Dr. Chapa’s Clinical Pearls.

Exploring innovative pain relief techniques for IUD insertion, including the use of viscous lidocaine and new FDA-approved devices. Discussing a Swedish study on pain relief methods for Noliparous Women. Exploring strategies like ultrasound guidance and Mapevicane for reducing discomfort during IUD placement.

Discover the debate on universal cervical length screening and progesterone use in pregnancy. Dive into recent data on preterm birth prediction and management, contrasting ACOG and SMFM recommendations. Enjoy music nostalgia and vacation planning anecdotes intertwined with a discussion on cervical length evaluation. Explore the impact of universal cervical length screening on preterm birth risk and management strategies.

Explore the latest guidance on gestational diabetes, including early screening before 24 weeks and postpartum screening for type 2 diabetes. Learn about the differences in diagnostic thresholds and the importance of adapting to changes in women's healthcare for improved patient outcomes.

The United States began adding fluoride to community water supplies in 1945. At that time, Grand Rapids, Michigan became the first community in the world to add fluoride to tapwater. Over the last several years, with an increase in reporting and media stories over the last 3 months, fluorinated drinking water has come under scrutiny and controversy. Does fluoride in drinking water affect children in the womb? Is this a cause of altered neurocognitive development? Does this lower IQ scores? This is a very HOT topic and there’s more fuel towards this fire with a publication which was released on May 20, 2024 in JAMA Network Open. In this episode, we will lay out the facts of this study, and why this must be interpreted with more than just face value. So grab your favorite fluorinated water beverage, and listen in!

Podcast family, this episode is recorded on the last day of the ACOG ACSM. Wanted to share with you some encouragement that I received from our podcast family members over these last 2 to 3 days. AND of course, in typical style, I’ll share with you a brand new publication which was released on May 17, 2024 in the AJOG (GRAY Journal) regarding “optimal dose of antenatal corticosteroids”. And lastly, I’ll share 3 Special Announcements, as an FYI.

Exploring the Lioness device as a new tool to reduce pre-term birth rates, focusing on a recent study's safety and efficacy. The podcast discusses the device's design and potential impact on prolonging gestation and reducing preterm delivery rates, highlighting the need for further research and potential FDA approval.

Unbelievable timing! In our immediate past episode, we discussed the controversy surrounding pharmacoprophylaxis for antepartum inpatients. Just 3 days from that episode, a new RCT has been published in the Green Journal (Obstet Gynecol) discussing this very subject! This new RCT (published May 14, 2024) investigates the “best dose” of unfractionated heparin (UFH) during antepartum admissions? is there an advantage to “gestational – age based” dosing? Or should standard UFH dosing be used?

All of us can agree that the rates of obesity are progressively climbing, not just in the US, but globally. Obesity is a known independent risk factor in pregnancy for VTE. Several professional societies (ACOG, CMQCC, RCOG, SMFM) have clear recommendations for VTE pharmacoprophylaxis in patients considered at high risk. These include having a high risk thrombophilia, having a personal history of VTE, or having multiple risk factors. But these recommendations address POSTPARTUM prophylaxis. The ACOG does not specifically address inpatient prophylaxis during the antepartum interval. However, in cases of prolonged antepartum admission, where ambulation may be slightly limited, there is concern that the hypercoagulable state of pregnancy, together with obesity, may raise the risk of VTE in these antepartum patients. To be clear, no professional organization or guidelines recommend strict bedrest for pregnancy complications. Is VTE pharmacoprophylaxis endorsed in these admitted antepartum patients? The answer is both YES and NO. The use of heparin based agents in this group is controversial, with published expert opinions having a dichotomy of thought. Plus, recent data (2023) has raised questions regarding pharmacoprophylaxis’ efficacy in the postpartum interval. nonetheless, at the end of the episode, will provide some common sense approaches to VTE prevention in the admitted antepartum, obese patient. (With a special shout-out to our podcast family in Australia.).

Explore the challenges with current BV treatments like metronidazole and clindamycin. Learn about DQC as a potential solution with promising results in Europe. Discover Dequalinium Chloride's efficacy for treating BV and yeast infections. Understand the importance of distinguishing between antibiotics and antiseptics. Delve into the gaps in data for BV medication and guidelines for administering vaginal medication, including precautions for pregnant individuals.

Exploring the controversy of tocolytic drugs in delaying preterm birth, the podcast delves into their efficacy, safety, and ACOG guidance. Highlighting the lack of data on patients with ruptured membranes, it teases new information from a May 2024 publication. The episode emphasizes the importance of interventions like corticosteroids and magnesium sulfate for improving neonatal outcomes, amidst ongoing debates about tocolysis therapy.