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. 

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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

INTEGRATED SCREENING FOR DOWN’S SYNDROME BASED ON TESTS PERFORMED DURING THE FIRST AND SECOND TRIMESTERS

First Trimester Biochemical Screening for Trisomy 21: The Role of Free Beta hCG, Alpha Fetoprotein and Pregnancy Associated Plasma Protein A

First trimester biochemical screening for trisomy 21: the role of free beta heG, alpha fetoprotein and pregnancy associated plasma protein A

SOMATIC CHROMOSOMES IN MONGOLISM

Screening for Down's Syndrome

UK multicentre project on assessment of risk of trisomy 21 by maternal age and fetal nuchal-translucency thickness at 10–14 weeks of gestation

Antenatal maternal serumscreening for Down's syndrome: results of a demonstration project

Reducing the need for amniocentesis in women 35 years of age or older with serum markers for screening

Low second trimester maternal serum unconjugated oestriol in pregnancies with Down's syndrome

Low second trimester maternal serum unconjugated oestriol in pregnancies Down's syndrome

Fetal nuchal translucency: ultrasound screening for chromosomal defectsinfirsttrimesterofpregnancy

Maternal serum screening for Down's syndrome in early pregnancy

Combining maternal age and serum alpha-fetoprotein to predict the risk of Down syndrome

Appropriate Biochemical Parameters in First-trimester Screening for Down Syndrome

Screening in early pregnancy for pre-eclampsia using Down syndrome Quadruple test markers

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

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.

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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.

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Other References:

1. Association Between Planned Cesarean Delivery and Neonatal Mortality and Morbidity in Twin Pregnancies
2. How singleton breech babies at term are born in France: a survey of data from the AUDIPOG network
3. Twin Birth Study: 2-year neurodevelopmental follow-up of the randomized trial of planned cesarean or planned vaginal delivery for twin pregnancy

In this episode we finish up PCOS by discussing the management and long-term consequences.

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1. Polycystic ovary syndrome: etiology, pathogenesis and diagnosis
2. Combined oral contraceptives in the treatment of polycystic ovary syndrome
3. Ovarian Suppression in Normal-Weight and Obese Women During Oral Contraceptive Use: A Randomized Controlled Trial
4. Ovulation incidence with oral contraceptives: a literature review
5. Shorter pill-free interval in combined oral contraceptives decreases follicular development
6. Comparison of efficacy of metformin and oral contraceptive combination of ethinyl estradiol and drospirenone in polycystic ovary syndrome
7. Evidence-Based and Potential Benefits of Metformin in the Polycystic Ovary Syndrome: A Comprehensive Review
8. Metformin, oral contraceptives or both to manage oligo-amenorrhea in adolescents with polycystic ovary syndrome? A clinical review
9. Additive Effects of Insulin-Sensitizing and Anti-Androgen Treatment in Young, Nonobese Women with Hyperinsulinism, Hyperandrogenism, Dyslipidemia, and Anovulation
10. Metformin and gonadotropins for ovulation induction in patients with polycystic ovary syndrome: a systematic review with meta-analysis of randomized controlled trials
11. Aromatase inhibitors for subfertile women with polycystic ovary syndrome: summary of a Cochrane review
12. Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society
13. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis
14. Lifestyle Modification Programs in Polycystic Ovary Syndrome: Systematic Review and Meta-Analysis
15. The Impact of Bariatric Surgery on Polycystic Ovary Syndrome: a Systematic Review and Meta-analysis
16. Assessment of Cardiovascular Risk and Prevention of Cardiovascular Disease in Women with the Polycystic Ovary Syndrome: A Consensus Statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society
17. Body Composition Is Improved During 12 Months' Treatment With Metformin Alone or Combined With Oral Contraceptives Compared With Treatment With Oral Contraceptives in Polycystic Ovary Syndrome
18. Influences of weight, body fat patterning and nutrition on the management of PCOS

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.

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1. Prenatal Exposure to Acetaminophen and Risk of ADHD
2. PregSource
3. 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. 

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• 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 
• Study were microsimulation was used to make a ratio of benefits vs harms of repeat steroids according to gestational age at birth 
• Uptodate.com article on antenatal steroids 
• study showing increased rds 1 to 24 hrs after booster dose
• Review from Nature in 2001 mentioning several animall studies that show negative effects of excess corticosteroids in utero
• Animal study from Kidney Int from 2000 showing increased risk of glucose intolerance with exogenous corticosteroid exposure in utero 
• Study in baboons from Nature in 2012 showing impaired myelination after exposure to repeat antenatal steroids 
• 3 studies that have shown impaired stress response inneonates exposed to antenatal steroids
• • https://www.ncbi.nlm.nih.gov/pubmed/?term=Antenatal+betamethasone+administration+alters+stress+physiology+in+healthy+neonates
  • https://www.ncbi.nlm.nih.gov/pubmed/?term=Effects+of+prenatal+betamethasone+exposure+on+regulation+of+stress+physiology+in+healthy+premature+infants
  • https://www.ncbi.nlm.nih.gov/pubmed/?term=Neonatal+adrenal+function+after+repeat+dose+prenatal+corticosteroids%3A+a+randomized+controlled+trial
  • https://www.ncbi.nlm.nih.gov/pubmed/?term=Multiple+courses+of+antenatal+corticosteroids+and+outcome+of+premature+neonates.+North+American+Thyrotropin-Releasing+Hormone+Study+Group
• Study showing impaired HPA function in children 6-11 years of age exposed to antenatal steroids 
• Study showing signs of glucose intolerance in participant who received antenatal steroids compared to placebo
• Study showing increased aortic stiffness in those exposed to antenatal steroids
• crowther et al mid childhood neurocgognitive development 
• meta analysis from 2016 in BMJ examining benefits and harms of antenatal steroids between 34 and 36 weeks gestation