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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.

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All Episodes

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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00:55:57

Optimizing PP HTN Care

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/11/22

Data 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 transitions

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00:48:31

Asthma in Pregnancy: the GINA Recs

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/11/20

ACOG’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 Acting B

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00:13:17

The “L” in TPAL: What is it Good For?

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/11/18

It’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 entirely

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00:13:41

NEW Home STI Tests Approved 👍

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/11/16

This 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.

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00:44:29

To CBE or Not to CBE

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/11/16

Recently, 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”, and

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00:41:59

ASX Trich in Preg: Treat or No Treat?

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/11/14

Trichomoniasis 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 membranes

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00:30:13

Get Your Fingers Outta There (New Data on ASX BMEs).

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/11/10

The 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 asymptomatic

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00:43:44

Fundal Accreta in a Nullip? YES (The Non-Previa...

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/11/08

What 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-Section

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00:21:39

Understanding.

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/11/07

I 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.

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00:38:35

The Ophthalmia Neonatorum Debate.

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/11/06

The 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

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00:21:02

MORE Support for Universal LDA in OB

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/11/03

On 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 until

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00:41:28

That Darn Persistent Yeast.

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/11/03

Recurrent 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

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00:34:26

“Intrapartum, Isolated Maternal fever”: Clinical...

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/11/01

In 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 important

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1,099 results

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