Episoder
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Depressive disorders during pregnancy are common, with estimated prevalence ranging from 11% to 16%. Accordingly, antidepressant drugs, most commonly selective serotonin reuptake inhibitors (SSRI), are used by approximately 3–4% of pregnant women worldwide, with a higher prevalence in the United States compared to Europe. As antidepressants cross the placenta and the fetal blood-brain barrier, exposure during pregnancy raises concerns of potential risks of adverse pregnancy outcomes. On August 30, 2024, a new study was released ahead of print in the AJOG. This confirmed the reduction in preterm birth risk with effective mental health counseling approaches; HOWEVER, it also concluded that “use of antidepressants during pregnancy was associated with an increased 31% risk of pre-delivery independent of underlying depression “. Do SSRI meds increase preterm labor risk by 31%?! This is indirect contrast to a separate publication published just six months earlier, in February 2024 in a separate journal. In this episode, we will discuss this very important topic of SSRI use in pregnancy and the preterm birth risk.
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Just when we thought we had put coronavirus in our rearview mirror for the most part, here comes mPOX again. We covered that in a previous episode. Unfortunately, that is not the only pathogen to be concerned about. Enter: OROPOUCHE VIRUS (OROV). This virus was first reported in 1955, but it is making news today due to a rapid increase in cases. Coming from the Amazon Basin, and even Cuba, there have been 21 cases in the USA diagnosed in US travelers. This virus is a concern for pregnant women. Information gaps still exist but things are moving quickly here: On August 16, 2024, the Centers for Disease Control and Prevention issued a Health Alert Network (HAN) Health Advisory to notify clinicians and public health authorities of an increase in Oropouche virus (OROV) disease, originating from endemic areas and in new areas in South America and the Caribbean. Then, on August 22, 2024, SMFM released its alert on the virus. Today, the ACOG released its Practice Advisory (August 29, 2024) on this very issue. Listen in for details.
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Manglende episoder?
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Polycystic ovary syndrome (PCOS) was first described in 1935 by Irving Freiler Stein and Michael Leo Leventhal at the Central Association of Obstetricians and Gynecologists. Since that time, it has gone through several name changes: Stein-Leventhal syndrome, PCOD, and currently PCOS. Nonetheless, proponents and scientists are still recommending yet another name change for this syndrome, one that better incorporates the multi-metabolic dysregulation that it incorporates. PCOS is not simply a gynecological issue. It is a metabolic issue with implications for adverse obstetrical outcomes. In this episode we will review 2 recent publications, one from July 2024 and the other from August 27th, 2024. These two studies, in two separate journals, each a month apart, validate what others have previously reported: PCOS doesn't just affect gynecological health but it also impacts obstetrical health. Listen in for details.
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Our immediate past episode focused on the “C-section scar pregnancy”. In that episode we discussed the ultrasound markers of early pregnancy (first trimester). Now – today – HOT 🔥🔥OFF THE PRESS- is a new publication in the AJOG, which is “A Lexicon For First Trimester US: Society of Radiologists in Ultrasound Consensus Conference Recommendations“. This consensus statement is through a MOU through the ACR, ACOG, AIUM, SMFM, ASRM, SFP, and the ACEP. For the first time, we have a proposed universal lexicon for ultrasound markers in the first trimester. This also discusses the cesarean scar topic pregnancy. Listen in for details!
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Cesarean scar pregnancy (CSP) occurs when an early pregnancy implants on the cesarean scar defect (CSD), myometrial tissue previously disrupted by cesarean delivery. The first case of CSP was reported in 1978 in a patient with a previous cesarean section (CS) who had heavy bleeding and abdominal pain after uterine curettage for a suspected miscarriage at 6 weeks. Eventual laparotomy revealed erosion of a major vessel in the scar sacculus by the products of conception which was successfully obliterated with subsequent revision of the previous surgical site. This was published in the South African Med Journal. Early ultrasound evaluation is crucial for detecting this condition. These are very complicated situations with increased rates of antepartum and postpartum hemorrhage, uterine rupture, PAS, preterm birth, and massive transfusion. Perhaps because of high worldwide cesarean delivery rates, there seems to be increased incidence and recognition of this condition over the past 2 decades. The clinical presentation is variable, and many are asymptomatic at presentation. In this episode, we will review the diagnosis and management of this unique and challenging high-risk pregnancy.
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(DISCLOSURE: Sexual Content) Back in April 2023, we released an episode on the “Jade Vaginal Egg” and vaginal weights for vaginal tightening. While we tackled the Jade Egg successfully, we now have a new player on the field: the VAGINAL TIGHTENING STICK. This over the counter “sex aid” can lead to chemical burns and severe vaginal dryness/agglutination. Marketed to improce vaginal laxity, some of these sticks have the real potential to cause tissue damage and scarring- as one of our podcast family members saw firsthand with a patient. Its an interesting market place out there! Listen in for details.
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The IUD is a very safe and supremely effective contraceptive method. Given its increasing rate of use, practitioners are bound to see its relatively infrequent complications with greater regularity. Typical complications are considered “lost strings“, uterine perforation at placement, and expulsion. But there is another complication, device FRACTURE at removal. This can cause distress to the patient and can lead to additional interventions. Fracture of an intrauterine device (IUD) upon removal is a very rare complication, with a prevalence rate of 1–2%. However, the numbers have been rising since 2021, causing the FDA to track these complications. There has even been a bizarre case report of the copper coils being found in the pelvis WITHOUT device fracture! How?? In this episode, we will describe and review this relatively recent issue, its diagnosis, ways to minimize its occurrence at removal, and management strategies.
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In 1958, James et al. first described umbilical cord blood gas analysis to evaluate the fetus's metabolic condition at the time of delivery. It's recommended by both the British and American Colleges of Obstetrics and Gynecology for all high-risk deliveries. Cord blood gas provides the most accurate and objective evidence of fetal acidosis at the time of birth. Still, there is no universal agreement on when to perform umbilical artery gas analysis, or cord gas, for babies. Some suggest that all babies should have their umbilical artery and vein sampled immediately after birth, while others recommend only sending a sample if you think you need one, or in high-risk pregnancies. Should we collect umbilical cord gases universally- in all deliveries? And what about umbilical cord lactate levels? Is that helpful in predicting adverse newborn outcomes? Listen in for details.
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According to the National Institutes of Health, almost 13,000 women in the United States are diagnosed with cervical cancer each year, resulting in around 4,000 deaths, with most of the deaths occurring among under-screened women. Now, there is potentially a barrier-breaker. As of August 15, 2024, self-collection kits for cervical cancer screening may be available in doctor's offices and other clinical sites, ready for use. The kits allow patients to collect their own vaginal sample for HPV testing in a health care setting, as an alternative to a Pap smear. The FDA approved the kits on May 15, 2024. This is different from the OTC at-home HPV test kits. The tests, which are FDA cleared, are not yet available for people to use at home. The FDA's approval of these tests aims to increase access to HPV screening and reduce barriers to sample collection. Roche and BD both plan to consider offering at-home options in the future. Although a variety of companies currently offer at-home HPV tests, the Food and Drug Administration (FDA) has not yet approved at-home HPV tests. Listen in to today’s episode for details.
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The rise of home testing for STIs/HIV started long before the recent pandemic (the FDA approved its first HIV home test collection kit way back in 1996), but COVID-19 seems to have accelerated the popularity of getting tested from the comfort of our homes. In Nov 2023, the Food and Drug Administration granted marketing authorization, the first of its kind, for an at-home test for chlamydia and gonorrhea. The test kit, called Simple 2, is available online through various offerings. Chlamydia and gonorrhea are the most common STIs in the U.S. Of course, syphilis has also been on the move. And now, as of August 2024, The FDA has granted new clearance to NOWDiagnostics (not a sponsor) for the first at-home, over-the-counter syphilis screening test. So now we have gonorrhea, chlamydia, and syphilis at home testing options. At home HPV swabs are also seeking entrance into the marketplace. While these options remove barriers to care and allow testing in the privacy of one’s own home, there are inherent problems balancing out each of these promises. In this episode, we will review the pros and cons of at home testing for STIs and we will discuss why this is still caveat emptor, “buyer beware”, in this new healthcare marketplace option.
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The World Health Organization declared on 8/14/24 that the increasing spread of Mpox in Africa is a global health emergency, warning the virus might ultimately spill across international borders. Mpox, also known as monkeypox, was first identified by scientists in 1958 when there were outbreaks of a “pox-like” disease in monkeys. Until recently, most human cases were seen in people in central and West Africa who had close contact with infected animals. In 2022, the virus was confirmed to spread via sex for the first time and triggered outbreaks in more than 70 countries across the world that had not previously reported Mpox. Unlike in previous Mpox outbreaks, where lesions were mostly seen on the chest, hands and feet, the new form of Mpox causes milder symptoms and lesions on the genitals. That makes it harder to spot, meaning people might also sicken others without knowing they’re infected. In this episode, we will review the pathophysiology of this virus and describe its implications during pregnancy. Does Monkeypox cause adverse pregnancy issues? It’s cesarean section indicated for those affected? And is there any available treatment for active infection? Listen in for details.
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On July 26, 2024, Boar’s Head issued its recall of 7 million pounds of ready-to-eat meat and poultry products that might be contaminated with the potential harmful bacteria, listeria. Sporadic listeria outbreaks are nothing new; in June 2024, chicken-based products were recalled for the same concern in Canada. The US recall includes more than 70 products — including liverwurst, ham, beef salami and bologna. Listeriosis is reportable to the local health department of the county in which the patient resides. Listeria can be very serious for 3 groups of people: pregnant women, people older than 65, and people with weakened immune systems. Pregnant women are about 13 times more likely than the general population to get listeriosis. Maternal infection may manifest as a nonspecific, flu-like illness with fever but can result in severe fetal and neonatal infection, leading to fetal loss, preterm labor, neonatal sepsis, meningitis, and death. Yep, we’ve been here before. There have been episodic outbreaks of listeria monocytogenes in the past. In 2014, the ACOG released its medical guidelines for the management of presumptive exposure to listeria monocytogenes (reaffirmed in 2023). In this episode, due to the recent outbreak and listeria concerns, we will review the pathophysiology, diagnosis, and therapy of L. Monocytogenes in pregnancy.
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Our tagline, “Medicine moves fast“, is the absolute truth! Historically, identification of fetuses at risk of hemolytic disease of the fetus/newborn (HDFN) required amniocentesis for determination of the Delta OD450, Liley Curve. This was the first screen, which would then trigger cordocentesis for determination of the fetal hematocrit. We’ve now moved on to middle cerebral artery (MCA) doppler of the fetus for identification of those at risk. Additionally, we now have an ability to ascertain antigens on the fetal red blood cells through the maternal serum (cell free DNA). That’s amazing! Nonetheless, despite these wonderful advances, HDFN can still exist. But Medicine moves fast… In this episode, we will present brand new data from the NEJM. This Phase 2 international study, published on 8/7/24, describes the use of a monoclonal antibody (Nipocalimab) to block maternal IgG passage to the child. This is a revolution in HDFN prevention. Yep, medicine moves fast! Listen in for details.
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Prior to the 1970s, when component therapy became the preferred method of resuscitation, whole blood (WB) was the resuscitative medium of choice for hemorrhagic shock. In modern medicine, sometimes it turns out that the old way is better than the new…and using whole blood for transfusions is one example. Research is emerging that shows whole blood works better for these patients than fractionated components of blood. Beginning in 2017, multiple stakeholders within the Southwest Texas Regional Advisory Council for Trauma- as well as others in different states, collaborated to incorporate cold-stored low-titer O RhD-positive whole blood into all phases of their trauma system, including the prehospital care via EMS. Although the program was initially focused on trauma resuscitation, it was expanded to include non-traumatic hemorrhagic shock patients that may benefit from whole blood resuscitation when MTP is needed. What about Low Titer O Pos whole blood use for maternal MTP resuscitation? Is there data there? And what about the risk with using type O whole blood as a donor. In this episode, we’ll dive into the details.
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MEC CHANGES ARE HERE! During January 2022, the CDC held virtual scoping meetings that included 27 participants with expertise in contraception, adolescent health, and thrombosis, as well as representatives from partner organizations, to solicit their individual input on the scope for updating both the 2016 U.S. MEC. The 27 invited participants represented various types of health care providers and health care provider organizations. This led to a subsequent expert meeting held during January 2023 which reviewed the scientific evidence for updating the MEC recommendations. This MEC update is now official (8/6/24). There are updates to the MEC guidelines, replacing the 2016 version. This is good news! In this episode, we will summarize the 129 PAGE MMWR report & review the most clinically applicable updates for patient counseling. Has migraine with aura and CHC been moved out of category 4? Are there changes to IUD/IUS recs? Listen in for details!
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In May 2023, the FDA approved fezolinetant (Veozah), an oral medication that's the first neurokinin 3 (NK3) receptor antagonist to treat moderate to severe hot flashes caused by menopause. Now, a separate oral medication which blocks the NK 1 and 3 receptor iis on the scene. Although not yet FDA approved, the published phase 1, 2, and 3 data make this approval very likely. Bayer, the manufacturer of elinzanetant, has just submitted a New Drug Application for its approval. In this episode, we will review this new up and coming medication option for moderate to severe VMS due to menopause.
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Artificial Intelligence (AI) has arrived. Machine Learningis a form of AI which is being investigated/used for improving maternal outcomes. The UK has already launched the TOMMY APP (through the RCOG) for use to reduce PTB and stillbirths in the UK. In this episode we will highlight a new systematic review which assessed Machine Learning’s ability to predict stillbirth. Did this work? This is a hot topic, especially since the passage of the Maternal and Child Stillbirth Prevention Act here in the US. Its fascinating how far AI has come and how it has found a “home” in OBGYN. Listen in for details.
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We all are aware that multiple adverse obstetrical outcomes have been linked to maternal obesity, such as stillbirth, preterm birth, NICUs admission, and congenital anomalies. But once delivery and hospital discharge occurs uneventfully, a new cohort study is raising the alarm for another possible adverse event up until the child’s first year of life: Sudden Unexpected Infant Death (SUID). SUID is devastating. In this episode we will review this new publication, which is making medical headlines. This was published on July 29th, 2024 in JAMA Pediatrics. We'll put this association between maternal obesity and SUID in perspective and summarize the key findings of this alarming data.
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Our immediate past episode summarized a validation study of cell-free DNA (cfDNA) isolated from maternal plasma for fetal RBC genotyping in alloimmunized patients. And now, in this episode, we will highlight a BRAND NEW ACOG Clinical Practice Update on this very subject! YEP... we now have new ACOG guidance regarding using maternal derived cfDNA for fetal RBC antigen detection as an option for care in alloimmunized pregnancies. This is how "medicine moves fast"! Listen in for details.
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In September 2022, a cell-free DNA assay using next-generation sequencing and quantitative counting tech for fetal antigen status determination became clinically available in the USA. This allowed maternal screening for fetal RBC genotypes for RH negative patients. This test was recognized by thre ACOG in March 2024 as one option to “triage” anti-D immunoglobulin in RH negative women. But can this technology be trusted in alloimmunized patients? In women with antibodies against foreign antibodies, this cell free DNA fetal screening option MUST get it right. We now have that data. In this episode, we will summarize remarkable results, published ahead of print on July 25, 2024 in the Green Journal. This study is a win for science and prenatal care. Listen in for details (BillontoOne, Inc is not a sponsor for this podcast).
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