Podcasts about AOG

What if the three most powerful words you could ever say to God are not “Send me”… but “Here I am”?In this inspiring message, Ps Byron explores Isaiah 6 and the Hebrew word Hineni—a response that means far more than simply being present. It speaks of a heart that is available, attentive, surrendered, and ready for God's purposes.Against the backdrop of a beautiful yet broken world, we're reminded that Jesus came for every person: the hurting, the hungry, the forgotten, the searching, and the successful-but-empty. And remarkably, God chooses to work through ordinary people to bring hope and healing.In this message: Why our world is both beautiful and broken  Isaiah's life-changing response: “Here I am. Send me.”  The deeper meaning of the Hebrew word Hineni Four powerful responses to God: Presence – “I am here” Attention – “I am listening” Availability – “I am ready” Surrender – “I am yours to send”  What Abraham, Moses, Ananias, and Jesus teach us about living available to God  Practical ways to live out a lifestyle of “Here I am” God isn't looking for perfection, influence, or extraordinary ability. He's looking for hearts willing to say, "Here I am."The greatest tragedy is not that there is so much need in the world. The greatest tragedy is when those who hear God's voice never respond.Here I am, Lord. Send me.Key Scriptures Isaiah 6:1–8  Genesis 22:1, 7, 11  Exodus 3:4  Acts 9:10  Hebrews 10:7 Key Takeaway"The promises of God are wrapped up in Christ-followers who are present, paying attention, available, and surrendered." — Ps Byron ChickenConnect With UsIf this message encouraged you, be sure to subscribe, share it with a friend, and join us as we continue our Send Me series.⛪ Thrive Church Helping people move towards Jesus.

The American College of Obstetricians and Gynecologists (ACOG) does not recommend routine ultrasound measurement of the lower uterine segment (LUS) thickness as part of the evaluation for trial of labor after cesarean delivery (TOLAC). ACOG Practice Bulletin No. 205 (2019) on Vaginal Birth After Cesarean Delivery does not include LUS measurement among its recommendations for TOLAC candidacy assessment. The guideline focuses on clinical factors such as type of prior uterine incision, number of prior cesarean deliveries, and other obstetric history to determine TOLAC candidacy, and emphasizes that most women with one previous low-transverse cesarean delivery should be counseled about and offered TOLAC. But what if you find a likely uterine window at the LUS? Does that mandate a repeat C-section? This topic comes from Serena, one of our podcast family members. Listen in for details. 1. Dr. Chapa's Clinical Pearls, Dec 31., 2023: LUST FOR TOLAC; and follow up episode Jan 15, 20242. ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery. Committee on Practice Bulletins—Obstetrics Obstetrics and Gynecology. 2019;133(2):e110-e127. doi:10.1097/AOG.0000000000003078.3. Rozenberg P, Sénat MV, Deruelle P, et al. Evaluation of the Usefulness of Ultrasound Measurement of the Lower Uterine Segment Before Delivery of Women With a Prior Cesarean Delivery: A Randomized Trial. American Journal of Obstetrics and Gynecology. 2022. 4. Swift BE, Shah PS, Farine D. Sonographic Lower Uterine Segment Thickness After Prior Cesarean Section to Predict Uterine Rupture: A Systematic Review and Meta-Analysis. Acta Obstetricia Et Gynecologica Scandinavica. 2019. 5. McLeish SF, Murchison AB, Smith DM, et al. Predicting Uterine Rupture Risk Using Lower Uterine Segment Measurement During Pregnancy With Cesarean History: How Reliable Is It? A Review. Obstetrical & Gynecological Survey. 2023. 6. Jastrow N, Demers S, Chaillet N, et al. Lower Uterine Segment Thickness to Prevent Uterine Rupture and Adverse Perinatal Outcomes: A Multicenter Prospective study.7. American Journal of Obstetrics and Gynecology. 2016. 8. Guerby P, Bujold E, Chaillet N. Impact of Third-Trimester Measurement of Low Uterine Segment Thickness and Estimated Fetal Weight on Perinatal Morbidity in Women With Prior Cesarean Delivery. Journal of Obstetrics and Gynaecology Canada. JOGC. 2022.

Outside of pregnancy, guidelines emphasize diabetes self-management education and support to facilitate informed decision making, self-care behaviors, problem solving, and active collaboration with health care professionals. This includes, in those with good health literacy, the concept of patient-led self-titration of basal insulin results which has data that it improves glycemic management compared with clinician-led titration for type 2 diabetes among nonpregnant adults. But what about for GDM? Can patient's self manage their BASAL insulin? In this episode, we will review a new RCT published in April 2026 in the Green Journal on this very subject. As novel as this is, it is not the first to report on this as it was also published (retrospective study in the UK) in 2022. This is a novel approach to insulin in GDM but there are some questions that remain. Listen in for details.1. Boonpattharatthiti K, Wechkunanukul K, Mayang N, et al . Comparison of Insulin Titration Strategies for Glycemic Control in Type 2 Diabetes: A Systematic Review and Network Meta-Analysis.Diabetes Care. 2025. 2. Valent, Amy M. DO, MCR; Barbour, Linda A. MD, MSPH. Insulin Management for Gestational and Type 2 Diabetes in Pregnancy. Obstetrics & Gynecology 144(5):p 633-647, November 2024. | DOI: 10.1097/AOG.00000000000056403. Wang, Xiao-Yu MD; Gabbe, Steven MD; Landon, Mark B. MD; Venkatesh, Kartik K. MD, PhD et al. Patient-Led Insulin Titration for Glycemic Management With Gestational Diabetes Mellitus: A Randomized Controlled Trial. Obstetrics & Gynecology 147(4):p 501-509, April 2026. 4. McGovern AP, Hirwa KD, Wong AK, et al. Patient-led rapid titration of basal insulin in gestational diabetes is associated with improved glycaemic control and lower birthweight. Diabet Med. 2022;39:e14926. doi: 10.1111/dme.14926

Hyperemesis gravidarum (HG) represents the most severe end of the nausea and vomiting of pregnancy spectrum. It has a reported incidence of approximately 0.3–3% of pregnancies and is the most common cause of hospitalization in early pregnancy and the second most common cause of hospitalization in pregnancy overall. In June 2024, the ACOG published a Clinical Expert series summarizing the inpatient management of HG. In that guidance, it describes mirtazapine as an “alternative pharmacologic” option. How effective is this medication compared to ondansetron? A new study (published ahead of print on 12/30/25 and officially out June 2026), out of Denmark, sheds some new light on this medication. This trial is the first double-blind RCT comparing mirtazapine to ondansetron AND placebo. Although a BIG limitation of this study exists (which we will discuss), it does provide some interesting insights. Listen in for details.1. (ACOG CES) Clark, Shannon M. MD; Zhang, Xue MD; Goncharov, Daphne Arena MD. Inpatient Management of Hyperemesis Gravidarum. Obstetrics & Gynecology 143(6):p 745-758, June 2024. | DOI: 10.1097/AOG.00000000000055182. Ostenfeld, AnneDroogh, Marjoes et al.Mirtazapine or ondansetron for hyperemesis gravidarum. A randomized placebo-controlled trial. American Journal of Obstetrics & Gynecology, June 2026

Episode DescriptionIn this powerful Mother's Day message, Ps Cathy Leicher honours every kind of mother and speaks life into the sacred calling of raising children. With honesty, humour, and biblical wisdom, she unpacks the challenges of parenting, the importance of balance, and the eternal impact of training children in the ways of God. Whether you are a parent, spiritual leader, or simply reflecting on your own upbringing, this message will encourage you to build faith into the next generation with intention and grace.Key Scriptures Deuteronomy 6:5–7 — Love God and teach His ways to your children  Proverbs 22:6 — Train up a child in the way they should go  John 14:6 — Jesus is the way, the truth, and the life  Luke 15:11–32 — The Prodigal Son Big Ideas from the Message1. Every mother matters Biological, adoptive, step, foster, spiritual, and expectant mothers are all honoured and celebrated. Motherhood carries deep responsibility and grace.2. Parenting requires balance Avoid extremes: Too soft → entitlement, lack of boundaries  Too harsh → rebellion, bitterness Healthy parenting finds the “just right” balance of love and discipline. 3. Over-parenting can hinder growth From “helicopter” to “lawnmower” parenting, overprotection can prevent children from developing responsibility, resilience, and confidence.4. Faith must not be withheld Children need consistent spiritual guidance. The greatest gift a parent can give is introducing their children to Jesus early.5. Train, show, and equip Train: Build daily habits of faith and life skills  Show: Model Jesus in everyday life  Equip: Prepare children to walk in their own faith journey Key Highlights Parenting is not about perfection, but grace, prayer, and consistency  Children are shaped most in the early years (4–14 “window of opportunity”)  Legacy is not what you leave behind, but what you leave within people  Even wayward children are never beyond prayer and restoration  The Father heart of God is seen in the story of the Prodigal Son Practical Takeaways Start with your own relationship with God before teaching others  Create daily rhythms of faith in your home (conversation, prayer, Scripture)  Step back where necessary to allow children to grow responsibility  Avoid extremes—lead with love, structure, and wisdom  Never stop praying for your children, no matter their season Closing Prayer EmphasisA call to commit children—and ourselves—to God's guidance, trusting Him to lead the next generation into truth, restoration, and purpose through Jesus Christ.⛪ Thrive Church Helping people move towards Jesus.

Faithful In The Small ThingsA message on habits, identity, and long-term faithfulness through the story of David and Goliath.Episode SummaryIn this powerful message, Ps Khulu Duma reminds us that David's victory over Goliath wasn't a random miracle moment — it was the result of years of faithfulness in unseen places. Long before the giant fell, David was faithfully practicing with his sling, protecting sheep, and developing character in private.This sermon challenges us to stop despising small beginnings and to recognize that the small habits, disciplines, and decisions we make consistently are shaping who we become. Whether it's prayer, generosity, discipline, health, relationships, or leadership — God honors faithfulness in the small things.The key question isn't just “What do I want to do?” but “Who am I becoming?”Key Scriptures 1 Samuel 17  Matthew 25:21  Ephesians 4:22–24  Galatians 6:9  Zechariah 4:10 Key Takeaways Public victories are built in private faithfulness.  Small consistent habits create massive long-term change.  Identity shapes habits, and habits reinforce identity.  Start with “Who am I becoming?” before asking “What must I do?”  God rejoices in small beginnings.  Repeated faithfulness leads to spiritual harvest. Practical Habits Mentioned:Spiritual Health Think same time + ahead of time for devotional rhythms.  Pre-plan Bible reading and prayer times. Emotional Health Use physical cues before reacting.  Pause and ask: “Will my response build or break this relationship?”Physical Health Make healthy habits obvious and accessible.  Reduce friction for exercise and hydration. Finances Automate giving and saving on payday.  Build faithful stewardship through consistency. Family Schedule intentional family time.  Put what matters most in the calendar. Reflection Questions What small habit is God asking you to stay faithful in?  Who are you becoming?  What repeated actions are shaping your future?  Are there any “small beginnings” you've been tempted to despise? Next StepsThis week: Write down who you want to become.  Choose one small habit to repeat consistently.  Pray for God to strengthen your identity in Christ.  Don't underestimate the impact of small faithful steps.⛪ Thrive Church Helping people move towards Jesus.

The belief that IV dextrose is necessary to clear ketones in hyperemesis gravidarum originated from a logical, and now known to be outdated, extrapolation of basic starvation ketosis physiology and the treatment paradigm for diabetic ketoacidosis (DKA). The original experiments that led to this conclusion go back to the 1960s (Foster data). Not only is this outdated, but it is also physiologically incorrect. We've learned a lot about IV fluid replacement about hyperemesis gravidarum in the last several years- in the last data review was in January 2026 in Lancet. Even the correction of hyponatremia has evolved. Should we be following urine ketones for patients being treated for HG? Is Dextrose needed? Listen in for details.1. Nana M, Painter R, Williamson C et al. Hyperemesis gravidarum. The Lancet, Jan 2026; 407, 78-892. Clark SM, Zhang X, Goncharov DA. Inpatient Management of Hyperemesis Gravidarum. Obstet Gynecol. 2024 Jun 1;143(6):745-758. doi: 10.1097/AOG.0000000000005518. Epub 2024 Feb 1. PMID: 38301258.3. Ayus JC, et al.Correction rates and clinical outcomes in hospitalized adults with severe hyponatremia: a systematic review and meta-analysis. JAMA Intern Med. 2025;185(1):38-51. 4. ACOG Clinical Epert Series: Inpatient Management of Hyperemesis Gravidarium. Obstet Gynecol; 2024

Faithful When It's Costly.Faithfulness isn't built in a moment—it's formed over a lifetime. In this powerful message, Ps Byron Chicken unpacks Jesus' radical call to steadfast loyalty, sacrificial love, and daily surrender.In a world that celebrates convenience and keeps options open, biblical faithfulness can feel costly. But whether it's in our relationships, convictions, calling, finances, or walk with God, faithfulness remains one of the highest virtues we can pursue—and it's always worth it.Jesus calls us to: • Give up our own way • Take up our cross • Follow HimFollowing Jesus rarely means one dramatic decision. More often, it means a thousand small choices, made faithfully, day after day.If you've been tempted to quit, compromise, or take the easier road, this message will strengthen your resolve and remind you that a faithful life becomes a source of life for others.Key Scripture: Matthew 16:21–25In This Message: Why faithfulness is the backbone of flourishing lives and societies  The real cost of following Jesus  How to stay faithful in a culture of convenience  Practical ways to live with courage, generosity, and conviction⛪ Thrive Church Helping people move towards Jesus.

Title: Faithful in the Waiting Speaker: Donovan CogillDescription: Waiting is hard. Whether it's for answers, breakthrough, or God to move—waiting can feel slow, silent, and even discouraging. But what if God is doing His greatest work in the waiting?In this message, Faithful in the Waiting, we're reminded that delay is not denial. Through the lives of Joseph, Abraham, and David, we see a powerful pattern: the promise, the waiting, the fulfillment. And in the middle of it all, a call to remain faithful.Key Takeaways:God works in the waiting When it feels like nothing is happening, God is still moving—often in ways we cannot see. Delay is not denial Just because it hasn't happened yet doesn't mean it won't. The waiting shapes you What happens in the “middle” prepares you for what God has promised. How to Stay Faithful While You Wait:Keep doing the right things (Joseph) Faithfulness is proven in the waiting, not the breakthrough. God is not just working for you—He's working in you. Believe God's promises (Abraham) What you believe shapes who you become. Even when circumstances say otherwise, choose to trust what God has said. Trust God's timing (David) Don't rush the process or take shortcuts. God is never late—He is always on time. Powerful Truths: “God does His greatest work in the waiting.”  “Delay is not denial.”  “Faith isn't proven in the breakthrough—it's proven in the waiting.”  “God will never promote you into something your character cannot sustain.” Scripture References: Genesis 39 (Joseph's faithfulness)  Romans 4:18–22 (Abraham's faith)  1 Samuel 24:4–7 (David's restraint)  Galatians 6:9 (Don't grow weary in doing good)  Isaiah 60:22 (God's perfect timing) Final Encouragement: If you're in a season of waiting, don't give up. God hasn't forgotten you. He is faithful—yesterday, today, and forever.Stay faithful. Keep trusting. At the right time, He will come through.⛪ Thrive Church Helping people move towards Jesus.

Title: Faithful When We're Faithless Speaker: Ps Amy-Jane DumaDescription: We all experience seasons—moments where faith feels strong and others where fear, disappointment, or uncertainty make it hard to believe. In this powerful message, Ps Amy-Jane reminds us of an unchanging truth: God remains faithful, even when we feel faithless.Through personal stories and the life of Peter, we see that God's faithfulness isn't dependent on our performance—it's rooted in His character. His love sees us, pursues us, and restores us.Key Scripture: 2 Timothy 2:13 – “If we are faithless, He remains faithful, for He cannot deny Himself.”Key Thought: God's faithfulness is not dependent on our faithfulness.3 Truths About God's Faithfulness: • He sees you – Even in your weakest, most faithless moments, God looks at you with love, not condemnation. • He pursues you – When you drift, He draws near. His love doesn't give up on you. • He restores your purpose – God doesn't just forgive; He reaffirms your calling and trusts you again.Illustration: Like sitting on a chair without hesitation, we can trust God to hold us—even when we can't see or feel Him. His faithfulness remains constant.Application:

Iron-deficiency anemia during pregnancy is associated withseveral adverse pregnancy outcomes, including severe maternal morbidity, preeclampsia, placenta previa, and placental abruption. It makes sense that diagnosing and treating anemia and its underlying causes in earlypregnancy may reduce the risk of adverse outcomes, but evidence has been scarce…until now. In this episode, we will review a new retrospective study based on nationwide data that examines this very issue (Green journal, April 2026).Listen for details. 1.  Booman A, Bateman BT, Siadat S, Berube C, Igbinosa I, Leggett C, Lyell DJ, Main EK, Leonard SA. Pregnancy Outcomes Associated With Anemia in the First Trimesterand Anemia Resolution by Late Pregnancy. Obstet Gynecol. 2026 Apr 1;147(4):518-527. doi: 10.1097/AOG.0000000000006183. Epub 2026 Feb 6. PMID:41643193; PMCID: PMC12880618.2.  ACOG OCC 5: Severe Maternal Morbidity: Screening and Review; 2016 and reaffirmed 20253.  ACOG PB 233

Jesus Over Everything | Easter Sunday 2026 What changed when the power of God returned to the tomb? Everything.In this Resurrection Sunday message, Ps. Byron Chicken unpacks the life-changing reality that Easter is not only about an empty tomb, but about the power of God breaking into human history and proving that Jesus is over everything.Looking at Matthew 28 and key New Testament passages, this sermon explores three great enemies every person faces:1. Jesus is over sin Sin is more than bad behavior. It is saying no to God and yes to ourselves. It is the root of our brokenness, damaged relationships, and inner struggle. But through the resurrection, Jesus broke the power of sin. Its grip can be weakened, its destruction can be stopped, and our lives can be changed as we become more like Christ.2. Jesus is over Satan The resurrection declared Christ's victory over the enemy of our souls. Satan may still accuse, but his accusations have lost their authority. The courtroom is closed, the sentence has been served, and because of Jesus, we now live from a place of grace, victory, and freedom.3. Jesus is over death Death no longer has the final word. Through the resurrection, death has been turned from a full stop into a comma. For those who belong to Jesus, death is no longer the end, but the doorway into eternal life in the presence of God.With humour, hope, and powerful illustrations, Ps. Byron reminds us that what looked like defeat on Friday became total victory on Sunday. Jesus is over sin. Jesus is over Satan. Jesus is over death.If you are feeling spiritually dry, disconnected, or ready to make Jesus Lord over your life, this message is a powerful Easter reminder that resurrection power changes everything.Scripture references: Matthew 28:1–7, Romans 6:5–11, Colossians 2:15, 1 Corinthians 15:51–57⛪ Thrive Church Helping people move towards Jesus.

What makes Good Friday “good”? In this powerful Good Friday message, Ps. Candice Chicken unpacks the tension of the cross: physically, it was a horrific day of suffering, sorrow, and grief — but spiritually, it was astounding.Looking at Isaiah 53, this sermon explores the deeper meaning behind Jesus' crucifixion and why His death was unlike any other. While crucifixion was common in the Roman world, what made Jesus' cross different was the spiritual reality of what took place there.In this message, we discover two life-changing truths:Jesus is over our suffering Jesus carries our weakness, enters our sorrow, and brings healing and wholeness through the cross. Whether you are facing anxiety, grief, disappointment, fatigue, illness, or deep personal pain, this message is a reminder that you do not suffer alone.Jesus is over our sin Ps. Candice explains the biblical meaning of atonement, showing how the Old Testament sacrifices pointed toward Jesus — the spotless Lamb of God who gave His life once and for all. Through His blood, our sin is forgiven, our shame is removed, and we can be made right with God.This message is both deeply reflective and full of hope, ending with a call to respond to Jesus and receive His forgiveness, freedom, healing, and grace.Key Scripture: Isaiah 53 Also referenced: 2 Corinthians 12, Romans 6:23, 1 John 1:7, Revelation 21If this message encouraged you, be sure to share it and join us again as we continue the Easter journey.⛪ Thrive Church Helping people move towards Jesus.

Rich and Ed are riffing about everything - and have THE ANSWER!Most importantly whether an air rifle or cross bow is better at defending procurement teams from chicken attack drones.Plus everything you needed to know about procurement; supply chain; risk; AOG; CIPS; buying Chinese chickens; weaponising supply chain; war in the middle east; and AI replacing your procurement role.And SIG - Sourcing Industry Group or Spectrum is Green (with thanks to Captain Scarlet), and the latest dead member of Motorhead.And why cats protect you on the toilet.So get ready to update your supply chain disruption excel spreadsheet.The only procurement podcast listened to in space.  Possibly.Become a supporter of this podcast: https://www.spreaker.com/podcast/procurement-says-no--5886102/support.

Ps Candice Chicken continues our Us – Growing Greater Relationships series with a powerful message on the difference between relationship breakers and relationship builders.In a world that often pushes selfishness, grudges, hurtful words, and distracted listening, Jesus shows us a better way to live and relate. This message unpacks four relationship breakers that damage connection, and four relationship builders that bring healing, strength, and unity.In this message, you'll discover how to: • Put others first instead of living “me first” • Extend grace instead of holding grudges • Use words to build up instead of tear down • Listen with your heart instead of being distractedPs Candice reminds us that healthy, life-giving relationships do not happen by accident. They are built as we follow the example and teaching of Jesus. With practical daily questions and simple habits, this message helps you identify one area to work on and start making changes immediately.This sermon also carries a heartfelt call to reconciliation — not only with others, but ultimately with God. Through the story of a father and son restored after years of distance, we're reminded that it's never too late for healing, forgiveness, and peace.If you're longing for stronger relationships, deeper connection, and a more Christ-centered way of living, this message is for you.Let Jesus show you a better way to build.⛪ Thrive Church Helping people move towards Jesus.

Platelet-rich plasma (PRP) injections do not have formal FDA approval for specific clinical indications. PRP is regulated as an autologous blood product and is used "off-label" in clinical practice. However, there is substantial clinical evidence supporting its use for certain dental surgeries and musculoskeletal conditions, particularly lateral epicondylitis, knee osteoarthritis, and plantar fasciitis. The American Medical Society for Sports Medicine notes that PRP is primarily used to treat tendinopathies and osteoarthritis, though clinical efficacy results remain mixed due to variability in PRP formulations and preparation methods. As of now, there are no FDA approved uses for PRP for gynecologic use, although there has been some evidence of possible benefit in vulvar dermatoses and possiblt ovarian function enhancement. But what about its use in the vagina for sexual pleasure? Injecting into the anterior vaginal wall (around the famed G-Spot location) is nothing new. Over a decade ago, a TV show introduced the masses to the “G-Spot amplication” shot which injected collagen to that area. But there was no data for this. Well, we are back to this idea in a new RCT in the Green Journal. Can PRP light up the vaginal fires of pleasure? Listen in for details. 1. Clarke, Bayley MD; Gaddam, Neha MD; Garcia, Bobby MD; Iglesia, Cheryl B. MD; Podolsky, Robert PhD; Dieter, Alexis A. MD. Vaginal Injection of Platelet-Rich Plasma for Sexual Function: A Randomized Controlled Trial. Obstetrics & Gynecology ():10.1097/AOG.0000000000006256, March 19, 2026. | DOI: 10.1097/AOG.00000000000062562. Finnoff JT, Awan TM, Borg-Stein J, et a American Medical Society for Sports Medicine Position Statement: Principles for the Responsible Use of Regenerative Medicine in Sports Medicine. Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2021. 3. Alsousou J, Ali A, Willett K, Harrison P. The Role of Platelet-Rich Plasma in Tissue Regeneration.Platelets. 2012.

Well, it's no doubt we live in a culture of immediate gratification. When we need to know something, we must know it immediately! This even applies to couples seeking pregnancy and their desire to find out if their monthly attempts have been successful. However, there is a problem with trying to prove pregnancy too promptly. In this episode, we will review a new publication just released on March 1st, 2026 out of the Green journal. These authors evaluated a prospective cohort (PRESTO cohort) of pregnancy planners to analyze their pregnancy test taking behaviors and their outcomes. The results are eye-opening. So, when is the best time to check a pregnancy test? Listen in for details. 1. Sundermann AC, Jasper EA, Jukic AMZ, Rothman KJ, Wise LA. Pregnancy Test Use and Timing of Pregnancy Detection in a Prospective Cohort of Pregnancy Planners. Obstet Gynecol. 2026 Mar 1;147(3):394-403. doi: 10.1097/AOG.0000000000006157. Epub 2026 Jan 8. PMID: 41505757; PMCID: PMC12788791.2. Wilcox AJ, Baird DD, Dunson D, McChesney R, Weinberg CR. Natural Limits of Pregnancy Testing in Relation to the Expected Menstrual Period. The Journal of the American Medical Association. 2001.

Podcast family we've all heard the rumors that oursmartphones are “LISTENING TO US”. Well, some of that is actually true, and trust me I'm not a conspiracy theorist. Our smartphones are capable of remarkable things. A new publication from the Green journal (released ahead ofprint on 03/05/2026 ) is proposing that it may now be able to detect fetal movement, fetal breathing, and even fetal hiccups when placed over the abdomen! Yep, it's not science fiction... it's science innovation. While this is not ready for prime time just yet, the science is absolutely astounding. In this quicky episode we will briefly summarize a fascinating new innovative study which proposes that our iPhones may be able to be a fetal movement detector.1.     Moise, Kenneth Jr MD; Gaither, Kelly PhD;Madden-Rusnak, Anna PhD; Lowry, Kathy RN, MSN; Hutson, Emily RN, MSN; Bruns, Danielle RDMS; Valero, Reinaldo MD, RDMS. Smartphone Detection of FetalMovements Using Artificial Intelligence. Obstetrics & Gynecology ():10.1097/AOG.0000000000006228, March 5, 2026. | DOI:10.1097/AOG.00000000000062282.     Lai J, Woodward R, Alexandrov Y, et al Performanceof a Wearable Acoustic System for Fetal Movement Discrimination. PloS One. 2017. 3.     Ashik AK, Gutierrez R, Ashraf F, et al. AMachine Learning Model for Assessing Fetal Health During Pregnancy. Frontiers in Bioengineering and Biotechnology. 2025. 4.     Antepartum Fetal Surveillance: ACOG PracticeBulletin, Number 229. Obstetrics and Gynecology. 2021.5.     Monitoring a Pregnancy at Home With a SmartphoneThis wearable device provides real-time ECG monitoring of a fetus: https://spectrum.ieee.org/pregnancy-heartbeat-monitor-smartphone

Neither the ACOG nor SMFM recommend strict bed rest for preterm birth prevention, or nor preeclampsia. Yet tradition often conflicts with evidence. A prior 2009 survey of MFM specialists, published in the AJOG, on the use of bed rest revealed that 71% used activity restriction in their practice for arrested preterm labor, despite the majority believing it had minimal or no benefit. The authors concluded, “Because most obstetricians in our survey indicated they would prescribe bed rest believing it was associated with minimal or no benefit, it is possible that even if a randomized, prospective trial showed no benefit associated with bed rest, it would still remain a common recommendation.” This brings us to a brand new publication from the Green Journal which is an ancillary study of two randomized trials of preterm birth prevention in women with a short cervical length. These authors sought to evaluate the amount of physical activity in patients at high risk for preterm birth and pregnancy latency and preterm birth. What did they find? It is a bit shocking. Listen in for details.1. Fox, Nathan S. et al. The recommendation for bed rest in the setting of arrested preterm labor and premature rupture of membranes. American Journal of Obstetrics & Gynecology, Volume 200, Issue 2, 165.e1 - 165.e6 https://www.ajog.org/article/S0002-9378(08)00909-5/fulltext2. Sciscione, Anthony C. DO; Booker, Whitney A. for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network, Bethesda, Maryland. Activity Restriction in Pregnancy and the Risk of Early Delivery: The AWARE Study. Obstetrics & Gynecology ():10.1097/AOG.0000000000006225, February 19, 2026. | DOI: 10.1097/AOG.0000000000006225 https://journals.lww.com/greenjournal/pages/articleviewer.aspx?year=9900&issue=00000&article=01460&type=FulltextVisit our SPONSOR's Webpage for information on the Hemorrhage View C-Section Drape: www.perspectivemedical.org

We recently covered an SMFM abstract that was presented at the annual Pregnancy Meeting held in early February 2026. The authors were from my Alma Mater, UT Southwestern/Parkland Hospital. This was a well-done study comparing 162 milligrams aspirin to 81 milligrams of aspirin. The results were very encouraging! However, aspirin definitely has an awkward acumen. It would be wonderful if ALL the data just leaned in the same direction... but it doesn't! Enter our podcast family member, and my friend Alex. Alex sent me an incredible and insightful message which was a rebuttal to my Southwestern colleagues' findings. In this episode you'll hear Alex's rebuttal and clinical conundrum, and we will explain why these two seemingly paradoxical findings makes sense. Listen in for details.1. Khander, Amrin MD; Thomas, Charlene MS; Matthews, Kathy MD; Christos, Paul DrPH; Alcus, Claire BA; Alam, Tanvir BS; Bush, Leah BA; Deshmukh, Diksha BA; Chasen, Stephen T. MD; Riley, Laura E. MD; Skupski, Daniel W. MD; August, Phyllis MD, MPH; Malha, Line MD, MS. Comparison of 162 mg and 81 mg Aspirin for Prevention of Preeclampsia: A Randomized Controlled Trial. Obstetrics & Gynecology 147(1):p 87-96, January 2026. | DOI: 10.1097/AOG.0000000000006100

There has been a shift in cervical cancer screening from primary cytology based to HPV based. Even HPV screening has had its evolution from physician collected samples to patient self-collection, either in a clinical setting or at home with an approved collection system. In May 2025, the FDA cleared the first at-home self-collection kit for HPV screening, specifically the Teal Wand by Teal Health. Now, we are seeing the advent of POSSIBLY another avenue for cervical HPV testing- although it is a bit awkward: the use of menstrual blood as an HPV screening test. In this episode we will review a new cross-sectional, population-based study from China which compared testing menstrual blood for human papillomavirus during cervical cancer screening to clinician-collected cervical samples for human papillomavirus (HPV). This concept, and these results, are not new at all! And there are important limitations to consider at this time. Listen in for details.1. Testing menstrual blood for human papillomavirus during cervical cancer screening in China: cross sectional population based study. BMJ 2026; 392 doi: https://doi.org/10.1136/bmj-2025-084831 (Published 04 February 2026)BMJ 2026;392:e084831https://www.bmj.com/content/392/bmj-2025-0848312. Naseri S, Young S, Cruz G, Blumenthal PD. Screening for High-Risk Human Papillomavirus Using Passive, Self-Collected Menstrual Blood. Obstet Gynecol. 2022 Sep 1;140(3):470-476. doi: 10.1097/AOG.0000000000004904. Epub 2022 Aug 3. PMID: 35926207; PMCID: PMC9377370.3. Fokom Domgue J, Chandra M, Oladoyin O, Desai M, Yu R, Shete S. Women's Preferences for Home-Based Self-Sampling or Clinic-Based Testing for Cervical Cancer Screening. JAMA Netw Open. 2026;9(2):e2558841. doi:10.1001/jamanetworkopen.2025.58841

We have covered the subject of whether to include the decidual (innermost) layer when closing the uterine incision during cesarean section (CS) on at least 2 episodes. The most recent was in September 2025, when we focused on a published (September 2025) systematic review and meta-analysis from the Green Journal. Back then, we compared those new findings to our prior episode from 2023 on the same matter. Well, we are back at it again with the same subject as there is a new EXPERT REVIEW from the AJOG on hysterotomy closure technique which just came out January 2026. What did these authors conclude? There are also some controversial suggestions made by the authors. Listen in for details. 1. Antoine C, Meyer JA, Silverstein J, Buldo-Licciardi J, Lyu C, Timor-Tritsch IE. Endometrium-Free Closure Technique During Cesarean Delivery for Reducing the Risk of Niche Formation and Placenta Accreta Spectrum Disorders. Obstet Gynecol. 2025 Jun 1;145(6):674-682. doi: 10.1097/AOG.0000000000005813. Epub 2025 Jan 9. PMID: 39787602. 2. Gialdini, Celina et al.Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews. eClinicalMedicine- Lancet (June 2024), Volume 72, 102632 3. Dahlke, Joshua D. MD; Mendez-Figueroa, Hector MD; Maggio, Lindsay MD, MPH; Sperling, Jeffrey D. MD, MS; Chauhan, Suneet P. MD, Hon DSc; Rouse, Dwight J. MD. The Case for Standardizing Cesarean Delivery Technique: Seeing the Forest for the Trees. Obstetrics & Gynecology 136(5):p 972-980, November 2020. | DOI: 10.1097/AOG.0000000000004120 4. Antoine C, Timor-Tritsch IE, Bujold E, Young BK, Reece EA. Endometrium-free closure technique for hysterotomy incision at cesarean delivery. Am J Obstet Gynecol. 2026 Jan;233(6S):S103-S114. doi: 10.1016/j.ajog.2025.07.009. PMID: 41485813.

Back in March of 2025, the green journal (obstetrics andgynecology) published A systematic review and meta-analysis on 2 medications (non-hormonal) and their efficacy in menopausal hot flash relief period these medications were Fezolinetant and Elinzanetant. However, the editors have just recently released an “Expression of Concern” about this review. Listen in for details. 1.     Menegaz de Almeida, Artur MS; Oliveira, PalomaMS; Lopes, Lucca MD; Leite, Marianna MS; Morbach, Victória MS; Alves Kelly,Francinny MD; Barros, Ítalo MS; Aquino de Moraes, Francisco Cezar MS;Prevedello, Alexandra MD. Fezolinetant and Elinzanetant Therapy for MenopausalWomen Experiencing Vasomotor Symptoms: A Systematic Review and Meta-analysis.Obstetrics & Gynecology 145(3):p 253-261, March 2025. | DOI:10.1097/AOG.00000000000058122.     Expression of Concern: Fezolinetant andElinzanetant Therapy for Menopausal Women Experiencing Vasomotor Symptoms: ASystematic Review and Meta-Analysis. Obstetrics & Gynecology():10.1097/AOG.0000000000006180, January 16, 2026. | DOI: 10.1097/AOG.0000000000006180

Ursodiol (ursodeoxycholic acid) is a prescription bile acid medication used to dissolve cholesterol gallstones, prevent gallstones during rapid weight loss, and treat liver diseases like primary biliary cholangitis (PBC) by reducing toxic bile acids and cholesterol production. It works by changing bile composition, making it less saturated with cholesterol, and is available as oral medication. Of course, it is also the foundational medication for treatment of diagnosed Intrahepatic Cholestasis of Pregnancy (ICP). Does this medication reduce adverse perinatal outcomes? In this episode, we will review a new study from the Green Journal, which will be out in February 2026, examining the recurrence risk for ICP using data from NY. In a patient with prior history of ICP, is there any guidance on monitoring of serum bile acids in the subsequent pregnancy before symptoms develop? We will explain. PLUS we will review the data on whether Ursodiol may hold promise in recurrence prevention or in reduction of adverse outcomes once the condition is diagnosed. Listen in for details. 1. 2019: Chappell LC, Bell JL, Smith A, Linsell L, Juszczak E, Dixon PH, Chambers J, Hunter R, Dorling J, Williamson C, Thornton JG; PITCHES study group. Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomised controlled trial. Lancet. 2019 Sep 7;394(10201):849-860. doi: 10.1016/S0140-6736(19)31270-X. Epub 2019 Aug 1. PMID: 31378395; PMCID: PMC6739598. https://pubmed.ncbi.nlm.nih.gov/31378395/2. February 08, 2025: Rahim, Mussarat N et al. Pregnancy and the liver. The Lancet. 2021; Volume 405, Issue 10477, 498 – 513 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02351-1/fulltext3. SMFM CS 53; 20214. Rosenberg, Henri M. MD; Sarker, Minhazur R. MD; Ramos, Gladys A. MD; Bianco, Angela MD; Ferrara, Lauren MD; DeBolt, Chelsea A. MD. Intrahepatic Cholestasis of Pregnancy Recurrence in a Subsequent Pregnancy. Obstetrics & Gynecology 147(2):p 239-241, February 2026. | DOI: 10.1097/AOG.0000000000006033 https://journals.lww.com/greenjournal/fulltext/2026/02000/intrahepatic_cholestasis_of_pregnancy_recurrence.13.aspx5. Ovadia C, Sajous J, Seed PT et al. Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy: a systematic review and individual participant data meta-analysis. Lancet Gastroenterol Hepatol. 2021 Jul;6(7):547-558. doi: 10.1016/S2468-1253(21)00074-1. Epub 2021 Apr 27. PMID: 33915090; PMCID: PMC8192305.6. EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy. European Association for the Study of the Liver; 2023

In this sponsored podcast hear from Stuart Gerrett, Sales Director for Precision Logistics at Marken, who discusses the aviation industry's parts crisis and how precision logistics strategies from the pharmaceutical sector could help solve the growing aircraft on ground (AOG) challenge. Find out more here

An easy way to learn APGAR, a scoring system designed to assess newborns. Includes APGAR mnemonic! PDFs available here: https://rhesusmedicine.com/pages/paediatricsConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Buy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is the APGAR Score?0:19 APGAR Score Mnemonic1:50 APGAR Score Interpretation / APGAR Score MeaningMSD Manual Professional Edition (2025) Neonatal resuscitation. MSD Manual Professional Edition. Available at: https://www.msdmanuals.com/professional/pediatrics/perinatal-problems/neonatal-resuscitation MedlinePlus (2024) Apgar score. MedlinePlus Medical Encyclopedia. Available at: https://www.medlineplus.gov/ency/article/003402.htm American College of Obstetricians and Gynecologists (2015) Committee Opinion No. 644: The Apgar score. Obstetrics & Gynecology, 126(4), pp.e52–e55. DOI: 10.1097/AOG.0000000000001108. Available at: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/10/the-apgar-score LINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/Disclaimer: Please remember this video and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition. The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice.

Uterine rupture or dehiscence associated with TOLAC results in the most significant increase in the likelihood of additional maternal and neonatal morbidity. It should be noted that the terms “uterine rupture” and “uterine dehiscence” are not consistently distinguished from each other in the literature and often are used interchangeably. Furthermore, the reported incidence of uterine rupture varies in part because some studies have grouped true, catastrophic uterine rupture together with asymptomatic scar dehiscence. In January 2026, a new meta-analysis examines the relationship between oxytocin use with TOLAC and uterine rupture. In this episode, we will summarize the key findings in that study and review the data on the use of internal monitors during TOLAC. Do internal monitors (FSE, IUPC) offer a safer TOLAC compared with external monitors? Listen in for details.1. Nicolì, Pierpaolo et al.Oxytocin dosing during trial of labor after cesarean to minimize the risk of uterine rupture: a systematic review and meta-analysisAmerican Journal of Obstetrics & Gynecology MFM, Volume 8, Issue 1, 1018462. Practice Bulletin No. 184: Vaginal Birth After Cesarean Delivery. Obstetrics & Gynecology 130(5):p e217-e233, November 2017. | DOI: 10.1097/AOG.00000000000023983. ACOG Clinical Practice Guideline No. 10:Intrapartum Fetal Heart Rate Monitoring: Interpretation and Management. Obstetrics & Gynecology 146(4):p 583-599, October 2025. | DOI: 10.1097/AOG.00000000000060494. Bruno AM, Allshouse AA, Metz TD. Maximum Oxytocin Dose and Uterine Rupture During Trial of Labor After Cesarean. Obstet Gynecol. 2025 Dec 1;146(6):843-850. doi: 10.1097/AOG.0000000000006106. Epub 2025 Oct 30. PMID: 41325062.

It's so interesting to see how medical evidence evolves, and changes, over time. The result of course is that clinical practice evolves and changes as well. The story of umbilical cord management at time of delivery highlights this very issue very well. The ACOG first recommended delayed cord clamping (DCC) in 2012, for preterm infants, as data showed marked improvement in neonatal outcomes in that population. In this episode, we will briefly walk through the timeline from 2012 to the latest update on DCC which came from the AAP in October 2025, just one month after the ACOG had their DCC update. This story also exemplifies how professional medical societies don't always have the SAME recommendations, with small tweaks, in their guidance. So, Dr Chapa and I will summarize these key updates…Listen in for details!1. ACOG 2012: DCC for preterm infants only 2. ACOG 2016: ACOG Recommends Delayed Umbilical Cord Clamping for All Healthy Infants, including term: https://mdedge.com/obgynnews/article/121349/obstetrics/acog-supports-delayed-umbilical-cord-clamping-term-infants3. ACOG Dec 2020, CO 814: Delayed Umbilical Cord Clamping After Birth4. ACOG Obstet Gynecol. January 2022; 139(1): 121–137. doi:10.1097/AOG.0000000000004625. Management of Placental Transfusion to Neonates After Delivery5. ACOG (ePUB July ) Sept 2025: ACOG releases a Clinical Practice Update: An Update to Clinical Guidance for Delayed Umbilical Cord Clamping After Birth in Preterm Neonates6. AHA/AAP Oct 2025 Update: Neonatal Resuscitation: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Misoprostol, as an E1 prostaglandin, is primarily used in obstetrics for cervical ripening (when the Bishop Score is under 6) and/or for labor INDUCTION (to begin labor). IV oxytocin is the principal agent used to augmentlabor, as needed, once labor has begun. In the US, misoprostol is not typically used after 4-6 cm cervical dilation. However, in a patient who requires augmentation,and who declines Pitocin while asking or oral misoprostol, can that be used? Is that evidence-based? The data may surprise you. Listen in for details. 1.     SOGC Guideline No. 432c: Induction of Labour Robinson,Debbie Campbell, Kim Hobson, Sebastian R. MacDonald, W. Kim Sawchuck, DianeWagner, Brenda et al. Journal of Obstetrics and Gynaecology Canada , Volume 45, Issue 1, 70 - 77.e32.     Bracken H, Lightly K, Mundle S, et al. OralMisoprostol Alone Versus Oral Misoprostol Followed by Oxytocin for Labour Induction in Women With Hypertension in Pregnancy (MOLI): Protocol for a Randomised Controlled Trial. BMC Pregnancy and Childbirth. 2021;21(1):537.doi:10.1186/s12884-021-04009-8.3.     Bleich AT, Villano KS, Lo JY, et al. OralMisoprostol for Labor Augmentation: A Randomized Controlled Trial. Obstetrics and Gynecology. 2011;118(6):1255-1260. doi:10.1097/AOG.0b013e318236df5b.4.     Ho M, Cheng SY, Li TC. Titrated Oral MisoprostolSolution Compared With Intravenous Oxytocin for Labor Augmentation: A Randomized Controlled Trial. Obstetrics and Gynecology. 2010;116(3):612-618. doi:10.1097/AOG.0b013e3181ed36cc. STRONG COFFEE PROMO CODE:https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Actinomyces species are considered part of the normal vaginal and urogenital tract flora. The percentage of Pap smears containing Actinomyces-like organisms varies but is most commonly reported as approximately 7% among women using IUDs. That number is supported by multiple sources, including the Infectious Diseases Society of America guideline and several clinical studies. The incidence can be higher or lower depending on the type of IUD; for example, copper IUDs have been associated with rates up to 20%, while levonorgestrel-releasing IUDs show lower rates around 2.9%. In women with an IUD, who are found to have this finding on their liquid-based Pap smear, what is the appropriate management? In this episode, which comes from one of our podcast family members, we will discuss this topic and it's management in both symptomatic and symptomatic (pelvic pain) IUD wearing women. 1. McHugh KE, Sturgis CD, Procop GW, Rhoads DD. The Cytopathology of Actinomyces, Nocardia, and Their Mimickers. Diagnostic Cytopathology. 2017;45(12):1105-1115. doi:10.1002/dc.23816.2. Practice Bulletin No. 186: Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Obstetrics and Gynecology. 2017;130(5):e251-e269. doi:10.1097/AOG.0000000000002400.3. Miller JM, Binnicker MJ, Campbell S, et al. Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 2024; ciae104. doi:10.1093/cid/ciae104.5. Carrara J, Hervy B, Dabi Y, et al. Added-Value of Endometrial Biopsy in the Diagnostic and Therapeutic Strategy for Pelvic Actinomycosis. Journal of Clinical Medicine. 2020;9(3):E821. doi:10.3390/jcm9030821.

Recurrent pregnancy loss (RPL) affects approximately 5% of couples and is an emotional burden on those affected. There is some evidence that vaginal progesterone supplementation may be considered in patients with recurrent pregnancy loss who are experiencing vaginal bleeding during the first trimester. But what about prophylactic low dose aspirin in the first trimester, or preconceptionally, for unexplained RPL? Is that evidence-based? A new publication from the SMFM's journal Pregnancy has examined this. Listen in for details. 1. 22 November 2025: Low-dose aspirin in unexplained recurrent pregnancy loss: A systematic review and meta-analysis (Pregnancy): https://obgyn.onlinelibrary.wiley.com/doi/10.1002/pmf2.700992. American College of Obstetricians and Gynecologists' Committee on Obstetric Practice, T. Flint Porter, Cynthia Gyanff-Bannerman, Tracy Manuck. Low-Dose Aspirin Use During Pregnancy. American College of Obstetricians and Gynecologists (2018)3. Naimi AI, Perkins NJ, Sjaarda LA, et al. The Effect of Preconception-Initiated Low-Dose Aspirin on Human Chorionic Gonadotropin-Detected Pregnancy, Pregnancy Loss, and Live Birth : Per Protocol Analysis of a Randomized Trial. Annals of Internal Medicine. 2021;174(5):595-601. doi:10.7326/M20-0469.4. Lee EE, Jun JK, Lee EB.Management of Women With Antiphospholipid Antibodies or Antiphospholipid Syndrome During Pregnancy. Journal of Korean Medical Science. 2021;36(4):e24. doi:10.3346/jkms.2021.36.e24.5. de Assis V, Giugni CS, Ros ST. Evaluation of Recurrent Pregnancy Loss. Obstet Gynecol. 2024 May 1;143(5):645-659. doi: 10.1097/AOG.0000000000005498. Epub 2024 Jan 4. PMID: 38176012.

Podcast Family, we have covered the subject of Measles previously on this show (links below). Those episodes were a preview of what has now been released ahead of print as a narrative review in the Green Journal! In this episode, we will summarize the KEY points of measles infection in pregnancy and re-state the “rule of 4” and the importance of the number 10 regarding this.1. Feb 24, 2025: Measles 101: https://open.spotify.com/episode/4lXrpqKTJPdDcTXPxpEmcb2. April 27, 2019: Measles!! ACOG Practice Advisory: https://creators.spotify.com/pod/profile/dr-hector-chapa/episodes/MEASLES---ACOG-practice-advisory-e3s1p43. Joseph, Naima T. MD, MPH. Measles in Pregnancy: Clinical Considerations and Challenges. Obstetrics & Gynecology ():10.1097/AOG.0000000000006126, November 14, 2025. | DOI: 10.1097/AOG.0000000000006126

Well, from time to time we cover RANDOM tidbits of information which cover RANDOM questions and/or RANDOM patient care issues that we encounter. In this episode we will cover one OB issue related to recurrent pregnancy loss, one GYN issue related to unilateral breast swelling in a patient with SLE, and one RANDOM life perspective response from a mock interview that I participated in for a residency candidate. Listen in fordetails!1.     Viviana DO; Giugni, Claudio Schenone MD; Ros, Stephanie T. MD, MSCI. Factor V and recurrent pregnancy loss: de Assis, Evaluation of Recurrent Pregnancy Loss. Obstetrics & Gynecology 143(5):p 645-659, May 2024. | DOI: 10.1097/AOG.0000000000005498Unilateral Breast Swelling with SLE: 2.     Voizard B, Lalonde L, Sanchez LM, et al. LupusMastitis as a First Manifestation of Systemic Disease: About Two Cases With a Review of the Literature. European Journal of Radiology. 2017;92:124-131. doi:10.1016/j.ejrad.2017.04.023.3.     Kinonen C, Gattuso P, Reddy VB. Lupus Mastitis:An Uncommon Complication of Systemic or Discoid Lupus. The American Journal of Surgical Pathology. 2010;34(6):901-6. doi:10.1097/PAS.0b013e3181da00fb.4.      Summers TA, Lehman MB, Barner R, Royer MC. Lupus Mastitis: A Clinicopathologic Review and Addition of a Case. Advances in Anatomic Pathology.2009;16(1):56-61. doi:10.1097/PAP.0b013e3181915ff7.5.     Jiménez-Antón A, Jiménez-Gallo D,Millán-Cayetano JF, Navarro-Navarro I, Linares-Barrios M. Unilateral Lupus Mastitis.Lupus. 2023;32(3):438-440. doi:10.1177/09612033221151011.STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

The ACOG acknowledges that maternal obesity affects labor curves and recommends allowing more time for cervical dilation before diagnosing labor arrest in obese patients. This approach aims to avoid unnecessary interventions, such as premature cesarean delivery, which may occur if standard labor curves are strictly applied to obese women. In this episode, we will review a new study from the AJOG (08 Nov 2025) which describes labor progression and duration according to maternal body mass index, validating the need (possibly) for a BMI -based labor curve. Has there been advocates of a BMI-based labor curve? Listen in for details.1. Edwards, Sara et al. Characterizing Labor Progression and Duration According to Maternal Body Mass Index. American Journal of Obstetrics & Gynecology, Volume 0, Issue 02. Lundborg L, Liu X, Åberg K, et al. Association of Body Mass Index and Maternal Age With First Stage Duration of Labour. Scientific Reports. 2021;11(1):13843. doi:10.1038/s41598-021-93217-5.3. Kominiarek MA, Zhang J, Vanveldhuisen P, et al. Contemporary Labor Patterns: The Impact of Maternal Body Mass Index. American Journal of Obstetrics and Gynecology. 2011;205(3):244.e1-8. doi:10.1016/j.ajog.2011.06.014.4. Norman SM, Tuuli MG, Odibo AO, et al. The Effects of Obesity on the First Stage of Labor.Obstetrics and Gynecology. 2012;120(1):130-5. doi:10.1097/AOG.0b013e318259589c.

Taking folic acid prior to conception and during pregnancy can help protect the unborn baby from developing abnormalities. Supplements are particularly important for women who have epilepsy, as anti-seizure medication (previously known as anti-convulsants or anti-epileptic drugs) can lead to a deficiency in folic acid. Until 2023, high doses of 4-5 mg per day were recommended. However, this has changed as the data has changed. Did you know the SMFM no longer recommends “high dose” folic acid preconceptionally for patients on seizure medications? This is also highlighted in a recently released epub from Obstetrics and Gynecology (Green Journal) on October 31, 2025. Listen in for details. 1. Mokashi, Mugdha MD, MPH; Cozzi-Glaser, Gabriella MD; Kominiarek, Michelle A. MD, MS. Dietary Supplements in the Perinatal Period. Obstetrics & Gynecology ():10.1097/AOG.0000000000006098, October 31, 2025. | DOI: 10.1097/AOG.00000000000060982. Asadi-Pooya AA. High dose folic acid supplementation in women with epilepsy: are we sure it is safe? Seizure. 2015 Apr;27:51-3. doi: 10.1016/j.seizure.2015.02.030. Epub 2015 Mar 7. PMID: 25891927.3. https://aesnet.org/about/aes-press-room/press-releases/guideline-issued-for-people-with-epilepsy-who-may-become-pregnant4. Turner C, McIntosh T, Gaffney D, Germaine M, Hogan J, O'Higgins A. A 10-year review of periconceptual folic acid supplementation in women with epilepsy taking antiseizure medications. J Matern Fetal Neonatal Med. 2025 Dec;38(1):2524094. doi: 10.1080/14767058.2025.2524094. Epub 2025 Jun 30. PMID: 40588438.5. https://www.aan.com/PressRoom/Home/PressRelease/5170#:~:text=The%20guideline%20recommends%20that%20people,and%20possibly%20improve%20neurodevelopmental%20outcomes.6. https://aesnet.org/about/aes-press-room/press-releases/guideline-issued-for-people-with-epilepsy-who-may-become-pregnant

Elinzanetant, sold under the brand name Lynkuet, receivedapproval from the U.S. Food and Drug Administration (FDA) on October 24, 2025, for the treatment of moderate to severe hot flashes due to menopause.  How is this different than Fezolinetant, which was approved in 2023? Listen in for details. 1.   Menegaz de Almeida, Artur MS; Oliveira, Paloma MS; Lopes, Lucca MD; Leite, Marianna MS; Morbach, Victória MS; Alves Kelly, Francinny MD; Barros, Ítalo MS; Aquino de Moraes, Francisco Cezar MS; Prevedello, Alexandra MD. Fezolinetant and Elinzanetant Therapy for Menopausal Women Experiencing Vasomotor Symptoms: A Systematic Review and Meta-analysis. Obstetrics & Gynecology 145(3):p 253-261, March 2025. | DOI: 10.1097/AOG.00000000000058122.     Pinkerton JV, Simon JA, Joffe H, Maki PM, NappiRE, Panay N, Soares CN, Thurston RC, Caetano C, Haberland C, Haseli Mashhadi N, Krahn U, Mellinger U, Parke S, Seitz C, Zuurman L. Elinzanetant for the Treatment of Vasomotor Symptoms Associated With Menopause: OASIS 1 and 2 Randomized Clinical Trials. JAMA. 2024 Aug 22;332(16):1343–54. doi: 10.1001/jama.2024.14618. Epub ahead of print. PMID: 39172446; PMCID: PMC11342219.3.     Cardoso F, Parke S, Brennan DJ, Briggs P,Donders G, Panay N, Haseli-Mashhadi N, Block M, Caetano C, Francuski M, Haberland C, Laapas K, Seitz C, Zuurman L. Elinzanetant for Vasomotor Symptomsfrom Endocrine Therapy for Breast Cancer. N Engl J Med. 2025 Aug 21;393(8):753-763. doi: 10.1056/NEJMoa2415566. Epub 2025 Jun 2. PMID: 40454634.STRONG COFFEE PROMO: 20% Off Strong CoffeeCompany https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

On January 18, 2020, we released an episode called “Vaginal Vit C for BV? Yep, it's DATA”. That was 5 years ago! Now, in the Green Journal, a new systematic review and meta-analysis is examining this subject….AGAIN. Plus, this is not the only systematic review to investigate this; a similar review was published in Acta Obstétrica e Ginecológica Portuguesa earlier this year (2025) in March. So, did we get it right 5 years ago? Can vaginal Vit C help in eliminating BV? Listen in for details!1. Khaikin, Yannay MD; Elangainesan, Praniya MD, MSc; Winkler, Eliot MD, MSc; Liu, Kuan PhD, MMath; Selk, Amanda MD, MSc; Yudin, Mark H. MD, MSc. Intravaginal Vitamin C for the Treatment and Prevention of Bacterial Vaginosis: A Systematic Review and Meta-analysis. Obstetrics & Gynecology ():10.1097/AOG.0000000000006092, October 23, 2025. | DOI: 10.1097/AOG.0000000000006092; https://journals.lww.com/greenjournal/pages/articleviewer.aspx?year=9900&issue=00000&article=01389&type=Fulltext2. Acta Obstétrica e Ginecológica Portuguesa (March 2025): chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://scielo.pt/pdf/aogp/v19n1/1646-5830-aogp-19-01-40.pdf3. Chapa Clinical pearls 2020: https://podcasts.apple.com/gh/podcast/vaginal-vit-c-for-bv-yep-its-data/id1412385746?i=1000463002444

I was recently asked to OPINE on the labor management for a patient who was receiving IV Pitocin for augmentation, who experienced a placental abruption. One physician stated that in "his opinion", Pitocin increased the risk of placental abruption intrapartum, a point which the original treating physician refuted. So, I was asked to be the "referee" on the play. IV Pitocin can result in some maternal-fetal complications but is abruption one of them as a stand-alone complication. Was the first reviewer's opinion correct? Listen in for details.1. Ben-Aroya Z, Yochai D, Silberstein T, Friger M, Hallak M, Katz M, Mazor M. Oxytocin use in grand-multiparous patients: safety and complications. J Matern Fetal Med. 2001 Oct;10(5):328-31. doi: 10.1080/714904358. PMID: 11730496.2. Morikawa M, Cho K, Yamada T, et al. Do Uterotonic Drugs Increase Risk of Abruptio Placentae and Eclampsia? Archives of Gynecology and Obstetrics. 2014;289(5):987-91. doi:10.1007/s00404-013-3101-8.3. ACOG: First and Second Stage Labor Management: ACOG Clinical Practice Guideline No. 8. Obstetrics and Gynecology. 2024;143(1):144-162. doi:10.1097/AOG.0000000000005447.4. Pitocin. FDA Drug Label. Food and Drug Administration Updated date: 2024-08-125. Litorp H, Sunny AK, Kc A. Augmentation of Labor With Oxytocin and Its Association With Delivery Outcomes: A Large-Scale Cohort Study in 12 Public Hospitals in Nepal.Acta Obstetricia Et Gynecologica Scandinavica. 2021;100(4):684-693. doi:10.1111/aogs.13919.

Current guidelines recommend universal collection of a vaginal-rectal swab for GBS colonization at 36-37 weeks and 6 days for the identification of patients who require intrapartum IV antibiotic coverage to prevent early onset neonatal GBS infection/sepsis. Recently, we had a patient in clinic whose GBS culture at 36 weeks was negative. Good right? Well, the patient was on amoxicillin at the time for pharyngitis. Did that course of oral PCN based therapy affect the GBS culture result? Should we believe that culture or could it be a false negative, demanding rescreen after therapy completion? There is currently a GAP here in the guidance. In this episode we will cover this controversial scenario, look at the data, and provide a real-world implementable approach to this case.1. Kim DD, Page SM, McKenna DS, Kim CM. Neonatal Group B Streptococcus Sepsis After Negative Screen in a Patient Taking Oral Antibiotics. Obstetrics and Gynecology. 2005;105(5 Pt 2):1259-61. doi:10.1097/01.AOG.0000159040.51773.bf.2. ACOG CO Number 797 (Replaces Committee Opinion No. 782, June 2019.); 20203. Mackay G, House MD, Bloch E, Wolfberg AJ. A GBS culture collected shortly after GBS prophylaxis may be inaccurate. J Matern Fetal Neonatal Med. 2012 Jun;25(6):736-8. doi: 10.3109/14767058.2011.596961. Epub 2011 Aug 1. PMID: 21801141.STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

On March 7, 2025, we released an episode summarizing key aspects of a NEJM publication regarding male partner therapy for women with recurrent BV. Although that study had limitations, the results were very surprising. Now, on 10/16/25 (7 months later), the ACOG has a new Clinical Practice Update (CPU) on this very issue. In this episode we will briefly summarize that March 2025 NEJM publication and highlight the TWO updated clinical recommendations from the ACOG regarding male partner therapy for the prevention of BV in women. PLUS, we will briefly discuss why although male partner therapy should be considered, partner EPT is “not recommended” at this time by the ACOG. 1. ACOG CLINICAL PRACTICE UPDATE: Concurrent Sexual Partner Therapy to Prevent Bacterial Vaginosis Recurrence Obstetrics & Gynecology ():10.1097/AOG.0000000000006102, October 16, 2025. | DOI: 10.1097/AOG.00000000000061022. Chapa Clinical Pearls March 2025 Episode: https://open.spotify.com/episode/4sW9tTe9CdYVQsCRBjqQQP3. Vodstrcil LA, Plummer EL, Fairley CK, Hocking JS, Law MG, Petoumenos K, et al. Male-partner treatment to prevent recurrence of bacterial vaginosis. N Engl J Med 2025;392:947–57. doi: 10.1056/NEJMoa2405404STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Podcast family, as we have said on many previous occasions, we get episode suggestions from either real-world patient encounters, from things that are hot in press, and/or from podcasts family member suggestions. Recently, one of our podcast family members asked me about the utility ofperforming pelvic floor muscle therapy (PFMT) antepartum. Is this evidence-based? Does performing PFMT help with postpartum urinary incontinence? Not all PFMTs are Kegel exercises! In this episode, we will review peripartum urinary incontinence and answer the question, “Is there value in teaching antepartum PFMT?”. We will summarize key concepts from the Oct 2025 Narrative Review on thissubject from the Green Journal (Obstet Gynecol).1.     Siddique, Moiuri MD, MPH; Hickman, Lisa MD;Giugale, Lauren MD. Peripartum Urinary Incontinence and Overactive Bladder.Obstetrics & Gynecology 146(4):p 466-472, October 2025. | DOI:10.1097/AOG.00000000000059932.     Woodley SJ, Lawrenson P, Boyle R, et al. PelvicFloor Muscle Training for Preventing and Treating Urinary and Faecal Incontinence in Antenatal and Postnatal Women. The Cochrane Database of SystematicReviews. 2020;5:CD007471. doi:10.1002/14651858.CD007471.pub4.3.     Pelvic Floor Muscle Training to Prevent andTreat Urinary and Fecal Incontinence in Antenatal and Postnatal Patients. AmericanAcademy of Family Physicians (2021). Practice Guideline STRONG COFFEE PROMO: 20% Off Strong CoffeeCompany https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

In the 09/1/2018 Society for Academic Specialists in General Obstetrics and Gynecology's (SASGOG's) Pearls of Exxcellence publication, “Management of Preeclampsia at Term”, it states: “If hypertension management requires acute IV treatment, it is often prudent to initiate oral labetalol or EXTENDED-release nifedipine to maintain blood pressures below the severe range. Intrapartum blood pressure management and consultation should not delay progress towards delivery. Fetal monitoring should be continuous.” In the original ACOG CO 692 from 2017, oral nifedipine was first referenced as an alternative to IV meds GIVEN INTRAPARTUM, stating, “Although relatively less information currently exists for the use of calcium channel blockers for this clinical indication, the available evidence suggests that immediate release oral nifedipine also may be considered as a first-line therapy, particularly when intravenous access is not available.” This may be given orally as 10mg, 20mg, and 20 mg separated in time by 20 minutes per dose. Notice it says “immediate release oral nifedipine”. But what about EXTENDED release nifedipine intrapartum as stated by the SASGOG? Is that an option after immediate attentive and therapy has been given with IV anti-hypertensives? Listen in for details.1. Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period: Committee Opinion, Number 692. Obstetrics & Gynecology 129(4):p e90-e95, April 2017. | DOI: 10.1097/AOG.00000000000020192. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020 Jun;135(6):e237-e260. doi: 10.1097/AOG.0000000000003891. PMID: 32443079.3. Cleary EM, Racchi NW, Patton KG, Kudrimoti M, Costantine MM, Rood KM. Trial of Intrapartum Extended-Release Nifedipine to Prevent Severe Hypertension Among Pregnant Individuals With Preeclampsia With Severe Features. Hypertension. 2023 Feb;80(2):335-342. doi: 10.1161/HYPERTENSIONAHA.122.19751. Epub 2022 Oct 3. PMID: 36189646.STRONG COFFEE PROMO: 20% Off Strong Coffee Company ⁠https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-452 Overview: The healthcare landscape is undergoing a sea change, significantly impacting established, evidence-based recommendations. Media coverage suggests that the HHS Secretary plans to release a report linking acetaminophen use during pregnancy with an increased risk of autism spectrum disorder (ASD) in offspring as well as linking maternal folate deficiency with ASD—associations that have not been supported by evidence. If promoted by public health agencies, such discrepancies pose a dilemma for clinicians who have relied on and trusted that guidance reflects evidence and is grounded in scientific methods. Join us to review the evidence on acetaminophen and ASD risk and learn strategies to ensure your practice is based on valid findings. Episode resource links: Ahlqvist VH, Sjöqvist H, Dalman C, et al. Acetaminophen Use During Pregnancy and Children's Risk of Autism, ADHD, and Intellectual Disability. JAMA. 2024;331(14):1205–1214. doi:10.1001/jama.2024.3172   Damkier, P., Gram, E. B., Ceulemans, M., Panchaud, A., Cleary, B., Chambers, C., Weber-Schoendorfer, C., Kennedy, D., Hodson, K., Grant, K. S., Diav-Citrin, O., Običan, S. G., Shechtman, S., & Alwan, S. (2025). Acetaminophen in Pregnancy and Attention-Deficit and Hyperactivity Disorder and Autism Spectrum Disorder. Obstetrics and gynecology, 145(2), 168–176. https://doi.org/10.1097/AOG.0000000000005802   Ji Y, Azuine RE, Zhang Y, et al. Association of Cord Plasma Biomarkers of In Utero Acetaminophen Exposure With Risk of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder in Childhood. JAMA Psychiatry. 2020;77(2):180–189. doi:10.1001/jamapsychiatry.2019.3259   Hirota T, King BH.  Autism Spectrum Disorder: A Review. JAMA. 2023;329(2):157–168. doi:10.1001/jama.2022.23661   Liu, X., Zou, M., Sun, C., Wu, L., & Chen, W. X. (2022). Prenatal Folic Acid Supplements and Offspring's Autism Spectrum Disorder: A Meta-analysis and Meta-regression. Journal of autism and developmental disorders, 52(2), 522–539. https://doi.org/10.1007/s10803-021-04951-8   DSM-5-TR: Neurocognitive Disorders Supplement; October 2022. https://psychiatryonline.org/pb-assets/dsm/update/DSM-5-TR_Neurocognitive-Disorders-Supplement_2022_APA_Publishing.pdf https://www.npr.org/sections/shots-health-news/2025/09/06/nx-s1-5532143/hhs-responds-to-report-about-autism-and-acetaminophen Guest: Susan Feeney, DNP, FNP-BC, NP-C   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com   

Just today in clinic, we had a patient, who was well into her third trimester, come to her regular scheduled appointment with new onset left-sided facial droop. Yeah, that's concerning! A complete history and physical was performed and the diagnosis was made of Bell's palsy. This is not a rare event and it can be extremely stressful for the affected mother to be because everybody knows facial droop is not normal! And we have recent data regarding this. In July 2025 in the Journal of Plastic, Reconstructive, and Aesthetic Surgery, authors confirmed that Bell's palsy can have real negative functional and psychosocial implications for those affected. So, in this episode, we are going to discuss Bell's palsy in pregnancy. How do we differentiate this from the more serious differential, which is a stroke? What about treatment? Listen in for details. 1. Wesley, Shaun R. MD; Vates, G. Edward MD, PhD; Thornburg, Loralei L. MD. Neurologic Emergencies in Pregnancy. Obstetrics & Gynecology 144(1):p 25-39, July 2024. | DOI: 10.1097/AOG.00000000000055752. Vrabec JT, Isaacson B, Van Hook JW. Bell's Palsy and Pregnancy.Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 2007;137(6):858-61. doi:10.1016/j.otohns.2007.09.009.3. Evangelista V, Gooding MS, Pereira L.Bell's Palsy in Pregnancy.Obstetrical & Gynecological Survey. 2019;74(11):674-678. doi:10.1097/OGX.00000000000007324. JPRAS (July 2025): https://www.jprasurg.com/article/S1748-6815(25)00328-6/fulltextSTRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

In 2023, we released 2 episodes on obstructive sleep apnea (OSA) and adverse pregnancy. Now, on September 16, 2025, a new publication from JAMA Network Open adds more insights to disturbed sleep and adverse pregnancy outcomes. How does insomnia affect pregnancy? And is there any data on night shift work and its altered circadian rhythms on adverse pregnancy outcomes? Listen in for details. 1. Ross N, Baer RJ, Oltman SP, et al. Ischemic Placental Disease and Severe Morbidity in Pregnant Patients With Sleep Disorders. JAMA Netw Open. 2025;8(9):e2532189. doi:10.1001/jamanetworkopen.2025.321892. Cai C, Vandermeer B, Khurana R, et al. The Impact of Occupational Shift Work and Working hours during Pregnancy on Health Outcomes: a systematic Review and Meta-Analysis.American Journal of Obstetrics and Gynecology. 2019;221(6):563-576. doi:10.1016/j.ajog.2019.06.051.3. Dominguez JE, Cantrell S, Habib AS, Izci-Balserak B, Lockhart E, Louis JM, Miskovic A, Nadler JW, Nagappa M, O'Brien LM, Won C, Bourjeily G. Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology Consensus Guideline on the Screening, Diagnosis, and Treatment of Obstructive Sleep Apnea in Pregnancy. Obstet Gynecol. 2023 Aug 1;142(2):403-423. doi: 10.1097/AOG.0000000000005261. Epub 2023 Jul 5. PMID: 37411038; PMCID: PMC10351908.4. Kader M, Bigert C, Andersson T, et al . Shift and Night Work During Pregnancy and Preterm Birth-a Cohort Study of Swedish Health Care Employees. International Journal of Epidemiology. 2022;50(6):1864-1874. doi:10.1093/ije/dyab135.STRONG COFFEE PROMO: 20% Off Strong Coffee Companyhttps://strongcoffeecompany.com/discount/CHAPANOSPINOBG

On Sept 10, 2023, er released an episode titled, “CS Ut Closure: Decidua or No Decidua?”. We highlighted the importance of AVOIDING the decidua at hysterotomy closure at CS. Now, in Sept 2025, in Obstetrics and Gynecology (the Green Journal), there is a new systematic review and meta-analysis on this very topic. Does this new study CONFIRM or REFUTE what we explained 2 years ago? Listen in for details. 1. Sept 10, 2023 Chapa Clinical Pearls Podcast: CS Ut Closure: Decidua or No Decidua?2. Lino GM, Galvão PVM, da Silva MLF, Conrado GAM. Not Closing Compared With Closing the Endometrial Layer During Cesarean Delivery: A Systematic Review and Meta-analysis. Obstet Gynecol. 2025 Jun 12;146(3):e55-e63. doi: 10.1097/AOG.0000000000005974. PMID: 40505112.

We have a wonderful podacst community! Within 24 hours of our immediate past episode release, one close friend- and fellow OBGYN, Dr. Eric Colton (OB Hospitalist Group) reached out and shared valuable words of wisdom regarding a potentially deadly complication of the CS-scar defect...the CS scar ectopic pregnancy. Listen in for Dr. Colton's cameo and details. 1. Ban, Yanli MD, PhD; Shen, Jia MD; Wang, Xia MD; Zhang, Teng MD, PhD; Lu, Xuxu MD; Qu, Wenjie MD; Hao, Yiping MD; Mao, Zhonghao MD; Li, Shizhen MD; Tao, Guowei MD, PhD; Wang, Fang MD, PhD; Zhao, Ying MD, PhD; Zhang, Xiaolei MD, PhD; Zhang, Yuan MD, PhD; Zhang, Guiyu MD, PhD; Cui, Baoxia MD, PhD. Cesarean Scar Ectopic Pregnancy Clinical Classification System With Recommended Surgical Strategy. Obstetrics & Gynecology 141(5):p 927-936, May 2023. | DOI: 10.1097/AOG.0000000000005113

Traditionally, we have learned that any imbalance in the estrogen: progesterone relationship can trigger irregular uterine bleeding. That makes sense, right? During anovulation, prolonged unopposed estrogen can result in HMB. In such a case, we give progesterone as both a therapeutic as well as diagnostic intervention. On the contrary, with progestin only contraception, we consider estrogen predominant products when progesterone breakthrough bleeding (BTB) occurs to restore endometrial stabilization. But a new RCT (AJOG) adds credence to adding MORE progesterone in cases of progesterone associated BTB. Listen in for details.1. Zigler RE, Madden T, Ashby C, Wan L, McNicholas C. Ulipristal Acetate for Unscheduled Bleeding in Etonogestrel Implant Users: A Randomized Controlled Trial. Obstet Gynecol. 2018 Oct;132(4):888-894. doi: 10.1097/AOG.0000000000002810. PMID: 30130351; PMCID: PMC6153077.2.ANDRADE MCR, et al. Norethisterone for Prolonged Uterine Bleeding Associated with Etonogestrel Implant (IMPLANET): A Randomized Controlled Trial, American Journal of Obstetrics and Gynecology (2025), doi: https://doi.org/10.1016/j.ajog.2025.08.029.

Routine vaginal examinations (VEs) are a standard component of intrapartum care, traditionally performed at regular intervals to monitor cervical dilation, effacement, and fetal station, which are indicators of labor progression. Yet, the American College of Obstetricians and Gynecologists states that there is insufficient evidence to recommend a specific frequency for cervical examinations during labor, and examinations should be performed as clinically indicated. Now, a recently published RCT form AJOG MFM is adding additional credence to that. Can we space out clinical exams in otherwise “low-risk” laboring women to 8 hours? Listen in for details. 1. AJOG MFM: (08/18/25) Routine Vaginal Examination Scheduled At 8 vs 4 Hours In Multiparous Women In Early Spontaneous Labour: A Randomised Controlled Trial https://www.sciencedirect.com/science/article/abs/pii/S25899333250016122. Nashreen CM, Hamdan M, Hong J, et al.Routine Vaginal Examination to Assess Labor Progress at 8 Compared to 4 h After Early Amniotomy Following Foley Balloon Ripening in the Labor Induction of Nulliparas: A Randomized Trial. Acta Obstetricia Et Gynecologica Scandinavica. 2024;103(12):2475-2484. doi:10.1111/aogs.14975.3. First and Second Stage Labor Management: ACOG Clinical Practice Guideline No. 8. Obstetrics and Gynecology. 2024;143(1):144-162. doi:10.1097/AOG.0000000000005447.4. Moncrieff G, Gyte GM, Dahlen HG, et al. Routine Vaginal Examinations Compared to Other Methods for Assessing Progress of Labour to Improve Outcomes for Women and Babies at Term. The Cochrane Database of Systematic Reviews. 2022;3:CD010088. doi:10.1002/14651858.CD010088.pub3.5. Gluck, O., et al. (2020). The correlation between the number of vaginal examinations during active labor and febrile morbidity, a retrospective cohort study. [BMC Pregnancy and Childbirth]6. Pan, WL., Chen, LL. & Gau, ML. Accuracy of non-invasive methods for assessing the progress of labor in the first stage: a systematic review and meta-analysis. BMC Pregnancy Childbirth 22, 608 (2022). https://doi.org/10.1186/s12884-022-04938-y

In the last 2 episodes we covered new updates in menopausal hormone therapy. However, we did not address TESTOSTERONE use. This episode idea comes from one our podcast family members and good friend, Eric. Eric is 100% correct: Testosterone replacement, when done correctly, has come along way. When is this indicated? Is this endorsed by professional medical/endocrine groups? What's the dose? We have fun stuff to review, so listen in!1. Davis SR, Baber R, Panay N, Bitzer J, Perez SC, Islam RM, Kaunitz AM, Kingsberg SA, Lambrinoudaki I, Liu J, Parish SJ, Pinkerton J, Rymer J, Simon JA, Vignozzi L, Wierman ME. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019 Oct 1;104(10):4660-4666. doi: 10.1210/jc.2019-01603. PMID: 31498871; PMCID: PMC6821450.2. Sharon J. Parish, James A. Simon, Susan R. Davis, Annamaria Giraldi, Irwin Goldstein, Sue W. Goldstein, Noel N. Kim, Sheryl A. Kingsberg, Abraham Morgentaler, Rossella E. Nappi, Kwangsung Park, Cynthia A. Stuenkel, Abdulmaged M. Traish, Linda Vignozzi, International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women, The Journal of Sexual Medicine, Volume 18, Issue 5, May 2021, Pages 849–867, https://doi.org/10.1016/j.jsxm.2020.10.0093. Levy, Barbara MD, MSCP; Simon, James A. MD, MSCP. A Contemporary View of Menopausal Hormone Therapy. Obstetrics & Gynecology 144(1):p 12-23, July 2024. | DOI: 10.1097/AOG.00000000000055534. NAMS The 2022 hormone therapy position statement of The North American Menopause Society: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf