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PODCAST

Dr. Chapa’s OBGYN Clinical Pearls

Dr. Chapa’s Clinical Pearls

Relevant, 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.

science

All Episodes

00:15:23

Feb 26, 24 SMFM Position Statement RHIG 12 Weeks:...

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/02/26

Yes, 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, under 12

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00:35:54

Stage 1 HTN in OB

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/02/24

February 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 hypertension in

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00:44:59

New Developments in HG 🤢🤮🤢

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/02/23

Hyperemesis 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 looking to

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00:47:03

Fetal Manual Rotation: 1st or 2nd Stage Practice?

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/02/20

Women 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 ultrasound to

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00:39:44

“Formula” to Predict SD?

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/02/17

The 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 episode

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00:41:47

GDM “Screen” in 3rd Trimester?

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/02/15

The 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 when it is

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00:39:42

Phthalates and PTB: “New Data”

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/02/14

On 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 potentially

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00:21:10

Another Nail in the Coffin for Late PT Steroids: New...

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/02/11

YES, 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.

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00:27:55

New Data on Naltrexone in Pregnancy

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/02/08

We 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 review a

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00:51:57

TOKOPHOBIA: Pregnant & Petrified

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/02/07

It 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 For

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00:50:10

The OB Steroid WARNING FLAGS: When CONS>PROS

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/02/05

In 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

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00:50:47

Putting LNG-IUS EC In Perspective

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/02/03

On 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

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00:35:38

The Incredible VIBRATING belt (Osteoboost device):...

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/02/01

On 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 why

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00:31:37

Place IUD/S if BV Present? What Would You Do?

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/01/30

Bacterial 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 which

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00:32:29

More Bad News Re: PreEclampsia

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/01/27

Hypertensive 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 data from

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00:52:47

OB Issues After IUD Perf?

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/01/25

Uterine 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

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00:20:39

Extencilline, Linezolid, & STUFF

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/01/22

Yep, 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 available as

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00:48:57

Preg Test in ESRD: Going Down the Rabbit Hole?

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/01/21

If 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 discussion and

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00:46:30

You Asked, We Answered!

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/01/18

Periodically, 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 combination

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00:40:18

Can Propranolol Rescue Labor?

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/01/17

It 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 medications to

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