Dr. Chapa’s OBGYN Clinical Pearls

Methamphetamine and amphetamine use has greatly increased all throughout the United States. While similar to cocaine, it’s mechanism of action is quite unique and dangerous. In this session we will cover the pharmacology of amphetamines/meth and its affects on pregnancy. We will also cover some common every day medications which can actually test false positive for meth/amphetamines on toxicology screening. Data for this podcast come from the ACOG, SMFM, and the CDC.

Interest in, and performance of, female cosmetic genital surgery increased 50% from 2014 to 2018. As close to 80% of US females have some degree of pubic hair removal, self awareness of vulvar variation is increasing. Although labial hypertrophy can be a true functional/medical concern requiring labial reduction, what about elective cosmetic genital procedures? In January 2020, the ACOG will release its updated committee opinion on this topic. These are important points to review as patients often seek “designer labioplasty“ or “vaginal rejuvenation“ from their gynecologist.

Pregnancy-related venous thromboembolism is the most common cause of maternal death and a significant cause of maternal morbidity. The factor V Leiden (FVL) mutation is the most common known genetic factor that predisposes to thrombosis. How does obstetric management differ regarding a heterozygous or homozygous carrier? When should anticoagulation be used, and at what dose? In this session we will review data from the SMFM, RCOG, and the ACOG practice bulletin 197.

The initial gynecological visit for an early teen/adolescent is crucial in establishing patient trust, education of gynecological health, and establishment of healthy personal and sexual behaviors. At what years should the first visit occur? What about patient confidentiality when dealing with minors? Is a clinical breast exam part of the adolescent screening exam? In this session, we will review the ACOG committee opinion (598) on the first gynecological visit.

Commercial laboratories offering cell free DNA for fetal prenatal screening are offering microdeletion testing. Is this valid? Microdeletions are varied and include 22q and 15q syndromes. In this session, we will review the pathophysiology of microdeletions and review 22q and 15q conditions. What does the SMFM have to say about cell free DNA screening for these conditions? How is Angelman syndrome related to Prader –Willi condition? Let’s cover this now.

The “ideal“ interpregnancy interval depends on the outcome of the immediate, prior pregnancy. For example, the recommended interpregnancy interval following a 1st trimester miscarriage is different compared to a live, term birth. But what about the interpregnancy interval after a stillbirth? Are the recommendations the same? In this podcast will review updated data from 2019 regarding interpregnancy interval following stillbirth. The reference for this podcast summary is Regan AK, et al; Lancet, April 2019.

You find that there is a medical indication for a cesarean birth- yet the patient refuses! What are your next steps? Should you seek a court order to intervene? “Informed refusal” encompasses a complex, multifaceted, ethical dilemma. In this session, we will review some clear guidelines from the American Academy of Pediatrics, the ACOG, and the AMA regarding the management of this difficult situation.

No! Julius Caesar was not born by cesarean birth. What does a pig-gelder in 1500 have to do with CS History? From Jacob Nufer to Munroe Kerr, we will walk down the path of the cesarean’s incredible history.

Medicine: it’s an incredibly rewarding profession. The opportunity and ability to comfort and heal the sick is an absolute privilege. BUT...if you are not careful, that wonderful of all professions can consume you, and may devour you. Two theories have been proposed to explain this: Burnout, and Moral Injury. But are these 2 separate conditions? How does the issue of mindset (fixed or growth) apply? In the session, we will review the latest (as of December 2019) on this ever evolving issue.

In December 2019, the ACOG will release committee opinion 794 covering quantitative blood loss in obstetrics. Does QBL use ALONE improve clinical outcomes? The answer may surprise you! Nonetheless, there is great value in utilizing obstetric hemorrhage toolkits/bundles such as the California Maternal Quality Care collaborative strategy. In the session, we will review the use of QBL in practice in why having it as part of a larger toolkit helps reduce maternal morbidity and mortality.