Dr. Chapa’s OBGYN Clinical Pearls

Being deaf and blind in the late 1800s (and a female!) was a prime recipe for failure and poverty. However, one young woman beat incredible odds to change American history. During these uncertain times of COVID19, we can still learn from Ms. Helen Keller, and her proven formula for overcoming life’s challenges: self-motivation, and personal encouragement.

Elmiron (pentosan polysulfate sodium) is the only oral FDA approved medication for interstitial cystitis/painful bladder syndrome. Initially approved in the late 1990s, recent evidence (within two years) has described a new medication associated ocular pathology: retinal maculopathy. In the journal Obstetrics and Gynecology, a new commentary will soon be released on this topic. In this podcast, we will review the data to date regarding this newfound medication concern.

The AAGL and the RCOG have released position statements regarding the use of laparoscopy during this viral pandemic. Can surgical plume from energy devices transmit infection? Is laparotomy safer for the OR team? In this podcast we will highlight and summarize the position statements of these professional societies regarding non-elective surgical procedures during this viral pandemic.

ARDS in pregnancy carries an increased rate of maternal and perinatal mortality. Specific respiratory physiological changes make care of the pregnant ARDS patient more complex than in the non-pregnant individual. Is temporary hypocapnia or hypercapnia more favorable? What about ventilation pressures? We will review maternal respiratory changes and ARDS care in this session (Source: SMFM Critical Care in Obstetrics).

The SMFM has just released new labor guidelines for SARS-CoV2 patients under investigation/confirmed COVID-19. This new practice guideline addresses oxygen use for fetal decelerations, amniotomy, labor epidural, HCW protection during 2nd stage of labor, as well as antenatal corticosteroids and magnesium sulfate. We will review these points in this session.

COVID-19 MEMEs are plentiful across social media platforms. Cynical medical humor has been around for decades. This phenomenon was made public in the late 1970s with a book called, “The House of God“. What does the literature say about the pros/cons of dark medical humor? Is this helpful or detrimental? And, what does dark humor have to do with “mind medicine”? We will dive into these questions in this session!

Phenylketonuria is better known as Phenylalanine Hydroxylase Deficiency (PAH-D). This genetic condition can have significant implications for the reproductive age woman including adverse pregnancy outcomes and congenital fetal malformations. In April 2020, the ACOG will release a new committee opinion (802) on the management of women with PAH-D. What Maternal serum levels are optimal to prevent adverse obstetrical outcomes? Do these pregnancies require specific fetal evaluation? What are the other health implications of elevated phenylalanine levels? We will answer these questions more in this session.

In April 2020, the ACOG will release a new committee opinion (803) on adolescent confidentiality and ObGyn. What is the difference between a “mature minor” and an “emancipated” minor? Can minors receive contraception without parental consent? What about emergency care? In this podcast we will highlight (and expand upon) very important points made in this new committee opinion. We will also address potential breaches of adolescent confidentiality due to the use of electronic health records.

It doesn’t matter who you are, what your title/position is, or how physically strong you are, times of social distancing and quarantine can take a mental toll on everyone. Nonetheless, we have a non-prescription, powerful anti-depressant at our disposable. Medical science has proven that the act of gratitude can physically affect not only our mindset, but can physically alter our brain, and impact our overall health as well. In this podcast, will take a look at the data.

The AHA has just released interim guidance for healthcare providers performing CPR on suspected or known COVID-19 patients. This guidance include the restriction on procedures that can generate aerosols (bag-valve masks, nebulizers, non-invasive positive pressure ventilation). This guidance is divided into pre-hospital/transport care, and hospital care. In this podcast we will summarize the AHA guidance adopted from the CDC.