Dr. Chapa’s Clinical Pearls.

According to the CDC, 1 in 8 of the 1.2 million people living with HIV in the United States are unaware of their HIV status and only half of those known to be infected are receiving effective anti-retroviral therapy. The combination pill tenofovir/emtricitabine has been FDA approved for pre-exposure prophylaxis (PrEP). In this podcast will review the current state of PrEP therapy. (Reference: HIV pre-exposure prophylaxis, a review: JAMA, 2018.)

Perinatal depression, which includes major and minor depressive episodes that occur during pregnancy or in the first 12 months after delivery, is one of the most common medical complications during pregnancy and the postpartum period. According to the ACOG, 1 in 7 women are affected by perinatal depression! In this session we will review the ACOG committee opinion on screening for perinatal depression from the winter of 2018 (committee opinion 132).

Polyhydramnios is an abnormal increase in amniotic fluid volume typically diagnosed in the second or third trimester. Either the single deepest vertical pocket or AFI can be used for diagnosis. The two most common pathological causes are maternal diabetes and fetal anomalies. In this session, we will summarize the SMFM consult series #46 (2018) on the evaluation and management of polyhydramnios.

Diabetic ketoacidosis in pregnancy is an obstetric and medical emergency and therefore requires prompt and aggressive treatment in a specialized care unit. Prompt and aggressive IV fluid management, IV insulin administration, and attention to key electrolytes are foundational to DKA management. In this podcast, we will review the SMFM protocol for DKA management in pregnancy.

Corticosteroid therapy for fetal lung maturity was first endorsed back in 1994. But what do we know about its affect on glycemic levels? Pregnant women with gestational diabetes, and of course pre-existing diabetes, are at higher risk of DKA at “lower” hyperglycemic levels compared to non-pregnant individuals. In this session, we will review the data on the effect of antenatal corticosteroids on the mothers’ glycemic levels.

You just have to listen…

Incidence of cerebral palsy is inversely related to gestational age a delivery. The first reported association between fetal exposure to mag sulfate and reduction in perinatal morbidity was published in 1992. Magnesium sulfate for fetal neuroprotection is now standard in women presenting with preterm labor at less than 32 weeks. In this podcast, we will review the data on mag sulfate for fetal neuroprotection and summarize current best practices. Data is taken from the ACOG, SMFM, and Cochrane review on mag sulfate for fetal neuroprotection.

In 1932 a governmental agency called the Public Health Service began working with the Tuskegee Institute to study syphilis in black men. In 1947, when penicillin was discovered as the illness cure, participants in the study were denied treatment in “order to study the natural outcome of disease”. In the early 1970s, the “study” was finally deemed unethical and was stopped. As syphilis cases continue to rise in the US, we must not forget the principles of ethical scientific discovery and not forget those who participated in a study which violated all currently accepted ethical standards.

This is Part 2 of our critical reappraisal of the WHI study. In this episode we will cover the NAMS 2017 guidelines on HRT use. Does hormone therapy increase breast cancer in BRCA carriers? What is the data on ovarian cancer? Dementia? Listen to find out! We will also briefly touch on transdermal hormone replacement therapy, at the end of the podcast.

(Part 1) The media attention surrounding the publication of the initial results of WHI in 2002 led to fear and confusion regarding the use of hormonal therapy (HT) after menopause. In 2006, re-analysis of more complete data seemed to contradict the original findings. This led to a “retraction“ and re-explanation of the original data in 2007. Hormone therapy initiation in older women is NOT the same as initiation in younger women! In this session, we will take a critical look at the original WHI data from 2002 and the complete data and reanalysis released in 2007. We will separate fear from reality! Data for this episode comes from the WHI original trial, NAMS analysis, WHO data, as well as the international menopause society.