Dr. Chapa’s OBGYN Clinical Pearls

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.

Examination (macroscopic and microscopic) of the placenta can give valuable insights into the intrauterine environment. The College of American Pathologists has issued guidelines about when to submit a placenta for histological examination. In this session, we will review the “what, when, and whys“ of histological placental referral. We will also review abnormal umbilical cord insertion and it’s link to adverse obstetrical/neonatal outcomes. SHOUTOUT TO LAUREN (our podcast listener) for the podcast topic!

Does the ACOG endorse universal screening for thyroid disease in pregnancy? What about treating subclinical hyperthyroidism or subclinical hypothyroidism? And what about those pesky anti-thyroid autoantibodies? In this podcast, we will highlight the June 2020 ACOG Practice Bulletin (223) covering thyroid disease in pregnancy.

The benefit of antenatal corticosteroids in preterm infants was first reported in 1972, but it took 20 years for widespread adoption. Now, antenatal steroids are recommended by the ACOG up to 36 weeks and 6 days. However, a new study (JAMA May 2020) has raised concerns about steroid exposure in utero and possible behavioral and mental diagnoses in children up to age 5. These outcomes were significant for infants who were born full term. In this podcast, we will highlight this new study and summarize the editorial perspective in JAMA regarding this study.

Information can be confusing regarding COVID-19. The WHO, CDC, ACOG, AAP all have slightly different recommendations based upon what topic you’re looking at. Is a patient with COVID-19 allowed to breast-feed? In this episode, we will review the CDC/AAP recommendations for breast-feeding regarding a patient under investigation or confirmed positive case.

Sexual assault/rape is a devastating occurrence for all victims. Post exposure infectious disease prophylaxis has been expanded to include hepatitis B and HPV vaccinations. In this session, we will review the medical/vaccine regimens as post exposure prophylaxis after assault. We will also cover HIV prophylaxis. Are 3 anti-retroviral medications more effective than 2 for HIV prevention? The answer is in this podcast!

The ACOG/SMFM does not recommend bedrest in pregnancy for the prevention of preterm birth for women at risk, nor in multiple gestation, or management of hypertensive disorders. Does bedrest actually RAISE PTB risk? In this session, we will summarize updated information about the real physiological, psychological, and possibly OB adverse effects of bedrest in pregnancy. (NEW SMFM Consult Series #50).

Advances in 1st trimester aneuploidy screening have increased the need for early prenatal diagnostic testing. There are only 2 prenatal diagnostic tests : CVS and amniocentesis. In this podcast, we will review these procedures and rates of potential complications. We will also summarize the difference between microarray chromosomal analysis and conventional karyotype.

On May 1, 2020, the FDA authorized the emergency use of Remdesivir for COVID-19. This was based on a preliminary analysis of an NIH clinical trial. However, information is still lacking on safety and efficacy in a larger study population. In this session, we will review the known mechanism of action of this novel antiviral medication and limitations of data.

In May 2020, the ACOG will release a new committee opinion regarding tobacco/nicotine use during pregnancy. What are the risks of nicotine use during pregnancy? Are medications to assist smoking cessation in pregnancy endorsed by the ACOG? In this session, we will highlight and summarize this new committee opinion.