Dr. Chapa’s Clinical Pearls.

A prolonged second stage of labor, or failed vaginal vacuum extraction, can lead to a deeply impacted fetal head. Is the “push“ technique better than the “pull“ technique? Have you heard of the Patwardhan method? What is a C-section SPOON? And is the “Fetal pillow” actually helpful? In this podcast we will review each of these techniques in detail.

An EIF is a small echogenic area appearing within the fetal cardiac ventricle that has a sonographic brightness equivalent to that of bone. What are the clinical implications of an isolated EIF? Are structural malformations of the heart more common with EIF? What specific workup is required? In this session, we will review the SMFM management of this ultrasound finding.

A woman in her 20s with preeclampsia has a worse cardiovascular prognosis at 10 years compared to a woman in her 40s without previous preeclampsia. Additionally, preeclampsia is linked to other future maladaptive conditions (even dementia and renal disease) which have severe life impact. In this session, we will review the data on preeclampsia as a risk factor for future morbidity.

Intraventricular hemorrhage (IVH) is the most common type of intracranial hemorrhage in the neonate and is the most serious. Which antepartum therapy is proven to reduce IVH severity? Does Mag Sulfate reduce IVH? How is umbilical cord “milking” related to IVH? In this session we will cover this in detail and highlight professional societal guidelines.

Recurrent pregnancy loss affects between 3 and 5% of reproductive age couples. Traditionally, the category of “unexplained“ pregnancy loss made up 25% of cases. However, use of Chromosomal MicroArray analysis (CMA) has dropped the category of unexplained to approximately 10%. In this session, we will review the traditional and updated algorithm for recurrent pregnancy loss using CMA for the products of conception (source: Clinical Opinions in ObGyn, published ahead of print)

There is biological plausibility for vitamin D to play a role in pregnancy outcomes, given the presence of receptors in gestational tissues. Data has progressed since the ACOG committee opinion regarding vitamin D supplementation in pregnancy released in 2011. Does low maternal vitamin D actually affect maternal outcomes? In the session we will review the latest data from “Current Opinions in OB/GYN” regarding vitamin D supplementation in pregnancy, focusing on preeclampsia risk and GDM.

On August 12, 2020, the ACOG released a revised practice bulletin (226) on screening for fetal aneuploidy. In this session we will focus on cell free DNA genetic screening. How should we counsel younger women on this screening tool? Can cell free DNA be used after an abnormal QUAD screen? How is cell free DNA related to maternal malignancy? We will answer these questions and more in this session.

TOAs are typically considered the end result of severe PID. However, not all cases are PID related. TOAs may also be a harbinger of genital tract malignancy in a subgroup of patients. In this session, we will review the presentation, work-up, and management of TOAs and we will end with who may be at greater risk of genital tract cancer with them.

Fantastic! As healthcare professionals, we have to remember to use “patient centered“ terms when possible. This is a brief commentary describing a very important issue as a follow up to today’s educational podcast released just hours ago.

It is the age old question at Gyn Surgery… Candy Cane leg holders or Boot support? Is it just physician preference? In August 2020, a new RCT published in the journal Obstetrics & Gynecology addresses this issue. However, as we will discuss, the study raises more questions than answers.