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 like placenta accreta in planned scenarios. You'll gain a deep understanding of the strategic decision-making required, especially in resource-limited environments, to ensure the best outcomes for patients.

Navigate the complexities of performing cesarean hysterectomies under challenging circumstances, particularly when severe hemorrhage threatens patient safety. We delve into surgical tips and techniques, emphasizing the significance of early and careful bladder dissection, effective use of energy sealing devices, and confident decision-making. Our discussion highlights innovative strategies for uterine preservation in placenta accreta spectrum disorders, offering creative solutions when complete resection isn't feasible, and exploring new protocols that balance operative blood loss and patient fertility.

Finally, take a journey through the historical evolution of cesarean hysterectomy with us, as we trace its transformation from a fearful, last-resort measure to a cornerstone of modern obstetric care. Learn about the pivotal technological advancements that have shaped current practices, such as preoperative arterial occlusion techniques, equipping today's surgeons with a wide array of tools to tackle even the most complex cases. This episode promises a comprehensive blend of historical insights and practical advice, making it an essential listen for both seasoned professionals and those new to the field.

00:00:01 Cesarean Hysterectomy
00:09:14 Surgical Tips for Cesarean Hysterectomy
00:17:42 Advanced Techniques in C-Hysterectomy
00:23:56 Surgical Tips for Planned C-Hysterectomy
00:31:36 Surgical Techniques for Hemorrhage Control
00:41:38 Uterine Preservation in Spectrum Placenta
00:53:37 Evolution of Cesarean Hysterectomy

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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 misunderstandings around its purpose and timing during labor and how it affects labor management.

We address the rise of dubious hormone tests, like the DUTCH Test, marketed to consumers, painting a cautionary picture of how social media amplifies these unvalidated products. We highlight the importance of consulting healthcare professionals while discussing the potential paradigm shift that self-collected HPV testing could bring to cervical screening, as recommended in the coming cervical cancer screening guiudelines. This new approach might revolutionize screening rates and quality of care, especially for underserved populations, all while realigning healthcare providers' focus on more pressing medical needs.

Prepare for an engaging conclusion as we scrutinize the comparative effectiveness of postpartum hemorrhage devices Jada and Bakri, emphasizing the ethical implications of cost versus efficacy. We'll take you on a historical journey through the concept of "quickening" in pregnancy, reflecting on its cultural significance and evolution with modern science.

Plus, changes for next season!

00:00:02 Metronidazole and Alcohol
00:13:03 Intrapartum GBS Prophylaxis Guidelines Clarified
00:24:54 Hormone Testing and Cervical Screening
00:31:07HPV Self-Collect Screening Implications
00:42:54 Comparative Efficacy of Postpartum Hemorrhage Devices
00:51:29 Historical Perspectives on Fetal Development

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In this episode, we give four simple tips for performing a Pap smear. Then we dive into the complicated problem of obstetric units closing across the United States and actions we need to take to stop this dangerous trend that threatens the safety of pregnant women and newborns. Also, we highlight the important of hospital based obstetric programs and the history of why births moved into the hospitals in the beginning of the 20th Century and the 99% decline in maternal and neonatal mortality that followed.

00:00:02 Cervical Cancer Screening Tips

00:14:13 Hospital Closures Affect Obstetric Care

00:37:27 Rural Obstetric Units Closing Challenges

00:44:53 Hospital vs. Home Birth Safety

00:49:40 Healthcare Disparities for Women and Children

00:55:08 Evolving Birth Settings in America

01:02:28 Email Advocacy for Healthcare Reform

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Do patients in labor need continuous bladder drainage? We will review the literature comparing intermittent to continuous drainage.

Next, we venture into the art and science of manual rotation for persistent posterior fetal presentations, a skillful maneuver that might just hold the key to lowering cesarean rates. Drawing from comprehensive reviews and trials, including the TURN-OUT trial and studies from UCSF, we debate the efficacy and applicability of manual rotation in various clinical settings. From ultrasound-guided techniques to hands-on learning, gain a nuanced understanding of how this practice might enhance delivery outcomes and reduce interventions.

Finally, we learn about Cesarean Scar Disorder, a relatively new diagnosis with important clinical ramifications.

00:00:10 Urinary Catheterization in Labor Management

00:16:10 Manual Rotation of the OP Fetus

00:49:32 Effectiveness of Labor Positioning Techniques

00:58:03 Cesarean Scar Disorder

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In this episode, we discuss four tips for effective birth control counseling. By dissecting communication techniques, we highlight how striking a balance between relational and task-oriented approaches can maximize patient interactions and ensure comprehensive, evidence-based care regarding birth control choices.

Then we delve into several studies from the recent ABOG MOC cycle that we found interesting or curious and point out several informative nuggets.

Finally, we discuss the book "Feminine Forever" and its impact on estrogen replacement therapy perceptions.

00:00:02 Communication Strategies for Birth Control Counseling

00:11:56 Effective Communication of Birth Control Risks

00:21:08 PAS After Myomectomy

00:23:03 Risk-Reducing Surgery Adherence Discussion

00:30:33 Issues With Modern Labor Curves

00:38:49 Stopping ASA Early

00:42:17 Prophylactic Slings

00:46:01 Clinical Updates on UTIs

00:51:34 Mental Health Guidelines and Other Articles

00:55:51 Feminine Forever

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Can IV fentanyl use during labor actually be safe for mothers and newborns beyond six centimeters of dilation? Join us as we unpack a pivotal 1989 study and question the stereotypes surrounding fentanyl use in labor.

Our second segment tackles sensational claims about IUDs and breast cancer, as we dissect a Danish study recently published in JAMA. Listen as we unpack the methodological nuances and confounders that mainstream publications have overlooked, and explore the media's role in shaping public perception with incomplete or skewed interpretations of data.

This episode closes with an in-depth look at the biases that pervade pharmaceutical research, particularly when funding sources have a vested interest in outcomes. By examining the "sponsorship effect" and its implications on research validity, we highlight the need for rigorous, unbiased scientific inquiry. We examine the evidence for the new Pretrm Test for preterm labor risk. Learn about the challenges of implementing biomarker testing for predicting preterm births and why high-quality evidence must remain the cornerstone of clinical practice. As we celebrate our 100th episode, we discuss the need for truth and transparency in scientific research—creating a future where clinical practices are driven by reliable, evidence-based insights.

00:00:02 Navigating IV Fentanyl Use in Labor

00:07:56 Debunking Misconceptions About IUDs and Breast Cancer

00:22:17 Evaluating Biomarker Testing for Preterm Birth: The PreTRM test

00:38:50 Conflicts of Interest in Medical Research

00:45:15 Biased Influence in Medical Research

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In this episode, we discuss four tips for finding evidence based answers quickly. Then we discuss some new literature about pap smears and new guidelines regarding iron supplementation in pregnancy. We also discuss the history of corticosteroids for fetal maturity and the hype cycle in medicine.

00:00:02 Finding Evidence-Based Clinical Answers Quickly

00:13:36 Understanding Evidence-Based Clinical Practice

00:23:30 Cervical Cancer Screening During Pandemic

00:33:51 Optimal Timing for Cervical Cancer Prevention

00:40:12 Iron Supplementation in Pregnancy

00:47:13 Corticosteroids and Hype in Medicine

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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

00:27:20 Uterine Closure Techniques in Cesarean Deliveries

00:36:44 Defining Minimally Invasive Surgery

00:48:18 Advanced Techniques in Minimally Invasive Surgery

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