Dr. Chapa’s Clinical Pearls.
846 episodes - English - Latest episode: 10 days ago - ★★★★★ - 252 ratingsRelevant, evidence based, and practical information for medical students, residents, and practicing healthcare providers regarding all things women’s healthcare! This podcast is intended to be clinically relevant, engaging, and FUN, because medical education should NOT be boring! Welcome...to Clinical Pearls.
Homepage Apple Podcasts Google Podcasts Overcast Castro Pocket Casts RSS feed
Episodes
Female Low T?
April 17, 2024 20:13 - 49 minutes - 45.2 MBThere is a STRONG debate within the medical community as to whether testosterone should be prescribed to women during menopause and the time before and after it. Social media influencers and other media personalities are touting testosterone as a cure-all for mood, sex drive, cognitive changes, fatigue, reduced muscle strength, and other symptoms associated with menopause. In fact, the number of testosterone prescriptions for women has risen within the last five years in the United States and...
IV Fe PP, and More
April 15, 2024 03:09 - 50 minutes - 46.3 MBWhile the importance of optimizing a woman's hemoglobin level during the peripartum period has been emphasized in recent guidelines by the Society for Obstetric Anesthesia and Perinatology, the ACOG, and the Enhanced Recovery After Surgery Society, postpartum anemia remains a real issue in both the developed and developing world. Postpartum anemia has been associated with depression, fatigue, impaired lactation, and impaired cognition. This may lead to impaired maternal-child bonding. Additio...
Amnioinfusion with IAI? Yay or Nay?
April 12, 2024 16:50 - 42 minutes - 38.6 MBAmnioinfusion was first described in 1976 using a rhesus monkey model. In that landmark study, the authors reported that variable decelerations occurred when amniotic fluid was removed from the uterine cavity and resolved when it was replaced. Although this experiment established that variable decelerations related to oligohydramnios and cord compression could be corrected by amnioinfusion, the technique did not achieve clinical application until 1983, when a novel approach to the relief of v...
Acetaminophen (Paracetamol) in Pregnancy and Autism: Latest Data (April 9, 2024)
April 10, 2024 15:36 - 30 minutes - 27.8 MBIn 2014, a publication out of JAMA Pediatrics raised questions regarding the safety of acetaminophen in pregnancy describing a possible “association” with later neurodevelopmental and cognitive delays in children. What followed was a string of controversial publications (observational) with mounds of conflicting data. This led to a controversial international consensus opinion in 2021 calling for “caution for use” regarding acetaminophen in pregnancy. The ACOG had a strong rebuttal to that st...
When Things Go South: Perinatal PTSD
April 08, 2024 21:13 - 48 minutes - 44.8 MBIt has been stated that “Trauma is in the eye of the beholder”. Healthcare providers must be aware that a woman makes experience a birth as traumatic, even if she and her infant are healthy. The ACOG has highlighted perinatal PTSD in several publications, which we will review in this episode. Perinatal PTSD has definitely been in the OB/GYN and psychology literature with an increased frequency just over the last 3 months. In this episode, we will review the very real and devastating condition...
New HDP Med Data: The PYTT Study
April 07, 2024 13:54 - 30 minutes - 28.3 MBIn July 2023 and again in November 2023, we discussed the “Rule of 55“ and its role in the management of hypertensive disorders of pregnancy. The Rule of 55 has been mainly applied in the selection of appropriate antipretensive medications when urgent/emergent hypertension is present. Does the Rule of 55 also work for antihypertensive management of gestational hypertension or preeclampsia without severe features? A new publication (April 1, 2024) from the AJOG MFM gives us that answer! In thi...
The Eclipse’s Effect on Pregnancy ☀️🌞🕶️🕶️🌖🌗🌘🌑
April 05, 2024 21:58 - 26 minutes - 24.3 MBOn April 8, 2024, parts of the United States will be within the Path of Totality for the total solar eclipse. The state of Texas has already declared a state of emergency as visitors flock to the state to witness the event. This is a fascinating celestial occurrence that is not scheduled to happen again until August 2044. Does the eclipse have a negative effect on pregnancy? Do lunar cycles affect birth rates? What does the data say? Does NASA have a statement on this? And what are neutrinos?...
⭐️NEW⭐️Clinical Practice Update: ACOG Updates PB 222 (Biomarkers for PreE).
April 04, 2024 00:18 - 25 minutes - 23.4 MBToday, April 3, 2024, the ACOG released a clinical practice update to practice bulletin# 222 (gestational hypertension eclampsia). This is in direct response to a recent FDA approved biomarker test for risk stratification for preeclampsia. On May 19, 2023, the FDA cleared a novel biomarker serum test for the risk stratification for severe preeclampsia in hypertensive pregnant women. This clearance is the first given to any blood-based biomarker test for assessing preeclampsia risk. The compan...
New Data Re: Obesity in Pregnancy- Weight Gain Recs, and NPWT at CS
April 02, 2024 19:48 - 44 minutes - 40.4 MBAccording to the CDC, as well as worldwide data, the percentage of individuals categorized as overweight or obese is rising. First released in 1990 by the IOM, the guidelines for expected weight gain in pregnancy-based on pre-pregnancy weight (BMI)- have been controversial. These guidelines were revised in 2009. Now, a new publication from the Lancet (28 March 2024), is questioning the validity of the “minimal weight gain” recommended for patients with obesity. In this episode, we will review...
The Steroids Saga: New Data, New Debate, New News.
April 01, 2024 17:44 - 38 minutes - 35.2 MBThe current dose and schedule for antenatal corticosteroids (ACS) follows the original publication by Liggins and Howie in 1972. That dose and schedule was based on sheep models from the 1960s. The dose in current use had never been evaluated to minimize exposures while assuring efficacy. New pharmacokinetic and pharmacodynamic data is calling into question whether the current dose and schedule is necessary. Translational research in animal models indicate that a constant, low concentration f...
Depo-Provera Causes Brain Tumors?! 😬🧠😬
March 29, 2024 19:41 - 38 minutes - 35.2 MBMeningiomas are common intracranial tumors with a female predominance. The vast majority of these tumors are benign (World Health Organization [WHO] grade 1) while 15% to 20% of these tumors can behave atypically (WHO grade 2) and rarely, in 1% to 2% of cases, these tumors can be malignant (WHO grade 3) Their etiology is still poorly documented. The role of sexual hormones has long been proposed, but data have been conflicting across studies. However, a dose-dependent relationship between the...
Depo-Provers Causes Brain Tumors?! 😬🧠😬
March 29, 2024 19:41 - 29 minutes - 27.1 MBMeningiomas are common intracranial tumors with a female predominance. The vast majority of these tumors are benign (World Health Organization [WHO] grade 1) while 15% to 20% of these tumors can behave atypically (WHO grade 2) and rarely, in 1% to 2% of cases, these tumors can be malignant (WHO grade 3) Their etiology is still poorly documented. The role of sexual hormones has long been proposed, but data have been conflicting across studies. However, a dose-dependent relationship between the...
Balloon For PROM? Yea or Nay
March 27, 2024 15:15 - 53 minutes - 49.3 MBAccording to the ACOG, pre-labor rupture of membranes (PROM) complicates 10% of all births in the United States and is a major contributor to perinatal morbidity and mortality. What is the best course of action when patients present with PROM with a “unfavorable cervix”? Should it be a pharmacological method of ripening, or a mechanical? What does the data say? In this episode, we will do a deep dive into published data from the 1980s up to 2023. We will also explain why the Bishop score “is ...
Neonatal Subgaleal Hemorrhage: Pearls of Wisdom
March 25, 2024 16:19 - 47 minutes - 43.5 MBObstetrical vacuum and forceps are incredible tools, when used correctly, to assist vaginal delivery. Appropriately selected and used, they can be pivotal in reducing the number of unnecessary cesareans and potentially decreasing certain fetal and maternal complications. However, there are several pearls of wisdom to remember when using them. In this episode, we will focus on a rare – but potentially fatal – complication of vacuum use: subgaleal hemorrhage. Although subgaleal hemorrhage can o...
New Menopause CURE? The Ovarian Autotransplantation Debate
March 22, 2024 03:38 - 30 minutes - 28.2 MBOvarian preservation by autologous transplantation has given hope to patients desiring future fertility after certain gonadotoxic therapies for malignant conditions. But now, the same procedure is being promoted as a “natural cure” for menopause. Can ovarian tissue-based therapies really be the female, endocrine “fountain of youth”? In this episode, we will highlight a recent publication from the AJOG describing the potential of this procedure. We will also discuss the history of ovarian auto...
PreMeal or PostPrandial Glucose Checks PP with Type I DM
March 21, 2024 00:10 - 43 minutes - 39.8 MBSince the late 1990s, the standard practice for GDM care has been to measure postprandial glucose values. For patients with pre-gestational diabetes, whether type I or type II, the ACOG recommends multi-level glucose checks (fasting, pre-meal , postprandial, and nighttime). But what about in the immediate postpartum interval? In patient’s with pre-existing diabetes, should blood sugars be checked pre-meal (qAC) or postprandial while still in the hospital, and after discharge? The topic for th...
Hep C and BF Confusion (and Updated HIV BF Guidance)
March 18, 2024 16:20 - 47 minutes - 43.4 MBIs breastfeeding with Hepatitis C safe? The answer: Yes! But confusion persists today mainly surrounding the serum hepatitis C viral load. That’s the topic and focus of the new publication released March 2024 in the Green journal, Obstetrics and Gynecology. We will highlight this new study in this episode. Yep, we have learned a lot about hepatitis C, and HIV, and breast-feeding. In this episode, we will review: the different hepatitis C genotypes and their implications, current breast-feedin...
Are ADHD Meds Safe In Pregnancy?
March 15, 2024 13:55 - 36 minutes - 33.4 MBIt has been estimated that up to 4.4% of the US adult population has been diagnosed with ADHD. Use of ADHD medication is increasing among pregnant women. In the last several years, there’s been a litany of publications looking at the effects of pregnancy on ADHD, as well as the effects of medication on the pregnancy. In this episode, we will highlight a new publication released March 2024 (Archives Women’s Mental Health) examining prenatal outcomes in women who continued dexamphetamine in pre...
Check the Box: REASSURING NEWs regarding US Maternal Mortality
March 13, 2024 19:21 - 37 minutes - 34.7 MBFour years, the US National Vital Statistics System has reported an abnormally high maternal mortality rate in the United States, showing it to be nearly doubled from 17.4 in 2018 to 32.9 per 100,000 live births in 2021. The United States’s maternal mortality rate has been on the media radar for many years because of this. But that rate is completely WRONG. How is it that maternal mortality rates are more than 2 to 3 times higher than other developed countries despite our vast progress in obs...
Should We Screen For Thrombophilia Pre-OCP? March 2024 Data
March 10, 2024 01:26 - 51 minutes - 47.2 MBThe ACOG, CDC, and WHO currently do not recommend universal screening for thrombophilia in the general population before starting oral contraceptive pills. However, a new publication in AJOG (March 2024) is challenging that stance. In this episode, we will review this new prospective population-based study to see if it makes the case for universal screening for thrombophilia variants before starting OCPs. In this episode, we’ll also discuss high-risk versus low-risk thrombophilia, discuss rel...
Metformin in OB and Child's Neurodevelopmental Outcomes (March 2024 Data)
March 08, 2024 18:28 - 40 minutes - 37.1 MBGestational Diabetes (GDM) is vastly more prevalent in pregnancy compared to pre-existing diabetes. In 2009, the ACOG states that 7% of all pregnancies were complicated by a diabetes diagnosis, with 86% being GDM. The prevalence of GDM keeps rising in the US and globally. Metformin is increasingly prescribed in pregnancy, yet its long-term effect on the neurocognitive development of the offspring remains incompletely described. However, newly published data (March 6, 2024; AJOG) has changed t...
OPill…Now HERE! (ACOG PA March 2024)
March 07, 2024 04:19 - 29 minutes - 27.3 MBOn this podcast, we have been following this story of the OPill for several months. Previous episodes on the subject can be found in our podcast library. As expected, this first ever daily use progestin only pill is now available over-the-counter in the US. 👏👏. On Wednesday, March 6, 2024, the ACOG released its Practice Advisory presenting some key reminders for clinicians regarding this new over-the-counter contraceptive option. In this episode, we will summarize this practice advisory and a...
GLP1 Agonist Exposure in Pregnancy
March 05, 2024 02:04 - 40 minutes - 36.8 MBUse of second-line noninsulin diabetic medications, like Glucagon-like peptide 1 (GLP-1) agonists and sodium-glucose co-transporter-2 (SGLT2) inhibitors, is rapidly increasing for treatment of T2D and other indications. As these drugs are being used by an increasing group of fertile women, it is expected that a few of them will get pregnant and data on their safety when used in the first trimester is needed. Is periconceptional use of glucagon-like peptide 1 (GLP-1) receptor agonists associat...
Foley For CX: Tension or No Tension? And More (March 2024 Data)
March 01, 2024 20:18 - 45 minutes - 41.6 MBUsing mechanical options as a way to prime/ripen the cervix for labor is nothing new. Balloon catheters have been used for labor induction as far back as the 1890s. Embrey and Mollison reinvigorated the method in 1967 using it in combination with extraamniotic prostaglandins. Since then numerous studies have been performed worldwide, mostly using the Foley catheter. Then, in 1990, the double balloon catheter was introduced by Atad; this paved the way for the Cook Balloon. But what is the best...
Things That Make You Go Hmmmm
February 29, 2024 01:52 - 32 minutes - 29.5 MBIt’s very important to stay up-to-date and current with new data. But sometimes you read something that is hot-off-the press and it makes you just stop and say, “hmmm”. In this episode, we will discuss the new USPSTF position statement on screening/treating iron deficiency anemia in pregnancy. We will also review the ACOG August 2023 clinical consensus #4 regarding UTI in pregnancy. In doing so, we present 2 things that “make you go hmmm”.
GDM Dx with Abnormal Fasting Value: Start Meds?
February 28, 2024 04:07 - 46 minutes - 42.9 MBThe “traditional“ Parkland management protocol for GDM included the immediate initiation of medical therapy for those with abnormal fasting blood sugar, in addition to another additional value, on the 3 hour GTT. These patients were automatically labeled as A2 GDM at time of diagnosis, rather than waiting the 1 to 2 weeks of nutritional/diet therapy. Does fasting hyperglycemia on the 100g GTT truly predict the need for subsequent medical therapy? In this episode, we will summarize new data on...
Feb 26, 24 SMFM Position Statement RHIG < 12 Weeks: Confused?
February 26, 2024 23:19 - 15 minutes - 14.1 MBYes, the subject of RhoGAM/RHIG administration to RH negative patients under 12 weeks gestational age is a continuously controversial issue. We have covered this issue in past episodes, most recently- last month- on January 4, 2024. Today, February 26, 2024, the SMFM released their position statement on the subject. As you would guess, the controversy continues! In this episode, we will review this brand new, hot off the press, position statement regarding RHIG administration, or avoidance, u...
Stage 1 HTN in OB
February 24, 2024 20:55 - 35 minutes - 32.9 MBFebruary 2024 has seen its share of medical and mainstream media stories highlighting hypertensive disorders in pregnancy. While some of this can be considered “old news”, there is “new news” and new developments on the horizon. We have covered hypertensive disorders in pregnancy on several past episodes; however, in this episode, we are going to pick up where we left off and review what the current state of understanding is for AHA/ACC Stage 1 hypertension in pregnancy. Does stage I hyperten...
New Developments in HG 🤢🤮🤢
February 23, 2024 03:52 - 44 minutes - 41.2 MBHyperemesis Gravidarum (HG) has a reported incidence of approximately 0.3–3% of pregnancies. Without prompt recognition and treatment, severe maternal dehydration, electrolyte abnormalities, cardiac arrhythmias, and potentially altered fetal neurodevelopment may result. Recently, HG made medical and general media news as new data has pinpointed 2 likely culprits of its origin- and neither one is estrogen. In this episode, we will discuss these 2 protein markers, and how researchers are lookin...
Fetal Manual Rotation: 1st or 2nd Stage Practice?
February 20, 2024 13:48 - 47 minutes - 43.1 MBWomen whose fetuses are in the occiput posterior head position at the time of delivery are known to have longer second stages of labor and more complicated deliveries, including more operative assisted births, more 3rd and 4th degree lacerations, PPH, and in some studies lower Apgar scores and lower umbilical cord arterial pH. At what point in labor should the healthcare provider attempt to rotate the fetal head: first stage or second stage of labor? Recent intrapartum studies using ultrasoun...
“Formula” to Predict SD?
February 17, 2024 23:57 - 39 minutes - 36.4 MBThe ACOG has long-held that shoulder dystocia is “unpreventable and unpredictable”. Nonetheless, as it is a devastating obstetrical occurrence, researchers have attempted to identify a reproducible mathematical formula using ultrasonographic, anthropometric factors to better predict it. What is the data behind these math models? Does the ACOG recognize their use? What is their positive predictive value? In this episode, we will examine the data – going back 40 years – and we will end the epis...
GDM “Screen” in 3rd Trimester?
February 15, 2024 00:08 - 41 minutes - 38.3 MBThe ACOG has consistently recommended universal screening for gestational diabetes between 24 and 28 gestational weeks. Although controversial, the ACOG does endorse earlier screening for GDM in patients with additional risk factors. But what about patients who present for prenatal care after the 28th or 29th week? Should screening for GDM be done in the 3rd trimester? And if we do screen in the then, what is the reference range for “normal “or “abnormal”? Is it the same interpretation as whe...
Phthalates and PTB: “New Data”
February 14, 2024 02:13 - 39 minutes - 36.4 MBOn February 6, 2024, a new publication in the Lancet Planetary Health received national and international headlines. This study, funded through the NIH, revealed a striking association between certain chemicals in our environment and preterm birth. But is this data really new? We have known that certain chemical components, called phthalates, have a strong association with preterm birth for over 10 years now. Nonetheless, it is always a good reminder to reduce or avoid exposures to potentiall...
Another Nail in the Coffin for Late PT Steroids: New RCT Data
February 11, 2024 23:56 - 21 minutes - 19.4 MBYES, it’s true… Not even Super Bowl Sunday 🏈🏈can stop us from getting our podcast episode up and out! In this episode, we will summarize the key findings of a newly released RCT (ahead of print, Obstetrics and Gynecology) that is yet another “nail in the coffin” for late pre-term/early term steroids. This is perfect timing, as we just covered this topic on a separate episode last week. So listen in as we summarize this newly released, triple-blind RCT with eye-opening results.
New Data on Naltrexone in Pregnancy
February 08, 2024 22:17 - 27 minutes - 25.6 MBWe are still in an opioid crisis. The number of women with opioid-related diagnoses at delivery has increased by 131% over the last several years (CDC, Data and Statistics, 2023). The ACOG has recommended the use of opioid agonist pharmacotherapy for MOUD during pregnancy. Traditionally, medically supervised withdrawal has not been endorsed for pregnancy. However, some patients may elect to discontinue opioid therapy in favor of an opioid antagonist like naltrexone. In this episode, we will r...
TOKOPHOBIA: Pregnant & Petrified
February 07, 2024 03:31 - 51 minutes - 47.6 MBIt is completely natural, and part of the human experience, to have some anticipatory concern about an upcoming delivery/childbirth. However, when that concern becomes overwhelming, it can develop into a debilitating phobia called Tokophobia. First coined as a term in 2000, there’s been growing awareness of this specific type of anxiety disorder/phobia. Even though it was first described in 2000, this extreme fear of pregnancy and childbirth has, of course, been part of the human experience F...
The OB Steroid WARNING FLAGS: When CONS>PROS
February 05, 2024 17:50 - 50 minutes - 45.9 MBIn 1972, Liggins and Howie published their landmark study on the benefits of antenatal corticosteroids (ACS) regarding their reduction of prematurity’s morbidity and mortality. This led to the weekly administration of ACS until 34 weeks. Weekly courses of steroids are no longer given, but the steroid story keeps evolving. In 2016, the ALPS trial demonstrated reduction in short-term respiratory morbidity when steroids were given in the late pre-term interval. Many professional societies and or...
Putting LNG-IUS EC In Perspective
February 03, 2024 01:05 - 50 minutes - 46.5 MBOn January 28, 2021, a non-inferiority RCT was published in the NEJM, “Levonorgestrelvs Copper T Device for Emergency Contraception”. This study concluded that the LNG 52mg IUD was “noninferior” to the CopperT IUD for emergency BC up to 120 hours after ill-protected intercourse. Since that time, use of the LNG 52mg IUS has remained controversial with some organizations endorsing its use as EC while others take a more cautionary stance. Now, as a February 1, 2024, a new commentary in the Green...
The Incredible VIBRATING belt (Osteoboost device): Good Data?
February 01, 2024 22:26 - 35 minutes - 32.6 MBOn January 18, 2024, the FDA cleared a novel new device for osteopenia treatment. This is a vibrating belt (wearable device) that transmits low-amplitude, high-frequency (20 to 40 Hz) vibration to the spine and hips. This belt is called Osteoboost. Osteoboost previously received a breakthrough designation from the FDA in Dec 2020. This FDA clearance has already generated a lot of commentaries regarding the single RCT results. In this episode, we will review the results critically and explain ...
Place IUD/S if BV Present? What Would You Do?
January 30, 2024 22:09 - 31 minutes - 29 MBBacterial vaginosis (BV) is the most common vaginal aberrant condition in women, in the general population. Even still, the majority of women with BV are asymptomatic. If BV is found at time of elective IUD/S placement, can the device still be inserted? Or is it an independent risk factor for upper tract infection? What category in the CDC MEC is vaginitis/vaginosis for IUD placement? There definitely is some confusion about this in clinical practice, highlighted by the 3 different clinicians...
More Bad News Re: PreEclampsia
January 27, 2024 16:11 - 32 minutes - 29.8 MBHypertensive Disorders of Pregnancy (HDP) affect 5 to 15% of women worldwide, and their increasing incidence is likely related to the growing levels of obesity, metabolic syndrome and advancing maternal age. It is widely accepted that women who have preeclampsia are at increased risk of future hypertension, cardiovascular disease, stroke, chronic kidney disease, and even diabetes in later life. But what is the association between HDP and dementia? In this episode, we will review the latest da...
OB Issues After IUD Perf?
January 25, 2024 16:22 - 52 minutes - 48.3 MBUterine wall perforation at time of IUD placement has been published to occur, in general, about 1-2/1,000 cases. It happens! While there are some risk factors for uterine perforation (very antiflexed, retroflexed, recent postpartum state, lactating), sometimes uterine perforation can happen even with the best of technique and no risk factors. While most providers are concerned about immediate short-term gynecological complications like infection and bleeding, we don’t really consider the pos...
Extencilline, Linezolid, & STUFF
January 22, 2024 23:19 - 20 minutes - 18.9 MBYep, Medicine moves fast! On Friday, January 5, 2024, I participated in a medical news report published in “The Guardian”. In that news commentary I stated that “Bicillin-LA is the only medication approved for syphilis during pregnancy”. We’ve all heard that statement, and it is a true statement. However, 5 days later on January 10, 2024, the FDA announced the importation allowance of “Extencillin” to combat the Bicillin-LA shortage. Yep, Medicine moves fast. Now we have this medication avail...
Preg Test in ESRD: Going Down the Rabbit Hole?
January 21, 2024 19:42 - 48 minutes - 44.8 MBIf you had 5 reproductive age women, all late on their menstrual cycle, who were having unprotected sex, and all have a positive pregnancy test… What would be your diagnosis? The most likely diagnosis would be that there are five pregnancies! Right?! But what if 1 of those patients had end stage renal disease (ESRD), on hemodialysis. Is there anything else to consider? While ruling out pregnancy is priority #1, it is possible that this HCG is a phantom result. This is a slippery slope discuss...
You Asked, We Answered!
January 18, 2024 17:08 - 46 minutes - 42.6 MBPeriodically, we respond to podcast family members’ questions as data is available. In this episode, we will cover 3 very clinically relevant questions from our podcast listeners. The first question is regarding our immediate past podcast topic, which was propranolol as a labor stimulant. The question is, “Does the ACOG have a statement on adjuvent propranolol use during labor?“. We’ll answer that question in this episode. The second question is whether the placebo/pill-free interval of combi...
Can Propranolol Rescue Labor?
January 17, 2024 01:26 - 40 minutes - 36.9 MBIt has been well reported that rates of elective induction have risen nationally and internationally since the adoption of the ARRIVE trial. But as medicine is at times controversial, some studies have suggested an increase in cesarean section rates with elective induction of labor at 39 weeks. While we will briefly discuss those studies, they are not the focus of this episode. However, as induction of labor becomes more common place, there has been renewed interest in use of adjuvant medicat...
More Data on LUST (Follow up to 12/31/23 Episode)
January 15, 2024 17:26 - 27 minutes - 25 MBOn New Year’s Eve 2023 we released “LUST for TOLAC”. LUST stands for lower uterine segment thickness. This is a very enticing, and controversial, approach to TOLAC counseling and direction. I encourage you to go back and listen to that episode, if you have not yet, before listening to this one as this is more data to support those conclusions. In this episode, we will highlight a multi-center, cluster-randomized trial out of Canada, the PRISMA study. This fantastic investigation sheds more li...
Beyond the 22 Week Birth
January 13, 2024 21:19 - 41 minutes - 38.4 MBThe gestational age boundary termed viability has shifted dramatically during the past 50 years, and more so in the last 15 years. In 1971, a widely used neonatology textbook stated that, “The lower limit of viability is probably around 28 weeks, at which time most infants weigh two pounds, four ounces (1000 g).” Today, the most immature infants routinely cared for by neonatologists in some parts of the world are born at 22 weeks of gestation, with many weighing around 500 grams. While most s...
NIPTS Clarify: “46 XX or 46 XY”?
January 12, 2024 22:47 - 6 minutes - 5.71 MBThis is NOT our regularly scheduled episode. Based on an incredible comment from Rachel – one of our podcast family members, which I received just moments ago, this was too good to not put out. A brief clarification on NIPTS and “46XX or 46XY”. (This is a supplement to our immediate past episode.) 😊😊🧐🧐
NIPT’s Sex Chromosome Abnormalities: Clinical Pearls.
January 11, 2024 01:13 - 50 minutes - 46.4 MBNIPT is a prenatal SCREENING method that involves analysis of cell-free fetal DNA (cfDNA) in maternal blood. Prenatal screening for sex chromosome aneuploidies (SCAs) has become readily available through expanded non-invasive prenatal testing (NIPT). NIPTs became commercially available in 2011 and has since been introduced in more than 60 countries around the world and is now part of mainstream obstetrical practice. Initially offered as a secondary screen for pregnancies with a high probabili...