Dr. Chapa’s OBGYN Clinical Pearls

Stillbirth rates in the U.S. are alarmingly high, showing a need for urgent reform. The podcast highlights comparisons with countries like Japan, the UK, and Australia, where effective prevention bundles have been implemented. It underscores the emotional toll on families and advocates for a national strategy to combat stillbirths, detailing systematic approaches that include smoking cessation and fetal monitoring. Recent legislative advancements and education are also examined as critical steps toward reducing these tragic losses.

Guillain-Barré syndrome (GBS) is a rare disorder that causes muscle weakness and sometimes paralysis. It's caused by the body's immune system damaging nerves. While most cases are triggered by respiratory or gastrointestinal infections, vaccinations have also been linked to GBS pathogenesis. GBS can last from weeks to years, but most people start to recover within a few weeks. The earlier symptoms improve, the better the outlook. Physical therapy is important to prevent muscle contractures and deformities. Some people may experience long-term weakness, numbness, fatigue, or pain. A small percentage of people with GBS may have a relapse, which can cause muscle weakness years after symptoms end. On Jan 7, 2025, the FDA required and approved UPDATED safety labeling changes to the Prescribing Information for Abrysvo (Respiratory Syncytial Virus Vaccine) manufactured by Pfizer Inc. and Arexvy (Respiratory Syncytial Virus Vaccine, Adjuvanted) manufactured by GlaxoSmithKline Biologicals. Specifically, FDA has required each manufacturer to include a new warning about the risk for Guillain-Barré syndrome (GBS) following administration of their Respiratory Syncytial Virus (RSV) vaccine. Who is most at risk for GBS? Where pregnant women affected? This is important information….listen in for details.

Sometimes you read a new study and you just have to say, "You Don't Say?!" In this episode, we will highlight 2 publications which were released Dec 26. 2024 and Jan 6, 2025 which make you say just that. This is a brief, fun, YET STILL EDUCATIONAL, episode...Listen in for details.

In this episode, we will cover 2 topics: the first is brand new in print (01/06/2025 ), and the second is just weird. In the “new” portion we'll summarize a new randomized study published in JAMA Network dealing with gestational diabetes. Should we add glyburide to metformin for GDM control? Listen in for details. In the second portion, we'll focus on unilateral ovarian absence not related to previous removal. Yep! This is why it's very important to check the adnexa at “routine” C-section or “routine” gynecological surgery. It is possible to be missing an ovary…and its weird! Listen in for details!

The podcast dives into the complexities of delivering preterm infants, especially in the critical periviable window. It examines the latest guidelines on mode of delivery, questioning if cesarean or vaginal birth affects neonatal outcomes. The discussion highlights the high risks involved for infants born at 22 to 24 weeks, comparing survival rates and resuscitation strategies. There's a particular focus on the implications of breech presentations versus vertex births, emphasizing the importance of informed decision-making for expecting mothers.

In most regions of the United States, RSV season starts in the fall and peaks in the winter. In September 2023, the ACOG released a Practice Advisory recommending a single dose of Pfizer’s RSV vaccine (Abrysvo) for eligible pregnant individuals between 32 0/7 and 36 6/7 weeks of gestation who do not have a planned delivery within 2 weeks, using seasonal administration, to prevent RSV lower respiratory tract infection (LRTI) in infants. This is recommended from September to January. Currently, the US recommendation is for this to be given once, with subsequent deliveries receiving neonatal Beyfortus in RSV season. The recommendation from NICE is to have this vaccination with every pregnancy. The prescribing information for Abrysvo includes a warning to inform patients that a numerical imbalance in preterm births in Abrysvo recipients (5.7%) occurred compared to those who received placebo (4.7%). This imbalance was only seen in trial participants residing in low- to middle-income countries with no temporal association to vaccination or association with other adverse events in the mother or the newborn. Now, that phase 3 clinical data has gone through peer review and is a new publication. This is the MATISSE global study and will be officially published in the Green Journal February 2025…but we will summarize the results NOW in this episode! Listen in for details.

In August 2024, researchers at Columbia University published a study that found measurable concentrations of 16 metals in multiple brands of tampons. The study evaluated levels of metals like cadmium, manganese, and arsenic in 30 tampons across 14 different brands. The study concluded that using tampons may be a potential source of metal exposure. We covered this publication in JULY 2024 before it was released! In response to the study, the FDA launched an investigation that includes 3 parts: 1. An independent literature review to learn more about data available regarding the presence of chemicals in tampons and possible health effects , 2. A laboratory study to evaluate metals in tampons and potential exposure people may experience when using them, and 3. Toxicity testing to identify potentially harmful substances and assess the risk of those substances being absorbed by the body. The literature review has been completed and was released by the FDA on Dec 23, 2024. Listen in for details.

Low-dose aspirin (LDA), typically prescribed at a dosage of 81 mg daily, is primarily used during pregnancy to prevent or delay the onset of preeclampsia. However, the question of whether to continue LDA postpartum is less clear and requires careful consideration of the benefits and risks associated with its use in the postpartum period. After all, the American College of Cardiology and American Heart Association recommend that low-dose aspirin use (75 to 100 mg/d) might be considered for the primary prevention of atherosclerotic CVD among select adults ages 40 to 70 years at higher CVD risk but not at increased risk of bleeding. Meanwhile, the 2022 US Preventive Services Task Force (USPSTF) recommendation notes that the decision to initiate daily aspirin therapy for primary prevention of cardiovascular disease (CVD) should be made on a case-by-case basis for adults ages 40 to 59 with a 10% or greater 10-year CVD risk. The recommendation applies to those without signs or symptoms of clinically evident CVD who are not at an increased risk of bleeding. So, does continuation of LDA after delivery reduce the persistence of, or development of, chronic hypertension. Is that evidence-based? The answer is both YES and NO. Listen in for details.

Somethings in medicine are pretty cut and dry. Others...not so much. Such is the case with obstetrical management of PPROM with a cervical cerclage in place. Should it be removed, or left in place? While the ACOG has some guidance from March 2020, there has been additional publications released, including one from SMFM. PLUS, a November 2024 review on the topic (AJOG MFM) has suggested a practical approach to this clinical scenario. Listen in for details.

The latest guidelines from the CDC on contraception for individuals with obesity are discussed, highlighting key updates due in 2025. There's a deep dive into whether specific birth control methods are contraindicated based on BMI. The podcast dismantles myths about contraceptives causing weight gain, and focuses on various contraceptive options, including the E-tronorgestrel implant. Interestingly, while most methods have little impact on weight, Depo-Provera does stand out as an exception. Tune in for valuable insights on shared decision-making in contraceptive use!