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

Preterm birth is the leading cause of death in newborns and children. Tocolytic drugs aim to delay preterm birth by suppressing uterine contractions to allow time for administration of corticosteroids for fetal lung maturation, magnesium sulphate for neuroprotection, and transport to a facility with appropriate neonatal care facilities. However, there is still uncertainty about their effectiveness and safety. Plus, more than 90% of the data regarding tocolytic use comes from patients with threatened preterm labor with intact membranes, with (according to the WHO) only 9% of available data is regarding patients with ruptured membranes. But in May 2024, a new publication adds further information to this subset of patients. In this episode, we will review this ongoing controversy regarding the benefits of tocolytic therapy, and when they may provide the most efficacy. And yes, of course, we will provide the ACOG guidance as well.

Haemorrhage, hypertensive disorders, and sepsis are responsible for more than half of maternal deaths worldwide. Further, it is estimated that for every death, there are 50 pregnant people with life-threatening morbidity from sepsis. Heartbreakingly, the incidence of puerperal sepsis has risen over the last decade, in some cases doubling, with increasing rates of severe sepsis contributing to mortality. Underlying this trend is increasing virulence of group A streptococcal (GAS) infection. This is suspected to be due to the predominance of emm1 and emm28 genotypes, which have higher associations with mortality, as well as increasing maternal risk factors for infection such as obesity and DM. PLUS, certain GAS antibiotic resistance is on the rise. Group A streptococcus infection remains an important contributor to pregnancy and puerperal morbidity and mortality. Early recognition, diagnosis and aggressive management are Important for favorable outcomes given the serious risk of sepsis and streptococcal toxic shock syndrome. In this episode, we will highlight this alarming rise of Group A strep in the peripartum period including the most recent 2021 International Society for Infectious Disease in Obstetrics and Gynecology (ISIDOG) guidelines regarding GAS in pregnancy. Listen in for details.

Menopausal HRT is getting a big, big facelift! Get ready for new research trials, physician education programs, and patient awareness campaigns on menopause! Since the WHI study was released in 2002, the world of menopausal HRT has gone through some major changes. WHI initially led to confusion and fear regarding the use of menopausal HRT. But now, 30 years later, where do we stand? In this episode, we will highlight 2 brand new publications released on May 1, 2024, which prove that we are finally digging out of the hole of WHI. Plus, there’s a Hollywood actress behind the new menopause awareness campaign… and we’ll tell you who that is, and more, in this episode. 😊😊😊

Just the other day in my University clinic, in one single morning, I had 3 separate patients with three very interesting histories; these became the basis of this episode. It’s amazing what’s out there in daily practice! So, we will dive into these 3 main questions which arose from these 3 patient encounters: 1. What single test is recommended before initiation of combination birth control pills? And if this is recommended, how do online pharmacies prescribe prescription birth control? 2. Does PCOS cause other hormone (Prolactin? HCG?) disturbances? And 3., Is treatment of acne within the wheelhouse of women’s healthcare providers? We’ve got lots to cover in this episode…so let’s get started, NOW.

Well, once again… Late breaking news! Today, April 30, 2024, the USPSTF released its updated recommendations for breast cancer screening (mammography) in average risk patients. This follows a firestorm of controversy and backlash over the last 1 to 2 years as the USPSTF continued to recommend initiation of mammogram at age 50, despite the increased incidence of breast cancer in women in their 40s. In this episode, we will review this brand new recommendation and summarize the ACOG response from ACOG President, Dr. Hicks.

Traditionally, clinical guidance has incorporated maternal fever as a required criterion for suspected intraamniotic infection. That is exactly what is stated in the ACOG committee opinion #712 from 2017. However, not all patients with clinical IAI have fever! Having fever as a required part of the diagnostic criterion may result in delayed administration of appropriate antibiotics intrapartum. This has now been addressed by the ACOG! Today, on April 29, 2024, the ACOG released a practice update regarding the criteria for the diagnosis of suspected intra-amniotic infection. This is hot of the press, and we will break it down for us all in this episode. 🔥🔥🔥🎙️🎙️🎙️👍👍🙏