Dr. Chapa’s Clinical Pearls.

BRCA1 & BRCA2 are tumor suppressor genes; mutations in either are transmitted in an autosomal dominant pattern. Loss of both copies of either BRCA1 or BRCA2 is just the 1st step in the process of potential carcinogenesis. In this session, we will review the pathophysiology of BRCA mutations and review the NCCN guidelines for breast and ovarian cancer screening. We will also review the surgical & chemoprophylactic management of the BRCA positive patient.

Once considered pathognomonic for gonorrhea or chlamydia, Bartholin’s gland abscesses are now recognized to be polymicrobial. Is I&D alone 1st line therapy for a Bartholin’s abscess? What about Word Catheter use? Are there any alternatives to Marsupialization for recurrent cases? In this session, we will review the data behind diagnosis and management of this common gynecological condition.

There are 4 types of single umbilical artery (SUA), based on pathogenesis. The incidence of SUA is up to 1% of all singleton fetuses, and up to 4.6% of twins. SUA can occur either as an isolated finding or as part of a congenital anomaly syndrome. In this session we will review the pathogenesis, identification of, fetal work-up, and patient management of SUA. Data from the SMFM, and ACOG.

Methamphetamine and amphetamine use has greatly increased all throughout the United States. While similar to cocaine, it’s mechanism of action is quite unique and dangerous. In this session we will cover the pharmacology of amphetamines/meth and its affects on pregnancy. We will also cover some common every day medications which can actually test false positive for meth/amphetamines on toxicology screening. Data for this podcast come from the ACOG, SMFM, and the CDC.

Interest in, and performance of, female cosmetic genital surgery increased 50% from 2014 to 2018. As close to 80% of US females have some degree of pubic hair removal, self awareness of vulvar variation is increasing. Although labial hypertrophy can be a true functional/medical concern requiring labial reduction, what about elective cosmetic genital procedures? In January 2020, the ACOG will release its updated committee opinion on this topic. These are important points to review as patients often seek “designer labioplasty“ or “vaginal rejuvenation“ from their gynecologist.

Pregnancy-related venous thromboembolism is the most common cause of maternal death and a significant cause of maternal morbidity. The factor V Leiden (FVL) mutation is the most common known genetic factor that predisposes to thrombosis. How does obstetric management differ regarding a heterozygous or homozygous carrier? When should anticoagulation be used, and at what dose? In this session we will review data from the SMFM, RCOG, and the ACOG practice bulletin 197.

The initial gynecological visit for an early teen/adolescent is crucial in establishing patient trust, education of gynecological health, and establishment of healthy personal and sexual behaviors. At what years should the first visit occur? What about patient confidentiality when dealing with minors? Is a clinical breast exam part of the adolescent screening exam? In this session, we will review the ACOG committee opinion (598) on the first gynecological visit.

Commercial laboratories offering cell free DNA for fetal prenatal screening are offering microdeletion testing. Is this valid? Microdeletions are varied and include 22q and 15q syndromes. In this session, we will review the pathophysiology of microdeletions and review 22q and 15q conditions. What does the SMFM have to say about cell free DNA screening for these conditions? How is Angelman syndrome related to Prader –Willi condition? Let’s cover this now.

The “ideal“ interpregnancy interval depends on the outcome of the immediate, prior pregnancy. For example, the recommended interpregnancy interval following a 1st trimester miscarriage is different compared to a live, term birth. But what about the interpregnancy interval after a stillbirth? Are the recommendations the same? In this podcast will review updated data from 2019 regarding interpregnancy interval following stillbirth. The reference for this podcast summary is Regan AK, et al; Lancet, April 2019.

You find that there is a medical indication for a cesarean birth- yet the patient refuses! What are your next steps? Should you seek a court order to intervene? “Informed refusal” encompasses a complex, multifaceted, ethical dilemma. In this session, we will review some clear guidelines from the American Academy of Pediatrics, the ACOG, and the AMA regarding the management of this difficult situation.