Dr. Chapa’s OBGYN Clinical Pearls

The Bandl Constriction Ring. It is real. It exists. Its true incidence is unclear as it lacks uniform reporting when found at time of cesarean. As labor guideline are more permissive of slowed labor progress, some fear that the incidence of Bandl's Band may rise. What is this ring? What is the pathophysiology of this abnormal uterine response? Can ultrasound detect this labor abnormality? In this...

Just a little description of what happens “behind the scenes“! Enjoy. 😊😊❤️❤️😩😩

Gestational diabetes (GDM) is a risk factor for adverse perinatal outcomes. Currently, the ACOG recommends early screening for GDM for women “at risk”. However, other experts disagree with this approach. On October 6, 2022 we released a podcast episode called “Early GDM Screening: Evidence-based?”. In that episode we covered the controversy regarding early GDM screening, in other words- screening...

Well, Well, Well, this is very interesting. Back in May 10, 2023, we released an episode on "OSA (Obstructive Sleep Apnea) in Pregnancy: Time to Screen?". In that episode, we summarized the impressive data on OSA in pregnancy and its association with some adverse perinatal sequelae. Spring forward to July 6, 2023, the ACOG has now released a brand new Consensus Statement on OSA in pregnancy. This...

The headline from CNN Health form June 28, 2023 reads, "HRT use by younger women linked to dementia, study says". That is FRIGHTENING to any patient using hormone therapy for menopausal symptoms. Does HT cause dementia? Or is HT a "easy suspect"? The question of HT and cognitive function has been a subject of controversy for many years. In this episode we will summarize the NAMS position statement...

First published in 1952, the Apgar Score has remained unchanged over 70 years and is entrenched in current OB/Pediatric/Neonatal care. The ACOG highlighted the Apgar Score in 2015 in CO 644. In that release, the ACOG reminds us that although it provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if need...

Listen to this! According to recent US statistics from both consumer reports and statista.org: 26% of Americans used CBD in 2022, 24% of people owning pets use CBD for their animals and themselves, 33% of Americans have used CBD products at least once, 64% of Americans have used CBD for pain, 49% of Americans use it for anxiety and stress, and 42% of Americans have used it for sleep and insomnia....

This episode subject was requested by Emily, one of our podcast family members. She has noticed the reporting of “large placental, venous lakes” on antepartum ultrasound. Placental lakes are enlarged spaces in the placenta filled with maternal blood. These spaces are also called intervillous spaces because they are found between the placental villi the finger-like projections of the placenta that...

We recently had a patient in our OB high-risk community clinic whose maternal carrier screen result was either late or lost. Thinking the test may be lost, another resident ordered hemoglobin electrophoresis. The electrophoresis was NEGATIVE (that is, no abnormal hemoglobin was found at detectable levels)…by the way, good for that resident! After calling the lab for the genetic screen and not gett...

Desquamative inflammatory vaginitis (DIV) made its debut in the medical literature in 1965, by the hands of Gray and Barnes. In that paper, they presented their findings on 478 women complaining of vaginal discharge. Then, in 2002, Donders et al. described a new entity, referred to as aerobic vaginitis (AV). This term emphasized the clear contrast with the far more common and acknowledged form of dy...

The word placenta, first used in a 1638 anatomy textbook, was borrowed from the New Latin phrase placenta uterina, meaning "uterine cake", because the circular, flat shape of the organ was thought to resemble a traditional Roman flat cake. Circumvallate is another Latin derived term meaning the "encircled placenta, by a rampart". Circumvallate placentas are a form of extrachorial placenta where th...

Over the past decade, there’s been about a 700% increase in the cases of congenital syphilis in the United States. That’s 700%! Rates of congenital syphilis, meaning the number of cases for every 100,000 live births, are highest in the South and Southwest, in states such as Arizona, New Mexico, Louisiana, Mississippi and Texas. Individual states have seen increases that are even more astounding. F...

LARCS provide remarkable contraception. The IUD and the IUS are both HIGHLY effective, although they do not have the same typical-use failure rates. While it is common knowledge that active mucopurulent cervicitis is a contraindication for IUD/IUS placement, what about the presence of bacterial vaginosis (BV)? BV has been identified for years as an independent risk factor for Pelvic Inflammatory D...

Endometriosis is caused by endometrial-like tissue containing endometrial glands and extensive fibrotic tissue growing outside the endometrial cavity, most often in the pelvic peritoneum or ovaries, resulting in chronic pelvic pain and infertility. It is reported to affect 10 to 15% of women of reproductive age, with an unknown percentage of women who go on undiagnosed or misdiagnosed. For decades...

The world of "Hypertension (HTN) in Pregnancy" is an ever-evolving environment! Many clinicians have adopted patients' home monitoring of blood pressure (BP) in their management of hypertensive disorders in pregnancy. Do you recommend home BP monitoring in your OB patients? On May 4, 2022 we summarized the results of 2 RCTs examining whether home BP monitoring during antepartum care prevents HTN m...

Just a quick clarification regarding a previous statement, on an earlier episode, regarding MSAFP….thank you Maggie Rey! ❤️❤️❤️this community.

Does the combination birth control pill cause depression? This has been a controversial subject for over 2 decades. While some observational studies have described a possible association, randomized clinical trials have shown little to no connection. On June 12, 2023, a new population-based cohort study from the UK sought to evaluate this possible association. This resulted in some interesting cla...

I recently received a message from one of our podcast family members requesting more gynecological topics...that was perfect timing, since the NAMS just released its 2023 Position Statement on "NonHormonal Therapies" for vasomotor symptoms on June 1st. In this episode we will summarize this 18 page monograph. The NAMS expert working work critically evaluated the published literature on all nonhorm...

Welcome back to part 2. In this episode we will wrap up our discussions on dermatoses of pregnancy, focusing on atopic eruptions of pregnancy and ICP. Do you know what the 3 comorbidities are which may follow a diagnosis of ICP? We’ll cover that here. AND we’ll throw in a weird one as our final discussion point, one that is considered by some to be the 5th dermatosis of pregnancy. This is the Trip...

I’ve said this many times before: I ❤️ our podcast community. This podcast topic idea comes from Jerry, an OBGYN Resident in Virginia. 👏👏 Jerry writes, “I wanted to know if you could do a topic on the Dermatoses of Pregnancy. My program has had some interesting cases recently and most of what I could find was in UpToDate. I couldn’t find a specific PB or CO on the topic, so I wanted to reach out...

It has long been considered that iron deficiency does not exist in Thalassemia syndromes, including Thalassemia major as well as Trait (Thal minor). But that is incorrect. Recent studies have shown the occurrence of iron deficiency in patients with Beta-Thalassemia Trait. Iron deficiency anemia (IDA) during pregnancy has been associated with an increased risk of low birth weight, preterm delivery,...

When performing cervical examinations during labor, providers in the United States commonly use sterile gloves, even when there is no rupture of membranes. Is this an evidence-based practice or is it simply tradition? This debate has been going on for decades. In this episode, we will highlight some interesting/intriguing hospital policies and procedures, and walk-down our history timeline of data...

Here’s a real world clinical conundrum: A patient first presents for prenatal care in the 3rd trimester. As healthcare providers, we play a game of “catch-up” with routine serum tests ordered to make up for time lost. But what about specific pregnancy tests that are restricted to gestational age? Take, for example, GDM screening. Currently, traditional screening for GDM occurs at 24 to 28 weeks ba...

We are now 5 years into the publication of the Arrive trial (2018) which opened the door to elective induction of labor at 39 weeks in an otherwise low risk pregnancy. But five years later authors and researchers are still debating whether a 39 week elective induction is helpful or not. Yep, the rebuttals and retorts against the ARRIVE trial began shortly after its publication, and they are still...

The fetal heart rate is controlled by various integrated physiological mechanisms, most importantly by a balance of parasympathetic and sympathetic nerve impulses. Intrapartum, fetal bradycardia may be in direct response to an evolving or acute hypoxic event, including tachysystole, uterine rupture, or placental abruption. Antepartum, excluding acute events like maternal trauma which could lead to...