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".

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

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

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

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

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

Alliance for Innovation on Maternal Health

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.

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.  

http://www.marchformoms.org

Dr. Bergoy walks us through the risks and benefits of elective cesarean delivery.

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• 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/

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

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

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

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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.

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.

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

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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

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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The frequency of intrapartum caesarean section use with the WHO partograph versus Zhang’s guideline in the Labour Progression Study (LaPS): a multicentre, cluster-randomised controlled trial

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

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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.

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

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

https://creogsovercoffee.com

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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

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

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Slack

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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. 

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.

Effect of Immediate vs Delayed Pushing
on Rates of Spontaneous Vaginal Delivery Among Nulliparous Women Receiving Neuraxial AnalgesiaA Randomized Clinical Trial

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National Perinatal Association Meeting

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

The First National Summit on Women’s Health

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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

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

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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

The assessment of combined first trimester screening in women of advanced maternal age in an Asian cohort

Amnio/CVS

PRENATAL DIAGNOSIS IN MULTIPLE GESTATION: 20 YEARS’ EXPERIENCE WITH AMNIOCENTESIS

Maternal complications following amniocentesis and chorionic villus sampling for prenatal karyotyping

Chorionic Villus Sampling

Fetal Complications of Amniocentesis

Intrauterine diagnosis and management of genetic defects

Needle puncture of fetus: A complication of second- trimester amniocentesis

Fetal loss rate after chorionic villus sampling
and amniocentesis: an 11-year national registry study

Procedure-Related Complications of Amniocentesis and Chorionic Villous Sampling

Cell-Free DNA

Presence of fetal DNA in maternal plasma and serum

Increased Fetal DNA Concentrations in the Plasma of Pregnant Women Carrying Fetuses with Trisomy 21

Single-Nucleotide Polymorphism–Based Noninvasive Prenatal Screening in a High-Risk and Low-Risk Cohort

Noninvasive prenatal diagnosis of fetal chromosomal aneuploidy by massively parallel genomic sequencing of DNA in maternal plasma

Plasma placental RNA allelic ratio permits noninvasive prenatal chromosomal aneuploidy detection

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

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.

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Slack

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

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

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

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

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

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

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

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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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 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

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 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

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 

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

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

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

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

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