Dr. Chapa’s Clinical Pearls.

In Feb 2023, the USPSTF recommended that clinicians “screen for hypertensive disorders of pregnancy”. Specifically, they stated that “measuring blood pressure at each prenatal visit is the best approach”. Mind blowing I know. 😳😊 But sarcasm aside, a new publication- set to be released next month in AJOG (Slade LJ et al; Aug 2023)- validates this recommendation…not that it needed validation, for frequent BP monitoring during pregnancy. This has to do with the “sensitivity” of BP results in pregnancy compared to the “specificity”. Ahhh…intrigued? In this episode, we will review this upcoming publication aimed at evaluate whether the definition of gestational HTN should be revised according to the 2017 ACC and AHA criteria, and whether or not there is an association between adverse maternal and perinatal outcomes based on those lower BP levels. And as always, you’ll want to stay with us until the end of the episode as we pass on real world clinical implications of these findings.

Exploring the potential of treating bacterial vaginosis as a strategy for preventing preterm birth, following the FDA withdrawal of a key medication. Discussing recent publications and advancements in diagnostic tools for vaginal infections, highlighting the importance of accurate diagnosis and optimized treatment strategies. Delving into the effectiveness of molecular screening tests for bacterial vaginosis in pregnant women, and the use of microbiome-based tests for enhancing diagnosis and treatment of common vaginal conditions.

FYI. We just released our episode for today, July 14, 2023, and will be out until July 23!

Its hard to be pregnancy in the late third trimester, especially in a HOT state like TEXAS in the summer. Pregnant individuals will try just about anything "to just get this baby to come out already!" Historically, walking, spicy foods, and SEX have been "employed" to get the labor process going. Does it work? In this episode we will look at the data examining whether labor can induce spontaneous labor. Is this a myth or a real thing? What about CURB WALKING?! That works, right? Lots to cover and explain in this one...so let's get our walking shoes on and get to it.

There’s no such thing as a “false positive syphilis confirmation test”, is there? After all… It’s right there in the name, CONFIRMATION test! Well, not all positive confirmation tests are true positives, especially when that test is the FTA-ABS. Yes, it’s true, the specificity for this is very good between 95 to 98%. But there are cases of BFPs (Biologic False Positives), which have been reported and published in the literature. This is why putting the test results in clinical context is very important. In this episode, we will highlight a real clinical scenario where a “low level“ confirmation test did not fit the clinical picture (asymptomatic, monogamous, low risk patient). Is there something else going on here? What about autoimmune conditions? Can pregnancy itself cause a false positive FTA-ABS? And more importantly… What are the options for management in this case? We’ll discuss all of this, and also review the “reverse syphilis algorithm” in this episode.

The Bandl Constriction Ring. It is real. It exists. Its true incidence is unclear as it lacks uniform reporting when found at time of cesarean. As labor guideline are more permissive of slowed labor progress, some fear that the incidence of Bandl's Band may rise. What is this ring? What is the pathophysiology of this abnormal uterine response? Can ultrasound detect this labor abnormality? In this episode we will cover the fascinating and controversial history of the Bandl Band and review some key publications describing its potential morbidity.

Just a little description of what happens “behind the scenes“! Enjoy. 😊😊❤️❤️😩😩

Gestational diabetes (GDM) is a risk factor for adverse perinatal outcomes. Currently, the ACOG recommends early screening for GDM for women “at risk”. However, other experts disagree with this approach. On October 6, 2022 we released a podcast episode called “Early GDM Screening: Evidence-based?”. In that episode we covered the controversy regarding early GDM screening, in other words- screening under 24 weeks. We have been following this story and debate for over 2 years now; we first released the episode investigating the utility of early screening back on May 7, 2021 with an episode called “early GDM screening: Does it matter?”. The controversy surrounds maternal and neonatal outcomes… does it improve with early screening? Well… we have more data now! YEP.. looks like we were vindicated in our prior messages covering this! In this episode, we will summarize key findings from a recent June 2023 publication in the NEJM titled, “Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy”. The lead author is Simmons. So…should we be doing early screening for GDM? We’ll highlight the data.

Well, Well, Well, this is very interesting. Back in May 10, 2023, we released an episode on "OSA (Obstructive Sleep Apnea) in Pregnancy: Time to Screen?". In that episode, we summarized the impressive data on OSA in pregnancy and its association with some adverse perinatal sequelae. Spring forward to July 6, 2023, the ACOG has now released a brand new Consensus Statement on OSA in pregnancy. This statement is a joint guideline from the Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology. Seems that we were ahead of the curve on this one. So, should we screen for OSA in pregnancy? The answer is YES and NO. Is CPAP really safe in pregnancy? We'll explain in this episode.

The headline from CNN Health form June 28, 2023 reads, "HRT use by younger women linked to dementia, study says". That is FRIGHTENING to any patient using hormone therapy for menopausal symptoms. Does HT cause dementia? Or is HT a "easy suspect"? The question of HT and cognitive function has been a subject of controversy for many years. In this episode we will summarize the NAMS position statement on HT for cognitive issues (2022) as well as summarize this new June 2023 publication from BMJ causing quite a stir among menopauses' medical experts. PLUS, we will provide a likely reason, which is the proverbial "elephant in the room", for this new study's conclusions.