Dr. Chapa’s Clinical Pearls.

Polyhydramnios can be mild, moderate, or severe. Is deepest vertical pocket (DVP) or AFI preferred for amniotic fluid assessment? Is antepartum Indocin a valid treatment option? What about antepartum fetal surveillance? In this session, which is Part 1, we will review the SMFM guidance regarding polyhydramnios.

Placenta accreta spectrum, formally known as morbidly adherent placenta, refers to a range of pathologic adherence of the placenta (accreta, increta, and percreta). There is significant risk of maternal morbidity and mortality including risk of blood transfusion, life-threatening hemorrhage, and hysterectomy. In this session, we will review the obstetric care consensus by the ACOG and SMFM regarding this condition (obstetric care consensus # 7).

On May 29, 2020, the U.S. FDA approved an novel oral drug, Oriahnn, for HMB use to fibroids. This medication (elagolix, estradiol, and norethindrone acetate) is the first oral medication designed specifically for Fibroid HMB. In this session, we will review this new medication. (No financial disclosures to report).

In this session, we will conclude our summary of the new ACOG clinical expert series, “Female Sexual Dysfunction“. This episode will focus on specific treatments of each of the 4 different DSM5 categories of female sexual dysfunction.

Human sexual response is a highly individual and emotional process. Sexual dysfunction is common among women and leads to personal distress. The ACOG has released a new “clinical expert series“ which currently is published ahead of print. In this session (Part 1), we will review the prevalence, risk factors, and DSM5 categories of female sexual dysfunction.

Unlike fetal thrombocytopenia resulting from maternal ITP, fetal- neonatal alloimmune thrombocytopenia may occur earlier in gestation and can lead to in-utero fetal intracranial hemorrhage. The condition can be severe. In this podcast, we will review the presentation, diagnosis, and management of this potentially lethal fetal acquired condition. (ACOG Data 2019).

On June 1, 2020, the American Journal of Obstetrics and Gynecology released a new publication with surprising results related to maternal oxygen use in labor for Category II fetal heart rate tracings. Although we have covered this in some form in previous episodes, we will provide new up-to-date information on this subject.

Medical information moves fast. Although the increased morbidity with fetal macrosomia has long been known, the ACOG has revised his practice bulletin on the subject (January 2020). In this session, we will review this updated practice bulletin. What’s the new data on exercise and fetal birthweight? Is operative vaginal delivery contraindicated in macrosomic infants? What about TOLAC with a suspected macrosomic infant? Let’s cover these topics, and more, in this session.

Multiple societies and experts have weighed in on whether 2nd stage of labor warrants universal use of respirators (e.g., N95 masks) vs surgical masks. The ACOG/SMFM has petitioned the CDC for clarity on this issue. In May 2020, the AJOG published a new “clinical perspective“ in MFM which is pushing for use of 1 mask over the other. We will highlight this new development in this session.

Some experts have called for universal screening of all patients admitted to labor and delivery. The foundation of this opinion is to decrease exposure to healthcare workers and identification of asymptomatic women for the prevention of horizontal newborn transmission. However, there are some potential negative implications of this proposal. In this podcast, we will review a soon to be released editorial (Torri Metz, MD) from Obstetrics & Gynecology (the Green Journal) on the pros/cons of universal testing in Labor & Delivery.