Dr. Chapa’s OBGYN Clinical Pearls

Today, April 11, 2022, the ACOG updated its practice advisory regarding chronic hypertension in pregnancy. This follows the statement from the Society of Maternal Fetal Medicine recognizing the change in practice based on the CHAP trial. In this session we will summary ACOG’s response.

Since 2005, experts have advocated for ovarian conservation, until the age of 65, at time of hysterectomy for benign indication. However, a soon to be released publication is calling for a retraction of that opinion! Based on brand new data, do you know the age NOW at which ovarian removal is recommended? In this session, we will review this brand new information that will greatly impact how we perform hysterectomy for benign indications.

A study published on April 2, 2022 in The New England Journal of Medicine, "Treatment for Mild Chronic Hypertension during Pregnancy” (CHAP Trial) has resulted in ACOG calling to order its Practice Advisory Committee to prepare a “practice update” regarding the management of mild to moderate hypertension in pregnancy. This recent publication is practice changing! While we await the revised guidelines and official statement from the ACOG, this podcast will review the current state of affairs regarding management of mild to moderate chronic hypertension in pregnancy.

Exploring different ROM tests for pregnant women, focusing on Amnisher and AMNIOTECH ROM vs ACTIM PROM tests. Comparison with ROM plus test and other available tests, highlighting the superiority of PAMG1. Discussing the performance of PAMG1 vs Nitrazine paper and ferning for detecting ruptured membranes in pregnant patients.

Exploring the evolution of PROM terminology, controversies in diagnosis and management, pitfalls of relying solely on ROM tests, and the importance of using these tests correctly to prevent unnecessary interventions and adverse perinatal outcomes.

Some things in medical practice stem more out of tradition than true clinical evidence. Such is the case for histological examination of the placenta. When is pathological examination of the placenta actually helpful? Should we send of the placenta in cases of multifetal birth? What about meconium or chorioamnionitis? In the session, we will review a soon to be released clinical brief from Obstetrics and Gynecology (ACOG) coming out April 2022. This new evidence review questions our current clinical practice of routine placental histological evaluation.

Learn about the importance of universal screening for Hepatitis B in pregnancy and the use of antiviral medications to prevent mother to child transmission. Explore the new data soon-to-be released in the American Journal of OB/GYN and the SMFM guidelines for managing Hepatitis B viral infection during pregnancy.

Why is Magnesium Sulfate the first-line medication for preeclampsia/eclampsia? How did that arise into the current, international, standard-of-care regiment for that condition? Is 24 hours of Postpartum Mag evidence-based? In this episode we will review the evolution of magnesium sulfate for eclampsia prevention/treatment. We will also summarize a soon to be released systematic review and meta-analysis publication from Obstetrics & Gynecology examining the duration of postpartum MagSulfate use.

Pregnancies that arise after assisted reproductive technologies (ART) are at higher risk of maternal, fetal, and even placental complications. In this session we will summarize and highlight key prenatal management pearls for pregnancies that arise after ART. This is a summary of the SMFM consult series # 60, from March 2022.

Preeclampsia occurs in 3 to 5% of the general OB population. It has even higher prevalence among those with high-risk conditions. Currently, aspirin stands alone as the most evidence-based pharmacological option for preeclampsia prevention (risk reduction). But over the last decade new interest has arisen for the use of statins for preeclampsia prevention. Well, do statins work? What is the state of statin therapy as of 2022? In this session we will review the latest data and review the key pathogenesis in preeclampsia formation.