Howard and Antonia dive into their tenth season with a critical look at several new studies. Topics include:

• Estrogen-soaked vaginal packing after surgery lacks evidence for benefits while carrying unnecessary costs
• Recent studies on vaginal birth after cesarean deserve careful interpretation beyond aggregate outcomes
• Hospital uterine rupture rate is 0.2-0.4%, with only 8% resulting in catastrophic outcomes when properly managed
• Warnings against infant co-sleeping date back to ancient times, predating modern pediatric recommendations
• Vaginal hysterectomy continues to decline despite shorter OR times, lower costs, and similar complication rates
• Swedish study shows only 25% of ideal candidates receive vaginal hysterectomies, with projections showing disastrous decline in rates of appropriate surgeries

Stay tuned for our next episode featuring Scott Guthrie discussing neonatal resuscitation and other neonatal concepts important for OB-GYNs to understand.

00:00:00 Season 10 Introduction

00:01:13 No Evidence for Estrogen Packs After Surgery

00:10:35 VBAC Studies: Interpreting Maternal Risks

00:19:12 Catastrophic Uterine Rupture: Hospital vs Home

00:28:53 King Solomon and Infant Co-Sleeping Dangers

00:39:50 Vaginal Hysterectomy: Declining Despite Evidence

00:54:09 Cost and Time Analysis of Hysterectomy Routes

01:06:24 Closing Thoughts on Season 10

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Surgical techniques in gynecology vary widely between surgeons, creating both excitement and frustration for residents trying to learn the "right way" to perform procedures. Howard and guest host Maddie White discuss this and more:

• Trocar placement during laparoscopy requires careful consideration of patient factors and potential adhesions
• Elevating the abdomen during trocar placement remains standard practice, though definitive evidence on its necessity would require studies of over 100,000 patients
• Surgeons should understand power analysis to recognize when studies are underpowered to detect meaningful differences in rare complications
• Visceral slide technique using ultrasound can identify adhesions and determine the safest entry point for laparoscopic surgery
• Palmer's point may no longer be the safest entry point for many patients given the prevalence of bariatric surgeries
• Jain's point (lateral to the umbilicus) may now be statistically safer for many patients with complex surgical histories
• Vaginal cuff dehiscence rates are 6-10 times higher with laparoscopic/robotic hysterectomy compared to vaginal approaches
• The higher dehiscence rate stems from using energy devices for colpotomy rather than cold scalpel techniques
• Barbed sutures simplify cuff closure but don't reduce dehiscence rates compared to standard suturing techniques
• Surgery consists of "a thousand little things done well" - mastering these micro-skills distinguishes excellent surgeons

00:00:00 Surgical Techniques: Excited and Frustrated

00:08:00 Elevation During Trocar Placement

00:17:00 Evidence and Power Analysis

00:21:35 Visceral Slide Technique

00:35:10 Alternative Trocar Entry Points

00:40:10 Cuff Closure and Dehiscence Risk

00:51:45 Laparoscopic vs Vaginal Colpotomies

01:03:00 First Accredited OB-GYN Residency Program

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Howard Herrell and Antonia Roberts explore evidence-based practices in obstetrics and gynecology, examining both established protocols and emerging research with critical perspectives on medical misinformation.

• Serial cervical length monitoring after LEEP procedures lacks evidence for improving outcomes despite being common practice
• SMFM's 2016 recommendation explicitly advises against routine cervical length screening for patients with history of cervical procedures
• Retrospective studies on induction timing require careful interpretation due to inherent biases in methodology
• Understanding the difference between intent-to-treat and per-protocol analysis is crucial when evaluating medical research
• Pseudoscience and alternative medicine have gained mainstream acceptance over decades through celebrity endorsements and media platforms
• Reusable surgical instruments like stainless steel uterine manipulators offer both economic and environmental advantages over disposable options
• Plus, Learn the history of The Green Journal's distinctive color

Be sure to check out thinkingaboutobgyn.com for more information and follow us on Instagram. We'll be back in two weeks.

00:00:35 Monitoring Cervical Length After LEEP

00:10:30 Understanding Intent-to-Treat Analysis

00:28:54 MAHA Movement and Medical Misinformation

00:53:49 Carbon Footprint of Uterine Manipulators

00:57:30 History of the Green Journal

Follow us on Instagram @thinkingaboutobgyn.