Dr. Chapa’s OBGYN Clinical Pearls

CMV is the most common congenital infection, occurring in 0.2 to 2.2% of all neonates. Vertical transmission of this herpesvirus is possible throughout all pregnancy with increasing rates of transmission per trimester (3 > 1). In the session, we will review the ACOG data on maternal and fetal CMV infection.

Historically, oral contraceptive pills were prescribed in attempt to help quicken resolution of ovarian cysts. Is this practice evidence-based? In this session we will review the Cochrane Database regarding this topic as well as the mechanism of action of how certain contraceptives (etonogestrel/levonorgestrel) pre-dispose to the “unruptured ovarian follicle“.

In 2018, The ACOG expanded the possibility of low-dose aspirin use in pregnancy for preeclampsia prevention. Women deemed at moderate risk (1 or more risk factor), or high-risk (only 1 high risk factor needed) were included in low-dose ASA prophylaxis. Now, a call is being made to consider “universal adoption“ of this low-cost, low risk intervention. This is a summary of this soon to be published (green journal) current commentary, “A nudge towards universal aspirin for preeclampsia prevention“.

Recently, the PROLONG Trial, investigating 17-OHP’s role in preventing recurrent preterm birth, called into question the effectiveness of this treatment regimen. However, most of the study patients in the manufacturer’s initiated study were outside of the United States and were significantly different than the original MFMU study participants. In this session, we will review both of these studies and put the results into proper perspective.

In 1858, Virchow reported on the triad of hypercoagulability, venous stasis, and vessel wall injury as the factors pertinent to venous thromboembolism. In this session, we will review the ACOG practice bulletin as well as the executive summary from the American College of Chest Physicians regarding VTE in gynecological surgery.

Postop DVT and PE are potentially devastating to a postop patient. What does the ACOG and the American College of Chest Physicians say about stopping hormone replacement therapy or oral contraceptive pills before surgery? Let’s take a look at the data.

In the United States, GDM is diagnosed by a 3 hour GTT when 2 or more values are above a designated cut off. But what happens when only one value is elevated? In this session, we will review the data regarding this clinical dilemma. We will also review if there is a clinical difference if the 1 elevated value is the fasting blood sugar or 1 of the 3 post glucose challenge. Data taken from SMFM briefings.

Umbilical cord blood banking still carries significant misperceptions regarding its potential use. Did you know, that umbilical cord blood is not meant to be used as in an AUTOLOGOUS transplant because stored cord blood contains the same genetic variant or pre-malignant condition that led to the condition being treated in the donor! In other words, a child who develops a genetic condition cannot be treated with his own donated umbilical cord blood! In this session, we will summarize the ACOG committee opinion on umbilical cord blood banking from March 2019.

IV fluids have been a hot topic with the debate between NS and LR. Recent data suggest prolonged NS therapy leads to poorer outcomes. Dive into the science behind balanced IV fluids and see why LR is now preferred for hydration.

FOAMed!!! A shout out to “free open access medical education”. Thanks for the information, Scott C.-one of our clinical medical students!