Dr. Chapa’s OBGYN Clinical Pearls

“Backdoor” Experiences: From Taboo to Mainstream.

03 Dec 2020

Contributed by Lukas

Once considered TABOO, women having receptive “Backdoor” sexual attention has gained a lot of press in both medical as well as non-medical publica...

Reglan/Benadryl for OB Migraine.

29 Nov 2020

Contributed by Lukas

The two most common types of headaches in pregnancy are tension type and migraine. Is Imitrex safe to use in pregnancy? A common alternative medicatio...

UPDATED ACOG CO#814: Delayed Cord Clamping (Dec2020)

20 Nov 2020

Contributed by Lukas

In December 2020, ACOG will release an updated committee opinion on delayed umbilical cord clamping with 3 additional areas addressed: 1. multiple ges...

ACC HTN Groups & OB outcomes

13 Nov 2020

Contributed by Lukas

In 2017, the American College of Cardiology and the American Heart Association revised the definition of normal BP, elevated BPs, and Stage 1 & 2 Hype...

Does “The Pill” Affect Libido?

09 Nov 2020

Contributed by Lukas

The birth control pill remains one of the most common medications used in reproductive aged women. As all birth control pills have a net antiandrogeni...

Choosing the “Right” Birth Control Pill: Does it Matter?

05 Nov 2020

Contributed by Lukas

Ever since the first progestin was isolated and reproduced out of Mexican Yams in the early 1950s, the race was on to formulate a low-risk, highly eff...

“Smart” Meds, BC, and Birth Defects

02 Nov 2020

Contributed by Lukas

Modafinil and armodafinil are stimulant meds called “smart meds”. Their use is on the rise, but there are important drug interactions with these m...

BV Screen Pre-HYST/D&C?

28 Oct 2020

Contributed by Lukas

It has been a debate for many years: should we be doing routine screening for BV before hysterectomy/gynecology procedures? What about at C-section? I...

BV’s Link to Infertility

27 Oct 2020

Contributed by Lukas

Bacterial vaginosis (BV) is one of the most common vaginal diagnoses in women’s health practices. Over the years there has been increasing evidence ...

Congenital Uterine Anomalies (Pt 2)

24 Oct 2020

Contributed by Lukas

In this continuation, we will cover the reported potential, adverse reproductive outcomes with CUAs. Which surgical corrective procedures should be at...

Congenital Uterine Anomalies (Pt 1)

21 Oct 2020

Contributed by Lukas

The evaluation of congenital uterine anomalies can be traced back to the mid 19th-century. In this session, we will review the ASRM and the ESHRE clas...

🚨UPDATE: New Guidelines Released for Min. Abnormal Cervical CA Screening TESTS❗️

19 Oct 2020

Contributed by Lukas

On September 25, 2020, a new cervical cancer screening working group revised the algorithm (as a proposal) for management of minimally abnormal cervic...

Labor Epidurals Up Autism Risk?😳😳☹️☹️

15 Oct 2020

Contributed by Lukas

In October 2020, JAMA Pediatrics released a publication that is drawing MAJOR criticism from 5 major professional societies. This study highlighted a ...

Phexxi! A New, Non-hormonal Vaginal Contraceptive.

14 Oct 2020

Contributed by Lukas

In May 2020, the FDA approved a new novel, non-hormonal vaginal contraceptive that can be used “on demand“. Although this functions as a “pH reg...

Cerclage to Prevent PTB

09 Oct 2020

Contributed by Lukas

There are calls to remove 17 OHP from the market based on the results of the PROMISE trial. This leaves us with a gap in tools for prevention of prete...

Can Endometriosis Lead to Ovarian Cancer?

05 Oct 2020

Contributed by Lukas

Over the past several years there’s been some alarming publications “linking“ endometriosis to certain ovarian epithelial malignancies. Is this ...

Antenatal Steroids for Preterm Chorio? Yes or No?

30 Sep 2020

Contributed by Lukas

Antenatal corticosteroids help reduce a number of morbidities in the preterm infant. However, chorioamnionitis is generally considered a contraindicat...

Non-Invasive DX of Endometriosis: MicroRNAs and MRI.

25 Sep 2020

Contributed by Lukas

Endometriosis, a chronic disease that afflicts millions of women worldwide, has traditionally been diagnosed by laparoscopic surgery. This diagnostic ...

Lasix for PP PreEclampsia

22 Sep 2020

Contributed by Lukas

One theory behind elevated post-partum blood pressure is that there is a large volume of sodium mobilized into the intravascular compartment in the po...

WES and Stillbirth

19 Sep 2020

Contributed by Lukas

Stillbirths occur in approximately 6/1000 pregnancies in the US. Currently, the ACOG recommends placental histological analysis and fetal chromosomal ...

Advanced Paternal Age

14 Sep 2020

Contributed by Lukas

Advanced Maternal Age (AMA) has long been associated with adverse obstetrical outcomes. However, is the same true for Advanced Paternal Age (APA)? Wha...

The Jada System: Vacuum-Pressure Uterine Tamponade for PPH.

10 Sep 2020

Contributed by Lukas

Postpartum hemorrhage is a leading cause of maternal mortality even in the United States. In September 2020, a new device to help treat postpartum hem...

The Deeply Impacted Fetal Head

07 Sep 2020

Contributed by Lukas

A prolonged second stage of labor, or failed vaginal vacuum extraction, can lead to a deeply impacted fetal head. Is the “push“ technique better t...

Isolated Echogenic Intracardiac Focus (EIF).

03 Sep 2020

Contributed by Lukas

An EIF is a small echogenic area appearing within the fetal cardiac ventricle that has a sonographic brightness equivalent to that of bone. What are t...

Life After Preeclampsia: Long-Term Issues.

31 Aug 2020

Contributed by Lukas

A woman in her 20s with preeclampsia has a worse cardiovascular prognosis at 10 years compared to a woman in her 40s without previous preeclampsia. Ad...

Prevention of Neonatal IVH?

26 Aug 2020

Contributed by Lukas

Intraventricular hemorrhage (IVH) is the most common type of intracranial hemorrhage in the neonate and is the most serious. Which antepartum therapy ...

CMA in Recurrent Preg Loss: Revised Workup Algorithm.

21 Aug 2020

Contributed by Lukas

Recurrent pregnancy loss affects between 3 and 5% of reproductive age couples. Traditionally, the category of “unexplained“ pregnancy loss made up...

Vit D and Pregnancy.

18 Aug 2020

Contributed by Lukas

There is biological plausibility for vitamin D to play a role in pregnancy outcomes, given the presence of receptors in gestational tissues. Data has ...

Cell Free DNA: ACOG PB #226 EPub

15 Aug 2020

Contributed by Lukas

On August 12, 2020, the ACOG released a revised practice bulletin (226) on screening for fetal aneuploidy. In this session we will focus on cell free ...

Tubo-Ovarian Abscess

14 Aug 2020

Contributed by Lukas

TOAs are typically considered the end result of severe PID. However, not all cases are PID related. TOAs may also be a harbinger of genital tract mali...

No “Stirrups” in Gynecology: Chelsea’s Reminder.

13 Aug 2020

Contributed by Lukas

Fantastic! As healthcare professionals, we have to remember to use “patient centered“ terms when possible. This is a brief commentary describing a...

Candy Cane or Boot Footrests at Gyn Surgery: New Data

12 Aug 2020

Contributed by Lukas

It is the age old question at Gyn Surgery… Candy Cane leg holders or Boot support? Is it just physician preference? In August 2020, a new RCT publis...

SMFM Aug 2020: VTE Prevention After CS.

09 Aug 2020

Contributed by Lukas

VTE is a major cause of maternal morbidity and mortality in pregnancy, particularly in postpartum after a cesarean birth. In August 2020, the SMFM rel...

OB Generic Carrier Screening

06 Aug 2020

Contributed by Lukas

Maternal genetic carrier screening is endorsed by the ACOG. Should this be ethnicity-based or should this be “pan-ethnic” screening of disorders? ...

AAP Update: Mother-Infant Separation and COVID19

04 Aug 2020

Contributed by Lukas

On July 26, 2020, the AAP updated its guidance regarding infant separation from a COVID19 positive mother in the immediate postpartum interval. In thi...

COVID19 and OCPs: Safe?

03 Aug 2020

Contributed by Lukas

Your patient is a 22 yo female who has tested positive for SARS-CoV2. Will you keep her on her estrogen containing birth control? In this podcast, we ...

Updated ACOG COVID19 Info (July 29, 2020 Update)

30 Jul 2020

Contributed by Lukas

Yes, information keeps changing! That is why medical education is so important. In this session, we will review the ACOG updated recommendations for b...

🥊 What Can Boxer Buster Douglas Teach Us? ALOT! 👏🥊👏

28 Jul 2020

Contributed by Lukas

⭐️Feb 11, 1990. ⭐️ It was a worldwide sports event. It has been called one of the greatest upsets in sports history. This brief recap of the D...

OB Aspirin Risks? New AJOG Data.

27 Jul 2020

Contributed by Lukas

Given the perceived safety of aspirin during pregnancy, there have even been increasing calls to administer aspirin universally to all pregnant wom...

HPV Vaccines: AUG 2020 ACOG CO

24 Jul 2020

Contributed by Lukas

In August 2020, the ACOG will release a new Committee Opinion (809) reviewing the HPV vaccination. How many doses are required by age? Can the vaccine...

Chlorhexidine Wipes Pre-CS? The STRIPES Trial.

23 Jul 2020

Contributed by Lukas

CS deliveries are the most frequently performed inpatient surgeries in the US. The ERAS pathway for planned cesarean deliveries does not include pread...

Maternal-Fetal Physiology.

21 Jul 2020

Contributed by Lukas

Pregnancy is a co-adaptive, quasi-symbiotic state. There are a variety of maternal physiological and anatomical adaptations which must not be interpre...

SMFM Checklist for PIH PP Discharge (Ahead of Print)

17 Jul 2020

Contributed by Lukas

On January 1, 2021, the Joint Commission will release new standards for maternal safety at discharge from the hospital. Discharge teaching and postpar...

COVID19, Preeclampsia, and Clots.

14 Jul 2020

Contributed by Lukas

COVID19 can have varied clinical manifestations. In pregnancy, new data has highlighted its potential to cause a “preeclampsia like syndrome“. Thi...

Tamoxifen for Nexplanon Bleeding? A New RCT.

12 Jul 2020

Contributed by Lukas

LARCS are endorsed by the ACOG due to the high efficacy. However, unpredictable bleeding can affect continuation rates. A new RCT has evaluated the us...

Cesarean’s AMAZING History (Part 2)

10 Jul 2020

Contributed by Lukas

Did you know that silver wire helped to dramatically reduce maternal mortality at cesarean section? And what does the Goodyear Rubber Company have to ...

Cesarean’s AMAZING History (Part 1)

09 Jul 2020

Contributed by Lukas

What does a pig gelder, a woman dressed as a man, and the Queen of England all have in common? The answer: ALL CONTRIBUTED TO CS’s history! The hist...

Pregnant & Prone for Resp Support

05 Jul 2020

Contributed by Lukas

Prone positioning during invasive mechanical ventilation improves oxygenation, as shown in large randomized clinical trials of patients with ARDS. In ...

Fetal Gastroschisis.

02 Jul 2020

Contributed by Lukas

Gastroschisis occurs in about 1 in 1800 births in the US. Does this abdominal wall herniation usually occur to the right or left of the umbilical cord...

Female Circumcision: ACOG/WHO Response

02 Jul 2020

Contributed by Lukas

Female genital mutilation (FGM) is also known as female circumcision. The ACOG and the World Health Organization have issued public statements condemn...

Polyhydramnios Part 2: SMFM Review, Intrapartum Care

28 Jun 2020

Contributed by Lukas

Is labor affected by polyhydramnios? What is the suggested manner of performing artificial rupture of membranes in this setting? In this session, we w...

Polyhydramnios Part 1 (SMFM #46)

26 Jun 2020

Contributed by Lukas

Polyhydramnios can be mild, moderate, or severe. Is deepest vertical pocket (DVP) or AFI preferred for amniotic fluid assessment? Is antepartum Indoci...

Placenta Accreta Spectrum

22 Jun 2020

Contributed by Lukas

Placenta accreta spectrum, formally known as morbidly adherent placenta, refers to a range of pathologic adherence of the placenta (accreta, increta, ...

Oriahnn for Fibroids HMB (New Med Approval)

20 Jun 2020

Contributed by Lukas

On May 29, 2020, the U.S. FDA approved an novel oral drug, Oriahnn, for HMB use to fibroids. This medication (elagolix, estradiol, and norethindrone a...

Female Sexual Dysfunction (Part2): Therapies.

15 Jun 2020

Contributed by Lukas

In this session, we will conclude our summary of the new ACOG clinical expert series, “Female Sexual Dysfunction“. This episode will focus on spec...

Female Sexual Dysfunction (Part1): New ACOG Clinical Expert Series (EPub).

13 Jun 2020

Contributed by Lukas

Human sexual response is a highly individual and emotional process. Sexual dysfunction is common among women and leads to personal distress. The ACOG ...

Fetal-Neonatal Alloimmune Thrombocytopenia

10 Jun 2020

Contributed by Lukas

Unlike fetal thrombocytopenia resulting from maternal ITP, fetal- neonatal alloimmune thrombocytopenia may occur earlier in gestation and can lead to ...

New Data: Maternal O2 in labor (not helpful!). AJOG June 2020 EPub

07 Jun 2020

Contributed by Lukas

On June 1, 2020, the American Journal of Obstetrics and Gynecology released a new publication with surprising results related to maternal oxygen use i...

Macrosomia (ACOG PB 216)

03 Jun 2020

Contributed by Lukas

Medical information moves fast. Although the increased morbidity with fetal macrosomia has long been known, the ACOG has revised his practice bulletin...

🚨NEW DATA🚨: N95 Masks for 2nd Stage of Labor? (AJOG MAY 2020 Clinical Perspectives)

28 May 2020

Contributed by Lukas

Multiple societies and experts have weighed in on whether 2nd stage of labor warrants universal use of respirators (e.g., N95 masks) vs surgical masks...

Universal SARS-CoV2 Screening in L&D? ACOG EPub Summary

25 May 2020

Contributed by Lukas

Some experts have called for universal screening of all patients admitted to labor and delivery. The foundation of this opinion is to decrease exposur...

Placental Examination: The When, Whys & Whats.

24 May 2020

Contributed by Lukas

Examination (macroscopic and microscopic) of the placenta can give valuable insights into the intrauterine environment. The College of American Pathol...

Thyroid & Pregnancy: June 2020 ACOG PB 223

22 May 2020

Contributed by Lukas

Does the ACOG endorse universal screening for thyroid disease in pregnancy? What about treating subclinical hyperthyroidism or subclinical hypothyroid...

Antenatal Steroids Developmental Harms? Editorial on JAMA May 2020

20 May 2020

Contributed by Lukas

The benefit of antenatal corticosteroids in preterm infants was first reported in 1972, but it took 20 years for widespread adoption. Now, antenatal s...

Is Breastfeeding OK with COVID19?

17 May 2020

Contributed by Lukas

Information can be confusing regarding COVID-19. The WHO, CDC, ACOG, AAP all have slightly different recommendations based upon what topic you’re lo...

Sexual Assault Post-exposure Prophylaxis.

11 May 2020

Contributed by Lukas

Sexual assault/rape is a devastating occurrence for all victims. Post exposure infectious disease prophylaxis has been expanded to include hepatitis B...

OB “Bed Rest” is DANGEROUS: SMFM Series #50 (AJOG EPUB)

09 May 2020

Contributed by Lukas

The ACOG/SMFM does not recommend bedrest in pregnancy for the prevention of preterm birth for women at risk, nor in multiple gestation, or management ...

CVS/Amnio and Microarray Analysis.

05 May 2020

Contributed by Lukas

Advances in 1st trimester aneuploidy screening have increased the need for early prenatal diagnostic testing. There are only 2 prenatal diagnostic tes...

Remdesivir for COVID-19

03 May 2020

Contributed by Lukas

On May 1, 2020, the FDA authorized the emergency use of Remdesivir for COVID-19. This was based on a preliminary analysis of an NIH clinical trial. Ho...

Tobacco/Nicotine & Pregnancy (ACOG May 2020 CO 807)

27 Apr 2020

Contributed by Lukas

In May 2020, the ACOG will release a new committee opinion regarding tobacco/nicotine use during pregnancy. What are the risks of nicotine use during ...

BV screening before hysterectomy?

25 Apr 2020

Contributed by Lukas

In 2018, the ACOG stated that screening for bacterial vaginosis before gynecological procedures “can be considered“ as a way to reduce infection. ...

Seizure Disorders in Reproductive Women (ACOG May 2020, CO 806).

24 Apr 2020

Contributed by Lukas

Women with seizure disorders often have altered menstrual function, with or without anti-seizure medications. One anti-seizure medication has even bee...

OB Exercise Revised Guidelines (April 2010, ACOG CO 804)

19 Apr 2020

Contributed by Lukas

Data on exercise during pregnancy and the postpartum period has evolved. For example, once considered relatively contraindicated, jogging during pregn...

Maternal O2 Harmful in Labor

16 Apr 2020

Contributed by Lukas

Maternal oxygen administration in labor has been used as a traditional tool for intrauterine fetal resuscitation. However, excluding times of maternal...

Against The Odds: Lessons Learned From Helen Keller

14 Apr 2020

Contributed by Lukas

Being deaf and blind in the late 1800s (and a female!) was a prime recipe for failure and poverty. However, one young woman beat incredible odds to ch...

Elmiron and Ocular Maculopathy: New Med Toxicity?

12 Apr 2020

Contributed by Lukas

Elmiron (pentosan polysulfate sodium) is the only oral FDA approved medication for interstitial cystitis/painful bladder syndrome. Initially approved ...

Surgical Procedures and COVID-19 (AAGL)

09 Apr 2020

Contributed by Lukas

The AAGL and the RCOG have released position statements regarding the use of laparoscopy during this viral pandemic. Can surgical plume from energy de...

ARDS in Pregnancy (SMFM Review)

09 Apr 2020

Contributed by Lukas

ARDS in pregnancy carries an increased rate of maternal and perinatal mortality. Specific respiratory physiological changes make care of the pregnant ...

New Labor Guidelines for PUI/COVID-19 (SMFM/SOAP)

02 Apr 2020

Contributed by Lukas

The SMFM has just released new labor guidelines for SARS-CoV2 patients under investigation/confirmed COVID-19. This new practice guideline addresses o...

Dark Medical Humor: Friend or Foe?

30 Mar 2020

Contributed by Lukas

COVID-19 MEMEs are plentiful across social media platforms. Cynical medical humor has been around for decades. This phenomenon was made public in the ...

Phenylalanine Hydroxylase Deficiency in Reproductive Women (ACOG C0 802)

29 Mar 2020

Contributed by Lukas

Phenylketonuria is better known as Phenylalanine Hydroxylase Deficiency (PAH-D). This genetic condition can have significant implications for the repr...

Adolescent Confidentiality in ObGyn (ACOG April 2020)

27 Mar 2020

Contributed by Lukas

In April 2020, the ACOG will release a new committee opinion (803) on adolescent confidentiality and ObGyn. What is the difference between a “mature...

The Neurochemistry of Gratitude.

26 Mar 2020

Contributed by Lukas

It doesn’t matter who you are, what your title/position is, or how physically strong you are, times of social distancing and quarantine can take a m...

AHA CPR Recs in COVID-19 Patients.

24 Mar 2020

Contributed by Lukas

The AHA has just released interim guidance for healthcare providers performing CPR on suspected or known COVID-19 patients. This guidance include the ...

Telemedicine OB Care: It Has Arrived.

22 Mar 2020

Contributed by Lukas

This current global viral pandemic has shed light on the value of telemedicine. The ACOG endorses the use of telemedicine for pregnancy care as a way ...

MIND MEDICINE: The Power of the Will.

20 Mar 2020

Contributed by Lukas

March 20, 2020: Currently, we are in desperate need of some encouraging news. Social distancing, times of quarantine, and a viral pandemic can easily ...

Personal Note to Our Listeners.

18 Mar 2020

Contributed by Lukas

Stay encouraged, focused, and passionate.

Universal HCV Screening (Obstet Gynecol EPub).

16 Mar 2020

Contributed by Lukas

Even though we have covered this topic in a prior podcast, the urgent need for Hepatitis C screening in pregnant women still leads the medical literat...

Soft Markers of Aneuploidy: Part 2

12 Mar 2020

Contributed by Lukas

Welcome back! In this session, we will cover the echogenic cardiac focus, short humerus and femur length, fetal pyelectasis, and single umbilical arte...

Soft Markers of Aneuploidy: Management Part 1 (SMFM;AIUM Data).

11 Mar 2020

Contributed by Lukas

In this session, Part 1, we will review soft markers of aneuploidy and their management. Soft markers of aneuploidy can be isolated or multiple. They ...

Can aspirin reduce preterm birth?

09 Mar 2020

Contributed by Lukas

In the ACOG committee opinion (743) on low-dose aspirin in pregnancy, the College states that more data is necessary before low-dose aspirin can be re...

VR Tech for Labor Pain Control

07 Mar 2020

Contributed by Lukas

Virtual reality is well-established in the gaming community, but data is expanding regarding its utility and effectiveness for a variety of medical co...

Air Travel, Viruses, and Pregnancy.

28 Feb 2020

Contributed by Lukas

Worried about airline travel amid global health concerns? Well, you’re not alone. What does the CDC say about airline infectious disease precautions...

Vulvodynia

25 Feb 2020

Contributed by Lukas

Vulvar pain (vulvodynia) is subdivided into generalized or local. The symptoms can either be spontaneous or provoked. Vulvodynia can result in painful...

PROM March 2020 Update!

23 Feb 2020

Contributed by Lukas

Pre-labor rupture of membranes should be diagnosed based on clinical assessment. In March 2020, the ACOG will release a new practice bulletin (217) on...

Chronic Pelvic Pain (ACOG PB 218)

21 Feb 2020

Contributed by Lukas

Chronic pelvic pain has been redefined by the ACOG and includes a broader range of etiologies. There are 3 main categories of potential etiologies for...

Cannabis Induced Hyperemesis

11 Feb 2020

Contributed by Lukas

Cannabinoid Hyperemesis Syndrome: Although widely recognized in the gastroenterology and psychiatry literature, its occurrence in pregnancy is well kn...

ORAL SEX! (and HPV)

05 Feb 2020

Contributed by Lukas

In 2013, actor Michael Douglas blamed frequent oral sex with his wife as a cause of his throat cancer. In the 17 years from 1999 through 2015, the mou...

Malignant GTD

31 Jan 2020

Contributed by Lukas

Malignant GTD includes choriocarcinoma, invasive mole, and placental site trophoblastic tumor. When is single agent chemotherapy indicated? What about...

Molar Pregnancies

30 Jan 2020

Contributed by Lukas

Gestational Trophoblastic Neoplasia is a complex condition with various histological and clinical distinct entities. In this episode, we will review t...