Dr. Chapa’s OBGYN Clinical Pearls

The U.S. Preventive Services Task Force and the World Health Organization recommend primary HPV screening, starting at age 25, as an option (some as preferred) for cervical cancer screening. Although primary HPV screening is as effective as cotesting at detecting cervical cancer, primary HPV screening decreases the number of lifetime screenings needed. The primary HPV screening tests approved by the U.S. Food and Drug Administration (FDA) are the Roche Cobas and BD Onclarity tests. HPV results for the Roche and BD tests can be reported as a pooled result. This means the physician receives a result of negative or positive, in which positive indicates that at least one, but possibly more, types of high-risk HPV were identified in the sample. HPV genotyping options differ by manufacturer. Roche Cobas reports HPV 16 and 18 individually and groups 12 other types (i.e., positivity means at least one of the 12 types triggered the positive result). BD Onclarity reports six individual HPV types (16, 18, 31 [the highest risk going immediately to colposcopy], 45, 51, and 52), and combined types (33/58), (35/39/68). Now, as of March/April 2024, the ASCCP has recognized another important and clinically useful HPV and co-test TRIAGE tool, the DUAL STAIN. This pertains only to the ROCHE COBAS HPV test. In this episode, we will review this latest ENDURING GUIDELINES update to the 2019 ASCCP management algorithms (already updated in the ASCCP app).

Explore the challenges breast cancer survivors face due to menopause, including vaginal dryness and other hypoestrogenic symptoms. Recent data sheds light on the safety of vaginal estrogen therapy for these women, particularly those on aromatase inhibitors. The discussion stresses the need for updated guidelines, addressing myths about increased cancer risks. Highlighting recent studies, it offers reassurance that vaginal estrogen does not link to higher mortality rates in breast cancer survivors, advocating for improved quality of life.

Yep! We have definitely covered the evolving saga and controversy regarding antenatal corticosteroids in the late preterm/early term interval. It's like Dorothy in the Wizard of Oz: "Lions and Tigers and Bears, Oh My!" More fitting for our discussion, its "Steroids, and Studies, and Shared-Decisions, Oh My!" In this episode we will highlight TWO pieces of literature coming out in DECEMBER 2024 in the Green Journal on this topic. The article is by Clapp et al and the associated editorial piece will be the core part of our episode. Listen in for details!

Well, in the last 4 weeks there have some interesting developments in the sphere of OBGYN medical news. In October 2024, out of the American Society of Anesthesiologists, came a study on the possibility of using serum FAR to predict preeclampsia with severe features in admitted patients (don’t worry, we’ll discuss what FAR is!). PLUS, some exciting, although preliminary, data has been published out of Baylor College of Medicine raising the possibility of a non-invasive test for endometriosis using…POOP! Yep, poop. And on October 31, 2024 a new clinical perspectives article was published in the Green Journal “CHALLANGING” the recent ACOG’s Clinical Practice Update regarding screening for pregestational DM in early pregnancy. Intrigued? You should be….we will cover these 3 tidbits of OBGYN news in this episode!

The ARRIVE was published in the New England Journal of Medicine on August 8, 2018 1. This study was a large unmasked multicenter trial conducted from March 2014 to August randomized 6,106 nulliparous women to either IOL or expectant management at full term. The trial was conducted at 41 facilities across the United States. This validated that eIOL at 39 weeks, in that patient population, had the ability to reduce cesarean sections and rates of hypertensive diseases of pregnancy. Since that time, elective IOLs have INCREASED at 39 weeks as some messaging was distorted implying that IOL was the BEST way to go over expectant management. Has other data since 2018 found the same thing? Or were the results of the ARRIVE trial an aberration? The ACOG has JUST RELEASED a new CPU which provides additional insights to this. Listen in for details!

Urinary tract infections (UTIs) are a leading cause of health care visits in the USA and around the world. In the US, they have a cost burden of $3.5 billion annually. Half of women experience at least one UTI in their lifetime, and approximately 25% of these women develop recurrent UTIs! On October 31, 2024, a study was published in Obstetrics Gynecology (the Green Journal) looking at UTI treatment trends in nonpregnant women. With the increased use of tele-visits, there is now a conundrum between allowing easier access to care (tele-visit) and treatment of UTIs online balanced against contributing to antibiotic resistance. Is urine culture recommended prior to antibiotic use for uncomplicated UTI? That depends on who you read! We will discuss this issue in this episode. PLUS, we will briefly discuss a NEW oral antibiotic for uncomplicated UTI in women; this was just FDA approved on October 25, 2024.

The discussion dives into the complexities of pregnancy-associated superficial thrombophlebitis and its need for anticoagulation. Differing guidelines reveal a debate on whether traditional beliefs are still valid. Key insights from a recent Danish study highlight that superficial venous disease can have serious complications. The importance of accurate diagnosis through ultrasound and tailored management strategies for treatment are emphasized. Ultimately, the conversation urges a reevaluation of how superficial vein thrombosis is approached in pregnant patients.

Discover why recent guidelines suggest women recovering from scheduled C-sections may be safe to go home within 24 hours. Learn about the challenges faced during the first day post-surgery, including pain management and new parenthood adjustments. A forthcoming meta-analysis supports these recommendations, showcasing the benefits of tailored, early discharge protocols. Plus, hear the importance of follow-up care and patient education to ensure smooth recoveries, backed by evolving research in maternal health.

Welcome Back to another episode of "You ask, We Answer"! As Abrysvo (RSV vaccine) now has some time on the market, some women may find themselves with a subsequent pregnancy after first receiving the injection in the prior pregnancy. Is another RSV vaccine recommended with each pregnancy, like TDap? The answer to that question depends on where you live. We will discuss in this episode. PLUS, have you heard of CLITOXIN? Its a little botulinum toxin injected into the clitoris for "enhanced sexual response". Is that evidence-based? Is there data for that?! Listen in for details.

Dive into the intriguing world of placental volume assessment and its potential link to fetal health. Discover how measuring the placenta's size might predict risks like stillbirth and understand the controversies surrounding its use as a preventive measure. Hear about the delicate balance between data interpretation and the realities of fetal surveillance. With insights from top medical guidelines, the discussion emphasizes the importance of ongoing research before making this practice routine. Don't miss this enlightening exploration!