Dr. Chapa’s OBGYN Clinical Pearls

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.

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).