Dr. Chapa’s OBGYN Clinical Pearls

Is the high dose Pitocin protocol (6 mU/min) associated with increased C-sections for fetal distress? What about perinatal outcomes? There are a variety of Pitocin protocols in L&D units across the country. In this episode, we will review a soon to be released publication out of Obstetrics and Gynecology. We will summarize an RCT comparing high-dose versus low-dose Oxytocin for labor augmentation...

Given the known benefits to BMZ for preterm infants and the difficulty in predicting which women will actually deliver preterm, it is common for providers to administer antenatal corticosteroids in an effort not to miss the opportunity to give them before delivery and to try and get the maximal time benefit. However, many of these babies will be born at term. Do these term born babies benefit or e...

Sex can fulfill the human psychological needs of connectedness as well as the physical needs of intimacy. Being alone and lonely can cause major health and psychological problems for many. Is there data that sexual frustration impairs well-being? This session will review this often controversial subject as well as summarize an eye-opening study previously published from Carnegie Mellon describing...

In this session we wrap up our review of Adenomyosis. Are you familiar with the MUSA ultrasound criteria? What is the role of MRI in the diagnosis of Adenomyosis? And is there a role for hysteroscopic diagnosis? Let’s wrap up our discussion on Adenomyosis now.

Historically, Adenomyosis was a pathological diagnosis only. However, new imaging standards/techniques have moved Adeno into a clinical diagnosis. Is there a patient risk profile for this condition? Is this strictly a gynecological issue or is there adverse perinatal outcomes as well? Welcome to Part 1 of Adenomyosis where we will answer these questions and more.

OB Patients admitted with medical or obstetrical complications to an antepartum hospital unit face separation from loved ones, stress from their diagnosis, face isolation, and are prone to develop perinatal mood disorders. In this episode, we will review a soon to be released publication from the Green Journal (May 2021) addressing this under diagnosed and under recognized issue.

On April 12, 2021, Illinois agreed to provide Medicaid benefits to eligible mothers for up to 12 months postpartum, a major extension from the previous 60-day limit. Follow up of postpartum women for 12 months after delivery is gaining favor as data is evolving which shows that “the 4th trimester” (the first 12 weeks postpartum) is just not long enough to detect postpartum complications. In this e...

We often encounter the acutely agitated patient. Acute agitation may be from and uncontrolled medical condition, psychiatric condition, or illicit substance induced. The acutely agitated patient is also at increased risk of some prenatal complications. In this session we will review the evidence-based protocols for management of the acutely agitated OB patient.

The ACOG has stated that caffeine consumption in pregnancy should be limited to 200 mg/day. However, a new study published on March 25, 2021 in JAMA Network Open is questioning that recommendation. In this study, we will review this longitudinal cohort publication stating that “there may be no safe limit to caffeine consumption”.

The CDC released a health alert through its Health Alert Network on April 13, 2021, notifying physicians and other health care practitioners that the CDC and FDA are reviewing data involving six U.S. cases of a rare type of blood clot in individuals after receiving the Johnson & Johnson COVID-19 vaccine. In this session, we will review what CVST is, how it can present, the work-up, and potential t...

The field of obstetrics was “birthed“ out of midwifery. The concept of second stage of labor in the lithotomy position was not how it was “always done”. In this episode we will review the evidence behind the “flexible sacral positions” and learn how maternal positional changes can assist with the labor process.

The prevalence of trauma is quite sobering. General population surveys have found extremely high rates of traumatic experiences encountered which span all races, ages, and socioeconomic status is. Nonetheless, some groups are disproportionately affected by trauma compared to others. This is why all healthcare providers should be aware of “trauma informed care” practices. In this episode, we will s...

Hysteroscopy, and especially office-based hysteroscopy, is a fantastic tool in the evaluation of suspected endometrial abnormalities and/or heavy menstrual bleeding. In this session, we will review the ACOG committee opinion on hysteroscopy. At what fluid deficit should you stop the procedure if using normal saline? What about glycine? What is the significance of a “mill-wheel” murmur. Do you know...

Algorithms and opinions on cervical cancer screening change quickly. In this session, we will review the uses for HPV testing as a primary screening tool as well as post treatment surveillance. Are you familiar with which HPV tests can be used as primary screening? What is the frequency of tests? Let’s cover this now.

In this session, we will pick up where we left off with our immediate past podcast covering the SMFM “Choosing Wisely” recommendations. When should we screen for MTHFR for adverse pregnancy outcomes? When should we start screening for FGR with Umbilical Dopplers? We’ll answer these questions and much more in this session as we wrap up the SMFM “don’t do” list.

Sometimes what sounds good in clinical practice actually is not evidence-based. In March 2021, the SMFM updated the “Choosing Wisely”list of practices/recommendations for OB care. Should routine screening for microdeletions be done? What about serum screening for preterm labor? In this session we will cover the most recent 5 “don’t do“ items released by SMFM.

In the era of social media and easy to spread public opinion platforms, misinformation can grow rampant. Is the Covid vaccine associated with infertility in the general population? Where did this idea come from? What is “Syncytin-1” and how is this related to this controversy? Here we will review the origin of this story, any theoretical basis for the claims, and the conclusions from the CDC, FDA,...

What are the delivery recommendations for pregnant Covid patients? When is expectant management favored compared with elective delivery? Is mechanical ventilation alone an indication for delivery? This is our second session in which we will wrap up our summary of the SMFM updated treatment guidelines for pregnant Covid patients (February 2021).

COVID-19 management guidelines change quickly. In this session we will review the February 2021 SMFM update regarding when to consider inpatient care for COVID-19 in pregnancy. Do you know which 02 saturation categorizes severe compared to moderate disease? What dose of dexamethasone is recommended for pregnant Covid patients that require oxygen? Is outpatient anticoagulation recommended? We will...

In February 2021, the ACOG will release a new committee opinion (818) updating guidelines on “medically indicated late preterm and early term deliveries”. Are steroids still recommended in this preterm interval? How has new data on fetal morbidity with intrauterine growth restriction and intrahepatic cholestasis affected these guidelines? Listen… And find out!

Historically, brachial plexus palsy was considered proof of shoulder dystocia or traumatic birth. Can brachial plexus injuries occur with normal, uneventful deliveries? Do brachial plexus palsies happen even at C-section? The answer may surprise you. In this episode, we will review the different types of brachial plexus injuries and review the most recent data on the pathophysiology of these nerve...

There have been a variety of published and accepted clinical presentations of COVID-19: from lack of taste, GI disturbances, muscle aches, to the usual fever and shortness of breath. But this COVID-19 affect a woman’s menstrual cycle? There is increased chatter on the ever accurate Internet regarding this. But is there data? In this session we will go over the possible association between COVID-19...

Are you still treating urogenital gonorrhea with ceftriaxone and azithromycin? That was a standard for over a decade. But things have now changed. In December 2020, the CDC updated the treatment regimen for urogenital infections with neisseria gonorrhea. Is “dual-agent” still a therapy? Does cefixime still have a treatment role? What about test of cure? We will cover these questions and more in th...

We all know there is a national opioid epidemic. This, like the current viral pandemic, is robbing people of their lives. Pregnant women are not immune to opioid use disorder. Is methadone endorsed for use in pregnancy? What about buprenorphine? Is naltrexone safe as an alternative treatment during pregnancy? In this session, we will review the updated literature regarding opioid use disorder and...

Historically, CS prophylactic antibiotics were given after umbilical cord clamp and cut to prevent exposure of the neonate to antimicrobials. The recommendation then changed, in line with typical surgical practice, to give prophylactic antibiotics before skin incision. However, new data published in December 2020 is calling this practice into question. In this session we will review this new publi...