Howard and guest hose Sivani Aluru unpack why the new PMOS name matters, how PCOS got tied to “cysts,” and what the evidence actually says about diagnosis, metabolic risk, and treatment. We also challenge a few habits we have all inherited, from pre-op antibiotic dosing to the way we talk about hormones, weight, and fertility with patients. 

• the evidence gap behind 2 g vs 3 g cefazolin in obese cesarean patients and how practice inertia forms 
• why PMOS shifts attention toward insulin resistance, metabolic screening, and multidisciplinary care 
• how NIH, Rotterdam, and androgen excess criteria shape who gets diagnosed and who gets missed 
• SHBG and free testosterone as a practical way to explain symptoms when total testosterone looks normal 
• why ovarian follicles are not the same as painful ovarian cysts and why ultrasound can mislead 
• patient frustration with “just take birth control” and how we explain progesterone protection for the endometrium 
• lean PMOS, weight-focused bias, and realistic conversations about lifestyle change, GLP-1s, and bariatric surgery 
• fertility takeaways from PPCOS II, metformin limitations, and what lifestyle trials suggest preconception 
Be sure to check out thinkingaboutobgyn.com for more information, and be sure to follow us on Instagram.

0:00 Welcome And Guest Introduction

2:01 The 3-Gram Ancef Habit

12:02 PCOS Becomes PMOS

12:55 How The Criteria Got Complicated

22:00 Insulin Resistance And Free Testosterone

30:40 Hormone Panels And TikTok Myths

32:30 Ovarian Follicles Are Not “Cysts”

36:03 Treating Symptoms Without Dismissing People

46:12 Fertility Trials And Lifestyle Results

57:27 ACOG At 75 And Why Join

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We push back on the idea that obstetrics “deserves” a malpractice crisis and explain how bad incentives and junk science can turn normal evidence-based care into courtroom blame. We also break down a few widely shared clinical myths and new research so we can practice with clearer eyes and less narrative noise.
• placental grading on ultrasound as low-value data with poor predictive power and high reader variability 
• how malpractice commentary can seed plaintiff-friendly arguments against evidence-based off-label use 
• why blaming misoprostol or “high-dose” oxytocin oversimplifies multifactorial outcomes 
• quality improvement bundles as useful tools but weak proof without controls or causal clarity 
• how massive verdicts and paid expert testimony can clash with modern science on cerebral palsy and HIE 
• the FAA’s five hazardous attitudes and practical antidotes for high-stakes clinical work 
• new data on LEEP versus cold knife cone for CIN, recurrence, HPV clearance, and access tradeoffs 
• genetics and BMI as major drivers of gut microbiome patterns, not influencer narratives 
• what a 1993 Doppler trial can and cannot prove, plus why replication changes conclusions 

Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram.

0:00 Welcome And Season Update

1:15 Placental Grading Myth On Ultrasound

6:44 Calling Out A Malpractice Influencer

14:06 The 2011 Policy Bundle Examined

23:20 What Drives The OB Malpractice Crisis

30:00 How Mega Verdicts Get Made

36:59 Five Hazardous Attitudes From Aviation

44:31 LEEP Versus Cone For CIN

48:04 Genetics And The Gut Microbiome

52:17 Does Doppler Ultrasound Harm Babies?

1:00:37 Recommendations And Closing

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We sit down with Joshua Oommen to get nerdy about clinical reasoning, FDA standards, and why “good evidence” is harder to define than most of us admit. We challenge the reflex to trust p-values and meta-analyses, then test our instincts against real OBGYN examples where the literature has whiplashed practice. 
• why the podcast is called Thinking About OBGYN and how clinical reasoning shapes our work 
• the NEJM proposal to make one pivotal trial the FDA default and what “confirmatory evidence” might mean 
• medical reversal, surrogate endpoints, and how trust erodes when practice changes late 
• why Bayesian thinking fits how clinicians interpret tests, trials, and prior beliefs 
• how meta-analyses fail through small study effects, publication bias, p-hacking, and heterogeneity 
• the amnioinfusion comeback as a case study in applicability and overconfident conclusions 
Be sure to check out thinking about obgyn.com for more information and be sure to follow us on Instagram. 

0:00 Welcome And Today’s Big Question

3:48 Why “Thinking About OBGYN” Exists

11:54 The NEJM Push For One Trial

16:38 Medical Reversal And Trust Problems

24:43 AI Proteins And CRISPR Pressure Tests

32:33 Bayes Thinking Beyond P Values

36:43 Why Meta-Analyses Often Mislead

41:08 Bias And Heterogeneity Red Flags

46:24 Amnioinfusion And A Meta-Analysis Comeback

1:02:29 Final Warnings And How To Learn

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We bring back the biggest takeaways from the ACOG ACSM, then move fast through the newest guidance and the newest hype shaping real OBGYN care. We focus on what the evidence actually supports, where practice still lags behind, and how “labels” can quietly push patients toward harm.

• conference highlights including rural OBGYN access and what gets attention on the exhibit floor 
• vitamin K shot refusal trends and why late bleeding still matters weeks after birth 
• 2026 ACOG cervical cancer screening changes with primary HPV testing preferred for ages 30 to 65 
• self-collected HPV screening and the systems needed to keep follow-up safe 
• why annual Pap testing and cytology-only strategies increase overdiagnosis and can miss HPV risk 
• postmenopausal bleeding workup shifting toward ultrasound plus endometrial biopsy up front 
• large baby induction data and why outcomes can worsen without neonatal benefit 
• third-trimester ultrasound screening performance and the real-world labeling effect 
• early proof-of-concept therapy for preeclampsia targeting sFlt1 removal to prolong pregnancy 
• hysterectomy duration and route as drivers of venous thromboembolism risk 
• laboring down claims from retrospective reports versus randomized trial findings 
• debunking physiologic third stage claims and reaffirming active management to prevent hemorrhage 

Be sure to check out thinkingaboutobgyn.com for more information, and be sure to follow us on Instagram.

0:00 ACOG Meeting Takeaways And Rural Access

3:58 Vitamin K Refusal And Newborn Bleeding

6:37 Cervical Screening Moves Toward HPV

14:48 Postmenopausal Bleeding Now Needs Biopsy

20:00 Tylenol Data And Macrosomia Induction

28:34 Ultrasound Labeling Effect And Liability Fears

37:29 Removing sFlt1 To Buy Time

40:14 Longer Hysterectomy Surgeries Raise VTE Risk

42:14 Laboring Down Claims Versus RCT Reality

49:59 Counseling Fatigue Without Ignoring Risk

54:21 Third Stage Myths And Hemorrhage Prevention

58:42 Evidence Literacy And Closing Notes

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We answer vaccine questions head-on, using real numbers to separate online fear from how vaccines, immunity, and public health actually work. We break down why diseases feel “gone,” what the modern schedule really exposes babies to, and how to spot misleading claims around ingredients, autism, and VAERS. Featuring Kate Moloney and our vaccine-hesitant friend Anah. 

• why vaccine success makes diseases look eradicated while risk returns when coverage drops 
• Stanford modeling estimates for measles, diphtheria, polio, and rubella without vaccination 
• meningococcal meningitis basics, who is most at risk, and why outcomes can be catastrophic 
• why clean water and sanitation do not explain protection from droplet-spread viruses 
• what antigens are and why antigen exposure is far lower than decades ago 
• downsides of delaying vaccines including longer vulnerability and more office visits 
• aluminum, formaldehyde, and mercury claims explained with real-world comparisons 
• “natural immunity” tradeoffs including measles pneumonia, immune amnesia, and SSPE 
• long flu and post-viral inflammatory syndromes as quality-of-life consequences 
• how vaccine schedules change, why the autism claim is debunked, and what profit incentives really look like 
• what VAERS can and cannot tell you, plus how bias and viral claims distort reports 
• why newborn hepatitis B vaccination exists, screening gaps, and true serious side effects 
• rubella history and why vaccination primarily protects fetuses 

1:05 Do We Vaccinate Too Much

3:32 Modeling A World Without Vaccines

6:20 Meningitis And Fast Catastrophes

8:28 Clean Water Is Not A Vaccine

11:02 Antigens And The Modern Schedule

15:44 Why Spacing Shots Can Backfire

16:53 Aluminum Formaldehyde Mercury Facts

22:00 Natural Immunity And Measles Damage

26:16 Long Flu And Post Viral Illness

28:26 Profit Fears And Autism Claims

31:26 VAERS Limits And Bad Math

38:39 Why Newborns Get Hepatitis B

45:09 Real Side Effects And Detox Scams

48:37 Rubella And Protecting Fetuses

51:57 Final Takeaways And Next Steps

Be sure to check out thinkingaoutobgyn.com for more information and be sure to follow us on Instagram. 

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We take on four stubborn myths in modern obstetrics and follow the evidence instead of the vibes, from thrombophilia testing to bed rest to seizure prophylaxis. We also spotlight a patient-empowering insulin strategy that may improve gestational diabetes outcomes faster than usual care. 
• distinguishing recurrent pregnancy loss evaluation from venous thromboembolism testing 
• focusing thrombophilia workups on antiphospholipid antibody syndrome when criteria are met 
• explaining why MTHFR variants and PAI-1 polymorphisms do not belong in routine panels 
• unpacking how social media and narrative fallacies keep low-value tests alive 
• reviewing the AWARE trial and why activity restriction lacks benefit and carries harms 
• clarifying reasonable pregnancy activity modifications versus false labor prevention claims 
• assessing late preterm antenatal corticosteroids for twins and the hypoglycemia signal 
• discussing inertia of practice and why weak evidence becomes hard to undo 
• breaking down patient-led insulin titration for gestational diabetes and why it may reduce macrosomia 
• evaluating laboring down and long-term pelvic floor outcomes plus statistical pitfalls 
• answering a listener question on Keppra alternatives to magnesium for preeclampsia seizures 
Be sure to check out thinking about obgyn.com for more information, and be sure to follow us on Instagram.

0:00 Welcome And What We’re Reviewing

0:28 Thrombophilia Testing After Miscarriage

3:51 What Belongs In A VTE Panel

5:55 MTHFR And PAI1 Myth Busting

13:36 Activity Restriction And The AWARE Trial

23:27 Practical Counseling Without False Promises

27:08 Late Preterm Steroids For Twins

32:53 Patient-Led Insulin Titration In GDM

38:38 Laboring Down And Pelvic Floor Outcomes

47:51 Keppra Versus Magnesium For Preeclampsia

1:00:25 Wrap Up And Where To Follow

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We talk with Dr. Emily Donelan about how conflicting labor management guidelines can derail communication between nurses and physicians and quietly raise patient safety risks. We map the biggest friction points and lay out practical ways to reconcile guidance locally while pushing for a unified national approach. 

• defining “communication dystocia” and why guideline discrepancies create real bedside conflict 
• how evidence gaps drive teams toward institutional culture and inertia in practice 
• the ARRIVE trial as a case study in differing priorities and framing 
• a detailed induction vignette showing where amniotomy, oxytocin titration and uterine activity definitions collide 
• why the 20 mU/min oxytocin threshold persists and what newer data suggests 
• tachysystole rules, Category II tracings and how prescriptive language shapes nursing behavior 
• delayed pushing versus pushing at complete dilation and the moral distress it can create 
• the need for standardized evidence grading and cleaner citations across organizations 
• a national interprofessional reconciliation program and who must be at the table 
• one actionable step for tomorrow: stay curious and surface the real reason behind the disagreement 

Be sure to check out thinking about obgyn.com for more information and be sure to follow us on Instagram.

0:01 Why Guideline Conflicts Matter

3:52 The ARRIVE Trial Framing Problem

12:23 A Labor Case Where Rules Collide

24:08 Oxytocin Thresholds And Litigation Fear

33:26 Pushing Timing And Moral Distress

38:05 Who Should Write Unified Guidance

44:04 Evidence Grading And Bedside Decisions

52:05 Inertia In Practice And De-Implementation

1:00:14 Takeaways Plus A No-Evidence Pet Peeve

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We use a plotline from The Pit to separate ovarian torsion facts from TV fiction and explain why Doppler findings can’t replace clinical judgment. Then we answer a listener question on trial of labor after myomectomy and how we counsel when the data are thin and the details matter. 

• why “competency porn” and “certainty porn” can distort real expectations of care 
• how color Doppler actually works and why red and blue do not always mean artery and vein 
• PCOS misconceptions and what really increases torsion risk 
• ovarian torsion as a clinical diagnosis and why preserved Doppler flow cannot rule it out 
• ultrasound clues that help beyond flow alone, including the whirlpool sign and peripheral follicles 
• when oophoropexy might be considered and why it remains controversial 
• why detorsion usually beats oophorectomy even with a black or blue ovary 
• limits of lab tests and the need to think in probabilities, not binaries 
• false positives and false negatives in pregnancy testing, including the hook effect and real-world mix-ups 
• counseling on vaginal delivery after myomectomy, focusing on depth, cavity entry, number and location of incisions, and shared decision-making 

Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram 

0:01 Welcome And What We Cover

0:32 The Pit Torsion Plot Setup

3:06 Competency Porn And Public Expectations

8:39 Color Doppler Basics BART Rule

10:09 PCOS Myths And Torsion Risk

13:27 Endometriosis Guidance And Clinical Diagnosis

18:29 Torsion Diagnosis Beyond Doppler Flow

24:30 Oophoropexy When It Helps And Harms

29:22 Scoring Tools For Torsion Triage

32:48 Detorsion Versus Oophorectomy And Recovery

37:09 Certainty Porn And Limits Of Tests

41:09 Pregnancy Tests False Positives And Negatives

47:10 Listener Question TOL After Myomectomy

50:01 Counseling Factors And Limited Rupture Data

55:31 Closing And Next Guest Tease

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We unpack the Gray Journal’s special edition on Cesarean Delivery, separating strong evidence from expert habit, and spotlight where technique, culture, and policy collide. From TXA and barbed sutures to better metrics and imaging, we share what to adopt now and what to question. Featuring Maddie White.

• evidence versus expert opinion across the special issue
• TXA at cesarean shows no meaningful outcome gains
• barbed versus braided sutures and the cost of “speed”
• why fundamentals beat gadgets for blood loss and time
• critique of New Jersey NTSV study and outcome framing
• imaging pearls for post‑cesarean complications
• infection prevention steps supported by trials
• history of cesarean steps and why we dropped some
• rising cesarean rates driven by non‑clinical forces
• better classification systems and dyadic metrics
• balancing maternal and neonatal outcomes
• tool use in obesity and cost‑conscious choices

Be sure to check out thinkingaboutobgyn.com for more information, and be sure to follow us on Instagram

0:01 Why A Massive C‑Section Special Issue Matters

3:15 Expert Opinion vs Evidence: Read With Caution

5:44 Safety Basics: Wear Eye Protection

7:46 Evidence‑Based Technique Still Stands

10:55 TXA At Cesarean: Reanalyzing TRAAP2

18:19 Barbed Sutures And The Myth Of Speed

27:30 Operative Time: Fundamentals Over Gadgets

33:54 New Jersey QI Study: Claims And Confounders

42:05 Outcomes Framing: “Cone Heads” And Bias

49:15 Imaging After Cesarean: What To Look For

54:35 Infection Prevention And SSI Takeaways

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We examine why U.S. maternal mortality headlines mislead, showing overdose and violence dominate early postpartum deaths while obstetric causes decline. We then cover strong evidence for opportunistic salpingectomy, debunk a shaky Cochrane-fueled home birth claim, clarify Nexplanon’s five-year approval and bleeding management, confirm no Tylenol-autism link, and walk through modern syphilis testing in pregnancy before closing with pragmatic magnesium use after delivery.

• overdose and violence as leading postpartum deaths
• pitfalls of cross-country maternal mortality comparisons
• fentanyl trends and infant risk
• opportunistic salpingectomy reduces ovarian cancer risk
• how bad meta-analyses distort home birth safety claims
• intent-to-treat and risk matching in birth setting data
• Nexplanon five-year efficacy and bleeding treatments
• no association between acetaminophen and autism
• syphilis screening algorithms and pregnancy timing
• magnesium postpartum as seizure prophylaxis, not BP treatment

Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram

0:00 Setting The Agenda: What Really Kills Moms

0:33 Redefining Maternal Mortality And Comparisons

2:11 Violence, Overdose, And Postpartum Risk

5:33 State Variability And Media Narratives

8:15 Data On Drugs, Fentanyl, And Infant Harm

11:06 Opportunistic Salpingectomy: New Evidence

14:06 Population Study And Risk Reduction Ranges

16:16 Cochrane Review And Home Birth Claims

20:24 Why Bad Meta-Analyses Mislead

24:15 Real-World Data And Intent-To-Treat For Birth Setting

28:02 Pain, Epidurals, And Cultural Narratives

31:00 Nexplanon Five Years And Bleeding Fixes

35:21 Tylenol And Autism: Meta-Analysis Revisited

38:04 Syphilis Testing In Pregnancy: Why It’s Hard

42:25 Traditional Vs Reverse Algorithms Explained

47:05 Managing Discordant Results And Reinfection

50:11 History, Ethics, And Tuskegee Lessons

54:15 Listener Question: Magnesium Duration Postpartum

59:05 Clinical Judgment Over Dogma And Wrap

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