Dr. Chapa’s OBGYN Clinical Pearls

Tuberculosis (TB) was historically called "consumption" due to the dramatic weight loss and wasting away experienced by patients. The modern name "tuberculosis" was first published by J. L. Schönlein in 1832. Today, between 3% and 5% of the U.S. population are estimated to be living with latent TB infection. Contrast that with the worldwide statistics which state that nearly one fourth of the world population has TB infection. In some countries in sub-Saharan Africa and Asia, the annual incidence is several hundred per 100,000 population. In the US, the annual incidence is <3 per 100,000 population, but immigrants from countries with a high TB burden and long-term residents of high-burden countries have a 10× greater incidence of TB than the US national average. Thankfully, only 5–10% of individuals with latent TB infection will progress to active TB disease over their lifetimes. But it is difficult to predict who will progress from latent TB infection to active TB disease. The perinatal period is a good opportunity to screen, diagnose, and treat those at high risk for TB. The ACOG the American Academy of Pediatrics, and the Centers for Disease Control and Prevention (CDC) recommend screening all women who are at high risk for TB at the initiation of antenatal care. In this episode, we will review the epidemiology of tuberculosis, who should be screened, and focus on latent TB infection management in pregnancy. What does the “4R” preferred regimen mean? Listen in and find out.

The discussion highlights the critical issues around previable and periviable PPROM, detailing its significant impact on neonatal mortality. Insights into the newly released SMFM guidelines point to the complexities of managing such pregnancies. The importance of shared decision-making is emphasized, with healthcare teams navigating tricky ethical waters. Additionally, the effectiveness of interventions like amnioinstillation and home outpatient management are explored, all while keeping an upbeat tone with listener engagement.

Researchers estimate that more than 100 million women in over 120 countries use tampons during their menstrual cycle. Tampons are generally considered safe and healthy menstrual products. However, a new study conducted by researchers at the UC Berkeley School of Public Health has identified the presence of 16 different heavy metals in tampons from 14 different brands purchased in the U.S. and the U.K. This is causing a flurry of on-line commentaries, controversies, and conundrums. Are tampons toxic? In this episode, we will summarize this new publication (set to be officially released Aug 2024) and relate it to some real-world, daily exposures.

It's Summer…and its getting HOT in here! Although the effect of heatwaves in pregnancy has been studied various times, the data remains limited because these studies are observational, with very heterogenous populations, so its hard to prove causation between heat exposure and adverse outcomes. Nonetheless, these associations are indeed concerning. YES…just to be clear, there are past studies that have observed associations between heatwaves and PTB, low birthweight, and in some studies…stillbirth. The most recent review on this was published just last year (June 2023) in the J Mother Child, and the title was “A Comprehensive Review on Hot Ambient Temperature and its Impacts on Adverse Pregnancy Outcomes”. This review of 23 articles did again find an association between heat stress and adverse pregnancy outcomes. PLUS, a new publication released July 3, 2024, now raises new concerns about ambient heat and in-utero childhood cancer programming! That article, from Lancet Planetary Health, is the focus of this episode. BUT WAIT there’s more! We will also look at the relationship between ambient heat and PTB and oligohydramnios. So, grab your ice cooled glass of water and Let’s look at the evidence.

Discussing the challenges in diagnosing endometriosis in adolescents with chronic pelvic pain, the podcast introduces a new FDA fast track designated diagnostic tool. The tool uses a molecular/protein ligand tracer for possible early detection. Safety and biodistribution of the 99TC Maricyclotide tracer are explored, highlighting its rapid exit from the body without adverse effects. The potential impact of the new fast track designation for the ENDO DX tool in revolutionizing endometriosis treatment for adolescents is also discussed.

Well, sometimes the "traditional", evidence-based recommendations don't have the desired result they are supposed to. When the "usual and standard" ways of doing things fail, its time for "shared-decision making"! In this episode, we will highlight, and give KUDDOS, to an OB care team who exampled thinking outside-the-box in order to care for an acutely ill patient s/p second trimester loss. This is soon to be released in the AJOG, and was released as a journal "pre-proof" July 9, 2024. This is a difficult case of a 19 week septic AB, retained placenta, an overtly abnormal uterus, and the surgical robot! Listen in for details.

Exploring the approval and usage of the maternal RSV vaccine for pregnant women to protect newborns. New data on preterm birth risks and real-world outcomes. Discussion on maternal RSV vaccine trial outcomes and the recent study findings.

Debunking controversial study on ovarian cancer risk reduction, exploring salpingectomy benefits and limitations, differentiating recommendations for general population and BRCA mutation carriers. Discussing origin theory of high-grade serous ovarian cancers, impact of prophylactic surgeries on BRCA carriers, and reviewing key publications.

The podcast discusses the importance of genetic testing in cases of recurrent pregnancy loss, highlighting different genetic tests and screening options available. It also delves into the limitations of microarray analysis in detecting certain genetic abnormalities and explores the controversies surrounding thyroid and diabetes screening in such cases.

Happy Independence Day, America! We hope you are enjoying this wonderful, national holiday. Yep...Its a PARTY in the USA! In light of the festivities, here's a clinical question for us: Do fireworks affect the fetus? Even broader than that, do loud sounds in general affect the developing child? The answer is both YES and NO. Listen in to this short- yet fun- episode as we prepare to light the night up in celebration of our nation's independence.