Dr. Chapa’s OBGYN Clinical Pearls

Women with endometriosis may represent a unique population of women at greater risk for adverse outcomes across pregnancy and birth. In this session, we will summarize the soon to be in print publication by Farland et al in Obstetrics and Gynecology. Information from the study may be helpful in counseling women with endometriosis when when they conceive.

Is 39 weeks the “sweet spot” for delivery? Neonatal and maternal adverse outcomes have been studied through increasing gestational ages from 37 weeks onward. In this episode, we will summarize the Aug 2019 publication by Chen et al, from Obstetrics and Gynecology. We will also review and apply the findings from the 2018 ARRIVE publication.

Healthcare professionals and patients may not realize that methylene blue has monoamine oxidase inhibitor (MAOI) properties. Methylene blue should generally not be given to patients taking serotonergic drugs. When should patients stop taking SSRIs prior to methylene blue use? When should they be restarted? In this session, we will review the MOA of this common dye utilized in surgery and review ways to prevent a possible lethal reaction.

Opioid use in pregnancy is a real issue! This podcast will review 2 pharmacotherapies for opioid dependency in pregnancy. We will end the session with a “rapid fire” side-by-side comparison of these 2 agents.

Chronic kidney disease can affect anywhere from 0.1 to 4% of all pregnancies. Pre-existing renal disease can have severe consequences for a pregnancy. Should low-dose aspirin be used in these patients? If so, at what dose? What about calcium supplementation? Are immunosuppressive agents safe to use? In this podcast we will cover the June 2019 ACOG “clinical expert series” monograph on chronic kidney disease in pregnancy.

Depression/anxiety can affect up to 20% of women during pregnancy. These 2 psychological conditions have adverse pregnancy outcomes in and of themselves. But what about medication use? Do SSRIs need to be tapered at end of pregnancy to reduce neonatal withdrawal? Are SSRIs linked to “Neonatal Persistent Pulmonary Hypertension”? What about other meds? This episode will review the ACOG/SMFM data on the subject.

For decades, women have been told that having intercourse/orgasms late in pregnancy can hasten the onset of labor. But is this a myth, or is this true? While it is well established that sexual intercourse/orgasms can trigger the onset of contractions, are those contractions enough to result in cervical change? Let’s take a look at the data.

Thirty percent of all cases of adnexal torsion occur in females younger than 20 years. In this episode, we will review the latest committee opinion from the ACOG on clinical presentation, use of diagnostic tests, and surgical management of adnexa torsion in adolescents. Here’s your quick test: 1. Do Doppler studies confirm a diagnosis? 2. What are the findings on CT or MRI? 3. Is cystectomy preferred over oophorectomy, or is another management option indicated? Answers...are...here!

This Enhanced Recovery After Surgery Society guideline was created to support the most common surgical procedure in the industrialized healthcare world, the cesarean delivery. In this section, we will highlight THREE new recommendations that CHANGE how we “traditionally” care for the postop CS Patient: Refeeding as soon as 2 hours postpartum, elimination of the postop urinary cath...and even new data on the use of heparin for postop CS patients!

Short interpregnancy intervals, as well as long intervals between pregnancies, are associated with some potential adverse obstetrical outcomes. What does the data show? What are the unique considerations that go into patient counseling regarding spacing of pregnancies? In this episode, we will review the SMFM data on interpregnancy intervals.