The Ob/Gyn Podcast

Episod

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  73: Menopause Part 1 24.06.2026 17min

  In Part 1 of our menopause series, we explore two fundamental questions: Why does menopause exist, and what physiologic changes drive the menopausal transition? Topics include: Definitions of perimenopause, menopause, and postmenopause Why humans are unusual among mammals in having a long post-reproductive lifespan The Mother and Grandmother hypotheses Chimpanzee and whale comparisons Oocyte development and follicular depletion AMH, inhibin B, FSH, and ovarian aging The hypothalamic-pituitary-ovarian axis Why menstrual cycles become irregular during perimenopause The physiologic foundation for menopausal symptoms This episode lays the groundwork for future discussions of vasomotor symptoms, mood changes, hormone therapy, and modern menopause management.   References Williams GC. Pleiotropy, natural selection, and the evolution of senescence. Evolution. 1957;11(4):398-411. doi:10.1111/j.1558-5646.1957.tb02911.x https://doi.org/10.1111/j.1558-5646.1957.tb02911.x Hamilton WD. The moulding of senescence by natural selection. Journal of Theoretical Biology. 1966;12(1):12-45. doi:10.1016/0022-5193(66)90184-6 https://doi.org/10.1016/0022-5193(66)90184-6 Hill K, Hurtado AM. Ache Life History: The Ecology and Demography of a Foraging People. New York, NY: Aldine de Gruyter; 1996. Hawkes K, O'Connell JF, Blurton Jones NG, Alvarez H, Charnov EL. Grandmothering, menopause, and the evolution of human life histories. Proc Natl Acad Sci U S A. 1998;95(3):1336-1339. doi:10.1073/pnas.95.3.1336 https://doi.org/10.1073/pnas.95.3.1336 Thompson ME, Jones JH, Pusey AE, et al. Aging and fertility patterns in wild chimpanzees provide insights into the evolution of menopause. Curr Biol. 2007;17(24):2150-2156. doi:10.1016/j.cub.2007.11.033 https://doi.org/10.1016/j.cub.2007.11.033 Jones KP, Walker LC, Anderson D, Lacreuse A, Robson SL, Hawkes K. Depletion of ovarian follicles with age in chimpanzees: similarities to humans. Biol Reprod. 2007;77(2):247-251. doi:10.1095/biolreprod.106.058156 https://doi.org/10.1095/biolreprod.106.058156 Faddy MJ, Gosden RG, Gougeon A, Richardson SJ, Nelson JF. Accelerated disappearance of ovarian follicles in mid-life: implications for forecasting menopause. Hum Reprod. 1992;7(10):1342-1346. doi:10.1093/oxfordjournals.humrep.a137570 https://doi.org/10.1093/oxfordjournals.humrep.a137570 Faddy MJ, Gosden RG. A model conforming the decline in follicle numbers to the age of menopause in women. Hum Reprod. 1996;11(7):1484-1486. doi:10.1093/oxfordjournals.humrep.a019425 https://doi.org/10.1093/oxfordjournals.humrep.a019425 Broekmans FJ, Knauff EA, te Velde ER, Macklon NS, Fauser BC. Female reproductive ageing: current knowledge and future trends. Trends Endocrinol Metab. 2007;18(2):58-65. doi:10.1016/j.tem.2007.01.004 https://doi.org/10.1016/j.tem.2007.01.004 Burger HG, Dudley EC, Robertson DM, Dennerstein L. Hormonal changes in the menopause transition. Recent Prog Horm Res. 2002;57:257-275. doi:10.1210/rp.57.1.257 https://doi.org/10.1210/rp.57.1.257
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  72: Diabetes in Pregnancy - Part 2 13.09.2020 24min

  In this episode we dive into the world of insulins and the management of preexisting diabetes in pregnancy.   feedback@obgyn.fm 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
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  71: Fertility Equality 16.08.2020 49min

  Drs. Jillian Kurtz & Vai Umesh join me to discuss fertility equality.   Drs. Jillian Kurtz & Vai Umesh join me to discuss fertility equality. feedback@obgyn.fm Discord Server The Fight for Fertility Equality - NYT How Much does IVF Really Cost? CNY Fertility West Coast Surrogacy
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  70: Journal Club - July 2020 06.08.2020 1j 12min

  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 feedback@obgyn.fm
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  69: Infertility Work-Up 27.07.2020 17min

  Dr. Jillian Kurtz walks us through an evidence-based approach to infertility.
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  68: Life in the time of COVID 21.07.2020 57min

  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
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  67: Maternal Mortality - Part 3 01.02.2020 55min

  Dr. Heather Link joins me to discuss maternal mortality in Lousiana. Racial Inequities in Preventable Pregnancy-Related Deaths in Louisiana, 2011–2016 louisiana maternal mortality review report 2011-2016  
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  66: Journal Club January 2020 16.01.2020 47min

  Drs. Jillian Kurtz and Caiyun Liao join me to discuss "Association Between Fertility Treatment and Cancer RIsk in Children" published 12/19 in JAMA  
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  65: Progesterone to Prevent Preterm Birth 13.12.2019 37min

  Dr. Ballas joins me to discuss the PROLONG trial and discuss the role of progesterone in the prevention of preterm birth.   PROLONG Trial
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  64: The 4th Trimester w/ Drs. Ballas and Zawisza 02.12.2019 57min

  Join us to discuss the changes in postpartum care and how we can help better support women.   ACOG Bulletin
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  63: Monthly Check Up - September 2019 18.10.2019 45min

  Drs. Sara Kim & Vai Umesh join me to dicuss stillbirth rates and medical treatment of uterine fibroids.
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  62: Diabetes in Pregnancy - Part 1 07.08.2019 23min

  Join me while we discuss the history of diabetes in pregnancy in the first part of our tour de force!
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  61: Journal Club - July 2019 25.07.2019 33min

  Dr. Umesh joins me to discuss Umbilical Cord Clamp Milking in preterm neonates. Delayed clamping vs milking of umbilical cord in preterm infants: a randomized controlled trial   feedback@obgyn.fm  
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  60: The Ethics of Breastfeeding with HIV 03.07.2019 58min

  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
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  59: Maternal Mortality - Part 2 26.06.2019 34min

  Dr. Heather Link joins me to discuss US health policy around maternal mortality.   Alliance for Innovation on Maternal Health E. Warren Op ed in Essence   CDC MMWR Maternal Mortality 5/10     California Maternal Quality Collaborative  
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  58: Postpartum Mood Disorders - Part 2 24.05.2019 27min

  Greg Kirschen takes us through the treatment of postpartum depression and psychosis. feedback@obgyn.fm American Psychiatric Association. (2013). In Diagnostic and statistical manual of mental disorders (5th ed.). doi:10.1176/appi.books.9780890425596.744053 Tate G. 1830. "A Treatise on Hysteria." London: S. Highley, 174 Fleet St & Webb St, Maze Pond, Borough. Smith TN. 1830. "Observations on hysteria." The Boston Medical and Surgical Journal. 3(34): 540. Louden, I. 1988. Puerperal insanity in the 19thCentury. Journal of the Royal Society of Medicine. 81, p 76-79. 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. Reid, J. 1848. Dr. Reid on Puerperal Insanity. Journal of Psychological and Medical Mental Pathology. 1(1): 128-151. Clark AC. 1887. Aetiology, Pathology, and Treatment of Puerperal Insanity. Journal of Mental Science. 33(142): 169-189. Donkin, AS. 1863. The Pathological Relation between Albuminuria and Puerperal Mania. Journal of Mental Science. 9(47): 401-405. Barkin V. 1929. Protein therapy in insanity of puerperal origin. British Medical Journal. 1(3549): 67. Earle P. 1854. Bloodletting in Mental Disorders. American Journal of Insanity. 10(4): 287-405. Mackenzie FW. 1851. Puerperal Insanity: Especially in Reference to Anaemia. London Journal of Medicine. 3(30): 504-521. 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. 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. 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. Waters ATH. 1857. On the use of chloroform in the treatment of puerperal insanity. American Journal of Psychiatry. 13(4): 341-353. Ramachandran CT, Subramanyam N, Baker G, et al. 2011. Antidepressants: From MAOIs to SSRIs and more. Indian Journal of Psychiatry. 53(2): 180-182. Agin HV. 1963. Phenelzine in the treatment of depression. American Journal of Psychiatry. 119(12): 1173-1174. Blacker KH, Weinstein BJ, Ellman GL. 1962. Mother's Milk and Chlorpromazine. 119(2): 178-179. Whalley LJ, Eagles JM, Bowler GMR, et al. 1987. Selective effects of ECT on hypothalamic-pituitary activity. Psychological Medicine. 17(2): 319-328. Williams RL, Barrera SE. 1950. Observations and opinions concerning complications and contraindications in electric convulsive therapy. Psychiatric Quarterly. 24(4): 800-809. 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.  Sobel DE. 1960. Fetal Damage Due to ECT, Insulin Coma, Chlorpromazine, or Reserpine. AMA Archives of General Psychiatry. 2(6): 606-611. Langan RC, Goodbred AJ. 2016. Identification and Management of Peripartum Depression.American Family Physician. 93(10): 852-858.  Information from your family doctor: Postpartum depression. 2010. American Family Physician. 82(8): 939-940. Schiller CE, Schmidt PJ, Rubinow D. 2014. Allopregnanolone as a Mediator of Affective Switching in Reproductive Mood Disorders. Psychopharmacology. 231(17): 3557-3567. 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. 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. 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.
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  57: Postpartm Mood Disorders - Part 1 10.05.2019 24min

  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.  
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  National Perinatal Association - Episode 2 07.05.2019 8min

  http://www.marchformoms.org
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  56: Elective Cesarean Delivery 04.05.2019 51min

  Dr. Bergoy walks us through the risks and benefits of elective cesarean delivery. www.obgyn.fm feedback@obgyn.fm 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 Gynecol2011;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/
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  National Perinatal Association - Episode 1 28.04.2019 15min

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