Dr. Chapa’s Clinical Pearls.

Pregnancy is a co-adaptive, quasi-symbiotic state. There are a variety of maternal physiological and anatomical adaptations which must not be interpreted as pathological. In this session we will review these vital changes as well as the fetal circulatory system and provide a quick review of fetal acid base status.

On January 1, 2021, the Joint Commission will release new standards for maternal safety at discharge from the hospital. Discharge teaching and postpartum follow up planning will be part of this mandate with a focus on patients with hypertensive disorders. To prepare everyone for this, the SMFM is releasing a new statement and checklist for postpartum discharge of hypertensive patients. In this session, we will review and summarize this new (July 2020) special statement which is scheduled to be in print in the American Journal of Obstetrics and Gynecology.

COVID19 can have varied clinical manifestations. In pregnancy, new data has highlighted its potential to cause a “preeclampsia like syndrome“. This, together with the increased thrombotic state of COVID-19, elevates the risk for VTE above that of pregnancy alone. Can TXA be used for PPH in these cases? In this podcast we will review these 2 high risk clinical manifestations of COVID-19 in pregnancy.

LARCS are endorsed by the ACOG due to the high efficacy. However, unpredictable bleeding can affect continuation rates. A new RCT has evaluated the use of tamoxifen to control and prevent future abnormal bleeding with etonogestrel implant use. Does this work? What is the MOA? In this session, we will summarize this new publication (published ahead of print) in Obstetrics and Gynecology.

Did you know that silver wire helped to dramatically reduce maternal mortality at cesarean section? And what does the Goodyear Rubber Company have to do with surgical techniques? In this episode we will wrap up our walk through history reviewing CS’s AMAZING History.

What does a pig gelder, a woman dressed as a man, and the Queen of England all have in common? The answer: ALL CONTRIBUTED TO CS’s history! The history of C-section has been called the combination of “death, deceit, and germs“. In this historical review (Part 1), we will take a look at the origin of this all too frequent abdominal surgery.

Prone positioning during invasive mechanical ventilation improves oxygenation, as shown in large randomized clinical trials of patients with ARDS. In an RCT that included 466 patients with moderate and severe ARDS, prone positioning for at least 16 hours per day with protective mechanical ventilation reduced 90-day mortality. Is prone positioning for respiratory support possible in pregnancy? In this session we will cover the beneficial effect of probe positioning and summarize an article (EPUB) soon to be in print in Obstetrics & Gynecology regarding prone therapy in pregnancy (Tolcher et al).

Gastroschisis occurs in about 1 in 1800 births in the US. Does this abdominal wall herniation usually occur to the right or left of the umbilical cord? Is this condition tied to chromosomal/genetic syndrome? What about antepartum fetal surveillance? Is a cesarean birth required? In this episode, we will review the SMFM and CDC data regarding management of gastroschisis.

Female genital mutilation (FGM) is also known as female circumcision. The ACOG and the World Health Organization have issued public statements condemning the practice. What is this procedure? What are the 4 different types of female genital cutting? In this session we will review these answers as well as the immediate and long-term complications of FGM. We will also review the WHO international response to this unnecessary medical practice.

Is labor affected by polyhydramnios? What is the suggested manner of performing artificial rupture of membranes in this setting? In this session, we will wrap up our discussion of polyhydramnios with a quick summary on intrapartum care.