Dr. Chapa’s Clinical Pearls.

Exploring the timing for manual rotation of occiput posterior fetuses in labor, with insights from recent data on optimal positions for descent. Debate on whole hand vs. digital rotation, historical context, cardinal movements in labor, and study findings on fetal head rotation during spontaneous labor.

Exploring the challenges of predicting shoulder dystocia using mathematical formulas based on ultrasound and anthropometric factors. Discussing the complexities of medical litigation and malpractice, as well as the limitations of current predictive models. Highlighting the historical studies and recent reviews that emphasize the limited positive predictive value of anthropometric measurements in pregnancies with diabetes.

The podcast explores the controversy surrounding screening for gestational diabetes in the third trimester, discussing guidelines and impact on perinatal outcomes. It highlights the challenges and lack of specific reference values for GDM screening in the later stages of pregnancy. The association between shoulder dystocia and GDM is discussed, as well as the impact of late GDM diagnosis on cesarean section rates. Two publications suggest that diagnosing GDM in the third trimester does not lead to significant changes in outcomes.

A recent study reveals the connection between phthalate exposure and increased risk of preterm births. Although the data is not new, it serves as a reminder to reduce our exposure to dangerous substances. The podcast explores the association between phthalates and preterm birth, discusses practical tips to minimize exposure, and provides recommendations to avoid harmful chemicals in everyday life.

In this podcast, they discuss new research challenging the use of late preterm steroids for reducing neonatal respiratory complications. They highlight concerns about the long-term effects on the developing brain. A study found no significant difference between the steroid and placebo groups in reducing the need for treatment of neonatal respiratory distress. They conclude that late preterm steroids do not provide measurable benefit.

We are still in an opioid crisis. The number of women with opioid-related diagnoses at delivery has increased by 131% over the last several years (CDC, Data and Statistics, 2023). The ACOG has recommended the use of opioid agonist pharmacotherapy for MOUD during pregnancy. Traditionally, medically supervised withdrawal has not been endorsed for pregnancy. However, some patients may elect to discontinue opioid therapy in favor of an opioid antagonist like naltrexone. In this episode, we will review a new systematic review just released ahead-of-print in Obstetrics and Gynecology. This systematic review evaluates OB and neonatal outcomes following naltrexone use during pregnancy. And listen in until the END of the episode for one of the “issues” with naltrexone as a MOUD option.

It is completely natural, and part of the human experience, to have some anticipatory concern about an upcoming delivery/childbirth. However, when that concern becomes overwhelming, it can develop into a debilitating phobia called Tokophobia. First coined as a term in 2000, there’s been growing awareness of this specific type of anxiety disorder/phobia. Even though it was first described in 2000, this extreme fear of pregnancy and childbirth has, of course, been part of the human experience For centuries. This is now considered a sub-type of PTSD when it happens after a traumatic childbirth experience. The idea for this episode originated from a real patient encounter that one of our residents had just yesterday. Have you heard of Toca phobia? How prevalent is it? And what are the “4 Rs” of trauma informed care? Will cover this, and more, in this episode.

Exploring the controversies surrounding the use of antenatal corticosteroids in pregnancy, focusing on the late preterm interval. Discussing the potential risks and benefits of steroid exposure in utero, as well as the long-term effects on fetal brain and body development.

On January 28, 2021, a non-inferiority RCT was published in the NEJM, “Levonorgestrelvs Copper T Device for Emergency Contraception”. This study concluded that the LNG 52mg IUD was “noninferior” to the CopperT IUD for emergency BC up to 120 hours after ill-protected intercourse. Since that time, use of the LNG 52mg IUS has remained controversial with some organizations endorsing its use as EC while others take a more cautionary stance. Now, as a February 1, 2024, a new commentary in the Green Journal (Obstet Gynecol) is raising eyebrows regarding this. What’s the controversy surrounding this? Is the LNG 52 mg IUS a reasonable option for emergency contraception? What does non-inferiority mean? In this episode, we will go through all of the data and put things in proper perspective. While gaps in evidence remain… There is plenty to draw an evidence-based opinion on. Curious? Listen in and find out more.

On January 18, 2024, the FDA cleared a novel new device for osteopenia treatment. This is a vibrating belt (wearable device) that transmits low-amplitude, high-frequency (20 to 40 Hz) vibration to the spine and hips. This belt is called Osteoboost. Osteoboost previously received a breakthrough designation from the FDA in Dec 2020. This FDA clearance has already generated a lot of commentaries regarding the single RCT results. In this episode, we will review the results critically and explain why there is a difference in “per protocol” RCT results and “intend to treat” RCT results. Is Osteoboost a game changer? Listen in and find out.