Can Placental Volume on Sono Predict IUFD?Ultrasound assessment of placental volume has been proposed as an important aspect of prenatal care. It involves measuring the size and volume of the placenta, which may provide critical information regarding fetal health and development. Abnormal placental volume can be associated with various complications such as FGR, preeclampsia, and other pregnancy-related conditions. Some advocates suggests the volume and vascularity of the first trimester placenta may be linked to the most devasting adverse pregnancy outcomes which is stillbirth. Social Media posts have been advocating and endorsing the measurement of placental volume antenatally as a stillbirth prevention strategy. Is this evidence-based? It’s very controversial. Nonetheless, we have principles from the AIUM. ISUOG, ACOG, and SMFM to guide us here. Listen in for details. Oct 26, 202451:04New AHA/ASA 2024 Guidance: WH FocusStroke is also a leading cause of adult-onset disability;among individuals who survive 6 months, almost half aredependent in at least 1 activity of daily living. In October 2024, the AHA/ASA released their 2024 Primary Prevention of Stroke guidance. This document has a striking focus on women's health, namely adverse pregnancy outcomes and certain gynecological conditions (Endometriosis, POI, PCOS). Listen in for details.Oct 24, 202427:38The Enigma of Endo and Early BirthSeveral observational studies have suggested that women with endometriosis have a slightly increased risk for preterm birth. The cause seems to be related to factors associated with pathogenesis of endometriosis, such as inflammation, reactive oxygen species, progesterone resistance, and alterations in the junctional zone of uterus leading to the shallow invasion of the placenta and to preterm birth. But is this association firmly established? It is actually more an enigma than solid evidence. In October 2024, a new cohort study in Fertility Sterility is questioning this relationship. These results are a contrast to the findings of a meta-analysis published in January 2022, which itself conflicted with results of a French observational study published the following month, February 2022. It’s the perpetual problem and enigma of whether endometriosis is associated with PTB, or not! Listen in for details. Oct 23, 202433:29Insulin Initiation Made EasyIn November's Green Journal, Drs Amy Valent and Linda Barbour will publish their Clinical Expert Series (CES) on insulin management in GDM and Type 2 DM in pregnancy. This is a FANTASTIC document and is our subject matter in this episode. Here, we will give clinical pearls for insulin initiation in pregnancy based on 3 regimens (NPH/Reg; NPH/RAAs; Basal-Bolus) and their initiation in an easy to follow format. Congratulations to Drs Valent and Barbour on a wonderful CES.Oct 20, 202447:01The OCP Makes You Gay?The relationship between hormonal birth control and sexual orientation has been a topic on social media channels and threads; it is a discussion of controversy. It is essential to clarify that the hormonal birth control pill itself does not determine or change an individual's sexual orientation. While there is evidence to suggest that hormonal birth control can influence sexual desire and partner preferences, there is insufficient data to support the idea that it can change a person's sexual orientation. Sexual orientation is a complex interplay of biological, environmental, and social factors, and current scientific consensus does not support the idea that hormonal contraceptives influence one's sexual orientation. Where did this concept come from? Are there large-scale studies which address this? Listen in for details. Oct 19, 202424:10RPL with APS: When to Start RXThe SMFM, ACOG and RCOG all recommend screening for Antiphospholipid Antibody Syndrome (APS) in women with Recurrent Pregnancy Loss (RPL). However, once identified, there has been controversy historically regarding the best TIME to initiate low dose aspirin and prophylactic LMWH. The main controversy regarding this is whether to begin treatment before a confirmed pregnancy, right after a positive pregnancy test, or only after an ultrasound confirms a viable fetus; with some studies suggesting potential benefits from starting earlier, while others debate the optimal timing due to lack of conclusive evidence and potential risks associated with early anticoagulation. Nonetheless, we DO HAVE current guidance here to make an evidence-based plan of care for these patients. In this episode, we will summarize a recent Clinical Expert Series from the ACOG (May 2024) and the RCOG (June 2023). PLUS, we will highlight some persistent controversies surrounding APS and RPL.Oct 15, 202434:03CHS in pregnancy (Updated Data)Cannabinoid Hyperemesis Syndrome (CHS): Yep, this is definitely an issue and has been in recent print. This was just covered in an expert commentary in J Gastroenterology in May 2024, and CMS was featured as a JAMA Patient Page on October 10, 2024 in JAMA Network. PLUS, we actually covered this back in Feb 10th, 2020! Yep…M-O-R-E information just keeps coming, including a new study in the OCT 2024 Green Journal, which shows that rates of THC in pregnancy are still increasing. This study, again from THIS MONTH, tells us that the prevalence of prenatal cannabis use increased from 5.5% in 2012 to 9.0% in 2022 among pregnant individuals, at least according to the database from Northern California ( Kaiser Permanente Northern California). In this episode, we will update our previous discussion on CHS (from back in 2020) based on these new publications.Oct 12, 202440:34Dehydration Causes OB Contractions? YES, and NO.Proper hydration is important for physiology whether male or female, and if female… hydration in pregnancy is important for proper uterine blood flow and proper amniotic fluid production. Interestingly, water recommendations do not specify differential water needs or hydration status recommendations by pregnancy month or trimester, nor do they take into account body composition, knowing that overweight and obesity increase the probability of being underhydrated. During pregnancy, dehydration is thought to contribute to Braxton-Hicks contractions possibly due to lactic acid buildup in the myometrial cells or via reflex secretion of ADH (vasopressin). But this is theoretical. Here is where IV hydration comes into clinical practice. What's hoped for in administering intravenous (IV) hydration is that the fast fluid volume increase will stop uterine activity and hence avert cervical change. Theoretically, hydration may reduce uterine contractility by increasing uterine blood flow and by decreasing pituitary secretion of antidiuretic hormone and oxytocin. Does mild-moderate dehydration lead to preterm labor? Is IV hydration a way to prevent preterm birth. There has been data since the 1980s up until 2021 which says, “No”. Listen in for details. Oct 10, 202444:40Dupixent Use in Pregnancy: Sept 2024 DataEczema is also known as a form of Atopic Dermatitis (AD). Males and females are not equally affected by AD, and studies have shown that AD is more common among males during infancy and childhood. However, around puberty, there is a shift towards more females than males having AD and this female predominance continues into adulthood. Eczema can impact any women during pregnancy. In fact, it is the most common prenatal skin condition. A majority of women with eczema in pregnancy have never it previously diagnosed. Actually, approximately 60%–80% of prenatal eczema patients have no prior history of the condition. Eczema in pregnancy may occur because of changes in hormones and the immune system. During pregnancy, the body’s immunity shifts a bit and this shift in immunity can make the mother more sensitive to allergens and dermal manifestations vis inflammatory mediators. Those with preexisting common hay fever or other allergies before pregnancy may be at higher risk of developing eczema during pregnancy. Eczema isn’t just about “itchy skin”, for some it has severe skin manifestations and affects quality of life. While biologics are generally not initiated in pregnancy except for very severe cases, some women may be on this medication when ENTERING pregnancy. Are they safe to use? We have new SURPRISING data from September 2024 which will help us in our shared-decision making with our patients. Listen in for details. Oct 09, 202431:48Pump the Brakes on "ROUTINE" IV Fluids in Labor (SMFM ALERT)Hurricane Helene has caused massive devastation for a part of the US, and now we are bracing again for Milton, set to affect Florida within the next 24 hours. Baxter, one of the country's leading manufactures for IV fluid bags has closed its plant for an unknown amount of time as it was affected by Helene. On October 4, 2024, the SMFM released a news brief on IVF conservation intrapartum. Listen in for details. Oct 08, 202418:47The Pregnancy “One-Stop Shop”: Screen for BRCA1? HPV Vacc PP?BRCA1 mutations dramatically increase the lifetime risk of breast, ovarian, pancreatic, and other cancers, yet most BRCA1-positive patients are not identified until after they have been diagnosed with cancer. At prenatal visits, women often undergo obstetrical prenatal carrier screening that can identify hundreds of genetic mutations which can be passed on to offspring and results in an inherited condition — however, BRCA1 and other autosomal dominant mutations are not included on these screening panels. However, a recent publication (September 2024) and related commentaries have brought this screening possibility to the limelight. There is also new data about endorsing offering the HPV vaccine during the immediate postpartum admission. Is pregnancy becoming a “one-stop shop” ( a “window of opportunity”) for women’s care? OK podcast family I think I've set it up enough, now…let's get to it. Oct 06, 202440:10'Lil Convo With the (ACOG) Prez! Podcast family, this episode comes to you NOT FROM THE STUDI, but was recorded LIVE at the ACOG Annual District Meeting (District XI in Texas). This episode is a "lil convo" with Dr. Stella Dantas, our current ACOG President. This is a brief, light-hearted, yet POWERFUL message to encourage you, lighten your day, and make you smile. PLUS, Dr. Dantas will share with us her struggle with something we all have dealt with at one point or another: the Imposter Syndrome! We really are :all in this together":....Listen in for details! (Shout out to Sivani Aluru, fellow ACOG Board Member for her cameo appearance as well!) Oct 05, 202412:51Bed Rest for FGR? Surprising 2024 DataThe ACOG defines Fetal Growth Restriction (FGR) as fetuses with an estimated fetal weight or abdominal circumference that is less than the 10th percentile for gestational age. Currently, the ACOG, SMFM, FIGO, and the ISUOG do not recommend maternal bed rest for this condition. However, a recent publication from the AJOG (May 2024) concluded that strict maternal bed rest could in fact reverse FGR in a short two-week interval! Is this possible? In this episode, we will dissect this controversial, retrospective study and give it proper perspective with real world clinical implications.Oct 02, 202432:11D-MER: Breastfeeding's Ugly SideDysphoric Milk Ejection Reflex (D-MER) is an abrupt emotional "drop" that occurs in some women just before milk release and continues for not more than a few minutes. Although research is still evolving, one study Published in 2019 (Breastfeeding Medicine) states that up to 9% of breastfeeding women may experience dysphoric milk ejection, although the true incidence is still unknown. The brief negative feelings range in severity from wistfulness to self-loathing. In Arch Gynecol Obstet, in July 2024, authors published, “Dysphoric milk ejection reflex – a call for future trials”. This is gaining interest in the published literature. The etiology of this is unclear but a new (soon-to-be-released) publication in the AJOG provides some interesting insights into this. This was just accepted for publication on September 18, 2024 and the official release is pending. Haven’t heard about D-MER? Due to a lack of awareness, this phenomenon is easily misdiagnosed as postpartum depression and aversion by many healthcare professionals. A July 2024 Harvard Review in Psychiatry publication called D-MER, “A Novel Neuroendocrine Condition with Psychiatric Manifestations”. This condition is a physiologic tale of oxytocin, milk- let down, dopamine and prolactin, and the fight and flight response. Listen in for details. Sep 28, 202434:26It's a Small WorldPodcast Family, every once in a while we need a little reminder that we are all wired for community. Despite differences in geographic locations, cultures, and family history, we really do have a lot in common. In this episode, I'll share with you 3 examples which prove that we really do live in a very small world. I hope this brings a smile to your face and encourages you! PLUS, of course, we will provide one main clinical pearl regarding CS-Hysterotomy closure while keeping with our "small world" theme. Listen in for details!Sep 26, 202417:22Does LNG-IUS Increase Breast CA?The LNG-IUS has been on the U.S. market since 2001. Since 2005, there have been several studies examining the association (if any) of LNG-IUS users and the diagnosis of breast cancers. This is a controversial and conflicting story. In this episode, we will highlight a soon to be released publication (OCT 2024) from the AJOG looking into this relationship. PLUS, we will very quickly walk down history’s timeline starting in 2005 and ending in October 2024 looking at the cumulative data on the subject. Does the ACOG has a statement on it? Listen in for details!Sep 24, 202437:34Labor Hacks? Pit Breaks, Propranolol, & Calcium We all what to win in life, right? That’s why we have life hacks…to beat the system. Sometimes those tricks are tremendously successful while some other random hack can be- well, just WACK. Such is the case for LABOR HACKS! We all want our inductions and augmentations of labor to be successful, and there have been some labor hacks promoted throughout the years. But is there evidence of their effectiveness? Is a Pitocin break effective at kickstarting the uterus back up? We will cover that in this episode. PLUS, we will highlight two new publications, both from AJOG MFM which have just been released (September 2024; October 2024): Can “pretreatment” with calcium help with labor? What about the use of propranolol? Listen in for details.Sep 22, 202442:39New Meta-Analysis on Immediate PP GTT (Sept 19, 2024)On May 22, 2024, we summarized a then soon-to-be-released ACOG CPU on Screening for GDM in Pregnancy and Postpartum. That CPU was officially released July 2024. That update endorsed the possibility of immediate postpartum GTT testing with a 75-gram OGTT. Now, on September 19, 2024, authors from UT Houston have published a systematic review/meta-analysis on this subject. In this episode, we will review what this data is and what it isn't. Listen in for details. Sep 20, 202431:59The "Tradition" of 24-Hrs PP MagSo4Magnesium Sulfate for preeclampisa can be traced back to the work of Horn in 1906! Yet, despite such a long history of use, there are still questions about mag sulfate use that we just don’t have good answers for, and that’s indicative of the all the continued articles and commentaries on the subject that are still being released. For example, there are still sparse data regarding the ideal dosage of magnesium sulfate for preeclampsia with severe features. Even the therapeutic range of 4–8 mEq/L quoted in the literature is questionable. What to know where that statement comes from? That’s in the ACOG PB 222 from 2020! So is the case for mag duration…you know, the 24-hour infusion tradition. The ACOG states in that same PB, “For women requiring cesarean delivery (before onset of labor), the infusion should ideally begin before surgery and continue during surgery, as well as for 24 hours afterwards. For women who deliver vaginally, the infusion should continue for 24 hours after delivery.” But this 24-hour mark, while TOTALLY OK, is more traditional than hard data driven. YES…its true, MOST if not ALL of would give mag for 24 hrs. in cases of eclampsia, and that is SUPER fitting and reasonable since they are the highest to have a recurrent seizure, but what about preeclampsia with severe features, without eclampsia or neurological symptoms. That’s where the 24-hour use can get into a greyer zone; can mag be used for less than 24hrs? Can we use diuresis as a clinical marker to stop mag? Two systematic reviews and meta-analyses looking at PP Mag duration were just published in July 2024 and in September 2024. We will summarize these findings- and more- in this episode.Sep 17, 202446:04Alpha-Gal Syndrome in PregnancyFilet Mignon, Pork Loin, Rib-Eye….all delicious (unless you are vegetarian)! If you are a meat- eater, be aware of AGS. Alpha-gal syndrome (AGS), also known as Red Meat Allergy, is a potentially life-threatening allergic reaction that can occur after a tick bite from a Lone Star tick or other tick species. While clustering within the US, Alpha-gal syndrome is found on every continent except Antarctica. With the tick bite, the tick transfers alpha-gal, a sugar molecule found in most mammals, into the person's bloodstream. The body then produces antibodies to fight the alpha-gal, which can trigger an allergic reaction when the person eats meat from a mammal or is exposed to other products containing alpha-gal. It's named for a molecule, galactose-α-1,3-galactose, that's found in most mammals but not in humans. According to the CDC, the overall prevalence is increasing. In this episode, we will review this allergic condition, the animal-based foods that may trigger it, and what the implications are during pregnancy.Sep 13, 202444:58NEW SPECIAL REPORT: FDA SAFETY NOTICE for VeozahToday, 9/12/24, the FDA released a SAFETY COMMUNICATION regarding Veozah. As you may recall, we have been following this novel medication since March 2023. This episode is NOT our regularly planned episode- that topic will come out as scheduled tomorrow AM 9/13/24! This is a SPECIAL REPORT episode in response to the FDA's communication released today. Listen in for important information regarding fezolinetnet.Sep 13, 202421:21New CPU from ACOG (9/10/24): RH IG Under 12 weeksBack in January 2024, we summarized the SFP's position statement on RH IG use (or rather non-use) under 12 weeks IUP gestations. Then, in February 2024, we released an episode summarizing the more conservative stance from the SMFM. Well now, 7 months after that episode, we have a new Clinical Practice Update from the ACOG on this very issue. That is the focus of this episode...and as we have said better, WORDING matters. We will discuss in this episode.Sep 11, 202424:27ONE MORE Random Question/Specific Answer: ABX with Bakri?In our last episode we tackled random questions with specific answers. After that episode went live, one of our nurses asked about the value of antibiotics with a Bakri balloon in place. This conversation happened as we were placing the balloon for PPH in a patient on Mag-Sulfate for Preeclampsia with Severe Features. That's antibiotic question is another random question that needs to be answered! So in this episode we will examine the data on prophylactic antibiotics with Bakri balloon for metritis prevention. Is there data for that? The ACOG has a statement on that very issue from back in 2018. Additional information has come to print since then, and we will review it. PLUS, as our patient was on Mag-Sulfate, we will also throw in this additional question as a FREEBEE: Is Mag-Sulfate an independent risk factor for PPH? The answer may not be what you think. Listen in for details. Sep 10, 202446:59Random Questions: Specific Answers!Welcome to this episode of "Random Questions: Specific Answers"! In this episode we will (surprise) answer random questions- with specific answers- from our podcast family members: 1. Can administration of IV Calcium at intrapartum CS reduce QBL?, 2. What are the 4 classes of CS performance urgency? and 3. If a normal MVP for amniotic fluid is 2-8cm on ultrasound, does an MVP of >8cm still get "2-points" at mBPP or full BPP? Listen in for details!Sep 08, 202437:02Failure Rates S/P Tubal Sterilization: NOT What we Thought.Tubal sterilization goes back to the 1880s. The first collaborative review of sterilization effectiveness was the CREST study published in 1996 in the AJOG. But that was with prior sterilization techniques. As a way to update the data researchers looked at the national survey for family growth (NSFG) from 2002 to 2015 to determine failure rates after more modern methods of tubal sterilization. This was published in NEJM Evidence on August 27, 2024. The results... Surprising! In this episode, we will review this new data and contrast it to the landmark CRESTstudy. Also, are you aware that the ACOG endorsed a mathematical formula to allow a patient to undergo tubal sterilization, until 1969? It's true! Listen in for details.Sep 04, 202434:60Do SSRIs Raise PTB Risk?Depressive disorders during pregnancy are common, with estimated prevalence ranging from 11% to 16%. Accordingly, antidepressant drugs, most commonly selective serotonin reuptake inhibitors (SSRI), are used by approximately 3–4% of pregnant women worldwide, with a higher prevalence in the United States compared to Europe. As antidepressants cross the placenta and the fetal blood-brain barrier, exposure during pregnancy raises concerns of potential risks of adverse pregnancy outcomes. On August 30, 2024, a new study was released ahead of print in the AJOG. This confirmed the reduction in preterm birth risk with effective mental health counseling approaches; HOWEVER, it also concluded that “use of antidepressants during pregnancy was associated with an increased 31% risk of pre-delivery independent of underlying depression “. Do SSRI meds increase preterm labor risk by 31%?! This is indirect contrast to a separate publication published just six months earlier, in February 2024 in a separate journal. In this episode, we will discuss this very important topic of SSRI use in pregnancy and the preterm birth risk. Sep 02, 202440:18OROPOUCHE!Just when we thought we had put coronavirus in our rearview mirror for the most part, here comes mPOX again. We covered that in a previous episode. Unfortunately, that is not the only pathogen to be concerned about. Enter: OROPOUCHE VIRUS (OROV). This virus was first reported in 1955, but it is making news today due to a rapid increase in cases. Coming from the Amazon Basin, and even Cuba, there have been 21 cases in the USA diagnosed in US travelers. This virus is a concern for pregnant women. Information gaps still exist but things are moving quickly here: On August 16, 2024, the Centers for Disease Control and Prevention issued a Health Alert Network (HAN) Health Advisory to notify clinicians and public health authorities of an increase in Oropouche virus (OROV) disease, originating from endemic areas and in new areas in South America and the Caribbean. Then, on August 22, 2024, SMFM released its alert on the virus. Today, the ACOG released its Practice Advisory (August 29, 2024) on this very issue. Listen in for details. Aug 30, 202432:10“New” Info on PCOS: Name Change? OB Implications?Polycystic ovary syndrome (PCOS) was first described in 1935 by Irving Freiler Stein and Michael Leo Leventhal at the Central Association of Obstetricians and Gynecologists. Since that time, it has gone through several name changes: Stein-Leventhal syndrome, PCOD, and currently PCOS. Nonetheless, proponents and scientists are still recommending yet another name change for this syndrome, one that better incorporates the multi-metabolic dysregulation that it incorporates. PCOS is not simply a gynecological issue. It is a metabolic issue with implications for adverse obstetrical outcomes. In this episode we will review 2 recent publications, one from July 2024 and the other from August 27th, 2024. These two studies, in two separate journals, each a month apart, validate what others have previously reported: PCOS doesn't just affect gynecological health but it also impacts obstetrical health. Listen in for details.Aug 29, 202431:06BRAND NEW Lexicon for 1st Trimester US (08/27/24)!Our immediate past episode focused on the “C-section scar pregnancy”. In that episode we discussed the ultrasound markers of early pregnancy (first trimester). Now – today – HOT 🔥🔥OFF THE PRESS- is a new publication in the AJOG, which is “A Lexicon For First Trimester US: Society of Radiologists in Ultrasound Consensus Conference Recommendations“. This consensus statement is through a MOU through the ACR, ACOG, AIUM, SMFM, ASRM, SFP, and the ACEP. For the first time, we have a proposed universal lexicon for ultrasound markers in the first trimester. This also discusses the cesarean scar topic pregnancy. Listen in for details!Aug 28, 202427:19CS Scar Pregnancy Cesarean scar pregnancy (CSP) occurs when an early pregnancy implants on the cesarean scar defect (CSD), myometrial tissue previously disrupted by cesarean delivery. The first case of CSP was reported in 1978 in a patient with a previous cesarean section (CS) who had heavy bleeding and abdominal pain after uterine curettage for a suspected miscarriage at 6 weeks. Eventual laparotomy revealed erosion of a major vessel in the scar sacculus by the products of conception which was successfully obliterated with subsequent revision of the previous surgical site. This was published in the South African Med Journal. Early ultrasound evaluation is crucial for detecting this condition. These are very complicated situations with increased rates of antepartum and postpartum hemorrhage, uterine rupture, PAS, preterm birth, and massive transfusion. Perhaps because of high worldwide cesarean delivery rates, there seems to be increased incidence and recognition of this condition over the past 2 decades. The clinical presentation is variable, and many are asymptomatic at presentation. In this episode, we will review the diagnosis and management of this unique and challenging high-risk pregnancy. Aug 26, 202448:53Make it TIGHT! 😳(DISCLOSURE: Sexual Content) Back in April 2023, we released an episode on the “Jade Vaginal Egg” and vaginal weights for vaginal tightening. While we tackled the Jade Egg successfully, we now have a new player on the field: the VAGINAL TIGHTENING STICK. This over the counter “sex aid” can lead to chemical burns and severe vaginal dryness/agglutination. Marketed to improce vaginal laxity, some of these sticks have the real potential to cause tissue damage and scarring- as one of our podcast family members saw firsthand with a patient. Its an interesting market place out there! Listen in for details.Aug 24, 202441:33The “Broken” IUD: Detection and Clinical ManagementThe IUD is a very safe and supremely effective contraceptive method. Given its increasing rate of use, practitioners are bound to see its relatively infrequent complications with greater regularity. Typical complications are considered “lost strings“, uterine perforation at placement, and expulsion. But there is another complication, device FRACTURE at removal. This can cause distress to the patient and can lead to additional interventions. Fracture of an intrauterine device (IUD) upon removal is a very rare complication, with a prevalence rate of 1–2%. However, the numbers have been rising since 2021, causing the FDA to track these complications. There has even been a bizarre case report of the copper coils being found in the pelvis WITHOUT device fracture! How?? In this episode, we will describe and review this relatively recent issue, its diagnosis, ways to minimize its occurrence at removal, and management strategies.Aug 22, 202432:03Umbilical Cord Gases: What, Why, When?In 1958, James et al. first described umbilical cord blood gas analysis to evaluate the fetus's metabolic condition at the time of delivery. It's recommended by both the British and American Colleges of Obstetrics and Gynecology for all high-risk deliveries. Cord blood gas provides the most accurate and objective evidence of fetal acidosis at the time of birth. Still, there is no universal agreement on when to perform umbilical artery gas analysis, or cord gas, for babies. Some suggest that all babies should have their umbilical artery and vein sampled immediately after birth, while others recommend only sending a sample if you think you need one, or in high-risk pregnancies. Should we collect umbilical cord gases universally- in all deliveries? And what about umbilical cord lactate levels? Is that helpful in predicting adverse newborn outcomes? Listen in for details.Aug 21, 202446:17FDA HPV Self-Swab Ready Aug 15, '24: NOT FOR HOME (Listen for Details)According to the National Institutes of Health, almost 13,000 women in the United States are diagnosed with cervical cancer each year, resulting in around 4,000 deaths, with most of the deaths occurring among under-screened women. Now, there is potentially a barrier-breaker. As of August 15, 2024, self-collection kits for cervical cancer screening may be available in doctor's offices and other clinical sites, ready for use. The kits allow patients to collect their own vaginal sample for HPV testing in a health care setting, as an alternative to a Pap smear. The FDA approved the kits on May 15, 2024. This is different from the OTC at-home HPV test kits. The tests, which are FDA cleared, are not yet available for people to use at home. The FDA's approval of these tests aims to increase access to HPV screening and reduce barriers to sample collection. Roche and BD both plan to consider offering at-home options in the future. Although a variety of companies currently offer at-home HPV tests, the Food and Drug Administration (FDA) has not yet approved at-home HPV tests. Listen in to today’s episode for details.Aug 18, 202422:16NEW Syphilis At-Home Test: Promises and ProblemsThe rise of home testing for STIs/HIV started long before the recent pandemic (the FDA approved its first HIV home test collection kit way back in 1996), but COVID-19 seems to have accelerated the popularity of getting tested from the comfort of our homes. In Nov 2023, the Food and Drug Administration granted marketing authorization, the first of its kind, for an at-home test for chlamydia and gonorrhea. The test kit, called Simple 2, is available online through various offerings. Chlamydia and gonorrhea are the most common STIs in the U.S. Of course, syphilis has also been on the move. And now, as of August 2024, The FDA has granted new clearance to NOWDiagnostics (not a sponsor) for the first at-home, over-the-counter syphilis screening test. So now we have gonorrhea, chlamydia, and syphilis at home testing options. At home HPV swabs are also seeking entrance into the marketplace. While these options remove barriers to care and allow testing in the privacy of one’s own home, there are inherent problems balancing out each of these promises. In this episode, we will review the pros and cons of at home testing for STIs and we will discuss why this is still caveat emptor, “buyer beware”, in this new healthcare marketplace option.Aug 18, 202432:302024 UPDATE: Mpox in PregnancyThe World Health Organization declared on 8/14/24 that the increasing spread of Mpox in Africa is a global health emergency, warning the virus might ultimately spill across international borders. Mpox, also known as monkeypox, was first identified by scientists in 1958 when there were outbreaks of a “pox-like” disease in monkeys. Until recently, most human cases were seen in people in central and West Africa who had close contact with infected animals. In 2022, the virus was confirmed to spread via sex for the first time and triggered outbreaks in more than 70 countries across the world that had not previously reported Mpox. Unlike in previous Mpox outbreaks, where lesions were mostly seen on the chest, hands and feet, the new form of Mpox causes milder symptoms and lesions on the genitals. That makes it harder to spot, meaning people might also sicken others without knowing they’re infected. In this episode, we will review the pathophysiology of this virus and describe its implications during pregnancy. Does Monkeypox cause adverse pregnancy issues? It’s cesarean section indicated for those affected? And is there any available treatment for active infection? Listen in for details.Aug 16, 202441:32Boar’s Head, Listeria, and PregnancyOn July 26, 2024, Boar’s Head issued its recall of 7 million pounds of ready-to-eat meat and poultry products that might be contaminated with the potential harmful bacteria, listeria. Sporadic listeria outbreaks are nothing new; in June 2024, chicken-based products were recalled for the same concern in Canada. The US recall includes more than 70 products — including liverwurst, ham, beef salami and bologna. Listeriosis is reportable to the local health department of the county in which the patient resides. Listeria can be very serious for 3 groups of people: pregnant women, people older than 65, and people with weakened immune systems. Pregnant women are about 13 times more likely than the general population to get listeriosis. Maternal infection may manifest as a nonspecific, flu-like illness with fever but can result in severe fetal and neonatal infection, leading to fetal loss, preterm labor, neonatal sepsis, meningitis, and death. Yep, we’ve been here before. There have been episodic outbreaks of listeria monocytogenes in the past. In 2014, the ACOG released its medical guidelines for the management of presumptive exposure to listeria monocytogenes (reaffirmed in 2023). In this episode, due to the recent outbreak and listeria concerns, we will review the pathophysiology, diagnosis, and therapy of L. Monocytogenes in pregnancy.Aug 13, 202443:19New Way to Reduce HDFN?: Enter, NipocalimabOur tagline, “Medicine moves fast“, is the absolute truth! Historically, identification of fetuses at risk of hemolytic disease of the fetus/newborn (HDFN) required amniocentesis for determination of the Delta OD450, Liley Curve. This was the first screen, which would then trigger cordocentesis for determination of the fetal hematocrit. We’ve now moved on to middle cerebral artery (MCA) doppler of the fetus for identification of those at risk. Additionally, we now have an ability to ascertain antigens on the fetal red blood cells through the maternal serum (cell free DNA). That’s amazing! Nonetheless, despite these wonderful advances, HDFN can still exist. But Medicine moves fast… In this episode, we will present brand new data from the NEJM. This Phase 2 international study, published on 8/7/24, describes the use of a monoclonal antibody (Nipocalimab) to block maternal IgG passage to the child. This is a revolution in HDFN prevention. Yep, medicine moves fast! Listen in for details. Aug 12, 202435:23The Return to LT-O-Whole Blood (LTOWB) for OB TransfusionPrior to the 1970s, when component therapy became the preferred method of resuscitation, whole blood (WB) was the resuscitative medium of choice for hemorrhagic shock. In modern medicine, sometimes it turns out that the old way is better than the new…and using whole blood for transfusions is one example. Research is emerging that shows whole blood works better for these patients than fractionated components of blood. Beginning in 2017, multiple stakeholders within the Southwest Texas Regional Advisory Council for Trauma- as well as others in different states, collaborated to incorporate cold-stored low-titer O RhD-positive whole blood into all phases of their trauma system, including the prehospital care via EMS. Although the program was initially focused on trauma resuscitation, it was expanded to include non-traumatic hemorrhagic shock patients that may benefit from whole blood resuscitation when MTP is needed. What about Low Titer O Pos whole blood use for maternal MTP resuscitation? Is there data there? And what about the risk with using type O whole blood as a donor. In this episode, we’ll dive into the details. Aug 09, 202439:51New Non-Estrogen Medication for Hot Flashes? Veozah's CompetitorIn May 2023, the FDA approved fezolinetant (Veozah), an oral medication that's the first neurokinin 3 (NK3) receptor antagonist to treat moderate to severe hot flashes caused by menopause. Now, a separate oral medication which blocks the NK 1 and 3 receptor iis on the scene. Although not yet FDA approved, the published phase 1, 2, and 3 data make this approval very likely. Bayer, the manufacturer of elinzanetant, has just submitted a New Drug Application for its approval. In this episode, we will review this new up and coming medication option for moderate to severe VMS due to menopause. Aug 03, 202424:05Antepartum AI for Stillbirth PreventionArtificial Intelligence (AI) has arrived. Machine Learningis a form of AI which is being investigated/used for improving maternal outcomes. The UK has already launched the TOMMY APP (through the RCOG) for use to reduce PTB and stillbirths in the UK. In this episode we will highlight a new systematic review which assessed Machine Learning’s ability to predict stillbirth. Did this work? This is a hot topic, especially since the passage of the Maternal and Child Stillbirth Prevention Act here in the US. Its fascinating how far AI has come and how it has found a “home” in OBGYN. Listen in for details. Aug 02, 202435:38Maternal Obesity and SUID: New DataWe all are aware that multiple adverse obstetrical outcomes have been linked to maternal obesity, such as stillbirth, preterm birth, NICUs admission, and congenital anomalies. But once delivery and hospital discharge occurs uneventfully, a new cohort study is raising the alarm for another possible adverse event up until the child’s first year of life: Sudden Unexpected Infant Death (SUID). SUID is devastating. In this episode we will review this new publication, which is making medical headlines. This was published on July 29th, 2024 in JAMA Pediatrics. We'll put this association between maternal obesity and SUID in perspective and summarize the key findings of this alarming data. Jul 30, 202433:54NEW Clinical Practice Update (Aug 2024)Our immediate past episode summarized a validation study of cell-free DNA (cfDNA) isolated from maternal plasma for fetal RBC genotyping in alloimmunized patients. And now, in this episode, we will highlight a BRAND NEW ACOG Clinical Practice Update on this very subject! YEP... we now have new ACOG guidance regarding using maternal derived cfDNA for fetal RBC antigen detection as an option for care in alloimmunized pregnancies. This is how "medicine moves fast"! Listen in for details. Jul 29, 202416:56cfDNA Fetal RBC Genotyping in Alloimmunized Pregnancies: July 2024 NEW DATAIn September 2022, a cell-free DNA assay using next-generation sequencing and quantitative counting tech for fetal antigen status determination became clinically available in the USA. This allowed maternal screening for fetal RBC genotypes for RH negative patients. This test was recognized by thre ACOG in March 2024 as one option to “triage” anti-D immunoglobulin in RH negative women. But can this technology be trusted in alloimmunized patients? In women with antibodies against foreign antibodies, this cell free DNA fetal screening option MUST get it right. We now have that data. In this episode, we will summarize remarkable results, published ahead of print on July 25, 2024 in the Green Journal. This study is a win for science and prenatal care. Listen in for details (BillontoOne, Inc is not a sponsor for this podcast). Jul 27, 202423:19Skyrocketing Sex Strangulation Rates: The AlertFirst off, let’s all agree that everyone has a different STYLE of sexual intimacy, and that’s OK. Yep, we all understand that there's always been a lot of sexual act “diversity” in the world… and throughout history. But there is a more recent trend that has increased in popularity, some surveys attribute it to its representation in pornography, that may be dangerous. This was in recent print as of July 3, 2024! This is "sexual choking”. But this term is not accurate because it actually is a form of strangulation. The increase in practice is mostly seen in teenagers and young adults. In this episode, we will discuss a real-world scenario that one of our podcast family members asked me about just the other day. This OBGYN physician was on call and one of her patients, a 21-year-old, non-pregnant, otherwise healthy, and THIN (yes, that was a factor in this case, and we will discuss why) presented with LOC during sex whose partner stated “she had a seizure” during sex. But this was no ordinary seizure. She had no history of epilepsy and was not on any medications. The “seizure” happened after sexual choking. Sexual choking is a big concern as it exposes the brain to recurrent episodes of hypoxia. We now have data showing there are real negative effects from this activity. Plus, we need to discuss this as it may also be a normalization, inappropriately, of sexual violence. In this episode, we will take a look at this alarming data and discuss why we need to ask about these sexual practices in a compassionate, empathic, and open way. Jul 26, 202445:15Candida as IAI & Perinatal Sepsis? YES.Candida in women is being right? Afterall, vulvovaginal candidiasis during pregnancy is common. Candida species may be isolated from the vagina of 15 %-21% of nonpregnant women; this rate increases to 30% during pregnancy. While it is generally benign and isolated to the vagina clinically, some Candida species have the capacity to be troublemakers. C. Glabrata has the potential to be a bad player, with the possibility of invasive disease. Candida IAI is rare but can lead to neonatal infection, high mortality, preterm prelabor rupture of membranes, and childhood neurodevelopmental impairment. The most prevalent predisposing condition is preterm prelabor rupture of membranes, followed by intrauterine pregnancy with a retained intrauterine contraceptive device, cervical cerclage, diabetes in pregnancy, and pregnancy after in vitro fertilization. Preterm labor is the most common symptom with Candida IAI, and only 13% of cases involved fever. Case reports have also associated C. Glabrata with third trimester stillbirth. Although case reports have documented this since the 1980s, this is still an evolving diagnosis as awareness of the condition increases. Nonetheless, the clinical features of Candida IAI are not well understood, and best management of the condition is unclear. In June 2024, Candida Glabrata was called a “global priority pathogens”. In this episode, we will review this rare but very real clinical conundrum. One of our podcast family members actually managed a patient, s/p IVF, with periviable PPROM found to have Candida Glabrata fungemia. How is this possible? Shall we treat Candida in the urine? We will discuss this in this episode.Jul 24, 202438:50
