Dr. Chapa’s OBGYN Clinical Pearls

Latest Episodes:

New Developments in HG 🤢🤮🤢 Feb 23, 2024

Show notes

Hyperemesis Gravidarum (HG) has a reported incidence of approximately 0.3–3% of pregnancies. Without prompt recognition and treatment, severe maternal dehydration, electrolyte abnormalities, cardiac arrhythmias, and potentially altered fetal neurodevelopment may result. Recently, HG made medical and general media news as new data has pinpointed 2 likely culprits of its origin- and neither one is estrogen. In this episode, we will discuss these 2 protein markers, and how researchers are looking to develop a genetic test for patients to predict HG. We will also summarize a new publication from Obstetrics & Gynecology (which was published on February 1, 2024) as an ACOG Clinical Expert Series on the inpatient management of HG.

Fetal Manual Rotation: 1st or 2nd Stage Practice? Feb 20, 2024

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Women whose fetuses are in the occiput posterior head position at the time of delivery are known to have longer second stages of labor and more complicated deliveries, including more operative assisted births, more 3rd and 4th degree lacerations, PPH, and in some studies lower Apgar scores and lower umbilical cord arterial pH. At what point in labor should the healthcare provider attempt to rotate the fetal head: first stage or second stage of labor? Recent intrapartum studies using ultrasound to verify fetal head position has provided new insights regarding the cardinal phases of labor. In this episode, we will tackle the fetal occiput posterior position and manual rotation. Should this be a 1st or 2nd stage of labor practice?

“Formula” to Predict SD? Feb 17, 2024

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The ACOG has long-held that shoulder dystocia is “unpreventable and unpredictable”. Nonetheless, as it is a devastating obstetrical occurrence, researchers have attempted to identify a reproducible mathematical formula using ultrasonographic, anthropometric factors to better predict it. What is the data behind these math models? Does the ACOG recognize their use? What is their positive predictive value? In this episode, we will examine the data – going back 40 years – and we will end the episode with the current stance from the ACOG regarding these mathematical calculations for shoulders dystocia prediction.

GDM “Screen” in 3rd Trimester? Feb 15, 2024

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The ACOG has consistently recommended universal screening for gestational diabetes between 24 and 28 gestational weeks. Although controversial, the ACOG does endorse earlier screening for GDM in patients with additional risk factors. But what about patients who present for prenatal care after the 28th or 29th week? Should screening for GDM be done in the 3rd trimester? And if we do screen in the then, what is the reference range for “normal “or “abnormal”? Is it the same interpretation as when it is done between 24 and 28 weeks? Does 3rd trimester screening impact parental outcome? In this episode, we will examine the data and provide a recommendation of when testing for gestational diabetes in the 3rd trimester may have the most impact.

Phthalates and PTB: “New Data” Feb 14, 2024

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On February 6, 2024, a new publication in the Lancet Planetary Health received national and international headlines. This study, funded through the NIH, revealed a striking association between certain chemicals in our environment and preterm birth. But is this data really new? We have known that certain chemical components, called phthalates, have a strong association with preterm birth for over 10 years now. Nonetheless, it is always a good reminder to reduce or avoid exposures to potentially dangerous substances which are ubiquitous in today’s culture. What exactly are phthalates? What did this new data reveal? In this episode, we will dive into the data and put things into proper perspective. PLUS, at the end of the episode, I’ll review 10 common-sense things that we can all do daily to try to reduce our exposure to these“forever chemicals”.

Another Nail in the Coffin for Late PT Steroids: New RCT Data Feb 11, 2024

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YES, it’s true… Not even Super Bowl Sunday 🏈🏈can stop us from getting our podcast episode up and out! In this episode, we will summarize the key findings of a newly released RCT (ahead of print, Obstetrics and Gynecology) that is yet another “nail in the coffin” for late pre-term/early term steroids. This is perfect timing, as we just covered this topic on a separate episode last week. So listen in as we summarize this newly released, triple-blind RCT with eye-opening results.

New Data on Naltrexone in Pregnancy Feb 08, 2024

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We are still in an opioid crisis. The number of women with opioid-related diagnoses at delivery has increased by 131% over the last several years (CDC, Data and Statistics, 2023). The ACOG has recommended the use of opioid agonist pharmacotherapy for MOUD during pregnancy. Traditionally, medically supervised withdrawal has not been endorsed for pregnancy. However, some patients may elect to discontinue opioid therapy in favor of an opioid antagonist like naltrexone. In this episode, we will review a new systematic review just released ahead-of-print in Obstetrics and Gynecology. This systematic review evaluates OB and neonatal outcomes following naltrexone use during pregnancy. And listen in until the END of the episode for one of the “issues” with naltrexone as a MOUD option.

TOKOPHOBIA: Pregnant & Petrified Feb 07, 2024

Show notes

It is completely natural, and part of the human experience, to have some anticipatory concern about an upcoming delivery/childbirth. However, when that concern becomes overwhelming, it can develop into a debilitating phobia called Tokophobia. First coined as a term in 2000, there’s been growing awareness of this specific type of anxiety disorder/phobia. Even though it was first described in 2000, this extreme fear of pregnancy and childbirth has, of course, been part of the human experience For centuries. This is now considered a sub-type of PTSD when it happens after a traumatic childbirth experience. The idea for this episode originated from a real patient encounter that one of our residents had just yesterday. Have you heard of Toca phobia? How prevalent is it? And what are the “4 Rs” of trauma informed care? Will cover this, and more, in this episode.

The OB Steroid WARNING FLAGS: When CONS>PROS Feb 05, 2024

Show notes

In 1972, Liggins and Howie published their landmark study on the benefits of antenatal corticosteroids (ACS) regarding their reduction of prematurity’s morbidity and mortality. This led to the weekly administration of ACS until 34 weeks. Weekly courses of steroids are no longer given, but the steroid story keeps evolving. In 2016, the ALPS trial demonstrated reduction in short-term respiratory morbidity when steroids were given in the late pre-term interval. Many professional societies and organizations endorsed this intervention shortly thereafter. But since then, there have been renewed commentaries and debates regarding steroids in the late pre-term interval, and steroid exposure in-utero for babies born late pre-term/term. several professional organizations, no longer endorse steroids in the late pre-term interval. In this episode, we will review this complicated and ever evolving debate, highlighting a recent systematic review and meta-analysis from August 2023.

Putting LNG-IUS EC In Perspective Feb 03, 2024

Show notes

On January 28, 2021, a non-inferiority RCT was published in the NEJM, “Levonorgestrelvs Copper T Device for Emergency Contraception”. This study concluded that the LNG 52mg IUD was “noninferior” to the CopperT IUD for emergency BC up to 120 hours after ill-protected intercourse. Since that time, use of the LNG 52mg IUS has remained controversial with some organizations endorsing its use as EC while others take a more cautionary stance. Now, as a February 1, 2024, a new commentary in the Green Journal (Obstet Gynecol) is raising eyebrows regarding this. What’s the controversy surrounding this? Is the LNG 52 mg IUS a reasonable option for emergency contraception? What does non-inferiority mean? In this episode, we will go through all of the data and put things in proper perspective. While gaps in evidence remain… There is plenty to draw an evidence-based opinion on. Curious? Listen in and find out more.

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