Dr. Chapa’s OBGYN Clinical Pearls

On October 25, 2019, the American Journal of Perinatology published the results of the PROLONG Trial. This study demonstrated no statistical difference in the co-primary outcome of preterm birth less than 35 0/7 weeks of gestation (P = 0.72) and neonatal composite index (P = 0.73) with 17-OHP use. Similarly, the rate of preterm birth less than 37 weeks and less than 32 weeks were not different. On October 25, 2019, the ACOG released a practice advisory about this. Let’s summarize this now.

The rate of sepsis appears to be increasing. Maternal sepsis is a significant cause of maternal morbidity and mortality. Sepsis is not a specific illness, but a syndrome that includes organ dysfunction caused by this regulated host response to infection. In this session we will review the SOFA score and it’s utilization. Is fever necessary for a diagnosis of sepsis? Which antibiotics should be used? What is the rate of IV fluid resuscitation? Are steroids contraindicated in the septic patient? We will answer these questions and more in this episode which summarizes the SMFM expert series #47, sepsis in pregnancy.

N2O is a nonflammable, tasteless, odorless gas. It was first synthesized by the English scientist and theologian Joseph Priestly in 1772, and was first used as a labor analgesic by Stanislav Klikovich in Poland in 1881. Although much more frequently used in the UK and Canada, interest in nitrous oxide for labor pain management is increasing in the USA. What is its mechanism of action? Is it effective? What are the contraindications? Let’s review this topic...NOW.

Universal thyroid screening in pregnancy is a key debate in endocrinology and obstetrics. While some countries advocate universal screening, the UK and USA adopt a “high-risk” based strategy. ACOG’s Practice Bulletin 148 (April 2015) keeps its recommendation to NOT perform routine screening for thyroid disease in pregnancy. BUT, should we screen for thyroid abnormalities universally? This podcast will review the pros and cons and make a push for once stance over the other.

The podcast explores the challenges in managing fetal tachycardia and the lack of clear guidelines for intervention. It discusses the different diagnoses and management of fetal tachycardia, including its associations with fetal arrhythmia and congenital heart defects. The podcast also focuses on super ventricular tachycardia (SVT) and the importance of tailored management for each case. Additionally, it highlights the challenges and interventions for uncomplicated cases of fetal tachycardia during labor and delivery.

With normal pregnancy, blood volume increases, which results in a concomitant hemodilution. Although red blood cell (RBC) mass increases during pregnancy, plasma volume increases more, resulting in a relative anemia. This results in a physiologically lowered hemoglobin (Hb) level, hematocrit (Hct) value, and RBC count, but it has no effect on the mean corpuscular volume (MCV). However, in women who are iron deficient, this problem is exacerbated due to low iron stores affecting the body’s ability to increase red blood cell production. Iron deficiency is the most common pathologic cause of anemia in pregnancy. Does IDA result in adverse maternal or neonatal outcomes? The data is more controversial than you would suspect. In this session, we will review the data regarding the impact of iron deficiency anemia on maternal neonatal outcomes.

The United States, along with Mexico and the Philippines, was ranked one of the world's worst places for human trafficking in 2018. In the US, there is no official number of human trafficking victims, but estimates place it in the hundreds of thousands. From illicit massage parlors, escort services, online pornography, and adult “dating” sites, women make up the majority of sex trafficked victims. In this session, we will review the ACOG committee opinion from September 2019, as well as review data from the US Homeland Security Bureau of statistics.

Ahhh...Oooh! The elusive G-Spot! First described in the 1950s by gynecologist Ernst Grafenberg, the “G-Spot” has been a “hot topic“ in sexual wellness circles. But does this exist? Is there a real “magic button“ for intense, female pleasure? New understandings of the relationship between the clitoris and anterior vaginal wall has resulted in a better name for this SPOT: The “Clitoral Urethral Vagina Complex" or "CUV." Let’s talk about that...now. {IMAGE/DIAGRAM on our Facebook page.}

Approximately 45% of pregnancies in the United States are unintended. Similarly, 70% of pregnancies that occur within 1 year of delivery are also unplanned. Interpregnancy interval shorter than 6 months are associated with increased risk of perinatal complications. In this session, we will review the stance from the ACOG and the SMFM regarding immediate postpartum LARC initiation. What is the difference between “immediate” placement and “early postpartum“ placement? Are there any risks? We will cover these topics and more in this episode.

Preterm birth is now the 2nd leading cause of death in children under 5 years worldwide and accounts for half of all newborn deaths, according to the March of Dimes and the World Health Organization (WHO). Besides progesterone, does DHA have a role in reducing preterm birth risk? In this session, we will summarize recent data regarding “fish oil” supplements and preterm birth risk. We will also describe a new proposed “DHA maternal blood test” which may help identify women who would benefit the most from DHA supplementation.