Howard and Antonia explore the evidence behind pit breaks in labor, cannabis use in pregnancy, and IUD options for hormone replacement therapy.

• Pit breaks in labor lack substantial evidence of benefit when used in active labor
• Current research suggests stopping oxytocin during active labor may slightly increase cesarean rates rather than decrease them
• Long pit breaks (up to 8 hours) in latent labor may be beneficial by allowing rest and promoting patience
• Recent systematic review shows prenatal cannabis use increases risk of low birth weight by 75%, preterm birth by 50%, and perinatal mortality by 29%
• Cannabis use during pregnancy (7.2% of pregnant women) now exceeds tobacco use
• Retrospective studies on doula care show association with better outcomes, but can't establish causation due to inherent differences in patients who seek doulas
• 52mg levonorgestrel IUDs (Mirena/Liletta) are suitable for endometrial protection during HRT, but evidence only supports use up to 5 years
• Most systematic reviews combine heterogeneous studies and shouldn't be considered level 1 evidence

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00:04:52 Pit Breaks in Labor

00:15:32 Examining Evidence on Oxytocin Discontinuation

00:26:08 Prenatal Cannabis Use and Adverse Outcomes

00:36:07 Doula Care Study Analysis

00:57:22 Levonorgestrel IUD Use in HRT

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Join Howard and Janeen Arbuckle for this discussion of pediatric and adolescent gynecology essentials. Pediatric and adolescent gynecology is a newer discipline bringing specialized care to young women with unique gynecologic needs, with a focus on counseling, education, and age-appropriate interventions.

• Abnormal uterine bleeding in adolescents is rarely caused by structural problems (unlike in adults) and typically relates to immaturity of the hypothalamic-pituitary-ovarian axis
• Hematologic workup should be considered for adolescents with heavy menstrual bleeding as this may be the first time their clotting system is challenged
• Hormonal therapies are safe to use once menarche has occurred, with no impact on bone growth
• Long-acting reversible contraceptives offer superior pregnancy prevention (1 in 10,000 for implants vs 8 in 100 for typical pill use) but require thoughtful counseling
• Private interviews with adolescent patients create trust while preparing them for independent healthcare navigation
• Tranexamic acid is effective for heavy menstrual bleeding in adolescents but pill size and frequency can limit compliance
• Most ovarian cysts in adolescents represent normal physiologic function and rarely require intervention
• Preservation of reproductive organs should be prioritized in adolescent surgery, including leaving ovaries after torsion when possible
• Vaginal bleeding in pre-pubertal girls requires assessment for secondary sexual characteristics to distinguish precocious puberty from other causes

00:00:00 Introduction to Pediatric Gynecology

00:07:20 Abnormal Uterine Bleeding in Adolescents

00:19:36 Contraception Choices for Young Patients

00:29:40 Managing Difficult Patient-Parent Conversations

00:38:04 Pelvic Pain and Endometriosis

00:46:58 Adnexal Pathology and Ovarian Issues

00:50:51 Congenital Anomalies and Vaginal Bleeding

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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

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