Dr. Chapa’s OBGYN Clinical Pearls

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...

That Darn Persistent Yeast.

03 Nov 2023

Contributed by Lukas

Recurrent vulvovaginal candidiasis (RVCC) is a highly burdensome, long-lasting medical condition that heavily compromises the activities of women and ...

“Intrapartum, Isolated Maternal fever”: Clinical Outcomes.

01 Nov 2023

Contributed by Lukas

In 2017, the ACOG released committee opinion (CO) 712 which described the 3 categories of intrapartum fever. One of those categories was “isolated i...

DiGeorge Deletion Syndrome

30 Oct 2023

Contributed by Lukas

DiGeorge syndrome… what a complicated condition for such a little area of a single chromosome being affected. The condition’s descriptive and pref...

Bee Pollen & BOOBS😳

27 Oct 2023

Contributed by Lukas

For years, herbalists have touted bee pollen as an exceptionally nutritious food. They've even claimed it is a cure for certain health problems. Bee p...

New SMFM Data: SCD in Pregnancy

25 Oct 2023

Contributed by Lukas

Although there were some early reports of sickle cell disease (SCD) in the late 19th century, the 1st time that the disease was referenced in literatu...

New CC (Nov ‘23) from “The College”: Comp Bioidentical Hormones

24 Oct 2023

Contributed by Lukas

In November 2023, the ACOG will release Clinical Consensus #6, “Compounded Bioidentical Menopausal Hormone Therapy”. We have covered bioidentical ...

NEW FIGO REC: Fe Deficiency w/o Anemia.

21 Oct 2023

Contributed by Lukas

On June 27, 2023, researchers published a population based analysis of the prevalence of Iron Deficiency and Iron-Deficiency Anemia in Females in the...

The Cat 2 FHT Conundrum

20 Oct 2023

Contributed by Lukas

In 2009, the ACOG released practice bulletin 106 which introduced the 3- tier fetal heart rate classification system. This was followed up in November...

Vag Progesterone Returns for PTB?

17 Oct 2023

Contributed by Lukas

In April 2023, both the ACOG and SMFM released their clinical updates regarding the use of progesterone for preterm birth prevention. While 17-OHP is ...

The Fetal Somersault Delivery Manever

16 Oct 2023

Contributed by Lukas

Finding a nuchal cord (NC) at delivery is not rare. NCs occur anywhere from 25-30% of all deliveries. When encountered at time of vaginal delivery, th...

Screen for Vit D in OB?

13 Oct 2023

Contributed by Lukas

Hypertensive Disorders in Pregnancy/Preeclampsia is a persistent problem, world-wide. Over the last decade, studies have highlighted the role of vitam...

Opill: Success and Suspicions

11 Oct 2023

Contributed by Lukas

The FDA’s approval of the first oral hormonal contraceptive pill, Enovid, in 1960 launched a revolution in women’s reproductive healthcare. From t...

יִשְׂרָאֵל

11 Oct 2023

Contributed by Lukas

Here.

CONTROVERSY: Second Stage, How Long is Too Long?

08 Oct 2023

Contributed by Lukas

There is no controversy regarding the definition of the 2nd stage of labor: it is the phase of labor from 10 cm until complete delivery of the child. ...

Mirror Syndrome

06 Oct 2023

Contributed by Lukas

Mirror Syndrome also known as “triple edema” or Ballantyne syndrome, is a rare disorder affecting pregnant women. Mirror Syndrome is often underdi...

Technique or Tuff Luck? OB “Issues”.

04 Oct 2023

Contributed by Lukas

Incorrect delivery technique can lead to fetal birth trauma. However, sometimes – despite proper technique and care – fetal birth injuries occur. ...

OB Pyelo FAKE NEWS

02 Oct 2023

Contributed by Lukas

The ACOG released Clinical Consensus #4 in August 2023, covering Urinary Track Infections in Pregnancy. Urinary tract infection (UTI) is one of the mo...

Advanced Paternal Age? YES

30 Sep 2023

Contributed by Lukas

The age at which couples have children in the United States continues to increase. While it is well documented and known that maternal age directly i...

Beyfortus PASSIVE Immunity info! For Katie!! ❤️❤️❤️

28 Sep 2023

Contributed by Lukas

A quick clarification about Beyfortus neonatal protection against RSV. Thank you Katie for bringing this to my attention! What a wonderful podcast com...

“The College” Clinical PA: Maternal RSV Vaccine Guidance

28 Sep 2023

Contributed by Lukas

We have been following this developing story on the Maternal RSV vaccine, Abrysvo. In the recent podcast, we stated that we would let you know when th...

LDA in Preg: The SAGA Continues

26 Sep 2023

Contributed by Lukas

Low Dose Aspirin has been a routine aspect of preeclampsia prevention since first mentioned by the ACOG’s Hypertension in Pregnancy Task Force repor...

OB Mental Health Meds: “The College” Data Review.

25 Sep 2023

Contributed by Lukas

According to the CDC’s press release from September 2022, the leading underlying causes of pregnancy-related death include mental health conditions ...

ASX Postmenopausal ES Thickness: Bx?

22 Sep 2023

Contributed by Lukas

It’s pretty standard of an evaluation… TVUS for postmenopausal bleeding. It’s well accepted that an endometrial thickness of 4 mm (5 mm in some ...

OB SMORGESBOARD: A Cornucopia of Info.

20 Sep 2023

Contributed by Lukas

Welcome to our “OB Smorgasburg” episode, where we have a CORNUCOPIA of topics. Well, maybe not a full cornucopia… But a mini-cornucopia. In this...

Weekly Labs for HDP (OB HTN)?

18 Sep 2023

Contributed by Lukas

Universal, weekly (surveillance) laboratory screening for expectant management of Hypertensive Disorders in Pregnancy has been routine practice since ...

The “Neglected” STI

17 Sep 2023

Contributed by Lukas

Trichomoniasis has been found in every continent and climate without showing any significant seasonal variability. According to the CDC, trichomoniasi...

Continue Metformin in PCOS Pregnancies?

15 Sep 2023

Contributed by Lukas

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting reproductive-aged women, with a prevalence between 10 to 13%. PCOS has a ...

OCPs + NSAIDS= VTE?

13 Sep 2023

Contributed by Lukas

NSAIDs have been shown to be associated with development of VTEs. This data is not new, but is more than 10 years old. Of course, hormonal contracepti...

Single- or Double-Layer Closure at CS?

12 Sep 2023

Contributed by Lukas

Optimal uterine closure remains one of the most studied and controversial aspects of cesarean delivery. Traditionally, a single-layer locking hysterot...

CS Ut Closure: Decidua or No Decidua?

10 Sep 2023

Contributed by Lukas

A uterine niche is a reservoir-like pouch in the anterior uterine isthmus located at the site of a previous CS scar. First published and describe din ...

SLE in OB: SMFM Info

08 Sep 2023

Contributed by Lukas

SLE can affect people of all ages, including children. However, women of childbearing ages—15 to 44 years—are at greatest risk of developing SLE. ...

Celiac Disease and Fertility/Pregnancy

06 Sep 2023

Contributed by Lukas

Celiac disease is an autoimmune disorder of the small intestine. Celiac disease is the only autoimmune disorder with a single clearly identified envir...

Probiotics for the Vag? Yea or Nay?

04 Sep 2023

Contributed by Lukas

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 ...

Cough Medicine as Antidepressant?

31 Aug 2023

Contributed by Lukas

We recently provided some additional information regarding the recently approved medication for postpartum depression, Zoranalone. One of the benefits...

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

29 Aug 2023

Contributed by Lukas

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 top...

Inositol for PCOS? Yes.

28 Aug 2023

Contributed by Lukas

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%...

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

27 Aug 2023

Contributed by Lukas

In 1990, the ACOG released the “Perinatal Hepatitis B Prevention Program“. OB healthcare workers have doing universal screening for Hepatitis B us...

OCPs and Varicose Veins: Risky or Not?

24 Aug 2023

Contributed by Lukas

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...

New FDA Approved OB RSV Vaccine? Nuances and Cautionary Notes!

22 Aug 2023

Contributed by Lukas

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...

EIN-AEH: New Clinical Consensus (Sept 2023)

21 Aug 2023

Contributed by Lukas

In 2015, the ACOG released its Committee Opinion on "Endometrial Intraepithelial Hyperplasia", or EIN (CO 631). EIN is of clinical significance becaus...

Vital Tips for Shoulder Dystocia: Understanding the Maneuvers

18 Aug 2023

Contributed by Lukas

Recently, a horrific and unimaginable birth event made national (USA) news. A case of shoulder dystocia resulted in an extremely morbid and rarely wit...

Add Cox2 Inhibitor to Plan B? New Data.

17 Aug 2023

Contributed by Lukas

Access to effective oral emergency contraception is vital, now more than ever. While use of either levonorgestrel or ulipristal is endorsed by the ACO...