Dr. Chapa’s OBGYN Clinical Pearls

The term "genitourinary syndrome of menopause" (GSM) was introduced in 2014 by the International Society for the Study of Women's Sexual Health and the North American Menopause Society (now the Menopause Society). This new term was created to replace older terms like vulvovaginal atrophy, urogenital atrophy, and atrophic vaginitis, and it encompasses the range of symptoms related to hormonal changes in the vulvovaginal and urinary tract areas that can occur during menopause. Recurrent UTIs are more likely in postmenopausal women not on vaginal estrogen therapy. IN this episode, we will highlight new data from the recent AUA meeting which looked at surprising benefits on postmenopausal vaginal estrogen in women with recurrent UTIs. Nonetheless, questions on the data remain. Listen in for details.

Discover the latest in Enhanced Recovery After Surgery protocols for cesarean sections, set to debut April 2025. Key changes around vaginal prep and extended antibiotic use for patients with obesity are highlighted. This update promises to impact clinical practice and patient recovery significantly. The discussion also ties back to earlier guidelines on prophylactic antibiotics, illustrating how rapidly the field of medicine evolves.

I know this sounds braggadocious, but I'm going to say it anyway: I work with some incredible people! We recently released a podcast on updated TOLAC uterine rupture data. One of our former residents reached out to me with a question about this: “Did they include interdelivery interval in their assessment?” You see, I work with really smart people! There's an answer to that question, and we're going to cover that in this episode. PLUS, a current resident, Spencer, had a great question about proof of immunity to rubeola (measles) in pregnancy. Can we assume that if a patient is rubella immune that she is also immune to rubeola? That's a great question, and we will explain in this episode!

Spontaneous twin pregnancies occur in about 1 out of every 250 pregnancies. A real world clinical question has to do with dating a spontaneous twin gestation: Do we use the smaller crown rump length or the larger for dating in the 1st trimester? Do we use the smaller or larger measurement of biometry in the 2nd trimester? We had this discussion today in our prenatal clinic, and in true form and fashion, I turned it into an episode! PLUS, there is practice guidance from Jan 2025 (ISUOG) to settle the debate. Listen in for details.

In the ACOG Practice Bulletin 205 (Reaffirmed August 2025), the stated risk of uterine rupture with TOLAC is stated as 0.7% (after 1 prior LTCS). However, as our podcast tag list holds true, "Medicine Moves Fast". In an new upcoming publication from Obstet Gynecol (The Green Journal), May 2025, authors looked at the rate of uterine rupture with TOLAC over a 12 year interval. The rate of uterine rupture was NOT close to the national quoted rate in the Practice Bulletin. This information, which was also presented at the Jan-Feb 2025 Pregnancy Meeting, can be very helpful in counseling patients desiring TOLAC. Listen in for details.

As healthcare professions we are often pulled in different directions ALL AT ONCE. It happens. We "multitask" every day. Or do we? Neuroscience actually states that we don't multitask at all; rather, we "task-switch" and that may lead to increased physiologic and mental stress and patient error. Yep, there is a MYTH about multitasking. In this brief episode, we remind ourselves that its OK to put somethings off, as able, until one task is completed. As the famed stoic philosopher Publilius Syrus wrote, "To do two things at once is to do neither". Listen in for details.

I love my home state of TEXAS. I am definitely full of Texas pride. We have Texas barbecue, Texas, hospitality, and of course, the Texas music scene! Our state definitely has some issues to improve on, mainly access to maternity care. We have a HUGE state and 50% of our counties are maternity care deserts. It’s a vast vast Land to cover! Texas has also received a lot of criticism regarding its heartbeat law originally named SB8, which was passed in 2021. Commentaries since then have stated that OBGYNs are leaving the state by the droves! Is that accurate? A new publication from JAMA network open (April 21, 2025) seems to contradict these commentaries. Listen in for detail details.

There have been various publications and commentaries published on “evidence-based” cesarean section techniques. Still, one of the persistent controversies on abdominal wall closure relates to the rectus. With transverse fascial entries, should we close/reapproximate the rectus or not? In June 2025, a new RCT looking at this very issue will be printed in the European J Obstetrics Gynecology and Reproductive Biology. Listen in for details.

On December 13, 2022, we released an episode describing a new concept in prenatal care, called the PATH model. This was to “redesign” prenatal care, as needed, for those who may have limitations for the “traditional” model of prenatal care visits. Well, what we covered 2.5 years ago is NOW an OFFIICAL guidance from the ACOG and will be out in May 2025. Similarly, the SMFM released their vision for redesigned maternal care teams on 16 April 2025 (J Pregnancy). We will BRIEFLY summarize these 2 publications in this episode.

Pelvic congestion syndrome is a controversial entity that does not currently have validated diagnostic criteria. In the ACOG PB 218 (2020), it states, “Pelvic congestion syndrome is a proposed etiology of chronic pelvic pain related to pelvic venous insufficiency. Although venous congestion appears to be associated with chronic pelvic pain, evidence is insufficient to conclude that there is a cause-and-effect relationship. In addition, there is no consensus on the definition of this condition, and diagnostic criteria are variable. Further research is needed to establish greater consistency in diagnosis and homogeneity in treatment studies”. Is that it? Is that all there is? NO! There has been great interest in the diagnosis of this enigmatic condition and in potential new treatment options. The last publication on this was just released in March 2025 as a “pilot study”. In this episode, we will combine multiple sources and explain this controversial condition and offer hope to patients who may indeed have this real disorder.