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.  

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.

1. Puerperal Pyrexia: A Review Part 1 and Part 2
2. Prevalence of postpartum infections: a population-based observational study
3. Lactation Mastitis
4. Lactation Mastitis: Occurrence and Medical Management among 946 Breastfeeding Women in the United States
5. Prevention and treatment of postpartum endometritis.
6. Early Postpartum Endometritis: The Role of Bacteria, Genital Mycoplasmas, and Chlamydia trachomatis.
7. A comparison of once-daily and 8-hour gentamicin dosing in the treatment of postpartum endometritis
8. Abbreviated Antibiotic Therapy for the Treatment of Postpartum Endometritis.
9. The association between manual removal of the placenta and postpartum endometritis following vaginal delivery
10. Prophylactic antibiotics for manual removal of retained placenta in vaginal birth
11. Association of post-cesarean delivery endometritis with colonization of the chorioamnion by Ureaplasma urealyticum
12. Postcesarean wound infection: prevalence, impact, prevention, and management challenges
13. Antimicrobial-Associated Risk Factors for Clostridium difficileInfection
14. The effect of manual removal of the placenta on post-cesarean endometritis
15. Breast Engorgement and Postpartum Fever.
16. Antibiotic regimens for postpartum endometritis
17. Antibiotic prophylaxis during the second and third trimester in pregnancy to reduce adverse pregnancy outcomes and morbidity
18. Vaginal cleansing before cesarean delivery to reduce post-cesarean infections
19. Fever and deep venous thrombosis. Findings from the RIETE registry
20. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery
21. A Randomized, Double-Blind, Placebo-Controlled Trial of Oral Antibiotic Therapy Following Intravenous Antibiotic Therapy for Postpartum Endometritis.
22. Prophylactic antibiotics for manual removal of retained placenta during vaginal birth: a systematic review of observational studies and meta-analysis
23. Methods of delivering the placenta at caesarean section

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In this episode we finish up PCOS by discussing the management and long-term consequences.

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1. Polycystic ovary syndrome: etiology, pathogenesis and diagnosis
2. Combined oral contraceptives in the treatment of polycystic ovary syndrome
3. Ovarian Suppression in Normal-Weight and Obese Women During Oral Contraceptive Use: A Randomized Controlled Trial
4. Ovulation incidence with oral contraceptives: a literature review
5. Shorter pill-free interval in combined oral contraceptives decreases follicular development
6. Comparison of efficacy of metformin and oral contraceptive combination of ethinyl estradiol and drospirenone in polycystic ovary syndrome
7. Evidence-Based and Potential Benefits of Metformin in the Polycystic Ovary Syndrome: A Comprehensive Review
8. Metformin, oral contraceptives or both to manage oligo-amenorrhea in adolescents with polycystic ovary syndrome? A clinical review
9. Additive Effects of Insulin-Sensitizing and Anti-Androgen Treatment in Young, Nonobese Women with Hyperinsulinism, Hyperandrogenism, Dyslipidemia, and Anovulation
10. Metformin and gonadotropins for ovulation induction in patients with polycystic ovary syndrome: a systematic review with meta-analysis of randomized controlled trials
11. Aromatase inhibitors for subfertile women with polycystic ovary syndrome: summary of a Cochrane review
12. Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society
13. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis
14. Lifestyle Modification Programs in Polycystic Ovary Syndrome: Systematic Review and Meta-Analysis
15. The Impact of Bariatric Surgery on Polycystic Ovary Syndrome: a Systematic Review and Meta-analysis
16. 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
17. 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
18. Influences of weight, body fat patterning and nutrition on the management of PCOS

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

Dr. Oystein Bergoy joins me to discuss the LaPS Study looking at the effect of Zhang's partograph on cesarean deliveries for labor dystocia.

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Drs. Sara Kim & Vai Umesh join me to dicuss stillbirth rates and medical treatment of uterine fibroids.

In this episode Dr. Kim and I discuss three current topics from the medical world.

1. CDC MMR - Placenta Encapsulation

1. https://www.ncbi.nlm.nih.gov/pubmed/27440542
2. https://www.ncbi.nlm.nih.gov/pubmed/27809380

2. Effect of Cervical Screening Changes on STD testing

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4279217/

3. Menstruation & Oral Contraceptives

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

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

In this episode we discuss the use of fetal scalp pH and scalp stimulation in the triage of abnormal electronic fetal heart rate tracings. 

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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

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.

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Links

1. NIH - America’s Addiction to Opioids: Heroin and Prescription Drug Abuse
2. NIH - The Science of Drug Abuse and Addiction: The Basics
3. Economic Botany - Archaeological evidence for the tradition of psychoactive plant use In the old world
4. AAPS - Opioid Tolerance Development: A Pharmacokinetic/Pharmacodynamic Perspective
5. AOGS - Prevalence of substance abuse in pregnancy among Danish women
6. ProPublica - How States Handle Drug Use During Pregnancy
7. CNN - Heroin laced with elephant tranquilizer hits the streets
8. NIH - Methadone Maintenance Treatment: a review of historical and clinical issues
9. Pain Medicine - Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United States
10. Obstetrics & Gynecology - Opioid Use Disorder in Pregnancy: Health Policy and Practice in the Midst of an Epidemic

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.

In this episode we trace the history of polycystic ovarian syndrome, learn about the underlying physiology, and how to diagnosis it.

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1. Current Practices of Measuring and Reference Range Reporting of Free and Total Testosterone in the United States.
2. Diagnostic Criteria for Polycystic Ovary Syndrome: Pitfalls and Controversies
3. Clinical Findings and Hormonal Responses in Patients With Polycystic Ovarian Disease With Normal Versus Elevated LH Levels.
4. 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
5. The Stein-Leventhal syndrome
6. Secretion of Androgens by the Polycystic Ovary and its Significance
7. Inappropriate Secretion of Follicle-Stimulating Hormone and Luteinizing Hormone in Polycystic Ovarian Disease
8. Defective Biosynthesis of Ovarian Steroids in the Stein-Leventhal Syndrome
9. Functional Studies of Aromatase Activity in Human Granulosa Cells from Normal and Polycystic Ovaries
10. The Effects of Ovarian Wedge Resection on Circulating Gonadotropin and Ovarian Steroid Levels in Patients with Polycystic Ovary Syndrome
11. Bilateral polycystic ovaries: Significance in sterility
12. Polycystic ovary syndrome: etiology, pathogenesis and diagnosis

Please join me for a discussion of the patient side of fertility treatment with author and journalist Amy Klein about her book "The Trying Game: Get Through Fertility Treatment and Get Pregnant Without Losing Your Mind".

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

Join us as we discuss "Intra-abdominal Irrigation at Cesarean Delivery" from a the Green Journal in 2012.

Guests: Dr. Jerry Ballas & Dr. Heather Link

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Join us to discuss the changes in postpartum care and how we can help better support women.

ACOG Bulletin

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.

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Dr. Ballas joins me to discuss the PROLONG trial and discuss the role of progesterone in the prevention of preterm birth.

PROLONG Trial

In this episode Dr. Ballas and I discuss the declining US birth rate and paretnal leave for ob/gyn residents.

Pregnancy and parental leave among obstetrics and gynecology residents: results of a nationwide survey of program directors

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

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.

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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

Dr. Heather Link starts a new series on Maternal Mortality by discussing what that even means and how we get those numbers.

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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.

2. Organization WH, Others. WHO guidance for measuring maternal mortality from a census. 2013. http://apps.who.int/iris/handle/10665/87982.
3. 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/.
4. 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.
5. 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.
6. New York State Maternal Mortality Review Report. https://www.health.ny.gov/community/adults/women/docs/maternal_mortality_review_2012-2013.pdf.
7. 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.
8. 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.
9. 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.
10. Maternal mortality - UNICEF DATA. UNICEF DATA. https://data.unicef.org/topic/maternal-health/maternal-mortality/.Accessed October 30, 2018.
11. 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.
12. Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38(8):1091-1110.
13. 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.
14. 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.
15. 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.
16. 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.
17. Lori JR, Starke AE. A critical analysis of maternal morbidity and mortality in Liberia, West Africa. Midwifery. 2012;28(1):67-72.
18. 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.
19. 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.
20. 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.
21. 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.
22. Rosindale L. Rural Maternal Mortality. Am J Nurs. 2018;118(12):10.
23. 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.
24. Sustainable Development Goals | UNDP. UNDP. http://www.undp.org/content/undp/en/home/sustainable-development-goals.html.Accessed December 1, 2018.
25. 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.

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

In this closing chapter on Puerperal Fever we will examine GBS related neonatal sepsis and the science behind its prevention.

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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

In this episode we discuss the mode of delivery in twin gestation

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Other References:

1. Association Between Planned Cesarean Delivery and Neonatal Mortality and Morbidity in Twin Pregnancies
2. How singleton breech babies at term are born in France: a survey of data from the AUDIPOG network
3. 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 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

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

Amnio/CVS

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

Dr. Kim walks us through the history of cord clamping and examines the evidence behind delayed vs. immediate clamping. 

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1. ACOG, Committee Opinion. Delayed Umbilical Cord Clamping After Birth. (American College of Obstetricians and Gynecologists, 2017).
2. Downey, C., and Bewley, S. Third Stage Practices and the Neonate. Fetal and MAternal Medicine Review 20, 229-246 (2009).
3. Downey, C., Bewley, S. HIstorical Perspectives on umbilical cord clamping and neonatal transition. Journal of the Royal Society of Medicine 105, 325-329 (2012).
4. Drife, J. The start of life: a history of obstetrics. Postgrad Medicine 78, 311-315 (2002).
5. Loudon, I. General practitioners and obstetrics: a brief history. JR Soc Med 101 (2008).
6. 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).
7. 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).
8. 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).
9. 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).
10. National Institute for Health and Care Excellence,. Intrapartum care for healthy women and babies, 2014).
11. 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).
12. 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).
13. 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).
14. 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).
15. 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).
16. 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).
17. Speer, H. Obstetrics and Gynecology: A history and iconography. New England Journal of Medicine 352, 844-845 (2005).
18. World Health Organization. WHO recommendations on Postnatal care of the mother and newborn. (2013)

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.

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Diagnosis

1. Howard Kelly. The Diagnosis of Pelvic Inflammatory Diseases. 1894.
2. Westrom L. Objectivized diagnosis of acute pelvic inflammatory disease. AJOG 1969
3. 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. 
4. 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
5. Kiviat, N et al. Endometrial Histopathology in Patients with Culture-proved Upper Genital Tract Infection and Laparoscopically Diagnosed Acute Salpingitis. AJOSP. 1990. 14(2)
6. B. Cacciatore et al. Transvaginal Sonographic Findings in Ambulatory Patients with suspected pelvic inflammatory disease. 1992. 80(6)
7. 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
8. J. Moss et al. Serum CA-125 in the diagnosis of acute pelvic inflammatory disease. Int Journal Gyn & Obstetrics. 1994. 44(1)
9. L Westrom et al. Diagnosis of pelvic inflammatory disease: time for a rethink. Sex Transm Infect 2003:79
10. CDC Statement

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

Greg Kirschen takes us through the treatment of postpartum depression and psychosis.

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1. American Psychiatric Association. (2013). In Diagnostic and statistical manual of mental disorders (5th ed.). doi:10.1176/appi.books.9780890425596.744053
2. Tate G. 1830. “A Treatise on Hysteria.” London: S. Highley, 174 Fleet St & Webb St, Maze Pond, Borough.
3. Smith TN. 1830. “Observations on hysteria.” The Boston Medical and Surgical Journal. 3(34): 540.
4. Louden, I. 1988. Puerperal insanity in the 19thCentury. Journal of the Royal Society of Medicine. 81, p 76-79.
5. 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.
6. Reid, J. 1848. Dr. Reid on Puerperal Insanity. Journal of Psychological and Medical Mental Pathology. 1(1): 128-151.
7. Clark AC. 1887. Aetiology, Pathology, and Treatment of Puerperal Insanity. Journal of Mental Science. 33(142): 169-189.
8. Donkin, AS. 1863. The Pathological Relation between Albuminuria and Puerperal Mania. Journal of Mental Science. 9(47): 401-405.
9. Barkin V. 1929. Protein therapy in insanity of puerperal origin. British Medical Journal. 1(3549): 67.
10. Earle P. 1854. Bloodletting in Mental Disorders. American Journal of Insanity. 10(4): 287-405.
11. Mackenzie FW. 1851. Puerperal Insanity: Especially in Reference to Anaemia. London Journal of Medicine. 3(30): 504-521.
12. 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.
13. 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.
14. 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.
15. Waters ATH. 1857. On the use of chloroform in the treatment of puerperal insanity. American Journal of Psychiatry. 13(4): 341-353.
16. Ramachandran CT, Subramanyam N, Baker G, et al. 2011. Antidepressants: From MAOIs to SSRIs and more. Indian Journal of Psychiatry. 53(2): 180-182.
17. Agin HV. 1963. Phenelzine in the treatment of depression. American Journal of Psychiatry. 119(12): 1173-1174.
18. Blacker KH, Weinstein BJ, Ellman GL. 1962. Mother’s Milk and Chlorpromazine. 119(2): 178-179.
19. Whalley LJ, Eagles JM, Bowler GMR, et al. 1987. Selective effects of ECT on hypothalamic-pituitary activity. Psychological Medicine. 17(2): 319-328.
20. Williams RL, Barrera SE. 1950. Observations and opinions concerning complications and contraindications in electric convulsive therapy. Psychiatric Quarterly. 24(4): 800-809.
21. 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. 
22. Sobel DE. 1960. Fetal Damage Due to ECT, Insulin Coma, Chlorpromazine, or Reserpine. AMA Archives of General Psychiatry. 2(6): 606-611.
23. Langan RC, Goodbred AJ. 2016. Identification and Management of Peripartum Depression.American Family Physician. 93(10): 852-858. 
24. Information from your family doctor: Postpartum depression. 2010. American Family Physician. 82(8): 939-940.
25. Schiller CE, Schmidt PJ, Rubinow D. 2014. Allopregnanolone as a Mediator of Affective Switching in Reproductive Mood Disorders. Psychopharmacology. 231(17): 3557-3567.
26. 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.
27. 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.
28. 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.

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. 

In this episode we dive into the world of insulins and the management of preexisting diabetes in pregnancy.

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• Uteroplacental blood flow in diabetic pregnancy: Measurements with iridium 113m and a computer-linked gamma camera. L. Nylund et al. AJOG. 1982
• Pre-existing diabetes, maternal glycated haemoglobin, and the risks of fetal and infant death: a population-based study . P. Tennant et al. Diabetologia. 2014
• Large for Gestational Age Neonates: Antrhopometric Reasons for Shoulder Dystocia. H. Mondanlou et al. Obset & Gynecology 1982
• Shoulder Dystocia: Incidence and Risk Factors. Clinical Obstetrics & Gynecology. 2016
• History of Insulin. C. Quianzon et al. Journal of Community Hospital Internal Medicine Perspectives 2012 
• Insulin Analogues. I. Hirsch. NEJM. 2005
• Insulin requirements during labor: a reappraisal. AJOG. 1982
• Insulin and glucose requirements during the first stage of labor in insulin-dependent diabetic women. AJM. 1983
• The use of continuous insulin infusion for the peripartum management of pregnant diabetic women. AJOG. 1978
• Peripartum metabolic control in gestational diabetes. AJOG 2010
• Constant intravenous insulin infusion during labor and delivery in diabetes mellitus. Diabetes Care. 1982

Labor Insulin Drip Protocol

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.

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

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. 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 Gynecol
    2011;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/

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

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.

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Links

1. Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies
2. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016
3. Abuse-Deterrent Formulations and the Prescription Opioid Abuse Epidemic in the United StatesLessons Learned From OxyContin
4. Impact of a Mandatory Prescription Drug Monitoring Program on Prescription of Opioid Analgesics by Dentists
5. 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.
6. Primary Care Physicians’ Knowledge And Attitudes Regarding Prescription Opioid Abuse and Diversion

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

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Dr. Jillian Kurtz discusses the ins and outs of ovulation induction.

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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. 

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

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In this episode Dr. Øystein Bergøy discusses the evidence behind the risks of antenatal corticosteroids for women at risk for preterm delivery. 

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• 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 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 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. 

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1. A controlled trial of the differential effects of intrapartum fetal monitoring - ScienceDirect
2. Intrapartum electronic fetal heart rate monitoring versus intermittent auscultation: A meta-analysis - ScienceDirect
3. Intrapartum Fetal Monitoring — A Disappointing Story — NEJM
4. A prospective comparison of selective and universal electronic fetal monitoring in 34,995 pregnancies. - PubMed - NCBI
5. Instrumentation of Fetal Electrocardiography | Science
6. ‎www.ajog.org/article/0002-9378(58)90707-5/pdf
7. The Beginnings of Perinatal Medicine - Google Books
8. https://www.mnhospitals.org/Portals/0/Documents/patientsafety/Perinatal/3a_ACOG%20Bulletin%20106.pdf
9. ‎www.ajog.org/article/S0002-9378(11)00480-7/pdf
10. ‎www.ajog.org/article/0002-9378(59)90052-3/pdf
11. ‎www.ajog.org/article/0002-9378(59)90639-8/pdf
12. The fetal heart rate patterns preceding death in utero - American Journal of Obstetrics & Gynecology
13. A randomized trial of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation. - PubMed - NCBI
14. Reasons for the rising cesarean delivery rates: 1978-1984. - PubMed - NCBI
15. https://www.ncbi.nlm.nih.gov/pubmed/122861

Please join Drs. Jillian Kurtz and Heather Link to discuss extended cycle contraception, changes to abortion laws, and the role of OB hospitalists.

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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

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.

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1. Prenatal Exposure to Acetaminophen and Risk of ADHD
2. PregSource
3. The case against hospital beds

Dr. Jillian Kurtz walks us through an evidence-based approach to infertility.

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.

1. Does Baby Powder Cause Cancer? A Jury Says Yes. Scientists Aren't So Sure
2. History of breast feeding and risk of incident endometriosis: prospective cohort study
3. The maternal childbirth experience more than a decade after delivery

Join me while we discuss the history of diabetes in pregnancy in the first part of our tour de force!

In this episode we trace the history of aneuploidy screening from the early days of amniocentesis to the modern day serum screening. 

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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:

In this episode Dr. Øystein Bergøy discusses the evidence behind antenatal corticosteroids for women at risk for preterm delivery. 

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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

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.

Dr. Umesh joins me to discuss Umbilical Cord Clamp Milking in preterm neonates.

Delayed clamping vs milking of umbilical cord in preterm infants: a randomized controlled trial

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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

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Drs. Sara Kim and Vai Umesh join me to discuss sexism in medicine.

https://creogsovercoffee.com

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Ending Sexual Harassment in Academic Medicine

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.

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History

1. 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

2. Goupil Bernutz. Clinical Memoirs on the Diseases of Women. 1866

3. Matthew Mann. A System of Gynecology - Vol. 1. 1887

Prevalence

1. L. Westrom. Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. 138:880. 1980
2. Pelvic Inflammatory Disease Statistics. CDC. 2015

Definition

1. Howard Kelly. The Diagnosis of Pelvic Inflammatory Diseases. 1894.
2. Pelvic Inflammatory Disease (PID) - CDC Fact Sheet. CDC. 2015
3. R. Brunham, S. Gottlieb. Pelvic Inflammatory Disease. NEJM 372:2309-2048. 2015.

Causes

1. Pelvic Inflammatory Disease (PID) - CDC Fact Sheet. CDC. 2015
2. R. Brunham, S. Gottlieb. Pelvic Inflammatory Disease. NEJM 372:2309-2048. 2015.
3. 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
4. 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
5. I Simms, et al. Associations between Mycoplasma genitalium, Chlamydia trachoma's and pelvic inflammatory disease. J Clin Pathology. 56(8):616-618. 2003.
6. CR Cohen, et al. Detection of Mycoplasma genitalium in women with laparoscopically diagnosed acute salpingitis. Sex Transm Infect. 81:463-466. 2005

Consequences

1. L Westrom. Effect of acute pelvic inflammatory disease on fertility. AJOG. 121(5):707-713. 1975
2. 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

1. 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.

In this episode Dr. Sara Kim and Dr. Jillian Kurtz join me to discuss some basic research papers about pregnancy dating and PCOS.

Dr. Gina Milone takes us through the pros and cons of post-delivery IUD placement.

feedback@obgyn.fm

1. 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. 
2. Center for Disease Control, U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC), 2016.
3. 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.
4. Immediate postpartum long-acting reversible contraception. Committee Opinion No. 670. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;128:e32-7.
5. Jatlaoui, T. C., et al. (2018). "Intrauterine Device Expulsion After Postpartum Placement: A Systematic Review and Meta-analysis." Obstet Gynecol132(4): 895-905.
6. Kapp, N. and K. M. Curtis (2009). "Intrauterine device insertion during the postpartum period: a systematic review." Contraception80(4): 327-336.
7. Long-acting reversible contraception: implants and intrauterine devices. Practice Bulletin No 186. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;130:e251-69.
8. Optimizing postpartum care. ACOG Committee Opinion No. 736. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e140-50.
9. Singh, S., et al. (2016). "A Dedicated Postpartum Intrauterine Device Inserter: Pilot Experience and Proof of Concept." Glob Health Sci Pract4(1): 132-140.
10. 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.

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

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ST Waveform Analysis

1. Fetal electrocardiogram: ST waveform analysis in intrapartum surveillance
2. ST waveform analysis versus cardiotocography alone for intrapartum fetal monitoring: a systematic review and meta-analysis of randomized trials
3. Electrocardiogram ST Analysis During Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials
4. Does ST analysis of fetal ECG reduce cesarean section rate for fetal distress?
5. The fetal electrocardiogram: ST waveform analysis during labour
6. Randomised trial of cardiotocography alone or with ST waveform analysis for intrapartum monitoring
7. Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial

Fetal Pulseoximetry

1. Fetal pulse oximetry for fetal assessment in labour
2. Intrapartum Oximetry of the Fetus
3. Update on intrapartum fetal pulse oximetry
4. The safety of fetal pulse oximetry in parturients requiring fetal scalp blood sampling
5. Intrapartum fetal pulse oximetry: Fetal oxygen saturation trends during labor and relation to delivery outcome

Join myself and Dr. Jerry Ballas to discuss what life has been like for us as Ob/Gyn's in the last 6 months. We delve into what COVID has done to our units and give some tips on how to protect ourselves.

OB Leadership - CoVID Response

Dr. Sara Kim discusses the etiology, diagnosis, and management of intrahepatic cholestasis of pregnancy.

Website

Slack

Patreon

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1. Fast, B., & Roulston, T. (1963). Idiopathic jaundice of pregnancy. Am J Obstetrics and Gynecology, 314-320.
2. Geenes, V., & Williamson, C. (2009). Intrahepatic cholestasis of pregnancy. World Journal of Gastroenterology, 2049-2066.
3. Gynecologists, R. C. (2011). Obstetric Cholestasis.
4. 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.
5. 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
6. Lammert, F., Marschall, H.-U., Glantz, A., & Matern, S. (2000). Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. Journal of Hepatology, 1012-1021.
7. 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
8. Pusl, T., & Beuers, U. (2007). Intrahepatic cholestasis of pregnancy. Orphanet Journal of Rare Diseases. 

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.

Dr. Heather Link joins me to discuss US health policy around maternal mortality.

Alliance for Innovation on Maternal Health

In this episode Dr. Sara Kim discusses the history, diagnosis, consequences, and treatment of bacterial vaginosis. 

feedback@obgyn.fm

1. ACOG. Vaginisits Practice Bulletin. (2015).
2. 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).
3. Eschenbach, D. A. History and review of bacterial vaginosis. American Journal of Obstetrics and Gynecology 169, 441-445 (1993).
4. 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).
5. 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).
6. 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).
7. 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).
8. Lachiewicz, M. M., Laura; Jaiyeoba, Oluwatosin. Pelvic Surgical Site Infection in Gynecologic Surgery. Infectious Diseases in Obstetrics and Gynecology 2015 (2014).
9. 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).
10. 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).
11. 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).
12. Menard, J.-P. Antibaterical treatment of bacterial vaginosis: current and emerging therapies. International Journal of Women's Health 3, 295-305 (2011).
13. 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).
14. Onderdonk, A. D., Mary L; Fichorova, Raina N. The Human Microbiome during Bacterial Vaginosis. Clinical Microbiology Reviews 29, 223-238 (2016).
15. Tebes, C. L., Catherine; Sinnott, John. The effect of treating bacterial vaginosis on preterm labor. Infect Dis Obstet Gynecol 11, 123-129 (2003).
16. 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).

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

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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.

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1. Goupil Bernutz. Clinical Memoirs on the Diseases of Women. 1866

2. Lachlan Aitken. Remarks on Pelvic Peritonitis and Pelvic Cellulitis. Baltimore Medical Journal. 1870. Volume 1

3. David Berry & Alexander Freeland. Manual of Gynecology - Volume 1. 1883

4. Howard Kelly. Operative Gynecology - Volume 2. 1898

5. Sexually Transmitted Diseases Treatment Guidelines. CDC. 2015

6. W. Stamm et al. Prevention of Pelvic Inflammatory Disease by Screening for Cervical Chlamydial Infection. N Engl J Med 1996; 334:1362-1366

7. 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

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

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In this episode we discuss the history, methods, effectiveness, and pitfalls of permanent sterilization. 

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1. Tubal Techniques
2. D. Bartz & J. Greenberg. Sterilization in the United States. Rev Obstet Gyn. 2008; 1(1): 23-32.
3. CREST Study
4. CREST Study: Regret
5. CREST Study: Ectopic
6. Fit to Be Tied: Sterilization and Reproductive Rights in America, 1950-1980

Join us as we discuss the future of residency training in the United States.

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Drs. Jillian Kurtz & Vai Umesh join me to discuss fertility equality.

Drs. Jillian Kurtz & Vai Umesh join me to discuss fertility equality.

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Discord Server

The Fight for Fertility Equality - NYT

How Much does IVF Really Cost?

CNY Fertility

West Coast Surrogacy

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

http://www.marchformoms.org