Dr. Chapa’s OBGYN Clinical Pearls

Latest Episodes:

⭐️NEW⭐️Clinical Practice Update: ACOG Updates PB 222 (Biomarkers for PreE). Apr 04, 2024

Show notes

Today, April 3, 2024, the ACOG released a clinical practice update to practice bulletin# 222 (gestational hypertension eclampsia). This is in direct response to a recent FDA approved biomarker test for risk stratification for preeclampsia. On May 19, 2023, the FDA cleared a novel biomarker serum test for the risk stratification for severe preeclampsia in hypertensive pregnant women. This clearance is the first given to any blood-based biomarker test for assessing preeclampsia risk. The company is Thermo Fisher Scientific (no disclosures). This new clinical practice update puts this test into proper perspective and gives clinicians some valuable insights of what it can, and what it cannot, do. Listen in for this “off the press” clinical practice update. 🔥🔥🔥🔥

New Data Re: Obesity in Pregnancy- Weight Gain Recs, and NPWT at CS Apr 02, 2024

Show notes

According to the CDC, as well as worldwide data, the percentage of individuals categorized as overweight or obese is rising. First released in 1990 by the IOM, the guidelines for expected weight gain in pregnancy-based on pre-pregnancy weight (BMI)- have been controversial. These guidelines were revised in 2009. Now, a new publication from the Lancet (28 March 2024), is questioning the validity of the “minimal weight gain” recommended for patients with obesity. In this episode, we will review this controversy. Additionally, we will highlight a separate publication from the AJOG MFM (systematic review and meta-analysis) discussing NPWT use at C-section for patients with obesity.

The Steroids Saga: New Data, New Debate, New News. Apr 01, 2024

Show notes

The current dose and schedule for antenatal corticosteroids (ACS) follows the original publication by Liggins and Howie in 1972. That dose and schedule was based on sheep models from the 1960s. The dose in current use had never been evaluated to minimize exposures while assuring efficacy. New pharmacokinetic and pharmacodynamic data is calling into question whether the current dose and schedule is necessary. Translational research in animal models indicate that a constant, low concentration fetal exposure to ACS is sufficient for lung maturation, resulting in lower fetal exposures. In this episode, we will summarize a new clinical commentary published in AJOG in March 2024 highlighting the current state and controversies regarding ACS for threatened preterm labor.

Depo-Provera Causes Brain Tumors?! 😬🧠😬 Mar 29, 2024

Show notes

Meningiomas are common intracranial tumors with a female predominance. The vast majority of these tumors are benign (World Health Organization [WHO] grade 1) while 15% to 20% of these tumors can behave atypically (WHO grade 2) and rarely, in 1% to 2% of cases, these tumors can be malignant (WHO grade 3) Their etiology is still poorly documented. The role of sexual hormones has long been proposed, but data have been conflicting across studies. However, a dose-dependent relationship between the incidence and growth of meningiomas and hormonal treatment with the synthetic progestin cyproterone acetate (CPA) has been recently established (2021). Now, a new observational study from France (BMJ) has raised the warning flag for a similar association with a common birth control option, depo medroxyprogesterone acetate. Does Depo-Provera cause brain tumors? It's very important to put this study into proper context. We’ll explain all of this, and more, in this episode.

Balloon For PROM? Yea or Nay Mar 27, 2024

Show notes

According to the ACOG, pre-labor rupture of membranes (PROM) complicates 10% of all births in the United States and is a major contributor to perinatal morbidity and mortality. What is the best course of action when patients present with PROM with a “unfavorable cervix”? Should it be a pharmacological method of ripening, or a mechanical? What does the data say? In this episode, we will do a deep dive into published data from the 1980s up to 2023. We will also explain why the Bishop score “is irrelevant“(SOGC) in patients at term with PROM. 😳. The literature does favor one pharmacological agent in cases of PROM. Curious? Listen in and find out more.

Neonatal Subgaleal Hemorrhage: Pearls of Wisdom Mar 25, 2024

Show notes

Obstetrical vacuum and forceps are incredible tools, when used correctly, to assist vaginal delivery. Appropriately selected and used, they can be pivotal in reducing the number of unnecessary cesareans and potentially decreasing certain fetal and maternal complications. However, there are several pearls of wisdom to remember when using them. In this episode, we will focus on a rare – but potentially fatal – complication of vacuum use: subgaleal hemorrhage. Although subgaleal hemorrhage can occur following normal birth processes, and even cesarean section, vacuum use is the strongest independent factor for its occurrence. In this, we will review these pearls of wisdom and the importance of detecting neonatal subgaleal hemorrhage quickly.

New Menopause CURE? The Ovarian Autotransplantation Debate Mar 22, 2024

Show notes

Ovarian preservation by autologous transplantation has given hope to patients desiring future fertility after certain gonadotoxic therapies for malignant conditions. But now, the same procedure is being promoted as a “natural cure” for menopause. Can ovarian tissue-based therapies really be the female, endocrine “fountain of youth”? In this episode, we will highlight a recent publication from the AJOG describing the potential of this procedure. We will also discuss the history of ovarian autotransplantation and why this procedure for menopause prevention has more questions than answers.

PreMeal or PostPrandial Glucose Checks PP with Type I DM Mar 21, 2024

Show notes

Since the late 1990s, the standard practice for GDM care has been to measure postprandial glucose values. For patients with pre-gestational diabetes, whether type I or type II, the ACOG recommends multi-level glucose checks (fasting, pre-meal , postprandial, and nighttime). But what about in the immediate postpartum interval? In patient’s with pre-existing diabetes, should blood sugars be checked pre-meal (qAC) or postprandial while still in the hospital, and after discharge? The topic for this episode comes from one of our podcast family members who had this clinical dilemma? In this episode, we will review the data and recommendations from the American Diabetes Association, the ACOG, and CDC. So grab your sugar-free drink of choice, and listen in!

Hep C and BF Confusion (and Updated HIV BF Guidance) Mar 18, 2024

Show notes

Is breastfeeding with Hepatitis C safe? The answer: Yes! But confusion persists today mainly surrounding the serum hepatitis C viral load. That’s the topic and focus of the new publication released March 2024 in the Green journal, Obstetrics and Gynecology. We will highlight this new study in this episode. Yep, we have learned a lot about hepatitis C, and HIV, and breast-feeding. In this episode, we will review: the different hepatitis C genotypes and their implications, current breast-feeding guidelines for women with hepatitis C, the updated guidelines for breast-feeding with HIV, how some may be spontaneously “cured” of hep C postpartum, and why viral load matters for one of these conditions – but not the other!

Are ADHD Meds Safe In Pregnancy? Mar 15, 2024

Show notes

It has been estimated that up to 4.4% of the US adult population has been diagnosed with ADHD. Use of ADHD medication is increasing among pregnant women. In the last several years, there’s been a litany of publications looking at the effects of pregnancy on ADHD, as well as the effects of medication on the pregnancy. In this episode, we will highlight a new publication released March 2024 (Archives Women’s Mental Health) examining prenatal outcomes in women who continued dexamphetamine in pregnancy. We will also summarize the data regarding the effect of ADHD medication on congenital anomalies and neurodevelopmental outcomes in the children.

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