Dr. Chapa’s OBGYN Clinical Pearls

In this session, we will conclude our summary of the new ACOG clinical expert series, “Female Sexual Dysfunction“. This episode will focus on specific treatments of each of the 4 different DSM5 categories of female sexual dysfunction.

Human sexual response is a highly individual and emotional process. Sexual dysfunction is common among women and leads to personal distress. The ACOG has released a new “clinical expert series“ which currently is published ahead of print. In this session (Part 1), we will review the prevalence, risk factors, and DSM5 categories of female sexual dysfunction.

Unlike fetal thrombocytopenia resulting from maternal ITP, fetal- neonatal alloimmune thrombocytopenia may occur earlier in gestation and can lead to in-utero fetal intracranial hemorrhage. The condition can be severe. In this podcast, we will review the presentation, diagnosis, and management of this potentially lethal fetal acquired condition. (ACOG Data 2019).

On June 1, 2020, the American Journal of Obstetrics and Gynecology released a new publication with surprising results related to maternal oxygen use in labor for Category II fetal heart rate tracings. Although we have covered this in some form in previous episodes, we will provide new up-to-date information on this subject.

Medical information moves fast. Although the increased morbidity with fetal macrosomia has long been known, the ACOG has revised his practice bulletin on the subject (January 2020). In this session, we will review this updated practice bulletin. What’s the new data on exercise and fetal birthweight? Is operative vaginal delivery contraindicated in macrosomic infants? What about TOLAC with a suspected macrosomic infant? Let’s cover these topics, and more, in this session.

Multiple societies and experts have weighed in on whether 2nd stage of labor warrants universal use of respirators (e.g., N95 masks) vs surgical masks. The ACOG/SMFM has petitioned the CDC for clarity on this issue. In May 2020, the AJOG published a new “clinical perspective“ in MFM which is pushing for use of 1 mask over the other. We will highlight this new development in this session.

Some experts have called for universal screening of all patients admitted to labor and delivery. The foundation of this opinion is to decrease exposure to healthcare workers and identification of asymptomatic women for the prevention of horizontal newborn transmission. However, there are some potential negative implications of this proposal. In this podcast, we will review a soon to be released editorial (Torri Metz, MD) from Obstetrics & Gynecology (the Green Journal) on the pros/cons of universal testing in Labor & Delivery.

Examination (macroscopic and microscopic) of the placenta can give valuable insights into the intrauterine environment. The College of American Pathologists has issued guidelines about when to submit a placenta for histological examination. In this session, we will review the “what, when, and whys“ of histological placental referral. We will also review abnormal umbilical cord insertion and it’s link to adverse obstetrical/neonatal outcomes. SHOUTOUT TO LAUREN (our podcast listener) for the podcast topic!

Does the ACOG endorse universal screening for thyroid disease in pregnancy? What about treating subclinical hyperthyroidism or subclinical hypothyroidism? And what about those pesky anti-thyroid autoantibodies? In this podcast, we will highlight the June 2020 ACOG Practice Bulletin (223) covering thyroid disease in pregnancy.

The benefit of antenatal corticosteroids in preterm infants was first reported in 1972, but it took 20 years for widespread adoption. Now, antenatal steroids are recommended by the ACOG up to 36 weeks and 6 days. However, a new study (JAMA May 2020) has raised concerns about steroid exposure in utero and possible behavioral and mental diagnoses in children up to age 5. These outcomes were significant for infants who were born full term. In this podcast, we will highlight this new study and summarize the editorial perspective in JAMA regarding this study.