Dr. Chapa’s OBGYN Clinical Pearls

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).

Marijuana is the most commonly used federally illegal drug in the United States; its use among pregnant and lactating women is on the rise. Is breast-feeding contraindicated with marijuana use? It is difficult to separate marijuana use from several confounding variables, leading to conflicting data in print. Is marijuana use and breast-feeding compatible? A patient friendly article on Parents.com, released on November 23, 2022 seems to imply just that. In this episode, we will review the data on marijuana use during lactation and help clear up the seemingly contradictory outcomes data. Also, we will summarize key position statements from a variety of professional organizations, and find out what data gaps still exist.

Several cohort studies and meta-analysis have shown a direct association between poor oral health and adverse pregnancy outcomes. The key driver for this association is systemic inflammation. In this episode, we will review the ADA, ACOG, and CDC data on how maternal oral health can influence pregnancy outcomes. Although this association is pretty strong, remember that association does not necessarily prove causation. We will explain this in this episode.

Happy Thanksgiving, Podcast family! As we gather with family, friends, and loved ones… Let’s make the practice of gratitude a daily habit, not some thing that we do just once a year. There is real science on the art and practice of gratitude! In this brief episode, we will remind ourselves that gratitude is not just “something we do” on Thanksgiving, but really should be our way of life. We will cover gratitude’s effect on neurochemistry and it’s activation of critical brain centers. ❤️🦃❤️🦃❤️🦃

On November 17, 2022 Wimbledon showed a major head nod to women’s health. Do you know what that was? Nonetheless, this recognition of menstruation is just one small move forward, noting that Period Poverty is still widespread right here in the US. In this episode, we will review “Wimbledon, the period, and lack”.

“The Lotus Birth”… Although first described back in the 1970s, this birthing trend is gaining popularity today mainly because of social media. Is this practice evidence-based? Is it safe? There are real concerns here which have spurred several professional organizations and societies to issue HARSH warnings about this practice. In this episode, we will review the origins and current state of “the Lotus Birth”. We will also review the tragic case of Baby Harlow Eden. We will wrap up this episode with some practical peer advice as to how to handle this unconventional birth experience. 🪷

Systemic Lupus Erythematosis is several-fold more common in women than in men. As it primarily targets reproductive age women, identification of and proper management of patients with associated antiphospholipid antibodies is crucial to improve maternal and neonatal outcomes. In this episode, we will review the 2019 ACR diagnostic criteria for SLE and review the management of SLE patients with/without antiphospholipid antibodies and with/without antiphospholipid antibody syndrome.

The idea of keeping women “Nil per os” (NPO) during labor traces back to the 1940s with the pivotal work of Dr. Curtis Mendelson. His work on “aspiration pneumonitis” has kept women NPO during labor up to present day. But is this still evidence-based? Is it risky to allow women to have PO intake during an otherwise uncomplicated labor course? In this episode we will walk through history and provide an updated view on the risks and benefits of this historic practice.

TXA was first found to reduce maternal morbidity at time of established postpartum hemorrhage in the WOMAN trial (2017). Since then, evidence has grown to include TXA as a prophylactic agent to prevent postpartum hemorrhage. Despite its known effectiveness in BOTH the prevention and treatment of postpartum hemorrhage, there is a renewed global warning regarding this medication. In this episode, we will review the WHO and FDA warning regarding the misapplication/inadvertent intrathecal use of TXA at time of cesarean section.