Dr. Chapa’s OBGYN Clinical Pearls

I received a very personal and impactful Facebook message today from one of our podcast family members. It was enough to stop me in my tracks, and issue this heartfelt response. For F. L.

The podcast explores the debate surrounding universal prophylaxis for ophthalmia neonatorum, discussing recommendations from different organizations and approaches taken by countries. The speakers address the pros and cons of universal prophylaxis, including its potential benefits in preventing infections and concerns about eye irritation. They also discuss the effectiveness of erythromycin in preventing ophthalmia neonatorum and the argument for targeted screening and treatment instead of universal prophylaxis.

On September 26, 2023 we released an episode titled “LDA in Preg: the SAGA Continues”. Well, it continues still. In this episode, we will review a brand new publication (a Narrative Review) released ahead-of-print yesterday on November 2, 2023 covering “Aspirin in Pregnancy” (Obstet Gynecol). We will focus on 2 main areas: 1. Dose of aspirin best suited for preeclampsia prevention, and 2. support for universal adoption. PLUS, we will throw in one other clinical pearl regarding continuation until delivery. As a reminder, the ACOG is still in the draft stages of revising its “low-dose aspirin for preeclampsia prevention” consensus guideline. Listen in to see which way the data is leaning regarding this common prophylactic treatment plan.

Recurrent vulvovaginal candidiasis (RVCC) is a highly burdensome, long-lasting medical condition that heavily compromises the activities of women and their quality of life. Recently, the prevalence of RVVC has increased, partly due to a rise in VVC caused by non-albicans species. Here's a real-world clinical dilemma (from a real case): What would you offer a patient who is allergic to fluconazole and terconazole, has taken 3 doses of Brexafemme, has used boric acid, and even tried vaginal probiotics? Oh- and vaginal Gent Violet is not available (in this case). In this episode, we are going to review 3 alternative vaginal therapies that could be very helpful in cases where that darn yeast will not go away.

In 2017, the ACOG released committee opinion (CO) 712 which described the 3 categories of intrapartum fever. One of those categories was “isolated intrapartum fever”. In that CO, the ACOG stated that practitioners “should consider” the use of antibiotics in patients with isolated intrapartum fever. However, there was no evidence to support or refute that. But that evidence has now arrived. In this episode, we will discuss an upcoming publication from the AJOG (November 2023) providing important insights into the treatment of “isolated, intrapartum fever”.

DiGeorge syndrome… what a complicated condition for such a little area of a single chromosome being affected. The condition’s descriptive and preferred name is 22q11.2. This is called a microdeletion. Along with microduplications, microdeletions are collectively known as copy number variants. Copy number variants can lead to disease when the change in copy number of a dose-sensitive gene or genes disrupts the ability of the gene(s) to function and affects the amount of protein produced. Other examples of microdeletion syndromes include Prader- Willi, (which is a deletion on 15q), and Cri du chat syndrome which results from a microdeletion on 5p. In this episode, we will review the varied penetrance of DiGeorge syndrome and review its genetic basis. What are some suggestive features found on prenatal ultrasound? What are the associated abnormalities/phenotypes? And how is this condition managed after birth? And why is this also known as CATCH22. We will answer all of these questions, and more, in this episode.

For years, herbalists have touted bee pollen as an exceptionally nutritious food. They've even claimed it is a cure for certain health problems. Bee pollen does contains vitamins, minerals, carbohydrates, lipids, and protein. It comes from the pollen that collects on the bodies of bees as they fly from one flower to another. Bee pollen may also include bee saliva. This is NOT the same as natural honey, honeycomb, bee venom, propolis, or royal jelly. These other products do not contain bee pollen although there are combination products that contain one or more of these substances. A recent Social Media trend has propagated the idea that bee pollen can help breasts grow. Can it? Can it really boost your immunity and longevity? And what is the recommendation for use during pregnancy or breastfeeding? And speaking of pregnancy, can pregnant women eat RAW honey? We’ll get to the “sweet spot” of the data!

Explore the history of sickle cell disease and its clinical manifestations. Discover the complications that can occur in pregnant women with SCD, including acute chest syndrome and preterm labor. Learn about the management of pregnant patients with SCD, including the use of prophylactic blood transfusions and fetal surveillance. Understand the importance of empathy and understanding for individuals with congenital conditions like SCD.

In November 2023, the ACOG will release Clinical Consensus #6, “Compounded Bioidentical Menopausal Hormone Therapy”. We have covered bioidentical hormones in past episodes. However, this ACOG clinical consensus sheds new light on an old topic. Is there ever a role for bioidentical hormone therapy? What about postmenopausal testosterone use? What does the College say about the marketing of these compounded options? And, were you aware that for the first time ever there is now a novel, bioavailable estrogen in a combination oral contraceptive? That same estrogen (E4) is now being considered as another option for bioidentical hormone use. In this episode, we will review this new estrogen, estetrol (E4), answer the questions posed, and provide other high yield facts from the clinical consensus.

On June 27, 2023, researchers published a population based analysis of the prevalence of Iron Deficiency and Iron-Deficiency Anemia in Females in the US who were aged 12-21 Years. This study spanned from 2003 to 2020. What they found was staggering: Almost 40% of American teenage girls and young women had iron deficiency. This was published in JAMA. It's the first research to look at iron deficiency in young women and adolescent girls. Iron deficiency and iron-deficiency anemia are both common, underappreciated conditions with significant morbidity and mortality despite widespread availability of effective treatment. Iron deficiency is the most common micronutrient deficiency worldwide and is the most frequent cause of anaemia. Historically, the focus of screening has been preschool-aged and pregnant females. The CDC-P recommends anemia screening for nonpregnant female adolescents and women every 5 to 10 years, whereas the USPSTF does not address screening for these populations. Ands that’s for anemia, not iron-deficiency alone. Oh, and that CDC recommendation is from 1998! That’s right, no update since 1998. Also, guidelines from the ACOG focus only on anemia during pregnancy. But now, and here’s a clinical pearls: This year, for the first time in its history, the International Federation of Gynecology and Obstetrics issued a recommendation that all women and girls who menstruate should regularly be screened for iron deficiency, not just for anemia and not just during pregnancy. This was recently picked up as a story in the New York Times, being published on October 17, 2023. And here’s another clinical pearl… It is completely possible for someone with normal hemoglobin levels to still have iron deficiency. So in this episode, we’re going to address the new FIGO guidelines and review why a “screening CBC“ just does not have the sensitivity to detect iron deficiency in reproductive age women. We will also review the appropriate screening test for this condition, as well as review basic iron physiology.