In this episode, Antonia and Howard explore the groundbreaking study on treating male partners for bacterial vaginosis, revealing significantly reduced recurrence rates and challenging our traditional understanding of BV pathophysiology.

Plus:

• Evidence doesn't support treating mild gestational hypertension with antihypertensives
• Studies confirm acetaminophen in pregnancy doesn't cause ADHD or autism
• New research questions the benefit of routine postpartum thromboprophylaxis

• The history of heparin and coumadin

00:00:34 Treating Mild Hypertension in Pregnancy

00:06:14 Distinguishing Chronic vs. Gestational Hypertension

00:15:46 Male Partner Treatment for Recurring BV

00:27:09 Understanding Bacterial Vaginosis Pathophysiology

00:35:42 Ineffective Treatments and Alternative Approaches

00:53:04 Tylenol in Pregnancy: Debunking ADHD Claims

00:58:02 Postpartum Thromboprophylaxis: Evidence Against Overuse

Follow us on Instagram @thinkingaboutobgyn.

This episode features our favorite podcast ninja, Dr. Maddie White. She and Howard discuss how medical dramatizations misrepresent obstetric emergencies (yes, we are watching The Pitt). Then, we dissect evidence-based approaches to common triage scenarios including labor evaluation, rupture of membranes, and preterm labor assessment.

• Television shows like "The Pitt" and "ER" portray shoulder dystocia and postpartum hemorrhage inaccurately, lacking proper urgency and technique
• Hospital-based labor triage often costs approximately 10 times more than office-based evaluation, often without clinical benefit
• Understanding pretest probability fundamentally changes how test results should be interpreted for suspected rupture of membranes
• Most expensive tests like Amnisure (>$500) provide minimal additional value over traditional approaches when interpreted properly
• Evidence doesn't support routine use of fetal fibronectin testing in preterm labor evaluation
• We discuss universal cervical length screening for prevention of preterm labor in the midtrimester and later in pregnancy for evaluation of threatened preterm labor

00:00:53 Critiquing Obstetric Emergencies in TV Shows

00:10:13 Proper Management of Shoulder Dystocia

00:14:52 Postpartum Hemorrhage Management Approaches

00:19:59 Evaluating Term Labor Complaints

00:25:35 Rupture of Membranes Testing Strategies

00:34:12 Understanding Test Probability and Performance

00:42:26 Cervical Length Screening Evidence

00:51:23 Preterm Labor Triage Tools

01:00:23 Concluding Thoughts on Evidence-Based Practice

Follow us on Instagram @thinkingaboutobgyn.

Antonia Roberts and Howard Herrell review several new articles:

• Epifoam for postpartum pain lacks evidence of effectiveness compared to simple ice packs while costing nearly $100 per unit
• AMH levels above 5.39 are associated with PCOS diagnosis, providing a specific threshold for clinical use
• External aortic compression demonstrated as a life-saving technique during severe obstetric hemorrhage
• Vaginal estrogen in breast cancer survivors shows no increased risk of cancer recurrence or mortality
• Delayed cord clamping in preterm twins reduces mortality by 30% and significantly decreases transfusion needs

Then they discuss new birth control options while questioning the value of expensive pharmaceutical products compared to established, less costly alternatives.

• New birth control options like Balcoltra ($280/month), FemLyv ($215/month), and Nextstellis ($250/month) offer minimal innovation over generic alternatives costing $10-15/month
• Marketing terms like "bioidentical" and "plant-based" are often misleading as all hormonal contraceptives are synthesized from plant precursors
• Progestin-only pills like Slynd provide only marginal DVT risk reduction (5 vs 4 per 100,000 person-years) compared to low-dose combined pills

Check our Instagram for more information and join us again in two weeks for our next episode.

00:00:00 Introduction and Epifoam Discussion

00:06:27 Financial Impact of Unnecessary Treatments

00:11:09 AMH Levels for PCOS Diagnosis

00:15:11 External Aortic Compression for Hemorrhage

00:20:22 Vaginal Estrogen and Delayed Cord Clamping

00:21:51 New Birth Control Products Overview

00:31:05 Analyzing Dissolvable Birth Control Pills

00:34:22 Slynd: Drosperinone-Only Pill Evaluation

00:42:09 Nextstellis and "Bioidentical" Estrogen Claims

00:56:37 History of Birth Control Development

Follow us on Instagram @thinkingaboutobgyn.