Dr. Chapa’s OBGYN Clinical Pearls

💥Hurricanes💥! No… Not the traditional and historic drink from New Orleans! 🍹🍹We’re talking about the intense, devastating, natural weather phenomena⚡️⚡️🌊💨🌪. We are in hurricane season! Do hurricanes cause women to enter labor, or affect pregnancy outcome? Is it an “old wives tale”, or is it true? Let’s examine the evidence....now.

Stillbirth is a pervasive problem worldwide. Maternal perception of reduced fetal movement has been identified as a potential strategy for stillbirth prevention. But is the strategy evidence-based? In this episode, we will review the 2018 randomized trial, the AFFIRM study (Lancet).

Vaginal steaming has become a cult phenomenon since 2010. But this “alternative“ practice has some real potential risks. Where did this even come from? Why is it done? And what are the potential morbidities? This podcast will cover these questions, as well as a recent (August 2019) case report highlighting the harms of this practice.

Because of the increased risk for breast cancer, BRCA mutation carriers may have concerns about taking oral contraceptives or using hormone replacement therapy after a premenopausal prophylactic bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes). Here, we review the current literature about hormone use by BRCA mutation carriers.

Women with endometriosis may represent a unique population of women at greater risk for adverse outcomes across pregnancy and birth. In this session, we will summarize the soon to be in print publication by Farland et al in Obstetrics and Gynecology. Information from the study may be helpful in counseling women with endometriosis when when they conceive.

Is 39 weeks the “sweet spot” for delivery? Neonatal and maternal adverse outcomes have been studied through increasing gestational ages from 37 weeks onward. In this episode, we will summarize the Aug 2019 publication by Chen et al, from Obstetrics and Gynecology. We will also review and apply the findings from the 2018 ARRIVE publication.

Healthcare professionals and patients may not realize that methylene blue has monoamine oxidase inhibitor (MAOI) properties. Methylene blue should generally not be given to patients taking serotonergic drugs. When should patients stop taking SSRIs prior to methylene blue use? When should they be restarted? In this session, we will review the MOA of this common dye utilized in surgery and review ways to prevent a possible lethal reaction.

Opioid use in pregnancy is a real issue! This podcast will review 2 pharmacotherapies for opioid dependency in pregnancy. We will end the session with a “rapid fire” side-by-side comparison of these 2 agents.

Chronic kidney disease can affect anywhere from 0.1 to 4% of all pregnancies. Pre-existing renal disease can have severe consequences for a pregnancy. Should low-dose aspirin be used in these patients? If so, at what dose? What about calcium supplementation? Are immunosuppressive agents safe to use? In this podcast we will cover the June 2019 ACOG “clinical expert series” monograph on chronic kidney disease in pregnancy.

Depression/anxiety can affect up to 20% of women during pregnancy. These 2 psychological conditions have adverse pregnancy outcomes in and of themselves. But what about medication use? Do SSRIs need to be tapered at end of pregnancy to reduce neonatal withdrawal? Are SSRIs linked to “Neonatal Persistent Pulmonary Hypertension”? What about other meds? This episode will review the ACOG/SMFM data on the subject.