As physicians, we’re used to thinking about dose (how much medication, how often, and for how long). But there’s another dimension that’s often overlooked: time. For decades, we’ve known that the body processes medicines differently depending on the time of day. A blood pressure pill or chemotherapy drug can have markedly different effects depending on when it’s taken. This field, known as chronopharmacology, has transformed how we think about drug …
An excerpt from Understanding High-Risk Pregnancy: A Patient’s Guide to Prenatal Complications.
If you are 35 or older and either pregnant or thinking about having a baby, you are not alone. The average age for women having babies in this country and around the developed world has increased significantly over the past two decades, and the percentage of women having children after age 35 has increased as well. The teenage …
As a fertility specialist, recurrent implantation failure is one of the most difficult and heartbreaking problems we face. Over the last forty years, we’ve made tremendous improvements in both IVF protocols and lab techniques. A high-quality embryo may have up to a 70 percent chance of yielding a live birth. However, how do we approach the patient when high quality embryos are not taking? And what does the evidence really …
A young woman in her late twenties came to me after surgery for extensive endometriosis. The procedure had given her relief; her pain was gone. Her follow-up testing looked reassuring: her fallopian tubes were open on hysterosalpingogram (HSG), and her anti-Müllerian hormone (AMH) level was above 4 ng/mL, which is considered normal. Her question was straightforward: “If my AMH is good and my tubes are open, doesn’t that mean everything …
An excerpt from Understanding High-Risk Pregnancy: A Patient’s Guide to Prenatal Complications.
What is a high-risk pregnancy?
You may find it strange that there is no single accepted definition of what constitutes a high-risk pregnancy. Probably more than half of women will have at least one risk factor that could be an issue, but for most of these women it will minimally affect their pregnancy care or the outcome. For other …
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Maternal-fetal medicine fellow Frank I. Jackson discusses his article “Affordable postpartum hemorrhage solutions every OB/GYN should know.” Frank explains how postpartum hemorrhage remains a leading cause of maternal mortality, especially in low-resource …
Since the fall of Roe v. Wade in 2022, the United States has been navigating a reproductive health crisis unlike anything in modern history. Now, in mid-2025, the picture is even more stark, and more urgent.
In the wake of the Dobbs decision, nearly 1 in 5 patients seeking abortion care, including care for miscarriage, have been forced to travel out of state. That is more than double the number from …
Historical, cultural, social, and political factors contribute to the disparities in reproductive health, making it a multifaceted and deeply rooted issue in the fabric of the United States. Historically, the legacy of slavery and the American eugenics movements established race-based medicine, systems, and stereotypes that continue to influence provider bias and patient mistrust, contributing to the ongoing inequities in reproductive health. Culturally, persistent stereotypes, particularly toward Black women, have led …
Postpartum hemorrhage (PPH) remains one of the most common causes of maternal death globally. In many cases, it’s not a matter of lacking knowledge—it’s about lacking access to the tools we need.
In well-resourced U.S. hospitals, the JADA® System has in many ways been a paradigm change by using vacuum-induced uterine tamponade—a technique that creates gentle intrauterine suction to trigger uterine contraction and bleeding control. However, for the vast majority of …
As a reproductive endocrinologist, I see countless patients who walk through my doors with quiet stories of loss—sometimes the loss of hope, sometimes the loss of time. But every year, there’s a particular group of gentlemen who share a strikingly similar history.
They come from different countries. Many grew up in regions where the measles-mumps-rubella (MMR) vaccine was unavailable or inconsistently administered. They had mumps as children, recovered, and thought nothing …
When reviewing poor maternal health outcomes in the U.S., it is clear we cannot keep doing the same thing and expect to make pregnancy safe and healthy for all. A new approach is needed that harnesses the power of molecular advances to bring precision medicine to pregnancy health. Preeclampsia, one of the most dangerous complications in pregnancy, is a disorder of high blood pressure that has eluded the ability to …
Menstrual health is one of the most neglected aspects of adolescent care—especially for teens living in poverty. For these adolescents, getting a period doesn’t just mean discomfort—it means missing school, hiding pain, and facing daily choices between basic needs and menstrual products.
In both low- and high-income countries, period poverty is a quiet crisis. In the U.S., nearly one in five teens has missed school because they couldn’t afford menstrual products. …
“I look at my baby and I don’t feel a thing,” the patient whispers as she cradles her 3-week-old baby. “I feel so much guilt … sometimes I don’t want to be here at all.” And yet, she is not alone. Her words echo the silent yet growing public health crisis of perinatal mental health.
Approximately 1 in 5 women is affected by mental health conditions during the perinatal period. …
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When reviewing poor maternal health outcomes in the U.S., it is clear we cannot keep doing the same thing and expect to make pregnancy safe and healthy for all. A new approach is needed that harnesses the power of molecular advances to bring precision medicine to pregnancy health. Preeclampsia, one of the most dangerous complications in pregnancy, is a disorder of high blood pressure that has eluded the ability to …
I was on another overnight shift in the OB/GYN emergency department. The air was thick with tension, as it always is when the night is full of contractions, cries, and codes. One woman arrived in active labor — her first baby, frightened eyes, and no family by her side.
Everyone rushed to prepare for the delivery. Monitors beeped. Gloves snapped. Orders flew around the room. The focus was on the baby. …
I’ve felt an overwhelming need to write for about a month now. I struggled to find the right words as recent events in medicine and society have created a constant state of confusion and distress. Most notably, I have found it increasingly difficult to understand or process how some medical professionals can remain silent or indifferent in the face of ethical crises. At times, the anger this evokes leads me …
Von Willebrand disease (VWD) is the most common inherited bleeding disorder, affecting approximately 1 percent of the population, though clinically significant symptoms occur in about 1 in 10,000 individuals. It is caused by a deficiency or dysfunction of von Willebrand factor (VWF), a protein critical for blood clotting. For women, VWD poses unique challenges during reproductive years, particularly in the context of fertility and assisted reproductive technologies like in vitro …
She looked relatively healthy. Middle-aged, calm, composed. She had tried everything—until she hadn’t. That’s how she found herself on the OR schedule for a hysterectomy.
Years of irregular, heavy bleeding had led her here. She didn’t want surgery, but she was tired. Tired of bleeding, tired of not being heard, tired of grasping for answers. This was the final option, or so it seemed.
But then, just before the surgery, a resident …
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Research scientist Nichole Cubbage discusses her article, “The silent grief of vanishing twin syndrome: Why words matter in health care.” She explains that Vanishing Twin Syndrome (VTS), the loss of one fetus …
I’m a family medicine-trained doctor working in a rural ER. I drive 90 minutes to get there, and I do it because if I don’t, no one will. The county I serve has seen its nearest hospital close. The OB unit is long gone. Specialist referrals are hit or miss. And the patients? They’re sick. Sicker than they should be. Because when access to health care disappears, what follows is …
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