Dr. Chapa’s OBGYN Clinical Pearls

PROM complicates 8% of term pregnancies, approximately 270,000 births in the US annually. In this session, we summarize and review a June 2021 Systematic Review/Meta-Analysis (of RCTs) where an intracervical balloon catheter was compared with a pharmacologic agent for the induction of labor after PROM,including preterm PROM.

Hepatitis C is the most commonly reported bloodborne infection in the United States. The ACOG is updating its Hepatitis C screening guidance regrading pregnancy. In this session, we will review the May 2021 ACOG Practice Advisory regarding hepatitis see screening in pregnancy.

The ACOG will release a new Practice Bulletin in June 2021 discussing obesity in pregnancy. The prevalence of obesity in reproductive age women in the United States is 39.7% In this session we will review some key practical issues regarding cesarean sections in the obese patient. Is one type of skin closure better than the other? What is the optimal VTE pharmacological protocol? Tune in and see!

The information in this section will shake your foundation regarding what you had previously been told about the origins of preeclampsia. Is the placenta the villain or the victim? This is Part 2 of our Myth-Busting Preeclampsia Episode. We will review the maternal cardiovascular changes that actually PRE-EXIST the development of preeclampsia.

The pathophysiology of preeclampsia continues to be discovered. For decades, the placenta has been portrayed as the “villain“ in the preeclampsia saga. But is it? Evolving data is putting that into question and is eliminating previously held concepts previously thought to be true. In this episode we will myth-bust some long-standing beliefs regarding preeclampsia.

Is the high dose Pitocin protocol (6 mU/min) associated with increased C-sections for fetal distress? What about perinatal outcomes? There are a variety of Pitocin protocols in L&D units across the country. In this episode, we will review a soon to be released publication out of Obstetrics and Gynecology. We will summarize an RCT comparing high-dose versus low-dose Oxytocin for labor augmentation in nulliparous women.

Given the known benefits to BMZ for preterm infants and the difficulty in predicting which women will actually deliver preterm, it is common for providers to administer antenatal corticosteroids in an effort not to miss the opportunity to give them before delivery and to try and get the maximal time benefit. However, many of these babies will be born at term. Do these term born babies benefit or experience adverse outcomes after steroid exposure? In this session, we will review an article that is published ahead of print from the AJOG. The results may surprise you. (Reference: McKinzie, A., et al. Are Newborn Outcomes Different for Term Babies Who Were Exposed to Antenatal Corticosteroids? AJOG 2021)

Sex can fulfill the human psychological needs of connectedness as well as the physical needs of intimacy. Being alone and lonely can cause major health and psychological problems for many. Is there data that sexual frustration impairs well-being? This session will review this often controversial subject as well as summarize an eye-opening study previously published from Carnegie Mellon describing state of happiness based on frequent of sex.

In this session we wrap up our review of Adenomyosis. Are you familiar with the MUSA ultrasound criteria? What is the role of MRI in the diagnosis of Adenomyosis? And is there a role for hysteroscopic diagnosis? Let’s wrap up our discussion on Adenomyosis now.

Historically, Adenomyosis was a pathological diagnosis only. However, new imaging standards/techniques have moved Adeno into a clinical diagnosis. Is there a patient risk profile for this condition? Is this strictly a gynecological issue or is there adverse perinatal outcomes as well? Welcome to Part 1 of Adenomyosis where we will answer these questions and more.