Dr. Chapa’s OBGYN Clinical Pearls

Latest Episodes:

NIPTS Clarify: “46 XX or 46 XY”? Jan 12, 2024

Show notes

This is NOT our regularly scheduled episode. Based on an incredible comment from Rachel – one of our podcast family members, which I received just moments ago, this was too good to not put out. A brief clarification on NIPTS and “46XX or 46XY”. (This is a supplement to our immediate past episode.) 😊😊🧐🧐

NIPT’s Sex Chromosome Abnormalities: Clinical Pearls. Jan 11, 2024

Show notes

NIPT is a prenatal SCREENING method that involves analysis of cell-free fetal DNA (cfDNA) in maternal blood. Prenatal screening for sex chromosome aneuploidies (SCAs) has become readily available through expanded non-invasive prenatal testing (NIPT). NIPTs became commercially available in 2011 and has since been introduced in more than 60 countries around the world and is now part of mainstream obstetrical practice. Initially offered as a secondary screen for pregnancies with a high probability of a fetal chromosomal anomaly, NIPT is now often offered and recommended as a first-line screening test for the main chromosomal aneuploidies. Initially, NIPT was available to screen for fetal trisomies 21 (Down syndrome), 18 (Edwards syndrome) and 13 (Patau syndrome). This has expanded of course to include (separately) fetal sex chromosome aneuploidy (SCA) screening. However, there are some VERY important points we must remember when seeing an “atypical sex chromosome” NIPT result. What is the PPV of a SCA found on NIPT? In this episode we will highlight a recent NIPT atypical sex chromosome result from our practice and review what this may and may not actually mean, and review why NIPT screening for SCA is actually VERY controversial with some potential ETHICAL concerns, with some countries recommending AGAINST ordering it. Lots to cover here….so listen in.

No Data, No Problem! Jan 07, 2024

Show notes

We take pride as healthcare providers in being “evidence based“. But sometimes things that we do, even in 2024, sound, reasonable and sound practical, but actually are NOT evidence-based. But lacking evidence means 2 things: 1. Studies have proven something does not work, or 2. Studies have not been done to confirm or refute the intervention. In this episode, we will discuss 2 common interventions that are recommended in pregnancy that actually don’t have the evidence behind them. First is the “test of cure” urine culture after treatment of ASB or cystitis, and the second is certain physical activities like specific yoga positions/Miles circuit as preparation for labor. I believe in both of these interventions- although we don’t have STRONG data for either. I will explain in this episode. That’s why I am calling this, “No data, No problem!”.

UPDATES Re: RHD Alloimmunization Jan 05, 2024

Show notes

Before the 1960s, there was no method available to prevent Rh sensitization during Rh-incompatible pregnancies. Then, in 1968, the FDA approved the use of RhoGAM to help prevent Rh immunization. This was a landmark move in the field of Obstetrics. More recently, ever evolving data and medical genomic technology has brought new insights to RHD alloimmunization care. Can maternal RH typing be avoided with early pregnancy loss (under 12 weeks)? Why about in cases of pregnancy termination? Is that safe? And what is the UNITY non-invasive prenatal test? How can it be used to decrease unnecessary Rhogam administration? Well cover all this new data in this episode (NOTE: UNITY is not a sponsor of this podcast nor of this episode).

Teratoma's "Crazy" Side: The "Brain on Fire" Jan 03, 2024

Show notes

Historically a range of psychiatric and medical conditions have been erroneously attributed to 2 gynecological organs/function. During the time of Hippocrates, the “wandering womb” theory blamed emotional disturbances in women on this condition. Not only was that erroneous, it was nonsensical. However, certain gynecological conditions can indeed manifest with neuro-behavioral disturbances. One of these syndromes can be triggered by the presence of an ovarian dermoid. Anti-N-methyl-D-aspartate receptor (NMDA-R) encephalitis is a paraneoplastic limbic syndrome which may be caused by ovarian teratomas containing neural components. Neural tissue in a teratoma can trigger the production of anti-NMDA-R antibodies, which causes neuronal dysfunction and loss by altering the neuronal cell-surface NMDA receptors in the limbic system. This syndrome presents with a range of psychiatric, neurological and autonomic features and if not promptly recognized and treated may be associated with long-term morbidity and mortality. Rare…yes. But it is out there in the community and patients are at HIGH risk of misdiagnosis. In this episode we will discuss this “Brain on Fire” syndrome and highlight a real case contributed by one of our podcast family members (HIPPA protected).

“LUST” for TOLAC: Last Episode for 2023! Dec 31, 2023

Show notes

This is our last episode for 2023! A podcast family member reached out to me notifying me of a thread on social media discussing ultrasound measurements of “lower uterine segment thickness” (LUST) for TOLAC candidates. I consider myself pretty social media friendly, but was unaware of this comment thread. Should we be measuring lower uterine segment thickness in the late 3rd trimester as a discriminatory tool for TOLAC approval/denial? Is this evidence-based? Where did this concept originate? Is this supported by the ACOG? The answer to all of this is both YES and NO. We will explain in this episode.

Year of the Doula Dec 28, 2023

Show notes

It’s no surprise and understatement to say that the US maternal/neonatal morbidity and mortality rates have to improve. As a way to increase maternal supportive care, an increasing number of states are turning to cover Doula services. Despite this forward thinking, there are still misperceptions, misunderstandings, and “boundary” issues regarding Doulas which must be addressed. Are Doula interventions evidence based? Are Doula services related to improved maternal and neonatal outcomes? What is the position from the ACOG? Does the March of Dimes have a position statement? We will answer all of these questions and explain why 2024 may be the “Year of the Doula” in this episode.

NEW DATA: Fetal Growth Trajectories – the Growth Velocity Issue Dec 26, 2023

Show notes

On May 8, 2023, we released an episode called “Slowed Fetal Growth Trajectory and Neonatal Outcome”. That episode highlighted data that slowed fetal growth was an independent risk factor for stillbirth. This is true even though the composite EFW remained above 10 percentile. Now, there is new data which validates this concept and provides a working model which may help predict fetuses with slowed fetal growth who are at risk of stillbirth. PLUS, we will describe a free online fetal growth trajectory calculator (UK) that helps with patient education and prognostication.

SMFM HBV Consult Series #69: Dec 21, 2033. Dec 23, 2023

Show notes

On August 26, 2023, we summarized the ACOG update on viral hepatitis in pregnancy and discussed new concepts regarding Hep B viral infection. To follow that up, the SMFM has now released its Consult Series #69 (Hepatitis B in Pregnancy: Updated Guidelines) which was published on December 21, 2023. In this episode, we will reinforce some topics originally discussed back in August 2023 and emphasize key management issues regarding Hep B in pregnancy based on this Consult Series… both for the infected, and the non-infected/non-immune patient. Is antepartum fetal surveillance indicated in these patients? Is C-section a way to prevent perinatal transmission? What’s the viral load cut-off to begin antiviral medication? Is it safe to administer hepatitis B vaccine during pregnancy for those who need it? Listen in for details.

Is Maternal Short Stature an OB Risk Factor? Dec 22, 2023

Show notes

The average height for men in the U.S. is about 5 feet 9 inches. For women, it’s about 5 feet 4 inches. Height stature has been correlated with some interesting health conditions at a population level: Some research shows that a below-average height may mean you have lower odds of getting some types of cancer. For example, a study of more than 100,000 women in Europe and North America showed that shorter women are less likely to get ovarian cancer. Also, although researchers can’t explain why, studies show that the shorter you are, the less likely you are to have a VTE. People who are 5 feet or shorter have the lowest chances of getting one. Those are good correlations to being short! BUT, short stature has also been linked to higher stroke risk, coronary heart disease, and diabetes. It is theorized that individuals at/around the 5 foot mark- outside of simple race/genetics- may have been imprinted for smaller growth trajectories either in utero or in early childhood which metabolically predisposes them to these future issues. What about short stature and pregnancy? Are there any correlations there? Is maternal short stature an independent OB risk factor for negative outcomes? And why do we only have ONE main EFW chart (Hadlock) in pregnancy vs population specific ones? We’ll get to the tall and short of it…in this episode.

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