Thinking About Ob/Gyn

We move from a Dolly Parton story to the very real ways policy, training, and clinical guidance shape what patients can access and what clinicians can safely provide. We break down the end of global OB billing, the risks of vaccine schedule “tweaks,” and why surgical convenience can quietly drive worse care. 
• rural maternity deserts and why reimbursement must cover facility costs 
• content warnings and protecting our own mental health while learning from high-profile perinatal cases 
• the shift from global maternity fees to E/M problem-based prenatal visits 
• work RVUs, delivery billing and why correct coding matters 
• measles deaths, herd immunity and why splitting MMR increases missed protection 
• robotic surgery dominance, laparoscopic deskilling and training priorities 
• ACOG opportunistic salpingectomy guidance for ovarian cancer prevention 
• practical techniques to complete salpingectomy during vaginal hysterectomy 
• listener question on urinary retention and pudendal nerve injury myths 

0:00 Welcome And A Dolly Parton Story
6:07 Perinatal Mental Health And Content Warnings
8:20 OB Billing Shifts From Global To E/M
15:17 Measles Deaths And The MMR Split
20:05 Robotic Dominance And Laparoscopy Deskilling
31:41 ACOG Salpingectomy Guidance And Ovarian Cancer
40:53 Vaginal Hysterectomy Tube Removal Techniques
53:10 Urinary Retention And Pudendal Nerve Myths
1:06:22 Final Takeaways And Where To Follow

Thanks for listening be sure to check out thinkingaboutobyn.com for more information and be sure to follow us on Instagram 

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JJ Cox joins us as we talk through what actually changes when we perform cesarean delivery in patients with morbid obesity, from incision planning to anesthesia risk to the wound that has to heal at home. We share practical tips, review key trials on negative pressure dressings and antibiotics, and focus on decisions that protect both safe delivery and lower wound complications. 
• panniculus anatomy driving incision choice more than BMI 
• using ultrasound to find the uterus when landmarks mislead 
• paniculus retraction treated as an anesthesia maneuver 
• distance and geometry limiting exposure and delivery technique 
• planning the wound’s postoperative “home” before making the cut 
• negative pressure wound therapy evidence including the 2020 JAMA trial and skin blistering risk 
• skin glue vs standard dressings as competing narratives with limited data 
• closing deep subcutaneous space in layers to reduce dead space 
• avoiding staples and favoring subcuticular suture based on available evidence 
• antibiotic prophylaxis realities including azithromycin dose questions and shortage workarounds 
• extended postoperative antibiotics data shift when azithromycin is already used 
• OR contamination habits including Yankauer discipline and glove-changing debate 
• calling for help early and building a short pre-op plan to prevent downstream problems 
Be sure to check out thinking about obgyn.com for more information. And be sure to follow us on Instagram. 

0:00 Welcome And Guest Introduction
2:55 Why These C-Sections Are Higher Risk
7:00 Picking The Incision With Ultrasound
14:25 Panniculus Retraction Is Anesthesia Critical
17:35 Delivery Tips When Distance Is The Enemy
19:55 Think About The Wound Before Cutting
24:20 Negative Pressure Dressings What Trials Show
34:45 Subcutaneous Closure Sutures Beat Shortcuts
38:55 Antibiotics Dosing Azithromycin Reality Check
45:55 Contamination Control Yankauer And Gloves
52:10 Assistance Planning And Hemorrhage Limits
55:30 Meta-Analysis Takeaways And Closing
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We challenge a few stubborn pieces of OB-GYN “common sense” and ask what the data actually supports, from trying to conceive after miscarriage to how we start and adjust ovulation induction. Then we shift into practical laparoscopy tips for obese patients and end with a sober look at how evidence quality shapes care, from magnesium sulfate debates to the rise in pregnancy-associated overdose deaths. 

• why waiting a full cycle after first-trimester miscarriage lacks evidence for better outcomes 
• why routine progestin withdrawal bleeds before letrozole or clomiphene can be unnecessary and even harmful 
• how stair-stepping ovulation induction dosing can shorten time to ovulation 
• four operating room tips for minimally invasive surgery in morbid obesity, including port geometry and Trendelenburg dry runs 
• what a recent D&E fetal demise paper suggests about DIC and hemorrhage risk beyond 28 days 
• why retrospective birth registry studies can mislead when randomized trial data exist 
• how Medicaid timing findings highlight confounding rather than causation 
• a clever low-port approach to perforated IUD removal using a transabdominal hysteroscope 
• why overdose deaths are rising faster in pregnant and postpartum people and what fentanyl changes 

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 Reading
0:29 The Myth Of Waiting After Miscarriage
1:08 Skip The Provera Withdrawal Bleed
7:49 Data On Conceiving Sooner
13:52 Laparoscopy Setup For Obese Patients
25:07 D&E After Second Trimester Demise
28:39 Magnesium Sulfate And Study Quality
39:06 Medicaid Timing And Confounding
44:57 Single Port Perforated IUD Removal
49:33 Overdose As Leading Pregnancy Associated Death
57:57 Book Shout Out And Closing

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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

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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.