Dr. Chapa’s OBGYN Clinical Pearls

Alright, as occasionally happens… There was an error in the editing of our prior podcast regarding nerve injury at gynecological surgery. This very brief section will clarify the occurrence of klumpke's palsy during steep trendelenburg positioning.

Gyn surgery can be associated with iatrogenic nerve injury. Neuropathy can be classified into three types: neuropraxia, axonotmesis, and neurotmesis. The most severe form of injury is nerve transaction or complete nerve ligation (neurotmesis). In this session, we will review the mechanism of nerve injury during Gyn surgery, their presentations, and prevention tips. Material is taken from the AAGL...

In this podcast, we will review the ACOG updated guidelines regarding intra-amniotic infections. Three classifications have been given by the ACOG: 1. Isolated maternal fever in labor, 2. Suspected intra-amniotic infection, and 3. Confirmed intra-amniotic infection. We will review these three categories, their diagnosis, and treatment recommendations. Data taken from the ACOG committee opinion 712...

The ACOG, as well as the AAP, recommends delayed umbilical cord clamping in stable term as well as preterm neonates. While once considered necessary to keep the Neonate at or below the level of the placenta, new data shows that placental to child transfusion still occurs if the child is placed on the maternal chest for skin to skin contact. Additionally, the presence of meconium stained fluid – in...

Ovarian cancer is the most deadly of all gynecological malignancies. Most cases present an advanced stage. Epithelial ovarian cancer is the most common histological class at diagnosis. In this session, we will cover the SGO data on presentation, staging, and treatment of epithelial ovarian malignancies. Avastin and PARP therapy will also be reviewed.

Howdy! Thanks for following our podcast. Be sure to find us, and follow us, on our Facebook page by the same name. Typically, additional information and data is posted on the Facebook feed which serves as a supplement to the podcast. Thanks for listening…

Persistence of high-grade oncogenic HPV is the key risk factor for the development of cervical carcinoma. In this session, we will review the pathophysiology, clinical staging, and treatment regimens for cervical carcinoma. Additionally, we will review the 2014 approved medication (Avastin) for the treatment of advanced, metastatic, recurrent cervical cancer. (Data taken from the Society of Gyneco...

Endometrial carcinoma is the most commonly diagnosed gynecologic malignancy. The SGO and the ACOG released a practice bulletin in 2015 which is the most recent bulletin on the subject (149). In this podcast we will review the classification, symptoms, work up, and surgical management of endometrial adenocarcinoma.

EIN Represents a true antecedent lesion in the endometrial cavity with the potential to develop into endometrial adenocarcinoma. This podcast will review the joint committee opinion released by the SGO and the ACOG (#631) covering pre-malignant endometrial pathology.

In this session, we will cover emergency contraception: levonorgestrel, Ullipristal, and the copper IUD. Data for this podcast comes from the ACOG practice bulletin 152.

MRI offers some advantages over ultrasound as a diagnostic tool in pregnancy. In this session, we were review the ACOG committee opinion on MRI use in pregnancy with a focus on gadolinium contrast agent.

In Part 1, we covered the basics of OB ultrasound. In this session, a short additional piece, we answer a few additional questions regarding ultrasound use in pregnancy. Data taken from the ACOG/AIUM practice bulletin 175

Ultrasound is the most common procedure performed during pregnancy. The ACOG recognizes three types of ultrasound: standard, limited, and specialized. In this session, we will review methods to date a pregnancy, determine fetal weight, discuss ultrasound use for genetic screening, and end with a quick recap of ultrasound use in multifetal gestations.

Unrecognized or misdiagnosed PID may result in infertility, tubal pregnancy, and chronic pelvic pain. In this session, we will review the CDC guidelines for diagnosis and treatment of PID (2015 updated guidelines).

In this session, we will review thromboembolism in pregnancy based on the July 2018 ACOG Practice Bulletin. We will cover DVT and PE presentation, work up, and management. Delivery considerations will also be reviewed.

In this session, we will review chancroid, a genital STI caused by H. Ducreyi. This bacterium causes ulcers presenting as painful sores (soft chancre) on the genitalia. We will cover presentation, diagnosis, and treatment. We will also review the differences between the genital ulcers of syphilis, LGV, and granuloma inguinale.

In this session, we will discuss the clinical stages of syphilis, diagnosis, treatments, and pregnancy considerations.

In this session, we will cover the microbiology and the pathophysiological processes of gonococcal infections. Screening, treatment, and prevention of neonatal infection will also be reviewed. Data is taken from the ACOG bulletin as well as the practice guidelines from the CDC.

Chlamydia Trachomatis is the most common bacterial STI. In this session, we will review screening recommendations, treatment, pregnancy considerations, and end with a quick recap and review of the microbiology of the organism.

In this short session, we will cover recommended delivery times for women with chronic hypertension as well as breast-feeding on antihypertensive medications.

Chronic hypertension affects 3 to 5% of all pregnancies. In this session, we will cover the SMFM and ACOG bulletins on the subject. Which patients need treatment? What meds should be used? What are the risks of chronic hypertension in pregnancy? Answers to these questioms AND MORE will be covered.

In January 2018, the ACOG changed the terminology for PROM, now referred to as pre-labor rupture of membranes. In this session, we will review practice bulletin 188 and discuss the clinical management of both term and preterm PROM.

In this session, we will review the process of mammogenesis and lactogenesis as well as the process of lactation. Mastitis and breast abscess management will also be reviewed.

Fetal macrosomia predisposes both the mother and child to increased risks. In this review, a summary of the ACOG practice bulletin #173, we will review risk factors for fetal macrosomia, the diagnosis, and when a primary elective C-section should be considered for the condition.

This is part 2 of our series on maternal alloimmunization. In this session, we will review prevention of RH isoimmunization with a brief review on RhoGAM use according to the ACOG practice bulletin # 181.