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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

00:44:17

“LUST” for TOLAC: Last Episode for 2023!

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/12/31

This 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? Is

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00:37:12

Year of the Doula

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/12/28

It’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 is the

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00:39:31

NEW DATA: Fetal Growth Trajectories – the Growth...

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/12/26

On 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 trajectory

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00:30:14

SMFM HBV Consult Series #69: Dec 21, 2033.

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/12/23

On 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 infected,

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00:41:29

Is Maternal Short Stature an OB Risk Factor?

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/12/22

The 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,

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00:47:34

“Orgasm Gave Me a Seizure”

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/12/20

Sex 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 of the

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00:43:03

UPDATED 1st & 2nd Stage Labor Mgmt: Jan 2024

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/12/18

BIG. 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 of labor

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00:27:44

GDF15 and N/V of Pregnancy: Moving Beyond Estrogen...

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/12/15

It’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 origin of

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00:46:01

AMH in PCOS DX: 2023 PCOS Update

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/12/15

According 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 will

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00:48:44

The Endometriosis-Migraine Link: New Data on Genes...

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/12/13

We 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 related

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00:57:06

IVH: OB Considerations

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/12/11

Advances 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 preterm

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00:28:19

DIY Insemination: YEP, It’s Real.

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/12/08

We 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 interesting

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00:43:59

AOK & AOK-T: Data Review for AFE Care

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/12/07

Amniotic 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 supplement

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00:36:52

The CIN2 Conundrum: New Population-Based Data.

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/12/05

Management 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 publications,

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00:42:06

The IR Issue: Evidence-Based Testing

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/12/03

A 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 evidence of

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00:23:32

🔥HOT OFF the PRESS: New Data on “Physiologic HTN”/...

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/12/01

On 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 the

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00:47:40

F/U Ov Cysts? The O-RADS Scale.

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/11/30

Population 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

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00:50:22

The Mysterious Bean: The Clitoris Needs Love 💕

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/11/28

The 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 both the

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00:48:32

Uterine Rupture in the Unscarred Uterus

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/11/25

A 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 has

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00:22:36

“Perfect Timing”: Mag for Late PP HTN (Supplement to...

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/11/23

On 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 main

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