Dr. Heather Link joins me to discuss maternal mortality in Lousiana. Racial Inequities in Preventable Pregnancy-Related Deaths in Louisiana, 2011–2016 louisiana maternal mortality review report 2011-2016  

Drs. Jillian Kurtz and Caiyun Liao join me to discuss "Association Between Fertility Treatment and Cancer RIsk in Children" published 12/19 in JAMA  

Dr. Mariel Gross joins me to discuss the ethics of breastfeeding with HIV.   Breastfeeding with HIV: An Evidence-Based Case for New Policy   Contact Dr. Gross

Greg Kirschen takes us through the treatment of postpartum depression and psychosis. [email protected] American Psychiatric Association. (2013). In Diagnostic and statistical manual of mental disorders (5th ed.). doi:10.1176/appi.books.9780890425596.744053 Tate G. 1830. “A Treatise on Hysteria.” London: S. Highley, 174 Fleet St & Webb St, Maze Pond, Borough. Smith TN. 1830. “Observations on hysteria.” The Boston Medical and Surgical Journal. 3(34): 540. Louden, I. 1988. Puerperal insanity in the 19thCentury. Journal of the Royal Society of Medicine. 81, p 76-79. Griffen W, Griffen D. 1829. Observations on Functional Disorders of the Spinal Cord, and Their Connexion with Hysterical, Nervous, and Other Diseases. Illustrated by Cases, Selected Chiefly from the Reports of the Pallas, Kenry, and Currah Dispensaries. London Medical and Physical Journal. 7(42) 477-489. Reid, J. 1848. Dr. Reid on Puerperal Insanity. Journal of

Medical Student Gregory Kirschen takes us through the history of postpartum depression from hippocrates to present day.   References American Psychiatric Association. (2013). Cautionary statement for forensic use of DSM-5. In Diagnostic and statistical manual of mental disorders (5th ed.). doi:10.1176/appi.books.9780890425596.744053 King, H. 1998. Hippocrates’ Woman: Reading the Female Body in Ancient Greece. London: Routledge, 1st ed. https://doi.org/10.4324/9780203025994   Adams, H. (1984). Comprehensive Handbook of Psychopathology. New York: Springer Science + Bus

http://www.marchformoms.org

Dr. Bergoy walks us through the risks and benefits of elective cesarean delivery. www.obgyn.fm [email protected] neonatal and maternal mortality https://www.acog.org/Clinical-Guidance-and-Publications/Obstetric-Care-Consensus-Series/Safe-Prevention-of-the-Primary-Cesarean-Delivery https://www.ncbi.nlm.nih.gov/pubmed/?term=24631705%5Buid%5D <a href= "https://www.up

Dr. David Gagnon leads us through the origins of the National Perinatal Association.

Dr. Gina Milone takes us through the pros and cons of post-delivery IUD placement. [email protected]   Blumenthal, P. D., et al. (2018). "Comparative safety and efficacy of a dedicated postpartum IUD inserter versus forceps for immediate postpartum IUD insertion: a randomized trial." Contraception98(3): 215-219.  Center for Disease Control, U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC), 2016. Eser, A., et al. (2018). "Clinical experience with a novel anchored, frameless copper-releasing contraceptive device for intra-caesarean insertion." Eur J Contracept Reprod Health Care23(4): 255-259. Immediate postpartum long-acting reversible contraception. Committee Opinion No. 670. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;128:e32-7. Jatlaoui, T. C., et al. (2018). "Intrauterine Device Expulsion After Postp

We follow-up last months dicsussion of termination by discussing the challenging stories of women who chose to terminate after 24 weeks and then have a great discsussion about embryo adoption.

Dr. Lian joins me to discuss "Opioid use after laparoscopic hysterectomy: prescriptions, patient use, and a predictive calculator" from AJOG. [email protected]

Please join Drs. Jillian Kurtz and Heather Link to discuss extended cycle contraception, changes to abortion laws, and the role of OB hospitalists. [email protected] How Abortion Law in New York Will Change, and How It Won’t FSRH Clinical Guidance: Combined Hormonal Contraception - January 2019 Obstetric hospitalists can screen for postpartum depression  

Dr. Oystein Bergoy joins me to discuss the LaPS Study looking at the effect of Zhang's partograph on cesarean deliveries for labor dystocia. www.obgyn.fm [email protected] The frequency of intrapartum caesarean section use with the WHO partograph versus Zhang’s guideline in the Labour Progression Study (LaPS): a multicentre, cluster-randomised controlled trial Friedman E. The graphic analysis of labor. Am J Obstet Gynecol 1954;68: 1568–75.  </d

Join us for this special 50th episode where we get together to discuss why we do what we do.   [email protected]

Dr. Heather Link starts a new series on Maternal Mortality by discussing what that even means and how we get those numbers.   [email protected]   Maternal mortality is a key indicator of a health system’s strength. Safe Motherhood Week. https://www.safemotherhoodweek.org/maternal-mortality-key-indicator-health-systems-strength/.Published October 30, 2017. Accessed July 19, 2018. Organization WH, Others. WHO guidance for measuring maternal mortality from a census. 2013. http://apps.who.int/iris/handle/10665/87982. <a href="http:/

Drs. Lian and Blaber join me to discuss "Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer" from NEJM. https://www.nejm.org/doi/full/10.1056/NEJMoa1806395 https://journals.lww.com/greenjournal/Fulltext/2018/10000/Noninferiority_Complex.5.aspx   [email protected]

Drs. Sara Kim and Vai Umesh join me to discuss sexism in medicine. https://creogsovercoffee.com [email protected] Ending Sexual Harassment in Academic Medicine

I speak with Dr. Cathy Cluver about her article in the October issue of American Journal of Obstetrics and Gynecology. https://www.ajog.org/article/S0002-9378(18)30606-9/fulltext [email protected] www.obgyn.fm

Dr. Sara Kim discusses the etiology, diagnosis, and management of intrahepatic cholestasis of pregnancy. Website Slack Patreon [email protected] Fast, B., & Roulston, T. (1963). Idiopathic jaundice of pregnancy. Am J Obstetrics and Gynecology, 314-320. Geenes, V., & Williamson, C. (2009). Intrahepatic cholestasis of pregnancy. World Journal of Gastroenterology, 2049-2066. Gynecologists, R. C. (2011). Obstetric Cholestasis. Jurate, K., Rimantas, Z., Jolanta, S., Vladas, G., & Limas, K. (2017). Sensitivity and specificity of bi

Join us as we discuss "Effect of Immediate vs Delayed Pushing on Rates of Spontaneous Vaginal Delivery Among Nulliparous Women Receiving Neuraxial Analgesia A Randomized Clinical Trial" from JAMA October 2018. Effect of Immediate vs Delayed Pushing on Rates of Spontaneous Vaginal Delivery Among Nulliparous Women Receiving Neuraxial AnalgesiaA Randomized Clinical Trial   Patreon link to support podcast   National Perinatal Association Meeting  

Join us as we discuss the future of residency training in the United States.   The First National Summit on Women’s Health   [email protected]

In this episode we speak with Dr. Hourigan about her randomized controlled trial on the effect of vaginal seeding on the neonatal microbiome and long-term health outcomes.   Dr. Suchitra Houriman - Bio RCT on Vaginal Seeding Contact Dr. Houriman    

Dr. Jillian Kurtz discusses the ins and outs of ovulation induction.   [email protected]

Join me as we finish our discussion on anueplody screening. In this episode we discuss the risks of amniocentisis and chorionic villus sampling, cell-free DNA, and different screening strategies. Comparing Different Strategies The assessment of combined first trimester screening in women of advanced maternal age in an Asian cohort   Amnio/CVS <div class="l

Join us for a discussion on sexism in medicine, STD screening for women diagnosed with PID, and the removal of the Essure device from the market.   [email protected]   Sexism in Obstetrics & Gynecology: Not just a “women’s issue” HIV and Syphilis Screening Among Adolescents Diagnosed With Pelvic Inflammatory Disease <a style="color: #000000;" href= "https://www.nytimes.com/2018/07/20/health/bayer-essu

In this episode we talk with Dr. J. Gerald Quirk about his efforts to start a state wide AFP screening program in Arkansas in the 1980s.   obgyn.fm   Slack

Dr. Ballas and Dr. Lian join us to discuss three great topics. 1. Social structure of the operating room 2. Ethical issues in laparoscopic surgery 3. US administration position on breast feeding   Slack invite link

I am joined by minimally invasive gynecologic surgeons Dr. Blaber and Dr. Lian to discuss a paper from the May issue of AJOG. Laparoscopic vs transvaginal cuff closure after total laparoscopic hysterectomy: a randomized trial by the Italian Society of Gynecologic Endoscopy Uccella S, Malzoni M, Cromi A, et al. Laparoscopic vs transvaginal cuff closure after total laparoscopic hysterectomy: a randomized trial by the Italian Society of Gynecologic Endoscopy. Am J Obstet Gynecol 2018;218:500.e1-13.

In this episode Dr. Sara Kim and Dr. Jillian Kurtz join me to discuss some basic research papers about pregnancy dating and PCOS.   Noninvasive blood tests for fetal development predict gestational age and preterm delivery Elevated prenatal anti-Müllerian hormone reprograms the fetus and induces polycystic ovary syndrome in adulthood

In this episode we trace the history of aneuploidy screening from the early days of amniocentesis to the modern day serum screening.    [email protected] 1987 Cuckle Paper: Estimating a woman’s risk of having a pregnancy associated with Down’s syndrome using her age and serum alpha-fetoprotein level Other references in no particular order: First-Trimester or Second-Trimester Screening, or Both, for Down’s Syndrome <div class="layoutArea

In this episode Dr. Ballas and I discuss the declining US birth rate and paretnal leave for ob/gyn residents.     Births: Provisional Data for 2017 Pregnancy and parental leave among obstetrics and gynecology residents: results of a nationwide survey of program directors

In this episode Dr. Jillian Kurtz walks us through the methods and rationale behind fertility preservation for patients with cancer or undergoing transgender procedures.

  In this episode I am joined by Dr. Ballas and Dr. Kim to dicsuss the paper "Pregnancy Exercise and Nutrition With Smartphone Application Support" from the May edition of Obstetrics & Gynecology.   [email protected]

In this episdoe we discuss the new postpartum guidelines from ACOG, newborn microbiome seeding, and the gentle cesarean.   ACOG Committee Opinion: Optimizing Postpartum Care ACOG Committee Opinion: Vaginal Seeding OBG Management: Gentle Cesarean   Podcast: Conversations in Obstetrics and Gynecology 

In this episode we discuss the mode of delivery in twin gestation Paper: Schmitz T, Korb D, Battie C, et al. Neonatal morbidity associated with vaginal delivery of noncephalic second twins. Am J Obstet Gynecol 2018;218:449.e1-13. [email protected] Other References: <a style= "color: #000000;" href= "https://journals.lww.com/greenjournal/Abstract/2017/06000/Association_Between_Planned_Cesarean_Del

In this episode we finish up PCOS by discussing the management and long-term consequences.   [email protected]   Polycystic ovary syndrome: etiology, pathogenesis and diagnosis Combined oral contraceptives in the treatment of polycystic ovary syndrome Ovarian Suppression in Normal-Weight and Obese Women During Oral Contraceptive Use: A Randomized Controlled Trial <a style= "co

In this Months Checkup Drs. Ballas and Kim join me to discuss the link (or non-link) between acetaminophen use during pregnancy and ADHD, the new NIH funded PregSource initiative, and how we architecture affects how we provide care. [email protected]   Prenatal Exposure to Acetaminophen and Risk of ADHD PregSource The case against hospital beds    

In this episode Dr. Øystein Bergøy discusses the evidence behind the risks of antenatal corticosteroids for women at risk for preterm delivery.    [email protected]   ACOG guidelines on fetal maturation  NICE guidelines on risk of premature labour  Norwegian guidelines on risk of premature labour  2015 cochrane analysis of repeat steroids  <a href= "https://www.ncbi

In this episode Dr. Øystein Bergøy discusses the evidence behind antenatal corticosteroids for women at risk for preterm delivery.  [email protected] Uptodate articles on RDS 1 <a style="color: #000000;" href= "https://www.uptodate.com/contents/pathophysiology-clinical-manifestations-and-diagnosis-of-respiratory-distress-syndrome-in-the-newborn?source=search_result

In this episode Dr. Kim joins me to discuss an article about postplacental IUD placement from the American Journal of Obstetrics and Gynecology.   Postplacental intrauterine device expulsion by 12 weeks: a prospective cohort study  

Please consider giving to www.breac225.org to help support the victims of Hurricane Harvey. In this episode we discuss the link between baby powder and ovarian cancer, the effect of breastfeeding on endometriosis, and the long term emotional effect of mode of delivery. Does Baby Powder Cause Cancer? A Jury Says Yes. Scientists Aren't So Sure History of breast feeding and risk of incident endometriosis: prospective cohort st

In this episode we trace the history of polycystic ovarian syndrome, learn about the underlying physiology, and how to diagnosis it. [email protected]   Current Practices of Measuring and Reference Range Reporting of Free and Total Testosterone in the United States. Diagnostic Criteria for Polycystic Ovary Syndrome: Pitfalls and Controversies Clinical Findings and Hormonal Responses in Patients With Polycystic Ovarian Disease With

In this episode we discuss "Patterns of Opioid Prescription and Use After Cesarean Delivery" published in Obstetrics & Gynecology in July 2017 by Brian Bateman et al. If you want to get in contact with Dr. Ballas then please send email to [email protected]  

In this episode Dr. Kim and I discuss three current topics from the medical world.   1. CDC MMR - Placenta Encapsulation https://www.ncbi.nlm.nih.gov/pubmed/27440542 https://www.ncbi.nlm.nih.gov/pubmed/27809380 2. Effect of Cervical Screening Changes on STD testing https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4279217/ 3. Menstruation & Oral Contraceptives

In this episode we conclude our discussion on intrapartum fetal monitoring by discussing fetal pulse oximetry and ST waveform analysis.    July Journal Club Article:  Patterns of Opioid Prescription and Use After Cesarean Delivery   [email protected]   ST Waveform Analysis Fetal electrocardiogram: ST waveform analysis in intrapartum surveillance ST waveform analysis versus cardiotocograph

In this episode we discuss the use of fetal scalp pH and scalp stimulation in the triage of abnormal electronic fetal heart rate tracings.    [email protected] Scalp pH http://www.sciencedirect.com/science/article/pii/0002937885903308 http://www.tandfonline.com/doi/abs/10.1080/14767050500526172 http://www.sciencedirect.com/science/article/pii/S0002937899700839 http://www.bmj.com/content/336/7656/1284 http://journals.lww.com/greenjournal/abstract/1975/10000/correlation_of_fetal_heart_rate_uterine.4.aspx <a href= "http://www.sciencedirect.com/science

In this episode Dr. Ballas and I review and discuss an article from the American Journal of Obstetrics & Gynecology from April 2017 entitled "Planned home births: the need for additional contraindications".   Link: http://www.ajog.org/article/S0002-9378(17)30119-9/abstract   [email protected]

In this episode we discuss the evolution of intrapartum fetal monitoring from the Pinard Horn to modern doppler techniques. We also discuss the benefits and harms of these approaches and their role in modern obstetrics.    [email protected]     A controlled trial of the differential effects of intrapartum fetal monitoring - ScienceDirect Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: A meta-analysis - ScienceDirect Intrapartum Fetal Monitoring — A Disappointing Story — NEJM A prospective comparison of selective and universal electronic fetal monitoring in

This is the first in our monthly Journal Club Series with Dr. Jerry Ballas. In this episode we will be discussing a paper from the April 2017 issue of the Green Journal entitled "Sildenafil Citrate Therapy for Oligohydramnios".   <a href= "http://ovidsp.uk.ovid.com/sp-3.25.0a/ovidweb.cgi?QS2=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" data-cke-saved-href= "http://ovidsp.uk.ovid.com/sp-3.25.0a/ovidweb.cgi?QS2=434f4e1a73d37e8c6d5cc3ea7a7100e0057d9b0f7807d5725aeb6e60bb44261

In this closing chapter on Puerperal Fever we will examine GBS related neonatal sepsis and the science behind its prevention.   [email protected]   Diagnosis and Management of Group B Streptococcus in Pregnancy Use of Cefazolin for Group B Streptococci Prophylaxis in Women Reporting a Penicillin Allergy Without Anaphylaxis   <a style= "color: #000000;" href= "https://static-content.springer.com/esm/art%3A10

Dr. Kim walks us through the history of cord clamping and examines the evidence behind delayed vs. immediate clamping.    [email protected]   ACOG, Committee Opinion. Delayed Umbilical Cord Clamping After Birth. (American College of Obstetricians and Gynecologists, 2017). Downey, C., and Bewley, S. Third Stage Practices and the Neonate. Fetal and MAternal Medicine Review 20, 229-246 (2009). Downey, C., Bewley, S. HIstorical Perspectives on umbilical cord clamping and neonatal transition. Journal of the Royal Society of Medicine 105, 325-329 (2012). Drife, J. The start of life: a history of obstetrics. Postgrad Medicine 78, 311-315 (2002). Loudon, I. General practitioners and obstetrics: a brief history. JR Soc Med 101 (2008). McDonald, S., Middletone, P, Dowswell,

In this episode we explore the differential diagnosis of postpartum fever.   Show notes and message board can be found at www.obgyn.fm   Please email me at [email protected] if you would like to join the slack community.   Puerperal Pyrexia: A Review Part 1 and Part 2 Prevalence of postpartum infections: a population-based o

Puerperal Fever is one of the leading causes of maternal and neonatal mortality throughout the world. In this episode we trace the role of modern medicine in both the rise and fall of the severity of childbed fever. We also review the causes, diagnosis, treatment, and prevention of chorioamnionitis.    [email protected]  

In this episode Dr. Sara Kim discusses the history, diagnosis, consequences, and treatment of bacterial vaginosis.    [email protected]   ACOG. Vaginisits Practice Bulletin. (2015). Chawla, R. B., Preena; Chadha, Sanjim; Grover, Sujatha; Garg, Suneela. Comparison of Hay's Criteria with Nugent's Scoring System for Diagnosis of Bacterial Vaginosis. Biomed Research International 2013 (2013). Eschenbach, D. A. History and review of bacterial vaginosis. American Journal of Obstetrics and Gynecology 169, 441-445 (1993). Fettweis, J. B., J Paul; Serrano, Myrna; Sheth, Nihar; Girerd, Philippe; Edwards, David; Strauss, Jerome; Jefferson, Kimberly; Buck, Gregory, Vaginal Microbiome Consortium. Differences in vaginal microbiome in African American women versus women of European ancestry. Microbiology 160, 2272-2282 (20

A bonus episode describing the life and contributions of Russel Earl Marker. He led a fascinating life and his work made possible the great advances in the understanding of female fertility that took place in the 1950s. Without his work the history of hormonal contraception would likely look completely different and in this episode we pay tribute to his brilliance and dedication.

In this episode we discuss the history, methods, effectiveness, and pitfalls of permanent sterilization.    [email protected]   Tubal Techniques D. Bartz & J. Greenberg. Sterilization in the United States. Rev Obstet Gyn. 2008; 1(1): 23-32. CREST Study CREST Study: Regret CREST Study: Ectopic Fit to Be Tied: Sterilization and Repr

In this episode we discuss the ancient and modern history of barrier contraceptives and their effect on society. We also review the development of the IUD and its place in the modern contraceptive landscape.   The story of the condom. F. Kahn et al. Indian Journal of Urology. 29(1):12-15. 2013 History of Intrauterine Devices. L. Margulies. Bulletin of the NY Academy of Medicine. 51(5). 1975 Trends in Long-acting Reversible Contraception Use Among U.S. Women Aged 15-44. NCHS 188. 2015 <a style="co

In this episode we discuss the menstrual cycle and how a few people figured out how to hack it to provide safe, effective contraception.    Menstrual Cycle Graphic #1 Menstrual Cycle Graphic #2 Effectiveness of Birth Control Methods History of the Oral Contraceptive #1 <a style="color: #000000;" href= "h

Contraception is major element in the life of women throughout the world. In this episode we chart its history from ancient Egypt to modern times and discuss its implications at the personal and societal levels. 

Pelvic inflammatory disease to PID has been a factor in the lives of women in the western world for at least 500 year. It effects up to 5% of US women at sometime during their life and its effects can be long-lasting and devastating. In this episode, part 3 of 3, we discuss the treatment and prevention of PID along with a detour into antibiotics.   [email protected] Goupil Bernutz. Clinical Memoirs on the Diseases of Women. 1866 Lachlan Aitken. Remarks on Pelvic Peritonitis and Pelvic Cellulitis. Baltimore Medical Journal. 1870. Volum

Pelvic inflammatory disease to PID has been a factor in the lives of women in the western world for at least 500 year. It effects up to 5% of US women at sometime during their life and its effects can be long-lasting and devastating. In the episode, part 2 of 3, we discuss the diagnosis of PID.   [email protected]   Diagnosis Howard Kelly. The Diagnosis of Pelvic Inflammatory Diseases. 1894. Westrom L. Objectivized diagnosis of acute pelvic inflammatory disease. AJOG 1969<

Pelvic inflammatory disease to PID has been a factor in the lives of women in the western world for at least 500 year. It effects up to 5% of US women at sometime during their life and its effects can be long-lasting and devastating. In the episode, part 1 of 2, we delve into the history, prevalence, causes, and consequences of PID.   [email protected]   History John Hirth. Syphilis – Its early history and Treatment until Penicillin and the Debate on its Origins. Journal of Military and Veterans' Health. 20(4). 2012 <a style="color: #000000;" href= "https://ia902609.us.archive.org/30/items/clinicalmemoirso02bernuoft/clinicalmemoir

Opioid addiction has a profound impact on many aspects of society. In this episode we examine the ways that doctors and other practitioners contribute to the epidemic and how we can be part of the solution. [email protected]   Links Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 Abuse-Deterrent Formulations an

Opioid Addiction has a profound impact on many aspects of society, including pregnancy. In this episode we delve into the history, pharmacology, effects, and treatment of opioid abuse with special consideration to its effects on pregnancy. [email protected]   Links NIH - America’s Addiction to Opioids: Heroin and Prescription Drug Abuse NIH - The Science of Drug Abuse and Addiction: