Dr. Chapa’s Clinical Pearls.

The old adage, “Too much of anything is a bad thing”, is traditionally credited to Mark Twain. Was he right? Does the same apply to medical information?What about finding incidental genetic carrier states from online companies like “23AndMe”? In a patient with no personal or family history of any medical complication or malignancy, is this information helpful or more psychologically harmful? In this episode we will review a recent real-world case of how gynecological care was impacted by a patient’s curiosity regarding her genetic makeup.

Semen allergy is a real (although rare) immune reaction. Do you know what the presenting signs/symptoms are?The ISSM has established diagnostic criteria for this. In this session, we will review the diagnostic algorithm for a patient presenting with possible semen allergy.

Postpartum hemorrhage continues to be a worldwide leaning cause of maternal morbidity and mortality. In May 2021, the WHO updated it’s global recommendations for the use of “uterine balloon tamponade” in the management of PPH. Did the WHO ban the Bakri? In the session we will review the May 2021 WHO updated guidance and summarize a soon to be released guideline commentary from the ACOG (proposed release date March 2022).

Globally, more than 200 million infants have been born since the onset of the COVID-19 pandemic. It has been unclear whether fetal exposure to maternal SARS-CoV2 infection can adversely affect the child’s neurodevelopmental progress. Does having Covid during pregnancy affect the child’s neurodevelopment? The answer is intriguing! This is a tale of a pandemic, psychosocial stress response, and epigenetic changes. (Data summary from JAMA Pediatrics; Jan 2022).

In the ACOG Practice Bulletin #106, which was released in 2009, the use of maternal supplemental oxygen for fetal heart rate tracing correction is mentioned. In that original bulletin, it states “despite inadequate data to support its use” consideration can be given to supplemental maternal oxygen for category II or III fetal heart rate tracings. However, within the last 7 years, an ever-growing body of evidence has proven that supplemental oxygen for fetal heart rate pattern abnormalities is not only ineffective but may actually be harmful to the premature fetus. Now, as of January 2022, we now have new guidance on this. Find out how and why the ACOG has now changed its original opinion.

Hypertensive disorders in pregnancy are a large contributor to maternal mortality. Maternal mortality rates for chronic hypertension in pregnancy have increased 15-fold over the last 4 decades! The California Maternal Quality Care Collaborative (CMQCC) has been a leading authority in the Pregnancy Hypertensive space. In the session, we will review BIG updates from the CMQCC. Should we aggressively treat chronic hypertension in pregnancy? What about treating nonsevere gestational hypertension? Are you familiar with the new Cardiology subspecialty of “Cardio- Obstetrics“? Let’s cover all this information… NOW!

Concerns about a possible association between COVID-19 vaccination and abnormal menstrual cycles may lead to vaccine hesitancy. Social media sites have claimed that cycles are affected, although temporarily, after vaccination. Is this true? In the session, we will summarize a soon to be released publication out of Obstetrics and Gynecology which helps clarify this issue. We will also highlight a press release from January 6, 2022 from a major news outlet which seemingly appears to distort those results.

Women with multiple prior low-transverse CSs show a trend toward increased risk of rupture compared with a single prior CS. While some have advocated planned repeat CS at 39 weeks as in patients with a SINGLE previous cesarean, planned repeat CD at 38 weeks is likely to be associated with a lower risk of uterine rupture. Yet, there is no consensus on best practice. In this session, we will summarize a new AJOG publication (Jan 2022) that raises some interesting and clinically meaningful data regarding the timing of repeat CS in women with 2+ prior cesareans (Shinar et al. Timing of cesarean delivery in women with 2+ previous cesarean deliveries. AJOG; Jan 2022).

In 1997, Mercer et al first published their data on antibiotic use for PPROM latency. With IV Erythromycin shortages, Zmax is a known substitute. New data (EPUB December 2021) now points to Zithromax’s validated clinical advantage over Erythromycin in this protocol. In this session, we will review this soon to be released publication in AJOG.

Traditionally, physicians have informed patients that long acting reversible contraceptives are “just as effective“ as female sterilization. While as a Class that statement is correct, not all individual LARCS have the same efficacy; one in particular beats all other birth control methods, hands-down. Do you know which one? In this session we will review key facts regarding female sterilization and review the individual efficacies of long acting reversible contraceptives. We will also review the historic “math model” for female sterilization.