In this episode, we discuss performing Cesarean for fetal weights at lower thresholds than currently recommended. Then we discuss new literature regarding utility of pelvic exams or screening asymptomatic women and early rupture of membranes after cervical ripening with a Foley bulb. Then we discuss an editorial discussing selecting the best test and hysteroscopy for miscarriage after embryo transfer. Plus, a new RCT that examines stopping oxytocin once a patient is in active labor. Finally, we answer listener questions about harms of yearly pap smears and whether we plan to use Zuranolone for treatment of postpartum depression. Buckle up!
This is Thinking About OPGYN, with your hosts Antonia Roberts and Howard Harrell.
Speaker 2:
Antonia.
Speaker 1:
Howard.
Speaker 2:
What are we thinking about on today's episode?
Speaker 1:
Well, we're going to answer some listener questions and review some new literature about pelvic exams, labor management, miscarriage management, among other things. So more of a potpourri day. And, speaking of questions, people should send us more questions, which they can do now by following our Instagram account, which is at Thinking About OPGYN, and sending a message or comment on there, but we do already have a few questions for today.
Speaker 2:
I hear is that the new co-host here.
Speaker 1:
Yes, he's here. He sometimes needs to eat and snuggle and do newborn things and he's very awake and engaged in our conversation already.
Speaker 2:
Well, and his job mainly is to add in cute background baby noises. So, we don't have much of a budget for sound effects, so anything he can do we appreciate.
Speaker 1:
Yeah, if there was any profitability to be made, I'm sure he would deserve a cut.
Speaker 2:
He gets 99% of all profits from this podcast.
Speaker 1:
Yes, perfect, okay, well, let's get started. So what's the thing we do without evidence?
Speaker 2:
Well, how about extensive counseling about the risk of a shoulder dystocia for a woman who may be about to go in labor or in labor or is in labor? Or even recommending a cesarean delivery prophylactically to avoid shoulder dystocia, for situations where the estimated feet of weight is just over 4,000 grams, something bigger than 4,000 grams?
Speaker 1:
I'm sure this does happen a lot and I can remember from at least in my training, whenever we would have turnover If someone said EFW over 4,000, and everyone would say, oh, is there a step in the room, are we all ready for the shoulder dystocia?
Speaker 1:
So I'm sure this happens a lot throughout at least the US, if not the world maybe. And I have read some of my patients' prior op notes from their prior C-sections and other OB records and I've seen this counseling just blatantly documented by their providers as if it was the standard of care to do a C-section because the EFW is 4,000. And a lot of times it was like then the baby was 3,800 grams and it's absolutely against the standard of care. So 4,000 is significant because it's the definition of macrosomia. So there may be clinicians who basically try to scare the patients out of their wits about everything that macrosomia has ever been associated with. So it is associated with a higher rate of shoulder dystocia, also an increased risk of hemorrhage, cesarean delivery or perineal trauma, as well as future obesity and insulin resistance in that baby when they grow up and just a ton of things statistic.