Dr. Chapa’s OBGYN Clinical Pearls
Episodes
Lioness Device: New Hope for PTB?
16 May 2024
Contributed by Lukas
We all can agree that we need a new ally against the foe of pre-term birth. With the disappointing results regarding the (lack of) efficacy of progest...
🔥OFF THE PRESS: Best Dose of UFH for Antepartum Inpatients? (May 14, 2024 Data)
14 May 2024
Contributed by Lukas
Unbelievable timing! In our immediate past episode, we discussed the controversy surrounding pharmacoprophylaxis for antepartum inpatients. Just 3 day...
Lovenox for Antepartum Inpatients?
11 May 2024
Contributed by Lukas
All of us can agree that the rates of obesity are progressively climbing, not just in the US, but globally. Obesity is a known independent risk factor...
DQC: New Hope for Vaginosis
09 May 2024
Contributed by Lukas
Bacterial vaginosis (BV) is known as a normal vaginal microbiota resulting in low lactobacilli; it affects one-quarter to one-third of reproductive-ag...
Tocolysis Confusion!
07 May 2024
Contributed by Lukas
Preterm birth is the leading cause of death in newborns and children. Tocolytic drugs aim to delay preterm birth by suppressing uterine contractions t...
Puerperal Group A Streptococcus Infection
05 May 2024
Contributed by Lukas
Haemorrhage, hypertensive disorders, and sepsis are responsible for more than half of maternal deaths worldwide. Further, it is estimated that for eve...
The HRT Makeover
03 May 2024
Contributed by Lukas
Menopausal HRT is getting a big, big facelift! Get ready for new research trials, physician education programs, and patient awareness campaigns on men...
What the What?!
01 May 2024
Contributed by Lukas
Just the other day in my University clinic, in one single morning, I had 3 separate patients with three very interesting histories; these became the b...
NEW TODAY! USPSTF MMG Update
30 Apr 2024
Contributed by Lukas
Well, once again… Late breaking news! Today, April 30, 2024, the USPSTF released its updated recommendations for breast cancer screening (mammograph...
🔥 Clinical Practice UPDATE: IAI and FEVER (April 29, 2024) 🔥
30 Apr 2024
Contributed by Lukas
Traditionally, clinical guidance has incorporated maternal fever as a required criterion for suspected intraamniotic infection. That is exactly what i...
Regenerative Medicine in GYN
28 Apr 2024
Contributed by Lukas
Regenerative Medicine is definitively a HOT and marketable offering across a variety of medical disciplines. But it is equally as controversial. The m...
⭐️OBGYN NEWS UPDATE (ALERT): 🔥🔥Off The PRESS
26 Apr 2024
Contributed by Lukas
WOW. There has been a lot of new developments in the ObGyn world within the last 48 hours. In this episode, we will highlight 3 big developments/alert...
FACT or FICTION: Menstrual Synching; and Use of the “Q” Word!
25 Apr 2024
Contributed by Lukas
(With Resident Co-Host Dr Taylor Apley) Menstrual synchrony is often reported by all-female living groups and by mothers, daughters and sisters who ar...
Good News for ALPS Follow up?
24 Apr 2024
Contributed by Lukas
Our regular podcast family members know that we have been following the antenatal corticosteroid story (especially in the late pre-term/early term int...
Gestational Breast Cancer (PABC)
22 Apr 2024
Contributed by Lukas
Breast cancer is the second most common cancer among women in the United States (with skin cancer are the most common). About 9% of all new cases of b...
Colostrum Harvesting? Do No or Not To Do…That’s The Question.
19 Apr 2024
Contributed by Lukas
Historically, colostrum was expressed by women mid- to late-pregnancy with the intent to avoid engorgement and breast trauma in the postnatal period, ...
New Practice Advisory for Syphilis in Pregnancy (April 2024)
18 Apr 2024
Contributed by Lukas
From 2012 to 2021, congenital syphilis cases in the United States increased by 755%. According to the CDC, 88% of congenital syphilis cases in 2022 co...
Female Low T?
17 Apr 2024
Contributed by Lukas
There is a STRONG debate within the medical community as to whether testosterone should be prescribed to women during menopause and the time before an...
IV Fe PP, and More
15 Apr 2024
Contributed by Lukas
While the importance of optimizing a woman's hemoglobin level during the peripartum period has been emphasized in recent guidelines by the Society for...
Amnioinfusion with IAI? Yay or Nay?
12 Apr 2024
Contributed by Lukas
Amnioinfusion was first described in 1976 using a rhesus monkey model. In that landmark study, the authors reported that variable decelerations occurr...
Acetaminophen (Paracetamol) in Pregnancy and Autism: Latest Data (April 9, 2024)
10 Apr 2024
Contributed by Lukas
In 2014, a publication out of JAMA Pediatrics raised questions regarding the safety of acetaminophen in pregnancy describing a possible “association...
When Things Go South: Perinatal PTSD
08 Apr 2024
Contributed by Lukas
It has been stated that “Trauma is in the eye of the beholder”. Healthcare providers must be aware that a woman makes experience a birth as trauma...
New HDP Med Data: The PYTT Study
07 Apr 2024
Contributed by Lukas
In July 2023 and again in November 2023, we discussed the “Rule of 55“ and its role in the management of hypertensive disorders of pregnancy. The ...
The Eclipse’s Effect on Pregnancy ☀️🌞🕶️🕶️🌖🌗🌘🌑
05 Apr 2024
Contributed by Lukas
On April 8, 2024, parts of the United States will be within the Path of Totality for the total solar eclipse. The state of Texas has already declared ...
⭐️NEW⭐️Clinical Practice Update: ACOG Updates PB 222 (Biomarkers for PreE).
04 Apr 2024
Contributed by Lukas
Today, April 3, 2024, the ACOG released a clinical practice update to practice bulletin# 222 (gestational hypertension eclampsia). This is in direct r...
New Data Re: Obesity in Pregnancy- Weight Gain Recs, and NPWT at CS
02 Apr 2024
Contributed by Lukas
According to the CDC, as well as worldwide data, the percentage of individuals categorized as overweight or obese is rising. First released in 1990 by...
The Steroids Saga: New Data, New Debate, New News.
01 Apr 2024
Contributed by Lukas
The current dose and schedule for antenatal corticosteroids (ACS) follows the original publication by Liggins and Howie in 1972. That dose and schedul...
Depo-Provera Causes Brain Tumors?! 😬🧠😬
29 Mar 2024
Contributed by Lukas
Meningiomas are common intracranial tumors with a female predominance. The vast majority of these tumors are benign (World Health Organization [WHO] g...
Balloon For PROM? Yea or Nay
27 Mar 2024
Contributed by Lukas
According to the ACOG, pre-labor rupture of membranes (PROM) complicates 10% of all births in the United States and is a major contributor to perinata...
Neonatal Subgaleal Hemorrhage: Pearls of Wisdom
25 Mar 2024
Contributed by Lukas
Obstetrical vacuum and forceps are incredible tools, when used correctly, to assist vaginal delivery. Appropriately selected and used, they can be piv...
New Menopause CURE? The Ovarian Autotransplantation Debate
22 Mar 2024
Contributed by Lukas
Ovarian preservation by autologous transplantation has given hope to patients desiring future fertility after certain gonadotoxic therapies for malign...
PreMeal or PostPrandial Glucose Checks PP with Type I DM
21 Mar 2024
Contributed by Lukas
Since the late 1990s, the standard practice for GDM care has been to measure postprandial glucose values. For patients with pre-gestational diabetes, ...
Hep C and BF Confusion (and Updated HIV BF Guidance)
18 Mar 2024
Contributed by Lukas
Is breastfeeding with Hepatitis C safe? The answer: Yes! But confusion persists today mainly surrounding the serum hepatitis C viral load. That’s th...
Are ADHD Meds Safe In Pregnancy?
15 Mar 2024
Contributed by Lukas
It has been estimated that up to 4.4% of the US adult population has been diagnosed with ADHD. Use of ADHD medication is increasing among pregnant wom...
Check the Box: REASSURING NEWs regarding US Maternal Mortality
13 Mar 2024
Contributed by Lukas
Four years, the US National Vital Statistics System has reported an abnormally high maternal mortality rate in the United States, showing it to be nea...
Should We Screen For Thrombophilia Pre-OCP? March 2024 Data
10 Mar 2024
Contributed by Lukas
The ACOG, CDC, and WHO currently do not recommend universal screening for thrombophilia in the general population before starting oral contraceptive p...
Metformin in OB and Child's Neurodevelopmental Outcomes (March 2024 Data)
08 Mar 2024
Contributed by Lukas
Gestational Diabetes (GDM) is vastly more prevalent in pregnancy compared to pre-existing diabetes. In 2009, the ACOG states that 7% of all pregnancie...
OPill…Now HERE! (ACOG PA March 2024)
07 Mar 2024
Contributed by Lukas
On this podcast, we have been following this story of the OPill for several months. Previous episodes on the subject can be found in our podcast libra...
GLP1 Agonist Exposure in Pregnancy
05 Mar 2024
Contributed by Lukas
Use of second-line noninsulin diabetic medications, like Glucagon-like peptide 1 (GLP-1) agonists and sodium-glucose co-transporter-2 (SGLT2) inhibito...
Foley For CX: Tension or No Tension? And More (March 2024 Data)
01 Mar 2024
Contributed by Lukas
Using mechanical options as a way to prime/ripen the cervix for labor is nothing new. Balloon catheters have been used for labor induction as far back...
Things That Make You Go Hmmmm
29 Feb 2024
Contributed by Lukas
It’s very important to stay up-to-date and current with new data. But sometimes you read something that is hot-off-the press and it makes you just s...
GDM Dx with Abnormal Fasting Value: Start Meds?
28 Feb 2024
Contributed by Lukas
The “traditional“ Parkland management protocol for GDM included the immediate initiation of medical therapy for those with abnormal fasting blood ...
Feb 26, 24 SMFM Position Statement RHIG < 12 Weeks: Confused?
26 Feb 2024
Contributed by Lukas
Yes, the subject of RhoGAM/RHIG administration to RH negative patients under 12 weeks gestational age is a continuously controversial issue. We have c...
Stage 1 HTN in OB
24 Feb 2024
Contributed by Lukas
February 2024 has seen its share of medical and mainstream media stories highlighting hypertensive disorders in pregnancy. While some of this can be c...
New Developments in HG 🤢🤮🤢
23 Feb 2024
Contributed by Lukas
Hyperemesis Gravidarum (HG) has a reported incidence of approximately 0.3–3% of pregnancies. Without prompt recognition and treatment, severe matern...
Fetal Manual Rotation: 1st or 2nd Stage Practice?
20 Feb 2024
Contributed by Lukas
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 compli...
“Formula” to Predict SD?
17 Feb 2024
Contributed by Lukas
The ACOG has long-held that shoulder dystocia is “unpreventable and unpredictable”. Nonetheless, as it is a devastating obstetrical occurrence, re...
GDM “Screen” in 3rd Trimester?
15 Feb 2024
Contributed by Lukas
The ACOG has consistently recommended universal screening for gestational diabetes between 24 and 28 gestational weeks. Although controversial, the AC...
Phthalates and PTB: “New Data”
14 Feb 2024
Contributed by Lukas
On February 6, 2024, a new publication in the Lancet Planetary Health received national and international headlines. This study, funded through the NI...
Another Nail in the Coffin for Late PT Steroids: New RCT Data
11 Feb 2024
Contributed by Lukas
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...
New Data on Naltrexone in Pregnancy
08 Feb 2024
Contributed by Lukas
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...
TOKOPHOBIA: Pregnant & Petrified
07 Feb 2024
Contributed by Lukas
It is completely natural, and part of the human experience, to have some anticipatory concern about an upcoming delivery/childbirth. However, when tha...
The OB Steroid WARNING FLAGS: When CONS>PROS
05 Feb 2024
Contributed by Lukas
In 1972, Liggins and Howie published their landmark study on the benefits of antenatal corticosteroids (ACS) regarding their reduction of prematurity’...
Putting LNG-IUS EC In Perspective
03 Feb 2024
Contributed by Lukas
On January 28, 2021, a non-inferiority RCT was published in the NEJM, “Levonorgestrelvs Copper T Device for Emergency Contraception”. This study c...
The Incredible VIBRATING belt (Osteoboost device): Good Data?
01 Feb 2024
Contributed by Lukas
On January 18, 2024, the FDA cleared a novel new device for osteopenia treatment. This is a vibrating belt (wearable device) that transmits low-amplit...
Place IUD/S if BV Present? What Would You Do?
30 Jan 2024
Contributed by Lukas
Bacterial vaginosis (BV) is the most common vaginal aberrant condition in women, in the general population. Even still, the majority of women with BV ...
More Bad News Re: PreEclampsia
27 Jan 2024
Contributed by Lukas
Hypertensive Disorders of Pregnancy (HDP) affect 5 to 15% of women worldwide, and their increasing incidence is likely related to the growing levels o...
OB Issues After IUD Perf?
25 Jan 2024
Contributed by Lukas
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 ris...
Extencilline, Linezolid, & STUFF
22 Jan 2024
Contributed by Lukas
Yep, Medicine moves fast! On Friday, January 5, 2024, I participated in a medical news report published in “The Guardian”. In that news commentary...
Preg Test in ESRD: Going Down the Rabbit Hole?
21 Jan 2024
Contributed by Lukas
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… Wha...
You Asked, We Answered!
18 Jan 2024
Contributed by Lukas
Periodically, we respond to podcast family members’ questions as data is available. In this episode, we will cover 3 very clinically relevant questi...
Can Propranolol Rescue Labor?
17 Jan 2024
Contributed by Lukas
It has been well reported that rates of elective induction have risen nationally and internationally since the adoption of the ARRIVE trial. But as me...
More Data on LUST (Follow up to 12/31/23 Episode)
15 Jan 2024
Contributed by Lukas
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...
Beyond the 22 Week Birth
13 Jan 2024
Contributed by Lukas
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 u...
NIPTS Clarify: “46 XX or 46 XY”?
12 Jan 2024
Contributed by Lukas
This is NOT our regularly scheduled episode. Based on an incredible comment from Rachel – one of our podcast family members, which I received just m...
NIPT’s Sex Chromosome Abnormalities: Clinical Pearls.
11 Jan 2024
Contributed by Lukas
NIPT is a prenatal SCREENING method that involves analysis of cell-free fetal DNA (cfDNA) in maternal blood. Prenatal screening for sex chromosome ane...
No Data, No Problem!
07 Jan 2024
Contributed by Lukas
We take pride as healthcare providers in being “evidence based“. But sometimes things that we do, even in 2024, sound, reasonable and sound practi...
UPDATES Re: RHD Alloimmunization
05 Jan 2024
Contributed by Lukas
Before the 1960s, there was no method available to prevent Rh sensitization during Rh-incompatible pregnancies. Then, in 1968, the FDA approved the us...
Teratoma's "Crazy" Side: The "Brain on Fire"
03 Jan 2024
Contributed by Lukas
Historically a range of psychiatric and medical conditions have been erroneously attributed to 2 gynecological organs/function. During the time of Hip...
“LUST” for TOLAC: Last Episode for 2023!
31 Dec 2023
Contributed by Lukas
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 measuremen...
Year of the Doula
28 Dec 2023
Contributed by Lukas
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 materna...
NEW DATA: Fetal Growth Trajectories – the Growth Velocity Issue
26 Dec 2023
Contributed by Lukas
On May 8, 2023, we released an episode called “Slowed Fetal Growth Trajectory and Neonatal Outcome”. That episode highlighted data that slowed fet...
SMFM HBV Consult Series #69: Dec 21, 2033.
23 Dec 2023
Contributed by Lukas
On August 26, 2023, we summarized the ACOG update on viral hepatitis in pregnancy and discussed new concepts regarding Hep B viral infection. To follo...
Is Maternal Short Stature an OB Risk Factor?
22 Dec 2023
Contributed by Lukas
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...
“Orgasm Gave Me a Seizure”
20 Dec 2023
Contributed by Lukas
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...
UPDATED 1st & 2nd Stage Labor Mgmt: Jan 2024
18 Dec 2023
Contributed by Lukas
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 do...
GDF15 and N/V of Pregnancy: Moving Beyond Estrogen and HCG
15 Dec 2023
Contributed by Lukas
It’s really amazing how fast medical information and discovery happens. For decades, we blamed nausea and vomiting of pregnancy/hyperemesis gravidar...
AMH in PCOS DX: 2023 PCOS Update
15 Dec 2023
Contributed by Lukas
According to ACOG’s CO 773 from 2019, “Currently, serum antimüllerian hormone levels are not part of the accepted diagnostic criteria for polycys...
The Endometriosis-Migraine Link: New Data on Genes and CGRP
13 Dec 2023
Contributed by Lukas
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 ...
IVH: OB Considerations
11 Dec 2023
Contributed by Lukas
Advances in obstetrical and neonatal care have allowed for increased survival rates in babies born at extremely premature gestational ages. However, e...
DIY Insemination: YEP, It’s Real.
08 Dec 2023
Contributed by Lukas
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 ...
AOK & AOK-T: Data Review for AFE Care
07 Dec 2023
Contributed by Lukas
Amniotic fluid embolism remains one of the most devastating conditions in obstetric practice with an incidence of approximately 1 in 40,000 deliveries...
The CIN2 Conundrum: New Population-Based Data.
05 Dec 2023
Contributed by Lukas
Management of CINI is straightforward, as is management of CIN3. CIN1 allows for observation, and CIN3 requires treatment regardless of the patient’...
The IR Issue: Evidence-Based Testing
03 Dec 2023
Contributed by Lukas
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 o...
🔥HOT OFF the PRESS: New Data on “Physiologic HTN”/ Rule off 55 (Nov 30)
01 Dec 2023
Contributed by Lukas
On July 30, 2023 we released an episode describing the hypertensive “rule of 55” otherwise known as the physiologic approach to hypertension manag...
F/U Ov Cysts? The O-RADS Scale.
30 Nov 2023
Contributed by Lukas
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 poten...
The Mysterious Bean: The Clitoris Needs Love 💕
28 Nov 2023
Contributed by Lukas
The word clitoris comes from the Greek word, “kleitoris” which means “little hill”. In 1559, the clitoris was “discovered” by an anatomist...
Uterine Rupture in the Unscarred Uterus
25 Nov 2023
Contributed by Lukas
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 f...
“Perfect Timing”: Mag for Late PP HTN (Supplement to immediate past episode)
23 Nov 2023
Contributed by Lukas
On Tuesday, November 21, we released an episode titled “Optimizing Postpartum HTN Care”. On Wednesday, November 22, I received notification that a...
Optimizing PP HTN Care
22 Nov 2023
Contributed by Lukas
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...
Asthma in Pregnancy: the GINA Recs
20 Nov 2023
Contributed by Lukas
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 be...
The “L” in TPAL: What is it Good For?
18 Nov 2023
Contributed by Lukas
It’s a universal nomenclature… The TPAL system. Despite its traditional and long-standing integration into obstetrical vernacular, there are signi...
NEW Home STI Tests Approved 👍
16 Nov 2023
Contributed by Lukas
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 Chlamyd...
To CBE or Not to CBE
16 Nov 2023
Contributed by Lukas
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 ...
ASX Trich in Preg: Treat or No Treat?
14 Nov 2023
Contributed by Lukas
Trichomoniasis is the most prevalent nonviral sexually transmitted infection (STI) in the United States and is more prevalent than chlamydia and gonor...
Get Your Fingers Outta There (New Data on ASX BMEs).
10 Nov 2023
Contributed by Lukas
The pelvic examination is a standard component of the annual gynecologic visit despite limited evidence supporting its utility. Pelvic examinations ca...
Fundal Accreta in a Nullip? YES (The Non-Previa Accreta).
08 Nov 2023
Contributed by Lukas
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 s...
Understanding.
07 Nov 2023
Contributed by Lukas
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 iss...
The Ophthalmia Neonatorum Debate.
06 Nov 2023
Contributed by Lukas
The Centers for Disease Control and Prevention, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the World Hea...
MORE Support for Universal LDA in OB
03 Nov 2023
Contributed by Lukas
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...