Dr. Chapa’s OBGYN Clinical Pearls
Episodes
Ad-Hoc Med Translators: Take Caution.
27 Jun 2021
Contributed by Lukas
According to the latest US Census Bureau report analyzing the use of languages in the United States, over 20% of Americans speak a language other than...
GO MOMs! A New NIH Study for GDM
23 Jun 2021
Contributed by Lukas
Our understanding of gestational diabetes has changed over the last two decades, and more changes are sure to come! The traditional screen between 24 ...
LEEP or CKC? Part 2
20 Jun 2021
Contributed by Lukas
Welcome back! In this session, we will review the contraindications for LEEP and the specific indications for CKC.
LEEP or CKC? A Review of ASCCP Guidelines for HG Dysplasia (Part 1)
16 Jun 2021
Contributed by Lukas
In 2019, the ASCCP made some impactful changes to the management algorithm for cervical dysplasia. Why was the treatment algorithm divided between tho...
Evidence Based Hysterotomy Closure
14 Jun 2021
Contributed by Lukas
Cesarean section is the most common laparotomy performed worldwide. So, you would think we would have a standardized way of closing the uterine incisi...
Mag for RLS? Allison’s Inquiry.
10 Jun 2021
Contributed by Lukas
I love how our medical community can come together to discuss and brainstorm on better ways to care for our patients. Last night I received a message ...
RLS in Pregnancy (Part 2)
10 Jun 2021
Contributed by Lukas
Welcome to Part 2! In this session we will complete our discussion of RLS in Pregnancy and review its workup and management strategies.
RLS in Pregnancy (Part 1)
07 Jun 2021
Contributed by Lukas
Restless Leg Syndrome (RLS), now often referred to as Willis–Ekbom Disease (WED), is a common sensorimotor disturbance much more prevalent in women ...
Brexafemme: Helpful, or Not?
03 Jun 2021
Contributed by Lukas
The FDA has approved Brexafemme, an antifungal drug, for treating vaginal yeast infections. The drug represents the first new antifungal drug class in...
Intracervical Balloon After PROM: June 2021 Meta-Analysis (AJOG).
02 Jun 2021
Contributed by Lukas
PROM complicates 8% of term pregnancies, approximately 270,000 births in the US annually. In this session, we summarize and review a June 2021 Systema...
Hep C Screening (ACOG Advisory May 2021)
29 May 2021
Contributed by Lukas
Hepatitis C is the most commonly reported bloodborne infection in the United States. The ACOG is updating its Hepatitis C screening guidance regrading...
The Obese CS Patient
26 May 2021
Contributed by Lukas
The ACOG will release a new Practice Bulletin in June 2021 discussing obesity in pregnancy. The prevalence of obesity in reproductive age women in the...
Myth-Busting: Preeclampsia Episode (Part 2)
23 May 2021
Contributed by Lukas
The information in this section will shake your foundation regarding what you had previously been told about the origins of preeclampsia. Is the place...
Myth-Busting: Preeclampsia Episode (Part 1)
20 May 2021
Contributed by Lukas
The pathophysiology of preeclampsia continues to be discovered. For decades, the placenta has been portrayed as the “villain“ in the preeclampsia ...
High vs Low-Dose Pitocin: Safety and Effectiveness.
17 May 2021
Contributed by Lukas
Is the high dose Pitocin protocol (6 mU/min) associated with increased C-sections for fetal distress? What about perinatal outcomes? There are a varie...
Term Birth Issues after BMZ?
13 May 2021
Contributed by Lukas
Given the known benefits to BMZ for preterm infants and the difficulty in predicting which women will actually deliver preterm, it is common for p...
Vitamin S: Can Sexual Frustration Cause Depression?
11 May 2021
Contributed by Lukas
Sex can fulfill the human psychological needs of connectedness as well as the physical needs of intimacy. Being alone and lonely can cause major healt...
Adenomyosis (Part 2)
06 May 2021
Contributed by Lukas
In this session we wrap up our review of Adenomyosis. Are you familiar with the MUSA ultrasound criteria? What is the role of MRI in the diagnosis of ...
Adenomyosis (Part 1)
02 May 2021
Contributed by Lukas
Historically, Adenomyosis was a pathological diagnosis only. However, new imaging standards/techniques have moved Adeno into a clinical diagnosis. Is ...
Mood Disorders in Admitted Antepartum Patients: LOOK FOR IT!
28 Apr 2021
Contributed by Lukas
OB Patients admitted with medical or obstetrical complications to an antepartum hospital unit face separation from loved ones, stress from their diagn...
The 4th Trimester: Not Long Enough.
23 Apr 2021
Contributed by Lukas
On April 12, 2021, Illinois agreed to provide Medicaid benefits to eligible mothers for up to 12 months postpartum, a major extension from the previou...
The Acutely Agitated OB Patient
21 Apr 2021
Contributed by Lukas
We often encounter the acutely agitated patient. Acute agitation may be from and uncontrolled medical condition, psychiatric condition, or illicit sub...
Is Caffeine in Pregnancy Bad?
18 Apr 2021
Contributed by Lukas
The ACOG has stated that caffeine consumption in pregnancy should be limited to 200 mg/day. However, a new study published on March 25, 2021 in JAMA N...
Cerebral Venous Sinus Thrombosis & COVID Vaccination
15 Apr 2021
Contributed by Lukas
The CDC released a health alert through its Health Alert Network on April 13, 2021, notifying physicians and other health care practitioners that the ...
Lessons from Midwifery: Maternal Position Changes in Labor
11 Apr 2021
Contributed by Lukas
The field of obstetrics was “birthed“ out of midwifery. The concept of second stage of labor in the lithotomy position was not how it was “alway...
Trauma Informed Care: ACOG April 2021
06 Apr 2021
Contributed by Lukas
The prevalence of trauma is quite sobering. General population surveys have found extremely high rates of traumatic experiences encountered which span...
Hysteroscopy
02 Apr 2021
Contributed by Lukas
Hysteroscopy, and especially office-based hysteroscopy, is a fantastic tool in the evaluation of suspected endometrial abnormalities and/or heavy mens...
HPV Screening & Surveillance
29 Mar 2021
Contributed by Lukas
Algorithms and opinions on cervical cancer screening change quickly. In this session, we will review the uses for HPV testing as a primary screening t...
DON’T DO THESE! (Part 2)
25 Mar 2021
Contributed by Lukas
In this session, we will pick up where we left off with our immediate past podcast covering the SMFM “Choosing Wisely” recommendations. When shoul...
DON’T DO THESE! (Revised SMFM “DON’T DO” LIST)
21 Mar 2021
Contributed by Lukas
Sometimes what sounds good in clinical practice actually is not evidence-based. In March 2021, the SMFM updated the “Choosing Wisely”list of pract...
COVID VACCINE CAUSES INFERTILITY?! (Umm...NO)
17 Mar 2021
Contributed by Lukas
In the era of social media and easy to spread public opinion platforms, misinformation can grow rampant. Is the Covid vaccine associated with infertil...
COVID and Preg: Delivery Timing (SMFM FEB 2021 UPDATE)
10 Mar 2021
Contributed by Lukas
What are the delivery recommendations for pregnant Covid patients? When is expectant management favored compared with elective delivery? Is mechanical...
When to Admit COVID Ob Patients: SMFM UPDATE FEB 2021
09 Mar 2021
Contributed by Lukas
COVID-19 management guidelines change quickly. In this session we will review the February 2021 SMFM update regarding when to consider inpatient care ...
New ACOG CO 818: Medically Indicated Late Preterm/Early Term Births
29 Jan 2021
Contributed by Lukas
In February 2021, the ACOG will release a new committee opinion (818) updating guidelines on “medically indicated late preterm and early term delive...
Non-Dystocia Plexus Injury.
24 Jan 2021
Contributed by Lukas
Historically, brachial plexus palsy was considered proof of shoulder dystocia or traumatic birth. Can brachial plexus injuries occur with normal, unev...
Does COVID-19 Affect Periods?
14 Jan 2021
Contributed by Lukas
There have been a variety of published and accepted clinical presentations of COVID-19: from lack of taste, GI disturbances, muscle aches, to the usua...
CDC RX Update for Gonorrhea.
13 Jan 2021
Contributed by Lukas
Are you still treating urogenital gonorrhea with ceftriaxone and azithromycin? That was a standard for over a decade. But things have now changed. In ...
Opioid Abuse in Pregnancy and MAT
11 Jan 2021
Contributed by Lukas
We all know there is a national opioid epidemic. This, like the current viral pandemic, is robbing people of their lives. Pregnant women are not immun...
Antibiotic timing at CS: New Data
06 Jan 2021
Contributed by Lukas
Historically, CS prophylactic antibiotics were given after umbilical cord clamp and cut to prevent exposure of the neonate to antimicrobials. The reco...
Darkness Within: A Reality-Check on Perinatal Suicide.
26 Dec 2020
Contributed by Lukas
It’s the holiday season, but the holidays can exacerbate depression/anxiety and even increase suicidal ideation in some individuals. Suicide deaths ...
OOOPS!
17 Dec 2020
Contributed by Lukas
A brief explanation regarding our podcast just released, “Ovaries In or Out”!
Ovaries In or Out at Hyst?
17 Dec 2020
Contributed by Lukas
Historically, prophylactic oophorectomy was performed at time of benign hysterectomy in patients at/over 45 years of age. Is this still evidence based...
Steroids and Chorio?
12 Dec 2020
Contributed by Lukas
Considered controversial, traditionally steroids for fetal lung maturation were not given in patients with clinical chorioamnionitis. But is this real...
COVID19 Vaccine Safety in Pregnancy?
09 Dec 2020
Contributed by Lukas
In the very near future, possibly just days away, the FDA is anticipated to approve at least 1 new COVID-19 vaccine. Were pregnant and/or lactating wo...
UNACCEPTABLE! Summary of US Maternal Death CALL TO ACTION Dec 2020
06 Dec 2020
Contributed by Lukas
A woman dies every 12 hours in this country from pregnancy-related complications. 2/3rds of these deaths are preventable! Let that sink in. On Decembe...
“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...