Thinking About Ob/Gyn

Can IV fentanyl use during labor actually be safe for mothers and newborns beyond six centimeters of dilation? Join us as we unpack a pivotal 1989 study and question the stereotypes surrounding fentanyl use in labor.

Our second segment tackles sensational claims about IUDs and breast cancer, as we dissect a Danish study recently published in JAMA. Listen as we unpack the methodological nuances and confounders that mainstream publications have overlooked, and explore the media's role in shaping public perception with incomplete or skewed interpretations of data.

This episode closes with an in-depth look at the biases that pervade pharmaceutical research, particularly when funding sources have a vested interest in outcomes. By examining the "sponsorship effect" and its implications on research validity, we highlight the need for rigorous, unbiased scientific inquiry. We examine the evidence for the new Pretrm Test for preterm labor risk. Learn about the challenges of implementing biomarker testing for predicting preterm births and why high-quality evidence must remain the cornerstone of clinical practice. As we celebrate our 100th episode, we discuss the need for truth and transparency in scientific research—creating a future where clinical practices are driven by reliable, evidence-based insights.

00:00:02 Navigating IV Fentanyl Use in Labor

00:07:56 Debunking Misconceptions About IUDs and Breast Cancer

00:22:17 Evaluating Biomarker Testing for Preterm Birth: The PreTRM test

00:38:50 Conflicts of Interest in Medical Research

00:45:15 Biased Influence in Medical Research

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In this episode, we discuss four tips for finding evidence based answers quickly. Then we discuss some new literature about pap smears and new guidelines regarding iron supplementation in pregnancy. We also discuss the history of corticosteroids for fetal maturity and the hype cycle in medicine.

00:00:02 Finding Evidence-Based Clinical Answers Quickly

00:13:36 Understanding Evidence-Based Clinical Practice

00:23:30 Cervical Cancer Screening During Pandemic

00:33:51 Optimal Timing for Cervical Cancer Prevention

00:40:12 Iron Supplementation in Pregnancy

00:47:13 Corticosteroids and Hype in Medicine

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In this episode, we discuss the evidence behind one layer and two layer Cesarean closures with an emphasis on inclusion of the endometrium and the risk of cesarean scar ectopics and placenta accreta spectrum disorders. Plus, we define minimally invasive surgery and trace the origin of the term and it's introduce a new concept: less invasive vs minimally invasive surgery.

00:00:02 Hysterotomy Closure Techniques in Cesarean Deliveries

00:14:46 Debunking Claims About Cesarean Techniques

00:27:20 Uterine Closure Techniques in Cesarean Deliveries

00:36:44 Defining Minimally Invasive Surgery

00:48:18 Advanced Techniques in Minimally Invasive Surgery

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In this episode, we discuss four tips for placing and using catheters for induction of labor. Then we revisit the issue of small for gestational age versus fetal growth restriction. We also discuss the most common mistake made in calculating due dates and how this can have a negative impact on pregnancies. Finally, we discuss the history of postpartum depression and the literature and stories of Kate Chopin and Sylvia Plath.

00:00:35 Four Tips for Cervical Catheter Placement

00:23:00 SGA vs FGR

00:28:55 Correcting Due Dates Prevents Mistakes

00:46:10 History of Postpartum Depression, Chopin and Plath

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In this episode, we discuss the frequency of Pap smears for twin pregnancies as well as the need for using twin-based growth data for the diagnosis of fetal growth restriction in twins. We will poke the fire of controversy of the use of the terms "fetal growth restriction" and "small for gestational age" and discover how the terms might harm pregnancies.

Next, we discuss the new AAP guidelines for diagnosis of tongue ties. Finally, we answer a listener question about pushy doctors, paying for unnecessary tests, and the disconnect many gynecologists have with guideline and evidence based care.

00:00:02 Ultrasound Use in Twin Pregnancies
00:14:06 Twin Growth and Fetal Growth Restriction
00:20:00 Fetal Growth Assessment in Twin Pregnancies
00:29:10 Overdiagnosis of Tongue Tie in Infants
00:38:05Breastfeeding and Tongue Tie Recommendations
00:45:43 Controversy Surrounding Pelvic Exams
00:58:21 Unnecessary Physical Exams and IUD Preferences

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In this episode, we discuss prevention of thromboembolism during pregnancy and the postpartum period and the evidence for which patients should receive anticoagulation. Plus, the history of heparin and four tips for preventing embolism.
00:00:02 Four Tips for Preventing Thromboembolism in Obstetrics

00:08:39 Anticoagulation Recommendations in Pregnancy

00:22:29 Assessing Anticoagulation Recommendations in Pregnancy

00:35:22 Evaluating Anticoagulation Protocols in Pregnancy

00:42:22 Debating Risks of Obstetric Anticoagulation

00:59:28 History of Heparin

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In this episode, we challenge the reliability of traditional tests like Homan's sign and cervical motion tenderness. Learn how understanding and applying likelihood ratios can vastly improve diagnostic accuracy, and why combining multiple findings is more reliable than putting faith in isolated tests.

Then we discuss a new JAMA study linking advanced endometriosis with a heightened risk of ovarian cancer. The study brings to light the complexities and gaps in our knowledge, underscoring the importance of personalized patient discussions regarding risks and treatment options.

Next, we discuss a new study about how surgical residents are treated during residency. From inadequate parental leave to cultural pressures, we highlight the urgent need for systematic changes to foster a supportive and equitable environment.

Then expose the deceptive practices in the umbilical cord blood banking industry, revealing the ethical issues and questioning the touted benefits.

Finally, we answer listener questions about use of sterile gloves for cervical exams and trials of labor after two cesareans. 

00:00:02 Obsolete Physical Exam Maneuvers in Gynecology
00:14:25 Endometriosis and Ovarian Cancer Risk
00:20:47 Residency Challenges for Parents and Discrimination
00:33:10 Deceptive Practices in Cord Blood Banking
00:49:19 Debate on Mammography Guidelines
00:54:17 Listener Questions: Sterile Gloves and VBA2C

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In this episode, we discuss four tips for Cesarean under local. Then we discuss some new literature including full versus empty bladder during gyn procedures and endometrial ablation vs IUD for abnormal uterine bleeding. We also discuss the inertia of old ideas in obstetric practice. Finally, we discuss the history of the diagnosis of preeclampsia and eclampsia.

00:00:02 Cesarean Delivery Under Local Anesthesia

00:07:04 Emergency Cesarean Delivery Procedure

00:19:47 Bladder Status in Gynecological Procedures

00:29:01 Endometrial Ablation vs IUD for Treatment

00:38:43 Inertia in Obstetrics Practice Trends

00:47:45 Historical Evolution of Eclampsia Diagnosis

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In the season 8 premiere, we discuss over-utilization of serial quantitative HCGs. Then we discuss several famous or influential studies in obstetrics, including the WOMAN trial, the CLASP trial, the ARRIVE trial, MagPIE, and several more. Finally, we discuss the history of how magnesium sulfate came to be used in obstetrics.

00:00:02 Overuse of HCG

00:13:17 Aspirin for Preeclampsia Prevention Debate

00:18:51 Debate on the ARRIVE Trial

00:29:10 MagPIE

00:39:05 Fetal Fibronectin Trials

00:44:53 Induction at 41 Weeks Discussion

00:55:16 History of Magnesium Use in Obstetrics

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In this episode, we discuss four tips for uterine inversion. Then, we discuss mistreatment and abuse of trainees in OB/GYN plus physician suicide. Finally, we answer a question about closure of peritoneum.

00:00:02 Managing Uterine Inversion in Obstetrics
00:13:39 Combatting Harassment in Medical Training
00:25:41 Addressing Mistreatment in Medical Training
00:31:13 Workplace Mobbing and Bystander Dynamics
00:37:29 Identifying and Addressing Workplace Abuse
00:59:30 Listener Question

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