Dr. Chapa’s OBGYN Clinical Pearls

This is TRUE, and a testament to what having a VISION, a strong will, and a desire to change the status-quo can accomplish! This is the remarkable true account of Dr. Kane, who performed 2 successful self-surgeries in 1921 and 1932.

In 2011, cf DNA from the maternal serum became commercially available to screen for fetal aneuploidy. Overall, about 3% of test results will detect an aneuploidy, and false positive results are only seen in 0.05% to 0.1% of tests. Evolving data, however, suggest that in women who have more than one aneuploidy suspected by cfDNA testing but who are found by diagnostic testing to carry a genetically normal fetus may harbor a higher risk of occult maternal malignancy. In this session, we will review published data on the risk of maternal malignancy in women who have discordant cfDNA test results.

Somethings in medicine are done by tradition. The use of Oxytocin during first trimester uterine evacuation is one such thing. Evidence seems to be lacking for the use of this common intervention. Remember, physiologically, oxytocin receptors show a linear increase in concentration as pregnancy progresses- rising quickly after 36 weeks of pregnancy, and are only present in negligible quantities on the myometeium in the first trimester! In this session, we will review the data on oxytocin use for first trimester OB D&C.

In March 2019, the FDA approved the first medication specifically targeted for postpartum depression, brexanolone (Zulresso). However, this medication requires a 60 hour, inpatient, IV-continuous infusion and there are some safety concerns. In May 2019, the Cleveland Clinic announced that it would release a pilot inpatient program (at one of its sites) for this medication. In this session, we will review this new medication and the Cleveland Clinic’s protocol for Zulresso.

Does finding an isolated echogenic cardiac focus or choroid plexus cyst require amnio? What about MTHFR testing for thrombophilia? AFI or deepest vertical pocket? Does cervical length screening matter after cerclage?In this session, which is part 2, we will complete our “OB don’ts“ from the SMFM.

(Part 1) Cerclage for twins? What about progesterone? Do gestational diabetics controlled with diet (A1) alone require antepartum fetal surveillance? In this session, we will review 10 (out of 15) obstetrical DON’TS from the Society of Maternal Fetal Medicine.

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The CDC confirmed in a report recently released that about 700 women die each year in the United States from cardiovascular conditions, infections, hemorrhages and other complications related to their pregnancies — up to a year after delivering their babies. In about 60% of the cases, the deaths could have been prevented, in part, with proper medical intervention, better access to care, and early recognition of risk factors/signs. The leading cause of death is CV conditions, such as heart disease and stroke, which accounts for 33% of pregnancy-related deaths. Infections account for nearly 13%, and obstetric hemorrhage accounts for 11%. In this session, we will review the ACOG practice bulletin (#212) as well as the CDC recent report on maternal mortality and cardiovascular disease.

Controversy surrounding screening mammography guidelines has resulted in conflicting recommendations from physicians and uncertainty for women. The Am Society of Breast Surgeons has released detailed/conservative screening recommendations for both average and high risk women. In this session, we will review their updated recommendations. We will also briefly review the following 4 supplemental screening modalities: 1. Contrast-enhanced Breast Magnetic Resonance Imaging (MRI), 2. Ultrasound, 3. Molecular Breast Imaging (MBI), and 4. Contrast-enhanced Mammography (CEM). (A summary table of screening recs can be found on our Facebook page).

In this session (Part 2), we will cover skin to skin neonatal contact at time of Cesarean birth. Is this possible? What does the data show? This will wrap up our two-part series.