The Ob/Gyn Podcast

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

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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.

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1. A controlled trial of the differential effects of intrapartum fetal monitoring - ScienceDirect
2. Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: A meta-analysis - ScienceDirect
3. Intrapartum Fetal Monitoring — A Disappointing Story — NEJM
4. A prospective comparison of selective and universal electronic fetal monitoring in 34,995 pregnancies. - PubMed - NCBI
5. Instrumentation of Fetal Electrocardiography | Science
6. ‎www.ajog.org/article/0002-9378(58)90707-5/pdf
7. The Beginnings of Perinatal Medicine - Google Books
8. https://www.mnhospitals.org/Portals/0/Documents/patientsafety/Perinatal/3a_ACOG%20Bulletin%20106.pdf
9. ‎www.ajog.org/article/S0002-9378(11)00480-7/pdf
10. ‎www.ajog.org/article/0002-9378(59)90052-3/pdf
11. ‎www.ajog.org/article/0002-9378(59)90639-8/pdf
12. The fetal heart rate patterns preceding death in utero - American Journal of Obstetrics & Gynecology
13. A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation. - PubMed - NCBI
14. Reasons for the rising cesarean delivery rates: 1978-1984. - PubMed - NCBI
15. https://www.ncbi.nlm.nih.gov/pubmed/122861

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".

Article Link

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In this closing chapter on Puerperal Fever we will examine GBS related neonatal sepsis and the science behind its prevention.

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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

Daily antibiotic cost estimates

Cost-effectiveness of strategies to prevent infection of group B streptococcus in neonates from maternal colonisation

Timing of intrapartum ampicillin and prevention of vertical transmission of group B streptococcus

Chlorhexidine vaginal irrigation for the prevention of peripartal infection: A placebo-controlled randomized clinical trial

Preventing Early-onset Group B Streptococcal Sepsis: Strategy Development Using Decision Analysis

The Prevention of Early-onset Neonatal Group B Streptococcal Disease

Dr. Kim walks us through the history of cord clamping and examines the evidence behind delayed vs. immediate clamping.

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1. ACOG, Committee Opinion. Delayed Umbilical Cord Clamping After Birth. (American College of Obstetricians and Gynecologists, 2017).
2. Downey, C., and Bewley, S. Third Stage Practices and the Neonate. Fetal and MAternal Medicine Review 20, 229-246 (2009).
3. Downey, C., Bewley, S. HIstorical Perspectives on umbilical cord clamping and neonatal transition. Journal of the Royal Society of Medicine 105, 325-329 (2012).
4. Drife, J. The start of life: a history of obstetrics. Postgrad Medicine 78, 311-315 (2002).
5. Loudon, I. General practitioners and obstetrics: a brief history. JR Soc Med 101 (2008).
6. McDonald, S., Middletone, P, Dowswell, T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes (Review). Cochrane Database of Systematic Reviews, 1-93 (2013).
7. Mercer, J., Vohr, BR, McGrath, MM, PAdbury, JF, WAllach, M, Oh, W. Delayed Cord Clamping in Very Preterm Infants Reduces the Incidence of Intraventricular Hemorrhage and Late-Onset Sepsis: A Randomized Controlled Trial. Pediatrics 117, 1235-1242 (2006).
8. Mercer, J., Vohr, BR, Erickson-Owens, DA, Padbury, JF and Oh, W. Seven-month developmental outcomes of very low birth weight infants enrolled in a randomized controlled trial of delayed versus immediate cord clamping. Journal of Perinatology 30, 11-16 (2010).
9. Mercer, J., Erickson-Owens, DA, Collins, J, Barcelos, MO, Parker, AB, Padbury, JF. Effects of Delayed cord clamping on residual placental blood volume, hemoglobin and bilirubin levels in term infants: a randomized controlled trial. Journal of Perinatology 37, 260-264 (2017).
10. National Institute for Health and Care Excellence,. Intrapartum care for healthy women and babies, 2014).
11. Paco, C., Florido, J, Garrido, MC, PRados, S, NAvarrete, L. Umbilical cord blood acid-base and gas analysis after early versus delayed cord clamping in neonates at term. Arch Gynecol Obstetric 283, 1011-1014 (2011).
12. Rabe, H., Wacker, A, Hulskamp, G, Hornig-Franz, I, Schulze-Everding, A, Harms, E, Cirkel, U, Louwen, F, Witteler, R, Schneider, H. A randomised controoled trial of delayed cord clamping in very low birth weight preterm infants. Eur J Pediatrics 159, 775-777 (2000).
13. Rabe, H., Reynolds, G. Diaz-Rossello, J. A Systematic Review and Meta-Analysis of a Brief Delay in Clamping the Umbilical Cord of Preterm Infants. Neonatology 93, 138-144 (2008).
14. Rabe, H., Jewison, A, Alvarez, RF, Crook, D, Stilton, D, Bradley, R, Holden, D. Milking Compared with Delayed Cord Clamping to increase Placental Transfusion in preterm neonates. Obstetrics and Gynecology 117, 205-211 (2011).
15. Rabe, H., Diaz-Rossello, JL, Duley, L, Dowswell, T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database of Systematic Reviews, 1-84 (2012).
16. Rabe, H., Sawyer, A, Amess, P, Ayers, S. Neurodevelopmental outcomes at 2 and 3.5 years for very preterm babies enrolled in a randomzied trial of milking the umbilical cord versus delayed cord clamping. Neonatology 109, 113-119 (2016).
17. Speer, H. Obstetrics and Gynecology: A history and iconography. New England Journal of Medicine 352, 844-845 (2005).
18. World Health Organization. WHO recommendations on Postnatal care of the mother and newborn. (2013)

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.

1. Puerperal Pyrexia: A Review Part 1 and Part 2
2. Prevalence of postpartum infections: a population-based observational study
3. Lactation Mastitis
4. Lactation Mastitis: Occurrence and Medical Management among 946 Breastfeeding Women in the United States
5. Prevention and treatment of postpartum endometritis.
6. Early Postpartum Endometritis: The Role of Bacteria, Genital Mycoplasmas, and Chlamydia trachomatis.
7. A comparison of once-daily and 8-hour gentamicin dosing in the treatment of postpartum endometritis
8. Abbreviated Antibiotic Therapy for the Treatment of Postpartum Endometritis.
9. The association between manual removal of the placenta and postpartum endometritis following vaginal delivery
10. Prophylactic antibiotics for manual removal of retained placenta in vaginal birth
11. Association of post-cesarean delivery endometritis with colonization of the chorioamnion by Ureaplasma urealyticum
12. Postcesarean wound infection: prevalence, impact, prevention, and management challenges
13. Antimicrobial-Associated Risk Factors for Clostridium difficileInfection
14. The effect of manual removal of the placenta on post-cesarean endometritis
15. Breast Engorgement and Postpartum Fever.
16. Antibiotic regimens for postpartum endometritis
17. Antibiotic prophylaxis during the second and third trimester in pregnancy to reduce adverse pregnancy outcomes and morbidity
18. Vaginal cleansing before cesarean delivery to reduce post-cesarean infections
19. Fever and deep venous thrombosis. Findings from the RIETE registry
20. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery
21. A Randomized, Double-Blind, Placebo-Controlled Trial of Oral Antibiotic Therapy Following Intravenous Antibiotic Therapy for Postpartum Endometritis.
22. Prophylactic antibiotics for manual removal of retained placenta during vaginal birth: a systematic review of observational studies and meta-analysis
23. Methods of delivering the placenta at caesarean section

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.

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In this episode Dr. Sara Kim discusses the history, diagnosis, consequences, and treatment of bacterial vaginosis.

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1. ACOG. Vaginisits Practice Bulletin. (2015).
2. 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).
3. Eschenbach, D. A. History and review of bacterial vaginosis. American Journal of Obstetrics and Gynecology 169, 441-445 (1993).
4. 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 (2014).
5. Greenwood, J. P., MJ. Transfer of Haemophilus vaginalis Gardner and Dukes to a New Genus, Gardnerella: G. vaginalis (Gardner and Dukes). International Journal of Systematic Bacteriology 30, 170-178 (1980).
6. Hillier, S. N., Robert; Eschenbach, David; Krohn, Marijane; Gibbs, Ronald; Martin, David; Cotach, Mary Frances; Edelman, Robert; Pastorek, Joseph; Rao, Vijaya; McNellis, Donald; Regan, Joan; Carey, Christopher; Klebanoff, Mary A. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. New England Journal of Medicine 333, 1737-1742 (1995).
7. Koumans, E. S., Maya; Bruce, Carol; McQuillan, Geraldine; Kendrick, Juliette; Sutton; MAdeline; Markowitz, Lauri. The Prevalence of Bacterial Vaginosis in the United States, 2001-2004; Associations with Symptosm, Sexual Behaviors, and Reproductive Health. Sexually Transmitted Diseaese 34, 864-869 (2007).
8. Lachiewicz, M. M., Laura; Jaiyeoba, Oluwatosin. Pelvic Surgical Site Infection in Gynecologic Surgery. Infectious Diseases in Obstetrics and Gynecology 2015 (2014).
9. Larsson, P.-G. a. C., Bodil. Does pre- and postoperative metronidazole treatment lower vaginal cuff infection rate after abdominal hysterectomy among women with bacterial vaginosis? Infect Dis Obstet Gynecol 10, 133-140 (2002).
10. Lin, L. S., J; Kimber, N; Shott, S; Tangora, J; Aroutcheva, A; Mazees, MB; Wells, A; Cohen, A; Faro, S. The Role of Bacterial Vaginosis in Infection After Major Gynecologic Surgery. Infectious Diseases in Obstetrics and Gynecology 7 (1999).
11. Ling, Z. L., Xia; Chen, Weiguan; Luo, Yueqiu; Yuan, Li; Xia, Yaxian; Nelson, KAren; Shalei, Huang; Zhang, Shaoen; Wang, Yuezhu; Yuan, Jieli; Li, Lanjuan; Xiang, Charlie. The Restoration of the Vaginal Microbiota After Treatment for Bacterial Vaginosis with Metronidazole or Probiotics. Microbial Ecology 65, 773-780 (2013).
12. Menard, J.-P. Antibaterical treatment of bacterial vaginosis: current and emerging therapies. International Journal of Women's Health 3, 295-305 (2011).
13. Muthuamy, S. E., Selvi. Comparison of Amsel's Criteria, Nugent Score and Culture for the Diagnosis of Bacterial Vaginosis. National Journal of Laboratory Medicine 5, 37-40 (2016).
14. Onderdonk, A. D., Mary L; Fichorova, Raina N. The Human Microbiome during Bacterial Vaginosis. Clinical Microbiology Reviews 29, 223-238 (2016).
15. Tebes, C. L., Catherine; Sinnott, John. The effect of treating bacterial vaginosis on preterm labor. Infect Dis Obstet Gynecol 11, 123-129 (2003).
16. Xiao, B. N., Xiaoxi; Wang, Ben; Du, Pengcheng; Na, Risu; Chen, Chen; Liao, Qinping. Predictive value of the composition of the vaginal microbiota in bacterial vaginosis, a dynamic study to identify recurrence-related flora. Scientific Reports Nature 6, doi:10.1038/srep26674 (2015).

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.

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1. Tubal Techniques
2. D. Bartz & J. Greenberg. Sterilization in the United States. Rev Obstet Gyn. 2008; 1(1): 23-32.
3. CREST Study
4. CREST Study: Regret
5. CREST Study: Ectopic
6. Fit to Be Tied: Sterilization and Reproductive Rights in America, 1950-1980