Dr. Chapa’s OBGYN Clinical Pearls

Wound healing is a complex and dynamic process! In this episode, we will review the 4 stages of wound healing using the analogy of “the broken house”. We will also describe the CDC criteria for surgical site infection (SSI) and review the 4 WHO classifications of wounds.

Air embolism during pregnancy has been reported… usually linked to blowing air into the vagina during orogenital sex. In this session, we will review the literature, presentation, and management of this uncommon- yet potentially lethal- occurrence.😳😳😳🤔

There is currently no FDA approved testosterone products for women. Internet sources, and some pharmacies, offer a variety of testosterone products for use by women. Is this evidence-based? In this session, we will review the summary statements from the US Endocrine Society and the British Menopause Society regarding testosterone supplementation in women. (US Endocrine Society Data and the British...

Many studies have evaluated the relationship between fertility drugs and breast cancer. Are you aware of what the data shows? How would you cancel your patients? In this episode we will review the ASRM data regarding fertility medication use and breast cancer risk.

The use of fertility drugs that may cause alterations in endogenous hormones and multiple ovulations has raised concerns about the long-term safety of such medications. One concern is that are invasive ovarian cancer. Is this concern evidence-based? In this session, we will review the ASRM Practice Guideline on the subject (2016), as well as a more recent updated ASCO/ESHRE review from 2018.

Amniotic fluid embolism is a rare but potentially lethal condition. Because of the rarity of this condition, most physicians and institutions have limited experience with the management of amniotic fluid embolism. The typical presentation of AFE includes a triad: sudden hypoxia hypotension, and coagulopathy. In this podcast, we will cover the latest data from the SMFM, ACOG, and AHA on this terrif...

Serum uric acid levels are often ordered for the evaluation of hypertensive disorders of pregnancy. But why is this done? Is this test able to guide clinical management? A staple of PIH evaluation in the 1970s and 1980s, uric acid levels are still around. In this session, we will review why uric acid determinations for hypertensive disorders of pregnancy is not clinically useful – in general. Refe...

Yes...it’s a real diagnosis. Sexual headaches may be PRIMARY (without other etiology) or secondary (due to a more serious issue). Primary sexual headaches are divided into 2 types: orgasmic, and pre-orgasmic. In this episode, we will review the data from the International Headache Association regarding sex headaches.

If you have never heard the story of Julie Moss (1982), start listening to this episode! This is an example of not just being interested in a project/work activity/hobby, but is an example of being PASSIONATELY committed. Let’s quickly review her story, now.

Surgery for biliary tract disease is among the top 3 reasons for non-obstetrical surgery during pregnancy (1:1500 to 1:10,000 pregnancies). What is the data on ERCP during pregnancy? Is radiation exposure a concern? What does ACOG recommend regarding intraoperative fetal monitoring? In this podcast, we will cover the ACOG, and AGA recommendations for this procedure in pregnancy.

💥Hurricanes💥! No… Not the traditional and historic drink from New Orleans! 🍹🍹We’re talking about the intense, devastating, natural weather phenomena⚡️⚡️🌊💨🌪. We are in hurricane season! Do hurricanes cause women to enter labor, or affect pregnancy outcome? Is it an “old wives tale”, or is it true? Let’s examine the evidence....now.

Stillbirth is a pervasive problem worldwide. Maternal perception of reduced fetal movement has been identified as a potential strategy for stillbirth prevention. But is the strategy evidence-based? In this episode, we will review the 2018 randomized trial, the AFFIRM study (Lancet).

Vaginal steaming has become a cult phenomenon since 2010. But this “alternative“ practice has some real potential risks. Where did this even come from? Why is it done? And what are the potential morbidities? This podcast will cover these questions, as well as a recent (August 2019) case report highlighting the harms of this practice.

Because of the increased risk for breast cancer, BRCA mutation carriers may have concerns about taking oral contraceptives or using hormone replacement therapy after a premenopausal prophylactic bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes). Here, we review the current literature about hormone use by BRCA mutation carriers.

Women with endometriosis may represent a unique population of women at greater risk for adverse outcomes across pregnancy and birth. In this session, we will summarize the soon to be in print publication by Farland et al in Obstetrics and Gynecology. Information from the study may be helpful in counseling women with endometriosis when when they conceive.

Is 39 weeks the “sweet spot” for delivery? Neonatal and maternal adverse outcomes have been studied through increasing gestational ages from 37 weeks onward. In this episode, we will summarize the Aug 2019 publication by Chen et al, from Obstetrics and Gynecology. We will also review and apply the findings from the 2018 ARRIVE publication.

Healthcare professionals and patients may not realize that methylene blue has monoamine oxidase inhibitor (MAOI) properties. Methylene blue should generally not be given to patients taking serotonergic drugs. When should patients stop taking SSRIs prior to methylene blue use? When should they be restarted? In this session, we will review the MOA of this common dye utilized in surgery and review wa...

Opioid use in pregnancy is a real issue! This podcast will review 2 pharmacotherapies for opioid dependency in pregnancy. We will end the session with a “rapid fire” side-by-side comparison of these 2 agents.

Chronic kidney disease can affect anywhere from 0.1 to 4% of all pregnancies. Pre-existing renal disease can have severe consequences for a pregnancy. Should low-dose aspirin be used in these patients? If so, at what dose? What about calcium supplementation? Are immunosuppressive agents safe to use? In this podcast we will cover the June 2019 ACOG “clinical expert series” monograph on chronic kidn...

Depression/anxiety can affect up to 20% of women during pregnancy. These 2 psychological conditions have adverse pregnancy outcomes in and of themselves. But what about medication use? Do SSRIs need to be tapered at end of pregnancy to reduce neonatal withdrawal? Are SSRIs linked to “Neonatal Persistent Pulmonary Hypertension”? What about other meds? This episode will review the ACOG/SMFM data on...

For decades, women have been told that having intercourse/orgasms late in pregnancy can hasten the onset of labor. But is this a myth, or is this true? While it is well established that sexual intercourse/orgasms can trigger the onset of contractions, are those contractions enough to result in cervical change? Let’s take a look at the data.

Thirty percent of all cases of adnexal torsion occur in females younger than 20 years. In this episode, we will review the latest committee opinion from the ACOG on clinical presentation, use of diagnostic tests, and surgical management of adnexa torsion in adolescents. Here’s your quick test: 1. Do Doppler studies confirm a diagnosis? 2. What are the findings on CT or MRI? 3. Is cystectomy prefer...

This Enhanced Recovery After Surgery Society guideline was created to support the most common surgical procedure in the industrialized healthcare world, the cesarean delivery. In this section, we will highlight THREE new recommendations that CHANGE how we “traditionally” care for the postop CS Patient: Refeeding as soon as 2 hours postpartum, elimination of the postop urinary cath...and even new d...

Short interpregnancy intervals, as well as long intervals between pregnancies, are associated with some potential adverse obstetrical outcomes. What does the data show? What are the unique considerations that go into patient counseling regarding spacing of pregnancies? In this episode, we will review the SMFM data on interpregnancy intervals.

How much do you know about the recently approved novel BC pill, SLYND? Do you know it’s efficacy? What are the contraindications? In this session, we will bring you up to speed on this new novel drosperinone only oral BC pill. (No financial disclosures).