Dr. Chapa’s OBGYN Clinical Pearls

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!

The podcast dives into the complexities of diagnosing severe hypertension in pregnant women, dissecting the tricky distinction between chronic hypertension and superimposed preeclampsia. Listeners learn about the significance of specific blood pressure thresholds and the risks of misclassification. The discussion emphasizes the importance of adhering to clinical guidelines for optimal maternal and fetal health. It also explores the challenges in interpreting blood pressure readings and the need for vigilance in treatment strategies.

According to the ACOG, eclampsia is a low frequency, high acuity emergent condition. The rate of an eclamptic seizure is 1/200 in those with preeclampsia without severe features but is 4 fold higher ( 4/200 ) in those with preeclampsia with severe features. Traditionally, “textbook eclampsia” management did not include cranial imaging. However, that consensus is changing! In this episode, we will review data making the case for a standardized approach to eclampsia, which includes universal non-contract cranial CT after eclampsia. We will highlight a Clinical Expert Series ACOG publication from July 2024 as well as an upcoming publication from Pregnancy Hypertension in March 2025 which makes the strong case for this radiological diagnostic tool. Listen in for details.

Well, in this episode we have a “3-in-1” subject review. Often in medicine, we find ourselves with some data to guide us, but definitely not a “predominance of evidence”. So in caring for our patients, we often come to the conclusion that doing a course of action can possibly help, and can't hurt... and therefore our plan “sounds reasonable”. That's the focus of our episode today! We're going to have fun with this one and cover three topics where we do have some data to guide us, but not our predominance of data that the dot leaving us to conclude that a plan of action “sounds reasonable”. 1. Can nitrous oxide be used for IUD/IUS insertion? 2. Should we follow total serum bile acids serially for ICP (new Jan 2025 data)? 3. And if IM Ceftriaxone is recommended as first-line RX for gonorrhea, can we give expedited partner therapy as an oral medication? Listen in for details!

Dive into the complexities of postpartum venous thromboembolism (VTE) and its implications for maternal health. The discussion highlights a new study questioning the effectiveness of postpartum pharmacologic therapy. Discover the divergent guidelines from RCOG and ACOG, and the emphasis on personalized care. Additionally, explore nostalgic reflections on 'Welcome Back, Cotter,' blending humor with serious topics. This engaging conversation poses critical questions about VTE management and patient safety.

This- is-CNN. No, that THAT CNN...This is Chapa News Network! WE have late-breaking news developments on 2 fronts: 1. The ACOG has released a clinical update (ACOG ROUNDS) in response to a recent study associating the RSV vaccine and GBS (we covered this study in a past episode). 2. The FDA has EXPANDED the label for an intranasal therapy for Treatment Resistant depression (TRD). Listen in for details.

Discover the surprising connection between sleep positions and stillbirth risk during pregnancy. Recent studies show conflicting data about the impact of how a mother sleeps. While some suggest there's no link, other research highlights the importance of sleeping on your side as pregnancy progresses. Delve into the timeline of research from 2011 to now, and learn why the starting position can be crucial for fetal safety. It's a fascinating exploration that sheds light on pregnancy outcomes beyond just sleep habits.

Internal manual aortic compression is a procedure that may be used intraoperatively in the management of massive pelvic bleeding. But what about EXTERNAL aortic compression? In February’s 2025 AJOG (Grey Journal), under their Surgeon’s Corner section, there will be a very nice video recap of an easy to adopt maneuver which may “buy time” in OB hemorrhage cases as surgical intervention is being planned. This is called the EAC maneuver. First described in 1994, this technique has regained the spotlight as rates of PPH have been on the rise. How is EAC done? Does it work? If so, why is this not part of the OB Hemorrhage bundle? Listen in for details.

Discover the groundbreaking potential of menstrual blood-derived mesenchymal stem cells (MenSCs). Learn how researchers are exploring their uses in diverse medical conditions from Alzheimer’s to infertility. The podcast tackles the challenges of collecting these stem cells non-invasively, while also critiquing the hype surrounding regenerative medicine. Engaging insights discuss regulatory hurdles and the importance of rigorous scientific evidence to legitimize stem cell therapies. Could there be a miracle cure hidden in menstruation? Tune in for this fascinating conversation!

Tachycardia in pregnancy is more common than you might think, but distinguishing between normal and concerning cases can be tricky. Recent research has clarified heart rate limits during pregnancy, unraveling when further evaluation is essential. The conversation dives into vital guidelines and studies surrounding maternal tachycardia. Discover the real increase in heart rate during pregnancy, and what to do when it spikes unexpectedly. Understanding these nuances could lead to better outcomes for both mothers and their babies!