Shows
Thinking About Ob/GynEpisode 9.10 Pit Breaks, Cannabis, and IUDs for Endometrial ProtectionHoward 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...2025-05-151h 06Thinking About Ob/GynEpisode 9.9 Pediatric & Adolescent Gynecology EssentialsJoin 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 oc...2025-05-0157 minThinking About Ob/GynEpisode 9.8 Rethinking Bacterial Vaginosis and More!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 coumadin00:00:34 Treating Mild Hypertension in Pregnancy00:06:14 Distinguishing Chronic vs. Gestational Hypertension00:15:46 Male Partner Treatment for Recurring BV00:27:0...2025-04-171h 05Thinking About Ob/GynEpisode 9.7 OB Triage Essentials (plus The Pitt)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•...2025-04-031h 01Thinking About Ob/GynEpisode 9.6 New Birth Control Products and Other UpdatesAntonia 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 needsThen they discuss new birth control options while questioning...2025-03-191h 05Thinking About Ob/GynEpisode 9.5 Operative Vaginal DeliveriesWe 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...2025-03-0500 minThinking About Ob/GynEpisode 9.3 Obstetric Life Support with Jacqueline VidoshJoin 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 •...2025-02-0652 minThinking About Ob/GynEpisode 9.2 Circumvallate Placenta, Pregnancy Apps, Oral Meds for GDM, and HPVIn 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 Placenta00:13...2025-01-231h 00Thinking About Ob/GynEpisode 8.1 Overuse of HCGs, Famous Studies in OB, and the History of Mag SulfateIn 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 HCG00:13:17 Aspirin for Preeclampsia Prevention Debate00:18:51 Debate on the ARRIVE Trial00:29:10 MagPIE00:39:05 Fetal Fibronectin Trials00:44:53 Induction at 41 Weeks Discussion00:55:16 History of Magnesium Use in ObstetricsFollow us on Instagram @thinkingaboutobgyn.2024-07-111h 03Thinking About Ob/GynEpisode 7.13 Uterine inversion, Trainee Harassment and Mistreatment, and SuicideIn 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 Obstetrics00:13:39 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 QuestionFollow us on Instagram @thinkingaboutobgyn.2024-06-261h 06Thinking About Ob/GynEpisode 7.12 BV Screening, WHI, First Trimester Anatomy Ultrasound, and Postpartum SterilizationIn 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 Labor00:12:28 Clinical Diagnosis of Bacterial Vaginosis00:21:14 First Trimester Ultrasound in Women's Health00:34:12 First Trimester Ultrasound Anomalies and Costs00:38:29 The Cost-Effectiveness of Early Ultrasounds00:46:32 Improving Postpartum Sterilization Access2024-06-131h 01Thinking About Ob/GynEpisode 7.11 IUD insertion, teaching residents and students, and the history of blood transfusionIn 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 Management00:23:04 Qualities of a Great Teacher00:35:16 The Benefits of Teaching in Medicine00:45:42 Teaching Strategies for Clinical Preceptors00:52:33 History of Blood Transfusion & ObstetricsFollow us on Instagram @thinkingaboutobgyn.2024-05-2957 minThinking About Ob/GynEpisode 7.10 Risks of multiple Cesareans, tips for vaginal hysterectomy, and listener questionsIn 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 Deliveries00:08:13 Risks and Outcomes of Cesarean Hysterectomies00:16:09 Uterine Dehiscence and Vaginal Hysterectomy00:24:01 Tips for Vaginal Hysterectomy Assistants00:35:24 Mastering the Anterior Colpotomy Technique00:44:01 Vaginal Hysterectomy Tips and Techniques00:55:36 Teaching Vaginal Hysterectomy Techniques00:57:55 Listener Question about ECVFollow us on Instagram @thinkingaboutobgyn.2024-05-151h 11Thinking About Ob/GynEpisode 7.9 Deeply Impacted Fetal Head, Route of Hysterectomy, and the Taj MahalIn 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 Cesarean00:13:53 Advantages of Vaginal Hysterectomy00:25:16 Optimizing Vaginal Hysterectomy Techniques00:31:53 Advancing Skills in Minimally Invasive Surgery00:40:24 Advancements in Vaginal Hysterectomy Technique00:49:20 Debating the Merits of v-Notes00:58:06 Taj Mahal and Maternal MortalityFollow us on Instagram @t...2024-05-011h 02Thinking About Ob/GynEpisode 7.8 Osteopenia treatments, antenatal steroids, IOL methods, VBAC risk factors, and surgical hemostasisIn 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 s...2024-04-171h 01Thinking About Ob/GynEpisode 7.7 Cord Prolapse, Radical Hysterectomy for Cervical CancerIn 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 Labor00:11:01 History and Evolution of Radical Surgery00:25:03 Recent Trials on Cervical Cancer Surgery00:48:33 Activity Restrictions in Surgical PracticeFollow us on Instagram @thinkingaboutobgyn.2024-04-031h 03Thinking About Ob/GynEpisode 7.6 Maternal Mortality Declining? Plus skin closures and listener questionsIn 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 Progress00:30:30 Maternal Mortality Misconceptions and Data Accuracy00:39:27 The Bishop's Score 00:45:41 Debating Oxytocin and Labor PoliciesFollow us on Instagram @thinkingaboutobgyn.2024-03-2059 minThinking About Ob/GynEpisode 7.5 Breech Delivery Tips, Laparoscopy Entry, and IVF LegalityIn 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 Deliveries00:13:17 Alabama Supreme Court and IVF00:29:15 Initial Laparoscopic EntryFollow us on Instagram @thinkingaboutobgyn.2024-03-071h 08Thinking About Ob/GynEpisode 7.4 Oxygen for Decels, Interpreting Studies Part 2, Frozen EggsIn 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 Labor00:11:00 Interpreting studies part 2: intranasal metoclopramide00:22:07 Evaluating Efficacy of Elagolix for Endometriosis00:38:23 Doulas and Birth Outcomes2024-02-211h 03Thinking About Ob/GynEpisode 7.3 Cephalic Version, Interpreting Studies Part 1, and Jackie KennedyIn 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 Version00:17:10 Evaluating Clinical Studies00:53:13 Jackie Kennedy's Impact on Cesarean DeliveriesFollow us on Instagram @thinkingaboutobgyn.2024-02-071h 01Thinking About Ob/GynEpisode 7.2 Cesareans for Macrosomia, Yearly Pelvic Exams, Zuranolone, and more!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!2024-01-251h 04Thinking About Ob/GynEpisode 7.1 New Mammography Guidelines, Four Tips for Fetal Tracings, and Pregnancy after HysterectomyIn 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 Guidelines00:30:12 Debating the Effectiveness of Mammography Screening00:41:01 Breast Cancer Screening and Overdiagnosis00:55:50 Pregnancy After HysterectomyFollow us on Instagram @thinkingaboutobgyn.2024-01-101h 05Thinking About Ob/GynEpisode 6.13 Hormone Replacement Myths Part 2In 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 Exams00:07:51 Myth #6: Lowest dose, shortest duration00:17:27 Myth #7: Women without a uterus need progesterone 00:22:44Myth #8: Transdermal estrogen is safer than oral00:36:25 Myth #9: All menopausal women should also be on Testosterone replacement00:39:50 Myth #10: Ineffective alternative treatments00:53:04 History of hormone productsFollow us on Instagram @thinkingaboutobgyn.2023-12-271h 06Thinking About Ob/GynEpisode 6.12 Hormone Replacement Therapy Myths Part 1In this episode we debunk the first of five myths about menopausal hormone replacement therapy. 00:00:02 Hormone Replacement Therapy For Smokers, HTN00:11:42 Misinformation from Women's Health Initiative00:17:18 Myth 1: Estrogen and Breast Cancer00:28:06 Myth 2: HRT and BRCA Patients00:33:17 Myth 3: Estrogen and Cardiovascular Disease00:39:14 Myth 4: Bioidentical Hormones00:51:00 Myth 5: Checking Hormone LevelsFollow us on Instagram @thinkingaboutobgyn.2023-12-131h 05Thinking About Ob/GynEpisode 6.11 Vaginal Estrogen and More!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 Surgery00:21:16 Oxytocin and Postpartum Hemorrhage Connection00:28:23 Comparing T...2023-11-2959 min