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A fresh and evidence-based perspective of all things related to obstetrics and gynecology. Follow us on Instagram @thinkingaboutobgyn or visit thinkingaboutobgyn.com for show notes and more.
123 Episodes
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Dr. Howard Harrell explores common questions about birth alternatives posed by Anna, a mom-to-be with questions, examining scientific evidence behind claims often found online that challenge evidence-based obstetric practices. The discussion separates facts from philosophy by analyzing actual research data on interventions like epidurals, oxytocin, and birthing positions. • Maternal mortality has decreased 173-fold since 1850, coinciding with the rise of modern obstetrics • The "cascade of i...
Howard and Antonia explore the safety of medications during pregnancy and the controversial reporting requirements for breast density on mammograms, examining how science is being overshadowed by fear-mongering in healthcare decision-making. • Examining the evidence behind avoiding fluconazole (Diflucan) in first trimester, finding that short courses likely pose minimal risk • Discussing the important distinction between possibility and probability when evaluating medication safety in pregna...
Dr. Jacqueline Vidosh shares her powerful journey as both an obstetrician and mother to Noah, who has trisomy 18, challenging traditional medical understanding of this condition and providing insights into compassionate patient care. Her story, recently featured in The New York Times, illustrates how medical perspectives on chromosomal conditions can evolve through lived experience, highlighting the spectrum nature of trisomy 18 and the importance of accurate, unbiased counseling. • Receivin...
Dr. Scott Guthrie joins us to explore the significant advances in neonatal care and the critical partnership between obstetricians and neonatologists to improve outcomes for newborns. Highlights include: • Successful implemented delayed cord clamping across Tennessee hospitals through collaborative quality improvement project • Neonatal mortality has decreased 30% between 1999-2022 due to advances in medical care and prenatal management • Survival rates for 22-week premature infants ha...
Howard and Antonia dive into their tenth season with a critical look at several new studies. Topics include: • Estrogen-soaked vaginal packing after surgery lacks evidence for benefits while carrying unnecessary costs • Recent studies on vaginal birth after cesarean deserve careful interpretation beyond aggregate outcomes • Hospital uterine rupture rate is 0.2-0.4%, with only 8% resulting in catastrophic outcomes when properly managed • Warnings against infant co-sleeping date back to ancien...
Surgical techniques in gynecology vary widely between surgeons, creating both excitement and frustration for residents trying to learn the "right way" to perform procedures. Howard and guest host Maddie White discuss this and more: • Trocar placement during laparoscopy requires careful consideration of patient factors and potential adhesions • Elevating the abdomen during trocar placement remains standard practice, though definitive evidence on its necessity would require studies of over 100...
Howard Herrell and Antonia Roberts explore evidence-based practices in obstetrics and gynecology, examining both established protocols and emerging research with critical perspectives on medical misinformation. • Serial cervical length monitoring after LEEP procedures lacks evidence for improving outcomes despite being common practice • SMFM's 2016 recommendation explicitly advises against routine cervical length screening for patients with history of cervical procedures • Retrospective stud...
Cervical cancer represents a success story in developed countries due to screening and vaccination, yet remains a significant global health problem with over 340,000 deaths annually worldwide. We explore the current state of cervical cancer prevention, screening, and treatment while discussing exciting advances that could eventually eliminate this disease. • Different levels of prevention for cervical cancer: primordial, primary, secondary, tertiary, and quaternary • HPV vaccination as the m...
Howard and Antonia explore the evidence behind pit breaks in labor, cannabis use in pregnancy, and IUD options for hormone replacement therapy. • Pit breaks in labor lack substantial evidence of benefit when used in active labor • Current research suggests stopping oxytocin during active labor may slightly increase cesarean rates rather than decrease them • Long pit breaks (up to 8 hours) in latent labor may be beneficial by allowing rest and promoting patience • Recent systematic review sho...
Join Howard and Janeen Arbuckle for this discussion of pediatric and adolescent gynecology essentials. Pediatric and adolescent gynecology is a newer discipline bringing specialized care to young women with unique gynecologic needs, with a focus on counseling, education, and age-appropriate interventions. • Abnormal uterine bleeding in adolescents is rarely caused by structural problems (unlike in adults) and typically relates to immaturity of the hypothalamic-pituitary-ovarian axis • Hemat...
In this episode, Antonia and Howard explore the groundbreaking study on treating male partners for bacterial vaginosis, revealing significantly reduced recurrence rates and challenging our traditional understanding of BV pathophysiology. Plus: • Evidence doesn't support treating mild gestational hypertension with antihypertensives • Studies confirm acetaminophen in pregnancy doesn't cause ADHD or autism • New research questions the benefit of routine postpartum thromboprophylaxis • The...
This episode features our favorite podcast ninja, Dr. Maddie White. She and Howard discuss how medical dramatizations misrepresent obstetric emergencies (yes, we are watching The Pitt). Then, we dissect evidence-based approaches to common triage scenarios including labor evaluation, rupture of membranes, and preterm labor assessment. • Television shows like "The Pitt" and "ER" portray shoulder dystocia and postpartum hemorrhage inaccurately, lacking proper urgency and technique • Hospital-ba...
Antonia Roberts and Howard Herrell review several new articles: • Epifoam for postpartum pain lacks evidence of effectiveness compared to simple ice packs while costing nearly $100 per unit • AMH levels above 5.39 are associated with PCOS diagnosis, providing a specific threshold for clinical use • External aortic compression demonstrated as a life-saving technique during severe obstetric hemorrhage • Vaginal estrogen in breast cancer survivors shows no increased risk of cancer recurren...
We discuss the pressing issues surrounding operative vaginal deliveries, including trends in their usage and the disparities impacting delivery outcomes. Join us as we navigate these critical insights with expert guests Jamie Perry and Howard Herrell, revealing the complexities and nuances surrounding forceps and vacuum deliveries. • Examining the historical context of operative vaginal deliveries • Analyzing the decline in forceps and vacuum usage since the 1990s • Discussing the rise of ...
This episode dives into the debate surrounding the efficacy and cost of barbed sutures in surgical practice, questioning whether their time-saving advantages are justified compared to traditional techniques, especially for uterine closure. Additionally, it explores the implications of non-invasive prenatal testing for cancer detection and recent maternal mortality statistics, while advocating for evidence-based practices in both surgical and obstetric care. • Analysis of barbed suture u...
Join Howard with guest host Jacqueline Vidosh as we explore the challenges of maternal cardiac arrest. This episode emphasizes the urgent need for specialized training in obstetric life support. From discussing causes of maternal mortality to sharing practical tips for first responders, the insights presented aim to enhance awareness and preparedness in critical situations. • Discussing the alarming rise in maternal mortality rates • Identifying common causes of maternal cardiac arrest • The...
In this episode, Howard and Antonia focuses on the evolving guidelines for HPV screening and the implications for women's health, highlighting its superior effectiveness over traditional Pap smear tests. Additionally, we explore the reliability of pregnancy apps for information and address a listener question about Group B Streptococcus screening and management. • Discusses the transition to HPV testing as primary cervical cancer screening • Reviews a recent study confirming HPV's effectiv...
Discover how cesarean hysterectomy, once a procedure shrouded in fear, has evolved into a life-saving operation with contributions from pioneering figures like Eduardo Porro and Lawson Tate. In this episode, we are joined by gynecologic oncologist Stuart Winkler, who shares invaluable insights into both unplanned and planned cesarean hysterectomies. Explore the primary indications for these critical surgeries, from uncontrollable bleeding in unplanned emergencies to managing known conditions ...
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 Deliveries 00:14:46 Debunking Claims About Cesarean Techniques 00:27:...
Challenge preconceived notions in obstetrics and gynecology with our latest episode, where we dismantle myths that have long influenced medical practices, even in the absence of scientific backing. From unraveling the misunderstood reaction between alcohol and metronidazole to examining the overlooked risks of clindamycin cream, we'll look at how these misconceptions take root in medical culture. We continue with a critical analysis of intrapartum GBS prophylaxis, correcting widespread misund...
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