Thinking About Ob/Gyn

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Thinking About Ob/Gyn

Antonia Roberts and Howard Herrell

120 episodes

1 week ago

Recent evidence challenges the practice of prescribing oral antibiotics after Cesarean delivery in obese patients, finding no significant reduction in infection rates compared to standard preoperative antibiotics alone. Howard and Antonia analyze studies showing why this once-promising intervention may not be necessary. • ACOG updates delayed cord clamping guidance to minimum 60 seconds for preterm infants • Baby born at 21 weeks and zero days celebrates first birthday, highlighting advances...

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Health & Fitness

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Recent evidence challenges the practice of prescribing oral antibiotics after Cesarean delivery in obese patients, finding no significant reduction in infection rates compared to standard preoperative antibiotics alone. Howard and Antonia analyze studies showing why this once-promising intervention may not be necessary. • ACOG updates delayed cord clamping guidance to minimum 60 seconds for preterm infants • Baby born at 21 weeks and zero days celebrates first birthday, highlighting advances...

Show more...

Health & Fitness

Episodes (20/120)

Thinking About Ob/Gyn

Episode 9:12 Serial Cervical Lengths, MAHA, and More!

Howard Herrell and Antonia Roberts explore evidence-based practices in obstetrics and gynecology, examining both established protocols and emerging research with critical perspectives on medical misinformation. • Serial cervical length monitoring after LEEP procedures lacks evidence for improving outcomes despite being common practice • SMFM's 2016 recommendation explicitly advises against routine cervical length screening for patients with history of cervical procedures • Retrospective stud...

1 week ago

1 hour 4 minutes

Thinking About Ob/Gyn

Episode 9.11 Cervical Cancer with Stuart Winkler

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 m...

3 weeks ago

1 hour 5 minutes

Thinking About Ob/Gyn

Episode 9.10 Pit Breaks, Cannabis, and IUDs for Endometrial Protection

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 sho...

1 month ago

1 hour 6 minutes

Thinking About Ob/Gyn

Episode 9.9 Pediatric & Adolescent Gynecology Essentials

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 • Hemat...

1 month ago

57 minutes

Thinking About Ob/Gyn

Episode 9.8 Rethinking Bacterial Vaginosis and More!

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...

2 months ago

1 hour 5 minutes

Thinking About Ob/Gyn

Episode 9.7 OB Triage Essentials (plus The Pitt)

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-ba...

2 months ago

1 hour 1 minute

Thinking About Ob/Gyn

Episode 9.6 New Birth Control Products and Other Updates

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 recurren...

3 months ago

1 hour 5 minutes

Thinking About Ob/Gyn

Episode 9.5 Operative Vaginal Deliveries

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 ...

3 months ago

1 hour

Thinking About Ob/Gyn

Episode 9.4 Barbs, Birth Control Risks, Maternal Cancers, Aspirin, and More!

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 u...

4 months ago

1 hour 5 minutes

Thinking About Ob/Gyn

Episode 9.3 Obstetric Life Support with Jacqueline Vidosh

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...

4 months ago

52 minutes

Thinking About Ob/Gyn

Episode 9.2 Circumvallate Placenta, Pregnancy Apps, Oral Meds for GDM, and HPV

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 effectiv...

5 months ago

1 hour

Thinking About Ob/Gyn

Episode 9.1 Cesarean Hysterectomy

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 ...

5 months ago

59 minutes

Thinking About Ob/Gyn

Episode 8.13 Flagyl, GBS, DUTCH, Jada, Quickening and More!

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 misund...

6 months ago

1 hour

Thinking About Ob/Gyn

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

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 t...

6 months ago

1 hour 3 minutes

Thinking About Ob/Gyn

Episode 8.11 Catheters in Labor, Occiput Posterior Fetuses, and Cesarean Scar Disorder

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 se...

6 months ago

1 hour 2 minutes

Thinking About Ob/Gyn

Episode 8.10 Birth Control Counseling, MOC Article Highlights, and Feminine Forever

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...

7 months ago

1 hour 5 minutes

Thinking About Ob/Gyn

Episode 8.9 Intrapartum Fentanyl, IUDs and Breast Cancer, Pretrm Test and Bias in Studies

Can IV fentanyl use during labor actually be safe for mothers and newborns beyond six centimeters of dilation? Join us as we unpack a pivotal 1989 study and question the stereotypes surrounding fentanyl use in labor.Our second segment tackles sensational claims about IUDs and breast cancer, as we dissect a Danish study recently published in JAMA. Listen as we unpack the methodological nuances and confounders that mainstream publications have overlooked, and explore the media's role in shaping...

7 months ago

56 minutes

Thinking About Ob/Gyn

Episode 8.8 Finding Clinical Answers, Iron, Fetal Testing, and Steroids

In this episode, we discuss four tips for finding evidence based answers quickly. Then we discuss some new literature about pap smears and new guidelines regarding iron supplementation in pregnancy. We also discuss the history of corticosteroids for fetal maturity and the hype cycle in medicine.00:00:02 Finding Evidence-Based Clinical Answers Quickly00:13:36 Understanding Evidence-Based Clinical Practice00:23:30 Cervical Cancer Screening During Pandemic00:33:51 Optimal Timing for Cervical Can...

8 months ago

57 minutes

Thinking About Ob/Gyn

Episode 8.7 One Layer or Two? Endometrium or Serosa? And Minimally Invasive Surgery

In this episode, we discuss the evidence behind one layer and two layer Cesarean closures with an emphasis on inclusion of the endometrium and the risk of cesarean scar ectopics and placenta accreta spectrum disorders. Plus, we define minimally invasive surgery and trace the origin of the term and it's introduce a new concept: less invasive vs minimally invasive surgery. 00:00:02 Hysterotomy Closure Techniques in Cesarean Deliveries00:14:46 Debunking Claims About Cesarean Techniques00:27:20 U...

8 months ago

1 hour 4 minutes

Thinking About Ob/Gyn

Episode 8.6 Cervical Catheters, SGA, Due Date Errors, History of Postpartum Depression

In this episode, we discuss four tips for placing and using catheters for induction of labor. Then we revisit the issue of small for gestational age versus fetal growth restriction. We also discuss the most common mistake made in calculating due dates and how this can have a negative impact on pregnancies. Finally, we discuss the history of postpartum depression and the literature and stories of Kate Chopin and Sylvia Plath. 00:00:35 Four Tips for Cervical Catheter Placement00:23:00 SGA vs FG...

9 months ago

59 minutes