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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

00:42:17

Probiotics for the Vag? Yea or Nay?

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/09/04

Probiotics may be good for your gut, but does your vagina need them too? Probiotics are in everything from fermented drinks to pills and powders, and in many cases, are being advertised as a way of improving your vaginal health. Is that evidence based? Do oral probiotics help support a healthy vaginal microbiome? What about vaginal probiotics? Can vaginal probiotics augment BV therapy? The answer may surprise you. So…Grab your kombucha and take a seat… We’re going to cover this and much more, in

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00:20:47

Cough Medicine as Antidepressant?

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/31

We recently provided some additional information regarding the recently approved medication for postpartum depression, Zoranalone. One of the benefits of this medication is it’s rapid mechanism of action. Although not yet approved for major depressive disorder outside of the perinatal interval, there is a separate medication, which was FDA approved last year, which is ultra-fast acting for depression. Oddly enough, one of its main ingredients is a traditional cough suppressant. Have you heard of

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00:28:03

MI Dose? Zuranolone for MDD? “Shoulder Shrug”? Your...

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/29

As a true testament that we read each one of our Podcast Facebook messages, this is a “You asked, We answered” episode regarding 3 main recent topics: 1. dose of oral MI for PCOS, 2. Zoranalone for Major Depressive Disorder, and 3. the “shoulder shrug” maneuver for shoulder dystocia. 👍👍👍👍

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00:46:14

Inositol for PCOS? Yes.

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/28

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder and one of the most frequent causes of infertility in women. It affects 5–20% of women of childbearing age. The pathogenesis of PCOS is still not fully understood; however, insulin resistance (IR) is known to have a central role in its pathogenesis. According to a cross-sectional study, IR is present in 75% of lean and 95% of overweight women with PCOS. This IR seems to have something else behind it: an imbalance in the ratio of

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00:33:36

UPDATED Recs: Hep B in Pregnancy (Sept 2023).

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/27

In 1990, the ACOG released the “Perinatal Hepatitis B Prevention Program“. OB healthcare workers have doing universal screening for Hepatitis B using HBsAg in each pregnancy, ever since. However, there is a new guidance being released in September 2023 from the ACOG. This new guidance aligns with the national Hep B screening and testing recommendations from the CDC released March 2023. Are you familiar with the “Hep B triple screen”? Is antiviral therapy recommended for Hep B in pregnancy? When

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00:35:15

OCPs and Varicose Veins: Risky or Not?

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/24

OK, OK…we all get that past history of DVT related to hormonal exposure is a true and persistent contraindication for estrogen birth control. We get that. But what about the incidental presence of lower extremity varicose veins? Are varicose veins a contraindication to estrogen containing birth control? After all, some data has linked superficial varicose veins to the development of DVT. That must mean that estrogen containing BC is contraindicated due to the additional risk of clot formation,

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00:19:58

New FDA Approved OB RSV Vaccine? Nuances and...

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/22

On August 21, 2023, the FDA approved a new RSV vaccine for maternal use, ideally in the late third trimester. However, there are some nuances and some cautionary notes here! In this episode, we will review the phase 3 data, which fostered the FDA approval and review the nuances to this study. Are we ready for mass incorporation of the maternal RSV vaccine into clinical practice? The answer quite simply is… “No”. We will explain why in this episode.

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00:41:15

EIN-AEH: New Clinical Consensus (Sept 2023)

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/21

In 2015, the ACOG released its Committee Opinion on "Endometrial Intraepithelial Hyperplasia", or EIN (CO 631). EIN is of clinical significance because it is often a precursor lesion to adenocarcinoma of the endometrium. Making the distinction between hyperplasia and true precancerous lesions or true neoplasia is super important because their differing cancer risks must be matched with an appropriate intervention to avoid under/overtreatment. As is our podcast tagline, "medicine moves fast"; coming

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00:36:04

Vital Tips for Shoulder Dystocia: Understanding the...

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/18

Recently, a horrific and unimaginable birth event made national (USA) news. A case of shoulder dystocia resulted in an extremely morbid and rarely witnessed complication. On August 16, 2023, an extremely important review article was released (ahead of print) in the American Journal of ObGyn. This article summarizes important key aspects and tips for the proper performance of rescue maneuvers for shoulder dystocia, with the aim of keeping both the mother and the baby safe. In this episode, we will

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00:26:20

Add Cox2 Inhibitor to Plan B? New Data.

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/17

Access to effective oral emergency contraception is vital, now more than ever. While use of either levonorgestrel or ulipristal is endorsed by the ACOG, pharmacodynamic and clinical data does show that ulipristal has the efficacy advantage. Although the process of ovulation is directed by the LH surge, it is also put into action by prostaglandin resulting from COX2 activity. So, can the addition of a COX2 inhibitor increase the efficacy of Plan B when taken as a combo? A new study published 24 hrs

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00:38:02

Persistent Genital Arousal Disorder: It’s a Real...

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/16

Persistent genital arousal disorder (PGAD), now called Genito-Pelvic Dysesthesia, was first described by Leiblum and Nathan in 2001 in a five-patient case series. This is now a well-recognized pelvic floor/genital abnormality with a consensus statement being released in 2019 by the International Society for the Study of Women's Sexual Health. Are you familiar with this condition? It is a source of severe emotional and mental hardship for those affected. In this episode, we will summarize the data on

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00:25:00

Recurrent AB? STOP Checking This! (ALIFE2 Data)

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/14

The definition of recurrent pregnancy loss (RPL) in the US is 2 or more consecutive failed clinical pregnancies documented by ultrasound or histopathology, while, in the United Kingdom, the definition is as having 3 or more consecutive early pregnancy losses. Up to 50 percent of cases of recurrent pregnancy loss lack a clear etiology. Where do we stand, in 2023, in regards to our understanding of the effects of inherited thrombophilias on recurrent pregnancy losses? Do they cause recurrent ABs? Does

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00:36:45

Does Perineal Massage Prevent SVD Lacs? New Data.

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/12

Perineal trauma after vaginal birth is common, with approximately 9 of 10 women being affected. Second-degree perineal tears are twice as likely to occur in primiparous births, with a incidence of 40%! Obstetrical lacerations of all degrees can lead to significant physical and even psychological morbidity, and have been identified as an independent risk factor for sexual dysfunction- which could last up to 18 months after delivery. Can perineal massage help reduce the rate of obstetrical trauma at

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00:20:58

Understanding ZURZUVAE™ (zuranolone): The First Oral...

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/10

In 2019, brexanolone, better known as Zulresso, became the first postpartum depression (PPD) drug to receive FDA approval. While we have previously discussed this IV medication for PPD in other episodes, there is now a novel oral version of this antidepressant which has made the news as of last week (ie, early august 2023). That medication was known as SAGE 217 during the clinical trials, but it is now known as zuranolone (ZURZUVAE™). YEP.. in the first week of August 2023, the US Food and Drug

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00:14:27

Brand New TXA at CS Data: Shout out to KC et al!

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/08

In our most recent episode on vaginal prep at C-section, we referenced a parallel topic where individual data pieces seem to be contradictory: prophylactic TXA at time of cesarean section. In that past episode, we referenced a systematic review and meta-analysis that showed prophylactic TXA was indeed beneficial. Well… we are going to build on that data regarding prophylactic TXA in this quick/targeted episode that we call our NEW DATA BLURB. In this episode, we will highlight a fantastic, brand

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00:40:55

Vag E2 After Breast CA: Nah or Yeah?

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/07

With improvements in the screening & treatment of Breast Ca, the number of female survivors continues to rise, with a reported 5-year survival rate of up to 90%. However, several of the systemic treatments for breast cancer, including endocrine therapy, chemotherapy, and radiotherapy, can result in a new or worsened hypoestrogenic state. Up to 70% of postmenopausal women will develop symptoms of genitourinary syndrome of menopause (GSM). With an estimated 3.8 million breast cancer survivors in the

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00:25:15

To Vag Prep or Not to Prep: That is the Question (Aug...

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/04

CS is the most important risk factor for postpartum infection with a 20-fold increase compared to the vaginal delivery route. For post-cesarean section metritis, infection is considered to be primary due to ascending bacteria from the vagina. Although antibiotic prophylaxis is thought to reduce postoperative infections, it has little effect on bacterial colonization of the vagina. Over the past 20 years, multiple randomized clinical trials have investigated the effect of preoperative vaginal

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00:41:07

VTE Med Prophylaxis After SVD?

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/04

Venous thromboembolic events (VTE) are among the top three causes of maternal death in developed countries and prevention with thromboprophylaxis has been identified as the most readily implementable means of reducing maternal mortality from VTE. Most guidelines address VTE prophylaxis after cesarean section, and/or in those with thrombophilias- not after vaginal delivery alone. The ACOG does not directly address inpatient pharmacologic thromboprophylaxis during antepartum admission nor after

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00:37:21

Kratom & Pregnancy

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/08/01

We are still in an opioid crisis state in the US. Have you heard of Kratom? It is likely at your neighborhood health food store or even on the counter at your local gas station. A derivative of the coffee plant, Kratom is making national headlines. Whether Kratom, a legal, widely available herbal supplement, should be classified as an opioid is contentious. Although the US Food and Drug Administration has recently addressed this controversy, Kratom continues to be marketed as an over the counter,

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00:42:40

The “Rule of 55” For HDP: A Critical Review of a New...

Dr. Chapa’s OBGYN Clinical Pearls ·

2023/07/30

In 2019, the ACOG released CO 767 discussing “Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period”. currently, 3 meds are recommended for the treatment of emergent hypertension in pregnancy: oral nifedipine, IV, labetalol, and IV hydralazine. But which one is “better” at normalizing blood pressure? A new meta-analysis, published on July 24, 2023, provides one answer. However, this meta-analysis did not take into account the most crucial factor determining

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