Dr. Chapa’s OBGYN Clinical Pearls

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...

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 ...