Dr. Chapa’s OBGYN Clinical Pearls

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...

“Backdoor” Activity? Ask,Screen,Treat: Nongenital STIs.

16 Sep 2019

Contributed by Lukas

Once taboo, anal sex has slowly been slipping into the mainstream. A recent study found that 37% of women reported having anal sex with the opposite s...

IC/Painful Bladder Syndrome (Part2): Treatment options

15 Sep 2019

Contributed by Lukas

Treatment strategies for IC should proceed using more conservative therapies first with less conservative therapies employed if symptom control is ina...

IC/Painful Bladder Syndrome: New AUA Guidelines

14 Sep 2019

Contributed by Lukas

The effects of IC/BPS on psychosocial functioning and QoL are pervasive, damaging work life, psychological well-being, personal relationships and gene...

Funisitis

12 Sep 2019

Contributed by Lukas

In 2017, the ACOG defined 3 classes of intraamniotic infection. Although most research/data has been on inflammation/infection of the placenta/membran...

OB Forceps’ Strange History

11 Sep 2019

Contributed by Lukas

Obstetrical forceps have a strange history: considered by historians to have been created by William Chamberlain, a French surgeon, the tool was kept ...

9.1.1.

11 Sep 2019

Contributed by Lukas

Never. Forget.

Female Athlete Triad

11 Sep 2019

Contributed by Lukas

Exercise in the young female adolescent is wonderful! But like everything else, too much can be dangerous. The Female Athlete Triad is marked by: 1. l...

Beyond Gardnerella: BV Biofilm New Data.

08 Sep 2019

Contributed by Lukas

Garderella Vaginalis may not be the only pathogen causing BV like symptoms. New data has linked BV with a vaginal BIOFILM ecosystem. It also increases...

Desquamative Inflammatory Vaginitis: An Old/New Awareness

07 Sep 2019

Contributed by Lukas

The human vaginal ecosystem is highly dynamic. The vaginal microbiome can affect host physiology, and vice versa. In 1965, Desquamative Inflammatory V...

BARE DOWN There? New data on STIs and going bare.

05 Sep 2019

Contributed by Lukas

Pubic hair grooming is a highly prevalent practice with self-reported rates between 75 to 99% of women. Does this increase STI risk? In this podcast, ...

Best Vaginal Prep PreCS? A new systematic review & meta-analysis.

05 Sep 2019

Contributed by Lukas

Post CS endometritis is thought to be linked to ascending vaginal bacteria. In 2016, the CSOAP trial concluded that adding ZMAX to standard antibiotic...

Mycoplasma genitalium: An Overlooked STI.

03 Sep 2019

Contributed by Lukas

Mycoplasma genitalium is a facultative anaerobic organism which has been associated with cervicitis, endometritis, PID, infertility, susceptibility to...

Adolescent BC leads to Depression? Let’s see.

02 Sep 2019

Contributed by Lukas

Previous evidence suggests that use of oral contraceptives, especially during adolescence, may increase women’s vulnerability to depression in the s...

⚠️ Labor 2nd Stage: Too Long?

01 Sep 2019

Contributed by Lukas

In 2014, the ACOG released a consensus statement, “Safe Prevention of the Primary Cesarean”. This extended the 2nd stage of labor by 1 hour. Was t...

Wound Healing Principles: A clinical review.

31 Aug 2019

Contributed by Lukas

Wound healing is a complex and dynamic process! In this episode, we will review the 4 stages of wound healing using the analogy of “the broken house...

The V is NOT a TRUMPET! Air embolism after cunnilingus. 😳

29 Aug 2019

Contributed by Lukas

Air embolism during pregnancy has been reported… usually linked to blowing air into the vagina during orogenital sex. In this session, we will revie...

Testosterone Use in Women: Wonder-Drug or Waste?

27 Aug 2019

Contributed by Lukas

There is currently no FDA approved testosterone products for women. Internet sources, and some pharmacies, offer a variety of testosterone products fo...

Fertility Meds Cause Breast CA? Let’s look at the data.

26 Aug 2019

Contributed by Lukas

Many studies have evaluated the relationship between fertility drugs and breast cancer. Are you aware of what the data shows? How would you cancel you...

Fertility Meds Cause Ovarian CA? Let’s look at the data.

25 Aug 2019

Contributed by Lukas

The use of fertility drugs that may cause alterations in endogenous hormones and multiple ovulations has raised concerns about the long-term safety of...

Amniotic Fluid Embolus

24 Aug 2019

Contributed by Lukas

Amniotic fluid embolism is a rare but potentially lethal condition. Because of the rarity of this condition, most physicians and institutions have lim...

Uric Acid for Preeclampsia Eval? No.

23 Aug 2019

Contributed by Lukas

Serum uric acid levels are often ordered for the evaluation of hypertensive disorders of pregnancy. But why is this done? Is this test able to guide c...

😳SEX Headaches😳: Yes...it’s a thing!

22 Aug 2019

Contributed by Lukas

Yes...it’s a real diagnosis. Sexual headaches may be PRIMARY (without other etiology) or secondary (due to a more serious issue). Primary sexual hea...

How Committed are YOU? A life lesson from Julie Moss.

19 Aug 2019

Contributed by Lukas

If you have never heard the story of Julie Moss (1982), start listening to this episode! This is an example of not just being interested in a project/...

ERCP in Pregnancy

18 Aug 2019

Contributed by Lukas

Surgery for biliary tract disease is among the top 3 reasons for non-obstetrical surgery during pregnancy (1:1500 to 1:10,000 pregnancies). What is th...

Do Hurricanes Cause Labor?

17 Aug 2019

Contributed by Lukas

💥Hurricanes💥! No… Not the traditional and historic drink from New Orleans! 🍹🍹We’re talking about the intense, devastating, natural wea...

Fetal Kick Counts: Tradition VS Truths; The AFFIRM Trial Data.

14 Aug 2019

Contributed by Lukas

Stillbirth is a pervasive problem worldwide. Maternal perception of reduced fetal movement has been identified as a potential strategy for stillbirth ...

Don’t Steam the V! The V is not a teapot. Here are the potential risks of vaginal steaming.

12 Aug 2019

Contributed by Lukas

Vaginal steaming has become a cult phenomenon since 2010. But this “alternative“ practice has some real potential risks. Where did this even come ...

OCPs/HRT in BRCA Carriers: What’s the Evidence?

11 Aug 2019

Contributed by Lukas

Because of the increased risk for breast cancer, BRCA mutation carriers may have concerns about taking oral contraceptives or using hormone replacemen...

Endometriosis and adverse OB outcomes.

09 Aug 2019

Contributed by Lukas

Women with endometriosis may represent a unique population of women at greater risk for adverse outcomes across pregnancy and birth. In this session, ...

OB Outcomes per Advancing Weeks of Term Gestation.

08 Aug 2019

Contributed by Lukas

Is 39 weeks the “sweet spot” for delivery? Neonatal and maternal adverse outcomes have been studied through increasing gestational ages from 37 we...

ALERT: Methylene Blue- A Potential Cause of Serotonin Toxicity

07 Aug 2019

Contributed by Lukas

Healthcare professionals and patients may not realize that methylene blue has monoamine oxidase inhibitor (MAOI) properties. Methylene blue should gen...

Opioid Use in Pregnancy: Methadone and Buprenorphine Medical Therapy.

06 Aug 2019

Contributed by Lukas

Opioid use in pregnancy is a real issue! This podcast will review 2 pharmacotherapies for opioid dependency in pregnancy. We will end the session with...

Chronic Kidney Disease in Pregnancy.

04 Aug 2019

Contributed by Lukas

Chronic kidney disease can affect anywhere from 0.1 to 4% of all pregnancies. Pre-existing renal disease can have severe consequences for a pregnancy....

Depression/Anxiety Meds in Pregnancy.

02 Aug 2019

Contributed by Lukas

Depression/anxiety can affect up to 20% of women during pregnancy. These 2 psychological conditions have adverse pregnancy outcomes in and of themselv...

Can SEX induce Labor?

31 Jul 2019

Contributed by Lukas

For decades, women have been told that having intercourse/orgasms late in pregnancy can hasten the onset of labor. But is this a myth, or is this true...

Adnexal Torsion in Adolescents: New ACOG Opinion (Aug 2019)

27 Jul 2019

Contributed by Lukas

Thirty percent of all cases of adnexal torsion occur in females younger than 20 years. In this episode, we will review the latest committee opinion fr...

NEW ERAS Post CS Guidelines

23 Jul 2019

Contributed by Lukas

This Enhanced Recovery After Surgery Society guideline was created to support the most common surgical procedure in the industrialized healthca...

Interpregnancy Intervals and OB Outcomes.

20 Jul 2019

Contributed by Lukas

Short interpregnancy intervals, as well as long intervals between pregnancies, are associated with some potential adverse obstetrical outcomes. What d...

SLYND! The new, novel drospirenone oral BC pill.

17 Jul 2019

Contributed by Lukas

How much do you know about the recently approved novel BC pill, SLYND? Do you know it’s efficacy? What are the contraindications? In this session, w...

How bad do you want it?

16 Jul 2019

Contributed by Lukas

DISCLOSURE: Not for the PC! Not for those who lack determination, or GRIT. This is the antidote for mediocrity. Just a little motivation to KEEP YOU F...

Recurrent Preg Loss (Part 2).

14 Jul 2019

Contributed by Lukas

Part 2: In this session, we will wrap up our discussion on recurrent pregnancy loss by focusing on 3 controversial areas: 1. Immunological therapy, 2....

Recurrent Preg Loss (Part 1).

13 Jul 2019

Contributed by Lukas

Recurrent pregnancy loss is devastating for the affected couple. In part 1, we will review the diagnosis of this condition. We will also cover parenta...

OB Rapid-Fire Q&A! Common questions and concerns raised during pregnancy.

11 Jul 2019

Contributed by Lukas

Howdy, all! Rather than discussing one topic, this session will review “quick facts“ on common OB concerns/questions. Should we screen for HSV dur...

Revised GBS Guidelines: ACOG CO 782 (July 2019)

08 Jul 2019

Contributed by Lukas

On July 1, 2019 ACOG updated/revised the GBS algorithm for intrapartum prophylaxis. In this session, we will cover GBS prophylactic indications, NAAT ...

Does H. Pylori lead to Hyperemesis?

04 Jul 2019

Contributed by Lukas

Persistent nausea and vomiting in pregnancy is a terrible condition! It affects quality-of-life, and impacts the mother’s overall psychological well...