Dr. Chapa’s Clinical Pearls.

Well, in the last 4 weeks there have some interesting developments in the sphere of OBGYN medical news. In October 2024, out of the American Society of Anesthesiologists, came a study on the possibility of using serum FAR to predict preeclampsia with severe features in admitted patients (don’t worry, we’ll discuss what FAR is!). PLUS, some exciting, although preliminary, data has been published out of Baylor College of Medicine raising the possibility of a non-invasive test for endometriosis using…POOP! Yep, poop. And on October 31, 2024 a new clinical perspectives article was published in the Green Journal “CHALLANGING” the recent ACOG’s Clinical Practice Update regarding screening for pregestational DM in early pregnancy. Intrigued? You should be….we will cover these 3 tidbits of OBGYN news in this episode!

The ARRIVE was published in the New England Journal of Medicine on August 8, 2018 1. This study was a large unmasked multicenter trial conducted from March 2014 to August randomized 6,106 nulliparous women to either IOL or expectant management at full term. The trial was conducted at 41 facilities across the United States. This validated that eIOL at 39 weeks, in that patient population, had the ability to reduce cesarean sections and rates of hypertensive diseases of pregnancy. Since that time, elective IOLs have INCREASED at 39 weeks as some messaging was distorted implying that IOL was the BEST way to go over expectant management. Has other data since 2018 found the same thing? Or were the results of the ARRIVE trial an aberration? The ACOG has JUST RELEASED a new CPU which provides additional insights to this. Listen in for details!

Urinary tract infections (UTIs) are a leading cause of health care visits in the USA and around the world. In the US, they have a cost burden of $3.5 billion annually. Half of women experience at least one UTI in their lifetime, and approximately 25% of these women develop recurrent UTIs! On October 31, 2024, a study was published in Obstetrics Gynecology (the Green Journal) looking at UTI treatment trends in nonpregnant women. With the increased use of tele-visits, there is now a conundrum between allowing easier access to care (tele-visit) and treatment of UTIs online balanced against contributing to antibiotic resistance. Is urine culture recommended prior to antibiotic use for uncomplicated UTI? That depends on who you read! We will discuss this issue in this episode. PLUS, we will briefly discuss a NEW oral antibiotic for uncomplicated UTI in women; this was just FDA approved on October 25, 2024.

Everyone understands that VTE (DVT and/or VTE) requires life-saving anticoagulation. That's simple. No controversy there. But what about pregnancy-associated superficial

According to the UK’s National Institute for Health and Care Excellence (NICE; 2024), women who are S/P scheduled CS and recovering well, who are afebrile, and do not have complications, should be discharged early (after 24 h) and followed at home because this is not related to the readmission of the baby or mother. However, the first 24 hours after a C-section can be challenging, with many of the same challenges as a vaginal delivery PLUS the usual post-surgical issues: The mother will be adjusting to new parenthood, attempting breastfeeding, and fielding visitors; the incision will be sore, and pain may increase as anesthesia wears off. Is this postop plan coming to the USA? A soon to be published systematic review and meta-analysis (Dec 2024) in the AJOG MFM seems to favor that. Is this the new progression of the postop ERAS protocol? Listen in for details.

Welcome Back to another episode of "You ask, We Answer"! As Abrysvo (RSV vaccine) now has some time on the market, some women may find themselves with a subsequent pregnancy after first receiving the injection in the prior pregnancy. Is another RSV vaccine recommended with each pregnancy, like TDap? The answer to that question depends on where you live. We will discuss in this episode. PLUS, have you heard of CLITOXIN? Its a little botulinum toxin injected into the clitoris for "enhanced sexual response". Is that evidence-based? Is there data for that?! Listen in for details.

Ultrasound assessment of placental volume has been proposed as an important aspect of prenatal care. It involves measuring the size and volume of the placenta, which may provide critical information regarding fetal health and development. Abnormal placental volume can be associated with various complications such as FGR, preeclampsia, and other pregnancy-related conditions. Some advocates suggests the volume and vascularity of the first trimester placenta may be linked to the most devasting adverse pregnancy outcomes which is stillbirth. Social Media posts have been advocating and endorsing the measurement of placental volume antenatally as a stillbirth prevention strategy. Is this evidence-based? It’s very controversial. Nonetheless, we have principles from the AIUM. ISUOG, ACOG, and SMFM to guide us here. Listen in for details.

Stroke is also a leading cause of adult-onset disability;

among individuals who survive 6 months, almost half are

dependent in at least 1 activity of daily living. In October 2024, the AHA/ASA released their 2024 Primary Prevention of Stroke guidance. This document has a striking focus on women's health, namely adverse pregnancy outcomes and certain gynecological conditions (Endometriosis, POI, PCOS). Listen in for details.

Several observational studies have suggested that women with endometriosis have a slightly increased risk for preterm birth. The cause seems to be related to factors associated with pathogenesis of endometriosis, such as inflammation, reactive oxygen species, progesterone resistance, and alterations in the junctional zone of uterus leading to the shallow invasion of the placenta and to preterm birth. But is this association firmly established? It is actually more an enigma than solid evidence. In October 2024, a new cohort study in Fertility Sterility is questioning this relationship. These results are a contrast to the findings of a meta-analysis published in January 2022, which itself conflicted with results of a French observational study published the following month, February 2022. It’s the perpetual problem and enigma of whether endometriosis is associated with PTB, or not! Listen in for details.

In November's Green Journal, Drs Amy Valent and Linda Barbour will publish their Clinical Expert Series (CES) on insulin management in GDM and Type 2 DM in pregnancy. This is a FANTASTIC document and is our subject matter in this episode. Here, we will give clinical pearls for insulin initiation in pregnancy based on 3 regimens (NPH/Reg; NPH/RAAs; Basal-Bolus) and their initiation in an easy to follow format. Congratulations to Drs Valent and Barbour on a wonderful CES.