Dr. Chapa’s Clinical Pearls.

Nuchal cord (NC) is common, and the vast majority of term deliveries with nuchal cord have normal outcomes. However, nuchal cord associated fetal morbidity is closely correlated to the number on nuchal cords present and the degree of “strangulation”/tightness. Even Hippocrates noted that nuchal cords could be associated with fetal loss in one of his writings, circa 370 BC. In this session, we will review data from the ACOG executive statement on neonatal encephalopathy, as well as a literature review on NCs by Peesay (2017) from the Journal of Maternal Health, Neonatology, and Perinatology.

Umbilical Artery Doppler studies are a valuable tool to assess vital well-being in the growth restricted fetus. What are the indices that are evaluated? What is the management when abnormal results are noted? In this session, we will review fetal doppler umbilical artery velocimetry. Clinical management based upon findings will also be discussed. Dated taken from SMFM Clinical Briefs and ACOG practice bulletin 145.

In this episode, which is part 2, we will cover the role of “prophylactic” red blood cell transfusion during pregnancy. We will also cover the medical management of sickle cell crisis, and wrap up the episode with notes on intrapartum and postpartum care.

Sickle cell disease is the most common inherited condition worldwide. Sickle cell disease carries unique maternal and fetal risks during pregnancy. In this episode, which is part 1, we will review preconception care, medication use in pregnancy, and review specific obstetrical complications associated with the condition. (Reference: CDC, SMFM, RCOG data).

The interpregnancy interval provides an ideal opportunity to discuss interventions which can maximize maternal as well as neonatal outcomes. Do you know at which interpregnancy interval adverse neonatal outcomes are highest? Is interpregnancy interval associated with higher TOLAC risk? In this session, we will summarize the ACOG obstetric care consensus report (#8) from January 2019.

At what gestational age does the uterus become responsive to oxytocin? Can Pitocin result in hypertension or HYPOtension?...And who was Sir Henry Dale? In this podcast, we will review the origins, development, pharmacology, and potential adverse affects of synthetic oxytocin.

Is Digoxin routinely used for peripartum cardiomyopathy? Can women who had peripartum cardiomyopathy take oral contraceptive pills? In this episode, which, is part 2, we will answer these questions as well as cover the workup, management, and prognosis of peripartum cardiomyopathy (Reference: Obstet Gynecol. Jan 2019).

(Part 1): Peripartum cardiomyopathy occurs in about 1 in 2,000 births in the United States. Although relatively rare, it can be devastating to the mother. In this session we will summarize the January 2019 clinical expert series on peripartum cardiomyopathy from Dr. Gary Cunningham, et al (Obstet Gynecol. Jan 2019).

Did you know the common, modern-day, colloquial expression about “blowing smoke up someone’s A$$” actually has a medical origin? Yep... it was a real therapy! In this podcast, we will review the bizarre practice, that made its way into modern vernacular.

In 2013, the ACOG released a comprehensive review on hypertensive disorders in pregnancy. In January 2019, the College re-visits gestational hypertension and preeclampsia and gives important updates. In this podcast, we will review 2 very clinically applicable aspects of intrapartum care for patients with gestational hypertension and preeclampsia. Who should get magnesium sulfate? And what’s the data on epidural use in these patients? Let’s find out what the ACOG has to say.