Howard Harrell

speaker

1,260 appearances 4 recordings 1 series first heard May 2026 last heard 23 Jul

Howard Harrell’s voice in public audio — every appearance, attributed to the second.

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recordings per month · last 12 months

Recordings per month over the last 12 months — 4 in all, peaking in Jul 2026 with 2.

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Thinking About Ob/Gyn · Episode 11.12 The Malpractice Crisis Is Real And Blaming Evidence-Based Care Makes It Worse · 10 Jun 2026 podcast

Cool.

Yes, listeners love these and I

We have no shortage of them, so we should do them as regularly as we can, really.

Okay, how about grading placentas on ultrasound and

and intervening on it somehow.

So it's fairly common to see obstetric ultrasound reports that mention the grade of the placenta.

I I do see it pretty frequently and

That this becomes

as a listed indication for either increased monitoring

during the pregnancy or for just inducing labor.

But is there any evidence that this matters?

And should we actually be changing our management of the patient because of a placental grade that's on the ultrasound?

Yeah, so already one one point of education here is that

at full term, grade three is normal, not like, oh no, the they're gonna placenta's about to abrupt or something.

No, it's normal.

So yeah, so when Granum introduced this idea in the 70s, he he it was thought that grading the placenta could potentially be a proxy for fetal lung maturity that was at the time determined by amniocentesis.

Doing a test of the amniotic fluid because those placental grades did tend to correspond to certain weeks of gestation.

But unfortunately that turned out not to be reliable at all.

A lot of pregnancies back then were still much more poorly dated because they didn't have really routine first trimester ultrasound.

So this was one way to help determine even is this thirty-six weeks or is this thirty-four?

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