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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

00:27:18

More Data on LUST (Follow up to 12/31/23 Episode)

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/01/15

On 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 light on

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00:41:55

Beyond the 22 Week Birth

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/01/13

The 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 studies

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00:06:09

NIPTS Clarify: “46 XX or 46 XY”?

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/01/12

This 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.) 😊😊🧐🧐

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00:50:39

NIPT’s Sex Chromosome Abnormalities: Clinical Pearls.

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/01/11

NIPT 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. Initiallyoffered as a secondary screen for pregnancies with a high probability of a

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00:48:26

No Data, No Problem!

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/01/07

We 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 the “test

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00:36:04

UPDATES Re: RHD Alloimmunization

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/01/05

Before 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 that safe

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00:50:29

Teratoma's "Crazy" Side: The "Brain on Fire"

Dr. Chapa’s OBGYN Clinical Pearls ·

2024/01/03

Historically 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

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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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1,099 results

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