The Ob/Gyn Podcast

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

In this episode Dr. Øystein Bergøy discusses the evidence behind antenatal corticosteroids for women at risk for preterm delivery.

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Uptodate articles on RDS

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• 2
• 3

Liggins 1972 paper

2013 cochrane analysis on type of steroid and regimens

2017 cochrane analysis of antenatal corticosteroids for accelerating fetal lung maturation

2015 cochrane analysis of repeat antenatal corticosteroids

2003 meta analysis of the effects of a single course corticosteroid compared to placebo/no treatment were delivery was 7 days or more after the treatment was given

website of the EPICE cohort

Study from EPICE looking at effects of steroids and time to delivery

ACOG guidelines on fetal maturation

NICE guidelines on risk of premature labour

Norwegian guidelines on risk of premature labour

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.

1. Does Baby Powder Cause Cancer? A Jury Says Yes. Scientists Aren't So Sure
2. History of breast feeding and risk of incident endometriosis: prospective cohort study
3. The maternal childbirth experience more than a decade after delivery

In this episode we trace the history of polycystic ovarian syndrome, learn about the underlying physiology, and how to diagnosis it.

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1. Current Practices of Measuring and Reference Range Reporting of Free and Total Testosterone in the United States.
2. Diagnostic Criteria for Polycystic Ovary Syndrome: Pitfalls and Controversies
3. Clinical Findings and Hormonal Responses in Patients With Polycystic Ovarian Disease With Normal Versus Elevated LH Levels.
4. A study of the end-results of the treatment of amenorrhea and sterility by radiation of 128 married women over a period of twelve years
5. The Stein-Leventhal syndrome
6. Secretion of Androgens by the Polycystic Ovary and its Significance
7. Inappropriate Secretion of Follicle-Stimulating Hormone and Luteinizing Hormone in Polycystic Ovarian Disease
8. Defective Biosynthesis of Ovarian Steroids in the Stein-Leventhal Syndrome
9. Functional Studies of Aromatase Activity in Human Granulosa Cells from Normal and Polycystic Ovaries
10. The Effects of Ovarian Wedge Resection on Circulating Gonadotropin and Ovarian Steroid Levels in Patients with Polycystic Ovary Syndrome
11. Bilateral polycystic ovaries: Significance in sterility
12. Polycystic ovary syndrome: etiology, pathogenesis and diagnosis

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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

1. https://www.ncbi.nlm.nih.gov/pubmed/27440542
2. https://www.ncbi.nlm.nih.gov/pubmed/27809380

2. Effect of Cervical Screening Changes on STD testing

1. 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:

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ST Waveform Analysis

1. Fetal electrocardiogram: ST waveform analysis in intrapartum surveillance
2. ST waveform analysis versus cardiotocography alone for intrapartum fetal monitoring: a systematic review and meta-analysis of randomized trials
3. Electrocardiogram ST Analysis During Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials
4. Does ST analysis of fetal ECG reduce cesarean section rate for fetal distress?
5. The fetal electrocardiogram: ST waveform analysis during labour
6. Randomised trial of cardiotocography alone or with ST waveform analysis for intrapartum monitoring
7. Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial

Fetal Pulseoximetry

1. Fetal pulse oximetry for fetal assessment in labour
2. Intrapartum Oximetry of the Fetus
3. Update on intrapartum fetal pulse oximetry
4. The safety of fetal pulse oximetry in parturients requiring fetal scalp blood sampling
5. Intrapartum fetal pulse oximetry: Fetal oxygen saturation trends during labor and relation to delivery outcome

In this episode we discuss the use of fetal scalp pH and scalp stimulation in the triage of abnormal electronic fetal heart rate tracings.

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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

http://www.sciencedirect.com/science/article/pii/0002937880908509

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1995.tb10878.x/full

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1995.tb10878.x/full

http://www.sciencedirect.com/science/article/pii/0002937869901021

http://onlinelibrary.wiley.com/doi/10.1111/j.1447-0756.1987.tb00238.x/full

http://www.bmj.com/content/340/bmj.c1471.long

http://journals.lww.com/greenjournal/Abstract/1994/06000/Elimination_of_Fetal_Scalp_Blood_Sampling_on_a.15.aspx

http://fn.bmj.com/content/80/3/F246

Scalp Stim

http://www.sciencedirect.com/science/article/pii/S0002937887802624

http://www.sciencedirect.com/science/article/pii/S0002937886800072

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1989.tb03256.x/full

http://www.sciencedirect.com/science/article/pii/S0002937884800678

http://www.ajog.org/article/S0002-9378(84)80067-8/pdf

http://www.sciencedirect.com/science/article/pii/S0029784401016453

http://www.sciencedirect.com/science/article/pii/S002978449600525X