Dr. Chapa’s OBGYN Clinical Pearls

The World Health Organization declared on 8/14/24 that the increasing spread of Mpox in Africa is a global health emergency, warning the virus might ultimately spill across international borders. Mpox, also known as monkeypox, was first identified by scientists in 1958 when there were outbreaks of a “pox-like” disease in monkeys. Until recently, most human cases were seen in people in central and West Africa who had close contact with infected animals. In 2022, the virus was confirmed to spread via sex for the first time and triggered outbreaks in more than 70 countries across the world that had not previously reported Mpox. Unlike in previous Mpox outbreaks, where lesions were mostly seen on the chest, hands and feet, the new form of Mpox causes milder symptoms and lesions on the genitals. That makes it harder to spot, meaning people might also sicken others without knowing they’re infected. In this episode, we will review the pathophysiology of this virus and describe its implications during pregnancy. Does Monkeypox cause adverse pregnancy issues? It’s cesarean section indicated for those affected? And is there any available treatment for active infection? Listen in for details.

A major recall has sparked concerns about Listeria contamination in ready-to-eat meats, particularly affecting pregnant women. With heightened risks for expectant mothers, the discussion delves into dietary precautions and the dangers posed by this bacteria. Listeriosis can cause severe complications like fetal loss and neonatal infections. The experts also touch upon past outbreaks and address guidelines for managing exposure, emphasizing the critical need for awareness and prevention.

Our tagline, “Medicine moves fast“, is the absolute truth! Historically, identification of fetuses at risk of hemolytic disease of the fetus/newborn (HDFN) required amniocentesis for determination of the Delta OD450, Liley Curve. This was the first screen, which would then trigger cordocentesis for determination of the fetal hematocrit. We’ve now moved on to middle cerebral artery (MCA) doppler of the fetus for identification of those at risk. Additionally, we now have an ability to ascertain antigens on the fetal red blood cells through the maternal serum (cell free DNA). That’s amazing! Nonetheless, despite these wonderful advances, HDFN can still exist. But Medicine moves fast… In this episode, we will present brand new data from the NEJM. This Phase 2 international study, published on 8/7/24, describes the use of a monoclonal antibody (Nipocalimab) to block maternal IgG passage to the child. This is a revolution in HDFN prevention. Yep, medicine moves fast! Listen in for details.

Prior to the 1970s, when component therapy became the preferred method of resuscitation, whole blood (WB) was the resuscitative medium of choice for hemorrhagic shock. In modern medicine, sometimes it turns out that the old way is better than the new…and using whole blood for transfusions is one example. Research is emerging that shows whole blood works better for these patients than fractionated components of blood. Beginning in 2017, multiple stakeholders within the Southwest Texas Regional Advisory Council for Trauma- as well as others in different states, collaborated to incorporate cold-stored low-titer O RhD-positive whole blood into all phases of their trauma system, including the prehospital care via EMS. Although the program was initially focused on trauma resuscitation, it was expanded to include non-traumatic hemorrhagic shock patients that may benefit from whole blood resuscitation when MTP is needed. What about Low Titer O Pos whole blood use for maternal MTP resuscitation? Is there data there? And what about the risk with using type O whole blood as a donor. In this episode, we’ll dive into the details.

The latest updates to the CDC's birth control guidelines are finally here! Discover the implications for hormonal methods and the safety of contraceptives in specific populations. Key discussions include changes regarding migraines with aura and IUD placements in postpartum scenarios. The expert insights shed light on how these recommendations will impact patient counseling and health advocacy efforts. Stay informed on the evolving landscape of contraceptive recommendations!

The podcast highlights groundbreaking advancements in non-hormonal treatments for hot flashes, focusing on Elizinidat, pending FDA approval. Listeners learn about its unique dual mechanism and how it compares to the established Veozah. With insights from the OASIS clinical trials, the discussion blends innovative medical research with cultural references, emphasizing the importance of supporting women's health during menopause. A playful parody adds humor while addressing the serious challenges women face.

Artificial Intelligence is reshaping maternal healthcare, particularly in predicting stillbirth rates. The UK’s TOMMY APP is a notable development, aimed at reducing preterm births. A recent systematic review sheds light on machine learning's capabilities in stillbirth prediction, a crucial topic in light of new legislation in the U.S. Advances in AI promise to enhance fetal monitoring, while also underscoring the challenges it presents. Dive into the fascinating intersection of technology and obstetrics!

A recent study links maternal obesity to an alarming increase in Sudden Unexpected Infant Death (SUID), elevating concerns even after a baby’s discharge from the hospital. The discussion emphasizes the emotional toll on families, especially those facing socioeconomic challenges. Attention is drawn to the importance of compassionate care, nutritional education, and parental awareness regarding co-sleeping. With obesity rates on the rise among pregnant women, proactive health measures are advocated to reduce these risks and promote healthier outcomes.

Discover groundbreaking advancements in the management of alloimmunized pregnancies. Learn about the newly updated ACOG guidelines that emphasize the role of paternal and fetal genotyping. Delve into the use of cell-free DNA testing as a non-invasive tool for fetal red blood cell antigen detection. This update illustrates how quickly the medical field evolves to enhance care for high-risk pregnancies!

In September 2022, a cell-free DNA assay using next-generation sequencing and quantitative counting tech for fetal antigen status determination became clinically available in the USA. This allowed maternal screening for fetal RBC genotypes for RH negative patients. This test was recognized by thre ACOG in March 2024 as one option to “triage” anti-D immunoglobulin in RH negative women. But can this technology be trusted in alloimmunized patients? In women with antibodies against foreign antibodies, this cell free DNA fetal screening option MUST get it right. We now have that data. In this episode, we will summarize remarkable results, published ahead of print on July 25, 2024 in the Green Journal. This study is a win for science and prenatal care. Listen in for details (BillontoOne, Inc is not a sponsor for this podcast).