Dr. Chapa’s OBGYN Clinical Pearls

Maternal carrier screening (either pan-ethnic or expanded carrier panel) is recommended by the ACOG and SMFM. Ideally, this is done pre-conception or with the first pregnancy. Did you know that in August 2022 the ACOG added an additional test for universal maternal carrier screening? Does this maternal carrier screen include BRCA? In this episode we will cover what maternal carrier screening is, and what it is not.

Katie Couric recently described her path to her diagnosis of breast cancer, urging women with “dense breast tissue” to get supplemental breast imaging. Do these supplemental imaging tests improve overall survival? In this session, we will review the statements of 4 professional societies/organizations regarding the use of supplemental breast imaging for women with dense breasts who have no additional breast cancer risk factors and are asymptomatic.

Dense breasts can decrease the sensitivity of screening mammogram (MMG). Some US states have mandated reporting of breast density on MMG, while the rest of the states report on dense breasts voluntarily as a standardized reporting system. What supplemental breast imaging tools are advised as a follow up in these patients? Does the ACOG support supplemental breast imaging in average risk patients? What about the USPSTF? In this session we will do a deep dive into this common MMG description of “dense breast noted”.

The Enhanced Recovery After Surgery guidelines were birthed (no pun intended) as a way to curb post-op morbidity from colorectal surgery. In 2019, CSection ERAS guidelines were published in the AJOG. Despite widespread agreement that ERAS is valuable, one aspect of the guideline is controversial: timing of Foley removal. Should the Foley be removed immediately after C-section? Should an indwelling bladder catheter be used at all? Let’s dive into this topic now.

The United States is currently facing an oxytocin shortage. How long this medication shortage is projected to continue is not clear. In an attempt to curb unnecessary use of oxytocin, is it safe to consider stopping oxytocin after induction, once the active phase of labor is reached? Is there data to support the practice? And what about using oxytocin for first trimester D&C? Is that evidence-based? In this session, we will review the data regarding discontinuation of oxytocin once the active phase of labor is reached. Is it safe? Is this effective? Let’s find out!

In 1964, John O’Sullivan published his original research describing abnormal cut off values following an oral glucose challenge in pregnancy. O’Sullivan laid the foundation for screening and diagnosis of gestational diabetes. We have learned a lot since that 1964 publication. In this session, we will review a new meta-analysis coming to print in November 2022 comparing the 1-step with the 2-step oral glucose tolerance test. We will also summarize data on point of care glucometers (capillary blood glucose) for diagnosing gestational diabetes. Is the use of POC testing devices for GDM diagnosis evidence-based? There’s an answer for that… And we will cover it.

Hattie… with these kind of insights, you are going to ROCK your oral boards in the next 72 hours! We are cheering you on! 👏👏👏👏

Recently, we reviewed the 3 vaccines generally recommended for every woman, in each pregnancy. But as they often say on late night commercials, “but wait… There’s more!” In this session, we will review 3 separate vaccinations which are applicable in special populations. Do you know which 3 they are? In this session our special guest, Carley Hager (3rd year medical student), will help us review the ACOG recommendations.

Fetal fibronectin was first reported as a possible biomarker for identifying those at risk of preterm birth back in 1991. Despite over 3 decades of ever evolving published data on FFN, underuse, misuse, and misunderstandings regarding what fetal fibronectin is and is not still persist. In the session we will review the SMFM recognized transvaginal ultrasound/FFN algorithm for preterm labor triage assessment. What is traditionally accepted as a “short cervix” on TVUS? Is it really safe to send patients home after a negative FFN result? Let’s review the data now. (Thank you Matt S. for the podcast suggestion.)

In 2015, the ACOG included immediate release nifedipine as an intervention for acute, emergent hypertension in pregnancy. But what about extended release nifedipine? Is there a role for this medication in patients with preeclampsia with severe features intrapartum? Does this calcium channel blocker prevent uterine contractility? In this session we will review a new study from the American Heart Association reviewing the effectiveness of oral extended release nifedipine during labor induction for preeeclampsia with severe features.