35: Monthly Check-up - June 2018

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

Noninvasive blood tests for fetal development predict gestational age and preterm delivery

Elevated prenatal anti-Müllerian hormone reprograms the fetus and induces polycystic ovary syndrome in adulthood

34: Aneuploidy - Part 1

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:

First-Trimester or Second-Trimester Screening, or Both, for Down’s Syndrome

INTEGRATED SCREENING FOR DOWN’S SYNDROME BASED ON TESTS PERFORMED DURING THE FIRST AND SECOND TRIMESTERS

First Trimester Biochemical Screening for Trisomy 21: The Role of Free Beta hCG, Alpha Fetoprotein and Pregnancy Associated Plasma Protein A

First trimester biochemical screening for trisomy 21: the role of free beta heG, alpha fetoprotein and pregnancy associated plasma protein A

SOMATIC CHROMOSOMES IN MONGOLISM

Screening for Down's Syndrome

Contingent screening for Down syndrome completed in the

First trimester: a multicenter study

UK multicentre project on assessment of risk of trisomy 21 by maternal age and fetal nuchal-translucency thickness at 10–14 weeks of gestation

Antenatal maternal serumscreening for Down's syndrome: results of a demonstration project

Reducing the need for amniocentesis in women 35 years of age or older with serum markers for screening

Low second trimester maternal serum unconjugated oestriol in pregnancies with Down's syndrome

Low second trimester maternal serum unconjugated oestriol in pregnancies Down's syndrome

Fetal nuchal translucency: ultrasound screening for chromosomal defectsinfirsttrimesterofpregnancy

Maternal serum screening for Down's syndrome in early pregnancy

Combining maternal age and serum alpha-fetoprotein to predict the risk of Down syndrome

Appropriate Biochemical Parameters in First-trimester Screening for Down Syndrome

Screening in early pregnancy for pre-eclampsia using Down syndrome Quadruple test markers

33: Monthly Check-up - May 2018

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

Births: Provisional Data for 2017

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

32: Oncofertility and fertility preservation

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

31: Journal Club - May 2018

In this episode I am joined by Dr. Ballas and Dr. Kim to discuss the paper "Pregnancy Exercise and Nutrition With Smartphone Application Support" from the May edition of Obstetrics & Gynecology.

Pregnancy Exercise and Nutrition With Smartphone Application Support: A Randomized Controlled Trial

30: The Monthly Checkup - April 2018

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

29: Journal Club - April 2018

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

Paper:

Schmitz T, Korb D, Battie C, et al. Neonatal morbidity associated with vaginal delivery of noncephalic second twins. Am J Obstet Gynecol 2018;218:449.e1-13.

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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

28: PCOS - Part 2

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

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

27: The Monthly Checkup - November 2017

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
4.  

26: Antenatal Steroids - Part 2

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

25: Antenatal Steroids - Part 1

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

feedback@obgyn.fm

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

24: Journal Club - September 2017

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

 

23: The Monthly Checkup - August 2017

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

22: PCOS - Part 1

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
    

21: Journal Club - August 2017

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

20: Monthly Checkup - July 2017

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

18: Intrapartum Fetal Monitoring - Part 2

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

19: Intrapartum Fetal Monitoring - Part 3

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

1.  

17: Journal Club - June 2017

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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16: Intrapartum Fetal Monitoring

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