Dr. Chapa’s OBGYN Clinical Pearls
Episodes
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...
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...