Dr. Chapa’s OBGYN Clinical Pearls

Latest Episodes:

Funic Presentations at Term: CS or Not? Timing? Feb 20, 2025

Show notes

Funic presentation, the umbilical cord presenting as the leading feal component seen on ultrasound, may be a transient phenomenon and is usually considered insignificant until ~32 weeks. However, its persistence beyond that gestational age raises the possibility of cord prolapse intrapartum as cervical dilation progresses. Cord prolapse is a mostly unpredictable obstetric emergency, in which the umbilical cord comes through the cervical os in advance of (overt prolapse – usually palpable or even visible within the vagina) or alongside the fetal presenting part in the presence of ruptured membranes (occult prolapse). The reported incidence of umbilical cord prolapse ranges from 1 to 6 per 1000 pregnancies. Though rare, cord prolapse is associated with high perinatal mortality and morbidity as cord compression and umbilical artery vasospasm may occur preventing blood flow. Consequently, expert opinion recommends CS when funic presentation is detected INTRAPARTUM. But WHEN is delivery recommended a funic presentation is found in the late third trimester? Does that need a CS? Funic presentation is notably absent from the ACOG CO 831 on medically indicated late preterm and early term deliveries. Listen in for details.

Excessive Maternal Wt Gain (gwg) = Stillbirth? Feb 17, 2025

Show notes

One in five women in the U.S. have a BMI of 30 or more at the START of pregnancy. Around 1 in 5 women gain more than 40 pounds during pregnancy, which is more than any woman should gain. Only about one-third of women gain the recommended amount of weight during pregnancy. Gaining too much weight during pregnancy can increase the risk of HDP, GDM, fetal macrosomia, and can cause complications of birth, such as shoulder dystocia or preterm birth. Excessive weight gain during pregnancy can also increase the likelihood of postpartum weight retention. But what about stillbirth risk? Does excessive maternal weight gain during pregnancy increase still birth risk? The ACOG recommends antepartum fetal surveillance based on pre-pregnancy BMI. Why is maternal weight during pregnancy not an indication for an antepartum fetal surveillance? The data may surprise you! Listen in for details.

PUR and Peppermint Oil? Feb 15, 2025

Show notes

Estimates of Postpartum Urinary Retention (PUR) incidence vary widely from 1.5% to 17.9%, with undiagnosed cases making the true incidence difficult to determine. A postvoid residual (PVR) volume of <150 mL is typically considered appropriate for normal bladder emptying, but this has been in the nonpregnant/non-postpartum population. In this group, some have proposed a PUR of up to 500ml as normal! That protocol, using the 500ml cut off, was just recently published in the J Matern Fetal Neonatal Med in Dec 2023. PUR is classified into 2 groups: overt (AKA symptomatic) and covert (asymptomatic) urinary retention; overt PUR traditionally has been defined as an inability to spontaneously void 4-6 h after vaginal delivery or the need for re-catheterization 4- 6 h after catheter removal following cesarean section. What’s the recommended plan of care after diagnosing PUR? Does bethanechol help? Can peppermint oil vapor help? Well…this is SOME data on this! Listen in for details.

PP Ibuprofen with HDP? “NEW info”. Feb 12, 2025

Show notes

In 2013, The ACOG’s Hypertension Task Force suggested that NSAIDS not be used in postpartum patients with hypertensive disorders of pregnancy due to theoretical concerns on BP aggravation. But “medicine moves fast”. In 2020, the ACOG “green lighted” ibuprofen use postpartum in these patients if no evidence of renal insufficiency was present. In episode, we will review a brand-new publication (soon to come out), in AJOG, released ahead of print on February 10, 2025. This study is a randomized trial also evaluating the effect of ibuprofen on blood pressure control in those with hypertensive disorders of pregnancy. Did they find something new? This highlights the importance of going through an entire study’s materials and methods focusing on the years of patient recruitment to properly interpret results. Listen in for details!

The Survey Says....! (FULL EPISODE) Feb 11, 2025

Show notes

(We were made aware that this original posting had the last section DROPPED accidentally)...here is the full episode! Ahhh...TECHNOLOGY! *This is why AI will likely replace our production team...Just kidding production team, just kidding).

Episode Details:

Well, we typically focus on ONE or maybe TWO publications to highlight and review. However, in this episode, which we have decided to call, “Survey said…!”, we will go through some common and REAL WORLD “mental battles”regarding what is and what is not part of a diagnostic criteria. These are every day OBGYN things that we KNOW, but when asked to define them…we can easily get ourselves confused. We are going to clear these up…Game Show style! First, when only one abnormal value is found in the two-step, 100-gram GTT, it is called borderline GDM, or impaired glucose tolerance. But what is it called when there is an abnormal (failed) 1-Hour 50 gram, but completely normal 3-Hr 100-gram GTT? Is this also called “impaired glucose tolerance”? We….the Survey Said…! (Yep, we’ll get to that). Secondly, does the criteria for Preeclampsia with Severe Criteria include platelets of 100,000 or not? The Survey Said…! (Yep, we’ll cover that). We will also review the numbers for MVP oligo, for a “normal” postmenopausal ES, and MORE! Listen in for details!

The Survey Says...! (PLEASE SEE UPDATED VERSION 2/11/25) Feb 10, 2025

Show notes

Well, we typically focus on ONE or maybe TWO publications to highlight and review. However, in this episode, which we have decided to call, “Survey said…!”, we will go through some common and REAL WORLD “mental battles” regarding what is and what is not part of a diagnostic criteria. These are every day OBGYN things that we KNOW, but when asked to define them…we can easily get ourselves confused. We are going to clear these up…Game Show style! First, when only one abnormal value is found in the two-step, 100-gram GTT, it is called borderline GDM, or impaired glucose tolerance. But what is it called when there is an abnormal (failed) 1-Hour 50 gram, but completely normal 3-Hr 100-gram GTT? Is this also called “impaired glucose tolerance”? We….the Survey Said…! (Yep, we’ll get to that). Secondly, does the criteria for Preeclampsia with Severe Criteria include platelets of 100,000 or not? The Survey Said…! (Yep, we’ll cover that). We will also review the numbers for MVP oligo, for a “normal” postmenopausal ES, and MORE! Listen in for details!

Severe CHTN or Superimposed PreE w/Severe Features? Feb 06, 2025

Show notes

Yep, its an area of debate and confusion. Controversy surrounds the diagnosis of CHTN with severe BPs vs superimposed preeclampsia with severe features. Do you need “new onset proteinuria” for the diagnosis of superimposed preeclampsia over CHTN? What about “with severe features”? This is something that is very clear to understand, yet muddy; there is well defined guidance here which is grey! Yep, we will cover this controversy and give PRACTICAL insights for the care of CHTN with severe BPs in the third trimester.

Eclampsia = Brain Scan? Feb 04, 2025

Show notes

According to the ACOG, eclampsia is a low frequency, high acuity emergent condition. The rate of an eclamptic seizure is 1/200 in those with preeclampsia without severe features but is 4 fold higher ( 4/200 ) in those with preeclampsia with severe features. Traditionally, “textbook eclampsia” management did not include cranial imaging. However, that consensus is changing! In this episode, we will review data making the case for a standardized approach to eclampsia, which includes universal non-contract cranial CT after eclampsia. We will highlight a Clinical Expert Series ACOG publication from July 2024 as well as an upcoming publication from Pregnancy Hypertension in March 2025 which makes the strong case for this radiological diagnostic tool. Listen in for details.

“Sounds Reasonable”! 3 Things to Consider. Feb 01, 2025

Show notes

Well, in this episode we have a “3-in-1” subject review. Often in medicine, we find ourselves with some data to guide us, but definitely not a “predominance of evidence”. So in caring for our patients, we often come to the conclusion that doing a course of action can possibly help, and can't hurt... and therefore our plan “sounds reasonable”. That's the focus of our episode today! We're going to have fun with this one and cover three topics where we do have some data to guide us, but not our predominance of data that the dot leaving us to conclude that a plan of action “sounds reasonable”. 1. Can nitrous oxide be used for IUD/IUS insertion? 2. Should we follow total serum bile acids serially for ICP (new Jan 2025 data)? 3. And if IM Ceftriaxone is recommended as first-line RX for gonorrhea, can we give expedited partner therapy as an oral medication? Listen in for details!

No Need for PP LMWH VTE Prophylaxis? Jan 28, 2025

Show notes

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is responsible for 9–30% of pregnancy-related mortality in high resource countries and remains a significant, increasing cause of severe maternal morbidity. Peripartum, 50% of VTE events occur in the postpartum interval, which has a 6-fold higher risk compared to antepartum. There is wide variation in LMWH pharmacological postpartum prophylaxis guidance. The RCOG, for example, recommends 10 days of LMWH for all postop CS patients unless it was elective, and additional risk factors exist. The ACOG uses a more selective approach. However, on Jan 16, 2025, a new multicenter retrospective study from the US is raising questions about the efficacy of postpartum VTE pharmacologic therapy. Is there really no need for pp VTE pharmacologic therapy? Or does the answer lie in the reality of VTE as a “low frequency, high acuity” event? Listen in for details!

Our TOPPODCAST Picks

Follow Us

Stay Connected

Dr. Chapa’s OBGYN Clinical Pearls

Related Podcasts

Links

Stay Connected