Dr. Chapa’s Clinical Pearls‪.‬ Dr. Chapa’s Clinical Pearls

June is CMV awareness month. And that’s the keyword there… Awareness! The way we prevent CMV transmission is by awareness. It would be great to have a vaccine against this virus, but we just don’t…yet. Until a safe and effective CMV vaccine is clinically available, primary prevention of cCMV relies on patient education and hygiene measures. In this episode, will take a look at this strategy and see what the data has to say about it. Will also discuss the very controversial (and non-ACOG recommended) use of antiviral medication’s for primary, perinatal CMV.

In 2011, Congress passed a resolution naming June "National CMV Awareness Month," to raise awareness about the most common congenital infection in the US, affecting 1 of 200 live births. It is the leading VIRAL cause of IUFD & miscarriage & the leading cause of neonatal hearing loss, second only to genetic causes. Furthermore, cCMV is more common than many other neonatal conditions, such as spina bifida and fetal alcohol syndrome. Neonates affected by the virus can experience a wide array of symptoms, from none to severe neurodevelopmental disability, & even death. However, public and healthcare provider awareness remains low. In this episode, which is Part 1, we will cover the presentation, transmission, and work up of CMV in pregnancy.

(VACAY EDITION) Recently in our high-risk OB clinic, I saw a patient who was disappointed that she “had to stop breastfeeding” as she entered her 3rd trimester with her 2nd child. Her first pregnancy was via vaginal birth, at term, with no complications. This situation is not frequently addressed and is a clinical dilemma. First, when nursing coincides with pregnancy, there is frequently a significant cultural taboo leading many women to wean their infants when they become pregnant again. Secondly, there is the concern for potential maternal “nutritional depletion” and thirdly, there is a fear of triggering preterm birth due to oxytocin release with breastfeeding. Nonetheless, there are mothers who wish to breastfeed throughout their subsequent pregnancy. This practice is known as breastfeeding during pregnancy (BDP). Is there data that shows that BDP increase miscarriage risk? What about FGR? Does it increase the risk of PTB? In this episode, we will review the latest data on this not too frequent- but real world- occurrence.

In our podcast archive, we have an episode titled, “TikToc’s #IUD is Killing a Good LARC”. In that episode, I discussed our protocol of using viscous lidocaine applied topically to the cervix, cervical canal, and coating the IUD device for placement. This works! In this episode, we will build on that concept by reviewing a publication released on May 23, 2024 in the AJOG. Could this be the remedy for painful IUD insertion? Plus, have you heard of the CAREVIX device? Listen in for details.

It definitely is interesting how published data tends to have sporadic “groupings” in print. For example, last week 2 publications were released which could be placed under one “group”: prediction/prevention of spontaneous preterm birth. One publication (AJOG MFM) presented a systematic review and meta-analysis on universal cervical length screening. The second publication, SMFM’s consult series # 70, pertains to the management of a short cervix in individuals without a history of spontaneous preterm birth. In this episode, we will review these 2 similar, yet different, publications and make sense of all! 👍👍👍

It’s exciting to know that we are practicing a type of medicine that is alive and ever-evolving! Such is the case regarding our clinical practice/management of gestational diabetes. In this episode, we will review brand new (as of May 21, 2024) clinical guidance from the ACOG regarding gestational diabetes. Should we be screening for diabetes before 24 weeks? Is there one diagnostic threshold which is suggested for use over the other (CC versus NDDG)? And is it possible to screen for postpartum DM as early as 2 days after delivery?😳 Listen in and find out.