Dr. Chapa’s OBGYN Clinical Pearls

Latest Episodes:

The Incredible VIBRATING belt (Osteoboost device): Good Data? Feb 01, 2024

Show notes

On January 18, 2024, the FDA cleared a novel new device for osteopenia treatment. This is a vibrating belt (wearable device) that transmits low-amplitude, high-frequency (20 to 40 Hz) vibration to the spine and hips. This belt is called Osteoboost. Osteoboost previously received a breakthrough designation from the FDA in Dec 2020. This FDA clearance has already generated a lot of commentaries regarding the single RCT results. In this episode, we will review the results critically and explain why there is a difference in “per protocol” RCT results and “intend to treat” RCT results. Is Osteoboost a game changer? Listen in and find out.

Place IUD/S if BV Present? What Would You Do? Jan 30, 2024

Show notes

Bacterial vaginosis (BV) is the most common vaginal aberrant condition in women, in the general population. Even still, the majority of women with BV are asymptomatic. If BV is found at time of elective IUD/S placement, can the device still be inserted? Or is it an independent risk factor for upper tract infection? What category in the CDC MEC is vaginitis/vaginosis for IUD placement? There definitely is some confusion about this in clinical practice, highlighted by the 3 different clinicians which were interviewed in this episode! So…. IUD placement with BV: test and place, or test and differ placement? Listen and find out.

More Bad News Re: PreEclampsia Jan 27, 2024

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Hypertensive Disorders of Pregnancy (HDP) affect 5 to 15% of women worldwide, and their increasing incidence is likely related to the growing levels of obesity, metabolic syndrome and advancing maternal age. It is widely accepted that women who have preeclampsia are at increased risk of future hypertension, cardiovascular disease, stroke, chronic kidney disease, and even diabetes in later life. But what is the association between HDP and dementia? In this episode, we will review the latest data from a systematic review and meta-analysis published on January 24, 2024 in the AJOG.

OB Issues After IUD Perf? Jan 25, 2024

Show notes

Uterine wall perforation at time of IUD placement has been published to occur, in general, about 1-2/1,000 cases. It happens! While there are some risk factors for uterine perforation (very antiflexed, retroflexed, recent postpartum state, lactating), sometimes uterine perforation can happen even with the best of technique and no risk factors. While most providers are concerned about immediate short-term gynecological complications like infection and bleeding, we don’t really consider the possibility of any potential future OB complications. Is a patient at higher risk of future adverse OB issues after perforation during IUD placement? It’s an interesting question, with an even more fascinating answer! In this episode we will dive into the data, and make sense of published case reports and clinical opinions which help us arrive at the answer to that question.

Extencilline, Linezolid, & STUFF Jan 22, 2024

Show notes

Yep, Medicine moves fast! On Friday, January 5, 2024, I participated in a medical news report published in “The Guardian”. In that news commentary I stated that “Bicillin-LA is the only medication approved for syphilis during pregnancy”. We’ve all heard that statement, and it is a true statement. However, 5 days later on January 10, 2024, the FDA announced the importation allowance of “Extencillin” to combat the Bicillin-LA shortage. Yep, Medicine moves fast. Now we have this medication available as an option until Bicillin-LA increases its availability. But what about Linezolid? In this episode, we will also discuss a recent non-inferiority trial of Linezolid for early syphilis, which was published in “The Lancet”. Although that study had disappointing results, there are some caveats which need explaining. Listen in to find out more.

Preg Test in ESRD: Going Down the Rabbit Hole? Jan 21, 2024

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If you had 5 reproductive age women, all late on their menstrual cycle, who were having unprotected sex, and all have a positive pregnancy test… What would be your diagnosis? The most likely diagnosis would be that there are five pregnancies! Right?! But what if 1 of those patients had end stage renal disease (ESRD), on hemodialysis. Is there anything else to consider? While ruling out pregnancy is priority #1, it is possible that this HCG is a phantom result. This is a slippery slope discussion and one that could easily lead down the rabbit hole. In this podcast, we will highlight this clinical conundrum, based on a real case from our practice, and summarize some fascinating reports from the literature.

You Asked, We Answered! Jan 18, 2024

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Periodically, we respond to podcast family members’ questions as data is available. In this episode, we will cover 3 very clinically relevant questions from our podcast listeners. The first question is regarding our immediate past podcast topic, which was propranolol as a labor stimulant. The question is, “Does the ACOG have a statement on adjuvent propranolol use during labor?“. We’ll answer that question in this episode. The second question is whether the placebo/pill-free interval of combination birth control pills is linked to anxiety/depression. This is a COMPLICATED issue but there is brand new data that helps answer that exact question, and we will cover that in this episode. The final question is whether or not “HPV booster vaccination“ is indicated after CIN2+ treatment in patient who had previous vaccination. Lots of data to help answer these questions… and we will summarize it here.

Can Propranolol Rescue Labor? Jan 17, 2024

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It has been well reported that rates of elective induction have risen nationally and internationally since the adoption of the ARRIVE trial. But as medicine is at times controversial, some studies have suggested an increase in cesarean section rates with elective induction of labor at 39 weeks. While we will briefly discuss those studies, they are not the focus of this episode. However, as induction of labor becomes more common place, there has been renewed interest in use of adjuvant medications to augment induction success. One of those medication is propranolol. Can giving a beta-blocker help with uterine contractility? The data is conflicting with recent evidence saying “No!“. In this episode, we’re going to put the evidence on trial and present both arguments: one as plaintiff, and one argument as the defense for our shared client, which is propranolol. Is propranolol guilty of its charges of being a labor stimulant? Or is it innocent of all charges? Let’s let the data decide.

More Data on LUST (Follow up to 12/31/23 Episode) Jan 15, 2024

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On New Year’s Eve 2023 we released “LUST for TOLAC”. LUST stands for lower uterine segment thickness. This is a very enticing, and controversial, approach to TOLAC counseling and direction. I encourage you to go back and listen to that episode, if you have not yet, before listening to this one as this is more data to support those conclusions. In this episode, we will highlight a multi-center, cluster-randomized trial out of Canada, the PRISMA study. This fantastic investigation sheds more light on the application of LUST for prediction of TOLAC uterine rupture.

Beyond the 22 Week Birth Jan 13, 2024

Show notes

The gestational age boundary termed viability has shifted dramatically during the past 50 years, and more so in the last 15 years. In 1971, a widely used neonatology textbook stated that, “The lower limit of viability is probably around 28 weeks, at which time most infants weigh two pounds, four ounces (1000 g).” Today, the most immature infants routinely cared for by neonatologists in some parts of the world are born at 22 weeks of gestation, with many weighing around 500 grams. While most studies reporting on neonatal resuscitation at 22 weeks give a main outcome as “alive at discharge”, there are other potential long-term morbid conditions which cannot be ignored. The ability to perform neonatal resuscitation at 22 weeks and 0 days has led to many powerful ethical debates and published commentaries. In this episode we will take a look at the complexities of neonatal resuscitation at 22 weeks focusing on the potential long morbidity after hospital discharge.