Dr. Chapa’s OBGYN Clinical Pearls

DISCLOSURE: Not for the PC! Not for those who lack determination, or GRIT. This is the antidote for mediocrity. Just a little motivation to KEEP YOU FOCUSED! Now... go-and-get-it!

Part 2: In this session, we will wrap up our discussion on recurrent pregnancy loss by focusing on 3 controversial areas: 1. Immunological therapy, 2. thrombophilia testing, and 3. Progesterone supplementation. (Data referenced from ACOG, RCOG, ASRM).

Recurrent pregnancy loss is devastating for the affected couple. In part 1, we will review the diagnosis of this condition. We will also cover parental genetics, APS, and uterine anomalies. In part 2, we will see if thrombophilia testing is indicated, discuss progesterone supplementation, and what role/if any, immunological reactions have with recurrent miscarriage. (Data from ASRM, ACOG, and RCOG...

Howdy, all! Rather than discussing one topic, this session will review “quick facts“ on common OB concerns/questions. Should we screen for HSV during pregnancy? What about deli meat consumption? Are there any issues with air travel during pregnancy? Can pregnant women use hot tub? Can pregnant women dye their hair? We will answer these questions – and more! – in this session of clinical pearls.

On July 1, 2019 ACOG updated/revised the GBS algorithm for intrapartum prophylaxis. In this session, we will cover GBS prophylactic indications, NAAT testing for GBS, GBS Bacteriuria, and antibiotic dosages.

Persistent nausea and vomiting in pregnancy is a terrible condition! It affects quality-of-life, and impacts the mother’s overall psychological well-being. What is the role of helicobacter pylori infection in this condition? Is there a link? Let’s look at the data.

It has long been held that maternal perception of fetal movement may protect against stillbirth. However, the 2018 AFFIRM trial called the tradition into question. Related to that is the traditional recommendation to drink “sugary” drinks to increase fetal movements. Is this evidence-based? In this episode, we will review the AFFIRM trial and review sugary intake to increase fetal movement.

Left...Right...Left...Right...Left! I just recently completed my military boot camp experience! That was an adventure. In this session, we will cover 3 brief “life lessons“ that I learned during my Texas Military Forces Boot Camp! This information will truly help you every single day! Hooah!!

Sexual intimacy is an important part of a couples’ relationship. On June 21, 2019, the FDA approved a new novel medication for hypoactive sexual desire disorder in women. The medication, Vylessi, is a melanocortin receptor activator, which is different then the previously approved medication for the same condition, Addyi. In this episode, we will review the MOA and data behind this new medication.

🌞🌞IT IS SUMMER!! 👏👏 Are sunscreens safe to use during pregnancy? What does ACOG say? In this session, we will review the ACOG practice statement as well as provide some SUN-SAFE 🌞🌞tips for pregnant women during summertime!👍👍

Turmeric is an edible root used in cooking. It’s powdered into a bright yellow spice popular in Asian cuisine. Turmeric also has a history of medicinal use. It contains an active compound, curcumin, that has antioxidant and anti-inflammatory properties. Research has found that curcumin has the potential to improve a number of health conditions — including depression. This includes mild depression...

Just a brief hiatus!

What is the mechanism by which elevated hemoglobin A-1C causes birth defects? Is there a “cut off“ level for this affect? Let’s look at the data.

Maternal cardiac arrest… a devastating condition! Techniques for maternal resuscitation have changed, even from when I was a resident. 30° left lateral tilt is no longer recommended by the American heart Association during CPR. Manual left uterine displacement is preferred! We’ll talk about this, as well as cover the basics of maternal cardiac resuscitation in this session. (Reference: AHA Scienti...

Weight gain is commonly cited as a side effect of combination oral contraception, and is amount the top reasons for pill discontinuation. Do birth control pills make women gain weight? Where did this perception come from? What does the data show? In this session we will review systematic reviews and the Cochran database regarding this subject.

(Part 3): The Finale of our 3-Part series! Remember when you would have done anything to get into medical school, and cried/struggled to get that perfect residency?! Remember why you started! This brief session will wrap up our 3- part “mini-series” on THRIVE. (ERRATA: In part 2, we attributed the famed “The man in the arena” excerpt to Churchill. The author was not Churchill, but Theodore Rooseve...

(Part 2): Take the challenge! This is Principle #2 in our “mini-series”. It is easy to fall into a trap of “the routine“, and the mundane. Doing so leads to dissatisfaction and frustration. Great medical leaders in the past, innovators, and countless historical figures broke out of the routine, took the challenge, and changed history forever. So… Are you up to the challenge? (Post production ERRAT...

WARNING: This is my most personal, and passionate podcast yet. In light of the recent CNBC news article regarding physician well-being, this podcast will cover centuries old dogmas PROVEN to make you thrive. What does the historic emperor Marcus Aurelius have in common with leaders like Zig Ziglar, Les Brown, and Stephen R. Covey?... this podcast answers that. BUT, you have been warned! Listening...

For decades, common practice in Labor And Delivery has been to use supplemental maternal oxygen by facemask as a remedy for fetal heart rate decelerations. However, is more oxygen delivery to the fetus actually helpful? Does it change neonatal outcomes? Well… the data is not so clear, and there may be some cause for concern. In this podcast, we will cover the evolving data on the use of supplement...

This is TRUE, and a testament to what having a VISION, a strong will, and a desire to change the status-quo can accomplish! This is the remarkable true account of Dr. Kane, who performed 2 successful self-surgeries in 1921 and 1932.

In 2011, cf DNA from the maternal serum became commercially available to screen for fetal aneuploidy. Overall, about 3% of test results will detect an aneuploidy, and false positive results are only seen in 0.05% to 0.1% of tests. Evolving data, however, suggest that in women who have more than one aneuploidy suspected by cfDNA testing but who are found by diagnostic testing to carry a genetically...

Somethings in medicine are done by tradition. The use of Oxytocin during first trimester uterine evacuation is one such thing. Evidence seems to be lacking for the use of this common intervention. Remember, physiologically, oxytocin receptors show a linear increase in concentration as pregnancy progresses- rising quickly after 36 weeks of pregnancy, and are only present in negligible quantities on...

In March 2019, the FDA approved the first medication specifically targeted for postpartum depression, brexanolone (Zulresso). However, this medication requires a 60 hour, inpatient, IV-continuous infusion and there are some safety concerns. In May 2019, the Cleveland Clinic announced that it would release a pilot inpatient program (at one of its sites) for this medication. In this session, we will...

Does finding an isolated echogenic cardiac focus or choroid plexus cyst require amnio? What about MTHFR testing for thrombophilia? AFI or deepest vertical pocket? Does cervical length screening matter after cerclage? In this session, which is part 2, we will complete our “OB don’ts“ from the SMFM.

(Part 1) Cerclage for twins? What about progesterone? Do gestational diabetics controlled with diet (A1) alone require antepartum fetal surveillance? In this session, we will review 10 (out of 15) obstetrical DON’TS from the Society of Maternal Fetal Medicine.