Dr. Chapa’s OBGYN Clinical Pearls

Hypertensive Disorders in Pregnancy/Preeclampsia is a persistent problem, world-wide. Over the last decade, studies have highlighted the role of vitamin D in modulating several mechanisms associated with hypertensive disorders of pregnancy, including but not limited to vessel compliance, the maternal immune response, the renin angiotensin response, and placental implantation and angiogenesis. Ther...

The FDA’s approval of the first oral hormonal contraceptive pill, Enovid, in 1960 launched a revolution in women’s reproductive healthcare. From that one initial pill sprang a plethora of oral contraceptive choices, representing estrogen-progestin combinations in standard dose to ultra-low dose options, progesterone only pills, and cyclic or continuous use pre-packaged formulations. According to a...

Here.

There is no controversy regarding the definition of the 2nd stage of labor: it is the phase of labor from 10 cm until complete delivery of the child. However, there has been persistent controversy about what defines a prolonged 2nd stage of labor. In other words, are the hour limits stated by the ACOG “active pushing” or “total duration” in 2nd stage? 🤔 Historically, this has been a very gray are...

Mirror Syndrome also known as “triple edema” or Ballantyne syndrome, is a rare disorder affecting pregnant women. Mirror Syndrome is often underdiagnosed or misdiagnosed due to a general unawareness of the condition, and sometimes its preeclampsia-like manifestations. However, until now, the characteristics of Mirror Syndrome have not been fully elucidated. But medicine moves fast, and we now have...

Incorrect delivery technique can lead to fetal birth trauma. However, sometimes – despite proper technique and care – fetal birth injuries occur. As I was taught as an intern, “Mal-occurrences don’t always mean Mal-practice“. Does that rule hold true for fetal clavicular fracture? What about Erb’s palsy found at birth? Can these issues occur as part of normal labor and delivery? And at time of ces...

The ACOG released Clinical Consensus #4 in August 2023, covering Urinary Track Infections in Pregnancy. Urinary tract infection (UTI) is one of the more common perinatal complications, affecting approximately 8% of pregnancies. These infections represent a spectrum, from asymptomatic bacteriuria, to symptomatic acute cystitis, to the most serious, pyelonephritis. In this episode we will summarize...

The age at which couples have children in the United States continues to increase. While it is well documented and known that maternal age directly impacts fetal and child outcomes, less attention has been given to advanced paternal age (APA). Medical and Genetic commentaries have stated that limited APA principles have been advocated for or disseminated into the medical communities and the genera...

A quick clarification about Beyfortus neonatal protection against RSV. Thank you Katie for bringing this to my attention! What a wonderful podcast community we have. ❤️❤️❤️

We have been following this developing story on the Maternal RSV vaccine, Abrysvo. In the recent podcast, we stated that we would let you know when the ACOG releases its “Practice Advisory”, which is its clinical guidance update. This is now out! In this episode will provide the summary, high-yield points regarding this vaccine’s use in pregnancy. Can this be co-administered with other vaccines? W...

Low Dose Aspirin has been a routine aspect of preeclampsia prevention since first mentioned by the ACOG’s Hypertension in Pregnancy Task Force report, back in November 2013. Since that time, there has been several revisions of the criteria of who qualifies for low-dose aspirin in pregnancy. Nonetheless, there are calls and expert opinions challenging this “risk factor based” approach, favoring a m...

According to the CDC’s press release from September 2022, the leading underlying causes of pregnancy-related death include mental health conditions (including deaths to suicide and overdose/poisoning related to substance use disorder), accounting for 23% of cases. The top 2 perinatal, mental health conditions are anxiety and depression. And, although much more rare with an incidence of 1–2/1,000,...

It’s pretty standard of an evaluation… TVUS for postmenopausal bleeding. It’s well accepted that an endometrial thickness of 4 mm (5 mm in some studies) should trigger further endometrial tissue analysis in women with postmenopausal bleeding. But is there a cut-off endometrial thickness at which endometrial tissue should be evaluated in a postmenopausal patient WITHOUT bleeding, where this was fou...

Welcome to our “OB Smorgasburg” episode, where we have a CORNUCOPIA of topics. Well, maybe not a full cornucopia… But a mini-cornucopia. In this episode, we will address 2 recent publications that really are my “pet peeves“ about medical data! One is from the US Preventive Service Task Force, and the other has to do with “timed intercourse”. You have to listen to this! Then we will get into new da...

Universal, weekly (surveillance) laboratory screening for expectant management of Hypertensive Disorders in Pregnancy has been routine practice since the release of the ACOG’s Hypertension in Pregnancy executive summary in November of 2013. This plan of care was also recommended in the ACOG Practice Bulletin 222 focused on Gestational Hypertension and Preeclmapsia. But does this actually help prev...

Trichomoniasis has been found in every continent and climate without showing any significant seasonal variability. According to the CDC, trichomoniasis is estimated to be the most prevalent nonviral STI worldwide, affecting approximately 2.6 million persons in the United States. Conditions shown to be associated with T vaginalis infection include: Increased risk of HIV acquisition and transmission...

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting reproductive-aged women, with a prevalence between 10 to 13%. PCOS has a large component of Insulin Resistance at its core. This is not only a metabolic complication in gynecology, but also has adverse implications for pregnancy. Since metformin is a staple of PCOS care, not only for infertility but also for the metabolic...

NSAIDs have been shown to be associated with development of VTEs. This data is not new, but is more than 10 years old. Of course, hormonal contraception is also known to potentially increase the risk of VTE depending on the amount of estrogen in the combination product as well as the type of progestin used. So, a reasonable question to ask is whether the use of these two medications TOGETHER syner...

Optimal uterine closure remains one of the most studied and controversial aspects of cesarean delivery. Traditionally, a single-layer locking hysterotomy closure has been taught and passes down. Is this evidence based? Is there any advantage to doing a double-layer myometrial closure? We’ll get down to the data in this episode.

A uterine niche is a reservoir-like pouch in the anterior uterine isthmus located at the site of a previous CS scar. First published and describe din 1961, there have been a variety of publications looking at "best practice" at cesarean hysterotomy closure to try to minimize its occurrence. This defect has been linked to abnormal placentation in subsequent pregnancies, CS scar ectopic pregnancies,...

SLE can affect people of all ages, including children. However, women of childbearing ages—15 to 44 years—are at greatest risk of developing SLE. Women of all ages are affected far more than men (estimates range from 4 to 12 women for every 1 man). Are you familiar with the 2019 updated diagnostic criteria for SLE? What are some specific concerns regarding this condition in pregnancy? Do patients...

Celiac disease is an autoimmune disorder of the small intestine. Celiac disease is the only autoimmune disorder with a single clearly identified environmental trigger...DIET. Although the exact mechanism of the disease development is unknown, celiac disease appears to form after gluten intake from a complex interplay of environmental, immune, and genetic factors. What is Tropical Sprue and how is...

Probiotics may be good for your gut, but does your vagina need them too? Probiotics are in everything from fermented drinks to pills and powders, and in many cases, are being advertised as a way of improving your vaginal health. Is that evidence based? Do oral probiotics help support a healthy vaginal microbiome? What about vaginal probiotics? Can vaginal probiotics augment BV therapy? The answer...

We recently provided some additional information regarding the recently approved medication for postpartum depression, Zoranalone. One of the benefits of this medication is it’s rapid mechanism of action. Although not yet approved for major depressive disorder outside of the perinatal interval, there is a separate medication, which was FDA approved last year, which is ultra-fast acting for depress...

As a true testament that we read each one of our Podcast Facebook messages, this is a “You asked, We answered” episode regarding 3 main recent topics: 1. dose of oral MI for PCOS, 2. Zoranalone for Major Depressive Disorder, and 3. the “shoulder shrug” maneuver for shoulder dystocia. 👍👍👍👍