Dr. Chapa’s OBGYN Clinical Pearls

Screening for spinal muscular atrophy (SMA) should be offered to all women who are considering pregnancy or are currently pregnant. SMA is an autosomal recessive disease characterized by degeneration of spinal cord motor neurons that leads to atrophy of skeletal muscle and overall weakness. Once identified, oral therapy may be started in the neonatal interval for those with the most severe phenotype (SMA-1). However, on Feb 19, 2025, a medical team piloted an investigational PRENATAL protocol as treatment starting in utero! While more data is needed, the results have been incredible. In this episode we will highlight this fascinating therapy which was "parent proposed". Listen in for details!

Vitamin D gets a lot of attention, and it should, mainly for its known role in bone stability. However, vitamin D has significant additional roles in physiology. Vit D, and its metabolites, also functions as modulator of inflammatory and immune responses. According to a number of recent studies, this important micronutrient plays a complex role in numerous biochemical pathways in the immune system and disorders that are associated with them. In pregnancy, the association of Vit D deficiency and adverse perinatal outcomes has been controversial with conflicting data. Nonetheless, in August 2024, the Endocrine Society published its recommendation (J Clin Endocrin Metabol) for routine supplementation for children, adults older than 75 years, pregnant women, and adults with prediabetes. In this episode, we will review a new publication (Feb 2025) from the Am J Clinical Nutrition regarding low vit D levels in the first trimester and PTB. Could vit D supplementation be the answer for preterm birth prevention? The answer may surprise you! Listen in for details.

According to published estimates, the prevalence of an NSAID allergy (hypersensitivity) in the general population is estimated to be between 0.5% and 2%, with some studies reporting a range of 1-3% of people experiencing a reaction to NSAIDs; however, this rate can be significantly higher in individuals with conditions like asthma, nasal polyps, or chronic urticaria, where it may reach up to 20-30%. Genetic and epigenetic backgrounds are implicated in various processes of NSAID-induced hypersensitivity reactions. Aspirin is a type of NSAID and may result in some cross sensitivity in NSAID allergic people. Well, as low dose aspirin is currently the only pharmacological recommended prophylactic agent for HDP, what can we do for these patients? In a new publication (ahead of print, 2/17/2025), clinicians from Singapore provide helpful insights- and an easy to adopt protocol- for aspirin desensitization in pregnancy. Listen in for details.

Its BACK. While the current outbreak is in western Texas and Eastern NM, it is expected to spread to other States. Measles is an acute viral respiratory illness characterized by fever, malaise, cough, conjunctivitis, a pathognomonic enanthema (oral lesions), followed by a maculopapular rash. In pregnancy, this could lead to significant maternal and fetal morbidity. What are Koplick Spots? What is the "Rule of 4" with measles, and what is important about the number 10? Listen in for this QUICK RECAP of Measles 101!

The ACOG's PB 205 (2019; reaffirmed Aug 2024) states that "when compared with spontaneous labor, induced labor is associated with a lower likelihood of achieving VBAC". Additionally, that guidance states, "Several studies have noted an increased risk of uterine rupture in the setting of induction of labor in women attempting TOLAC". These are important observations to review with a patient. However, according to a study soon to be published in March 2025, based on US Vital Statistics birth certificate data, that may not be the case. YEP...Medicine Moves Fast. Listen in for details.

Funic presentation, the umbilical cord presenting as the leading feal component seen on ultrasound, may be a transient phenomenon and is usually considered insignificant until ~32 weeks. However, its persistence beyond that gestational age raises the possibility of cord prolapse intrapartum as cervical dilation progresses. Cord prolapse is a mostly unpredictable obstetric emergency, in which the umbilical cord comes through the cervical os in advance of (overt prolapse – usually palpable or even visible within the vagina) or alongside the fetal presenting part in the presence of ruptured membranes (occult prolapse). The reported incidence of umbilical cord prolapse ranges from 1 to 6 per 1000 pregnancies. Though rare, cord prolapse is associated with high perinatal mortality and morbidity as cord compression and umbilical artery vasospasm may occur preventing blood flow. Consequently, expert opinion recommends CS when funic presentation is detected INTRAPARTUM. But WHEN is delivery recommended a funic presentation is found in the late third trimester? Does that need a CS? Funic presentation is notably absent from the ACOG CO 831 on medically indicated late preterm and early term deliveries. Listen in for details.

One in five women in the U.S. begin pregnancy with a BMI of 30 or higher. Excessive weight gain during this time can lead to serious complications like gestational diabetes and shoulder dystocia. Surprisingly, the link between high maternal weight gain and stillbirth risk is complex. While guidelines recommend monitoring based on pre-pregnancy BMI, the reasons for this approach may not be as straightforward as expected. The discussion uncovers startling data and insights on maternal health throughout pregnancy!

Estimates of Postpartum Urinary Retention (PUR) incidence vary widely from 1.5% to 17.9%, with undiagnosed cases making the true incidence difficult to determine. A postvoid residual (PVR) volume of <150 mL is typically considered appropriate for normal bladder emptying, but this has been in the nonpregnant/non-postpartum population. In this group, some have proposed a PUR of up to 500ml as normal! That protocol, using the 500ml cut off, was just recently published in the J Matern Fetal Neonatal Med in Dec 2023. PUR is classified into 2 groups: overt (AKA symptomatic) and covert (asymptomatic) urinary retention; overt PUR traditionally has been defined as an inability to spontaneously void 4-6 h after vaginal delivery or the need for re-catheterization 4- 6 h after catheter removal following cesarean section. What’s the recommended plan of care after diagnosing PUR? Does bethanechol help? Can peppermint oil vapor help? Well…this is SOME data on this! Listen in for details.

The podcast dives into the evolving landscape of postpartum pain management using ibuprofen, revisiting past guidelines from ACOG. A new study highlights safety for patients with hypertensive disorders of pregnancy, revealing no significant impact on blood pressure. Discrepancies in fetal surveillance guidelines also come under scrutiny, reflecting the challenges faced by clinicians. The hosts emphasize the importance of understanding study timelines and offer insights on effective communication in medical practices, all while valuing listener feedback.

(We were made aware that this original posting had the last section DROPPED accidentally)...here is the full episode! Ahhh...TECHNOLOGY! *This is why AI will likely replace our production team...Just kidding production team, just kidding).Episode Details:Well, we typically focus on ONE or maybe TWO publications to highlight and review. However, in this episode, which we have decided to call, “Survey said…!”, we will go through some common and REAL WORLD “mental battles”regarding what is and what is not part of a diagnostic criteria. These are every day OBGYN things that we KNOW, but when asked to define them…we can easily get ourselves confused. We are going to clear these up…Game Show style!  First, when only one abnormal value is found in the two-step, 100-gram GTT,  it is called borderline GDM, or impaired glucose tolerance. But what is it called when there is an abnormal (failed) 1-Hour 50 gram, but completely normal 3-Hr 100-gram GTT? Is this also called “impaired glucose tolerance”? We….the Survey Said…! (Yep, we’ll get to that). Secondly, does the criteria for Preeclampsia with Severe Criteria include platelets of 100,000 or not? The Survey Said…! (Yep, we’ll cover that). We will also review the numbers for MVP oligo, for a “normal” postmenopausal ES, and MORE! Listen in for details!