Vision Changes in Pregnancy

Today we are joined by Dr. Ben Young. Ben is an ophthalmology resident at Yale New Haven Hospital in Connecticut, and is sharing with us a common complaint that we know very little about - the eye in pregnancy!

Ben also hosts Eyes For Ears, an educational podcast and flashcard reference for ophthalmology residents. If you happen to know any vision sciences students or residents, let them know about it!

We start out talking about the “ocular vital signs,” which are:
- Visual Acuity
- Pupils (“swinging light test”)
- Intraocular pressure
- Visual Fields
- Extra-ocular movements

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Image copyright of FOAMCast

The most common reasons for ophthalmology issues in pregnancy relate to either 1) vision changes requiring a new prescription, or 2) dry eye. However, don’t forget some key pearls:

- Monocular (single eye) double vision — dry eye. Binocular (both eye) double vision — badness!
- A Snellen chart and a flashlight are the best tools you have to help out a consultant.
- Check out this video on how to perform a swinging flashlight test.

Further reading from the OBG Project:
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Is Cataract Surgery in Women Associated with Decreased Mortality?

Special SMFM Interview: Dr. George Saade

Our first special interview from SMFM is with Dr. George Saade. Dr. Saade is the Jennie Sealy Smith Distinguished Chair, Chief of Obstetrics and Maternal Fetal Medicine, and Professor of Obstetrics and Gynecology and Cell Biology at the University of Texas Medical Branch in Galveston, TX. His official bio can be found at this link.

Dr. Saade shared with us a number of great pearls, including his philosophy on pregnancy as a window to future health. We hope you enjoy and look forward to our next interview coming next Wednesday!

SMFM Interviews: Teaser Trailer

Hi all! We have a special release today after our exciting time at the Society for Maternal-Fetal Medicine’s 39th annual meeting. We were lucky enough to interview a bunch of exciting people in the field, and will be releasing interviews over the next several weeks.

If you want exclusive access to all of our interviews immediately, become a $5 / month member on our Patreon. Otherwise, we’ll be releasing a new interview every Wednesday for the foreseeable future!

Our fabulous interviews included:
- Dr. George Saade (UTMB)
- Dr. Sean Blackwell (UT Houston)
- Dr. Alison Steube (UNC)
- Dr. Mary D’Alton (Columbia)
- Dr. Cynthia Gyamfi (Columbia)
- Dr. Aaron Caughey (Oregon)
- Dr. Stephanie Ros (USF)
- Dr. Jeffrey Sperling (UCSF)
- Dr. Desmond Sutton (Columbia)
- Dr. Vincenzo Berghella (Thomas Jefferson)
- Dr. William Grobman (Northwestern)

Breastfeeding Part I

Today we start a two part series on breastfeeding with Dr. Erin Cleary, Assistant Professor of Obstetrics and Gynecology and Clinician Educator at the Warren Alpert Brown School of Medicine. She’s also the incoming MFM fellow at the Ohio State University — so look out for her in July, Buckeye listeners!

Also, thank you Dr. Daniel Ginn, our first Patreon sponsor — and apologies for the dad joke with your name!

We start today with a discussion of the anatomy of the breast, and in particular with lactation. At the bottom of this post is a corresponding Netter image to guide your listening.

The physiology of lactation is somewhat confusing, but in bulleted summary:
Lactogenesis I Early in pregnancy, human placental lactogen, prolactin, and chorionic gonadotropin contribute to maturation of the breast tissue to prepare for lactogenesis.

• In the second trimester, secretory material which resembles colostrum appears in the glands.  A woman who delivers after 16 weeks gestation can be expected to produce colostrum.

• Differentiated secretory alveolar cells develop at the ends of the mammary ducts under the influence of prolactin.  Progesterone acts to inhibit milk production during pregnancy. This makes sense from a viewpoint of energy expenditure- grow your baby first in utero, then switch to focus on growing it with milk.

Lactogenesis II is the onset of copious milk production at delivery.  In all mammals, it is associated with a drop in progesterone levels; in humans, this occurs during the 1st 4 days postpartum, with “milk coming in” by day 5

• During the next 10 days, the milk composition changes to mature milk.  Establishing this supply is Lactogenesis III, and is NOT a hormonally-driven process like Lactogenesis I or II. Rather, this is supply/demand-driven with expression of milk

• When the milk is not removed, the increased pressure lessens capillary blood flow and inhibits the lactation process.  Lack of sucking stimulation means lack of prolactin release from the pituitary.

Next week, we’ll be back again with Dr. Cleary discussing breastfeeding myths and contraindications, so stay tuned!

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Netter’s Anatomy. Copyright Elsevier texts.

Biostatistics Part II

Welcome back to biostatistics! Today we spend some time on study design and study-specific statistical calculations.

If you have more time, check out the Khan Academy series of videos and infographics on statistics and study design. Their resources are phenomenal and can really help with both understanding CREOG questions as well as helping you out in your own research design!

And for a concise review, check out our own quick notes on the subject.