Afleveringen
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(VACAY EDITION) Recently in our high-risk OB clinic, I saw a patient who was disappointed that she “had to stop breastfeeding” as she entered her 3rd trimester with her 2nd child. Her first pregnancy was via vaginal birth, at term, with no complications. This situation is not frequently addressed and is a clinical dilemma. First, when nursing coincides with pregnancy, there is frequently a significant cultural taboo leading many women to wean their infants when they become pregnant again. Secondly, there is the concern for potential maternal “nutritional depletion” and thirdly, there is a fear of triggering preterm birth due to oxytocin release with breastfeeding. Nonetheless, there are mothers who wish to breastfeed throughout their subsequent pregnancy. This practice is known as breastfeeding during pregnancy (BDP). Is there data that shows that BDP increase miscarriage risk? What about FGR? Does it increase the risk of PTB? In this episode, we will review the latest data on this not too frequent- but real world- occurrence.
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In our podcast archive, we have an episode titled, “TikToc’s #IUD is Killing a Good LARC”. In that episode, I discussed our protocol of using viscous lidocaine applied topically to the cervix, cervical canal, and coating the IUD device for placement. This works! In this episode, we will build on that concept by reviewing a publication released on May 23, 2024 in the AJOG. Could this be the remedy for painful IUD insertion? Plus, have you heard of the CAREVIX device? Listen in for details.
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Zijn er afleveringen die ontbreken?
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It definitely is interesting how published data tends to have sporadic “groupings” in print. For example, last week 2 publications were released which could be placed under one “group”: prediction/prevention of spontaneous preterm birth. One publication (AJOG MFM) presented a systematic review and meta-analysis on universal cervical length screening. The second publication, SMFM’s consult series # 70, pertains to the management of a short cervix in individuals without a history of spontaneous preterm birth. In this episode, we will review these 2 similar, yet different, publications and make sense of all! 👍👍👍
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It’s exciting to know that we are practicing a type of medicine that is alive and ever-evolving! Such is the case regarding our clinical practice/management of gestational diabetes. In this episode, we will review brand new (as of May 21, 2024) clinical guidance from the ACOG regarding gestational diabetes. Should we be screening for diabetes before 24 weeks? Is there one diagnostic threshold which is suggested for use over the other (CC versus NDDG)? And is it possible to screen for postpartum DM as early as 2 days after delivery?😳 Listen in and find out.
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The United States began adding fluoride to community water supplies in 1945. At that time, Grand Rapids, Michigan became the first community in the world to add fluoride to tapwater. Over the last several years, with an increase in reporting and media stories over the last 3 months, fluorinated drinking water has come under scrutiny and controversy. Does fluoride in drinking water affect children in the womb? Is this a cause of altered neurocognitive development? Does this lower IQ scores? This is a very HOT topic and there’s more fuel towards this fire with a publication which was released on May 20, 2024 in JAMA Network Open. In this episode, we will lay out the facts of this study, and why this must be interpreted with more than just face value. So grab your favorite fluorinated water beverage, and listen in!
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Podcast family, this episode is recorded on the last day of the ACOG ACSM. Wanted to share with you some encouragement that I received from our podcast family members over these last 2 to 3 days. AND of course, in typical style, I’ll share with you a brand new publication which was released on May 17, 2024 in the AJOG (GRAY Journal) regarding “optimal dose of antenatal corticosteroids”. And lastly, I’ll share 3 Special Announcements, as an FYI.
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We all can agree that we need a new ally against the foe of pre-term birth. With the disappointing results regarding the (lack of) efficacy of progesterone in reducing preterm birth, the search is out for a new, effective tool to reduce pre-term birth rates. Enter: the Lioness(tm) device. In this episode, we will review a new “safety and efficacy” study published today (May 16, 2024) in the AJOG. Is this ready for prime time? And how does this device work? Listen in for details.
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Unbelievable timing! In our immediate past episode, we discussed the controversy surrounding pharmacoprophylaxis for antepartum inpatients. Just 3 days from that episode, a new RCT has been published in the Green Journal (Obstet Gynecol) discussing this very subject! This new RCT (published May 14, 2024) investigates the “best dose” of unfractionated heparin (UFH) during antepartum admissions? is there an advantage to “gestational – age based” dosing? Or should standard UFH dosing be used?
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All of us can agree that the rates of obesity are progressively climbing, not just in the US, but globally. Obesity is a known independent risk factor in pregnancy for VTE. Several professional societies (ACOG, CMQCC, RCOG, SMFM) have clear recommendations for VTE pharmacoprophylaxis in patients considered at high risk. These include having a high risk thrombophilia, having a personal history of VTE, or having multiple risk factors. But these recommendations address POSTPARTUM prophylaxis. The ACOG does not specifically address inpatient prophylaxis during the antepartum interval. However, in cases of prolonged antepartum admission, where ambulation may be slightly limited, there is concern that the hypercoagulable state of pregnancy, together with obesity, may raise the risk of VTE in these antepartum patients. To be clear, no professional organization or guidelines recommend strict bedrest for pregnancy complications. Is VTE pharmacoprophylaxis endorsed in these admitted antepartum patients? The answer is both YES and NO. The use of heparin based agents in this group is controversial, with published expert opinions having a dichotomy of thought. Plus, recent data (2023) has raised questions regarding pharmacoprophylaxis’ efficacy in the postpartum interval. nonetheless, at the end of the episode, will provide some common sense approaches to VTE prevention in the admitted antepartum, obese patient. (With a special shout-out to our podcast family in Australia.).
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Bacterial vaginosis (BV) is known as a normal vaginal microbiota resulting in low lactobacilli; it affects one-quarter to one-third of reproductive-age women. The BV treatment landscape has not appreciably changed in decades: in the US, metronidazole and clindamycin are recommended as first-line treatments for symptomatic BV, and secnidazole and tinidazole are used as alternatives. Although these treatments are effective in the short term, up to 60% of women experience BV recurrence within 1 year of treatment. Some have more frequent recurrences. Suppressive vaginal metronidazole fails for 25% of patients and leads to secondary vulvovaginal candidiasis (VVC) in up to 40%, and many patients have BV recurrence after stopping suppressive therapy. But now a “new” therapeutic option has been in print and is attracting a lot of attention. DQC has been available in other parts of the world for decades, and recently published results from a new European clinical investigation (May 2024) adds more reassuring date. This has led many in the United States to call for trials in this country to begin FDA approval. Listen in for details.
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Preterm birth is the leading cause of death in newborns and children. Tocolytic drugs aim to delay preterm birth by suppressing uterine contractions to allow time for administration of corticosteroids for fetal lung maturation, magnesium sulphate for neuroprotection, and transport to a facility with appropriate neonatal care facilities. However, there is still uncertainty about their effectiveness and safety. Plus, more than 90% of the data regarding tocolytic use comes from patients with threatened preterm labor with intact membranes, with (according to the WHO) only 9% of available data is regarding patients with ruptured membranes. But in May 2024, a new publication adds further information to this subset of patients. In this episode, we will review this ongoing controversy regarding the benefits of tocolytic therapy, and when they may provide the most efficacy. And yes, of course, we will provide the ACOG guidance as well.
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Haemorrhage, hypertensive disorders, and sepsis are responsible for more than half of maternal deaths worldwide. Further, it is estimated that for every death, there are 50 pregnant people with life-threatening morbidity from sepsis. Heartbreakingly, the incidence of puerperal sepsis has risen over the last decade, in some cases doubling, with increasing rates of severe sepsis contributing to mortality. Underlying this trend is increasing virulence of group A streptococcal (GAS) infection. This is suspected to be due to the predominance of emm1 and emm28 genotypes, which have higher associations with mortality, as well as increasing maternal risk factors for infection such as obesity and DM. PLUS, certain GAS antibiotic resistance is on the rise. Group A streptococcus infection remains an important contributor to pregnancy and puerperal morbidity and mortality. Early recognition, diagnosis and aggressive management are Important for favorable outcomes given the serious risk of sepsis and streptococcal toxic shock syndrome. In this episode, we will highlight this alarming rise of Group A strep in the peripartum period including the most recent 2021 International Society for Infectious Disease in Obstetrics and Gynecology (ISIDOG) guidelines regarding GAS in pregnancy. Listen in for details.
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Menopausal HRT is getting a big, big facelift! Get ready for new research trials, physician education programs, and patient awareness campaigns on menopause! Since the WHI study was released in 2002, the world of menopausal HRT has gone through some major changes. WHI initially led to confusion and fear regarding the use of menopausal HRT. But now, 30 years later, where do we stand? In this episode, we will highlight 2 brand new publications released on May 1, 2024, which prove that we are finally digging out of the hole of WHI. Plus, there’s a Hollywood actress behind the new menopause awareness campaign… and we’ll tell you who that is, and more, in this episode. 😊😊😊
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Just the other day in my University clinic, in one single morning, I had 3 separate patients with three very interesting histories; these became the basis of this episode. It’s amazing what’s out there in daily practice! So, we will dive into these 3 main questions which arose from these 3 patient encounters: 1. What single test is recommended before initiation of combination birth control pills? And if this is recommended, how do online pharmacies prescribe prescription birth control? 2. Does PCOS cause other hormone (Prolactin? HCG?) disturbances? And 3., Is treatment of acne within the wheelhouse of women’s healthcare providers? We’ve got lots to cover in this episode…so let’s get started, NOW.
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Well, once again… Late breaking news! Today, April 30, 2024, the USPSTF released its updated recommendations for breast cancer screening (mammography) in average risk patients. This follows a firestorm of controversy and backlash over the last 1 to 2 years as the USPSTF continued to recommend initiation of mammogram at age 50, despite the increased incidence of breast cancer in women in their 40s. In this episode, we will review this brand new recommendation and summarize the ACOG response from ACOG President, Dr. Hicks.
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Traditionally, clinical guidance has incorporated maternal fever as a required criterion for suspected intraamniotic infection. That is exactly what is stated in the ACOG committee opinion #712 from 2017. However, not all patients with clinical IAI have fever! Having fever as a required part of the diagnostic criterion may result in delayed administration of appropriate antibiotics intrapartum. This has now been addressed by the ACOG! Today, on April 29, 2024, the ACOG released a practice update regarding the criteria for the diagnosis of suspected intra-amniotic infection. This is hot of the press, and we will break it down for us all in this episode. 🔥🔥🔥🎙️🎙️🎙️👍👍🙏
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Regenerative Medicine is definitively a HOT and marketable offering across a variety of medical disciplines. But it is equally as controversial. The most well known type of regenerative medicine is the use of Platelet Rich Plasma (PRP). This has been proposed as a novel care therapy for musculoskeletal pain disorders, and a variety of GYNECOLOGICAL applications- including POI, pelvic floor dysfunction, uterine infertility treatment, and even some forms of vaginal fistulas. AND YES... RPR is even being used as a type of cosmetic fascial (with a new CDC health investigation underway!). In this episode, we will review the concept of Regenerative Medicine in gynecology, summarizing some key points from a brand new narrative review of the subject published in the Green Journal (Obstetrics Gynecology).
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WOW. There has been a lot of new developments in the ObGyn world within the last 48 hours. In this episode, we will highlight 3 big developments/alerts regarding women’s healthcare: 1. the FDA’s approval of a new oral antibiotic for UTIs in females; 2. The updated ACOG practice advisory regarding maternal cell-free fetal RHD testing; and 3. The FDA’s recent (within last 24 hours) clearance of a new digital app for postpartum depression (MAMMALIFT). Special shout out to Dr. Colton for bringing MAMMALIFT to my attention.
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(With Resident Co-Host Dr Taylor Apley) Menstrual synchrony is often reported by all-female living
groups and by mothers, daughters and sisters who are living together. Is this real? Is this a pheromone issue? Is there biological signaling occurring here? The answer may surprise you! How does this work? Or does it work at all? And…what is the “MALE Effect”?? Where did this concept come from? This topic of menstrual synchronization is still getting its share of publications, like from November 2023- which we will review. Yep, we’re going to get into this fun topic in this episode. PLUS…DON’T say the “Q” word when all is still in L&D, or the ER. Or the OR! Saying the word QUIET is a sure-fire way to increase hospital admissions and patient pass through, right?! Can you believe there is an RCT that actually studied this? YEP…we’ll check out this issue as well: Fact or FICTION? Listen in, and find out. -
Our regular podcast family members know that we have been following the antenatal corticosteroid story (especially in the late pre-term/early term interval) for several years now. A variety of countries have now pulled back from recommending corticosteroids in the late pre-term/early term interval due to concerns of adverse child neurodevelopment, especially when the children deliver at term. But today, April 24, 2024, a new publication from JAMA has provided some reassuring information. Is this data truly reassuring? Or is there more to the story? In this episode, we will dive into this brand new publication, released today, which provides follow-up from the original ALPS Study. This issue of steroids in the late pre-term/early term interval is hot hot hot 🔥🔥🔥. Listen in to get the latest information!
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