Dr. Chapa’s OBGYN Clinical Pearls

Latest Episodes:

Another Nail in the 81mg ASA Coffin? Move to 162mg? Dec 02, 2024

Show notes

In November 2013, ACOG issued the Hypertension in Pregnancy Task Force Report recommending daily low-dose aspirin (81mg) beginning in the late 1st trimester for women with a history of early-onset preeclampsia and preterm delivery at less than 34 0/7 weeks, or for women with more than one prior pregnancy complicated by preeclampsia. The following year, the USPSTF published a similar guideline, although the list of indications for low-dose aspirin use was more expansive. Since then, the ACOG has issued new guidance on low-dose aspirin, in 2018 and 2021. Nonetheless, while criteria for use has evolved, the dosage recommended has remained as 81 mg. But MEDICINE MOVES FAST, and a new Expert Review in the AJOG MFM is making a case for 162mg. Are we underdosing low-dose aspirin for prevention of preeclampsia? A litany of data says YES. Listen in for details.

The Fertility Anxiety Panic: Freeze Eggs in 20s? Nov 28, 2024

Show notes

The first successful births from frozen eggs were twins, born in Australia in 1986. IVF serves a valuable role for those with persistent infertility issues or other conditions where natural conception is hindered. Although oocyte cryopreservation was initially used as a fertility preservation strategy for medical indications, currently, it is increasingly used to circumvent age-related infertility. This process of elective egg retrieval and cryopreservation- targeting women in their 20s- has gotten out of hand! Mainly due to social media, Gen Z women are panicking about their fertility. Should They Be? For decades, the age of 35 has been seen as a “demarcation line” for female fertility. Before 35, the theory often goes, most women will have little trouble conceiving, but at that point, fertility falls off a cliff. This misunderstanding of natural fertility processes, spurred on by false information on social media, has led to 20-somethings calling for egg retrieval and egg freezing. The dread of age 35 is so pervasive that its effect bleeds backward in time, with women in their early 30s—and yes, sometimes even in their late 20s—already feeling as if they are behind in the race against their “biological clock.” But the reality of fertility “loss” is much more complicated then just “falling off a cliff” and should be viewed more as of a natural “slope” rather than a “cliff”. About a decade after it shed its “experimental” label from the ASRM, oocyte retrieval and cyropreservation has become ubiquitous in our social media culture and has ballooned in popularity, with over a million frozen eggs or embryos stored in the United States today. It has done little, however, to materially change women’s lives. The ASRM has an ETHICS COMMITTEE OPINION (2024) on this very thing. Is 35 really a fertility cliff? Or it it 32? Is egg freezing in late or early 30s the best way to go for delayed fertility? Listen in for details as we set the record straight.

Avoiding Sex While Pregnant, To Avoid Pregnancy? And MORE! Nov 26, 2024

Show notes

Introducing one of our Senior Residents, Dr. Mauldin: Dr. Mauldin just told me of a real patient encounter she had just today, that I felt we HAD to share with everyone. This real encounter is WHY we are passionate about EVIDENCE-BASED medicine! PLUS, we will introduce our NEXT episode which will focus on "elective egg harvesting and freezing" for young women who may have "delayed fertility" due to career path. The social media influence on what has come t be called "social egg harvesting" by some, has gotten out of hand! Listen in to her personal history and perspective on this!

Chewing Gum to Prevent Preterm Birth! Maybe. Nov 23, 2024

Show notes

In the United States, more than 400,000 babies are born prematurely each year, which is about 1 in 10 babies. Over the last several decades, multiple studies have shown a link between poor oral health and increased occurrence of preterm birth. Researchers have looked at various ways to improve dental health during pregnancy, including doing a “deep-teeth cleaning” (also called ‘scaling and planing’), which involves removing plaque and tarter on the teeth and below the gum line. However, despite improving periodontitis, deep teeth cleaning approaches have not proven to be effective in the prevention of preterm birth. But now new data has discovered an easy and inexpensive way to improve oral health and potentially reduce preterm births. This data was originally presented at the annual Pregnancy meeting at SMFM, but now it is a peer reviewed publication. In this episode, we will review how chewing xylitol gum has promising results for preterm birth reduction. Nonetheless, some important limitations must be reviewed. Listen In for details.

Understanding Dual Stain in HPV Triage (ASCCP 2024 Update) Nov 20, 2024

Show notes

The U.S. Preventive Services Task Force and the World Health Organization recommend primary HPV screening, starting at age 25, as an option (some as preferred) for cervical cancer screening. Although primary HPV screening is as effective as cotesting at detecting cervical cancer, primary HPV screening decreases the number of lifetime screenings needed. The primary HPV screening tests approved by the U.S. Food and Drug Administration (FDA) are the Roche Cobas and BD Onclarity tests. HPV results for the Roche and BD tests can be reported as a pooled result. This means the physician receives a result of negative or positive, in which positive indicates that at least one, but possibly more, types of high-risk HPV were identified in the sample. HPV genotyping options differ by manufacturer. Roche Cobas reports HPV 16 and 18 individually and groups 12 other types (i.e., positivity means at least one of the 12 types triggered the positive result). BD Onclarity reports six individual HPV types (16, 18, 31 [the highest risk going immediately to colposcopy], 45, 51, and 52), and combined types (33/58), (35/39/68). Now, as of March/April 2024, the ASCCP has recognized another important and clinically useful HPV and co-test TRIAGE tool, the DUAL STAIN. This pertains only to the ROCHE COBAS HPV test. In this episode, we will review this latest ENDURING GUIDELINES update to the 2019 ASCCP management algorithms (already updated in the ASCCP app).

New Data: Vaginal Estrogen Use in Breast CA Survivors Nov 18, 2024

Show notes

With an estimated 3.8 million breast cancer survivors in the United States, OBGYNs and other women's healthcare providers often are on the front lines of addressing survivorship issues, including the hypoestrogenic-related adverse effects of cancer therapies or early menopause in survivors. Although systemic and vaginal estrogen are used widely for symptomatic relief of genitourinary syndrome of menopause in the general population, among individuals with a history of hormone-sensitive cancer, there is uncertainty about the safety of hormone-based therapy, leading many individuals with bothersome symptoms to remain untreated, with potential negative consequences on quality of life. The term genitourinary syndrome of menopause (GSM) is the term used to describe to a constellation of symptoms that relate to hypoestrogenic effects on the genital epithelium, such as genital dryness, burning, and irritation; potential downstream effects of vulvar and vaginal atrophy such as dyspareunia; urinary symptoms such as urgency or dysuria; and recurrent urinary tract infections. Is vaginal estrogen or estrogen-like therapies safe in these patients? What about in those using aromatase inhibitors? A new Meta-Analysis (AJOG) provides insights. Listen in for details.

Steroids & Studies & "Shared-Decisions": Oh My! Nov 15, 2024

Show notes

Yep! We have definitely covered the evolving saga and controversy regarding antenatal corticosteroids in the late preterm/early term interval. It's like Dorothy in the Wizard of Oz: "Lions and Tigers and Bears, Oh My!" More fitting for our discussion, its "Steroids, and Studies, and Shared-Decisions, Oh My!" In this episode we will highlight TWO pieces of literature coming out in DECEMBER 2024 in the Green Journal on this topic. The article is by Clapp et al and the associated editorial piece will be the core part of our episode. Listen in for details!

A Mini-Plethora of ObGyn News Nov 13, 2024

Show notes

Well, in the last 4 weeks there have some interesting developments in the sphere of OBGYN medical news. In October 2024, out of the American Society of Anesthesiologists, came a study on the possibility of using serum FAR to predict preeclampsia with severe features in admitted patients (don’t worry, we’ll discuss what FAR is!). PLUS, some exciting, although preliminary, data has been published out of Baylor College of Medicine raising the possibility of a non-invasive test for endometriosis using…POOP! Yep, poop. And on October 31, 2024 a new clinical perspectives article was published in the Green Journal “CHALLANGING” the recent ACOG’s Clinical Practice Update regarding screening for pregestational DM in early pregnancy. Intrigued? You should be….we will cover these 3 tidbits of OBGYN news in this episode!

Was the ARRIVE Trial an IOL Mandate? (New ACOG CPU) Nov 09, 2024

Show notes

The ARRIVE was published in the New England Journal of Medicine on August 8, 2018 1. This study was a large unmasked multicenter trial conducted from March 2014 to August randomized 6,106 nulliparous women to either IOL or expectant management at full term. The trial was conducted at 41 facilities across the United States. This validated that eIOL at 39 weeks, in that patient population, had the ability to reduce cesarean sections and rates of hypertensive diseases of pregnancy. Since that time, elective IOLs have INCREASED at 39 weeks as some messaging was distorted implying that IOL was the BEST way to go over expectant management. Has other data since 2018 found the same thing? Or were the results of the ARRIVE trial an aberration? The ACOG has JUST RELEASED a new CPU which provides additional insights to this. Listen in for details!

New Data for UTI in Women Nov 07, 2024

Show notes

Urinary tract infections (UTIs) are a leading cause of health care visits in the USA and around the world. In the US, they have a cost burden of $3.5 billion annually. Half of women experience at least one UTI in their lifetime, and approximately 25% of these women develop recurrent UTIs! On October 31, 2024, a study was published in Obstetrics Gynecology (the Green Journal) looking at UTI treatment trends in nonpregnant women. With the increased use of tele-visits, there is now a conundrum between allowing easier access to care (tele-visit) and treatment of UTIs online balanced against contributing to antibiotic resistance. Is urine culture recommended prior to antibiotic use for uncomplicated UTI? That depends on who you read! We will discuss this issue in this episode. PLUS, we will briefly discuss a NEW oral antibiotic for uncomplicated UTI in women; this was just FDA approved on October 25, 2024.

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