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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 public perception with incomplete or skewed interpretations of data.
This episode closes with an in-depth look at the biases that pervade pharmaceutical research, particularly when funding sources have a vested interest in outcomes. By examining the "sponsorship effect" and its implications on research validity, we highlight the need for rigorous, unbiased scientific inquiry. We examine the evidence for the new Pretrm Test for preterm labor risk. Learn about the challenges of implementing biomarker testing for predicting preterm births and why high-quality evidence must remain the cornerstone of clinical practice. As we celebrate our 100th episode, we discuss the need for truth and transparency in scientific research—creating a future where clinical practices are driven by reliable, evidence-based insights.
00:00:02 Navigating IV Fentanyl Use in Labor00:07:56 Debunking Misconceptions About IUDs and Breast Cancer
00:22:17 Evaluating Biomarker Testing for Preterm Birth: The PreTRM test
00:38:50 Conflicts of Interest in Medical Research
00:45:15 Biased Influence in Medical Research
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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 Practice
00:23:30 Cervical Cancer Screening During Pandemic
00:33:51 Optimal Timing for Cervical Cancer Prevention
00:40:12 Iron Supplementation in Pregnancy
00:47:13 Corticosteroids and Hype in Medicine
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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 Techniques
00:27:20 Uterine Closure Techniques in Cesarean Deliveries
00:36:44 Defining Minimally Invasive Surgery
00:48:18 Advanced Techniques in Minimally Invasive Surgery
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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 FGR
00:28:55 Correcting Due Dates Prevents Mistakes
00:46:10 History of Postpartum Depression, Chopin and Plath
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In this episode, we discuss the frequency of Pap smears for twin pregnancies as well as the need for using twin-based growth data for the diagnosis of fetal growth restriction in twins. We will poke the fire of controversy of the use of the terms "fetal growth restriction" and "small for gestational age" and discover how the terms might harm pregnancies.
Next, we discuss the new AAP guidelines for diagnosis of tongue ties. Finally, we answer a listener question about pushy doctors, paying for unnecessary tests, and the disconnect many gynecologists have with guideline and evidence based care.
00:00:02 Ultrasound Use in Twin Pregnancies
00:14:06 Twin Growth and Fetal Growth Restriction
00:20:00 Fetal Growth Assessment in Twin Pregnancies
00:29:10 Overdiagnosis of Tongue Tie in Infants
00:38:05Breastfeeding and Tongue Tie Recommendations
00:45:43 Controversy Surrounding Pelvic Exams
00:58:21 Unnecessary Physical Exams and IUD PreferencesFollow us on Instagram @thinkingaboutobgyn.
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In this episode, we discuss prevention of thromboembolism during pregnancy and the postpartum period and the evidence for which patients should receive anticoagulation. Plus, the history of heparin and four tips for preventing embolism.
00:00:02 Four Tips for Preventing Thromboembolism in Obstetrics00:08:39 Anticoagulation Recommendations in Pregnancy
00:22:29 Assessing Anticoagulation Recommendations in Pregnancy
00:35:22 Evaluating Anticoagulation Protocols in Pregnancy
00:42:22 Debating Risks of Obstetric Anticoagulation
00:59:28 History of Heparin
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In this episode, we challenge the reliability of traditional tests like Homan's sign and cervical motion tenderness. Learn how understanding and applying likelihood ratios can vastly improve diagnostic accuracy, and why combining multiple findings is more reliable than putting faith in isolated tests.
Then we discuss a new JAMA study linking advanced endometriosis with a heightened risk of ovarian cancer. The study brings to light the complexities and gaps in our knowledge, underscoring the importance of personalized patient discussions regarding risks and treatment options.
Next, we discuss a new study about how surgical residents are treated during residency. From inadequate parental leave to cultural pressures, we highlight the urgent need for systematic changes to foster a supportive and equitable environment.
Then expose the deceptive practices in the umbilical cord blood banking industry, revealing the ethical issues and questioning the touted benefits.
Finally, we answer listener questions about use of sterile gloves for cervical exams and trials of labor after two cesareans.
00:00:02 Obsolete Physical Exam Maneuvers in Gynecology
00:14:25 Endometriosis and Ovarian Cancer Risk
00:20:47 Residency Challenges for Parents and Discrimination
00:33:10 Deceptive Practices in Cord Blood Banking
00:49:19 Debate on Mammography Guidelines
00:54:17 Listener Questions: Sterile Gloves and VBA2CFollow us on Instagram @thinkingaboutobgyn.
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In this episode, we discuss four tips for Cesarean under local. Then we discuss some new literature including full versus empty bladder during gyn procedures and endometrial ablation vs IUD for abnormal uterine bleeding. We also discuss the inertia of old ideas in obstetric practice. Finally, we discuss the history of the diagnosis of preeclampsia and eclampsia.
00:00:02 Cesarean Delivery Under Local Anesthesia00:07:04 Emergency Cesarean Delivery Procedure
00:19:47 Bladder Status in Gynecological Procedures
00:29:01 Endometrial Ablation vs IUD for Treatment
00:38:43 Inertia in Obstetrics Practice Trends
00:47:45 Historical Evolution of Eclampsia Diagnosis
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In the season 8 premiere, we discuss over-utilization of serial quantitative HCGs. Then we discuss several famous or influential studies in obstetrics, including the WOMAN trial, the CLASP trial, the ARRIVE trial, MagPIE, and several more. Finally, we discuss the history of how magnesium sulfate came to be used in obstetrics.
00:00:02 Overuse of HCG00:13:17 Aspirin for Preeclampsia Prevention Debate
00:18:51 Debate on the ARRIVE Trial
00:29:10 MagPIE
00:39:05 Fetal Fibronectin Trials
00:44:53 Induction at 41 Weeks Discussion
00:55:16 History of Magnesium Use in Obstetrics
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In this episode, we discuss four tips for uterine inversion. Then, we discuss mistreatment and abuse of trainees in OB/GYN plus physician suicide. Finally, we answer a question about closure of peritoneum.
00:00:02 Managing Uterine Inversion in Obstetrics
00:13:39 Combatting Harassment in Medical Training
00:25:41 Addressing Mistreatment in Medical Training
00:31:13 Workplace Mobbing and Bystander Dynamics
00:37:29 Identifying and Addressing Workplace Abuse
00:59:30 Listener QuestionFollow us on Instagram @thinkingaboutobgyn.
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In this episode, we discuss routine bacterial vaginosis screening in patients with preterm labor symptoms. Then, we discuss some dietary and other less-discussed findings from the Women's Health Initiative. We also discuss a new review article about first trimester anatomic ultrasounds. Finally, we answer a listener question about implementing postpartum sterilization routinely into unsupportive hospitals.
00:00:02 Testing for BV in Preterm Labor00:12:28 Clinical Diagnosis of Bacterial Vaginosis
00:21:14 First Trimester Ultrasound in Women's Health
00:34:12 First Trimester Ultrasound Anomalies and Costs
00:38:29 The Cost-Effectiveness of Early Ultrasounds
00:46:32 Improving Postpartum Sterilization Access
00:55:32 Strategies for Postpartum Sterilization Procedures
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In this episode, we discuss four tips for IUD insertion. Then we discuss the qualities of good teachers and the important of teaching students and residents, with some practical advice thrown in as well. Finally, we discuss the history of blood transfusion.
00:00:02 IUD Insertion Techniques and Anxiety Management00:23:04 Qualities of a Great Teacher
00:35:16 The Benefits of Teaching in Medicine
00:45:42 Teaching Strategies for Clinical Preceptors
00:52:33 History of Blood Transfusion & Obstetrics
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In this episode, we discuss the risks and counseling related to higher numbers of Cesareans. Then, we finish our discussion about vaginal hysterectomy with tips and tricks for some common problems. Finally, we answer a listener question about external cephalic version.
00:00:02 Considerations for Multiple Cesarean Deliveries
00:08:13 Risks and Outcomes of Cesarean Hysterectomies
00:16:09 Uterine Dehiscence and Vaginal Hysterectomy
00:24:01 Tips for Vaginal Hysterectomy Assistants
00:35:24 Mastering the Anterior Colpotomy Technique
00:44:01 Vaginal Hysterectomy Tips and Techniques
00:55:36 Teaching Vaginal Hysterectomy Techniques
00:57:55 Listener Question about ECVFollow us on Instagram @thinkingaboutobgyn.
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In this episode, we discuss four tips for managing the deeply impacted fetal head at the time of Cesarean. Then we discuss the optimal route of hysterectomy (hint: its a vaginal hysterectomy). Finally, we discuss the obstetric history of the Taj Mahal.
00:00:02 Four Tips For Deeply Impacted Head at Cesarean00:13:53 Advantages of Vaginal Hysterectomy
00:25:16 Optimizing Vaginal Hysterectomy Techniques
00:31:53 Advancing Skills in Minimally Invasive Surgery
00:40:24 Advancements in Vaginal Hysterectomy Technique
00:49:20 Debating the Merits of v-Notes
00:58:06 Taj Mahal and Maternal Mortality
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In this episode, we discuss the latest recommendations for treatments for osteopenia and osteoporosis, including vitamin D and calcium, as well as bisphophonates and other medications.
Then we discuss new literature about best methods for induction of labor and risks factors for uterine rupture during a trial of labor after Cesarean. We also discuss a new trial about late preterm antenatal steroids.
Also we talk about a new article about mammalian menopause the evolutionary rolls of menopause and concealed ovulation (fun people, we know!)
Finally, we answer a listener question about bleeding during surgery.
00:00:02 Treatment of Osteopenia and Osteoporosis00:14:40 Vaginal Birth After Cesarean Recommendations
00:24:05 Effectiveness of Late Preterm Steroids
00:35:49 Menopause and Evolution in Mammals
00:41:05 Concealed Estrus and Weight Gain Recommendations
00:47:56 Managing Surgical Hemostasis and Bleeding
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In this episode, Dr. Stuart Winkler returns to discuss new evidence about the risks and benefits of radical hysterectomy for cervical cancers. Also, for fun, we torture a Gyn-Onc with a four tips for managing cord prolapse. Also, we discuss a new commentary on activity restriction after gynecologic surgery.
00:00:02 Management of Cord Prolapse in Labor00:11:01 History and Evolution of Radical Surgery
00:25:03 Recent Trials on Cervical Cancer Surgery
00:48:33 Activity Restrictions in Surgical Practice
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In this episode, we discuss which laparoscopic ports need to be closed and how. Plus, we discuss more evidence that the current narrative about maternal mortality in the US is false. Finally, we answer listener questions about oxytocin protocols and the history and utility of the Bishop's Score.
00:00:02 Closing Laparoscopic Ports
00:13:32 The Maternal Mortality Rate Debate
00:21:04 Maternal Mortality Misconceptions and Progress
00:30:30 Maternal Mortality Misconceptions and Data Accuracy
00:39:27 The Bishop's Score
00:45:41 Debating Oxytocin and Labor PoliciesFollow us on Instagram @thinkingaboutobgyn.
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In this episode, we discuss four tips for breech vaginal delivery. Then, we respond to the Alabama Supreme Court's decisions about embryos and the impact on IVF and reproductive rights. Finally, we discuss the best methods for initial laparoscopic entry and discuss the history of laparoscopy.
00:00:02 Four Tips for Vaginal Breech Deliveries00:13:17 Alabama Supreme Court and IVF
00:29:15 Initial Laparoscopic Entry
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In this episode, we discuss the use of supplemental oxygen for fetal decelerations. Then we get into part 2 of our discussion of interpreting clinical studies and when to adopt new interventions into practice, including a discussion of intranasal metoclopramide, elagolix, and a new study about an app based doula service. Finally, we answer user questions about surprise billing at the time of annual exams and the pros and cons of egg freezing.
00:00:02 Oxygen Supplementation in Labor00:11:00 Interpreting studies part 2: intranasal metoclopramide
00:22:07 Evaluating Efficacy of Elagolix for Endometriosis
00:38:23 Doulas and Birth Outcomes
00:44:32 Listener Question: Surprise Billing
00:51:30 Listener Question: Egg Preservation
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In this episode, we discuss four tips for external cephalic version. Then we dive into the basics of interpreting scientific studies. Finally, we discuss the pregnancy history of Jackie Kennedy.
00:00:20 Tips for External Cephalic Version00:17:10 Evaluating Clinical Studies
00:53:13 Jackie Kennedy's Impact on Cesarean Deliveries
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