Dr. Chapa’s Clinical Pearls.

Opioid use disorder (OUD) Is a national crisis. Pregnancy is not immune to OUD. Traditionally, methadone and buprenorphine have been used as medical treatments for this condition in pregnancy, with concerns about naltrexone (an opioid antagonist) use. In January 2020, a new prospective cohort study (AJOH) adds reassuring data on the safety and effectiveness of this medication option.

Up to 30% of initial BV diagnoses will have a recurrence. Does partner therapy (male or female) help reduce recurrence? Most of the original data which stated “No”, is now outdated. Additionally, what is the data on vaginal Vit C for recurrence prevention? Does that actually work? Let’s examine both of these questions...now.

Vaginismus is the involuntary tightening of pelvic floor muscles that surround the vagina; this can make penetration very painful, if not impossible. The DSM5 reclassified female sexual dysfunction into 4 main categories, with vaginismus fitting in the “penetration disorder“ group. What role does medical therapy play with this condition? Does physical therapy have a role? In this session, we will review the July 2019 practice bulletin from the ACOG (213) focusing specifically on vaginismus.

In 2018, the Lancet released the AFFIRM trial. They reported a NONsignificant decrease in the stillbirth rate from 4.40/1,000 births in the control group to 4.06/1,000 births in the fetal movement counting intervention group. In February 2020, a new systematic review and meta-analysis reveals additional information on the clinical utility of maternal perception of fetal movement. Let’s review that data now.

Currently, the ACOG and SMFM recommend a “risk-based” approach to HCV screening in pregnancy. HOWEVER, a soon to be published original article (February 2020) in Obstet Gynecol confirms that “The reported prevalence of maternal HCV infection has increased 161% from 2009 to 2017”. The IDSA has called for UNIVERSAL screening of HCV. In the session, we will review the Nov 2019 IDSA HCV screening recommendations and provide key points from the Rossi et al Feb 2020 Green Journal publication.

Most studies on the risks of post menopausal hormone therapy have focused on the oral route of administration. Does the transdermal route of estrogen delivery reduce the risk of VTE? In this episode, we will review the ACOG committee opinion (556) and ASRM guidelines on the use of transdermal estrogen vs oral estrogen therapy.

Is vaginal E2 therapy safe in women with a history of breast cancer? What is the data regarding systemic absorption levels? Are you familiar with the recently FDA approved medication IMVEXXY? In the session, we will review the data behind the use of vaginal estrogen and vaginal, non-estrogen therapy for persistent genital atrophy symptoms in women with a current or past history of breast cancer.

In North America, the median age of menopause is 51 years. Among women reporting menopausal symptoms, vasomotor and vaginal symptoms are the most closely associated with these hormonal changes. Can progesterone use alone relieve vasomotor symptoms? What about the use of testosterone? What is Intrarosa vaginal therapy? Does ospemifene increase endometrial a risk? In this session, we will answer these questions and review the medical management of menopause according to the ACOG practice bulletin 141.

Up to 30% to 50% of infertile women have endometriosis, based on laparoscopic diagnosis. Endometriosis affects fertility through a variety of mechanisms. In this session, we will review the ASRM position statement on endometriosis related infertility: work-up and patient management.

Infertility can affect up to 15% of all couples. Male factor infertility can account for up to 40 to 50% of cases, while in 30% of couples there may no identifiable etiology (unexplained infertility). This session, we will review the ASR M guidelines for the infertility evaluation. Is postcoital testing still recommended? What role does laparoscopy play in the infertility evaluation? We will answer these questions and more in this session.(ACOG CO 781).