Dr. Chapa’s OBGYN Clinical Pearls

Acute fatty liver of pregnancy is a rare but potentially life-threatening condition which usually presents in the 36th week of pregnancy. In this podcast we will cover the ACG (Am. Coll Gastro) clinical guidelines regarding acute fatty liver disease in pregnancy.

In this session, we will review the ACOG committee opinion on prevention of early onset GBS neonatal infection. This comes from the committee opinion 485.

Levonorgestrel and ulipristal are 2 oral emergency contraceptive options. Since 2010, pharmacokinetic studies have suggested a lower effectiveness of levonorgestrel in overweight and obese women. In this podcast, we will review the pharmacokinetic data as well as professional society opinions on this topic.

In this session, we will review the diagnostic criteria for premenstrual syndrome and premenstrual dysphoric disorder. Options for therapy will also be discussed. Data taken from the ACOG and the APA.

In this session, we will review and obstetrical emergency that has the potential to result in severe Ville and morbidity or even mortality… Umbilical cord prolapse.

In this session, we will review the ACOG practice bulletin (199) from September 2018 on the use of prophylactic antibiotics in labor and delivery. This podcast will cover the optimal dose of intravenous antibiotics before C-section, the use of vaginal cleansing, and the adjuvant use of Zithromax before cesarean birth. Care of the MRSA colonized patient, as well as infective endocarditis prophylaxis will be covered.

Ovarian vein thrombosis was recently the subject of a clinical review by the American College of OBGYN in November 2017. Ovarian vein thrombosis occurs in 1 and 600 to 1 in 2000 pregnancies and may have severe sequelae including pulmonary embolism. In this podcast, we will review the latest information from the ACOG and the ACCP on the pathophysiology, diagnosis, and treatment of ovarian vein thrombosis.

Alright, as occasionally happens… There was an error in the editing of our prior podcast regarding nerve injury at gynecological surgery. This very brief section will clarify the occurrence of klumpke's palsy during steep trendelenburg positioning.

Gyn surgery can be associated with iatrogenic nerve injury. Neuropathy can be classified into three types: neuropraxia, axonotmesis, and neurotmesis. The most severe form of injury is nerve transaction or complete nerve ligation (neurotmesis). In this session, we will review the mechanism of nerve injury during Gyn surgery, their presentations, and prevention tips. Material is taken from the AAGL and the Society of Gyn Surgeons.

In this podcast, we will review the ACOG updated guidelines regarding intra-amniotic infections. Three classifications have been given by the ACOG: 1. Isolated maternal fever in labor, 2. Suspected intra-amniotic infection, and 3. Confirmed intra-amniotic infection. We will review these three categories, their diagnosis, and treatment recommendations. Data taken from the ACOG committee opinion 712.