Dr. Chapa’s OBGYN Clinical Pearls

In March 2018, the ACOG released an updated practice bulletin on the management of alloimmunization during pregnancy. The ability to determine genotype of an RH positive father and the use of middle cerebral artery Doppler ultrasound have revolutionized the care of alloimmunization. This is part one of a two-part series.

Multifetal gestations are either dizygotic or monozygotic. The rate of monozygotic twins tends to be constant worldwide. Twin and triplet pregnancies are at risk of certain maternal and fetal complications. In this session, we will cover the ACOG practice bulletin on multifetal gestations as well as the SMFM bulletin on the topic.

In this session we will cover general surgery comditiond in pregnancy. The three most common non-obstetrical surgical conditions in pregnancy are: appendicitis, gallbladder disease, and acute intestinal obstruction. In this session, we will cover the diagnostic evaluation and treatment of these non-obstetrical surgical conditions.

Cell free DNA screening evaluates short segments of DNA in a maternal serum and can be used to screen for fetal aneuploidy, fetal RH type, and sex chromosome abnormalities. In this session, we will review the data on cell free DNA screening from the ACOG practice bulletin number 163.

In this session, we will cover data from the ACOG practice bulletin number 150, on early pregnancy loss. We will cover etiology, diagnosis, and the three types of management: expectant management, medical management, and surgical management. We will end a podcast with a quick review of the different categories of spontaneous abortion (threatened, inevitable/incomplete, missed, blighted, septic).

In this final session, we will review RhoGAM use, GBS screening, and the ACOG update on vaccinations in pregnancy (Tdap).

This is part 2 of our 3 part series on antepartum care. In this session, we will cover ultrasound use, screens for aneuploidy, screening for inherited genetic conditions, and gestational diabetes screening.

In this session, we will review the ACOG guidelines regarding specific screening tests, monitoring, and interventions during routine prenatal/antepartum care. This is part 1 of the podcast set.

In this session, we will review guidelines for pre-conception care based on the ACOG current commentary.

1955, Emmanuel Friedman described the labor progress of 500 nulliparous wowen. That curve became the standard for labor management for 60 years. However, in 2014, the ACOG revised the definitions of the active phase of labor and re-defined the second stage of labor. In this session, we will review these labor guidelines.

In this session, we will cover specifics of the mechanisms of labor. We will cover details on the fetus (lie, attitude, presentation, and position) and attributes of the maternal pelvis. We will cover the powers of labor (uterine contractions strength and the revised Friedman curve) in another session.

In this session, we will review intimate partner violence which was presented in the American College of OB/GYN committee opinion #518.

In this session we will cover the maternal physiological changes which occurr during pregnancy.

In this session, we will review the pathophysiology of human papillomavirus infections. We will also cover HPV immunization, and contrast primary screening for cervical cancer ACOG recommendations with the recommendations of the US preventative services task force.

In this session, we will review the ACOG committee opinion (592) on sexual assault as well as the CDC algorithm for post exposure prophylaxis following sexual assault.

In this session, we will cover polycystic ovarian syndrome. Although the etiology is not clearly understood, there are set diagnostic criteria for PCOS. Management of the condition depends on the patient's desire for immediate fertility as well as consideration of metabolic derangements.

Hyperprolactinemia may be physiological, pharmacological, or pathological. In this session, we will review possible causes of, and workup for, an elevated prolactin. Information taken from the American Society of Reproductive Medicine.

In this session, we will review the diagnostic algorithm for primary amenorrhea based on the American Society of Reproductive Medicine (ASRM). Primary amenorrhea is much less common than secondary amenorrhea. Primary amenorrhea occurs in less in

This is a brief review of the ACOG committee opinion number 700, Methods for Establishing the Due Date. We will review discrepancies between first, second, and third trimester ultrasound and the last menstrual period.

Tranexamic acid is ACOG endorsed for the treatment of established postpartum hemorrhage. Postpartum hemorrhage is now defined as greater or equal to 1000mls estimated blood loss regardless of mode of delivery. In this brief session, we will review the dosing regimen for TXA for established PPH.

In this session, we will cover the May 2018 new Committee Opinion from the ACOG on optimizing postpartum care. The postpartum interval, referred to as "the 4th Trimester", can pose unique health challanges to the mother. In an effort to better identify and treat postpartum complications, the ACOG has released new guidelines reviewed here.

In this session, we will cover cholelithiasis and cholecystitis in pregnancy. Data taken from the society of maternal fetal medicine and the American College of OB/GYN.

In this session, we will review the ACOG committee opinion number 692 and the medical protocols for management of acute-onset, severe hypertension during pregnancy and postpartum period.

In this session, we will highlight the ACOG Task Force Report on Hypertension in Pregnancy.

In this session we will cover the vast cardiovascular changes which occur in the maternal compartment during pregnancy.