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Dr. Chapa’s Clinical Pearls.
19 minutes | Feb 26, 2022
Optimizing Natural Fertility (ASRM)
Couples trying to conceive often ask questions like these: When is the best time to have sex to get pregnant? Is there a better sexual position to have sex in order to conceive? Is one type of over the counter lubrication better than the other? Well despite weird myths and misperceptions about these subjects, there are firm answers we can give. In this podcast we will cover the January 2022 ASRM Bulletin on ways to “optimize natural fertility”.
14 minutes | Feb 22, 2022
Water Immersion in Labor: AAP/ACOG vs ACNM
Hydrotherapy (water immersion) has a proven safety record and proven benefits in the first stage of labor. But what about actually delivering with water immersion? In January 2022, the AAP released a Committee Opinion regarding water immersion delivery. The AAP echoes the words from the ACOG regarding water immersion births. However, the ACNM does not agree. In this session, we will review the established and conflicting viewpoints from these organizations regarding water immersion in labor and delivery.
17 minutes | Feb 17, 2022
23AndMe and OCPs
The old adage, “Too much of anything is a bad thing”, is traditionally credited to Mark Twain. Was he right? Does the same apply to medical information?What about finding incidental genetic carrier states from online companies like “23AndMe”? In a patient with no personal or family history of any medical complication or malignancy, is this information helpful or more psychologically harmful? In this episode we will review a recent real-world case of how gynecological care was impacted by a patient’s curiosity regarding her genetic makeup.
19 minutes | Feb 13, 2022
SMFM US Criteria for PAS (MOC Review)
Placenta Accreta Spectrum (PAS) encompasses a range of abnormally adherent placentas. This is a major cause of maternal morbidity and mortality. The SMFM recently published a consensus opinion with input from a variety of professional/medical societies to standardize the diagnostic evaluation and diagnosis of this condition. In the session, we will review the SMFM Special Report on ultrasound markers for PAS. (This is also one of the ABOG’s articles for January 2022 MOC).
21 minutes | Feb 8, 2022
Allergic to Semen!
Semen allergy is a real (although rare) immune reaction. Do you know what the presenting signs/symptoms are?The ISSM has established diagnostic criteria for this. In this session, we will review the diagnostic algorithm for a patient presenting with possible semen allergy.
16 minutes | Feb 5, 2022
Did WHO Ban Bakri?
Postpartum hemorrhage continues to be a worldwide leaning cause of maternal morbidity and mortality. In May 2021, the WHO updated it’s global recommendations for the use of “uterine balloon tamponade” in the management of PPH. Did the WHO ban the Bakri? In the session we will review the May 2021 WHO updated guidance and summarize a soon to be released guideline commentary from the ACOG (proposed release date March 2022).
19 minutes | Feb 1, 2022
Standardizing CS Surgery: 2022 MOC Review
Cesarean section is the most common major abdominal surgery performed worldwide. Despite its common performance, authors have been unable to agree on the best way to do it. The variety of C-section techniques makes it difficult to perform systematic reviews dealing with cesarean sections. Should we standardize C-section technique? What would that look like? Would we exteriorize the uterus for repair or leave it in-situ? Would we perform intra-abdominal irrigation, or not? In this session, we will review an article from the ABOG’s Jan 2022 MOC list which makes “the case for standardizing C-section technique”.
16 minutes | Jan 26, 2022
Hematuria! (ABOG MOC Summary)
Hematuria is subdivided into visible (gross) hematuria and microhematuria. Most cases of microhematuria are thankfully benign, but in some patients it may be a red flag (no pun intended) for something more ominous. What defines hematuria? Do all patients need urological referral? In this session, we will summarize and highlight one of the ABOG MOC articles (Jan 2022) which helps clear up the mystery of Hematuria.
18 minutes | Jan 22, 2022
Adolescent BC and Bone Health: ABOG MOC Jan 2022
The adolescent years are critical for peak bone mass acquisition, a major determinant of future bone health. Adolescence is also the time of initiation of sexual activity, and improved contraceptive use has contributed to the decline of unintended teen pregnancies. In this episode, we will review the effect of various contraceptive agents on bone health. This is an ABOG MOC article from January 2022 (Pediatric and Adolescent Gynecology section).
13 minutes | Jan 20, 2022
Birth During Covid and Child Development: NEW DATA
Globally, more than 200 million infants have been born since the onset of the COVID-19 pandemic. It has been unclear whether fetal exposure to maternal SARS-CoV2 infection can adversely affect the child’s neurodevelopmental progress. Does having Covid during pregnancy affect the child’s neurodevelopment? The answer is intriguing! This is a tale of a pandemic, psychosocial stress response, and epigenetic changes. (Data summary from JAMA Pediatrics; Jan 2022).
6 minutes | Jan 15, 2022
NEW ACOG ADVISORY: JAN 2022
In the ACOG Practice Bulletin #106, which was released in 2009, the use of maternal supplemental oxygen for fetal heart rate tracing correction is mentioned. In that original bulletin, it states “despite inadequate data to support its use” consideration can be given to supplemental maternal oxygen for category II or III fetal heart rate tracings. However, within the last 7 years, an ever-growing body of evidence has proven that supplemental oxygen for fetal heart rate pattern abnormalities is not only ineffective but may actually be harmful to the premature fetus. Now, as of January 2022, we now have new guidance on this. Find out how and why the ACOG has now changed its original opinion.
20 minutes | Jan 13, 2022
OB HTN UPDATES (BIG CMQCC Recommendations).
Hypertensive disorders in pregnancy are a large contributor to maternal mortality. Maternal mortality rates for chronic hypertension in pregnancy have increased 15-fold over the last 4 decades! The California Maternal Quality Care Collaborative (CMQCC) has been a leading authority in the Pregnancy Hypertensive space. In the session, we will review BIG updates from the CMQCC. Should we aggressively treat chronic hypertension in pregnancy? What about treating nonsevere gestational hypertension? Are you familiar with the new Cardiology subspecialty of “Cardio- Obstetrics“? Let’s cover all this information… NOW!
12 minutes | Jan 7, 2022
New Data on Periods After Covid Vaccination
Concerns about a possible association between COVID-19 vaccination and abnormal menstrual cycles may lead to vaccine hesitancy. Social media sites have claimed that cycles are affected, although temporarily, after vaccination. Is this true? In the session, we will summarize a soon to be released publication out of Obstetrics and Gynecology which helps clarify this issue. We will also highlight a press release from January 6, 2022 from a major news outlet which seemingly appears to distort those results.
12 minutes | Jan 6, 2022
Repeat CS timing with 2+ CSs
Women with multiple prior low-transverse CSs show a trend toward increased risk of rupture compared with a single prior CS. While some have advocated planned repeat CS at 39 weeks as in patients with a SINGLE previous cesarean, planned repeat CD at 38 weeks is likely to be associated with a lower risk of uterine rupture. Yet, there is no consensus on best practice. In this session, we will summarize a new AJOG publication (Jan 2022) that raises some interesting and clinically meaningful data regarding the timing of repeat CS in women with 2+ prior cesareans (Shinar et al. Timing of cesarean delivery in women with 2+ previous cesarean deliveries. AJOG; Jan 2022).
13 minutes | Jan 4, 2022
Zmax Beats E-Mycin for PPROM Care
In 1997, Mercer et al first published their data on antibiotic use for PPROM latency. With IV Erythromycin shortages, Zmax is a known substitute. New data (EPUB December 2021) now points to Zithromax’s validated clinical advantage over Erythromycin in this protocol. In this session, we will review this soon to be released publication in AJOG.
17 minutes | Dec 29, 2021
Not All LARCS Are Equal!
Traditionally, physicians have informed patients that long acting reversible contraceptives are “just as effective“ as female sterilization. While as a Class that statement is correct, not all individual LARCS have the same efficacy; one in particular beats all other birth control methods, hands-down. Do you know which one? In this session we will review key facts regarding female sterilization and review the individual efficacies of long acting reversible contraceptives. We will also review the historic “math model” for female sterilization.
10 minutes | Dec 23, 2021
Tale of 2 Anti-Covid ORAL MEDS: Ok for Pregnancy?
As of December 23, 2021 the FDA has granted Emergency Use Authorization to 2 different oral medications (Pfizer; Merck) in the fight against Covid-19. Do you know the differences between PAXLOVID and molnupiravir (LAGEVRIO)? What are their indications for use? Are both allowable in pregnancy? This information is “hot off the press” and will update you on these 2 new, novel therapies.
9 minutes | Dec 22, 2021
Nonvigorous Newborn & Delayed Cord Clamping
In our previous podcast, we stated that – due to lack of data – early cord clamping may be considered with nonvigorous neonates. However, the babies that may benefit the most (preterm or extremely pre-term) are often “nonvigorous” at birth. So how do we reconcile this issue? This podcast will answer this dilemma, summarizing points from the January 2022 CME publication on “Placental Transfusion of the Neonate“.
24 minutes | Dec 19, 2021
Placental Transfusion of the Neonate (Jan 2022 ACOG CME Summary)
There are 3 umbilical cord management strategies at time of delivery: (1) Early cord clamping, (2) Delayed clamping, and (3) Cord milking. How long should umbilical cord clamping be delayed? Is cord milking beneficial or potentially harmful? Are you familiar with the contraindications to delayed umbilical cord clamping? In this session, we will review this soon to be released CME article from Obstetrics & Gynecology (The Green Journal) covering “placental transfusion of the neonate”.
13 minutes | Dec 15, 2021
SSE: To Lube or Not to Lube.
The clinical gold standard for the diagnosis of ruptured membranes is the sterile speculum examination (SSE). Tests like Amnisure or ROM+ are considered ancillary and supplemental. What is best clinical practice for performing a SSE? In the session we will review this procedure, discuss ancillary testing, and answer the age-old-question… “To lube or not to lube”.
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