Dr. Chapa’s OBGYN Clinical Pearls

The “ideal“ interpregnancy interval depends on the outcome of the immediate, prior pregnancy. For example, the recommended interpregnancy interval following a 1st trimester miscarriage is different compared to a live, term birth. But what about the interpregnancy interval after a stillbirth? Are the recommendations the same? In this podcast will review updated data from 2019 regarding interpregnan...

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 intervene? “Informed refusal” encompasses a complex, multifaceted, ethical dilemma. In this session, we will review some clear guidelines from the American Academy of Pediatrics, the ACOG, and the AMA regarding the management of this difficult situat...

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 walk down the path of the cesarean’s incredible history.

Medicine: it’s an incredibly rewarding profession. The opportunity and ability to comfort and heal the sick is an absolute privilege. BUT...if you are not careful, that wonderful of all professions can consume you, and may devour you. Two theories have been proposed to explain this: Burnout, and Moral Injury. But are these 2 separate conditions? How does the issue of mindset (fixed or growth) appl...

In December 2019, the ACOG will release committee opinion 794 covering quantitative blood loss in obstetrics. Does QBL use ALONE improve clinical outcomes? The answer may surprise you! Nonetheless, there is great value in utilizing obstetric hemorrhage toolkits/bundles such as the California Maternal Quality Care collaborative strategy. In the session, we will review the use of QBL in practice in...

Breast-feeding mastitis is a common occurrence and a source of disruption of breast-feeding and negatively affects quality-of-life. In this session, we will review the Academy of Breastfeeding Medicine’s treatment protocol for the condition. When is abscess identification required? What about drainage? We will answer these questions and more in this episode!

Obesity is a known modifiable risk factor for complications of pregnancy- both antepartum and intrapartum. Data has confirmed a direct link/risk of stillbirth with obesity. In this session, we will review the data on this link as well as the effect of gestational age on the risk of stillbirth. We will also briefly review the ACOG practice bulletin on gestational diabetes and how this may relate to...

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 steroids for fetal lung maturation, and what about magnesium sulfate for neuroprotection? When should tocolytics be utilized? And when is the earliest just stational age to consider a C-section for fetal benefit? In this session, we will cover these ques...

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 adverse health issues with MTHFR variants? In this session, we will review the difference between the 2 most common variants (C677T, A1298C) and true MUTATIONS. We will also review statements from the ACOG, ACMG, SMFM, as well as the Canadian Guideli...

Persistent cough, congestion, low-grade fever… Yep, typical symptoms of acute bronchitis! The CDC and the American College of Physicians have published guidelines on antibiotic stewardship regarding acute bronchitis. When are antibiotics indicated? What about beta-agonist therapy? Do mucolytics work? In this podcast we will review the presentation, etiology, and treatment algorithm of this common...

“Never events“, “Sentinel events”, and “Near misses”. These terms strike fear in any healthcare provider! The National Quality Forum, the Agency for Healthcare Quality and Research, and the Joint Commission, all have stressed the importance of patient safety in the operating room and medical wards. In this podcast we will review alarming statistics regarding preventable medical errors, and remind...

That’s right… We’re talking about vaginal lubricants! In general, there are 3 main categories: water-based, silicone based, and oil based. Each has their own advantages and disadvantages. Some lubes can actually place the patient at risk of pregnancy if used with a latex condom! In this podcast, we will cover the “lube library“ so that we can better inform our patients since education is key!

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 rare consequence of fetal hydrops. By convention, delivery is recommended in pregnancies complicated by mirror syndrome due to grave fetal prognosis. Severe maternal morbidity has also been described. In this session, we will review the clinical pre...

On October 25, 2019, the American Journal of Perinatology published the results of the PROLONG Trial. This study demonstrated no statistical difference in the co-primary outcome of preterm birth less than 35 0/7 weeks of gestation (P = 0.72) and neonatal composite index (P = 0.73) with 17-OHP use. Similarly, the rate of preterm birth less than 37 weeks and less than 32 weeks were not different. On...

The rate of sepsis appears to be increasing. Maternal sepsis is a significant cause of maternal morbidity and mortality. Sepsis is not a specific illness, but a syndrome that includes organ dysfunction caused by this regulated host response to infection. In this session we will review the SOFA score and it’s utilization. Is fever necessary for a diagnosis of sepsis? Which antibiotics should be use...

N2O is a nonflammable, tasteless, odorless gas. It was first synthesized by the English scientist and theologian Joseph Priestly in 1772, and was first used as a labor analgesic by Stanislav Klikovich in Poland in 1881. Although much more frequently used in the UK and Canada, interest in nitrous oxide for labor pain management is increasing in the USA. What is its mechanism of action? Is it effect...

Universal thyroid screening in pregnancy is a key debate in endocrinology and obstetrics. While some countries advocate universal screening, the UK and USA adopt a “high-risk” based strategy. ACOG’s Practice Bulletin 148 (April 2015) keeps its recommendation to NOT perform routine screening for thyroid disease in pregnancy. BUT, should we screen for thyroid abnormalities universally? This podcast...

Fetal Tachycardia (FT) is described as increase in baseline fetal heart rate (FHR) above 160bpm, for longer than 10 minutes. In clinical daily practice, management of mild-moderate uncomplicated tachycardia can be challenging because clinicians do not have clear guidelines for intervention in cases of uncomplicated fetal tachycardia (in the absence of maternal pyrexia or decelerations) in cases wh...

With normal pregnancy, blood volume increases, which results in a concomitant hemodilution. Although red blood cell (RBC) mass increases during pregnancy, plasma volume increases more, resulting in a relative anemia. This results in a physiologically lowered hemoglobin (Hb) level, hematocrit (Hct) value, and RBC count, but it has no effect on the mean corpuscular volume (MCV). However, in women wh...

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 is no official number of human trafficking victims, but estimates place it in the hundreds of thousands. From illicit massage parlors, escort services, online pornography, and adult “dating” sites, women make up the majority of sex trafficked victims....

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 wellness circles. But does this exist? Is there a real “magic button“ for intense, female pleasure? New understandings of the relationship between the clitoris and anterior vaginal wall has resulted in a better name for this SPOT: The “Clitoral Urethral Vagi...

Approximately 45% of pregnancies in the United States are unintended. Similarly, 70% of pregnancies that occur within 1 year of delivery are also unplanned. Interpregnancy interval shorter than 6 months are associated with increased risk of perinatal complications. In this session, we will review the stance from the ACOG and the SMFM regarding immediate postpartum LARC initiation. What is the diff...

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 March of Dimes and the World Health Organization (WHO). Besides progesterone, does DHA have a role in reducing preterm birth risk? In this session, we will summarize recent data regarding “fish oil” supplements and preterm birth risk. We will also de...

In our previous episode, we covered the revised FIGO ovarian cancer staging which now includes fallopian tube and peritoneal malignancies. In this episode, we will cover the FIGO guidelines regarding the management of OVFTP cancer. What role do PARP inhibitors play? Does treatment for asymptotic recurrence based on CA125 help? Can tamoxifen be used in recurrent malignancy? Let’s find out… Now.