Fear the 37.5-37.9 °C Temp with PROM?

(Here’s a WONDERFUL QI Project for this New Residency Academic Year) With 70.8% of pregnancies among adolescents being unintended, there is a clear need for increased access to contraceptive services. Many adolescents use the emergency department (ED) as their primary healthcare source, highlighting the importance of providing comprehensive sexual health services in this setting. The risk of pregnancy is high among adolescents seeking ED care, indicating an opportunity to expand pregnancy prevention services in this setting. ED clinicians are in a unique position to address pregnancy prevention among adolescents. Novel ED staff training tools kits do exist for brief contraceptive counseling interventions during the ED visit for interested adolescents who present for any chief complaint. Talking to teens about contraceptives in the ED is feasible, acceptable, and allows ED staff to reach youth that may not have access or choose not to access medical care in any other setting. In this episode, we will summarize striking data from a recent publication (June 28, 2024), in JAMA Network Open, which revealed gaps in addressing contraceptive needs among vulnerable adolescent females and gaps in provisions of EC when needed. Additionally, we will propose an easy to adopt strategy to better equip Emergency Department staff for having these conversations.

PROM occurs in approximately 10% of pregnancies and leads to a risk of IAI in women that is 3 times higher than that in non-PROM women. The risk of early-onset sepsis of neonates born to mothers exposed to PROM is 20 times higher than in non-PROM mothers. An increasing time period with PROM increases the risk of infection for both mothers and newborns accordingly. Nonetheless, the ACOG states that there is insufficient evidence to justify the routine use of prophylactic antibiotics with PROM at term in the absence of an indication for GBS prophylaxis (ACOG PB217). HOWEVER, now that the ACOG has provided a clinical practice update on IAI (JULY 2027), emphasizing that the traditional “requirement” of maternal temperature of 38 °C (100.4F) need NOT be present for IAI diagnosis, new data suggests that febrile and infectious morbidity may be increased with PROM after 12 hrs with “low grade” maternal temps. In this episode, we will review the ACOG clinical practice update (briefly, as we covered that previously) in light of a June 11, 2024 AJOG publication analyzing the relation between low-grade fever during prolonged rupture of membranes (>12 hours) at term and infectious outcomes.

Podcast Family, I hope this episode gives you pause and brightens your day 🌞. Just a quick work and acknowledgement to likley our YOUNGEST podcast family member and his mother, a Co-OBGYN preparing for oral Boards. 👏👏 Let this speak to you as the message spoke to me! (and introducing ​callmestevieray & Connor Price, whose words/song- “GRATEFUL”- always lightens my load). 🎶👏🎶👏🎶

Oral Hormonal contraception gets the blame for a lot of things, including the development of hypothyroidism. Hypothyroidism is one of the most common endocrine disorders affecting 5 to 10 times more women than men, and its prevalence increases with age. This association of OCPs with hypothyroidism comes from a controversial article in BMJ published in 2021, but is still very active in current social media posts. Does combination oral birth control cause hypothyroidism with prolonged use? Are birth control pills responsible for “micronutrient depletion” which negatively affects the thyroid? In this episode, we will explore and dissect this study and look at a January 2024 case-control study that provides an alternative conclusion. Listen in for details.

Podcast Fam, on March 27, 2024 our episode was called "Balloon for PROM: Yea or Nay". Although mechanical cervical balloons for induction were the focus, we also discussed which medication is better (based on published data) for labor induction after PROM. Well, in this episode, we pick up from March with ANOTHER NEW STUDY released today (June 25, 2024) in AJOG MFM. This RCT builds on the evidence that going straight to Pitocin (despite an unfavorable cervix) is the way to go after PROM. Although there are study design limitations, this is reassuring- and validating- information. Listen in for the "I TOLD YOU SO DANCE", and for details.

Anxiety disorders are the most common mental health issue in the United States, affecting nearly 1 in 5 adults, or 40 million people. Another 19 million adults – 8% of the population – has depression. Prenatal mood disturbances are known to affect the fetal brain, and endocrine system. Left amygdalar volumes were smaller in newborns whose mothers had high psychological distress during the COVID-19 pandemic, a small cross-sectional study suggested. Infants of mothers with elevated maternal distress during the pandemic had median reductions in white matter, right hippocampal, and left amygdala volumes compared with neonates whose mothers had low distress levels, this is according to research from the Children's National Hospital in Washington, D.C. This was published in JAMA Network Open on June 20, 2024 and is making the medical headlines. This is fascinating data. BUT, this is NOT new news. In this episode, we will review the concerning effect that maternal mood and stress has on the developing fetal brain, and how maternal stress may even be leading to changes in the child’s puberty! Listen in for details.

Respect for patient autonomy is a fundamental part of the clinician-patient relationship and discussion of healthcare interventions. Some patients decline transfusion of blood products, either for religious or non-religious reasons, but most frequently as part of the Jehovah’s Witness faith. Acceptance of, and decision-making, surrounding blood products and human blood derived medications is complex, however, and some patients who decline certain blood products may still accept other interventions. Because childbirth can be associated with excess blood loss and need for resuscitation, it is important before delivery to clearly delineate which blood products will be accepted or declined, realizing that the patient can change her preferences at any time. One way proposed to address blood loss at cesarean section is the use is intraoperative cell saver (IOCS) for autologous infusion (re-infusion of blood). Is it appropriate to use cell savers to collect and re-infuse blood during a C-section? Does ACOG mention this as an option? And what about the use of erythropoietin antepartum to increase RBC capacity? These questions are the focus of this episode.

"HSDD" as a diagnosis has been gone for some time. According to the ACOG, the DSM-V defines the combined entity of female sexual interest/arousal disorder as a complete lack of or a substantial decrease in at least three of the following symptoms for at least six months: interest in sexual activity and sexual or erotic thoughts or fantasies. This is the most common sexual dysfunction in women, affecting an estimated 5.4–13.6% of women, based on who you read. It is most prevalent in women between the ages of 40–60 and in women who have undergone surgical menopause. Now, a new publication from the Green Journal (June 18, 2024) provides a potential “new”therapeutic option for women, although the data for this actually first came out June of 2023. Can topical sildenafil help with Female Sexual Arousal Disorder? There is already an over the counter cream like this!Let’s take a look at this June 2024 RCT. PLUS, we will also briefly discuss the EROS device for female sexual arousal.

Hypertensive disorders of pregnancy (HDP), including chronic hypertension, gestational hypertension, and pre-eclampsia, are increasingly common in the United States, complicating close to 15% of births, and the incidence is continuing to rise! On this show we have addressed medical management of urgent hypertension in pregnancy and in the immediate postpartum interval. This topic continues to EVOLVE, with a brand new study which has gained a lot of medical news attention. This new study was published in JAMA CARDIOLOGY on June 12, 2024 and is helping redefine the "BP cut off" for medication use in the pp interval. AND...this is evolving within the ACOG as well! We have LOTS of late breaking news to cover here....so listen in!

At time of post cesarean discharge, most providers prescribe a fixed number of opioid tablets. However, past data has shown that most patients don't use all the opioids they are prescribed. This leads to an excess of opioids in the community, which can ultimately lead to misuse and diversion. In this episode, we will highlight a new publication from the Green Journal (Obstet Gynecol) exemplifying an adoptable strategy using a individualized opioid prescribing protocol (IOPP). While this was published ahead of print on June 10, 2024, the concept of IOPP is not "new" at all. Listen in for details.