Dr. Chapa’s OBGYN Clinical Pearls

Latest Episodes:

MI Dose? Zuranolone for MDD? “Shoulder Shrug”? Your questions answered. Aug 29, 2023

Show notes

As a true testament that we read each one of our Podcast Facebook messages, this is a “You asked, We answered” episode regarding 3 main recent topics: 1. dose of oral MI for PCOS, 2. Zoranalone for Major Depressive Disorder, and 3. the “shoulder shrug” maneuver for shoulder dystocia. 👍👍👍👍

Inositol for PCOS? Yes. Aug 28, 2023

Show notes

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder and one of the most frequent causes of infertility in women. It affects 5–20% of women of childbearing age. The pathogenesis of PCOS is still not fully understood; however, insulin resistance (IR) is known to have a central role in its pathogenesis. According to a cross-sectional study, IR is present in 75% of lean and 95% of overweight women with PCOS. This IR seems to have something else behind it: an imbalance in the ratio of 2 vital inositols! In the treatment of PCOS, metformin is the gold standard metabolic treatment. However, metformin may induce mild to severe gastrointestinal side effects such as nausea, diarrhea, and vomiting. So, an evidence-based and data driven alternative is highly welcome…especially one that could be seen as “natural”. Can inositol, specifically myo—inositol, “reverse” some PCOS metabolic derangements? Can it help normalize cycles? The data may surprise you.

UPDATED Recs: Hep B in Pregnancy (Sept 2023). Aug 27, 2023

Show notes

In 1990, the ACOG released the “Perinatal Hepatitis B Prevention Program“. OB healthcare workers have doing universal screening for Hepatitis B using HBsAg in each pregnancy, ever since. However, there is a new guidance being released in September 2023 from the ACOG. This new guidance aligns with the national Hep B screening and testing recommendations from the CDC released March 2023. Are you familiar with the “Hep B triple screen”? Is antiviral therapy recommended for Hep B in pregnancy? When should it be used? And is breast-feeding still allowed in mothers with Hep B viral infection? We will cover all of this- and more- in this episode. 🎙️🎙️🎙️

OCPs and Varicose Veins: Risky or Not? Aug 24, 2023

Show notes

OK, OK…we all get that past history of DVT related to hormonal exposure is a true and persistent contraindication for estrogen birth control. We get that. But what about the incidental presence of lower extremity varicose veins? Are varicose veins a contraindication to estrogen containing birth control? After all, some data has linked superficial varicose veins to the development of DVT. That must mean that estrogen containing BC is contraindicated due to the additional risk of clot formation, right? Is that true? There is some STRANGE information on the internet regarding the association of oral birth control pills and varicose veins. Do combo OCPs cause varicose veins? Do they increase the risk of DVT in those with varicose veins? In this episode we will explore the science, data, and published guidelines related to the prescribing of estrogen containing birth control in patients with varicose veins. PLUS, we will cover which patients- who do by chance develop a superficial venous thrombus in a varicose vein- need anticoagulation.

New FDA Approved OB RSV Vaccine? Nuances and Cautionary Notes! Aug 22, 2023

Show notes

On August 21, 2023, the FDA approved a new RSV vaccine for maternal use, ideally in the late third trimester. However, there are some nuances and some cautionary notes here! In this episode, we will review the phase 3 data, which fostered the FDA approval and review the nuances to this study. Are we ready for mass incorporation of the maternal RSV vaccine into clinical practice? The answer quite simply is… “No”. We will explain why in this episode.

EIN-AEH: New Clinical Consensus (Sept 2023) Aug 21, 2023

Show notes

In 2015, the ACOG released its Committee Opinion on "Endometrial Intraepithelial Hyperplasia", or EIN (CO 631). EIN is of clinical significance because it is often a precursor lesion to adenocarcinoma of the endometrium. Making the distinction between hyperplasia and true precancerous lesions or true neoplasia is super important because their differing cancer risks must be matched with an appropriate intervention to avoid under/overtreatment. As is our podcast tagline, "medicine moves fast"; coming out in September 2023, the ACOG will release a new Clinical Consensus guideline on "EIN-AEH". What are the new changes? Why are we moving from a EIN designation to EIN-AEH? Is a progestin IUS a reasonable therapeutic option for those wishing to preserve fertility after this diagnosis? In his episode, we will answer all these questions and more, focusing on this new Clinical Consensus guideline.

Vital Tips for Shoulder Dystocia: Understanding the Maneuvers Aug 18, 2023

Show notes

Recently, a horrific and unimaginable birth event made national (USA) news. A case of shoulder dystocia resulted in an extremely morbid and rarely witnessed complication. On August 16, 2023, an extremely important review article was released (ahead of print) in the American Journal of ObGyn. This article summarizes important key aspects and tips for the proper performance of rescue maneuvers for shoulder dystocia, with the aim of keeping both the mother and the baby safe. In this episode, we will review these critical and vital tips for safe resolution of shoulder dystocia. Should the buttocks rotate upwards with McRoberts maneuver? What is the Ruben I procedure? We’ll get to all of this, and more, in this episode.

Add Cox2 Inhibitor to Plan B? New Data. Aug 17, 2023

Show notes

Access to effective oral emergency contraception is vital, now more than ever. While use of either levonorgestrel or ulipristal is endorsed by the ACOG, pharmacodynamic and clinical data does show that ulipristal has the efficacy advantage. Although the process of ovulation is directed by the LH surge, it is also put into action by prostaglandin resulting from COX2 activity. So, can the addition of a COX2 inhibitor increase the efficacy of Plan B when taken as a combo? A new study published 24 hrs ago in the Lancet provides some exciting data. We will cover this new RCT, and more, in this episode.

Persistent Genital Arousal Disorder: It’s a Real Thing! (Genito-Pelvic Dysesthesia) Aug 16, 2023

Show notes

Persistent genital arousal disorder (PGAD), now called Genito-Pelvic Dysesthesia, was first described by Leiblum and Nathan in 2001 in a five-patient case series. This is now a well-recognized pelvic floor/genital abnormality with a consensus statement being released in 2019 by the International Society for the Study of Women's Sexual Health. Are you familiar with this condition? It is a source of severe emotional and mental hardship for those affected. In this episode, we will summarize the data on this strange but very REAL condition that is NOT related to sexual desire or sexual arousal.

Recurrent AB? STOP Checking This! (ALIFE2 Data) Aug 14, 2023

Show notes

The definition of recurrent pregnancy loss (RPL) in the US is 2 or more consecutive failed clinical pregnancies documented by ultrasound or histopathology, while, in the United Kingdom, the definition is as having 3 or more consecutive early pregnancy losses. Up to 50 percent of cases of recurrent pregnancy loss lack a clear etiology. Where do we stand, in 2023, in regards to our understanding of the effects of inherited thrombophilias on recurrent pregnancy losses? Do they cause recurrent ABs? Does LMWH help? In this episode, we will summarize a June 2023 publication in the Lancet that provides a clear answer.

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