Dr. Heather Link joins me to discuss maternal mortality in Lousiana. Racial Inequities in Preventable Pregnancy-Related Deaths in Louisiana, 2011–2016 louisiana maternal mortality review report 2011-2016  

Drs. Jillian Kurtz and Caiyun Liao join me to discuss "Association Between Fertility Treatment and Cancer RIsk in Children" published 12/19 in JAMA  

Dr. Mariel Gross joins me to discuss the ethics of breastfeeding with HIV.   Breastfeeding with HIV: An Evidence-Based Case for New Policy   Contact Dr. Gross

Greg Kirschen takes us through the treatment of postpartum depression and psychosis. feedback@obgyn.fm American Psychiatric Association. (2013). In Diagnostic and statistical manual of mental disorders (5th ed.). doi:10.1176/appi.books.9780890425596.744053 Tate G. 1830. “A Treatise on Hysteria.” London: S. Highley, 174 Fleet St & Webb St, Maze Pond, Borough. Smith TN. 1830. “Observations on hysteria.” The Boston Medical and Surgical Journal. 3(34): 540. Louden, I. 1988. Puerperal insanity in the 19thCentury. Journal of the Royal Society of Medicine. 81, p 76-79. Griffen W, Griffen D. 1829. Observations on Functional Disorders of the Spinal Cord, and Their Connexion with Hysterical, Nervous, and Other Diseases. Illustrated by Cases, Selected Chiefly from the Reports of the Pallas, Kenry, and Currah Dispensaries. London Medical and Physical Journal. 7(42) 477-489. Reid, J. 1848. Dr. Reid on Puerperal Insanity. Journal of Psychological and Medical Mental Pathology. 1(1): 128-151. Clark AC. 1887. Aetiology, Pathology, and Treatment of Puerperal Insanity. Journal of Mental Science. 33(142): 169-189. Donkin, AS. 1863. The Pathological Relation between Albuminuria and Puerperal Mania. Journal of Mental Science. 9(47): 401-405. Barkin V. 1929. Protein therapy in insanity of puerperal origin. British Medical Journal. 1(3549): 67. Earle P. 1854. Bloodletting in Mental Disorders. American Journal of Insanity. 10(4): 287-405. Mackenzie FW. 1851. Puerperal Insanity: Especially in Reference to Anaemia. London Journal of Medicine. 3(30): 504-521. Gordon HL. 1897. Sir James Young Simpson and Chloroform (1811-1870). Masters of Medicine. T. Fisher Unwin, for Great Britain and Longmans Green & Co. for the United States of America. Dunn, PM. 2002. Sir James Young Simpson (1811-1870) and obstetric anesthesia. Archives of Disease in Childhood-Fetal and Neonatal edition. 86(3): F207-F209. Koppanyi T, Dille JM, Linegar CR. 1936. Studies on Barbiturates: XVII. The Effect of Prolonged Chloroform Anesthesia on the Duration of Action of Barbiturates. The Journal of Pharmacology and Experimental Therapeutics. 119-127. Waters ATH. 1857. On the use of chloroform in the treatment of puerperal insanity. American Journal of Psychiatry. 13(4): 341-353. Ramachandran CT, Subramanyam N, Baker G, et al. 2011. Antidepressants: From MAOIs to SSRIs and more. Indian Journal of Psychiatry. 53(2): 180-182. Agin HV. 1963. Phenelzine in the treatment of depression. American Journal of Psychiatry. 119(12): 1173-1174. Blacker KH, Weinstein BJ, Ellman GL. 1962. Mother’s Milk and Chlorpromazine. 119(2): 178-179. Whalley LJ, Eagles JM, Bowler GMR, et al. 1987. Selective effects of ECT on hypothalamic-pituitary activity. Psychological Medicine. 17(2): 319-328. Williams RL, Barrera SE. 1950. Observations and opinions concerning complications and contraindications in electric convulsive therapy. Psychiatric Quarterly. 24(4): 800-809. Matthew JR, Constan E. 1964. Complications following ECT over a three year period in a state institution. American Journal of Psychiatry. 120(11)-1119-1120.  Sobel DE. 1960. Fetal Damage Due to ECT, Insulin Coma, Chlorpromazine, or Reserpine. AMA Archives of General Psychiatry. 2(6): 606-611. Langan RC, Goodbred AJ. 2016. Identification and Management of Peripartum Depression.American Family Physician. 93(10): 852-858.  Information from your family doctor: Postpartum depression. 2010. American Family Physician. 82(8): 939-940. Schiller CE, Schmidt PJ, Rubinow D. 2014. Allopregnanolone as a Mediator of Affective Switching in Reproductive Mood Disorders. Psychopharmacology. 231(17): 3557-3567. Bitran D, Hilvers RJ, Kellogg CK. 1991.Anxiolytic effects of 3α-hydroxy-5α[β]-pregnan-20-one:endogenous metabolites of progesterone that are active at the GABAA receptor. Brain Research. 561:157–161. Ottander U, Poromaa IS, Bjurulf E, et al. 2005. Allopregnanolone and pregnanolone are produced by the human corpus luteum. Molecular and Cellular Endocrinology. 239(1-2): 37-44. Meltzer-Brody S, Colquhoun H. Reisenberg R, et al. 2018. Brexanolone injection in post-partum depression: two multicentre, double-blind, randomised, placebo-controlled, phase 3 trials. The Lancet. 392(10152): 1058-1070.

Medical Student Gregory Kirschen takes us through the history of postpartum depression from hippocrates to present day.   References American Psychiatric Association. (2013). Cautionary statement for forensic use of DSM-5. In Diagnostic and statistical manual of mental disorders (5th ed.). doi:10.1176/appi.books.9780890425596.744053 King, H. 1998. Hippocrates’ Woman: Reading the Female Body in Ancient Greece. London: Routledge, 1st ed. https://doi.org/10.4324/9780203025994   Adams, H. (1984). Comprehensive Handbook of Psychopathology. New York: Springer Science + Business Media. P. 319. ISBN 97814615668.   Louden, I. 1988. Puerperal insanity in the 19th Century. Journal of the Royal Society of Medicine. 81, p 76-79.   Reid, J. 1848. Dr. Reid on Puerperal Insanity. Journal ofPsychological and Medical Mental Pathology. 1(1): 128-151.   Meltzer HY, Stahl SM. 1976. The dopamine hypothesis of schizophrenia: a review. Schizophrenia Bulletin. 2(1): 19-76.   Hirschfeld, R. 2000. History and evolution of the monoamine hypothesis of depression. The Journal of Clinical Psychiatry. 61(Suppl6), 4-6.   Winn, JM. 1855. On the Treatment of Puerperal Mania. Journal of Psychological and Medical Mental Pathology.. 8(30): 309-313.   MacLeod, MD. 1886. An address on puerperal insanity. British Medical Journal. 2(1336): 239-242.   Theriot, N. 1989. Diagnosing Unnatrual Motherhood: Nineteenth-century Physicians and ‘Puerperal Insanity.’ American Studies. 30(2): 69-88.   Henry, WO. 1907. To what extent can the gynecologist prevent and cure insanity in women? JAMA. XLVIII(12): 997-1002.   Boyd, R. 1870. Observations on puerperal insanity. Journal of Mental Science. 16(74): 153-165.   Clark, AC. 1887. Aetiology, Pathology, and Treatment of Puerperal Insanity. Journal of Mental Science. 33(142): 169-189.   Dunn, PM. 2002. Sir James Young Simpson (1811-1870) and obstetric anesthesia. Archies of Disease in Childhood-Fetal and Neonatal edition. 86(3): F207-F209.   Tuke, JB. 1867. Cases illustrataive of insanity of pregnancy, puerperal mania, and insanity of lactation. Edinburgh Medical Journal. 12(12): 1083-1101.   Donkin, AS. 1863. The Pathological Relation between Albuminuria and Puerperal Mania. Journal of Mental Science. 9(47): 401-405.   Miller GE, Cohen S, Ritchey AK. 2002. Chronic psychological stress and the regulation of pro-inflammatory cytokines: a glucocorticoid-resistance model. Health Psychology. 21(6): 531-541.   Cassidy-Bushrow AE, Peters RM, Johnson DA, et al. 2012. Association between depressive symptoms with inflammatory biomarkers among pregnant African-American women. Journal of Reproductive Immunology. 94(2): 202-209.   O’Mahony SM, Myint AM, van der Hove D, et al. 2006. Gestational stress leads to depressive-like behavioural and immunological changes in the rat. Neuroimmunomodulation. 13: 82-88.   Bamford, CB. 1934. An analytical review of a series of cases of insanity with pregnancy. Journal of Mental Science. 80(328): 58-63.   Ballantyne, JW. 1892. A series of thirteen cases of alleged maternal impression. Edinburgh Medical Journal. 37(11): 1025-1034.   Fisher GJ. 1870. Does Maternal Mental Influence Have any Constructive or Destructive Power in the Production of Malformations or Monstrosities at any Stage of Embryonic Development? American Journal of Insanity. XXVI(III): 241-295.   Pohlman AG. 1911. Maternal impression. Proceedings of the Indiana Academy of Science. 65-70.   Kundakovic M, Gudsnuk K, Herbstman JB, et al. 2015. DNA methylation of BNDF as a biomarker of early-life adversity.PNAS. 112(22): 6807-6813.   Boersma GJ., Lee RS, Cordner ZA, et al. 2014. Prenatal stress decreases Bdnf expression and increases methylation of Bdnf exon IV in rats. Epigenetics. 9(3): 437-447.   Zajicek-Farber ML. 2009. Postnatal depression and infant health practices among high-risk women. Journal of Child and Family Studies. 18:236.   Ban L, Gibson JE, West J, et al. 2010. Association between perinatal depression in mothers and the risk of childhood infections in offspring: a population-based cohort study. BMC Public Health. 10:799.   Ertel KA, Koenen KC, Rich-Edwards JW, et al. 2010. Antenatal and postpartum depressive symptoms are differentially associated with early childhood weight and adiposity. Paediatric and Perinatal Epidemiology. 24: 179-189.   Beck CT. 1998. The effects of postpartum depression on child development: A meta-analysis. Archives of Psychiatric Nursing. 12(1): 12-20.   Tuovinen S, Lahti-Pulkkinen M, Girchenko P, et al. 2018. Maternal depressive symptoms during and after pregnancy and child developmental milestones. Depression and Anxiety. 35(8): 732-741.   Foundeur M, Fixsen C, Tribel WA, et al. 1957. Postpartum Mental Illness: A Controlled Study. AMA Archives of Neurology and Psychiatry. 77(5): 503-512.  

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Dr. Bergoy walks us through the risks and benefits of elective cesarean delivery. www.obgyn.fm feedback@obgyn.fm neonatal and maternal mortality https://www.acog.org/Clinical-Guidance-and-Publications/Obstetric-Care-Consensus-Series/Safe-Prevention-of-the-Primary-Cesarean-Delivery https://www.ncbi.nlm.nih.gov/pubmed/?term=24631705%5Buid%5D https://www.uptodate.com/contents/cesarean-delivery-on-maternal-request?search=cesarean%20section%20complications&source=search_result&selectedTitle=6~150&usage_type=default&display_rank=6#H16 Primary cs vs trial of labor Visco et al’s review https://www.ncbi.nlm.nih.gov/pubmed/?term=visco+cesarean+delivery+on+maternal+request+obstetrics+and+gynecology+2006 Declercq et al’s study https://www.ncbi.nlm.nih.gov/pubmed/?term=Declercq+et+al%2C+green+journal%2C+109(3)%2C+2007+%C2%ABMaternal+Outcomes+Associated+With+Planned+Primary+Cesarean+Births+Compared+With+Planned+Vaginal+Births%C2%BB Allen et al https://www.ncbi.nlm.nih.gov/pubmed/16880297 Liu et al, AJOG, vol 212 issue 6 2015. “Cesarean delivery on maternal request in China: what are the risks and benefits?” https://www.ncbi.nlm.nih.gov/pubmed/?term=25640048 Liu et al, CMAJ, vol 176, issue 4 2007 “Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1800583/ TOLAC vs secondary elective cesarean Guise et al, Obstet gynecol, june 2010 vol 115, no 6, “Vaginal birth after cesarean: new insights on maternal and neonatal outcomes.” https://www.ncbi.nlm.nih.gov/pubmed/?term=20502300 Crowther et al, PLoS med, 2012, 9(3). «Planned Vaginal Birth or Elective Repeat Caesarean: Patient Preference Restricted Cohort with Nested Randomised Trial« RDS Hansen et al BMJ 2008 “Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study” https://www.bmj.com/content/336/7635/85 Long term complications Marshall et al «Impact of multiple cesarean deliveries on maternal morbidity: a systematic review» Am J Obstet Gynecol2011;205:262.e1-8. https://www.ncbi.nlm.nih.gov/pubmed/22071057 Keag et al systematic review and metaanalysis of long term risks and benefits of cs vs vag delivery for mother and child from jan 18 in PLoS med https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002494 editorial in the green journal from 2011 on the evidence of CS as protective of pelvic floor damage https://www.ncbi.nlm.nih.gov/pubmed/21934440 composite outcomes Freemantle et al Jama 2003 https://jamanetwork.com/journals/jama/fullarticle/196588 Cordoba et al BMJ 2010 https://www.bmj.com/content/341/bmj.c3920 Various An article on how to counsel a patient on risks and benefits woth cesarean on maternal request from Jama 2013 https://jamanetwork.com/journals/jama/fullarticle/1685873 NNT https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4524406/

Dr. David Gagnon leads us through the origins of the National Perinatal Association.

Dr. Gina Milone takes us through the pros and cons of post-delivery IUD placement. feedback@obgyn.fm   Blumenthal, P. D., et al. (2018). "Comparative safety and efficacy of a dedicated postpartum IUD inserter versus forceps for immediate postpartum IUD insertion: a randomized trial." Contraception98(3): 215-219.  Center for Disease Control, U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC), 2016. Eser, A., et al. (2018). "Clinical experience with a novel anchored, frameless copper-releasing contraceptive device for intra-caesarean insertion." Eur J Contracept Reprod Health Care23(4): 255-259. Immediate postpartum long-acting reversible contraception. Committee Opinion No. 670. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;128:e32-7. Jatlaoui, T. C., et al. (2018). "Intrauterine Device Expulsion After Postpartum Placement: A Systematic Review and Meta-analysis." Obstet Gynecol132(4): 895-905. Kapp, N. and K. M. Curtis (2009). "Intrauterine device insertion during the postpartum period: a systematic review." Contraception80(4): 327-336. Long-acting reversible contraception: implants and intrauterine devices. Practice Bulletin No 186. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;130:e251-69. Optimizing postpartum care. ACOG Committee Opinion No. 736. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e140-50. Singh, S., et al. (2016). "A Dedicated Postpartum Intrauterine Device Inserter: Pilot Experience and Proof of Concept." Glob Health Sci Pract4(1): 132-140. Unal, C., et al. (2018). "Comparison of expulsions following intracesarean placement of an innovative frameless copper-releasing IUD (Gyn-CS(R)) versus the TCu380A: A randomized trial." Contraception.    

We follow-up last months dicsussion of termination by discussing the challenging stories of women who chose to terminate after 24 weeks and then have a great discsussion about embryo adoption.

Dr. Lian joins me to discuss "Opioid use after laparoscopic hysterectomy: prescriptions, patient use, and a predictive calculator" from AJOG. feedback@obgyn.fm

Please join Drs. Jillian Kurtz and Heather Link to discuss extended cycle contraception, changes to abortion laws, and the role of OB hospitalists. feedback@obgyn.fm How Abortion Law in New York Will Change, and How It Won’t FSRH Clinical Guidance: Combined Hormonal Contraception - January 2019 Obstetric hospitalists can screen for postpartum depression  

Dr. Oystein Bergoy joins me to discuss the LaPS Study looking at the effect of Zhang's partograph on cesarean deliveries for labor dystocia. www.obgyn.fm feedback@obgyn.fm The frequency of intrapartum caesarean section use with the WHO partograph versus Zhang’s guideline in the Labour Progression Study (LaPS): a multicentre, cluster-randomised controlled trial Friedman E. The graphic analysis of labor. Am J Obstet Gynecol 1954;68: 1568–75.   Zhang J, Troendle JF, Yancey MK. Reassessing the labor curve in nulliparous women. Am J Obstet Gynecol 2002; 187: 824–28. Zhang J, Landy HJ, Branch DW, et al. Contemporary patterns ofspontaneous labor with normal neonatal outcomes. Obstet Gynecol2010; 116: 1281–87.

Join us for this special 50th episode where we get together to discuss why we do what we do.   feedback@obgyn.fm

Dr. Heather Link starts a new series on Maternal Mortality by discussing what that even means and how we get those numbers.   feedback@obgyn.fm   Maternal mortality is a key indicator of a health system’s strength. Safe Motherhood Week. https://www.safemotherhoodweek.org/maternal-mortality-key-indicator-health-systems-strength/.Published October 30, 2017. Accessed July 19, 2018. Organization WH, Others. WHO guidance for measuring maternal mortality from a census. 2013. http://apps.who.int/iris/handle/10665/87982. Knight M, Kenyon S, Brocklehurst P, et al. Saving Lives, Improving Mothers’ Care Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-2012. 2014. http://discovery.ucl.ac.uk/1464330/. Humphrey MD, Bonello MR, Chughtai A, Macaldowie A, Harris K & Chambers GM. Maternal Deaths in Australia 2008–2012. Maternal Deaths Series No. 5. Canberra: AIHW.; 2015. http://apo.org.au/system/files/55131/apo-nid55131-20636.pdf. Pregnancy Mortality Surveillance System | Maternal and Infant Health | CDC. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm.Published August 7, 2018. Accessed August 27, 2018. New York State Maternal Mortality Review Report. https://www.health.ny.gov/community/adults/women/docs/maternal_mortality_review_2012-2013.pdf. Maternal mortality ratio (MMR) — MEASURE Evaluation. https://www.measureevaluation.org/prh/rh_indicators/womens-health/sm/maternal-mortality-ratio-mmr.Published November 23, 2010. Accessed October 8, 2018. Division of Reproductive Health, Family and Reproductive Health. The Sisterhood Method for Estimating Maternal Mortality. World Health Organization ; 1997. http://apps.who.int/iris/bitstream/handle/10665/64007/WHO_RHT_97.28.pdf;jsessionid=ACC253E82A5392CD768522ABE2716AA7?sequence=1. Wilmoth JR, Mizoguchi N, Oestergaard MZ, et al. A New Method for Deriving Global Estimates of Maternal Mortality. Stat Politics Policy. 2012;3(2). https://www.ncbi.nlm.nih.gov/pubmed/24416714. Maternal mortality - UNICEF DATA. UNICEF DATA. https://data.unicef.org/topic/maternal-health/maternal-mortality/.Accessed October 30, 2018. WHO, Department of Reproductive Health and Research. Trends in Maternal Mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. World Health Organization ; 2014. http://apps.who.int/iris/bitstream/handle/10665/112697/WHO_RHR_14.13_eng.pdf;jsessionid=435F8C2D8482EF587423E845839727BC?sequence=1. Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38(8):1091-1110. Montagu D, Yamey G, Visconti A, Harding A, Yoong J. Where do poor women in developing countries give birth? A multi-country analysis of demographic and health survey data. PLoS One. 2011;6(2):e17155. Somé DT, Sombié I, Meda N. How decision for seeking maternal care is made--a qualitative study in two rural medical districts of Burkina Faso. Reprod Health. 2013;10:8. Scott S, Chowdhury ME, Pambudi ES, Qomariyah SN, Ronsmans C. Maternal mortality, birth with a health professional and distance to obstetric care in Indonesia and Bangladesh. Trop Med Int Health. 2013;18(10):1193-1201. Hanson C, Cox J, Mbaruku G, et al. Maternal mortality and distance to facility-based obstetric care in rural southern Tanzania: a secondary analysis of cross-sectional census data in 226 000 households. Lancet Glob Health. 2015;3(7):e387-e395. Lori JR, Starke AE. A critical analysis of maternal morbidity and mortality in Liberia, West Africa. Midwifery. 2012;28(1):67-72. Gwilliam F, Archondo-Callao B-G, Nogales S. Roads in Sub-Saharan Africa. Africa Infrastructure Country Diagnostic AICD. 2008. http://documents.worldbank.org/curated/en/938171468194345853/pdf/551050WP0p109210Box349439B01PUBLIC1.pdf. Amdd WUU. Monitoring Emergency Obstetric Care: A Handbook. World Health Organization; 2009. http://apps.who.int/iris/bitstream/handle/10665/44121/9789241547734_eng.pdf;jsessionid=8894BA499197FB974E66D8624AFCDFEF?sequence=1. UNICEF, Ministry of Health -Puntland. EmONC Needs Assessment in Selected Health Facilities in NEZ, Puntland- September 2011. UNICEF European Commission; 2011. https://www.unicef.org/somalia/EmONC_needs_Assessment_Report_-_Puntland_Oct._2011.pdf. Mony PK, Krishnamurthy J, Thomas A, et al. Availability and distribution of emergency obstetric care services in Karnataka State, South India: access and equity considerations. PLoS One. 2013;8(5):e64126. Rosindale L. Rural Maternal Mortality. Am J Nurs. 2018;118(12):10. Alkema L, Chou D, Hogan D, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016;387(10017):462-474. Sustainable Development Goals | UNDP. UNDP. http://www.undp.org/content/undp/en/home/sustainable-development-goals.html.Accessed December 1, 2018. WHO | Projections of mortality and causes of death, 2016 to 2060. November 2018. https://www.who.int/healthinfo/global_burden_disease/projections/en/.Accessed December 1, 2018.

Drs. Lian and Blaber join me to discuss "Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer" from NEJM. https://www.nejm.org/doi/full/10.1056/NEJMoa1806395 https://journals.lww.com/greenjournal/Fulltext/2018/10000/Noninferiority_Complex.5.aspx   feedback@obgyn.fm

Drs. Sara Kim and Vai Umesh join me to discuss sexism in medicine. https://creogsovercoffee.com feedback@obgyn.fm Ending Sexual Harassment in Academic Medicine

I speak with Dr. Cathy Cluver about her article in the October issue of American Journal of Obstetrics and Gynecology. https://www.ajog.org/article/S0002-9378(18)30606-9/fulltext feedback@obgyn.fm www.obgyn.fm

Dr. Sara Kim discusses the etiology, diagnosis, and management of intrahepatic cholestasis of pregnancy. Website Slack Patreon feedback@obgyn.fm Fast, B., & Roulston, T. (1963). Idiopathic jaundice of pregnancy. Am J Obstetrics and Gynecology, 314-320. Geenes, V., & Williamson, C. (2009). Intrahepatic cholestasis of pregnancy. World Journal of Gastroenterology, 2049-2066. Gynecologists, R. C. (2011). Obstetric Cholestasis. Jurate, K., Rimantas, Z., Jolanta, S., Vladas, G., & Limas, K. (2017). Sensitivity and specificity of biochemical tests for diagnosis of intrahepatic cholestasis of pregnancy. Annals of Hepatology, 569-573. Kenyon, A., Piercy, C. N., Girling, J., Williamson, C., RM, T., & Shennan, A. (2002). Obstetric cholestasis, outcome with active management: a series of 70 cases. BJOG: an International Journal of Obstetrics and Gynecology, 282-288 Lammert, F., Marschall, H.-U., Glantz, A., & Matern, S. (2000). Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. Journal of Hepatology, 1012-1021. Lindor, K., & Lee, R. (2018). Intrahepatic cholestasis of pregnancy. Retrieved from UptoDate: https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy?search=cholestasis%20of%20pregnancy&source=search_result&selectedTitle=1~59&usage_type=default&display_rank=1 Pusl, T., & Beuers, U. (2007). Intrahepatic cholestasis of pregnancy. Orphanet Journal of Rare Diseases.   

Join us as we discuss "Effect of Immediate vs Delayed Pushing on Rates of Spontaneous Vaginal Delivery Among Nulliparous Women Receiving Neuraxial Analgesia A Randomized Clinical Trial" from JAMA October 2018. Effect of Immediate vs Delayed Pushing on Rates of Spontaneous Vaginal Delivery Among Nulliparous Women Receiving Neuraxial AnalgesiaA Randomized Clinical Trial   Patreon link to support podcast   National Perinatal Association Meeting  

Join us as we discuss the future of residency training in the United States.   The First National Summit on Women’s Health   feedback@obgyn.fm

In this episode we speak with Dr. Hourigan about her randomized controlled trial on the effect of vaginal seeding on the neonatal microbiome and long-term health outcomes.   Dr. Suchitra Houriman - Bio RCT on Vaginal Seeding Contact Dr. Houriman    

Dr. Jillian Kurtz discusses the ins and outs of ovulation induction.   feedback@obgyn.fm

Join me as we finish our discussion on anueplody screening. In this episode we discuss the risks of amniocentisis and chorionic villus sampling, cell-free DNA, and different screening strategies. Comparing Different Strategies The assessment of combined first trimester screening in women of advanced maternal age in an Asian cohort   Amnio/CVS A report of the safety and accuracy of midtrimester amniocentesis at the Medical College of Georgia: Eight and one half years' experience PRENATAL DIAGNOSIS IN MULTIPLE GESTATION: 20 YEARS’ EXPERIENCE WITH AMNIOCENTESIS Maternal complications following amniocentesis and chorionic villus sampling for prenatal karyotyping Chorionic Villus Sampling Fetal Complications of Amniocentesis Intrauterine diagnosis and management of genetic defects Role of Amniocentesis in the Intrauterine Detection of Genetic Disorders Needle puncture of fetus: A complication of second- trimester amniocentesis Fetal loss rate after chorionic villus sampling and amniocentesis: an 11-year national registry study Procedure-Related Complications of Amniocentesis and Chorionic Villous Sampling Analysis of 2136 genetic amniocenteses: Experience of a single physician Midtrimester amniocentesis: An analysis of 923 cases with neonatal follow-up Cell-Free DNA Presence of fetal DNA in maternal plasma and serum Increased Fetal DNA Concentrations in the Plasma of Pregnant Women Carrying Fetuses with Trisomy 21 Single-Nucleotide Polymorphism–Based Noninvasive Prenatal Screening in a High-Risk and Low-Risk Cohort Noninvasive prenatal diagnosis of fetal chromosomal aneuploidy by massively parallel genomic sequencing of DNA in maternal plasma Isolating fetal cells from maternal blood. Advances in prenatal diagnosis through molecular technology. Fetal DNA in maternal plasma is elevated in pregnancies with aneuploid fetuses Noninvasive Prenatal Detection of Aneuploidy Plasma placental RNA allelic ratio permits noninvasive prenatal chromosomal aneuploidy detection

Join us for a discussion on sexism in medicine, STD screening for women diagnosed with PID, and the removal of the Essure device from the market.   Feedback@obgyn.fm   Sexism in Obstetrics & Gynecology: Not just a “women’s issue” HIV and Syphilis Screening Among Adolescents Diagnosed With Pelvic Inflammatory Disease Bayer Will Stop Selling the Troubled Essure Birth Control Implants

In this episode we talk with Dr. J. Gerald Quirk about his efforts to start a state wide AFP screening program in Arkansas in the 1980s.   obgyn.fm   Slack

Dr. Ballas and Dr. Lian join us to discuss three great topics. 1. Social structure of the operating room 2. Ethical issues in laparoscopic surgery 3. US administration position on breast feeding   Slack invite link

I am joined by minimally invasive gynecologic surgeons Dr. Blaber and Dr. Lian to discuss a paper from the May issue of AJOG. Laparoscopic vs transvaginal cuff closure after total laparoscopic hysterectomy: a randomized trial by the Italian Society of Gynecologic Endoscopy Uccella S, Malzoni M, Cromi A, et al. Laparoscopic vs transvaginal cuff closure after total laparoscopic hysterectomy: a randomized trial by the Italian Society of Gynecologic Endoscopy. Am J Obstet Gynecol 2018;218:500.e1-13.

In this episode Dr. Sara Kim and Dr. Jillian Kurtz join me to discuss some basic research papers about pregnancy dating and PCOS.   Noninvasive blood tests for fetal development predict gestational age and preterm delivery Elevated prenatal anti-Müllerian hormone reprograms the fetus and induces polycystic ovary syndrome in adulthood

In this episode we trace the history of aneuploidy screening from the early days of amniocentesis to the modern day serum screening.    feedback@obgyn.fm 1987 Cuckle Paper: Estimating a woman’s risk of having a pregnancy associated with Down’s syndrome using her age and serum alpha-fetoprotein level Other references in no particular order: First-Trimester or Second-Trimester Screening, or Both, for Down’s Syndrome INTEGRATED SCREENING FOR DOWN’S SYNDROME BASED ON TESTS PERFORMED DURING THE FIRST AND SECOND TRIMESTERS First Trimester Biochemical Screening for Trisomy 21: The Role of Free Beta hCG, Alpha Fetoprotein and Pregnancy Associated Plasma Protein A First trimester biochemical screening for trisomy 21: the role of free beta heG, alpha fetoprotein and pregnancy associated plasma protein A SOMATIC CHROMOSOMES IN MONGOLISM Screening for Down's Syndrome Contingent screening for Down syndrome completed in the first trimester: a multicenter study  UK multicentre project on assessment of risk of trisomy 21 by maternal age and fetal nuchal-translucency thickness at 10–14 weeks of gestation Antenatal maternal serumscreening for Down's syndrome: results of a demonstration project Reducing the need for amniocentesis in women 35 years of age or older with serum markers for screening Low second trimester maternal serum unconjugated oestriol in pregnancies with Down's syndrome Low second trimester maternal serum unconjugated oestriol in pregnancies Down's syndrome Fetal nuchal translucency: ultrasound screening for chromosomal defectsinfirsttrimesterofpregnancy Maternal serum screening for Down's syndrome in early pregnancy Combining maternal age and serum alpha-fetoprotein to predict the risk of Down syndrome Appropriate Biochemical Parameters in First-trimester Screening for Down Syndrome Screening in early pregnancy for pre-eclampsia using Down syndrome Quadruple test markers

In this episode Dr. Ballas and I discuss the declining US birth rate and paretnal leave for ob/gyn residents.     Births: Provisional Data for 2017 Pregnancy and parental leave among obstetrics and gynecology residents: results of a nationwide survey of program directors

In this episode Dr. Jillian Kurtz walks us through the methods and rationale behind fertility preservation for patients with cancer or undergoing transgender procedures.

  In this episode I am joined by Dr. Ballas and Dr. Kim to dicsuss the paper "Pregnancy Exercise and Nutrition With Smartphone Application Support" from the May edition of Obstetrics & Gynecology.   feedback@obgyn.fm

In this episdoe we discuss the new postpartum guidelines from ACOG, newborn microbiome seeding, and the gentle cesarean.   ACOG Committee Opinion: Optimizing Postpartum Care ACOG Committee Opinion: Vaginal Seeding OBG Management: Gentle Cesarean   Podcast: Conversations in Obstetrics and Gynecology 

In this episode we discuss the mode of delivery in twin gestation Paper: Schmitz T, Korb D, Battie C, et al. Neonatal morbidity associated with vaginal delivery of noncephalic second twins. Am J Obstet Gynecol 2018;218:449.e1-13. feedback@obgyn.fm Other References: Association Between Planned Cesarean Delivery and Neonatal Mortality and Morbidity in Twin Pregnancies How singleton breech babies at term are born in France: a survey of data from the AUDIPOG network Twin Birth Study: 2-year neurodevelopmental follow-up of the randomized trial of planned cesarean or planned vaginal delivery for twin pregnancy

In this episode we finish up PCOS by discussing the management and long-term consequences.   feedback@obgyn.fm   Polycystic ovary syndrome: etiology, pathogenesis and diagnosis Combined oral contraceptives in the treatment of polycystic ovary syndrome Ovarian Suppression in Normal-Weight and Obese Women During Oral Contraceptive Use: A Randomized Controlled Trial Ovulation incidence with oral contraceptives: a literature review Shorter pill-free interval in combined oral contraceptives decreases follicular development Comparison of efficacy of metformin and oral contraceptive combination of ethinyl estradiol and drospirenone in polycystic ovary syndrome Evidence-Based and Potential Benefits of Metformin in the Polycystic Ovary Syndrome: A Comprehensive Review Metformin, oral contraceptives or both to manage oligo-amenorrhea in adolescents with polycystic ovary syndrome? A clinical review Additive Effects of Insulin-Sensitizing and Anti-Androgen Treatment in Young, Nonobese Women with Hyperinsulinism, Hyperandrogenism, Dyslipidemia, and Anovulation Metformin and gonadotropins for ovulation induction in patients with polycystic ovary syndrome: a systematic review with meta-analysis of randomized controlled trials Aromatase inhibitors for subfertile women with polycystic ovary syndrome: summary of a Cochrane review Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis Lifestyle Modification Programs in Polycystic Ovary Syndrome: Systematic Review and Meta-Analysis The Impact of Bariatric Surgery on Polycystic Ovary Syndrome: a Systematic Review and Meta-analysis Assessment of Cardiovascular Risk and Prevention of Cardiovascular Disease in Women with the Polycystic Ovary Syndrome: A Consensus Statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society Body Composition Is Improved During 12 Months' Treatment With Metformin Alone or Combined With Oral Contraceptives Compared With Treatment With Oral Contraceptives in Polycystic Ovary Syndrome Influences of weight, body fat patterning and nutrition on the management of PCOS

In this Months Checkup Drs. Ballas and Kim join me to discuss the link (or non-link) between acetaminophen use during pregnancy and ADHD, the new NIH funded PregSource initiative, and how we architecture affects how we provide care. feedback@obgyn.fm   Prenatal Exposure to Acetaminophen and Risk of ADHD PregSource The case against hospital beds    

In this episode Dr. Øystein Bergøy discusses the evidence behind the risks of antenatal corticosteroids for women at risk for preterm delivery.    feedback@obgyn.fm   ACOG guidelines on fetal maturation  NICE guidelines on risk of premature labour  Norwegian guidelines on risk of premature labour  2015 cochrane analysis of repeat steroids  Study were microsimulation was used to make a ratio of benefits vs harms of repeat steroids according to gestational age at birth  Uptodate.com article on antenatal steroids  study showing increased rds 1 to 24 hrs after booster dose Review from Nature in 2001 mentioning several animall studies that show negative effects of excess corticosteroids in utero Animal study from Kidney Int from 2000 showing increased risk of glucose intolerance with exogenous corticosteroid exposure in utero  Study in baboons from Nature in 2012 showing impaired myelination after exposure to repeat antenatal steroids  3 studies that have shown impaired stress response inneonates exposed to antenatal steroids https://www.ncbi.nlm.nih.gov/pubmed/?term=Antenatal+betamethasone+administration+alters+stress+physiology+in+healthy+neonates https://www.ncbi.nlm.nih.gov/pubmed/?term=Effects+of+prenatal+betamethasone+exposure+on+regulation+of+stress+physiology+in+healthy+premature+infants https://www.ncbi.nlm.nih.gov/pubmed/?term=Neonatal+adrenal+function+after+repeat+dose+prenatal+corticosteroids%3A+a+randomized+controlled+trial https://www.ncbi.nlm.nih.gov/pubmed/?term=Multiple+courses+of+antenatal+corticosteroids+and+outcome+of+premature+neonates.+North+American+Thyrotropin-Releasing+Hormone+Study+Group Study showing impaired HPA function in children 6-11 years of age exposed to antenatal steroids  Study showing signs of glucose intolerance in participant who received antenatal steroids compared to placebo Study showing increased aortic stiffness in those exposed to antenatal steroids crowther et al mid childhood neurocgognitive development  meta analysis from 2016 in BMJ examining benefits and harms of antenatal steroids between 34 and 36 weeks gestation 

In this episode Dr. Øystein Bergøy discusses the evidence behind antenatal corticosteroids for women at risk for preterm delivery.  feedback@obgyn.fm Uptodate articles on RDS 1 2 3   Liggins 1972 paper 2013 cochrane analysis on type of steroid and regimens 2017 cochrane analysis of antenatal corticosteroids for accelerating fetal lung maturation    2015 cochrane analysis of repeat antenatal corticosteroids 2003 meta analysis of the effects of a single course corticosteroid compared to placebo/no treatment were delivery was 7 days or more after the treatment was given website of the EPICE cohort Study from EPICE looking at effects of steroids and time to delivery  ACOG guidelines on fetal maturation  NICE guidelines on risk of premature labour Norwegian guidelines on risk of premature labour

In this episode Dr. Kim joins me to discuss an article about postplacental IUD placement from the American Journal of Obstetrics and Gynecology.   Postplacental intrauterine device expulsion by 12 weeks: a prospective cohort study  

Please consider giving to www.breac225.org to help support the victims of Hurricane Harvey. In this episode we discuss the link between baby powder and ovarian cancer, the effect of breastfeeding on endometriosis, and the long term emotional effect of mode of delivery. Does Baby Powder Cause Cancer? A Jury Says Yes. Scientists Aren't So Sure History of breast feeding and risk of incident endometriosis: prospective cohort study The maternal childbirth experience more than a decade after delivery

In this episode we trace the history of polycystic ovarian syndrome, learn about the underlying physiology, and how to diagnosis it. feedback@obgyn.fm   Current Practices of Measuring and Reference Range Reporting of Free and Total Testosterone in the United States. Diagnostic Criteria for Polycystic Ovary Syndrome: Pitfalls and Controversies Clinical Findings and Hormonal Responses in Patients With Polycystic Ovarian Disease With Normal Versus Elevated LH Levels. A study of the end-results of the treatment of amenorrhea and sterility by radiation of 128 married women over a period of twelve years The Stein-Leventhal syndrome Secretion of Androgens by the Polycystic Ovary and its Significance Inappropriate Secretion of Follicle-Stimulating Hormone and Luteinizing Hormone in Polycystic Ovarian Disease Defective Biosynthesis of Ovarian Steroids in the Stein-Leventhal Syndrome Functional Studies of Aromatase Activity in Human Granulosa Cells from Normal and Polycystic Ovaries The Effects of Ovarian Wedge Resection on Circulating Gonadotropin and Ovarian Steroid Levels in Patients with Polycystic Ovary Syndrome Bilateral polycystic ovaries: Significance in sterility Polycystic ovary syndrome: etiology, pathogenesis and diagnosis

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In this episode we discuss "Patterns of Opioid Prescription and Use After Cesarean Delivery" published in Obstetrics & Gynecology in July 2017 by Brian Bateman et al. If you want to get in contact with Dr. Ballas then please send email to feedback@obgyn.fm  

In this episode Dr. Kim and I discuss three current topics from the medical world.   1. CDC MMR - Placenta Encapsulation https://www.ncbi.nlm.nih.gov/pubmed/27440542 https://www.ncbi.nlm.nih.gov/pubmed/27809380 2. Effect of Cervical Screening Changes on STD testing https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4279217/ 3. Menstruation & Oral Contraceptives

In this episode we conclude our discussion on intrapartum fetal monitoring by discussing fetal pulse oximetry and ST waveform analysis.    July Journal Club Article:  Patterns of Opioid Prescription and Use After Cesarean Delivery   feedback@obgyn.fm   ST Waveform Analysis Fetal electrocardiogram: ST waveform analysis in intrapartum surveillance ST waveform analysis versus cardiotocography alone for intrapartum fetal monitoring: a systematic review and meta-analysis of randomized trials Electrocardiogram ST Analysis During Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials Does ST analysis of fetal ECG reduce cesarean section rate for fetal distress? The fetal electrocardiogram: ST waveform analysis during labour Randomised trial of cardiotocography alone or with ST waveform analysis for intrapartum monitoring Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial Fetal Pulseoximetry Fetal pulse oximetry for fetal assessment in labour Intrapartum Oximetry of the Fetus Update on intrapartum fetal pulse oximetry The safety of fetal pulse oximetry in parturients requiring fetal scalp blood sampling Intrapartum fetal pulse oximetry: Fetal oxygen saturation trends during labor and relation to delivery outcome

In this episode we discuss the use of fetal scalp pH and scalp stimulation in the triage of abnormal electronic fetal heart rate tracings.    Feedback@obgyn.fm Scalp pH http://www.sciencedirect.com/science/article/pii/0002937885903308 http://www.tandfonline.com/doi/abs/10.1080/14767050500526172 http://www.sciencedirect.com/science/article/pii/S0002937899700839 http://www.bmj.com/content/336/7656/1284 http://journals.lww.com/greenjournal/abstract/1975/10000/correlation_of_fetal_heart_rate_uterine.4.aspx http://www.sciencedirect.com/science/article/pii/0002937880908509 http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1995.tb10878.x/full http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1995.tb10878.x/full http://www.sciencedirect.com/science/article/pii/0002937869901021 http://onlinelibrary.wiley.com/doi/10.1111/j.1447-0756.1987.tb00238.x/full http://www.bmj.com/content/340/bmj.c1471.long http://journals.lww.com/greenjournal/Abstract/1994/06000/Elimination_of_Fetal_Scalp_Blood_Sampling_on_a.15.aspx http://fn.bmj.com/content/80/3/F246   Scalp Stim http://www.sciencedirect.com/science/article/pii/S0002937887802624 http://www.sciencedirect.com/science/article/pii/S0002937886800072 http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1989.tb03256.x/full http://www.sciencedirect.com/science/article/pii/S0002937884800678 http://www.ajog.org/article/S0002-9378(84)80067-8/pdf http://www.sciencedirect.com/science/article/pii/S0029784401016453 http://www.sciencedirect.com/science/article/pii/S002978449600525X

In this episode Dr. Ballas and I review and discuss an article from the American Journal of Obstetrics & Gynecology from April 2017 entitled "Planned home births: the need for additional contraindications".   Link: http://www.ajog.org/article/S0002-9378(17)30119-9/abstract   feedback@obgyn.fm

In this episode we discuss the evolution of intrapartum fetal monitoring from the Pinard Horn to modern doppler techniques. We also discuss the benefits and harms of these approaches and their role in modern obstetrics.    feedback@obgyn.fm     A controlled trial of the differential effects of intrapartum fetal monitoring - ScienceDirect Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: A meta-analysis - ScienceDirect Intrapartum Fetal Monitoring — A Disappointing Story — NEJM A prospective comparison of selective and universal electronic fetal monitoring in 34,995 pregnancies. - PubMed - NCBI Instrumentation of Fetal Electrocardiography | Science ‎www.ajog.org/article/0002-9378(58)90707-5/pdf The Beginnings of Perinatal Medicine - Google Books https://www.mnhospitals.org/Portals/0/Documents/patientsafety/Perinatal/3a_ACOG%20Bulletin%20106.pdf ‎www.ajog.org/article/S0002-9378(11)00480-7/pdf ‎www.ajog.org/article/0002-9378(59)90052-3/pdf ‎www.ajog.org/article/0002-9378(59)90639-8/pdf The fetal heart rate patterns preceding death in utero - American Journal of Obstetrics & Gynecology A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation. - PubMed - NCBI Reasons for the rising cesarean delivery rates: 1978-1984. - PubMed - NCBI https://www.ncbi.nlm.nih.gov/pubmed/122861

This is the first in our monthly Journal Club Series with Dr. Jerry Ballas. In this episode we will be discussing a paper from the April 2017 issue of the Green Journal entitled "Sildenafil Citrate Therapy for Oligohydramnios".   Article Link   feedback@obgyn.fm

In this closing chapter on Puerperal Fever we will examine GBS related neonatal sepsis and the science behind its prevention.   feedback@obgyn.fm   Diagnosis and Management of Group B Streptococcus in Pregnancy Use of Cefazolin for Group B Streptococci Prophylaxis in Women Reporting a Penicillin Allergy Without Anaphylaxis   Daily antibiotic cost estimates Cost-effectiveness of strategies to prevent infection of group B streptococcus in neonates from maternal colonisation Timing of intrapartum ampicillin and prevention of vertical transmission of group B streptococcus Chlorhexidine vaginal irrigation for the prevention of peripartal infection: A placebo-controlled randomized clinical trial Chlorhexidine for prevention of neonatal colonization with group B streptococci. IV. Depressed puerperal carriage following vaginal washing with chlorhexidine during labour Chlorhexidine maternal-vaginal and neonate body wipes in sepsis and vertical transmission of pathogenic bacteria in South Africa: a randomised, controlled trial. Feasibility of Oral Prenatal Probiotics against Maternal Group B Streptococcus Vaginal and Rectal Colonization Influence of probiotic enterococci on the growth of Streptococcus agalactiae The Impact of Prenatal Probiotics on Group B Streptococcus Colonization Preventing Early-onset Group B Streptococcal Sepsis: Strategy Development Using Decision Analysis The Prevention of Early-onset Neonatal Group B Streptococcal Disease ORACLE Childhood outcomes after prescription of antibiotics to pregnant women with spontaneous preterm labour: 7-year follow-up of the ORACLE II trial.

Dr. Kim walks us through the history of cord clamping and examines the evidence behind delayed vs. immediate clamping.    feedback@obgyn.fm   ACOG, Committee Opinion. Delayed Umbilical Cord Clamping After Birth. (American College of Obstetricians and Gynecologists, 2017). Downey, C., and Bewley, S. Third Stage Practices and the Neonate. Fetal and MAternal Medicine Review 20, 229-246 (2009). Downey, C., Bewley, S. HIstorical Perspectives on umbilical cord clamping and neonatal transition. Journal of the Royal Society of Medicine 105, 325-329 (2012). Drife, J. The start of life: a history of obstetrics. Postgrad Medicine 78, 311-315 (2002). Loudon, I. General practitioners and obstetrics: a brief history. JR Soc Med 101 (2008). McDonald, S., Middletone, P, Dowswell, T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes (Review). Cochrane Database of Systematic Reviews, 1-93 (2013). Mercer, J., Vohr, BR, McGrath, MM, PAdbury, JF, WAllach, M, Oh, W. Delayed Cord Clamping in Very Preterm Infants Reduces the Incidence of Intraventricular Hemorrhage and Late-Onset Sepsis: A Randomized Controlled Trial. Pediatrics 117, 1235-1242 (2006). Mercer, J., Vohr, BR, Erickson-Owens, DA, Padbury, JF and Oh, W. Seven-month developmental outcomes of very low birth weight infants enrolled in a randomized controlled trial of delayed versus immediate cord clamping. Journal of Perinatology 30, 11-16 (2010). Mercer, J., Erickson-Owens, DA, Collins, J, Barcelos, MO, Parker, AB, Padbury, JF. Effects of Delayed cord clamping on residual placental blood volume, hemoglobin and bilirubin levels in term infants: a randomized controlled trial. Journal of Perinatology 37, 260-264 (2017). National Institute for Health and Care Excellence,. Intrapartum care for healthy women and babies, 2014). Paco, C., Florido, J, Garrido, MC, PRados, S, NAvarrete, L. Umbilical cord blood acid-base and gas analysis after early versus delayed cord clamping in neonates at term. Arch Gynecol Obstetric 283, 1011-1014 (2011). Rabe, H., Wacker, A, Hulskamp, G, Hornig-Franz, I, Schulze-Everding, A, Harms, E, Cirkel, U, Louwen, F, Witteler, R, Schneider, H. A randomised controoled trial of delayed cord clamping in very low birth weight preterm infants. Eur J Pediatrics 159, 775-777 (2000). Rabe, H., Reynolds, G. Diaz-Rossello, J. A Systematic Review and Meta-Analysis of a Brief Delay in Clamping the Umbilical Cord of Preterm Infants. Neonatology 93, 138-144 (2008). Rabe, H., Jewison, A, Alvarez, RF, Crook, D, Stilton, D, Bradley, R, Holden, D. Milking Compared with Delayed Cord Clamping to increase Placental Transfusion in preterm neonates. Obstetrics and Gynecology 117, 205-211 (2011). Rabe, H., Diaz-Rossello, JL, Duley, L, Dowswell, T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database of Systematic Reviews, 1-84 (2012). Rabe, H., Sawyer, A, Amess, P, Ayers, S. Neurodevelopmental outcomes at 2 and 3.5 years for very preterm babies enrolled in a randomzied trial of milking the umbilical cord versus delayed cord clamping. Neonatology 109, 113-119 (2016). Speer, H. Obstetrics and Gynecology: A history and iconography. New England Journal of Medicine 352, 844-845 (2005). World Health Organization. WHO recommendations on Postnatal care of the mother and newborn. (2013)

In this episode we explore the differential diagnosis of postpartum fever.   Show notes and message board can be found at www.obgyn.fm   Please email me at feedback@obgyn.fm if you would like to join the slack community.   Puerperal Pyrexia: A Review Part 1 and Part 2 Prevalence of postpartum infections: a population-based observational study Lactation Mastitis Lactation Mastitis: Occurrence and Medical Management among 946 Breastfeeding Women in the United States Prevention and treatment of postpartum endometritis. Early Postpartum Endometritis: The Role of Bacteria, Genital Mycoplasmas, and Chlamydia trachomatis. A comparison of once-daily and 8-hour gentamicin dosing in the treatment of postpartum endometritis Abbreviated Antibiotic Therapy for the Treatment of Postpartum Endometritis. The association between manual removal of the placenta and postpartum endometritis following vaginal delivery Prophylactic antibiotics for manual removal of retained placenta in vaginal birth Association of post-cesarean delivery endometritis with colonization of the chorioamnion by Ureaplasma urealyticum Postcesarean wound infection: prevalence, impact, prevention, and management challenges Antimicrobial-Associated Risk Factors for Clostridium difficileInfection The effect of manual removal of the placenta on post-cesarean endometritis Breast Engorgement and Postpartum Fever. Antibiotic regimens for postpartum endometritis Antibiotic prophylaxis during the second and third trimester in pregnancy to reduce adverse pregnancy outcomes and morbidity Vaginal cleansing before cesarean delivery to reduce post-cesarean infections Fever and deep venous thrombosis. Findings from the RIETE registry Adjunctive Azithromycin Prophylaxis for Cesarean Delivery A Randomized, Double-Blind, Placebo-Controlled Trial of Oral Antibiotic Therapy Following Intravenous Antibiotic Therapy for Postpartum Endometritis. Prophylactic antibiotics for manual removal of retained placenta during vaginal birth: a systematic review of observational studies and meta-analysis Methods of delivering the placenta at caesarean section

Puerperal Fever is one of the leading causes of maternal and neonatal mortality throughout the world. In this episode we trace the role of modern medicine in both the rise and fall of the severity of childbed fever. We also review the causes, diagnosis, treatment, and prevention of chorioamnionitis.    feedback@ogbgyn.fm  

In this episode Dr. Sara Kim discusses the history, diagnosis, consequences, and treatment of bacterial vaginosis.    feedback@obgyn.fm   ACOG. Vaginisits Practice Bulletin. (2015). Chawla, R. B., Preena; Chadha, Sanjim; Grover, Sujatha; Garg, Suneela. Comparison of Hay's Criteria with Nugent's Scoring System for Diagnosis of Bacterial Vaginosis. Biomed Research International 2013 (2013). Eschenbach, D. A. History and review of bacterial vaginosis. American Journal of Obstetrics and Gynecology 169, 441-445 (1993). Fettweis, J. B., J Paul; Serrano, Myrna; Sheth, Nihar; Girerd, Philippe; Edwards, David; Strauss, Jerome; Jefferson, Kimberly; Buck, Gregory, Vaginal Microbiome Consortium. Differences in vaginal microbiome in African American women versus women of European ancestry. Microbiology 160, 2272-2282 (2014). Greenwood, J. P., MJ. Transfer of Haemophilus vaginalis Gardner and Dukes to a New Genus, Gardnerella: G. vaginalis (Gardner and Dukes). International Journal of Systematic Bacteriology 30, 170-178 (1980). Hillier, S. N., Robert; Eschenbach, David; Krohn, Marijane; Gibbs, Ronald; Martin, David; Cotach, Mary Frances; Edelman, Robert; Pastorek, Joseph; Rao, Vijaya; McNellis, Donald; Regan, Joan; Carey, Christopher; Klebanoff, Mary A. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. New England Journal of Medicine 333, 1737-1742 (1995). Koumans, E. S., Maya; Bruce, Carol; McQuillan, Geraldine; Kendrick, Juliette; Sutton; MAdeline; Markowitz, Lauri. The Prevalence of Bacterial Vaginosis in the United States, 2001-2004; Associations with Symptosm, Sexual Behaviors, and Reproductive Health. Sexually Transmitted Diseaese 34, 864-869 (2007). Lachiewicz, M. M., Laura; Jaiyeoba, Oluwatosin. Pelvic Surgical Site Infection in Gynecologic Surgery. Infectious Diseases in Obstetrics and Gynecology 2015 (2014). Larsson, P.-G. a. C., Bodil. Does pre- and postoperative metronidazole treatment lower vaginal cuff infection rate after abdominal hysterectomy among women with bacterial vaginosis? Infect Dis Obstet Gynecol 10, 133-140 (2002). Lin, L. S., J; Kimber, N; Shott, S; Tangora, J; Aroutcheva, A; Mazees, MB; Wells, A; Cohen, A; Faro, S. The Role of Bacterial Vaginosis in Infection After Major Gynecologic Surgery. Infectious Diseases in Obstetrics and Gynecology 7 (1999). Ling, Z. L., Xia; Chen, Weiguan; Luo, Yueqiu; Yuan, Li; Xia, Yaxian; Nelson, KAren; Shalei, Huang; Zhang, Shaoen; Wang, Yuezhu; Yuan, Jieli; Li, Lanjuan; Xiang, Charlie. The Restoration of the Vaginal Microbiota After Treatment for Bacterial Vaginosis with Metronidazole or Probiotics. Microbial Ecology 65, 773-780 (2013). Menard, J.-P. Antibaterical treatment of bacterial vaginosis: current and emerging therapies. International Journal of Women's Health 3, 295-305 (2011). Muthuamy, S. E., Selvi. Comparison of Amsel's Criteria, Nugent Score and Culture for the Diagnosis of Bacterial Vaginosis. National Journal of Laboratory Medicine 5, 37-40 (2016). Onderdonk, A. D., Mary L; Fichorova, Raina N. The Human Microbiome during Bacterial Vaginosis. Clinical Microbiology Reviews 29, 223-238 (2016). Tebes, C. L., Catherine; Sinnott, John. The effect of treating bacterial vaginosis on preterm labor. Infect Dis Obstet Gynecol 11, 123-129 (2003). Xiao, B. N., Xiaoxi; Wang, Ben; Du, Pengcheng; Na, Risu; Chen, Chen; Liao, Qinping. Predictive value of the composition of the vaginal microbiota in bacterial vaginosis, a dynamic study to identify recurrence-related flora. Scientific Reports Nature 6, doi:10.1038/srep26674 (2015).

A bonus episode describing the life and contributions of Russel Earl Marker. He led a fascinating life and his work made possible the great advances in the understanding of female fertility that took place in the 1950s. Without his work the history of hormonal contraception would likely look completely different and in this episode we pay tribute to his brilliance and dedication.

In this episode we discuss the history, methods, effectiveness, and pitfalls of permanent sterilization.    feedback@obgyn.fm   Tubal Techniques D. Bartz & J. Greenberg. Sterilization in the United States. Rev Obstet Gyn. 2008; 1(1): 23-32. CREST Study CREST Study: Regret CREST Study: Ectopic Fit to Be Tied: Sterilization and Reproductive Rights in America, 1950-1980  

In this episode we discuss the ancient and modern history of barrier contraceptives and their effect on society. We also review the development of the IUD and its place in the modern contraceptive landscape.   The story of the condom. F. Kahn et al. Indian Journal of Urology. 29(1):12-15. 2013 History of Intrauterine Devices. L. Margulies. Bulletin of the NY Academy of Medicine. 51(5). 1975 Trends in Long-acting Reversible Contraception Use Among U.S. Women Aged 15-44. NCHS 188. 2015 UN report on contraceptive choices Side effects from the copper IUD: do they decrease over time? D. Hubacher et al. Contraception. 2009 May; 79(5):356-362

In this episode we discuss the menstrual cycle and how a few people figured out how to hack it to provide safe, effective contraception.    Menstrual Cycle Graphic #1 Menstrual Cycle Graphic #2 Effectiveness of Birth Control Methods History of the Oral Contraceptive #1 History of the Oral Contraceptive #2

Contraception is major element in the life of women throughout the world. In this episode we chart its history from ancient Egypt to modern times and discuss its implications at the personal and societal levels. 

Pelvic inflammatory disease to PID has been a factor in the lives of women in the western world for at least 500 year. It effects up to 5% of US women at sometime during their life and its effects can be long-lasting and devastating. In this episode, part 3 of 3, we discuss the treatment and prevention of PID along with a detour into antibiotics.   feedback@obgyn.fm Goupil Bernutz. Clinical Memoirs on the Diseases of Women. 1866 Lachlan Aitken. Remarks on Pelvic Peritonitis and Pelvic Cellulitis. Baltimore Medical Journal. 1870. Volume 1 David Berry & Alexander Freeland. Manual of Gynecology - Volume 1. 1883 Howard Kelly. Operative Gynecology - Volume 2. 1898 Sexually Transmitted Diseases Treatment Guidelines. CDC. 2015 W. Stamm et al. Prevention of Pelvic Inflammatory Disease by Screening for Cervical Chlamydial Infection. N Engl J Med 1996; 334:1362-1366 P. Oakeschott et al. Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. BMJ 2010; 340

Pelvic inflammatory disease to PID has been a factor in the lives of women in the western world for at least 500 year. It effects up to 5% of US women at sometime during their life and its effects can be long-lasting and devastating. In the episode, part 2 of 3, we discuss the diagnosis of PID.   feedback@obgyn.fm   Diagnosis Howard Kelly. The Diagnosis of Pelvic Inflammatory Diseases. 1894. Westrom L. Objectivized diagnosis of acute pelvic inflammatory disease. AJOG 1969 Sellors J, Mahony J, Goldsmith C et al. The accuracy of clinical findings and laparoscopy in pelvic inflammatory disease. Am J Obstet Gynecol 1991; 164: 113–120.  Paavonen, J et al. Comparison of endometrial biopsy and peritoneal fluid cytologic testing with laparoscopy in the diagnosis of acute pelvic inflammatory disease. AJOG. 151 (5):645-650. 1985 Kiviat, N et al. Endometrial Histopathology in Patients with Culture-proved Upper Genital Tract Infection and Laparoscopically Diagnosed Acute Salpingitis. AJOSP. 1990. 14(2) B. Cacciatore et al. Transvaginal Sonographic Findings in Ambulatory Patients with suspected pelvic inflammatory disease. 1992. 80(6) Tukeva TA, Aronen HJ, Karjalainen PT, Molander P, Paavonen T, Paavonen J. MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology 1999;210:209-16 J. Moss et al. Serum CA-125 in the diagnosis of acute pelvic inflammatory disease. Int Journal Gyn & Obstetrics. 1994. 44(1) L Westrom et al. Diagnosis of pelvic inflammatory disease: time for a rethink. Sex Transm Infect 2003:79 CDC Statement

Pelvic inflammatory disease to PID has been a factor in the lives of women in the western world for at least 500 year. It effects up to 5% of US women at sometime during their life and its effects can be long-lasting and devastating. In the episode, part 1 of 2, we delve into the history, prevalence, causes, and consequences of PID.   feedback@obgyn.fm   History John Hirth. Syphilis – Its early history and Treatment until Penicillin and the Debate on its Origins. Journal of Military and Veterans' Health. 20(4). 2012 Goupil Bernutz. Clinical Memoirs on the Diseases of Women. 1866 Matthew Mann. A System of Gynecology - Vol. 1. 1887 Prevalence L. Westrom. Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. 138:880. 1980 Pelvic Inflammatory Disease Statistics. CDC. 2015 Definition Howard Kelly. The Diagnosis of Pelvic Inflammatory Diseases. 1894. Pelvic Inflammatory Disease (PID) - CDC Fact Sheet. CDC. 2015 R. Brunham, S. Gottlieb. Pelvic Inflammatory Disease. NEJM 372:2309-2048. 2015. Causes Pelvic Inflammatory Disease (PID) - CDC Fact Sheet. CDC. 2015 R. Brunham, S. Gottlieb. Pelvic Inflammatory Disease. NEJM 372:2309-2048. 2015. JA McGregor, et al. Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: results of a controlled trial of topical clindamycin cream. AJOG. 170(4):1048-59. 1994 DL Draper, et al. Levels of vaginal secretory leukocyte protease inhibitor are decreased in women with lower reproductive tract infections. AJOG. 183(5):1243-8. 2000 I Simms, et al. Associations between Mycoplasma genitalium, Chlamydia trachoma's and pelvic inflammatory disease. J Clin Pathology. 56(8):616-618. 2003. CR Cohen, et al. Detection of Mycoplasma genitalium in women with laparoscopically diagnosed acute salpingitis. Sex Transm Infect. 81:463-466. 2005 Consequences L Westrom. Effect of acute pelvic inflammatory disease on fertility. AJOG. 121(5):707-713. 1975 RB Ness, et al. Effectiveness of treatment strategies of some women with pelvic inflammatory disease: a randomized trial. Obstet Gynecol. 106(3):573-80. 2005. Cost Rein DB, et al. Direct medical cost of pelvic inflammatory disease and its sequelae: decreasing, but still substantial. Obstet Gynecol. 95(3):397-402. 2000.

Opioid addiction has a profound impact on many aspects of society. In this episode we examine the ways that doctors and other practitioners contribute to the epidemic and how we can be part of the solution. feedback@obgyn.fm   Links Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 Abuse-Deterrent Formulations and the Prescription Opioid Abuse Epidemic in the United StatesLessons Learned From OxyContin Impact of a Mandatory Prescription Drug Monitoring Program on Prescription of Opioid Analgesics by Dentists A Joint Statement From 21 Health Organizations and the Drug Enforcement Administration. Promoting pain relief and preventing abuse of pain medications: A critical balancing act. Primary Care Physicians’ Knowledge And Attitudes Regarding Prescription Opioid Abuse and Diversion

Opioid Addiction has a profound impact on many aspects of society, including pregnancy. In this episode we delve into the history, pharmacology, effects, and treatment of opioid abuse with special consideration to its effects on pregnancy. feedback@obgyn.fm   Links NIH - America’s Addiction to Opioids: Heroin and Prescription Drug Abuse NIH - The Science of Drug Abuse and Addiction: The Basics Economic Botany - Archaeological evidence for the tradition of psychoactive plant use In the old world AAPS - Opioid Tolerance Development: A Pharmacokinetic/Pharmacodynamic Perspective AOGS - Prevalence of substance abuse in pregnancy among Danish women ProPublica - How States Handle Drug Use During Pregnancy CNN - Heroin laced with elephant tranquilizer hits the streets NIH - Methadone Maintenance Treatment: a review of historical and clinical issues Pain Medicine - Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United States Obstetrics & Gynecology - Opioid Use Disorder in Pregnancy: Health Policy and Practice in the Midst of an Epidemic