Dr. Chapa’s Clinical Pearls.

In January 2023, a new publication in Obstetrics and Gynecology- the Green Journal, will highlight the disheartening statements being made on social media (TikTok) regarding IUDs. IUDs are highly effective forms of contraception and the progesterone releasing variety have significant non-contraceptive benefits. Most of the dissatisfaction stated on social media surrounds pain during insertion. Do you offer topical lidocaine for IUD insertion? Ever consider lavender aromatherapy? What about music as a non-pharmacological intervention? Are these options evidence-based? In this episode, we will review the soon to be released January 2023 publication and also summarize a 2020 systematic review analyzing both pharmacological and non-pharmacological strategies to reduce pain and anxiety during IUD insertions.

Pre-operative vaginal preparation before gynecological surgery has unquestionable benefit for the prevention of postop infectious morbidity. Does the same hold true for vaginal prep at C-section? There has been over a decade of data, but a new publication- soon to be released in AJOG- is calling previous results into question. Does iodine work as a vaginal prep? What about chlorhexidine? There’s answers for all of these questions, and we will summarize them in this episode.

Surgical site infection (SSI) is the most common complication resulting from cesarean section. Despite advances in infection control, SSIs remain a significant post-op burden, to the patient first, and to the healthcare system second. Negative pressure wound therapy devices (NPWT) are a potential solution to post C-section. wound infections/complications. Do these devices prevent incisional wound complications after C-section? In this episode, will dive into the data and review the specific CDC criteria for diagnosing surgical site infections.

Traditionally, the CDC has recommended delaying IUD insertion for 3 months in a woman diagnosed with asymptomatic, cervical Gonorrheal or Chlamydial infection. This is to first confirm a negative test of cure. However, this leaves the patient at a greater risk of unplanned pregnancy compared to the risk of PID. Is this really the most evidence-based approach? The CHOICE CONTRACEPTIVE Study data provides an alternative approach. In this episode, we will discuss this dilemma and allow the data to settle the discussion. (With special co-host guest: 3rd year medical student, Ms. Carley Hagar).

In the upcoming (May) 2023 ACOG Annual Clinical Meeting, the College will have a highlighted session to “redesign, prenatal care”. The traditional model of prenatal care includes 12 to 14 in-person visits. However, there is no data that supports the theory that adverse outcomes are reduced by the number of prenatal contact visits. In 2020, at the height of the COVID-19 pandemic, women’s healthcare practitioners became more flexible in how they delivered prenatal care. Now, the ACOG is supporting an alternative prenatal care visit schedule for patients at “average risk”. This is called the PATH Prenatal proposal. Let’s talk about that in this episode, and discuss the ONE BIG Limitation to this proposal.

Did you know that not all cases of a single umbilical artery (SUA) result in a 2-vessel cord? Some umbilical cords with a SUA still have 3 vessels! How is that possible? Although SUA is only found between 0.2 to 1% of all live births, they can have important clinical implications. Although sonographic absence of other congenital anomalies is very reassuring (isolated SUA), some fetal conditions may not be apparent until time of birth. In the session, we will review the etiology of, diagnosis of, and management of the SUA.

The ACOG recommends universal screening for gestational diabetes between 24 and 28 weeks of pregnancy with occasional early screening for those at high risk. Is there an advantage to completing the 1-hour 50 g GTT while fasting? First studied in the 1990s, a new publication further validates the original study results. In this episode we will summarize this new publication soon to be released in Obstetrics & Gynecology (the Green journal) and discuss the paradox/conundrum of GTTs while fasting.

As I’ve said on previous podcasts, “we all need some encouragement every now and again”. Well this morning I received mine, through a small gift…from Germany!

Anti-D immune globulin has been advocated for use in appropriate patients since the 1970s. Historic data showed that 0.1ml of fetal D+ blood was all that was required to potentially sensitize an Rh negative mother. New data is questioning whether this prophylaxis is required in all cases of threatened miscarriage/abortion in early pregnancy, or if a more selective approach is appropriate. In this episode, we will highlight a soon to be released “Questioning Clinical Practice” commentary from Obstet Gynecol (the Green Journal) tackling this issue. Is it time to change our current and standard practice?

Fragile X Syndrome is the most common inherited form of intellectual disability, and the most common single gene cause of Autism Spectrum Disorder. It is also responsible for some cases of premature ovarian insufficiency. Do you recall the difference between a Fragile X “pre-mutation” versus the full mutation? Should we do universal screening for this as part of expanded maternal carrier testing, or should this be a targeted screening approach? Although we covered maternal carrier screening on November 4, 2022, this episode will go into much more detail, focusing specifically on Fragile X Syndrome and who should be screened for this. (For Emma…Great question! Thank you for reaching out to us).