When to Best Deliver With a Uterine "Window"

Welcome back to the show, everybody! Today, we are diving deep into the intersection of maternal-fetal medicine and cardiology. We’re tackling a condition that keeps every OB/GYN, MFM, and cardiologist up at night: Peripartum Cardiomyopathy, or PPCM. And to keep our clinical gears turning, we are framing this discussion squarely through the lens of Society for Maternal-Fetal Medicine (SMFM) Consult Series #73, which focuses on right and left heart failure in pregnancy, alongside the foundational data from ACOG Practice Bulletin #212. PPCM presents fundamentally as acute left heart failure with reduced ejection fraction. Think of the left ventricle as the primary engine pump of the systemic circulation. When it stalls, everything upstream gets backed up. While this was traditionally called IDIOPATHIC, newer data says otherwise. We are going to cover presentation, eval, care and prognosis. So, get your palpitations in check- here we go. 16% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG1. SMFM CS 73; 20252. ACOG PB 212; 20193. Arany Z. Peripartum Cardiomyopathy. The NEJM. 2024. 4. Sliwa K, Hilfiker-Kleiner D, Damasceno A, Al Farhan H, Goland S, Johnson MR, Bauersachs J. Peripartum cardiomyopathy. Lancet. 2025 Nov 22;406(10518):2483-2493. doi: 10.1016/S0140-6736(25)01451-5. Epub 2025 Oct 28. PMID: 41173010.

Podcast Family, in this episode we will focus on the “20-minute rule” for vacuum assisted vaginal delivery. This is an important aspect of neonatal safety and is a vital part of procedure documentation. Documentation for vacuum assisted vaginal delivery should include station at application, number of tractions, number of pop-offs and the total traction time and the vacuum trackable time (time from first application to delivery). This has historical roots as well as new data to validate it (March 2026). Listen in for details. 1. ACOG PB 219; 20202. Preuss E, Porto A, Sheiman V, Bitton M, Tovbin J, Kedem HI, Barzilay E. When to stop? A single center experience on vacuum-assisted deliveries. Eur J Obstet Gynecol Reprod Biol. 2026 Mar 25;320:114983. 3. Teng FY, Sayre JW. Vacuum Extraction: Does Duration Predict Scalp Injury?.Obstetrics and Gynecology. 1997. 4. Tsakiridis I, Giouleka S, Mamopoulos A, et al.Operative Vaginal Delivery: A Review of Four National Guidelines. Journal of Perinatal Medicine. 2020. 16% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG

The March 2026 ACC/AHA Guideline on the Management of Dyslipidemia made a major pivot regarding Lipoprotein(a) by establishing a formal recommendation for universal screening in adults. This 2026 guideline, published in the Journal of the American College of Cardiology, issued a Class 1 recommendation stating that every adult should have their Lp(a) measured at least once in their lifetime. Because Lp(a) levels are genetically determined and remain highly stable throughout a person's life, a single lifetime check is sufficient for the vast majority of the population to establish their baseline risk. Well, that’s great for Family medicine or internal medicine, but how does that affect us in women’s health? Well, it’s complicated: lipoprotein(a) has been associated with an increased risk of VTE and has also been associated, in some studies, with FGR, preeclampsia, and preterm birth! So, can these patients receive oral contraceptives? What about Perioperative and postop care? Do these patients require anticoagulation? What about pregnancy- is LDA recommended here? And lastly, what about TXA use in patients with HMB? This podcast topic comes from one of our podcast family members who is an OBGYN military personnel caring for our wonderful troops overseas. Listen in for details!16% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG1. Ezzat, D., Lopez, D. M., Claggett, B. L., Li, L., Mohammadnia, N., Schuermans, A., Hemeryck, J., Chang, A., Murillo, S., O'Donoghue, M. L., Bikdeli, B., Yu, Z., Natarajan, P., Patel, A. P., Pabon, M. A., & Honigberg, M. C. (2026). Lipoprotein(a) and incident venous thromboembolism in pre- and postmenopausal women, and in men. European Heart Journal, ehag252. https://doi.org/10.1093/eurheartj/ehag2522.ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Dyslipidemia Writing Committee. (2026). 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia. Circulation, 153, e1155–e1300. https://doi.org/10.1161/CIR.00000000000014233. CDC MEC 4. Prevention of Venous Thromboembolism in Gynecologic Surgery: ACOG Practice Bulletin, Number 232. Obstetrics and Gynecology. 2021. Committee on Practice Bulletins—Gynecology5. Sofi F, Marcucci R, Abbate R, Gensini GF, Prisco D.Lipoprotein(a) as a Risk Factor for Venous Thromboembolism: A Systematic Review and Meta-Analysis of the Literature.Seminars in Thrombosis and Hemostasis. 2017. Dentali F, Gessi V, Marcucci R, et al. Lipoprotein (A) and Venous Thromboembolism in Adults: The American Journal of Medicine. 2007.

Hey everyone, thanks for tuning in. If you’ve spent any time in the OR during a cesarean delivery, you know that the choice between uterine exteriorization and in situ repair usually comes down to how you were trained or personal surgeon preference. It’s a debate as old as modern obstetrics. But a major piece of clarity is coming down the pipeline. This episode, we are getting a sneak peek at a brand-new systematic review and meta-analysis dropping this July 2026 in the European Journal of OBGYN. We’re asking the big question: is this the study that finally settles the debate once and for all? Grab your coffee, stick around, and let’s find out.16% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG​ Coutinho, I. C., Ramos de Amorim, M. M., Katz, L., & Bandeira de Ferraz, Á. A. (2008). Uterine exteriorization compared with in situ repair at cesarean delivery: A randomized controlled trial. Obstetrics & Gynecology, 111(3), 639–647. https://doi.org/10.1097/aog.0b013e31816521e2 . (One of the most heavily cited clinical trials on the subject. It established that women in the exteriorized group experienced a 41% greater risk of moderate-to-severe pain at 6 hours postoperatively compared to the non-exteriorized cohort).​ Tan, H. S., Taylor, R. C., Sharawi, N., Sultana, R., Barton, K. D., & Habib, A. S. (2021). Uterine exteriorization versus in situ repair in Cesarean delivery: A systematic review and meta-analysis. Canadian Journal of Anaesthesia, 69(2), 216–233. https://doi.org/10.1007/s12630-021-02142-8​ Fonseca Queiroz L, Lemos M, Pereira da Silva D . Uterine exteriorization versus in-situ uterine repair during cesarean delivery: a systematic review and meta-analysis of randomized controlled trial. European Journal of Obstetrics and Gynecology and Reproductive Biology, 2026; 323

In the ACOG PB 231, Multifetal Gestations Twin Triplet and Higher-Order Multifetal Pregnancies, it states, “based on the improved outcomes reported in singleton gestations, the National Institutes of Health recommends that, unless a contraindication exists, a course of antenatal corticosteroids should be administered to all patients who are at risk of delivery within 7 days and who are between 24 weeks and 34 weeks of gestation, irrespective of the fetal number”. But a BRAND NEW meta-analysis is saying the exact opposite- with a catch. Listen in for details.1. ACOG PB 2312. Felippe, Carolina Alves MS; Ruiz, Sinrraim dos Santos Chaves MD; de Souza, Rebeca Ferreira MS; de Lima, Aliny Silva MS; dos Santos, Priscila Luiza MS; Fonseca, Pandora Eloa Oliveira MS; de Almeida Silva, Ingryd MS; Montes-de-Oca-Saucedo, Carlos Roberto MD; Santana, Ana Cecília Oliveira MS; Veta Darkovski, Jasmina MD; Matlaw, Hadas Rachel MD; Fonseca Queiroz, Laura MD. Antenatal Corticosteroid Use in Twin Pregnancies: A Systematic Review and Meta-analysis. Obstetrics & Gynecology ():10.1097/AOG.0000000000006344, June 4, 2026. | DOI: 10.1097/AOG.000000000000634416% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG

Historically we were taught as surgeons that 1-centimeter bites that between suture throws on a Pfannenstiel (low transverse) fascial closure was enough to prevent hernia formation and optimize facial healing. But is this still evidence based? We can extrapolate data from a May 2026 systematicreview/meta-anlysis as well as a separate study from the Dutch published in 2021. Both of these studies were in the journal Hernia. The evidence does favor one technique over the other! Listen in for details.1.     Golling M, Baumann P, Kuger F, Fortelny RH.Impact of the SUture BIte TEchnique on clinical outcomes after midlinelaparotomy closure: SUBITE-a systematic review and meta-analysis. Hernia. 2026May 19;30(1):221. doi: 10.1007/s10029-026-03700-z. PMID: 42154339; PMCID:PMC13186860.2.     Paulsen CB, Zetner D, Rosenberg J. Variation inabdominal wall closure techniques in lower transverse incisions: a nationwidesurvey across specialties. Hernia. 2021 Apr;25(2):345-352. doi:10.1007/s10029-020-02280-w. Epub 2020 Aug 8. PMID: 32770366.

Today, we are talking about a true paradigm shift in prenatal genetics. For decades, we’ve relied on cell-free DNA for screening, but when it came to definitive confirmation of fetal aneuploidy, we’ve had to counsel our patients through the anxiety and physical risks of invasive procedures like amniocentesis and CVS. But what if the line between screening and confirmation just blurred? In this episode, we are diving into an avant-garde, first-of-its-kind maternal blood test that is now actively in clinical use and may prove to rival traditional invasive testing for fetal aneuploidy confirmation: the Unity CONFIRM test. To break down the cutting-edge science, the clinical validity, and exactly what this means for your daily practice, I am thrilled to welcome Jen Hoskovec, the Vice President of Medical Affairs for BillionToOne. You might have recently seen her insights featured alongside Dr. Haywood Brown in Contemporary OB/GYN, and today, she’s here with us. We’re going to discuss the availability of this test, the technology that makes it possible, and what the next concrete steps are for integrating this into modern obstetrical care. Grab your coffee. Let’s get into the science.1. https://www.contemporaryobgyn.net/view/haywood-brown-md-jennifer-hoskovec-explain-new-non-invasive-confirmatory-test2. Screening for Fetal Chromosomal Abnormalities PA; January 2026

Back in June 2024, we highlighted surprising data from JAMA Network Open regarding adolescent care in the ED. Because many adolescents use the ED as their primary care provider, it’s a good opportunity for them to have contraception addressed regardless of why they presented. But that’s not what was happening. That publication from two years ago showed significant gaps in addressing contraception in the ED to pregnancy vulnerable young women, mainly teens. We covered those results back then and said that that would be a wonderful QI project for any resident or medical students to work with their hospital ED to improve that. Well, now a similar publication, looking at a different target- STI empiric treatment among pregnant women in the ED, has been published with that same vibe. Yep, there are BIG discrepancies in what pregnant women are given- or in this case, NOT GIVEN, in the ED compared to their nonpregnant peers. This was published in mid-April 2026. Two big questions remain unanswered in this data. Listen in for details. 1. Gottlieb M, Moyer E, Slocum GW, et al. Sexually Transmitted Infection Treatment Rates Among Pregnant vs Nonpregnant Patients in Emergency Departments. JAMA Network Open. 2026. 2. Canter H, Reed J, Palmer C, et al. Contraception Use and Pregnancy Risk Among Adolescents in Pediatric Emergency Departments. JAMA Netw Open. 2024;7(6):e2418213. doi:10.1001/jamanetworkopen.2024.18213

It's a QUICKY: IMPROMPTU episode in clinic today..

Welcome back, everyone. Today we're diving into one of the most hotly debated topics in obstetrics- should we be treating preeclampsia without severe features with antihypertensive medications during expectant management? Now, if you've been following the literature- and our show, you know that the landmark CHAP trial changed the game for chronic hypertension in pregnancy. It showed us that targeting a blood pressure below 140 over 90 reduces serious maternal complications, without harming the baby. That was a big deal. But here's the thing, CHAP studied chronic hypertension. Then there was the CHIP trial- that also found that tight control of gestational hypertension and nonproteinuric chronic hypertension was also beneficial. These did not address preeclampsia without severe features, and yet, the ripple effects of that trial have sparked a global conversation about whether we should be extending those same treatment principles to women with preeclampsia who don't yet have severe features. And this is where it gets really interesting, because the guidelines don't agree. In the United States, ACOG and the Society for Maternal-Fetal Medicine still say: hold off on antihypertensives unless blood pressures hit the severe range at 160/110. But step outside the US, and you'll find the World Health Organization, the International Society for the Study of Hypertension in Pregnancy, FIGO, NICE, and Hypertension Canada all recommending treatment at 140 over 90, regardless of whether the diagnosis is chronic hypertension, gestational hypertension, or preeclampsia. So who's right? And more importantly what does this mean for the patient sitting in front of you right now, at 34 weeks, with a blood pressure of 150 over 95, some proteinuria, but no severe features? Today, we're going to break this down. We'll review the controversy, walk through the divergent guidelines, and most importantly talk about the real, practical implications that favor treating these patients during expectant management. Because when you're watching someone with preeclampsia, waiting for the right time to deliver, there's a strong argument that controlling their blood pressure isn't just reasonable…may be protective. So grab your coffee, settle in, and let's get into it.1. Society for Maternal-Fetal Medicine Statement: Antihypertensive Therapy For mild chronic Hypertension in Pregnancy-The Chronic Hypertension And Pregnancy Trial. American Journal of Obstetrics and Gynecology. 2022. Society for Maternal-Fetal Medicine; Publications Committee. 2. Preeclampsia. The New England Journal of Medicine. 2022. Magee LA, Nicolaides KH, von Dadelszen P.3. Antihypertensive Drug Therapy for Mild to Moderate Hypertension During Pregnancy.The Cochrane Database of Systematic Reviews. 2018. Abalos E, Duley L, Steyn DW, C.4. Prevention and Treatment of Maternal Stroke in Pregnancy and Postpartum: A Scientific Statement From the American Heart Association. Stroke. 2026. Miller EC, Bello NA, Chen PR, et al.5.Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association. Hypertension. 2022. Garovic VD, Dechend R, Easterling T, et al.