Thinking About Ob/Gyn

Antonia Roberts and Howard Herrell
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A fresh and evidence-based perspective of all things related to obstetrics and gynecology. Follow us on Instagram @thinkingaboutobgyn or visit thinkingaboutobgyn.com for show notes and more. 

  1. −4 d

    Episode 12.2 Cuff Dehiscence and Classic Papers

    Howard Herrell and Stuart Winkler question long-standing OB-GYN habits that feel “routine” but do not add value, then replace them with evidence and practical decision-making. We move from hysterectomy follow-up and cuff dehiscence management to the data behind cesarean sutures, endometrial cancer evaluation in postmenopausal bleeding, and the ongoing shift to HPV-based cervical cancer screening.  • why routine 6 to 8 week vaginal cuff exams after hysterectomy may not prevent or predict dehiscence  • how telehealth post-op care can improve access while keeping symptom-driven safety nets  • four tips for evaluating and managing vaginal cuff dehiscence, including when laparoscopy matters  • what Ethicon discontinuing chromic and plain gut could mean for cesarean technique choices  • how the CORONIS trial informs chromic vs Vicryl decisions and why transfusion risk is part of the conversation  • where the 4 mm endometrial stripe rule came from and why it can fail in real-world care  • why persistent postmenopausal bleeding still warrants endometrial biopsy despite reassuring ultrasound  • how race, tumor subtype, and fibroids affect endometrial cancer detection and counseling  • the arc from Pap smear cytology to HPV DNA testing, vaccines, and primary HPV screening  • why self-collected HPV testing may raise screening uptake for patients avoiding speculum exams  Be sure to check out thinking about obgyn.com for more information, and be sure to follow us on Instagram. 0:00 Welcome And Today’s Game Plan 0:35 Rethinking The Six-Week Pelvic Exam 13:25 Four Practical Tips For Cuff Dehiscence 24:42 Chromic Gut Is Disappearing 35:40 CORONIS Trial And Cesarean Sutures 42:22 Postmenopausal Bleeding And The 4 mm Rule 53:12 HPV Testing Takes Over Screening Follow us on Instagram @thinkingaboutobgyn.

  2. 9 juli

    Episode 12.1 IVF Add-Ons and More!

    We follow the footnotes on a common gyn rule, then use that same evidence-first lens to question popular fertility add-ons and persistent pregnancy myths. Along the way, we talk pretest probability, counseling tradeoffs, and why simple cutoffs often replace better clinical reasoning.  • tracing the “biopsy Bartholin cysts after 40” claim back to weak citations  • using pretest probability and exam features to decide on selective biopsy  • weighing hysteropexy versus hysterectomy for prolapse with long-term cancer risk in mind  • breaking down a Lancet review of IVF add-ons and what actually shows benefit  • spotting how marketing and online forums amplify unproven fertility interventions  • reviewing data on sedentary time in pregnancy and why activity restriction persists  • debunking “walking progresses labor” with randomized trial evidence  • clarifying early diabetes testing as screening for preexisting diabetes and when A1C makes more sense than early glucose tolerance tests  Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram. 0:00 Welcome And What’s Ahead 0:23 Bartholin Cyst Biopsy Age Rule 14:17 Prolapse Repair With Uterus Preservation 21:45 IVF Add-Ons And The Lancet Review 37:35 Pregnancy Activity Myths And New Data 50:53 Early Diabetes Testing And A1C Follow us on Instagram @thinkingaboutobgyn.

  3. 25 juni

    Episode 11.13 PMOS, PCOS, and the Metabolic Truth

    Howard and guest hose Sivani Aluru unpack why the new PMOS name matters, how PCOS got tied to “cysts,” and what the evidence actually says about diagnosis, metabolic risk, and treatment. We also challenge a few habits we have all inherited, from pre-op antibiotic dosing to the way we talk about hormones, weight, and fertility with patients.  • the evidence gap behind 2 g vs 3 g cefazolin in obese cesarean patients and how practice inertia forms  • why PMOS shifts attention toward insulin resistance, metabolic screening, and multidisciplinary care  • how NIH, Rotterdam, and androgen excess criteria shape who gets diagnosed and who gets missed  • SHBG and free testosterone as a practical way to explain symptoms when total testosterone looks normal  • why ovarian follicles are not the same as painful ovarian cysts and why ultrasound can mislead  • patient frustration with “just take birth control” and how we explain progesterone protection for the endometrium  • lean PMOS, weight-focused bias, and realistic conversations about lifestyle change, GLP-1s, and bariatric surgery  • fertility takeaways from PPCOS II, metformin limitations, and what lifestyle trials suggest preconception  Be sure to check out thinkingaboutobgyn.com for more information, and be sure to follow us on Instagram. 0:00 Welcome And Guest Introduction 2:01 The 3-Gram Ancef Habit 12:02 PCOS Becomes PMOS 12:55 How The Criteria Got Complicated 22:00 Insulin Resistance And Free Testosterone 30:40 Hormone Panels And TikTok Myths 32:30 Ovarian Follicles Are Not “Cysts” 36:03 Treating Symptoms Without Dismissing People 46:12 Fertility Trials And Lifestyle Results 57:27 ACOG At 75 And Why Join Follow us on Instagram @thinkingaboutobgyn.

  4. 10 juni

    Episode 11.12 The Malpractice Crisis Is Real And Blaming Evidence-Based Care Makes It Worse

    We push back on the idea that obstetrics “deserves” a malpractice crisis and explain how bad incentives and junk science can turn normal evidence-based care into courtroom blame. We also break down a few widely shared clinical myths and new research so we can practice with clearer eyes and less narrative noise. • placental grading on ultrasound as low-value data with poor predictive power and high reader variability  • how malpractice commentary can seed plaintiff-friendly arguments against evidence-based off-label use  • why blaming misoprostol or “high-dose” oxytocin oversimplifies multifactorial outcomes  • quality improvement bundles as useful tools but weak proof without controls or causal clarity  • how massive verdicts and paid expert testimony can clash with modern science on cerebral palsy and HIE  • the FAA’s five hazardous attitudes and practical antidotes for high-stakes clinical work  • new data on LEEP versus cold knife cone for CIN, recurrence, HPV clearance, and access tradeoffs  • genetics and BMI as major drivers of gut microbiome patterns, not influencer narratives  • what a 1993 Doppler trial can and cannot prove, plus why replication changes conclusions  Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram. 0:00 Welcome And Season Update 1:15 Placental Grading Myth On Ultrasound 6:44 Calling Out A Malpractice Influencer 14:06 The 2011 Policy Bundle Examined 23:20 What Drives The OB Malpractice Crisis 30:00 How Mega Verdicts Get Made 36:59 Five Hazardous Attitudes From Aviation 44:31 LEEP Versus Cone For CIN 48:04 Genetics And The Gut Microbiome 52:17 Does Doppler Ultrasound Harm Babies? 1:00:37 Recommendations And Closing Follow us on Instagram @thinkingaboutobgyn.

  5. 28 maj

    Episode 11.11 When Evidence Misleads

    We sit down with Joshua Oommen to get nerdy about clinical reasoning, FDA standards, and why “good evidence” is harder to define than most of us admit. We challenge the reflex to trust p-values and meta-analyses, then test our instincts against real OBGYN examples where the literature has whiplashed practice.  • why the podcast is called Thinking About OBGYN and how clinical reasoning shapes our work  • the NEJM proposal to make one pivotal trial the FDA default and what “confirmatory evidence” might mean  • medical reversal, surrogate endpoints, and how trust erodes when practice changes late  • why Bayesian thinking fits how clinicians interpret tests, trials, and prior beliefs  • how meta-analyses fail through small study effects, publication bias, p-hacking, and heterogeneity  • the amnioinfusion comeback as a case study in applicability and overconfident conclusions  Be sure to check out thinking about obgyn.com for more information and be sure to follow us on Instagram.  0:00 Welcome And Today’s Big Question 3:48 Why “Thinking About OBGYN” Exists 11:54 The NEJM Push For One Trial 16:38 Medical Reversal And Trust Problems 24:43 AI Proteins And CRISPR Pressure Tests 32:33 Bayes Thinking Beyond P Values 36:43 Why Meta-Analyses Often Mislead 41:08 Bias And Heterogeneity Red Flags 46:24 Amnioinfusion And A Meta-Analysis Comeback 1:02:29 Final Warnings And How To Learn Follow us on Instagram @thinkingaboutobgyn.

  6. 13 maj

    Episode 11.10 New Guidelines For Cervical Cancer Screening and More!

    We bring back the biggest takeaways from the ACOG ACSM, then move fast through the newest guidance and the newest hype shaping real OBGYN care. We focus on what the evidence actually supports, where practice still lags behind, and how “labels” can quietly push patients toward harm. • conference highlights including rural OBGYN access and what gets attention on the exhibit floor  • vitamin K shot refusal trends and why late bleeding still matters weeks after birth  • 2026 ACOG cervical cancer screening changes with primary HPV testing preferred for ages 30 to 65  • self-collected HPV screening and the systems needed to keep follow-up safe  • why annual Pap testing and cytology-only strategies increase overdiagnosis and can miss HPV risk  • postmenopausal bleeding workup shifting toward ultrasound plus endometrial biopsy up front  • large baby induction data and why outcomes can worsen without neonatal benefit  • third-trimester ultrasound screening performance and the real-world labeling effect  • early proof-of-concept therapy for preeclampsia targeting sFlt1 removal to prolong pregnancy  • hysterectomy duration and route as drivers of venous thromboembolism risk  • laboring down claims from retrospective reports versus randomized trial findings  • debunking physiologic third stage claims and reaffirming active management to prevent hemorrhage  Be sure to check out thinkingaboutobgyn.com for more information, and be sure to follow us on Instagram. 0:00 ACOG Meeting Takeaways And Rural Access 3:58 Vitamin K Refusal And Newborn Bleeding 6:37 Cervical Screening Moves Toward HPV 14:48 Postmenopausal Bleeding Now Needs Biopsy 20:00 Tylenol Data And Macrosomia Induction 28:34 Ultrasound Labeling Effect And Liability Fears 37:29 Removing sFlt1 To Buy Time 40:14 Longer Hysterectomy Surgeries Raise VTE Risk 42:14 Laboring Down Claims Versus RCT Reality 49:59 Counseling Fatigue Without Ignoring Risk 54:21 Third Stage Myths And Hemorrhage Prevention 58:42 Evidence Literacy And Closing Notes Follow us on Instagram @thinkingaboutobgyn.

  7. 29 apr.

    Episode 11.9 Vaccine Q&A

    We answer vaccine questions head-on, using real numbers to separate online fear from how vaccines, immunity, and public health actually work. We break down why diseases feel “gone,” what the modern schedule really exposes babies to, and how to spot misleading claims around ingredients, autism, and VAERS. Featuring Kate Moloney and our vaccine-hesitant friend Anah.  • why vaccine success makes diseases look eradicated while risk returns when coverage drops  • Stanford modeling estimates for measles, diphtheria, polio, and rubella without vaccination  • meningococcal meningitis basics, who is most at risk, and why outcomes can be catastrophic  • why clean water and sanitation do not explain protection from droplet-spread viruses  • what antigens are and why antigen exposure is far lower than decades ago  • downsides of delaying vaccines including longer vulnerability and more office visits  • aluminum, formaldehyde, and mercury claims explained with real-world comparisons  • “natural immunity” tradeoffs including measles pneumonia, immune amnesia, and SSPE  • long flu and post-viral inflammatory syndromes as quality-of-life consequences  • how vaccine schedules change, why the autism claim is debunked, and what profit incentives really look like  • what VAERS can and cannot tell you, plus how bias and viral claims distort reports  • why newborn hepatitis B vaccination exists, screening gaps, and true serious side effects  • rubella history and why vaccination primarily protects fetuses  1:05 Do We Vaccinate Too Much 3:32 Modeling A World Without Vaccines 6:20 Meningitis And Fast Catastrophes 8:28 Clean Water Is Not A Vaccine 11:02 Antigens And The Modern Schedule 15:44 Why Spacing Shots Can Backfire 16:53 Aluminum Formaldehyde Mercury Facts 22:00 Natural Immunity And Measles Damage 26:16 Long Flu And Post Viral Illness 28:26 Profit Fears And Autism Claims 31:26 VAERS Limits And Bad Math 38:39 Why Newborns Get Hepatitis B 45:09 Real Side Effects And Detox Scams 48:37 Rubella And Protecting Fetuses 51:57 Final Takeaways And Next Steps Be sure to check out thinkingaoutobgyn.com for more information and be sure to follow us on Instagram.  Follow us on Instagram @thinkingaboutobgyn.

  8. 15 apr.

    Episode 11.8 MTHFR, Bed Rest, and More!

    We take on four stubborn myths in modern obstetrics and follow the evidence instead of the vibes, from thrombophilia testing to bed rest to seizure prophylaxis. We also spotlight a patient-empowering insulin strategy that may improve gestational diabetes outcomes faster than usual care.  • distinguishing recurrent pregnancy loss evaluation from venous thromboembolism testing  • focusing thrombophilia workups on antiphospholipid antibody syndrome when criteria are met  • explaining why MTHFR variants and PAI-1 polymorphisms do not belong in routine panels  • unpacking how social media and narrative fallacies keep low-value tests alive  • reviewing the AWARE trial and why activity restriction lacks benefit and carries harms  • clarifying reasonable pregnancy activity modifications versus false labor prevention claims  • assessing late preterm antenatal corticosteroids for twins and the hypoglycemia signal  • discussing inertia of practice and why weak evidence becomes hard to undo  • breaking down patient-led insulin titration for gestational diabetes and why it may reduce macrosomia  • evaluating laboring down and long-term pelvic floor outcomes plus statistical pitfalls  • answering a listener question on Keppra alternatives to magnesium for preeclampsia seizures  Be sure to check out thinking about obgyn.com for more information, and be sure to follow us on Instagram. 0:00 Welcome And What We’re Reviewing 0:28 Thrombophilia Testing After Miscarriage 3:51 What Belongs In A VTE Panel 5:55 MTHFR And PAI1 Myth Busting 13:36 Activity Restriction And The AWARE Trial 23:27 Practical Counseling Without False Promises 27:08 Late Preterm Steroids For Twins 32:53 Patient-Led Insulin Titration In GDM 38:38 Laboring Down And Pelvic Floor Outcomes 47:51 Keppra Versus Magnesium For Preeclampsia 1:00:25 Wrap Up And Where To Follow Follow us on Instagram @thinkingaboutobgyn.

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A fresh and evidence-based perspective of all things related to obstetrics and gynecology. Follow us on Instagram @thinkingaboutobgyn or visit thinkingaboutobgyn.com for show notes and more. 

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  • Skapad av
    Antonia Roberts and Howard Herrell
  • Aktiva år
    2021 - 2026
  • Avsnitt
    145
  • Åldersgräns
    Vuxet innehåll
  • Copyright
    © 2026 Thinking About Ob/Gyn
  • Programmets webbplats
    Thinking About Ob/Gyn

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