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Practice Bulletin #84 - Published August 2007 (Reaffirmed 2018) 1. Most patients who die from PE do so within 30 minutes of the event, so prevention is key. 2. If a patient is known to have Factor V Leiden mutation or prothrombin gene mutation 20210A, they should be considered high risk and managed appropriately intra- and post-operatively and in pregnancy 3. Compression stockings, pneumatic compression devices, and pharmacologic prophylaxis are all safe and useful in preventing VTE 4. Highest risk patients benefit most from a combined approach of mechanical or stocking prophylaxis combined with pharmacologic prophylaxis 5. Platelet inhibitors should be stopped 14 days before spinal or epidural anesthesia, unfractionated heparin or twice daily low molecular weight heparin 8-12 hours before, and low molecular weight heparin 18 hours before   Show Notes Wine pairing: 2019 Les Quatre Cepages from Domaine de Pajot Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

Practice Bulletin #81 - Published May 2007 (Reaffirmed 2018)   1. Both resectoscopic and non-resectoscopic techniques are safe and effective. 2. Size and shape of the uterine cavity and the presence of fibroids may impact efficacy of non-resectoscopic techniques 3. With resectoscopic techniques, careful monitoring of distension medium fluid is important. If too much fluid intravasates, dilutional electrolyte imbalances can have serious consequences. 4. Ablation is not recommended for patients who wish to preserve fertility. 5. Sample the endometrium before performing an ablation to evaluate for hyperplasia or malignancy.   Show Notes Wine pairing: 2017 Nero d’Avola Cabernet Sauvignon from Barone Montalto Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

Practice Bulletin #78 - Published Janury 2007 (Reaffirmed 2018) 1. Sickle cell trait (heterozygous for the mutation) is generally asymptomatic; sickle cell disease can have severe consequence 2. Sickle cell disorders are more common among individuals of African descent, whereas the thalassemias are more common among individuals of Southeast Asian and Mediterranean descent. 3. Alpha thalassemia results from deletion of any number of the four genes that code for the alpha chain. The more deletions, the worse the presentation. 4. Beta thalassemia results from mutation of one or both of the genes that code for the beta chain. Severity of disease is determined by presence and degree of functionality within intact genes. 5. Sickle cell disease is a risk factor for preterm delivery, IUFD, IUGR, etc., therefore, antepartum fetal surveillance is recommended Show Notes Wine pairing: 2018 Sainte Marie Corbieres from Domaine Faillenc Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

Practice Bulletins #219 - Published April 2020 1. Episiotomies should never be performed routinely, even if you were trained to do it routinely to assist in operative vaginal delivery. If you think it's absolutely necessary, counsel the patient so that she can make an informed decision. 2. Overall, operative vaginal delivery carries low absolute risk for baby and mom w/ comparable relative risk compared to c-section 3. Vacuum-assisted delivery carries higher risks to the fetus when compared to forceps and lower risks to mom. 4. Major benefit to operative vaginal birth is decreased risk of hypoxic injury to the newborn in the event of successful expedited vaginal delivery through operative means (assuming there is concern for fetal acidemia) 5. Forceps, even in trained hands, carries significantly higher risk of severe perineal injury compared to vacuum. Show Notes **Visit our friends at www.intimatewellnessshop.com for bushels of sex positivity, including toys, massage oils, self-care products, and more! Use code MOREWINE at checkout for 15% off your purchase!** Wine pairing: 2018 Willamette Valley Pinot Noir from Inscription Wine Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

Practice Bulletins #188 - Published January 2018 1. Management recommendations in PROM/PPROM is dependent on gestational age: >37 0/7 wga => induction/augmentation 34 0/7 - 36 6/7 wga => expectant management or induction/augmentation <34 0/7 wga => expectant management 2. Diagnosis of  PROM is based on history and physical: pooling of fluid, pH of vaginal fluid, and ferning on microscopy. 3. Indications for induction/augmentation for both PROM and PPROM include abnormal fetal testing, evidence of intra-amniotic infection, and vaginal bleeding suggestive of abruptio placentae. 4. For PPROM (24 0/7 - 33 6/7 wga) --> antibiotics and steroids should be offered, and magnesium sulfate should be offered at <32 wga 5. The diagnosis of periviable ROM is best followed up with careful counseling around the risks and benefits. It can be managed with induction or expectant management, which, after hospital assessment, can be provided via home care until viability Show Notes Wine pairing: 2019 Malbec from Espuela del Gaucho Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

SPECIAL EPISODE - Interview w/ Hermine Hayes-Klein, JD, and Brad Bootstaylor, MD, FACOG In this episode, we'll be discussing the problematic culture of hospital-based birth. We explore the physician-patient relationship, the responsibilities that come with the rights to informed consent and refusal of treatment, and how supercomputers in the hands of our patients have enabled them to view us as the enemy, and vice-versa. Most importantly, we discuss ways in which we may all begin to mend the physician-patient relationship in order to redirect the culture of hospital-based birth. Show Notes Wine pairing: 2017 Sauvignon Blanc from Psyche Wines Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

Practice Bulletins #189 - Published January 2018 Five pearls: 1. The decision to treat should be informed by the woman’s perception of the severity of symptoms, her desire for treatment, and the potential effect of treatment on her fetus 2. Use of prenatal vitamins 1 mo before fertilization may reduce incidence and treating nausea and vomiting of pregnancy (NVP) can prevent progression from NVP to hyperemesis gravidarum (HG) 3. After dietary and nonpharmacologic options (e.g. ginger) have been tried, first-line pharmacotherapy entails trying vitamin B6 alone or vitamin B6 plus doxylamine 4. Antithyroid drugs are not recommended for abnormal maternal thyroid tests attributable to gestational transient thyrotoxicosis or HG 5 .Hospitalization for evaluation and treatment of dehydration and electrolyte imbalance is indicated when a woman can’t tolerate liquids without vomiting and hasn’t responded to outpatient management Show Notes Wine pairing: 2018 Pinot Noir from Hedgeline Vineyards Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

SPECIAL EPISODE - Interview w/ Elizabeth Catlin, CPM, Melissa Carman, CPM, and Hermine Hayes-Klein, J.D.  In this special episode, I speak with two midwives about their recently being arrested and charged with the "unauthorized practice of a profession" in the state of New York. They have served the Amish and Mennonites communities for years, and these charges are just another piece in the government's and medical profession's efforts to control a woman's right to choice in pregnancy and childbirth. We are joined by an attorney who specializes in human rights in childbirth. Show Notes Wine pairing: 2017 Merlot from Chalkboard Wines Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

"Today is my final shift as an obstetrician. You'll find me breaking bread with the birth educators, doulas, witches, midwives, nurses, and other physicians who guide their patients to safety without failing to appreciate the beauty and majesty displayed by a birthing human." www.ObgynoWino.com

Practice Bulletins #181 and #192 - Reaffirmed in 2019 Five pearls: 1. Risk of alloimmunization is around 15% after 2nd delivery of an Rh positive fetus to an Rh negative mother; this risk is decreased dramatically with administration of postpartum RhoGam 2. RhoGam is never indicated if both mom and dad are Rh negative or in women who are already sensitized (indirect coombs screen) 3. The KB test can used to determine if excessive feto-maternal hemorrhage has occurred in order to guide RhoGam administration in less obvious cases such as abdominal trauma in pregnancy 4. Alloimmunization can present as mild to severe anemia; if concerning antibodies are found, serial titers and/or peak systolic velocity of the middle cerebral artery ma be indicated 5. "Kell kills" Show Notes SIGN UP FOR LOUISVILLE BREECH WORKSHOP! Wine pairing: 2017 Pinot Noir from Longford Estate Wines Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

We need more senseless acts of kindness in our world, in feeding the masses, in home repair needs, and particularly in medicine. www.ObgynoWino.com

SPECIAL EPISODE - Interview w/ Rebecca Dekker, PhD (Instagram, Twitter, and Website).  Rebecca also wrote a book called Babies Are Not Pizzas...you may have heard of it. Show Notes SIGN UP FOR LOUISVILLE BREECH WORKSHOP! Wine pairing: 2017 Chardonnay from Montoya Vineyards Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

SPECIAL EPISODE - Interview w/ Lori Forner BScH, MPhtySt, PhD Candidate, APAM, Physiotherapist (Instagram, Twitter, and Website) 5 Pearls: 1. Exercise with intensity in addition to strength training is non-negotiable 2. Exercise needs to be enjoyable in order to be sustainable 3. Pelvic floor health needs to be taken into consideration with exercise, and this goes beyond muscle strength and contraction 4. Risk factors for pelvic floor dysfunction exist (e.g. pelvic floor trauma, POP, family hx, parity, etc), but they shouldn't preclude exercise 5. Abdominal strengthening exercises are not dangerous, though the focus in pregnancy is different. Show Notes Mentioned in this podcast: - ACOG CO#650: Physical Activity and Exercise During Pregnancy and the Postpartum Period Wine pairing: 2018 Malbec from Alamos Wines Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

With space, we pick ourselves up, in our new place - in some ways stronger, in some ways broken and in need of repair - and we move forward together, in love, through death, birth, and rebirth. www.obgynowino.com

Practice Bulletin #195 - Published June 2018 Four pearls: 1. Clean your hands, clean the skin, prep the vagina, treat remote infections and keep blood sugars controlled preoperatively to reduce infection rate. 2. Antibiotic prophylaxis is indicated for all hysterectomies, open surgery, and D&C for abortion, but it's generally not indicated in other procedures unless there's risk of entry into the bowel or a communication made between the abdominal cavity and the vagina. 3. Evidence is poor for antibiotic prophylaxis for indwelling foley or suprapubic catheters 4. For patients with penicillin allergy, switch to cephalosporin if allergy is mild, switch to metronidazole (or clindamycin) plus gentamicin (or aztreonam) if allergy is severe or if history of anaphylaxis Shout-outs: - Julie Duhon and Haddie Katz, CPM are looking for an OB to help them open a birth center in Bloomington, IN (email: hellomidwife@gmail.com) SHOW NOTES This episode pairs nicely with the Lot 1 Bonanza Sauvignon by Chuck Wagner Wine. Main theme music by my main amigo, Evan Handyside

Practice Bulletin #216 - Published January 2020 Five pearls: 1. Large babies come with a relatively higher risk to mom and baby, but absolute risks remain low. 2. Shoulder dystocia is generally difficult to. predict, but in diabetic patients with large fetuses, the risk is significantly higher, especially if vacuum or forceps is attempted. 3. Ultrasound is. notoriously inaccurate at predicting fetal weight (+/- 15%), and it's no better than using your hands or asking your patient to guess based on a previous pregnancy. 4. Diet, insulin and exercise are helpful in preventing macrosomia. 5. Inducing labor if fetus found to be macrosomic is not indicated. C-section reasonable if fetus measuring >4500 g in a diabetic patient or >5000 g in a non-diabetic patient Shout-outs: - Maryn Green, CPM (her podcast, on Twitter, Instagram) - Sunita Puri, MD (buy her book on Amazon) SHOW NOTES This episode pairs nicely with the 2014 Restitution Red Wine Blend from Magistrate Wines. Main theme music by my main amigo, Evan Handyside

SPECIAL EPISODE - Interview w/ Maryn Green, CPM (Instagram and Twitter) Five pearls: 1. The desire from home birth often stems from a desire to follow our physiology as mammals and is particularly focused on mom and baby connection. 2.  Listening to women and supporting them, no matter what they desire, is the work. 3.  “Radical informed choice” is the way many midwives support women in making choices. They assess their own benefits and risks along with research, intuition and more. 4.  Transparency is key in serving women. 5.  The world is not black and white (e.g. home vs. hospital) in achieving the best birth outcome. Shout-outs: - Indie Birth Association - Maryn's home birth website - Milo Chavira, MD - Dr. Stu's Podcast (w/ Blyss Young, CPM) - Felicia Sokol, doula (Instagram) - Juli Anderson, CPM (Instagram) - Nick Capetanakis, DO (low intervention OB/GYN in Encinitas) - Madeline Murray, CPM of Believe in Midwifery - Rebecca Dekker, PhD (her book and blog, Evidence Based Birth) - Augustine Colebrook, CPM (Art of Birthing) - Nicole Morales, CPM (Facebook) SHOW NOTES This episode should be paired with the 2018 Macon-Villages Chardonnay from Louis Jadot. Main theme music by my main amigo, Evan Handyside

When society values women, women won't have to prove their worth...The queen bee will be honored for being the queen bee, and birth will once again be trusted and embraced, not feared. www.obgynowino.com

As at the end of life, this must become a priority in our care for pregnant women: know thy patient. www.obgynowino.com

If we can't sit comfortably with the issue of a woman's experience in birth, beyond simply "healthy mom, healthy baby", we will continue to neglect the cries of our patients, like passing ships in the night. www.obgynowino.com