The vast majority of the time, “community standard of care” reflects evidence-based recommendations. This means that both the predominance of clinical data and what is clinically practice align one with another period but at times, clinical standard practice doesn't always align with what the data shows. How is this possible? This is exactly the case for home blood pressure monitoring in pregnancy (HBPM). This episode idea comes from an OB PGY-3, soon PGY-4, who asked his attending this brilliant question: “If the BUMP1 and BUMP2 clinical trials did not show a benefit with HBPM, why are we still doing it?” That is a complicated question that has a solid answer! Unsatisfied with his response, he asked for our opinion. Listen in for details.

1. Tucker KL, et al. (2022). "Effect of self-monitoring of blood pressure on diagnosis of hypertension during higher-risk pregnancy: the BUMP 1 randomized clinical trial. JAMA

2. Chappell LC, et al. (2022). "Effect of self-monitoring of blood pressure on blood pressure control in pregnant individuals with chronic or gestational hypertension: The BUMP 2 Randomized Clinical Trial. JAMA

3. SMFM Special Statement (2023): Society for Maternal-Fetal Medicine Special Statement: Telemedicine in obstetrics—quality and safety considerations; AJOG

Outside of pregnancy, guidelines emphasize diabetes self-management education and support to facilitate informed decision making, self-care behaviors, problem solving, and active collaboration with health care professionals. This includes, in those with good health literacy, the concept of patient-led self-titration of basal insulin results which has data that it improves glycemic management compared with clinician-led titration for type 2 diabetes among nonpregnant adults. But what about for GDM? Can patient’s self manage their BASAL insulin? In this episode, we will review a new RCT published in April 2026 in the Green Journal on this very subject. As novel as this is, it is not the first to report on this as it was also published (retrospective study in the UK) in 2022. This is a novel approach to insulin in GDM but there are some questions that remain. Listen in for details.

1. Boonpattharatthiti K, Wechkunanukul K, Mayang N, et al . Comparison of Insulin Titration Strategies for Glycemic Control in Type 2 Diabetes: A Systematic Review and Network Meta-Analysis.Diabetes Care. 2025.

2. Valent, Amy M. DO, MCR; Barbour, Linda A. MD, MSPH. Insulin Management for Gestational and Type 2 Diabetes in Pregnancy. Obstetrics & Gynecology 144(5):p 633-647, November 2024. | DOI: 10.1097/AOG.0000000000005640

3. Wang, Xiao-Yu MD; Gabbe, Steven MD; Landon, Mark B. MD; Venkatesh, Kartik K. MD, PhD et al. Patient-Led Insulin Titration for Glycemic Management With Gestational Diabetes Mellitus: A Randomized Controlled Trial. Obstetrics & Gynecology 147(4):p 501-509, April 2026.

4. McGovern AP, Hirwa KD, Wong AK, et al. Patient-led rapid titration of basal insulin in gestational diabetes is associated with improved glycaemic control and lower birthweight. Diabet Med. 2022;39:e14926. doi: 10.1111/dme.14926

Hyperemesis gravidarum (HG) represents the most severe end of the nausea and vomiting of pregnancy spectrum. It has a reported incidence of approximately 0.3–3% of pregnancies and is the most common cause of hospitalization in early pregnancy and the second most common cause of hospitalization in pregnancy overall. In June 2024, the ACOG published a Clinical Expert series summarizing the inpatient management of HG. In that guidance, it describes mirtazapine as an “alternative pharmacologic” option. How effective is this medication compared to ondansetron? A new study (published ahead of print on 12/30/25 and officially out June 2026), out of Denmark, sheds some new light on this medication. This trial is the first double-blind RCT comparing mirtazapine to ondansetron AND placebo. Although a BIG limitation of this study exists (which we will discuss), it does provide some interesting insights. Listen in for details.

1. (ACOG CES) Clark, Shannon M. MD; Zhang, Xue MD; Goncharov, Daphne Arena MD. Inpatient Management of Hyperemesis Gravidarum. Obstetrics & Gynecology 143(6):p 745-758, June 2024. | DOI: 10.1097/AOG.0000000000005518

2. Ostenfeld, AnneDroogh, Marjoes et al.Mirtazapine or ondansetron for hyperemesis gravidarum. A randomized placebo-controlled trial. American Journal of Obstetrics & Gynecology, June 2026

Cervical exams can be tricky for the novice practitioner. Think about this: it’s a blind exam, we measure that distance using only two fingers, through a layer of tissue, sometimes with a patient moving up on the bed as we examine. That is the reality of a cervical exam. Intrapartum, some nursing staff and clinicians use qualitative descriptors like "a tight 4" or "a generous 5" to convey nuance. In line with this, some report cervical examinations in “half- centimeters”. This sounds like this: “well, her last cervical exam was 5cm but now she is 5 and a half”. Is that a thing? What does the data say? Listen in for details.

1. Hamilton EF, Zhoroev T, Warrick PA, et al. New Labor Curves of Dilation and Station to Improve the Accuracy of Predicting Labor Progress. American Journal of Obstetrics and Gynecology. 2024.

2. Hanidu A, Kovalenko M, Usman S, et al. Intrapartum Ultrasound for Cervical Dilatation: Inter- And Intra-Observer Agreement. Acta Obstetricia Et Gynecologica Scandinavica. 2024.

3. Abedi, P. (n.d.). Accuracy of ultrasound methods versus other methods for detecting of cervical dilatation during labor, a protocol for systematic review. ECronicon.

Oh, What’s in a Name? Irving F. Stein and Michael L. Leventhal first described the syndrome, originally known as Stein-Leventhal syndrome, in 1935, in the AJOG. They published a case series of seven women displaying a triad of symptoms, including hirsutism, amenorrhea (absent menstruation), and bilaterally enlarged polycystic ovaries. We now know that PCOS affects 1 in 8 women globally (170 million women of reproductive age worldwide), and that there are 4 main manifestations of the condition- reflecting its diverse phenotype. Now, as of 05/12/25, a collaboration across 56 leading academic, clinical, and patient organizations, as well as iterative global surveys that garnered responses from over 14,300 people with PCOS and multidisciplinary health professionals have endorsed a NEW term (Lancet) for this: polyendocrine metabolic ovarian syndrome. This is actually STAGE 7 of an 8 stage process Yep, 1-6 are already done). But hold on…this is not taking over tomorrow! There is a THREE-YEAR implementation strategy that has already gotten started and culminating in 2028. Listen in for details.

1. Teede HJ, Khomami MB, Morman R, et al. Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. The Lancet. Published online May 12, 2026. Accessed May 12, 2026. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00717-8/fulltext

2. International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome; 2023

3. https://www.contemporaryobgyn.net/view/global-consensus-renames-pcos-to-polyendocrine-metabolic-ovarian-syndrome-pmos-?utm_campaign=42986360-COG%20-%20Breaking%20News&utm_medium=email&_hsenc=p2ANqtz--5Of8-OwjOeKLtknr8YdFbh9G8_c7iQqliHnMz2pYOpi2x4Pp8dRH6bSHjrQIqnth_fLPywQM2ByNp7via22VJ8yyLbg&_hsmi=418414457&utm_content=418414457&utm_source=hs_email

4. Polyendocrine Metabolic Ovarian Syndrome: New name to improve diagnosis and care of condition affecting 170 million women worldwide. Monash University. News release. May 12, 2026. Accessed May 12, 2026. https://www.eurekalert.org/news-releases/1127647

As I have said many times before, some podcast ideas come from REAL clinic encounters. In this episode, Dr Hanna V, our dedicated PGY1 on our call team, and I will answer TWO real questions which arose just today on morning rounds, on our service: 1. Does NORMOTENSIVE HELLP still need Mag Sulfate? And 2. Does an indwelling foley s/p iatrogenic bladder injury at CS require prophylactic antibiotic coverage for urinary infection? Yep: It’s a BOGO sale on today’s podcast- Buy ONE GET ONE! Listen in for details.

1. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222.

Obstetrics and Gynecology. 2020. Committee on Practice Bulletins—ObstetricsGuideline

2. Woudstra DM, Chandra S, Hofmeyr GJ, Dowswell T.SR. Corticosteroids for HELLP (Hemolysis, Elevated Liver Enzymes, Low Platelets) Syndrome in Pregnancy.

The Cochrane Database of Systematic Reviews. 2010.

3. Joshi D, James A, Quaglia A, Westbrook RH, Heneghan MA.Liver Disease in Pregnancy. Lancet. 2010. Review

4. Rimaitis K, Grauslyte L, Zavackiene A, et al.Observational. Diagnosis of HELLP Syndrome: A 10-Year Survey in a Perinatology Centre. International Journal of Environmental Research and Public Health. 2019

5. Reau N, Munoz SJ, Schiano T.Guideline Liver Disease During Pregnancy.

The American Journal of Gastroenterology. 2022.

6. ACG Clinical Guideline: Liver Disease and Pregnancy.

The American Journal of Gastroenterology. 2016. Tran TT, Ahn J, Reau NS.

7. ACOG Practice Bulletin No. 195: Prevention of Infection After Gynecologic Procedures. Obstetrics and Gynecology. 2018. Committee on Practice Bulletins—Gynecology Guideline

8. Niels Johnsen, Hunter Wessells, Krystal Archer-Arroyo, et al. Best Practices Guidelines Management of Gentiunrinary Injuries.American College of Surgeons (2025). 2025

9. Fletke KJ, Jeong DH, Herrera AV . Urinary Catheter Management. American Family Physician. 2024..

Hantavirus was first discovered in the early 1950s near the Hantaan River in South Korea. The US has seen this before: the 1993 Four Corners outbreak was the first recognition of the virus in the United States, causing a deadly respiratory syndrome. Now, Hantavirus is in the news again with 17 Americans currently (5.10.26) enroute back to the US for specialized observation. In this episode, we will briefly review what this virus does and cover the SPARSE data we have regarding hantavirus infection in pregnancy.

1. Gilson GJ, Maciulla JA, Nevils BG, et al. Hantavirus Pulmonary Syndrome Complicating Pregnancy. American Journal of Obstetrics and Gynecology. 1994.

2. 5.10.26: https://www.nbcnews.com/health/health-news/hantavirus-stricken-cruise-ship-arrives-tenerife-rcna344318

3. Janwadkar RS, Ritchie HM, Johnson CA. Unexpected Challenges: A Case Report of Hantavirus Infection in a Pregnant Patient in a Rural Emergency Department. The Journal of Emergency Medicine. 2025.

Uterine hysterotomy unintended extensions happen. For sure. This has been analyzed over many years, and it is still making news. Look at this mini-timeline: Back in 2018, authors published “Unintended hysterotomy extension during caesarean delivery: risk factors and maternal morbidity”. Moving up the timeline to 2020, others published in J Maternal-Fetal Neonatal Medicine, “Risk factors for uterine incision extension during cesarean delivery”. Then in 2024, in the PINK journal, authors published a related study, “The association between unintended hysterotomy extensions with cesarean delivery and subsequent preterm birth”. In this episode, we will review a new narrative review (in the Green Journal, May 3, 2026) of unintended hysterotomy extension at C-section. We will summarize known risk factors and focus on subsequent uterine rupture risk. Does unintended hysterotomy extension at CS increase TOLAC uterine rupture? It’s complicated. Listen in for details.

1. Giugale LE, Sakamoto S, Yabes J, Dunn SL, Krans EE. Unintended hysterotomy extension during caesarean delivery: risk factors and maternal morbidity. J Obstet Gynaecol. 2018 Nov;38(8):1048-1053.

2. Epub: Unintentional Extensions of the Cesarean Hysterotomy Incision. A Review and Proposed Classification System (May 3, 2026)

Genome-wide noninvasive prenatal testing (GW-NIPT) was introduced in 2015 and became widely available in 2019. Nonetheless, we are still learning more about this important prenatal screening test. In January 2026, the ACOG released a new PA on this, which we will also review in this episode. Our main publication ti review, however, will be the AJOG May 2026’s systematic review and meta-analysis on the finding of “genome-wide” cfDNA discordant results and what this may mean for the pregnancy. Although rare, this may lead (over a third of cases) to some adverse perinatal issues. Listen in for details.

1. ACOG PA Jan 2026: Screening for Fetal Chromosomal Abnormalities

2. AJOG May 2026: https://click.notification.elsevier.com/CL0/https:%2F%2Fwww.ajog.org%2Farticle%2FS0002-9378(25)00865-8%2Ffulltext%3Fdgcid=raven_jbs_etoc_email/1/0100019d9ec37d7b-c586438d-021a-4097-8db3-c158e6f97c9b-000000/Vq6ksekOuvTxcv8OEZZ2uBesCg_hG6qlhqU_BlCnAK4=452

There is no denying it, you know of one or MORE individuals or patients currently on a GLP1 agent. Although not FDA approved for PCOS as a stand-alone diagnosis, there is growing evidence supporting their offlabel use in PCOS, and international guidelines now include them as a conditional recommendation. In women, the weight loss associated with these medications may trigger the return of spontaneous ovulation, making mistimed pregnancy a possibility. A key study by Sanz and Blázquez (back in 2011) demonstrated that both GLP-1 and the GLP-1 receptor are present in mouse embryos as early as embryonic day 6 (E6) and continue through the first trimester, as well as in pluripotent mouse embryonic stem cells. In these undifferentiated cells, GLP-1 modified the expression of endodermal, ectodermal, and mesodermal gene markers, as well as critical developmental signaling molecules. So, there is a concern about embryogenesis if inadvertent exposure to these meds occurs in early pregnancy. In this episode, we will summarize 2 recent and separate systematic reviews (March 2026; April 2026) on fetal/OB outcomes after periconceptional exposure. This builds on the Parker data set from 2025. One of these reviews, from April 2026, is also a meta-analysis. Listen in for details.

1. Ozbek L, Shah E, Al-Shiab R, Inal A, Guldan M, Afsar B, Covic A, Kanbay M. Safety of GLP-1 and Dual GLP-1/GIP Receptor Agonists in Preconception, Pregnancy, and Lactation: A Systematic Review of Maternal, Fetal, and Neonatal Outcomes. Diabetes Obes Metab. 2026 Mar 26. https://pubmed.ncbi.nlm.nih.gov/41885132/

2. Hakim J, Rajesh D, Tello J. Neonatal and Obstetric Outcomes Following Periconceptional Exposure to Glucagon-Like Peptide-1 Receptor Agonists: A Systematic Review and Meta-analysis. AJOG; April 28, 2026; https://www.ajog.org/article/S0002-9378(26)00222-X/fulltext

3. Parker CH, et al. Glucagon-Like Peptide 1 (GLP-1) Receptor Agonists' Use During Pregnancy: Safety Data From Regulatory Clinical Trials. Diabetes, Obesity & Metabolism. 2025.

The belief that IV dextrose is necessary to clear ketones in hyperemesis gravidarum originated from a logical, and now known to be outdated, extrapolation of basic starvation ketosis physiology and the treatment paradigm for diabetic ketoacidosis (DKA). The original experiments that led to this conclusion go back to the 1960s (Foster data). Not only is this outdated, but it is also physiologically incorrect. We’ve learned a lot about IV fluid replacement about hyperemesis gravidarum in the last several years- in the last data review was in January 2026 in Lancet. Even the correction of hyponatremia has evolved. Should we be following urine ketones for patients being treated for HG? Is Dextrose needed? Listen in for details.

1. Nana M, Painter R, Williamson C et al. Hyperemesis gravidarum. The Lancet, Jan 2026; 407, 78-89

2. Clark SM, Zhang X, Goncharov DA. Inpatient Management of Hyperemesis Gravidarum. Obstet Gynecol. 2024 Jun 1;143(6):745-758. doi: 10.1097/AOG.0000000000005518. Epub 2024 Feb 1. PMID: 38301258.

3. Ayus JC, et al.Correction rates and clinical outcomes in hospitalized adults with severe hyponatremia: a systematic review and meta-analysis. JAMA Intern Med. 2025;185(1):38-51.

4. ACOG Clinical Epert Series: Inpatient Management of Hyperemesis Gravidarium. Obstet Gynecol; 2024