Dr. Chapa’s OBGYN Clinical Pearls

Latest Episodes:

Can “Shrooms” Cure HPV? Apr 20, 2023

Show notes

Once considered on the fringe of main-stream medicine, “alternative therapies” are becoming more accepted into clinical practice. Such is the case of psilocybin (a mushroom extract) for certain mood disorders. 🍄 And now, another mushroom extract (AHCC) has gained attention in gynecology. Could this extract help eliminate the most common viral STI? Is this evidence-based? The research may surprise you. Let’s review the data on ‘shrooms and HPV. Thank you Leah for the episode suggestion! Keep up the great work up north in Long Island! 😊

You Asked, We Answered. 🤔👏🤔 Apr 18, 2023

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We ❤️ our podcast community! Over the last 3 recent episodes, we have received similar “themed“ listener questions. So in this episode, we are going to respond to some recent inquiries regarding three recent episodes: 1. combination birth control and estrogen levels (and Perimenopausal use), 2. vaginal progesterone for patients without a history of preterm birth, and 3. the use of vaginal dilators for vaginismus. This is how we all grow together! Now… Let’s get to your questions. 😊😊😊🤔🤔🤔

Jade Egg, & Vaginal Weight Lifting 🤔 Apr 16, 2023

Show notes

I recently had a patient (young reproductive age, without prolapse or urinary incontinence) ask me about using the “Jade Egg” vaginally for better sex. Women’s sexual intimacy is a big dollar commercial industry. What’s the history behind this Jade Egg and/or other vaginal insertion weights? Is there a benefit to using these inside the vagina for pelvic floor training and enhanced sexual intimacy? Are these any better than regular Kegel exercises? In this episode, we’ll do a deep-dive into the data and find out when, if ever, these devices may be used as ancillary tools.

Does Mec Staining Correlate to Duration of Exposure? Apr 14, 2023

Show notes

Presence of meconium stained membranes/placental tissue has been used in medico-legal cases by both plaintiffs and the defense alike. Using the presence of meconium stained tissue has been used as a tool to “timeline” fetal hypoxia. Is this evidence-based? In the session, we will review the historical data (1985) that fueled this concept, and give the latest scientific and medical expert opinion regarding the possibility of this theory (highlighting a new Expert Review in the AJOG, April 2023).

Cerclage, Vag Prog, & PTB: SMFM April 13 Statement. Apr 13, 2023

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Oh, the ever evolving drama of “progesterone in high risk obstetrics”. Today, April 13, 2023, the SMFM released its Special Statement response to the recent change in the progesterone PTB prevention landscape. Where does cerclage fit in? In this episode we will summarize the current recommendation for cerclage for preterm birth prevention and how it fits in to the vaginal progesterone story. Is cervical ultrasound surveillance after vaginal progesterone initiation warranted? We will make it clear in this episode.

PostPartum IUDs: Best Time to Place? Apr 12, 2023

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We have come a long way in our understanding regarding the safety of intrauterine contraception. Once withheld from adolescents and immediately postpartum patients, the safety in both populations is now well established. Postpartum IUD/IUS placement is a balance between risk of expulsion and patient loss to follow up. In this episode, we will summarize a new RCT from JAMA discussing this very subject. Is it better to place immediately Postpartum, at 2 weeks after delivery, or as an interval procedure at 6 to 8 weeks? We will summarize this Level I evidence and also provide helpful resources for increased accessibility of LARC options, including the new (April 2023) ACOG Committee Statement on this very issue.

Low-dose ComboBC VTE Risk (PLUS HRT E2 Serum Levels) Apr 10, 2023

Show notes

This episode is in reply to one of our fantastic podcast family members who had some wonderful clinical questions regarding dosage of combination BC after listening to our past episode. In our immediate past episode, we discussed hypoestrogenemic symptoms on ultra low-dose pills in certain patients (young, thin). Is a 20 µg BC pill less thrombotic than a 30 or 35 µg pill? What does the data say? In this episode will answer this question and also dive deeper into serum estradiol levels not only with combination birth control but also with menopausal hormone therapy. Is there a “target level” of systemic/serum estrogen with combination HRT? Listen in and find out.

ComboBC & Serum E2 Levels Apr 08, 2023

Show notes

In 1972, a publication in which a radioimmunoassay measured serum estradiol levels in participants taking oral combination birth control concluded that levels of serum estrogen were “sufficient to prevent symptoms of estrogen deficiency”. Knowing NOW what we do, and looking back to that article, those authors’ conclusions were completely incorrect! Is it possible for a patient to experience hypoestrogenic symptoms despite taking an estrogen containing birth-control? What are normal, endogenous estradiol levels in a reproductive age female? In this episode, we will review the various degrees of hypothalamic – pituitary – ovarian axis suppression from different categories of hormonal birth-control. Should certain micrograms of ethinylestradiol be preferred in thin and/or adolescent patients? Listen in and find out.

New Practice Advisory on Dense Breasts at MMG (ACOG PA April 2023) 🚨 Apr 07, 2023

Show notes

Here’s proof that our catchphrase, “Medicine Moves Fast“ is 100% true! On October 30, 2022, and again on November 1, 2022, we released episodes on “Dense Breasts on MMG? What to do?”. Those episodes were in response to Katie Couric’s public outcry for the need for additional screening at time of mammogram in the setting of dense breasts. On March 9, 2023, the FDA issued a new ruling/guidance on patient notification of breast density at screening mammogram. And now, in April 2023, the ACOG has released its new Practice Advisory (PA) on the subject. In this episode, we will quickly summarize this practice advisory, it’s implications for us as clinicians, and implications to our patients.

Makena is GONE. Apr 07, 2023

Show notes

A quick update and commentary on the recent (April 6, 2023) FDA decision to withdraw approval of Makena for preterm birth prophylaxis.

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