Dr. Chapa’s OBGYN Clinical Pearls

Gerri, thank you for your voice message today! Welcome to our podcast family. Here’s some helpful notes for you. 😊😊

In Oct 2006, the ACOG released Opinion Number 346. This stated that “Based on current literature, routine prophylactic amnioinfusion for the dilution of amnioinfusion for meconium-stained amniotic fluid should be done only in the setting of additional clinical trials”. Back then, some experts criticized the decision to abandon amnioinfusion for meconium based on the limitations of the 2005 study which helped to motivate the ACOG decision. And now, a new systematic review and meta-analysis (published ahead of print March 18, 2023; AJOG) has brought new life into this old debate. Can amnio-infusion, in fact, reduce meconium aspiration syndrome (MAS)? Do current professional guidelines need to be updated? We will explore and dissect this new data in this episode.

Infertility. It’s real. It affects 10-15% of couples in the US. After a thorough investigation, 30% of couples will be left without an identifiable cause for their infertility. This has been termed unexplained infertility. While traditionally this may have been considered a reassuring result, new data is raising the yellow flag of caution in these patients. Research has now established the link between infertility and some potential future negative health outcomes. As “next generation“ genetic tests become more integrated into clinical practice, new data (released ahead of print on March 16, 2023 in the New England Journal of Medicine) has revealed some life-changing realities for couples struggling with unexplained infertility. In this episode, we will highlight the advances in genetic medicine and summarize the key findings of this eye-opening new publication.

Such a small gland… Yet so much confusion, and controversy: the THYROID gland in pregnancy. Let’s start with this foundational question: should we universally screen for thyroid abnormalities in pregnancy? And as a follow-up question, should we be checking for anti-thyroid antibodies? The answer to both of those queries depends on who you ask! In this episode, we will solve the conundrum of whether we should be screening for anti-thyroid antibodies pre-pregnancy and/or during pregnancy itself. Does identification of these antibodies affect management? What is their role in recurrent miscarriage? Listen in, and find out.

The traditional explanation and assumed pathophysiology of HELLP syndrome stated that it was a late manifestation/further progress of preeclampsia with severe features. But can HELLP present clinically without hypertension? What about without proteinuria? If a patient has lab criteria of HELLP alone, without hypertension, does she still require magnesium sulfate? In this episode, we will summarize data from 3 sources (ACOG practice bulletin on thrombocytopenia, ACOG practice bulletin on gestational hypertension and preeeclampsia, CMQCC hypertension bundle), and answer these questions and more.

The pathophysiology of menopausal hot flashes has remained largely a mystery until about a decade ago when KNDy neurons were found to be the key triggers of the hot flash. Since then, research and development has been going fullsteam to develop a non-hormonal, receptor-based therapy for the common hot flash. In April 2023 in the journal, Obstetrics and Gynecology (the Green Journal), new safety data will be published on the revolutionary new medication, Fezolinetant. With Phase 3 study results already in print, the FDA is projected to rule on this new medication’s approval potentially in May 2023. In this episode, we will review the fascinating biochemistry of KNDy activity and how this new medication works.

The fetal NST is a hallmark of antepartum fetal surveillance and a key component of the BioPhysical Profile (BPP). Historically, and still done today, one of the low-risk interventions for rectifying a non-reactive NST has been the maternal administration of glucose/PO challenge. Is this evidence-based? Does maternal hypoglycemia contribute to a nonreactive NST? In this episode, we will review the data spanning a 40-year interval that has sought to answer this question. And what about fetal movement? Does maternal glucose loading increase perception of fetal movement? Let’s go to the data now.

The Liggins and Howie trial demonstrating the benefit of antenatal corticosteroids (ACSs) on fetal lungs was published in 1972 in the journal Pediatrics. First adopted as weekly injections, ACSs were then found to be associated with decreased birth weights and decreased head circumferences. Hence, weekly administration was abandoned in the late 1990s. But the ACOG/SMFM does still recognize a single repeat dose “based on clinical scenario”, called a rescue dose. Is a rescue dose of steroids associated with altered neurodevelopment in the child? In this episode, we will summarize a brand new study just accepted for publication in the AJOG MFM (the Pink Journal) shedding some light on this question.

This is a brief update regarding our recent podcast on “the French C-section”. Having an Israeli member of our podcast family…is priceless! ❤️Listen to the latest development regarding the extraperitoneal C-section in Israel and how this situation bears similarities to the US approval of ADDYI in 2015. Thank you Liel N.!! 😊😊

In 1999, the CDC had a national plan of action to “completely eliminate syphilis” by the year 2005. Although rates of syphilis did dramatically decrease to record lows during that time, we are now experiencing record HIGH rates of congenital syphilis. Some states are having a close to 500% increase in congenital cases. How did we get to this point? In this episode, we will review and summarize 3 key recent publications regarding the rise of congenital syphilis (Journal Women’s Health Issues [Elsevier]– article in press: AJOG Dec 2022; ACOG Clinical Expert Series May 2020) which have resulted in the SCARY STATE of SYPHILIS. We will also review the JH reaction, and provide a clinical pearl regarding the interval restriction between doses of Penicillin G injections, AND we will summarize the time frames permitted to allow a decrease in RPR titers after therapy. Lots of material covered in this episode! 👍