Dr. Chapa’s OBGYN Clinical Pearls
Episodes
Epidurals=Autism? New 2023 Data.
25 Jan 2023
Contributed by Lukas
A 2020 publication from JAMA Pediatrics reported that labor epidural analgesia may be associated with an up to 37% increased risk of offspring autism ...
PRP Ovarian “Rejuvenation”
22 Jan 2023
Contributed by Lukas
Platelet Rich Plasma (PRP) therapy is a HOT and TRENDY item right now. PRP use was initiated in sports medicine in the 1970s. It has since expanded in...
Routine OB Urine Dips per Visits?
19 Jan 2023
Contributed by Lukas
Routine, repetitive urine dipsticks (meaning at each prenatal visit) were introduced into prenatal care back in the 1960s and 70s. The idea was to act...
IUDs Don’t Cause Abortion
17 Jan 2023
Contributed by Lukas
Paragard, Mirena, and Liletta IUDs are the most effective types of emergency contraception. Data from the 1980s, now seemingly forgotten, showed that ...
The Placenta Menu? Placentophagy Reviewed.
15 Jan 2023
Contributed by Lukas
“Placentophagy” is not a new concept. Most non-human mammals eat their placentas after giving birth but humans, historically, have not. Is there e...
Max Pitocin Infusion Rate (mU/min)?
12 Jan 2023
Contributed by Lukas
The American College of Obstetricians and Gynecologists supports the use of both low-dose and high-dose oxytocin regimens to induce and augment labor,...
Don’t Do Surveillance For These!
10 Jan 2023
Contributed by Lukas
The ACOG states, “In spite of its unproven value, antepartum fetal surveillance is widely integrated into clinical practice in the developed world”...
Breech! ECV and Beyond
08 Jan 2023
Contributed by Lukas
Breech presentation at term occurs in approximately 3 to 4% of pregnancies. While the vast majority are simply chance events, breech presentation coul...
Folic Acid, Folate, or L-Methylfolate?
04 Jan 2023
Contributed by Lukas
On some current social media channels, there is a hot debate as to why professional medical societies still recommend prenatal folic acid compared to ...
Don’t Forget Prenatal Choline!
02 Jan 2023
Contributed by Lukas
Currently on social media, there seems to be an interest in prenatal choline supplementation. Choline, a B vitamin, is not typically within standard p...
Fibroids, Menopause, and HRT
28 Dec 2022
Contributed by Lukas
Uterine fibroids are benign tumors that arise from a single genetically altered myometrial stem cell under the influence of gonadal hormones. Traditio...
A Life Lesson From “ER”
27 Dec 2022
Contributed by Lukas
I am a fan of the original hit TV show, “ER”. Although mostly melodramatic and outside of bounds of reality Medicine, one episode (season 6, episo...
TikTok’s #IUD is Killing a GOOD LARC!
23 Dec 2022
Contributed by Lukas
In January 2023, a new publication in Obstetrics and Gynecology- the Green Journal, will highlight the disheartening statements being made on social m...
Vag Prep at CS UPDATE
20 Dec 2022
Contributed by Lukas
Pre-operative vaginal preparation before gynecological surgery has unquestionable benefit for the prevention of postop infectious morbidity. Does the ...
NPWT at CS: Yay or Nay?
18 Dec 2022
Contributed by Lukas
Surgical site infection (SSI) is the most common complication resulting from cesarean section. Despite advances in infection control, SSIs remain a si...
Timed IUD Insert After Chlamydia Rx?
15 Dec 2022
Contributed by Lukas
Traditionally, the CDC has recommended delaying IUD insertion for 3 months in a woman diagnosed with asymptomatic, cervical Gonorrheal or Chlamydial i...
Redesigning Prenatal Care: An ACOG Initiative.
13 Dec 2022
Contributed by Lukas
In the upcoming (May) 2023 ACOG Annual Clinical Meeting, the College will have a highlighted session to “redesign, prenatal care”. The traditional...
The Single Umbilical Artery
10 Dec 2022
Contributed by Lukas
Did you know that not all cases of a single umbilical artery (SUA) result in a 2-vessel cord? Some umbilical cords with a SUA still have 3 vessels! Ho...
Fasting Better for 1-Hr GTT?
07 Dec 2022
Contributed by Lukas
The ACOG recommends universal screening for gestational diabetes between 24 and 28 weeks of pregnancy with occasional early screening for those at hig...
😊😊Thank you, Ivana!❤️❤️
06 Dec 2022
Contributed by Lukas
As I’ve said on previous podcasts, “we all need some encouragement every now and again”. Well this morning I received mine, through a small gift...
Nix RhoGAM® Under 12 weeks?
03 Dec 2022
Contributed by Lukas
Anti-D immune globulin has been advocated for use in appropriate patients since the 1970s. Historic data showed that 0.1ml of fetal D+ blood was all t...
Fragile X Syndrome: Targeted or Universal Screening?
01 Dec 2022
Contributed by Lukas
Fragile X Syndrome is the most common inherited form of intellectual disability, and the most common single gene cause of Autism Spectrum Disorder. It...
Weed and Breastfeeding: Yay or Nay.
28 Nov 2022
Contributed by Lukas
Marijuana is the most commonly used federally illegal drug in the United States; its use among pregnant and lactating women is on the rise. Is breast-...
The Mouth’s Effect on Pregnancy
26 Nov 2022
Contributed by Lukas
Several cohort studies and meta-analysis have shown a direct association between poor oral health and adverse pregnancy outcomes. The key driver for t...
🧠Your Brain on Gratitude 🙏 🧠❤️
24 Nov 2022
Contributed by Lukas
Happy Thanksgiving, Podcast family! As we gather with family, friends, and loved ones… Let’s make the practice of gratitude a daily habit, not som...
Wimbledon, The Period, and Lack.
21 Nov 2022
Contributed by Lukas
On November 17, 2022 Wimbledon showed a major head nod to women’s health. Do you know what that was? Nonetheless, this recognition of menstruation i...
🪷 The Lotus Birth Request 🪷
17 Nov 2022
Contributed by Lukas
“The Lotus Birth”… Although first described back in the 1970s, this birthing trend is gaining popularity today mainly because of social media. I...
SLE and APS: ASA, LMW Heparin, or Both?
13 Nov 2022
Contributed by Lukas
Systemic Lupus Erythematosis is several-fold more common in women than in men. As it primarily targets reproductive age women, identification of and p...
NPO in Labor? No!
10 Nov 2022
Contributed by Lukas
The idea of keeping women “Nil per os” (NPO) during labor traces back to the 1940s with the pivotal work of Dr. Curtis Mendelson. His work on “a...
New OB TXA Data/WARNING 😳😳
08 Nov 2022
Contributed by Lukas
TXA was first found to reduce maternal morbidity at time of established postpartum hemorrhage in the WOMAN trial (2017). Since then, evidence has grow...
Maternal Carrier Screening: What it is and isn’t.
05 Nov 2022
Contributed by Lukas
Maternal carrier screening (either pan-ethnic or expanded carrier panel) is recommended by the ACOG and SMFM. Ideally, this is done pre-conception or ...
Dense Breasts on MMG: Part 2
01 Nov 2022
Contributed by Lukas
Katie Couric recently described her path to her diagnosis of breast cancer, urging women with “dense breast tissue” to get supplemental breast ima...
Dense Breasts on MMG? What to do (Part 1)
30 Oct 2022
Contributed by Lukas
Dense breasts can decrease the sensitivity of screening mammogram (MMG). Some US states have mandated reporting of breast density on MMG, while the re...
CSection ERAS: DC Foley?
26 Oct 2022
Contributed by Lukas
The Enhanced Recovery After Surgery guidelines were birthed (no pun intended) as a way to curb post-op morbidity from colorectal surgery. In 2019, CSe...
Save the Pitocin! Safe to stop Pit once in Active Phase?
24 Oct 2022
Contributed by Lukas
The United States is currently facing an oxytocin shortage. How long this medication shortage is projected to continue is not clear. In an attempt to ...
Finger-sticks (CBG) for GDM DX?
21 Oct 2022
Contributed by Lukas
In 1964, John O’Sullivan published his original research describing abnormal cut off values following an oral glucose challenge in pregnancy. O’Su...
Hattie’s Hep B Vaccine in Pregnancy Clarification
15 Oct 2022
Contributed by Lukas
Hattie… with these kind of insights, you are going to ROCK your oral boards in the next 72 hours! We are cheering you on! 👏👏👏👏
OB Vaccines: The Sequel!
14 Oct 2022
Contributed by Lukas
Recently, we reviewed the 3 vaccines generally recommended for every woman, in each pregnancy. But as they often say on late night commercials, “but...
Understanding FFN as an L&D Triage Tool.
14 Oct 2022
Contributed by Lukas
Fetal fibronectin was first reported as a possible biomarker for identifying those at risk of preterm birth back in 1991. Despite over 3 decades of ev...
ER-Nifedipine Intrapartum Beneficial for PreE with Severe Features.
08 Oct 2022
Contributed by Lukas
In 2015, the ACOG included immediate release nifedipine as an intervention for acute, emergent hypertension in pregnancy. But what about extended rele...
Early GDM Screening: Evidence-Based?
06 Oct 2022
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...
Anticoag Bridge Therapy in the GYN Patient
04 Oct 2022
Contributed by Lukas
Anticoagulation sure has come along way from warfarin. Although largely replaced by direct oral anticoagulants (DOACs), warfarin is still in use- main...
HMB Control in the Anticoagulated Woman
02 Oct 2022
Contributed by Lukas
Up to 70% of women who are anticoagulated will experience episodes of heavy menstrual bleeding. Traditionally, progestin only hormonal agents have bee...
For Ana and Luis! 😊
01 Oct 2022
Contributed by Lukas
A great podcast topic recommendation/suggestion: anticoagulation bridge therapy, and patients undergoing gynecological surgery. More to come…
Best BP Med for PP HTN? Labetalol or Nifedipine?
28 Sep 2022
Contributed by Lukas
In January 2022, the American Heart Association conducted a study and concluded that labetalol may be the best antihypertensive medication antepartum....
For Dr. Rob S: MPA or Aygestin for AUB-O
25 Sep 2022
Contributed by Lukas
This message is for Dr. Rob in Northern California preparing for his OBGYN oral boards. Rob, thank you for your voice memo on the app! Great question ...
New GBS Vaccine? YES
24 Sep 2022
Contributed by Lukas
Current ACOG/SMFM/CDC guidelines for the prevention of Group B Strep neonatal infection are aimed at prevention of early onset GBS neonatal disease. B...
Acetaminophen + Pregnancy= Autism?
19 Sep 2022
Contributed by Lukas
Acetaminophen (Paracetamol) is the most common medication used in pregnancy. For several years now, observational studies have raised concern for use ...
cBHT/Testosterone For Women
14 Sep 2022
Contributed by Lukas
There is a current trend advocating for women to do complete “hormone panels” for wellness. There is also persistent confusion surrounding the use...
The #1 Killer in Pregnancy
11 Sep 2022
Contributed by Lukas
Maternal mortality in the United States is among the highest of all industrialized nations. Shockingly, the top cause of obstetric death no longer bel...
HSV Discordancy in Pregnancy
07 Sep 2022
Contributed by Lukas
Neonatal herpes infection can be devastating to the newborn. For patients with a history of known genital herpes, daily suppression beginning at 36 we...
The Purple Vagina: Is GV Safe?
03 Sep 2022
Contributed by Lukas
Gentian Violet has been used for over a century for a variety of conditions including vaginal candidiasis. Does it work? More importantly… is it saf...
Does Progesterone Prevent Miscarriage?
28 Aug 2022
Contributed by Lukas
Progesterone has long been hoped to be a remedy for 1st trimester pregnancy loss. Does progesterone help reduce miscarriage risk? The data is ever evo...
FAIL! Disappointing New Data on Vaginal Progesterone
24 Aug 2022
Contributed by Lukas
Oh, the twisted love story of progesterone and pre-term birth! Ever since the Meis trial in 2003, we have been fascinated with the use of progesterone...
White Classification: Still Relevant?
20 Aug 2022
Contributed by Lukas
In 1949, Priscilla White published her landmark study on diabetes in pregnancy, launching the “White Classification”. This has been a staple of pr...
Epilepsy and Women’s Care
17 Aug 2022
Contributed by Lukas
Epilepsy/seizure disorders disproportionately affects women of reproductive age over men. The influence of sex hormones on seizure prevalence is well ...
OB Listeriosis
14 Aug 2022
Contributed by Lukas
There are so many things to go over with our pregnant patients especially at their initial intake visit. However, one thing that should not be left of...
InTOXiCaTED?
11 Aug 2022
Contributed by Lukas
I’ll let this episode title speak for itself… LOL. Hope this makes you smile.
New Med for ENDO! (With Guest Co-Host)
08 Aug 2022
Contributed by Lukas
Endometriosis is a devastating condition. Once thought to have its impact only during reproductive age, endometriosis has been linked to an increased ...
Mag Neuroprotection at 22 Weeks?
02 Aug 2022
Contributed by Lukas
Yesterday, 08/01/2022, we released a podcast on “The 22 Week Birth”. As a follow-up to this, and in response to 5 separate questions (all related ...
The 22 Week Birth
02 Aug 2022
Contributed by Lukas
Over the last several years, the “limit of viability” for neonates has decreased dramatically. The new “lower limit” of neonatal viability can...
Polyhydramnios
28 Jul 2022
Contributed by Lukas
Polyhydramnios affects from 0.2 to 2% of all pregnancies. Which is preferred for diagnosis, MVP or AFI? Is amnioreduction an effective intervention? W...
Misuse of Fetal Scalp Stimulation
23 Jul 2022
Contributed by Lukas
One of the most common techniques to assess fetal status intrapartum is the fetal scalp stimulation test. First proposed in 1936, its incorporation in...
HT in BRCA Patients?
19 Jul 2022
Contributed by Lukas
In this session, we will continue our brief summary of the NAMS 2022 clinical update on hormone therapy. Is hormone therapy allowed in patients with k...
Can HT continue past 65? NAMS 2022 UPDATE
16 Jul 2022
Contributed by Lukas
Medical information moves fast. We know a lot more about risks and benefits of hormone therapy since the impactful WHI study was first released. In th...
New Data on Water Births (July 2022)
12 Jul 2022
Contributed by Lukas
For several years, data has validated the value of water immersion during labor (1st stage). However, when it comes to the 2nd stage of labor, the AAP...
Melatonin Use in Pregnancy?
08 Jul 2022
Contributed by Lukas
Sleep disruption and poor sleep quality are not unusual during pregnancy. That’s obvious! What’s not so obvious is whether a common over-the-count...
“Reverse Sequence” Syphilis Tests
03 Jul 2022
Contributed by Lukas
Lots of practical clinical pearls in this episode! “Reverse sequence testing” for syphilis has largely taken over the traditional testing algorith...
Does Ella Cause Abortion?
27 Jun 2022
Contributed by Lukas
Over the last several days I have received numerous Facebook messages, podcast voice memos, and personal texts regarding the potential for misapplicat...
New ACOG (June 16, 2022) Advisory: “PreP Talk”
25 Jun 2022
Contributed by Lukas
On June 16, 2022, the ACOG released a new practice advisory regarding PreP in the ObGyn patient population. This has important implications on how we ...
PCOS and ACUTE PeriPartum Risks
23 Jun 2022
Contributed by Lukas
We have come a long way from the first report from Stein and Leventhal describing “polycystic ovaries“ on ultrasound in infertile women back in th...
UPDATE
20 Jun 2022
Contributed by Lukas
Well…so there’s this. 😳😳😳
Monkeypox 101: Effect in Pregnancy and Beyond.
13 Jun 2022
Contributed by Lukas
This is your crash course into all things “Monkeypox”. Data for this podcast comes from the CDC, WHO, and the Royal College of Obstetricians and G...
Hydration for Oligo?
09 Jun 2022
Contributed by Lukas
Which is better for determining amniotic fluid volume: the AFI or MVP? There’s data to support one or the other. In cases of isolated oligohydramnio...
Is Myfembree Birth Control?
06 Jun 2022
Contributed by Lukas
According to the ACOG, by natural menopause it is estimated that up to 70% of women will have developed a uterine leiomyoma. 70%! Most of course are a...
Ganas!
03 Jun 2022
Contributed by Lukas
Meet Hilda! In this quick episode, I’ll share a very unique story of one of our coworkers (our featured guest on the podcast). I know this will enco...
Does the Progestin Matter?
02 Jun 2022
Contributed by Lukas
There are currently (in the USA) 4 generations of available progestins in combination birth control pills. Are these differences clinically relevant, ...
Fetal Microcephaly
28 May 2022
Contributed by Lukas
Fetal microcephaly is a devastating diagnosis. Prognosis is dependent on whether fetal microcephaly is isolated or part of other congenital anomalies....
Update
26 May 2022
Contributed by Lukas
Here’s what’s going on… As of May 26, 2022.
The Mask of Pregnancy
21 May 2022
Contributed by Lukas
Pregnancy can definitely work some changes on the body. Melasma is a common pregnancy reaction, and can be a cosmetic concern to many affected. Are tr...
The Non-Palpable Implant
17 May 2022
Contributed by Lukas
The etonogestrel implant is the most effective LARC available. Well, how many years AFTER the FDA approval of 3 years does the implant remain effectiv...
Is Too Much FM Bad?
12 May 2022
Contributed by Lukas
Historically, obstetrical providers cautioned patients about decreased fetal movement. But what about maternal perception of INCREASED fetal movement?...
The Metronidazole Myth!
08 May 2022
Contributed by Lukas
Since the 1960s, metronidazole has carried a label warning stating that alcohol use while taking the medication can lead to significant side-effects. ...
BUMP1 and BUMP2! (May 2022)
05 May 2022
Contributed by Lukas
On May 3, 2022, JAMA published 2 separate randomized clinical trials (RCTs) regarding patient’s self-monitoring of blood pressures at home. Historic...
Headaches in Pregnancy: New ACOG Guidance (May 2022)
29 Apr 2022
Contributed by Lukas
In May 2022, the ACOG Will release a new Clinical Practice Guidance (#3). This will cover “Headaches in Pregnancy and Postpartum”. Do you know whi...
Epidural’s Secret Benefit!
26 Apr 2022
Contributed by Lukas
Addressing severe maternal morbidity is a public health priority in the US. Postpartum hemorrhage is one of the driving contributors to severe materna...
NIPTS Takes a HIT (May 2022 New Publication from Obstetrics & Gynecology)
22 Apr 2022
Contributed by Lukas
It could not have been timed any better: Coming off the heels of the recent FDA warning on the use of noninvasive prenatal test (NIPTS), a new study s...
ACOG’s 4/20/22 Response to FDA Warning!
21 Apr 2022
Contributed by Lukas
On April 19, 2022 the FDA released a warning regarding the inappropriate use of cell free DNA genetic screening tests. Within 24 hours, the ACOG (Apri...
IUS Use and Acne: It’s Real!
19 Apr 2022
Contributed by Lukas
Without doubt, the most common reason for requested progestin-intrauterine system (IUS) removal is abnormal bleeding patterns. But do you know what th...
Matthew’s Question: ROM Plus and EGA
16 Apr 2022
Contributed by Lukas
On Friday, April 15, 2022, I received a Facebook question regarding a recent episode on ROM test. We stated that ROM Plus, as a test, has accuracy bet...
🚨ACOG Practice Advisory🚨: CHAP Trial Response (April 2022).
11 Apr 2022
Contributed by Lukas
Today, April 11, 2022, the ACOG updated its practice advisory regarding chronic hypertension in pregnancy. This follows the statement from the Society...
Ovaries OUT! (New Data On Age of BSO at Benign Hyst)
10 Apr 2022
Contributed by Lukas
Since 2005, experts have advocated for ovarian conservation, until the age of 65, at time of hysterectomy for benign indication. However, a soon to be...
🚨ACOG ALERT🚨 (April 6, 2022): CHAP Trial
07 Apr 2022
Contributed by Lukas
A study published on April 2, 2022 in The New England Journal of Medicine, "Treatment for Mild Chronic Hypertension during Pregnancy” (CHAP Trial) h...
ROM Tests: Not All Are The Same.
02 Apr 2022
Contributed by Lukas
This is Part 2 where we will wrap up our review of commercially available screening tests for ROM. Do you know what each test specifically checks for?...
Understanding ROM Tests: Pitfall Prevention Pearls (Part 1)
30 Mar 2022
Contributed by Lukas
PROM is a common diagnosis in Labor and Delivery. However, making a false positive diagnosis OR a false negative one may place the pregnancy at risk o...
Send The Placenta? Hmm…likely NO.
26 Mar 2022
Contributed by Lukas
Some things in medical practice stem more out of tradition than true clinical evidence. Such is the case for histological examination of the placenta....
Prevention of HBV Vertical Transmission: New Data
22 Mar 2022
Contributed by Lukas
There is a recommendation for universal screening of Hepatitis B surface antigen in pregnancy. Which antiviral medication is recommended for preventio...
Duration of PP MagSulfate: New Data
14 Mar 2022
Contributed by Lukas
Why is Magnesium Sulfate the first-line medication for preeclampsia/eclampsia? How did that arise into the current, international, standard-of-care re...
OB Care After ART (SMFM Series #60; 2022)
07 Mar 2022
Contributed by Lukas
Pregnancies that arise after assisted reproductive technologies (ART) are at higher risk of maternal, fetal, and even placental complications. In this...
Statins and Preeclampsia Prevention: Yes or No.
03 Mar 2022
Contributed by Lukas
Preeclampsia occurs in 3 to 5% of the general OB population. It has even higher prevalence among those with high-risk conditions. Currently, aspirin s...