Thinking About Ob/Gyn

In this episode, we discuss performing Cesarean for fetal weights at lower thresholds than currently recommended. Then we discuss new literature regarding utility of pelvic exams or screening asymptomatic women and early rupture of membranes after cervical ripening with a Foley bulb. Then we discuss an editorial discussing selecting the best test and hysteroscopy for miscarriage after embryo transfer. Plus, a new RCT that examines stopping oxytocin once a patient is in active labor. Finally, we answer listener questions about harms of yearly pap smears and whether we plan to use Zuranolone for treatment of postpartum depression. Buckle up!

00:01:00 Cesarean for Fetal Weight > 4000 g
00:13:20 Pelvic Exams in Asymptomatic Women
00:30:10 Early Amniotomy After Foley Bulbs
00:33:43 The Best Test: Hysteroscopy for Miscarriage
00:40:59 Stopping Oxytocin in Active Labor
00:45:00 Listener Question: Harms Of Yearly Paps
00:55:26 Listener Question: Zuranolone

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In the first episode of our new season, we introduce a new segment with Four Tips for managing fetal heart tracings. Then we discuss the new mammography guidelines. And finally we discuss a case of a viable pregnancy in a woman who had had a hysterectomy.

00:20:45 Mammography Guidelines
00:30:12 Debating the Effectiveness of Mammography Screening
00:41:01 Breast Cancer Screening and Overdiagnosis
00:55:50 Pregnancy After Hysterectomy

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In this episode, we discuss five more myths about hormone replacement therapy. Also, we discuss the utility of cervical exams at later pregnancy visits and the history of synthetic hormones.

00:00:02 Intro and Routine Cervical Exams
00:07:51 Myth #6: Lowest dose, shortest duration
00:17:27 Myth #7: Women without a uterus need progesterone 
00:22:44Myth #8: Transdermal estrogen is safer than oral
00:36:25 Myth #9: All menopausal women should also be on Testosterone replacement
00:39:50 Myth #10: Ineffective alternative treatments
00:53:04 History of hormone products

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In this episode we debunk the first of five myths about menopausal hormone replacement therapy.

00:00:02 Hormone Replacement Therapy For Smokers, HTN

00:11:42 Misinformation from Women's Health Initiative

00:17:18 Myth 1: Estrogen and Breast Cancer

00:28:06 Myth 2: HRT and BRCA Patients

00:33:17 Myth 3: Estrogen and Cardiovascular Disease

00:39:14 Myth 4: Bioidentical Hormones

00:51:00 Myth 5: Checking Hormone Levels

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In this episode, we discuss several new articles related to treatment of vaginal atrophy or genitourinary syndrome of menopause, including literature that clarifies the role of vaginal estrogen cream. Plus, we discuss the role of washings at the time of management of adnexal masses. We also discuss new literature about the true impact of oxytocin on postpartum hemorrhage risk and examine a paper that claim that female gynecologists receive lower patient satisfaction scores than males. Finally, we discuss the true rate of pregnancy loss.
 
00:00:02 Peritoneal Washings in OBGYN Surgery
00:21:16 Oxytocin and Postpartum Hemorrhage Connection
00:28:23 Comparing Therapies for Menopausal Symptoms
00:42:54 Female Gynecologists and Patient Satisfaction
00:52:11 The True Rate of Pregnancy Loss

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In this episode, we review the literature regarding the use of magnesium sulfate for neuroprotection to prevent CP in preterm infants.

00:00:02 Magnesium Sulfate for Neuroprotection
00:11:00 The Controversy Surrounding Magnesium Sulfate
00:36:37 Research Study Mistakes and Bias
00:46:33 Magnesium Sulfate's Effects on Preterm Birth
00:52:24 Magnesium for Fetal Neuroprotection Reevaluated

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In this episode, we discuss neonatal circumcision and the pros, cons, and ethics. Prepare for controversy. We also discuss the utility of labs for fetal growth restriction.
 
00:00:02 Circumcision Controversy
00:05:00 Labs for Fetal Growth Restriction
00:15:31 Global Perspectives on Male Circumcision
00:26:17 Significance of Male Circumcision in History
00:33:52 The Arguments for and Against Circumcision
00:53:44 Ethical Considerations of Circumcision

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In this episode, we speculate about the near future of advancement of obstetrics, including new vaccines, new uses for cell-free DNA screening, advancement in diabetes monitoring, the use of artificial intelligence and remote monitoring in obstetrics, and artificial womb technology. Also, do you need to stick the GBS swab in you know where?

00:00:02 GBS Swab Technique
00:10:09 Emerging Innovations in Obstetrics
00:18:35 Advancements in Vaccines and Prenatal Care
00:27:49 Diabetes Management and Assisted Birth Advances
00:39:06 AI, Prenatal Care and Fetal Monitoring Advances
00:53:20 Advancements in Artificial Womb Technology

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In this episode, we discuss the utility of repeat antibody testing at 28 weeks. Plus, new evidence about early screening for GDM, the concept of tension in the pelvic floor, the evidence about vaginal prep at the time of unplanned Cesarean, new literature about interventions for preterm birth, and the safety of Mayo (or raw eggs) during pregnancy.

00:00:02 Repeating Type and Screen for RH-Negative Pregnant Women
00:13:54 Evaluating Early Screening for Gestational Diabetes
00:19:24 Discussing Outcomes of Gestational Diabetes Study
00:27:17 Pelvic Therapy and Vaginal Cleansing
00:37:30 The Controversy Surrounding Preterm Birth Interventions
00:50:58 UK and US Egg Safety Standards

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In this episode we welcome back Stuart Winkler to discuss over-consulting in OB/GYN and how to improve surgical eduction in our training programs and how to balance generalists vs subspecialists. Plus, colace!

00:00:02 Misuse of Docusate Sodium

00:09:24 Appropriate Specialty Referrals in Gynecology

00:20:51 Considerations for EIN Management and Referrals

00:33:57 Endometrial Ablation in Gynecologic Surgery

00:41:53 Practice, Mentorship, Surgical Coaching Importance

00:51:04 Speed and Surgical Competence

00:57:59 Teaching and Expectations in OBGYN

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