Dr. Chapa’s OBGYN Clinical Pearls

The ACOG recommends universal screening for gestational diabetes between 24 and 28 weeks of pregnancy with occasional early screening for those at high risk. Is there an advantage to completing the 1-hour 50 g GTT while fasting? First studied in the 1990s, a new publication further validates the original study results. In this episode we will summarize this new publication soon to be released in O...

As I’ve said on previous podcasts, “we all need some encouragement every now and again”. Well this morning I received mine, through a small gift…from Germany!

Anti-D immune globulin has been advocated for use in appropriate patients since the 1970s. Historic data showed that 0.1ml of fetal D+ blood was all that was required to potentially sensitize an Rh negative mother. New data is questioning whether this prophylaxis is required in all cases of threatened miscarriage/abortion in early pregnancy, or if a more selective approach is appropriate. In this...

Fragile X Syndrome is the most common inherited form of intellectual disability, and the most common single gene cause of Autism Spectrum Disorder. It is also responsible for some cases of premature ovarian insufficiency. Do you recall the difference between a Fragile X “pre-mutation” versus the full mutation? Should we do universal screening for this as part of expanded maternal carrier testing,...

Marijuana is the most commonly used federally illegal drug in the United States; its use among pregnant and lactating women is on the rise. Is breast-feeding contraindicated with marijuana use? It is difficult to separate marijuana use from several confounding variables, leading to conflicting data in print. Is marijuana use and breast-feeding compatible? A patient friendly article on Parents.com,...

Several cohort studies and meta-analysis have shown a direct association between poor oral health and adverse pregnancy outcomes. The key driver for this association is systemic inflammation. In this episode, we will review the ADA, ACOG, and CDC data on how maternal oral health can influence pregnancy outcomes. Although this association is pretty strong, remember that association does not necessa...

Happy Thanksgiving, Podcast family! As we gather with family, friends, and loved ones… Let’s make the practice of gratitude a daily habit, not some thing that we do just once a year. There is real science on the art and practice of gratitude! In this brief episode, we will remind ourselves that gratitude is not just “something we do” on Thanksgiving, but really should be our way of life. We will c...

On November 17, 2022 Wimbledon showed a major head nod to women’s health. Do you know what that was? Nonetheless, this recognition of menstruation is just one small move forward, noting that Period Poverty is still widespread right here in the US. In this episode, we will review “Wimbledon, the period, and lack”.

“The Lotus Birth”… Although first described back in the 1970s, this birthing trend is gaining popularity today mainly because of social media. Is this practice evidence-based? Is it safe? There are real concerns here which have spurred several professional organizations and societies to issue HARSH warnings about this practice. In this episode, we will review the origins and current state of “the...

Systemic Lupus Erythematosis is several-fold more common in women than in men. As it primarily targets reproductive age women, identification of and proper management of patients with associated antiphospholipid antibodies is crucial to improve maternal and neonatal outcomes. In this episode, we will review the 2019 ACR diagnostic criteria for SLE and review the management of SLE patients with/wit...

The idea of keeping women “Nil per os” (NPO) during labor traces back to the 1940s with the pivotal work of Dr. Curtis Mendelson. His work on “aspiration pneumonitis” has kept women NPO during labor up to present day. But is this still evidence-based? Is it risky to allow women to have PO intake during an otherwise uncomplicated labor course? In this episode we will walk through history and provid...

TXA was first found to reduce maternal morbidity at time of established postpartum hemorrhage in the WOMAN trial (2017). Since then, evidence has grown to include TXA as a prophylactic agent to prevent postpartum hemorrhage. Despite its known effectiveness in BOTH the prevention and treatment of postpartum hemorrhage, there is a renewed global warning regarding this medication. In this episode, we...

Maternal carrier screening (either pan-ethnic or expanded carrier panel) is recommended by the ACOG and SMFM. Ideally, this is done pre-conception or with the first pregnancy. Did you know that in August 2022 the ACOG added an additional test for universal maternal carrier screening? Does this maternal carrier screen include BRCA? In this episode we will cover what maternal carrier screening is, a...

Katie Couric recently described her path to her diagnosis of breast cancer, urging women with “dense breast tissue” to get supplemental breast imaging. Do these supplemental imaging tests improve overall survival? In this session, we will review the statements of 4 professional societies/organizations regarding the use of supplemental breast imaging for women with dense breasts who have no additio...

Dense breasts can decrease the sensitivity of screening mammogram (MMG). Some US states have mandated reporting of breast density on MMG, while the rest of the states report on dense breasts voluntarily as a standardized reporting system. What supplemental breast imaging tools are advised as a follow up in these patients? Does the ACOG support supplemental breast imaging in average risk patients?...

The Enhanced Recovery After Surgery guidelines were birthed (no pun intended) as a way to curb post-op morbidity from colorectal surgery. In 2019, CSection ERAS guidelines were published in the AJOG. Despite widespread agreement that ERAS is valuable, one aspect of the guideline is controversial: timing of Foley removal. Should the Foley be removed immediately after C-section? Should an indwelling...

The United States is currently facing an oxytocin shortage. How long this medication shortage is projected to continue is not clear. In an attempt to curb unnecessary use of oxytocin, is it safe to consider stopping oxytocin after induction, once the active phase of labor is reached? Is there data to support the practice? And what about using oxytocin for first trimester D&C? Is that evidence-base...

In 1964, John O’Sullivan published his original research describing abnormal cut off values following an oral glucose challenge in pregnancy. O’Sullivan laid the foundation for screening and diagnosis of gestational diabetes. We have learned a lot since that 1964 publication. In this session, we will review a new meta-analysis coming to print in November 2022 comparing the 1-step with the 2-step o...

Hattie… with these kind of insights, you are going to ROCK your oral boards in the next 72 hours! We are cheering you on! 👏👏👏👏

Recently, we reviewed the 3 vaccines generally recommended for every woman, in each pregnancy. But as they often say on late night commercials, “but wait… There’s more!” In this session, we will review 3 separate vaccinations which are applicable in special populations. Do you know which 3 they are? In this session our special guest, Carley Hager (3rd year medical student), will help us review the...

Fetal fibronectin was first reported as a possible biomarker for identifying those at risk of preterm birth back in 1991. Despite over 3 decades of ever evolving published data on FFN, underuse, misuse, and misunderstandings regarding what fetal fibronectin is and is not still persist. In the session we will review the SMFM recognized transvaginal ultrasound/FFN algorithm for preterm labor triage...

In 2015, the ACOG included immediate release nifedipine as an intervention for acute, emergent hypertension in pregnancy. But what about extended release nifedipine? Is there a role for this medication in patients with preeclampsia with severe features intrapartum? Does this calcium channel blocker prevent uterine contractility? In this session we will review a new study from the American Heart As...

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. In this session, we will review the latest controversies regarding early screening for gestational diabetes. Is hemoglobin A1c an option for early testing? What about impaired glucose tolerance? W...

Anticoagulation sure has come along way from warfarin. Although largely replaced by direct oral anticoagulants (DOACs), warfarin is still in use- mainly for patients with mechanical heart valves. For those on anticoagulation chronically, who require gynecological surgery, how/when is bridge therapy performed? In this episode, we will cover the ins and outs of anticoagulation bridge therapy. We wil...

Up to 70% of women who are anticoagulated will experience episodes of heavy menstrual bleeding. Traditionally, progestin only hormonal agents have been used in these cases. Can combination birth control pills be used in the anticoagulated patient? Is there data regarding their safety? In this episode, we will walk down the data timeline starting in 2009 and ending in 2021 regarding the use of comb...