Dr. Chapa’s OBGYN Clinical Pearls

Recent recommendations from the American College of Cardiology (ACC) and the American Heart Association (AHA) have changed the criteria for diagnosing hypertension in adults. In January 2019, the ACOG will release Practice Bulletin #203 addressing these changes, and provide renewed guidance for management of chronic hypertension in pregnancy. This is PART 1, of a 2-Part review of PB#203.

OK, so your pregnant patient comes to you with persistent itching between the fingers and toes and you suspect scabies. Which medication is safe to use in pregnancy? This is a brief review of scabies in pregnancy and its accepted medical treatments.

Genitourinary syndrome of menopause causes a significant disruption in quality of life for many menopausal women. The ACOG and NAMS endorse vaginal estrogen to relieve local symptoms. However, the FDA has a current Black Box warning on vaginal estrogen. This podcast will cover brand new data from the Nurses Health Study, released December 20, 2018 in the journal, Menopause.

As legal access to marijuana continues expanding across the US, more researchers are studying the effects of tetrahydrocannabinol, (THC), in teens, adults and pregnant women. New research from Duke Health suggests men in their child-bearing years should also consider how THC could impact their sperm and possibly the children they conceive during periods of Marijuana use. This is a tale of marijuana, sperm, and epigenetics! Data for this podcast came from the recently published study from Duke researchers, published in EPIGENETICS, 19 December 2018 (Murphey et al) and the medical news update from MDLinks (12/19/18).

Just something fun to break up the monotony.

Lichen Planus is a chronic inflammatory mucocutaneous disorder that can affect the mouth, vulva, vagina, and anus. Wickham’s Striae are characteristic of mucosal involvement. Biopsy is often needed to confirm the diagnosis and rule out other neoplastic conditions. The more afflicting type of Lichen Planus is erosive lichen planus. In this session, we will review the presentation, pathophysiology, diagnosis, and treatment of vulvar Lichen Planus. (Reference: ACOG expert series CME edition on vulvar skin dermatoses; 2018)

Vulvar Lichen Simplex Chronicus is a non-scarring, chronic inflammatory disease of the skin characterized by intense itching. 65% to 75% of patients have a history of allergic conditions including asthma or childhood dermatitis. In this session, we will review the presentation, diagnosis, and medical care of vulvar Lichen Simplex Chronicus. (Reference: ACOG clinical expert series, CME edition, “Diagnosis and Treatment of Vulvar Dermatosis“ ; 2018)

Vulvar Lichen Sclerosus is a chronic inflammatory vulvar dermatosis. There is an association between this condition and various systemic autoimmune conditions (e.g., thyroid dysfunction, vitiligo). Additionally, patients with this condition have a 4-5% risk of vulvar cancer in the future! In this session, we will discuss the pathophysiology, diagnosis, and management options for this condition. (Reference: CME Series on “Diagnosis and Treatment of Vulvar Dermatosis”, 2018; Obstet Gynecol)

The etonogestrel contraceptive implant is a type of LARC with proven high efficacy. Yet, similar to all progestin only contraception, abnormal bleeding can become bothersome to the patient- especially in the first 3 to 6 months of use. Ulipristal, a progesterone receptor modulator, has shown promise as a new medical agent to help relieve bothersome bleeding in these patients. In this podcast, we will review the latest data from a randomized controlled trial (Oct 2018) on ulipristal for bleeding control in Nexplanon users.

On December 15, 2018, the ACOG released a Practice Update regarding subcutaneous use of 17OHP rather than IM 17OHP for preterm birth prevention. Weekly IM injections of 17OHP were endorsed by the ACOG after the 2003 MEIS MFM Network clinical study demonstrated a reduced risk of preterm birth in women with prior preterm birth, with its use. In this podcast, we will review the ACOG practice update regarding subcutaneous rather than IM 17 OHP for preterm birth prevention.