Thinking About Ob/Gyn podcast

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Inhalt bereitgestellt von Antonia Roberts and Howard Herrell, Antonia Roberts, and Howard Herrell. Alle Podcast-Inhalte, einschließlich Episoden, Grafiken und Podcast-Beschreibungen, werden direkt von Antonia Roberts and Howard Herrell, Antonia Roberts, and Howard Herrell oder seinem Podcast-Plattformpartner hochgeladen und bereitgestellt. Wenn Sie glauben, dass jemand Ihr urheberrechtlich geschütztes Werk ohne Ihre Erlaubnis nutzt, können Sie dem hier beschriebenen Verfahren folgen https://de.player.fm/legal.

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Thinking About Ob/Gyn

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A fresh and evidence-based perspective of all things related to obstetrics and gynecology. Follow us on Instagram @thinkingaboutobgyn or visit thinkingaboutobgyn.com for show notes and more.

115 Episoden

#Fitness #Medicine #Antonia Roberts and Howard Herrell #Antonia Roberts #Howard Herrell

Thinking About Ob/Gyn

updated vor 7 Tagen

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A fresh and evidence-based perspective of all things related to obstetrics and gynecology. Follow us on Instagram @thinkingaboutobgyn or visit thinkingaboutobgyn.com for show notes and more.

115 Episoden

#Fitness #Medicine #Antonia Roberts and Howard Herrell #Antonia Roberts #Howard Herrell

All episodes

Thinking About Ob/Gyn

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Episode 9.11 Cervical Cancer with Stuart Winkler 1:05:24

vor 7 Tagen1:05:24

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Cervical cancer represents a success story in developed countries due to screening and vaccination, yet remains a significant global health problem with over 340,000 deaths annually worldwide. We explore the current state of cervical cancer prevention, screening, and treatment while discussing exciting advances that could eventually eliminate this disease. • Different levels of prevention for cervical cancer: primordial, primary, secondary, tertiary, and quaternary • HPV vaccination as the most effective primary prevention method, with Australia on track to make cervical cancer rare by 2035 • Evolution from Pap smears to primary HPV testing, with potential future urine-based screening options • Less radical surgical approaches for early-stage disease, improving quality of life without compromising outcomes • Immunotherapy advances showing 6-12 month survival benefits in metastatic disease • Howard Kelly's pioneering work with radium in the early 1900s, establishing foundations for radiation therapy • Importance of addressing healthcare disparities, as rural Americans are 25% more likely to develop cervical cancer and 42% more likely to die from it Visit our website at thinkingaboutobgyn.com for more information and follow us on Instagram for updates. 00:00:00 Introduction to Cervical Cancer 00:08:10 Prevention Strategies Explained 00:18:02 HPV Screening Evolution 00:26:51 Treatment of Early-Stage Disease 00:37:09 Advances in Locally Advanced Disease 00:50:31 Radium and Howard Kelly's History 01:02:48 Final Thoughts on Prevention Follow us on Instagram @thinkingaboutobgyn .…

Thinking About Ob/Gyn

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Episode 9.10 Pit Breaks, Cannabis, and IUDs for Endometrial Protection 1:06:37

vor 21 Tagen1:06:37

1:06:37

Howard and Antonia explore the evidence behind pit breaks in labor, cannabis use in pregnancy, and IUD options for hormone replacement therapy. • Pit breaks in labor lack substantial evidence of benefit when used in active labor • Current research suggests stopping oxytocin during active labor may slightly increase cesarean rates rather than decrease them • Long pit breaks (up to 8 hours) in latent labor may be beneficial by allowing rest and promoting patience • Recent systematic review shows prenatal cannabis use increases risk of low birth weight by 75%, preterm birth by 50%, and perinatal mortality by 29% • Cannabis use during pregnancy (7.2% of pregnant women) now exceeds tobacco use • Retrospective studies on doula care show association with better outcomes, but can't establish causation due to inherent differences in patients who seek doulas • 52mg levonorgestrel IUDs (Mirena/Liletta) are suitable for endometrial protection during HRT, but evidence only supports use up to 5 years • Most systematic reviews combine heterogeneous studies and shouldn't be considered level 1 evidence We'd love to hear your questions! Send them to us through our Instagram or website thinkingaboutobgyn.com. 00:04:52 Pit Breaks in Labor 00:15:32 Examining Evidence on Oxytocin Discontinuation 00:26:08 Prenatal Cannabis Use and Adverse Outcomes 00:36:07 Doula Care Study Analysis 00:57:22 Levonorgestrel IUD Use in HRT Follow us on Instagram @thinkingaboutobgyn .…

Thinking About Ob/Gyn

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Episode 9.9 Pediatric & Adolescent Gynecology Essentials 57:12

vor 5 weeks57:12

57:12

Join Howard and Janeen Arbuckle for this discussion of pediatric and adolescent gynecology essentials. Pediatric and adolescent gynecology is a newer discipline bringing specialized care to young women with unique gynecologic needs, with a focus on counseling, education, and age-appropriate interventions. • Abnormal uterine bleeding in adolescents is rarely caused by structural problems (unlike in adults) and typically relates to immaturity of the hypothalamic-pituitary-ovarian axis • Hematologic workup should be considered for adolescents with heavy menstrual bleeding as this may be the first time their clotting system is challenged • Hormonal therapies are safe to use once menarche has occurred, with no impact on bone growth • Long-acting reversible contraceptives offer superior pregnancy prevention (1 in 10,000 for implants vs 8 in 100 for typical pill use) but require thoughtful counseling • Private interviews with adolescent patients create trust while preparing them for independent healthcare navigation • Tranexamic acid is effective for heavy menstrual bleeding in adolescents but pill size and frequency can limit compliance • Most ovarian cysts in adolescents represent normal physiologic function and rarely require intervention • Preservation of reproductive organs should be prioritized in adolescent surgery, including leaving ovaries after torsion when possible • Vaginal bleeding in pre-pubertal girls requires assessment for secondary sexual characteristics to distinguish precocious puberty from other causes 00:00:00 Introduction to Pediatric Gynecology 00:07:20 Abnormal Uterine Bleeding in Adolescents 00:19:36 Contraception Choices for Young Patients 00:29:40 Managing Difficult Patient-Parent Conversations 00:38:04 Pelvic Pain and Endometriosis 00:46:58 Adnexal Pathology and Ovarian Issues 00:50:51 Congenital Anomalies and Vaginal Bleeding Follow us on Instagram @thinkingaboutobgyn .…

Thinking About Ob/Gyn

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Episode 9.8 Rethinking Bacterial Vaginosis and More! 1:05:20

vor 7 weeks1:05:20

1:05:20

In this episode, Antonia and Howard explore the groundbreaking study on treating male partners for bacterial vaginosis, revealing significantly reduced recurrence rates and challenging our traditional understanding of BV pathophysiology. Plus: • Evidence doesn't support treating mild gestational hypertension with antihypertensives • Studies confirm acetaminophen in pregnancy doesn't cause ADHD or autism • New research questions the benefit of routine postpartum thromboprophylaxis • The history of heparin and coumadin 00:00:34 Treating Mild Hypertension in Pregnancy 00:06:14 Distinguishing Chronic vs. Gestational Hypertension 00:15:46 Male Partner Treatment for Recurring BV 00:27:09 Understanding Bacterial Vaginosis Pathophysiology 00:35:42 Ineffective Treatments and Alternative Approaches 00:53:04 Tylenol in Pregnancy: Debunking ADHD Claims 00:58:02 Postpartum Thromboprophylaxis: Evidence Against Overuse Follow us on Instagram @thinkingaboutobgyn .…

Thinking About Ob/Gyn

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Episode 9.7 OB Triage Essentials (plus The Pitt) 1:01:45

vor 9 weeks1:01:45

1:01:45

This episode features our favorite podcast ninja, Dr. Maddie White. She and Howard discuss how medical dramatizations misrepresent obstetric emergencies (yes, we are watching The Pitt). Then, we dissect evidence-based approaches to common triage scenarios including labor evaluation, rupture of membranes, and preterm labor assessment. • Television shows like "The Pitt" and "ER" portray shoulder dystocia and postpartum hemorrhage inaccurately, lacking proper urgency and technique • Hospital-based labor triage often costs approximately 10 times more than office-based evaluation, often without clinical benefit • Understanding pretest probability fundamentally changes how test results should be interpreted for suspected rupture of membranes • Most expensive tests like Amnisure (>$500) provide minimal additional value over traditional approaches when interpreted properly • Evidence doesn't support routine use of fetal fibronectin testing in preterm labor evaluation • We discuss universal cervical length screening for prevention of preterm labor in the midtrimester and later in pregnancy for evaluation of threatened preterm labor 00:00:53 Critiquing Obstetric Emergencies in TV Shows 00:10:13 Proper Management of Shoulder Dystocia 00:14:52 Postpartum Hemorrhage Management Approaches 00:19:59 Evaluating Term Labor Complaints 00:25:35 Rupture of Membranes Testing Strategies 00:34:12 Understanding Test Probability and Performance 00:42:26 Cervical Length Screening Evidence 00:51:23 Preterm Labor Triage Tools 01:00:23 Concluding Thoughts on Evidence-Based Practice Follow us on Instagram @thinkingaboutobgyn .…

Thinking About Ob/Gyn

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Episode 9.6 New Birth Control Products and Other Updates 1:05:53

vor 11 weeks1:05:53

1:05:53

Antonia Roberts and Howard Herrell review several new articles: • Epifoam for postpartum pain lacks evidence of effectiveness compared to simple ice packs while costing nearly $100 per unit • AMH levels above 5.39 are associated with PCOS diagnosis, providing a specific threshold for clinical use • External aortic compression demonstrated as a life-saving technique during severe obstetric hemorrhage • Vaginal estrogen in breast cancer survivors shows no increased risk of cancer recurrence or mortality • Delayed cord clamping in preterm twins reduces mortality by 30% and significantly decreases transfusion needs Then they discuss new birth control options while questioning the value of expensive pharmaceutical products compared to established, less costly alternatives. • New birth control options like Balcoltra ($280/month), FemLyv ($215/month), and Nextstellis ($250/month) offer minimal innovation over generic alternatives costing $10-15/month • Marketing terms like "bioidentical" and "plant-based" are often misleading as all hormonal contraceptives are synthesized from plant precursors • Progestin-only pills like Slynd provide only marginal DVT risk reduction (5 vs 4 per 100,000 person-years) compared to low-dose combined pills Check our Instagram for more information and join us again in two weeks for our next episode. 00:00:00 Introduction and Epifoam Discussion 00:06:27 Financial Impact of Unnecessary Treatments 00:11:09 AMH Levels for PCOS Diagnosis 00:15:11 External Aortic Compression for Hemorrhage 00:20:22 Vaginal Estrogen and Delayed Cord Clamping 00:21:51 New Birth Control Products Overview 00:31:05 Analyzing Dissolvable Birth Control Pills 00:34:22 Slynd: Drosperinone-Only Pill Evaluation 00:42:09 Nextstellis and "Bioidentical" Estrogen Claims 00:56:37 History of Birth Control Development Follow us on Instagram @thinkingaboutobgyn .…

Thinking About Ob/Gyn

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Episode 9.5 Operative Vaginal Deliveries 1:00:00

vor 13 weeks1:00:00

1:00:00

We discuss the pressing issues surrounding operative vaginal deliveries, including trends in their usage and the disparities impacting delivery outcomes. Join us as we navigate these critical insights with expert guests Jamie Perry and Howard Herrell, revealing the complexities and nuances surrounding forceps and vacuum deliveries. • Examining the historical context of operative vaginal deliveries • Analyzing the decline in forceps and vacuum usage since the 1990s • Discussing the rise of cesarean deliveries as an alternative • Revealing racial disparities adjacent to delivery practices • Outlining effective techniques for both forceps and vacuum-assisted deliveries Learn more about this pressing topic and gain valuable insights by listening to our episode. 00:00:00 ntroduction and Overview of the Episode 00:01:18 The Decline in Operative Vaginal Deliveries 00:05:24 Forceps 00:24:21 Vacuums 00:49:30 Advice For Trainees 00:55:38 Four Tips for Forceps and Vacuums Follow us on Instagram @thinkingaboutobgyn .…

Thinking About Ob/Gyn

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Episode 9.4 Barbs, Birth Control Risks, Maternal Cancers, Aspirin, and More! 1:05:22

vor 15 weeks1:05:22

1:05:22

This episode dives into the debate surrounding the efficacy and cost of barbed sutures in surgical practice, questioning whether their time-saving advantages are justified compared to traditional techniques, especially for uterine closure. Additionally, it explores the implications of non-invasive prenatal testing for cancer detection and recent maternal mortality statistics, while advocating for evidence-based practices in both surgical and obstetric care. • Analysis of barbed suture use and cost implications • Discussion of unexpected cancer detection via NIPS • Exploration of maternal mortality statistics and misconceptions • The relative value of baby (a discussion of the perverse economics of pediatric and obstetric care) • Summary of recent findings on aspirin dosages for preeclampsia • Examination of venous thromboembolism risks with hormonal contraceptives 00:00:01 Barbed Suture in OBGYN Surgery 00:09:13 Comparing Surgical Sutures 00:17:11 NIPS Results and Maternal Cancer Detection 00:24:04 Maternal Mortality Trends and Data Analysis 00:38:50 Medical Reimbursements and Healthcare Priorities 00:47:20 Risk Factors in Birth Control Thromboembolism 00:54:37 Birth Control and Thromboembolism Risk Follow us on Instagram @thinkingaboutobgyn .…

Thinking About Ob/Gyn

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Episode 9.3 Obstetric Life Support with Jacqueline Vidosh 52:19

vor 17 weeks52:19

52:19

Join Howard with guest host Jacqueline Vidosh as we explore the challenges of maternal cardiac arrest. This episode emphasizes the urgent need for specialized training in obstetric life support. From discussing causes of maternal mortality to sharing practical tips for first responders, the insights presented aim to enhance awareness and preparedness in critical situations. • Discussing the alarming rise in maternal mortality rates • Identifying common causes of maternal cardiac arrest • The importance of OBLS training and education for healthcare providers • Emphasizing the need for left uterine displacement during resuscitation • Addressing healthcare disparities affecting Black women • Sharing unique physiological adaptations in pregnant patients • Strategies for improving outcomes in maternal cardiac arrest cases • Highlighting the value of simulation training for all healthcare personnel Every healthcare professional plays a role in improving maternal health outcomes. Listen in for tips and insights on how we can enhance readiness for maternal cardiac arrest situations. 00:00:01 Obstetric Life Support 00:03:34 Maternal Mortality and OBLS Training 00:15:23 Maternal Health Disparities and Physiologic Changes 00:27:53 Cesarean Delivery and Post-Delivery Care 00:41:15 History and Implementation of CPR Follow us on Instagram @thinkingaboutobgyn .…

Thinking About Ob/Gyn

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Episode 9.2 Circumvallate Placenta, Pregnancy Apps, Oral Meds for GDM, and HPV 1:00:56

vor 19 weeks1:00:56

1:00:56

In this episode, Howard and Antonia focuses on the evolving guidelines for HPV screening and the implications for women's health, highlighting its superior effectiveness over traditional Pap smear tests. Additionally, we explore the reliability of pregnancy apps for information and address a listener question about Group B Streptococcus screening and management. • Discusses the transition to HPV testing as primary cervical cancer screening • Reviews a recent study confirming HPV's effectiveness in preventing cervical cancer • Examines the reliability and misinformation in pregnancy apps • Answers listener questions regarding Group B Streptococcus management 00:00:01 Circumvallate Placenta 00:13:51 Evaluating Pregnancy Apps for Accuracy 00:26:56 Evaluating Risks of Pregnancy Apps 00:36:51 Gestational Diabetes Treatment Options 00:45:47 Manage GBS Risk Factors Follow us on Instagram @thinkingaboutobgyn .…

Thinking About Ob/Gyn

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Episode 9.1 Cesarean Hysterectomy 59:08

vor 21 weeks59:08

59:08

Discover how cesarean hysterectomy, once a procedure shrouded in fear, has evolved into a life-saving operation with contributions from pioneering figures like Eduardo Porro and Lawson Tate. In this episode, we are joined by gynecologic oncologist Stuart Winkler, who shares invaluable insights into both unplanned and planned cesarean hysterectomies. Explore the primary indications for these critical surgeries, from uncontrollable bleeding in unplanned emergencies to managing known conditions like placenta accreta in planned scenarios. You'll gain a deep understanding of the strategic decision-making required, especially in resource-limited environments, to ensure the best outcomes for patients. Navigate the complexities of performing cesarean hysterectomies under challenging circumstances, particularly when severe hemorrhage threatens patient safety. We delve into surgical tips and techniques, emphasizing the significance of early and careful bladder dissection, effective use of energy sealing devices, and confident decision-making. Our discussion highlights innovative strategies for uterine preservation in placenta accreta spectrum disorders, offering creative solutions when complete resection isn't feasible, and exploring new protocols that balance operative blood loss and patient fertility. Finally, take a journey through the historical evolution of cesarean hysterectomy with us, as we trace its transformation from a fearful, last-resort measure to a cornerstone of modern obstetric care. Learn about the pivotal technological advancements that have shaped current practices, such as preoperative arterial occlusion techniques, equipping today's surgeons with a wide array of tools to tackle even the most complex cases. This episode promises a comprehensive blend of historical insights and practical advice, making it an essential listen for both seasoned professionals and those new to the field. 00:00:01 Cesarean Hysterectomy 00:09:14 Surgical Tips for Cesarean Hysterectomy 00:17:42 Advanced Techniques in C-Hysterectomy 00:23:56 Surgical Tips for Planned C-Hysterectomy 00:31:36 Surgical Techniques for Hemorrhage Control 00:41:38 Uterine Preservation in Spectrum Placenta 00:53:37 Evolution of Cesarean Hysterectomy Follow us on Instagram @thinkingaboutobgyn .…

Thinking About Ob/Gyn

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Episode 8.13 Flagyl, GBS, DUTCH, Jada, Quickening and More! 1:00:00

vor 23 weeks1:00:00

1:00:00

Challenge preconceived notions in obstetrics and gynecology with our latest episode, where we dismantle myths that have long influenced medical practices, even in the absence of scientific backing. From unraveling the misunderstood reaction between alcohol and metronidazole to examining the overlooked risks of clindamycin cream, we'll look at how these misconceptions take root in medical culture. We continue with a critical analysis of intrapartum GBS prophylaxis, correcting widespread misunderstandings around its purpose and timing during labor and how it affects labor management. We address the rise of dubious hormone tests, like the DUTCH Test, marketed to consumers, painting a cautionary picture of how social media amplifies these unvalidated products. We highlight the importance of consulting healthcare professionals while discussing the potential paradigm shift that self-collected HPV testing could bring to cervical screening, as recommended in the coming cervical cancer screening guiudelines. This new approach might revolutionize screening rates and quality of care, especially for underserved populations, all while realigning healthcare providers' focus on more pressing medical needs. Prepare for an engaging conclusion as we scrutinize the comparative effectiveness of postpartum hemorrhage devices Jada and Bakri, emphasizing the ethical implications of cost versus efficacy. We'll take you on a historical journey through the concept of "quickening" in pregnancy, reflecting on its cultural significance and evolution with modern science. Plus, changes for next season! 00:00:02 Metronidazole and Alcohol 00:13:03 Intrapartum GBS Prophylaxis Guidelines Clarified 00:24:54 Hormone Testing and Cervical Screening 00:31:07 HPV Self-Collect Screening Implications 00:42:54 Comparative Efficacy of Postpartum Hemorrhage Devices 00:51:29 Historical Perspectives on Fetal Development Follow us on Instagram @thinkingaboutobgyn .…

Thinking About Ob/Gyn

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Episode 8.12 Four Tips for Paps, OB Unit Closures, and the Importance of Hospital Based Obstetrics 1:03:10

vor 25 weeks1:03:10

1:03:10

In this episode, we give four simple tips for performing a Pap smear. Then we dive into the complicated problem of obstetric units closing across the United States and actions we need to take to stop this dangerous trend that threatens the safety of pregnant women and newborns. Also, we highlight the important of hospital based obstetric programs and the history of why births moved into the hospitals in the beginning of the 20th Century and the 99% decline in maternal and neonatal mortality that followed. 00:00:02 Cervical Cancer Screening Tips 00:14:13 Hospital Closures Affect Obstetric Care 00:37:27 Rural Obstetric Units Closing Challenges 00:44:53 Hospital vs. Home Birth Safety 00:49:40 Healthcare Disparities for Women and Children 00:55:08 Evolving Birth Settings in America 01:02:28 Email Advocacy for Healthcare Reform Follow us on Instagram @thinkingaboutobgyn .…

Thinking About Ob/Gyn

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Episode 8.11 Catheters in Labor, Occiput Posterior Fetuses, and Cesarean Scar Disorder 1:02:18

vor 27 weeks1:02:18

1:02:18

Do patients in labor need continuous bladder drainage? We will review the literature comparing intermittent to continuous drainage. Next, we venture into the art and science of manual rotation for persistent posterior fetal presentations, a skillful maneuver that might just hold the key to lowering cesarean rates. Drawing from comprehensive reviews and trials, including the TURN-OUT trial and studies from UCSF, we debate the efficacy and applicability of manual rotation in various clinical settings. From ultrasound-guided techniques to hands-on learning, gain a nuanced understanding of how this practice might enhance delivery outcomes and reduce interventions. Finally, we learn about Cesarean Scar Disorder, a relatively new diagnosis with important clinical ramifications. 00:00:10 Urinary Catheterization in Labor Management 00:16:10 Manual Rotation of the OP Fetus 00:49:32 Effectiveness of Labor Positioning Techniques 00:58:03 Cesarean Scar Disorder Follow us on Instagram @thinkingaboutobgyn .…

Thinking About Ob/Gyn

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Episode 8.10 Birth Control Counseling, MOC Article Highlights, and Feminine Forever 1:05:08

vor 29 weeks1:05:08

1:05:08

In this episode, we discuss four tips for effective birth control counseling. By dissecting communication techniques, we highlight how striking a balance between relational and task-oriented approaches can maximize patient interactions and ensure comprehensive, evidence-based care regarding birth control choices. Then we delve into several studies from the recent ABOG MOC cycle that we found interesting or curious and point out several informative nuggets. Finally, we discuss the book "Feminine Forever" and its impact on estrogen replacement therapy perceptions. 00:00:02 Communication Strategies for Birth Control Counseling 00:11:56 Effective Communication of Birth Control Risks 00:21:08 PAS After Myomectomy 00:23:03 Risk-Reducing Surgery Adherence Discussion 00:30:33 Issues With Modern Labor Curves 00:38:49 Stopping ASA Early 00:42:17 Prophylactic Slings 00:46:01 Clinical Updates on UTIs 00:51:34 Mental Health Guidelines and Other Articles 00:55:51 Feminine Forever Follow us on Instagram @thinkingaboutobgyn .…

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