ENTG New Removal Guidance (SGP Article in Press)

Welcome back to the show, everyone! Today,we are diving deep into one of the most effective, set-it-and-forget-it contraceptive options available: the Nexplanon implant. With a failure rate of about 0.05%, it is apowerhouse of birth control. You pop it just under the skin of the inner upper arm, and for up to five years, you are covered. Standard removal is usually a quick, straightforward, in-office visit. But what happens when you go to feel for the implant... and it’s not palpable? That single scenario can beincredibly anxiety-provoking—both for the patient lying othe table and for the clinician trying to locate it. Did it migrate? Is it sitting deeper in the fascia or muscle? Or was it ever actually inserted in the first place? When an implant isn’t palpable, standard removal techniques won't cut it. What are theexact next steps for clinical localization? Which imaging modalities should you order first—high-resolution ultrasound, X-ray, or MRI? And here is a twist you might not expect: what on earth does a vasectomy procedure have to do withremoving a difficult Nexplanon implant? Believe it or not, specialized removal techniques borrowing instruments from vasectomies are changing the game for deep implant retrievals! In today’s episode, we break down the brand-newclinical guidance from the Society of Family Planning, authored by Dr. Paula Castaño et al. and published in the journal Contraception. We’ll walk through the step-by-step algorithms for localization, safety protocols, and advanced removal techniques so you can handle non-palpable implants with complete confidence. Grab your coffee, hit subscribe, and let’s dive into the details!1.     Castaño PM, Creinin MD, Eisenberg DL, et al.Society of Family Planning Committee Statement: Management and removal of deep and nonpalpable contraceptive implants. Contraception. Published 2026.doi:10.1016/j.contraception.2026.1115672.     Society of Family Planning. News release: TheSociety releases clinical guidance addressing contraceptive implant removal, expands pathways to timely care. Published August 31, 2026. Accessed September 10, 2026. https://societyfp.org/about/society-statements/news-release-the-society-releases-clinical-guidance-addressing-contraceptive-implant-removal-expands-pathways-to-timely-care/ 

Picture this common, late-gestation conundrum: You’re reviewing a 34-week sono. The mid-pregnancy 24-to-28-week glucose screen was completely normal. But now, the sonogram pops up with an estimated fetal weight of over 90%, or maybe a MVP (or AFI) that’s overtly elevated. The classic clinical dilemma hits: Do you order a repeat OGTT this late in the game? Is it actually worth poking the patient again, or are you just chasing shadows? Well, we now have new meta-analytic data. Today, we are reviewing fresh, high-yield data hot off the press from the American Journal of Obstetrics & Gynecology (OCT 2026). We’re breaking down this systematic review evaluating late-onset GDM- looking at precisely who may yield a positive diagnosis on a repeat third-trimester test, why LGA and polyhydramnios are not created equal when deciding to re-screen, and what these late numbers mean for neonatal hypoglycemia and cesarean delivery rates. AND, although these insights are helpful- some questions remain. Let’s jump in!1. Dominsky O, Berkovitz-Shperling R, Rosenberg-Fridman M .Late-onset diagnosis of gestational diabetes after normal mid-pregnancy screening in women with large for gestational age or polyhydramnios: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology, 2026; 235, 789-799

Today we’re diving into a lab order that almost every ob-gyn, midwife, and labor-and-delivery nurse were traditionally trained to do: the routine Postpartum Day 1 Hemoglobin and hematocrit. For decades, checking a patient’s H&H after delivery was automatic. Didn’t matter if it was a smooth, uncomplicated vaginal birth with minimal blood loss or a complex emergency C-section- come 6:00 AM the next morning, someone was drawing blood. Historically, the logic felt airtight: First, visual estimation of blood loss (the EBL) during delivery is notoriously inaccurate; clinicians often underestimate heavy bleeding by as much as 30 to 50 percent. Second, severe postpartum anemia can be sneaky. A patient might look fine lying in bed, but an undetected crash in hemoglobin can lead to severe fatigue, impaired bonding, delayed recovery, or even delayed postpartum hemorrhage complications. And third, early detection meant early intervention- giving iron or transfusing blood before the patient got discharged home. It was standard, it was defensive, and it felt safe. But here is the million-dollar question: Is a blanket, universal Postpartum H&H actually evidence-based in modern obstetric care? Or are we just poking healthy, asymptomatic patients, driving up healthcare costs, and treating lab numbers instead of the clinical patient? Today we will be looking at what the major guidelines, including ACOG, actually say, and why target-based screening has long replaced universal testing. Let’s get into it!1. Ruiz de Viñaspre-Hernández R, Gea-Caballero V, Juárez-Vela R, Iruzubieta-Barragán FJ.The definition, screening, and treatment of postpartum anemia: A systematic review of guidelines. Birth. 2021. 2. Anemia in Pregnancy: ACOG Practice Bulletin, Number 233.Obstetrics and Gynecology. 2021. Committee on Practice Bulletins—Obstetric3. Muñoz M, et al. Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement. Transfus Med. 2018 Feb;28(1):22-39

If you’ve been following health and medical headlines over the past few weeks, you’ve likely seen a renewed and urgent conversation around postpartum depression—a condition that affects millions of new mothers worldwide, often with devastating consequences. While we’ve long understood that postpartum depression is deeply multifactorial—shaped by a complex web of hormonal shifts, psychological stressors, and socio-economic factors—a compelling wave of new data points to a key physical variable that might be playing a far bigger role than we previously realized: how we manage pain during cesarean deliveries. Specifically, emerging studies are highlighting a striking potential association between the use of general anesthesia during C-sections and a higher risk of subsequent postpartum depression compared to neuraxial options like epidurals or spinal blocks. Why would the choice of anesthetic in the operating room ripple into neurochemical changes weeks or months later? In today’s episode, we’re going to dive deep into this latest data. We’ll break down what the numbers actually tell us, examine the clinical nuances, and explore the potential biological and neuroendocrine mechanisms of action—from acute inflammatory cascades to neurotransmitter disruption—that could explain this link.1. Oh TK, Song IA. Neuraxial versus General Anesthesia for Cesarean Delivery and the Risk of Postpartum Depression: A Nationwide Population-Based Study. Anaesth Crit Care Pain Med. 2026 Jun 3:101871. doi: 10.1016/j.accpm.2026.101871. Epub ahead of print. PMID: 42242358.2. Fagan JJ, Dufour SI, Duet SJ, Downs EM, Siddaiah H, Viswanath O, Shekoohi S, Kaye AD. Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature. Neuropsychiatr Dis Treat. 2026 Apr 14;22:579920.3. Guglielminotti J, Monk C, Russell MT, Li G. Association of General Anesthesia for Cesarean Delivery with Postpartum Depression and Suicidality. Anesth Analg. 2025 Sep 1;141(3):618-628. 4. Xie SC, Liu CH, Hung YT. Association between postpartum depression and anaesthesia methods in women undergoing caesarean section: A systematic review and meta-analysis. Eur J Anaesthesiol. 2026 Jan 1;43(1):66-73. doi: 10.1097/EJA.0000000000002252. Epub 2025 Aug 6. PMID: 40771157.

MS is a complex polygenic disease with over 200 associated genetic variants. The risk of an offspring developing MS if one parent is affected is relatively low at 2% to 3% (though maternal transmission shows slightly higher heritability), with some possible epigenetic influences. The National Multiple Sclerosis Society reports that up to 4 times as many women have MS as men. The average age at MS diagnosis is around 30 years. Studies show this ratio has grown over the past several decades; in the mid-20th century, the ratio was roughly 2:1, but the proportion of affected females has steadily increased due to a combination of environmental, hormonal, and diagnostic factors. MS does not impair natural fertility, so OB providers should be aware of the effect of pregnancy on MS and vice verse. In this episode, we will review a brand new (as of Aug 8, 2026) expert review on the subject which was published in the AJOG. Over the last decade, clinical guidance has shifted from advising women with MS to avoid pregnancy to a more active and permissive stance, largely due to the advent of new pharmacological and biologic therapies. Listen in for details. 1. Balshi A, et al. Management of Multiple Sclerosis During Pregnancy and the Reproductive Years in 2026: An Expert Clinical Review, American Journal of Obstetrics and Gynecology (2026), doi: https://doi.org/10.1016/j.ajog.2026.08.043.

The ACOG PB 222 states, “In women with preeclampsia with severe features at less than 34 0/7 weeks of gestation, with stable maternal and fetal condition, expectant management may be considered”. The expectant management of preeclampsia with severe features before 34 0/7 weeks of gestation is based on strict selection criteria of those appropriate candidates and is best accomplished in a setting with resources appropriate for maternal and neonatal care. BOX 4 in that ACOG guidance lists “Conditions Precluding Expectant management”, with one of the conditions being “Uncontrolled severe-range blood pressures (persistent systolic blood pressure 160 mm Hg or more or diastolic blood pressure 110 mm Hg or more not responsive to antihypertensive medication” (i.,e. persistent and refractory to appropriate medication). But what defines “uncontrolled hypertension”? When is preterm delivery indicated based on that feature? In this episode, we will answer this real-world clinical question. So, for a patient who is otherwise stable, asymptomatic, without HELLP syndrome, whose fetus is stable but is under 34 weeks, when can “uncontrolled hypertension” be diagnosed to prompt delivery? Listen in for details as we highlight the 2022 SMFM Special Report on that matter. 1. ACOG PB 2222. SMFM Special report: Preeclampsia: a report and recommendations of the workshop of the Society for Maternal-Fetal Medicine and the Preeclampsia Foundation, Nov 20223. De Backer J, Haugaa KH, Hasselberg NE, et al. 2025 ESC Guidelines for the Management of Cardiovascular Disease and Pregnancy. European Heart Journal. 20254. SOGC Clinical Practice Guideline: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy: Executive Summary; No. 307, May 20145. ISSHP (2018): The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Preg Hypertension. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/http://www.isshp.org/wp-content/uploads/2018/06/1-s2.0-S2210778918301260-main.pdf

So, here is a not uncommon situation: A new OB patient presents for initial prenatal care at 28 weeks by “sure LMP” but her ultrasound EGA is just over 3 weeks behind. Simple redating, right? How can we be assured that we are not missing FGR? That is where the “ancillary” use of transcerebellar diameter (TCD) plays a role. In this episode, we will highlight the recent JUNE 2026 data on this and review the 4 scenarios when this supplemental ultrasound finding can play a vital role. 1. Fetal Transcerebellar Diameter Measurement With Particular Emphasis in the Third Trimester: A Reliable Predictor of Gestational Age. AJOG. 2004. 2. Elgadi A, Wagealla M, Idris E, Eissa AYH, Altraifi S, Altraifi H, Abdallah E, Noorallah T, AbdAlla E. Accuracy of Ultrasonographic Transcerebellar Diameter for Gestational Age Estimation: A Systematic Review and Meta-Analysis. J Clin Ultrasound. 2026 Jun 17.3. ACOG Committee on Obstetric Practice. Committee Opinion No 700: Methods for Estimating the Due Date.Obstetrics and Gynecology. 2017. 4. Arzik IG, Golbasi H, Can ST, Aktas HA, Cakir ZE, Purut CS, Torun R, Toka I, Oztataroglu C, Ekin A. Role of Transcerebellar Diameter in Estimating Gestational Age in the Third Trimester: A Comparative Analysis in Fetuses With Different Growth Patterns. J Ultrasound Med. 2026 Apr;45(4):895-903.

Today we are diving into a topic that is incredibly close to my heart—one that has the potential to fundamentally change how we approach prenatal care and protect pregnant patients. We’re talking about low-dose aspirin for the prevention of hypertensive disorders of pregnancy. Now, if you follow current formal guidelines, you probably know the standard protocol: 81 milligrams a day, prescribed based on specific risk factors. But there’s a growing body of evidence suggesting we might be underdosing—and under-prescribing. What if 162 milligrams taken universally across the board is actually far more effective?In today’s episode, we’re unpacking a brand-new, groundbreaking study published in the American Journal of Obstetrics & Gynecology. And I’m especially excited to cover this one because it comes straight out of my alma mater, Parkland Hospital! This study takes a bold look at real-world outcomes by comparing a period of universal 162-milligram aspirin use directly against a historical period when aspirin wasn’t recommended at all. Did a higher, universal dose significantly cut down on hypertensive disorders? And just as importantly …were there any adverse safety events we need to be aware of? Grab your coffee, settle in, and let's get into the details.1. Duryea E, Ambia A, Pruszynski J. et al. Universal Aspirin Dispensation for Prevention of Preeclampsia in a High-Risk Population. AJOG, 2026; ePub 8/27/282. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013 Nov;122(5):1122-1131. 3. ACOG Issues Updated Hypertension Guidance, Discusses New ACC/AHA Criteria (2018): https://www.acog.org/news/news-releases/2018/12/acog-issues-updated-hypertension-guidance4. Low-Dose Aspirin Use During Pregnancy, ACOG Committee Opinion Number 743 (2018)5. Low-Dose Aspirin Use for the Prevention of Preeclampsia and Related Morbidity and Mortality. ACOG Practice Advisory; December 2021

Today, we are tackling a massive grey area in obstetrics/maternal-fetal medicine: What happens after early fetal growth restriction resolves? When a baby bounces back on the growth chart during the second or third trimester, are they completely out of the woods? Or is there a hidden, lingering risk we aren’t talking about enough? To find out, we’re doing a deep dive into two major publications that dropped just this month, in August 2026 in sister journals (AJOG and AJOG MFM). Both are retrospective, both ask the exact same burning question…and get this: they arrive at completely opposing conclusions. How is that possible? Listen in for details. 1. Melamed B, Mei-Dan E, Aviram A. Sonographic fetal weight estimation percentiles should be interpreted with caution in the second trimester. Int J Gynaecol Obstet. 2026 May;173(2):930-939. doi: 10.1002/ijgo.70693. Epub 2025 Nov 25. PMID: 41288086.2. Ramos SZ, Has P, Gimovsky AC, Danilack VA, Savitz DA, Lewkowitz AK. Outcomes among Neonates after a Diagnosis of Persistent or Transient Fetal Growth Restriction Delivered at Term. Am J Perinatol. 2024 May;41(S 01):e1470-e1477. doi: 10.1055/a-2051-3859. Epub 2023 Mar 9. Erratum in: Am J Perinatol. 2024 May;41(S 01):e1478. doi: 10.1055/s-0044-1786526. PMID: 36894159; PMCID: PMC10562520.3. Keller N, Jackson F, Abelman S .Neonatal morbidity following resolution of fetal growth restriction diagnosed at second-trimester anatomy ultrasound. American Journal of Obstetrics & Gynecology MFM, 2026; Aug 8. 4. Cenac LA, Wodoslawsky S, Patel V, McLaren Jr. R, Aghai ZH, Makhamreh MM, Al-Kouatly HB, Persistent, Resolved, and Absent Fetal Growth Restriction: A Comparison of Neonatal Outcomes, American Journal of Obstetrics and Gynecology (2026), doi: https:// doi.org/10.1016/j.ajog.2026. Aug 19

The word CERCLAGE comes from the French word, cercle, meaning "hooping" or "encirclement". Cerclage was traditionally reserved for cervical insufficiency but is now a recognized option for patients with a history of preterm birth and a short cervix noted on ultrasound between 16-24 weeks. There are three (3) main indications for obstetrical, cervical cerclage: History-Based, Ultrasound-Based, and Physical- Exam Based. In this episode, we will summarize the key takeaways from the new ACOG CPG on OBSTETRICAL CERCLAGE, being released in September 2026.1. ACOG CPG, Obstertrical Cerclage, Sept 20262. ACOG Practice Bulletin #234: Prediction and Prevention of Spontaneous Preterm Birth, 2021