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.
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In-depth explorations into the field of Sanskrit Studies. Featuring candid conversations and interviews with scholars of Sanskrit across the disciplines of Indology, Linguistics, Religious Studies, Philosophy, History, and more. Hosted by Dr. Antonia Ruppel.
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Episode 8.5 Ultrasounds of Twins, Tongue Ties, and Pap-sploitation
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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 pregna…
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Episode 8.4 Anticoagulation Use In Pregnancy
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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 Obstetrics 00:08:39 Anticoagulation Recommendations in Pregn…
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Episode 8.3 Antiquated Physical Exam Techniques, Cord Blood Banking, and More!
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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 advanc…
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Episode 8.2 Cesarean Under Local, New Literature, and History of Preeclampsia
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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 …
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Episode 8.1 Overuse of HCGs, Famous Studies in OB, and the History of Mag Sulfate
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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 HC…
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Episode 7.13 Uterine inversion, Trainee Harassment and Mistreatment, and Suicide
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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…
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Episode 7.12 BV Screening, WHI, First Trimester Anatomy Ultrasound, and Postpartum Sterilization
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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 post…
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Episode 7.11 IUD insertion, teaching residents and students, and the history of blood transfusion
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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 Management 00:23:04 Qualities of a Great Teach…
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Episode 7.10 Risks of multiple Cesareans, tips for vaginal hysterectomy, and listener questions
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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 Outc…
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Episode 7.9 Deeply Impacted Fetal Head, Route of Hysterectomy, and the Taj Mahal
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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 Cesarean 00:13:53 Advantages of Vaginal Hysterecto…
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Episode 7.8 Osteopenia treatments, antenatal steroids, IOL methods, VBAC risk factors, and surgical hemostasis
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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 discus…
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Episode 7.7 Cord Prolapse, Radical Hysterectomy for Cervical Cancer
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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 L…
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Episode 7.6 Maternal Mortality Declining? Plus skin closures and listener questions
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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 Mate…
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Episode 7.5 Breech Delivery Tips, Laparoscopy Entry, and IVF Legality
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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 Deliveries 00:13:1…
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Episode 7.4 Oxygen for Decels, Interpreting Studies Part 2, Frozen Eggs
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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 que…
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Episode 7.3 Cephalic Version, Interpreting Studies Part 1, and Jackie Kennedy
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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 Version 00:17:10 Evaluating Clinical Studies 00:53:13 Jackie Kennedy's Impact on Cesarean Deliveries Follow us on Insta…
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Episode 7.2 Cesareans for Macrosomia, Yearly Pelvic Exams, Zuranolone, and more!
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In this episode, we discuss performing Cesarean for fetal weights at lower thresholds than currently recommended. Then we discuss new literature regarding utility of pelvic exams or screening asymptomatic women and early rupture of membranes after cervical ripening with a Foley bulb. Then we discuss an editorial discussing selecting the best test a…
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Episode 7.1 New Mammography Guidelines, Four Tips for Fetal Tracings, and Pregnancy after Hysterectomy
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In the first episode of our new season, we introduce a new segment with Four Tips for managing fetal heart tracings. Then we discuss the new mammography guidelines. And finally we discuss a case of a viable pregnancy in a woman who had had a hysterectomy. 00:20:45 Mammography Guidelines 00:30:12 Debating the Effectiveness of Mammography Screening 0…
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Episode 6.13 Hormone Replacement Myths Part 2
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In this episode, we discuss five more myths about hormone replacement therapy. Also, we discuss the utility of cervical exams at later pregnancy visits and the history of synthetic hormones. 00:00:02 Intro and Routine Cervical Exams 00:07:51 Myth #6: Lowest dose, shortest duration 00:17:27 Myth #7: Women without a uterus need progesterone 00:22:44M…
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Episode 6.12 Hormone Replacement Therapy Myths Part 1
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In this episode we debunk the first of five myths about menopausal hormone replacement therapy. 00:00:02 Hormone Replacement Therapy For Smokers, HTN 00:11:42 Misinformation from Women's Health Initiative 00:17:18 Myth 1: Estrogen and Breast Cancer 00:28:06 Myth 2: HRT and BRCA Patients 00:33:17 Myth 3: Estrogen and Cardiovascular Disease 00:39:14 …
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Episode 6.11 Vaginal Estrogen and More!
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In this episode, we discuss several new articles related to treatment of vaginal atrophy or genitourinary syndrome of menopause, including literature that clarifies the role of vaginal estrogen cream. Plus, we discuss the role of washings at the time of management of adnexal masses. We also discuss new literature about the true impact of oxytocin o…
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Episode 6.10 Magnesium Sulfate for Neuroprotection for Preterm Infants
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In this episode, we review the literature regarding the use of magnesium sulfate for neuroprotection to prevent CP in preterm infants. 00:00:02 Magnesium Sulfate for Neuroprotection 00:11:00 The Controversy Surrounding Magnesium Sulfate 00:36:37 Research Study Mistakes and Bias 00:46:33 Magnesium Sulfate's Effects on Preterm Birth 00:52:24 Magnesiu…
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Episode 6.9 Male Circumcision: A Global, Historical, and Ethical Debate
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In this episode, we discuss neonatal circumcision and the pros, cons, and ethics. Prepare for controversy. We also discuss the utility of labs for fetal growth restriction. 00:00:02 Circumcision Controversy 00:05:00 Labs for Fetal Growth Restriction 00:15:31 Global Perspectives on Male Circumcision 00:26:17 Significance of Male Circumcision in Hist…
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Episode 6.8 The (Near) Future of Obstetrics
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In this episode, we speculate about the near future of advancement of obstetrics, including new vaccines, new uses for cell-free DNA screening, advancement in diabetes monitoring, the use of artificial intelligence and remote monitoring in obstetrics, and artificial womb technology. Also, do you need to stick the GBS swab in you know where? 00:00:0…
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Episode 6.7 Early GDM screening, repeat antibody testing, mayo and more
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In this episode, we discuss the utility of repeat antibody testing at 28 weeks. Plus, new evidence about early screening for GDM, the concept of tension in the pelvic floor, the evidence about vaginal prep at the time of unplanned Cesarean, new literature about interventions for preterm birth, and the safety of Mayo (or raw eggs) during pregnancy. …
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Episode 6.6 Overconsulting and Surgical Training
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In this episode we welcome back Stuart Winkler to discuss over-consulting in OB/GYN and how to improve surgical eduction in our training programs and how to balance generalists vs subspecialists. Plus, colace! 00:00:02 Misuse of Docusate Sodium 00:09:24 Appropriate Specialty Referrals in Gynecology 00:20:51 Considerations for EIN Management and Ref…
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Episode 6.5 How to Deliver A Baby (an evidence based approach)
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In this episode we discuss the evolution and evidence behind vaginal delivery techniques. Plus, we discuss the importance of the golden hour after birth for the mother and baby. 00:00:02 Golden Hour Care After Birth 00:09:23 Traditional Practices in Vaginal Deliveries 00:20:54 Optimal Practices for Labor Management 00:26:10 Monitoring and Positions…
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Episode 6:4 Frequency of Prenatal Visits and Eat, Sleep, Console
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In this episode, we discuss guidelines about bulb suctioning at the time of delivery. Then we discuss the nearly 100 year old schedule of prenatal visits and how these can be modernized. Finally, we discuss the next Eat, Sleep, Console approach for neonatal abstinence. 0:02 Neonatal Suctioning 11:33 Reforming Prenatal Visits and Outdated Recommenda…
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Episode 6.3 Rural vs Urban Obstetrics, Screening for BV, and Prophylactic Salpingectomy
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In this episode, we discuss screening for BV to prevent preterm birth. Then new data about the safety of obstetric care in rural vs urban hospitals of different sizes. Plus, new evidence that prophylactic salpingectomy is working and new data about vaginal cuff dehiscence and the analogy between clinical studies and lab tests. 0:02 Treating Bacteri…
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Episode 6.2 Surgical Restrictions, Probiotics for GBS, Stratafix and more
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In this episode, we discuss current evidence about post-surgical activity restrictions. Plus, we explore probiotics for GBS prevention, vaginal seeding, barbed sutures, disposable staples, and how to be faster during surgery. Follow us on Instagram @thinkingaboutobgyn.Por Antonia Roberts and Howard Herrell
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Episode 6.1 Antidepressants in Pregnancy and Cephalosporins in Patients with Penicillin Allergy
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In this episode, we discuss current evidence about potential cross-reactivity for patients with penicillin allergy who receive a cephalosporin. Then we discuss the safety of antidepressant medications in pregnancy. Follow us on Instagram @thinkingaboutobgyn.Por Antonia Roberts and Howard Herrell
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Episode 5.13 Tori Bowie and Maternal Mortality
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In this episode, we discuss the death of Tori Bowie and new data about maternal mortality and the closing gap of black to white mortality in hospital birth. Plus, we discuss pelvic rest after childbirth. Follow us on Instagram @thinkingaboutobgyn.Por Antonia Roberts and Howard Herrell
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Episode 5.12 The ARRIVE Trial, Hydration, Partograms, and more
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In this episode, we discuss the practice of IV hydration for preterm contractions. Then we take a look at the ARRIVE trial and some recent studies about this controversial study. Plus, we look at several articles from the Labor and Delivery special edition of the Gray Journal. Follow us on Instagram @thinkingaboutobgyn.…
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In this episode, we discuss data about the methods of breech vaginal delivery, including new studies describing the forces with different maneuvers and the ideal position for maximizing pelvic side. Plus, can pregnant women eat sushi? Follow us on Instagram @thinkingaboutobgyn.Por Antonia Roberts and Howard Herrell
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Episode 5.10 Ten Things We Wish ER Docs Knew About OB/GYN
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In this episode, we discuss ten things we wish ER docs knew. Also, the history of IUDS, new mammogram guidelines, over the counter birth control, and urine screening for pregnant women with sickle cell trait. Follow us on Instagram @thinkingaboutobgyn.Por Antonia Roberts and Howard Herrell
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Episode 5.9 Cookies, Virgin Birth, Forceps, and the History of Handwashing
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In this episode, we discuss several new articles, including evidence about operative delivery in obese women, lactation, cookies, propranolol for labor arrest. We also discuss virgin birth in America, whether to place IUD's early in women who have had chorioamnionitis, and the history of hand-washing. Featuring guest co-host Jamie Perry, MD. Follow…
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Episode 5.8 Medical and Surgical Management of Missed Abortion
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In this episode, we discuss a variety of commonly ordered prenatal labs that are unnecessary. We also discuss new studies that affect both surgical and medical management of miscarriage. Finally, we debunk a new study that claims that induction of labor leads to lower test performance in children. Follow us on Instagram @thinkingaboutobgyn.…
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Episode 5.7 In vitro fertilization (infertility Part 4)
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In this episode, we discuss routine labs for patients with a history of hypertension. Then, we take a deeper dive into in vitro fertilization (IVF). Follow us on Instagram @thinkingaboutobgyn.Por Antonia Roberts and Howard Herrell
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Episode 5.6 COVID Update, Cystotomies, Scope, and More
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In this episode, we discuss the repair of cystotomies along with the scope of general OB/GYN. Plus, COVID and maternal mortality updates. Then some new literature including an update on Clomiphene vs Letrozole and Azithromycin for vaginal birth. Finally, the best female eponym ever and the removal of Makena from the market. Follow us on Instagram @…
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In this episode, we discuss Polycystic Ovary Syndrome and discover a couple of more female eponyms. Follow us on Instagram @thinkingaboutobgyn.Por Antonia Roberts and Howard Herrell
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16. Amba Kulkarni | Sanskrit and Computers
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My guest this month is Amba Kulkarni from the Department of Sanskrit at the University of Hyderabad, who has also been associated with IIT Kanpur and the National Sanskrit University. Professor Kulkarni is best known for her work linking traditional Indian linguistic theory (starting with Pāṇini and focussing on aspects such as Śabdabodha and Kārak…
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Episode 5.4 Meds for IUD placement, some recent studies, and a poem!
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In this episode, we discover three more female eponyms, plus we review the utility of premedication for IUD placement. We review new literature about maximum dose of oxytocin in labor, surgery vs pessary for pelvic organ prolapse, buprenorphine vs methadone for management of addiction in pregnancy, new guidelines for male infertility evaluation, fa…
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Episode 5.3 Eponyms! and some oncology
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In this episode, we have our new favorite guest Stuart Winkler, to discuss eponyms and also a touch of oncology, including the appropriate work up of unilocular ovarian cysts. Follow us on Instagram @thinkingaboutobgyn.Por Antonia Roberts and Howard Herrell
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Episode 5.2 Baby Season (a listener question) and RhoGAM
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In this episode, we discuss the use of RhoGAM in the first trimester. Then we discuss the timing of birth and why babies are born more commonly in some months and days than others. Follow us on Instagram @thinkingaboutobgyn.Por Antonia Roberts and Howard Herrell
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Episode 5.1 OB Emergencies Part 2
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In this episode, we discuss caffeine and other supplements and breast pain, then we continue our discussion of management of obstetric emergencies, focusing on amniotic fluid embolism, shoulder dystocia, cesarean under local, and eclamptic seizure. Follow us on Instagram @thinkingaboutobgyn.Por Antonia Roberts and Howard Herrell
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In this episode, we discuss the management of nuchal cords at the time of delivery. Then we begin part 1 of our review of obstetric emergencies, focusing on postpartum hemorrhage, uterine inversion, cord prolapse, breech deliveries, and other not so fun stuff. Follow us on Instagram @thinkingaboutobgyn.…
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Episode 4.12 Angle of Progression, Two Layer Closure, and Deliverance
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In this episode, we discuss the newest evidence for two layer closure at the time of Cesarean. Plus, delivery vs birth, a clarification from the prior episode about sexism. Finally, we take a deep dive into the angle of progression and how it can be used to reduces cesareans and promote safety during delivery. Follow us on Instagram @thinkingabouto…
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15. Robert Zydenbos | The Life of Sanskrit Traditions
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My guest this month is Robert Zydenbos, who is Professor of Modern Indology at the LMU Munich. (Full disclosure: we thus are colleagues!) His first point of contact with Indian languages and philosophies was through Collier's Encyclopaedia. It introduced him to such ideas as rebirth, a concept found in various traditions (see e.g. here, here or her…
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Episode 4.11: Amnioinfusions, Stat Cesareans, Braxton-Hicks, and TikTok
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In this episode, we discuss the utility of amnioinfusion for both variable decelerations and meconium stained fluid. Plus, how fast do we need to go when doing a Cesarean under general anesthesia. Then we talk about how Braxton-Hicks is still relevant today. Finally, new studies about TikTok and the placebo effect in menopause treatments. Follow us…
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Episode 4.10 Iron in pregnancy, Sexism in OB/GYN, and the Postpartum visit
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In this episode, we discuss the pros and cons of iron supplementation during pregnancy. We take a big of a dangerous dive into chauvinism and sexism in OB/GYN. Then, we discuss rethinking the postpartum visit(s) to better serve patients. Follow us on Instagram @thinkingaboutobgyn.Por Antonia Roberts and Howard Herrell
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