Dr. Chapa’s OBGYN Clinical Pearls

Latest Episodes:

CHS in pregnancy (Updated Data) Oct 12, 2024

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Cannabinoid Hyperemesis Syndrome (CHS): Yep, this is definitely an issue and has been in recent print. This was just covered in an expert commentary in J Gastroenterology in May 2024, and CMS was featured as a JAMA Patient Page on October 10, 2024 in JAMA Network. PLUS, we actually covered this back in Feb 10th, 2020! Yep…M-O-R-E information just keeps coming, including a new study in the OCT 2024 Green Journal, which shows that rates of THC in pregnancy are still increasing. This study, again from THIS MONTH, tells us that the prevalence of prenatal cannabis use increased from 5.5% in 2012 to 9.0% in 2022 among pregnant individuals, at least according to the database from Northern California ( Kaiser Permanente Northern California). In this episode, we will update our previous discussion on CHS (from back in 2020) based on these new publications.

Dehydration Causes OB Contractions? YES, and NO. Oct 10, 2024

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Proper hydration is important for physiology whether male or female, and if female… hydration in pregnancy is important for proper uterine blood flow and proper amniotic fluid production. Interestingly, water recommendations do not specify differential water needs or hydration status recommendations by pregnancy month or trimester, nor do they take into account body composition, knowing that overweight and obesity increase the probability of being underhydrated. During pregnancy, dehydration is thought to contribute to Braxton-Hicks contractions possibly due to lactic acid buildup in the myometrial cells or via reflex secretion of ADH (vasopressin). But this is theoretical. Here is where IV hydration comes into clinical practice. What's hoped for in administering intravenous (IV) hydration is that the fast fluid volume increase will stop uterine activity and hence avert cervical change. Theoretically, hydration may reduce uterine contractility by increasing uterine blood flow and by decreasing pituitary secretion of antidiuretic hormone and oxytocin. Does mild-moderate dehydration lead to preterm labor? Is IV hydration a way to prevent preterm birth. There has been data since the 1980s up until 2021 which says, “No”. Listen in for details.

Dupixent Use in Pregnancy: Sept 2024 Data Oct 09, 2024

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Eczema is also known as a form of Atopic Dermatitis (AD). Males and females are not equally affected by AD, and studies have shown that AD is more common among males during infancy and childhood. However, around puberty, there is a shift towards more females than males having AD and this female predominance continues into adulthood. Eczema can impact any women during pregnancy. In fact, it is the most common prenatal skin condition. A majority of women with eczema in pregnancy have never it previously diagnosed. Actually, approximately 60%–80% of prenatal eczema patients have no prior history of the condition. Eczema in pregnancy may occur because of changes in hormones and the immune system. During pregnancy, the body’s immunity shifts a bit and this shift in immunity can make the mother more sensitive to allergens and dermal manifestations vis inflammatory mediators. Those with preexisting common hay fever or other allergies before pregnancy may be at higher risk of developing eczema during pregnancy. Eczema isn’t just about “itchy skin”, for some it has severe skin manifestations and affects quality of life. While biologics are generally not initiated in pregnancy except for very severe cases, some women may be on this medication when ENTERING pregnancy. Are they safe to use? We have new SURPRISING data from September 2024 which will help us in our shared-decision making with our patients. Listen in for details.

Pump the Brakes on "ROUTINE" IV Fluids in Labor (SMFM ALERT) Oct 08, 2024

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Hurricane Helene has caused massive devastation for a part of the US, and now we are bracing again for Milton, set to affect Florida within the next 24 hours. Baxter, one of the country's leading manufactures for IV fluid bags has closed its plant for an unknown amount of time as it was affected by Helene. On October 4, 2024, the SMFM released a news brief on IVF conservation intrapartum. Listen in for details.

The Pregnancy “One-Stop Shop”: Screen for BRCA1? HPV Vacc PP? Oct 06, 2024

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BRCA1 mutations dramatically increase the lifetime risk of breast, ovarian, pancreatic, and other cancers, yet most BRCA1-positive patients are not identified until after they have been diagnosed with cancer. At prenatal visits, women often undergo obstetrical prenatal carrier screening that can identify hundreds of genetic mutations which can be passed on to offspring and results in an inherited condition — however, BRCA1 and other autosomal dominant mutations are not included on these screening panels. However, a recent publication (September 2024) and related commentaries have brought this screening possibility to the limelight. There is also new data about endorsing offering the HPV vaccine during the immediate postpartum admission. Is pregnancy becoming a “one-stop shop” ( a “window of opportunity”) for women’s care? OK podcast family I think I've set it up enough, now…let's get to it.

Bed Rest for FGR? Surprising 2024 Data Oct 02, 2024

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The ACOG defines Fetal Growth Restriction (FGR) as fetuses with an estimated fetal weight or abdominal circumference that is less than the 10th percentile for gestational age. Currently, the ACOG, SMFM, FIGO, and the ISUOG do not recommend maternal bed rest for this condition. However, a recent publication from the AJOG (May 2024) concluded that strict maternal bed rest could in fact reverse FGR in a short two-week interval! Is this possible? In this episode, we will dissect this controversial, retrospective study and give it proper perspective with real world clinical implications.

Use 130/80 Cut-off in OB? Depends! (CHIP, CHAP, & CLIP). Oct 01, 2024

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In the ACOG practice bulletin 203, the ACOG states that, “Traditionally, the diagnosis of hypertension (HTN) in pregnancy has been 140/90, on 2 occasions at least 4 hrs apart“. The keyword there is… “Traditionally”. In 2017, the ACC/AHA redefined hypertension with Stage I HTN being 130/80. Do some societies recommend the use of this lowered blood pressure criteria in pregnancy? It’s a complicated answer. Does aspirin help prevent preeclampsia in women with Stage I (130/80) hypertension? The answer may surprise you! In this episode, we will do a deep dive into ACOG PB 203, the ACOG practice advisory from 2022 in response to the CHAP trial, and discuss the CLIP 2021 published data. This is a story of CHIP, CHAP, and CLIP… And we will give clear clinical implications of each in this episode!

D-MER: Breastfeeding's Ugly Side Sep 28, 2024

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Dysphoric Milk Ejection Reflex (D-MER) is an abrupt emotional "drop" that occurs in some women just before milk release and continues for not more than a few minutes. Although research is still evolving, one study Published in 2019 (Breastfeeding Medicine) states that up to 9% of breastfeeding women may experience dysphoric milk ejection, although the true incidence is still unknown. The brief negative feelings range in severity from wistfulness to self-loathing. In Arch Gynecol Obstet, in July 2024, authors published, “Dysphoric milk ejection reflex – a call for future trials”. This is gaining interest in the published literature. The etiology of this is unclear but a new (soon-to-be-released) publication in the AJOG provides some interesting insights into this. This was just accepted for publication on September 18, 2024 and the official release is pending. Haven’t heard about D-MER? Due to a lack of awareness, this phenomenon is easily misdiagnosed as postpartum depression and aversion by many healthcare professionals. A July 2024 Harvard Review in Psychiatry publication called D-MER, “A Novel Neuroendocrine Condition with Psychiatric Manifestations”. This condition is a physiologic tale of oxytocin, milk- let down, dopamine and prolactin, and the fight and flight response. Listen in for details.

It's a Small World Sep 26, 2024

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Podcast Family, every once in a while we need a little reminder that we are all wired for community. Despite differences in geographic locations, cultures, and family history, we really do have a lot in common. In this episode, I'll share with you 3 examples which prove that we really do live in a very small world. I hope this brings a smile to your face and encourages you! PLUS, of course, we will provide one main clinical pearl regarding CS-Hysterotomy closure while keeping with our "small world" theme. Listen in for details!

Does LNG-IUS Increase Breast CA? Sep 24, 2024

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The LNG-IUS has been on the U.S. market since 2001. Since 2005, there have been several studies examining the association (if any) of LNG-IUS users and the diagnosis of breast cancers. This is a controversial and conflicting story. In this episode, we will highlight a soon to be released publication (OCT 2024) from the AJOG looking into this relationship. PLUS, we will very quickly walk down history’s timeline starting in 2005 and ending in October 2024 looking at the cumulative data on the subject. Does the ACOG has a statement on it? Listen in for details!

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