Dr. Chapa’s OBGYN Clinical Pearls

Latest Episodes:

Misuse of Fetal Scalp Stimulation Jul 23, 2022

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One of the most common techniques to assess fetal status intrapartum is the fetal scalp stimulation test. First proposed in 1936, its incorporation in modern obstetric practice is still evident. However, there are some common misapplications and misunderstandings of this intervention. Does fetal scalp stimulation help resolve a fetal deceleration? Or could it be potentially harmful? In this podcast we will set the record straight to prevent misuse of the fetal scalp stimulation test. Thank you Abby for the podcast topic and bringing this to my attention.

HT in BRCA Patients? Jul 19, 2022

Show notes

In this session, we will continue our brief summary of the NAMS 2022 clinical update on hormone therapy. Is hormone therapy allowed in patients with known BRCA genetic mutations? Is Bazedoxifene safe? What about vaginal estrogen therapy? We will answer these questions and more in this session.

Can HT continue past 65? NAMS 2022 UPDATE Jul 16, 2022

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Medical information moves fast. We know a lot more about risks and benefits of hormone therapy since the impactful WHI study was first released. In this session we will review important new concepts from the NAMS Hormone Therapy update just released Summer of 2022. Is it safe to continue hormone therapy beyond the age of 65? Is “lowest dose for shortest duration” still a valid concept? We will tackle this question and more in this session!

New Data on Water Births (July 2022) Jul 12, 2022

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For several years, data has validated the value of water immersion during labor (1st stage). However, when it comes to the 2nd stage of labor, the AAP and the ACOG are unified in their positions which is at odds with the ACNM. But what does the new data support? In this session we will cover a new systematic review and meta-analysis from BMJ Open which was published July 2022. Let’s set the record straight on water immersion during the first and second stages of labor.

Melatonin Use in Pregnancy? Jul 08, 2022

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Sleep disruption and poor sleep quality are not unusual during pregnancy. That’s obvious! What’s not so obvious is whether a common over-the-counter sleep agent, melatonin, is safe to use during pregnancy or not. While traditionally, options like diphenhydramine and doxylamine have been used as sleep aids during pregnancy, up to 4% of women (reportedly) use this over-the-counter supplement during gestation. What does the data say? Let’s address this common supplement use…now.

“Reverse Sequence” Syphilis Tests Jul 03, 2022

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Lots of practical clinical pearls in this episode! “Reverse sequence testing” for syphilis has largely taken over the traditional testing algorithm. Traditionally, non-Treponemal tests (RPR, VDRL) were done first with a reflex to a Treponema specific test if that was positive (MHATP). But this is now considered the antiquated technique. Reverse sequence testing has the advantage of potentially identifying infected patients very early on. In this session, we will give easy to use/practical tools for reverse sequence test interpretation, and how to best manage “discordant“ results.

Does Ella Cause Abortion? Jun 27, 2022

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Over the last several days I have received numerous Facebook messages, podcast voice memos, and personal texts regarding the potential for misapplication of Ulipristal’s mechanism of action as emergency contraception. Will Ella be banned? Does it affect implantation? It’s time to clear the dust and set the record straight.

New ACOG (June 16, 2022) Advisory: “PreP Talk” Jun 25, 2022

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On June 16, 2022, the ACOG released a new practice advisory regarding PreP in the ObGyn patient population. This has important implications on how we counsel patients especially after recent STI diagnosis. In this podcast we will cover important aspects of PreP to get you comfortable with this preventative option. What are the 3 currently approved options? Are they safe? What about monitoring? Do adolescent patients qualify? We will answer all of these questions and more in this session.

PCOS and ACUTE PeriPartum Risks Jun 23, 2022

Show notes

We have come a long way from the first report from Stein and Leventhal describing “polycystic ovaries“ on ultrasound in infertile women back in the 1950s. We already well understand that PCOS raises the risk of certain antepartum complications including gestational diabetes, possible macrosomia, and the development of gestational hypertension or preeclampsia. But there actually is scant data on the risk of acute peripartum complications. In this podcast we will summarize a large study just published June 16, 2022 out of the Journal of AHA. We will also cover the importance of distinguishing between “Odds Ratios” and “absolute numbers” for clinical implications. Ready? Let’s dive into acute PeriPartum risks for women with PCOS.

UPDATE Jun 20, 2022

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Well…so there’s this. 😳😳😳

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