Dr. Chapa’s OBGYN Clinical Pearls

Latest Episodes:

Phexxi! A New, Non-hormonal Vaginal Contraceptive. Oct 14, 2020

Show notes

In May 2020, the FDA approved a new novel, non-hormonal vaginal contraceptive that can be used “on demand“. Although this functions as a “pH regulator“ of the vagina with spermicidal properties, it is not nonoxynol-9-based. In this session, we will review the information in the instructions for use of Phexxi, and summarize key points from some published commentary on the subject.

Cerclage to Prevent PTB Oct 09, 2020

Show notes

There are calls to remove 17 OHP from the market based on the results of the PROMISE trial. This leaves us with a gap in tools for prevention of preterm birth. This is where CERCLAGE comes in. Cerclage is not only indicated in patients with previous history of incompetent cervix, as there is emerging data that cerclage plays a role in preterm birth prevention based on cervical length. In this podcast, we will give an in-depth summary of the data on how cerclage may be used as an intervention to prevent preterm birth. At what cervical length can cerclage be used? How does previous history come into play? Is this valid in twins? Let’s cover that… Now.

Can Endometriosis Lead to Ovarian Cancer? Oct 05, 2020

Show notes

Over the past several years there’s been some alarming publications “linking“ endometriosis to certain ovarian epithelial malignancies. Is this a valid cause for concern? What is the absolute risk? In this podcast we will put the data into perspective and highlight information from the Lancet as well as MD Anderson‘s Gynecology Oncology data.

Antenatal Steroids for Preterm Chorio? Yes or No? Sep 30, 2020

Show notes

Antenatal corticosteroids help reduce a number of morbidities in the preterm infant. However, chorioamnionitis is generally considered a contraindication. The scientific basis for this is actually unclear. On September 28, 2020, the AJOG released a new publication ahead of print that helped shed some light on the subject. Are steroids harmful or beneficial to the preterm infant in the setting of Chorio? Let’s check it out.

Non-Invasive DX of Endometriosis: MicroRNAs and MRI. Sep 25, 2020

Show notes

Endometriosis, a chronic disease that afflicts millions of women worldwide, has traditionally been diagnosed by laparoscopic surgery. This diagnostic barrier delays identification and treatment by years, resulting in prolonged pain and disease progression. Development of a noninvasive diagnostic test could significantly improve timely disease detection. Recently, 2 innovative/non-invasive tools have gained attention for the diagnosis of Endo: MicroRNAs (Oct 2010; AJOG) and MRI (Sept 2020; Acad Rad). In the session, we will highlight these 2 interesting publications.

Lasix for PP PreEclampsia Sep 22, 2020

Show notes

One theory behind elevated post-partum blood pressure is that there is a large volume of sodium mobilized into the intravascular compartment in the post-partum period. Loop diuretics have been suggested as methods to accelerate post-partum blood pressure recovery due to their ability to mobilize sodium and fluid excretions. Is there level I data on the use of furosemide for postpartum preeclampsia/hypertension management? Does the use of Lasix affect serum magnesium levels? In this session, we will review 2 recent RCTs on the use of furosemide for Postpartum hypertension management and briefly review the pharmacology of furosemide.

WES and Stillbirth Sep 19, 2020

Show notes

Stillbirths occur in approximately 6/1000 pregnancies in the US. Currently, the ACOG recommends placental histological analysis and fetal chromosomal study in these cases. However, as up to 50% (or more) of cases are left “unexplained“, more investigation/options are needed. On September 17, 2020, a new publication in the NEJM adds valuable insights as to how whole exon sequencing may help provide a genetic cause in an otherwise unexplained stillbirth. In this podcast, we will review this publication by Stanley et al.

Advanced Paternal Age Sep 14, 2020

Show notes

Advanced Maternal Age (AMA) has long been associated with adverse obstetrical outcomes. However, is the same true for Advanced Paternal Age (APA)? What is the specific characteristic mutation associated with APA? What does paternal age have to do with chromosomal telomere length and how is that related to cancer in the child? In this podcast, we will review Data from the American College of Medical Genetics regarding APA. This information will be helpful in giving prenatal counseling to couples who present with fathers with age equal to/greater than 40.

The Jada System: Vacuum-Pressure Uterine Tamponade for PPH. Sep 10, 2020

Show notes

Postpartum hemorrhage is a leading cause of maternal mortality even in the United States. In September 2020, a new device to help treat postpartum hemorrhage was FDA cleared (The Jada System). This is a novel device that uses vacuum pressure for uterine cavity collapse/myometrial compression. In the session, we will review this new data which was published ahead of print September 10, 2020 in Obstetrics Gynecology (Green Journal).

The Deeply Impacted Fetal Head Sep 07, 2020

Show notes

A prolonged second stage of labor, or failed vaginal vacuum extraction, can lead to a deeply impacted fetal head. Is the “push“ technique better than the “pull“ technique? Have you heard of the Patwardhan method? What is a C-section SPOON? And is the “Fetal pillow” actually helpful? In this podcast we will review each of these techniques in detail.

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