![Dr. Chapa’s Clinical Pearls.](https://s3-us-west-2.amazonaws.com/anchor-generated-image-bank/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Dr. Chapa’s Clinical Pearls.
By Dr. Chapa’s Clinical Pearls
Relevant, evidence based, and practical information for medical students, residents, and practicing healthcare providers regarding all things women’s healthcare! This podcast is intended to be clinically relevant, engaging, and FUN, because medical education should NOT be boring! Welcome...to Clinical Pearls.
![Currently playing episode](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_episode400/384576/384576-1559687387064-18efe6af4b40d.jpg)
Dr. Chapa’s Clinical Pearls. Jun 05, 2019
00:00
08:17
![Female Low T?](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Female Low T?
There is a STRONG debate within the medical community as to whether testosterone should be prescribed to women during menopause and the time before and after it. Social media influencers and other media personalities are touting testosterone as a cure-all for mood, sex drive, cognitive changes, fatigue, reduced muscle strength, and other symptoms associated with menopause. In fact, the number of testosterone prescriptions for women has risen within the last five years in the United States and internationally. But is that evidence-based. The answer is both YES and NO. In this episode, we will focus on testosterone replacement for female low sexual interest. We will highlight the position statements from a large international coalition in 2019, a separate 2021 position statement, and the opinion of the ACOG. We have LOTS to cover here, so go lather up with your testosterone cream (JK) and listen in!
Apr 17, 202449:23
![IV Fe PP, and More](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
IV Fe PP, and More
While the importance of optimizing a woman's hemoglobin level during the peripartum period has been emphasized in recent guidelines by the Society for Obstetric Anesthesia and Perinatology, the ACOG, and the Enhanced Recovery After Surgery Society, postpartum anemia remains a real issue in both the developed and developing world. Postpartum anemia has been associated with depression, fatigue, impaired lactation, and impaired cognition. This may lead to impaired maternal-child bonding. Additionally, severe anemia during the antepartum interval is an important predictive factor of PPH! This relationship was shown in a published meta-analysis in 2021. Postpartum, IV Fe has been proven to be of value for asymptomatic anemia. Packed RBC transfusion may be recommended for women with postpartum hemoglobin levels
Apr 15, 202450:31
![Amnioinfusion with IAI? Yay or Nay?](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Amnioinfusion with IAI? Yay or Nay?
Amnioinfusion was first described in 1976 using a rhesus monkey model. In that landmark study, the authors reported that variable decelerations occurred when amniotic fluid was removed from the uterine cavity and resolved when it was replaced. Although this experiment established that variable decelerations related to oligohydramnios and cord compression could be corrected by amnioinfusion, the technique did not achieve clinical application until 1983, when a novel approach to the relief of variable or prolonged decelerations was described. Amnioinfusion is mainly utilized in the rescue of recurrent fetal variable decelerations intrapartum. But what if the patient has suspected IAI? Is that a relative contraindication for amnioinfusion? Is that safe? In this episode we will examine the data and provide some clinical insights.
Apr 12, 202442:09
![Acetaminophen (Paracetamol) in Pregnancy and Autism: Latest Data (April 9, 2024)](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Acetaminophen (Paracetamol) in Pregnancy and Autism: Latest Data (April 9, 2024)
In 2014, a publication out of JAMA Pediatrics raised questions regarding the safety of acetaminophen in pregnancy describing a possible “association” with later neurodevelopmental and cognitive delays in children. What followed was a string of controversial publications (observational) with mounds of conflicting data. This led to a controversial international consensus opinion in 2021 calling for “caution for use” regarding acetaminophen in pregnancy. The ACOG had a strong rebuttal to that statement at that time. But now, as of April 9, 2024, we have new data on acetaminophen/paracetamol use in pregnancy and possible neurodevelopmental affects in children. This new study was published out of JAMA network and followed 2.4 million children with sibling pairs out of Sweden. This is making a lot of news within the last 24 hours and it is hot off the press 🔥🔥🔥. Listen in, and find out more.
Apr 10, 202430:23
![When Things Go South: Perinatal PTSD](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
When Things Go South: Perinatal PTSD
It has been stated that “Trauma is in the eye of the beholder”. Healthcare providers must be aware that a woman makes experience a birth as traumatic, even if she and her infant are healthy. The ACOG has highlighted perinatal PTSD in several publications, which we will review in this episode. Perinatal PTSD has definitely been in the OB/GYN and psychology literature with an increased frequency just over the last 3 months. In this episode, we will review the very real and devastating condition of perinatal PTSD, its diagnosis, and discuss interventions to reduce its development. We will also review new data on “service dogs“ detecting PTSD in people with trauma histories? NOTE: We will also highlight a real world account of a traumatic birth event from one of our podcast listeners (Deidentified, and shared with permission).
Apr 08, 202448:53
![New HDP Med Data: The PYTT Study](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
New HDP Med Data: The PYTT Study
In July 2023 and again in November 2023, we discussed the “Rule of 55“ and its role in the management of hypertensive disorders of pregnancy. The Rule of 55 has been mainly applied in the selection of appropriate antipretensive medications when urgent/emergent hypertension is present. Does the Rule of 55 also work for antihypertensive management of gestational hypertension or preeclampsia without severe features? A new publication (April 1, 2024) from the AJOG MFM gives us that answer! In this episode, we will cover the newly released PYTT study from Italy.
Apr 07, 202430:53
![The Eclipse’s Effect on Pregnancy ☀️🌞🕶️🕶️🌖🌗🌘🌑](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
The Eclipse’s Effect on Pregnancy ☀️🌞🕶️🕶️🌖🌗🌘🌑
On April 8, 2024, parts of the United States will be within the Path of Totality for the total solar eclipse. The state of Texas has already declared a state of emergency as visitors flock to the state to witness the event. This is a fascinating celestial occurrence that is not scheduled to happen again until August 2044. Does the eclipse have a negative effect on pregnancy? Do lunar cycles affect birth rates? What does the data say? Does NASA have a statement on this? And what are neutrinos?! Listen in… And find out. 🌖🌗🌑
Apr 05, 202426:32
![⭐️NEW⭐️Clinical Practice Update: ACOG Updates PB 222 (Biomarkers for PreE).](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
⭐️NEW⭐️Clinical Practice Update: ACOG Updates PB 222 (Biomarkers for PreE).
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. 🔥🔥🔥🔥
Apr 04, 202425:35
![New Data Re: Obesity in Pregnancy- Weight Gain Recs, and NPWT at CS](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
New Data Re: Obesity in Pregnancy- Weight Gain Recs, and NPWT at CS
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.
Apr 02, 202444:08
![The Steroids Saga: New Data, New Debate, New News.](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
The Steroids Saga: New Data, New Debate, New News.
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.
Apr 01, 202438:26
![Depo-Provera Causes Brain Tumors?! 😬🧠😬](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Depo-Provera Causes Brain Tumors?! 😬🧠😬
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.
Mar 29, 202438:28
![Balloon For PROM? Yea or Nay](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Balloon For PROM? Yea or Nay
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.
Mar 27, 202453:51
![Neonatal Subgaleal Hemorrhage: Pearls of Wisdom](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Neonatal Subgaleal Hemorrhage: Pearls of Wisdom
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.
Mar 25, 202447:27
![New Menopause CURE? The Ovarian Autotransplantation Debate](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
New Menopause CURE? The Ovarian Autotransplantation Debate
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.
Mar 22, 202430:46
![PreMeal or PostPrandial Glucose Checks PP with Type I DM](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
PreMeal or PostPrandial Glucose Checks PP with Type I DM
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!
Mar 21, 202443:26
![Hep C and BF Confusion (and Updated HIV BF Guidance)](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Hep C and BF Confusion (and Updated HIV BF Guidance)
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!
Mar 18, 202447:23
![Are ADHD Meds Safe In Pregnancy?](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Are ADHD Meds Safe In Pregnancy?
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.
Mar 15, 202436:24
![Check the Box: REASSURING NEWs regarding US Maternal Mortality](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Check the Box: REASSURING NEWs regarding US Maternal Mortality
Four years, the US National Vital Statistics System has reported an abnormally high maternal mortality rate in the United States, showing it to be nearly doubled from 17.4 in 2018 to 32.9 per 100,000 live births in 2021. The United States’s maternal mortality rate has been on the media radar for many years because of this. But that rate is completely WRONG. How is it that maternal mortality rates are more than 2 to 3 times higher than other developed countries despite our vast progress in obstetrical care? The answer? It is a statistical error! In this episode, we will review a brand new publication from the AJOG published on March 12, 2024 that is making media headlines. We have known that this reporting system is greatly flawed for several years, and now it is getting the attention it deserves. Although this is reassuring news for the country overall, there is still ONE patient demographic where we need to dramatically reduce the maternal mortality rate. Curious? Listen in and find out more.
Mar 13, 202437:52
![Should We Screen For Thrombophilia Pre-OCP? March 2024 Data](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Should We Screen For Thrombophilia Pre-OCP? March 2024 Data
The ACOG, CDC, and WHO currently do not recommend universal screening for thrombophilia in the general population before starting oral contraceptive pills. However, a new publication in AJOG (March 2024) is challenging that stance. In this episode, we will review this new prospective population-based study to see if it makes the case for universal screening for thrombophilia variants before starting OCPs. In this episode, we’ll also discuss high-risk versus low-risk thrombophilia, discuss relative risk versus absolute risk of VTE on the combination pill, and give clear clinical implications for patient management.
Mar 10, 202451:32
![Metformin in OB and Child's Neurodevelopmental Outcomes (March 2024 Data)](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Metformin in OB and Child's Neurodevelopmental Outcomes (March 2024 Data)
Gestational Diabetes (GDM) is vastly more prevalent in pregnancy compared to pre-existing diabetes. In 2009, the ACOG states that 7% of all pregnancies were complicated by a diabetes diagnosis, with 86% being GDM. The prevalence of GDM keeps rising in the US and globally. Metformin is increasingly prescribed in pregnancy, yet its long-term effect on the neurocognitive development of the offspring remains incompletely described. However, newly published data (March 6, 2024; AJOG) has changed that! In this episode, we will summarize and review a systematic review and meta-analysis of childhood neurodevelopmental outcomes after in utero exposure to metformin. Additionally, does some evidence suggest that metformin may be superior to insulin in pregnancy for perinatal outcomes? We will discuss all this and more, in this episode. This information will be helpful as we counsel and educate our patients on metformin use in pregnancy.
Mar 08, 202440:31
![OPill…Now HERE! (ACOG PA March 2024)](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
OPill…Now HERE! (ACOG PA March 2024)
On this podcast, we have been following this story of the OPill for several months. Previous episodes on the subject can be found in our podcast library. As expected, this first ever daily use progestin only pill is now available over-the-counter in the US. 👏👏. On Wednesday, March 6, 2024, the ACOG released its Practice Advisory presenting some key reminders for clinicians regarding this new over-the-counter contraceptive option. In this episode, we will summarize this practice advisory and answer some real-world questions patients may have regarding this: does the OPill help with acne? Is this approved for endometriosis pain? What happens if a patient misses the next dose at the scheduled time? Listen in for these answers and more.
Mar 07, 202429:46
![GLP1 Agonist Exposure in Pregnancy](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
GLP1 Agonist Exposure in Pregnancy
Use of second-line noninsulin diabetic medications, like Glucagon-like peptide 1 (GLP-1) agonists and sodium-glucose co-transporter-2 (SGLT2) inhibitors, is rapidly increasing for treatment of T2D and other indications. As these drugs are being used by an increasing group of fertile women, it is expected that a few of them will get pregnant and data on their safety when used in the first trimester is needed. Is periconceptional use of glucagon-like peptide 1 (GLP-1) receptor agonists associated with increased risk of major congenital malformations? In this episode, we will look at the available data (although limited) regarding these medications, focusing on specific GLP1 options.
Mar 05, 202440:07
![Foley For CX: Tension or No Tension? And More (March 2024 Data)](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_episode400/384576/384576-1709327558987-cbc8ad884d8ad.jpg)
Foley For CX: Tension or No Tension? And More (March 2024 Data)
Using mechanical options as a way to prime/ripen the cervix for labor is nothing new. Balloon catheters have been used for labor induction as far back as the 1890s. Embrey and Mollison reinvigorated the method in 1967 using it in combination with extraamniotic prostaglandins. Since then numerous studies have been performed worldwide, mostly using the Foley catheter. Then, in 1990, the double balloon catheter was introduced by Atad; this paved the way for the Cook Balloon. But what is the best way to use a balloon for cervical ripening? Should be a single balloon or a double balloon? If single balloon, does volume of the balloon matter? Should it be used alone or with combination with a second agent? Can it be used safely as an outpatient procedure? In this episode, we will present new data regarding traction vs no-traction for single balloon cervical ripening therapy. This new study was published on March 1, 2024 in Obstetrics and Gynecology (the Green Journal).
Mar 01, 202445:26
![Things That Make You Go Hmmmm](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Things That Make You Go Hmmmm
It’s very important to stay up-to-date and current with new data. But sometimes you read something that is hot-off-the press and it makes you just stop and say, “hmmm”. In this episode, we will discuss the new USPSTF position statement on screening/treating iron deficiency anemia in pregnancy. We will also review the ACOG August 2023 clinical consensus #4 regarding UTI in pregnancy. In doing so, we present 2 things that “make you go hmmm”.
Feb 29, 202432:10
![GDM Dx with Abnormal Fasting Value: Start Meds?](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
GDM Dx with Abnormal Fasting Value: Start Meds?
The “traditional“ Parkland management protocol for GDM included the immediate initiation of medical therapy for those with abnormal fasting blood sugar, in addition to another additional value, on the 3 hour GTT. These patients were automatically labeled as A2 GDM at time of diagnosis, rather than waiting the 1 to 2 weeks of nutritional/diet therapy. Does fasting hyperglycemia on the 100g GTT truly predict the need for subsequent medical therapy? In this episode, we will summarize new data on this subject from AJOG MFM published on February 17, 2024. Does immediate medical therapy after GDM diagnosis improve overall maternal/neonatal outcome? It’s a complicated answer, and we will review it in this episode.
Feb 28, 202446:48
![Feb 26, 24 SMFM Position Statement RHIG < 12 Weeks: Confused?](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Feb 26, 24 SMFM Position Statement RHIG < 12 Weeks: Confused?
Yes, the subject of RhoGAM/RHIG administration to RH negative patients under 12 weeks gestational age is a continuously controversial issue. We have covered this issue in past episodes, most recently- last month- on January 4, 2024. Today, February 26, 2024, the SMFM released their position statement on the subject. As you would guess, the controversy continues! In this episode, we will review this brand new, hot off the press, position statement regarding RHIG administration, or avoidance, under 12 weeks gestation.
Feb 26, 202415:23
![Stage 1 HTN in OB](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Stage 1 HTN in OB
February 2024 has seen its share of medical and mainstream media stories highlighting hypertensive disorders in pregnancy. While some of this can be considered “old news”, there is “new news” and new developments on the horizon. We have covered hypertensive disorders in pregnancy on several past episodes; however, in this episode, we are going to pick up where we left off and review what the current state of understanding is for AHA/ACC Stage 1 hypertension in pregnancy. Does stage I hypertension in pregnancy require medication? What about antepartum fetal surveillance? What are these patients at risk for? Listen in as we simplify the latest data and summarize the latest evidence regarding serum biomarkers for hypertensive disorders in pregnancy.
Feb 24, 202435:53
![New Developments in HG 🤢🤮🤢](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
New Developments in HG 🤢🤮🤢
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.
Feb 23, 202444:58
![Fetal Manual Rotation: 1st or 2nd Stage Practice?](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Fetal Manual Rotation: 1st or 2nd Stage Practice?
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?
Feb 20, 202447:02
![“Formula” to Predict SD?](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
“Formula” to Predict SD?
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.
Feb 17, 202439:42
![GDM “Screen” in 3rd Trimester?](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
GDM “Screen” in 3rd Trimester?
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.
Feb 15, 202441:46
![Phthalates and PTB: “New Data”](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Phthalates and PTB: “New Data”
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”.
Feb 14, 202439:41
![Another Nail in the Coffin for Late PT Steroids: New RCT Data](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Another Nail in the Coffin for Late PT Steroids: New RCT Data
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.
Feb 11, 202421:09
![New Data on Naltrexone in Pregnancy](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
New Data on Naltrexone in Pregnancy
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.
Feb 08, 202427:53
![TOKOPHOBIA: Pregnant & Petrified](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
TOKOPHOBIA: Pregnant & Petrified
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.
Feb 07, 202451:56
![The OB Steroid WARNING FLAGS: When CONS>PROS](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
The OB Steroid WARNING FLAGS: When CONS>PROS
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.
Feb 05, 202450:08
![Putting LNG-IUS EC In Perspective](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Putting LNG-IUS EC In Perspective
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.
Feb 03, 202450:46
![The Incredible VIBRATING belt (Osteoboost device): Good Data?](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
The Incredible VIBRATING belt (Osteoboost device): Good Data?
On January 18, 2024, the FDA cleared a novel new device for osteopenia treatment. This is a vibrating belt (wearable device) that transmits low-amplitude, high-frequency (20 to 40 Hz) vibration to the spine and hips. This belt is called Osteoboost. Osteoboost previously received a breakthrough designation from the FDA in Dec 2020. This FDA clearance has already generated a lot of commentaries regarding the single RCT results. In this episode, we will review the results critically and explain why there is a difference in “per protocol” RCT results and “intend to treat” RCT results. Is Osteoboost a game changer? Listen in and find out.
Feb 01, 202435:37
![Place IUD/S if BV Present? What Would You Do?](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Place IUD/S if BV Present? What Would You Do?
Bacterial vaginosis (BV) is the most common vaginal aberrant condition in women, in the general population. Even still, the majority of women with BV are asymptomatic. If BV is found at time of elective IUD/S placement, can the device still be inserted? Or is it an independent risk factor for upper tract infection? What category in the CDC MEC is vaginitis/vaginosis for IUD placement? There definitely is some confusion about this in clinical practice, highlighted by the 3 different clinicians which were interviewed in this episode! So…. IUD placement with BV: test and place, or test and differ placement? Listen and find out.
Jan 30, 202431:36
![More Bad News Re: PreEclampsia](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
More Bad News Re: PreEclampsia
Hypertensive Disorders of Pregnancy (HDP) affect 5 to 15% of women worldwide, and their increasing incidence is likely related to the growing levels of obesity, metabolic syndrome and advancing maternal age. It is widely accepted that women who have preeclampsia are at increased risk of future hypertension, cardiovascular disease, stroke, chronic kidney disease, and even diabetes in later life. But what is the association between HDP and dementia? In this episode, we will review the latest data from a systematic review and meta-analysis published on January 24, 2024 in the AJOG.
Jan 27, 202432:28
![OB Issues After IUD Perf?](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
OB Issues After IUD Perf?
Uterine wall perforation at time of IUD placement has been published to occur, in general, about 1-2/1,000 cases. It happens! While there are some risk factors for uterine perforation (very antiflexed, retroflexed, recent postpartum state, lactating), sometimes uterine perforation can happen even with the best of technique and no risk factors. While most providers are concerned about immediate short-term gynecological complications like infection and bleeding, we don’t really consider the possibility of any potential future OB complications. Is a patient at higher risk of future adverse OB issues after perforation during IUD placement? It’s an interesting question, with an even more fascinating answer! In this episode we will dive into the data, and make sense of published case reports and clinical opinions which help us arrive at the answer to that question.
Jan 25, 202452:46
![Extencilline, Linezolid, & STUFF](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Extencilline, Linezolid, & STUFF
Yep, Medicine moves fast! On Friday, January 5, 2024, I participated in a medical news report published in “The Guardian”. In that news commentary I stated that “Bicillin-LA is the only medication approved for syphilis during pregnancy”. We’ve all heard that statement, and it is a true statement. However, 5 days later on January 10, 2024, the FDA announced the importation allowance of “Extencillin” to combat the Bicillin-LA shortage. Yep, Medicine moves fast. Now we have this medication available as an option until Bicillin-LA increases its availability. But what about Linezolid? In this episode, we will also discuss a recent non-inferiority trial of Linezolid for early syphilis, which was published in “The Lancet”. Although that study had disappointing results, there are some caveats which need explaining. Listen in to find out more.
Jan 22, 202420:39
![Preg Test in ESRD: Going Down the Rabbit Hole?](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Preg Test in ESRD: Going Down the Rabbit Hole?
If you had 5 reproductive age women, all late on their menstrual cycle, who were having unprotected sex, and all have a positive pregnancy test… What would be your diagnosis? The most likely diagnosis would be that there are five pregnancies! Right?! But what if 1 of those patients had end stage renal disease (ESRD), on hemodialysis. Is there anything else to consider? While ruling out pregnancy is priority #1, it is possible that this HCG is a phantom result. This is a slippery slope discussion and one that could easily lead down the rabbit hole. In this podcast, we will highlight this clinical conundrum, based on a real case from our practice, and summarize some fascinating reports from the literature.
Jan 21, 202448:56
![You Asked, We Answered!](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
You Asked, We Answered!
Periodically, we respond to podcast family members’ questions as data is available. In this episode, we will cover 3 very clinically relevant questions from our podcast listeners. The first question is regarding our immediate past podcast topic, which was propranolol as a labor stimulant. The question is, “Does the ACOG have a statement on adjuvent propranolol use during labor?“. We’ll answer that question in this episode. The second question is whether the placebo/pill-free interval of combination birth control pills is linked to anxiety/depression. This is a COMPLICATED issue but there is brand new data that helps answer that exact question, and we will cover that in this episode. The final question is whether or not “HPV booster vaccination“ is indicated after CIN2+ treatment in patient who had previous vaccination. Lots of data to help answer these questions… and we will summarize it here.
Jan 18, 202446:29
![Can Propranolol Rescue Labor?](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Can Propranolol Rescue Labor?
It has been well reported that rates of elective induction have risen nationally and internationally since the adoption of the ARRIVE trial. But as medicine is at times controversial, some studies have suggested an increase in cesarean section rates with elective induction of labor at 39 weeks. While we will briefly discuss those studies, they are not the focus of this episode. However, as induction of labor becomes more common place, there has been renewed interest in use of adjuvant medications to augment induction success. One of those medication is propranolol. Can giving a beta-blocker help with uterine contractility? The data is conflicting with recent evidence saying “No!“. In this episode, we’re going to put the evidence on trial and present both arguments: one as plaintiff, and one argument as the defense for our shared client, which is propranolol. Is propranolol guilty of its charges of being a labor stimulant? Or is it innocent of all charges? Let’s let the data decide.
Jan 17, 202440:17
![More Data on LUST (Follow up to 12/31/23 Episode)](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
More Data on LUST (Follow up to 12/31/23 Episode)
On New Year’s Eve 2023 we released “LUST for TOLAC”. LUST stands for lower uterine segment thickness. This is a very enticing, and controversial, approach to TOLAC counseling and direction. I encourage you to go back and listen to that episode, if you have not yet, before listening to this one as this is more data to support those conclusions. In this episode, we will highlight a multi-center, cluster-randomized trial out of Canada, the PRISMA study. This fantastic investigation sheds more light on the application of LUST for prediction of TOLAC uterine rupture.
Jan 15, 202427:17
![Beyond the 22 Week Birth](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
Beyond the 22 Week Birth
The gestational age boundary termed viability has shifted dramatically during the past 50 years, and more so in the last 15 years. In 1971, a widely used neonatology textbook stated that, “The lower limit of viability is probably around 28 weeks, at which time most infants weigh two pounds, four ounces (1000 g).” Today, the most immature infants routinely cared for by neonatologists in some parts of the world are born at 22 weeks of gestation, with many weighing around 500 grams. While most studies reporting on neonatal resuscitation at 22 weeks give a main outcome as “alive at discharge”, there are other potential long-term morbid conditions which cannot be ignored. The ability to perform neonatal resuscitation at 22 weeks and 0 days has led to many powerful ethical debates and published commentaries. In this episode we will take a look at the complexities of neonatal resuscitation at 22 weeks focusing on the potential long morbidity after hospital discharge.
Jan 13, 202441:54
![NIPTS Clarify: “46 XX or 46 XY”?](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
NIPTS Clarify: “46 XX or 46 XY”?
This is NOT our regularly scheduled episode. Based on an incredible comment from Rachel – one of our podcast family members, which I received just moments ago, this was too good to not put out. A brief clarification on NIPTS and “46XX or 46XY”. (This is a supplement to our immediate past episode.) 😊😊🧐🧐
Jan 12, 202406:10
![NIPT’s Sex Chromosome Abnormalities: Clinical Pearls.](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
NIPT’s Sex Chromosome Abnormalities: Clinical Pearls.
NIPT is a prenatal SCREENING method that involves analysis of cell-free fetal DNA (cfDNA) in maternal blood. Prenatal screening for sex chromosome aneuploidies (SCAs) has become readily available through expanded non-invasive prenatal testing (NIPT). NIPTs became commercially available in 2011 and has since been introduced in more than 60 countries around the world and is now part of mainstream obstetrical practice. Initially
offered as a secondary screen for pregnancies with a high probability of a fetal chromosomal anomaly, NIPT is now often offered and recommended as a first-line
screening test for the main chromosomal aneuploidies. Initially, NIPT was available to screen for fetal trisomies 21 (Down syndrome), 18 (Edwards syndrome) and 13 (Patau syndrome). This has expanded of course to include
(separately) fetal sex chromosome aneuploidy (SCA) screening. However, there are some VERY important points we must remember when seeing an “atypical sex
chromosome” NIPT result. What is the PPV of a SCA found on NIPT? In this episode we will highlight a recent NIPT atypical sex chromosome result from our practice and review what this may and may not actually mean, and review why NIPT screening for SCA is actually VERY controversial with some potential ETHICAL concerns, with some countries recommending AGAINST ordering it. Lots to cover here….so listen in.
offered as a secondary screen for pregnancies with a high probability of a fetal chromosomal anomaly, NIPT is now often offered and recommended as a first-line
screening test for the main chromosomal aneuploidies. Initially, NIPT was available to screen for fetal trisomies 21 (Down syndrome), 18 (Edwards syndrome) and 13 (Patau syndrome). This has expanded of course to include
(separately) fetal sex chromosome aneuploidy (SCA) screening. However, there are some VERY important points we must remember when seeing an “atypical sex
chromosome” NIPT result. What is the PPV of a SCA found on NIPT? In this episode we will highlight a recent NIPT atypical sex chromosome result from our practice and review what this may and may not actually mean, and review why NIPT screening for SCA is actually VERY controversial with some potential ETHICAL concerns, with some countries recommending AGAINST ordering it. Lots to cover here….so listen in.
Jan 11, 202450:37
![No Data, No Problem!](https://d3t3ozftmdmh3i.cloudfront.net/production/podcast_uploaded_nologo400/384576/384576-1709327597959-72fe99ae25818.jpg)
No Data, No Problem!
We take pride as healthcare providers in being “evidence based“. But sometimes things that we do, even in 2024, sound, reasonable and sound practical, but actually are NOT evidence-based. But lacking evidence means 2 things: 1. Studies have proven something does not work, or 2. Studies have not been done to confirm or refute the intervention. In this episode, we will discuss 2 common interventions that are recommended in pregnancy that actually don’t have the evidence behind them. First is the “test of cure” urine culture after treatment of ASB or cystitis, and the second is certain physical activities like specific yoga positions/Miles circuit as preparation for labor. I believe in both of these interventions- although we don’t have STRONG data for either. I will explain in this episode. That’s why I am calling this, “No data, No problem!”.
Jan 07, 202448:24