A DCC Conundrum

Delayed cord clamp is standard of care. On today’s episode, we are stepping into a high-pressure dilemma in the labor and delivery room. Imagine this (which doesn’t need a lot of imagination, because it is a real event which occurred to one of our podcast family members): A mother has carefully drafted a birth plan. One of her non-negotiable requests is delayed cord clamping for two full minutes. But the moment the baby is delivered, it becomes clear that the infant is non-vigorous: floppy, pale, and not breathing. The baby urgently needs immediate resuscitation.The physician reaches for the cord shears, but the mother demands: "No! Wait the two minutes! It's my decision!" What happens next? Whose rights win out? Today, we’re exploring clinical guidelines, the core ethical principles, the legal mandates, and state FOUR established norms that govern the delivering professional’s actions. 1. American College of Obstetricians and Gynecologists Committee on Clinical Consensus–Obstetrics. ACOG Clinical Practice Update: An Update to Clinical Guidance for Delayed Umbilical Cord Clamping After Birth in Preterm Neonates. Obstet Gynecol. 2025 Jul 24;146(3):442-444. doi: 10.1097/AOG.0000000000006020. PMID: 40706055.2. Jabeen S, Salam SS, Gillespie S, Hasan M, Islam S, Chowdhury AT, Ameen S, Balen J, Rahman AE, Arifeen SE, Nahar Q, Anumba DO. Delayed cord clamping: Perceptions, practices and influencers among the healthcare providers of selected healthcare facilities in Bangladesh. PLoS One. 2024 Dec 5;19(12):e0313938.

Here is a sobering fact: Iron deficiency is one of the most common health conditions in the world. Iron deficiency affects an estimated one in three people, yet many go undiagnosed and untreated despite widespread treatment options. Iron deficiency can progress to iron deficiency anemia. If you’ve been listening for a while, you know we have banged the drum on this podcast time and time again about why serum ferritin matters. We’ve talked about how so many people suffer from low iron stores even when their basic blood work comes back looking "normal," and why we have to look way beyond just standard iron deficiency anemia. Well, guess what? The medical establishment is officially catching up! In September 2026, the American Society of Hematology (ASH) released brand new, evidence-based recommendations that are set to completely change how we diagnose iron deficiency. Published in ASH’s prestigious, peer-reviewed journal Blood Advances, these new guidelines were brought together by a multidisciplinary team of experts across multiple medical specialties to redefine critical thresholds- especially for women and during pregnancy. Today, we are diving deep into what these new guidelines actually mean for us. Listen in for details1. https://www.hematology.org/newsroom/press-releases/2026/ash-sets-new-standards-for-diagnosing-iron-deficiency2. https://ashpublications.org/bloodadvances/article/doi/10.1182/bloodadvances.2025015950/570502/American-Society-of-Hematology-2026-guidelines-for

Innie vs Outies: no, we are not referring to bellybuttons. In this episode, we’re talking about the labia of the Volva! Does it actually matter? Which one is more common? Now, this episode was actually sparked by a brilliant listener who sent us her question to our IG inbox (as a non-clinician): “Can having an innie labia actually cause me to have recurrent bacterial vaginosis?” Such a good question, right? So today, we’re going to break down what the medical literature actually says about anatomy and BV. Plus, well answer the question: What is ACOG’s stance on elective labioplasty? Grab a cup of coffee, get comfortable, and let’s normalize the normal. 1. Lykkebo AW, Drue HC, Lam JUH, Guldberg R. The Size of Labia Minora and Perception of Genital Appearance: A Cross-Sectional Study. J Low Genit Tract Dis. 2017 Jul;21(3):198-203. doi: 10.1097/LGT.0000000000000308. PMID: 28369012.2. Aydın A, Atılgan AE, Sönmez MG, Sönmez L, Boğa MS, Balasar M. Do variations in labial anatomy have an effect on recurrent urinary tract infection? Int Urogynecol J. 2020 Oct;31(10):2129-2136. doi: 10.1007/s00192-020-04310-8. Epub 2020 May 9. PMID: 32388633. 3. Elective Female Genital Cosmetic Surgery. American College of Obstetricians and Gynecologists. 2020. Committee on Gynecologic PracticeGuideline4. ACOG Committee Opinion 795: Elective Female Genital Cosmetic Surgery; 2020 (reaffirmed 2026)

Marfan syndrome is an autosomal dominant, connective tissue disorder. Because it’s autosomal dominant, an affected parent has a 50% chance of passing the genetic mutation to their offspring in every pregnancy. Approximately 25% of cases actually stem from spontaneous, de novo mutations with no prior family history. In the United States, the prevalence of Marfan syndrome is estimated at roughly 1 in 5,000 individuals. It affects males and females equally across all ethnic backgrounds. Although this topic and condition might sound rare at first glance- Marfan syndrome in pregnancy- it is in our communities, and we need to be ready for the potential complications that come with it. When is vaginal delivery allowable here? Do these patients need any maintenance meds during pregnancy? What about postpartum surveillance? Grab your coffee, get comfortable, and let's jump right in!1. Elkayam U et al. High-Risk Cardiac Disease in Pregnancy: Part II. J Am Coll Cardiol. 2016 Aug 2;68(5):502-516. doi: 10.1016/j.jacc.2016.05.050. 2. Milleron O, Arnoult F, Delorme G, et al. Pathogenic FBN1 Genetic Variation and Aortic Dissection in Patients With Marfan Syndrome. J Am Coll Cardiol. 2020 Mar 3;75(8):843-853. 3. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 Dec 13;80(24):e223-e393. 4. Narula N. et al. Pregnancy-Related Aortic Complications in Women With Marfan Syndrome. J Am Coll Cardiol. 2021 Aug 31;78(9):870-879.

If you’ve ever managed postpartum preeclampsia, you know the clinical gray zone: after an initial intrapartum course of magnesium sulfate, when do you actually restart it for a postpartum, readmission exacerbation? Always? There’s no standard national guidance on this. Every unit seems to do something a little different. In this episode, we’re summarizing a new study looking at practice patterns across the country. This study is actually a survey of US MFM fellowship directors across the ACOG Districts. This publication will be officiallyreleased/published in the Journal of Maternal-Fetal and Neonatal Medicine in December 2026. We’ll break down what these fellowship directors would do, why the variation exists, and what this means for your clinical practice. Let’sget into it.1.    Dellapiana G, Thompson K, Gregory KD. Repeatadministration of magnesium for an exacerbation of postpartum preeclampsia: anational survey. J Matern Fetal Neonatal Med. 2026 Dec;39(1):2738315. doi:10.1080/14767058.2026.2738315. Epub 2026 Sep 28. PMID: 42805980.

If you’ve been listening for a while, you might remember an episode we ran about two years ago where we dove deep into the use of low-titer O-positive whole blood in emergency resuscitation. At the time, the consensus in trauma care was leaning heavily "pro"—advocating for getting O-positive blood into bleeding patients fast, especially given the persistent and severe shortages of O-negative inventory. Fast forward to today, and the conversation around balancing immediate survival against downstream risks has taken center stage. In just the last two months, two major publications have come out with seemingly conflicting perspectives on this exact issue. First, in July 2026, the American College of Surgeons released their consensus guidance, which attempts to strike a delicate balance between saving lives in acute trauma and mitigating future reproductive risks associated with Rh sensitization in patients of childbearing potential. But then, in September 2026, Obstetrics & Gynecology—the Green Journal—published an editorial by Jacobs et al. offering a very different lens on the practice. In today's episode, we’re unpacking both papers, comparing where they align, where they clash, and what this evolving debate means for trauma protocols, blood bank management, and patient care on the front lines. Let’s dive in.​Post-Transfusion Management of RhD-Negative Females of Childbearing Potential Who Receive RhD-Positive Low-Titer Group O Whole Blood and Red Blood Cells During Trauma Resuscitation: A Joint Position Statement and Resource Document of the American College of Surgeons Committee on Trauma (ACS-COT), Prehospital Blood Transfusion Coalition (PBTC), National Association of Emergency Medical Services Physicians (NAEMSP), Trauma Hemostasis and Oxygenation Research (THOR) Network, and Allo Hope Foundation (AHF). J Am Coll Surg. July 2026.2. Jacobs, J. W., Callum, J., Adkins, B. D., Abels, E. A., Raza, S., Sharma, D., Wheeler, A. P., Osmundson, S. S., Chooljian, D. M., & Booth, G. S. (2026). RhD-Positive Whole Blood for Patients With Reproductive Potential After Two Randomized Trials of Prehospital Trauma Resuscitation; Obstetrics & Gynecology.

In June 2026, the ASRM released its updated guidance on recurrent pregnancy loss. This is the most updated guidance in over a decade and includes a decision tree algorithm that starts with a pivotal test. In this episode we will review this “first pass” triage test and provide clinical implications.1. ASRM CO: https://www.asrm.org/practice-guidance/practice-committee-documents/recurrent-pregnancy-loss-a-committee-opinion-2026/2. de Assis V, Giugni CS, Ros ST. Evaluation of Recurrent Pregnancy Loss. Obstet Gynecol. 2024 May 1;143(5):645-659. doi: 10.1097/AOG.0000000000005498. Epub 2024 Jan 4. PMID: 38176012.

Currently, the CDC U.S. Medical Eligibility Criteria (USMEC) rate CHCs as category 4 (unacceptable health risk) for migraine with aura, versus category 2 for migraine without aura; ACOG similarly recommends avoiding estrogen-containing contraception in migraine with aura. But, recent data published in August 2026 from the UK seems to show no increased risk with “modern”/low-dose combination birth control pills when compared to progesterone only options. Is the CDC contraindication out outdated? Not quite. Listen in for details.1. https://www.podcastrepublic.net/podcast/1412385746Ihara K, et al. Estrogen exposure from modern contraceptives and vascular risk in women with migraine: A nationwide electronic medical record database study. Cephalalgia. 2025 Dec;45(12):3331024251404924. doi: 10.1177/03331024251404924. Epub 2025 Dec 17. 2. Gibbs LR, Fox MP, Aparicio HJ, Jick S. Combined Oral Contraceptives and Stroke Risk in Individuals With Migraine With Aura. Obstet Gynecol. 2026 Aug 1;148(2):160-170. doi: 10.1097/AOG.0000000000006306. Epub 2026 May 7.

A growing body of research reveals the link between STIs andthe pathogens that cause most cases of vaginitis. Over 90% of vaginitis cases result from BV, yeast, or trich- alone or in combination. But, a recent 2024 study from Schwebke et al., in the J Clinical Microbiology, found that about 1 in 5 women who presented with symptoms of vaginitis also had at least one STI…a good reminder to not just stop at a VP3 or wet mount. Additionally, women who tested positive for BV had an STI infection rate double the rate found in womenwho tested negative for BV. In fact, T. vaginalis (TV) and Mycoplasma genitalium (M. gen) infections were significantly associated with BV. We generally trust our tests- don’t we? Negative VP3 for trich- all clear right? Not quite. In this episode, we will highlight our real case where the VP3 testconfirmed BV as the only issue in our symptomatic pregnant patient, yet the cervical NAAT collected at the same time returned positive for Trichomoniasis. Why the discrepancy? It actually is very common- and that may be a care gap.Listen in for details. 1.     Schwebke JR, Nyirjesy P, Dsouza M, et al.Vaginitis and risk of sexually transmitted infections: Results from a multi-center U.S. clinical study using STI nucleic acid amplification testing. J Clin Microbiol. 2024;62(9):e0081624.2.      Peebles, K., Velloza, J., Balkus, J. E.,McClelland, R. S. & Barnabas, R. V. High global burden and costs of bacterial vaginosis: a systematic review and meta-analysis. Sex. Trans. Dis. 46, 304–311 (2019).3.     Paladine HL and Desai UA. Vaginitis: Diagnosisand treatment. Am Fam Physician. 2018;97(5):321-329. 

An important clinical advantage of cfDNA screening for autosomal recessive conditions is its ability to provide meaningful fetal risk assessment in general-risk pregnancies at an early gestational age, even when partner carrier testing is unavailable. But is this reflex cell-free DNA approach reliable. In this episode, we will review NEW DATA (Oct 2026) from a prospective, multi-site study whose goal was to “evaluate the clinical performance of cell- free DNA (cfDNA) screening as a primary screening tool for autosomal recessive conditions in a large, prospective, general-risk population”. We will review the sensitivity, specificity, PPV and NPV of this (UNITY) approach. 1. A Prospective, Multi-Site Study of Performance of Cell-Free DNA Testing for Recessive Conditions in a Large, General-Risk Pregnancy Population. Obstet Gynecol (OCT) 2026;148:509–152. SMFM STATEMENT Society for Maternal-Fetal Medicine Statement: Evaluation and management of cell-free DNA screening for fetal red cell antigen genotype in alloimmunized and non-alloimmunized pregnancies. Pregnancy; June 2026