Dr. Chapa’s OBGYN Clinical Pearls

Birth control, especially progestin only methods, seem to take a lot of heat regarding their potential role in CAUSING depression. Although past individual studies have suggested a link, the most recent systematic review of 26 studies has debunked that possibility. In this podcast, we will review the study published in 2018, in the journal of Contraception, regarding this topic (Worly. The relationship between progestin hormonal contraception and depression: a systematic review. Contracep. 2018).

In 2016, the CSOAP trial confirmed that adding Azithromycin 500 mg IV to standard cephalosporin antibiotic prophylaxis pre-Cesarian helps reduce post operative infection. However, mounting evidence supports the addition of iodine-based vaginal prep to pre-CS care. However, no trial yet has compared the Zithromax – cephalosporin regimen to vaginal preparation and cephalosporin prophylaxis. In this podcast, we will summarize the current commentary by Duffy et al from April 2019’s Green Journal on pre-CSection vaginal preparation.

Iron deficiency anemia during pregnancy has been linked to several obstetrical adverse events including preterm birth, low birth weight, Cesarian Section, and of course the need for blood transfusion. Babies born to iron deficient mothers are also at risk of being iron deficient themselves- a condition which has been linked to poor psychosocial development. In this session, we will review the data favoring IV iron therapy over oral iron therapy during pregnancy and the postpartum period, especially for women with severe iron deficiency (hemoglobin < 10).

Prolactinomas are categorized as micro- or macroadenomas based on their size. These tumors are considered the most frequently diagnosed functioning, anterior pituitary tumor type. Most women with microprolactinomas will have no adverse effects during pregnancy; however, macroadenomas are at risk of tumor growth. In this session we will review the endocrine society’s management plan of prolactinomas during pregnancy.

Parvovirus B 19 is a single-stranded DNA virus that causes the childhood exanthem known as fifth disease. The risk of maternal Parvo B19 infection varies with the level of exposure to the infected individual. Parvo B19 may cause asymptomatic fetal infection or may result in fetal loss, hydrops fetalis, or stillbirth. Currently, the ACOG does not recommend universal screening of Parvo B19 immunity. In this session, we will review the ACOG data on maternal and fetal Parvo B19 infection.

In the United States, 1 out of 1,000-8,000 babies are born with toxoplasmosis. Vertical transmission increases per trimester but severity of fetal disease increases the earlier in pregnancy that transmission occurs. In this episode, we will review the ACOG data on maternal and fetal infection with T. gondii.

CMV is the most common congenital infection, occurring in 0.2 to 2.2% of all neonates. Vertical transmission of this herpesvirus is possible throughout all pregnancy with increasing rates of transmission per trimester (3 > 1). In the session, we will review the ACOG data on maternal and fetal CMV infection.

Historically, oral contraceptive pills were prescribed in attempt to help quicken resolution of ovarian cysts. Is this practice evidence-based? In this session we will review the Cochrane Database regarding this topic as well as the mechanism of action of how certain contraceptives (etonogestrel/levonorgestrel) pre-dispose to the “unruptured ovarian follicle“.

In 2018, The ACOG expanded the possibility of low-dose aspirin use in pregnancy for preeclampsia prevention. Women deemed at moderate risk (1 or more risk factor), or high-risk (only 1 high risk factor needed) were included in low-dose ASA prophylaxis. Now, a call is being made to consider “universal adoption“ of this low-cost, low risk intervention. This is a summary of this soon to be published (green journal) current commentary, “A nudge towards universal aspirin for preeclampsia prevention“.

Recently, the PROLONG Trial, investigating 17-OHP’s role in preventing recurrent preterm birth, called into question the effectiveness of this treatment regimen. However, most of the study patients in the manufacturer’s initiated study were outside of the United States and were significantly different than the original MFMU study participants. In this session, we will review both of these studies and put the results into proper perspective.