Dr. Chapa’s OBGYN Clinical Pearls

Tranexamic Acid’s use in obstetrics skyrocketed in 2017 after the release of the WOMEN trial. At that time, the ACOG endorsed TXA for use with diagnosed PPH, not for its prevention. Does TXA prophylaxis reduce postpartum hemorrhage? Does it matter whether it is used at vaginal birth or cesarean? Data moves fast and we will highlight those new answers here.

(Part 2) In this session, we will wrap up our summary review of the ACOG September 2021 Clinical Consensus bulletin on postpartum pain management. What are “ultra rapid metabolizers” of opioid medication? How does that affect our prescriptions for postpartum pain control? In this session we will answer these questions and more! ⚕️⚕️⚕️⚕️

Uncontrolled postpartum pain can lead to postpartum depression, impaired maternal-child bonding, and even chronic pain syndromes. Uncontrolled postpartum pain can also lead, in some individuals, to a form of PTSD. In this session, we will review the September 2021 Clinical Consensus statement from the ACOG on using a “MultiModal Stepwise Approach” to Postpartum pain management. Do NSAIDS increase blood pressure? When are TAP blocks recommended? We will answer these questions and more in this session. (This is Part 1)

The diagnostic algorithm for primary amenorrhea is extremely logical once one understands this pathophysiology. While some patients presenting with primary amenorrhea are indeed genetic females, some are actually 46XY. Do you remember the difference between Swyer syndrome and androgen insensitivity (AIS)? In this session, we will present an easy to follow diagnostic algorithm for primary amenorrhea based on ASRM guidelines. We will also provide high-yield facts contrasting Swyer syndrome with AIS.

At the end of July 2021, the CDC updated its treatment guidelines for sexually transmitted infections. Changes were made to recommended treatments for chlamydia, gonorrhea, trichomoniasis, and PID. There’s also new updated information regarding mycoplasma genitalium. In this session, we will provide a summary review of the key take-home changes made by the CDC.

In 2003, the ACOG/SMFM endorsed IM progesterone for PTB prevention. But new data has called this into question (PROLONG trial). In this session, we will review the PROLONG data and compare it to the newly released EPPPIC study. What does the ACOG now recommend? We will answer these questions and more in this session.

The last time ACOG released a practice bulletin on the prevention of preterm birth was in 2012. In August 2021, the ACOG will release a new practice bulletin addressing prediction and prevention of preterm birth. In this session, we will summarize transvaginal ultrasound for cervical length screening. Is there a “reassuring“ cervical length using TRANSABDOMINAL ultrasound? When should these be done? And what about all the new progesterone data? Listen to find out.

Non-sexually acquired genital ulceration (NSGU) is painful ulceration of the external genitalia, usually in adolescents, unrelated to sexual activity. In this session, we will review the likely ideology, the clinical presentation, its diagnostic criteria, and the management approach for this condition.

There is a whirlwind of false/misleading information on social media regarding the COVID-19 vaccines. Some social media posts state that breast-feeding should be STOPPED after this vaccine. Is that evidence-based? What does the Academy of Breast-Feeding Medicine recommend? In this session, we will review a recent report from JAMA Pediatrics (July 2021) which provides some much needed clarification on breast-feeding after COVID-19 (mRNA) vaccination.

Our understanding of Intrahepatic Cholestasis of Pregnancy has changed just over the last 5 years. What is the best laboratory test to help diagnose this condition? At what level of total serum bile acids is the risk of fetal death greatest? What does the SMFM say about induction of labor for these patients? In this episode, we will highlight and summarize the latest clinical brief on ICP from the SMFM (2021). This is SMFM consult series # 53.