Dr. Chapa’s OBGYN Clinical Pearls

Podcast Family, this episode has 2 parts: 1. First, a "non-medical" little life lesson that I heard recently which I will share with you...I hope it ENCOURAGES you, and 2. The MEDICAL part, which comes from Paul- one of our podcast family members. Paul had a GREAT question regarding the data covered in our immediate PAST episode on TOLAC....listen in for details!

Exploring the decision-making process between TOLAC and repeat C-section, including the use of a TOLAC calculator. Delving into the debate on elective induction at 39 weeks versus expectant management for TOLAC, with a discussion on uterine rupture rates.

Hemorrhagic disease of the newborn (HDNB) was first identified over a century ago, and presents as unexpected bleeding, often with gastrointestinal hemorrhage, ecchymosis and, in many cases, intracranial hemorrhage. In newborns, HDNB is typically caused by vitamin K deficiency as neonates are innately deficient in vitamin K secondary to very little vitamin K transferred through the placenta to fetuses in utero, limited liver storage of vitamin K, and low amounts of vitamin K in breast milk. IM administration of vitamin K for prevention of vitamin K deficiency bleeding (VKDB) has been a standard of care since the American Academy of Pediatrics recommended it in 1961. Despite the success of prevention of VKDB with vitamin K administration, the incidence of VKDB appears to be on the rise. This increase in incidence of VKDB is attributable to parental refusal as well as lowered efficacy of alternate methods of administration. Can parents decline this injection for their babies? In this episode, we will review IM Vit K neonatal administration and discuss the controversial data regarding Vit K oral supplementation.

Proving that our podcast tagline, “Medicine Moves Fast” is true… this episode highlights something that is, once again, 🔥🔥🔥 Off the Press! on June 4, 2024, the ACOG released a new Practice Update regarding the determination of paternal and fetal RBC genotyping in pregnancies affected by alloimmunization. This builds upon and updates PB #192 from 2018. There are 3 big areas of change here… And we will highlight each one!

June is CMV awareness month. And that’s the keyword there… Awareness! The way we prevent CMV transmission is by awareness. It would be great to have a vaccine against this virus, but we just don’t…yet. Until a safe and effective CMV vaccine is clinically available, primary prevention of cCMV relies on patient education and hygiene measures. In this episode, will take a look at this strategy and see what the data has to say about it. Will also discuss the very controversial (and non-ACOG recommended) use of antiviral medication’s for primary, perinatal CMV.

In 2011, Congress passed a resolution naming June "National CMV Awareness Month," to raise awareness about the most common congenital infection in the US, affecting 1 of 200 live births. It is the leading VIRAL cause of IUFD & miscarriage & the leading cause of neonatal hearing loss, second only to genetic causes. Furthermore, cCMV is more common than many other neonatal conditions, such as spina bifida and fetal alcohol syndrome. Neonates affected by the virus can experience a wide array of symptoms, from none to severe neurodevelopmental disability, & even death. However, public and healthcare provider awareness remains low. In this episode, which is Part 1, we will cover the presentation, transmission, and work up of CMV in pregnancy.

Exploring the dilemma of breastfeeding during pregnancy, concerns include cultural taboos, maternal nutritional depletion, and the risk of preterm birth. The podcast reviews the latest data on breastfeeding during pregnancy, addressing potential risks like miscarriage, FGR, and PTB. Recommendations, considerations, and challenges of continuing breastfeeding during pregnancy are discussed, emphasizing evidence-based support and proper nutrition for lactating pregnant women.

Exploring innovative pain relief techniques for IUD insertion, including the use of viscous lidocaine and new FDA-approved devices. Discussing a Swedish study on pain relief methods for Noliparous Women. Exploring strategies like ultrasound guidance and Mapevicane for reducing discomfort during IUD placement.

Discover the debate on universal cervical length screening and progesterone use in pregnancy. Dive into recent data on preterm birth prediction and management, contrasting ACOG and SMFM recommendations. Enjoy music nostalgia and vacation planning anecdotes intertwined with a discussion on cervical length evaluation. Explore the impact of universal cervical length screening on preterm birth risk and management strategies.

Explore the latest guidance on gestational diabetes, including early screening before 24 weeks and postpartum screening for type 2 diabetes. Learn about the differences in diagnostic thresholds and the importance of adapting to changes in women's healthcare for improved patient outcomes.