Dr. Chapa’s Clinical Pearls.

Intrahepatic Cholestasis of Pregnancy (ICP) has dichotomous effects: Benign for the mother (although the itching it causes may be a qualify of life issue, yet potentially devasting for the child in-utero. In 2021, SMFM released Consult series 53 on the subject. This, together with the ACOG 's CO 831 (Medically Indicated Late Preterm and early term delivery) also from 2021 provide management options for ICP. However, this month- July 2025- Dr. Cynthia Gyamfi-Bannerman et al published a new proposed ICP classification and management schema that is easy to follow. Listen in for details. ​ SMFM CS #53,2021​ ACOG CO #831, 2021​ Sarker M, Ramos GA, Ferrara L, Gyamfi-Bannerman C. Simplifying Management of Cholestasis: A Proposal for a Classification System. Am J Perinatol. 2025 Jul;42(9):1229-1234. doi: 10.1055/a-2495-3553. Epub 2024 Dec 4. PMID: 39631774

Stillbirth is profoundly tragic, affecting 1 in 160 deliveries in the U.S. A new checklist from the Society for Maternal-Fetal Medicine aims to enhance care for pregnancies impacted by stillbirth. The importance of history-taking, fetal autopsy, and advanced genetic testing are crucial in understanding causes. The updated checklist highlights detailed evaluations during delivery, focusing on neonate and placenta assessments. Additionally, evaluating placental health and facilitating timely decision-making are key in managing these sensitive cases.

Postpartum hemorrhage (PPH) is a pressing issue that requires swift assessment through the '4Ts.' New research reveals lasting health risks associated with PPH, including increased cardiovascular disease. Intriguingly, a low-cost, effective method involving a Foley catheter and vacuum suction emerges as a potential game changer. This innovative approach not only offers accessibility but also highlights the importance of early intervention in managing PPH. The conversation dives into practical applications and compelling case studies supporting this method.

The podcast dives into the potential of metformin as a preventive treatment for severe nausea during pregnancy. It highlights a retrospective study showing its ability to reduce hyperemesis gravidarum rates. Safety protocols and the impact of SSRIs on nausea relief are examined, revealing potential risks they pose. There's a focus on metformin dosage, emphasizing careful management due to side effects. Exciting new research sets the stage for future discussions on this important topic!

Discover the complexities of counseling patients with a history of severe perineal tears and their delivery options. The discussion highlights the importance of merging emotional and clinical factors for informed decision-making. Dive into the statistics and long-term consequences of obstetric anal sphincter injuries, and learn about the evolving insights guiding patient choices between vaginal delivery and cesarean sections. This informative session emphasizes the role of education and support for women's health.

Dive into the fascinating world of cervical cytology reporting! Discover why endocervical cells hold less significance than previously thought. Unravel the latest guidelines for cervical cancer screening and the evolving role of HPV testing. Plus, learn how continued magnesium sulfate infusion during cesarean sections may affect patient care. Each question reveals a new layer of clinical insight that challenges traditional practices and promotes evidence-based medicine!

Discover the updated ACOG guidelines on cervical ripening that are set to transform labor induction practices. Explore the exciting recognition of combination mechanical and pharmacologic methods. Get insights into outpatient cervical ripening and the latest protocols for using oral and vaginal prostaglandins. This discussion is essential for healthcare professionals looking to enhance their induction strategies and improve patient outcomes.

Second and/or Third trimester vaginal bleeding is a common reason for L&D Triage patient assessment. The evaluation starts with determining the status of maternal hemodynamic stability. This together with IV access are key first steps. This is followed by an assessment of fetal-placental status. Typically this includes bedside ultrasound for fetal position, visual confirmation of FHTs, amniotic fluid determination, and placental location. At the same time, lab data is obtained to guide care: CBC, fibrinogen, type and RH, and possibly type and cross. Do you order a KB test as part of the STANDRAD evaluation for suspected placental abruption? In this episode, we will review a new study released ahead of print on June 8, 2025 in the European J of Obstetrics, Gynecology, and Repro Biology. Listen in for details.

Dive into the evolving world of antenatal corticosteroids and their role in fetal lung maturation and neurodevelopment. The discussion centers on new research highlighting the effects of timing on both lung benefits and neurodevelopmental outcomes. Humor lightens the exploration of medical guidelines, as experts dissect the balance between benefits and risks. Recent studies spark debate on safety and efficacy, making for a thought-provoking conversation around prenatal care.

Innovation in medicine is happening. In our immediate past episode, we summarized how AI is improving standard mammography to now PREDICT breast cancer rather than just diagnosing it once it was appeared. In a past episode, we covered a new and novel “first in class” oral medication for uncomplicated UTIs in women called Blujepa. This is innovation! Well now, as of June 10, 2025, the FDA has granted a New Drud Application for a new and noval oral antibiotic against gonococcal (GC) infection! In this episode, we will review the current CDC treatment protocols for GC and highlight what this new medication’s MOA is and what to expect from this FDA process.