Podcasts about obstet gynecol

Today, we are taking a deep dive into a medical truth thatsounds completely counterintuitive, almost upside down, based on everything you think you know about women's health. But here's the kicker: it's actually nothing new at all. For over two decades, ever since the landmark Women'sHealth Initiative (WHI) study made global headlines back in 2002, the blanket narrative surrounding menopausal hormone therapy has been clear and persistent: hormones equal breast cancer risk. But there is a massive asterisk in thatscience that got completely lost in the media noise. While combination therapy with conjugated equine estrogens paired with medroxyprogesterone acetate (CEE +MPA) did show an increased risk, the story for estrogen-only therapy (mainly CEE) in women wh had a hysterectomy is entirely different. In fact, an overwhelming mountain of growing data shows that estrogen-only therapy is protectiveagainst both breast cancer incidence and breast cancer mortality. In this episode, we're unpacking the latest high-level evidence that cements this crucial distinction. We'll examine the broad statistical landscape, including a comprehensive meta-analysis by Qing et al. (officially set for the December 2026 issue of Annals of Medicine, following its ahead-of-print release in March 2026). Their work breaks down how randomized controlled trial data consistentlypoint to estrogen-only therapy having a protective effect, in stark contrast to combination therapy. We'll also dive into a brand-new Clinical Perspective published in mid-August 2026 in Obstetrics & Gynecology (the Green Journal) by Drs. Andrew Kaunitz and Jason Wright. They call urgent attention to this phenomenon, highlighting RCT meta-analyses that demonstrate a 23% reduction in breast cancer incidence with estrogen alone (RR = 0.77), alongside striking cohort data showing a dramatic risk reduction even in high-risk populations, like carriers of the BRCA mutation.  Listenin for details.1.     Wu Q, Shen L, Hu S, Yang R, Wang Y, Xue D, SunY, Ma H, Dai Z. Relationship between menopausal hormone therapy and incidencerisk of breast cancer: systematic review and meta-analysis. Ann Med. 2026Dec;58(1):2640244. doi: 10.1080/07853890.2026.2640244. Epub 2026 Mar.2.     Kaunitz, Wright. Menopausal Estrogen Therapy andRisk of Breast Cancer. Obstet Gynecol. Aug 20263.     Chlebowski RT, Aragaki AK, Pan K, et al.Randomized Trials of Estrogen-Alone and Breast Cancer Incidence: AMeta-Analysis. Breast Cancer Research and Treatment. 2024. 4.     Writing Group for the Women's Health InitiativeInvestigators. (2002). Risks and benefits of estrogen plus progestin in healthypostmenopausal women: Principal results from the Women's Health Initiativerandomized controlled trial. JAMA, 288(3), 321–333.

CardioNerds (Dr. Apoorva Gangavelli, Dr. Rebecca Garber, and Dr. Tina Reddy), discuss pre-pregnancy risk stratification and counseling with Dr. Katy Young across a range of risks.  This episode was produced as part of the CardioNerds Academy curriculum by House Einthoven under the guidance of House Chief, Dr. Apoorva Gangavelli and Academy Program Director, Dr. Gurleen Kaur. A matching review article will be published in US Cardiology Review, the official journal of CardioNerds. This discussion was planned in collaboration with the Mayo Clinic Cardiovascular Board Review Course. Audio editing by CardioNerds intern, Dr. Patrick Pekyi-Boateng. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Notes:  Why is pregnancy considered a “physiologic stress test,” and why does risk extend beyond delivery? Blood volume, heart rate, and cardiac output rise while systemic vascular resistance falls, peaking in the late second/early third trimester; underlying (even undiagnosed) heart disease can be unmasked or worsened. Postpartum (“fourth trimester”) is a high-risk period, not a safe zone – fluid shifts, rising SVR, and bleeding risk can precipitate decompensation in patients with heart failure, pulmonary hypertension, valvular disease, or aortopathy. Adverse pregnancy outcomes (hypertensive disorders, gestational diabetes, preterm birth, fetal growth restriction, peripartum cardiomyopathy) are markers of future cardiovascular risk and warrant long-term preventive follow-up. What is the practical framework for approaching pre-pregnancy cardiovascular risk? Four broad categories: (1) patients who may need cardiac screening before pregnancy, (2) patients needing risk-factor/medication optimization, (3) known cardiovascular disease where pregnancy is reasonable with structured risk stratification, and (4) high-risk disease where pregnancy may need to be delayed, modified by intervention, or discouraged. Testing should be targeted, not blanket – reserved for symptoms, abnormal exam, concerning family history, or reduced functional capacity. How is risk stratified in patients with known cardiovascular disease? Use a combination of tools per 2025 ESC guidelines: mWHO 2.0 (broad maternal risk category), CARPREG II (additional predictors of maternal cardiac events), and ZAHARA (useful in congenital heart disease). Key lesion-specific factors: aortic size/growth, valve severity, ventricular function, symptoms, blood pressure, and family history of dissection. Translate risk into practical terms for patients rather than leading with a numerical score. Which cardiovascular medications require review before conception? ACE inhibitors, ARBs, and ARNIs should be transitioned off before pregnancy; statins, MRAs, and SGLT2 inhibitors also need review. DOACs are contraindicated in pregnancy and lactation; mechanical valve anticoagulation requires individualized shared decision-making, as no strategy is risk-free for mother and fetus. Medication changes are best made proactively, before conception, rather than reactively. This is not an exhaustive list! The medication list needs to be reviewed carefully. Which conditions carry high or prohibitive risk in pregnancy? Pulmonary arterial hypertension, Eisenmenger syndrome, severe ventricular dysfunction, prior peripartum cardiomyopathy with residual LV dysfunction, severe left-sided obstructive valve disease (e.g., severe mitral stenosis), mechanical valves, significant aortopathy, cyanotic congenital heart disease, and Fontan physiology. Common theme: limited cardiovascular reserve and high risk of decompensation, thrombosis, arrhythmia, heart failure, aortic dissection, or death. These patients need expert multidisciplinary evaluation before pregnancy. Severe mitral stenosis is poorly tolerated because tachycardia shortens diastolic filling time and raises left atrial pressure, risking pulmonary edema and decompensation. When should genetic testing or counseling be offered? Consider when a diagnosis may be inherited or affect the patient, pregnancy, or family members: inherited cardiomyopathies, aortopathies, channelopathies, select congenital heart disease, and some pulmonary hypertension syndromes. Recurrence risk of congenital heart disease in offspring is roughly 6-10% when the mother has CHD; fetal echocardiography should be offered. How should contraception be approached in high-risk cardiac patients? Frame contraception as part of the cardiac care and reproductive safety plan to prevent unplanned high-risk pregnancy. Long-acting reversible contraception is often preferred; progestin-only methods are generally safer than estrogen-containing options with thrombosis risk, pulmonary hypertension, or mechanical valves. What are key delivery-planning considerations for cardiac patients? Vaginal delivery is preferred unless there is an obstetric indication for cesarean or a specific cardiac reason (e.g., unstable maternal status, therapeutic INR) to avoid labor. Planning should address delivery location, anesthesia involvement, telemetry needs, fluid management, and postpartum monitoring, clearly communicated across the multidisciplinary team in advance. How should clinicians counsel patients when pregnancy is discouraged but strongly desired? Acknowledge the patient’s goals and the emotional weight of the conversation; separate the goal (family building) from the timeline (safety now vs. after optimization). If pregnancy remains prohibitively risky, discuss alternatives for family building and ensure adequate patient support. What are the key gaps and future directions in cardio-obstetric risk stratification? Current risk tools (mWHO, CARPREG II, ZAHARA) provide common language but do not fully capture functional status, prior pregnancy history, or how risk evolves over time. Future direction: individualized, dynamic risk prediction incorporating imaging, biomarkers, exercise capacity, and social drivers of health, with better long-term links between pregnancy complications and cardiovascular prevention. References 1. European Society of Cardiology. 2025 ESC Guidelines for the management of cardiovascular disease and pregnancy. 2. Mehta LS, et al. Cardiovascular Considerations in Caring for Pregnant Patients: A Scientific Statement From the American Heart Association. Circulation. 2020;141:e884-e903. PMID: 32362133. doi:https://doi.org/10.1161/CIR.0000000000000772 3. ACOG Practice Bulletin No. 212. Pregnancy and Heart Disease. Obstet Gynecol. 2019;133(5):e320-e356. PMID: 31022123. doi:https://doi.org/10.1097/AOG.0000000000003243

Podcast family, we pride ourselves on this show on being avant-garde and forward thinking on the topics we choose. For example, on February the 20th, 2026, we released an episode called “New Data: Screen Maternal Ferritin with Prenatal Care?” In that episode we reviewed a publication from the previous month (January 2026) that was released in Lancet Hematology. This study made the case for screening for early iron deficiency, even without anemia, with serum ferritin at the initiation of prenatal care. This was a multicenter, 2-arm, randomized controlled trial. Earlier identification of low serum ferritin prevented iron deficiency anemia in the third trimester. That's a win! Back then, we also stated how Australia has been leading the charge on this with the Australian HOW. That stands for Hematology in Obstetrics and Women's Health. This Australian consensus committee now recommends screening for iron deficiency, not just iron deficiency anemia, at the initiation of prenatal care, at 24 to 28 weeks, and then again at the third trimester when necessary. And now, as of August 2026, we have additional supportive data that including serum ferritin at the initial OB visit is evidence-based and best for the patient! In this episode we will review this brand-new, prospective cohort study published as a Research Letter in the AJOG August 2026.1. Australian HOW: Iron optimisation in pregnancy: a Haematology in Obstetric and Women's Health Collaborative consensus statement; https://onlinelibrary.wiley.com/doi/10.1111/imj.166022. Konecke N, Jackson T, Angeles I. et al. The association between first trimester iron deficiency without anemia and the development of iron-deficiency anemia prior to childbirth. American Journal of Obstetrics & Gynecology, 2026; 235, e36-e383. ACOG Clinical Practice Update: An Update to Clinical Guidance for Delayed Umbilical Cord Clamping After Birth in Preterm Neonates. Obstet Gynecol. 2025 Jul 24;146(3):442-444.

In our first summer series episode, we review a topic that keeps coming back. Hormone therapy for menopause. It was a thing, then it stopped being a thing, now it's a thing again.   Become a supporter of our show today either on Patreon or through PayPal! Thank you! http://www.patreon.com/thebodyofevidence/ https://www.paypal.com/donate?hosted_button_id=9QZET78JZWCZE   Email us your questions at thebodyofevidence@gmail.com.   Editor:    Robyn Flynn Theme music: “Fall of the Ocean Queen“ by Joseph Hackl Rod of Asclepius designed by Kamil J. Przybos Chris' book, Does Coffee Cause Cancer?: https://ecwpress.com/products/does-coffee-cause-cancer   Obviously, Chris is not your doctor (probably). This podcast is not medical advice for you; it is what we call information. References:  Geographic variability of menopausal symptoms   1) Nappi RE et al. Global cross-sectional survey of women with vasomotor symptoms associated with menopause: prevalence and quality of life burden. Menopause. 2021 May 24;28(8):875-882. doi: 10.1097/GME.0000000000001793.    2) Nappi RE, et al.  Prevalence and quality-of-life burden of vasomotor symptoms associated with menopause: A European cross-sectional survey. Maturitas. 2023 Jan;167:66-74. doi: 10.1016/j.maturitas.2022.09.006.    What's the normal duration of symptoms   3) Avis NE, et al. Study of Women's Health Across the Nation. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015 Apr;175(4):531-9. doi: 10.1001/jamainternmed.2014.8063.  The Women's Health Initiative (WHI) studies   Rossouw JE et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002 Jul 17;288(3):321-33. doi: 10.1001/jama.288.3.321.    Anderson GL et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA. 2004 Apr 14;291(14):1701-12. doi: 10.1001/jama.291.14.1701.   Decline in HRT after WHI studies   Sprague BL, Trentham-Dietz A, Cronin KA. A sustained decline in postmenopausal hormone use: results from the National Health and Nutrition Examination Survey, 1999-2010. Obstet Gynecol. 2012 Sep;120(3):595-603. doi: 10.1097/AOG.0b013e318265df42.   Danish Osteoporosis Prevention Study Schierbeck LL metal. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ. 2012 Oct 9;345:e6409. doi: 10.1136/bmj.e6409.   Kronos Early Estrogen Prevention Study (KEEPS) Harman SM, et al. Arterial imaging outcomes and cardiovascular risk factors in recently menopausal women: a randomized trial. Ann Intern Med. 2014 Aug 19;161(4):249-60. doi: 10.7326/M14-0353.   Kronos Early Estrogen Prevention Study (KEEPS) Hodis HN et al. Vascular Effects of Early versus Late Postmenopausal Treatment with Estradiol. N Engl J Med. 2016 Mar 31;374(13):1221-31. doi: 10.1056/NEJMoa1505241.    Stopping hormonal therapy   Berman RS et al. Risk factors associated with women's compliance with estrogen replacement therapy. J Womens Health. 1997 Apr;6(2):219-26. doi: 10.1089/jwh.1997.6.219.   Grady D, Sawaya GF. Discontinuation of postmenopausal hormone therapy. Am J Med. 2005 Dec 19;118 Suppl 12B:163-5. doi: 10.1016/j.amjmed.2005.09.051.   Tapering vs. abrupt stop or hormonal therapy   Haimov-Kochman R et al. Gradual discontinuation of hormone therapy does not prevent the reappearance of climacteric symptoms: a randomized prospective study. Menopause. 2006 May-Jun;13(3):370-6. doi: 10.1097/01.gme.0000186663.36211.c0. PMID: 16735933.

In 2018, the ARIVE trial was published in the NEJM revealingthat induction of labor at 39 weeks reduced cesarean deliveries and gestational hypertension/preeclampsia in low-risk nulliparous women who had labor induced,compared to expectant management. Then, in 2025, and partly in response to L&D units across the country becoming saturated with low- risk, nulliparous patients awaiting their induction of labors at 39 weeks and 0 days, the ACOGreleased its clinical practice update in Jan 2025 stating, “The optimal timing of delivery for full-term pregnancies (39 0/7 to 40 6/7 weeks of gestation has not been determined”. Now there is new data, released as an article in press(June 26, 2026), out of the AJOG that raises some interesting questions about potential benefits of induction of labor LATER in the “full term” interval (40- 40 and 6 days) compared to earlier full term (39 weeks to 39 weeks 6 days). Thesefindings are “hypothesis- generating”.  Listen in for details. Strong Coffee Company - Protein Coffee PLUS MORE; Get 20%OFF | Promo Code: CHAPANOSPINOBG https://promocode.to/strong-coffee-company/chapanospinobg-hbv​     Grobman WA, Rice MM, Reddy UM, Tita ATN, et al;Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentMaternal–Fetal Medicine Units Network. Labor Induction versus ExpectantManagement in Low-Risk Nulliparous Women. N Engl J Med. 2018 Aug9;379(6):513-523. ​     Damri NT, Sheiner E, Wainstock T, GestationalAge at Full-Term Delivery and Long-Term Offspring Morbidity in Low-RiskPregnancies: A Population-Based Cohort Study, American Journal of Obstetricsand Gynecology (2026), ​     Management of Full-Term Nulliparous IndividualsWithout a Medical Indication for Delivery: ACOG Clinical Practice Update.Obstet Gynecol. 2025 Jan 1;145(1):e45-e50. doi: 10.1097/AOG.0000000000005783.Epub 2024 Nov 7. PMID: 39513607.

As colorectal cancer rates rise among younger adults, surgeons are increasingly caring for patients with rectal cancer who are pregnant or hoping to preserve future fertility. With more individuals delaying childbearing, balancing effective cancer treatment with fertility preservation and maternal–fetal safety has become an important clinical challenge. This timely topic was recently highlighted by Dr. Sharon Suwanabol during a presentation at the American Society of Colon and Rectal Surgeons annual meeting 2026. In this episode, we explore the intersection of rectal cancer, fertility, and pregnancy through a multidisciplinary, case-based discussion. We review how surgery, chemotherapy, and pelvic radiation can affect fertility and sexual function in both men and women, and why early counseling and referral to reproductive endocrinology specialists are essential. The discussion also emphasizes that evaluation and treatment during pregnancy can often be performed safely, with care individualized based on tumor stage, gestational age, and the patient's goals and values. Hosts and discussants ·      Dr. Betelhem Yohannes, General surgery resident at the University of Washington ·      Dr. Griffen Allen, General surgery resident at the University of Washington  ·      Dr. Raga Siddharthan, Assistant Professor of Surgery in the Section of Colorectal Surgery at the University of Washington  ·      Dr. Stacey Cohen, Professor in the Division of Hematology and Oncology at the University of Washington and a gastrointestinal medical oncologist at Fred Hutch Cancer Center, specializing in colorectal and other GI cancers. Learning objectives ·      Describe the impact of rectal cancer surgery on fertility, sexual function, and future childbearing potential. ·      Review the effects of chemotherapy and pelvic radiation on reproductive health and fertility preservation. ·      Discuss available fertility preservation strategies and the importance of early pre-treatment counseling and referral. ·      Recognize the diagnostic challenges of rectal cancer during pregnancy, including overlapping gastrointestinal symptoms. ·      Review appropriate staging and workup considerations for suspected rectal cancer in pregnant patients. ·      Discuss multidisciplinary management strategies for rectal cancer during pregnancy, including individualized treatment sequencing. ·      Examine ethical and patient-centered considerations when balancing maternal cancer treatment and fetal outcomes. References  Siegel RL, Wagle NS, Star J, Kratzer TB, Smith RA, Jemal A. Colorectal cancer statistics, 2026. CA Cancer J Clin. 2026;76(2):e70067. doi:10.3322/caac.70067 [https://pubmed.ncbi.nlm.nih.gov/38240409/] Pregnancy at Age 35 Years or Older: ACOG Obstetric Care Consensus No. 11. Obstet Gynecol. 2022;140(2):348-366. doi:10.1097/AOG.0000000000004873 [https://pubmed.ncbi.nlm.nih.gov/35640237/] Stal J, YI SY, Cohen-Cutler S, et al. Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates. Oncologist. 2022;27(7):579-586. doi:10.1093/oncolo/oyac052 [https://pubmed.ncbi.nlm.nih.gov/35708892/] Druvefors E, Myrelid P, Andersson RE, Landerholm K. Female and Male Fertility after Colectomy and Reconstructive Surgery in Inflammatory Bowel Disease: A National Cohort Study from Sweden. J Crohns Colitis. 2023;17(10):1631-1638. doi:10.1093/ecco-jcc/jjad079 [https://pubmed.ncbi.nlm.nih.gov/37341355/] Ito M, Tsukada Y, Watanabe J, et al. Long-term survival and functional outcomes of laparoscopic surgery for clinical stage I ultra-low rectal cancers located within 5 cm of the anal verge: A prospective phase II trial (Ultimate trial). Ann Surg. Published online April 1, 2024. doi:10.1097/SLA.0000000000006290 [https://pubmed.ncbi.nlm.nih.gov/38629555/] Teh WT, Stern C, Chander S, Hickey M. The impact of uterine radiation on subsequent fertility and pregnancy outcomes. Biomed Res Int. 2014;2014:482968.  Johnson GGRJ, Park J, Helewa RM, Goldenberg BA, Nashed M, Hyun E. Total neoadjuvant therapy for rectal cancer: a guide for surgeons. Can J Surg. 2023 Apr 21;66(2):E196-E201. doi: 10.1503/cjs.005822. PMID: 37085291; PMCID: PMC10125160. [https://pubmed.ncbi.nlm.nih.gov/37085291/] Naren G, Guo J, Bai Q, Fan N, Nashun B. Reproductive and developmental toxicities of 5-fluorouracil in model organisms and humans. Expert Rev Mol Med. 2022 Jan 31;24:e9. doi: 10.1017/erm.2022.3. PMID: 35098910; PMCID: PMC9884763. [https://pubmed.ncbi.nlm.nih.gov/35098910/] National Comprehensive Cancer Network. (2026). NCCN Clinical Practice Guidelines in Oncology: Rectal Cancer (Version 2.2026). Retrieved from NCCN Guidelines for Rectal Cancer [https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1449] Oktay, Kutluk M.D., Ph.D.. Expert Commentary on Fertility Preservation in Colorectal Cancers: Current State and Practical Tips for the Cancer Practitioner. Diseases of the Colon & Rectum 63(6):p 726-727, June 2020. | DOI: 10.1097/DCR.0000000000001688 [https://pubmed.ncbi.nlm.nih.gov/32479532/] Stal J, YI SY, Cohen-Cutler S, et al. Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates. Oncologist. 2022;27(7):579-586. doi:10.1093/oncolo/oyac052 [https://pubmed.ncbi.nlm.nih.gov/35708892/] Gentile G, Ciccarone M. Management of fertility preservation in young female patients with gastrointestinal cancer: A case series and systematic literature review. Curr Probl Cancer. 2025;57:101221. doi:10.1016/j.currproblcancer.2025.101221 [https://pubmed.ncbi.nlm.nih.gov/39598263/] Saif MW. Management of colorectal cancer in pregnancy: a multimodality approach. Clin Colorectal Cancer. 2005;5(4):247-256. doi:10.3816/ccc.2005.n.035 [https://pubmed.ncbi.nlm.nih.gov/16183863/] Rogers JE, Dasari A, Eng C. The Treatment of Colorectal Cancer During Pregnancy: Cytotoxic Chemotherapy and Targeted Therapy Challenges. Oncologist. 2016 May;21(5):563-70. doi: 10.1634/theoncologist.2015-0362. Epub 2016 Mar 21. PMID: 27000464; PMCID: PMC4861360. [https://pubmed.ncbi.nlm.nih.gov/27000464/] Jiang Q, Hua H. Fertility in young-onset colorectal patients with cancer: a review. Oncologist. 2024;29(10):e1237-e1245. doi:10.1093/oncolo/oyae141 [https://pubmed.ncbi.nlm.nih.gov/39292850/] Dolmans MM, Hollanders de Ouderaen S, Demylle D, Pirard C. Utilization rates and results of long-term embryo cryopreservation before gonadotoxic treatment. J Assist Reprod Genet. 2015;32(8):1233-1237. doi:10.1007/s10815-015-0533-z [https://pubmed.ncbi.nlm.nih.gov/26162569/ Moawad NS, Santamaria E, Rhoton-Vlasak A, Lightsey JL. Laparoscopic Ovarian Transposition Before Pelvic Cancer Treatment: Ovarian Function and Fertility Preservation. J Minim Invasive Gynecol. 2017;24(1):28-35. doi:10.1016/j.jmig.2016.08.831 [https://pubmed.ncbi.nlm.nih.gov/27599763/] Fish R. Ovarian transposition in rectal cancer: uncertain benefit at a high price. Colorectal Dis. 2022;24(6):706-707. doi:10.1111/codi.16086 [https://pubmed.ncbi.nlm.nih.gov/35191146/] Ribeiro R, Baiocchi G, Moretti-Marques R, Linhares JC, Costa CN, Pareja R. Uterine transposition for fertility and ovarian function preservation after radiotherapy. Int J Gynecol Cancer. 2023;33(12):1837-1842. Published 2023 Dec 4. doi:10.1136/ijgc-2023-004723 [https://pubmed.ncbi.nlm.nih.gov/38104863/] Haggar F, Pereira G, Preen D, et al. Maternal and neonatal outcomes in pregnancies following colorectal cancer. Surg Endosc. 2013;27(7):2327-2336. doi:10.1007/s00464-012-2774-6 [https://pubmed.ncbi.nlm.nih.gov/23645367/] Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

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

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

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.

Un nouvel épisode du Pharmascope est disponible! Dans ce 173e épisode, Nicolas, Olivier et Amélie discutent de la prise en charge de l'hypothyroïdie dans divers contextes: hypothyroïdie subclinique, personnes âgées, grossesse, et plus encore!  Les objectifs pour cet épisode sont les suivants: Discuter des évidences portant sur le traitement de l’hypothyroïdie subclinique Discuter de la prise en charge de l’hypothyroïdie chez la personne âgée Discuter du dépistage et de la prise en charge de l’hypothyroïdie subclinique et clinique durant la grossesse Ressources pertinentes en lien avec l'épisode Moon S, et coll. Subclinical Hypothyroidism and the Risk of Cardiovascular Disease and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies. Thyroid. 2018 Sep;28(9):1101-1110. Stott DJ, et coll.; TRUST Study Group. Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism. N Engl J Med. 2017 Jun 29;376(26):2534-2544. Feller M, et coll. Association of Thyroid Hormone Therapy With Quality of Life and Thyroid-Related Symptoms in Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-analysis. JAMA. 2018 Oct 2;320(13):1349-1359. Ringel MD, et coll. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer. Thyroid. 2025 Aug;35(8):841-985 Thyroid Disease in Pregnancy: ACOG Practice Bulletin, Number 223. Obstet Gynecol. 2020 Jun;135(6):e261-e274. Sankoda A, et coll. Effects of Levothyroxine Treatment on Fertility and Pregnancy Outcomes in Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Thyroid. 2024 Apr;34(4):519-530. Casey BM, et coll; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Treatment of Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy. N Engl J Med. 2017 Mar 2;376(9):815-825. Negro R, et coll. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab. 2010 Apr;95(4):1699-707. Ringel MD, et coll. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer. Thyroid. 2025 Aug;35(8):841-985.

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.

It's a controversial topic: the impact of uterine incision (hysterectomy) on the neonate delivery interval (also called the U-D interval). Does it matter? Just to be clear, we're talking about time from uterine entry to fetal extraction, not skin incision to fetal extraction. Past publications have produced conflicting results, often limited by small sample sizes, heterogeneous indications for delivery, and reliance on surrogate markers (like apgar scores) rather than clinical morbidity. But a new study published in the Gray journal at the end of 2025 (December 30, 2025) gives some new insights. In this episode, we will review this retrospective study and play the “Devil's advocate” as we summarize the rebuttal data. As the reports are conflicting, we will end the podcast with a real-world interpretation and application of this data. Listen in for details. 1. Bart, Yossi et al. Uterine Incision-to-Delivery Interval and Neonatal Outcomes among Non-urgent, Term, Cesarean Deliveries. American Journal of Obstetrics & Gynecology, Volume 0, Issue 0. https://www.ajog.org/article/S0002-9378(25)00980-9/fulltext?rss=yes2. Maayan-Metzger A, Schushan-Eisen I, Todris L, Etchin A, Kuint J. The effect of time intervals on neonatal outcome in elective cesarean delivery at term under regional anesthesia. Int J Gynaecol Obstet. 2010 Dec;111(3):224-8. doi: 10.1016/j.ijgo.2010.07.022. Epub 2010 Sep 19. PMID: 20855070. https://pubmed.ncbi.nlm.nih.gov/20855070/3. Spain JE, Tuuli M, Stout MJ, Roehl KA, Odibo AO, Macones GA, Cahill AG. Time from uterine incision to delivery and hypoxic neonatal outcomes. Am J Perinatol. 2015 Apr;32(5):497-502. doi: 10.1055/s-0034-1396696. Epub 2014 Dec 24. PMID: 25539409.4. Bader AM, Datta S, Arthur GR, Benvenuti E, Courtney M, Hauch M. Maternal and fetal catecholamines and uterine incision-to-delivery interval during elective cesarean. Obstet Gynecol. 1990 Apr;75(4):600-3. PMID: 2107478.5. Tekin, E., Inal, H.A. & Isenlik, B.S. A Comparison of the Effect of Time from Uterine Incision to Delivery on Neonatal Outcomes in Women with One Previous and Repeat (Two or More) Cesarean Sections. SN Compr. Clin. Med. 5, 80 (2023). https://doi.org/10.1007/s42399-023-01427-x

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.

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.

Un nouvel épisode du Pharmascope est disponible! Dans ce 167e épisode, Nicolas et Olivier reçoivent une invitée pour discuter d'un syndrome qui touchera environ la moitié des femmes au cours de leur vie, soit le syndrome génito-urinaire de la ménopause (le SGUM). Les objectifs pour cet épisode sont les suivants: Expliquer la présentation clinique, le diagnostic et la prise en charge du syndrome génito-urinaire de la ménopause (SGUM) Discuter du traitement non-pharmacologique du SGUM Comparer les données d'efficacité et d'innocuité des différents traitements pharmacologiques utilisés pour le SGUM Ressources pertinentes en lien avec l'épisode Johnston S, et coll. Directive clinique no 422b : Ménopause et santé génito-urinaire. J Obstet Gynaecol Can. 2021 Nov;43(11):1308-1315.e1. Mitchell CM, et coll. Efficacy of Vaginal Estradiol or Vaginal Moisturizer vs Placebo for Treating Postmenopausal Vulvovaginal Symptoms: A Randomized Clinical Trial. JAMA Intern Med. 2018 May 1;178(5):681-690. Lethaby A, Ayeleke RO, Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2016 Aug 31;2016(8):CD001500. Simunić V, Banović I, Ciglar S, Jeren L, Pavicić Baldani D, Sprem M. Local estrogen treatment in patients with urogenital symptoms. Int J Gynaecol Obstet. 2003 Aug;82(2):187-97. Constantine GD, et coll; REJOICE Study Group. The REJOICE trial: a phase 3 randomized, controlled trial evaluating the safety and efficacy of a novel vaginal estradiol soft-gel capsule for symptomatic vulvar and vaginal atrophy. Menopause. 2017 Apr;24(4):409-416. Faubion SS, et coll. Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: consensus recommendations from The North American Menopause Society and The International Society for the Study of Women’s Sexual Health. Menopause. 2018 Jun;25(6):596-608. Cardozo L, et coll. Meta-analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: second report of the Hormones and Urogenital Therapy Committee. Obstet Gynecol. 1998 Oct;92(4 Pt 2):722-7. Labrie F, et coll. Combined data of intravaginal prasterone against vulvovaginal atrophy of menopause. Menopause. 2017 Nov;24(11):1246-1256. Portman DJ, Bachmann GA, Simon JA; Ospemifene Study Group. Ospemifene, a novel selective estrogen receptor modulator for treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy. Menopause. 2013 Jun;20(6):623-30. Portman D, et coll. Ospemifene, a non-oestrogen selective oestrogen receptor modulator for the treatment of vaginal dryness associated with postmenopausal vulvar and vaginal atrophy: a randomised, placebo-controlled, phase III trial. Maturitas. 2014 Jun;78(2):91-8. Archer DF, et coll. Efficacy and safety of ospemifene in postmenopausal women with moderate-to-severe vaginal dryness: a phase 3, randomized, double-blind, placebo-controlled, multicenter trial. Menopause. 2019 Jan 28;26(6):611-621.

The ARRIVE Trial and the Term Breech Trial reshaped modern birth practices in ways researchers never intended. From skyrocketing inductions to the loss of vaginal breech training, these studies reveal how even “gold-standard” science can miss the human side of birth.Clara invites you to take a mindful pause: to look beyond the data, question how evidence gets translated into policy, get curious about how the research was designed, and remember that true evidence-based care must center the individual—not just the research.You'll Learn:What the ARRIVE Trial and the Term Breech Trial actually found (and what they didn't)How these studies shifted policy, practice, and training worldwideWhy over-reliance on “evidence” can erase skills, intuition, and personal choiceHow to bring mindfulness into your decision-making about induction, breech birth, or any medical recommendationWhy traditional and holistic birth practices still matter—even if they've never been studiedMindful Reflection“Mindfulness isn't about ignoring evidence—it's about pausing long enough to ask, ‘Does this research apply to me, in my body, in this context?' True evidence-based care is a dialogue between research, clinician experience, and your own wisdom.”Resources MentionedDownload Clara's Free Birth Plan Template, used at over 5,000 births.Ready for an evidence based birth class? Check out A Path to A Powerful BirthThe Birth Advocacy Toolkit is a great option for expectant parents who have already taken a class but want to make sure their preferences are heard and want evidence based information to help make their decisions. Evidence Based Birth: Evidence on the ARRIVE Trial and Elective Induction at 39 WeeksEvidence Based Birth: Evidence on Breech BirthGrobman WA, et al. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. NEJM, 2018.Evidence Based Birth: “Evidence on the ARRIVE Trial and Elective Induction at 39 Weeks.”Nethery E, et al. Obstet Gynecol, 2023. Post-ARRIVE induction impact study.Hannah ME, et al. Planned Cesarean vs Planned Vaginal Birth for Breech. Lancet, 2000.Kotaska A. BMJ, 2004. “Inappropriateness of RCTs for complex intrapartum phenomena.”Goffinet F, et al. PREMODA Study. Am J Obstet Gynecol, 2006.RCOG Green-top Guideline No. 20b (2017).ACOG Committee Opinion No. 745 (2018).SOGC No. 384 (2019).Get 20% off your first monthly subscription with NEEDED Vitamins 

Overview: In this episode, Dr Gina Brown and Dr Sahar Khalili draw on their expertise in HIV prevention to provide an overview of the current PrEP landscape in the United States. They highlight advancements in HIV prevention and emphasize the importance of targeted programs to address disparities in access and uptake across population groups and geographic regions. The views expressed are those of the panelist(s) and not necessarily Gilead Sciences, Inc. The information provided in this podcast is not intended to be and should not be understood to provide medical advice. Listeners should note that our discussions in this episode are relevant to the USA only and may not be appropriate for other regions. This episode was recorded in August 2025 and the content reflects the information available at that time. Guest: Gina Brown, MD; Sahar Khalili, PharmD   For more information, please visit: https://www.pri-med.com/clinical-resources/curriculum/hiv-in-focus  References ACOG. Preexposure prophylaxis for the prevention of human immunodeficiency virus. 2024. Available from: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2022/06/preexposure-prophylaxis-for-the-prevention-of-human-immunodeficiency-virus (Accessed June 25, 2025). ADAP Directory. About. 2024. Available from: https://adap.directory/about (Accessed June 25, 2025). Aidsmap. Condoms. 2023. Available from: https://www.aidsmap.com/about-hiv/condoms#toc-how-effective-are-condoms (Accessed June 25, 2025). AIDSVu. AIDSVu releases new PrEP data and launches PrEPVu.org, a new PrEP equity platform. 2024. Available from: https://aidsvu.org/news-updates/aidsvu-releases-new-prep-data-and-launches-prepvu-org-a-new-prep-equity-platform/ (Accessed June 25, 2025). AIDSVu.org was developed by the Rollins School of Public Health at Emory University in partnership with Gilead Sciences, Inc. AIDSVu. AIDSVu releases 2024 PrEP use data showing growing use across the U.S. 2025. Available from: https://aidsvu.org/news-updates/aidsvu-releases-2024-prep-use-data-showing-growing-use-across-the-u-s/ (Accessed July 18, 2025). AIDSVu.org was developed by the Rollins School of Public Health at Emory University in partnership with Gilead Sciences, Inc. AIDSVu. Location profiles: South. 2025. Available from: https://map.aidsvu.org/profiles/region/south/prevention-and-testing#1-2-PnR (Accessed July 31, 2025). AIDSVu.org was developed by the Rollins School of Public Health at Emory University in partnership with Gilead Sciences, Inc. AIDSVu. PrEP use significantly associated with decreasing new HIV diagnoses across U.S. states. 2025. Available from: https://aidsvu.org/news-updates/prep-use-significantly-associated-with-decreasing-new-hiv-diagnoses-across-u-s-states/ (Accessed June 25, 2025). AIDSVu.org was developed by the Rollins School of Public Health at Emory University in partnership with Gilead Sciences, Inc. Baeten J et al. Curr HIV/AIDS Rep 2013;10:142–51. Bekker LG et al. N Engl J Med 2024;391:1179–92. CDC. About ending the HIV epidemic in the US. 2024. Available from: https://www.cdc.gov/ehe/php/about/index.html (Accessed June 2, 2025). CDC. Clinical Guidance for PrEP. 2025. Available from: https://www.cdc.gov/hivnexus/hcp/prep/index.html (Accessed June 25, 2025). CDC. Preexposure prophylaxis for the prevention of HIV infection in the United States - 2021 update. 2021. Available from: https://stacks.cdc.gov/view/cdc/112360 (Accessed June 25, 2025). Coates TJ et al. Lancet 2008;372:669–84. DHHS. Pre-exposure (PrEP) to prevent HIV during periconception, antepartum, ad postpartum. 2024. Available from: https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/perinatal-hiv/pre-exposure-prophylaxis-prep-prevent-hiv-perinatal.pdf (Accessed June 25, 2025). Gandhi RT et al. JAMA 2023;329:63–84. HIV.gov. HIV treatment as prevention. 2023. Available from: https://www.hiv.gov/tasp (Accessed June 25, 2025). HIV.gov. Key EHE strategies. 2024. Available from: https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/key-strategies (Accessed June 2, 2025). HIV.gov. Pre-exposure prophylaxis. 2025. Available from: https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/pre-exposure-prophylaxis (Accessed June 25, 2025). Kelley CF et al. N Engl J Med 2025;392:1261–76. Kourtis AP et al. Ann Epidemiol 2025:106:48-54. Landers S et al. Am J Public Health 2017;107:1534–35. Landovitz RJ et al. N Engl J Med 2021;385:595–608. NIH. HIV and sexually transmitted infections (STIs). 2021. Available from: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-and-sexually-transmitted-diseases-stds (Accessed June 25, 2025). NIH. HIV medicines during pregnancy and childbirth. 2025. Available from: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-medicines-during-pregnancy-and-childbirth (Accessed July 31, 2025) NIH. Post-exposure prophylaxis (PEP). 2025. Available from: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/post-exposure-prophylaxis-pep (Accessed June 25, 2025). NIH. PrEP to prevent HIV and promote sexual health. 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556471/ (Accessed June 25 2025). Siegler AJ et al. Ann Epidemiol 2020;45:24–31.e37 Sullivan PS et al. J Int AIDS Soc 2025;28:e26459. Townes A et al. Obstet Gynecol 2023;143:294–301. Underhill K et al. PLoS Med 2007;4:e275. United States Census Bureau. National population by characteristics: 2020–2024. 2024. Available from: https://www.census.gov/data/tables/time-series/demo/popest/2020s-national-detail.html (Accessed June 25, 2025). Owens DK et al. JAMA 2019;321:2326–36. Vermund SH et al. J Acquir Immune Defic Syndr 2013;63:S12–25. Washington State Department of Health. Pre-exposure prophylaxis drug assistance program (PrEP DAP). Available from: https://doh.wa.gov/you-and-your-family/illness-and-disease-z/hiv/prevention/pre-exposure-prophylaxis-drug-assistance-program-prep-dap (Accessed June 25, 2025). World Health Organization. Global HIV programme: pre-exposure prophylaxis (PrEP). Available from: https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/prevention/pre-exposure-prophylaxis (Accessed June 25, 2025).

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

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

Après les vaccins contenant des puces 5G, voici le tout nouveau produit au potentiel de surveillance sous-estimé: l'implant contraceptif NexplanonMD  Dans ce 70ème épisode disponible exclusivement aux membres Premium du Pharmascope, Nicolas, Sébastien et Isabelle discutent de tout ce qu'il y a à savoir sur cette nouvelle méthode contraceptive.  Les objectifs pour cet épisode sont les suivants: Identifier les patients pour qui l'implant d'étonogestrel NexplanonMD est indiqué Comparer l'efficacité et l'innocuité de l'implant d'étonogestrel NexplanonMD aux autres contraceptifs disponibles sur le marché Expliquer les avantages et les inconvénients de l'implant d'étonogestrel NexplanonMD   Ressources pertinentes en lien avec l'épisode Monographie de produit: NexplanonMD. Merck Canada. Mai 2020. Darney P et coll. Safety and efficacy of a single-rod etonogestrel implant (Implanon): results from 11 international clinical trials. Fertil Steril. 2009;91:1646-53. Secura GM et coll. The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception. Am J Obstet Gynecol. 2010;203:115.e1-7. Xu H et coll. Contraceptive failure rates of etonogestrel subdermal implants in overweight and obese women. Obstet Gynecol. 2012;120:21-6.

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.

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.

Infecções de repetição, como candidíase e vaginose, afetam a qualidade de vida de milhões de mulheres. E se a chave para a prevenção e o tratamento estiver em um ecossistema muitas vezes esquecido? Neste terceiro episódio, o Dr. Dan Waitzberg e a Dra. Barbara Peters exploram o fascinante universo da microbiota vaginal.Descubra como os lactobacilos atuam como uma linha de defesa natural, como os probióticos podem restaurar esse equilíbrio e quais os benefícios para mulheres na menopausa.ReferênciasHan Y, Liu Z, Chen T. Role of Vaginal Microbiota Dysbiosis in Gynecological Diseases and the Potential Interventions. Front Microbiol. 2021 Jun 18;12:643422. doi: 10.3389/fmicb.2021.643422. PMID: 34220737; PMCID: PMC8249587.Gupta S, Kakkar V, Bhushan I. Crosstalk between Vaginal Microbiome and Female Health: A review. Microb Pathog. 2019 Nov;136:103696. doi: 10.1016/j.micpath.2019.103696. Epub 2019 Aug 23. PMID: 31449855.Lewis FMT, Bernstein KT, Aral SO. Vaginal Microbiome and Its Relationship to Behavior, Sexual Health, and Sexually Transmitted Diseases. Obstet Gynecol. 2017 Apr;129(4):643-654. doi: 10.1097/AOG.0000000000001932. PMID: 28277350; PMCID: PMC6743080.Rezazadeh MB, Zanganeh M, Jarahi L, Fatehi Z. Comparative efficacy of oral and vaginal probiotics in reducing the recurrence of bacterial vaginosis: a double-blind clinical trial. BMC Womens Health. 2024 Oct 26;24(1):575. doi: 10.1186/s12905-024-03418-z. PMID: 39462408; PMCID: PMC11515199.Hertz FB, Holm JB, Pallejá A, Björnsdóttir MK, Mikkelsen LS, Brandsborg E, Frimodt-Møller N. Vaginal microbiome following orally administered probiotic. APMIS. 2022 Oct;130(10):605-611. doi: 10.1111/apm.13261. Epub 2022 Jul 25. PMID: 35801409; PMCID: PMC9540456.Hertz FB, Holm JB, Pallejá A, Björnsdóttir MK, Mikkelsen LS, Brandsborg E, Frimodt-Møller N. Vaginal microbiome following orally administered probiotic. APMIS. 2022 Oct;130(10):605-611. doi: 10.1111/apm.13261. Epub 2022 Jul 25. PMID: 35801409; PMCID: PMC9540456.Kim JM, Park YJ. Probiotics in the Prevention and Treatment of Postmenopausal Vaginal Infections: Review Article. J Menopausal Med. 2017 Dec;23(3):139-145. doi: 10.6118/jmm.2017.23.3.139. Epub 2017 Dec 29. PMID: 29354612; PMCID: PMC5770522.Silva VF, Refinetti P, Vicariotto F, Baracat EC, Soares Junior JM. Oral probiotics and vaginal microbiome in post-menopause women: an opinion for the improvement of natural therapies in gynecology. Rev Assoc Med Bras (1992). 2024 Jan 5;70(2):e702EDIT. doi: 10.1590/1806-9282.702EDIT. PMID: 38198300; PMCID: PMC10768674.https://bhbfood.com/noticias/iff-health-sciences-conquista-aprovacao-da-anvisa-para-probiotico/Petrova MI, van den Broek M, Balzaretti S, et al. Lactobacillus crispatus dominates healthy vaginal microbiota and inhibits pathogens. Microbiome. 2017;5:74.Grin PM, Kowalewska PM, Alhasson F, et al. Probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 for genitourinary health in women. Eur J Clin Microbiol Infect Dis. 2013;33(6):917–922.Verdenelli MC, Coman MM, Ghelardi E, et al. Lactobacillus acidophilus LA-14 role in vaginal health: adhesion and acidification. Probiotics Antimicrob Proteins. 2015;7(2):114–120.Swidsinski A, Mendling W, Loening-Baucke V, et al. Biofilm of Lactobacillus gasseri in healthy and diseased vagina. PLoS One. 2018;13(5):e0194214.

Thank goodness for William Morton and Horace Wells- pioneers in anesthesia. Anesthesia has come a long way since them and there is even a professional medical society for OB anesthesia called SOAP. Today, August 07, 2025, there is a new Clinical Expert Series which was just released in the Green Journal. That publication (which is ahead of print) is titled, Key Management Considerations in Obstetric Anesthesiology, is our episode focus. Can you safely have an epidural placed if the patient has platelets under 100K? Can labor epidurals cause pyrexia alone? Do labor epidurals slow labor? Listen in for details. 1. Clinical Expert Series, Key Management Considerations in Obstetric Anesthesiology. Obstet Gynecol; ePub 08/07/2025. 2. ACOG PB 2017; 20193. Adams AK. Tarnished Idol: William Thomas Green Morton and the Introduction of Surgical Anesthesia. J R Soc Med. 2002 May;95(5):266–7. PMCID: PMC1279690.4. Hegvik, Tor-Arne et al. Labor epidural analgesia and subsequent risk of offspring autism spectrum disorder and attention-deficit/hyperactivity disorder: a cross-national cohort study of 4.5 million individuals and their siblings.American Journal of Obstetrics & Gynecology, Volume 228(2): 233.e1 - 233.e125. https://med.stanford.edu/news/all-news/2021/04/Epidural-use-at-birth-not-linked-to-autism-risk-study-finds.html

Antenatal Corticosteroids (ACS) for Fetal Lung Maturation (and more) is an ever evolving saga. This is how science and medicine evolve, by always seeking more information. The effect of antenatal corticosteroids on neonatal/child neurodevelopmental outcomes is controversial and may be influenced by the gestational age at which exposure occurred. In this episode we will highlight TWO recent publications, one from May 2025 (JAMA Netw) and the other from June 2025 (Obstet Gynecol). The first adds data to the "Dose to Delivery interval" question for ACS benefit, and the second article relates to neurodevelopmental outcomes after exposure. Listen in for details.

Drs. Amy Crockett (@amyhcrockett), Ben Ereshefsky (@brainofbpharm), and Pamela Bailey (@pamipenem) join Dr. Julie Ann Justo (@julie_justo) to discuss new treatment strategies for management of intraamniotic infections, also known as chorioamnionitis. They discuss whether it is time to move away from the combination of ampicillin, gentamicin, and/or clindamycin, alternative antibiotic regimens to consider, and stewardship strategies to approach this practice change at a local level. References: Basic stats/epi on chorioamnionitis: Romero R, et al. Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques. J Perinat Med. 2015 Jan;43(1):19-36. doi: 10.1515/jpm-2014-0249. PMID: 25720095. ACOG 2017 Guideline for IAI: Committee Opinion No. 712: Intrapartum Management of Intraamniotic Infection. Obstet Gynecol. 2017 Aug;130(2):e95-e101. doi: 10.1097/AOG.0000000000002236. PMID: 28742677. ACOG 2024 Update on clinical criteria for IAI: ACOG Clinical Practice Update: Update on Criteria for Suspected Diagnosis of Intraamniotic Infection. Obstetrics & Gynecology 144(1):p e17-e19, July 2024. doi: 10.1097/AOG.0000000000005593 Helpful review with more recent microorganisms : Jung E, et al. Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment. Am J Obstet Gynecol. 2024 Mar;230(3S):S807-S840. doi: 10.1016/j.ajog.2023.02.002. PMID: 38233317. Cochrane Review: Chapman E, et al. Antibiotic regimens for management of intra-amniotic infection. Cochrane Database Syst Rev. 2014 Dec 19;2014(12):CD010976. doi: 10.1002/14651858.CD010976.pub2. PMID: 25526426. Helpful recent review on intrapartum infections: Bailey, P, et al_._ Out with the Old, In with the New: A Review of the Treatment of Intrapartum Infections. Curr Infect Dis Rep. 2024;26:107–113 doi: 10.1007/s11908-024-00838-8. Role of genital mycoplasmas in IAI: Romero R, et al. Evidence that intra-amniotic infections are often the result of an ascending invasion - a molecular microbiological study. J Perinat Med. 2019 Nov 26;47(9):915-931. doi: 10.1515/jpm-2019-0297. PMID: 31693497. Regimens without enterococcal coverage with similar clinical outcomes: Blanco JD, et al. Randomized comparison of ceftazidime versus clindamycin-tobramycin in the treatment of obstetrical and gynecological infections. Antimicrob Agents Chemother. 1983 Oct;24(4):500-4. doi: 10.1128/AAC.24.4.500. PMID: 6360038. Bookstaver PB, et al. A review of antibiotic use in pregnancy. Pharmacotherapy. 2015 Nov;35(11):1052-62. doi: 10.1002/phar.1649. PMID: 26598097. Updated review in pregnancy, includes data on frequency of antibiotic use in pregnancy: Nguyen J, et al. A review of antibiotic safety in pregnancy-2025 update. Pharmacotherapy. 2025 Apr;45(4):227-237. doi: 10.1002/phar.70010. Epub 2025 Mar 19. PMID: 40105039. Locksmith GJ, et al. High compared with standard gentamicin dosing for chorioamnionitis: a comparison of maternal and fetal serum drug levels. Obstet Gynecol. 2005 Mar;105(3):473-9. doi: 10.1097/01.AOG.0000151106.87930.1a. PMID: 15738010. Clindamycin CDI Risk: Miller AC, et al. Comparison of Different Antibiotics and the Risk for Community-Associated Clostridioides difficile Infection: A Case-Control Study. Open Forum Infect Dis. 2023 Aug 5;10(8):ofad413. doi: 10.1093/ofid/ofad413. PMID: 37622034. Impact of penicillin allergy on clindamycin use & cites 47% clindamycin resistance per CDC among GBS: Snider JB, et al. Antibiotic choice for Group B Streptococcus prophylaxis in mothers with reported penicillin allergy and associated newborn outcomes. BMC Pregnancy Childbirth. 2023 May 30;23(1):400. doi: 10.1186/s12884-023-05697-0. PMID: 37254067. Clindamycin anaerobic coverage data: Hastey CJ, et al. Changes in the antibiotic susceptibility of anaerobic bacteria from 2007-2009 to 2010-2012 based on the CLSI methodology. Anaerobe. 2016 Dec;42:27-30. doi: 10.1016/j.anaerobe.2016.07.003. PMID: 27427465. Older PK study of ampicillin & gentamicin for chorioamnionitis: Gilstrap LC 3rd, Bawdon RE, Burris J. Antibiotic concentration in maternal blood, cord blood, and placental membranes in chorioamnionitis. Obstet Gynecol. 1988 Jul;72(1):124-5. PMID: 3380500. Paper putting out the call for modernization of OB/Gyn antibiotic regimens: Pek Z, Heil E, Wilson E. Getting With the Times: A Review of Peripartum Infections and Proposed Modernized Treatment Regimens. Open Forum Infect Dis. 2022 Sep 5;9(9):ofac460. doi: 10.1093/ofid/ofac460. PMID: 36168554. Vanderbilt University Medical Center experience with modernizing OB/Gyn infection regimens: Smiley C, et al. Implementing Updated Intraamniotic Infection Guidelines at a Large Academic Medical Center. Open Forum Infect Dis. 2024 Sep 5;11(9):ofae475. doi: 10.1093/ofid/ofae475. PMID: 39252868. Prisma Health/University of South Carolina experience with modernizing OB/Gyn infection regimens: Bailey P, et al. Cefoxitin for Intra-amniotic Infections and Endometritis: A Retrospective Comparison to Traditional Antimicrobial Therapy Regimens Within a Healthcare System. Clin Infect Dis. 2024 Jul 19;79(1):247-254. doi: 10.1093/cid/ciae042. PMID: 38297884.

A new year and a new beginning. Special guest co-host Pedro Mendes joins Dr. Chris Labos to answer a viewer question about menopause. Become a supporter of our show today either on Patreon or through PayPal! Thank you! http://www.patreon.com/thebodyofevidence/ https://www.paypal.com/donate?hosted_button_id=9QZET78JZWCZE Email us your questions at thebodyofevidence@gmail.com. Assistant researcher: Aigul Zaripova, MD Editor: Robyn Flynn Theme music: “Fall of the Ocean Queen“ by Joseph Hackl Rod of Asclepius designed by Kamil J. Przybos Chris' book, Does Coffee Cause Cancer?: https://ecwpress.com/products/does-coffee-cause- cancer Obviously, I'm not your doctor (probably). This podcast is not medical advice for you; it is what we call information. References: Geographic variability of menopausal symptoms 1) Nappi RE et al. Global cross-sectional survey of women with vasomotor symptoms associated with menopause: prevalence and quality of life burden. Menopause. 2021 May 24;28(8):875-882. doi: 10.1097/GME.0000000000001793. 2) Nappi RE, et al. Prevalence and quality-of-life burden of vasomotor symptoms associated with menopause: A European cross-sectional survey. Maturitas. 2023 Jan;167:66-74. doi: 10.1016/j.maturitas.2022.09.006. What's the normal duration of symptoms 3) Avis NE, et al. Study of Women's Health Across the Nation. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015 Apr;175(4):531-9. doi: 10.1001/jamainternmed.2014.8063. The Women's Health Initiative (WHI) studies Rossouw JE et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002 Jul 17;288(3):321-33. doi: 10.1001/jama.288.3.321. Anderson GL et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA. 2004 Apr 14;291(14):1701-12. doi: 10.1001/jama.291.14.1701. Decline in HRT after WHI studies Sprague BL, Trentham-Dietz A, Cronin KA. A sustained decline in postmenopausal hormone use: results from the National Health and Nutrition Examination Survey, 1999-2010. Obstet Gynecol. 2012 Sep;120(3):595-603. doi: 10.1097/AOG.0b013e318265df42. Danish Osteoporosis Prevention Study Schierbeck LL metal. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ. 2012 Oct 9;345:e6409. doi: 10.1136/bmj.e6409. Kronos Early Estrogen Prevention Study (KEEPS) Harman SM, et al. Arterial imaging outcomes and cardiovascular risk factors in recently menopausal women: a randomized trial. Ann Intern Med. 2014 Aug 19;161(4):249-60. doi: 10.7326/M14-0353. Kronos Early Estrogen Prevention Study (KEEPS) Hodis HN et al. Vascular Effects of Early versus Late Postmenopausal Treatment with Estradiol. N Engl J Med. 2016 Mar 31;374(13):1221-31. doi: 10.1056/NEJMoa1505241. Stopping hormonal therapy Berman RS et al. Risk factors associated with women's compliance with estrogen replacement therapy. J Womens Health. 1997 Apr;6(2):219-26. doi: 10.1089/jwh.1997.6.219. Grady D, Sawaya GF. Discontinuation of postmenopausal hormone therapy. Am J Med. 2005 Dec 19;118 Suppl 12B:163-5. doi: 10.1016/j.amjmed.2005.09.051. Tapering vs. abrupt stop or hormonal therapy Haimov-Kochman R et al. Gradual discontinuation of hormone therapy does not prevent the reappearance of climacteric symptoms: a randomized prospective study. Menopause. 2006 May-Jun;13(3):370-6. doi: 10.1097/01.gme.0000186663.36211.c0. PMID: 16735933.

Dr. Jim Simon discusses the importance of hormones in sexual health and the intersectionality of ISSWSH and NAMS. He emphasizes the need for all healthcare providers to be comfortable talking about sex and hormones. Dr. Simon also talks about his paper on menopausal hormone therapy and the misconceptions surrounding hormone therapy and breast cancer. He highlights the importance of individualized risk assessment and informed decision-making. The conversation also covers the future of hormones, the role of lifestyle factors in healthy aging, and the development of new drugs for hot flashes, including Fezolinetant and a new one coming on the market in one year. In this conversation, Dr. James Simon and Dr. Kelly Casperson discuss various topics related to women's health, including the challenges of getting a female dosed testosterone approved by the FDA, of treating sexual dysfunction, the underutilization of certain medications, and the importance of advocating for better access to care. They also touch on the off-label use of medications and the need for comprehensive education on hormones and sex medicine. Additionally, they explore the role of hormones in sleep issues and the impact of anxiety on menopausal women. TakeawaysHealthcare providers should be comfortable discussing sex and hormones with their patients.Individualized risk assessment is crucial when considering hormone therapy.Lifestyle factors, such as diet and exercise, play a significant role in healthy aging.New drugs for hot flashes offer more options for women who cannot or should not use hormones. Advocacy is crucial in improving access to care for women's sexual health issues.Certain medications for sexual dysfunction are underutilized and may be more cost-effective options.Off-label use of medications can be beneficial and should be considered when appropriate.Comprehensive education on hormones and sex medicine is needed for healthcare professionals.Sleep issues in menopausal women should be addressed beyond hot flashes and night sweats.Anxiety is a common concern for menopausal women and should be treated alongside other symptoms.Dr. Jim Simon was previously on YANB episode #111 – go back and check it out!Dr. James A. Simon is a D.C.-based physician providing patient-focused care for women across the reproductive life cycle, from adolescence to childbirth, and through the menopause transition. His unique approach to care encourages women to be a part of their own wellness, disease prevention, treatment and recovery; and through his renowned clinical research efforts, he offers one-of-a-kind opportunities for patients to experience the latest innovations in women's health.Levy B, Simon JA. A Contemporary View of Menopausal Hormone Therapy. Obstet Gynecol. 2024 Jul 1;144(1):12-23. doi: 10.1097/AOG.0000000000005553. Epub 2024 Mar 14. PMID: 38484309.See Full Prescribing Information and Medication Guide, including Boxed Warning for severe low blood pressure and fainting in certain settings at addyi.com/piThanks to our sponsor Sprout Pharmaceuticals. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment.Thanks to our sponsor Midi Women's Health. Designed by midlife experts, delivered by experienced clinicians, covered by insurance.Midi is the first virtual care clinic made exclusively for women 40+. Evidence-based treatments. Personalized midlife care.https://www.joinmidi.comOrder my book "You Are Not Broken: Stop "Should-ing" All Over You Sex Life"Listen to my Tedx Talk: Why we need adult sex edTake my Adult Sex Ed Master Class:Join my membership to get these episodes ASAP, a privatefacebook group to discuss and my private accountability group for your health,hormones and life support!www.kellycaspersonmd.com/membershipInterested in my sexual health and hormone clinic? Starts January 2025.  Learn more about your ad choices. Visit podcastchoices.com/adchoicesSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Dr. Jim Simon discusses the importance of hormones in sexual health and the intersectionality of ISSWSH and NAMS. He emphasizes the need for all healthcare providers to be comfortable talking about sex and hormones. Dr. Simon also talks about his paper on menopausal hormone therapy and the misconceptions surrounding hormone therapy and breast cancer. He highlights the importance of individualized risk assessment and informed decision-making. The conversation also covers the future of hormones, the role of lifestyle factors in healthy aging, and the development of new drugs for hot flashes, including Fezolinetant and a new one coming on the market in one year. In this conversation, Dr. James Simon and Dr. Kelly Casperson discuss various topics related to women's health, including the challenges of getting a female dosed testosterone approved by the FDA, of treating sexual dysfunction, the underutilization of certain medications, and the importance of advocating for better access to care. They also touch on the off-label use of medications and the need for comprehensive education on hormones and sex medicine. Additionally, they explore the role of hormones in sleep issues and the impact of anxiety on menopausal women. Takeaways Healthcare providers should be comfortable discussing sex and hormones with their patients. Individualized risk assessment is crucial when considering hormone therapy. Lifestyle factors, such as diet and exercise, play a significant role in healthy aging. New drugs for hot flashes offer more options for women who cannot or should not use hormones. Advocacy is crucial in improving access to care for women's sexual health issues. Certain medications for sexual dysfunction are underutilized and may be more cost-effective options. Off-label use of medications can be beneficial and should be considered when appropriate. Comprehensive education on hormones and sex medicine is needed for healthcare professionals. Sleep issues in menopausal women should be addressed beyond hot flashes and night sweats. Anxiety is a common concern for menopausal women and should be treated alongside other symptoms. Dr. Jim Simon was previously on YANB episode #111 – go back and check it out! Dr. James A. Simon is a D.C.-based physician providing patient-focused care for women across the reproductive life cycle, from adolescence to childbirth, and through the menopause transition. His unique approach to care encourages women to be a part of their own wellness, disease prevention, treatment and recovery; and through his renowned clinical research efforts, he offers one-of-a-kind opportunities for patients to experience the latest innovations in women's health. Levy B, Simon JA. A Contemporary View of Menopausal Hormone Therapy. Obstet Gynecol. 2024 Jul 1;144(1):12-23. doi: 10.1097/AOG.0000000000005553. Epub 2024 Mar 14. PMID: 38484309. See Full Prescribing Information and Medication Guide, including Boxed Warning for severe low blood pressure and fainting in certain settings at addyi.com/pi Thanks to our sponsor Sprout Pharmaceuticals. To find out if Addyi is right for you, go to addyi.com/notbroken and use code NOTBROKEN for a $10 telemedicine appointment. Thanks to our sponsor Midi Women's Health. Designed by midlife experts, delivered by experienced clinicians, covered by insurance. Midi is the first virtual care clinic made exclusively for women 40+. Evidence-based treatments. Personalized midlife care. https://www.joinmidi.com Order my book "You Are Not Broken: Stop "Should-ing" All Over You Sex Life" Listen to my Tedx Talk: Why we need adult sex ed Take my Adult Sex Ed Master Class: Join my membership to get these episodes ASAP, a private facebook group to discuss and my private accountability group for your health, hormones and life support! www.kellycaspersonmd.com/membership Interested in my sexual health and hormone clinic? Starts January 2025.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Women's health has a history of being underfunded in the United States, leading many women to receive suboptimal care. In this episode of the BackTable OBGYN podcast, hosts Dr. Mark Hoffman and Dr. Amy Park engage in a detailed discussion with Dr. Louise P. King, a minimally invasive gynecologic surgeon, and Christopher Robertson, a law professor at Boston University, regarding the inequitable reimbursement structures that persist within the field of OBGYN. --- SYNPOSIS The guests emphasize the systemic discrepancies between gynecologic and other surgical disciplines. The conversation delves into the origins of these disparities, the complexities of revising current codes and creating new codes, and potential legislative and legal remedies to address gender-based inequities. The guests also stress the importance of patient care outcomes and the role of proper reimbursement in enhancing healthcare delivery. --- TIMESTAMPS 00:00 - Introduction 06:28 - Background on RVUs and Disparities in OBGYN 12:39 - Gender Disparities in Medical Billing 18:00 - Efforts to Address Inequities 31:22 - RUC Structure and Surgical Specialties 32:42 - Billing and Reimbursement Inequities 35:15 - Diagnosis Related Groups 36:42 - Turnover Times and Gender Disparities 40:21 - Advocacy and Legislative Solutions 48:23 - Legal Approaches for Change 52:44 - Conclusion --- RESOURCES Watson KL, King LP. Double Discrimination, the Pay Gap in Gynecologic Surgery, and Its Association With Quality of Care. Obstet Gynecol. 2021 Apr 1;137(4):657-661. doi: 10.1097/AOG.0000000000004309. PMID: 33706362. Robertson, Christopher T. and Kupke, Annabel and King, Louise P., Structural Sex Discrimination: Why Gynecology Patients Suffer Avoidable Injuries and What the Law Can Do About It (May 9, 2024). Emory Law Journal, Forthcoming, Boston Univ. School of Law Research Paper Forthcoming, Available at SSRN: https://ssrn.com/abstract=4800783 or http://dx.doi.org/10.2139/ssrn.4800783

Kennedy Dunn and Terinney Haley, 3rd year medical students at Howard U, explore soil and how we nourish those around us and what it means to be human in the fourth episode of Stranger Fruit Vol I.   Chapters: 0:00 Understanding Soil and Self-Care: Foundations for Growth 11:39 The Journey of Medical Education and Personal Development 40:36 Authenticity and Growth: Embracing Heritage and Personal Identity 51:37 Navigating Adversity: Cultivating Resilience and Authenticity 58:15 Mental Health and Motivation: Harnessing Anxiety for Success   Guest Host Socials! TikTok: goldendocther Instagram: goldendocther Works Cited: Prevalence of Incontinence Among Older Americans. Vital & Health Statistics, Series 3, Number 36, US Department of Health And Human Services. June, 2014 : https://www.cdc.gov/nchs/data/series/sr_03/sr03_036.pdf Nygaard I et al. Urinary incontinence and depression in middle-aged United States women. Obstet Gynecol 2003; 101: 149-156 Bogner HR et al. Anxiety disorders and disability secondary to urinary incontinence among adults over age 50. Int J Psychiatry Med 2002; 32: 141-154. Sutherst J, Brown M: Sexual dysfunction associated with urinary incontinence. Urol Int 35: 414, 1980 Intro Music: Bosch's Garden - by Kjartan Abel. This work is licensed under the following: CC BY-SA 4.0 Attribution-ShareAlike 4.0 International.    

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There continues to be great confusion regarding the impact of hormone therapy on the breast. And despite the known benefits of hormone therapy, and reassuring data regarding the impact of hormone therapy on breast cancer, most clinicians are still reluctant to prescribe it, and most women are reluctant to take it. Even more so if a woman is high risk for breast cancer or has a breast cancer diagnosis.  In this episode, I am joined by Dr. Corinne Menn, a board-certified Ob GYN and menopause expert who herself had a breast cancer diagnosis when she was in her 20s. We will be reviewing the latest research on the impact of estrogen on the breast in several different scenarios.  PREGNANCY post breast cancer Women who have a BREAST CANCER diagnosis  Women with a FAMILY HISTORY of breast cancer Women with a BRCA MUTATION after prophylactic ovary removal The approach to therapy for women with a NEW BREAST CANCER DIAGNOSIS The use of local vaginal estrogen in women with a breast cancer diagnosis that are taking TAMOXIFEN or using an AROMOTASE INHIBITOR If a LOCAL VAGINAL ESTROGEN needs to  be used at the lowest dose What to do if your DOCTOR NOT WILLING to prescribe local or systemic estrogen (list of articles to share is below)  If a woman with a breast cancer diagnosis can use TESTOSTERONE for libido and other possible benefits Dr. Corrine Menn https://drmenn.com/ @drmennobgyn For more information: Episode 124 All Hormones Are Not Created Equal with Dr. James Simon Episode 65- The Dilemma of Menopause and Breast Cancer Episode 31 The TRUTH About Hormone Therapy: Does it CAUSE or Does it PREVENT Breast Cancer? Episode 28: The BEST approach for BREAST Cancer Screening and Risk Reduction with Dr. Lisa Larkin Dr. Streicher's Inside Information podcast is not intended to replace medical advice and should be used to supplement, not replace, care by your personal health care clinician. Dr. Streicher disclaims liability for any medical outcomes that may occur because of applying methods suggested or discussed in this podcast. Scientific Articles  Hormone Therapy and Risk of Breast Cancer Bluming AZ, Hodis HN, Langer RD. 'Tis but a scratch: a critical review of the Women's Health Initiative evidence associating menopausal hormone therapy with the risk of breast cancer. Menopause. 2023 Dec 1;30(12):1241-1245.  Bluming AZ. Introduction: Estrogen Reconsidered: Exploring the Evidence for Estrogen's Benefits and Risks. Cancer J. 2022 May-Jun 01;28(3):157-162.  Hodis HN, Sarrel PM. Menopausal hormone therapy and breast cancer: what is the evidence from randomized trials? Climacteric 2018;21:521–8. Levy B, Simon JA. A Contemporary View of Menopausal Hormone Therapy. Obstet Gynecol. 2024 Mar 14.  Chlebowski RT, Aragaki AK, Pan K, Mortimer JE, Johnson KC, Wactawski-Wende J, LeBoff MS, Lavasani S, Lane D, Nelson RA, Manson JE. Randomized trials of estrogen-alone and breast cancer incidence: a meta-analysis. Breast Cancer Res Treat. 2024 Apr 23. doi: 10.1007/s10549-024-07307-9.  Pan K, Lavasani S, Aragaki AK, Chlebowski RT. Estrogen therapy and breast cancer in randomized clinical trials: a narrative review. Menopause. 2022 Sep 1;29(9):1086-1092.  Use of Hormone Therapy in Women with a Breast Cancer Diagnosis Bluming A. Hormone replacement therapy after breast cancer: it is time. Cancer J 2022;28:183–90.  Bluming AZ. Safety of systemic hormone replacement therapy in breast cancer survivors. Breast Cancer Res Treat. 2022 Feb;191(3):685-686. doi: 10.1007/s10549-021-06479-y.  Fahlén M, Fornander T, Johansson H, Johansson U, Rutqvist LE, Wilking N, von Schoultz E. Hormone replacement therapy after breast cancer: 10 year follow up of the Stockholm randomised trial. Eur J Cancer. 2013 Jan;49(1):52-9. Mikkola TS, Savolainen-Peltonen H, Tuomikoski P, Hoti F, Vattulainen P, Gissler M, et al. Reduced risk of breast cancer mortality in women using postmenopausal hormone therapy: a Finnish nationwide comparative study. Menopause 2016;23:1199–203 Hormone Therapy in Women with BRCA Mutation Kotsopoulos J, Gronwald J, Karlan BY, Huzarski T, Tung N, Moller P, Armel S, Lynch HT, Senter L, Eisen A, Singer CF, Foulkes WD, Jacobson MR, Sun P, Lubinski J, Narod SA; Hereditary Breast Cancer Clinical Study Group. Hormone Replacement Therapy After Oophorectomy and Breast Cancer Risk Among BRCA1 Mutation Carriers. JAMA Oncol. 2018 Aug 1;4(8):1059-1065.. Lauren Streicher, MD is a clinical professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine, and the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause. She is a certified menopause practitioner of the North American Menopause Society.  Sign up to receive DR. STREICHER'S FREE NEWSLETTER Dr. Streicher is the medical correspondent for Chicago's top-rated news program, the WGN Morning News, and has been seen on The Today Show, Good Morning America, The Oprah Winfrey Show, CNN, NPR, Dr. Radio, Nightline, Fox and Friends, The Steve Harvey Show, CBS This Morning, ABC News Now, NBCNightlyNews,20/20, and World News Tonight. She is an expert source for many magazines and serves on the medical advisory board of The Kinsey Institute, Self Magazine, and Prevention Magazine. She writes a regular column for The Ethel by AARP and Prevention Magazine.  Subscribe and Follow Dr. Streicher on  DrStreicher.com Instagram @DrStreich Facebook  @DrStreicher YouTube  DrStreicherTV Books by Lauren Streicher, MD  Slip Sliding Away: Turning Back the Clock on Your Vagina-A gynecologist's guide to eliminating post-menopause dryness and pain Hot Flash Hell: A Gynecologist's Guide to Turning Down the Heat Sex Rx- Hormones, Health, and Your Best Sex Ever The Essential Guide to Hysterectomy

Navigating breastfeeding as an EM physician In the previous two episodes, we explored some of the challenges related to fertility and pregnancy for EM physicians. In the final episode of our three part series, we take it one step further to discuss yet another challenge: breastfeeding. Of course, fed is always best, and there are many reasons to formula feed, but providing breastmilk is very important to many families. For EM physicians, choosing to breastfeed usually means figuring out how to pump and store milk while you're on shift. This can be daunting, especially for residents and junior physicians. How do you find time to sneak away? Is there an easily accessible pumping room close by? Will you feel supported by colleagues and your department? We cover these questions and much more with experts, Dr. Claire Abramoff, and Dr. Shada Rouhani.  Does your ED have policies to support breastfeeding and pumping? Share your experience with us on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guests: Dr. Claire Abramoff, Assistant professor at Jefferson, Sidney Kimmel Medical Center College and Assistant Residency Program Director, Department of Emergency Medicine, Einstein Medical Center in Philadelphia, PA Dr. Shada Rouhani, Assistant Professor of Emergency Medicine at Harvard Medical School and Emergency Physician at Brigham and Women's Hospital in Boston, MA Resources: Practice Management Breastfeeding Disasters and Solutions for EPs, by Claire Abramoff, MD, for Emergency Medicine News, March 14, 2023.  Cleveland Manchanda EC, Vogel LD, Kass D, Rouhani SA. Best Practices for Lactation Support at Conferences and Standardized Testing Centers. Obstet Gynecol. 2020 Feb;135(2):475-478. doi: 10.1097/AOG.0000000000003661. PMID: 31923075. McDonald L, Illg Z, Dow A, Gunaga S. Maternity Experiences and Perceptions of Emergency Medicine Physicians. Spartan Med Res J. 2021 Apr 13;6(1):22009. doi: 10.51894/001c.22009. PMID: 33870004; PMCID: PMC8043905. ***** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Every available type of hormone therapy will effectively eliminate hot flashes and other menopause symptoms.   However, all hormone therapy is not the same.  Individual formulations impact bone health, breast health, and cardiovascular health differently.   In episode 123, Dr. James Simon and I discussed starting hormone therapy after the age of 60. In this episode, we discuss the nuances between different hormones and their impact on breast cancer and bone health.  Why it is important to individualize hormone therapy Why there is the perception that estrogen causes breast cancer There is a difference between causing breast cancer and making breast cancer grow The differences between conjugated equine estrogen (Provera) and a plant-derived bioidentical beta-estradiol in terms of breast cancer impact The differences between the different estrogens and progestogens as far as bone health Transdermal vs oral estrogen Dr. Simon's Article : Levy B, Simon JA. A Contemporary View of Menopausal Hormone Therapy. Obstet Gynecol. 2024 Mar 14.  Ms Magazine article with Lancet Rebuttal https://msmagazine.com/2024/04/15/menopause-treatment-the-lancet/ List of doctors who signed rebuttal                                                 James A. Simon, MD                                      Clinical Professor George Washington University                                                  www.IntimMedicine.com The Menopause Society Find a menopause practitioner page  Midi Health https://www.joinmidi.com/ For more information on this topic:  Episode 51- Transdermal versus Oral Estrogen- What's the Difference?  Episode 67- How Long Can you Safely Take Hormone Therapy? Episode 114- Is Duovee the Ideal Hormone Therapy?  Episode 123 Is Starting Hormone Therapy After Age 60 an Option?  Slip Sliding Away: Turning Back the Clock on Your Vagina-A gynecologist's guide to eliminating post-menopause dryness and pain Hot Flash Hell: A Gynecologist's Guide to Turning Down the Heat Dr. Streicher's Inside Information podcast is not intended to replace medical advice and should be used to supplement, not replace, care by your personal health care clinician. Dr. Streicher disclaims liability for any medical outcomes that may occur because of applying methods suggested or discussed in this podcast. Lauren Streicher, MD is a clinical professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine, and the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause. She is a certified menopause practitioner of the North American Menopause Society.  Sign up to receive DR. STREICHER'S FREE NEWSLETTER Dr. Streicher is the medical correspondent for Chicago's top-rated news program, the WGN Morning News, and has been seen on The Today Show, Good Morning America, The Oprah Winfrey Show, CNN, NPR, Dr. Radio, Nightline, Fox and Friends, The Steve Harvey Show, CBS This Morning, ABC News Now, NBCNightlyNews,20/20, and World News Tonight. She is an expert source for many magazines and serves on the medical advisory board of The Kinsey Institute, Self Magazine, and Prevention Magazine. She writes a regular column for The Ethel by AARP and Prevention Magazine.  Subscribe and Follow Dr. Streicher on  DrStreicher.com Instagram @DrStreich Facebook  @DrStreicher YouTube  DrStreicherTV Books by Lauren Streicher, MD  Slip Sliding Away: Turning Back the Clock on Your Vagina-A gynecologist's guide to eliminating post-menopause dryness and pain Hot Flash Hell: A Gynecologist's Guide to Turning Down the Heat Sex Rx- Hormones, Health, and Your Best Sex Ever The Essential Guide to Hysterectomy

In this episode of BackTable OBGYN, renowned reproductive endocrinologist and minimally invasive gynecologic surgeon Dr. Charles (Chuck) Miller delves into the topic of isthmoceles, a common yet often overlooked complication of C-sections, and shares his best practices for repair. Dr. Miller shares his extensive experience in diagnosing and treating isthmoceles, discussing various surgical techniques including hysteroscopic, laparoscopic, and robotic-assisted resection. He emphasizes the importance of an aggressive surgical approach for achieving higher success rates in terms of future fertility and resolving symptoms such as abnormal bleeding. Moreover, Dr. Miller highlights the need for standardized treatment protocols and reflects on the mentorship, the ongoing journey of learning and adapting in medicine, and the noble profession of healthcare. The episode offers insightful perspectives on a lesser-known gynecologic issue, underscores the value of experience and mentorship in medicine, and advocates for concerted efforts toward establishing best practices in surgical procedures. --- SHOW NOTES 00:00 - Introduction 07:18 - Defining Isthmocele and the History of Isthmocele 10:00 - The Diagnosis of Isthmocele and Its Impact on Fertility 19:31 - Exploring Surgical Techniques for Isthmocele Repair 27:54 - Understanding Hysteroscopic Resection 30:12 - Addressing C-Section Ectopics and Isthmocele Repairs 36:46 - Adapting the Surgical Approach to Different Patient Scenarios 39:35 - Postoperative Complications and Safety Measures 40:55 - The Future of Isthmocele: Surgical Standardization 50:51 - Closing Thoughts and Acknowledgements --- RESOURCES Ban Y, Shen J, Wang X, Zhang T, Lu X, Qu W, Hao Y, Mao Z, Li S, Tao G, Wang F, Zhao Y, Zhang X, Zhang Y, Zhang G, Cui B. Cesarean Scar Ectopic Pregnancy Clinical Classification System With Recommended Surgical Strategy. Obstet Gynecol. 2023 May 1;141(5):927-936. doi: 10.1097/AOG.0000000000005113. Epub 2023 Apr 5. PMID: 37023450; PMCID: PMC10108840.

Contributor: Kiersten Williams MD, Travis Barlock MD, Jeffrey Olson MS2 Summary: In this episode, Dr. Travis Barlock and Jeffrey Olson meet in the studio to discuss a clip from Dr. Williams' talk at the “Laboring Under Pressure, Managing Obstetric Emergencies in a Global Setting” event from May 2023. This event was hosted at the University of Denver and was organized with the help of Joe Parker as a fundraiser for the organization Health Outreach Latin America (HOLA). Dr. Kiersten Williams completed her OBGYN residency at Bay State Medical Center and practices as an Obstetric Hospitalist at Presbyterian/St. Luke's Medical Center in Denver, Colorado. During her talk, Dr. Williams walks the audience through the common causes and treatments for post-partum hemorrhage (PPH). Some important take-away points from this talk are: The most common causes of PPH can be remembered by the 4 T's. Tone (atony), Trauma, Tissue (retained placenta), and Thrombin (coagulopathies). AV malformations of the uterus are probably underdiagnosed. Quantitative blood loss is much more accurate than estimated blood loss (EBL). The ideal fibrinogen for an obstetric patient about to deliver is above 400 mg/dl - under 200 is certain to cause bleeding. Do not deliver oxytocin via IV push dose, it can cause significant hypotension. Tranexamic Acid is available in both IV and PO and can be administered in the field. The dose is 1 gram and can be run over 10 minutes if administered via IV. It is best if used within 3 hours of delivery. When performing a uterine massage, place one hand inside the vagina and one hand on the lower abdomen. Then rub the lower abdomen like mad. A new option for treating PPH is called the JADA System which is slimmer than a Bakri  Balloon and uses vacuum suction to help the uterus clamp down.* Another option for a small uterus is to insert a 60 cc Foley catheter. In an operating room, a B-Lynch suture can be put in place, uterine artery ligation can be performed, and as a last resort, a hysterectomy can be done. *EMM is not sponsored by JADA system or the Bakri balloon. References Andrikopoulou M, D'Alton ME. Postpartum hemorrhage: early identification challenges. Semin Perinatol. 2019 Feb;43(1):11-17. doi: 10.1053/j.semperi.2018.11.003. Epub 2018 Nov 14. PMID: 30503400. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. 2017 Oct;130(4):e168-e186. doi: 10.1097/AOG.0000000000002351. PMID: 28937571. Federspiel JJ, Eke AC, Eppes CS. Postpartum hemorrhage protocols and benchmarks: improving care through standardization. Am J Obstet Gynecol MFM. 2023 Feb;5(2S):100740. doi: 10.1016/j.ajogmf.2022.100740. Epub 2022 Sep 2. PMID: 36058518; PMCID: PMC9941009. Health Outreach for Latin America Foundation - HOLA Foundation. (n.d.). http://www.hola-foundation.org/ Kumaraswami S, Butwick A. Latest advances in postpartum hemorrhage management. Best Pract Res Clin Anaesthesiol. 2022 May;36(1):123-134. doi: 10.1016/j.bpa.2022.02.004. Epub 2022 Feb 24. PMID: 35659949. Pacheco LD, Saade GR, Hankins GDV. Medical management of postpartum hemorrhage: An update. Semin Perinatol. 2019 Feb;43(1):22-26. doi: 10.1053/j.semperi.2018.11.005. Epub 2018 Nov 14. PMID: 30503399. Produced by Jeffrey Olson, MS2 | Edited by Jeffrey Olson and Jorge Chalit, OMSII

If you operate for long enough, chances are you will come across the unique, and potentially daunting scenario of operating on a pregnant patient. If, and when, you do, would you know what to do? Join University of Washington and MIS faculty Drs. Andrew Wright, Nicole White, and Nick Cetrulo, and residents Drs. Ben Vierra and Paul Herman as they discuss non-obstetric surgery in the pregnant patient so that you will be better informed when the challenge arises. Hosts: 1. Andrew Wright, UW Medical Center—Montlake and Northwest, @andrewswright 2. Nick Cetrulo, UW Medical Center—Northwest, @Trules25 3. Nicole White, UW Medical Center—Northwest, @NicoleWhiteTho1 4. Paul Herman, UW General Surgery Resident PGY-3, @paul_herm 5. Ben Vierra, UW General Surgery Resident PGY-2 Learning Objectives 1. Describe important physiologic changes in pregnancy that are relevant for the surgeon to know. 2. Review the epidemiology of non-obstetric general surgery in the pregnant patient. 3. Discuss specific imaging considerations in the pregnant patient. 4. Become more familiar with the technical aspects of approaching a typical surgical case in a pregnant patient. References 1. Pearl, J.P., Price, R.R., Tonkin, A.E. et al. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc 31, 3767–3782 (2017). https://doi.org/10.1007/s00464-017-5637-3 2. Vasileiou G, Eid AI, Qian S, Pust GD, Rattan R, Namias N, Larentzakis A, Kaafarani HMA, Yeh DD; EAST Appendicitis Study Group. Appendicitis in Pregnancy: A Post-Hoc Analysis of an EAST Multicenter Study. Surg Infect (Larchmt). 2020 Apr;21(3):205-211. https://pubmed.ncbi.nlm.nih.gov/31687887/ 3. Dongarwar D, Taylor J, Ajewole V, Anene N, Omoyele O, Ogba C, Oluwatoba A, Giger D, Thuy A, Argueta E, Naik E, Salemi JL, Spooner K, Olaleye O, Salihu HM. Trends in Appendicitis Among Pregnant Women, the Risk for Cardiac Arrest, and Maternal-Fetal Mortality. World J Surg. 2020 Dec;44(12):3999-4005. https://pubmed.ncbi.nlm.nih.gov/32737556/ 4. Fong ZV, Pitt HA, Strasberg SM, Molina RL, Perez NP, Kelleher CM, Loehrer AP, Sicklick JK, Talamini MA, Lillemoe KD, Chang DC; California Cholecystectomy Group. Cholecystectomy During the Third Trimester of Pregnancy: Proceed or Delay? J Am Coll Surg. 2019 Apr;228(4):494-502.e1. https://pubmed.ncbi.nlm.nih.gov/30769111/ 5. Hong J, Yang J, Zhang X, Su J, Tumati A, Garry D, Docimo S, Bates AT, Spaniolas K, Talamini MA, Pryor AD. Considering delay of cholecystectomy in the third trimester of pregnancy. Surg Endosc. 2021 Aug;35(8):4673-4680. https://pubmed.ncbi.nlm.nih.gov/32875420/ 6. ACOG Committee Opinion No. 775: Nonobstetric Surgery During Pregnancy. Obstet Gynecol. 2019 Apr;133(4):e285-e286. https://pubmed.ncbi.nlm.nih.gov/30913200/ 7. Ashbrook M, Cheng V, Sandhu K, Matsuo K, Schellenberg M, Inaba K, Matsushima K. Management of Complicated Appendicitis During Pregnancy in the US. JAMA Netw Open. 2022 Apr 1;5(4):e227555. https://pubmed.ncbi.nlm.nih.gov/35426921/ 8. Capella CE, Godovchik J, Chandrasekar T, Al-Kouatly HB. Nonobstetrical Robotic-Assisted Laparoscopic Surgery in Pregnancy: A Systematic Literature Review. Urology. 2021 May;151:58-66. https://pubmed.ncbi.nlm.nih.gov/32445766/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other Behind the Knife minimally invasive surgery episodes: https://behindtheknife.org/podcast-category/minimally-invasive/

There has been a lot of news about abortion (abortifacient) medications recently. Since the overturn of Roe v. Wade in 2022, individual states passed their own laws restricting access to abortion, this includes access to abortion medications. This clearly impacts the way pharmacists practice. In this episode, we summarize the science behind the two main abortive drugs, mifepristone and misoprostol, and provide a picture of how the access to these medications stand in the United States. Key Concepts Among other modalities to terminate pregnancies, medication abortion is a safe and alternative option that is picking up popularity given recent changes post-Dobbs vs. Jackson WHO decision. The FDA-approved use of combination mifepristone and misoprostol regimen to terminate pregnancy up to 70 days (10 weeks of gestation) is based on strong evidence for its efficacy and safety. Since the overturning of Roe vs. Wade in 2022, states have taken their own action to further restrict or increase access to abortion services including access to medication abortion.   These legal changes further impact dispensing of mifepristone and misoprostol by pharmacists across the country adding to more confusion. Legal councils, state boards of pharmacies, or state pharmacy associations may serve as suitable resources to consult regarding these fast-changing laws. References American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology, Society of Family Planning. Medication Abortion Up to 70 Days of Gestation: ACOG Practice Bulletin, Number 225. Obstet Gynecol. 2020 Oct;136(4):e31-e47. doi: 10.1097/AOG.0000000000004082. PMID: 32804884. Kaiser Family Foundation. https://www.kff.org/womens-health-policy/fact-sheet/the-availability-and-use-of-medication-abortion Guttmacher Institute. https://www.guttmacher.org/state-policy/explore/overview-abortion-laws

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog At Biobalance® Health we often find cysts or masses on the ovaries of women who are menopausal quite by accident.  We order an ultrasound before we treat a menopausal woman with estradiol to see if there is a thickened lining that might cause bleeding under the influence of estrogen replacement, or to make sure there is no uterine cancer before we treat a new patient.  We also incidentally find ovarian masses or cysts when we are investigating pelvic pain or postmenopausal bleeding on our patients who are already on estrogen replacement.  In general, since BioBalance's female patients have their own GYN we don't do pelvic exams in the office, therefore we don't find a mass by palpating (feeling) the pelvic structures, however ovarian cysts and masses can be found by ultrasound as well as by physical exam.  We generally find ours by vaginal ultrasound. Why do we get ovarian cysts? Before menopause we make an egg every month (if we are not on birth control) that grows within a fluid filled sack. This egg will grow to about 18 mm, or 1.8 cm before it ruptures and releases the egg.  That is the miracle of ovulation.  It is normal to see one or two of these small cysts on the ovaries of ovulating, fertile women. These small sacks are not cysts because of their size.  Ovarian cysts are fluid filled sacks attached to the ovary that are over 2.5 cm. They often occur secondary to a trapped egg that won't ovulate for some reason, and the cyst will remain until the next period.  If the cyst doesn't dissolve before the next cycle, it can grow larger with the surges of hormones and it can prevent future ovulation, or it can cause pain from the stretching of the outer covering of the ovary. If a cyst is less than 2.5 mg. we don't re-ultrasound in cycling women.   If it is larger or continues to cause pain, we follow up an ultrasound in 6 weeks to see if it is growing.  If it is growing but is still clear, depending on the size and the pain involved, we might do a laparoscopy to remove the cyst from the ovary.  If it is growing and looks unusual in shape or density, we order 2 blood tumor markers for ovarian cancer.  If those are negative, we follow up with another ultrasound in 3 more months. In some patients, multiple ovarian cysts are the norm.  Those patients with polycystic ovaries create multiple cysts each month and rarely ovulate.  It helps to use the drug Metformin ER to improve ovulation in PCO patients (and the rupture of cysts).  Some patients require laparoscopy to punch holes in all the cysts especially if she is trying to get pregnant. What does a postmenopausal ovarian mass or cyst mean indicate? Now for postmenopausal patient's ovarian cysts and masses are much more worrisome but much rarer. Because the ovary is not metabolically active, and therefore not ovulating the menopausal ovary should look small without cystic structures, however there are some exceptions!  The menopausal ovary that has a fluid filled cyst 2.5 cm or less can have been there since the patient stopped ovulating and it never deflated, or ovulated.  This type of cyst doesn't grow and is not malignant. Ovarian cysts in postmenopausal women that are fluid filled and larger than 2.5 cm, or solid, or partially fluid filled and partially solid are suspicious for malignancy. In this case your doctor may order an MRI, a CT scan of the pelvis, and order cancer tumor markers.  In most cases these masses are benign, or early in a malignancy and can be treated with surgery.  Sometimes we find a suspicious mass that needs confirmatory ultrasound or MRI by a GYN Oncologist, tumor markers, and surgery would be scheduled to take the uterus tubes and ovaries and sometimes the omentum and lymph nodes. When will a patient know that her mass if not malignant and if she needs surgery? The surgeon may do a frozen section in the operating room to see if more than the ovary itself must be removed or your GYN may wait for the final pathology report to determine if it is malignant. That takes several days to a week. How common is ovarian cancer? Ovarian cancer is very rare and tends to run in families.  If you have not had a relative with ovarian cancer, then you are not likely to have ovarian cancer if you have a suspicious mass. That does not mean you won't' need surgery, it just means the outcome has a high chance of being benign. What can be mistaken for an ovarian mass on ultrasound? There are several pelvic structures that might be confused with an ovarian cyst/mass. The most common is a pedunculated fibroid that hangs down from the uterus and looks like it is coming from the ovary. These muscle masses from the ovary are generally benign, but they can grow under the influence of estrogens.  There are cysts called para-ovarian cysts that can originate from the fallopian tube.  They are fluid filled and can actually grow, looking like an ovarian mass, but they are benign, and most are sedentary and don't grow or become a problem. In my 25 years of operating on women I only had one of the next types of cysts that was thought to be a malignancy at first. It was a very large cyst, 12x 12 inches in diameter and I asked a general surgeon to come in and work with me to help with the surgery if it was a malignancy.  In the end, it was a cyst in the retroperitoneal space, called a peritoneal cyst, that was totally benign, and the patient did not require any further treatment after the surgery. Postmenopausal women who have had an ovarian cyst or ovarian mass you know that it can be an anxiety producing situation, however the great majority of the simple ovarian cysts in postmenopausal women are benign and surgery is not necessary.  Most ovarian cysts are likely to remain unchanged or disappear during the follow-up period. The malignancy rate of these cysts is about 1 in 10,000, so worry is usually unnecessary.  In my 25 years of private practice, I only operated on 5 patients with an ovarian cyst or mass that turned out to be malignant. As gynecologic surgeons we are trained to investigate any ovarian cysts that are suspicious through ultrasound, or surgically even if there is a very slight chance that they might be malignant. We are expected to remove any ovary that is suspected to be cancer, even if the chance is minimal that the cyst is malignant. In our practice we send all our patients with suspicious ovarian masses to their gynecologist for evaluation and treatment. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. Practice Bulletin No. 174: evaluation and management of adnexal masses. Obstet Gynecol 2016;128:e210–e226. doi: 10.1097/AOG.0000000000001768

Episode 139: What is PCOS      Future Dr. Salimi explains the pathophysiology, signs, and symptoms of PCOS. Diagnostic criteria and the basics of treatment are also discussed. Dr. Arreaza adds some comments about the treatment of obesity.  Written by Elika Salimi, MS3, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Hello there! My name is Elika and I am a third-year medical student at Western University of Health Sciences. Today I will be talking to you about polycystic ovary syndrome AKA PCOS.Do you have a female patient in her reproductive years with irregular menstrual cycles, or no menstrual cycles at all? Is she unable to conceive a child? Did she have an unexpected diagnosis of diabetes? Does she have more acne than she would like, or has hair in unwanted or unexpected areas such as her chin?Does she have a hard time losing weight? If you answered YES to many of these questions, it is possible that your patient is suffering from polycystic ovary syndrome also known as PCOS, which is one of the most common endocrine disorders in women. Pathophysiology:The exact pathophysiology behind this syndrome is unknown; however, per the American College of Obstetricians and Gynecologists committee, some studies have shown a strong association between PCOS and obesity. In a woman with obesity disorder, the excess adipose tissue ends up increasing peripheral estrogen synthesis and as a result, there is a decrease in peripheral sensitivity to insulin which means many of these women tend to have hyperinsulinemia. To be more detailed, it is important to mention that during these anovulatory cycles, the increase in estrogen, which is also unopposed estrogen with a lack of progesterone, can lead to endometrial hyperplasia and consequently increase the risk of endometrial carcinoma.Clinical Features: Unless there is a clear history and physical or if perhaps there was an incidental ultrasound finding of polycystic ovaries, the diagnosis of PCOS is not exactly black-and-white. That is why it is important to increase awareness so that women can put the pieces of the puzzle together and come in to get evaluated. Multiple cysts in ovaries can present in patients without PCOS, and they are common in teenagers. To use the multiple cysts as part of the diagnosis, the patient has to be 2 years after menarche (AAFP). Some of these clinical symptoms typically start during adolescence displaying menstrual irregularities such as she could've had her period and then stopped getting it or she has a very delayed onset of her menstrual cycle. It is also possible to have spotty menstrual cycles also known as breakthrough bleeding or menorrhagia. And very important to many women, she could be infertile or have difficulties conceiving.She could also have diabetes because of insulin resistance that comes with the metabolic syndrome that develops with PCOS, which is also increased if she has obesity. This obesity disorder going hand in hand with the metabolic syndrome, can also increase the risk of having sleep apnea, which could affect the quality of her sleep, finding herself more fatigued than she should be after adequate hours of rest. Other symptoms include skin conditions such as hirsutism which is basically male pattern hair growth in women in areas such as the upper lip, chin, around the umbilicus, back, or even buttocks. She could also have male pattern hair loss on the head or too much acne or oily skin or acanthosis nigricans which are these brown/velvety hyperpigmented streaks on the neck or axilla, or groin. She could also find herself more depressed or anxious.Diagnosis:The diagnostic criteria and treatments are mainly addressed in the Journal of Clinical Endocrinology & Metabolism, an evidence-based guideline for the assessment and management of polycystic ovary syndrome, and the American Family Physician Journal:The diagnosis of PCOS requires the presence of at least two criteria that are not due to any other endocrine disorder such as thyroid disease or hyperprolactinemia, or other. 1) Periods of oligo-ovulation and or anovulation which means she's either having very low ovulatory cycles or she's not ovulating at all. 2) hyperandrogenism and this could be based on her clinical features or laboratory studies showing elevated testosterone levels or LH to FSH ratio and 3) Seeing enlarged and/or polycystic ovaries on a pelvic ultrasound. This means that the pelvic ultrasound shows an ovarian volume of equal to or greater than 10 mL and/or there's multiple cystic follicles that are about 2 to 9 mm in one or both of her ovaries which also usually tend to have a string of pearls appearance.So, if you have 2 out of the 3, you have PCOS. There are ways to confirm that there is in fact hyperandrogenism by doing lab studies and this could mean that her testosterone levels are elevated, or her androstenedione is elevated as well as elevated dehydro-epi-androsterone sulfate (DHEAS) and of course we need to rule out pregnancy and other endocrine disorders as I mentioned earlier. However, if the clinical picture of hyperandrogenism is there then that fulfills the diagnostic criteria for PCOS even if the serum antigen levels are normal. This also applies to an elevated LH:FSH ratio of typically greater than 2 to 1 which is also a characteristic finding of most patients with PCOS but this is not exactly necessary for diagnosis. We also don't need to find cystic follicles in order to diagnose PCOS. Treatment: In family medicine practices and even OB/GYN practice for PCOS the most common recommendation for all patients is to encourage them to increase their physical activity (exercise) and eat healthy and try to consider behavioral modifications to have a target BMI of ideally less than 25 kg/m² because this can reduce estrone production in adipose tissue.Then we are thinking about ways to treat patients who are not planning to conceive versus those that are. For those patients that are not planning to conceive the goal is to regulate their menstrual cycles and irregularities as well as their hyperandrogenism and to treat the comorbidities as well to overall improve their quality of life.The first line treatment for hyperandrogenism to try to regulate menstrual cycle abnormalities is combined oral contraceptives also known as birth control pills. This also reduces endometrial hyperplasia which in turn can decrease the risk of endometrial carcinoma as mentioned earlier and it can reduce menstrual bleeding and you can reduce acne and try to assist with the hirsutism as well. As mentioned earlier, PCOS can also go hand-in-hand with insulin resistance or hyperinsulinemia and therefore we can also use metformin that can improve menstrual irregularities but also address the metabolic side of this as well. Summary: Diet, exercise, combined oral contraceptives, and metformin.Some other more controversial medications to treat hyperandrogenism could be potassium-sparing diuretics such as spironolactone that also inhibits 17-a-hydroxylase or finasteride which is a 5-alpha-reductase inhibitor and flutamide which is an androgen receptor blocker. The mentioned examples are typically for those people that can't really tolerate combined oral contraceptives. Other things to consider for those that are suffering from obesity syndrome are to possibly consider bariatric surgery if of course the criteria are met, and this is on a case-by-case basis. Bariatric surgery may be an answer to many of our metabolic problems that's why it is now called metabolic surgery. For patients who are planning to conceive the goal is to manage their comorbidities such as weight loss but also to try to induce ovulation.Now the first-line therapy for inducing ovulation is a medication called letrozole which is an aromatase inhibitor that in turn reduces estrogen production stimulating FSH secretion and ultimately inducing ovulation, not to get too heavily into the weeds of how these medications work, but basically it improves pregnancy and live birth rate outcomes in patients who are infertile because of the fact that they have anovulatory cycles or a.k.a. they are not ovulating.Then we also have clomiphene which is just an alternative to letrozole and has a different mechanism of action but it also stimulates ovulation by more particularly causing a pulsatile secretion of GnRH and in turn increasing FSH and LH as well, and this medication might be actually preferred over metformin monotherapy in women that are suffering from obesity syndrome who also have anovulatory infertility. However, apparently, clomiphene can cause more chance of multiple gestations versus letrozole.Also, letrozole is preferred over clomiphene to induce ovulation because of a higher rate of live births, but we have the risk of multiple pregnancies with both these methods. Let's talk about the second-line therapies.As mentioned earlier we have this 2 to 1 ratio of FSH to LH in women with PCOS or at least a good amount of them. We said that that is not required to diagnose this disorder but we can also give women exogenous FSH plus human menopausal gonadotropin, but this is really a second-line treatment for ovulation induction and typically we go for second-line treatments if first-line therapies aren't successful. But I will mention that using this exogenous gonadotropin is very expensive and it requires you to have access to specialized healthcare facilities and constant ultrasound monitoring so this may just not be feasible for many people but if you have the resources and it's affordable for you then exogenous gonadotropins are actually preferred over clomiphene and metformin therapy.Metformin can also use as a second-line monotherapy for fertility treatments and this in combination with clomiphene can increase pregnancy rates, especially in women who are suffering from obesity disorder, and of course, this is first-line therapy for insulin resistance.Now if we're talking about an invasive type of procedure for infertility it would be laparoscopic ovarian drilling which basically, we use a laser beam or surgical needle to reduce ovarian tissue to decrease its volume and try to reduce androgen production. Doing this can cause a hormone shift that can induce FSH secretion and ultimately improve ovarian function as well. This is also a second-line treatment for ovulation induction, but it can be performed as a first line if other indications for laparoscopy are present. Third-line therapy would be in vitro fertilization which means that basically we take mature eggs from ovaries and then we fertilize them with sperm in a lab and then the fertilized egg or the embryo is transferred to a uterus to be implanted.For the management of hirsutism, the first-line therapy is usually non-pharmacological and that's electrolysis or light-based hair removal with laser or photo-epilation. For acne, we can consider benzoyl peroxide or topical antibiotics if necessary.Final thoughts: Now I know that was a ton of information but ultimately, we are trying to make women more aware of PCOS and let them know that they are not alone, also we are trying to reduce complications such as cardiovascular problems, diabetes, endometrial cancer, infertility or even pregnancy loss. The best we can do is try to educate more women because many are suffering from this condition and they have no idea. Again, my name is Elika Salimi, and I am a third-year medical student. If you have any questions, you can reach me at elika.salimi@westernu.edu.___________________________Conclusion: Now we conclude episode number 139, “What is PCOS.” Future Dr. Salimi explained that patients with Polycystic Ovary Syndrome present with: Hyperandrogenism, Oligo-ovulation or anovulation, and multiple cysts in ovaries. If your patient meets 2 out of the 3 criteria, then you can confidently give the diagnosis of PCOS. Dr. Arreaza reminded us that by treating obesity you are also treating PCOS. This week we thank Hector Arreaza and Elika Salimi. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology..ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome..Obstet Gynecol.2018; 131(6): p.e157-e171.doi:10.1097/AOG.0000000000002656Hoeger KM, Dokras A, Piltonen T.Update on PCOS: Consequences, Challenges, and Guiding Treatment.The Journal of Clinical Endocrinology & Metabolism.2020; 106(3): p.e1071-e1083.doi:10.1210/clinem/dgaa839Williams T, Mortada R, Porter S.Diagnosis and Treatment of Polycystic Ovary Syndrome..Am Fam Physician.2016; 94(2): p.106-13.pmid: 27419327.Legro RS, Arslanian SA, Ehrmann DA, et al.Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline.J Clin Endocrinol Metab.2013; 98(12): p.4565-4592.doi:10.1210/jc.2013-2350.International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018.https://www.monash.edu/__data/assets/pdf_file/0004/1412644/PCOS_Evidence-Based-Guidelines_20181009.pdf 

We found out last Monday evening that the Colorado legislature is ramming through a package of three radical pro-abortion bills: SB23-188, SB23-189, and SB23-190.The most dangerous and impacting to pregnancy resource centers is SB23-190: Deceptive Trade Practice Pregnancy-related Service. The language of this bill could penalize pregnancy centers for trying to advertise their services to help pregnant women in crisis. Even more devastating is a clear ban on any means of offering anything intending to reverse an abortion pill.Chelsea and I spent this last week engaged in this battle. Tuesday evening we were working on Chelsea's testimony for the judiciary committee on Wednesday. Thursday and Friday we worked on information to send out to legislators about this bill.In this episode we play Chelsea's testimony in the bill committee. We also play some salient points from other testimonies. In particular, we respond to some of the testimony of Dr. Mitchell Creinin, who conducted the world-renowned "inconclusive" clinical trial on abortion pill reversal. Dr. Creinin concludes that the practice is unproven and "medical fraud."We also played clips from other medical professionals who disputed Dr. Creinin's claims.If you are listening to this episode the day it is released, March 19, 2023, the bill is at the Colorado Senate floor and will voted on today. Prayers for this situation are very much appreciated.Update: Senate floor debate for these bills has been moved to the next day, Tuesday, March 21.Scriptures Referenced:Proverbs 14:27Sources Consulted:Colorado Senate Judiciary [March 15, 2023 - Upon Adjournment] [Recording]Delgado G, Condly SJ, Davenport M, Tinnakornsrisuphap T, Mack J, Khauv V, Zhou PS. A case series detailing the successful reversal of the effects of mifepristone using progesterone. Issues Law Med. 2018 Spring;33(1):21-31. PMID: 30831017. [Full study PDF]Creinin MD, Hou MY, Dalton L, Steward R, Chen MJ. Mifepristone Antagonization With Progesterone to Prevent Medical Abortion: A Randomized Controlled Trial. Obstet Gynecol. 2020 Jan;135(1):158-165. doi: 10.1097/AOG.0000000000003620. PMID: 31809439. [Full study PDF]Wahabi HA, Fayed AA, Esmaeil SA, Bahkali KH. Progestogen for treating threatened miscarriage. Cochrane Database Syst Rev. 2018 Aug 6;8(8):CD005943. doi: 10.1002/14651858.CD005943.pub5. PMID: 30081430; PMCID: PMC6513446. [Full study PDF]Kooistra B, Dijkman B, Einhorn TA, Bhandari M. How...

We found out last Monday evening that the Colorado legislature is ramming through a package of three radical pro-abortion bills: SB23-188, SB23-189, and SB23-190. The most dangerous and impacting to pregnancy resource centers is SB23-190: Deceptive Trade Practice Pregnancy-related Service. The language of this bill could penalize pregnancy centers for trying to advertise their services to help pregnant women in crisis. Even more devastating is a clear ban on any means of offering anything intending to reverse an abortion pill. Chelsea and I spent this last week engaged in this battle. Tuesday evening we working on Chelsea's testimony for the judiciary committee on Wednesday. Thursday and Friday we worked on information to send out to legislators about this bill. In this episode we play Chelsea's testimony in the bill committee. We also play some salient points from other testimonies. In particular, we respond to some of the testimony of Dr. Mitchell Creinin, who conducted the world-renowned "inconclusive" clinical trial on abortion pill reversal. Dr. Creinin concludes that the practice is unproven and "medical fraud." We also played clips from other medical professionals who disputed Dr. Creinin's claims. If you are listening to this episode the day it is released, March 19, 2023, the bill is at the Colorado Senate floor and will voted on today. Prayers for this situation are very much appreciated. Update: Senate floor debate for these bills has been moved to the next day, Tuesday, March 21. Scriptures Referenced: Proverbs 14:27 Sources Consulted: Colorado Senate Judiciary [March 15, 2023 - Upon Adjournment] [Recording] Delgado G, Condly SJ, Davenport M, Tinnakornsrisuphap T, Mack J, Khauv V, Zhou PS. A case series detailing the successful reversal of the effects of mifepristone using progesterone. Issues Law Med. 2018 Spring;33(1):21-31. PMID: 30831017. [Full study PDF] Creinin MD, Hou MY, Dalton L, Steward R, Chen MJ. Mifepristone Antagonization With Progesterone to Prevent Medical Abortion: A Randomized Controlled Trial. Obstet Gynecol. 2020 Jan;135(1):158-165. doi: 10.1097/AOG.0000000000003620. PMID: 31809439. [Full study PDF] Wahabi HA, Fayed AA, Esmaeil SA, Bahkali KH. Progestogen for treating threatened miscarriage. Cochrane Database Syst Rev. 2018 Aug 6;8(8):CD005943. doi: 10.1002/14651858.CD005943.pub5. PMID: 30081430; PMCID: PMC6513446. [Full study PDF] Kooistra B, Dijkman B, Einhorn TA, Bhandari M. How to design a good case series. J Bone Joint Surg Am. 2009 May;91 Suppl 3:21-6. doi: 10.2106/JBJS.H.01573. PMID: 19411496. Dalziel K, Round A, Stein K, Garside R, Castelnuovo E, Payne L. Do the findings of case series studies vary significantly according to methodological characteristics? Health Technol Assess. 2005 Jan;9(2):iii-iv, 1-146. doi: 10.3310/hta9020. PMID: 15588556. Abortion Pill Reversal Helpline Heartbeat International

In this episode we talk with Samantha Reisz, EBB Childbirth Class graduate about her experiences taking the class and preparing for a waterbirth in a hospital with her “Golden Ticket” birth team, who were skilled and prepared to manage a placental cord avulsion also known as cord snapping.   Samantha Reisz, she/her, is a Scholarly Assistant Professor of Human Development at Washington State University in Vancouver, Washington, just outside of the Portland, Oregon area. She completed her bachelor's in Psychology and master's in Infant Mental Health from Mills College in Oakland, California when she first began studying childbirth. Samantha then earned her PhD in Human Development and Family Sciences from the University of Texas at Austin, where she studied infant parent relationships and the transition to parenthood. Samantha is a passionate scholar and educator. After years of studying these topics academically, she finally was able to live her own research with the birth of her first child. Samantha lives in Vancouver, Washington with her baby, partner, and two dogs.    Samantha shares how she prepared to give birth for the first time with the use of a doula who recommended the EBB Childbirth Course. Samantha and her partner planned for a waterbirth in a hospital with an OBGYN attending the birth. After experiencing the beautiful waterbirth she had desired, complications arose in the 3rd stage with a placental cord avulsion. Her “Golden Ticket Birth Team” was skilled and prepared to support her through this experience. Content & Trigger warning: complications in the third stage of labor, active management of the third phase, umbilical cord snapping or avulsion, excessive blood loss Resources: Find out more about Samantha's work and research here. Find out about Scarlett Lynsky's EBB Childbirth Education class here and listen to her EBB Podcast interview here. Read the EBB Sigature Article on The Evidence on Waterbirth here Read the EBB Signature Article on Eating & Drinking here Listen to the EBB Natural Induction series here Find out more about the Evidence on Nitrous Oxide in EBB Episode 15 here Listen to all the EBB Podcast Episodes on Waterbirth and Cord Avulsion:  Find EBB 4 – Waterbirth and the Newborn Microbiome here Find EBB 11 – Evidence on: Waterbirth here  Find EBB 202 - A Fast First Time Birth Expereince with Childbirth Class Graduate, Haley Grachico here  Find EBB 223 – An Empowering Hospital Water Birth Story with Samantha Parker and Justin Fontaine here  Find EBB 230 – An Inspirational Home Waterbirth Story with EBB Childbirth Class Parent Shelitha Owens here Go to our YouTube channel to see video versions of the episode listed above!! References:   Bovbjerg, M.L., Cheyney, M., Caughey, A. B. (2022). “Maternal and neonatal outcomes following waterbirth: a cohort study of 17,530 waterbirths and 17,530 propensity score-matched land births.” BJOG 129 (6): 950-958. Access the article here     Burns, E. E., Boulton, M.G., Cluett, E., et al. (2012). “Characteristics, interventions, and outcomes of women who used a birthing pool: a prospective observational study.” Birth 39(3): 192-202. Access the article here     Schafer, R. (2014). “Umbilical cord avulsion in waterbirth.” J Midwifery Womens Health 59(1): 91-94. Access the article here     Sidebottom, A.C., Vacquier, M., Simon, K., et al. (2020). “Maternal and neonatal outcomes in hospital-based deliveries with water immersion.” Obstet GYnecol 136(4): 707-715. Access the article here  For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on:  TikTok Instagram Pinterest Ready to get involved?  Check out our Professional membership (including scholarship options) here  Find an EBB Instructor here  Click here to learn more about the Evidence Based Birth® Childbirth Class.

In this episode, Dr. Mark Hoffman invites Dr. Cheryl Iglesia to shed light on the topic of cosmetic gynecology. --- SHOW NOTES Dr. Iglesia is the Director of the Section of Female Pelvic Medicine and Reconstructive Surgery at MedStar Washington Hospital Center, as well the current President of the Society of Gynecologic Surgeons. In addition to being involved with a consensus document regarding cosmetic gynecology, Dr. Iglesia has contributed numerous studies to the growing field and hopes to educate other providers on the topic. The episode begins with Dr. Iglesia sharing how she became passionate about cosmetic gynecology. Her experience initially began with a weekend course in California learning about topics such as “laser vaginal rejuvenation” and “designer laser vaginoplasty,” which were early marketing terms used for the field. After multiple years of training and education within a field filled with gray areas and limited evidence-based medicine, she later helped develop a consensus document about cosmetic gynecology procedures, which provides clarification for patients and opportunity for future research studies. Dr. Iglesia then describes the field of cosmetic gynecology, which includes the elective intervention to alter the aesthetic appearance of the external genitalia or modify the genital organs. These elective, functional procedures may be performed in the absence of any pathology (e.g., no incontinence, prolapse, etc.) with the goal of improving a person's quality of life (e.g., sexual function). She describes two pillars of the field, including cosmetic (e.g., labiaplasty) versus functional (e.g., surgical tightening of the vagina for vaginal laxity) procedures. The physicians then address the concerns of societal pressure, agreeing that the goal is to help patients make well-informed, ethical decisions, which requires discussing goals with patients. After discussing the field as a whole, Dr. Iglesia then highlights different procedures and technologies. For example, a fractionated laser may be used to stimulate tissue growth and may be utilized for diagnosis such as genitourinary syndrome (GSM) of menopause or lichen sclerosis. In addition, she briefly mentions aesthetic procedures, including a clitoral frenulum reduction (frenulectomy) or clitoral amplification with platelet rich plasma or the O-Shot. She addresses that a lot of the procedures and technologies are proprietary, have limited evidence, and are not risk-free. Ultimately, Dr. Iglesia states that there is a need for more data, urging the need for future level I trials. --- RESOURCES Developed by the Joint Writing Group of the International Urogynecological Association and the American Urogynecologic Society. Joint Report on Terminology for Cosmetic Gynecology. Int Urogynecol J. 2022 Jun;33(6):1367-1386. Li FG, Maheux-Lacroix S, Deans R, Nesbitt-Hawes E, Budden A, Nguyen K, Lim CY, Song S, McCormack L, Lyons SD, Segelov E, Abbott JA. Effect of Fractional Carbon Dioxide Laser vs Sham Treatment on Symptom Severity in Women With Postmenopausal Vaginal Symptoms: A Randomized Clinical Trial. JAMA. 2021 Oct 12;326(14):1381-1389. Paraiso MFR, Ferrando CA, Sokol ER, Rardin CR, Matthews CA, Karram MM, Iglesia CB. A randomized clinical trial comparing vaginal laser therapy to vaginal estrogen therapy in women with genitourinary syndrome of menopause: The VeLVET Trial. Menopause. 2020 Jan;27(1):50-56. Burkett LS, Siddique M, Zeymo A, Brunn EA, Gutman RE, Park AJ, Iglesia CB. Clobetasol Compared With Fractionated Carbon Dioxide Laser for Lichen Sclerosus: A Randomized Controlled Trial. Obstet Gynecol. 2021 Jun 1;137(6):968-978. Cosmetic Gynecology and the Elusive Quest for the “Perfect” Vagina: https://journals.lww.com/greenjournal/Citation/2012/10000/Cosmetic_Gynecology_and_the_Elusive_Quest_for_the.34.aspx

REFERENCES: August, P., Siabi, B. (2022). Preeclampsia: Clinical Features and Diagnosis.  Up-to-Date. Judy AE, McCain CL, Lawton ES, Morton CH, Main EK, Druzin ML. Systolic Hypertension, Preeclampsia-Related Mortality, and Stroke in California. Obstet Gynecol. 2019 Jun;133(6):1151-1159. doi: 10.1097/AOG.0000000000003290. PMID: 31135728.

What's going down:   All about IUD insertions: what to know prior, how to mentally prepare, and the best ways to treat the pain if need be  The many uses of an IUD beyond preventing pregnancy  The 2 different types of IUDs: Hormonal vs. Copper, and what to expect from each   Discussing anxiety surrounding IUDs: uterine perforation, string placement, and hormonal concerns  The importance of doing your own research, speaking with your healthcare provider, and avoiding misinformation on social media   Clitorally, we can't believe how confused (some) men are about IUDs. Watch full TikTok here!   Thank you for continuing the conversation and calling into the Viva la Vulva Voicemail at (503) 893-2016! Please be sure to rate, follow, review, and remember that nothing is considered TMI around here.   Social & Website  Tiktok: @drjenniferlincoln  Instagram: @drjenniferlincoln  YouTube: @drjenniferlincoln  Website: www.drjenniferlincoln.com    Resources   Grab a copy of my book HERE!  Obstetricians For Reproductive Justice    References  1. Whitworth K, Neher J, Safranek S. Effective analgesic options for intrauterine device placement pain. Can Fam Physician. 2020;66(8):580 581.   2. Gemzell-Danielsson K, Mansour D, Fiala C, Kaunitz AM, Bahamondes L. Management of pain associated with the insertion of intrauterine contraceptives. Hum Reprod Update. 2013;19(4):419-427. doi:10.1093/humupd/dmt022.   3. Laura Nguyen, Larkin Lamarche, Robin Lennox, Amanda Ramdyal, Tejal Patel, Morgan Black, Dee Mangin. Strategies to Mitigate Anxiety and Pain in Intrauterine Device Insertion: A Systematic Review. Journal of Obstetrics and Gynaecology Canada, Volume 42, Issue 9, 2020, Pages 1138-1146.e2, ISSN 1701-2163.  4. Lopez LM, Bernholc A, Zeng Y, Allen RH, Bartz D, O'Brien PA, Hubacher D. Interventions for pain with intrauterine device insertion. Cochrane Database Syst Rev. 2015 Jul 29;(7):CD007373. doi: 10.1002/14651858.CD007373.pub3. PMID: 26222246.  5. Karabayirli S, Ayrim AA, Muslu B. Comparison of the analgesic effects of oral tramadol and naproxen sodium on pain relief during IUD insertion. J Minim Invasive Gynecol. 2012 Sep-Oct;19(5):581-4. doi: 10.1016/j.jmig.2012.04.004. Epub 2012 Jul 4. PMID: 22766124.   6. Ngo LL, Ward KK, Mody SK. Ketorolac for Pain Control With Intrauterine Device Placement: A Randomized Controlled Trial. Obstet Gynecol. 2015 Jul;126(1):29-36. doi: 10.1097/AOG.0000000000000912. PMID: 26241253; PMCID: PMC4527080.   7. Mody SK, Farala JP, Jimenez B, Nishikawa M, Ngo LL. Paracervical Block for Intrauterine Device Placement Among Nulliparous Women: A Randomized Controlled Trial. Obstet Gynecol. 2018 Sep;132(3):575-582. doi: 10.1097/AOG.0000000000002790. PMID: 30095776; PMCID: PMC6438819.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Anti-D immune globulin has been advocated for use in appropriate patients since the 1970s. Historic data showed that 0.1ml of fetal D+ blood was all that was required to potentially sensitize an Rh negative mother. New data is questioning whether this prophylaxis is required in all cases of threatened miscarriage/abortion in early pregnancy, or if a more selective approach is appropriate. In this episode, we will highlight a soon to be released “Questioning Clinical Practice” commentary from Obstet Gynecol (the Green Journal) tackling this issue. Is it time to change our current and standard practice?

On today's podcast, we're going to talk with Stephaney Moody, a Health Equity Ambassador and an advocate for Healthy Birthday and Count the Kicks about the importance of kick counting to prevent stillbirth. Stephaney Moody's passion for stillbirth prevention came after her family experienced loss, when her sister lost her daughter. Upon learning about the inequities that persist in stillbirth outcomes in the African-American Community, she felt led to join the fight against preventable stillbirth and strive for equity. Stephaney is also the Founder of Black Women's Health and Wellness Webcast which addresses issues that impact the health and wellbeing of African-American women. She also serves in her community as a Pastor at New Beginnings Discipleship Ministries and as a Chaplain to the Des Moines Police Department. We will talk about the importance of kick counting in the third trimester to prevent stillbirth. Stephaney shares how her family has been affected by stillbirth and how she became involved in Kick the Counts, an evidence-based stillbirth prevention public health awareness campaign for expectant parents in the 3rd trimester. We will discuss the evidence on kick counting and how Count the Kicks and Healthy Birthday's public health and awareness campaigns are having a direct impact on stillbirth rates in the United States and abroad. A video with this episode will also come out later today at our YouTube channel here. **Content warning: pregnancy loss, stillbirth, racial inequities in healthcare, maternal mortality, maternal morbidity infant mortality** Resources: Count the Kicks Evidence and Resources here. Download the Count the Kicks App here  Healthy Birthday Resources here Find Count the Kick on Social Media:  Instragam Youtube Twitter Facebook Stephaney moderates the Black Women's Health and Wellness group here. Research discussed: Tveit, J.V., et al. (2009). "Reduction of late stillbirth with the introduction of fetal movement information and guidelines - a clinical quality improvement." BMC Pregnancy Childbirth 9:32: http://europepmc.org/article/PMC/2734741 Sadovsky, E. and Yaffe, H. (1973). "Daily fetal movement recording and fetal prognosis." Obstet Gynecol 41(6): 845-850. https://journals.lww.com/greenjournal/Abstract/1973/06000/Daily_Fetal_Movement_Recording_and_Fetal_Prognosis.8.aspx Leader, L. R., Baillie, P. and Van Schalwyk, D. J. (1981). “Fetal movement and fetal outcome: A prospective study.” Obstet Gynecol 57(4): 431-436. https://pubmed.ncbi.nlm.nih.gov/7243088/ For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on:  TikTok Instagram  Pinterest   Ready to get involved?  Check out our Professional membership (including scholarship options) here  Find an EBB Instructor here  Click here to learn more about the Evidence Based Birth® Childbirth Class.