Dr. Chapa’s OBGYN Clinical Pearls

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.

In October 2020, JAMA Pediatrics released a publication that is drawing MAJOR criticism from 5 major professional societies. This study highlighted a potential association between labor epidurals and child autism risk. However, there is a lot more to the story that needs to be told. In this session, we will break down the study and offer reassurance that “association“ does not prove “causation“. Also summarize the key rebuttals from these professional societies, which are pretty much ON FIRE.

In May 2020, the FDA approved a new novel, non-hormonal vaginal contraceptive that can be used “on demand“. Although this functions as a “pH regulator“ of the vagina with spermicidal properties, it is not nonoxynol-9-based. In this session, we will review the information in the instructions for use of Phexxi, and summarize key points from some published commentary on the subject.

There are calls to remove 17 OHP from the market based on the results of the PROMISE trial. This leaves us with a gap in tools for prevention of preterm birth. This is where CERCLAGE comes in. Cerclage is not only indicated in patients with previous history of incompetent cervix, as there is emerging data that cerclage plays a role in preterm birth prevention based on cervical length. In this podcast, we will give an in-depth summary of the data on how cerclage may be used as an intervention to prevent preterm birth. At what cervical length can cerclage be used? How does previous history come into play? Is this valid in twins? Let’s cover that… Now.

This discussion delves into the intriguing connection between endometriosis and ovarian cancer. Recent research highlights potential risks, but the actual incidence remains low. Experts emphasize the importance of managing endometriosis symptoms effectively. Insights from reputable sources like the Lancet and MD Anderson provide a deeper understanding of this complex relationship, reassuring listeners while raising awareness.

Antenatal corticosteroids help reduce a number of morbidities in the preterm infant. However, chorioamnionitis is generally considered a contraindication. The scientific basis for this is actually unclear. On September 28, 2020, the AJOG released a new publication ahead of print that helped shed some light on the subject. Are steroids harmful or beneficial to the preterm infant in the setting of Chorio? Let’s check it out.

Endometriosis, a chronic disease that afflicts millions of women worldwide, has traditionally been diagnosed by laparoscopic surgery. This diagnostic barrier delays identification and treatment by years, resulting in prolonged pain and disease progression. Development of a noninvasive diagnostic test could significantly improve timely disease detection. Recently, 2 innovative/non-invasive tools have gained attention for the diagnosis of Endo: MicroRNAs (Oct 2010; AJOG) and MRI (Sept 2020; Acad Rad). In the session, we will highlight these 2 interesting publications.

One theory behind elevated post-partum blood pressure is that there is a large volume of sodium mobilized into the intravascular compartment in the post-partum period. Loop diuretics have been suggested as methods to accelerate post-partum blood pressure recovery due to their ability to mobilize sodium and fluid excretions. Is there level I data on the use of furosemide for postpartum preeclampsia/hypertension management? Does the use of Lasix affect serum magnesium levels? In this session, we will review 2 recent RCTs on the use of furosemide for Postpartum hypertension management and briefly review the pharmacology of furosemide.

Stillbirths occur in approximately 6/1000 pregnancies in the US. Currently, the ACOG recommends placental histological analysis and fetal chromosomal study in these cases. However, as up to 50% (or more) of cases are left “unexplained“, more investigation/options are needed. On September 17, 2020, a new publication in the NEJM adds valuable insights as to how whole exon sequencing may help provide a genetic cause in an otherwise unexplained stillbirth. In this podcast, we will review this publication by Stanley et al.