Dr. Chapa’s Clinical Pearls.

Eclampsia is a life-threatening pregnancy complication, defined as the new onset of seizures during pregnancy with a concomitant diagnosis of preeclampsia. Clinicians often ask patients with suspected preeclampsia about headaches, visual changes, or epigastric pain. Are the symptoms predictive of eclampsia? In this session, we will review the soon to be published (systematic review) evaluating the current literature regarding signs and symptoms that occurred before the onset of eclampsia and estimate their predictive value. Are they enough to determine who does/does NOT get MagSulfate? Let’s see.

The prevalence of obesity is at an all-time high in the United States, and the obesity rate among women is 40%, with 9.8% of women having class III obesity (BMI 40 or higher). As a result, obesity is a frequent and severe comorbidity of pregnancy. Whether or not incisional negative pressure wound therapy reduces wound morbidity is an important question for obstetricians and patients. In this podcast, we will summarize the key findings from a soon to be released RCT from my Alma Mater, UT Southwestern, investigating whether or not negative pressure devices applied at CS in obese patients prevents wound morbidity...or not.

Are green scrubs just a fashion statement? What’s behind the choice of green (or sometimes blue) scrubs? Well, there actually is some science to that… In addition to just interesting history. Let’s take a look at that, now.

In Sept 2019, the USPTF revised and updated its 2013 recommendations on medications for risk reduction of primary breast cancer. Who qualifies for medical strategies? Which meds are recommended? In this session we will highlight the new USPSTF Guidelines, review the use of Prediction Models, and compare Tamoxifen, Raloxifene, and Aromatase Inhibitors.

Once taboo, anal sex has slowly been slipping into the mainstream. A recent study found that 37% of women reported having anal sex with the opposite sex in their lifetime, and over 60% reported providing oral sex. However, the CDC does not specifically mention routine screening of extragenital sites for STIs. In this podcast, we will review the most up-to-date data on extragenital infection and make the case for “routine“ screening of extragenital STIs.

Treatment strategies for IC should proceed using more conservative therapies first with less conservative therapies employed if symptom control is inadequate for acceptable quality of life. Multiple, concurrent treatments may be considered if it is in the best interests of the patient. In this session, we will review the AUA clinical guidelines regarding management of IC with a review of the 1st-line to 6th-line treatment recommendations.

The effects of IC/BPS on psychosocial functioning and QoL are pervasive, damaging work life, psychological well-being, personal relationships and general health. There’s been a lot of new data regarding this condition and some historic information has been deleted. For example, potassium installation into the bladder is no longer recommended. That diagnostic test, occasionally still found in some gynecological texts, can cause exquisite pain if the bladder is acutely inflamed. Therefore, this is no longer considered a diagnostic tool. Additionally, options for treatment are now quite varied and include FIRST-line to SIXTH-line options. This is PART 1 covering IC pathophysiology, clinical presentation, and diagnostics (including physical exam and ancillary testing). We will leave treatment options for Part 2.

In 2017, the ACOG defined 3 classes of intraamniotic infection. Although most research/data has been on inflammation/infection of the placenta/membranes itself (chorioamnionitis), only recently has data on inflammation of the umbilical cord (funisitis) been forthcoming. Is inflammation of the umbilical cord directly related to microbial invasion? Does this have any neonatal implications? In this podcast we will review the pathological basis and clinical implications of funisitis.

Obstetrical forceps have a strange history: considered by historians to have been created by William Chamberlain, a French surgeon, the tool was kept a close family “secret” for well over a century! Eventually, the device and concept was sold by a destitute Chamberlain family member. William Smellie would then take this device to the masses. In this podcast, we provide a brief historical perspective on obstetrical forceps.

Never. Forget.