Dr. Chapa’s Clinical Pearls.

Virtual reality is well-established in the gaming community, but data is expanding regarding its utility and effectiveness for a variety of medical conditions. In February 2020, at the annual meeting of SMFM, researchers released their findings on a randomized controlled trial using VR headsets for labor pain. In this podcast we will briefly review VR technology and its application for medical pain conditions including labor. (NOTE: No financial disclosures or other commercial interests in any VR device exist or were implied in the generation of this podcast).

Worried about airline travel amid global health concerns? Well, you’re not alone. What does the CDC say about airline infectious disease precautions? And what about air travel during pregnancy in general? In this podcast, we will review the CDC recommendations regarding viral precautions and highlight some key points from the ACOG committee opinion, 746, regarding air travel in pregnancy.

Vulvar pain (vulvodynia) is subdivided into generalized or local. The symptoms can either be spontaneous or provoked. Vulvodynia can result in painful intercourse, and affect other quality-of-life measures. In this session we will review the diagnosis, subcategories, and management of vulvodynia.

Pre-labor rupture of membranes should be diagnosed based on clinical assessment. In March 2020, the ACOG will release a new practice bulletin (217) on PROM. This bulletin highlights the potential hazards of over reliance on lab tests for the diagnosis, and offers a new management option for PROM in the late preterm interval. Are steroids contraindicated in the presence of suspected intraamniotic infection? We will take a look at the data in this session.

Chronic pelvic pain is more complex than previously thought, with a broader range of causes outlined in a recent ACOG bulletin. Key topics include the usefulness of the Carnett test and the effectiveness of trigger point injections. The discussion also delves into the role of SNRI medications and highlights the limited success of routine laparoscopic adhesiolysis. Emphasis is placed on the importance of accurate diagnosis, physical therapy, and strategies to reduce opioid dependency for better management of this condition.

Cannabinoid Hyperemesis Syndrome: Although widely recognized in the gastroenterology and psychiatry literature, its occurrence in pregnancy is well known. The pathophysiology of this condition is not well known but potential MOAs have been published. How does this present? And what do “hot baths“/“hot showers“ have to do with his condition? In this podcast we will review this interesting and intriguing condition specifically as it relates to pregnancy.

In 2013, actor Michael Douglas blamed frequent oral sex with his wife as a cause of his throat cancer. In the 17 years from 1999 through 2015, the mouth and throat replaced the cervix as the most common site of cancer associated with human papillomavirus (HPV) infection in the United States. What is a data show about vaginal to oral HPV transmission, and even oral to oral transmission? Does Gardasil have a role in prevention here as well? In this podcast, we were review published data on oral HPV transmission and trends of acquisition.

Malignant GTD includes choriocarcinoma, invasive mole, and placental site trophoblastic tumor. When is single agent chemotherapy indicated? What about multiagent care? What is the classification system for malignant GTD? In this episode we will review the diagnosis, work up, and management of this condition.

Gestational Trophoblastic Neoplasia is a complex condition with various histological and clinical distinct entities. In this episode, we will review the benign variants of GTN, hydatidiform moles (complete and partial). We will review their clinical presentations, diagnosis, management, and follow up. Data for this podcast comes from the ACOG practice bulletin 53 as well as the SGO.

Currently, the CDC does not recommend “routine screening” for extragenital gonorrhea or chlamydia in women, although it does make that recommendation for MSM or bisexual males. However, as most extragenital infections are asymptomatic, this is potentially missing a large reservoir of infection. In this episode, we will review the USPSTF and CDC screening guidelines and compared that to evolving prevalence data of extragenital STIs.