Dr. Chapa’s OBGYN Clinical Pearls

Latest Episodes:

"CNN" Update (Chapa News Network): 1. ACOG RSV-GBS Response, 2. TRD Jan 24, 2025

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This- is-CNN. No, that THAT CNN...This is Chapa News Network! WE have late-breaking news developments on 2 fronts: 1. The ACOG has released a clinical update (ACOG ROUNDS) in response to a recent study associating the RSV vaccine and GBS (we covered this study in a past episode). 2. The FDA has EXPANDED the label for an intranasal therapy for Treatment Resistant depression (TRD). Listen in for details.

Is Sleep Position REALLY Linked to Stillbirth? Jan 23, 2025

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Around a third of a person’s life is spent asleep. Previous studies have reported an association between sleep disordered breathing, like OSA, and pregnancy complications such as pre-eclampsia, gestational diabetes, and preterm birth. We recently discussed a stillbirth bundle from Australia which includes patient education on sleeping practices and stillbirth risk. Does maternal sleeping position ready influence stillbirth risk? Some data says NO, but there’s a catch to those. Other population level data says YES. Why the difference? And why is the position the mother STARTS to sleep very important here? Listen in for details as we walk down the timeline of data from 2011 to present day.

External Aortic Compression: Buying Time in Pelvic Hemorrhage Jan 21, 2025

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Internal manual aortic compression is a procedure that may be used intraoperatively in the management of massive pelvic bleeding. But what about EXTERNAL aortic compression? In February’s 2025 AJOG (Grey Journal), under their Surgeon’s Corner section, there will be a very nice video recap of an easy to adopt maneuver which may “buy time” in OB hemorrhage cases as surgical intervention is being planned. This is called the EAC maneuver. First described in 1994, this technique has regained the spotlight as rates of PPH have been on the rise. How is EAC done? Does it work? If so, why is this not part of the OB Hemorrhage bundle? Listen in for details.

The Miracle Med in Menses? MenSCs. Jan 20, 2025

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Mesenchymal stem cells (MSCs) are multipotent adult stem cells which can differentiate into multiple cell types. MSCs can be isolated from the bone marrow, umbilical cord blood, adipose tissue, muscle, and dental pulp. However, the use of these MSCs involves a number of barriers. Human umbilical cord is limited to collection at birth. Bone marrow and fat biopsy are painful and requires general anesthesia. If only there was an easily obtainable method to collect these MSCs, like maybe even once a month, collectable in a little cup, without biopsy. WHAT… use menstrual blood you say?! Menstrual blood-derived mesenchymal stem cells (MenSCs) were first described by Meng et al. in 2007, as a novel source of MSCs. Most of the MenSC are produced by the endometrium. With the potential of multi-directional differentiation, this has spurred a list of preclinical and animal studies looking into the collection of menstrual blood for MSC processing. Men SCs have been investigated for use in Alzheimer’s disease, Stroke, Spinal Cord Injury, Type I DM, wound healing, endometriosis therapy, infertility, and even Muscular Dystrophy. Is there a miracle med in menses? Listen in for details.

Maternal Tachycardia: When to Eval. Jan 17, 2025

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Tachycardia in pregnancy is common and distinguishing between physiological and pathological causes can be a challenge. Plus, until recently, there had not been a well-defined or universally accepted definition of the upper limit of normal for heart rate in pregnancy. But a study published in 2020 from the Green Journal, from the NHS in London has shed light on this issue. The finding of persistent tachycardia beyond a certain rate (and we’ll discuss that rate in this episode), regardless of symptoms, should prompt a search for potential etiologies and at least some basic investigations. Of course, any tachyarrhythmia in pregnancy causing hemodynamic instability requires urgent cardioversion as per adult life support guidelines. In 2023, The Heart Rhythm Society (HRS) developed expert consensus guidelines in collaboration with the American College of Cardiology (ACC), the ACOG, and the AHA to address arrhythmias in pregnancy. In this episode we will focus on and review maternal tachycardia. Does HR really increase by “10-20%” in pregnancy as we all were taught? What heart rate is generally considered evaluable? And what’s the suggested evaluation? Listen in for details.

Time for Stillbirth Prevention Bundle: NOW. Jan 13, 2025

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The stillbirth rate in the US is considerably higher than in many countries with similar resources. In 2021, the United States stillbirth (loss before birth at ≥20 weeks’ gestation) ratio was 5.73 per 1000 births or 1 in 175 pregnancies with 21,000 stillbirths occurring annually. Contrast that to the rate in Japan which is 1.6/1000! The UK and Australia have both implemented stillbirth prevention bundles which have proved worthwhile. It is long past due for the US to have its won national stillbirth prevention bundle. In this episode we will review a publication from Aug 2024 (AJOG) describing this bundle proposal and highlight a letter to the editor from January 9, 2025 in the AJOG in response to that August publication. Listen in for details.

*FDA Warning*: RSV Vacc and GBS (Breaking it Down) Jan 10, 2025

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Guillain-Barré syndrome (GBS) is a rare disorder that causes muscle weakness and sometimes paralysis. It's caused by the body's immune system damaging nerves. While most cases are triggered by respiratory or gastrointestinal infections, vaccinations have also been linked to GBS pathogenesis. GBS can last from weeks to years, but most people start to recover within a few weeks. The earlier symptoms improve, the better the outlook. Physical therapy is important to prevent muscle contractures and deformities. Some people may experience long-term weakness, numbness, fatigue, or pain. A small percentage of people with GBS may have a relapse, which can cause muscle weakness years after symptoms end. On Jan 7, 2025, the FDA required and approved UPDATED safety labeling changes to the Prescribing Information for Abrysvo (Respiratory Syncytial Virus Vaccine) manufactured by Pfizer Inc. and Arexvy (Respiratory Syncytial Virus Vaccine, Adjuvanted) manufactured by GlaxoSmithKline Biologicals. Specifically, FDA has required each manufacturer to include a new warning about the risk for Guillain-Barré syndrome (GBS) following administration of their Respiratory Syncytial Virus (RSV) vaccine. Who is most at risk for GBS? Where pregnant women affected? This is important information….listen in for details.

Response to 2 New Pubs: “Ya Don’t Say?!” (Sarcasm Added) Jan 08, 2025

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Sometimes you read a new study and you just have to say, "You Don't Say?!" In this episode, we will highlight 2 publications which were released Dec 26. 2024 and Jan 6, 2025 which make you say just that. This is a brief, fun, YET STILL EDUCATIONAL, episode...Listen in for details.

2 Topics: 1.New, and 2.Weird! Jan 07, 2025

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In this episode, we will cover 2 topics: the first is brand new in print (01/06/2025 ), and the second is just weird. In the “new” portion we'll summarize a new randomized study published in JAMA Network dealing with gestational diabetes. Should we add glyburide to metformin for GDM control? Listen in for details. In the second portion, we'll focus on unilateral ovarian absence not related to previous removal. Yep! This is why it's very important to check the adnexa at “routine” C-section or “routine” gynecological surgery. It is possible to be missing an ovary…and its weird! Listen in for details!

Mode of Delivery for Periviable PTB: Does it Matter? Jan 05, 2025

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Preterm infants, especially those born at periviability, are at inherent risk of a variety of short-term neonatal complications- depending on their gestational age- including sepsis, respiratory distress, IVH, and have an overall higher mortality compared to term born infants. Well known interventions are intended to reduce these complications; these include antenatal corticosteroids, magnesium sulfate for CNS protection, and antibiotics for latency in PPROM. This is an even bigger issue for those born in the periviable interval. That group is a unique population. But does mode of delivery matter? Cesarean delivery is currently not recommended before 25 weeks' gestation unless for maternal indications, even in the setting of malpresentation. We’ll cover recently stated guideline in this episode. These recommendations are based on a lack of evidence of improved neonatal outcomes and survival following cesarean delivery and the maternal risks associated with cesarean delivery at this early gestational age. Plus, for non-vertex presenting fetuses, C-section has been reported to reduce risk of neonatal mortality, but what about vertex presenting preterm/periviable babies? In this episode, we will review the mode of delivery and neonatal outcomes in preterm birth with a special focus on those born in the periviable interval, like 22- and 23-weeks gestation. There’s lots to cover here…so listen in for details.

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