Dr. Chapa’s Clinical Pearls.

In December 2020, ACOG will release an updated committee opinion on delayed umbilical cord clamping with 3 additional areas addressed: 1. multiple gestations, 2. cord milking in extreme premature infants, and 3. the effect of delayed cord clamping on umbilical cord blood collection. We will summarize these key points in this session!

In 2017, the American College of Cardiology and the American Heart Association revised the definition of normal BP, elevated BPs, and Stage 1 & 2 Hypertension. ACOG has not adopted these new classifications for pregnancy care. Are women with elevated blood pressures or Stage I hypertension at risk of adverse pregnancy outcomes? In this podcast, we will review a soon to be released publication from the AJOG which helps answer these questions. (Data from: “Perinatal outcomes in women with elevated blood pressure and stage 1 hypertension”, GREENBERG et al)

The birth control pill remains one of the most common medications used in reproductive aged women. As all birth control pills have a net antiandrogenic affect, does this result in less libido? What does the data say? Do you inform women of this potential side effect when they start combination birth control? We will tackle these questions in this session!

Ever since the first progestin was isolated and reproduced out of Mexican Yams in the early 1950s, the race was on to formulate a low-risk, highly effective, oral birth control agent. Birth control pills remain one of the most common medications used by reproductive age women. We are now in the 4th generation of synthetic progestins in the pill. But do these matter? Is anti-androgenic activity real or just something found in the lab? In this podcast, we will review not just the history of the pill but we will also review how to “choose the right one“. Thank you, Lindsey and Jeanna, for the recommendation.

Modafinil and armodafinil are stimulant meds called “smart meds”. Their use is on the rise, but there are important drug interactions with these meds and certain birth control (BC) options. Additionally, new data has revived attention to the association of the stimulants to congenital birth defects. In this session, we will review the MOA of these meds and discuss BC options with their use. We will also summarize the newly released data showing the association with congenital birth defects.

It has been a debate for many years: should we be doing routine screening for BV before hysterectomy/gynecology procedures? What about at C-section? It’s a good question especially acknowledging that there is a high rate of asymptomatic BV. In this episode, we will review an “expert review“ from the AJOG from March 2020 and a recently released rebuttal to that review. What does the ACOG say? Let’s take a look now.

Bacterial vaginosis (BV) is one of the most common vaginal diagnoses in women’s health practices. Over the years there has been increasing evidence that BV is not just an annoying vaginal condition but has true risks of heightened STI acquisition, PID, post-op vaginal complications, and even infertility. In this session, we will review a new soon to be released publication from the AJ0G. This article makes a strong case for the link between BV and infertility. We will summarize this new data here ( Ravel J et al; AJOG EPub Oct 19,2020).

In this continuation, we will cover the reported potential, adverse reproductive outcomes with CUAs. Which surgical corrective procedures should be attempted, and when? Let’s cover that now.

The evaluation of congenital uterine anomalies can be traced back to the mid 19th-century. In this session, we will review the ASRM and the ESHRE classification schemes for these anomalies. What is the gold standard for diagnosis? When is an MRI necessary? We will answer these questions and more in the session. We will address reproductive outcomes in part 2.

On September 25, 2020, a new cervical cancer screening working group revised the algorithm (as a proposal) for management of minimally abnormal cervical cancer screening tests. This was released in JAMA. The new focus is on the presence/persistence of high risk HPV in the pathogenesis of cytology abnormalities. Let’s cover that in this session.