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

At time of post cesarean discharge, most providers prescribe a fixed number of opioid tablets. However, past data has shown that most patients don't use all the opioids they are prescribed. This leads to an excess of opioids in the community, which can ultimately lead to misuse and diversion. In this episode, we will highlight a new publication from the Green Journal (Obstet Gynecol) exemplifying an adoptable strategy using a individualized opioid prescribing protocol (IOPP). While this was published ahead of print on June 10, 2024, the concept of IOPP is not "new" at all. Listen in for details.

Podcast Family, this episode has 2 parts: 1. First, a "non-medical" little life lesson that I heard recently which I will share with you...I hope it ENCOURAGES you, and 2. The MEDICAL part, which comes from Paul- one of our podcast family members. Paul had a GREAT question regarding the data covered in our immediate PAST episode on TOLAC....listen in for details!

After a primary CS, the decision to undergo trial of labor after cesarean (TOLAC) or schedule a repeat cesarean birth is one in which a patient’s values and preferences should be prioritized in a process of shared decision making. Some clinicians elect to utilize a TOLAC calculator as part of the shared decision-making process, while others use a more generalized counseling approach. Once TOLAC is decided upon, which is better: elective induction at 39 weeks, or expected management? Does elective induction at 39 weeks increase the rate of uterine rupture compared to expected management? Older observation data has suggested that very thing. In this episode, we will review a brand new publication from the AJOG (released on June 7, 2024) that provides valuable information in counseling patients on either IOL or expectant care at 39+ weeks for TOLAC.

Hemorrhagic disease of the newborn (HDNB) was first identified over a century ago, and presents as unexpected bleeding, often with gastrointestinal hemorrhage, ecchymosis and, in many cases, intracranial hemorrhage. In newborns, HDNB is typically caused by vitamin K deficiency as neonates are innately deficient in vitamin K secondary to very little vitamin K transferred through the placenta to fetuses in utero, limited liver storage of vitamin K, and low amounts of vitamin K in breast milk. IM administration of vitamin K for prevention of vitamin K deficiency bleeding (VKDB) has been a standard of care since the American Academy of Pediatrics recommended it in 1961. Despite the success of prevention of VKDB with vitamin K administration, the incidence of VKDB appears to be on the rise. This increase in incidence of VKDB is attributable to parental refusal as well as lowered efficacy of alternate methods of administration. Can parents decline this injection for their babies? In this episode, we will review IM Vit K neonatal administration and discuss the controversial data regarding Vit K oral supplementation.

Proving that our podcast tagline, “Medicine Moves Fast” is true… this episode highlights something that is, once again, 🔥🔥🔥 Off the Press! on June 4, 2024, the ACOG released a new Practice Update regarding the determination of paternal and fetal RBC genotyping in pregnancies affected by alloimmunization. This builds upon and updates PB #192 from 2018. There are 3 big areas of change here… And we will highlight each one!

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.