Dr. Chapa’s OBGYN Clinical Pearls

Postop DVT and PE are potentially devastating to a postop patient. What does the ACOG and the American College of Chest Physicians say about stopping hormone replacement therapy or oral contraceptive pills before surgery? Let’s take a look at the data.

In the United States, GDM is diagnosed by a 3 hour GTT when 2 or more values are above a designated cut off. But what happens when only one value is elevated? In this session, we will review the data regarding this clinical dilemma. We will also review if there is a clinical difference if the 1 elevated value is the fasting blood sugar or 1 of the 3 post glucose challenge. Data taken from SMFM bri...

Umbilical cord blood banking still carries significant misperceptions regarding its potential use. Did you know, that umbilical cord blood is not meant to be used as in an AUTOLOGOUS transplant because stored cord blood contains the same genetic variant or pre-malignant condition that led to the condition being treated in the donor! In other words, a child who develops a genetic condition cannot b...

IV fluids?! Does it really make a difference if the patient receives normal saline (NS) or Lactated Ringers (LR)? Well, for short bouts of rehydration (1L to 2 L), probably not. However, data now confirms that prolonged IV therapy with NS results in poorer outcomes compared to LR! In this episode, we will review the basic science of a “balanced“ IV fluid and review the data which has now placed LR...

FOAMed!!! A shout out to “free open access medical education”. Thanks for the information, Scott C.-one of our clinical medical students!

Incredibly, Although the frequency of multiple gestation is 3 to 5% at 8 weeks, vanishing twin syndrome occurs in 20-30% of all multifetal gesstations! This is not a rare occurrence. Maternal and fetal morbidity- and possibly mortality- is linked to the timing of the single fetal loss. Risks increase when a single fetus is lost in the second or third trimester. In this session, we will review the...

According to the CDC, 1 in 8 of the 1.2 million people living with HIV in the United States are unaware of their HIV status and only half of those known to be infected are receiving effective anti-retroviral therapy. The combination pill tenofovir/emtricitabine has been FDA approved for pre-exposure prophylaxis (PrEP). In this podcast will review the current state of PrEP therapy. (Reference: HIV...

Perinatal depression, which includes major and minor depressive episodes that occur during pregnancy or in the first 12 months after delivery, is one of the most common medical complications during pregnancy and the postpartum period. According to the ACOG, 1 in 7 women are affected by perinatal depression! In this session we will review the ACOG committee opinion on screening for perinatal depres...

Polyhydramnios is an abnormal increase in amniotic fluid volume typically diagnosed in the second or third trimester. Either the single deepest vertical pocket or AFI can be used for diagnosis. The two most common pathological causes are maternal diabetes and fetal anomalies. In this session, we will summarize the SMFM consult series #46 (2018) on the evaluation and management of polyhydramnios.

Diabetic ketoacidosis in pregnancy is an obstetric and medical emergency and therefore requires prompt and aggressive treatment in a specialized care unit. Prompt and aggressive IV fluid management, IV insulin administration, and attention to key electrolytes are foundational to DKA management. In this podcast, we will review the SMFM protocol for DKA management in pregnancy.

Corticosteroid therapy for fetal lung maturity was first endorsed back in 1994. But what do we know about its affect on glycemic levels? Pregnant women with gestational diabetes, and of course pre-existing diabetes, are at higher risk of DKA at “lower” hyperglycemic levels compared to non-pregnant individuals. In this session, we will review the data on the effect of antenatal corticosteroids on t...

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Incidence of cerebral palsy is inversely related to gestational age a delivery. The first reported association between fetal exposure to mag sulfate and reduction in perinatal morbidity was published in 1992. Magnesium sulfate for fetal neuroprotection is now standard in women presenting with preterm labor at less than 32 weeks. In this podcast, we will review the data on mag sulfate for fetal neu...

In 1932 a governmental agency called the Public Health Service began working with the Tuskegee Institute to study syphilis in black men. In 1947, when penicillin was discovered as the illness cure, participants in the study were denied treatment in “order to study the natural outcome of disease”. In the early 1970s, the “study” was finally deemed unethical and was stopped. As syphilis cases contin...

This is Part 2 of our critical reappraisal of the WHI study. In this episode we will cover the NAMS 2017 guidelines on HRT use. Does hormone therapy increase breast cancer in BRCA carriers? What is the data on ovarian cancer? Dementia? Listen to find out! We will also briefly touch on transdermal hormone replacement therapy, at the end of the podcast.

(Part 1) The media attention surrounding the publication of the initial results of WHI in 2002 led to fear and confusion regarding the use of hormonal therapy (HT) after menopause. In 2006, re-analysis of more complete data seemed to contradict the original findings. This led to a “retraction“ and re-explanation of the original data in 2007. Hormone therapy initiation in older women is NOT the sam...

Nuchal cord (NC) is common, and the vast majority of term deliveries with nuchal cord have normal outcomes. However, nuchal cord associated fetal morbidity is closely correlated to the number on nuchal cords present and the degree of “strangulation”/tightness. Even Hippocrates noted that nuchal cords could be associated with fetal loss in one of his writings, circa 370 BC. In this session, we will...

Umbilical Artery Doppler studies are a valuable tool to assess vital well-being in the growth restricted fetus. What are the indices that are evaluated? What is the management when abnormal results are noted? In this session, we will review fetal doppler umbilical artery velocimetry. Clinical management based upon findings will also be discussed. Dated taken from SMFM Clinical Briefs and ACOG prac...

In this episode, which is part 2, we will cover the role of “prophylactic” red blood cell transfusion during pregnancy. We will also cover the medical management of sickle cell crisis, and wrap up the episode with notes on intrapartum and postpartum care.

Sickle cell disease is the most common inherited condition worldwide. Sickle cell disease carries unique maternal and fetal risks during pregnancy. In this episode, which is part 1, we will review preconception care, medication use in pregnancy, and review specific obstetrical complications associated with the condition. (Reference: CDC, SMFM, RCOG data).

The interpregnancy interval provides an ideal opportunity to discuss interventions which can maximize maternal as well as neonatal outcomes. Do you know at which interpregnancy interval adverse neonatal outcomes are highest? Is interpregnancy interval associated with higher TOLAC risk? In this session, we will summarize the ACOG obstetric care consensus report (#8) from January 2019.

At what gestational age does the uterus become responsive to oxytocin? Can Pitocin result in hypertension or HYPOtension?...And who was Sir Henry Dale? In this podcast, we will review the origins, development, pharmacology, and potential adverse affects of synthetic oxytocin.

Is Digoxin routinely used for peripartum cardiomyopathy? Can women who had peripartum cardiomyopathy take oral contraceptive pills? In this episode, which, is part 2, we will answer these questions as well as cover the workup, management, and prognosis of peripartum cardiomyopathy (Reference: Obstet Gynecol. Jan 2019).

(Part 1): Peripartum cardiomyopathy occurs in about 1 in 2,000 births in the United States. Although relatively rare, it can be devastating to the mother. In this session we will summarize the January 2019 clinical expert series on peripartum cardiomyopathy from Dr. Gary Cunningham, et al (Obstet Gynecol. Jan 2019).

Did you know the common, modern-day, colloquial expression about “blowing smoke up someone’s A$$” actually has a medical origin? Yep... it was a real therapy! In this podcast, we will review the bizarre practice, that made its way into modern vernacular.