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.
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Episodes
No Data, No Problem!
January 07, 2024 19:48 - 48 minutes - 44.4 MBWe take pride as healthcare providers in being “evidence based“. But sometimes things that we do, even in 2024, sound, reasonable and sound practical, but actually are NOT evidence-based. But lacking evidence means 2 things: 1. Studies have proven something does not work, or 2. Studies have not been done to confirm or refute the intervention. In this episode, we will discuss 2 common interventions that are recommended in pregnancy that actually don’t have the evidence behind them. First is th...
UPDATES Re: RHD Alloimmunization
January 05, 2024 00:21 - 36 minutes - 33 MBBefore the 1960s, there was no method available to prevent Rh sensitization during Rh-incompatible pregnancies. Then, in 1968, the FDA approved the use of RhoGAM to help prevent Rh immunization. This was a landmark move in the field of Obstetrics. More recently, ever evolving data and medical genomic technology has brought new insights to RHD alloimmunization care. Can maternal RH typing be avoided with early pregnancy loss (under 12 weeks)? Why about in cases of pregnancy termination? Is tha...
Teratoma's "Crazy" Side: The "Brain on Fire"
January 03, 2024 03:47 - 50 minutes - 46.2 MBHistorically a range of psychiatric and medical conditions have been erroneously attributed to 2 gynecological organs/function. During the time of Hippocrates, the “wandering womb” theory blamed emotional disturbances in women on this condition. Not only was that erroneous, it was nonsensical. However, certain gynecological conditions can indeed manifest with neuro-behavioral disturbances. One of these syndromes can be triggered by the presence of an ovarian dermoid. Anti-N-methyl-D-aspartate...
“LUST” for TOLAC: Last Episode for 2023!
December 31, 2023 06:24 - 44 minutes - 40.6 MBThis is our last episode for 2023! A podcast family member reached out to me notifying me of a thread on social media discussing ultrasound measurements of “lower uterine segment thickness” (LUST) for TOLAC candidates. I consider myself pretty social media friendly, but was unaware of this comment thread. Should we be measuring lower uterine segment thickness in the late 3rd trimester as a discriminatory tool for TOLAC approval/denial? Is this evidence-based? Where did this concept originate?...
Year of the Doula
December 28, 2023 22:38 - 37 minutes - 34.1 MBIt’s no surprise and understatement to say that the US maternal/neonatal morbidity and mortality rates have to improve. As a way to increase maternal supportive care, an increasing number of states are turning to cover Doula services. Despite this forward thinking, there are still misperceptions, misunderstandings, and “boundary” issues regarding Doulas which must be addressed. Are Doula interventions evidence based? Are Doula services related to improved maternal and neonatal outcomes? What ...
NEW DATA: Fetal Growth Trajectories – the Growth Velocity Issue
December 26, 2023 21:04 - 39 minutes - 36.2 MBOn May 8, 2023, we released an episode called “Slowed Fetal Growth Trajectory and Neonatal Outcome”. That episode highlighted data that slowed fetal growth was an independent risk factor for stillbirth. This is true even though the composite EFW remained above 10 percentile. Now, there is new data which validates this concept and provides a working model which may help predict fetuses with slowed fetal growth who are at risk of stillbirth. PLUS, we will describe a free online fetal growth tra...
SMFM HBV Consult Series #69: Dec 21, 2033.
December 23, 2023 17:28 - 30 minutes - 27.7 MBOn August 26, 2023, we summarized the ACOG update on viral hepatitis in pregnancy and discussed new concepts regarding Hep B viral infection. To follow that up, the SMFM has now released its Consult Series #69 (Hepatitis B in Pregnancy: Updated Guidelines) which was published on December 21, 2023. In this episode, we will reinforce some topics originally discussed back in August 2023 and emphasize key management issues regarding Hep B in pregnancy based on this Consult Series… both for the in...
Is Maternal Short Stature an OB Risk Factor?
December 22, 2023 19:57 - 41 minutes - 38 MBThe average height for men in the U.S. is about 5 feet 9 inches. For women, it’s about 5 feet 4 inches. Height stature has been correlated with some interesting health conditions at a population level: Some research shows that a below-average height may mean you have lower odds of getting some types of cancer. For example, a study of more than 100,000 women in Europe and North America showed that shorter women are less likely to get ovarian cancer. Also, although researchers can’t explain why...
“Orgasm Gave Me a Seizure”
December 20, 2023 22:17 - 47 minutes - 43.6 MBSex has always had its share of misinformation, even as it relates to some medical conditions- like epilepsy. "Coitus brevis epilepsia est" ("Sex is a brief seizure") is an ancient proverb attributed to Galen, the influential Greek physician and philosopher in the Roman Empire. Then, in the 18th and 19th centuries, some physicians, including Samuel-Auguste Tissot and Edward Sieveking, argued that excessive masturbation could cause epilepsy! At the time, castration and clitoridectomy (removal ...
UPDATED 1st & 2nd Stage Labor Mgmt: Jan 2024
December 18, 2023 13:07 - 43 minutes - 39.4 MBBIG. BIG. BIG Update. In March 2014, the ACOG/SMFM released OCC #1 (Safe Prevention of the Primary C-section) which redefined the labor curve. That document has now been WITHDRAWN. It is being replaced with Obstetrical Care Consensus #8 coming out January 2024. In this episode, we will highlight key points from this updated guidance including: 1. ACOG’s new language surrounding the length of latent phase, 2. the role of “early” amniotomy in labor induction, and 3. clarification on 2nd stage o...
GDF15 and N/V of Pregnancy: Moving Beyond Estrogen and HCG
December 15, 2023 20:45 - 27 minutes - 25.4 MBIt’s really amazing how fast medical information and discovery happens. For decades, we blamed nausea and vomiting of pregnancy/hyperemesis gravidarum on either estrogen or high levels of HCG. While these 2 hormones definitely have some association with that condition, new evidence has pointed to a separate compound as the likely offender. In this episode, we will review data just published on December 13, 2023 from an international research think tank. This group has likely pinpointed the or...
AMH in PCOS DX: 2023 PCOS Update
December 15, 2023 03:56 - 46 minutes - 42.1 MBAccording to ACOG’s CO 773 from 2019, “Currently, serum antimüllerian hormone levels are not part of the accepted diagnostic criteria for polycystic ovary syndrome (PCOS)”. But medicine moves fast, and that statement is no longer valid, at least it isn’t valid from the ASRM July 2023 Standpoint. Yep, once considered experimental, AMH has now entered the PCOS diagnostic algorithm. Nonetheless, some important limitations and facts must be understood for its use in this way. In this episode, we ...
The Endometriosis-Migraine Link: New Data on Genes and CGRP
December 13, 2023 00:15 - 48 minutes - 44.6 MBWe thought we had endometriosis all figured out. After all, we know it’s a chronic pain syndrome that’s hormone responsive. But there’s more to it than that. Within the last few years, including this year 2023, we have grown even more in our understanding of this pelvic pain condition. We now have new data explaining the link between endometriosis and migraine attacks. Are you familiar with CGRP? While most attention has focused on this biochemical messenger’s role in migraines, CGRP is also ...
IVH: OB Considerations
December 11, 2023 00:03 - 57 minutes - 52.3 MBAdvances in obstetrical and neonatal care have allowed for increased survival rates in babies born at extremely premature gestational ages. However, extreme prematurity brings its own set of issues and problems. One of these issues is intraventricular hemorrhage (IVH). Intraventricular hemorrhage is not simply a neonatology issue, but is something that all obstetrical providers should be familiar with. Does the mode of delivery impact the rates of intraventricular hemorrhage for extremely pre...
DIY Insemination: YEP, It’s Real.
December 08, 2023 04:05 - 28 minutes - 25.9 MBWe are definitely a “DIY“ society. And now, consumers can add DIY Insemination to that list! On December 6, 2023 the FDA cleared the first device for at home insemination. This over-the-counter option will be available in 2024. In this episode, we will review this landmark and historic device clearance. We will also clarify the distinction between FDA “approval” and FDA “clearance”. Who is best suited to use this device? Is this considered first-line for unexplained infertility? Lots of inter...
AOK & AOK-T: Data Review for AFE Care
December 07, 2023 03:19 - 43 minutes - 40.3 MBAmniotic fluid embolism remains one of the most devastating conditions in obstetric practice with an incidence of approximately 1 in 40,000 deliveries. The associated mortality for this condition has been reported to be 20% at the low-end, to 80% at the high-end. The use of atropine (1 mg intravenously [IV]), ondansetron (8 mg IV), and ketorolac (30 mg IV) (AOK) as an adjunctive treatment has been widely discussed by obstetric providers as a treatment option which should be considered to supp...
The CIN2 Conundrum: New Population-Based Data.
December 05, 2023 21:08 - 36 minutes - 33.8 MBManagement of CINI is straightforward, as is management of CIN3. CIN1 allows for observation, and CIN3 requires treatment regardless of the patient’s age as it is a true pre-cancerous lesion. But some “gray zone“ exits for CIN2 management. Population-based data has confirmed a high rate of spontaneous resolution within 2 years after CIN2 diagnosis. Is the rate of cervical cancer higher in this surveillance group compared to immediate LEEP? In this episode, we will highlight 2 separate publica...
The IR Issue: Evidence-Based Testing
December 03, 2023 15:29 - 42 minutes - 38.6 MBA recent analysis of NHANES data from 2021 found that 40% of US adults aged 18 to 44 are insulin-resistant (IR) based on HOMA-IR measurements. While obesity rates have increased considerably over the past 2 decades, this rapid increase in prevalence was not only associated with increased adiposity. Hypertension, dyslipidemia, and limited physical activity also increased insulin resistance. PCOS and IR are intimately tied, although not all PCOS patients will have clinical or biochemical eviden...
🔥HOT OFF the PRESS: New Data on “Physiologic HTN”/ Rule off 55 (Nov 30)
December 01, 2023 04:27 - 23 minutes - 21.6 MBOn July 30, 2023 we released an episode describing the hypertensive “rule of 55” otherwise known as the physiologic approach to hypertension management. The rule of 55 breaks down hypertension into either hyperdynamic/high cardiac output in origin, or systemic vascular resistance in origin. There is plenty of evidence to support this management approach. Late this evening, on November 30, 2023, Obstetrics and Gynecology released a new research letter ahead of print, providing more insights on...
F/U Ov Cysts? The O-RADS Scale.
November 30, 2023 13:01 - 47 minutes - 43.7 MBPopulation based data tells us that 15 to 20% of women will develop an ovarian cyst during their lifetime. Although most ovarian cyst have a low potential for malignancy, their presence causes anxiety for both the patient and the provider. Our typical mental-exercise is balancing the risks of expected management vs choosing surgery prematurely. Which ovarian masses are likely to resolve if given enough time? Do septated ovarian cysts resolve the same as simple cysts? In this episode, we will ...
The Mysterious Bean: The Clitoris Needs Love 💕
November 28, 2023 02:16 - 50 minutes - 46.1 MBThe word clitoris comes from the Greek word, “kleitoris” which means “little hill”. In 1559, the clitoris was “discovered” by an anatomist Renaldus Columbus who called it the “love of venus” and concluded that its primary function was strictly for pleasure. It is quite shocking 2 believe, although true, that the first anatomical paper on the clitoris was published only in 1998 and its anatomy, using MRI, fully described in full in 2005. This lack of scientific attention, until recently, to bo...
Uterine Rupture in the Unscarred Uterus
November 25, 2023 17:36 - 48 minutes - 44.4 MBA ruptured uterus is a potentially catastrophic event in which the integrity of the myometrial wall is breached. We all have memorized the usual red flags and contraindications to labor as prior classical cesarean, multiple (more than 2) low transverse cesarean, prior transmural gyn surgery, or grand multiparity. In the absence of previous surgery or multiparity, uterine rupture may go unnoticed, resulting in late diagnosis and considerable mortality and morbidity. Uterine rupture intrapartum...
“Perfect Timing”: Mag for Late PP HTN (Supplement to immediate past episode)
November 23, 2023 20:48 - 22 minutes - 20.7 MBOn Tuesday, November 21, we released an episode titled “Optimizing Postpartum HTN Care”. On Wednesday, November 22, I received notification that a new clinical opinion piece will be released in AJOG in December 2023 which also discusses whether or not mag sulfate, should be used in the late postpartum interval in these patients. Amazing timing! Our podcast, and this soon-to-be released clinical opinion, match 100% in the data and recommendations! 🎉🎉🎉 So in this episode, we will highlight the ...
Optimizing PP HTN Care
November 22, 2023 01:46 - 55 minutes - 51.2 MBData has shown that more than half of maternal deaths occur past the traditional 6 week postpartum mark. This is why the ACOG recognized the “fourth trimester” in 2018 (ACOG CO 736), reflecting the fact that the patient is still at risk beyond the first 6 weeks after delivery. One of the main areas of focus postpartum is on hypertension care. Growing understanding of the long-term implications of HDP and other medical complications of pregnancy have led to an increasing focus on building tran...
Asthma in Pregnancy: the GINA Recs
November 20, 2023 20:58 - 48 minutes - 44.4 MBACOG’s last practice bulletin on asthma in pregnancy (ACOG PB 90) was back in February 2008. Yep, 2008. Sooo… No advances since then? There’s been big shifts in the management of asthma, of course. That’s why we’re doing this podcast- things move so fast, and it’s often hard for guidelines to keep pace at times. That’s why we’re here. And that’s why it’s important to always stay ahead of the data. are you aware of the new recommendations from the GINA? It has changed the way we view Short Act...
The “L” in TPAL: What is it Good For?
November 18, 2023 19:35 - 13 minutes - 12.2 MBIt’s a universal nomenclature… The TPAL system. Despite its traditional and long-standing integration into obstetrical vernacular, there are significant gaps in this system. And, although we use these terms daily, there is controversy about what one of those elements actually means. What is the “L“ actually for? We’ve all learned it as “living children”. But what does that actually mean? Is that live births? Is it number of living children at time of the report? Or does it mean something enti...
NEW Home STI Tests Approved 👍
November 16, 2023 16:12 - 13 minutes - 12.5 MBThis episode is our NEWS BRIEF. Yesterday, on November 15, 2023, the FDA approved the first, patient self-collected, home test kits for GC and Chlamydia. This is a BIG advancement for women's health. But, this is actually not the first at home STI test to be approved. In this episode, we will review this new FDA approved test, the specifics of the product, and why this is not just a "direct to consumer" purchase item.
To CBE or Not to CBE
November 16, 2023 03:47 - 44 minutes - 40.7 MBRecently, we released an episode regarding the limited utility of by BMEs; now, I mean, limited utility as a routine, annual exercise in the low-risk asymptomatic, and non-pregnant patient. And there’s plenty of evidence that has shown that just doing a bimanual exam because “that’s what we’ve always done” -without a real indication- is just not helpful. All to say, we received numerous comments regarding that episode with 99% saying, “this is great”, “thank you for sticking with the evidence...
ASX Trich in Preg: Treat or No Treat?
November 14, 2023 01:34 - 41 minutes - 38.4 MBTrichomoniasis is the most prevalent nonviral sexually transmitted infection (STI) in the United States and is more prevalent than chlamydia and gonorrhea combined. In the US, the southern states share a disproportionate burden of infection, with rates up to 14%. Infection with Trichomonas vaginalis increases risk of human immunodeficiency virus (HIV) acquisition and is associated with adverse perinatal outcomes, including preterm birth, low birth weight, and preterm premature rupture of memb...
Get Your Fingers Outta There (New Data on ASX BMEs).
November 10, 2023 22:56 - 30 minutes - 27.7 MBThe pelvic examination is a standard component of the annual gynecologic visit despite limited evidence supporting its utility. Pelvic examinations can be a source of discomfort and anxiety for some patients seeking routine health care, whereas, for others, they can offer reassurance. In 2018, the ACOG released CO 754 on "The Utility of and Indications for Routine Pelvic Examination". What does the AAFP, ACP, and ACOG say about "routine" pelvic examinations in low-risk, nonpregnant, and asymp...
Fundal Accreta in a Nullip? YES (The Non-Previa Accreta).
November 08, 2023 15:58 - 43 minutes - 40.1 MBWhat do think about when I mention to you, Placenta Accreta Spectrum (PAS)? You would probably think placenta previa and prior C-section, right? You should! Those are the two most well-known risk factors. But placenta accrete can happen without either of those 2 factors, although less commonly. I was recently asked to provide insights on a real case of suspected PAS in a primiparous patient who was suspected of having placenta accrete at attempted placenta extraction at time of her primary C-...
Understanding.
November 07, 2023 01:27 - 21 minutes - 19.8 MBI received a very personal and impactful Facebook message today from one of our podcast family members. It was enough to stop me in my tracks, and issue this heartfelt response. For F. L.
The Ophthalmia Neonatorum Debate.
November 06, 2023 17:35 - 38 minutes - 35.3 MBThe Centers for Disease Control and Prevention, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the World Health Organization all recommend universal topical ocular prophylaxis to prevent gonococcal ophthalmia neonatorum. In the United States, ophthalmia neonatorum caused by N. gonorrhoeae has an incidence of 0.3 per 1000 live births, while Chlamydia trachomatis represents 8.2 of 1000 cases. However, this prophylaxis is not a uniform GLOBAL stance. The...
MORE Support for Universal LDA in OB
November 03, 2023 22:17 - 21 minutes - 19.3 MBOn September 26, 2023 we released an episode titled “LDA in Preg: the SAGA Continues”. Well, it continues still. In this episode, we will review a brand new publication (a Narrative Review) released ahead-of-print yesterday on November 2, 2023 covering “Aspirin in Pregnancy” (Obstet Gynecol). We will focus on 2 main areas: 1. Dose of aspirin best suited for preeclampsia prevention, and 2. support for universal adoption. PLUS, we will throw in one other clinical pearl regarding continuation un...
That Darn Persistent Yeast.
November 03, 2023 04:50 - 41 minutes - 38 MBRecurrent vulvovaginal candidiasis (RVCC) is a highly burdensome, long-lasting medical condition that heavily compromises the activities of women and their quality of life. Recently, the prevalence of RVVC has increased, partly due to a rise in VVC caused by non-albicans species. Here's a real-world clinical dilemma (from a real case): What would you offer a patient who is allergic to fluconazole and terconazole, has taken 3 doses of Brexafemme, has used boric acid, and even tried vaginal pro...
“Intrapartum, Isolated Maternal fever”: Clinical Outcomes.
November 01, 2023 01:21 - 34 minutes - 31.5 MBIn 2017, the ACOG released committee opinion (CO) 712 which described the 3 categories of intrapartum fever. One of those categories was “isolated intrapartum fever”. In that CO, the ACOG stated that practitioners “should consider” the use of antibiotics in patients with isolated intrapartum fever. However, there was no evidence to support or refute that. But that evidence has now arrived. In this episode, we will discuss an upcoming publication from the AJOG (November 2023) providing importa...
DiGeorge Deletion Syndrome
October 30, 2023 03:16 - 43 minutes - 39.4 MBDiGeorge syndrome… what a complicated condition for such a little area of a single chromosome being affected. The condition’s descriptive and preferred name is 22q11.2. This is called a microdeletion. Along with microduplications, microdeletions are collectively known as copy number variants. Copy number variants can lead to disease when the change in copy number of a dose-sensitive gene or genes disrupts the ability of the gene(s) to function and affects the amount of protein produced. Other...
Bee Pollen & BOOBS😳
October 27, 2023 02:42 - 40 minutes - 37.1 MBFor years, herbalists have touted bee pollen as an exceptionally nutritious food. They've even claimed it is a cure for certain health problems. Bee pollen does contains vitamins, minerals, carbohydrates, lipids, and protein. It comes from the pollen that collects on the bodies of bees as they fly from one flower to another. Bee pollen may also include bee saliva. This is NOT the same as natural honey, honeycomb, bee venom, propolis, or royal jelly. These other products do not contain bee pol...
New SMFM Data: SCD in Pregnancy
October 25, 2023 13:55 - 46 minutes - 42.5 MBAlthough there were some early reports of sickle cell disease (SCD) in the late 19th century, the 1st time that the disease was referenced in literature was in 1910. Then in 1957, a doctor studying protein chemistry in England discovers that a single genetic mutation causes the abnormal hemoglobin found in patients who inherit SCD. And our knowledge of SCD continues to grow. In this episode, we will review a soon-to-be released new SMFM Consult Series # 68 highlighting the data on management ...
New CC (Nov ‘23) from “The College”: Comp Bioidentical Hormones
October 24, 2023 01:59 - 37 minutes - 34.2 MBIn November 2023, the ACOG will release Clinical Consensus #6, “Compounded Bioidentical Menopausal Hormone Therapy”. We have covered bioidentical hormones in past episodes. However, this ACOG clinical consensus sheds new light on an old topic. Is there ever a role for bioidentical hormone therapy? What about postmenopausal testosterone use? What does the College say about the marketing of these compounded options? And, were you aware that for the first time ever there is now a novel, bioavail...
NEW FIGO REC: Fe Deficiency w/o Anemia.
October 21, 2023 13:27 - 34 minutes - 32 MBOn June 27, 2023, researchers published a population based analysis of the prevalence of Iron Deficiency and Iron-Deficiency Anemia in Females in the US who were aged 12-21 Years. This study spanned from 2003 to 2020. What they found was staggering: Almost 40% of American teenage girls and young women had iron deficiency. This was published in JAMA. It's the first research to look at iron deficiency in young women and adolescent girls. Iron deficiency and iron-deficiency anemia are both commo...
The Cat 2 FHT Conundrum
October 20, 2023 00:35 - 54 minutes - 50.1 MBIn 2009, the ACOG released practice bulletin 106 which introduced the 3- tier fetal heart rate classification system. This was followed up in November 2010 with its sister practice bulletin, number 116, “Management of Intrapartum Fetal Heart Rate Tracings”. Yet now, 13 years later, management of the category II tracing remains a conundrum. How long can you watch/observe a category II tracing? Can category II tracings predict fetal acidemia? And what is a step-by-step, evidence-based algorithm...
Vag Progesterone Returns for PTB?
October 17, 2023 20:11 - 39 minutes - 35.9 MBIn April 2023, both the ACOG and SMFM released their clinical updates regarding the use of progesterone for preterm birth prevention. While 17-OHP is gone, vaginal progesterone remains an option in the appropriate patient, with some slight differences between the opinions from ACOG and SMFM. A new expert commentary from October 2023 in the AJOG -MFM is calling for a reappraisal of those opinions. Is vaginal progesterone for PTB prevention coming back to treat ALL patients with a history of PT...
The Fetal Somersault Delivery Manever
October 16, 2023 16:42 - 39 minutes - 36.2 MBFinding a nuchal cord (NC) at delivery is not rare. NCs occur anywhere from 25-30% of all deliveries. When encountered at time of vaginal delivery, the first line maneuver should be an attempt to "reduce" the loop of cord around the fetal head by gently pulling the cord up and around the presenting part. However, if the NC is tight, an attempt at reduction may not be successful- or may risk inadvertent cord rupture withs subsequent fetal blood loss. Historically, the next move described was t...
Screen for Vit D in OB?
October 13, 2023 20:17 - 53 minutes - 48.6 MBHypertensive Disorders in Pregnancy/Preeclampsia is a persistent problem, world-wide. Over the last decade, studies have highlighted the role of vitamin D in modulating several mechanisms associated with hypertensive disorders of pregnancy, including but not limited to vessel compliance, the maternal immune response, the renin angiotensin response, and placental implantation and angiogenesis. There has also been published concern that maternal vitamin D deficiency may be associated with child...
Opill: Success and Suspicions
October 11, 2023 21:11 - 31 minutes - 28.6 MBThe FDA’s approval of the first oral hormonal contraceptive pill, Enovid, in 1960 launched a revolution in women’s reproductive healthcare. From that one initial pill sprang a plethora of oral contraceptive choices, representing estrogen-progestin combinations in standard dose to ultra-low dose options, progesterone only pills, and cyclic or continuous use pre-packaged formulations. According to a survey conducted from 2017 to 2019 by the Centers for Disease Control and Prevention (CDC), arou...
CONTROVERSY: Second Stage, How Long is Too Long?
October 08, 2023 18:18 - 42 minutes - 38.5 MBThere is no controversy regarding the definition of the 2nd stage of labor: it is the phase of labor from 10 cm until complete delivery of the child. However, there has been persistent controversy about what defines a prolonged 2nd stage of labor. In other words, are the hour limits stated by the ACOG “active pushing” or “total duration” in 2nd stage? 🤔 Historically, this has been a very gray area. Even though we have guidance on this going back to 2014 with the ACOG Obstetric Care Consensus ...
Mirror Syndrome
October 06, 2023 02:53 - 33 minutes - 30.8 MBMirror Syndrome also known as “triple edema” or Ballantyne syndrome, is a rare disorder affecting pregnant women. Mirror Syndrome is often underdiagnosed or misdiagnosed due to a general unawareness of the condition, and sometimes its preeclampsia-like manifestations. However, until now, the characteristics of Mirror Syndrome have not been fully elucidated. But medicine moves fast, and we now have a better understanding of its presentation, likely contributing factors, and outcomes. Still, s...
Technique or Tuff Luck? OB “Issues”.
October 04, 2023 16:41 - 41 minutes - 37.6 MBIncorrect delivery technique can lead to fetal birth trauma. However, sometimes – despite proper technique and care – fetal birth injuries occur. As I was taught as an intern, “Mal-occurrences don’t always mean Mal-practice“. Does that rule hold true for fetal clavicular fracture? What about Erb’s palsy found at birth? Can these issues occur as part of normal labor and delivery? And at time of cesarean section, does meticulous surgical technique always prevent immediate postop bleeding compli...