Dr. Chapa’s OBGYN Clinical Pearls

Latest Episodes:

Mirror Syndrome Oct 06, 2023

Show notes

Mirror Syndrome also known as “triple edema” or Ballantyne syndrome, is a rare disorder affecting pregnant women. Mirror Syndrome is often underdiagnosed or misdiagnosed due to a general unawareness of the condition, and sometimes its preeclampsia-like manifestations. However, until now, the characteristics of Mirror Syndrome have not been fully elucidated. But medicine moves fast, and we now have a better understanding of its presentation, likely contributing factors, and outcomes. Still, some knowledge gaps remain. In this episode we will summarize the data on this terrible, potentially life threatening, obstetrical emergency. Our centerpiece for discussion will be a recent systematic review published in September 2023 in the AJOG with authors from my home state of Texas.

Technique or Tuff Luck? OB “Issues”. Oct 04, 2023

Show notes

Incorrect delivery technique can lead to fetal birth trauma. However, sometimes – despite proper technique and care – fetal birth injuries occur. As I was taught as an intern, “Mal-occurrences don’t always mean Mal-practice“. Does that rule hold true for fetal clavicular fracture? What about Erb’s palsy found at birth? Can these issues occur as part of normal labor and delivery? And at time of cesarean section, does meticulous surgical technique always prevent immediate postop bleeding complications? In this episode, we’re going to review the data on 3 perinatal adverse events that may occur despite proper care: clavicular fracture, Erb’s palsy, and post-operative, rectus sheath bleeding/hematoma.

OB Pyelo FAKE NEWS Oct 02, 2023

Show notes

The ACOG released Clinical Consensus #4 in August 2023, covering Urinary Track Infections in Pregnancy. Urinary tract infection (UTI) is one of the more common perinatal complications, affecting approximately 8% of pregnancies. These infections represent a spectrum, from asymptomatic bacteriuria, to symptomatic acute cystitis, to the most serious, pyelonephritis. In this episode we will summarize some the key points from this monograph, and we will tackle 3 common myths/misperceptions related to OB Pyelonephritis. Are most people who claim a PCN allergy truly allergic? Can an anaphylactic PCN response decrease over time? What antibiotic is recommended for OB Pyelo if patients do have a real anaphylactic PCN history? Can OB Pyelo present without fever? Listen in and find out.

Advanced Paternal Age? YES Sep 30, 2023

Show notes

The age at which couples have children in the United States continues to increase. While it is well documented and known that maternal age directly impacts fetal and child outcomes, less attention has been given to advanced paternal age (APA). Medical and Genetic commentaries have stated that limited APA principles have been advocated for or disseminated into the medical communities and the general population. There may be considerations for the development and application of a couple-centered strategy counseling on age-related genetic risks. Is APA a real issue? What age defines that? And what has APA been associated with? Listen in and find out!

Beyfortus PASSIVE Immunity info! For Katie!! ❤️❤️❤️ Sep 28, 2023

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A quick clarification about Beyfortus neonatal protection against RSV. Thank you Katie for bringing this to my attention! What a wonderful podcast community we have. ❤️❤️❤️

“The College” Clinical PA: Maternal RSV Vaccine Guidance Sep 28, 2023

Show notes

We have been following this developing story on the Maternal RSV vaccine, Abrysvo. In the recent podcast, we stated that we would let you know when the ACOG releases its “Practice Advisory”, which is its clinical guidance update. This is now out! In this episode will provide the summary, high-yield points regarding this vaccine’s use in pregnancy. Can this be co-administered with other vaccines? What did ACOG say about the preterm birth “numerical imbalance” among study trial participants who received this vaccine? And which option provides a stronger and longer lasting immune response in the child: maternal vaccination, or newborn vaccination? Listen in and find out.

LDA in Preg: The SAGA Continues Sep 26, 2023

Show notes

Low Dose Aspirin has been a routine aspect of preeclampsia prevention since first mentioned by the ACOG’s Hypertension in Pregnancy Task Force report, back in November 2013. Since that time, there has been several revisions of the criteria of who qualifies for low-dose aspirin in pregnancy. Nonetheless, there are calls and expert opinions challenging this “risk factor based” approach, favoring a more universal adoption. Additionally, the DOSE of low-dose aspirin has also come under recent critique. Is 81 mg the correct dose to use? Does aspirin have the potential to reduce preterm birth? In this episode, we will review a soon-to-be released clinical commentary from the AJOG (October 2023) which addresses these matters.

OB Mental Health Meds: “The College” Data Review. Sep 25, 2023

Show notes

According to the CDC’s press release from September 2022, the leading underlying causes of pregnancy-related death include mental health conditions (including deaths to suicide and overdose/poisoning related to substance use disorder), accounting for 23% of cases. The top 2 perinatal, mental health conditions are anxiety and depression. And, although much more rare with an incidence of 1–2/1,000, postpartum psychosis is a major cause of self-harm an infant harm. In this episode, we will review “The College’s” recent clinical practice guidelines on mental health therapies in the perinatal interval. Do you know which 2 classes of medications are most preferred for treating anxiety/depression in the perinatal period? Are SSRIs a leading cause of PPHN? Is Lithium allowed in pregnancy? And what is “neonatal adaptation syndrome”? We will cover all these questions, and more, in this episode.

ASX Postmenopausal ES Thickness: Bx? Sep 22, 2023

Show notes

It’s pretty standard of an evaluation… TVUS for postmenopausal bleeding. It’s well accepted that an endometrial thickness of 4 mm (5 mm in some studies) should trigger further endometrial tissue analysis in women with postmenopausal bleeding. But is there a cut-off endometrial thickness at which endometrial tissue should be evaluated in a postmenopausal patient WITHOUT bleeding, where this was found incidentally? There is definitely an evidence-based recommendation, and we will cover that in this episode.(With a special guest host 😊…. “Anything for SELENAs”)

OB SMORGESBOARD: A Cornucopia of Info. Sep 20, 2023

Show notes

Welcome to our “OB Smorgasburg” episode, where we have a CORNUCOPIA of topics. Well, maybe not a full cornucopia… But a mini-cornucopia. In this episode, we will address 2 recent publications that really are my “pet peeves“ about medical data! One is from the US Preventive Service Task Force, and the other has to do with “timed intercourse”. You have to listen to this! Then we will get into new data regarding the association of 1 abnormal glucose value on the 3 hour GTT with adverse neonatal outcomes. And lastly, is there such a thing as “organic” 50 g glucose challenge? Let’s get into all this information…Now!

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