Replacement Therapy For Smokers, HTN
00:11:42 Misinformation from Women's Health Initiative
00:17:18 Myth 1: Estrogen and Breast Cancer
00:28:06 Myth 2: HRT and BRCA Patients
00:33:17 Myth 3: Estrogen and Cardiovascular Disease
00:39:14 Myth 4: Bioidentical Hormones
00:51:00 Myth 5: Checking Hormone Levels
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In this episode, we discuss several new articles related to treatment of vaginal atrophy or genitourinary syndrome of menopause, including literature that clarifies the role of vaginal estrogen cream. Plus, we discuss the role of washings at the time of management of adnexal masses. We also discuss new literature about the true impact of oxytocin on postpartum hemorrhage risk and examine a paper that claim that female gynecologists receive lower patient satisfaction scores than males. Finally, we discuss the true rate of pregnancy loss.
00:00:02 Peritoneal Washings in OBGYN Surgery
00:21:16 Oxytocin and Postpartum Hemorrhage Connection
00:28:23 Comparing Therapies for Menopausal Symptoms
00:42:54 Female Gynecologists and Patient Satisfaction
00:52:11 The True Rate of Pregnancy Loss
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In this episode, we review the literature regarding the use of magnesium sulfate for neuroprotection to prevent CP in preterm infants.
00:00:02 Magnesium Sulfate for Neuroprotection
00:11:00 The Controversy Surrounding Magnesium Sulfate
00:36:37 Research Study Mistakes and Bias
00:46:33 Magnesium Sulfate's Effects on Preterm Birth
00:52:24 Magnesium for Fetal Neuroprotection Reevaluated
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In this episode, we discuss neonatal circumcision and the pros, cons, and ethics. Prepare for controversy. We also discuss the utility of labs for fetal growth restriction.
00:00:02 Circumcision Controversy
00:05:00 Labs for Fetal Growth Restriction
00:15:31 Global Perspectives on Male Circumcision
00:26:17 Significance of Male Circumcision in History
00:33:52 The Arguments for and Against Circumcision
00:53:44 Ethical Considerations of Circumcision
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In this episode, we speculate about the near future of advancement of obstetrics, including new vaccines, new uses for cell-free DNA screening, advancement in diabetes monitoring, the use of artificial intelligence and remote monitoring in obstetrics, and artificial womb technology. Also, do you need to stick the GBS swab in you know where?
00:00:02 GBS Swab Technique
00:10:09 Emerging Innovations in Obstetrics
00:18:35 Advancements in Vaccines and Prenatal Care
00:27:49 Diabetes Management and Assisted Birth Advances
00:39:06 AI, Prenatal Care and Fetal Monitoring Advances
00:53:20 Advancements in Artificial Womb Technology
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In this episode, we discuss the utility of repeat antibody testing at 28 weeks. Plus, new evidence about early screening for GDM, the concept of tension in the pelvic floor, the evidence about vaginal prep at the time of unplanned Cesarean, new literature about interventions for preterm birth, and the safety of Mayo (or raw eggs) during pregnancy.
00:00:02 Repeating Type and Screen for RH-Negative Pregnant Women
00:13:54 Evaluating Early Screening for Gestational Diabetes
00:19:24 Discussing Outcomes of Gestational Diabetes Study
00:27:17 Pelvic Therapy and Vaginal Cleansing
00:37:30 The Controversy Surrounding Preterm Birth Interventions
00:50:58 UK and US Egg Safety Standards
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In this episode we welcome back Stuart Winkler to discuss over-consulting in OB/GYN and how to improve surgical eduction in our training programs and how to balance generalists vs subspecialists. Plus, colace!
00:00:02 Misuse of Docusate Sodium
00:09:24 Appropriate Specialty Referrals in Gynecology
00:20:51 Considerations for EIN Management and Referrals
00:33:57 Endometrial Ablation in Gynecologic Surgery
00:41:53 Practice, Mentorship, Surgical Coaching Importance
00:51:04 Speed and Surgical Competence
00:57:59 Teaching and Expectations in OBGYN
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In this episode we discuss the evolution and evidence behind vaginal delivery techniques. Plus, we discuss the importance of the golden hour after birth for the mother and baby.
00:00:02 Golden Hour Care After Birth
00:09:23 Traditional Practices in Vaginal Deliveries
00:20:54 Optimal Practices for Labor Management
00:26:10 Monitoring and Positions in Labor
00:30:52 Labor Positions and Pushing Techniques
00:36:30 Episiotomy and Preventing Perineal Tears
00:49:54 Third Stage and Cord Clamping Guidelines
In this episode, we discuss guidelines about bulb suctioning at the time of delivery. Then we discuss the nearly 100 year old schedule of prenatal visits and how these can be modernized. Finally, we discuss the next Eat, Sleep, Console approach for neonatal abstinence.
0:02
Neonatal Suctioning
11:33
Reforming Prenatal Visits and Outdated Recommendations
21:41
Streamlining Prenatal Visits and Remote Monitoring
28:47
The Controversy Surrounding Home Dopplers
33:36
Efficiency and Effectiveness of Prenatal Visits
40:48
Prenatal Care and Biomarkers for Preeclampsia
51:27
Comparing Methods of Diagnosing NAS
In this episode, we discuss screening for BV to prevent preterm birth. Then new data about the safety of obstetric care in rural vs urban hospitals of different sizes. Plus, new evidence that prophylactic salpingectomy is working and new data about vaginal cuff dehiscence and the analogy between clinical studies and lab tests.
0:02
Treating Bacterial Vaginosis in Pregnancy
10:12
Morbidity Rates in Rural and Urban Hospitals
20:43
Hospital Size and Patient Care Impact
32:56
Maternity Deserts
37:04
Salpingectomy for Ovarian Cancer Prevention
44:10
Analogy of Clinical Trials
49:53
Vaginal Cuff Dehiscence
In this episode, we discuss current evidence about post-surgical activity restrictions. Plus, we explore probiotics for GBS prevention, vaginal seeding, barbed sutures, disposable staples, and how to be faster during surgery.
In this episode, we discuss current evidence about potential cross-reactivity for patients with penicillin allergy who receive a cephalosporin. Then we discuss the safety of antidepressant medications in pregnancy.
In this episode, we discuss the death of Tori Bowie and new data about maternal mortality and the closing gap of black to white mortality in hospital birth. Plus, we discuss pelvic rest after childbirth.
In this episode, we discuss the practice of IV hydration for preterm contractions. Then we take a look at the ARRIVE trial and some recent studies about this controversial study. Plus, we look at several articles from the Labor and Delivery special edition of the Gray Journal.
In this episode, we discuss data about the methods of breech vaginal delivery, including new studies describing the forces with different maneuvers and the ideal position for maximizing pelvic side. Plus, can pregnant women eat sushi?
In this episode, we discuss ten things we wish ER docs knew. Also, the history of IUDS, new mammogram guidelines, over the counter birth control, and urine screening for pregnant women with sickle cell trait.
In this episode, we discuss several new articles, including evidence about operative delivery in obese women, lactation, cookies, propranolol for labor arrest. We also discuss virgin birth in America, whether to place IUD's early in women who have had chorioamnionitis, and the history of hand-washing.
Featuring guest co-host Jamie Perry, MD.
In this episode, we discuss a variety of commonly ordered prenatal labs that are unnecessary. We also discuss new studies that affect both surgical and medical management of miscarriage. Finally, we debunk a new study that claims that induction of labor leads to lower test performance in children.
In this episode, we discuss routine labs for patients with a history of hypertension. Then, we take a deeper dive into in vitro fertilization (IVF).
In this episode, we discuss the repair of cystotomies along with the scope of general OB/GYN. Plus, COVID and maternal mortality updates. Then some new literature including an update on Clomiphene vs Letrozole and Azithromycin for vaginal birth. Finally, the best female eponym ever and the removal of Makena from the market.
In this episode, we discuss Polycystic Ovary Syndrome and discover a couple of more female eponyms.
In this episode, we discover three more female eponyms, plus we review the utility of premedication for IUD placement. We review new literature about maximum dose of oxytocin in labor, surgery vs pessary for pelvic organ prolapse, buprenorphine vs methadone for management of addiction in pregnancy, new guidelines for male infertility evaluation, fasting for the glucose challenge, increasing VBAC rates, delayed pushing, and a poem!
In this episode, we have our new favorite guest Stuart Winkler, to discuss eponyms and also a touch of oncology, including the appropriate work up of unilocular ovarian cysts.
In this episode, we discuss the use of RhoGAM in the first trimester. Then we discuss the timing of birth and why babies are born more commonly in some months and days than others.
In this episode, we discuss caffeine and other supplements and breast pain, then we continue our discussion of management of obstetric emergencies, focusing on amniotic fluid embolism, shoulder dystocia, cesarean under local, and eclamptic seizure.
In this episode, we discuss the management of nuchal cords at the time of delivery. Then we begin part 1 of our review of obstetric emergencies, focusing on postpartum hemorrhage, uterine inversion, cord prolapse, breech deliveries, and other not so fun stuff.
In this episode, we discuss the newest evidence for two layer closure at the time of Cesarean. Plus, delivery vs birth, a clarification from the prior episode about sexism. Finally, we take a deep dive into the angle of progression and how it can be used to reduces cesareans and promote safety during delivery.
In this episode, we discuss the utility of amnioinfusion for both variable decelerations and meconium stained flood. Plus, how fast do we need to go when doing a Cesarean under general anesthesia. Then we talk about how Braxton-Hicks is still relevant today. Finally, new studies about TikTok and the placebo effect in menopause treatments.
In this episode, we discuss the pros and cons of iron supplementation during pregnancy. We take a big of a dangerous dive into chauvinism and sexism in OB/GYN. Then, we discuss rethinking the postpartum visit(s) to better serve patients.
In this episode, we discuss management of soft markers of aneuploidy on ultrasound. Also, on update on Makena's potential withdrawal by the FDA. And finally, we discuss value based care for vaginal induction and delivery, including methods of inductions, routine labs, methods of hemorrhage control, sterilization, etc.
In this episode, we discuss the value of eating fish during pregnancy and the potential harm of warning women about fish. Plus, we discuss factors driving an increase in maternity deserts in the US and discuss value based care in obstetrics and how that may reverse this dangerous trend. In Part 1 of this discussion, we discuss value decisions at the time of Cesarean, including the Alexis O retractor, the fetal pillow, routine gases and labs, methods for salpingectomy, appropriate lengths of stay, and lots more.
In this episode, we discuss the utility of cord blood gases. Then we discuss the impact of THC exposure during pregnancy. Plus, new studies about cord milking, tighter glycemic control during pregnancy, the effects of maternal infection on the development of autism, appropriate dosing of Lovenox after Cesarean, dermatoses of pregnancy, and the metabolomic profile of hormonal IUDs.
In this episode we discuss the history of Queen Elizabeth's birth and the the birth of her children - which includes home Cesareans and home VBACs. Plus, we discuss checking IUD strings, rising blood pressure rates, and draining the placenta after birth.
In this episode, we catch up on a lot of recent literature including differences in surgical outcomes by gender, preferences for race of obstetrician, a new study about cut-offs for gestational diabetes screening, suture vs staples for Cesarean, and vitamin D screening and treatment. Plus, we discuss the evidence for fetal kick count recommendations. Oh, and Howard apologizes for being offensive!
In this episode, we finish up our dive into fertility issues with a discussion of basic fertility treatments and answer several fundamental questions with current evidence. Also, 36-37 weeks routine ultrasounds: yea or nay?
In this episode, we continue our discussion of fertility with a discussion of the basic fertility evaluation. Plus, should you sound before placing an IUD? Or use a tenaculum?
In this episode we discuss the evidence behind stress dose steroids. Then we discuss scientific ways of optimizing natural fertility (and debunk some myths as well). TLDR: save your money on those Facebook fertility testing gimmicks.
In this episode, we discuss routine use of LDH and uric acid in evaluation of hypertension. Plus, new studies about caffeine use during pregnancy, the efficacy of home visits to pregnant patients, and the declining value of mammography. We also discuss emergency contraception and birth control in a world post Dobbs and how many women died of illegal abortions before Roe. Finally, we discuss forced sterilization of Native American women as depicted in Dark Winds and Adam Kay's book, This Is Going to Hurt.
In this episode, we discuss appropriate use of internal fetal monitors. Then an update on abortion legislation, thoughts about lawsuits, and a discussion of why the US actually has the best maternal and infant care system in the world, not one of the worst. Plus, how abortion restrictions affect our rates of maternal and infant mortality. And a lot about Finland, for some reason.
In this episode, we discuss the Second Victim Syndrome and Just Culture. We also discuss progesterone levels and vaginal progesterone for prevention of preterm labor, a new study about Exparel, the ARRIVE trial and news of a lower primary Cesarean rate, piercings and surgery, and whether we should include the endometrium in the closure of Cesareans.
In this episode, we discuss the science of fundal heights, a captivating new article about the science of continuous electronic fetal monitoring, and other whatnots, including the formula shortage, SIDS breakthrough, the optimal age of prophylactic oophorectomy, overdose deaths in America, and few other things (including calcium!).
In this episode we discuss some hits and misses at the ACOG Annual Clinical Meeting, including the Prevena incision management system, as well as other products and how they are marketed to Ob/Gyns. Plus, we discuss the implications for practice of a total abortion ban.
In this episode, we revisit outcomes in the CHAP Trial and have a general discussion about understanding the difference in the rate of diagnosis and disease. Along the way, we discuss PCOS and inositol, the Bump Studies, HIV tests and several important concepts for clinicians.
In this episode, we discuss the evidence for the best ways to measure amniotic fluid and diagnose oligohydramnios and polyhydramnios. We also discuss a new study about when to stop magnesium after delivery of patients with preeclampsia and then we discuss the CHAP study that has changed our management of chronic hypertensive patients while pregnant.
In this episode, we finish up the Choosing Wisely recommendations relating to OB/GYN. Plus, the new book, Clinical Reasoning is now available! Buy it here: https://square.link/u/V5FKsaD2
In this episode, we review women's health related recommendations from the Choosing Wisely project.
In this episode we discuss a several new articles relating to mode of delivery for preterm twins, outpatient cervical ripening with balloons, PCOS, and pessaries for prevention of preterm birth in women with shortened cervixes. We also discuss the lateral tilt at the time of Cesarean.
In this episode, we discuss reasons for the falling rates of ovarian cancers and the rising rates of endometrial cancers. We also discuss the impact that endometrial ablation may have on worsening endometrial cancer outcomes in light of other alternatives to hysterectomy, such as IUDs. Finally, we discuss some COVID updates including whether or not pregnant women with COVID should receive anticoagulation.
In this episode we discuss the new Jada postpartum hemorrhage device. More importantly, we discuss the process for choosing to utilize new interventions in clinical practice. Then we discuss a recent New York Times article detailing the problem of false positives in the noninvasive prenatal screening tests.
In this episode, special guest Scott Guthrie, MD joins us to discuss optimal cord clamping (or what used to be called delayed cord clamping). We discuss the vital benefits of this practice and efforts in Tennessee to make this available to more than 90% of babies born in the next two years.
In this episode, we tell the story of the first insulin injection 100 years ago yesterday. Then we discuss the history of pap smear guidelines and the reasons for current recommendations. We also discuss the harms associated with doing too many pap smears. Finally, we discuss the reasons why some practice changes are adopted rapidly by OB/Gyns while others languish for decades. Oh, and Betty White of course.
In this episode, we discuss evidence-based Cesarean Delivery technique. Plus, we review the evidence for use of prenatal supplements in multiples and an update on Omicron and new antivirals for COVID.
In this episode, we interview Tracy Gilmour-Nimoy, M.S., LMFT, PMH-C who describes her own pregnancy loss and gives us many insights into dealing with patients who have suffered recurrent pregnancy loss, fetal demises, and infertility.
In this episode, we discuss some Covid updates. Then we talk about marijuana and CBD use in pregnancy as well as the effects of marijuana use on sperm counts. We talk about the debate of whether sperm counts are becoming lower globally over the last 60 years (and whether breasts are becoming bigger). We talk about how to define normal. Finally, we have three updates about gestational diabetes, including when to perform a 75 gram test and and the value of early diabetes screens in at risk women.
In this episode, we discuss the evidence for risks and benefits for progesterone to prevent miscarriage. Then we discuss new evidence about epidural use and long term neonatal and child outcomes, including risks of autism. We also dive into the McClintock Effect and discuss some lunar-Ob myths.
In this episode, we discuss the use of vaginal lasers for vaginal rejuvenation. We discuss the role of metformin in the treatment of PCOS. We discuss new literature about the need for blood transfusion preparedness on L&D. Finally, we discuss the safety of birth at home compared to birth at free standing birth centers.
In this episode, we discuss new evidence about how many obstetric patients benefit from thromboprophylaxis. Then we discuss techniques for Cesareans involving impacted fetal heads. Also, we discuss the guidelines for aspirin to prevent preeclampsia and the link between autism and epidurals.
In this episode, we talk about some updates about Mirena and other IUDs. Then we discuss a new study that looks at the best way to handle pregnancy of unknown location with persistently abnormal HCGs. We discuss new data about the risks of COVID vaccine and miscarriage. Finally, we discuss a variety or claimed and utilized COVID treatments, including Vitamins C and D, Zinc, Azithromycin, Cimetidine, Fenofibrate, Ivermectin, Hydroxychloroquine, Remdesivir, convalescent plasma, monoclonal antibodies, and more.
In this episode, we talk about two new articles relating to burnout and moral injury and discuss strategies to address these growing problems.
In this episode, we discuss a new systematic review of robotic surgery and its implications for gynecologic surgery. Plus some updates about COVID and a discussion of the ethics around treating patients who are not vaccinated. Plus, new studies about monochorionic twins, relationship between Apgars and cord gases, maternal sepsis, and capuslar rupture of early stage ovarian cancers.
We review a new study about calcium channel blockers used for tocolysis for preterm labor, as well as other drugs, including ethanol, beta agonists, magnesium sulfate, COX inhibitors, oxytocin receptor antagonists, and more!
In this episode, we invite a guest to talk about breastfeeding, including basic tips and problems, as well as review the literature about supplements and galactologues.
In this episode, we discuss two recent review articles from JAMA. The first discusses the value of the general health/preventative exam and the second discusses chronic female pelvic pain. We also discuss neuropathy risk for candy cane versus boot stirrups and a trial of steroids added to interstitial cystitis bladder cocktails.
In this episode we discuss the new Netflix film "Fatherhood," starring Kevin Hart, and discuss issues relating to the death of Liz Logelin, including bedrest, fetal growth restriction, oligohydramnios, and prophylaxis of thromboembolism. Hear the real story of Liz Logelin based on Matthew Logelin's book, Two Kisses for Maddie, and his blog from 2008.
In this episode, we discuss a new article with some negative findings relating to administration of antenatal steroids to fetuses who go on to deliver at term. Then we revisit the literature that led to the recommendation for antenatal testing in obese patients. Finally, we discuss manipulation of P-values and the American Statistical Association's statements about the use of P-values and the term "statistical significance."
In this episode, we discuss some new information about obesity in pregnancy, including the accuracy of BMI, antenatal testing recommendations, and more. We also look at a new study evaluating the safety of higher dose oxytocin regimens in induction. Finally, we discuss the new ACOG/SMFM statement on antenatal testing in pregnancy.
In this episode, we discuss two new articles relating to Covid during pregnancy. Then we look at new data regarding the safety of birth at freestanding birth centers. Next we discuss initiatives in California that have led to a reduction in the rate of Cesarean delivery. We also discuss a new study that quantifies the impact that surgeon skill has on patient outcomes and ways to improve surgeon skill. We discuss several unnecessary things done at the time of Gyn surgeries and procedures. Finally, we discuss the role of minimally invasive hysterectomy for cervical cancer.
In this episode, we review a recent systematic review of the impact of ursodiol in patients with cholestasis of pregnancy as well as a recent review of the risks and benefits of intermittent fetal monitoring in labor compared to other continuous methods of fetal monitoring.
Then we take a look at the portrayal of childbirth in movies with a discussion of the new Netflix film, Pieces of a Woman. If you want to skip to the movie reviews, that starts at 13:00.
In this episode we discuss the use of TAP blocks for Cesarean delivery with and without liposomal bupivacaine or Exparel and discuss issues related to intrathecal morphine and postoperative pain management in the context of the opioid epidemic. Plus, we celebrate the centennial of the discovery of insulin with a quick look at the the history of diabetes in pregnancy.
In this episode, we discuss some new literature about the effectiveness of progesterone for preterm labor as well as some new evidence implicating 17-hydroxyprogesterone as a possible endocrine disruptor that might cause increased risk of cancer. We also discuss emergency contraception and new studies in that field. Finally, we discuss the relationship between breastfeeding and IQ.
In this episode, we discuss several micro-skills that add up to a lower Cesarean rate, including delivery of breach second twin, external cephalic version, VBAC, and more. We also discuss some tips for placing cervical Foley catheters for induction of labor.
In this episode we discuss the risk factors and management strategies for shoulder dystocia. We also discuss the botched birth of Kaiser Wilhelm II and the history of the Zavanelli maneuver.
In this episode, we discuss US and international maternal mortality and strategies to reduce the local and global rates of maternal death. We also discuss the rising rates of Cesareans in Canada and 10 clinical diamonds to lower maternal mortality in the United States.
In this episode, we discuss a new article about the possible benefits of nuchal translucency screening in women who have undergone cell-free DNA testing and two new articles about using negative pressure dressing systems. Mainly, we focus on the link between estrogen and breast cancer. Does estrogen cause breast cancer? Can women with breast cancer use vaginal estrogen cream? And more.
In this episode we discuss the efficacy of Makena (17-hydroxyprogesterone caproate) for the prevention of recurrent preterm labor in light of the PROLONG Trial. We also discuss myths about the COVID Vaccine and miscarriage or infertility as well as Daphne Akhurst and the Australian Women's Tennis Tournament.
In this episode, we discuss the latest guidance about screening for fetal abnormalities with cell-free DNA testing, the COVID 19 vaccine for breastfeeding and lactating women, and some true and not so true ways to determine fetal gender.