Dr. Chapa’s OBGYN Clinical Pearls

Latest Episodes:

"TOLAC SEEMS SAFE": Ya Don't Say. (NEW DATA) Apr 27, 2025

Show notes

In the ACOG Practice Bulletin 205 (Reaffirmed August 2025), the stated risk of uterine rupture with TOLAC is stated as 0.7% (after 1 prior LTCS). However, as our podcast tag list holds true, "Medicine Moves Fast". In an new upcoming publication from Obstet Gynecol (The Green Journal), May 2025, authors looked at the rate of uterine rupture with TOLAC over a 12 year interval. The rate of uterine rupture was NOT close to the national quoted rate in the Practice Bulletin. This information, which was also presented at the Jan-Feb 2025 Pregnancy Meeting, can be very helpful in counseling patients desiring TOLAC. Listen in for details.

The MYTH of Multitasking Apr 25, 2025

Show notes

As healthcare professions we are often pulled in different directions ALL AT ONCE. It happens. We "multitask" every day. Or do we? Neuroscience actually states that we don't multitask at all; rather, we "task-switch" and that may lead to increased physiologic and mental stress and patient error. Yep, there is a MYTH about multitasking. In this brief episode, we remind ourselves that its OK to put somethings off, as able, until one task is completed. As the famed stoic philosopher Publilius Syrus wrote, "To do two things at once is to do neither". Listen in for details.

The OBGYN EXODUS that wasn't (April 21, 2025 Data) Apr 23, 2025

Show notes

I love my home state of TEXAS. I am definitely full of Texas pride. We have Texas barbecue, Texas, hospitality, and of course, the Texas music scene! Our state definitely has some issues to improve on, mainly access to maternity care. We have a HUGE state and 50% of our counties are maternity care deserts. It’s a vast vast Land to cover! Texas has also received a lot of criticism regarding its heartbeat law originally named SB8, which was passed in 2021. Commentaries since then have stated that OBGYNs are leaving the state by the droves! Is that accurate? A new publication from JAMA network open (April 21, 2025) seems to contradict these commentaries. Listen in for detail details.

Rectus at CS: Close or Not? Apr 22, 2025

Show notes

There have been various publications and commentaries published on “evidence-based” cesarean section techniques. Still, one of the persistent controversies on abdominal wall closure relates to the rectus. With transverse fascial entries, should we close/reapproximate the rectus or not? In June 2025, a new RCT looking at this very issue will be printed in the European J Obstetrics Gynecology and Reproductive Biology. Listen in for details.

New ACOG Guidance on PATH Prenatal Care (May 2025) Apr 19, 2025

Show notes

On December 13, 2022, we released an episode describing a new concept in prenatal care, called the PATH model. This was to “redesign” prenatal care, as needed, for those who may have limitations for the “traditional” model of prenatal care visits. Well, what we covered 2.5 years ago is NOW an OFFIICAL guidance from the ACOG and will be out in May 2025. Similarly, the SMFM released their vision for redesigned maternal care teams on 16 April 2025 (J Pregnancy). We will BRIEFLY summarize these 2 publications in this episode.

Pelvic Congestion Syndrome (PCS): Fact or Fiction? Apr 17, 2025

Show notes

Pelvic congestion syndrome is a controversial entity that does not currently have validated diagnostic criteria. In the ACOG PB 218 (2020), it states, “Pelvic congestion syndrome is a proposed etiology of chronic pelvic pain related to pelvic venous insufficiency. Although venous congestion appears to be associated with chronic pelvic pain, evidence is insufficient to conclude that there is a cause-and-effect relationship. In addition, there is no consensus on the definition of this condition, and diagnostic criteria are variable. Further research is needed to establish greater consistency in diagnosis and homogeneity in treatment studies”. Is that it? Is that all there is? NO! There has been great interest in the diagnosis of this enigmatic condition and in potential new treatment options. The last publication on this was just released in March 2025 as a “pilot study”. In this episode, we will combine multiple sources and explain this controversial condition and offer hope to patients who may indeed have this real disorder.

Baby After Uterine Transplant Q&A: Fantastical Facts Apr 14, 2025

Show notes

On Monday April 7, 2025, the UK’s publication The Guardian wrote, “Surgeons are hailing an ‘astonishing’ medical breakthrough as a woman became the first in the UK to give birth after a womb transplant. Grace Davidson, 36, who was a teenager when diagnosed with a congenitally absent uterus, said she and her husband had been given ‘the greatest gift we could ever have asked for’. Grace’s sister donated her own womb during an eight-hour operation in 2023. Davidson said she felt shocked when she first held her daughter, who was born by planned NHS caesarean section on 27 February. She was first UK womb transplant recipient to give birth”. Since the first successful uterine transplant in 2011, there have been over 70 live births worldwide. These births have occurred following more than 100 uterine transplant procedures. This episode, we will review the fascinating history of this procedure. We will also answer some questions regarding uterine transplant like can the patient has vagina sex after this? How is this procedure done? Are these babies born vaginally? And which location in TEXAS become a world-renowned uterine transplant center? Listen in for details.

2025 Update (ACCP): ABX Safety in Pregnancy Apr 11, 2025

Show notes

On March 19. 2025, The American College of Clinical Pharmacy published, "A review of antibiotic safety in pregnancy- 2025 Update". In this episode, we will review some of the confusion surrounding aminoglycosides, sulfa, and nitrofurantoin in pregnancy. Its interesting how different professions view certain medications in pregnancy. Does ACOG say you can use Sulfa in the third trimester? Can you use nitrofurantoin in the first trimester? Listen in for details. (SHOUT OUT to our partner podcast, CLINICAL PEARLS LATINO, for the topic idea. GRACIAS AMIGOS)

EASY BREEZY IUS Patient Tale Apr 10, 2025

Show notes

Well Podcast Family, in this VERY BRIEF episode, we will highlight a patient's perspective on IUS insertion with lidocaine jelly pre-insertion prep. As we have stated in past episodes, I am a BIG ADVOCATE of lidocaine jelly for IUD/IUS insertion. This patient agreed to share her experience of the EASY BREEZY IUS placement. (NOTE: HIPAA protected, patient agreed to participate in this episode).

CAT BITTEN in Pregnancy Apr 09, 2025

Show notes

Animal bites in humans are a common problem in the United States, with two to five million occurring each year. The vast majority of animal bites are caused by dogs (85 to 90 percent), with the remainder caused by cats (5 to 10 percent) and rodents (2 to 3 percent). Children are bitten more often than adults. The most feared complication of an animal bite is rabies, although skin infection is the most common complication. In our community high risk clinic, we recently saw a pregnant patient, who also has diabetes, who had a “cat bite” reported to our nursing staff. On examination, it was more like she was mauled by the cat! Both her feet had significant scratches and bite marks. Are you up to date in your animal bite care algorithm? It's one of those occurrances that are low frequency but have potential high morbidity. So in this episode I thought we would review the care plan for a patient who has suffered a cat bite, or animal bite in general. Meow Meow.

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