Dr. Chapa’s OBGYN Clinical Pearls

Latest Episodes:

New DATA on Endo RX for Pain (May 2025) May 19, 2025

Show notes

Endometriosis is a prevalent gynecologic condition that affects approximately 10–15% of women of reproductive age worldwide. For endometriosis related pelvic pain, continuous combination birth control pills have long been the first-line pharmacologic intervention of choice. But new data published May 15, 2025 (ahead of print) in Obstetrics and Gynecology is challenging that tradition. In this episode , we will summarize the key findings of this brand new network systematic review and metanalysis. Plus, we will also review what is missing from the ACOG PB 114 regarding the management of endometriosis. Listen in for details.

IUD/S Placement NEW Guidance: Was It Racism Before? May 17, 2025

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In August 2024, the CDC updated its MEC. This included a recommendation for local anesthesia for IUD/S placement and also had guidance regarding misoprostol for that procedure. Coming up in July 2025, the ACOG will officially release a new clinical consensus on “Pain Management for In-Office Uterine and Cervical Procedures”. Are these recommendations similar to the CDC’s? What about misoprostol? Was the non-use of local anesthesia for these office-based procedures rooted in racism and sexism? Listen in for details.

POPs=Asthma? New Data May 14, 2025

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Asthma is more prevalent in adult women than in adult men. Specifically, data from the National Health Interview Survey (NHIS) indicates that 9.7% of adult women had asthma, compared to 5.5% of adult men. This higher prevalence is observed across various racial and ethnic groups within the adult female population. At the end of April 2025, new population-level data was published (UK) describing an alarming association between progastrin only pills and asthma exacerbations. Is this a new finding? Recently, it seems that there has been a barrage of negative press towards progestin only contraceptives: depo provera and brain tumors, progestin releasing IUS and breast cancer, and the progestin IUS and rosacea. What is happening here?! We'll break it all down in this episode.

FGM 2025 Update. May 12, 2025

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Female Genital Mutilation (FGR) is condemned by the WHO, Unicef, and the US. Nonetheless, it is still being performed worldwide, and in North America. In this episode, we will recently published data (April 2025) from BMC regarding this practice. This episode's topic was brought to me by one of our podcast family members who currently has a pregnant patient with FGR. Does this patient require a cesarean section? What are the 4 types (classifications) of FGR? Listen in for details.

Ca-Mg “Love-Hate” Bond: Follow Ca Levels on MagSulfate? May 09, 2025

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(Topic Requested): Serum Magnesium and Calcium have an intimate and complex relationship best described as “love-hate”. One of our podcast family members sent me this fascinating question: “Should we be following serum calcium levels in patients undergoing IV Mag Sulfate use in obstetrics, in order to identify dangerous hypocalcemia?...Should we be giving these patients prophylactic calcium?” Thera are indeed published case reports of hypocalcemia induced tetany in patients. However, are there national guidelines which call for “calcium surveillance”? Do you remember what the Chvostek's and Trousseau's signs are? Listen in for details.

ERAS POST CS 2025 UPDATE: Stop Stuff Early? May 07, 2025

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Some debates in medicine and in OBGYN are “the same ol’ thing”. Like the debate on when to remove the urinary catheter after a “routine” cesarean section. In the original 2019 ERAS publication, the authors stated that “immediate” removal of the urinary catheter was “strongly recommended”. This drew concern and criticism as being too early in the recovery process. Not, in the UPDATED ERAS guidelines (as of end of April 2025), this recommendation has once again changed! In this episode, we will review the new guidance from the ERAS Society regarding post cesarean section care focusing on when to stop IV fluids and urinary drainage.

Estrogen the Vag: Live Better! May 05, 2025

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The term "genitourinary syndrome of menopause" (GSM) was introduced in 2014 by the International Society for the Study of Women's Sexual Health and the North American Menopause Society (now the Menopause Society). This new term was created to replace older terms like vulvovaginal atrophy, urogenital atrophy, and atrophic vaginitis, and it encompasses the range of symptoms related to hormonal changes in the vulvovaginal and urinary tract areas that can occur during menopause. Recurrent UTIs are more likely in postmenopausal women not on vaginal estrogen therapy. IN this episode, we will highlight new data from the recent AUA meeting which looked at surprising benefits on postmenopausal vaginal estrogen in women with recurrent UTIs. Nonetheless, questions on the data remain. Listen in for details.

NEW ERAS-CS UPDATE: 2025! May 03, 2025

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The ERAS (Enhanced Recovery After Surgery) concept was initially developed for colorectal surgery in 1997 to standardize surgical protocols. The ERAS Society then first published a guideline for cesarean section (ERAC) in 2018-2019. Now, as of April 28, 2025, the ERAS Society has released a NEW UPDATE for ERAS-CS. In this episode we will focus on 2 main areas: 1. Vaginal prep at CS, and 2.Extended antibiotic prophylaxis in patients with obesity! Medicine moves fast, and this data exemplifies that. PLUS, we will relate these 2 points back to the ACOG PB 199 which focused on prophylactic antibiotics at cesarean section.

Mini Q&A: 1. TOLAC Ut Rupture, & 2.Measles! May 02, 2025

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I know this sounds braggadocious, but I'm going to say it anyway: I work with some incredible people! We recently released a podcast on updated TOLAC uterine rupture data. One of our former residents reached out to me with a question about this: “Did they include interdelivery interval in their assessment?” You see, I work with really smart people! There's an answer to that question, and we're going to cover that in this episode. PLUS, a current resident, Spencer, had a great question about proof of immunity to rubeola (measles) in pregnancy. Can we assume that if a patient is rubella immune that she is also immune to rubeola? That's a great question, and we will explain in this episode!

Dating a TWIN Gestation: Smaller or Larger Fetal Estimate? Apr 30, 2025

Show notes

Spontaneous twin pregnancies occur in about 1 out of every 250 pregnancies. A real world clinical question has to do with dating a spontaneous twin gestation: Do we use the smaller crown rump length or the larger for dating in the 1st trimester? Do we use the smaller or larger measurement of biometry in the 2nd trimester? We had this discussion today in our prenatal clinic, and in true form and fashion, I turned it into an episode! PLUS, there is practice guidance from Jan 2025 (ISUOG) to settle the debate. Listen in for details.