Dr. Chapa’s OBGYN Clinical Pearls

In 2013, the ACOG released a comprehensive review on hypertensive disorders in pregnancy. In January 2019, the College re-visits gestational hypertension and preeclampsia and gives important updates. In this podcast, we will review 2 very clinically applicable aspects of intrapartum care for patients with gestational hypertension and preeclampsia. Who should get magnesium sulfate? And what’s the d...

Alcohol use during pregnancy is well studied with well stated warnings. But what about alcohol use during breastfeeding? What’s the data on that? In the session, we will review alcohol intake by the mother during breastfeeding and take a look at some accepted recommendations.

Our BEST Holiday wishes to you!

This is part 2 of our review of the ACOG practice bulletin #203. In this session, we will review low-dose aspirin for preeclampsia prevention, as well as target blood pressure goals for medical management of chronic hypertension in pregnancy. We will end this podcast with a quick word about NSAIDS for postpartum pain control in hypertensive patients.

Recent recommendations from the American College of Cardiology (ACC) and the American Heart Association (AHA) have changed the criteria for diagnosing hypertension in adults. In January 2019, the ACOG will release Practice Bulletin #203 addressing these changes, and provide renewed guidance for management of chronic hypertension in pregnancy. This is PART 1, of a 2-Part review of PB#203.

OK, so your pregnant patient comes to you with persistent itching between the fingers and toes and you suspect scabies. Which medication is safe to use in pregnancy? This is a brief review of scabies in pregnancy and its accepted medical treatments.

Genitourinary syndrome of menopause causes a significant disruption in quality of life for many menopausal women. The ACOG and NAMS endorse vaginal estrogen to relieve local symptoms. However, the FDA has a current Black Box warning on vaginal estrogen. This podcast will cover brand new data from the Nurses Health Study, released December 20, 2018 in the journal, Menopause.

As legal access to marijuana continues expanding across the US, more researchers are studying the effects of tetrahydrocannabinol, (THC), in teens, adults and pregnant women. New research from Duke Health suggests men in their child-bearing years should also consider how THC could impact their sperm and possibly the children they conceive during periods of Marijuana use. This is a tale of marijuan...

Just something fun to break up the monotony.

Lichen Planus is a chronic inflammatory mucocutaneous disorder that can affect the mouth, vulva, vagina, and anus. Wickham’s Striae are characteristic of mucosal involvement. Biopsy is often needed to confirm the diagnosis and rule out other neoplastic conditions. The more afflicting type of Lichen Planus is erosive lichen planus. In this session, we will review the presentation, pathophysiology,...

Vulvar Lichen Simplex Chronicus is a non-scarring, chronic inflammatory disease of the skin characterized by intense itching. 65% to 75% of patients have a history of allergic conditions including asthma or childhood dermatitis. In this session, we will review the presentation, diagnosis, and medical care of vulvar Lichen Simplex Chronicus. (Reference: ACOG clinical expert series, CME edition, “Di...

Vulvar Lichen Sclerosus is a chronic inflammatory vulvar dermatosis. There is an association between this condition and various systemic autoimmune conditions (e.g., thyroid dysfunction, vitiligo). Additionally, patients with this condition have a 4-5% risk of vulvar cancer in the future! In this session, we will discuss the pathophysiology, diagnosis, and management options for this condition. (R...

The etonogestrel contraceptive implant is a type of LARC with proven high efficacy. Yet, similar to all progestin only contraception, abnormal bleeding can become bothersome to the patient- especially in the first 3 to 6 months of use. Ulipristal, a progesterone receptor modulator, has shown promise as a new medical agent to help relieve bothersome bleeding in these patients. In this podcast, we w...

On December 15, 2018, the ACOG released a Practice Update regarding subcutaneous use of 17OHP rather than IM 17OHP for preterm birth prevention. Weekly IM injections of 17OHP were endorsed by the ACOG after the 2003 MEIS MFM Network clinical study demonstrated a reduced risk of preterm birth in women with prior preterm birth, with its use. In this podcast, we will review the ACOG practice update r...

Nipple discharge is a common breast symptom. Keys and clues to stratify patients as either low risk or high-risk include: the patient’s age, unilateral or bilateral discharge, single duct or multi duct, whether a mass is also present in the breast, and the color of the discharge. Most nipple discharge thankfully is benign, but some require more attention. In this session, we will review the ACOG p...

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Pregnant women and their partners often ask whether or not sex is allowed in pregnancy and what possible consequences may occur. Does sex cause preterm labor? Is PID possible during pregnancy? Is oral sex allowed? Does sex induced labor? Let’s take a look at these questions... and provide answers!

Premature Ovarian Insufficiency (POI) has replaced the previous term of “premature ovarian failure” or “premature menopause”. POI is a stressful and emotional taxing diagnosis for any woman, especially the adolescent and young patient. Other endocrinopathies may be present in patients with POI including thyroid abnormalities and adrenal insufficiency. In this session, we will review the last ACOG...

Progestin only contraceptive options include the subdermal implant, Injection, IUS, and pills. Progestin based LARCs provide HIGHLY effective contraception. A common perception in the public community is that these options may result in depression! Do they? Let’s take a look at a systematic review from 2018 on the subject.

Dr. Samuel A. Mudd. Although few in modern times are aware of this physician, many have heard of the unwelcoming statement, “Your name is Mudd!“. In this brief “medicine in history” segment, we will cover the incredible story of Dr. Mudd.

Talc Before Panties? A look at the curious & controversial data on talc and female cancer... The controversy between the use of talc in the female genital area and risk of ovarian cancer dates back to the 1970s. This decades long conundrum still persists with more questions than answers. Recently, Health Canada issued a health advisory warning on the potential development of ovarian cancer after r...

An evolving burden of evidence supports the theory that a large majority of high-risk ovarian epithelial cancers have a tubal origin. RRS is growing in practice as the preferred option at time of benign Gyn surgery and sterilization. Although RRSO is still preferred in high-risk women (germline mutation carriers), RRS is a possible alternative option, with delayed oophorectomy after age 40. In thi...

The “BIG O”!! This podcast will cover the biology of, purpose of, and surprising health benefits of... female orgasm. (Yep...Oh, the topics we cover all in the name of SCIENCE!)

PRES may be associated with Preeclampsia and Eclampsia. The condition is theorized to result from dys-autoregulation of posterior cerebral perfusion. In this session, we will cover the pathophysiology, presentation, workup, and prognosis of PRES.

Ovarian torsion is considered a gynecological emergency. Ovarian torsion can also occur in pregnancy. Recent data has confirmed the feasibility of ovarian conservation at time of laparoscopic surgery. In this session, we will review the pathophysiology, clinical presentation, work-up, and management of this condition.