Dr. Chapa’s OBGYN Clinical Pearls

The podcast explores new reassuring information from a recent publication regarding antenatal corticosteroids in late pre-term pregnancies. The discussion delves into the ALPS study, respiratory morbidity, neurodevelopmental outcomes, concerns about data loss, and revisions in clinical practice guidance.

Breast cancer is the second most common cancer among women in the United States (with skin cancer are the most common). About 9% of all new cases of breast cancer in the United States are found in women younger than 45 years of age. Unfortunately, breast cancer is being diagnosed in women under 40 at an increased rate. This was recently published in a Jan 2024 JAMA population-based, cross-sectional study using data from Surveillance, Epidemiology, and End Results database. Every year, more than 1,000 women under age 40 die from breast cancer. Nearly 80% of young women diagnosed with breast cancer find their breast abnormality themselves. Breast cancer is the most common form of cancer in women who are pregnant or have recently given birth. According to US statistics, Breast cancer occurs about once in every 3,000 pregnancies, with some reports stating it may be as high as 1 in 1,000. For those under the age of 40, most are diagnosed between the ages 32 to 38 years. Because many women are choosing to delay having children, it is likely that the number of new cases of breast cancer during pregnancy will increase. In this episode, we’re going to look at breast cancer in reproductive age women with a focus on gestational breast cancer. Is MMG contraindicated in pregnancy? Can chemotherapy be used during pregnancy? What about radiation therapy? And is it better to have a complete mastectomy or breast conservation, during pregnancy? Listen in for details.

Historically, colostrum was expressed by women mid- to late-pregnancy with the intent to avoid engorgement and breast trauma in the postnatal period, but it was not stored for use after birth. But storing colostrum antepartum for newborn feeding has gained attention in social media channels. Is antenatal milk expression, also called colostrum harvesting, evidence-based? Are there benefits to this? Does this run the risk of initiating labor? Are there published studies? In this episode, we will “milk” the data- including a RCT from 2023 – and present some key points to consider about what it is and what it isn’t.

From 2012 to 2021, congenital syphilis cases in the United States increased by 755%. According to the CDC, 88% of congenital syphilis cases in 2022 could have been prevented with timely screening and treatment. Despite repetitive messaging about the need to identify syphilis early in pregnancy, with appropriate treatment, gaps remain. A new publication in the Green Journal (4/17/24) provides shocking information about gaps in diagnosis and treatment. In this episode, we will review that original research as well as summarize the new ACOG Practice Advisory (April 2024) regarding screening for syphilis in pregnancy.

Debate on prescribing testosterone to women for menopause symptoms, rise in testosterone prescriptions, controversy in medical community, evolution of terminology for female sexual disorders, analysis of DHEA and testosterone use in different age groups, understanding testosterone levels and sexual interest in women, exploring long-term testosterone use and ACOG's recommendations

Exploring the impacts of postpartum anemia on maternal health and bonding, the podcast delves into the benefits of IV iron for asymptomatic anemia. Discussions include the correlation between antepartum severe anemia and PPH, along with practical protocols for managing postpartum anemia effectively.

Exploring the debate on using amnioinfusion in cases of suspected infection during labor, assessing risks and benefits, and examining its role in preventing meconium aspiration syndrome. Delving into clinical insights and controversies surrounding the use of amnioinfusion in obstetrics, particularly in cases of recurrent variable decelerations and intra-amniotic infection.

The podcast explores the controversy around acetaminophen use in pregnancy and its alleged association with autism. It discusses the conflicting data and expert opinions over the years, culminating in a recent study of 2.4 million children that found no increased risk of neurodevelopmental issues. The episode also touches on other factors linked to autism, such as labor epidurals, emphasizing the importance of evidence-based medicine.

It has been stated that “Trauma is in the eye of the beholder”. Healthcare providers must be aware that a woman makes experience a birth as traumatic, even if she and her infant are healthy. The ACOG has highlighted perinatal PTSD in several publications, which we will review in this episode. Perinatal PTSD has definitely been in the OB/GYN and psychology literature with an increased frequency just over the last 3 months. In this episode, we will review the very real and devastating condition of perinatal PTSD, its diagnosis, and discuss interventions to reduce its development. We will also review new data on “service dogs“ detecting PTSD in people with trauma histories? NOTE: We will also highlight a real world account of a traumatic birth event from one of our podcast listeners (Deidentified, and shared with permission).

Exploring the application of the Rule of 55 in managing hypertensive disorders of pregnancy, validation of a medication tailoring model for hypertension, diving into the PYTT study on hyperdynamic and non-hyperdynamic blood pressure models in pregnancy, discussing evidence-based practice and controversies around amniotic infusions, and emphasizing the importance of tailored medication for pregnant women based on individual blood pressure dynamics.