Dr. Chapa’s OBGYN Clinical Pearls

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...

Throat/Rectal STI

27 Jan 2020

Contributed by Lukas

Currently, the CDC does not recommend “routine screening” for extragenital gonorrhea or chlamydia in women, although it does make that recommendat...

Naltrexone for Pregnancy OUD.

24 Jan 2020

Contributed by Lukas

Opioid use disorder (OUD) Is a national crisis. Pregnancy is not immune to OUD. Traditionally, methadone and buprenorphine have been used as medical t...

Vaginal Vit C for BV? Yep, it’s DATA.

18 Jan 2020

Contributed by Lukas

Up to 30% of initial BV diagnoses will have a recurrence. Does partner therapy (male or female) help reduce recurrence? Most of the original data whic...

Vaginismus

16 Jan 2020

Contributed by Lukas

Vaginismus is the involuntary tightening of pelvic floor muscles that surround the vagina; this can make penetration very painful, if not impossible. ...

Beyond the AFFIRM Trial: Fetal Movement Counting (Feb) 2020 Systematic Review and Meta-Analysis

13 Jan 2020

Contributed by Lukas

In 2018, the Lancet released the AFFIRM trial. They reported a NONsignificant decrease in the stillbirth rate from 4.40/1,000 births in the control gr...

HCV in Pregnancy: IDSA Update

12 Jan 2020

Contributed by Lukas

Currently, the ACOG and SMFM recommend a “risk-based” approach to HCV screening in pregnancy. HOWEVER, a soon to be published original article (Fe...

HT VTE Risk by Route of Administration.

09 Jan 2020

Contributed by Lukas

Most studies on the risks of post menopausal hormone therapy have focused on the oral route of administration. Does the transdermal route of estrogen ...

Vaginal E2 after Breast CA? Yes or No? ACOG CO 659.

07 Jan 2020

Contributed by Lukas

Is vaginal E2 therapy safe in women with a history of breast cancer? What is the data regarding systemic absorption levels? Are you familiar with the ...

Management of Menopausal SXs: ACOG PB 141

05 Jan 2020

Contributed by Lukas

In North America, the median age of menopause is 51 years. Among women reporting menopausal symptoms, vasomotor and vaginal symptoms are the most clos...

Endometriosis & Fertility

03 Jan 2020

Contributed by Lukas

Up to 30% to 50% of infertile women have endometriosis, based on laparoscopic diagnosis. Endometriosis affects fertility through a variety of mechanis...

The Infertility Evaluation: ASRM Guidelines

01 Jan 2020

Contributed by Lukas

Infertility can affect up to 15% of all couples. Male factor infertility can account for up to 40 to 50% of cases, while in 30% of couples there may n...

The BRCA Mutation Carrier

30 Dec 2019

Contributed by Lukas

BRCA1 & BRCA2 are tumor suppressor genes; mutations in either are transmitted in an autosomal dominant pattern. Loss of both copies of either BRCA1 or...

Bartholin’s Abscess: Management Review.

28 Dec 2019

Contributed by Lukas

Once considered pathognomonic for gonorrhea or chlamydia, Bartholin’s gland abscesses are now recognized to be polymicrobial. Is I&D alone 1st line ...

The 2-Vessel Umbilical Cord: Management Review

25 Dec 2019

Contributed by Lukas

There are 4 types of single umbilical artery (SUA), based on pathogenesis. The incidence of SUA is up to 1% of all singleton fetuses, and up to 4.6% o...

Understanding METH: MOA, Pregnancy Effects, and FALSE POSITIVE Tests.

22 Dec 2019

Contributed by Lukas

Methamphetamine and amphetamine use has greatly increased all throughout the United States. While similar to cocaine, it’s mechanism of action is qu...

Cosmetic Genital Surgery: ACOG Jan 2020 Update

20 Dec 2019

Contributed by Lukas

Interest in, and performance of, female cosmetic genital surgery increased 50% from 2014 to 2018. As close to 80% of US females have some degree of pu...

Understanding Factor V Leiden Mutations in Pregnancy

17 Dec 2019

Contributed by Lukas

Pregnancy-related venous thromboembolism is the most common cause of maternal death and a significant cause of maternal morbidity. The factor V Leiden...

Adolescent 1st Gyn Visit: Confidentiality & More (ACOG review)

12 Dec 2019

Contributed by Lukas

The initial gynecological visit for an early teen/adolescent is crucial in establishing patient trust, education of gynecological health, and establis...

Understanding Microdeletions in OB Genetics

10 Dec 2019

Contributed by Lukas

Commercial laboratories offering cell free DNA for fetal prenatal screening are offering microdeletion testing. Is this valid? Microdeletions are vari...

Pregnancy Spacing After Stillbirth: 2019 Data

07 Dec 2019

Contributed by Lukas

The “ideal“ interpregnancy interval depends on the outcome of the immediate, prior pregnancy. For example, the recommended interpregnancy interval...

“Informed Refusal” of a Recommended C-section: An Ethical Review.

03 Dec 2019

Contributed by Lukas

You find that there is a medical indication for a cesarean birth- yet the patient refuses! What are your next steps? Should you seek a court order to ...

Cesarean Section History: From “Lex Regia” to Modern day.

01 Dec 2019

Contributed by Lukas

No! Julius Caesar was not born by cesarean birth. What does a pig-gelder in 1500 have to do with CS History? From Jacob Nufer to Munroe Kerr, we will ...

Burnout? Moral Injury? Here’s the VACCINE for both.

29 Nov 2019

Contributed by Lukas

Medicine: it’s an incredibly rewarding profession. The opportunity and ability to comfort and heal the sick is an absolute privilege. BUT...if you a...

Ob QUANTITATIVE Blood Loss: Dec 2019 ACOG CO

25 Nov 2019

Contributed by Lukas

In December 2019, the ACOG will release committee opinion 794 covering quantitative blood loss in obstetrics. Does QBL use ALONE improve clinical outc...

Lactational Mastitis and Abscess

22 Nov 2019

Contributed by Lukas

Breast-feeding mastitis is a common occurrence and a source of disruption of breast-feeding and negatively affects quality-of-life. In this session, w...

Obesity-Stillbirth Link

20 Nov 2019

Contributed by Lukas

Obesity is a known modifiable risk factor for complications of pregnancy- both antepartum and intrapartum. Data has confirmed a direct link/risk of st...

Periviable Birth

17 Nov 2019

Contributed by Lukas

Periviable birth is defined as delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation. When is the earliest time to consider antenatal ster...

MTHFR: The FACTS

14 Nov 2019

Contributed by Lukas

MTHFR... Yep, it gets blamed for a variety of health and pregnancy concerns. But does the data actually confirm the presence of adverse pregnancy and ...

Dr. Chapa’s OBGYN Clinical Pearls (Trailer)

08 Nov 2019

Contributed by Lukas

Acute Bronchitis: Antibiotics?

07 Nov 2019

Contributed by Lukas

Persistent cough, congestion, low-grade fever… Yep, typical symptoms of acute bronchitis! The CDC and the American College of Physicians have publis...

Keeping Patients Safe!

03 Nov 2019

Contributed by Lukas

“Never events“, “Sentinel events”, and “Near misses”. These terms strike fear in any healthcare provider! The National Quality Forum, the ...

LUBE Library: Not all are the same.

31 Oct 2019

Contributed by Lukas

That’s right… We’re talking about vaginal lubricants! In general, there are 3 main categories: water-based, silicone based, and oil based. Each ...

Mirror (Ballantyne) Syndrome

28 Oct 2019

Contributed by Lukas

Mirror syndrome (first described in 1892) is another term for what is also known as Ballantyne Syndrome or triple edema. Maternal mirror syndrome is a...

ACOG Clinical Alert: (Oct 25, 2019) Progesterone for PTB Reduction

25 Oct 2019

Contributed by Lukas

On October 25, 2019, the American Journal of Perinatology published the results of the PROLONG Trial. This study demonstrated no statistical differenc...

Sepsis in Pregnancy (SMFM Data)

25 Oct 2019

Contributed by Lukas

The rate of sepsis appears to be increasing. Maternal sepsis is a significant cause of maternal morbidity and mortality. Sepsis is not a specific illn...

Nitrous Oxide in Labor: YES, PLEASE.

22 Oct 2019

Contributed by Lukas

N2O is a nonflammable, tasteless, odorless gas. It was first synthesized by the English scientist and theologian Joseph Priestly in 1772, and was firs...

Universal Thyroid Screening in Pregnancy: Pros and Cons.

20 Oct 2019

Contributed by Lukas

Universal thyroid screening in pregnancy is a key debate in endocrinology and obstetrics. While some countries advocate universal screening, the UK an...

Intrapartum Fetal Tachycardia

18 Oct 2019

Contributed by Lukas

Fetal Tachycardia (FT) is described as increase in baseline fetal heart rate (FHR) above 160bpm, for longer than 10 minutes. In clinical daily practic...

Fe Deficiency Anemia’s Effects on Pregnancy: A Controversial Topic.

15 Oct 2019

Contributed by Lukas

With normal pregnancy, blood volume increases, which results in a concomitant hemodilution. Although red blood cell (RBC) mass increases during pregna...

Human Sex Trafficking: A Call for Awareness

14 Oct 2019

Contributed by Lukas

The United States, along with Mexico and the Philippines, was ranked one of the world's worst places for human trafficking in 2018. In the US, there i...

😳The G-SPOT😳: Why the CUV Complex Matters!

12 Oct 2019

Contributed by Lukas

Ahhh...Oooh! The elusive G-Spot! First described in the 1950s by gynecologist Ernst Grafenberg, the “G-Spot” has been a “hot topic“ in sexual ...

Immediate PostPartum LARCS: ACOG and SMFM Review.

10 Oct 2019

Contributed by Lukas

Approximately 45% of pregnancies in the United States are unintended. Similarly, 70% of pregnancies that occur within 1 year of delivery are also unpl...

Omega-3s and Preterm Birth Prevention? A Data Review.

07 Oct 2019

Contributed by Lukas

Preterm birth is now the 2nd leading cause of death in children under 5 years worldwide and accounts for half of all newborn deaths, according to the ...

OVFTP Cancer Treatment: FIGO’s 2018 Summary

05 Oct 2019

Contributed by Lukas

In our previous episode, we covered the revised FIGO ovarian cancer staging which now includes fallopian tube and peritoneal malignancies. In this epi...

Staging for OVFTP malignancies: FIGO’s Revised Ovarian CA System

03 Oct 2019

Contributed by Lukas

The lifetime risk of a woman in the USA developing ovarian cancer is approximately 1 in 70. Malignant tumors of the ovaries occur at all ages with var...

Endometrial CA (Part2): Adjuvant Therapy

01 Oct 2019

Contributed by Lukas

In this session, we will review adjuvant therapy for endometrial carcinoma. What is the role of radiation therapy? What about chemotherapy? Is progest...

Endometrial CA: (Part1) FIGO 2018 Update

30 Sep 2019

Contributed by Lukas

Endometrial carcinoma is the most common type of all the gynecological malignancies. The most common symptom is abnormal vaginal bleeding, especially ...

Cervical CA (Part 2):Management, 2018 FIGO Guidelines

28 Sep 2019

Contributed by Lukas

In this Part 2, we will review the pathological reports which may influence cervical cancer clinical staging. We will also summarize the 2018 FIGO tre...

Cervical CA 2018 FIGO Update (Part1): Revised Staging system.

27 Sep 2019

Contributed by Lukas

Recent developments in imaging and increased use of minimally invasive surgery have changed the paradigm for diagnosis and management of cervical can...

Over-the-Counter Birth Control? A summary of ACOG’s UPCOMING Committee Opinion.

26 Sep 2019

Contributed by Lukas

While offering OTC birth control may be controversial here in the U.S., it is a non-issue in many other countries. China, India, Greece, Turkey, Mexic...

💉💉Flu Vaccine 101! 💉💉💉

25 Sep 2019

Contributed by Lukas

We all recommend it! The influenza vaccine. However, when asked specific questions about the vaccination, a fair number of healthcare providers will n...

PreEclampsia Symptoms: Reliable or Not?

23 Sep 2019

Contributed by Lukas

Eclampsia is a life-threatening pregnancy complication, defined as the new onset of seizures during pregnancy with a concomitant diagnosis of preeclam...

Do Negative Pressure Wound Systems Prevent Wound Infection? A new RCT gives an answer!

21 Sep 2019

Contributed by Lukas

The prevalence of obesity is at an all-time high in the United States, and the obesity rate among women is 40%, with 9.8% of women having class III ob...

Why are SCRUBS/O.R. Gowns Green (or Blue)? A Historical Review.

20 Sep 2019

Contributed by Lukas

Are green scrubs just a fashion statement? What’s behind the choice of green (or sometimes blue) scrubs? Well, there actually is some science to tha...

Breast CA Medical Risk Reduction: USPSTF Sept 2019 Guidelines

18 Sep 2019

Contributed by Lukas

In Sept 2019, the USPTF revised and updated its 2013 recommendations on medications for risk reduction of primary breast cancer. Who qualifies for med...