A Doctor Delivers Podcast with Shannon M. Clark, MD

Dr. Shannon M. Clark discusses the following with genetic counselor, Liz Sheehan @agirlsnameisbizbiz: •what are fetal chromosomal aneuploidies •different types of antenatal screening tests •cell-free DNA screening •NT measurement plus serum screening in first trimester •quad screen in second trimester •screening PGT tested embryos •ultrasound soft markers: choroid plexus cysts, echogenic intracardiac focus, echogenic bowel, pylectasis, single umbilical artery

Sen. Bill Cassidy of LA, who is also an MD specializing in GI or liver disease, had an interview with POLITICO for the Harvard Chan School of Public Health series Public Health on the Brink on May 19. He has claimed to be unapologetically “prolife”, but said in this interview when asked what needs to be done about LAs high maternal mortality rate, “About a third of our population is African American; African Americans have a higher incidence of maternal mortality. So, if you correct our population for race, we’re not as much of an outlier as it’d otherwise appear. Now, I say that not to minimize the issue but to focus the issue as to where it would be. For whatever reason, people of color have a higher incidence of maternal mortality.” I discuss these statements with Charles Johnson who founded of 4Kira4moms on 2017 after losing his wife Kira Dixon Johnson during a routine cesarean at Cedar Sinai hospital in Los Angeles. He is a voice for families facing unnecessary maternal loss and ending the maternal mortality crisis in this country. Recently, he worked with congress to pass the preventing maternal death act which is the first ever to combat the maternal mortality crisis in the US. The bill was signed into law on 12/21/2018 and dedicated to the memory of Kira Dixon Johnson.

Dr. Shannon M. Clark discusses the following with ObGyn, Dr. Fatima Daoud @doctordaoud:  •where does amniotic fluid go during a cesarean  •pregnancy after uterine rupture  •what is a uterine dehiscence  •cesarean birth and pelvic floor dysfunction  •lowering drape during a cesarean  •routine prenatal care •spontaneous preterm birth and cervical insufficiency and cerclage  •anterior placenta  •recommended interpregnancy and interdelivery intervals  •placenta previa  •TTC after a first trimester miscarriage  •hyperemesis gravidarum  •prevention of preeclampsia •delaying childbearing  •stillbirth after age 35  •recovering from a perineal tear  •going nontoxic for TTC  •pregnancy after tummy tuck  •TTC with menstrual cup/disc  •cervical ectropion and pregnancy

Dr. Shannon M. Clark discusses the following with ObGyn, Dr. Erica Montes @the.modern.mujer! •pregnancy monitoring after COVID infection •second COVID booster in pregnancy •interpregnancy and interdelivery intervals •exercise and activities with a short cervix •progesterone for short cervix •tubal ligation during a cesarean delivery •reasons for IUGR and recurrence risk •different ways to push •safety of tylenol in pregnancy •fetal kick counts •antiphospholipid antibody syndrome •adhesions during surgery •uterine atony •fetal hiccups •elective hysterectomy

This is National Infertility Awareness Week! Dr. Shannon M. Clark discusses the following with REI, Dr. Lucky Sekhon @lucky.sekhon: •IVF ad-ons: acupuncture, different forms of PGT, endometrial scratching, growth hormone, assisted hatching, steroids, embryo glue, aspirin •chromosomally abnormal versus mosaic embryos and embryo transfers •preparing your body for an embryo transfer •unexplained infertility •recurrent pregnancy loss •low or no sperm and biopsy •biochemical pregnancies •fresh versus frozen embryo transfer •following progesterone levels in early pregnancy

Dr. Shannon M. Clark discusses the following with MFM, Dr. Jasmine Johnson @mrsmommymd: -assessing fertility and future family planning at annual exams -health disparities and provider decisions about sterilization, treatment for ectopic pregnancy, fibroid management and more -disparities in fertility awareness -addressing preexisting medical conditions and medications -racial and ethnic disparities in severe maternal morbidities and mortality -maternal mortality data from 2020 and age groups -IVF pregnancy over age 40 and adverse pregnancy outcomes and multiple gestations -racial and socioeconomic disparities in those seeking fertility care -barriers to seeking fertility care -special considerations for first, second and third trimester care in those over 40 -special considerations for delivery planning in those over 40

Dr. Shannon M. Clark discusses gynecologic office procedures (EMB, IUD placement, colposcopy) and lack of pain control with ObGyn, Dr. Mary Claire Haver @thegalvestondiet and I discuss the following:  -How we were trained -Our personal experiences with these procedures -Myths about innervation of cervix -Why patients are not being heard -Options for pain control -What needs to be done to change things!

Dr. Shannon M. Clark discusses the following with Sierra Richard, PharmD @happypharmlife:  -Old and new pregnancy category labeling systems for medications in pregnancy  -How research on medications in pregnancy is done •Roadblocks to studying medications in pregnancy and lactation  -How to sign up for a pregnancy registry for a medication you are on  -Post-market and off-label use of medications in pregnancy and lactation  -What to do if your pharmacist refuses to fill a prescription for you because of pregnancy Recommend resources: @mothertobabyotis @postpartumsupportinternational InfantRisk for providers and MommyMeds for patients (apps) Perinatology.com, Drugs in Pregnancy and Breastfeeding @centerforwmh FDA Pregnancy Exposure Registries Drugs and Lactation Database (LactMed) For pharmacists: Brigg's Drugs in Pregnancy and Lactation that is built into Lexicomp

Dr. Shannon m. Clark discusses the following with REI specialist, Dr. Lucky Sekhon @lucky.sekhon:    -The role of progesterone and/or progesterone supplementation and ovulation, conception, corpus luteum , IVF, luteal phase defect, early pregnancy: threatened miscarriage and recurrent pregnancy loss -Prophylactic use during implantation window   -Preterm birth: 17OHPC, vaginal progesterone, cervical length  -Short cervix: vaginal progesterone, cerclage and 17OHPC  -We also discuss bioidentical progesterone supplementation and if 17OHPC still being used!

Dr. Shannon M. Clark discusses the following with ObGyn Dr. Tamika Cross @tcross_md: -monitoring the uterine scar in someone with a prior cesarean for risk of uterine rupture and counseling for TOLAC  -uterine rupture  -pap smears and HPV  -subchorionic hemorrhage  -abruption and chronic abruption  -hiatal hernia in pregnancy  -ARRIVE trial and IOL at 39 weeks for AMA  -postpartum care and pelvic floor PT, behavioral health therapy, nutritional counseling  -what is a D&C  -cephalopelvic disproportion