Dr. Chapa’s OBGYN Clinical Pearls

Latest Episodes:

VTE and Gyn Surgery Mar 16, 2019

Show notes

In 1858, Virchow reported on the triad of hypercoagulability, venous stasis, and vessel wall injury as the factors pertinent to venous thromboembolism. In this session, we will review the ACOG practice bulletin as well as the executive summary from the American College of Chest Physicians regarding VTE in gynecological surgery.

Do BC Pills have to be stopped before GYN surgery? Mar 10, 2019

Show notes

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.

One abnormal value on 3 Hr GTT: Implications? Mar 07, 2019

Show notes

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 briefings.

ACOG: Umbilical Cord Blood Banking Feb 26, 2019

Show notes

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 be treated with his own donated umbilical cord blood! In this session, we will summarize the ACOG committee opinion on umbilical cord blood banking from March 2019.

NS or LR: The IV Fluid Battle May Have Ended. Feb 23, 2019

Show notes

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 at the forefront of IV fluid hydration.

FOAMed!! Feb 20, 2019

Show notes

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

Vanishing Twin Syndrome Feb 20, 2019

Show notes

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 ACOG and SMFM Data regarding the vanishing twin syndrome.

HIV PrEP Feb 14, 2019

Show notes

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 pre-exposure prophylaxis, a review: JAMA, 2018.)

Screening for Perinatal Depression Feb 11, 2019

Show notes

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 depression from the winter of 2018 (committee opinion 132).

Polyhydramnios Feb 08, 2019

Show notes

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.

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