Recent evidence challenges the practice of prescribing oral antibiotics after Cesarean delivery in obese patients, finding no significant reduction in infection rates compared to standard preoperative antibiotics alone. Howard and Antonia analyze studies showing why this once-promising intervention may not be necessary.

• ACOG updates delayed cord clamping guidance to minimum 60 seconds for preterm infants
• Baby born at 21 weeks and zero days celebrates first birthday, highlighting advances in neonatal care
• Systematic reviews show no difference between chlorhexidine and iodine for vaginal prep before hysterectomy
• Conservative management of placenta accreta spectrum disorders shows improved outcomes over immediate cesarean hysterectomy
• Labor arrest Cesareans have highest blood loss among non-accreta cesarean indications
• New HPV testing terminology recommends "HPV detected" rather than "positive" to avoid relationship misunderstandings
• USPSTF preeclampsia prevention guidelines classify 89% of pregnant women as aspirin candidates despite limited evidence
• Endometrial sampling best practices include stepwise approach starting with ultrasound before considering hysteroscopy

In two weeks, Jacqueline Vidosch returns to discuss her son Noah who has trisomy 18, following a feature in the New York Times.

00:00:00 Episode Introduction

00:06:43 Post-Cesarean Antibiotics: Evidence Review

00:17:11 Delayed Cord Clamping Updates

00:22:13 Extreme Preterm Survival Case

00:26:40 Vaginal Prep and Placenta Accreta Management

00:30:11 Cesarean Blood Loss by Indication

00:34:21 HPV Testing Language Changes

00:37:45 Aspirin for Preeclampsia Prevention

00:51:33 Endometrial Sampling Question

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Dr. Scott Guthrie joins us to explore the significant advances in neonatal care and the critical partnership between obstetricians and neonatologists to improve outcomes for newborns. Highlights include:

• Successful implemented delayed cord clamping across Tennessee hospitals through collaborative quality improvement project
• Neonatal mortality has decreased 30% between 1999-2022 due to advances in medical care and prenatal management
• Survival rates for 22-week premature infants have improved to 30-40%, with many having normal development
• Modern ventilation strategies now allow extremely premature babies to avoid intubation completely
• Delivery room practices have shifted from routine suctioning to prioritizing effective ventilation
• Therapeutic cooling has revolutionized treatment for hypoxic ischemic encephalopathy when initiated within 6 hours
• Historical treatment of meconium stained fluid has evolved as we better understood its pathophysiology
• Neonatal intensive care advances were catalyzed by Patrick Kennedy's death from hyaline membrane disease in 1963

Join us for our continuing exploration of obstetrical and neonatal advances as we work together to improve outcomes for mothers and babies.

00:00:00 Introduction to Neonatal Care Advances

00:10:13 Neonatal Mortality Trends and Challenges

00:16:27Technological Evolution in NICU Care

00:24:07 Periviable Infants: Improved Survival Rates

00:31:09 Delivery Room Best Practices for Newborns

00:38:44 Modern Meconium Management Approaches

00:47:19 Therapeutic Hypothermia for HIE

00:55:42 Causes and Detection of Hypoxic Ischemic Encephalopathy

01:03:01 History of Neonatal Care Evolution

01:12:25 Concluding Thoughts on Collaborative Care

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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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