Dr. Chapa’s OBGYN Clinical Pearls

Over the last several days I have received numerous Facebook messages, podcast voice memos, and personal texts regarding the potential for misapplication of Ulipristal’s mechanism of action as emergency contraception. Will Ella be banned? Does it affect implantation? It’s time to clear the dust and set the record straight.

On June 16, 2022, the ACOG released a new practice advisory regarding PreP in the ObGyn patient population. This has important implications on how we counsel patients especially after recent STI diagnosis. In this podcast we will cover important aspects of PreP to get you comfortable with this preventative option. What are the 3 currently approved options? Are they safe? What about monitoring? Do...

We have come a long way from the first report from Stein and Leventhal describing “polycystic ovaries“ on ultrasound in infertile women back in the 1950s. We already well understand that PCOS raises the risk of certain antepartum complications including gestational diabetes, possible macrosomia, and the development of gestational hypertension or preeclampsia. But there actually is scant data on th...

Well…so there’s this. 😳😳😳

This is your crash course into all things “Monkeypox”. Data for this podcast comes from the CDC, WHO, and the Royal College of Obstetricians and Gynecologists. Information is moving fast and we’re here to keep you evidence-based. How does Monkeypox affect pregnancy? When is a C-Section indicated? What are the treatments available? And what about the 2 vaccines available in the USA… Why is one more...

Which is better for determining amniotic fluid volume: the AFI or MVP? There’s data to support one or the other. In cases of isolated oligohydramnios in the late preterm interval, is there a role for maternal oral hydration? Does that actually work? We are going to dive into the amniotic fluid (no pun intended) dilemmas now.

According to the ACOG, by natural menopause it is estimated that up to 70% of women will have developed a uterine leiomyoma. 70%! Most of course are asymptomatic. For those with symptoms, heavy menstrual bleeding and pain are the most common afflictions. In May 2021, the FDA approved a new triple combination pill for heavy menstrual bleeding associated with fibroids. Can this medication also be us...

Meet Hilda! In this quick episode, I’ll share a very unique story of one of our coworkers (our featured guest on the podcast). I know this will encourage, inspire, and just make your day! Listen in, and find out why.

There are currently (in the USA) 4 generations of available progestins in combination birth control pills. Are these differences clinically relevant, or is it all manufacturer marketing? In this session we will review the chemical nature, biology of, and clinical manifestations of the different progestins. We will set the record straight. (This topic was suggested by an OB/GYN senior resident at L...

Fetal microcephaly is a devastating diagnosis. Prognosis is dependent on whether fetal microcephaly is isolated or part of other congenital anomalies. Prognosis is also directly related to the degree of fetal microcephaly. In this session, we will review the diagnostic criteria, workup, and prognosis of this devastating fetal condition.

Here’s what’s going on… As of May 26, 2022.

Pregnancy can definitely work some changes on the body. Melasma is a common pregnancy reaction, and can be a cosmetic concern to many affected. Are treatments safe to use during pregnancy? Are cutaneous lasers allowed? In this session we will review the available literature and cover the first, second, and third-line options for treatment of the mask of pregnancy.

The etonogestrel implant is the most effective LARC available. Well, how many years AFTER the FDA approval of 3 years does the implant remain effective? Also, currently, the usual and customary standard is for the provider and patient to palpate the implant area after insertion. But what happens when the insert is non-palpable? In the session, we will review the evidence-based protocol to find thi...

Historically, obstetrical providers cautioned patients about decreased fetal movement. But what about maternal perception of INCREASED fetal movement? Is increased fetal movement a harbinger of adverse neonatal outcome? In this session we will highlight and summarize a new publication from the AJOG (April 26, 2022) that helps shed light on this clinical conundrum.

Since the 1960s, metronidazole has carried a label warning stating that alcohol use while taking the medication can lead to significant side-effects. This was termed a “Disulfurim-like reaction”. However, that’s 100% not true! Where did this metronadazole myth come from? Why has it survived for over 50 years? In this podcast… We’ll set the record straight! Yes, you can have your cake and eat it to...

On May 3, 2022, JAMA published 2 separate randomized clinical trials (RCTs) regarding patient’s self-monitoring of blood pressures at home. Historically, clinicians instructed patients either at risk of developing hypertension in pregnancy or those with existing chronic hypertension/hypertensive disorders in pregnancy to self-monitor their blood pressure in-between clinician visits. Is that recomm...

In May 2022, the ACOG Will release a new Clinical Practice Guidance (#3). This will cover “Headaches in Pregnancy and Postpartum”. Do you know which classes of medication are considered first line for primary headache prevention during pregnancy? And for acute treatment of migraine, which medications are recommended? Are Ergot alkaloids safe for use? What about Triptans? In this session, we will s...

Addressing severe maternal morbidity is a public health priority in the US. Postpartum hemorrhage is one of the driving contributors to severe maternal morbidity/mortality peri-partum. A recent study published in JAMA open network in February 2022 is showing an unusual benefit of labor epidural analgesia which may help close the gap in severe maternal morbidity-related healthcare disparities. In t...

It could not have been timed any better: Coming off the heels of the recent FDA warning on the use of noninvasive prenatal test (NIPTS), a new study soon to be released in May 2022 is calling its use into further question. Is this a return of the Maternal Serum QUAD screen? Listen in and find out.

On April 19, 2022 the FDA released a warning regarding the inappropriate use of cell free DNA genetic screening tests. Within 24 hours, the ACOG (April 20, 2022) issued a statement response. In this podcast we will highlight these two key documents. We will also review what cell free DNA is and is not. What is the role of Ultrasound in genetic screening? Can cell free DNA be repeated after a “no c...

Without doubt, the most common reason for requested progestin-intrauterine system (IUS) removal is abnormal bleeding patterns. But do you know what the second most common reason is? It’s acne! In this episode, we will summarize a soon to be released article accepted for print in Obstetrics and Gynecology (the Green Journal). This episode will provide practical clinical pearls to truly obtain infor...

On Friday, April 15, 2022, I received a Facebook question regarding a recent episode on ROM test. We stated that ROM Plus, as a test, has accuracy between 23 to 37 weeks. Where does that come from? In this brief episode, will explain the facts.

Today, April 11, 2022, the ACOG updated its practice advisory regarding chronic hypertension in pregnancy. This follows the statement from the Society of Maternal Fetal Medicine recognizing the change in practice based on the CHAP trial. In this session we will summary ACOG’s response.

Since 2005, experts have advocated for ovarian conservation, until the age of 65, at time of hysterectomy for benign indication. However, a soon to be released publication is calling for a retraction of that opinion! Based on brand new data, do you know the age NOW at which ovarian removal is recommended? In this session, we will review this brand new information that will greatly impact how we pe...

A study published on April 2, 2022 in The New England Journal of Medicine, "Treatment for Mild Chronic Hypertension during Pregnancy” (CHAP Trial) has resulted in ACOG calling to order its Practice Advisory Committee to prepare a “practice update” regarding the management of mild to moderate hypertension in pregnancy. This recent publication is practice changing! While we await the revised guideli...