Dr. Chapa’s OBGYN Clinical Pearls

Persistent Genital Arousal Disorder: It’s a Real Thing! (Genito-Pelvic Dysesthesia)

16 Aug 2023

Contributed by Lukas

Persistent genital arousal disorder (PGAD), now called Genito-Pelvic Dysesthesia, was first described by Leiblum and Nathan in 2001 in a five-patient ...

Recurrent AB? STOP Checking This! (ALIFE2 Data)

14 Aug 2023

Contributed by Lukas

The definition of recurrent pregnancy loss (RPL) in the US is 2 or more consecutive failed clinical pregnancies documented by ultrasound or histopatho...

Does Perineal Massage Prevent SVD Lacs? New Data.

12 Aug 2023

Contributed by Lukas

Perineal trauma after vaginal birth is common, with approximately 9 of 10 women being affected. Second-degree perineal tears are twice as likely to oc...

Understanding ZURZUVAE™ (zuranolone): The First Oral Med for PPD

10 Aug 2023

Contributed by Lukas

In 2019, brexanolone, better known as Zulresso, became the first postpartum depression (PPD) drug to receive FDA approval. While we have previously di...

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

08 Aug 2023

Contributed by Lukas

In our most recent episode on vaginal prep at C-section, we referenced a parallel topic where individual data pieces seem to be contradictory: prophyl...

Vag E2 After Breast CA: Nah or Yeah?

07 Aug 2023

Contributed by Lukas

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...

To Vag Prep or Not to Prep: That is the Question (Aug 2023 Data)

04 Aug 2023

Contributed by Lukas

CS is the most important risk factor for postpartum infection with a 20-fold increase compared to the vaginal delivery route. For post-cesarean sectio...

VTE Med Prophylaxis After SVD?

04 Aug 2023

Contributed by Lukas

Venous thromboembolic events (VTE) are among the top three causes of maternal death in developed countries and prevention with thromboprophylaxis has ...

Kratom & Pregnancy

01 Aug 2023

Contributed by Lukas

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...

The “Rule of 55” For HDP: A Critical Review of a New Meta-Analysis

30 Jul 2023

Contributed by Lukas

In 2019, the ACOG released CO 767 discussing “Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period”. c...

NEW HPV Vaccine ADVISORY: Use After CIN2+ Therapy (PRACTICE ADVISORY; July 2023)

28 Jul 2023

Contributed by Lukas

We have learned so much about the natural progression of HPV induced cervical abnormalities. In 2019/2020, the ASCCP published its updated guidance us...

Amniotic Fluid Injections? 😳💉💉💉

26 Jul 2023

Contributed by Lukas

There are, indeed, FDA indicated applications for purified, amniotic membrane (wound healing). Is there also a role for the use of purified amniotic f...

HS in Pregnancy

25 Jul 2023

Contributed by Lukas

Skin conditions can't affect pregnancy outcomes, right? After all, the skin is just the skin. WRONG! As a chronic inflammatory disease, hidradenitis s...

AHA BP Cutoffs Helpful in Pregnancy? (Aug 2023 Data)

23 Jul 2023

Contributed by Lukas

In Feb 2023, the USPSTF recommended that clinicians “screen for hypertensive disorders of pregnancy”. Specifically, they stated that “measuring...

BV RX to Prevent PTB?

22 Jul 2023

Contributed by Lukas

On April 5,2023 the U.S. FDA withdrew its approval of Makena and generic forms of 17-a hydroxyprogesterone caproate for the prevention of recurrent pr...

Up, Up, and AWAY!😊👋😊👋😊

14 Jul 2023

Contributed by Lukas

FYI. We just released our episode for today, July 14, 2023, and will be out until July 23!

Does Walking Induce Labor? 🚶‍♀️🚶‍♀️🤰

14 Jul 2023

Contributed by Lukas

Its hard to be pregnancy in the late third trimester, especially in a HOT state like TEXAS in the summer. Pregnant individuals will try just about any...

False Positive “Confirmation” Syphilis Test?

13 Jul 2023

Contributed by Lukas

There’s no such thing as a “false positive syphilis confirmation test”, is there? After all… It’s right there in the name, CONFIRMATION test...

The Bandl Band

11 Jul 2023

Contributed by Lukas

The Bandl Constriction Ring. It is real. It exists. Its true incidence is unclear as it lacks uniform reporting when found at time of cesarean. As lab...

How the Sausage is Made! 🤣😊😳

10 Jul 2023

Contributed by Lukas

Just a little description of what happens “behind the scenes“! Enjoy. 😊😊❤️❤️😩😩

Early GDM RX New Data: 👎😕🙁😔

09 Jul 2023

Contributed by Lukas

Gestational diabetes (GDM) is a risk factor for adverse perinatal outcomes. Currently, the ACOG recommends early screening for GDM for women “at ris...

Brand NEW Consensus Statement on OSA in Pregnancy (July 6, 2023)

06 Jul 2023

Contributed by Lukas

Well, Well, Well, this is very interesting. Back in May 10, 2023, we released an episode on "OSA (Obstructive Sleep Apnea) in Pregnancy: Time to Scree...

HT Causes Dementia?! New June 2023 Data.

06 Jul 2023

Contributed by Lukas

The headline from CNN Health form June 28, 2023 reads, "HRT use by younger women linked to dementia, study says". That is FRIGHTENING to any patient u...

The “Antiquated” Apgar Score

03 Jul 2023

Contributed by Lukas

First published in 1952, the Apgar Score has remained unchanged over 70 years and is entrenched in current OB/Pediatric/Neonatal care. The ACOG highli...

CBD in Pregnancy, OK? New Data

01 Jul 2023

Contributed by Lukas

Listen to this! According to recent US statistics from both consumer reports and statista.org: 26% of Americans used CBD in 2022, 24% of people owning...

Placental Lakes on Sono: Implications?

29 Jun 2023

Contributed by Lukas

This episode subject was requested by Emily, one of our podcast family members. She has noticed the reporting of “large placental, venous lakes” o...

Genetic Screen or E-phoresis For Hemoglobinopathy? Is One Better Than the Other?

28 Jun 2023

Contributed by Lukas

We recently had a patient in our OB high-risk community clinic whose maternal carrier screen result was either late or lost. Thinking the test may be ...

Can GBS Cause Vaginitis? New Data on Aerobic Vaginitis.

27 Jun 2023

Contributed by Lukas

Desquamative inflammatory vaginitis (DIV) made its debut in the medical literature in 1965, by the hands of Gray and Barnes. In that paper, they pres...

Circumvallate Placenta: Maleficent or Meh?

23 Jun 2023

Contributed by Lukas

The word placenta, first used in a 1638 anatomy textbook, was borrowed from the New Latin phrase placenta uterina, meaning "uterine cake", because the...

Syphilis' Vertical Transmission (Congenital Syphilis)

21 Jun 2023

Contributed by Lukas

Over the past decade, there’s been about a 700% increase in the cases of congenital syphilis in the United States. That’s 700%! Rates of congenita...

IUD(S) Insert with BV? IUD(S) Pearls.

18 Jun 2023

Contributed by Lukas

LARCS provide remarkable contraception. The IUD and the IUS are both HIGHLY effective, although they do not have the same typical-use failure rates. W...

Bacteria Causes Endometriosis? Surprising New Data From June 2023.

15 Jun 2023

Contributed by Lukas

Endometriosis is caused by endometrial-like tissue containing endometrial glands and extensive fibrotic tissue growing outside the endometrial cavity,...

New Data on PP Home BP Checks: June 2023 Systematic Review

15 Jun 2023

Contributed by Lukas

The world of "Hypertension (HTN) in Pregnancy" is an ever-evolving environment! Many clinicians have adopted patients' home monitoring of blood pressu...

MSAFP “Addendum”: Thank you Maggie Ray!

13 Jun 2023

Contributed by Lukas

Just a quick clarification regarding a previous statement, on an earlier episode, regarding MSAFP….thank you Maggie Rey! ...

The Pill Causes Depression? New June 2023 Data

13 Jun 2023

Contributed by Lukas

Does the combination birth control pill cause depression? This has been a controversial subject for over 2 decades. While some observational studies h...

NAMS 06/2023 NonHormonal Position Statement

11 Jun 2023

Contributed by Lukas

I recently received a message from one of our podcast family members requesting more gynecological topics...that was perfect timing, since the NAMS ju...

Dermatoses of Pregnancy (Pt 2)

09 Jun 2023

Contributed by Lukas

Welcome back to part 2. In this episode we will wrap up our discussions on dermatoses of pregnancy, focusing on atopic eruptions of pregnancy and ICP....

Dermatoses of Pregnancy (Pt 1)

07 Jun 2023

Contributed by Lukas

I’ve said this many times before: I ❤️ our podcast community. This podcast topic idea comes from Jerry, an OBGYN Resident in Virginia. 👏👏 ...

IDA + BetaThal Trait in OB: Fe, or No Fe?

04 Jun 2023

Contributed by Lukas

It has long been considered that iron deficiency does not exist in Thalassemia syndromes, including Thalassemia major as well as Trait (Thal minor). B...

Sterile or Clean Gloves for Labor Checks? New RCT Data (June 2023)

02 Jun 2023

Contributed by Lukas

When performing cervical examinations during labor, providers in the United States commonly use sterile gloves, even when there is no rupture of membr...

GDM Screen After 28 Weeks? Yay or Nay.

31 May 2023

Contributed by Lukas

Here’s a real world clinical conundrum: A patient first presents for prenatal care in the 3rd trimester. As healthcare providers, we play a game of ...

The 39 Week IOL “Dilemma”

29 May 2023

Contributed by Lukas

We are now 5 years into the publication of the Arrive trial (2018) which opened the door to elective induction of labor at 39 weeks in an otherwise lo...

Nonhypoxic Antepartum Fetal Bradycardia

26 May 2023

Contributed by Lukas

The fetal heart rate is controlled by various integrated physiological mechanisms, most importantly by a balance of parasympathetic and sympathetic ne...

New Serum Biomarker Test for sPreeclampsia (The Praecis Study).

23 May 2023

Contributed by Lukas

On May 19, 2023, the FDA cleared a novel biomarker serum test for the risk stratification for severe preeclampsia in hypertensive pregnant women. This...

Umbilical Vein Injection for 3rd Stage?

22 May 2023

Contributed by Lukas

The 3rd stage of labor is the time from child's birth to delivery of the placenta. Delayed placental separation and expulsion is a potentially life-th...

Laughing Gas in Labor.

20 May 2023

Contributed by Lukas

Although labor epidural remains the gold standard for labor analgesia, some patients may opt for a trial of a less invasive analgesic agent. While IV/...

Bipolar in Pregnancy

17 May 2023

Contributed by Lukas

Just the other day I received a text from one of our wonderful FM attendings in our group concerned about refilling a patient’s Lamictal in early pr...

Lactational Mastitis and Abscess: New Data on the Milk Microbiota

15 May 2023

Contributed by Lukas

The ACOG recommends exclusive breastfeeding for the first 6 months of life, with continued breastfeeding while complementary foods are introduced duri...

You Asked, We Answered! (#2): 4 Topics Clarified.

13 May 2023

Contributed by Lukas

This is our second episode in the format of “You Asked, We Answered!” In this episode we will clarify and discuss 4 topics currently active: (1) I...

“Completed” Gestational Weeks?

12 May 2023

Contributed by Lukas

Historically, governmental and professional societies referred to gestational "completed" weeks in their definitions of preterm or term deliveries. Bu...

OSA in Pregnancy: Time to Screen?

10 May 2023

Contributed by Lukas

Obstructive sleep apnea (OSA) affects nearly 30 million people in the United States. OSA isn’t just a disruption to pregnant women’s sleep, it is ...

Pregnancy After Stillbirth: Does Timing Matter?

09 May 2023

Contributed by Lukas

Stillbirth is one of the most common adverse pregnancy outcomes, occurring in 1 in 160 deliveries in the United States. The optimal interpregnancy int...

Slowed Fetal Growth Trajectory & Neonatal Outcomes

08 May 2023

Contributed by Lukas

The ACOG defines FGR as fetuses with an estimated fetal weight or abdominal circumference that is less than the 10th percentile for gestational age (A...

FASD and Paternal ETOH Use

06 May 2023

Contributed by Lukas

Can you believe that in 1977, the public health guidelines issued by the National Institutes of Health suggested a two-drink-per-day limit for pregnan...

Epidural Related Maternal Fever (ERMF)

03 May 2023

Contributed by Lukas

Epidural anesthesia remains the gold standard for relieving labor pain. Currently, there are 3 techniques for providing epidural related analgesia (tr...

MH in L&D: Recognize & Act

01 May 2023

Contributed by Lukas

Medical/Nursing simulations which focus on high-acuity, low-frequency crisis events improve team dynamics, team morale, and most importantly patient o...

Daily Dilemmas, Easy Answers!

29 Apr 2023

Contributed by Lukas

One of the sources of ideas for our podcast topics is our daily clinical practice. During my recent shift in ultrasound clinic, we encountered 4 clini...

CGM in Diabetic Pregnancies

27 Apr 2023

Contributed by Lukas

In June 1999 the FDA approved the first continuous glucose monitor for diabetic intervention. We have come along way since 1999. Continuous glucose mo...

Literature References!

26 Apr 2023

Contributed by Lukas

You asked… We did! Listen in and find out what this means.

Incidental HCG in Menopause?

26 Apr 2023

Contributed by Lukas

It’s a rather uncommon, but not rare, phenomenon: the incidental hCG finding in a postmenopausal patient. What are we supposed to do with that? Is t...

Max Misoprostol Total Dose For Ripening?

24 Apr 2023

Contributed by Lukas

The earliest studies of misoprostol’s use in cervical ripening and labor induction were done by South American investigators, who reported their exp...

IUPC Pros &Cons vs EUM

23 Apr 2023

Contributed by Lukas

The concept of measuring intrauterine contractions strength was first proposed in 1949, and eventually published in 1952. The use of an IUPC is well i...

Can “Shrooms” Cure HPV?

20 Apr 2023

Contributed by Lukas

Once considered on the fringe of main-stream medicine, “alternative therapies” are becoming more accepted into clinical practice. Such is the case...

You Asked, We Answered. 🤔👏🤔

18 Apr 2023

Contributed by Lukas

We ❤️ our podcast community! Over the last 3 recent episodes, we have received similar “themed“ listener questions. So in this episode, we are...

Jade Egg, & Vaginal Weight Lifting 🤔

16 Apr 2023

Contributed by Lukas

I recently had a patient (young reproductive age, without prolapse or urinary incontinence) ask me about using the “Jade Egg” vaginally for better...

Does Mec Staining Correlate to Duration of Exposure?

14 Apr 2023

Contributed by Lukas

Presence of meconium stained membranes/placental tissue has been used in medico-legal cases by both plaintiffs and the defense alike. Using the presen...

Cerclage, Vag Prog, & PTB: SMFM April 13 Statement.

13 Apr 2023

Contributed by Lukas

Oh, the ever evolving drama of “progesterone in high risk obstetrics”. Today, April 13, 2023, the SMFM released its Special Statement response to ...

PostPartum IUDs: Best Time to Place?

12 Apr 2023

Contributed by Lukas

We have come a long way in our understanding regarding the safety of intrauterine contraception. Once withheld from adolescents and immediately postpa...

Low-dose ComboBC VTE Risk (PLUS HRT E2 Serum Levels)

10 Apr 2023

Contributed by Lukas

This episode is in reply to one of our fantastic podcast family members who had some wonderful clinical questions regarding dosage of combination BC a...

ComboBC & Serum E2 Levels

08 Apr 2023

Contributed by Lukas

In 1972, a publication in which a radioimmunoassay measured serum estradiol levels in participants taking oral combination birth control concluded tha...

New Practice Advisory on Dense Breasts at MMG (ACOG PA April 2023) 🚨

07 Apr 2023

Contributed by Lukas

Here’s proof that our catchphrase, “Medicine Moves Fast“ is 100% true! On October 30, 2022, and again on November 1, 2022, we released episodes ...

Makena is GONE.

07 Apr 2023

Contributed by Lukas

A quick update and commentary on the recent (April 6, 2023) FDA decision to withdraw approval of Makena for preterm birth prophylaxis.

“Momnesia”: Your Brain on Pregnancy 🧠😳🧠

06 Apr 2023

Contributed by Lukas

Pregnancy causes some well-known and well documented physical changes to the body. While hyperpigmentation, breast enlargement, and increase in vagina...

The STI “Testing Window”

04 Apr 2023

Contributed by Lukas

For a patient who presents after an episode of unprotected sexual intercourse, seeking testing for STIs, it’s important to know when to perform the ...

VWD in Pregnancy

02 Apr 2023

Contributed by Lukas

Von Willebrand Disease (VWD) is the most common inherited bleeding disorder among American women, and it may present with a history of mucocutaneous b...

Urine STI Screening: New Data

31 Mar 2023

Contributed by Lukas

For women’s healthcare, there are 3 ways to screen for genital GC, chlamydia, and trichomoniasis: 1. vaginal swab, 2. endocervical swab, or 3. first...

The 4 PCOS Phenotypes

29 Mar 2023

Contributed by Lukas

We have come a long way in our understanding of the “Stein and Leventhal Syndrome”. First described in 1935, our understanding of the pathogenesis...

The Vegan OB Patient

26 Mar 2023

Contributed by Lukas

The rate of vegetarianism in the United States is dramatically on the rise. While in 2014, a national survey found that only 1% of the US population c...

AC < 10% with Normal EFW: Risks?

26 Mar 2023

Contributed by Lukas

Traditionally, fetal growth restriction (FGR) was diagnosed when the Hadlock EFW was

Birthing Ball: Toy or Labor Tool?

24 Mar 2023

Contributed by Lukas

Our current discipline of obstetrics owes a lot to the practice of Midwifery. In a previous episode, we covered “lessons learned from Midwifery” a...

For Gerri (CNM)! Quick response regarding a common gyn problem!

22 Mar 2023

Contributed by Lukas

Gerri, thank you for your voice message today! Welcome to our podcast family. Here’s some helpful notes for you. 😊😊

Back to Amnioinfusion for Mec? New Metaanalysis Data (03/2023)

20 Mar 2023

Contributed by Lukas

In Oct 2006, the ACOG released Opinion Number 346. This stated that “Based on current literature, routine prophylactic amnioinfusion for the dilutio...

Unexplained Infertility: New LIFE-CHANGING Genetic Data.

18 Mar 2023

Contributed by Lukas

Infertility. It’s real. It affects 10-15% of couples in the US. After a thorough investigation, 30% of couples will be left without an identifiable ...

OB Anti-Thyroid Antibody Tests: 👍or👎

14 Mar 2023

Contributed by Lukas

Such a small gland… Yet so much confusion, and controversy: the THYROID gland in pregnancy. Let’s start with this foundational question: should we...

HELLP w/o HTN? YES.

11 Mar 2023

Contributed by Lukas

The traditional explanation and assumed pathophysiology of HELLP syndrome stated that it was a late manifestation/further progress of preeclampsia wit...

Fezolinetant: A Revolutionary Medication.

09 Mar 2023

Contributed by Lukas

The pathophysiology of menopausal hot flashes has remained largely a mystery until about a decade ago when KNDy neurons were found to be the key trigg...

Nonreactive NST: Give OJ?

07 Mar 2023

Contributed by Lukas

The fetal NST is a hallmark of antepartum fetal surveillance and a key component of the BioPhysical Profile (BPP). Historically, and still done today,...

Do Rescue ACSs Affect Neurodevelopment? New March 2023 Data.

05 Mar 2023

Contributed by Lukas

The Liggins and Howie trial demonstrating the benefit of antenatal corticosteroids (ACSs) on fetal lungs was published in 1972 in the journal Pediatri...

UPDATE: Israel, “French CSs”, & Patient Groups.

03 Mar 2023

Contributed by Lukas

This is a brief update regarding our recent podcast on “the French C-section”. Having an Israeli member of our podcast family…is priceless! ❤️...

The Scary State of Syphilis

03 Mar 2023

Contributed by Lukas

In 1999, the CDC had a national plan of action to “completely eliminate syphilis” by the year 2005. Although rates of syphilis did dramatically de...

BEWARE The French C-Section!

01 Mar 2023

Contributed by Lukas

The historic saying is, “there is nothing new under the sun”. So true! Such is the case with the extraperitoneal C-section. First advocated in 182...

Pravastatin For Preeclampsia: New (Feb 2023) Data (AJOG).

26 Feb 2023

Contributed by Lukas

The “cure” for preeclampsia is NOT delivery. Preeclampsia is an important signal for future cardiovascular complications once pregnancy is over. W...

The Short Interpregnancy Interval (IPI)

25 Feb 2023

Contributed by Lukas

Some obstetrical publications discuss adverse perinatal outcomes based on a short interpregnancy interval (IPI). A separate, yet related topic, is a s...

The 34-36 WK PPROM Dilemma

23 Feb 2023

Contributed by Lukas

In 2018, the ACOG recommended immediate induction of labor/delivery for patients with PPROM, who had sure gestational dating, and were at 34 weeks and...

Is Proliferative Endometrium in Menopause Benign?

20 Feb 2023

Contributed by Lukas

As part of our medical training and education, we often learn diagnoses in isolation. For example, we have learned that Proliferative Endometrium on E...

Marginal Cord Insertion: Benign or Not?

19 Feb 2023

Contributed by Lukas

Marginal cord insertions can be found on antenatal ultrasound. What is the data regarding marginal cord insertion and adverse neonatal outcomes? Is th...

Beyond the PHQ9: Dr. Leon-Arango’s Case

16 Feb 2023

Contributed by Lukas

This is our impromptu podcast session in-between patients in our OB Clinic. In this episode, Dr. Leon-Arango (Senior Resident) highlights the importan...

Winning Against Placenta Accreta Spectrum

01 Feb 2023

Contributed by Lukas

The first case of placenta accreta listed on PubMed was reported in 1927 by Dr D.S. Forster out of Montreal. That was 1 case in 8000 deliveries! Now, ...

Non-vigorous Baby & Umbilical Cord Milking: New Feb 2023 Data

29 Jan 2023

Contributed by Lukas

Delayed cord clamping (DCC) provides vital placental transfusion to newborns and is endorsed by ACOG, SMFM, March of Dimes, and the ACNM. However, DCC...

IUD Use After Ectopic?

27 Jan 2023

Contributed by Lukas

Historically, IUDs where considered contraindicated in a patient with a prior ectopic pregnancy. This was due to concerns that IUDs may be causative o...