Howard and guest hose Sivani Aluru unpack why the new PMOS name matters, how PCOS got tied to “cysts,” and what the evidence actually says about diagnosis, metabolic risk, and treatment. We also challenge a few habits we have all inherited, from pre-op antibiotic dosing to the way we talk about hormones, weight, and fertility with patients.

• the evidence gap behind 2 g vs 3 g cefazolin in obese cesarean patients and how practice inertia forms
• why PMOS shifts attention toward insulin resistance, metabolic screening, and multidisciplinary care
• how NIH, Rotterdam, and androgen excess criteria shape who gets diagnosed and who gets missed
• SHBG and free testosterone as a practical way to explain symptoms when total testosterone looks normal
• why ovarian follicles are not the same as painful ovarian cysts and why ultrasound can mislead
• patient frustration with “just take birth control” and how we explain progesterone protection for the endometrium
• lean PMOS, weight-focused bias, and realistic conversations about lifestyle change, GLP-1s, and bariatric surgery
• fertility takeaways from PPCOS II, metformin limitations, and what lifestyle trials suggest preconception
Be sure to check out thinkingaboutobgyn.com for more information, and be sure to follow us on Instagram.

0:00 Welcome And Guest Introduction

2:01 The 3-Gram Ancef Habit

12:02 PCOS Becomes PMOS

12:55 How The Criteria Got Complicated

22:00 Insulin Resistance And Free Testosterone

30:40 Hormone Panels And TikTok Myths

32:30 Ovarian Follicles Are Not “Cysts”

36:03 Treating Symptoms Without Dismissing People

46:12 Fertility Trials And Lifestyle Results

57:27 ACOG At 75 And Why Join

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We push back on the idea that obstetrics “deserves” a malpractice crisis and explain how bad incentives and junk science can turn normal evidence-based care into courtroom blame. We also break down a few widely shared clinical myths and new research so we can practice with clearer eyes and less narrative noise.
• placental grading on ultrasound as low-value data with poor predictive power and high reader variability
• how malpractice commentary can seed plaintiff-friendly arguments against evidence-based off-label use
• why blaming misoprostol or “high-dose” oxytocin oversimplifies multifactorial outcomes
• quality improvement bundles as useful tools but weak proof without controls or causal clarity
• how massive verdicts and paid expert testimony can clash with modern science on cerebral palsy and HIE
• the FAA’s five hazardous attitudes and practical antidotes for high-stakes clinical work
• new data on LEEP versus cold knife cone for CIN, recurrence, HPV clearance, and access tradeoffs
• genetics and BMI as major drivers of gut microbiome patterns, not influencer narratives
• what a 1993 Doppler trial can and cannot prove, plus why replication changes conclusions

Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram.

0:00 Welcome And Season Update

1:15 Placental Grading Myth On Ultrasound

6:44 Calling Out A Malpractice Influencer

14:06 The 2011 Policy Bundle Examined

23:20 What Drives The OB Malpractice Crisis

30:00 How Mega Verdicts Get Made

36:59 Five Hazardous Attitudes From Aviation

44:31 LEEP Versus Cone For CIN

48:04 Genetics And The Gut Microbiome

52:17 Does Doppler Ultrasound Harm Babies?

1:00:37 Recommendations And Closing

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We sit down with Joshua Oommen to get nerdy about clinical reasoning, FDA standards, and why “good evidence” is harder to define than most of us admit. We challenge the reflex to trust p-values and meta-analyses, then test our instincts against real OBGYN examples where the literature has whiplashed practice.
• why the podcast is called Thinking About OBGYN and how clinical reasoning shapes our work
• the NEJM proposal to make one pivotal trial the FDA default and what “confirmatory evidence” might mean
• medical reversal, surrogate endpoints, and how trust erodes when practice changes late
• why Bayesian thinking fits how clinicians interpret tests, trials, and prior beliefs
• how meta-analyses fail through small study effects, publication bias, p-hacking, and heterogeneity
• the amnioinfusion comeback as a case study in applicability and overconfident conclusions
Be sure to check out thinking about obgyn.com for more information and be sure to follow us on Instagram.

0:00 Welcome And Today’s Big Question

3:48 Why “Thinking About OBGYN” Exists

11:54 The NEJM Push For One Trial

16:38 Medical Reversal And Trust Problems

24:43 AI Proteins And CRISPR Pressure Tests

32:33 Bayes Thinking Beyond P Values

36:43 Why Meta-Analyses Often Mislead

41:08 Bias And Heterogeneity Red Flags

46:24 Amnioinfusion And A Meta-Analysis Comeback

1:02:29 Final Warnings And How To Learn

Follow us on Instagram @thinkingaboutobgyn.