PPH is terrible. PPH must be assessed quickly via the “4Ts” and acted upon in a timely manner. And listen to this: new data from the Journal of Maternal-Fetal & Neonatal Medicine (June 24, 2025 ahead of print) finds an association with PPH and adverse outcomes years later: the odds of cardiovascular disease (CVD) and thromboembolism disease are increased in patients with postpartum hemorrhage (PPH), to a magnitude of 1.76 fold. That’s why these authors recommended "proactive postpartum care". That’s what we’re gonna talk about in this episode. Control of PPH includes bladder drainage, uterine massage, medications as appropriate, and mechanical methods of bleeding control. So… Vacuum uterine contraction works, and a balloon works. Even a simply 24 Fr foley has efficacy data in this setting as a uterine tamponade tool. But, in an attempt to have a LOW-COST, HIGHLY EFFECTIVE, and easy to use alternative to the Jada and Bakri- could we just use an intrauterine foley catheter and connect that to vacuum suction? JADA is effective but it limited based on uterine (EGA) size, or in cases of uterine anomaly. But most importantly…JADA and Bakri are expensive! Well, we now have data that this approach, using a low-cost, easy to use alternative, may be a consideration. It is FOCUS. This idea comes from one of our podcast family members, Dr. Frank Jackson- an MFM fellow- who has published his experience with this and already has a new publication on this technique (FOCUS), which was released as we were recording this very episode! Listen in for details.
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35:07
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35:07
Can Metformin Prevent HG?
Severe nausea and vomiting in pregnancy/hyperemesis gravidarum (HG) takes a toll on patient, and the healthcare system. According to a June 2024 ACOG Clinical Expert Series on the subject, GFD15 and IGFBP7 both play important roles in placentation, appetite, and cachexia that are linked to hyperemesis gravidarum. Specifically, LOW pre-pregnancy GFD15 is associated with increased frequency of HG as GFD15 levels spike post pregnancy in an otherwise "naive" system. Since metformin increases GFD15, can this be a pre-pregnancy, chemoprophylactic option in high risk women? New data just released (June 2025; AJOG) provides some eye-opening insights. Listen in for details.
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32:37
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32:37
SVD or CS After OASIS?
OASIS (3rd and 4th degree perineal lacerations) occur at a rate of 4-11% (average around 5.5%). OASIS lacerations have both short term and ling term potential morbidities. Practice Bulletin 198, from 2018, briefly discusses counseling patients following OASIS on subsequent mode of delivery options. Now, in a soon to be released AJOG publication, authors have provided a wonderful and comprehensive review on "patient-centered" guidance regarding mode of delivery in a subsequent pregnancy following OASIS. This is a detailed episode, so listen in for the update!
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50:04
You Asked, We Answered (Again)
Ladies and gentlemen, welcome back to another addition of “You asked, We answered”! In this brief episode, we will tackle 2 very appropriate clinical questions:1. Why do cervical psychology reports still state the presence or absence of endocervical cells/TZ component if it does not change management, and 2. Does continued magnesium sulfate infusion during C-section increased blood loss? We have done similar “you asked, we answered” episodes in the past and we will continue to do them as questions arise. Listen in for details.
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26:41
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26:41
New Guidance on OB CX Ripening (July 2025)
The Bishop Score was originally developed in 1964 by Dr. Edward Bishop and remains the central assessment tool for determining the appropriateness of cervical ripening for labor induction. We have covered pharmacologic and mechanical methods of cervical ripening for labor induction many times in prior episodes. Ut now, in July 2025, there will be a new clinical practice guideline (#9) from the ACOG which has some notable items. Does the ACOG recognize COMBINATION mechanical and pharmacologic agents for cervical ripening for labor induction? What about outpatient cervical ripening? What are the recommended protocols for oral and vaginal prostaglandins? Listen in for details.
Relevant, evidence based, and practical information for medical students, residents, and practicing healthcare providers regarding all things women’s healthcare! This podcast is intended to be clinically relevant, engaging, and FUN, because medical education should NOT be boring! Welcome...to Clinical Pearls.
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